No abstract

Background: Among many lithotripters available for fragmentation of ureteric stones, pneumatic and Holmium: YAG laser lithotripsy have reported favorable outcomes. Aim of this study is to compare the intracorporeal Holmium: YAG laser with pneumatic lithotripsy in ureteral calculi fragmentation in terms of fragmentation time, stone migration, intra-operative and post-operative complications, stone free rate and need for auxiliary procedures. Material & Methods: Fifty patients selected with diagnosis of calculus in ureter suitable for endoscopic treatment. They were subsequently randomized in to two groups by sealed envelope method. Group 1 was treated with Holmium: YAG laser lithotripsy and group 2 with pneumatic lithotripsy. All patients with ureteral calculi of size 6-20 mm were included while stone size >20mm, patients with sign of sepsis, pregnancy, renal insufficiency or urinary tract abnormalities were excluded from the study. Results: Maximum number of cases (64%) were from 21-40 years age group in both the groups, while least number of cases (8% of all) were from age group <20 years in pneumatic (4%) and Holmium group (12%) respectively. At six weeks, only 22 patients were stone free in pneumatic group (88%) while all patients in holmium group (100%) were free of stones. However, difference was not statistically significant (p=0.074). Conclusion: Both Holmium: YAG laser lithotripsy and Pneumatic lithotripsy are very safe methods of ureteroscopic stone fragmentation in experienced hands. However, Holmium: YAG laser is more successful in treatment of upper ureteric stones.

Isolated diaphragmatic injury in blunt trauma occurs acutely and can be associated with other life-threatening organ injuries. A sudden increase in abdominal pressure causes injury in the membranous or muscular part of the diaphragm. Isolated left diaphragmatic injury after blunt trauma is rarely seen, its diagnosis can be overlooked frequently. Early diagnosis is the most important step in the treatment thereby reducing morbidity and mortality. The most critical point during the diagnosis is the suspicion for clinical diaphragm injury like respiratory distress. Single or serial plain chest radiographs with a high index of suspicion are diagnostic in most cases. Computed tomography of the abdomen and thorax can be a guide for identifying the size of diaphragmatic injury and the contents. In this case report, we presented an isolated left side diaphragmatic rupture after blunt abdominal trauma and treated with an urgent surgical operation.