Autosomal dominant polycystic kidney disease (ADPKD) is one of the most common hereditary kidney diseases. In addition to renal involvement, vascular complications including intracranial arterial, aortic aneurysms and dissections are common in these patients. We report the case of a 35-year-old male patient with ADPKD who presented with hematuria and was diagnosed with two intrarenal arterial pseudoaneurysms. Endovascular embolization using coils was performed to resolve these symptoms. Vascular complications are often encountered in patients with ADPKD; hence, sufficient clinical suspicion and timely diagnosis can help manage the disease. The most common causes of hematuria in ADPKD patients are cyst hemorrhage or infection; however, vascular aneurysms should also be considered a possibility.

Autosomal dominant polycystic kidney disease (ADPKD) is one of the most common hereditary kidney diseases. In addition to renal involvement, vascular complications including intracranial arterial, aortic aneurysms and dissections are common in these patients. We report the case of a 35-year-old male patient with ADPKD who presented with hematuria and was diagnosed with two intrarenal arterial pseudoaneurysms. Endovascular embolization using coils was performed to resolve these symptoms. Vascular complications are often encountered in patients with ADPKD; hence, sufficient clinical suspicion and timely diagnosis can help manage the disease. The most common causes of hematuria in ADPKD patients are cyst hemorrhage or infection; however, vascular aneurysms should also be considered a possibility.

Autosomal dominant polycystic kidney disease (ADPKD) is one of the most common hereditary kidney diseases. In addition to renal involvement, vascular complications including intracranial arterial, aortic aneurysms and dissections are common in these patients. We report the case of a 35-year-old male patient with ADPKD who presented with hematuria and was diagnosed with two intrarenal arterial pseudoaneurysms. Endovascular embolization using coils was performed to resolve these symptoms. Vascular complications are often encountered in patients with ADPKD; hence, sufficient clinical suspicion and timely diagnosis can help manage the disease. The most common causes of hematuria in ADPKD patients are cyst hemorrhage or infection; however, vascular aneurysms should also be considered a possibility.

Autosomal dominant polycystic kidney disease (ADPKD) is one of the most common hereditary kidney diseases. In addition to renal involvement, vascular complications including intracranial arterial, aortic aneurysms and dissections are common in these patients. We report the case of a 35-year-old male patient with ADPKD who presented with hematuria and was diagnosed with two intrarenal arterial pseudoaneurysms. Endovascular embolization using coils was performed to resolve these symptoms. Vascular complications are often encountered in patients with ADPKD; hence, sufficient clinical suspicion and timely diagnosis can help manage the disease. The most common causes of hematuria in ADPKD patients are cyst hemorrhage or infection; however, vascular aneurysms should also be considered a possibility.

Autosomal dominant polycystic kidney disease (ADPKD) is one of the most common hereditary kidney diseases. In addition to renal involvement, vascular complications including intracranial arterial, aortic aneurysms and dissections are common in these patients. We report the case of a 35-year-old male patient with ADPKD who presented with hematuria and was diagnosed with two intrarenal arterial pseudoaneurysms. Endovascular embolization using coils was performed to resolve these symptoms. Vascular complications are often encountered in patients with ADPKD; hence, sufficient clinical suspicion and timely diagnosis can help manage the disease. The most common causes of hematuria in ADPKD patients are cyst hemorrhage or infection; however, vascular aneurysms should also be considered a possibility.

BACKGROUND: Epidural steroid injection is an established treatment modality for intervertebral disc prolapse leading to radiculopathy. In cases where two levels of radiculopathy are present, two separate injections are warranted. Herein, we present our experience of management of such cases with a single epidural injection of local anaesthetic, tramadol and methylprednisolone, and table tilt for management of both radiculopathies. METHODS: 50 patients of either sex aged between 35-65 years presenting with features of cervical and lumbar radiculopathic pain were included and were subjected to single lumbar epidural injection of local anaesthetic, tramadol and methylprednisolone, in the lateral position. The table was then tilted in the trendelberg position with a tilt of 25 degrees, and patients were maintained for 10 minutes before being turned supine. All patients were administered 3 such injections with an interval of 2 weeks between subsequent injections, and pain relief was assessed with a visual analogue scale. Immediate complications after the block were assessed. RESULTS: Immediate and post procedural complications observed were nausea and vomiting (20%), painful injection site (4%), hypotension (10%) and high block (4%). Pain relief was assessed after the three injections by three grades: 37 (74%) had complete resolution of symptoms; 18% had partial relief and 8% did not benefit from the procedure. CONCLUSIONS: This technique may be used as an alternative technique for pain relief in patients with unilateral cervical and lumbar radiculopathies.
Aged ; Humans ; Hypotension ; Injections, Epidural ; Intervertebral Disc ; Methylprednisolone ; Nausea ; Prolapse ; Radiculopathy ; Tramadol ; Vomiting

Median nerve is formed by lateral root from lateral cord and medial root from medial cord of brachial plexus.Formation of median nerve occur in front or lateral to axillary artery in axilla. In the present study we observed anatomical variations of median nerve formation in the brachial plexus. We examined formalin fixed 60 upper limbs from 30 adult cadavers (15 males and 15 females) which were above the age 40 years from the department of Anatomy. All the cadavers were dissected on both sides according to Cunningham’s Manual of Practical Anatomy. Normal formation of median nerve by two roots noted in 42 (70.0%) of upper limb specimen. Variation of median nerve formation noted in 18 (30.0%) upper limb specimen. Three roots taking part in the formation of median nerve in 13 (21.7%) upper limb specimen where additional root coming from lateral cord of brachial plexus. Four roots taking part in formation of median nerve in 3 (5.0%) upper limb specimen, where additional roots coming from lateral cord and posterior cord of brachial plexus. Lateral root crossed the axillary artery anteriorly to join with medial root lying medial to axillary artery. The median nerve formed medial to third part of axillary artery. Additional communication with musculocutaneous nerve with median nerve seen in 2 (3.3%) upper limb specimen. Knowledge of such anatomical variations is of interest to the anatomist and clinician alike. Surgeons who perform procedures involving neoplasm or repairing trauma need to be aware of these variations. Median nerve variation may lead to confusions in surgical procedures and axillary brachial plexus nerve block anesthesia.

OBJECTIVEThe treatment of subtrochanteric fractures is challenging and treatment modalities and implants are constantly evolving. This study attempts to revisit and compare extramedullary vs. intramedullary devices in relatively young population.

METHODSThirty patients with subtrochanteric fractures were enrolled and treated with extramedullary or intramedullary devices and follow-up continued one year for clinico-radiological assessment.

RESULTSThe mean age of patients was 37.53 years. Most were males between 21-40 years. The dominant mode of injury was traffic accidents (66%). Fractures were classified according to Russell-Taylor classification. Forty percent were Russell-Taylor type IA, 37% type IB and 23% type IIA. Average time to surgery was 3.6 days from the time of admission to hospital. Mean duration of surgery was 45 minutes for intramedullary device (group A) and 105 minutes for extramedullary device (group B). Average blood loss was 100 ml in group A and 200 ml in group B. Mean duration of radiation exposure was 130 seconds and 140 seconds for groups A and B, while average duration of hospital stay was 12 days and 16 days respectively. Excellent results were seen in 47% of cases in group A and 33% of cases in group B.

CONCLUSIONIntramedullary device is a reliable implant for subtrochanteric fractures. It has high rates of union with minimal soft-tissue damage. Intramedullary fixation has biological and biomechanical advantages, but surgery is technically demanding. Gradual learning and patience is needed to make this method truly rewarding.

Adult ; Bone Screws ; Female ; Fracture Fixation, Internal ; methods ; Fracture Fixation, Intramedullary ; instrumentation ; Hip Fractures ; surgery ; Humans ; Male ; Tertiary Care Centers ; Treatment Outcome

With rapid advancement in surgical techniques and improvement in implant materials, rate of internal fixation for pubic symphyseal disruption in rotationally and vertically unstable pelvic ring injuries has increased. Among various modes of implant failure, screw/plate breakage and loosening are common complications following unstable fixation. Migration of loose screws into the urinary bladder has been reported as an extremely uncommon complication of pubic symphyseal plating. Here we present a case report of a 52-year-old female who presented with asymptomatic passage of screws in her urine following migration into the bladder, 2 years after symphyseal plating for pubic diastasis in an anteroposterior compression pelvic ring injury.
Accidents, Traffic ; Bone Plates ; Bone Screws ; adverse effects ; Female ; Foreign-Body Migration ; diagnosis ; Humans ; Metals ; Middle Aged ; Pubic Symphysis Diastasis ; etiology ; surgery ; Urination

Adenine phosphoribosyltransferase enzyme deficiency is a rare, autosomal recessive disorder. It is a disease limited to the renal system and usually presents with urolithiasis. Herein, we report a young female with dihydroxyadenine (DHA) crystal-induced nephropathy presenting with rapidly progressive renal failure. DHA crystals can be easily diagnosed by their pathognomic color and shape in urine and biopsy specimens. A high index of clinical suspicion helps in the early diagnosis of this potentially treatable renal disease.
Adenine Phosphoribosyltransferase ; Biopsy ; Early Diagnosis ; Female ; Humans ; Renal Insufficiency* ; Urolithiasis