Pub Date : 2023-01-01DOI: 10.7860/ijars/2023/57153.2861
Kabilan Thavamurugan, B. Sangeetha, N. Ramalingam
Tubular adenomas of the breast belong to the category of fibroepithelial tumours of the breast, and it is composed of compact bilayer tubules with a sparse intervening stroma. It is usually circumscribed (may be nodular) benign tumour of the breast.Tubular adenomas are very rare benign tumours of the breast which mimic the clinical and radiological presentation of fibroadenomas. It usually presents as, a well-circumscribed, palpable painless mass. Surgical excision of this tumour is the main stay treatment. This report documents, a rare presentation of tubular adenoma in a 17-year-old girl who presented with a swelling in the right breast with pain, nipple discharge and nipple inversion. Breast ultrasound revealed, a large well-circumscribed heteroechoic lesion (8.5*3.8cm) within the right breast, giving breast within breast appearance and reported as Breast Imaging Reporting and Diagnostic Scoring system BIRADS III. Patient was provisionally diagnosed as giant fibroadenoma and was planned for excisional biopsy. Histopathological examination confirmed it to be tubular adenoma. The patient had an excellent postoperative recovery.
{"title":"Tubular Adenoma of the Right Breast- A Case Report","authors":"Kabilan Thavamurugan, B. Sangeetha, N. Ramalingam","doi":"10.7860/ijars/2023/57153.2861","DOIUrl":"https://doi.org/10.7860/ijars/2023/57153.2861","url":null,"abstract":"Tubular adenomas of the breast belong to the category of fibroepithelial tumours of the breast, and it is composed of compact bilayer tubules with a sparse intervening stroma. It is usually circumscribed (may be nodular) benign tumour of the breast.Tubular adenomas are very rare benign tumours of the breast which mimic the clinical and radiological presentation of fibroadenomas. It usually presents as, a well-circumscribed, palpable painless mass. Surgical excision of this tumour is the main stay treatment. This report documents, a rare presentation of tubular adenoma in a 17-year-old girl who presented with a swelling in the right breast with pain, nipple discharge and nipple inversion. Breast ultrasound revealed, a large well-circumscribed heteroechoic lesion (8.5*3.8cm) within the right breast, giving breast within breast appearance and reported as Breast Imaging Reporting and Diagnostic Scoring system BIRADS III. Patient was provisionally diagnosed as giant fibroadenoma and was planned for excisional biopsy. Histopathological examination confirmed it to be tubular adenoma. The patient had an excellent postoperative recovery.","PeriodicalId":56235,"journal":{"name":"International Journal of Anatomy Radiology and Surgery","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71263703","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.7860/ijars/2023/57478.2857
VEnkAtA RAngA SwAmy, D. Reddy, Raja Sekhar Guddeti, Mutyasri Pedapathnapu
Introduction: The management of renal trauma includes operative and non operative approach based on clinical profile of patient. However, management of the high-grade renal trauma remains controversial. Aim: To evaluate mode of renal injury, staging and its management outcomes. Materials and Methods: This prospective, observational study included 49 patients (>15 years of age) who presented with abdominal trauma. Computed tomography was performed for grading of renal trauma. The patients were stratified based on whether they underwent open renal surgery or conservative management for their renal injury. Demographic characteristics and a detailed history of renal injuries were recorded. The patients were evaluated based on the rate of renal preservation and complications at 6-month follow-up. Results: The mean age was 32.10 years and majority of the patients were males (87.76%). Blunt trauma (95.92%) was most frequently reported. According to American Association for the Surgery of Trauma (AAST), 8 (16.33%) patients were categorized in grade I, 17 (34.69%) patients in grade II, 8 (16.33%) patients in grade III, 12 (24.49%) patients in grade IV, and 4 (8.16%) patients in grade V. Microscopic haematuria (42.86%) was the most common clinical presentation. The majority of the patients were managed conservatively (89.8%). Only two belonging to grade 4 and three from grade 5 were managed operatively due to haemodynamic instability. Rib fractures (n=10) were the most frequently associated injury, and Urinary Tract Infection (UTI) (n=8) was the most common complication, followed by persistent haematuria (n=3), and hypertension (n=3). All patients with grades I to III showed 100% renal preservation rate with conservative management. However, patients with grades IV and V showed renal preservation rate of 83.33% and 50%, respectively. Conclusion: Conservative treatment is a preferred choice of treatment in the most of the renal trauma. The present study reported high renal preservation rate in low-grade renal injuries, which were managed conservatively. However, there is still need of surgical treatment in high grade haemodynamically unstable patients.
{"title":"Clinical Characteristics and Management of Renal Trauma: A Single-centre Observational Study","authors":"VEnkAtA RAngA SwAmy, D. Reddy, Raja Sekhar Guddeti, Mutyasri Pedapathnapu","doi":"10.7860/ijars/2023/57478.2857","DOIUrl":"https://doi.org/10.7860/ijars/2023/57478.2857","url":null,"abstract":"Introduction: The management of renal trauma includes operative and non operative approach based on clinical profile of patient. However, management of the high-grade renal trauma remains controversial. Aim: To evaluate mode of renal injury, staging and its management outcomes. Materials and Methods: This prospective, observational study included 49 patients (>15 years of age) who presented with abdominal trauma. Computed tomography was performed for grading of renal trauma. The patients were stratified based on whether they underwent open renal surgery or conservative management for their renal injury. Demographic characteristics and a detailed history of renal injuries were recorded. The patients were evaluated based on the rate of renal preservation and complications at 6-month follow-up. Results: The mean age was 32.10 years and majority of the patients were males (87.76%). Blunt trauma (95.92%) was most frequently reported. According to American Association for the Surgery of Trauma (AAST), 8 (16.33%) patients were categorized in grade I, 17 (34.69%) patients in grade II, 8 (16.33%) patients in grade III, 12 (24.49%) patients in grade IV, and 4 (8.16%) patients in grade V. Microscopic haematuria (42.86%) was the most common clinical presentation. The majority of the patients were managed conservatively (89.8%). Only two belonging to grade 4 and three from grade 5 were managed operatively due to haemodynamic instability. Rib fractures (n=10) were the most frequently associated injury, and Urinary Tract Infection (UTI) (n=8) was the most common complication, followed by persistent haematuria (n=3), and hypertension (n=3). All patients with grades I to III showed 100% renal preservation rate with conservative management. However, patients with grades IV and V showed renal preservation rate of 83.33% and 50%, respectively. Conclusion: Conservative treatment is a preferred choice of treatment in the most of the renal trauma. The present study reported high renal preservation rate in low-grade renal injuries, which were managed conservatively. However, there is still need of surgical treatment in high grade haemodynamically unstable patients.","PeriodicalId":56235,"journal":{"name":"International Journal of Anatomy Radiology and Surgery","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71263991","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.7860/ijars/2023/60484.2892
Dhrubajyoti Maulik, Debjit Nandi
This case series is about four incidences where the patients had introduced rings around the penis. The duration of the presentation ranged from eight to ninety-six hours. All patients had different degrees of injury and clinical presentation and were managed accordingly. Help of one metallic electrical cutter and two non hospital staff were required while removing those rings and same method was used in all cases. At the time of discharge, one patient was found to have degloved penile skin, others showed sloughed-out skin at the base of the penis. Late presenters had lower Erection Hard Score (EHS) but all had normal voiding of urine at the time of discharge. One patient was known to have schizophrenia. Other patients had no history of mental disorders and psychiatric evaluation was also done during hospital stay. Penile strangulation needs urgent medical attention and the removal of the rings as early as possible. Duration of strangulation and type of object plays a vital role in determining the grade of injury and complications.
{"title":"Abnormal Behaviour of Introducing Ring in Penis and its Fatal Consequences: A Case Series","authors":"Dhrubajyoti Maulik, Debjit Nandi","doi":"10.7860/ijars/2023/60484.2892","DOIUrl":"https://doi.org/10.7860/ijars/2023/60484.2892","url":null,"abstract":"This case series is about four incidences where the patients had introduced rings around the penis. The duration of the presentation ranged from eight to ninety-six hours. All patients had different degrees of injury and clinical presentation and were managed accordingly. Help of one metallic electrical cutter and two non hospital staff were required while removing those rings and same method was used in all cases. At the time of discharge, one patient was found to have degloved penile skin, others showed sloughed-out skin at the base of the penis. Late presenters had lower Erection Hard Score (EHS) but all had normal voiding of urine at the time of discharge. One patient was known to have schizophrenia. Other patients had no history of mental disorders and psychiatric evaluation was also done during hospital stay. Penile strangulation needs urgent medical attention and the removal of the rings as early as possible. Duration of strangulation and type of object plays a vital role in determining the grade of injury and complications.","PeriodicalId":56235,"journal":{"name":"International Journal of Anatomy Radiology and Surgery","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71264258","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.7860/ijars/2023/59502.2869
P. Agrawal, A. Saxena, Prakhar Verma, A. Yadav, Radhika Sahni, Z. Parkar, Nitish Jain, Anam Fatima
Introduction: Haemorrhoids is a very common condition in patients presenting to surgery Outpatient Department (OPD) with complaints of bleeding per rectum. Injection Foam Sclerotherapy has been established as a safe, simple and effective non surgical modality in treatment of symptomatic grade 1 and 2 haemorrhoids. Aim: To evaluate the effectiveness of foam sclerotherapy as a treatment modality in patients suffering with symptomatic Grade I and II Haemorrhoidal diseases. Materials and Methods: This prospective interventional study was conducted in General Surgery department of FH Medical College and Hospital, Agra, Uttar Pradesh, India between April 2021 to September 2021. A total of 42 patients with complaints of bleeding per rectum, and who were diagnosed as a case of Grade I or II internal haemorrhoids were included. 3% Polidocanol was used as the sclerosing agent for sclerotherapy. Effectiveness of sclerotherapy was evaluated, parameters assessed were bleeding per rectum, pain and pruritis with regular follow-ups of the patients at specific intervals. Results: Among 42 patients 29 (69.05%) patients had grade I haemorrhoids while 13 (30.95%) presented as a case of grade II haemorrhoidal disease. Among the patients with grade I haemorrhoids, 82.76% (24/29) were treated successfully after a single session of foam sclerotherapy while 53.85% (7/13) of the patients with grade II haemorrhoids were symptomatically relieved after a single session. The success rate after 2nd session of sclerotherapy was 100% (29/29) in patients diagnosed as a case of grade I haemorrhoids comparing it to 69.23% (9/13) in those with grade II haemorrhoids. The overall cure rate for either grade of haemorrhoid after three sessions of therapy was 95.24% (40/42). Conclusion: This study reflects that 3% polidocanol when used as a sclerosant agent was found to be cheap, safe and effective, and first line treatment modality in grade I and II haemorrhoids that can be done on outpatient basis with minimal complication.
{"title":"Effectiveness of Foam Sclerotherapy in Treatment of Symptomatic Haemorrhoidal Diseases at a Tertiary Care Hospital, Agra, Uttar Pradesh, India: A Prospective Interventional Study","authors":"P. Agrawal, A. Saxena, Prakhar Verma, A. Yadav, Radhika Sahni, Z. Parkar, Nitish Jain, Anam Fatima","doi":"10.7860/ijars/2023/59502.2869","DOIUrl":"https://doi.org/10.7860/ijars/2023/59502.2869","url":null,"abstract":"Introduction: Haemorrhoids is a very common condition in patients presenting to surgery Outpatient Department (OPD) with complaints of bleeding per rectum. Injection Foam Sclerotherapy has been established as a safe, simple and effective non surgical modality in treatment of symptomatic grade 1 and 2 haemorrhoids. Aim: To evaluate the effectiveness of foam sclerotherapy as a treatment modality in patients suffering with symptomatic Grade I and II Haemorrhoidal diseases. Materials and Methods: This prospective interventional study was conducted in General Surgery department of FH Medical College and Hospital, Agra, Uttar Pradesh, India between April 2021 to September 2021. A total of 42 patients with complaints of bleeding per rectum, and who were diagnosed as a case of Grade I or II internal haemorrhoids were included. 3% Polidocanol was used as the sclerosing agent for sclerotherapy. Effectiveness of sclerotherapy was evaluated, parameters assessed were bleeding per rectum, pain and pruritis with regular follow-ups of the patients at specific intervals. Results: Among 42 patients 29 (69.05%) patients had grade I haemorrhoids while 13 (30.95%) presented as a case of grade II haemorrhoidal disease. Among the patients with grade I haemorrhoids, 82.76% (24/29) were treated successfully after a single session of foam sclerotherapy while 53.85% (7/13) of the patients with grade II haemorrhoids were symptomatically relieved after a single session. The success rate after 2nd session of sclerotherapy was 100% (29/29) in patients diagnosed as a case of grade I haemorrhoids comparing it to 69.23% (9/13) in those with grade II haemorrhoids. The overall cure rate for either grade of haemorrhoid after three sessions of therapy was 95.24% (40/42). Conclusion: This study reflects that 3% polidocanol when used as a sclerosant agent was found to be cheap, safe and effective, and first line treatment modality in grade I and II haemorrhoids that can be done on outpatient basis with minimal complication.","PeriodicalId":56235,"journal":{"name":"International Journal of Anatomy Radiology and Surgery","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71264353","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.7860/ijars/2023/60529.2886
P. Sirikonda, .. Mariya, R. Sugavasi, R. Katikireddi
Introduction: Regarding the disorders associated with multiple renal arteries, they are of specific interest to urologists, nephrologists, surgeons, and radiologists. Aim: To identify the presence of multiple renal arteries in the human cadavers. Materials and Methods: An observational cadaveric study was conducted on 50 formalin-fixed human cadavers in Osmania Medical College, Hyderabad, Telangana, India, from May 2017 to July 2022. Dissection procedure was followed according to standard techniques. Variations and patterns of renal arteries were observed. Descriptive statistics were used and results were expressed in terms of frequency (N) and percentages (%). Results: Out of 50 cadavers, variations in the renal artery were seen in eight cadavers. Four cadavers showed double renal arteries (one right side and three left side). Three cadavers showed early division and one cadaver which has shown double Right Renal Artery (RRA) also showed Early Division of RRA (ED of RRA) and one cadaver showed an Accessory Renal Artery (ARA) on the left side. Conclusion: Variations observed were mainly double renal arteries, early division of the renal arteries, and ARA. This kind of different pattern of variations may play an important role in renal transplants and any surgeries involving the renal arteries.
{"title":"Variations in Renal Arteries- A Cadaveric Study in Telangana, India","authors":"P. Sirikonda, .. Mariya, R. Sugavasi, R. Katikireddi","doi":"10.7860/ijars/2023/60529.2886","DOIUrl":"https://doi.org/10.7860/ijars/2023/60529.2886","url":null,"abstract":"Introduction: Regarding the disorders associated with multiple renal arteries, they are of specific interest to urologists, nephrologists, surgeons, and radiologists. Aim: To identify the presence of multiple renal arteries in the human cadavers. Materials and Methods: An observational cadaveric study was conducted on 50 formalin-fixed human cadavers in Osmania Medical College, Hyderabad, Telangana, India, from May 2017 to July 2022. Dissection procedure was followed according to standard techniques. Variations and patterns of renal arteries were observed. Descriptive statistics were used and results were expressed in terms of frequency (N) and percentages (%). Results: Out of 50 cadavers, variations in the renal artery were seen in eight cadavers. Four cadavers showed double renal arteries (one right side and three left side). Three cadavers showed early division and one cadaver which has shown double Right Renal Artery (RRA) also showed Early Division of RRA (ED of RRA) and one cadaver showed an Accessory Renal Artery (ARA) on the left side. Conclusion: Variations observed were mainly double renal arteries, early division of the renal arteries, and ARA. This kind of different pattern of variations may play an important role in renal transplants and any surgeries involving the renal arteries.","PeriodicalId":56235,"journal":{"name":"International Journal of Anatomy Radiology and Surgery","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71264372","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.7860/ijars/2023/59640.2875
K. Sangameswaran
Introduction: Symptomatic cholelithiasis is usually treated by cholecystectomy. Cystic Artery (CA) should be ligated prior to removal of gallbladder during cholecystectomy. CA arises from Right Hepatic Artery (RHA) posterolateral to common hepatic duct inside Calot’s triangle but variations of CA are very common. If surgeons fail to identify these variations during cholecystectomy, this artery is more prone to iatrogenic injury leading the profuse bleeding. Aim: To study the variations of CA in terms of its origin, number, length, course and its relation with the biliary ductal system and Calot’s triangle. Materials and Methods: The present cross-sectional study was conducted in the department of Anatomy, Government Tiruvannamalai Medical College, Tamil Nadu, India from August 2019 to July 2022. Forty adult cadaveric liver specimens with intact vasculature of gallbladder were dissected and the variations of CA were noted. Length of CA was measured by using Vernier caliper, and it’s descriptive statistics like range, mean, Standard Deviation (SD) were evaluated by using Microsoft excel 2019 software. Results: The CA arose from RHA in 33 (82.5%), from replaced RHA in 2 (5%), from Left Hepatic Artery (LHA) in 2 (5%), from Proper Hepatic Artery (PHA) in 2 (5%), and from Common Hepatic Artery (CHA) in 1 (2.5%) specimens. Its mean length ±SD was 2.6±0.35 cm. CA was single in 39 specimens (97.5%) (38 single CA inside Calot’s triangle, one single CA was outside of Calot’s triangle). Double cystic arteries were seen in only one specimen (2.5%) and forming compound type of relation with Calot’s triangle (one CA was outside of Calot’s triangle and the other one was inside of that triangle) in it. CA was superomedial to Cystic Duct (CD) in 34 (85%) specimens. This artery was passing anterior and posterior to common hepatic duct in 6 (15%) and 2 (5%) specimens, respectively. Conclusion: The overall prevalence of variations in different parameters of CA in the present study was found to be high as 35%.
{"title":"Variations of Cystic Artery Supplying the Gallbladder and its Surgical Importance: A Cadaveric Study from Tamil Nadu, India","authors":"K. Sangameswaran","doi":"10.7860/ijars/2023/59640.2875","DOIUrl":"https://doi.org/10.7860/ijars/2023/59640.2875","url":null,"abstract":"Introduction: Symptomatic cholelithiasis is usually treated by cholecystectomy. Cystic Artery (CA) should be ligated prior to removal of gallbladder during cholecystectomy. CA arises from Right Hepatic Artery (RHA) posterolateral to common hepatic duct inside Calot’s triangle but variations of CA are very common. If surgeons fail to identify these variations during cholecystectomy, this artery is more prone to iatrogenic injury leading the profuse bleeding. Aim: To study the variations of CA in terms of its origin, number, length, course and its relation with the biliary ductal system and Calot’s triangle. Materials and Methods: The present cross-sectional study was conducted in the department of Anatomy, Government Tiruvannamalai Medical College, Tamil Nadu, India from August 2019 to July 2022. Forty adult cadaveric liver specimens with intact vasculature of gallbladder were dissected and the variations of CA were noted. Length of CA was measured by using Vernier caliper, and it’s descriptive statistics like range, mean, Standard Deviation (SD) were evaluated by using Microsoft excel 2019 software. Results: The CA arose from RHA in 33 (82.5%), from replaced RHA in 2 (5%), from Left Hepatic Artery (LHA) in 2 (5%), from Proper Hepatic Artery (PHA) in 2 (5%), and from Common Hepatic Artery (CHA) in 1 (2.5%) specimens. Its mean length ±SD was 2.6±0.35 cm. CA was single in 39 specimens (97.5%) (38 single CA inside Calot’s triangle, one single CA was outside of Calot’s triangle). Double cystic arteries were seen in only one specimen (2.5%) and forming compound type of relation with Calot’s triangle (one CA was outside of Calot’s triangle and the other one was inside of that triangle) in it. CA was superomedial to Cystic Duct (CD) in 34 (85%) specimens. This artery was passing anterior and posterior to common hepatic duct in 6 (15%) and 2 (5%) specimens, respectively. Conclusion: The overall prevalence of variations in different parameters of CA in the present study was found to be high as 35%.","PeriodicalId":56235,"journal":{"name":"International Journal of Anatomy Radiology and Surgery","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71264392","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.7860/ijars/2023/63521.2935
Guru Thangiah Arun, Faaz Salah Gomha, Sheik Akbar Hussein, Nasser Jassim Al Maslamani
Ureteric stenting using a Double-J Stent (DJS) is one of the commonly used urological management techniques to ensure adequate drainage from the renal pelvis to the bladder. However, DJS placements are known to be associated with various consequences and complications. Hereby, the authors present a case of a 46-year-old male who presented to the Emergency Department with left flank pain and haematuria that had persisted for one week. The patient had previously undergone ureteric stenting one year prior for the management of a left ureteric calculus. Unfortunately, he had not returned for follow-up due to the Coronavirus Disease 2019 (COVID-19) pandemic. X-ray of the Kidney, Ureter, and Bladder (KUB) and Computed Tomography (CT) of the KUB revealed a missed left ureteral stent that was completely encrusted and associated with the highest stone burden. This stent was causing obstruction of the left renal pelvis-calyceal system and thinning of the left renal parenchyma. The patient also had a co-existing staghorn calculus and urinary tract infection. After completing a course of antibiotics, the encrusted ureteral stent was surgically removed using cystolitholapaxy with pneumatic lithotripsy, ureteral lithoclast, and percutaneous nephrolithotomy. A new DJS was placed to maintain drainage through the ureter. The patient had no complications during the follow-up period. Authors reported a case of a missed DJS with the highest stone burden within a year to highlight the importance of patient and family education. Authors recommended implementing electronic follow-up systems for patients who undergo ureteric stenting to prevent lost to follow-up, minimise long-term complications, and ensure patient safety.
{"title":"Missed Double-J Ureteric Stent Presenting as a Large Stone Burden: A Case Report","authors":"Guru Thangiah Arun, Faaz Salah Gomha, Sheik Akbar Hussein, Nasser Jassim Al Maslamani","doi":"10.7860/ijars/2023/63521.2935","DOIUrl":"https://doi.org/10.7860/ijars/2023/63521.2935","url":null,"abstract":"Ureteric stenting using a Double-J Stent (DJS) is one of the commonly used urological management techniques to ensure adequate drainage from the renal pelvis to the bladder. However, DJS placements are known to be associated with various consequences and complications. Hereby, the authors present a case of a 46-year-old male who presented to the Emergency Department with left flank pain and haematuria that had persisted for one week. The patient had previously undergone ureteric stenting one year prior for the management of a left ureteric calculus. Unfortunately, he had not returned for follow-up due to the Coronavirus Disease 2019 (COVID-19) pandemic. X-ray of the Kidney, Ureter, and Bladder (KUB) and Computed Tomography (CT) of the KUB revealed a missed left ureteral stent that was completely encrusted and associated with the highest stone burden. This stent was causing obstruction of the left renal pelvis-calyceal system and thinning of the left renal parenchyma. The patient also had a co-existing staghorn calculus and urinary tract infection. After completing a course of antibiotics, the encrusted ureteral stent was surgically removed using cystolitholapaxy with pneumatic lithotripsy, ureteral lithoclast, and percutaneous nephrolithotomy. A new DJS was placed to maintain drainage through the ureter. The patient had no complications during the follow-up period. Authors reported a case of a missed DJS with the highest stone burden within a year to highlight the importance of patient and family education. Authors recommended implementing electronic follow-up systems for patients who undergo ureteric stenting to prevent lost to follow-up, minimise long-term complications, and ensure patient safety.","PeriodicalId":56235,"journal":{"name":"International Journal of Anatomy Radiology and Surgery","volume":"31 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135445021","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.7860/ijars/2023/61995.2918
A Venkata Ranga Swamy, Jandhyam Manikantan, D Raja Reddy, Mutyasri Pedapathnapu, K Sitha Ramaiah, A Bhagavan
Introduction: Tadalafil and tamsulosin have both been approved for use in the management of Lower Urinary Tract Symptoms (LUTS). Limited studies have shown the efficacy of tadalafil in terms of maximum urinary output flow (Qmax) and post-void residual (PVR). Aim: To compare the efficacy of tadalafil 5 mg and tamsulosin 0.4 mg in patients with Benign Prostatic Hyperplasia (BPH). Materials and Methods: A prospective, open-label, Randomised clinical study was conducted in the Department of Urology at Kurnool Medical College, Kurnool, Andhra Pradesh, India. The study duration was one year and five months, from February 2015 to July 2016. A total of 83 patients clinically diagnosed with BPH were included, but 23 patients were excluded from the analysis due to lost follow-up. The remaining 60 patients were randomly assigned to two groups: one receiving tadalafil 5 mg (n=30) and the other receiving tamsulosin 0.4 mg (n=30) for 12 weeks. Demographic characteristics, total International Prostate Symptom Score (IPSS), individual IPSS, Quality of Life (QoL) score, Qmax, PVR, and differences in symptoms were analysed. Data were analysed using the Wilcoxon signed-rank test and Mann-Whitney U test. A p-value<0.05 was considered statistically significant. Results: The mean age for group I (tadalafil 5 mg) and Group II (tamsulosin 0.4 mg) was 62.7 and 61.0 years, respectively (p=0.147). Patients who received tadalafil showed significantly higher efficacy in all measures from baseline to 12 weeks, including increased Qmax (12.0 mL/sec vs 15.1 mL/sec), reduced QoL scores (4.2 vs 3.7), and PVR (26.5 mL vs 15.8 mL), compared to tamsulosin where the increase in Qmax was 11.6 mL/sec vs 13.6 mL/sec, reduction in QoL scores was 4.1 vs 2.4, and PVR was 24.0 mL vs 16.2 mL, between baseline and 12 weeks. Conclusion: Tadalafil 5 mg is a recent drug option available for the treatment of LUTS-BPH. The efficacy and safety of tadalafil 5 mg and tamsulosin 0.4 mg are comparable.
他达拉非和坦索罗辛都已被批准用于治疗下尿路症状(LUTS)。有限的研究表明他达拉非在最大尿输出流量(Qmax)和尿后残留(PVR)方面的有效性。目的:比较他达拉非5mg与坦索罗辛0.4 mg治疗良性前列腺增生(BPH)的疗效。材料和方法:在印度安得拉邦Kurnool医学院泌尿科进行了一项前瞻性、开放标签、随机临床研究。研究时间为一年零五个月，从2015年2月至2016年7月。共纳入83例临床诊断为BPH的患者，但有23例患者因失去随访而被排除在分析之外。其余60例患者随机分为两组:一组接受他达拉非5 mg (n=30)，另一组接受坦索罗辛0.4 mg (n=30)，疗程12周。分析人口学特征、国际前列腺症状评分(IPSS)、个体IPSS、生活质量(QoL)评分、Qmax、PVR和症状差异。数据分析采用Wilcoxon符号秩检验和Mann-Whitney U检验。p值0.05被认为具有统计学意义。结果:I组(他达拉非5 mg)和II组(坦索罗辛0.4 mg)患者的平均年龄分别为62.7岁和61.0岁(p=0.147)。从基线到12周，接受他达拉非的患者在所有测量中都显示出显着更高的疗效，包括Qmax增加(12.0 mL/sec vs 15.1 mL/sec)， QoL评分降低(4.2 vs 3.7)和PVR (26.5 mL vs 15.8 mL)，与坦索罗辛相比，Qmax增加11.6 mL/sec vs 13.6 mL/sec, QoL评分降低4.1 vs 2.4, PVR为24.0 mL vs 16.2 mL，基线和12周。结论:他达拉非5mg是治疗LUTS-BPH的最新药物选择。他达拉非5mg与坦索罗辛0.4 mg的疗效和安全性相当。
{"title":"Tadalafil vs Tamsulosin for the Management of Lower Urinary Tract Symptoms in Men with Benign Prostatic Hyperplasia: A Randomised Clinical Trial","authors":"A Venkata Ranga Swamy, Jandhyam Manikantan, D Raja Reddy, Mutyasri Pedapathnapu, K Sitha Ramaiah, A Bhagavan","doi":"10.7860/ijars/2023/61995.2918","DOIUrl":"https://doi.org/10.7860/ijars/2023/61995.2918","url":null,"abstract":"Introduction: Tadalafil and tamsulosin have both been approved for use in the management of Lower Urinary Tract Symptoms (LUTS). Limited studies have shown the efficacy of tadalafil in terms of maximum urinary output flow (Qmax) and post-void residual (PVR). Aim: To compare the efficacy of tadalafil 5 mg and tamsulosin 0.4 mg in patients with Benign Prostatic Hyperplasia (BPH). Materials and Methods: A prospective, open-label, Randomised clinical study was conducted in the Department of Urology at Kurnool Medical College, Kurnool, Andhra Pradesh, India. The study duration was one year and five months, from February 2015 to July 2016. A total of 83 patients clinically diagnosed with BPH were included, but 23 patients were excluded from the analysis due to lost follow-up. The remaining 60 patients were randomly assigned to two groups: one receiving tadalafil 5 mg (n=30) and the other receiving tamsulosin 0.4 mg (n=30) for 12 weeks. Demographic characteristics, total International Prostate Symptom Score (IPSS), individual IPSS, Quality of Life (QoL) score, Qmax, PVR, and differences in symptoms were analysed. Data were analysed using the Wilcoxon signed-rank test and Mann-Whitney U test. A p-value<0.05 was considered statistically significant. Results: The mean age for group I (tadalafil 5 mg) and Group II (tamsulosin 0.4 mg) was 62.7 and 61.0 years, respectively (p=0.147). Patients who received tadalafil showed significantly higher efficacy in all measures from baseline to 12 weeks, including increased Qmax (12.0 mL/sec vs 15.1 mL/sec), reduced QoL scores (4.2 vs 3.7), and PVR (26.5 mL vs 15.8 mL), compared to tamsulosin where the increase in Qmax was 11.6 mL/sec vs 13.6 mL/sec, reduction in QoL scores was 4.1 vs 2.4, and PVR was 24.0 mL vs 16.2 mL, between baseline and 12 weeks. Conclusion: Tadalafil 5 mg is a recent drug option available for the treatment of LUTS-BPH. The efficacy and safety of tadalafil 5 mg and tamsulosin 0.4 mg are comparable.","PeriodicalId":56235,"journal":{"name":"International Journal of Anatomy Radiology and Surgery","volume":"21 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135446397","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction: The arch of the aorta normally gives off three major branches from its convex surface. Variations in the branching pattern of the Aortic Arch (AA) are not uncommon. Knowledge of these variations is crucial during aortic instrumentation and thoracic or neck surgeries. Aim: This study aimed to investigate the anatomical variations in the branching pattern of the AA in perinatal and adult cadavers. Materials and Methods: A cross-sectional cadaveric study was conducted in the Department of Anatomy, at Assam Medical College and Hospital, Dibrugarh, from August 2018 to July 2021. The study included cadavers of various ages and both genders (N=46). Perinatal cadavers received from the Obstetrics and Gynecology department were also included. The thoracic cavity was opened by cutting through the costochondral junctions and reflecting the sternum. Fibrofatty tissue was removed to expose the branches of the AA, which were then examined and classified. Variations were observed, and the results were expressed in terms of frequency and percentages. Results: A classical branching pattern (Type-A) was observed in 89.1% of cadavers. Five cadavers (10.9%), comprising four males and one female, exhibited branching patterns different from the classical pattern. Among them, Type-C variation was noted in 4 (8.7%) cadavers, and Type-D variation was found in 1 (2.2%) male cadaver. Conclusion: Having a good understanding of the variations in the branching pattern of the arch of the aorta can be beneficial for surgeons performing complex vascular surgery.
{"title":"Anatomical Variations of Branching Pattern of the Arch of Aorta: A Cadaveric Cross-sectional Study","authors":"Gautam Shyam, Anjanjyoti Rajkonwar, Deepsikha Thengal, Giriraj Kusre","doi":"10.7860/ijars/2023/65112.2923","DOIUrl":"https://doi.org/10.7860/ijars/2023/65112.2923","url":null,"abstract":"Introduction: The arch of the aorta normally gives off three major branches from its convex surface. Variations in the branching pattern of the Aortic Arch (AA) are not uncommon. Knowledge of these variations is crucial during aortic instrumentation and thoracic or neck surgeries. Aim: This study aimed to investigate the anatomical variations in the branching pattern of the AA in perinatal and adult cadavers. Materials and Methods: A cross-sectional cadaveric study was conducted in the Department of Anatomy, at Assam Medical College and Hospital, Dibrugarh, from August 2018 to July 2021. The study included cadavers of various ages and both genders (N=46). Perinatal cadavers received from the Obstetrics and Gynecology department were also included. The thoracic cavity was opened by cutting through the costochondral junctions and reflecting the sternum. Fibrofatty tissue was removed to expose the branches of the AA, which were then examined and classified. Variations were observed, and the results were expressed in terms of frequency and percentages. Results: A classical branching pattern (Type-A) was observed in 89.1% of cadavers. Five cadavers (10.9%), comprising four males and one female, exhibited branching patterns different from the classical pattern. Among them, Type-C variation was noted in 4 (8.7%) cadavers, and Type-D variation was found in 1 (2.2%) male cadaver. Conclusion: Having a good understanding of the variations in the branching pattern of the arch of the aorta can be beneficial for surgeons performing complex vascular surgery.","PeriodicalId":56235,"journal":{"name":"International Journal of Anatomy Radiology and Surgery","volume":"30 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134887758","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.7860/ijars/2023/60566.2925
B Anisha, S Syamly, SV Uma
Introduction: The radial nerve is commonly injured during posterior approach humerus surgeries, making it crucial for surgeons to identify and preserve the nerve. The tricipital aponeurosis (TA) serves as a reliable landmark for identifying the radial nerve during these procedures. Aim: This study aimed to investigate the different shapes and patterns of the TA and their relationship with the radial nerve, as well as their clinical significance. Materials and Methods: A cross-sectional observational cadaveric study was conducted in the Department of Anatomy, Dr. Chandramma Dayanand Sagar Institute of Medical Education and Research (CDSIMER), a unit of Dayanand Sagar University (DSU), Bengaluru, Karnataka, India, from January 2022 to April 2022. A total of 40 arms from 20 adult cadavers obtained from CDSIMER were examined. The TA was assessed to record variations in its shape and classified accordingly. The distance of the radial nerve from the point of confluence was measured for different types. Vernier calipers were used for all measurements. The collected data was analysed using the Statistical Package for the Social Sciences (SPSS) version 16.0, and paired two-tailed Student's t-test was performed. Results: The classical type A was observed in 32 (80%) of the specimens. The mean distance of the radial nerve from the point of confluence of the TA was 30.58±4.29 mm on the right side and 31.27±4.48 mm on the left side, with a p-value of 0.621. Conclusion: Knowledge of the different shapes of the TA and its distance from the radial nerve can assist surgeons in creating a safe zone during various procedures, thereby preventing radial nerve injuries.
在肱骨后入路手术中，桡神经常受到损伤，因此识别和保存桡神经对外科医生来说至关重要。在这些手术中，肱三头腱膜(TA)是识别桡神经的可靠标志。目的:探讨TA的不同形状、形态及其与桡神经的关系及临床意义。材料和方法:横断面观察性尸体研究于2022年1月至2022年4月在印度卡纳塔克邦邦班加罗尔Dayanand Sagar大学(DSU)的Chandramma Dayanand Sagar博士医学教育与研究所(CDSIMER)解剖学系进行。从CDSIMER获得的20具成人尸体共40只手臂进行了检查。评估TA以记录其形状的变化并相应分类。测量不同类型的桡神经离汇合点的距离。所有测量均使用游标卡尺。收集的数据使用SPSS 16.0版本进行分析，并进行配对双尾Student's t检验。结果:经典A型32例(80%)。桡神经距TA汇合点的平均距离右侧30.58±4.29 mm，左侧31.27±4.48 mm, p值为0.621。结论:了解TA的不同形状及其与桡神经的距离可以帮助外科医生在各种手术过程中创建安全区，从而防止桡神经损伤。
{"title":"Morphological Variations of the Tricipital Aponeurosis and Its Clinical Significance: A Cross-sectional Cadaveric Study","authors":"B Anisha, S Syamly, SV Uma","doi":"10.7860/ijars/2023/60566.2925","DOIUrl":"https://doi.org/10.7860/ijars/2023/60566.2925","url":null,"abstract":"Introduction: The radial nerve is commonly injured during posterior approach humerus surgeries, making it crucial for surgeons to identify and preserve the nerve. The tricipital aponeurosis (TA) serves as a reliable landmark for identifying the radial nerve during these procedures. Aim: This study aimed to investigate the different shapes and patterns of the TA and their relationship with the radial nerve, as well as their clinical significance. Materials and Methods: A cross-sectional observational cadaveric study was conducted in the Department of Anatomy, Dr. Chandramma Dayanand Sagar Institute of Medical Education and Research (CDSIMER), a unit of Dayanand Sagar University (DSU), Bengaluru, Karnataka, India, from January 2022 to April 2022. A total of 40 arms from 20 adult cadavers obtained from CDSIMER were examined. The TA was assessed to record variations in its shape and classified accordingly. The distance of the radial nerve from the point of confluence was measured for different types. Vernier calipers were used for all measurements. The collected data was analysed using the Statistical Package for the Social Sciences (SPSS) version 16.0, and paired two-tailed Student's t-test was performed. Results: The classical type A was observed in 32 (80%) of the specimens. The mean distance of the radial nerve from the point of confluence of the TA was 30.58±4.29 mm on the right side and 31.27±4.48 mm on the left side, with a p-value of 0.621. Conclusion: Knowledge of the different shapes of the TA and its distance from the radial nerve can assist surgeons in creating a safe zone during various procedures, thereby preventing radial nerve injuries.","PeriodicalId":56235,"journal":{"name":"International Journal of Anatomy Radiology and Surgery","volume":"44 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134888297","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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