Prevalence of Congenital Malaria in Minna; North Central Nigeria

The study was designed to determine the true prevalence of congenital; cord; and placental malaria in General Hospital Minna; North Central Nigeria. Peripheral blood smears of near-term pregnant women; as well as the placental; cord; and peripheral blood smears of their newborn babies; were examined for malaria parasites; using the Giemsa staining technique. Out of 152 pregnant women screened; 21 (13.82) of them were infected with malaria parasites. Of the 152 new born babies; 4 (2.63) showed positive peripheral parasitaemia. Placental parasitaemia was 7/152 (4.61); while cord blood parasitaemia was 9/152 (5.92). There were strong associations between peripheral and cord malaria parasitaemia and congenital malaria (P 0.05). Plasmodium falciparum occurred in all; and none had mixed infection. The average birth weights of the babies delivered of nonmalarious pregnant women were higher than those delivered by malarious pregnant women; though not significant (P 0.05). Malaria parasitaemia occurred more frequently in primigravidae than multigravidae

Extracorporeal shock wave lithotripsy versus lasertripsy for the treatment of upper ureteric calculi

Objectives: To compare the efficacy, cost effectiveness and safety of both ESWL and Holmium:YAG laser lithotripsy for the management of upper ureteric stones.Patients and Methods: One hundred and eight patients of various age groups and of both sexes who had primary or recurrent unilateral or bilateral upper ureteric stones underwent 108 primary procedures and 19 ancillary procedures (total: 127) including in-situ ESWL (60 patients) using the Dornier MPL 9000 machine and ureteroscopy combined with Holmium:YAG laser lithotripsy (46 patients). Results: The overall stone-free rate was (93.75%) for cases subjected to uretero-scopy in combination with laser lithotripsy and (91.7%) for cases subjected to ESWL. For stones < 1 cm, the success rate was 100% in the laser and 95.65% in the ESWL group. For stones > 1 cm, the success rate was 90% in the laser and 78.6% in the ESWL group. For impacted stones, the success rate was 92.85% in the laser and 72.7% in the ESWL group. The EQ for the laser and ESWL groups was 0.86 and 0.73, respectively. The complication rate was 12.53% in the laser and 11.7% in the ESWL group. The average cost (in Egyptian pounds) was 1618.1 £E for Holmium: YAG laser treatment and 1069.1 £E for ESWL treatment. Conclusion: Apart from impacted stones and stones larger than 1 cm, ESWL is the first line of choice as a treatment modality for upper ureteric stones. However both ESWL and URS combined with holmium: YAG laser lithotripsy may be complementary to each other in treating upper ureteric stones

Diagnosis of unilateral single system ectopic ureter in girls in the era of magnetic resonance urography (MRU)

Objective: The ectopic ureter frequently drains an ectopic dysplastic or hypoplastic kidney. The present study aims at defining the role of MRU in establishing the diagnosis of this anomaly. Patients and Methods: Between February 1996 and March 2000; 11 girls presented or were referred to our department for management of urinary incontinence. Their age at presentation ranged from 4-9 years (mean 6.5 years). Radiological work up included abdominal ultrasound (US); excretory urogram (IVU); voiding cystourethrography (VCUG); 99 m technetium-dimercaptosuccinic acid (99m Tc-DMSA) renal scan; enhanced spiral computed tomography (CT) and magnetic resonance urography (MRU). Results: Ultrasound showed evidence of a solitary kidney with failure to visualize a contralateral kidney in 7/11 patients. In the remaining 4 patients (36.4); US revealed a pelvic kidney in two and a pelvic cystic mass in another two patients. IVU revealed only one functioning renal unit in all cases. None of the patients showed vesicoureteral reflux on VCUG. On 99m Tc-DMSA ; a single kidney was seen in 9/11 patients and ectopic pelvic kidneys with normal contralateral kidneys in 2/11 patients. The 7 patients; in whom US and 99m Tc-DMSA scan had failed to localize the kidney; underwent CT scanning which visualized a pelvic hypoplastic kidney with a normal contralateral kidney in 2/7 patients. The remaining 5 patients underwent MRU that disclosed a normal kidney with a contralateral lumbar hypoplastic kidney in one and a pelvic ectopic kidney in four. The patients were managed by nephrectomy (n=9) and ureteroneocystostomy (n=2). Conclusions: A single system ectopic ureter should be suspected in all girls with continuous urinary dribbling after the age of successful toilet training. With the inclusion of MRU into radiological workup; dysplastic or hypoplastic kidneys can be accurately localized. MRU is indicated for the diagnosis and for therapeutic planning in such cases

Assiut experience in the application of holmium laser in treatment of ureteral calculi in adults

Objective This study was carried out to evaluate the safety and efficacy of holmium:YAG laser in the treatment of ureteral calculi in adults. Patients and Methods Between April 1999 and November 2000; one hundred and seven patients presented to the urology department of Assiut university with symptomatic ureteral stone disease in different locations. The patients were divided into three groups according to the stone location which was determined radiologically. Group I included 38 patients with stones located in the upper third of the ureter; Group II included 19 patients with stones located in the middle third of the ureter and Group III included 50 patients with stones located in the lower third of the ureter. Lithotripsy was done in all patients using the Holmium:YAG laser machine. The stone-free status was checked three months after the procedure. Patients with residual stones were scheduled for another session. Results In Group I; 38 patients with 38 stones underwent 39 procedures for intracorporeal lithotripsy. Eight patients presented with obstructive anuria and elevated blood urea and serum creatinine. Complete stone fragmentation was achieved in 37 cases; while in one case the stone migrated to the kidney and was treated by ESWL. In Group II; 19 patients underwent 20 procedures. Re-treatment after three weeks was necessary in one case due to ureteral wall injury and minimal extravasation. Four patients presented with obstructive anuria; while in 6 patients the stones were impacted. Complete fragmentation could be achieved in all cases. In Group III; 50 patients underwent 51 procedures. A re-treatment session was required in one patient after three months due to a residual stone (5 mm) detected during follow up. In eleven cases the stones were impacted; and one patient had bilateral lower ureteral stones treated in the same session. Out of 50 patients with 55 stones; 54 stones (98.1) were completely fragmented and cleared in a single session. Conclusion Holmium:YAG laser lithotripsy is a safe and effective modality for the treatment of ureteral stones.Key Words Holmium:YAG laser; ureter; lithotripsy

Evaluation of staged fowler-stephens orchiopexy for the high abdominal testis

Objective: To evaluate staged Fowler - Stephens orchiopexy for the high intra-abdominal testis. Patients and Methods: The study included 78 patients with laparoscopically diagnosed high intra-abdominal testes. Their age ranged from 2 -16 years. All cases underwent staged Fowler - Stephens orchiopexy. The first stage was done during diagnostic laparoscopy by clipping the internal spermatic artery and vein 2-3 cm superior to the intra-abdominal testis. Six months later the second stage of the procedure in the form of open (67 cases) or laparoscopic orchiopexy (11 cases) was performed. Only 65 patients were available for follow up at 6 and 18 months following the second stage. At each follow-up visit; the testicular position; size and viability were assessed by Technetium 99 (Tc99m) testicular scintigraphy. Results: Out of 78 cases; 10 had bilateral high intra-abdominal testes. Second stage open orchiopexy was done in 67 cases while the remaining 11 cases were subjected to laporoscopic orchiopexy. No operative or postoperative complications were detected apart from a prolonged ileus after the second stage in 6 patients. On follow up; 49 testes were scrotal and of good size while 6 testes were scrotal and atrophic. In the remaining 10 cases the testes were at the neck of the scrotum and of good size. Tc99m testicular scintigraphy was done in 65 cases. A good perfusion was detected in the majority of them (59 cases) while no radiotracer accumulation was detected in the remaining 6 cases. Conclusion: Laparoscopic clipping of the gonadal vessels is safe in patients with high abdominal testes. The staged approach with preservation of the testicular collateral vascular supply provides an adequate viability of the high abdominal testis with a high success rate. Tc99m testicular scintigraphy allows a proper assessment of the testicular viability as compared to measurement of the testicular size only