Changing Mallampati score during labour.

We present the case of a changing Mallampati score during the course of labour in a healthy primigravida. On admission to hospital, the airway was assessed as Mallampati class I-II. At 5 cm cervical dilation, the woman began to bear down strenuously and continued this despite being advised of the inherent hazard. At 8 cm dilation, Caesarean delivery was contemplated because of fetal heart rate decelerations. Repeat airway evaluation revealed marked oedema of the lower pharynx giving rise to a Mallampati score of III-IV. Improvement of the fetal heart rate tracing permitted vaginal delivery under local infiltration. Postpartum, the Mallampati score was still III-IV. However, 12 hr later it had returned to the admission classification of I-II. We recommend that, in addition to the usual airway evaluation on admission, the assessment be repeated in the obstetric patient before induction of general anaesthesia.

Bellevue pouch: ileocolonic continent urinary reservoir.

The technique for the Bellevue Pouch, another continent intestinal reservoir, is described. A large-capacity low-pressure reservoir is created from detubularized ascending colon, cecum, and terminal ileum. Continence is achieved by means of an intussuscepted segment of ileum and a modulating colonic pressure cuff wrapped around it. The operation has been performed on 19 patients, all of whom achieved satisfactory continence. Two patients were converted to free drainage systems at a later date. Average follow-up was twenty-five months.

Scrotal fistula from urethro-vasal reflux in paraplegia.

A case is presented of a paraplegic in whom urethro-vasal reflux and scrotal fistula developed. Urodynamics testing showed a hyperreflexic bladder with detrusor-external sphincter dyssynergia.

Postpartum renal vein thrombosis with left retroaortic renal vein.

An unusual case of thrombosis in a left retroaortic renal vein is presented. Noninvasive radiologic diagnosis is reviewed.

Antireflux ureteroileal anastomosis: experimental technique.

A technique for ureteroileal anastomosis with an antireflux extraluminal seromuscular ureteral tunnel was evaluated in 9 dogs. Evidence will be presented to show that this approach is effective in preventing reflux while preserving the integrity of the renal units.

An absorbable intravasal stent and a silicone intravasal reversible plug. Report of experiments on animals.

The high failure rate of vasovasotomy to restore fertility in vasectomized men prompted this investigation using guinea pigs as the experimental animals. The vasa were divided and absorbable intravasal stents were inserted into the lumens of the vasa at the site of anastomosis. The success or failure to secure patency and reestablish fertility was appraised by histologic sections, vasograms, semen analyses, and breeding tests. A second group of animals had silicone plugs equipped with a detachable central pin placed in both vasa. The design of this procedure was to produce an occlusive azoospermia which might be reversed by removing the central pin. Similar tests were used to establish the effectiveness of this reversible device in producing a temporary sterilization. The procedures were controlled by sham operations and insertion of plugs without pins.

PIP: Vasovasotomy with absorbable intravasal stents and reversible intravasal plugs was evaluated in guinea pigs. The stents were made of either starch, collagen, or polyester. The reversible plugs had removable stainless steel or nylon pins. The starch stents were completely absorbed within 2 weeks, and the collage stents were absorbed within 2 months. Patency of the vasa was confirmed by asogram in both g roups. 9 of 12 animals became azoospermic, on the average, 18 weeks aft er insertion of the stainless steel device. Approximately 33 weeks after removal of the pin, 5 of 9 animals successfully impregnated females. Azoospermia was observed in all 5 animals receiving plugs with nylon pins. 2 of these animals were able to impregnate females about 18 weeks after removal of the nylon pin. Animals receiving intravasal plugs without pins did not become azoospermic, and had an 80% successful breeding rate. A moderate inflammatory reaction of the vasa around the plug was observed.

An absorbable artificial vas deferens for vasovasotomy.

An absorbable artificial vas deferens is being developed in order to improve the relativley poor conception rates of vasovasotomy. The capillary device which is 0.4 mm I.D. by 0.7 mm O.D. and 15 mm long vas made from 3 absorbable polymers: starch, collagen, and a copolyester of lactide and glycolide. Preliminary evaluation of the device was made by implantation in the guinea pig was deferens immediately following vasectomy. Absorption of the starch and the copolyester occurred within 2-4 wks after implantation, whereas collagen required 3 mos and sometimes longer. Gross and histological examination showed little or no adverse effect on the tissues of the vas deferens, epididymes and testes. Active spermatogenesis continued in most cases and sperm count and motility remained essentially unchanged. Breeding studies with males implanted with the device for 5 mos have resulted in 12/13 prrgnancies with starch, 19/19 pregnancies with the copolyester and 9/11 pregnancies with collagen.