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Biomedical subjects

R Biyabani

Publications and source records attributed to R Biyabani.

5 recordsLinked to original sources
PubMed2000

Reduction of radiation exposure to patients in the follow-up of shockwave lithotripsy.

OBJECTIVES: To assess, in patients undergoing extracorporeal shock wave lithotripsy (ESWL), if a policy of using unilateral X-rays of the kidney, ureter and bladder (hemi-KUB) whenever possible and appropriate during diagnosis and follow-up, was successful in reducing the radiation exposure associated with ESWL. PATIENTS AND METHODS: Two groups of patients of statistically comparable size and demography were assessed retrospectively before and after the implementation of the policy. All had undergone ESWL for radio-opaque upper urinary tract stones and all were finally rendered stone-free. The number and type of all radiological procedures from initial diagnosis of the stone to documented stone-free status were recorded and the dose calculated. RESULTS: The appropriate use of hemi-KUB X-rays resulted in a significant mean reduction of radiation exposure after treatment of 2.28 mSv per patient (P<0.05). Furthermore, as expected, the radiation dose was clearly but not closely correlated with stone size (r = 0.419). CONCLUSIONS: The appropriate use of hemi-KUB X-rays during the follow-up after ESWL is a simple and effective way of significantly reducing the radiation exposure of such patients.

Adult↗
PubMed2000

Physician responsibility for removal of implants: the case for a computerized program for tracking overdue double-J stents.

PURPOSE: Ureteral stents are used in various modern urologic procedures. Although forgotten double-J (JJ) stents are an infrequent problem, they are associated with significant medical problems. Encrustation from excessive indwelling time increases morbidity and may require extracorporeal shock wave lithotripsy to free the coils of the cementing calcerous material. An effective system should be in place to ensure timely removal. The previously used "card" system not only is difficult to manage but has proved unreliable. We describe a computerized program that tracks JJ stents and alerts physicians about stents that need removal. MATERIALS AND METHODS: Two hundred eighteen patients who were stented between January 1997 and December 1998 were tracked through an integrated computerized program. This program keeps a log of all patients who received a JJ stent and determines the last date by which it should be removed. Patients are reminded if they have not returned for removal of the implant 2 weeks before it is overdue. RESULTS: Two hundred twenty-five JJ stents were placed in 218 patients. Comparison of data between the periods before and after computer program inception showed that the incidence of stents retained longer than their expiration time decreased from 12.5% to 1.2% in the first year of the program and 1.5% in the second year of the program. CONCLUSIONS: Forgotten implants pose a significant management dilemma for physicians. Our tracking program significantly lowered the incidence of overdue JJ stents from 12.5% to 1.2% and 1.5% in the first and second years, of the program respectively (p = .00039). We propose that this technically simple program should be in place for all implants placed in patients. The problems we encountered in the smooth running of this system could be averted by incorporating several recommendations.

Adolescent↗
PubMed1998

Urolithiasis in pregnancy--a clinical challenge.

Symptomatic urolithiasis in pregnancy is a rare event. We present a series of 13 cases. Although controversial, we think that X-rays should be avoided if possible. Ultrasound may not be the perfect diagnostic tool in every case of stone disease, however in pregnancy it is the imaging of choice and led to an accurate diagnosis in all our cases. Thirty-eight percent of the patients were managed conservatively throughout their pregnancy, and another thirty-eight percent of our patients needed more extended treatment but could be managed by simple insertion of a double J ureteric stent (DJ). Therefore, in our series invasive treatment was not necessary in the majority of patients. Each one patient required a percutaneous nephrostomy (PCN) and a nephrectomy for a non-functional pyonephrotic kidney. Urolithiasis in pregnant women constitutes a challenge for the treating urologists since they are deprived of some of their essential tools, such as X-rays and extracorporeal shock wave lithotripsy (ESWL), and since normally tolerable complications of less invasive treatments can have disastrous consequences in pregnant patients. Therefore, decisions on any kind of treatment have to be made very prudently and critically. We present an algorithm for the management of stones in pregnancy which may be helpful in decision making.

Adult↗
PubMed1998

Persistent Müllerian duct syndrome.

Persistent müllerian duct syndrome (PMDS) is a rare form of male pseudohermaphroditism. We present 5 cases with PMDS (2 cases associated with testicular malignancy) and discuss the diagnosis and management. Management strategies of PMDS have changed. Whereas in the past, removal of the müllerian remnants was targeted together with orchidopexy or -ectomy, this is no longer recommended. However, testicles that cannot be descended at an early stage are at a high risk of malignancy and should, therefore, be removed. If this is necessary on both sides, there is the additional problem of lifelong testosterone substitution which requires efficient patient monitoring and good patient compliance. In cases where this cannot be achieved, compromises, such as temporarily delayed orchidectomy, may be considered.

Adult↗