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Kumar D, Mittal A, Panwar V, Talwar H, Singh GJ. Small Tumor, Major Complication: A Case of Spontaneous Perinephric Hematoma From a Small Renal Angiomyolipoma. Cureus 2023; 15:e44761. [PMID: 37809192 PMCID: PMC10556976 DOI: 10.7759/cureus.44761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/04/2023] [Indexed: 10/10/2023] Open
Abstract
A renal angiomyolipoma is a benign kidney tumor composed of muscle, fat, and blood vessels. It is the most common benign kidney tumor, and it affects women more frequently than men. Angiomyolipomas can be small and asymptomatic, or they can be large, presenting with symptoms such as discomfort, hematuria, and hypertension. Occasionally, the rupture of an angiomyolipoma can cause a perinephric hematoma. This case report discusses a patient who developed a spontaneous large perinephric hematoma alongside a small renal angiomyolipoma. Aneurysm was seen on imaging. Angioembolization was successfully used for treatment. We explore the significance of the presence or absence of an aneurysm in predicting the risk of hemorrhage, particularly in association with small lesions. Angioembolization is an excellent choice for treating angiomyolipomas associated with significant hematomas.
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Affiliation(s)
- Deepak Kumar
- Urology, All India Institute of Medical Sciences (AIIMS) Rishikesh, Rishikesh, IND
| | - Ankur Mittal
- Urology, All India Institute of Medical Sciences (AIIMS) Rishikesh, Rishikesh, IND
| | - Vikas Panwar
- Urology, All India Institute of Medical Sciences (AIIMS) Rishikesh, Rishikesh, IND
| | - Harkirat Talwar
- Urology, All India Institute of Medical Sciences (AIIMS) Rishikesh, Rishikesh, IND
| | - Gurpremjit J Singh
- Urology, All India Institute of Medical Sciences (AIIMS) Rishikesh, Rishikesh, IND
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Panwar V, Gupta N, Bhoriwal SK. Left main bronchus completely occluded by tumour fragment following right pneumonectomy. Anaesth Rep 2023; 11:e12261. [PMID: 38028659 PMCID: PMC10680573 DOI: 10.1002/anr3.12261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2023] [Indexed: 12/01/2023] Open
Affiliation(s)
- V. Panwar
- Department of Onco‐Anaesthesia and Palliative MedicineDr. B.R.A. Institute‐Rotary Cancer Hospital, All India Institute of Medical SciencesNew DelhiIndia
| | - N. Gupta
- Department of Onco‐Anaesthesia and Palliative MedicineDr. B.R.A. Institute‐Rotary Cancer Hospital, All India Institute of Medical SciencesNew DelhiIndia
| | - S. K. Bhoriwal
- Department of Surgical OncologyDr. B.R.A. Institute‐Rotary Cancer Hospital, All India Institute of Medical SciencesNew DelhiIndia
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Theja RS, Gupta N, Panwar V, Kumar N. Erector spinae plane block for peri-operative analgesia in a patient undergoing surgery for Ewing's sarcoma of the clavicle. Anaesth Rep 2023; 11:e12228. [PMID: 37124664 PMCID: PMC10143598 DOI: 10.1002/anr3.12228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2023] [Indexed: 05/02/2023] Open
Abstract
The erector spinae plane block is a regional anaesthetic technique originally developed to manage thoracic neuropathic pain. It is popular because of its ease of learning and its applicability in various types of surgeries, providing both cutaneous and visceral analgesia. We report a case of a 30-year-old man who underwent excision of Ewing's sarcoma of the clavicle with brachiocephalic vein repair and pectoralis major myocutaneous flap reconstruction under general anaesthesia, with bilateral erector spinae plane block, with catheter insertion on the side of the lesion. The operation necessitated peri-operative anticoagulation, and so erector spinae blocks were performed to provide analgesia where epidural insertion was contraindicated. Adequate pain relief was achieved during the entire postoperative stay. The erector spinae plane block is thought to work due to the direct spread and diffusion of local anaesthetic into the posterior rami of spinal nerves located deep to the erector spinae muscles, and anterior spread into paravertebral space with additional effect potentially due to systemic absorption This case highlights the role of the erector spinae plane block in complex clavicular surgery requiring peri-operative anticoagulation, and potentially obviates the need for neuraxial analgesia.
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Affiliation(s)
- R. S. Theja
- Department of Surgical Oncology, Rotary Cancer HospitalAll India Institute of Medical SciencesDelhiIndia
| | - N. Gupta
- Department of Surgical Oncology, Rotary Cancer HospitalAll India Institute of Medical SciencesDelhiIndia
| | - V. Panwar
- Department of Surgical Oncology, Rotary Cancer HospitalAll India Institute of Medical SciencesDelhiIndia
| | - N. Kumar
- Department of Surgical Oncology, Rotary Cancer HospitalAll India Institute of Medical SciencesDelhiIndia
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Abstract
<b>Background:</b> Genitourinary tuberculosis is one of the most common forms of extra-pulmonary tuberculosis. Owing to a myriad of clinical presentations and discrepancies in the diagnostic modalities, patients usually present late, which results in a high number of them requiring surgical intervention. The present study aims to retrospectively analyze the role of surgery in genitourinary tuberculosis. <br><b>Patients and method:</b> All patients diagnosed with genitourinary tuberculosis at our centre between October 2017 and September 2019 were included in the study. The mode of presentation, duration of symptoms, investigations performed, treatment received, and follow-up were studied. <br><b>Results:</b> Out of 25 patients diagnosed with genitourinary tuberculosis (GUTB), there were 15 (60%) males and 10 (40%) females. The mean age of presentation was 40.84 years. Nineteen (76%) patients underwent surgical intervention, and many patients required more than one surgical procedure. A reconstructive procedure was carried out in seven patients. At a median follow-up of 12 months, all patients did well, showing no relapse. <br><b>Conclusion:</b> Surgery, along with antitubercular treatment, is the key to the management of GUTB presenting with structural damage. However, surgery can be ablative or reconstructive, depending on various factors discussed in the present study. This preserves or restores the optimal function of the genitourinary system affected by the mycobacterium bacilli.
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Ranjan R, Mittal A, Panwar V, Navriya S, Singh S, Mandal A. Novel scoring system and advanced management algorithm for emphysematous pyelonephritis. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)00554-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Ranjan R, Navriya S, Kumar S, Mittal A, Singh S, Panwar V, Mandal A. Emerging role of Telemedicine in urology: COVID brought the opportunity for the future! Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)01359-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Ranjan R, Mittal A, Ranjan SK, Panwar V, Talwar HS. Ganglioneuroma presenting as an adrenal incidentaloma: Feasibility of adrenal-sparing surgery. J Minim Access Surg 2021; 17:389-391. [PMID: 34045401 PMCID: PMC8270040 DOI: 10.4103/jmas.jmas_147_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Adrenal ganglioneuromas (GNs) are very rare tumours that originate from neural crest cells. Most of the time, they are diagnosed incidentally as they are usually non-functional and remain asymptomatic. Nowadays, they are being detected more often due to better availability of imaging facilities such as computed tomography (CT)/magnetic resonance imaging (MRI). Minimally invasive adrenalectomy (laparoscopic or robotic) remains the standard of care for such lesions. Hereby, we report a case of a 15-year-old young girl with right adrenal incidentaloma which was diagnosed on CT with the features suggestive of GN. She underwent robot-assisted excision of the mass with adrenal-sparing surgery. Histopathology revealed benign GN and no adjuvant treatment was required. As GN is not known for recurrence or metastasis, minimal invasive adrenal-sparing surgery should be a preferred modality of choice.
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Affiliation(s)
- Rohit Ranjan
- Department of Urology, All India Institute of Medical Science, Rishikesh, Uttarakhand, India
| | - Ankur Mittal
- Department of Urology, All India Institute of Medical Science, Rishikesh, Uttarakhand, India
| | - Satish Kumar Ranjan
- Department of Urology, All India Institute of Medical Science, Rishikesh, Uttarakhand, India
| | - Vikas Panwar
- Department of Urology, All India Institute of Medical Science, Rishikesh, Uttarakhand, India
| | - Harkirat Singh Talwar
- Department of Urology, All India Institute of Medical Science, Rishikesh, Uttarakhand, India
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Ranjan R, Mittal A, Panwar V, Narain TA, Talwar HS, Mammen KJ. Extending Horizon of Robotic Surgery to Bladder-Preserving Approach for Vesical Paraganglioma: Rare Case with Unusual Presentation. J Endourol Case Rep 2020; 6:319-321. [PMID: 33457663 DOI: 10.1089/cren.2020.0077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Background: Vesical paraganglioma is rare and accounts for <0.1% of all urinary bladder tumors. They are mostly functional because of secretion of catecholamines and clinical presentation may mimic like a hyperfunctioning adrenal pheochromocytoma. They are easily misdiagnosed as urothelial malignancy and adequate perioperative attention is not provided. Case presentation: We hereby report a case of 55-year-old Indian lady with silent vesical paraganglioma at anatomically difficult location of bladder neck managed with robot-assisted excision of mass and bladder preservation. Conclusion: Surgery is the mainstay of the treatment that requires total excision of mass. However, minimally invasive bladder-preserving approach should be always kept as an option, if feasible. Robot assistance can help in bladder preservation even in difficult anatomic locations.
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Affiliation(s)
- R Ranjan
- Department of Urology, All India Institute of Medical Science (AIIMS), Rishikesh, Uttarakhand, India
| | - A Mittal
- Department of Urology, All India Institute of Medical Science (AIIMS), Rishikesh, Uttarakhand, India
| | - V Panwar
- Department of Urology, All India Institute of Medical Science (AIIMS), Rishikesh, Uttarakhand, India
| | - T A Narain
- Department of Urology, All India Institute of Medical Science (AIIMS), Rishikesh, Uttarakhand, India
| | - H S Talwar
- Department of Urology, All India Institute of Medical Science (AIIMS), Rishikesh, Uttarakhand, India
| | - K J Mammen
- Department of Urology, All India Institute of Medical Science (AIIMS), Rishikesh, Uttarakhand, India
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Kumar V, Dhaka SK, Panwar V, Singh N, Rao AS, Malik S, Yoden S. Detection of Solar Cycle Signal in the Tropospheric Temperature using COSMIC Data. CURR SCI INDIA 2018. [DOI: 10.18520/cs/v115/i12/2232-2239] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Kumar N, Panwar V, Borm JH, Chai J, Yoon J. Adaptive neural controller for space robot system with an attitude controlled base. Neural Comput Appl 2012. [DOI: 10.1007/s00521-012-1186-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Panwar V, Kumar N, Sukavanam N, Borm JH. Adaptive neural controller for cooperative multiple robot manipulator system manipulating a single rigid object. Appl Soft Comput 2012. [DOI: 10.1016/j.asoc.2011.08.051] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Kumar N, Panwar V, Sukavanam N, Sharma S, Borm J. Neural network-based nonlinear tracking control of kinematically redundant robot manipulators. ACTA ACUST UNITED AC 2011. [DOI: 10.1016/j.mcm.2011.01.014] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Roberts R, Speers L, Cowman G, Panwar V, Roseblade C. O803 Immediate emotional response as a predictor of subsequent psychological problems following early pregnancy loss. Int J Gynaecol Obstet 2009. [DOI: 10.1016/s0020-7292(09)61176-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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