Stones in Urethra: Dr. Movahid Anwer Removes 80 urethral stones


Dr. Movahid Anwer (PGR- NHM)

Dr. Movahid Anwer (one of the most adventurous and self-starting PGRs of ward-5) removed 80 stones lodged in the urethra of a 55 years old male patient who came with urinary retention in the accident and emergency department. He was complaining of severe lower abdominal and penile pain. On examination, the patient had a lot of stones deposited throughout his urethra. Dr. Movahid Anwer (PGR) and Dr. Muzammil Irshad (H/S) got laid down the patient on the bed and tried to remove the stones using lignocaine gel and artery forceps. Dr. Tauqeer Ahmad (notorious punster H/S of ward-5) helped a lot during all this conquest. Dr. Nadeem PGR (cool gagster) and Dr. Khalid Javed PGR (decent humorist) apprised the case with their eloquent knowledge of conduct.

It made the doctors mouths gap opened when they found large sized stones pegged throughout the urethra. The patient passed urine when the 80th stone was being removed. It was all the effort of Dr. Movahid and Dr. Muzammil Irshad who made the patient to get rid of his urethral stones.

Dr. Movahid Anwer removing urethral stones

Actually, the patient had been taking homeopathic medicines for kidney stones for the last 3 months. These were the kidney stones which had reached the urethra passing through the ureters and urinary bladder, and caused urinary retention. On the removal of urethral stones, the patient was passed urinary catheter (Folley’s catheter) in order to avoid urethral stricture.

Urinary retention is one of the most common causalities seen in surgical department. Urinary retention can be acute, chronic and retention with overflow. Urinary retention differs in male, female, infants and children. Chronic retention can be caused by BPH, bladder neck

Dr. Muzammil showing discared urethral stones

contracture, urethral stricture and stones. BPH and prostate cancer occur in old age. Trauma to pelvis may lead to urethral strictures. Similarly, perineal surgeries such as haemorrhoidectomy, fistulectomy, fissurectomy, pelvic surgeries and surgeries for hip fracture or pelvic bone can also cause urinary retention. Moreover, spinal injuries and certain drugs (anticholinergic, antihistamines, and antidepressants) also contribute to urinary retention.

Discarded urethral stones

Usually, the patient with chronic urinary retention presents pain and swelling in the supra-pubic region. The patient is unable to urinate or just dribbles. Smooth, soft, tender swelling in hypogastrium

Discarded rethral Stones

can be palpated which on percussion manifests dullness of the area. Urinary retention can be relieved by catheterization or supra-pubic cystostomy. But, it is more important to deal with the cause of urinary retention.

Removal of urethral stones with artery forceps

Can you imagine eighty stones in in such a small urethra? Can these be removed within half an hour? Yes it happened to occur that patient came with stones in his urethra and were removed by the genius doctors!

By:

Dr. Muzammil Irshad (drmuzammilirshad@gmail.com)

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Dr. Azim Khan Operates a Big Inguinal Hernia


Today, in operation theater (Nishtar Hospital Multan), Dr. Azim Khan (SR) operated a big inguinal hernia. The operation was assisted by Dr. Khalid (PGR), Dr. Muzammil Irshad (H/S), Dr. Ali Akash Parhar (H/S) and Dr. Adeel Arshad (H/S). It was a male of 60 years old having a big left inguinal hernia. The hernia really looked like monstrous one. The patient had to Continue reading

Professor Dr. Iftikhar Hussain Bobi Delivers Lectures on CT Scan


Delivering a lecture is not an easy fun. Rather it is a serious and challenging task. Each and every person (teacher, professor) delivers lectures in his/her own way and the way varies by person to person. Some make it easy to absorb the lecture by the audience while others make it boring and indigestible. Audience likes easy and gettable lectures. Stuffy and boring lectures are always detested and hardly benefit the listeners. But, on the other hand, easy, well composed and competently delivered content is appreciated. In this regard, Professor Doctor Iftikhar Hussain Bobi (Thoracic Surgeon working at Nishtar Hospital Multan) is second to none in delivering digestible and winning lectures.

Today, Professor Doctor Iftikhar Hussain Bobi delivered two laudable and exceptional lectures, one on ‘THE BASIC UNDERSTANDING OF CT SCAN’ and the other on ‘THE INTERPRETATION OF CT SCAN’. Both the lectures were easy to understand and won the audience’s pleasure. In order to attend the lectures I had to exchange my duty with one of my fellows as I planned not to miss them and, of course, I am satisfied by getting something of value through these valuable lectures. It was great experience to know how to interpret the CT scan results (though it was more limited to chest and somewhat to the abdomen).

“CT scan is a glorified x-ray”, said Dr. Iftikhar Bobi. I came to know that one CT scan delivers radiations to the body equal to 50-500 ordinary/conventional x-rays. Conventional x-ray uses 200 shades while CT scan can modify the picture with 2000 shades. Concept of Pixels and Voxels demonstrated by Dr. Iftikhar Bobi was so easy that it left no confusion behind it. “Normal adrenal glands are seen as arrow heads on CT scan”, he pointed, and “Biliary tributaries and hepatic vessels look like little masses on CT scan, and it needs to be obtained with contrast which makes the abnormalities clear.”

While delivering lecture on the interpretation of CT scan, Dr. Iftikhar Bobi stressed on the point that “each and every patient with Myasthenia Gravis needs his/her chest to be opened until unless the patient does not agree or unable to be operated.” Additionally, while demonstrating lesions of chest on CT scan, he stressed and advised, “Never intubate the patients with Bullae lung and never leave the patient with pneumothorax without chest intubation; if not followed it leads the patient to demise.”

In the end, salute to his humbleness, he had a slide with written Surah Al-Asr. Without any doubt, it was an awesome and priceless lesson about our life through Surah Al-asr…Indeed man is at a loss (for he is losing his valuable lifetime), except for those who Believe and do Good deeds and exhort one another to Truth and exhort one another to Patience.”

Dr. Iftikhar Bobi (an honoured thoracic surgeon) offered a lot of knowledge about CT scan. I just wrote the above lines just to salute his sincere and devoted attitude. [Remember, if I went wrong somewhere in above lines, it would be my mistake.]

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By: Dr. Muzammil Irshad (drmuzammilirshad@gmail.com)

Cellulitis: What is Cellulitis?


What is cellulitis?

Cellulitis is a non-suppurating spreading inflammation and infection of deeper layers of the skin (dermis) and underneath subcutaneous tissues. Generally, cellulitis is subcutaneous but can also happen to occur in the other areas of the body such as pelvis and perinephric areas. Normal flora and exogenous bacteria both can cause cellulitis.

Corticosteroid-induced Toxicity

What is cellulitis?

What causes cellulitis?

Beta hemolytic streptococci (group A streptococci) are the main culprits of cellulitis. Hyaluronidase and streptokinase enzymes produced by these bacteria dissolve the intercellular matrix and the fibrin barrier respectively. These reactions lead to the development and spread of cellulitis. Continue reading