Ureterovaginal Fistula: Aetiological Factors and Treatment Outcome

Ureterovaginal fistula commonly occurs as a result of complication of pelvic surgeries with gynaecologic surgeries accounting for approximately two thirds. It is one of the most feared complications of pelvic surgery. Objectives: This study aims to determine the aetiological factors, role of ultrasound in the confirmation of dignosis and outcome of surgical repair of ureterovaginal fistula at the National Obstetric Fistula Centre, Katsina (NOFIC). Methods: This was a two-year retrospective review of all cases that underwent surgical repair for ureterovaginal fistula at the National Obstetric Fistula Centre Babbar Ruga, Katsina from 1st Jan, 2016 to 31st Dec, 2017. Result: A total of 27 patients had surgery for ureterovaginal fistula during the study period. However only 25 case notes were eligible for data entry and analysis. The mean age of the patients was 29.88 ± 8.53 with a modal parity of one. Eighty-eight percent presented with history of leakage of urine per vagina following emergency caesarean section, caesarean hysterectomy in 8%, prolonged obstructed labour in 8% and gynaecological hysterectomy in 4%. The onset of leakage varied from 2 to 10 days with a mean duration of onset of 5.64 ± 1.70. In addition to the ureterovaginal fistula, 3 had vesicouterine (VUF) fistula and 1 had vesicocervicovaginal (VCVF) fistula. The fistula was bilateral in 2 of the patients. The fistulae involved the left ureter in 13 patients and the right ureter in 10. Abdominal ultrasound was the main means of confirmation of diagnosis. Abdominal reimplantation of the ureter was the most common (88%) treatment approach. Majority 88% (22/25) were healed and continent at discharge. Conclusion: Emergency caesarean section was found to be commonest aetiological factor and the use of abdominopelvic ultrasound was found to be effective in the confirmation of diagnosis and identifying the affected ureter.

Profile of Acute Renal Failure in Children in Kashmir.

We report on the etiology and the short term outcome (3 month) of children with acute renal failure (ARF) at a tertiary care centre in north India. Acute tubular necrosis was the commonest cause of ARF (33%) especially in children <5 years of age; while in children >10 years, glomerulonephritis was the commonest cause. The overall mortality rate was 20%.The outcome at 3 months showed normal renal function in 72 patients and CKD in 5 patients. Three patients were lost to follow-up.

Uterine Sex Cord Tumour- Management Dilemma

Uterine sex cord tumour is a very rare tumour with uncertain management strategies and prognosis. A 61-year-old, nulliparous, who was not on hormone replacement therapy, presented with first episode of postmenopausal bleeding. A transvaginal scan revealed an enlarged uterus with thick endometrial lining and features of multiple degenerated fibroid. Endometrial biopsy was negative for malignancy. Computed tomography of the abdomen and pelvis confirmed the mass, with atrophic ovaries and incidental finding of bilateral hydronephrosis requiring stentings. Otherwise, there were no pelvic lymph nodes enlargement. Our impression was a uterine sarcoma and we decided for total abdominal hysterectomy with bilateral salpingooophorectomy. Surprisingly, the histology report confirmed uterine sex cord tumour. There are less cases of recurrence and there is no general consensus on the management. However, we decided for adjuvant chemotherapy (BEP regime) as the malignant cells infiltrated more than half of myometrial thickness, with good outcome.

Inverse polymerase chain reaction mediated chromosome walking within the human glutamic acid decarboxylase gene.

Using inverse polymerase chain reaction (PCR), we have cloned partial intronic sequences from human glutamic acid decarboxylase (GAD) gene. A small ]53 bp core region was selected from the GAD cDNA sequence to design outward primers corresponding to its 3' and 5' ends. EcoRI digested human DNA which had been circularized by self-ligation and then linearized with SacIl was used as a substrate to can.y out PCR. This gave a 900 bp long product which was cloned into pUC]9. The sequence analysis of this fragment revealed the presence of introns in the region flanking the selected core DNA. In this work we used this technique to walk into the upsteam region of the GAD gene using sequence information from its cloned cDNA.