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Vesical calculi are unusual in females, and giant calculi (weighing >100 g) are even more uncommon, considering the advances in contemporary diagnostic modalities. The entity is associated with a variety of pestering symptoms--frequency, dysuria, and hematuria, to name a few--causing serious effects on patients' quality of life. This report cites the case of an elderly female with a giant vesical calculus weighing 1.28 kg (12.5 cm in diameter). Our patient had no past surgical history or symptoms suggestive of bladder outlet obstruction or neurogenic bladder. As per our literature search, a stone as large as that of our patient has not yet been found in females. She underwent an uneventful open suprapubic cystolithotomy. A biopsy from a suspicious lesion during the surgery revealed squamous cell carcinoma. Given that such a large stone was found in an elderly female without any predisposing causative factors, it is worthwhile looking into the etiopathogenesis and management of giant vesical calculi. [ABSTRACT FROM AUTHOR]

Synovial sarcomas constitute 5-10% of all soft-tissue sarcomas and tend to occur in the extremities, particularly the lower extremity. Renal sarcoma is a rare entity, constituting approximately 1-5% of all malignant renal tumours. Metastatic large renal synovial sarcoma with Inferior Vena Cava (IVC) thrombus is a rare surgical challenge that demands thorough preoperative evaluation and planning for its management. A 31-year-old young male presented with symptoms of left flank pain for 10 days, with a past history of similar complaints two years prior. On examination, a massively large renal mass was palpable. A Computed Tomography (CT) scan showed an IVC thrombus and metastatic deposits. The patient underwent a radical nephrectomy with ileal segment resection, followed by chemotherapy, which showed near-complete resolution of the metastatic deposits. Renal synovial sarcoma should be considered as a differential diagnosis in young patients presenting with a metastatic, exceptionally large renal mass complicated by an IVC thrombus, necessitating thorough preoperative evaluation for effective management. [ABSTRACT FROM AUTHOR]

Crossed fused ectopic kidney is a rare congenital anomaly wherein the kidneys are present on the same side due to fusion. It is a rare disease that may remain undiagnosed throughout life. Its rarity and anatomical abnormality make any intervention challenging. A 32-year-old male patient presented with symptoms of pain in the abdomen and burning micturition for a year. Serum creatinine, along with other blood tests, was normal. X-ray KUB showed renal calculi in the region of the right kidney. However, a Computed Tomography (CT) scan showed that the left kidney was malrotated and fused with the lower pole of the right kidney, suggestive of crossed fused renal ectopia. A cystoscopy and retrograde pyelography were performed, followed by open pyelolithotomy, wherein calculi were removed, and a stent was placed. Through this case report, it is suggested that adequate presurgery evaluation is necessary for patients with such malformations. [ABSTRACT FROM AUTHOR]

Background: Spontaneous renal hemorrhage is relatively uncommon but may be life- threatening. There are some challenges in early diagnosis due to the lack of specific presentations Case: We reported a case of A 45-year-old female presented with chief complaints of pain in right flank for 2 days. The pain was sudden in onset, severe, progressive and relieved by taking analgesics. On examination, vitals were stable. Tenderness and guarding were present in right renal angle with rest of the abdomen normal. Patient was shifted to ICU for observation and started on antibiotics, analgesics and antacids. USG Abdomen, CT Renal Angiography, MRI Abdomen were done. Diagnosis of perinephric haematoma was made. Patient was managed conservatively with close observation in view of normal vitals and was discharged in a stable condition after 12 days of uneventful stay in the hospital. She followed up twice in the OPD in a stable condition. Conclusion: We believe conservative management should be tried in cases where aetiology is not clear, failure of which should follow surgical intervention in the form of evacuation of haemorrhage. [ABSTRACT FROM AUTHOR]

Aim: The aim of the study was to evaluate the use of C-reactive protein (CRP) in predicting bacterial co-infection in patients hospitalized for bronchiolitis and to correlate the results with the use of antibiotics. Patients and Methods: This is a prospective study that included patients diagnosed with bronchiolitis admitted to a tertiary care medical centre during the study period. A tracheal aspirate culture was taken from all patients with bronchiolitis. Blood was drawn to test C-reactive protein level, white cell count, transaminases level, and blood sugar level Results: Fifty patients were enrolled in the study and were divided into two groups. Group 1 included patients with positive tracheal aspirate culture and Group 2 included those with negative culture. All patients with a CRP level =2 mg/dL have had bacterial co-infection. White cell count, transaminases and blood sugar levels were not predictive for bacterial co-infection Conclusion: Bacterial co-infection is frequent in infants with moderate to severe bronchiolitis and requires admission. Our data showed that a CRP level greater than 1.1 mg/dL raised suspicion for bacterial co-infection. Thus, a tracheal aspirate should be investigated microbiologically in all hospitalized patients in order to avoid unnecessary antimicrobial therapy. [ABSTRACT FROM AUTHOR]

Purpose: To review our success in PCNL for managing large horse shoe kidney stones as primary treatment . Method: Between 2012 and 2016, a total of 23patients (24 renal units) underwent percutaneous renal surgery for stone dieses in horseshoe kidneys. Indications were HSK with stone more than 1 cm in size and failed ESWL. Results: Mean age was 35.60 ± 10.10 years out of which 18 were males and 5 females .One patient had stone in both kidneys. Mean stone size was 22.03 ± 10.33 mm . Access site was upper calyceal and subcostal in all patients. In 2 patients an extra middle calyceal puncture were used for total clearance (8.69%). Mean operation time was 67.22 ± 7.63 minutes. One patient with staghorn stone was converted to open surgery because of inaccessibility of the stone and complexity of the renal calyceal system. Post operatively, 2 renal units with residual stone more than 8mm were cleared with ESWL. Complete clearance was achieved in 21 renal units with PCNL (87.50%). There was no significant intra operative complication. Post operatively 2 patients developed fever which was treated conservatively(clavien grade I). Conclusion: PCNL can be recommended as first line of management in the treatment of horseshoe kidneys with large stone burden considering its higher clearance rate and minimal complications. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study is to compare the outcomes of miniaturized percutaneous nephrolithotomy (mini-perc) and retrograde intrarenal surgery (RIRS) in management of renal stones with a diameter <15 mm. Materials and Methods: This was an open-label prospective study that included a total of 80 cases underwent mini-perc (n = 40) and RIRS (n = 40) between July 2014 and August 2017. The primary outcome objective was stone-free rate, retreatment rate, complications, hospital stay, operative time, and reduction in hemoglobin level. Data were analyzed using SPSS version 16.0 Software. Results: Overall, 80 patients were enrolled in this study. The mean age was 40.12 and 38.20 years, and the mean stone size was 1.15 and 1.30 cm in mini-perc and RIRS group, respectively. Majority of the study participants were males. Overall, mini-perc and RIRS had stone clearance rates of 100% and 95.4%, respectively. Two patients required retreatment in RIRS group. The duration of hospital stay and the rate of complication was similar in both the groups. Operative duration was more in RIRS group. Decrease in hemoglobin level was more in mini-perc group. Conclusions: Results demonstrated that both modalities were associated with high stone clearance rates with minimal complications. RIRS was associated with less reduction in hemoglobin and could be used as standard treatment modality for small renal calculi. [ABSTRACT FROM AUTHOR]

Background: The passage meconium in utero has been noted in 7-22 % of live births. It puts the neonate at risk of for meconium aspiration syndrome (MAS). The risk of meconium aspiration is high with thick meconium, therefore any mechanism by which thick meconium can be converted into thin meconium is postulated to have positive effect on neonatal outcome. Amnioinfusion theoretically restores amniotic fluid volume, dilutes thick meconium & cushions the umbilical cord which reduces cord compression. This study is an effort to evaluate whether amnioinfusion helps in reducing neonatal morbidity & mortality in patients with meconium stained amniotic fluid (MASF); also to see whether it decreases operative intervention in mother. Methods: In prospective randomised study, 160 pregnant women with meconium stained liquor were categorised into amnioinfusion group and control group with 80 patients in each. Amnioinfusion group received transcervical amnioinfusion in addition to routine care. Maternal complications and neonatal outcome in both groups were compared. Results: Amnioinfusion group had higher incidence of vaginal delivery especially in multipara and maternal complications and neonatal outcome was comparable in both the groups. Meconium aspiration syndrome was significantly less in case group neonates. Conclusion: AI significantly reduces the incidence of MAS, meconium below vocal cords and therefore reduces requirement for mechanical ventilation and NICU admission. Amnioinfusion is relatively easy to perform, inexpensive and safe technique that reduces operative intervention (caesarean section) and can play a major role in management of patients with meconium stained liquor especially in developing countries with limited resources. [ABSTRACT FROM AUTHOR]

Introduction: Children with urolithiasis are associated with considerable morbidity and commonly associated with metabolic abnormalities. By treating these abnormalities stone formation is prevented. Objectives: To study the metabolic risk factors of urolithiasis in children and compare them with literature. materials and methods: In open, prospective and observational study, 75 children were evaluated from August 2010 to June 2014. In all patients' dietary history, water intake and results of laboratory findings were recorded. All urine samples obtained from patients were without dietary restrictions. Reference paediatric 24 hour urinary parameter was used according to western literature. results: We investigated 75 patients with urolithiasis. Low urine volume was found in 49 patients which is comparable with previous studies indicating simple intervention as to increase water intake. Low calcium intake was found in 44 patients suggesting that low calcium intake is associated with higher incidence of urolithiasis due to increased intestinal oxalate absorption. Hypocalcaemia was found in 32 patients and 24 hour urinary abnormality was found in only 16 patients'. Both these finding does not support previous literature. Stone analysis finding does not correlate with urinary finding. conclusions: Low urine volume secondary to low water intake is predominant finding. Hypocalcaemia is major metabolic abnormality in contradiction to western literature. There are no nomograms for urinary excretion of Calcium, uric acid, oxalate and citrate in Indian children. Keeping the optimum blood calcium level & increased fluid intake can prevent stone formation in children. [ABSTRACT FROM AUTHOR]

Introduction: With significant advances in the area of interventional radiology, angioplasty and stenting have become preferred first-line treatment in patients with significant renal artery stenosis. However, not all patients have favorable anatomy to undergo minimally invasive treatments, and reconstruction of the renal artery is an option. In select cases, either improved renal function or maintenance of existing function and sometimes resolution of hypertension can follow surgical treatment., Material and Methods: This was a prospective observational study conducted from August 2010 to June 2016. Patients <45 years of age with uncontrolled hypertension secondary to renovascular hypertension (RVH) and refractory to medical management and renal arterial disease unfavorable for percutaneous intervention were included in the study. All patients were evaluated thoroughly using computed tomography angiography and diethylenetriaminepentaacetic acid renal scan. Patients underwent autotransplantation either into the right or left iliac fossa. Some kidneys required bench reconstruction of the renal artery and/or its branches before being implanted into either iliac fossa., Results: Nine patients were included in the study. The mean age was 27 years. Seven were males and two were females. Five patients had bilateral renal artery stenosis. After autotransplantation, initially five patients became free of antihypertensive medicines, but on the follow-up, two patients showed rising trend of blood pressure. The evaluation revealed narrowing at anastomosis site in both patients with salvageable kidney function in one patient. Angioplasty with stenting was done in this patient while the second patient underwent secondary nephrectomy. At 2 years of follow-up, four patients required no antihypertensive medicines., Conclusion: Autotransplantation can be a successful treatment of severe RVH and should be considered in patients with renal arterial disease unfavorable for percutaneous intervention., Competing Interests: There are no conflicts of interest.

Infantile colic in exclusively breastfed infant is very common. The mother in this situation gets panickyand under stress. This is very common emergency in paediatric hospital. Infantile colic is characterised by paroxysms of uncontrollable crying in an otherwise healthy and well fed infants younger than three months of age, more specifically infantile colic is defined as cry exceeding 180 minutes per 24 hours on 3 days in the week in first 3 months of life. The incidence of infantile colic is 5 to 19% in different studies. The mothers' description of this condition is that the breastfed baby who has been apparently alright in the day, frowns, his face becomes red, draws up his legs, screams, continues to cry for about 2 to 20 minutes and then attack ends suddenly. Episodes of cry are usually clustered in the late evening and early morning hours, which may cause significant disruption of family interactions. To find out the any supportive cause for infantile colic pertaining to maternal diet, we have conducted a study, where 110 crying infants were examined who happened to attend paediatric department over a period of one year. In this study it was found that more infants (50%) were in the age group >2-3 months, then >1-2 months (39.09%). Most of the patients happened to attend in casualty hours (5PM-9 AM) than in OPD hours (9 AM - 5 PM). Most cases (30.9%) took pulses in last 48 hours, followed by buffalo milk (20%). Most mothers (n=34) took pulses in diet in last 48 hours. It can be concluded that protein rich diet in one of the factor causing infantile colic.