Biomedical subjects
Publications and source records attributed to M Rafique.
A case of wandering (pelvic) spleen associated with third degree uterovaginal prolapse and ascaris in the biliary and intestinal tract is being presented here. On laparotomy; congested splenomegaly was found in the pelvis. Splenectomy, total abdominal hysterectomy and bilateral salpingo-ophrectomy was performed.
A case is reported in which a 46-year-old normotensive male patient presented with large right-sided painless abdominal mass. On sonography there was a large cyst in the lower pole of right kidney. Intravenous urography showed distortion of pelvicollecting system and medial shift of upper right ureter. Exploration revealed a cystic mass (18 x 15 cm) located in lower pole of right kidney. It contained brownish fluid and because of suspicion of malignancy radical nephrectomy was carried out. Histological examination showed the cystic mass to be adrenal tissue infiltrated by neoplastic cells. Characteristic organoid nests of malignant cells ("Zellaballen" were present. Cells stained positively for chromogranin, neurone specific enolase (NSE), neurofilament, and synaptophysin. Sustentacular cells showed positive reaction to S-100 protein. No further treatment was offered. Patient remains well at 30 months follow-up. On medline search there is record of three cases of intra-renal paraganglioma in English literature and the present case appears to be the fourth one.
Intrauterine contraceptives devices have been in use for many years. Although perforation of the uterus by an intrauterine device is not uncommon, intravesical migration with secondary stone formation is a rare complication. We report on a 32-year-old woman in whom an intrauterine contraceptive device (Copper T) migrated from her uterus into the bladder. She had lower urinary tract symptoms for nearly 2 years but sought no treatment. The onset of hematuria and fear of cancer prompted her to seek treatment. On investigation, a vesical stone was discovered that had formed on a copper T contraceptive device. It was removed via suprapubic cystostomy. In any woman in whom an intrauterine device is fitted and who presents with lower urinary tract symptoms, the possibility of intravesical migration of the device should be included in the differential diagnosis.
Intravesical migration of an intra-uterine contraceptive device (IUCD) in a 28-year-old woman resulted in recurrent urinary tract infections. She received antibiotic treatment from her general practitioner but had no investigations done. Later on she became pregnant and investigations revealed that the thread of IUCD was missing and there was a vesical calculus. After she had delivered the baby, a pelvic X-ray was taken and showed a vesical calculus on the IUCD. Both calculus and IUCD were removed cystoscopically.
OBJECTIVE: To review the results of management of 42 cases of genitourinary fistulas of obstetric origin. SETTINGS: Department of urology, Nishtar Hospital, Multan, Pakistan. METHODS: Forty two cases of genitourinary fistulas (36 vesicovaginal, 2 vesicouterine, one ureterovaginal and 3 urethrovaginal) were repaired from 1st December, 1999 to 31st May, 2002). All fistulas were repaired three months or more after formation. Trans-abdominal and vaginal repair of vesicovaginal fistulas was undertaken in 29 and 7 patients respectively. Two patients had trans-abdominal closure of vesicouterine fistulas. Ureteroneocystostomy with antireflux mechanism was performed for uretereovaginal fistula. For three urethrovaginal fistulas transvaginal layered repair was carried out. RESULTS: Overall success rate for all types of fistula was 85.7% (36 pts). CONCLUSION: The surgical treatment of genitourinary fistulas will depend upon the type, size and location of fistula. Acceptable results can be achieved by adhering to the surgical principles of fistula repair i.e. optimal tissue conditions, adequate exposure and tension free closure.
OBJECTIVE: To study the chemical composition of upper renal tract (renal and ureteric) calculi in Multan. SETTING: Department of Urology, Nishtar Hospital, Multan. STUDY PERIOD: September 1992 to February 1999. MATERIAL AND METHODS: A total of 700 renal and ureteric calculi were analyzed by chemical method of Hodgkinson. RESULTS: The commonest were uric acid (28.1%) calculi, followed in frequency by calcium oxalate calculi (26.1%), mixed calculi containing calcium oxalate and uric acid (21.8%) and calculi containing calcium oxalate and calcium phosphate (10.4%). Other variety of calculi were less common. CONCLUSION: Uric acid, calcium oxalate and mixed uric acid and calcium oxalate calculi are the main types in Multan region (JPMA 50:145, 2000).
BACKGROUND: The fascia propria of the rectum is an upward capsular projection from the superior fascia of the pelvic floor which surrounds the rectum and its mesorectum posteriorly and the fat, blood vessels, nerves and lymphatics in front and laterally. It is postulated that if rectal cancer is contained within the fascia propria and extrafascial excision of the rectum is performed then it would be exceptional for the cancer to recur locally. METHODS: A total of 122 consecutive patients with rectal cancer underwent extrafascial excision of the rectum. The operation involved mobilizing the rectum outside its fascia propria and removing not only the rectum and its mesorectum posteriorly but also the fat, blood vessels, nerves and lymphatics in front and laterally. Resection was considered curative unless there were distant metastases or the tumour had involved the resection margins. RESULTS: There was one postoperative death. The cumulative cancer-free survival rate at 5 years was 68 per cent. In 100 patients in whom the operation was considered to be curative, the cumulative cancer-free survival rate was 81 per cent. Eighty-four of these patients were available for a minimum follow-up of 24 (median 73, range 24-193) months. Three (4 per cent) developed local recurrence. In two patients this was at the anastomosis. CONCLUSION: If the cancer is contained within the fascial tube surrounding the rectum and complete extrafascial excision has been performed, local recurrence will be minimal.
BACKGROUND: Adjuvant intraportal chemotherapy has been used with a view to prevent the development of metachronous hepatic metastases following curative resection for colorectal cancer. To evaluate the effects of this therapy on systemic antitumor immunological activity, 35 colorectal cancer patients who underwent curative resection were investigated. METHOD: Among them. 19 had adjuvant intraportal chemotherapy with mitomycin C and 5-fluorouracil (treated group) and 16 had no chemotherapy (untreated group). Natural killer (NK) cell activity, lymphocyte subpopulations, and immunosuppressive acidic protein (IAP) in the peripheral blood were measured serially before and after operation, and the values were compared between the two groups. RESULTS: The NK cell activity and the percentages of CD16 positive and CD56 positive cells were markedly reduced in the treated group postoperatively. Significant difference was also observed between the two groups on the 4th postoperative day in regard to NK cell activity and CD56 positive cells. CONCLUSIONS: Intraportal chemotherapy in our study reduced the NK cell activity and its population in the peripheral blood.
To evaluate the effects of continuous intraportal chemotherapy on tumor immunity of the liver, natural killer (NK) cell activity was estimated in the rat liver. In an in vitro study, NK-enriched mononuclear cells collected from rat liver were incubated with 5-fluorouracil (5-FU) alone and with a 5-fluorouracil/mitomycin C (5-FU/MMC) combination at different concentrations. NK activity was measured after 24-hour incubation. In an in vivo study, the continuous intraportal administration of chemotherapeutic (5-FU/MMC) and chemoimmunotherapeutic (5-FU/MMC/lentinan) agents was carried out in rats for 5 days, and NK-enriched mononuclear cells were then collected from the liver for the measurement of NK activity. Neither 5-FU alone nor the 5-FU/MMC combination affected NK activity in vitro. In the in vivo study, however, the 5-FU/MMC combination significantly decreased NK activity, and the addition of lentinan recovered the activity to the control level. It can thus be concluded that the intraportal administration of chemotherapeutic agents reduces NK activity in the liver and the addition of an immunostimulator to such agents prevents this reduction.
Preoperative intraperitoneal (IP) chemotherapy was performed in 23 patients with gastric malignancies to inhibit peritoneal recurrence. Cis-diamminedichloroplatinum (CDDP) and mitomycin C (MMC) were administered intraperitoneally 3 days prior to surgery, at which time a very viscid peritoneum and mucinous intraperitoneal fluid were found in 100% and 83% of the patients, respectively. Inflammatory changes were microscopically observed in the subserosal layer of the resected stomachs and in the intraperitoneal fluid, but degenerative changes characteristic of cancer cells could not be seen. The 3-year survival rate of the stage III patients was 55.6%, and peritoneal recurrence was found in three of six patients with recurrence. Extensive adhesions were found in eight patients (34.8%) as a delayed peritoneal complication, and chronic bowel obstruction resulting from the adhesion developed in five patients (21.7%). Thus, we conclude that the administration of this IP chemotherapy demonstrated no definite antitumor effects or survival benefits, but was frequently associated with delayed peritoneal complications.
Sixty-two overweight gastric cancer patients were compared with 201 normal-weight patients to clarify the influences of excessive weight on the surgical treatment of gastric cancer. The frequencies of hypertension and diabetes mellitus were significantly higher in the overweight group (P < 0.01), but no pathologic differences in the resected tumor were found between the two groups. The operative times were longer (P < 0.01) and the number of lymph nodes extirpated and examined was smaller (P < 0.01) in the overweight group. The incidence of postoperative complications was not higher in the overweight group. The postoperative survival rate of patients with nodal metastasis was statistically lower in the overweight group (P < 0.05). Regarding the causes of death in patients with nodal metastasis, 61.1% of overweight patients and 43.8% of normal-weight patients died of recurrence of gastric cancer. In conclusion, surgical treatment of overweight patients with gastric cancer was found to be technically more difficult and the prognosis of such patients with nodal metastasis may thus be worse than that of their normal-weight counterparts.
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The results of adjuvant continuous intraportal chemotherapy in preventing hepatic metastasis, following curative colorectal surgery, are still equivocal. To improve the efficacy of this treatment we tried to establish an experimental model for continuous intraportal infusion in Wistar male rats. Using a drug infusion balloon catheter, which can be fixed on the back of the rat, the continuous intraportal administration of chemo/immunotherapeutic agents was carried out in 47 rats for 5 days. Of them, 23 received chemotherapeutic (Mitomycin C/5-fluorouracil) and 24 received chemoimmunotherapeutic (Mitomycin C/5-fluorouracil/Lentinan) agents. The overall success rate of complete 5-day infusion of the agents was 70.2%. The concentration of 5-fluorouracil in the peripheral blood ranged from 5ng/ml to 17ng/ml (mean 10.4ng/ml) and in the portal blood from 192ng/ml to 610ng/ml (mean 312.0ng/ml) following the perfect continuous infusion of the agents. It can thus be suggested that our established experimental model can be used for the study of continuous intraportal infusion in unrestrained rats.
BACKGROUND/AIMS: In order to improve the management of patients of gastric cancer with synchronous hepatic metastasis, their records were retrospectively studied. MATERIALS AND METHODS: From January 1981 to July 1993, 558 gastric cancer patients were admitted in our institute. Twenty-five with synchronous hepatic metastasis were used in this study. Among these 25 patients, six had hepatic metastasis alone and nineteen had some other additional noncurative prognostic factors. For the primary lesion, 12 patients received gastrectomy (total or distal subtotal) and 13 patients did not. For the hepatic metastasis, 12 patients had regional therapy (hepatectomy or hepatic arterial chemotherapy) and 13 had not. Both gastrectomy and regional therapy for hepatic metastasis were carried out in 6 patients who had hepatic metastasis alone. RESULTS: Five year cumulative survival rate was 9%. Survival rate of patients with hepatic metastasis alone was significantly better than the patients with additional noncurative factors (p < 0.05). The two long term survivors in this study had no other noncurative factors except hepatic metastasis. CONCLUSIONS: Neither gastrectomy nor regional therapy for hepatic metastasis had beneficial effects on the patients with additional noncurative factors. Gastrectomy and regional therapy for hepatic metastasis should be performed in patients without additional noncurative factors.