Retroiliac ureter presenting as right upper ureteric obstruction – report of a rare case.

Retroiliac ureter is an extremely rare urological entity in which the ureter passes deep to the iliac vessels. Congenital causes are most often secondary to vascular variants. A 39 year old lady presented with one month history of right loin pain. CECT showed right gross HUN till L3 and EC renogram showed 33% function in right kidney with obstructive pattern. RGP revealed Right Pelvic Ureteric Junction Obstruction (PUJO) obstruction, but at exploration was found to have retroiliac ureter. Ureteral division with anterior relocation and dismembered pyeloplasty was done. Anomalous vascular structures are often not diagnosed until surgical intervention for an obstruction of unknown etiology, unless vascular studies are considered, Most of these patients require surgical exploration to exclude tubercular stricture or malignant process

Extensive xanthogranulomatous cystitis mimicking bladder cancer

Xanthogranulomatous cystitis [XC] is a rare benign disease of unknown etiology. A 39-year-old female presented with 2 month history of urgency, dysuria, lower abdominal mass. On physical examination a hard hypogastric mass was present fixed to the rectus muscle. Computerized tomography [CT] abdomen showed heterogeneous enhancing mass arising from the anterior bladder wall with infiltration of the overlying parietal wall. Cystoscopy revealed extensive growth involving the entire wall of the bladder. A biopsy showed cystitis with focal areas suggestive of urothelial neoplasia of unknown malignant potential. Suspecting bladder cancer, we proceeded with radical cystectomy with ileal conduit. Histopathology revealed cystitis cystica with XC of the entire bladder. This is, to our knowledge, the first time that a case has been found to be so extensive with infiltration of the parietal wall and second time that radical cystectomy has been performed for XC

Synthesis and antimicrobial study of N-[4-(2-piperidine-1-yl-ethoxy) phenyl] acetamide analogues.

In the present study, a novel series of N-[4-(2-piperidine-1-yl-ethoxy) phenyl]- acetamides were synthesized from 4-aminophenol and characterised by IR, 1H-NMR, Mass spectral studies and elemental analysis. The antimicrobial potency of compounds is tested against variety of fungal and bacterial strains by disc agar diffusion technique. in comparison to to fluconazole and chloramphenicol respectively. Some of the synthesized compounds exhibit the potency comparable to that of standard drugs.

Osteomyelitis of the mandible due to Aggregatibacter (Actinobacillus) actinomycetemcomitans.

Aggregatibacter (Actinobacillus) actinomycetemcomitans is a capnoic gram negative coccobacilli known to produce juvenile periodontitis. This organism was isolated in pure culture from an unusual case of osteomyelitis of the mandible. The patient was treated with tetracycline, which is the drug of choice for A. actinomycetemcomitans and the clinical response improved. From our limited review of the literature, it appears that this is the first case of osteomyelitis due to A.actinomycetemcomitans reported in India.

Potentiation of antinociceptive effect of NSAIDs by a specific lipooxygenase inhibitor, acetyl 11-keto-beta boswellic acid.

The present study was aimed to assess the combined effects of cyclooxygenase and 5-lipoxygenase (COX/5-LOX) inhibitors in different animal models of nociception. Naproxen, nimesulide and rofecoxib are well-established antinociceptive agents acting via COX inhibition. AKBA (acetyl-keto-beta-boswellic acid) is a 5-LOX inhibitor. AKBA (50-200 mg/kg) produced a dose dependent and significant antinociceptive effect in different animal models of nociception. Based on the earlier reports from our laboratory, sub effective doses of all the three COX Inhibitors were selected and they were administered (naproxen, 5 mg/kg; nimesulide, 1 mg/kg; and rofecoxib, 1 mg/kg) with AKBA (100 mg/kg). This produced a more significant antinociceptive effect as compared to per se effect observed in all the three models of nociception. However, the effect of combination of nimesulide with AKBA was more pronounced as compared to naproxen and rofecoxib and their combination with AKBA. The present finding provided an evidence for the potentiation of antinociceptive effect of NSAIDs with AKBA. Such a combination may help to reduce the therapeutic doses of conventional NSAIDs and also reduce side effects (gastric, cardiac and renal) that are popularly associated with the NSAIDs.

Post lumbar puncture spinal subarachnoid hematoma causing paraplegia: a short report.

A 53 year old male underwent total excision of a large sphenoidal wing meningioma. Patient was treated with cephalosporins and phenytoin for postoperative meningitis. Three weeks after surgery, a follow up lumbar puncture was done. The patient became paraplegic over a few hours. Imaging of the dorsolumbar spine and other investigations demonstrated a large intraspinal hematoma caused by thrombocytopenia which was probably drug induced. After normalising the platelet count surgical evacuation of the spinal subarachnoid hematoma was done. Relevant literature is reviewed.

Socio-demographic and maternal determinants of low birth weight: a multivariate approach.

A community based study was conducted in the rural areas of Udupi taluk, Karnataka state of South India to identify the socio-demographic, maternal and obstetric determinants of low birth weight. All singleton live births that occurred in the study area during a one year period (October 1991 to September 1992) were included. A total of 2919 singleton child-mother pairs formed the basis of the analysis. Information about social, demographic and economic conditions of the families; maternal factors such as age, parity, quality of antenatal care and previous obstetric history were collected by interviewing the mothers and family members and verifying the available medical records through the field investigators especially recruited and trained for this purpose. Data was analyzed using multiple logistic regression model. Primis, elderly mothers and mothers who had not received good quality antenatal care were found to be more at risk of having low birth weight babies. Other significant determinants were family custom, socio-economic status and environmental sanitation.

Perinatal mortality in a rural district of south India.

Perinatal mortality is one of the most sensitive indices of maternal and child health. The perinatal mortality rate is an indicator of the extent of pregnancy wastage as well as of the quality and quantity of health care available to the mother and the newborn. A community based prospective study carried out on 13,214 births in South Kanara district between Oct. 1991-Sept. 1992 revealed a perinatal mortality rate (PNMR) of 44.65/1000 births. Among the various factors influencing perinatal mortality, breech deliveries and babies of multiple pregnancies had a very high perinatal mortality rate of 180.81/1000 births (adjusted odd's ratio: 4.90) and 128/1000 births (adjusted odd's ratio: 2.64). The previous bad obstetric history of the mother, parity and sex of the newborn were among the other important factors influencing the PNMR.

Infant feeding--knowledge and attitudes in a rural area of Karnataka.

A study of the knowledge and attitude towards infant feeding was conducted in South India on a group of 300 mothers whose babies' ages from 3 days to 17 months. Most of the mothers opined that breast-feeding had to be initiated within 24 hours of birth. However, only 32% felt that breast milk should be the first feed, whereas 68% considered prelacteal feeds a necessity. 71% of the mothers considered 3 to 5 months to be the optimum duration of exclusive breast-feeding. 90% felt that cow's milk was an ideal supplement. 78.3% subscribed to the view that breast-feeding should continue beyond one year. A sizeable proportion expressed the need to discontinue breastfeeds during babies' or maternal illness, particularly diarrhoea. Our results will form the babies of the content and the target groups in our future health education programme.