Dig Vijay Singh

A Comparative Randomized Prospective Study to Evaluate Efficacy and Safety of Combination of Tamsulosin and Tadalafil vs. Tamsulosin or Tadalafil Alone in Patients with Lower Urinary Tract Symptoms due to Benign Prostatic Hyperplasia

INTRODUCTION Lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH) and erectile dysfunction are common disorders of advancing age. AIM To evaluate the efficacy and safety of tamsulosin and tadalafil in patients with LUTS due to BPH. METHODS In this prospective randomized study, 133 men complaining of LUTS due to BPH were included. Forty-five patients received tamsulosin 0.4 mg/day alone (Group A), 44 patients received tadalafil 10 mg/day (Group B), and combination therapy (tamsulosin and tadalafil both) was instituted in 44 patients (Group C). After a 2-week medication free run-in period, they were evaluated for International Prostatic Symptom Score (IPSS), International Index of Erectile Function score (IIEF5), quality of life (IPSS QoL), maximum urinary flow rate (Qmax), post-void residual urine (PVR) volume, and safety parameters before and at 3 months of treatment. MAIN OUTCOME MEASURES There were primary (IPSS, IPSS QoL index, Qmax, and PVR) and secondary (erectile function [EF] domain scores from IIEF5) efficacy end points. Safety assessment included laboratory tests and patients reporting of adverse event. RESULTS A significant improvement in IPSS score was observed in all the 3 groups A, B, and C (-50.90%, P < 0.05; -33.50%, P < 0.05; and -53.90%, P < 0.05, respectively). IIEF5 score increased significantly in these three groups (+39.28%, P < 0.05; +45.96%, P < 0.05; and +60.23%, P < 0.05, respectively). A significant increase in Qmax and decrease in PVR were also observed (33.99%, P < 0.05; 29.78%, P < 0.05; and 37.04%, P < 0.05) and (-60.90%, P < 0.05; -49.45%, P < 0.05; and -62.97%, P < 0.05, respectively). The QoL scores improved significantly (-73.35%, P < 0.05; -70.26%, P < 0.05; and -79.65%, P < 0.05, respectively). Side effects were dyspepsia, heartburn, headache, flushing, myalgia, and backache. Adverse effect dropout was 3.7%. No participant experienced any severe or serious adverse events. CONCLUSIONS In patients with LUTS due to BPH, tamsulosin and tadalafil alone or in combination cause a significant improvement in patients with LUTS. Their EF also improves with these medications. The improvement is better with combination therapy compared with single agent alone.

Choroid Metastasis from Testicular Carcinoma: A Rare Entity

The aim of this report is to contribute to the clinical understanding of choroid metastasis from testicular carcinoma. A young male patient presented with loss of vision in his left eye with ptosis and proptosis. Fundoscopy revealed bullous retinal detachment with dark hazy vitreous. The preliminary diagnosis of choroid carcinoma with vitreous involvement was made by an ophthalmologist. Later in the physical examination, there was a firm painless left testicular swelling. Testicular tumor markers were raised. Based on ultrasonography, MRI and PET-CT, a clinical diagnosis of left testicular carcinoma metastasizing to the left choroid and vitreous was made. A mixed germ cell tumor was reported on histopathological examination. After cisplatin-based chemotherapy, serum tumor markers normalized and vision improved. Exceptional choroidal and vitreous metastases with absence of other visceral and bony involvement constituted the presenting sign. Although rare, testicular carcinoma must be considered to metastasize to the eye, especially if loss of vision is the chief complaint.

Giant Renal Angiomyolipoma: Unusual Cause of Huge Abdominal Mass

We present the imaging and histopathological characteristics of a giant renal angiomyolipoma (AML) in a 49-year-old female patient, who presented with bloating sensation in the abdomen and a steadily increasing abdominal girth for about 3 years. Contrast enhanced computed tomography (CECT) scan films of abdomen revealed that a large fat containing tumor had replaced the left kidney while displacing the rest of the abdominal contents toward the other side of the midline. Intraoperatively the left kidney was completely replaced by a fat containing tumor. The recovered surgical specimen measured 39 cm × 25 cm × 9 cm and weighed 7500 g. Histopathological investigation with immuno-histochemical staining of the specimen with hydroxy beta-methylbutyric acid-45 confirmed this lesion as AML. CECT scan of the head did not show any lesion suggestive of tuberous sclerosis. The giant tumor of the present case is the heaviest AML in both syndromic and sporadic categories and largest by dimensions as sporadic AML ever reported in the literature.

Evaluation of bacteriological profile and antibiotic sensitivity patterns in children with urinary tract infection: A prospective study from a tertiary care center.

Introduction: Development of regional surveillance programs is necessary for the development of community-acquired urinary tract infection (UTI) guidelines, especially for sub-urban and rural areas where empirical treatment is the mainstay in the absence of proper diagnostic modalities. Our aim was to evaluate the bacteriological profile and antibiotic sensitivity patterns in children with UTI prospectively from a tertiary care center. Methods: A total of 800 children up to 18 years of age with suspected UTI attending our center were included. For all suspected cases urine microscopy, gram staining, and culture were done. Antibiotic sensitivity was performed on selected antimicrobials using disk diffusion method following Clinical Laboratory Standards Institute guidelines. Results: Majority of pathogens were isolated from female (54.2%) patients. Pre-teens (52.1%) and teens (27.1%) were most commonly affected age group. The most common presentation in culture-proven UTI was fever with urinary symptoms (33.3%). In a group of 192 patients 26.7% had proven UTI. Escherichia coli (42.3%) was the most common aetiological agent, followed by Enterococcus fecalis (13.5%), Klebsiella spp. (11.5%) and Staphylococcus aureus (11.5%). Most active antibiotics against Gram-negative isolates were nitrofurantoin, cefotaxime, and amikacin. Gram-positive isolates were sensitive to nitrofurantoin, cotrimoxazole, and novobiocin. Conclusion: E. coli was the commonest isolate. The organisms grown in significant numbers were E. fecalis, Klebsiella spp. and S. aureus, causing UTI in 0–18 years of age group. Gram-negative isolates were sensitive to nitrofurantoin, amikacin, and cefotaxime. Gram-positive isolates were sensitive to nitrofurantoin, cotrimoxazole, and novobiocin. Prospective, regional studies are ensured periodically to explain bacteriological profile and antibiotic sensitivity patterns to be applicable for children with UTI over that geographic area.

Fulminant Buddchiari syndrome caused by renal primitive neuroectodermal tumor with inferior vena cava thrombus extending to atrium

Primitive neuroectodermal tumors (PNET) of the kidney are rare, the diagnosis usually being made at histopathology. A young female presented with a massive right renal mass with features of hepatic dysfunction. Computed tomography scan of the abdomen revealed a large tumor of right kidney with tumor thrombus extending from inferior vena cava (IVC) to right atrium with features suggesting Buddchiari syndrome (BCS). Needle biopsy of mass showed a round cell neoplasm and positive staining for neuron specific enolase and minimum inhibitory concentration-2 on immunohistochemistry. She was managed with neo-adjuvant chemotherapy, surgery and adjuvant chemotherapy. To the best of our knowledge this is the first case of renal PNET with inferior IVC tumor thrombus extending to right atrium with BCS. We suggest that renal PNET should be kept in mind as a differential diagnosis in young adults presenting with a large kidney mass extending to IVC that shows evidence of necrosis on imaging, which may be associated with BCS as in index case.

Incomplete transverse vesical septum: An unusual congenital anomaly.

A rare case of incomplete transverse vesical septum with urinary tract tuberculosis is being reported. A 52-year-old male presented with lower urinary tract and systemic symptoms. On investigation he had anemia, leucocytosis, and high serum creatinine. On cystopanendoscopy, there was a transverse ledge of tissue connecting the two lateral walls of the bladder approximately 4 cm proximal to the bladder neck dividing the caudal vesical cavity into anterior and posterior parts. Also, the left ureteric orifice had double barrel look. To our knowledge this is the first ever reported case of incomplete transverse vesical septum.

Changes in Antioxidants and Minerals in Noni (Morinda citrifolia L.) Fruits during Development Process

Noni (Morinda citrifolia L.) fruits of different maturity stages are used in traditional medicine and modern beverage or herbal industry for its rich profile of more than 200 bioactive compounds. The present study was aimed to evaluate the changes in metabolites during Noni fruit development stages by spectrophotometeric methods and identification of individual compounds in phenolics and carotenoids groups. During fruit development polyphenol content was increased by 41.4%, tannin by 81.1%, flavonoids by 166.1%, carotenoids by 404.1%, anthocyanin by 40.8%. Micronutrients showed variable concentration during fruit development and highest Zn was observed at 10 days after fruit initiation (DAFI; 70.3 ppm), Cu at 50 DAFI (34.7 ppm), Mn at 130 DAFI (34.9 ppm), Na at Original Research Article Singh et al.; BJPR, 10(5): 1-11, 2016; Article no.BJPR.23836 2 20 DAFI (0.37%), K at 90 DAFI (1.5%). Free amino acids, total sugar, reducing sugar and nonreducing sugar increased upto 120 DAFI while nitrate, oxalate and phytate contents were decreased significantly (p<0.05). HPLC analysis identified lutein, zeaxanthin, betacarotene and betacryptoxanthin while epicatechin gallate, syringic acid, epigallocatechin gallate, vanillic Acid, naringin and cinnamic acid in Noni fruits. The information is useful for determining the fruit harvest stage of Noni fruit and showed the changes in predominant metabolites which can be used for investigating the synthesis pathways for bioactives in Noni.

Sustained systemic response paralleled with ovarian metastasis progression by sunitinib in metastatic renal cell carcinoma: Is this an anti-angiogenic potentiation of cancer?

Metastatic renal cell cancer is associated with poor prognosis and survival and is resistant to conventional chemotherapy. Therapeutic targeting of molecular pathways for tumor angiogenesis and other specific activation mechanisms offers improved tumor response and prolonged survival. A 48-year-old, female patient presented with large right renal mass with features suggesting of renal cell cancer without metastasis on contrast enhanced computed tomography (CT). Right radical nephrectomy was done. After 9 months of surgery, she got metastasis in lung, liver and ovary. The patient received sunitinib via an expanded access program. After eight 6-week cycles of sunitinib, a reassessment CT scan confirmed an excellent partial response with the almost complete disappearance (90%) of liver and lung metastasis but the adnexal mass had increased in size (>10 times) and the possibility was thought of second malignancy. Excision of the mass performed. Histopathology of the mass depicted metastatic renal cell cancer. There is possibility of a ′site-specific anti-angiogenic potentiation mechanism′ of malignancy in relation to sunitinib based upon the preclinical studies, in reference to the index case. Regression of one site with concurrent progression is possible. The exact mechanism of site-specific response, especially organ specific progression by vascular endothelial growth factor inhibitors in metastatic renal cell cancer warrants further study.

Is there need of an extension channel/new double-cuffed channel in surgical management for channel perforation and aneurysm of Tenckhoff catheter?: modified partial replantation.

Peritoneal Dialysis (PD) was introduced by Popovich et al. in 1976 (1). There has been a dramatic rise in continuous ambulatory PD (CAPD) over the last 2 decades. Whereas there has been an increase in PD prevalence, the proportion of all dialysis patients using PD has declined. This modality of dialysis has been one of the most important therapeutic methods for patients with end-stage renal disease (eSRD). Tenckhoff catheter placement is well established to facilitate PD in the treatment of eSRD. Complications with these catheters, while in situ, are well documented (2). The removal and replacement of Tenckhoff catheters in response to these complications adds morbidity in an already immunocompromised eSRD patient. The most common cause of catheter loss has been reported to be catheter-related infection (3). A salvage technique, ‘partial replantation of Tenckhoff catheters’, is well established as a means of rescuing the still-functioning conduit with refractory exit-site or tunnel infection, which requires the placement of a new double-cuffed catheter/extension channel in view of the infective nature of the damaged catheter (4). Ironically, very little is known about the incidence, etiology, presentation, and surgical management of Tenckhoff catheter damage due to a crack/leak resulting from mechanical trauma. We hereby present our single-center experience of the causative factor, mode of presentation and modification of partial replantation as a salvage procedure for catheter damage due to physical/ chemical insult in 14 patients over 17 years.

Unusual cause of urethral bleeding in an adolescent: a case in dilemma.

Abstract Numerous cases of self-inflicted foreign bodies in the male urethra have been reported. A case of a self-inflicted urethral injury or hemangioma in an adolescent that presented a dilemma is described here. An adolescent male of 14 years presented with a complaint of intermittent urethral bleeding for a week. He attributed this to blunt trauma sustained while playing in school. On examination, there was no sign suggestive of any trauma or any abnormal lesion on the genitalia or surrounding area. On cystourethroscopy, there was a solitary hemorrhagic lesion of 0.5 cm with a bluish base on the ventral surface of the pendular urethra, 1 cm proximal to the fossa navicularis, which was ablated using Ho:YAG laser fiber (365 μm) through a working channel mounted in an OIU (optical internal urethrotomy) sheath. The absence of any sign of external trauma or presentation after 1 week of the incident suggests an element of falseness in the history. It may be due to embarrassment or fear, which contributes to self-insertion of foreign bodies into the urethra as the primary cause, especially in adolescent males. However, the trauma can be coincidental, with the bleeding of the urethra caused by a urethral lesion like a hemangioma and might present after a long gap of 1 week due to a lack of understanding or lack of severe symptoms. Most patients of self-inflicted injuries are too ashamed to admit that they inserted any object. A psychiatric evaluation is recommended for all these adolescents, with appropriate medical therapy when indicated.