Biomedical subjects

Muhammad Rafique

Publications and source records attributed to Muhammad Rafique.

11 recordsLinked to original sources

PubMed2007

Life threatening hypokalemia and quadriparesis in a patient with ureterosigmoidostomy.

We report quadriparesis as a result of severe hypokalemia and acidosis in a 15-years-old young man who had undergone ureterosigmoidostomy for bladder extrophy 3 months earlier. The patient was initially mistakenly diagnosed to be a case of Guillain-Barre syndrome. On investigations acidosis and profound hypokalemia were present. Dramatic improvement occurred after correction of hypokalemia and acidosis with intravenous potassium and bicarbonate. The underlying mechanism as well as the treatment of hyperchloremic metabolic acidosis and hypokalemia after ureterosigmoidostomy are hereby discussed.

Adolescent↗

PubMed2006

Xanthogranulomatous prostatitis: a mimic of carcinoma of prostate.

BACKGROUND: Xanthogranulomatous prostatitis is an unusual benign inflammatory process of prostate. Clinically it mimics prostatic carcinoma, requiring pathological examination for diagnosis. CASE PRESENTATION: A 60-year-old patient presented with 6 months history of increasing difficulty in micturition. On digital rectal examination prostate was hard and nodular and estimated weight was 50-gram. His serum prostate specific antigen (PSA) was 150 ng/ml. Clinically a locally advanced carcinoma of prostate was suspected. In view of severe obstructive urinary symptoms and significant post-micturition residual urine, transurethral resection of prostate was carried out. Histopathological examination of resected prostatic tissue revealed xanthogranulomatous prostatitis with no evidence of malignancy. Patient remains symptom free at 16 months follow-up and serum PSA has decreased to 6 ng/ml. CONCLUSION: Xanthogranulomatous prostatitis is a benign inflammatory disorder of prostate that can clinically and even biochemically mimic prostatic carcinoma. A high degree of suspicion and close co-operation with pathologist is necessary for the diagnosis of xanthogranulomatous prostatitis.

Journal Article↗

PubMed2006

Value of routine renal and abdominal ultrasonography in patients undergoing prostatectomy.

OBJECTIVE: To evaluate the frequency of urological and non-urological abnormalities detected on routine renal and abdominal ultrasonography in patients undergoing surgery for benign prostatic hyperplasia (BPH) and to see if they affected the intended decision for prostate surgery. METHODS: Medical records of 250 patients who underwent open or endoscopic surgery for BPH at Nishtar Hospital, Multan, Pakistan between May 2003 and December 2004 were studied. All patients had abdominal ultrasonography performed during routine preoperative workup. The frequency of urological and non-urological conditions detected on ultrasonography was calculated and the effect of these conditions on the intended decision for prostate surgery was observed. RESULTS: In 102 patients (40.8%) urological and in 8 patients (3.2%) non-urological abnormalities were detected by ultrasonography. Urological conditions detected included uni/bilateral hydronephrosis (34 pts), vesical stones (34 pts), renal cysts (15 pts), renal stones (6 pts), small shrunken kidneys (2 pts), renal tumour (1 pt) and bladder carcinoma (1 pt). Non-urological conditions included gall stones (4 pts), liver abscess (2 pts), hydatid cyst (1 pt) and liver carcinoma (1 pt). CONCLUSION: The study shows that a sizeable number of patients (44%) had urological and non-urological conditions detected by renal and abdominal ultrasonography. Most patients had benign conditions but three of these patients had potentially life threatening conditions (renal, bladder and hepatic carcinoma) detected by sonography that were unrelated to the prostate. However, in only one patient (0.4%) with bladder carcinoma, surgery for prostate was postponed and bladder tumour was dealt with prior to transurethral resection of prostate (TURP). Various conditions detected by ultrasonography would have been missed if it had not been performed. As ultrasonography is a non-invasive, cost-effective and quite a safe imaging technique, in author's opinion abdominal and renal tract evaluation by ultrasonography should be routinely performed in patients undergoing surgery for BPH.

Abdomen↗

PubMed2006

Clinico-pathological features of bladder carcinoma: experience from a tertiary care hospital of Pakistan.

UNLABELLED: Bladder carcinoma is most common urological malignancy in Pakistan. The objective of the study was to determine the clinico-pathological characteristics of histologically confirmed bladder carcinoma at a tertiary care hospital of South Punjab, Pakistan. METHODS: In two hundreds and twenty one patients (172 male and 49 female) bladder carcinoma was diagnosed from Jan 1998 to June 2005. All patients were evaluated with regards to clinical presentation, cystoscopic findings and histo-pathological data. RESULTS: Male female ratio was 3.5:1. The median age was 58 years (range 18-87 years). 65% men had history of cigarette smoking while 51% women had long history of smokeless tobacco (nasal snuff or chewable) use. Most patients presented with painless hematuria. Primary transitional cell carcinoma was the most common (i.e. 96%) histological variety of bladder carcinoma. 63% patients had muscle invasive disease at the time of presentation. Even in superficial bladder carcinoma, most patients had invasion of lamina propria (pT1 disease). CONCLUSION: More than 90% of primary bladder carcinoma are of transitional cell variety and over 60% having muscle invasive disease at the time of diagnosis. Even in patients with superficial disease, majority (i.e. 98%) have invasion of lamina propria.

Adolescent↗

PubMed2005

Clinico-pathological features of bladder carcinoma in women in Pakistan and smokeless tobacco as a possible risk factor.

BACKGROUND: Bladder carcinoma is one of the common urological malignancies occurring worldwide in both sexes. Use of smokeless tobacco by women is common in rural areas of Pakistan. The clinico-pathological features of bladder carcinoma in women and association of smokeless tobacco as a possible risk factor for bladder carcinoma has not been well described in the literature. The objective of the study was to determine the clinico-pathological features of histologically confirmed bladder carcinoma in women and to investigate the role of smokeless tobacco use as a possible risk factor for its development. PATIENTS AND METHODS: Of the 204 patients (160 male and 44 female M:F ratio 3.6:1) of newly diagnosed bladder carcinoma treated at Nishtar Medical College Hospital Multan from January 1998 to December 2004, the 44 female patients were evaluated with respect to age, clinical presentation, cystoscopic findings, histopathological reports and possible etiological factors. Data were collected and prospectively updated at the time of discharge from hospital and during follow-up in urology out-patient clinic. RESULTS: Transitional cell carcinoma accounted for all of the bladder carcinoma in women. Median age of the patients was 55 years and 68% patients were under 60 years of age. Majority of patients (88%) presented with hematuria. Eleven (25%) patients had superficial (pTa/pT1) while 33 (75%) patients had muscle invasive (T2-T4) bladder carcinoma. Most (81%) superficial tumors were papillary while muscle invasive tumors had solid configuration at cystoscopy. Of these, 21 (47%) patients had long history of smokeless tobacco use (chewable or moist snuff). CONCLUSION: Transitional cell carcinoma is the most common bladder malignancy in women in Pakistan. Many women with bladder carcinoma had long history of use of smokeless tobacco. Majority of patients presented with hematuria and were under 60 years of age. At the time of diagnosis 75% women had muscle invasive bladder carcinoma. In women using smokeless tobacco, the correlation between stage of bladder carcinoma and duration of smokeless tobacco use was significant (p = 0.03). Further studies are needed to clarify the role of smokeless tobacco in the development of bladder carcinoma.

Journal Article↗

PubMed2005

Simulation of corrosion product activity for nonlinearly rising corrosion on inner surfaces of primary coolant pipes of a typical PWR under flow rate transients.

For nonlinear accelerating corrosion, calculation of activated corrosion products on inner surfaces of primary coolant pipes have been done in a typical pressurized water reactor (PWR) under flow rate perturbations. Computer program CPAIR-P (Corrosion Product Activity In Reactors) (Deeba et al., 1999) has been modified to accommodate for time-dependent corrosion rates. Results, for (24)Na, (56)Mn, (59)Fe, (58)Co, (60)Co and (99)Mo, show that the specific activity in primary loop approaches equilibrium value under normal operating conditions fairly rapidly. Predominant corrosion product activity during operation is due to (56)Mn, and cobalt isotopes dominate the activity after shutdown of reactor. Flow rate perturbations and different types of rising corrosion rates were introduced in the system and effects on saturation activity were studied. For a linear decrease in flow rate and a constant corrosion rate, the total coolant activity and activity on pipe scale approaches higher saturation values when compared to normal condition values. With a nonlinearly accelerating corrosion, the behavior of specific activity changes considerably. The flow rate perturbations on specific activity for pipe scale results in a new saturation value which depends on both the changes in flow rate (Delta w) and equilibrium corrosion rate (C(s)) values. However, the time taken to reach the saturation activity depends on the slope of corrosion rate. For a slow pump coastdown, the activity does not show an initial drop when flow rate starts decreasing. It monotonically rises and follows the slope of corrosion rate. The peak value and decay of activity after scram are strong functions of flow rate and removal efficiencies.

Journal Article↗

PubMed2005

Vesical calculus formation on permanent sutures.

Bladder calculi are uncommon in adults and usually result from either obstruction or foreign objects. The present case report describes an elderly man presenting with recurrent urinary tract infections. Investigations revealed a bladder calculus that had formed on a permanent suture material used previously in bladder surgery (diverticulectomy) 5-years ago.

Device Removal↗

PubMed2003

Vesical gossypiboma.

Gossypiboma (retained surgical sponge) is an iatrogenic complication. It is infrequently reported in literature because of legal implications setting up a vicious cycle of non-anticipation and misdiagnosis. Four cases of vesical gossypiboma following transvesical prostatectomy are presented. Clinical presentation, diagnostic aspects and preventive strategies are discussed.

Aged↗

PubMed2002

Management of iatrogenic ureteric injuries associated with gynecological surgery.

OBJECTIVE: This retrospective study defines the presentation and management of iatrogenic ureteric injuries consequent upon gynecological surgery in a teaching hospital in Punjab, Pakistan. PATIENTS AND METHODS: 18 patients with median age 35 years (range 18-80 years) with iatrogenic ureteric injuries associated with gynecological surgery were referred to the department of urology at Nishtar Hospital Multan Pakistan. Main presenting symptoms were urinary incontinence, loin pain and anuria. Median time since injury and presentation was 3 weeks (range 1 day to 7 years). In 16 (88%) patients injury resulted from abdominal hysterectomy. Other causes included ovarian cystectomy (one patient) and vaginal hysterectomy (one patient). 11 (61%) patients had ureterovaginal fistula, 5 (28%) patients had complete unilateral ureteric obstruction and 2 (11%) patients had bilateral ureteric obstruction and anuria. In 11 patients with ureterovaginal fistula ureteroneocystostomy was performed. In five patients with unilateral ureteric obstruction, one had end to end anastomosis of ureter, three had ureteroneocystostomy only and one had ureteroneocystostomy and psoas hitch done. Two had anuria secondary to bilateral ureteric obstruction. In one of these patients Boari flap and ureteroneocystostomy was carried out. The second patient had deligation of catgut sutures on ipsilateral side and ureteroneocystostomy on the contra-lateral side. RESULTS: In 17 patients no major complication occurred. One patient who had deligation of catgut sutures, the distal ureter sloughed and re-exploration and ureteroneocystostomy was performed. Renal salvage was achieved in all cases. CONCLUSION: Open surgical procedures for repair of iatrogenic ureteric injuries are associated with good outcome. Strategies to prevent these injuries include adequate surgical training and meticulous surgical techniques.

Adolescent↗

PubMed2002

Case report: an unusual intravesical foreign body: cause of recurrent urinary tract infections.

A 16-year-old boy presented with recurrent urinary tract infections in spite of antibiotic treatment. Investigations revealed the presence of an unusual intravesical foreign body i.e. a common ballpoint. It was removed via cystostomy. In any patient presenting with recurrent urinary tract infections the possibility of an intravesical foreign body should always be considered.

Adolescent↗

PubMedDate not supplied

Role of intravenous urography and transabdominal ultrasonography in the diagnosis of bladder carcinoma.

INTRODUCTION: The present study was carried out to compare the efficacy of transabdominal ultrasonography and intravenous urography in the diagnosis of bladder carcinoma in those patients presenting painless hematuria. MATERIALS AND METHODS: Medical records of 100 patients who had both ultrasonography and intravenous urography were studied. The reported findings of these investigations were correlated with those of cystoscopy. RESULTS: Ultrasonography was significantly more sensitive (96%) in the detection of bladder carcinoma compared to urography (87%). By applying the test of equality of proportions, the value of Z is 2.28, which is statistically significant (p < 0.01). In addition, ultrasonography was more sensitive in clarifying the pathology in upper renal tracts i.e. ureteric obstruction secondary to bladder carcinoma when urography failed due to none or poor excretion of contrast. COMMENTS: We recommend the use of ultrasonography as the initial radiological investigation for detection of bladder carcinomas in patients presenting hematuria. Ultrasonography is safe, easily available, cost effective and provides images of both upper and lower renal tract. Patients diagnosed to be suffering from bladder carcinoma by ultrasonography should be scheduled directly and promptly for cystoscopy and bladder tumor resection.

Adolescent↗