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1.
J Laparoendosc Adv Surg Tech A ; 24(3): 159-64, 2014 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-24479819

RESUMO

OBJECTIVES: To analyze the outcomes with mid- to long-term follow-up of laparoscopic ureterolysis (LU) and omental wrapping in retroperitoneal fibrosis (RPF) with obstructive uropathy. PATIENTS AND METHODS: Records of 9 patients with RPF who had obstructive uropathy at presentation and had undergone LU and omental wrapping at our center during January 2004 to June 2012 were collected and analyzed. RESULTS: Six females and three males underwent LU for RPF. Underlying causes of RPF could not be found in 8 (89%) cases. Two patients underwent bilateral LU. Mean operative time and estimated blood loss were 213 minutes (range, 180-280 minutes) and 119 mL (range, 70-200 mL), respectively. No case required conversion to open surgery. The only significant intraoperative complication (1/9 [11%]) was ureteral injury, which was easily repaired intraoperatively. The postoperative complication rate was 44% (4/9). Most complications (75% [3/4]) were minor and did not need specific treatment. The mean follow-up period was 46 months (range, 4-72 months). The success rate at last follow-up was 89%. CONCLUSIONS: Treatment of RPF is still controversial. Any future prospective randomized comparative trials seem unlikely in view of the low incidence of RPF. LU and omental wrapping in the setting of obstructive uropathy are safe and an effective alternative with a high success rate at mid- to long-term follow-up.


Assuntos
Laparoscopia/métodos , Omento/cirurgia , Fibrose Retroperitoneal/complicações , Fibrose Retroperitoneal/cirurgia , Obstrução Uretral/complicações , Obstrução Uretral/cirurgia , Adulto , Feminino , Seguimentos , Humanos , Complicações Intraoperatórias/etiologia , Laparoscopia/efeitos adversos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos , Fibrose Retroperitoneal/diagnóstico , Estudos Retrospectivos , Obstrução Uretral/diagnóstico
2.
Updates Surg ; 65(3): 245-8, 2013 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-22407593

RESUMO

Genitourinary tuberculosis (GUTB) is the second most common form of extrapulmonary TB after lymph nodes. Advanced GUTB leading to strictures of ureters and urethra, and bladder contracture frequently need surgical management. These are usually treated by ileal replacement of ureter, substitution urethroplasty using buccal mucosal graft (BMG) and augmentation ileo-cystoplasty, respectively. These procedures have been well demonstrated individually but all these three procedures have never been combined as single procedure in the same patient. We report a case of advanced GUTB with ureteric and urethral strictures, and bladder contracture which was treated by the ileal replacement of ureter, augmentation ileo-cystoplasty combined with BMG substitution urethroplasty in a single sitting.


Assuntos
Íleo/cirurgia , Mucosa Bucal/transplante , Procedimentos de Cirurgia Plástica/métodos , Tuberculose Urogenital/complicações , Estreitamento Uretral/cirurgia , Bexiga Urinária/cirurgia , Procedimentos Cirúrgicos Urológicos Masculinos/métodos , Adulto , Humanos , Masculino , Tuberculose Urogenital/diagnóstico , Tuberculose Urogenital/cirurgia , Uretra/cirurgia , Estreitamento Uretral/diagnóstico , Estreitamento Uretral/etiologia , Urografia
4.
Surg Today ; 41(9): 1314-8, 2011 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-21874439

RESUMO

Cystic lymphangiomas are lymphatic malformations rather than true neoplasms. These are mainly childhood lesions. Involvement of the breast is extremely uncommon, and to the best of our knowledge only 17 such cases have been found in the literature. Breast involvement is even rarer in children, as only four of the reported cases are in the pediatric age group. We herein report a case of cystic lymphangioma of the breast in an 8-year-old male child, which was treated by excision. A review of the reported cases is also presented.


Assuntos
Neoplasias da Mama Masculina/diagnóstico , Linfangioma Cístico/diagnóstico , Adolescente , Neoplasias da Mama Masculina/epidemiologia , Criança , Diagnóstico Diferencial , Feminino , Humanos , Linfangioma Cístico/epidemiologia , Masculino
5.
Urology ; 78(4): 797-801, 2011 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-21862116

RESUMO

OBJECTIVE: To evaluate the outcome of laparoscopic nephrectomy in patients with xanthogranulomatous pyelonephritis (XGPN). METHODS: The medical and procedural records of patients with pathologically confirmed XGPN from February 2004 to December 2010 were reviewed retrospectively. During this period, 19 patients (mean age 37.5 years, range 14-77) underwent surgical management of XGPN. The records of the clinical history, mode of presentation, surgical management, hospital stay, and complications were analyzed. RESULTS: Laparoscopic nephrectomy was performed successfully in 14 patients (73.2%); 5 patients required conversion to open surgery. Of these 5 patients, 3 electively underwent conversion to open surgery because of nonprogression of the procedure, and in 2 patients, conversion was performed on an emergency basis because of bleeding from hilar vessels in 1 patient and diaphragmatic injury in the other. The operative time was 284 minutes (range 181-340), with a mean estimated blood loss of 220 mL (range 90-500) and mean analgesic (tramadol) requirement of 150 mg (range 50-500). Clavien grade I complications occurred in 2 patients, grade II in 3, and grade IIIa in 1 patient. Two patients had grade IVb complications. One patient required a blood transfusion. The mean hospital stay duration and the return to routine activities was 4.4 days (range 2-37) and 21 days (range 12-66), respectively. CONCLUSION: Laparoscopic nephrectomy, although challenging, can be performed safely in most patients with XGPN. A greater conversion rate and longer operative time should be expected, and early conversion to an open approach might be required in difficult cases owing to a failure to proceed.


Assuntos
Laparoscopia/métodos , Nefrectomia/métodos , Pielonefrite Xantogranulomatosa/cirurgia , Adolescente , Adulto , Idoso , Feminino , Humanos , Índia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Estudos Retrospectivos , Resultado do Tratamento
7.
J Cutan Aesthet Surg ; 4(1): 12-6, 2011 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-21572675

RESUMO

OBJECTIVE: Biological dressings like collagen are impermeable to bacteria, and create the most physiological interface between the wound surface and the environment. Collagen dressings have other advantages over conventional dressings in terms of ease of application and being natural, non-immunogenic, non-pyrogenic, hypo-allergenic, and pain-free. This study aims to compare the efficacy of collagen dressing in treating burn and chronic wounds with that of conventional dressing materials. MATERIALS AND METHODS: The records of 120 patients with chronic wounds of varied aetiologies and with mean age 43.7 years were collected and analyzed. The patients had been treated either with collagen or other conventional dressing materials including silver sulfadiazine, nadifloxacin, povidone iodine, or honey (traditional dressing material). Patients with co-morbidities that could grossly affect the wound healing like uncontrolled diabetes mellitus, chronic liver or renal disease, or major nutritional deprivation were not included. For the purpose of comparison the patients were divided into two groups; 'Collagen group' and 'Conventional group', each having 60 patients. For assessment the wound characteristics (size, edge, floor, slough, granulation tissue, and wound swab or pus culture sensitivity results) were recorded. With start of treatment, appearance of granulation tissue, completeness of healing, need for skin grafting, and patients' satisfaction was noted for each patient in both groups. RESULTS: With two weeks of treatment, 60% of the 'collagen group' wounds and only 42% of the 'conventional group' wounds were sterile (P=0.03). Healthy granulation tissue appeared earlier over collagen-dressed wounds than over conventionally treated wounds (P=0.03). After eight weeks, 52 (87%) of 'collagen group' wounds and 48 (80%) of 'conventional group' wounds were >75% healed (P=0.21). Eight patients in the 'collagen group' and 12 in the 'conventional group' needed partial split-skin grafting (P=0.04). Collagen-treated patients enjoyed early and more subjective mobility. CONCLUSION: No significant better results in terms of completeness of healing of burn and chronic wounds between collagen dressing and conventional dressing were found. Collagen dressing, however, may avoid the need of skin grafting, and provides additional advantage of patients' compliance and comfort.

8.
Saudi J Kidney Dis Transpl ; 22(1): 130-3, 2011 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-21196629

RESUMO

A 29-year-old woman presented with unilateral loin pain because of severely hydro-nephrotic kidney due to deposits of pelvic endometriosis. Double J-stent was placed beyond the obstruction and she was started on hormone therapy. The stent was removed after three months when back pressure changes had resolved. This case is being presented along with a short relevant discussion, due to rarity of ureteral involvement by endometriosis.


Assuntos
Endometriose/complicações , Hidronefrose/etiologia , Doenças Ureterais/complicações , Obstrução Ureteral/complicações , Adulto , Endometriose/diagnóstico , Endometriose/terapia , Feminino , Humanos , Hidronefrose/diagnóstico , Hidronefrose/terapia , Dispositivos Intrauterinos , Levanogestrel/administração & dosagem , Imageamento por Ressonância Magnética , Stents , Resultado do Tratamento , Doenças Ureterais/diagnóstico , Doenças Ureterais/terapia , Obstrução Ureteral/diagnóstico , Obstrução Ureteral/terapia , Ureteroscopia/instrumentação , Urografia
10.
Int Urol Nephrol ; 43(1): 85-90, 2011 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-20490670

RESUMO

AIM: Laparoscopic pyeloplasty (LP) is a minimally invasive approach that is becoming a standard treatment of ureteropelvic junction obstruction (UPJO). It is providing similar results when compared with open surgery. We here present our technique and analyses of experience of our first 100 cases. PATIENTS AND METHODS: We retrospectively reviewed and analyzed the records of first 100 cases of LP performed for UPJO with dilatation of renal pelvis at our centre. Patients' profile; perioperative, intraoperative and postoperative parameters like time of surgery, blood loss, complications, duration of hospital stay, outcome of procedure were analyzed. RESULTS: The mean operative time, need for an extra-port, conversions to open, estimated blood loss, complications and recurrences all significantly decreased after first 50 cases. One patient developed shock due to bleeding from inferior epigastric vessels near port-site, and had to be explored. Overall success rate was 96%. Lesser incidence of fourth-port insertion, conversions to open, and thus decreased operative time was attributed to introduction of additional techniques to reduce the learning curve. CONCLUSION: LP is a technically difficult procedure. Sticking to the basic steps of LP, and trying and thus incorporating additional tactics are useful to reduce the learning curve.


Assuntos
Pelve Renal/cirurgia , Laparoscopia/métodos , Procedimentos de Cirurgia Plástica/métodos , Ureter/cirurgia , Obstrução Ureteral/cirurgia , Procedimentos Cirúrgicos Urológicos/métodos , Adolescente , Adulto , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva , Estudos Retrospectivos , Resultado do Tratamento , Obstrução Ureteral/diagnóstico , Adulto Jovem
11.
Urol Int ; 86(1): 1-10, 2011.
Artigo em Inglês | MEDLINE | ID: mdl-20956850

RESUMO

A review of the recent literature on the surgical management of anterior urethral stricture was performed. The literature was searched via PubMed using the search terms 'urethral stricture' and 'urethroplasty' from 1996 to 2009. The management of anterior urethral strictures is changing rapidly in the sense that the reconstructive procedures have evolved greatly. Penile skin, because of its location and because it is hairless, has been popular and used for a long time. Since the early 1990s, buccal mucosa graft (BMG) was introduced in urethral reconstructive surgery and has become the first choice of most practicing urologists. Recently, there has been an increase in the use of lingual mucosa graft with various doctors reporting easy harvesting and lesser morbidity in comparison to BMG. Also, fibrin glue has recently been used to fix the graft with promising results. With the success of tissue-engineered materials that are still in the experimental phase, the urologist would no longer be limited by the quantity of the graft. These substitutes will also boost the appealing scarless endoscopic urethroplasty. This article provides a brief up-to-date review of the main surgical techniques in the management of anterior urethral stricture disease for the contemporary practicing urologists. Present controversies have been given special emphasis. The possible future techniques and the future of the anterior urethral stricture surgery are also discussed in brief.


Assuntos
Estreitamento Uretral/cirurgia , Procedimentos Cirúrgicos Urológicos/métodos , Humanos , Resultado do Tratamento
12.
JSLS ; 15(4): 580-4, 2011.
Artigo em Inglês | MEDLINE | ID: mdl-22643523

RESUMO

BACKGROUND AND OBJECTIVES: Testicular vein syndrome (TVS) is a rare cause of ureteral obstruction. Only 5 previous cases are on record in the literature, and no review exists on this topic to date. Laparoscopic treatment has never been mentioned in the management of TVS. MATERIALS AND METHODS: We reviewed the literature related to this unusual entity to clarify the preoperative evaluation and the management of TVS. For this purpose, the data related to all the 5 cases previously reported so far in the English literature have been reviewed. Also, we report the sixth case of TVS, and the first patient to be successfully treated with the laparoscopic approach. This was a 37-year-old male with a 6-month history of left loin pain. Preoperative diagnosis was confirmed by CT-Urography. RESULTS: Our patient underwent laparoscopic excision of the left testicular vein followed by ureteroureterostomy in a single sitting. The laparoscopic transperitoneal approach was used. Histopathological examination of the vein showed normal venous tissue. This is the sixth reported case of TVS and the first to be successfully treated with a laparoscopic technique. CONCLUSIONS: A laparoscopic approach is safe and effective for treating patients with TVS with the common advantages of minimal invasiveness and better visualization of the complex anatomy of the retroperitoneum. Thus, it should be the treatment of choice for TVS.


Assuntos
Laparoscopia/métodos , Testículo/irrigação sanguínea , Obstrução Ureteral/etiologia , Obstrução Ureteral/cirurgia , Veias/anormalidades , Adulto , Diagnóstico Diferencial , Humanos , Masculino , Síndrome , Obstrução Ureteral/diagnóstico
13.
ANZ J Surg ; 81(7-8): 547-51, 2011.
Artigo em Inglês | MEDLINE | ID: mdl-22295386

RESUMO

OBJECTIVES: To compare the effectiveness of percutaneous catheter drainage (PCD) and percutaneous needle aspiration (PNA) in the management of large (>10 cm diameter) amoebic liver abscesses. METHODS: Eighty-two patients with amoebic liver abscess were randomly allocated to PCD (n = 42) or PNA (n = 40). Intervention was done under ultrasonography (US) [mainly] or computed tomography guidance within 24 h of admission. PNA was repeated every 3rd day if the cavity size had not reduced to 50% of the original size, for up to three times. Persistence of cavity or of clinical symptoms was considered failure of treatment. Duration to attain clinical relief, duration of hospital stay, complications, treatment failure and deaths were recorded. RESULTS: PNA was successful in 32 (80%) patients (one aspiration in 4, two in 18 and three in 10 patients), while PCD was successful in 38 (90.5%) patients. Durations to attain clinical relief and parentral antibiotics required were significantly lesser in the PCD group. Hospital stay, although did not differ significantly, was lesser for PCD group. The only procedure-related complication due to PCD was rupture of abscess in two cases, leading to sepsis and death of one patient. Complications of PNA included pleural injury in one patient, and haemorrhage leading to subcapsular hematoma in another. CONCLUSION: PCD is a better treatment option than PNA for the management of large (>10 cm diameter) amoebic liver abscess, in terms of duration to attain clinical relief and duration for which parentral antibiotics were needed.


Assuntos
Drenagem , Abscesso Hepático Amebiano/terapia , Sucção , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Cateterismo , Drenagem/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Agulhas , Adulto Jovem
14.
Urol Int ; 86(2): 233-8, 2011.
Artigo em Inglês | MEDLINE | ID: mdl-21088373

RESUMO

BACKGROUND: Isolated renal trauma in case of blunt trauma abdomen (BTA) is not common. Renal artery occlusion by thrombosis in such cases is seen very rarely. These cases had been traditionally treated by early nephrectomy, but nowadays, renal preservation is considered whenever possible. Treatment options to do so are being developed. METHODS: Recently we came across one such case of isolated unilateral renal artery thrombosis (RAT) because of BTA. Relevant literature especially on various therapeutic techniques has been critically reviewed briefly along with case presentation. RESULTS: Isolated blunt traumatic RAT has an incidence of less than 1%. Only about 400 cases have been reported. It must be diagnosed and treated as soon as possible to avoid progressive permanent loss of renal function. Contrast-enhanced CT scanning is the preferred modality for evaluation and follow-up of RAT. Conservative treatment is reserved for unilateral cases. For bilateral cases and when RAT occurs in a solitary kidney, revascularization either surgically or more preferably by less invasive percutaneous techniques has been recommended. CONCLUSION: Renal arterial thrombosis because of blunt abdominal trauma is still an underreported entity, treatment for which has not yet been established. Both early nephrectomy and delayed revascularization are not justified treatment options.


Assuntos
Traumatismos Abdominais/complicações , Artéria Renal/patologia , Trombose/complicações , Ferimentos não Penetrantes/complicações , Traumatismos Abdominais/patologia , Acidentes de Trânsito , Criança , Humanos , Masculino , Nefrectomia/métodos , Stents , Terapia Trombolítica/métodos , Trombose/patologia , Tomografia Computadorizada por Raios X/métodos , Ultrassonografia Doppler/métodos , Urografia/métodos , Procedimentos Cirúrgicos Vasculares/métodos , Ferimentos não Penetrantes/patologia
15.
J Cutan Aesthet Surg ; 4(3): 183-7, 2011 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-22279383

RESUMO

OBJECTIVE: The aim was to evaluate the effect of honey dressing and silver sulfadiazene (SSD) dressing on wound healing in burn patients. MATERIALS AND METHODS: We retrospectively reviewed the records of 108 patients (14-68 years of age), with first and second degree burns of less than 50% of the total body surface area admitted to our institution, over a period of 5 years (2004-2008). Fifty-one patients were treated with honey dressings and 57 with SSD. Time elapsed since burn, site, percentage, degree and depth of burns, results of culture sensitivity at various time intervals, duration of healing, formation of post-treatment hypertrophic scar, and/or contracture were recorded and analyzed. RESULTS: The average duration of healing was 18.16 and 32.68 days for the honey and SSD group, respectively. Wounds of all patients reporting within 1 h of burns became sterile with the honey dressing in less than 7 days while there was none with SSD. All wounds treated with honey became sterile within 21 days while for SSD-treated wounds, this figure was 36.5%. A complete outcome was seen in 81% of all patients in the "honey group" while in only 37% patients in the "SSD group." CONCLUSION: Honey dressings make the wounds sterile in less time, enhance healing, and have a better outcome in terms of hypertropic scars and postburn contractures, as compared to SSD dressings.

16.
J Cancer Res Ther ; 6(3): 316-7, 2010.
Artigo em Inglês | MEDLINE | ID: mdl-21119262

RESUMO

Cutaneous metastases from asymptomatic colonic carcinoma have been documented rarely in the literature. But cutaneous metastasis to an already present operative scar as the mode of presentation of otherwise asymptomatic colon cancer is an extremely rare phenomenon which has been described only thrice till now. We report such a case of adenocarcinoma of sigmoid colon which presented as a large subcutaneous metastasis to an already existing scar of hysterectomy.


Assuntos
Cicatriz , Neoplasias do Colo/patologia , Histerectomia/efeitos adversos , Neoplasias Cutâneas/secundário , Idoso , Feminino , Humanos
17.
Saudi J Kidney Dis Transpl ; 21(6): 1122-6, 2010 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-21060185

RESUMO

We report a case of a 32-year-old female who presented with right flank pain. Ultrasonography done for hematuria 10 years ago indicated the presence of renal cysts in the right kidney, but she had been asymptomatic since then. This history attracted our attention to the possibility of "localized renal cystic disease" (LRCD). Diagnosis was confirmed by computerized tomogram, negative renal ultrasound of one of the parents and absence of family history of renal disease. She is still being followed up for the last 3 years and is doing well. LRCD has been given various names since it was first recognized as a distinct clinical entity but the term LRCD appears to be the most accurate. Here, we present a brief discussion of clinical significance, diagnosis and differentials of this rare condition.


Assuntos
Doenças Renais Císticas/diagnóstico , Rim , Adulto , Diagnóstico Diferencial , Feminino , Dor no Flanco/etiologia , Humanos , Rim/diagnóstico por imagem , Doenças Renais Císticas/complicações , Doenças Renais Císticas/diagnóstico por imagem , Valor Preditivo dos Testes , Tomografia Computadorizada por Raios X , Urografia
18.
J Minim Access Surg ; 6(2): 53-5, 2010 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-20814513

RESUMO

We report two cases of retrocaval ureter that were successfully treated by a laparoscopic transperitoneal approach. Presentation of both these cases was with flank pain. Ureteroureterostomy using an intracorporeal suture technique was performed for one, and pyelopyelostomy for the other case. Operative time was 120 min and 110 min, respectively. Pyelopyelostomy was technically easier to perform than ureteroureterostomy that required an extra fourth port insertion to facilitate dissection. With increasing experience with the intracorporeal suturing laparoscopic technique of either pyelopyelostomy or ureteroureterostomy should be the first choice for retrocaval ureter.

19.
J Endourol ; 24(9): 1431-4, 2010 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-20626236

RESUMO

BACKGROUND AND PURPOSE: Laparoscopic dismembered pyeloplasty (LDP) is a minimally invasive approach that is becoming standard management of ureteropelvic junction obstruction (UPJO). It provides similar results when compared with open surgery. The main goal of LDP is to meet the standard of open dismembered pyeloplasty with reduced trauma for the patients. The purpose of the study was to evaluate the postoperative and functional results of LDP. PATIENTS AND METHODS: We retrospectively reviewed and analyzed 142 cases of LDP performed at our center over a period of 7 years (January 2003 to December 2009) for UPJO with dilatation of the renal pelvis. Patients' profiles and perioperative, intraoperative, and postoperative parameters, such as time of surgery, blood loss, complications, duration of hospital stay, and outcomes of the procedure, were all evaluated and analyzed. RESULTS: The mean operative time for LDP was 145 minutes (range 110-180 min), and the mean estimated blood loss was negligible in all patients. The mean hospital stay was 3.5 days (3-6 d). Two conversions to open surgery occurred because of difficulty to complete the anastomosis. In one patient, shock caused by bleeding from inferior epigastric vessels near the port site developed and had to be explored. The success rate was 96.8%. CONCLUSION: When performed by expert surgeons, LDP can safely achieve success rates that are comparable to those of open surgery described in the literature, with fewer complications and less morbidity to the patients. The few important difficulties with their management that we encountered are discussed.


Assuntos
Laparoscopia , Procedimentos de Cirurgia Plástica/métodos , Obstrução Ureteral/cirurgia , Adolescente , Adulto , Feminino , Seguimentos , Humanos , Cuidados Intraoperatórios , Masculino , Pessoa de Meia-Idade , Cuidados Pós-Operatórios , Adulto Jovem
20.
J Cancer Res Ther ; 6(1): 86-8, 2010.
Artigo em Inglês | MEDLINE | ID: mdl-20479554

RESUMO

Breast hamartoma is a rare tumor that has been reported only thrice in a male breast. The pediatric age group is seldom involved. We present a case of breast hamartoma in a 13-year-old boy, which interestingly, extended through but without definite involvement of the chest wall into the thoracic cavity. In view of occasional recurrence and documented malignancy in hamartomas, tumor was excised along with two ribs.


Assuntos
Doenças Mamárias/patologia , Hamartoma/patologia , Adolescente , Doenças Mamárias/cirurgia , Hamartoma/cirurgia , Humanos , Masculino , Parede Torácica/patologia
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