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Varicocelectomy remains the same mainstay of treatment for varicoceles. However, with growing focus on minimally invasive techniques, recent literature has investigated the use of venous embolization for the treatment of varicoceles in patients with recurrence after surgical treatment. Embolization has many advantages, including use of local anaesthesia, lower operating time, decreased risk of hydrocele and faster recovery times. In addition to this direct visualization of the vasculature during embolization allows for identification of any anatomic variants or collateral vessel accounting for the recurrence. This permits more definitive treatment in case of prior surgical failure. We present a case series where venous embolization is successfully done following failure of varicocelectomy. For patients who experience recurrence after a varicocelectomy, we recommend consideration for varicocele embolization.

Background: The volume of medical knowledge has increased exponentially and so has the need to improve the efficiency of current teaching practices.With increasing emphasis on interactive and problem based learning, the place of lectures in modern medical education has become a questionable issue. Objectives were to assess the perspective of undergraduate medical students regarding the role and effectiveness of lectures as a mode of instruction as well as the ways and means that can be employed to enhance the effectiveness of lectures., Methods: A cross sectional study was carried out among 2nd to final year medical students from five medical colleges including both private and public sector institutions. A total of 347 students participated by completing a structured questionnaire. Data was analyzed using SPSS-17., Results: Sixty seven percent students considered lectures as a useful mode of instruction (47% males and 77% females), whereas 83% of the students reported that clinical sessions were superior to lectures because of small number of students in clinical sessions, active student participation, enhanced clinical orientation, and interaction with patients. About 64% responded that lectures should be replaced by clinical sessions. Majority of the students (92%) reported not being able to concentrate during a lecture beyond 30 minutes, whereas 70% skipped lectures as they were boring. A significantly greater proportion of male respondents, students from clinical years, and those who skipped lectures, considered lectures to be boring, a poor utilization of time and resources, and could not concentrate for the full duration of a lecture compared to females, students from preclinical years, and those who do not skip lectures, respectively., Conclusion: Lecturing techniques need to be improvised. The traditional passive mode of instruction has to be replaced with active learning and inquiry based approach to adequately utilize the time and resources spent on lectures.

Background: Teaching bedside manner might prove to be one of the most challenging tasks in medical education as it is not easy to structure or formalise such training. Besides, the rigorous training process for acquiring clinical and technical skills often overshadows the humanistic aspect of medical care. The aim of this study was to assess the perception of final year medical students as well as the faculty regarding the teaching and practice of bedside manner including a brief evaluation of students' bedside manner., Methods: A cross-sectional study was conducted involving final year medical students from five medical colleges (n = 193) and faculty from a single institution (n=29). Sample was selected using systematic random or convenient sampling techniques. Data was collected using self administered, anonymous, structured questionnaire. Data were analysed using SPSS-17., Results: While evaluating students' bedside manner, 85% of the students reported they always take consent while interacting with a patient whereas, only 17% of the faculty members agreed with this. Only 3% of the faculty members reported that students take care of privacy of patients and none of them thought that students reassure a patient during an encounter whereas the percentages among students were 76% and 48%, respectively. Though students thought they need to improve, majority (56%) of them was confident of their bedside manner. On the other hand, 83% of the faculty members rated students' bedside manner from fair to poor. A large proportion (69%) of the faculty members were not satisfied with the quality of teaching regarding bedside manner, reporting lack of focus on this particular aspect of medical care as the most important cause. Majority of the students (87%) believed doctors have a better bedside manner in private as compared to public hospitals., Conclusion: Students have an inflated evaluation of their bedside manner but majority felt a need to improve. A sharp contrast exists between students' and faculty's opinion regarding the practice of bedside manner by students. An outright lack of focus on bedside manner was reported as the most important cause for inadequate emphasis on teaching this particular aspect of medical care.

Background: Haemodialysis is the primary mode of renal replacement therapy for patients of end stage renal disease. The most important determinant for effective haemodialysis is a reliable vascular access. Arterio-venous (AV) fistula is the closest to be an ideal long-term haemodialysis vascular access. The creation of fistulas or grafts is recommended before starting haemodialysis, this study was undertaken to determine the impact of timing of AV fistula creation on its failure rate., Methods: It is a descriptive study. All patients with chronic kidney disease (CKD) reporting to Armed Forces Institute of Urology (AFIU) and Military Hospital (MH) Rawalpindi from January 2008 to October 2009 in whom vascular access was created were included. The patients were followed prospectively and a complete data about their haemodialysis and vascular access was maintained., Results: A total of 168 permanent accesses were created in 112 patients in this study. The mean duration of follow-up was 14.05 +/- 4.45 months. Early access creation group included 23 patients and late access creation group included 89 patients. Out of 168 fistulas that were created, 54 fistulas failed with 45 (83.3%) of these from patients of late access creation group. Age, gender and diabetes mellitus (DM) had no significant affect on failure rate of fistulas., Conclusion: Timely referral to nephrologists and early creation of permanent vascular access by dedicated team work can improve the success rate of AV fistulae so enhancing quality of life of patients of end stage renal disease.