Rajdeep Singh

Autosomal dominant polycystic kidney disease with diffuse proliferative glomerulonephritis - an unusual association: a case report and review of the literature

IntroductionAutosomal dominant polycystic kidney disease is an inherited disorder that is characterized by the development and growth of cysts in the kidneys and other organs. Urinary protein excretion is usually less than 1 g/24 hours in autosomal dominant polycystic kidney disease, and an association of nephrotic syndrome with this condition is considered rare. There are only anecdotal case reports of autosomal dominant polycystic kidney disease associated with nephrotic syndrome, with focal segmental glomerulosclerosis being the most commonly reported histopathological diagnosis. Nephrotic-range proteinuria in the presence of autosomal dominant polycystic kidney disease, with or without an accompanying decline in renal function, should be investigated by open renal biopsy to exclude coexisting glomerular disease. To the best of our knowledge, this is the first case of autosomal dominant polycystic kidney disease with histologically proven diffuse proliferative glomerulonephritis presenting with nephrotic-range proteinuria. No other reports of this could be found in a global electronic search of the literature.Case presentationWe report the case of a 35-year-old Indo-Aryan man with autosomal dominant polycystic kidney disease associated with nephrotic syndrome and a concomitant decline in his glomerular filtration rate. Open renal biopsy revealed diffuse proliferative glomerulonephritis. An accurate diagnosis enabled us to manage him conservatively with a successful outcome, without the use of corticosteroid which is the standard treatment and the drug most commonly used to treat nephrotic syndrome empirically.ConclusionDespite the reluctance of physicians to carry out a renal biopsy on patients with autosomal dominant polycystic kidney disease, our case supports the idea that renal biopsy is needed in patients with polycystic kidney disease with nephrotic-range proteinuria to make an accurate diagnosis. It also illustrates the importance of open renal biopsy in planning appropriate treatment for patients with autosomal dominant polycystic kidney disease with nephrotic-range proteinuria. The treatment for various histological subtypes leading to nephrotic syndrome is different, and in this modern era we should practice evidence-based medicine and should avoid empirical therapy with its associated adverse effects.

Elastic and Velcro dressing for penis

A simple, quick, painless, and versatile dressing that fulfills most of the criteria of an ideal hypospadias dressing is described.

Traumatic diaphragmatic hernia

BackgroundAbdominal trauma is frequently encountered, but traumatic injuries to the diaphragm are often missed.Material and methodsA retrospective review of all the case files of patients presenting with traumatic diaphragmatic injury was performed. These patients were analyzed for their presentation, injury, surgery performed and outcomeResultsA total of 14 patients were thus identified (12 males and 2 females). The average age was 31.5 years. Road traffic accidents were the most common cause, accounting for the majority of cases (12 patients). 10 patients presented within 24 hours of injury; the other 4 presented late (2 1/2 months to 20 years) with the signs and symptoms of acute intestinal obstruction. The left side of the diaphragm was injured more commonly. Herniation of multiple intra abdominal viscera was common, with the stomach being the organ most commonly implicated. There were 2 deaths.ConclusionsTraumatic injury to the diaphragm must be kept in mind while dealing with patients who have sustained abdominal trauma. The diagnosis can easily be picked up on chest x-ray. Treatment is surgical, with simple suturing of the diaphragm with non-absorbable suture giving good result

Management of inguinal hernia with benign prostatic hyperplasia: Simultaneous inguinal hernioplasty with transurethral resection of prostate

Background: Elderly patients frequently suffer from inguinal hernia and benign prostatichyperplasia. When these two occur together, itbecomes important to decide which surgeryshould be done first.Methods: Data was maintainedprospectively for 35 patients undergoingsimultaneous transurethral resection ofprostate (TURP) and inguinal mesh hernioplastyat our hospital between May 2000 and December2002. The results were analyzed to determinewhether the performance of the two operationssimultaneously was a viable option in such apatient category.Results: In 33 patients unilateralhernioplasty, and in 2, Stoppas mesh repair(for bilateral hernia) was performed along withsimultaneous TURP by two independent operatingteams. There was no significant increase inoperating time or post-operative stay when thetwo procedures were performed together. Therewere no major in-hospital complications. Onfollow up, all the patients have remained well,with no recurrence of hernia.Conclusions: Combining mesh hernioplastyand TURP is a better option because of lowwound infection and hernia recurrence rates.Combining these two also saves the patient ofhaving to undergo another hospital admissionand surgery, besides the significant costsavings.

Intraperitoneal rupture of cysticercosal cyst mimicking appendicular perforation

Anaphylaxis following intraperitoneal rupture of a cysticercosal cyst mimicking pelvic peritonitis secondary to appendicular perforation is reported. Human cysticercosis occurs following ingestion of Taenia solium eggs, usually from faecally contaminated food. A case of pelvic cysicercosis presenting with signs and symptoms of anaphylaxis and peritonitis is reported, with plausible explanations for this unusual presentation.

Taenia-induced ileal perforation.

An unusual case of taenia-induced ileal perforation is reported and the management is discussed.

A new technique for correction of disproportionate preputial growth with phimosis

A new surgical solution to correct the rare anomaly of asymmetric phimosis is described, with a note on its symptomatology and etiopathogenesis.

Drainage of deep-seated amoebic liver abscess by Supra cath.

Supra cath® is an effective alternative to trocar for drainage of deep-seated liver abscess especially in obese or muscular patients with a thick parietal wall.

Purse-string closure of a mucous fistula in loop colostomy.

The technique of purse-string closure of a mucous fistula to prevent faecal contamination during loop colostomy is described in six patients who underwent the procedure. Complete faecal diversion was achieved in all six patients without complications.