Inpatient interventions that may preclude outpatient open pyeloplasty in infants

ABSTRACT Objective: In the majority of published series, children undergoing open pyeloplasty are admitted for at least one night. We hypothesized that it would be possible in the majority of infants to perform open pyeloplasty as an outpatient procedure. Materials and Methods: All patients who underwent open pyeloplasty by a single surgeon between 2008 and 2016 were retrospectively reviewed. Demographic data (age at surgery, gender, pre- and postoperative imaging studies, laterality, type of local anesthesia), operative time, duration of hospital stay, need for narcotic analgesics, complications, readmission within 1-month after surgery and need for additional procedures were abstracted. Results: A total of 18 infants underwent open pyeloplasty by single surgeon. Mean age at time of surgery was 19 months (range 3-23 months). There were 8 girls and 10 boys. In addition to general anesthesia, all of the patients received regional anesthesia (caudal block 8, epidural block 8, subcutaneous nerve block 2). Median operative time was 135 minutes (range 81-166). Median hospital stay was 1 day (range 1 to 2). Two patients required iv narcotics for pain management. None of the patients required parenteral administration of other medications during the short hospitalization. No patients required any additional procedures or hospital readmissions within 1 month from surgery. Conclusions: In appropriately selected patients, outpatient pyeloplasty appears to be feasible with an oral postoperative analgesia plan to be administered at home.

An unanswered question in pediatric urology: the post pubertal persistence of prepubertal congenital penile curvature correction by tunical plication

ABSTRACT Objective: The aim of this study is to analyze post pubertal results of pre pubertal tunica albuginea plication with non-absorbable sutures in the correction of CPC. Materials and Methods: The files of patients who underwent tunica albuginea plication without incision (dorsal/lateral) were retrospectively reviewed. Patients younger than 13 years of age at the time of operation and older than 14 years of age in November 2015 were included. Patients with a penile curvature of less than 30 degrees & more than 45 degrees and penile/urethral anomalies were excluded. All of the patients underwent surgery followed by circumcision. Results: The mean age of patients at the time of the operation was 9.7 years (range, 6-13 years). The mean degree of ventral penile curvature measured during the operation was 39 degrees while it was 41 degrees in the lateral curvatures. All of the patients were curvature-free at the end of the operation. At the time of the follow-up examination, the mean age was 16.7 years (range, 14-25 years). Six patients had a straight (0-10 degrees) penis during erection and seven patients had recurrent penile curvatures ranging from 30 to 50 degrees. Conclusion: Pre pubertal tunica albuginea plication of congenital penile curvature (30-45 degrees) with non-absorbable sutures performed without incision is a minimal invasive method especially when performed during circumcision. However, recurrence might be observed in half of the patients after puberty.

The Early Histological Effects of Intravesical Instillation of Platelet-Rich Plasma in Cystitis Models / 대한배뇨장애요실금학회지

PURPOSE: To evaluate the early histological effects of the intravesical instillation of platelet-rich plasma (PRP) in rabbit models of interstitial and hemorrhagic cystitis. METHODS: Thirty-six rabbits were classified into 6 groups: saline (S), S+PRP, hydrochloric acid (HCl), HCl+PRP, cyclophosphamide (CyP), and CyP+PRP. At 48 hours after induction, PRP was prepared and intravesically administered to the S+PRP, HCl+PRP, and CyP+PRP groups. Bladder sections were stained with toluidine blue for mast cell counting and with hematoxylin and eosin for histopathology and mitotic index determination. The proliferation index was determined by proliferating cell nuclear antigen (PCNA) immunolabeling. The nonparametric Mann-Whitney U-test was used for statistical analysis. RESULTS: No abnormalities were observed in the S group, whereas increased interstitial edema and increased average mitotic and proliferation indices were observed in the S+PRP group (P=0.023, P=0.004, and P=0.009, respectively). Intense epithelial loss, hemorrhage, and leukocyte infiltration were detected in the HCl and HCl+PRP groups, whereas a significantly increased average mitotic index was observed in the HCl+PRP group (P=0.002). When compared with its CyP counterpart, a significant reduction in hemorrhage and an increase in leukocyte infiltration and mitotic index were observed in the CyP+PRP group (P=0.006, P=0.038, and P=0.002, respectively). In addition, PCNA staining revealed a significantly increased proliferation index in the HCl+PRP and CyP+PRP groups (P=0.032 and P=0.015, respectively). CONCLUSIONS: The intravesical instillation of PRP increased the mitotic index in the saline and cyclophosphamide groups while decreasing macroscopic bleeding.

Effectiveness of sterilization and disinfection of extracted human teeth for institutional use: a case control study conducted at a tertiary care hospital

Objectives: To determine the most effective method of sterilization and disinfection of extracted human teeth foruse in dentalcolleges

Study Design: Case Control study

Place and Duration of Study: This study was conducted at OMFS and Microbiology Department, KMDC, Karachi from June 2013 to December 2013

Materials and Methods: Freshly extracted human teeth [n=50] were obtained and sent for bacteriological processing. Teeth were dividing into 5 groups; samples were taken pre and post treatment. A platinum wire loop was flamed in red heat and cooled; sample was inoculatedinC for 48 hours. Colony count was noted to observe the quantity of microorganism, which determines the efficacy of the sterilizing method

Results: The results of the study revealed that the autoclave, hot air oven had shown no growth.While5% sodium hypochlorite, hydrogen peroxide and normal saline had shown positive growth of microorganisms

Conclusion: Autoclave and Hot air oven are effective methods of sterilization of extracted human being teeth for use in dental college in preclinical settings

rare variant of multiple myeloma; non-secretory myeloma with diffuse osteolytic lesions

Non-secretory myeloma is a very rare entity of plasma cell dyscrasia. It is delineated as symptomatic myeloma without detectable monoclonal immunoglobulin peak on serum or urine electrophoresis with normal immunoquantification. Due to the inability to detect monoclonality often it is difficult to ascertain an early and accurate diagnosis. Misdiagnosing results to undue delay in therapeutic intervention. Consequently extensive imaging studies, serum free light chains detection and morphological confirmation are mandatory. Lytic bone lesions are less frequently seen in this type of myeloma. Here we report the case of a patient with this rare variant having diffuse osteolytic lesions in whom we established the diagnosis by bone marrow examination and document light chain restriction by immunophenotyping. Patient is classified as stage III according to Durie and Salmon criteria in view of anemia and multiple lytic lesions observed

Evaluation of enzyme linked immunosorbent assay (ELISA) for IgG in the diagnosis of human hydatid disease.

The aim of this study was to evaluate the role of ELISA for IgG antibodies against Echinococcus granulosus in detecting hydatid disease of liver and lung. The levels of IgG antibodies against Echinococcus granulosus were measured by indirect ELISA. A total of 32 patients were included in this study of which 20 had hydatid cysts in liver and 12 had in lung. Among 20 patients with hydatid cysts of liver, 18 had positive serology while 2 had negative serology. In patients having cysts in lung, 9 had positive serology while 3 had negative. The test showed 90% sensitivity in the diagnosis of hepatic cysts. However the sensitivity of this test was only 75% for pulmonary cysts. The overall diagnostic sensitivity of IgG ELISA in the diagnosis of both liver and lung hydatidosis was 84.37%. Conclusion: ELISA test is a sensitive test and can be used in the diagnosis of human hydatidosis.

Ultrasonic scissors-assisted 'open-book' thyroidectomy in massive goiter compressing airway and causing unilateral vocal cord paralysis

A massive goiter may constrict the trachea resulting in shortness of breath. Recurrent laryngeal nerve compression may cause vocal cord paralysis. We highlight a case of a 62- year-old female with a 30 year history of an anterior neck swelling gradually increasing in size. She presented with acute symptoms of upper airway obstruction and voice changes. Emergency thyroidectomy was performed by dividing the middle part of the gland using ultrasonic scissors. The recovery was uneventful and the patient regained normal vocal cord function post operatively.

Nasopharyngeal Hairy Polyp as a Rare Cause of Neonatal Respiratory Distress: A Case Report

Hairy polyps are rare developmental malformations. They are benign lesions presented as a pedunculated mass that may arise from the naso-oropharyngeal region. Larger mass can cause upper respiratory obstruction causing respiratory distress or feeding diffi culty, while smaller mass will present as intermittent respiratory distress due to a ball-valve type of obstruction. They are commonly seen in female, with ratio of 6:1 and majority of the cases occur in the infantile period. We are reporting a case of hairy polyp in a female infant that causing intermittent respiratory distress.

Outcome of Total Thyroidectomy and Subtotal Thyroidectomy in Non Toxic Multinodular Goiter: Hospital Universiti Sains Malaysia Experience

Introduction: Thyroid enlargement is one of the common surgical presentations in the Department of Surgery, Hospital Universiti Sains Malaysia (HUSM). Among them, benign non-toxic multinodular goiter constitutes one third (30%) of patients who underwent thyroidectomy. Common complications of thyroidectomy include recurrent laryngeal nerve (RLN) injury, hypocalcaemia, and recurrence of the thyroid lesion. Objective & Methods: This is a retrospective study of patients diagnosed with multinodular goiter treated in HUSM between January 1996 and December 2005. A total of 111 patients were studied and 52 of them underwent subtotal thyroidectomy while 59 underwent total thyroidectomy. The outcome in terms of RLN injury, hypocalcaemia and mass recurrence were analyzed. Results: Post operative complications were studied in both groups. Permanent recurrent laryngeal nerve injury occurs in 2.4% (1 case) in subtotal thyroidectomy group compared to total thyroidectomy group (3.6%, 2 cases). Five cases from total thyroidectomy group suffered from permanent hypocalcaemia but none in the other group. 70.7% (29 cases) from subtotal thyroidectomy group have functional remnant of thyroid tissue. Recurrence rate post subtotal thyroidectomy after 5 years is only 4.9% (2 cases). Conclusion: The post operative outcome in patients who underwent subtotal thyroidectomy in HUSM from January 1996 to December 2005 was better than total thyroidectomy with significant functional thyroid remnant.

Recurrent Glossal Leiomyoma

Oral leiomyomas are rare benign tumour of smooth muscle. The first case of oral leiomyoma was reported by Blanc in 1884 and since then more cases has been published following advancement in immunohistochemical study. This tumour has an excellent prognosis and recurrences are extremely rare. We report a case of a recurrent glossal leiomyoma in a patient with HIV infection and the lesion recurred one year after the first excision.

An Annual Audit Of The Ear Foreign Bodies in Hospital Universiti Sains Malaysia

Foreign bodies or objects in the ear are one of the most common problems encountered by otorhinolaryngologist (ORL) with attendant complications, removal of which requires expertise. Patients with this problem who sought treatment in the otorhinolaryngology clinic of Hospital Universiti Sains Malaysia (HUSM) were studied for duration of one year from January 2010 to December 2010. Specifically, the clinical presentation, type of foreign body and management outcome were analysed. 72 patients were reviewed - 44 (61.1%) males and 28 (38.9%) females. The age range was one year to 75 years with 59.8% being children below 10 years old. Ear pain (56.9%) was recorded as the most common and persistent symptom and insects (54%) were the commonest foreign body encountered. 95% (69) of the foreign bodies were removed under clinic setting with only three (4.2%) cases requiring general anaesthesia. Post-removal complications were noted in only one patient (1.4%). Repeated attempts by untrained personnel should be avoided and timely referral is vital to avoid undesirable complications.

Vesicovaginal fistula, causative factors and outcome of surgical management: an experience at PMC/allied hospital Faisalabad

Objectives: To assess the causative factors and outcome of surgical management of Vesicovaginal fistula [VVF] in our set up

Duration and Design of Study: Retrospective descriptional study from January 2008 to June 2012 conducted at Department of Urology PMC/Allied Hospital Faisalabad

Methodology: All patients with VVF who presented in our out patient department and underwent surgical repair in our department were included in this study. The records of patients were reviewed and data was entered in a structured proforma and analyzed. After history, physical examination, relevant investigations, IVU, Cystoscopy and vaginoscopy, patients were divided into two groups. Patients with supratrigonal fistula were operated through abdominal approach and those with infratrigonal fistula were operated through vaginal approach. The outcome of surgical procedures and post operative complications were noted

Results: This study included 68 patients. In 42 [61.76%] patients, cause of VVF was iatrogenic injury during hysterectomy, and 26 [38.24%] patients developed VVF due to obstetric causes. Fifty patients [73.53%] had supratrigonal fistula and eighteen patients [26.47%] were having trigonal or subtrigonal fistula. We achieved 90% and 83.33% success rate with abdominal and vaginal repair respectively

Conclusion: The most common cause of VVF is iatrogenic injury during hysterectomy. Both approaches of surgical repair had almost equally good results

Significance of serological monitoring for hepatitis b viral infection in hemodialysis patients

To find out the prevalence of Hepatitis B by serologicai monitoring in chronic hemodialysis patients. The study was carried out in the department of Microbiology BMSI, JPMC Karachi, from January 2010 till February 2011. Two hundred blood samples were coiiected from the patients on chronic maintenance hemodialysis from the different hospitals/ dialysis centres in Karachi, that had at least twenty cycles of hemodialysis in tertiary care hospitals of Karachi. Biood was collected from each patient and the test was performed according to the standard protocol. Out of 200 patients, 51 [25.5%] patients were already vaccinated for HBV while in 149 [74.5%] patients there was no history of HBV vaccination. Among these 149 patients, 32 [21.47%] showed seropositivity for HBV infections in our study. The risk for acquiring these infections is significantly as-sociated with increasing duration of dialysis. Mean age of 56.7_SD 0.68 years with male predominance. There are only 25.5% patients who were vaccinated against HBV infection among 200 patients. The study revealed that HBV prevalence was commonly found among dialysis patients and only quarter of them were vaccinated. The vaccination should be mandatory in dialysis centers to prevent and control hepatitis B in hemodialysis units

A CHILD WITH EPISTAXIS, REDUCED HEARING AND CERVICAL LYMPHADENOPATHY: A RARE CASE OF NASOPHARYNGEAL CARCINOMA IN A CHILD

Although nasopharyngeal carcinoma (NPC) is common in this part of the world, the incidence among children is still very low worldwide. The diagnosis is sometimes delayed because of the late reporting of the symptom by the patient or parents, or difficulty in reaching the final diagnosis due to its hidden anatomical location. The challenges include the difficult endoscopy in children, inability to differentiate an adenoid from the tumour on radiograph and often the inconclusive fine needle aspiration findings. If the tumour mass at Fossa of Rosenmuller can be clearly appreciated and biopsied with undoubtedly proven histology of NPC, the diagnosis can be straight forward and treatment can be commenced as early as possible. We report a 10-year-old child presented with bilateral neck cervical lymphadenopathy and epistaxis with fine needle aspiration cytology (FNAC) of the neck mass reported as lymphoma. Further work-up confirmed he was suffering from NPC.

Etiological determinants of congenital pelviureteric junction obstruction

Congenital ureteropelvic junction obstruction is an important and treatable cause of neonatal hydronephrosis. It may be due to congenital absence of nerves leading to adynamic segment causing functional obstruction. It may also be due to defective muscular arrangement and replacement of muscles by fibrosis leading to anatomical obstruction or it may be caused by extrinsic compression by aberrant lower polar vessel. The aim of the present study is to define the etiological determinants of congenital PUJ obstruction

Objectives: To study the macroscopic abnormalities of congenital PUJ obstruction and correlating theses abnormalities with the microscopic and immunohistological findings

Material and Methods: It was a cross sectional observational study and patients presenting to outpatients department, irrespective of age and sex, with the diagnosis of PUJ obstruction and needing surgery were included in the study. Anderson Hynes Pyeloplasty was done in all cases and resected portion of redundant pelvis and narrow segment was submitted for histopathological and immunohistological examination

Results: Congenital PUJ obstruction was more common in males with a male to female ratio of 2:1 and it was common on left side in 55.55% cases. Presentation was in wide age range patients [2-40 years]. In 33.33% patients it was structural abnormality where we were unable to pass feeding tube and in 66.66% patients it was functional abnormality where it was distensible PUJ. Predominantly circular muscle arrangement was seen in 15[57.69%] cases. Varying degree of replacement of muscle fibers with fibrous tissue was seen in all cases and total replacement in those where kidney was nonfunctional due to PUJ obstruction. Nerves were present in 5/26 [19.23%] cases. In 4/5 [80%] cases of crossing vessels, nerves were present

Conclusion: Most cases of congenital PUJ obstruction are due to functional obstruction but anatomical obstruction also has a significant contribution [33.33%].Predominant circular muscle arrangement is the abnormality leading to impaired peristalsis. Absence of nerves leading to functional obstruction is the major defect in congenital PUJ obstruction. Crossing vessel is the real cause of PUJ obstruction mechanically compressing the PUJ in vascular tangle cases

Gentamycin induced nephrotoxicity in albino mice

Twelve, male albino mice, aged 6-8 weeks, were injected intraperitoneally, aqueous solution of gentamicin [80 mg / kg / day] for fifteen days and the effects observed on the kidney structure and function. Group A served as control while Group B was given gentamicin. At the end of the experiment, blood was drawn from each animal by cardiac puncture for renal function tests and kidneys were fixed for histological studies. In group B, values of serum urea [66.40 +/- 0.54 mg/dl] and serum creatinine [1.41 +/- 0.08 mg/dl] were significantly increased [p < 0.001] when compared with control group A [34.73 +/- 0.84 and 0.53 +/- 0.04 mg/dl respectively]. Both body weight [p < 0.001] and kidney weight [p < 0.05] decreased significantly in gentamicin treated groups. In histological preparations from group B, the proximal convoluted tubules in cortex were dilated and their epithelial cells showed hydropic changes with cytoplasmic vacuolations in some areas. Loss of brush border, patchy necrosis, presence of cellular debris and accumulation of inflammatory exudates within lumina of proximal convoluted tubules were also observed. The renal medulla from group B, showed an increase in intra-luminal tubular protein casts. Chi-square test showed statistically significant [p < 0.00] association between tubular necrosis and tubular casts. It is concluded that gentamycin is nephrotoxic in albino mice

Frequency of peptic ulcer in patients having decompensated cirrhosis of liver

Hepatitis B and C are spreading like an endemic disease in developing countries like Pakistan, due to many reasons. The late diagnosis of HCV and HBV infection has resulted in increased number of patients with decompensated liver disease. One of the common complications of cirrhosis is upper GI bleed caused by peptic ulceration in UK. Local data shows peptic ulceration was the second commonest of the lesions causing upper GI bleed after esophageal varices. Present study was conducted to determine the frequency of peptic ulcer in patients having decompensated cirrhosis of liver presenting with upper GI bleed, also to emphasize the importance of primary prophylaxis with proton pump inhibitors for prevention of peptic ulcer in these patients. Descriptive study. MU-III Allied Hospital Faisalabad. Hundred consecutive patients having decompensated cirrhosis of liver were selected according to pre designed proforma and endoscopy was performed to determine the site of bleeding, from Jun to November 2007. This study showed peptic ulcer as the second most important cause of upper GI bleed [34%] after esophegeal varices [57%], also decompensate cirrhotics have increased incidence of peptic ulceration [34%] as compared to general population [8.3%]. Also significant relationship between source of upper GI bleed and serum albumin level in patients having decompensated cirrhosis of liver. [P value = .019] was found. There is definitely an increased frequency of bleeding peptic ulcer in patients having decompensated liver cirrhosis as compared to general population necessitating the need of primary prophylaxis of peptic ulcer with proton pump inhibitor in decompensated cirrhotics

Can conversion rate be minimized?

To evaluate intraoperative difficulties during laproscopic cholecystectomy and to minimize the rate of conversion from laproscopic cholecystectomy to open cholecystectomy. It was a prospective study carried out at Department of Surgery, Ziauddin Medical University Hospital over 2 year period from Jan.2000-Dec.2001. Consecutive patients admitted with the diagnosis of cholelithiasis confirmed on ultrasonography and undergoing laproscopic cholecystectomy during the same admission. Various parameters were analyzed including gender, comorbids, past history of known gall stones, jaundice and previous surgeries Statistical analysis were carried out utilizing SPSS 10.0 for Windows. One hundred and seven patients were included in the study .Mean age was 49.8 with male to female ratio of 1:4. Laproscopic cholecystectomy was successfully done in 61 [57%], nine patients needed conversion to open cholecystectomy, the reasons for conversions were adhesions at calots triangle, bleeding and instrument failure. 37 patients were excluded from the study [28 were elective open cholecystectomy due to non approval from corporate 6 had CBD exploration and 3 had associated hernia repair. This study was done to identify factors responsible for conversion from laproscopic cholecystectomy to open cholecystectomy