A rare case of antepartum posterior reversible encephalopathy syndrome.

Pre-eclampsia and eclampsia are well-known causative factors of posterior reversible encephalopathy syndrome (PRES). There are only a few reported cases of antepartum PRES. We report a 25-year-old primigravid woman who presented with eight months of amenorrhoea and an abrupt onset of eclampsia associated with a history of a fall. A computed tomography scan ruled out intracranial haemorrhage and PRES was diagnosed. She responded well to supportive care, labour was induced and maternal and neonatal outcomes were good. Antepartum PRES poses different challenges to those of PRES in non-obstetric or postpartum patients, because of the additional management aspects required to ensure foetal wellbeing. We were posed with a difficult decision about the disadvantages of caesarean section versus those of vaginal delivery in our patient.

Profuse bleeding in epiphrenic diverticula: an unusual finding.

Profuse bleeding is an unusual and previously unreported finding in epiphrenic diverticula. The present case describes a man with a history of significant alcohol and tobacco abuse who presented to an emergency room expectorating blood and was then admitted. Further evaluation revealed a large bleeding ulcer crater in the distal esophagus. Findings consistent with candida esophagitis were noted on biopsy. Radiographic examination revealed two large, wide-mouthed diverticula. While hypertensive lower esophageal pressure was noted on manometric evaluation, surgery was not performed on the patient, and he subsequently curtailed his alcohol and tobacco intake. A follow-up examination at 90 days' postdischarge revealed no further bleeding episodes with continued decreased alcohol and tobacco intake.

A new outlook in the management of complex female urethral injuries.

Management of complex female urethral injuries is challenging. We present our experience of 9 cases over the last 3 years with a mean follow-up of 14 months. The spectrum of clinical problems and results of various forms of innovative management are highlighted. Injuries which could not be managed by primary repair or by applying regular urethroplasty principles of using local vaginal flaps were treated with core-through urethrotomy (2), creation of distal urethrovaginal fistula (5), and continent urinary diversion (2). Individualised treatment technique to fit the special circumstance as presented by each patient is stressed because of the rarity of female urethral injury.

Primary benign vesical teratoma. A case report.

Primary benign vesical teratomas are rare. Most of the cases reported are paravesical teratomas rupturing into the bladder. A case of primary benign vesical teratoma suspected preoperatively and later confirmed at histopathology is reported.

Instillation of silver nitrate in the treatment of chyluria.

A series of 62 patients with chyluria received instillations of 1% silver nitrate in the renal pelvis over an 8-year period; 51 patients responded well but 11 showed no response to treatment. Follow-up ranged from 2 to 7 years. The treatment was found to be safe, effective and minimally invasive.

Giant ureteral stone.

A 58-year-old man presented with left flank pain and a high grade fever. Investigations revealed left pyonephrosis with a left renal stone and a giant left ureteral stone. Nephroureterectomy was performed. The ureteral stone measured 13 cm. long and weighed 90 gm.

Experience of continent urinary diversion with modified Koff's technique.

Continent abdominal neourethrostomy is a procedure in which a bladder flap from the dome is raised, converted into a tube and then brought out on the abdominal wall as a stoma, just below the umbilicus. We have done this procedure on 5 patients of different age groups and for various indications. All our patients are perfectly continent postoperatively during the day as well as night. They are doing regular self-catheterisation. They are dry in periods between self-catheterisations. The maximum follow-up is two years and six months.

Catheter-less suprapubic cystolithotomy in children.

Bladder stones in children are common in developing countries and the procedure of choice for their removal is suprapubic cystolithotomy. It is standard practice to drain the bladder for a few days post-operatively to prevent urinary leakage. We have observed that, if the bladder is closed meticulously in 2 layers, bladder drainage by means of a catheter is not required. We have analysed 86 children treated by suprapubic cystolithotomy without a catheter. Size of the stones and intra-operative findings were noted and it was found that 85% of the patients had an excellent result; 10% had a satisfactory result and 4.7% were unsatisfactory. The advantages of the procedure and selection of the patients are discussed.