Can concomitant bladder neck incision and primary valve ablation reduce early re-admission rate and secondary intervention?

ABSTRACT Objective: To assess the effect of bladder neck morphology and its incision (BNI) in patients with posterior urethral valve (PUV) on early reintervention rate. Patients and methods: Infants undergoing PUV ablation (PVA) before 24 months of age and had at least 18 months of follow-up, were categorized into three groups according to the bladder neck appearance on baseline radiological and endoscopic examination: group 1; normal bladder neck underwent PVA, group 2; high bladder neck underwent PVA plus BNI, group 3; high bladder neck underwent PVA only. Early reintervention was defined as the need for check cystoscopy because of persistent renal function deterioration, worsening hydronephrosis and/or unsatisfactory VCUG improvement during the 1st six months post primary PVA. Results: Between 2000 and 2017, a total of 114 patients underwent PVA and met the study criteria with a median follow-up of 58 (18-230) months. For group 1, 16 (22.9%) patients needed readmission. Check cystoscopy was free and no further intervention was performed in 5(7.5%) and re-ablation was performed in 11(15.7%) patients. For group 2, 3(14.3%) patients needed reintervention. Re-ablation and re-ablation plus BNI were performed in 1(4.8%) and 2(9.5%), respectively. For group 3, cystoscopy was free in 1(4.3%), re-ablation and re-ablation plus BNI were performed 2(8.7%) and 1(4.3%), respectively. There were no significant differences in the re-admission and re-intervention rates among the three study groups (p=0.65 and p=0.50, respectively). Conclusion: In morphologically high bladder neck associated PUV, concomitant BNI with PVA doesn't reduce early re-intervention rate.

Can Concomitant Bladder Neck Incision and Primary Valve Ablation Reduce Early Re-admission Rate and Secondary Intervention?

OBJECTIVE: To assess the effect of bladder neck morphology and its incision (BNI) in patients with posterior urethral valve (PUV) on early reintervention rate. PATIENTS AND METHODS: Infants undergoing PUV ablation (PVA) before 24 months of age and had at least 18 months of follow-up, were categorized into three groups according to the bladder neck appearance on baseline radiological and endoscopic examination: group 1; normal bladder neck underwent PVA, group 2; high bladder neck underwent PVA plus BNI, group 3; high bladder neck underwent PVA only. Early reintervention was defined as the need for check cystoscopy because of persistent renal function deterioration, worsening hydronephrosis and/or unsatisfactory VCUG improvement during the 1st six months post primary PVA. RESULTS: Between 2000 and 2017, a total of 114 patients underwent PVA and met the study criteria with a median follow-up of 58 (18-230) months. For group 1, 16 (22.9%) patients needed readmission. Check cystoscopy was free and no further intervention was performed in 5(7.5%) and re-ablation was performed in 11(15.7%) patients. For group 2, 3(14.3%) patients needed reintervention. Re-ablation and re-ablation plus BNI were performed in 1(4.8%) and 2(9.5%), respectively. For group 3, cystoscopy was free in 1(4.3%), re-ablation and re-ablation plus BNI were performed 2(8.7%) and 1(4.3%), respectively. There were no significant differences in the re-admission and re-intervention rates among the three study groups (p=0.65 and p=0.50, respectively). CONCLUSION: In morphologically high bladder neck associated PUV, concomitant BNI with PVA doesn't reduce early re-intervention rate.

Assessing the clinical significance of echocardiograms in determining treatment of patent ductus arteriosus in neonates.

BACKGROUND: To evaluate the utility of echocardiogram (ECHO) in detection and treatment of patent ductus arteriosus (PDA) and hemodynamically significant PDA (hsPDA) in preterm neonates. METHODS: This was a retrospective case-control study of all preterm infants born or admitted to the level III Neonatal Intensive Care Unit in McMaster Children's Hospital from January 2009 to January 2013. These cases were further classified into the following sub-groups: group A) hsPDA confirmed on ECHO; and the control, group B) PDA (but not hemodynamically significant) confirmed on ECHO. Patients without an ECHO were excluded from all analyses. The primary outcome was incidence of treatment for PDA. RESULTS: PDA treatment was administered in 83.3% and 11.2% of patients in groups A and B respectively (P < 0.05). Among patients with a hsPDA within group A, 17% did not receive treatment, while 11% of patients with non-hemodynamically significant PDA received treatment for the PDA. Within the cohort of patients who received treatment for a hsPDA, gestational age below 35 weeks as well as murmurs heard on auscultation were both found to be predictors of treatment. CONCLUSION: While the ECHO remains the gold standard for detecting pathological PDA, there is evidence that other traditional clinical measures continue to guide clinical practice and treatment decisions. Further research is required to gain an understanding of how clinical measures and ECHO may be used in conjunction to optimize resource utilization.

Morphometric and neuropsychologic studies in children with arachnoid cysts.

Temporal lobe arachnoid cysts are common findings during brain imaging. Debate exists regarding whether they result from temporal lobe agenesis or are a malformation of the arachnoid matter. We measured temporal lobe volumes in five children with left middle cranial fossa arachnoid cysts using morphometric analysis of magnetic resonance imaging scans. Three patients had neuropsychologic testing, and two patients had positron emission tomography scanning. All patients had significantly smaller left temporal lobes compared with the right side. On neuropsychologic testing two patients had cognitive deficits suggestive of left temporal lobe dysfunction. Temporal lobes adjacent to arachnoid cysts are smaller and less metabolically active when compared with the temporal regions on the opposite side. Patients with middle cranial fossa arachnoid cysts should undergo careful assessment of temporal lobe structure and function before any therapeutic intervention.

Changes in prosthetic screw stability because of misfit of implant-supported prostheses.

PURPOSE: The effect of two levels of prosthesis misfit on prosthetic screw stability was evaluated. MATERIALS AND METHODS: Two levels of vertical discrepancies--100 and 175 microns--were introduced between an implant-supported complete denture and the terminal abutment. An implant-supported complete denture without vertical discrepancy served as a control. Cyclic load was delivered vertically on the cantilever portion of the prosthesis next to the terminal abutment for 48 hours for each trial. A total of seven sets of new screws were tested for each level of fit. RESULTS: The results revealed significant prosthetic screw instability at both the 100- and 175-micron levels of discrepancy. CONCLUSION: Vertical discrepancies of 100 and 175 microns introduced between an implant-supported fixed complete denture and the terminal abutment resulted in significant prosthetic screw instability.

A trial to enhance the efficiency of Cyclosporin A in the treatment of Schistosoma mansoni infection by immunization of mice.

Cyclosporin A (CsA) acts in two distinct modes against Schistosoma mansoni (S. mansoni) infection. It behaves in part as an antihelminthic and also as an immunomodulator. In this study, two methods were performed to increase the efficacy of the subcurative dose of CsA (30 mg/kg). These methods were, passive immunization where the drug was given simultaneously with rabbit antisera post infection and active immunization where the worm surface antigen was given prior to infection. The results showed that both methods led to enhancement of the curative effect of the CsA. However, the active immunization gave more significant reduction in liver worm and egg loads. Histopathological study showed small size and few number of hepatic granulomas in the passively immunized group while in the active group, there was just few and small collection of inflammatory cells. Moreover, the indirect fluorescent antibody test visualized damage to the worm tegument in both types of immunization. Thus, it could be concluded that active immunization increased the immunomodulatory effect of CsA in treatment of S. mansoni with less toxic effects by using a subcurative dose.

Detection of Trichinella pseudospiralis antigen in the parenteral phase in experimentally infected mice.

Antigen distribution of T. pseudospiralis in muscles was studied at 10 days, 2,3 and 5 weeks post infection. Immunocytolocalization of antigen in the muscle was performed by peroxidase antiperoxidase (PAP) and immunogold silver staining techniques. Weak positive reaction of the stichosome and the cuticle was observed at 10 days post-infection which increased to attain its highest level in the fully infective stage larvae 3 and 5 weeks post infection. The intensity of staining reaction in the cytoplasm and nucleoplasm of infected host cell and surrounding tissue was highest at 5 weeks p.i. The small nuclei of the host cells and the inflammatory cells were unstained.

Detection of Trichinella pseudospiralis antigen in the enteral phase in experimentally infected mice.

The distribution of T. pseudospiralis antigen in tissue sections of the intestine of infected mice was studied at different intervals (10, 21, 35 hours and 10 days post-infection (P.I.). Immunocytolocalization of antigen in the intestine was done by peroxidase antiperoxidase staining technique. Positive staining reaction of the enterocytes was noted in all durations examined. The mononuclear cells of the lamina propria were positively stained at 10 hrs P.I. while patchy staining of muscularis mucosa was observed at 10 days P.I. The present study revealed intense staining reaction in the stichosome and the cuticle of 10 hrs-old larvae L1, the intensity of the reaction decreased throughout the worm development, until it almost disappeared at 10 days P.I. The gut lining and its occupying substance were positive throughout the enteral phase. Intense staining reaction of the hypodermal cells was observed in L2, L3 and adult stage worm. The genital primordium was weakly stained in the larval stages while the male and female reproductive systems were moderately stained at the adult stage.