Management of Stricture Urethra: Our Experience at a Tertiary Care Centre

Introduction: Surgical correction is the fundamental strategyfor severe rheumatic mitral regurgitation as (MR) as medicalmanagement for MR can not prevent the hemodynamicconsequences of severe MR in the asymptomatic andminimally symptomatic subjects. The purpose of this study isto assess the impact of duration of progressive rheumatic MRon LVEF, PH, LV and right ventricular dysfunction and decideabout the selection of optimal timing for surgical interventionin our patient population.Material and methods: This study involves the data of 30patients of MVR divided over 2 groups, from 1st January 2015to 31st December, 2018 and follow up of the survivors. Therewere (a) 12 cases of isolated severe MR described as MR and(b) 18 cases of severe MR associated with mild MS describedas MS +MR. Changes in echocardiographic parameters inboth the groups after MVR, LVEF, LVESD, LV end diastolicdiameter (LVEDD), PASP and NYHA functional class wereassessed, analyzed and compared at 30 and 180 days.Results: In the postoperative period after 30 days,improvement of NYHA status were observed to be higher in13 survivors with MS +MR from III to I while it was 6 in MRgroup. This improvement noted more in younger group below40 years. NYHA changes from III to II was observed in 4 ineach in both groups more in older group above 40 years. At180 days, 1 each from NYHA II improved to I in youngergroup. Out of the 2 post operative mortality, there was 1 in MRgroup who had post operative RV dysfunction and died afterdischarge on 29th day and 1 in MS+MR group and who diedof respiratory failure after 7 days though the cardiac indicesimproved and both were in older group.Conclusion: MVR can reversely remodel hearts and restoreLV function with relatively preserved LV.

Role of Conservative Management in High Grade Renal Injuries: Our Experience at a Tertiary Care Centre

Introduction: Renal injuries account for up to 1–5% of alltrauma related injuries. Over the years there has been a shifttowards non-operative treatment for blunt renal trauma. Theaim of our study was to assess outcomes of patients managedconservatively (non-operatively) for high grade blunt renalinjury at our centre.Material and methods: The study was conducted in aretrospective manner using hospital records of last 5 years. Allpatients with blunt renal injuries were included. These patientswere categorized based on AAST(1989) injury gradingand further subdivided into operative and non-operativemanagement groups. These management strategies wereanalyzed in terms of ‘failure of non- operative management’,complications and need for adjunctive procedures. Descriptiveanalysis was done using Microsoft Excel(2010, ver14)software.Results: Forty three patients were included in the study witha mean age of 44.6 years. Out of the total, 28 had grade I– III injuries, 11 had grade IV and 4 had grade V injuries.All the grade I-III patients were managed conservatively andrequired no adjunctive procedures. One (9%) of grade IV and2(50%) of grade V injuries underwent immediate exploration.Out of 10 cases of grade IV injuries which underwent nonoperative management, 3(30%) required delayed explorationand none of the grade V injuries required delayed exploration.Complications included urinary tract infection (UTI) (6 cases),persistent hematuria (3 cases), hypertension(2 cases), urinoma(2 cases) and ileus(2 cases) .All complications were Claviengrade 1-2 with no mortalities overall.Conclusion: If the patient is hemodynamically stable,even grade IV and V blunt renal injuries can be managedconservatively, as is seen in our study where failure of nonoperative management occured in only 30% of grade IV andnone of the Grade V injuries.

A Clinical Study on Correlation of Non-Invasive Diagnostic Tests in Evaluation and Management of Patients with Symptomatic Benign Prostatic Hyperplasia

Introduction: The gold standard for diagnosing bladderoutlet obstruction is pressure flow study but it is associatedwith side effects of high cost, invasiveness, infection, limitedavailability. So non invasive diagnostic tests becomes a goodoption. The diagnostic accuracy of these non invasive tests,however, remains uncertain. So this study was conductedto know the role of non invasive diagnostic tests likeInternational prostate symptom score (IPSS), Uroflowmetry(UFR), prostate volume, bladder wall thickness, post voidresidual urine in symptomatic patients with BPH in theirevaluation and in the planning of management.Material and methods: The present study included 108 malepatients above 50 years suffering from symptomatic BPH whoattended urology OPD at SVIMS, Tirupati. IPSS, Urinaryflow rates, bladder wall thickness, prostate volume, post voidresidual urine and urodynamic study have been recorded inthese patients at the time of enrollment into study.Results: One hundred and eight men between 50 – 79 years ofage with mean age of 62.4 years participated in this study. Allthe patients were divided into two groups as either obstructedor un obstructed based on Abraham – Griffith numbercalculated from the urodynamic study. Bladder wall thickness,Q max, Post void residual urine and prostate volume allhad statistically significant values between obstructed andun obstructed patients. However, there was no statisticalsignificant differences between age, IPSS in both the groupsConclusion: This study shows that in a subset of patientswith BPH with predefined inclusion and exclusion criteria,it should be possible to define obstruction with simple noninvasive parameters, without using invasive pressure flowstudy

A Study of Clinical Outcome of Double Folded Rectosigmoid Bladder with Extramural Subserous Tunneled Ureterocolonic Anastomosis (Abol-Enein and Ghoneim) for Urinary Diversion.

Background: To study and analyze the clinical outcome of double folded rectosigmoid bladder with extramural subserous tunnels done in various cases for urinary diversion after cystectomy. Method: Analysis and follow up of 18 cases of double - folded rectosigmoid urinary diversions done in various patients following cystectomy for various indications in Department of urology, King George Hospital, Vishakapatnam during the period between 2008 - 2009. Results: There was no deaths or deterioration of the upper tracts recorded in the study group. In early post-operative period wound infection developed in 4 cases, prolonged ileus was seen in 3 cases, Electrolyte imbalance was seen in 4 cases. Late complications noted, were pyelonephritis in 3 cases, acidosis in 2 cases and hypokalemia in 3 cases. All the early and late postoperative complications were successfully treated conservatively. Conclusion: Our study has shown that the double folded rectosigmoid bladder reconstruction is an easier procedure with an easier technique of reimplantation suited even for dilated ureters with a short operating time and has shown better continence rate with postoperative complications less in number and severity.

Novel Therapy for Oral Cancer - Gene Therapy an Update.

Gene therapy provides modern medicine with new perspectives and had great potential as a novel therapeutic modality. Progress in molecular biology, especially molecular medicine is now changing the basics of genetic disease. This technology takes advantage of our understanding of cancer at the molecular level. It has been exploited to develop new strategies for killing cells selectively or arresting their growth. This is new technique, being developed which offers incredible pledge for the upcoming therapeutic modality in oral cancer treatment. The aim of this paper is to review delivery routes, vector design, therapeutic applications and possible obstacles faced by gene therapist.

33-kDa C-terminal heparin binding fragment of fibronectin promotes attachment and spreading of hepatocytes.

The possibility of interaction of hepatocytes with the heparin binding domain of Fibronectin was examined. Rat hepatocytes adhered to coverslips coated with the 33- kDa heparin binding fragment of the C-terminal region of plasma fibronectin. When different concentrations of the heparin binding fragment were used to coat coverslips and used as substratum, cell attachment showed saturation kinetics. Half the maximum attachment was observed at 30–40 min after seeding of cells. The cells became flat after 2–3 h indicating that they spread on the heparin binding domain as they do on intact fibronectin. Among the different glycosaminoglycans tested, maximum inhibition of attachment was observed for heparin. However it was not possible to completely inhibit attachment even at high concentrations. These results indicate that hepatocytes interact with fibronectin not only through the Arg–Gly–Asp-containing cell binding fragment, but also through the heparin binding domain of fibronectin and, further, that there exist heparin-dependent and heparin-independent mechanisms of interaction of cells with the 33- kDa heparin binding fragment of fibronectin.