Experience of extracorporeal shockwave lithotripsy for kidney and upper ureteric stones by electromagnetic lithotriptor.

BACKGROUND: Extracorporeal Shock Wave Lithotripsy (ESWL) is a non-invasive treatment of urinary stones which breaks them, by using externally applied, focused, high intensity acoustic pulse, into smaller pieces so that they can pass easily through ureter. Shock wave generation, focusing, coupling and stone localisation by fluoroscope or ultrasound are the basic components of ESWL. ESWL has some complications and is contraindicated in certain situations. The aim of this study was to evaluate the effectiveness and safety of ESWL in kidney and upper ureteric stones by Electromagnetic Lithotriptor. METHODS: All adult patients with renal and upper ureteric stones having a diameter of up to 1 Cm were included in the study. Basic evaluation such as history, examination, ultrasound and excretory urography were performed. Electromagnetic lithotripsy was done and data were collected on a printed proforma from 1st January 2008 to 30th March 2009 in Institute of Kidney Diseases, Peshawar. RESULTS: Out of a total of 625 patients 463 were male and 162 were female; 67.36% of patients were having renal stones, 23.84% upper ureteric and 8.8% both renal and ureteric stones. Complications noted were renal colic in 9.76%, haematuria in 3.2%, steinstrasse in 2.72%, and fever in 1.12% of patients. The stone free rate was 89% and 7% of patients were having stone fragments <4 mm. ESWL failed in 4% of patients. CONCLUSION: ESWL is a safe and effective way of treating kidney and upper ureteric stones.

Successful separation of pygopagus conjoined twins and primary skin closure using V-shaped flaps.

Pygopagus conjoined twins were born by caesarean section at 34 weeks of gestation. Initial evaluation revealed no other abnormalities apart from their attachment at lower back, buttocks and perineum. They had two separate anal and urogenital openings. Their investigations included roentgenograms, ultrasound, barium enema, cystourethrogram, CT scan and MRI. There were two separate spinal columns fused distally at the lower sacral level. Lower gastrointestinal studies showed two separate rectums and cystourethrogram showed normal and separate urinary tracts. MRI showed a single dural sac between two fused sacral bones with no other vertebral anomalies. They were successfully separated with primary skin closure using V-shaped flaps.

Successful separation of pygopagus conjoined twins.

Conjoined pygopagus twins are very rare. They represent about 17% of all conjoined twins and commonly share the gluteal region, terminal spine, and lower gastrointestinal, urological, and reproductive tracts. Meticulous preoperative investigations and planning as well as a multispecialty team approach contribute to the success of surgical separation. We report a case of successful surgical separation of pygopagus conjoined twins.

Situs inversus abdominus in association with congenital duodenal obstruction: a report of two cases and review of the literature.

This report describes two newborns with persistent bile-stained vomiting. Their radiological investigations revealed the existence of situs inversus and duodenal obstruction. In one, the duodenal obstruction was partial, secondary to a duodenal diaphragm with a central aperture, whereas the other child had complete duodenal atresia as well as Fallot's tetralogy. Such an association is extremely rare, with only 18 cases reported so far in the literature. Embryological aspects, investigations, and treatment are also discussed.

Congenital duodenal diaphragm in eight children.

BACKGROUND: Congenital duodenal obstruction (CDO) is a common and usually easy to diagnose cause of intestinal obstruction in the newborn, except when the cause of the obstruction is a duodenal diaphragm. We describe our experience with eight children who had intrinsic duodenal obstruction secondary to a duodenal diaphragm. METHODS: The medical records of 22 children with the diagnosis of congenital intrinsic duodenal obstruction were reviewed for age at diagnosis, sex, gestation, birth weight, clinical features, associated anomalies, method of diagnosis, treatment and outcome. Operative findings and procedures were obtained from the operative notes. RESULTS: Eight of the 22 children (36.4%) had congenital duodenal diaphragm (CDD). In all children, the diagnosis was made from plain abdominal X-ray, which showed the classic double-bubble appearance, and barium meal, which showed duodenal obstruction. Four patients had associated anomalies, including two with Down's syndrome. Intraoperatively, five patients were found to have duodenal diaphragm with a central hole, while the other three had complete duodenal diaphragms. Postoperatively, all patients did well. Six required total parenteral nutrition. CONCLUSIONS: The 100% survival rate among these children is comparable to that in Western countries, and can be attributed to the lack of major associated abnormalities, good perioperative management, and the availability of total parenteral nutrition.

Eradication of Cryptosporidium in four children with acute lymphoblastic leukemia.

Four children on chemotherapy for acute lymphoblastic leukemia presented with severe diarrhea and dehydration. Cryptosporidium was identified in the stools using modified Ziehl-Neelsen stain. Two of them received paromomycin and responded well. One was started on paromomycin for 10 days and although there was clinical improvement, his stools examination continued to be positive for Cryptosporidium. He then received azithromycin for 10 days. He responded well and his stools became negative for Cryptosporidium. The fourth patient received azithromycin from the start and responded well. Cryptosporidium should be considered in all immunocompromised children with severe or prolonged diarrhea, and since it is not seen in a routine ova and parasite examination, the laboratory should be notified for diagnostic confirmation using modified Ziehl-Neelsen stain. Immunocompromised children with Cryptosporidium diarrhea may benefit from paromomycin or azithromycin therapy.

A rare association of urogenital duplication and anorectal malformation.

An unusual case of urogenital duplication in association with anorectal malformation is presented. A 3-year-old girl was referred to the authors' hospital with double vagina, double urethra, double sacrum, double ureters on the right side, multiple vertebral anomalies, together with anorectal malformation. Successful surgical reconstruction was performed.

Volvulus of the sigmoid colon in a child.

Sigmoid volvulus although a common cause of large bowel obstruction in the elderly, is considered rare in the pediatric age group. We report a case of sigmoid volvulus in a 10-year-old child with mental retardation and myopathy. The various predisposing factors for sigmoid volvulus in children are discussed, and the literature on the subject is also reviewed.