Introduction. Urolithiasis is one of the common disorder with which about 1/5th is found in the ureter, of which 2/3rd is seen in the lower ureter. Medical expulsive therapy is one of the routine modalities of treatment which uses various drugs acting on the ureter smooth muscle by different mechanism. We aim to compare the efficacy of combination vs. single drug. Methods. This randomized controlled trial was done in 176 consecutive patients over a period of six months (March 2019 to August 2019) in Department of Urology and Kidney Transplant Surgery, Tribhuvan University Teaching. Participants were divided into two groups (Group A, tamsulosin plus tadalafil, and Group B, tamsulosin) from computer-generated random numbers. Therapy was continued for a maximum of 3 weeks. Stone expulsion rate, time to stone expulsion, analgesic use, number of colic and emergency room visits for pain, early intervention, and adverse effects of drugs were recorded. Results. Among 176 patients who were enrolled in study, 7 were lost to follow-up, and 5 people required immediate intervention. There was a significant higher stone passage rate in group A than group B (64 vs. 50; P=0.025) and shorter expulsion time (1.66 vs. 2.32 weeks P=0.001) and less number of emergency room visits and colic episodes. No significant side effects were noted during study. Conclusion. Tamsulosin plus Tadalafil is more effective than tamsulosin with early passage of stone and decreased number of colic episodes and emergency visits without significant side effects for lower ureteric calculi of 5 mm to 10 mm.
Pheochromocytoma associated with inferior vena cava (IVC) thrombosis is very rare. A 27-year-old female presented with right flank pain and hypertensive urgency. Contrast-enhanced CT abdomen and gadolinium-contrast MRI abdomen revealed right adrenal mass suspicious of malignancy with invasion and compression to the right IVC wall along with IVC thrombus extending from the level of renal veins to the level of confluence with hepatic veins. Her routine laboratory investigations including 24-hour urine fractionated metanephrines, vanillylmandelic acid, and cortisol were normal. Right adrenalectomy with IVC thrombectomy was done. Perioperative period was uneventful. Histopathology of the mass turned out to be pheochromocytoma with thrombus revealing fibroadipose tissue with fibrin. Pheochromocytoma may present with IVC thrombus as well as normal serum and urinary markers. Thus, clinical suspicion is imperative in perioperative management of adrenal mass.
Introduction: Skin is the mirror of an internal disease, including the renal system. Chronic kidney disease presents with variety of skin diseases, which is caused either by kidney disease or by treatment modalities.Objective: To evaluate the revalence of various skin disease in patients with chronic renal disease and relation of various skin diseases with serum creatinine, blood urea, hemoglobin and number of hemodialysis cycle.Methodology: A cross-sectional analytical study was conducted in hundred patients of either sex, aged 18 years and above; with chronic kidney disease (stage V) admitted for dialysis in Nephrology department of Nobel Medical College and teaching hospital, Biratnagar, Nepal. The study groups were evaluated for various skin manifestation and parameters of renal function like blood urea and serum creatinine.Results: Among the total patients (n=100), 84 patients presented with complain of skin manifestation but on detail examination 97 patients had at least one skin disease. The causes leading to chronic kidney disease were found to be hypertension 58%, diabetes mellitus 49%, IgA nephropathy 7%, systemic lupus erythematosus 7% and glomerulonephritis 4%. Xerosis was the commonest skin disease encountered in these patients amounting to 71% among which 43 were hypertensive and 34 were diabetic. Xerosis was followed by pruritus (62%), pallor (54%), mucosal changes (39%), skin infection (36%), hair changes (34%), pigmentation (33%) and nail changes (29%). Serum creatinine showed statistically significant association with pruritus ( =0.030) and pigmentation ( =0.010), similarly blood urea showed significant association with pruritus ( =0.001). Similarly, number of dialysis cycle showed significant association with pigmentation of skin ( =<0.001).Conclusion: Chronic kidney disease is associated with variety of skin diseases. The commonest were xerosis and pruritus. Early detection and appropriate intervention can relieve and decrease suffering. BJHS 2018;3(2)6:468-474.
Introduction: Adrenal gland surgery is a challenging art as it encompasses diverse physiological derangements which are even life-threatening. Also, it remains a medical finesse to rightly identify the correct patient who will benefit from surgery which include strong biochemical and radiological resource. Soundly performed surgery will lead to oncologic and homeostatic correction leading to near normal course. Methods: This is a retrospective analysis of adrenalectomy cohort over three years in a tertiary center in Nepal identifying diagnosis, preoperative management and postoperative course. The objective of this study is to review the presentation, histopathology and clinical outcomes of patients operated for adrenal mass in our center. Results: There were 42 surgeries performed via open approach. The number of adenoma, phaeochromocytoma, carcinoma and non-functioning tumor were 13, 16, 12 and one respectively. In most of the hypertensive patients, control was achieved with minimal drug and recurrences were observed in 25% of carcinoma in postoperative follow up. Conclusion: A large proportion of operative adrenal mass are observed clinically in our setup. The surgical outcome is satisfactory but judicious perioperative management is essential.
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