Current Issue : January - March Volume : 2016 Issue Number : 1 Articles : 8 Articles
Objective: To describe patients presenting with acute kidney injury after rhabdomyolysis at a\ntertiary renal care center in Pakistan. Patients and Methods: An observational cohort of patients\nidentified as having acute kidney injury (AKI) with rhabdomyolysis, which was diagnosed by rise\nin creatinine phosphokinase (CK) and lactate dehydrogenase (LDH) more than 4 times the reference\nrange whereas AKI was defined according to RIFLE criteria. On ultrasonography, all patients\nhad normal size non obstructed kidneys, and no other co morbid. Results: Between January 1990\nto December 2014, 334 patients with rhabdomyolysis and AKI registered to this hospital. Mean age\nwas 28.22 �± 11.22 years with M:F ratio of 3.33:1. Mean values of CK and LDH were 597,749.790 �±\n180,461.360 and 4077.026 �± 5050.704 U/L with reference range of 26 - 174 U/L and 91 - 180 U/L\nrespectively. We divided the study population into 4 groups over timeline. Rhabdomyolysis etiology\nwas divided in 3 groups; 1) traumatic, 2) non-traumatic exertional, and 3) non-traumatic\nnon-exertional. In the last group, which spans from 2010-2014, we treated many cases with toxic\nrhabdomyolysis and main toxin was paraphenylenediamine (PPD). The other causes showed more\nor less same prevalence over two and a half decade, except non-traymatic exertional which has\ndecreased during last 5 years without any explainable cause. Renal replacement therapy (RRT)\nwas required on arrival in 94% cases. Complete renal recovery was observed in 70%, while 15.86%\ndied and 10% were lost during recovery phase. A small number 2.69% left against medical advice\nduring acute phase of illness and 0.8% developed chronic kidney disease (CKD). Conclusion: The\ncommon clinical conditions found associated with rhabdomyolysis and AKI includes trauma, immobilization,\nsepsis, overexertion, and drugs and toxins. In recent years, we have seen many\nyoung patients with PPD poisoning; we have found good renal recovery in patients who survived\ninitial 2 - 3 weeks....
Introduction. To determine the efficacy of bipolar transurethral incision with mitomycin C (MMC) injection for the treatment\nof refractory bladder neck stenosis (BNS). Materials and Methods. Patients who underwent bipolar transurethral incision of BNS\n(TUI BNS) with MM Cinjection at our institution from2013 to 2014 were retrospectively reviewed.A total of 2mg of 40% mitomycin\nC solution was injected in four quadrants of the treated BNS. Treatment failure was defined as the need for subsequent intervention.\nResults. Thirteen patients underwent 17 bipolar TU IBNS with MMC injection. Twelve (92%) patients had failed a mean of 2.2 Ã?±\n1.1 prior endoscopic procedures. Median follow-up was 16.5 months (IQR: 14ââ?¬â??18.4 months). Initial success was 62%; five (38%)\npatients had a recurrence with a median time to recurrence of 7.3 months. Four patients underwent a repeat procedure, 2 (50%)\nof which failed. Overall success was achieved in 77% (10/13) of patients after a mean of 1.3 Ã?± 0.5 procedures. BNS recurrence was\nnot significantly associated with history of pelvic radiation (33% versus 43%, ...
Purpose. We aimed to compare and evaluate the outcomes and complications of two endoscopic treatment procedures, semirigid\nureteroscopy (SR-URS) and flexible ureteroscopy (F-URS), in the treatment of proximal ureteral stones (PUS). Methods. SR-URS\n(group 1) was done on 68 patients whereas 64 patients underwent F-URS (group 2) for the treatment of PUS. Success rate was\ndefined as the absence of stone fragments or presence of asymptomatic insignificant residual fragments < 2 mm. Outcomes and\ncomplications were recorded. Results.The differences were statistically not significant in age, gender, body mass index (BMI), and\nstone characteristics between groups.Mean ureteral stone size was 9.1 �± 0.4mm and 8.9 �± 0.5mm for groups 1 and 2.Mean operative\ntime was 34.1 �± 1.5 min and 49.4 �± 2.3 min for groups 1 and 2 (...
Objective. To evaluate the recurrence rate of bulbar urethral strictures managed with cold knife direct vision internal urethrotomy\nand high dose corticosteroid injection. Methods. 28 patients with bulbar urethral strictures underwent direct vision internal\nurethrotomy with high dose triamcinolone injection into the periurethral tissue and were followed up for recurrence. Results.\nOur cohort had a mean age of 60 years and average stricture length of 1.85 cm, and 71% underwent multiple previous urethral\nstricture procedures with an average of 5.7 procedures each. Our technique modification of high dose corticosteroid injection had a\nrecurrence rate of 29% at amean follow-up of 20months with a low rate of urinary tract infections. In patients who failed treatment,\nmean time to stricture recurrence was 7 months. Patients who were successfully treated had significantly better International\nProstate Symptom Scores at 6, 9, and 12 months.There was no significant difference in maximum flow velocity on Uroflowmetry at\nlast follow-up but there was significant difference in length of follow-up (...
The evolutionarily conserved planar cell polarity (PCP) signaling pathway controls tissue polarity within the plane orthogonal to the\napical-basal axis. PCP was originally discovered in Drosophila melanogaster where it is required for the establishment of a uniform\npattern of cell structures and appendages. In vertebrates, including mammals, the PCP pathway has been adapted to control various\nmorphogenetic processes that are critical for tissue and organ development. These include convergent extension (crucial for neural\ntube closure and cochlear duct development) and oriented cell division (needed for tubular elongation), ciliary tilting that enables\ndirectional fluid flow, and other processes. Recently, strong evidence has emerged to implicate the PCP pathway in vertebrate kidney\ndevelopment. In this review, we will describe the experimental data revealing the role of PCP signaling in nephrogenesis and kidney\ndisease....
This review highlights recent advances in pathophysiology and treatment for uremic pruritus, especially\nfocusing on various interventions. Pruritus in patients on hemodialysis (HD) and peritoneal\ndialysis (PD) still remains an unresolved issue. Recently, the efficacy and safety of nalfurafine\nhydrochloride have been reported in Japan, and at present, more than thirty thousand patients\nreceive this new drug. In comparison with the efficacy of this new drug, acupuncture, a form of\ntraditional Japanese therapy, has been validated for relief of symptoms of pruritus. In this review,\nvarious interventions for relief of symptoms of pruritus as well as recent studies on its pathophysiology\nwill be introduced. This review will be helpful for treatment of pruritus in patients on\ndialyzed therapy in clinical practice....
Objectives. To review the available literature describing the three most common approaches for buccal mucosal graft (BMG)\naugmentation during reconstruction of bulbar urethral strictures. Due to its excellent histological properties, buccal mucosa graft\nis now routinely used in urethral reconstruction. The best approach for the placement of such a graft remains controversial.\nMethods. PubMed search was conducted for available English literature describing outcomes of bulbar urethroplasty augmentation\ntechniques using dorsal, ventral, and lateral approaches. Prospective and retrospective studies as well as meta-analyses and latest\nsystematic reviews were included. Results. Most of the studies reviewed are of retrospective nature and majority described dorsal\nor ventral approaches. Medium- and long-term outcomes of all three approaches were comparable ranging between 80 and 88%.\nConclusion. Various techniques of BMG augmentation urethroplasty have been described for repairs of bulbar urethral strictures.\nIn this review, we describe and compare the three most common ââ?¬Å?competingââ?¬Â approaches for bulbar urethroplasty with utilization\nof BMG....
Background. Thirty to forty percent of patients with high grade nonmuscle invasive bladder cancer (NMIBC) fail to respond to\nintravesical therapy with bacillus Calmette-Guerin (BCG). Interferon-...
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