Single ileal segment in a cat-tail configuration for bilateral ureteric strictures.

INTRODUCTION: Management of bilateral long length ureteric strictures is difficult with few options for reconstruction. In this report, we describe our experience with the use of a single, 15- 20 cm ileal segment for reconstruction of bilateral long length (involving more than 2/3rd ureter) ureteric strictures. PATIENTS AND METHODS: A retrospective analysis of 5 cases operated between 2015 and 2020for bilateral long length ureteric strictures, using a single segment ileal interposition in a cat tail configuration was performed. We evaluated renal function, surgical success, incidence of urinary tract infection and complications of the procedure. Surgical success was defined as an asymptomatic patient with no hydronephrosis and/or prompt drainage of the kidney on radiological investigations. RESULTS: The average age of presentation was 42.8 ± 7.4 years (33-53) years). All the cases were secondary to a gynaecological intervention. The mean creatinine prior to surgery was 0.81 ± 0.36 mg % (range 0.5 -1.4 mg%). Mean duration of follow-up was 28.6 ± 20.6 months (Range 10 - 56 months). Mean hospital stay was 14.4 ± 3.36 days (range 12-20 days). Two patients developed ileus and one patient developed deep venous thrombosis in the post-operative period. One patient developed pyelonephritis within one month of surgery. There was no deterioration of renal function with the mean serum creatinine at last follow-up being 0.9 ± 0.36 mg% (range 0.6 - 1.5 mg%). CONCLUSION: The use of an ileal segment in cat-tail configuration for bilateral simultaneous ileal replacement is a feasible and safe option. The medium-term result states that it is effective in the preservation of renal function and provides a good conduit for drainage.

ROLE OF MICROPERC IN MINIMAL INVASIVE EXTRACTION OF Renal STONES IN CHILDREN.

BACKGROUND: Microperc using all-seeing needle is associated with reduced tract-related morbidity. AIM & OBJECTIVES: The purpose of this study was to examine the effectiveness and safety of microperc in children. PATIENTS & METHODS: From July 2010 to August 2014, a total of 17 children with renal stones underwent microperc at Muljibhai Patel Urological Hospital, Nadiad, India. Renal access was achieved through 4.85-Fr (16 gauge) all-seeing needle (PolyDiagnost, Pfaffenhofen, Germany). and fragmentation with 200 µm holmium:YAG laser fiber. The patient's demographic data, clinical features, operating time, hemoglobin drop, stone clearance, complications (Clavien-Dindo), and length of hospital stay were prospectively studied. RESULTS: A total of 17 patients with a median age of 9 years were studied. The stone size ranged from 5.3mm to 24.9mm. The median operative time was 40 minutes. The median decrease in haemoglobin was 1.2 mg/dl. The stone-free rate at first postoperative day and at the first month after the procedure were 82.4% and 88.2% respectively. The mean hospital stay was 56.4 hours. None of the patients required blood transfusion. An overall success rate of 94.1% was achieved at median follow-up of 4 months. Comparing small size stones (< 1cm) and moderate size stone (1-3cm); the immediate clearance rates were 100% and 75% respectively (p=0.331). There was no statistically significant difference in the operating time (40 vs 43mins; p=0.592), haemoglobin drop (0.85 vs 1.25 g/dl; p=0.595) and the length of hospital stay. One patient in each group had conversion to miniperc to remove residual stone fragment. There was one minor intra-operative pelvic perforation (Clavien II). There were two postoperative complications in patients with moderate stone; one of the patients had right lower lobar pneumonia and the other had colic pain and both cases were managed conservatively (Clavien I). CONCLUSION: This study has demonstrated that microperc is a safe and effective procedure in the extraction of small to medium size renal stones in children.

Aflatoxin related occupational exposure to maize processing workers.

A study was undertaken on environmental mycoflora of a maize processing industry in Ahmedabad. The airborne fungal communities were isolated and identified both qualitatively by Petri-plate exposure method and quantitatively by using Andersen-6-stage viable sampler, Midget impinger and high volume samples (cone and Hexhlet for total and respirable dusts, respectively). Of all the isolates genus Aspergillus was the dominant environmental mycoflora and among all the species of Aspergillus A. flavus was the common isolates irrespective of the method applied for sample collection. Maximum number of isolates were recovered from Elevator department. From total and respirable dusts, about 56.6% and 44.4% of recovery accounted for genus Aspergillus alone. Total percentages of aflatoxin positive strains of A. flavus were 5.65% and 9.73% from total and respirable dusts, respectively. These toxigenic strains were identified on various media like CZ with 0.05% anisaldehyde, APA and CAM. Surface morphology of toxigenic strains and dust samples were carried out using SEM.

Recognition of pallor associated with severe anaemia by primary caregivers in western Kenya.

OBJECTIVES: To explore which pallor signs and symptoms of severe anaemia could be recognized by primary caregivers following minimal instructions. METHODS: Data from three community-based cross-sectional surveys were used. Test characteristics to predict haemoglobin (Hb) concentrations < 5 and < 7 g/dl were compared for different combinations of pallor signs (eyelid, tongue, palmar and nailbed) and symptoms. RESULTS: Pallor signs and haemoglobin levels were available for 3782 children under 5 years of age from 2609 households. Comparisons of the sensitivity and specificity at a range of haemoglobin cut-offs showed that Hb < 5 g/dl was associated with the greatest combined sensitivity and specificity for pallor at any anatomical site (sensitivity = 75.6%, specificity = 63.0%, Youden index = 38.6). Higher or lower haemoglobin cut-offs resulted in more children being misclassified. Similar results were obtained for all individual pallor sites. Combining a history of soil eating with pallor at any site improved the sensitivity (87.8%) to detect Hb < 5 g/dl with a smaller reduction in specificity (53.3%; Youden index 41.1). Other combinations including respiratory signs or poor feeding resulted in lower accuracy. CONCLUSION: Primary caregivers can recognize severe anaemia (Hb < 5 g/dl) in their children, but only with moderate accuracy. Soil eating should be considered as an additional indicator of severe anaemia. The effect of training caretakers to improve recognition of severe anaemia and care-seeking behaviour at the household level should be assessed in prospective community-based studies.

Fluid absorption during percutaneous nephrolithotomy: does it matter?

BACKGROUND AND PURPOSE: Large amounts of irrigating fluid are used during percutaneous nephrolithotomy (PCNL). This use may be associated with migrating calculus debris, infection, and fluid absorption. This study evaluated the presence of fluid absorption during PCNL, its clinical and biochemical significance, and maneuvers to reduce it. PATIENTS AND METHODS: Fluid absorption during PCNL was evaluated in 148 patients by estimating the expired breath ethanol concentration. Factors thought to affect the amount of fluid absorbed were studied, including the amount of irrigating fluid used, the number of nephrostomy tracts, the presence of a low-pressure system, the presence of existing tracts, and complications such as bleeding or perforation of the pelvicaliceal wall. RESULTS: Fluid absorption was evident in all patients, although no patient had any clinical or biochemical evidence of intraoperative or postoperative electrolyte imbalance. Creating a low-pressure system by using an Amplatz sheath, reducing the amount of irrigating fluid used, and staging the procedure significantly reduced the amount of fluid absorbed. CONCLUSIONS: Fluid absorption does take place during PCNL. This may be clinically significant in patients with compromised cardiorespiratory or renal status and in pediatric patients, leading to fluid overload. Using a low-pressure system, reducing the nephroscopy time and the amount of irrigating fluid used, and staging the procedure for large renal stone burdens, especially in the presence of complications such as perforation of the pelvicaliceal system, reduces fluid absorption and avoids volume overload. Fluid absorption may also be associated with both infective and noninfective pyrexia, necessitating adequate preoperative control of urinary infection.

Percutaneous nephrolithotripsy in ectopic kidneys.

BACKGROUND: Percutaneous nephrolithotomy (PCNL), although an accepted treatment modality in anatomically normal kidneys, is still not universally performed for calculi in pelvic ectopic kidneys. Fear of injury to abdominal viscera makes it a technically challenging procedure. PATIENTS AND METHODS: We have performed PCNL in nine patients with calculi in pelvic ectopic kidneys. Technical factors which made this procedure safe include ultrasound-guided puncture, use of a mature tract or an Amplatz sheath, routine postoperative double-J stenting, and nephrostogram prior to nephrostomy tube removal. RESULTS: Complete stone clearance was achieved in all cases. Six patients were treated in a single stage, while three patients required two stages. Seven patients needed only one tract, and two needed two tracts. No notable complications were encountered. The average hospital stay was 5.2 days. CONCLUSION: With proper precautions and meticulous technique, PCNL is a safe and effective modality to treat calculi in pelvic ectopic kidney.

Airborne aflatoxin in the grain processing industries in India.

Airborne aflatoxin generated in rice and maize processing plants was assayed by an indirect competitive enzyme-linked immunosorbent assay. In the rice mill, levels of airborne aflatoxin were always higher in the respirable dust samples (< 7 microns) compared with the total dust samples (< 7 microns). The concentrations of total airborne aflatoxin in the respirable dusts were 26 picogram/m3 and 19 pg/m3, respectively, for the workplace and the storage area of the rice mill, while the concentrations of total dust were 12 pg/m3 for the workplace and 11 pg/m3 for the storage area. Airborne aflatoxin was not detected in control sites of either of the grain processing plants or from the total dust samples obtained from the maize plant. Three sites in the maize processing plant-the elevator (18 pg/m3), the loading/unloading area (800 pg/m3), and the oil mill (816 pg/m3)-showed the presence of airborne aflatoxin only in the respirable dust samples.

Extracorporeal shock wave lithotripsy for lower calyceal stones: can clearance be predicted?

OBJECTIVE: To determine the influence of pelvicalyceal angle, size of the lower calyx infundibulum and lowerpole calyceal anatomy in predicting the clearance of fragments after extracorporeal shock wave lithotripsy (ESWL) for lower calyceal stones. PATIENTS AND METHODS: The study comprised a retrospective analysis of 133 patients, divided into 92 who were considered to be completely clear of fragments 6 months after ESWL and 41 who had residual stones. The pelvicalyceal angle, diameter of the lower calyx infundibulum and lower-pole calyceal pattern were determined from intravenous urograms. RESULTS: There were residual stones in 64% of the patients with a pelvicalyceal angle < 90 degrees, in 12% of those with an angle > 90 degrees, in 70% of patients with an infundibular diameter < 4 mm, in 16% of those with a diameter > 4 mm, in 78% with a complex calyceal pattern and 12% with a simple calyceal pattern. CONCLUSIONS: These three anatomical factors play a key role in predicting the clearance of stone and they should be assessed during intravenous urography to facilitate the planning of treatment for lower calyceal stones.