Background and Objectives: Though medical expulsive therapy for ureteric stones is increasingly used these days, some recent randomized controlled trials have questioned its benefit. This study evaluates the result of treatment of ureteric stones with tamsulosin. Materials and Methods: This prospective study involved ultrasonographically confirmed cases of uncomplicated unilateral ureteric stones. All patients received tamsulocin 0.4 mg daily for 2 to 6 weeks. The primary end point was stone expulsion. The secondary endpoints were the use of analgesics and adverse events.   Results: One hundred and sixty two patients completed the study. Ninety seven patients were male and male to female ratio was 3:2. The mean age was 34.9 ± 9.8 (range: 18-71) years. The mean stone size was 6.17 ± 1.68 (range: 3.3-11.2) mm. By the end of 2, 4 and 6 weeks, cumulative stone expulsion rate was 110 (69.1%), 121 (74.7%) and 126 (77.8%) respectively. For the 49 stones of size £ 5 mm, the expulsion rate was 47 (95.9%) by the end of 6 weeks. The expulsion rates for stones of size > 5 - 7 mm, > 7 – 9 mm and ³ 9 mm were 59 (85.5%), 17 (53.1%) and 3 (25%) respectively by the end of 6 weeks. Lower ureteric stones had the highest expulsion rate of 106 (87.6%) by the end of 6 weeks, and the rate was lowest for upper ureteric stones (34.6%). Ten (6.1%) patients required additional analgesics during the course of treatment. Eleven (6.8%) patients complained of mild light-headedness and dizziness which subsided in a few days. Conclusion: Tamsulocin appears to facilitate expulsion of ureteric stones especially the distal ones. The benefit of tamsulocin seems to be maximum for the stones of size up to 9 mm. Further large scale randomized controlled trial should better define the real benefit and more rationale use of tamsulocin in routine clinical practice.

Introduction Photo-biomodulation (PBM), also known as low level Laser therapy (LLLT), is a novel non-pharmacological adjunct for enhancing the healing process of resistant wounds and ulcers. PBM promotes cellular proliferation and activates angiogenesis. We present a novel approach in the treatment of radiotherapy-related ulcer resistant to standard ulcer care. Case description A 60-year-old gentleman was referred with a complex left heel ulcer and pain following radiotherapy and chemotherapy post non-HIV related Kaposi's sarcoma resection. Conservative management failed and a below knee amputation was considered. The patient opted for an advanced therapy program. Repeated sessions of PBM were given (660 nm and 810 nm wavelength, 20Hz, 44.6 milliwatt/cm2, 26.76 Joules/cm2). The wound was covered with a novel fish skin xenograft Kerecis™ and supported with PICO™ dressing. A combination of further debridement, PBM, re-application of Kerecis™, PICO™ dressing and long-term antibiotics allowed a new vascularized layer with good pulsatile flow along wound edges to establish within 6 weeks at a rate of 4mm2/week. Achilles tendon was partially excised, and maggots were used. Full coverage of the ulcer bed with a new healthy granulation tissue was achieved in 12 weeks’ time. The pain improved dramatically, opioids were stopped, and the patient managed to mobilize independently again with occasional aids. The wound was allowed to heal with secondary intention. Conclusions PBM, Kerecis and best standards of wound care allowed avoiding a major amputation and healing of a malignancy-related and radiotherapy-related ulcer. PBM can be considered as an adjunct in slow / non-healing wounds for skin malignancies and radiotherapy patients.