Biomedical subjects

Pawan K Kesarwani

Publications and source records attributed to Pawan K Kesarwani.

5 recordsLinked to original sources

PubMed2004

Upper pole access for complex lower pole renal calculi.

OBJECTIVES: To assess the efficacy of superior pole access for complex lower pole calyceal calculi. PATIENTS AND METHODS: In all, 102 patients with complex inferior calyceal calculi were included in a prospective unrandomized study. Complex inferior calyceal calculi were defined as multiple calculi in two or more inferior calyces of the lower polar group, with each calyx draining through a separate infundibulum and at an acute angle to each other. In 33 patients (32%; group 1) an inferior calyceal puncture was made and in 69 (68%; group 2) access was obtained through a superior calyceal puncture. The stone-free rates, decrease in haemoglobin, operative duration, requirement for additional tracts and second procedures in the two groups were compared. RESULTS: Stone clearance rates and blood loss values were better in group 2, although they were not significantly different. The mean operative duration, number of tracts required and the re-look procedure rate was significantly less in group 2. Two patients (3%) in group 2 had hydrothorax related to supracostal puncture and required chest tube insertion. CONCLUSIONS: Superior calyceal puncture (supracostal or infracostal) affords optimum access to complex inferior calyceal stones, providing faster and better clearance with a single puncture, and less requirement for second-look procedures.

Female↗

PubMed2004

Hemostasis in tubeless PNL: point of technique.

INTRODUCTION: Tubeless PNL (percutaneous nephrolithotomy), in a highly selected group of patients, is a modification aimed at reducing the morbidity of PNL. We present a simple technique of achieving tract hemostasis as an adjunct to the safe performance of a tubeless PNL. MATERIALS AND METHODS: Charts of 40 consecutive patients who underwent tubeless PNL at our center were reviewed. In the latter 20 consecutive patients, diathermy coagulation of the intrarenal bleeders and tract was done and these patients were compared with the earlier 20 patients in whom fulguration was not done. Drop in hemoglobin, postoperative analgesic requirement, operating time, length of hospitalization and postoperative complications were compared. RESULTS: No statistical difference was found between the operative times and drop in hemoglobin for both the groups. The length of hospitalization and postoperative analgesic requirement were significantly less in the fulguration group. No significant complications were noted in either of the two groups. CONCLUSIONS: Fulguration of visible intrarenal and tract bleeders is a simple, safe and effective hemostatic adjunct in patients undergoing tubeless PNL.

Adult↗

PubMed2003

Spontaneous perirenal hematoma during coronary angiography.

We report a case of spontaneous perirenal hematoma that developed acutely during an elective coronary angiography in a 65-year-old man with suspected coronary artery disease, probably related to the use of heparin during angiography. The patient did not have any systemic vasculitides and was not receiving antiplatelet or anticoagulant agents prior to the angiography. Serial follow-up high resolution CT scans with 2 mm cuts in the renal areas showed resolution of the hematoma but no underlying mass lesion or any other abnormality.

Aged↗

PubMed2003

An unusual complication of urethral stent.

A 62-year-old man with recurrent urethral stricture and an indwelling urethral stent presented to us with symptoms of difficult voiding. Retrograde urethrogram confirmed narrowing of the lumen of the urethra and a visual internal urethrotomy was done. However, during the urethrotomy, dense fibrosis around the stent was encountered making the incision difficult and leading to breakage of the blade of the urethrotome.

Equipment Failure↗

PubMedDate not supplied

Percutaneous antegrade removal of impacted upper-ureteral calculi: still the treatment of choice in developing countries.

PURPOSE: To assess the safety and efficacy of antegrade percutaneous nephrolithotomy (PCNL) of large impacted proximal-ureteral calculi. PATIENTS AND METHODS: Between July 1998 and October 2003, a total of 66 patients (43 male and 23 female; mean age 37.5 years) underwent PCNL for impacted proximal-ureteral calculi. The inclusion criteria were calculi >15 mm that were densely impacted and located between the ureteropelvic junction and the lower border of the 4th lumbar vertebra. The mean drop in hemoglobin, operating time, analgesic requirement, and hospital stay were assessed. RESULTS: Sixty-five patients (98.5%) had complete calculus clearance in a single session through a single tract. The mean operating time and hospital stay were 47 minutes and 46 hours, respectively. The mean analgesic requirement was 65 mg of pethidine (meperidine). The mean follow-up was 14 months. There were no significant postoperative complications. CONCLUSION: Antegrade PCNL is a safe and effective option for large, impacted proximal-ureteral calculi.

Adult↗