Factors Accountable for Unabated Obstruction Following Pyeloplasty.

PURPOSE: Split renal function (SFR) and frusemide washout (FWO) are assessed by the DTPA renogram to measure the renal parenchymal functions as well as the evidence of obstruction, both for diagnosis and to treat the pelviureteric junction obstruction. In good number of renal units, both these parameters remain unaltered even after surgery and cause anguish to parents and referring physicians and are usually attributed toward "defective pyeloplasty." In this study, we have tried to single out the bona fide responsible factor for the bad outcome; either the nonreversible kidney or the restenosis of pyeloplasty. PATIENTS AND METHODS: We studied file of 69 patients in whom a double "J" (DJ) stent was left in situ for internal drainage for a duration of 8 weeks in the postoperative period. DTPA scans were performed preoperative, at 8 weeks with a stent in place, and at 12 and 24 months postremoval of the stent to assess renal function. RESULTS: In our study, 45 patients (65.2%) showed improvement either in SRF or in FWO or in both after 8 weeks following pyeloplasty and 24 of 69 units (34.8%) did not show any change in renal function with DJ stent in place. Only in six units (8.7%), out of 69 units had deterioration of renal function after removal of DJ stent. CONCLUSIONS: In our opinion, no improvement of renal function found in 24 units (34.8%) even with internal drainage with DJ indicates irreversible renal damage. In 45 units (65.2%), renal function reversed after pyeloplasty and DJ stent. However, after the removal of the DJ, functions deteriorated in six units (8.7%) due to restenosis following pyeloplasties.

Advances in chemistry and composition of soft materials for drug releasing contact lenses.

Ocular drug delivery has always been a challenging feat to achieve in the field of medical sciences. One of the existing methods of non-invasive ocular drug delivery is the use of eye drops. However, drugs administered through these formulations have low bioavailability in the ocular system. This limitation can been overcome by using contact lenses as drug delivery vehicles. According to USA FDA definitions they can be categorized into two main categories-hard and soft contact lenses. Based on the material properties, hard contact lenses are mostly produced from polymers of acrylate monomers such as MMA (methyl methacrylate). These have the least water retention capacity, thereby, having minimal ability to diffuse oxygen into the corneal layer and are not ideal for long term use. Soft material contact lenses are flexible and are mainly hydrogel based. They have higher water retention capacities as compared to rigid contact lenses, which gives them the ability to transmit oxygen to the corneal layer. These hydrogel based soft materials are mainly produced from polymers of acrylate monomers such as HEMA (hydroxyethyl methacrylate) and found to be better for drug delivery contact lenses. These polymer-based soft materials have been efficiently modified in terms of their chemistry to achieve diverse physicochemical properties to produce efficient ocular drug delivery systems. However, complications such as drug leaching during storage and distribution, sterilisation, preservation of integrity of the lens and the possibility of surface roughness due to the incorporated drug molecules still need to be optimised. This review highlights the chemistries of various polymeric molecules through which physicochemical properties can be modified to achieve optimum drug loading and sustained release of the drug for application in the ocular system.

Vestibulo-Rectal Pull Through in H-Fistula in Girls.

AIMS AND OBJECTIVES: Vestibulo-rectal pull-through (VRPT) in H-fistula in girls was first described by Chatterjee et al. We are presenting our experience with this approach in 47 cases. MATERIALS AND METHODS: We have total 47 cases of which one is a recurrent fistula operated outside. A circumferential incision is made around the fistula in the vestibule; fistula tract is dissected liberally and delivered by invagination into the bowel. Then, the fistula tract is excised adequately and closed from within the bowel lumen so that no anterior outpouching of the rectum remains. The perineal body is repaired through the vestibular incision. In no cases, protective colostomy was performed. Only the recurrent fistula case had colostomy done in another institution. RESULTS: Complete cure was obtained in 45 out of 47 cases. Two of our earlier cases had recurrences perhaps due to inadequate mobilization, but in later cases, we had no recurrence. CONCLUSION: VRPT yields good result without the need for colostomy. Incisions on the perineal skin or the anal verge are avoided, thus improving the cosmetic outcome.

Regenerative urethroplasty in reoperative hypospadias: Buried strip principle revisited.

AIM: Reporting the feasibility of the Denis Browne (buried strip) principle along with tunica vaginalis (TV) pedicled wrapping of the strip in reoperative urethroplasty in hypospadias. MATERIALS AND METHODS: Over a period of 5 years, 32 patients presented with failure of previous urethroplasty and the range of failure was between 2 and 6 times; mean 2.5 times. Mean age was 12.9 (range 2 to 26 years) years. "Buried strip" urethroplasty (i.e., without tubularization of urethral plate) and wrapping with TV were done along with supra pubic cystostomy (SPC) for diversion of urine. Mean follow-up was 29.8 (range 12 to 56 months) months. RESULTS: One patient had fistula and vertical slit meatus was possible in 26 patients. The flow of urine was satisfactory in 31 patients and one patient developed pouch in penile urethra. CONCLUSIONS: The buried strip along with the additional coverage with TV was found to be simple and effective in salvaging the failed urethroplasty.

Novel bladder augmentation in a bilateral single system vaginal ectopia.

A 3-month-old girl presented with total urinary incontinence along with small bladder and bilateral single-system vaginal ectopic ureters [BSSVEU]. Bladder augmentation was done with dilated ureters (ureterocystoplasty) based on proximal blood supply of the ureters.

Congenital pouch colon: an unusual histological finding.

Congenital pouch colon (CPC) is an unusual abnormality in which the colon ends in a pouch-like dilatation and there is generally an associated anorectal malformation. The condition varies from complete absence of normal colon to a nearly normal length of proximal colon with only recto-sigmoid involvement. There is a paucity of data on histological findings in cases of pouch colon. Resected specimens of five cases of CPC were taken. Microscopic sections were stained for H&E and Masson's trichrome stains. We present here an interesting histological finding, namely an unusual muscle layer, inner to the circular muscle layer, in five cases of complete or almost complete CPC and discuss the clinical significance of this finding.

Ischiopagus tetrapus conjoined twins: 22 years after separation.

There is no record of both separated ischiopagus tetrapus conjoined twins leading normal lives 22 years after separation. We separated a pair of such twins in 1986 and have followed them up till date. Details regarding the technique of separation and the procedures required to ensure normal defecation and micturition and normal musculoskeletal function have been described by us in earlier communications. In this paper we describe their present status and ability to face the world as independent adult females. The outcome reflects the responsibilities and dedication of pediatric surgeons for infant patients with congenital problems after they have become adults, taking a pivotal role to involve surgeons of other disciplines as and when necessary.

Preliminary report on the International Conference for the Development of Standards for the Treatment of Anorectal Malformations.

BACKGROUND: Anorectal malformations (ARM) are common congenital anomalies seen throughout the world. Comparison of outcome data has been hindered because of confusion related to classification and assessment systems. METHODS: The goals of the Krinkenbeck Conference on ARM was to develop standards for an International Classification of ARM based on a modification of fistula type and adding rare and regional variants, and design a system for comparable follow up studies. RESULTS: Lesions were classified into major clinical groups based on the fistula location (perineal, recto-urethral, recto-vesical, vestibular), cloacal lesions, those with no fistula and anal stenosis. Rare and regional variants included pouch colon, rectal atresia or stenosis, rectovaginal fistula, H-fistula and others. Groups would be analyzed according to the type of procedure performed stratified for confounding associated conditions such as sacral anomalies and tethered cord. A standard method for postoperative assessment of continence was determined. CONCLUSIONS: A new International diagnostic classification system, operative groupings and a method of postoperative assessment of continence was developed by consensus of a large contingent of participants experienced in the management of patients with ARM. These methods should allow for a common standardization of diagnosis and comparing postoperative results.

Rectourinary perineal fistula--a unique anomaly.

Two patients who presented with a unique anorectal malformation are described. They had what we have named rectourinary perineal fistula. The first patient had a more severe malformation, rectovesicoperineal fistula, and has been followed up for 28 years. The second, with a lesser malformation, rectourethroperineal fistula, has been followed up for 19 years.

Perineal groove with penoscrotal hypospadias.

We describe a boy who presented with penoscrotal hypospadias with bifid scrotum as well as a perineal groove. The operative procedures carried out have been delineated and the reasons for our reporting this case are explained.

Lipoblastomatosis--a case report.

Lipoblastoma and lipoblastomatosis are benign fatty tumors of soft tissues that are unique to childhood. A male infant aged 5 months presented with a history of recurrent lump in the left scapular region. He had been operated upon for the same lump 2 months earlier. A review of the histology of the two consecutive lumps showed an adipocytic tumor. Microscopically the tumor was composed of lobules of immature adipose tissue separated by thick fibrous septae. Plentiful lipoblasts were noted in various stages of differentiation and myxoid material was also present. A diagnosis of lipoblastomatosis was made. The second excision had a higher proportion of mature adipose tissue.