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Biomedical subjects

L N Dorairajan

Publications and source records attributed to L N Dorairajan.

At least 19 recordsLinked to original sources
PubMed2006

Hyperinsulinemia and dyslipidemia in non-diabetic benign prostatic hyperplasia.

BACKGROUND: BPH is a multifactorial disease. Several studies have elucidated the role of hormones and growth factors in its etiology. Insulin is a growth-stimulating hormone. Previous studies have reported the association between hyperinsulinemia, dyslipidemia and BPH in patients with metabolic disorders like diabetes. We evaluated insulin and lipid profile parameters in non-diabetic BPH cases and correlated it with prostate size. METHODS: 50 symptomatic BPH cases and 38 controls were included in this study. Fasting serum insulin concentrations were measured by radioimmunoassay. Insulin resistance was assessed by HOMA. Fasting glucose, total cholesterol and triglycerides were quantified by enzymatic methods. HDL-cholesterol was quantified by phosphotungstate magnesium chloride method. LDL-cholesterol was calculated by Friedwald's formula. RESULTS: Fasting serum insulin, HOMA, total cholesterol, and LDL-cholesterol were significantly higher and HDL-cholesterol was significantly lower in cases as compared to controls. Insulin was significantly associated with prostate size, cholesterol, triglycerides, VLDL-cholesterol and LDL-cholesterol in BPH cases. Stepwise regression analysis showed insulin as an independent risk factor in the development of BPH. CONCLUSIONS: Hyperinsulinemia associated with insulin resistance is an independent risk factor in the development of BPH.

Aged↗
PubMed2004

Tubercular mass mimicking a tumour in a horseshoe kidney: a unique presentation.

Tuberculosis of the kidney is quite a common disease and various forms of presentation are described. In most cases the disease results in atrophy, calcification or necrosis of parenchyma. The kidney is not generally palpable except occasionally in case of hydronephrosis; caused by upper ureteral structure. Renal tuberculosis presenting as large solid mass has not yet been reported. We present a case of solid renal mass of tubercular etiology. Diagnosis and management are presented.

Adult↗
PubMed2003

Primary squamous carcinomatous ureteric stricture of a solitary kidney with spontaneous intraperitoneal urinary extravasation.

We report a very rare case of a carcinoma of the ureter occurring in association with contralateral renal agenesis. Owing to this association, the patient had a unique presentation with urinary ascites and anuria. He was initially managed by retrograde ureteral stenting and supportive measures for renal failure. Thereafter, once the renal parameters became normal, distal ureterectomy and Boari flap reconstruction were performed. Although most patients with ureteral tumours present with advanced disease, the disease was localized in our patient, as the absence of the contralateral kidney resulted in an early presentation.

Carcinoma, Squamous Cell↗
PubMed2003

Emphysematous perinephric abscess without diabetes or urinary obstruction.

Emphysematous pyelonephritis is a rare disease seen usually in patients with diabetes mellitus or obstructive uropathy. We report a case of emphysematous pyelonephritis in a male who had no evidence of diabetes or obstructive uropathy. Such an occurrence of emphysematous pyelonephritis without diabetes or obstructive uropathy is very rare. The patient was managed with antibiotics, supportive measures and surgical drainage and he recovered completely.

Abscess↗
PubMed2001

Stone necklace of urinary tract presenting as renal failure: one stage management.

We describe three cases with bilateral extensive involvement of both upper and lower urinary tract with calculi presenting in renal failure. The management of these patients in a single operative session and rendering them stone free is discussed. Modern endourologic techniques have made it possible to treat patients with such an extensive involvement of the urinary tract with stone disease with minimum morbidity.

Aged↗
PubMed2001

Acute renal failure due to bilateral matrix renal calculi--a diagnostic dilemma.

We report an unusual case of acute renal failure caused by bilateral matrix calculi. The difficulties in diagnosing the cause of renal failure and the management of the case are discussed. Matrix calculi are rare causes of acute renal failure. Being radiolucent they can be elusive and systematic investigation and a diligent search are required for correct diagnosis and appropriate treatment.

Acute Kidney Injury↗
PubMed2001

Bilateral transection of the vas deferens: an unusual trauma from a cross stab injury of the scrotum.

An unusual case of division of both vas deferens in a patient with a cross stab injury to the root of scrotum is described. The management of this case in the emergency setting is discussed. The case illustrates the need to explore every case of penetrating trauma to the scrotum, even in the absence of active bleeding, to avoid missing such injuries. These injuries, although not life-threatening, can have a profound impact on the patient's future fertility and this may only manifest several years after the injury.

Adult↗
PubMed2000

Diagnosis and management of post-cesarean ureterouterine fistulae.

Urinary leakage following obstetric or gynecologic surgery is a dreaded complication, most often caused by a urogenital fistula. Of these, uretero-uterine fistulae are relatively rare and pose a diagnostic and therapeutic dilemma. A 29-year-old woman presented with paradoxical incontinence of urine for 3 months. She had developed vaginal leakage of urine 2 weeks following an uneventful cesarean section. Conservative measures in the form of catheterization and bed rest did not relieve her symptoms. Subsequent examination and investigations revealed that she had a ureterouterine fistula. The case is discussed as well as the diagnostic modalities and treatment options.

Adult↗
PubMed2000

Posttraumatic complete and partial loss of urethra with pelvic fracture in girls: an appraisal of management.

PURPOSE: Urethral injury in girls accompanying fracture of the pelvis is rare. We present our experience with 5 such complex cases and review the literature to define the types of problem and determine appropriate management. MATERIALS AND METHODS: We report on 5 girls with posttraumatic urethral injuries and pelvic fracture resulting in stricture as well as management based on the site and length of urethral stricture. Associated injuries and results are discussed. RESULTS: Of the 5 girls who presented with stricture 4 had undergone suprapubic cystostomy as initial treatment, whereas in 1 primary repair had failed. Urethral reconstruction using a bladder flap tube and distal urethrotomy into the vagina were performed in 3 and 1 cases, respectively. These 4 girls were continent although 1 required clean intermittent catheterization for a short period. The 3 patients with complete urethral loss had a more severe degree of pelvic fracture, including 1 treated with core through internal urethrotomy. CONCLUSIONS: Posttraumatic urethral injury accompanying pelvic fracture in young girls results in challenging management situations. More severely displaced pelvic fracture is associated with greater urethral loss and requires more complex repair. Cases of partial urethral injury or urethral transection without much displacement are better managed by primary repair of the transected urethra, which decreases morbidity. Primary repair may not be feasible in patients with extensive injury, who should be treated with secondary appropriate reconstruction after preliminary suprapubic cystostomy. Complete urethral loss may be managed by bladder flap tube neourethra creations with effective continence and excellent outcomes. Short segment distal urethral strictures may be treated with meatotomy or core through internal urethrotomy.

Child↗
PubMed1999

Primary obstructive megaureter in adults: need for an aggressive management strategy.

PURPOSE: Primary obstructive megaureter (POM) is an uncommon disease in adults. We reviewed our experience with this disease to determine the clinical profile, management and prognosis of this disease in adults. METHODS: We studied 37 adults with POM who presented from January 1989 to December 1998. Their clinical presentation, renal function, radiologic data, complications, treatment as well as the results and follow-up were studied. RESULTS: The patients' age ranged from 13 to 52 years. Male:female ratio was 27:10. Seven patients had bilateral disease. All patients were symptomatic excepting 2. Complications at presentation were loin pain (26 cases), urinary infection (15 cases), calculus disease (17 cases), azotaemia (5 cases), and obstructive jaundice (1 case). Associated congenital anomalies included contralateral renal agenesis (2 cases), posterior urethral valve (1 case) and exstrophy of bladder (1 case). Thirty-four patients required surgical intervention. Of these, 26 patients underwent ureteroneocystostomy (UNC) with ureteral tailoring in 18 patients; 4 patients were treated endoscopically by ureteric meatotomy and stenting, 2 patients with nonfunctioning kidney by nephroureterectomy, 2 patients in advanced renal failure by percutaneous nephrostomy alone. In 4 out of 5 patients uraemia did not improve despite adequate drainage. CONCLUSION: The majority of adults with POM are symptomatic, have complications and require surgical correction. Complications of stone formation (46%) and renal failure (13.5%) are unusually common in adults. Once renal failure is advanced, intervention appears futile, therefore, it is imperative to treat these patients as soon as possible. Surgical correction by ureteric re-implantation is effective and has low morbidity.

Adolescent↗
PubMed1999

Infected congenital urethral diverticulum in an adult male.

Congenital anterior urethral diverticulum is a rare anomaly. The majority present in infancy with urinary obstruction. Those who present beyond infancy do so on account of recurrent urinary tract infection or dribbling. We present a case of congenital anterior urethral diverticulum manifesting in adulthood with suppuration in the diverticulum.

Diverticulum↗
PubMed1999

Cutaneous metastases in renal cell carcinoma.

Cutaneous metastasis from renal cell carcinoma is believed to be rare. We present our experience with 10 (3.3%) cases seen in the last 12 years among 306 cases of renal adenocarcinoma treated at our center. There were 9 males and 1 female. Age ranged from 30 to 65 years (average 45 years). 5 patients had skin metastases at the time of presentation (stage IV). In one of them the skin nodule, rather than urologic symptoms, was the presenting complaint. 5 patients presented with skin metastasis during follow-up after nephrectomy. The average time to skin metastasis was 51 months for patients in stage I and 13 months in stage IIIb. The scalp was the most common site of metastasis followed by chest and abdomen. 90% of patients had secondaries in at least one other site, most commonly in lungs (4 cases) and bones (5 cases). 4 patients were treated with interferon-alpha 6 MIU, subcutaneously, three times a week for varying periods from 3 to 4 months but there was no response. In conclusion, cutaneous secondaries from RCC, though uncommon, are not very rare. A few patients may present with a skin mass before detection of the renal tumor. Patients with low-stage disease at presentation may also develop cutaneous secondaries, therefore a prolonged follow-up is required. The commonest site for cutaneous metastasis from RCC is the scalp and face. Most patients had at least one other site of systemic metastasis, hence they were not candidates for curative therapy. Interferon therapy was not helpful. Mean survival after detection of cutaneous metastasis was 7 months.

Carcinoma, Renal Cell↗
PubMed1998

Total genitourinary reconstruction in adult female epispadias: a report of 2 cases and literature review.

Female incontinent episadias is a very rare congenital anomaly presenting in childhood. We report 2 cases of adults presenting with this anomaly. These were treated by total genitourinary reconstruction in a single stage using a combined perineal abdominal approach, with satisfactory results. We recommend this technique as the procedure of choice in adults presenting with this rare anomaly.

Adolescent↗
PubMed1998

Obstructive jaundice: a unique presentation of primary obstructive megaureter.

A case of giant hydronephrosis leading to obstructive jaundice due to primary obstructive megaureter in an adult is the subject of this presentation. Giant hydronephrosis due to primary obstructive megaureter in adults is uncommon. This is also the first case of obstructive jaundice due to primary obstructive megaureter reported in the literature. The patient was initially treated with a percutaneous nephrostomy till the jaundice resolved. This was followed by definitive surgery in the form of ureteral tailoring and reimplantation along with nephroplication and nephropexy, with a successful outcome.

Adult↗
PubMed1997

Transurethral resection of a bladder tumor in pregnancy: a report of 2 cases.

Carcinoma of the urinary bladder presenting during pregnancy is rare. We report two such cases presenting with gross hematuria, both of which were managed by transurethral electroresection of the tumor; there was no adverse effect on the pregnancies. Transurethral resection thus appears to be the procedure of choice in the management of this condition, and carries minimal morbidity even when performed during pregnancy.

Adenocarcinoma↗
PubMed1996

Spontaneous rupture of spleen in viral hepatitis A.

A twenty-five year old man presented with history of fever, malaise and jaundice and developed a spontaneous rupture of the spleen during hospital admission. Investigations revealed deranged liver function tests and positive serology for hepatitis A.

Adult↗