Window rectostomy: an alternative method of fecal diversion for high anorectal malformations in males without a urinary fistula.

This report analyzes our initial experience with window rectostomy (WR) as a new method of fecal diversion for high anorectal malformations (ARM) in 27 males without a urinary fistula between May 1994 and May 1998; total correction was achieved in two stages. In the first stage, during the neonatal period, the dilated rectum was exteriorized as a WR through the left lower abdomen. In the second, after 3-5 months an abdominoperineal pull-through (APPT) procedure was performed in which the window rectostomy was mobilized and taken down to form a new anus. The results were compared with cases of high ARM with urinary fistula that were managed in three stages, i.e., proximal sigmoid colostomy, APPT, and colostomy closure. All 27 cases showed satisfactory results without any mortality or major pelvic infection. The main advantages of WR are that it provides more functioning bowel length after diversion and avoids a colostomy-closure operation and repeated hospitalizations, thus reducing the total cost of treatment.

Posterior sagittal approach for repair of rectourethral fistula occurring after perineal surgery for imperforated anus at birth.

PURPOSE: Posterior sagittal approach was used for the repair of 11 cases of rectourethral fistula between 1992 and 1998. METHODS: All these patients had rectourethral fistula as a result of perineal procedure performed for imperforate anus at the time of birth. In addition to the fistula repair, an associated anorectal stenosis (3 cases) and urethral stricture 11 case) also were corrected with this approach. All the patients underwent surgery under cover of a protective colostomy. RESULTS: Successful repair was achieved in all patients, and the follow-up period ranged from 10 months to 7 years. As far as bladder and bowel control, urinary control was normal in all 11 patients, whereas bowel control was normal in 10 cases. One patient who had severe scarring of anal sphincters caused by infection in the previous surgery still suffers occasional perianal soiling after 18 months of follow-up. CONCLUSIONS: Posterior sagittal approach not only gives adequate exposure but also suits the basic principles of fistula repair, namely, completely separating the rectum from urethra and leaving normal rectal wall behind the urethral sutures thus eliminating the possibility of recurrence. In addition to fistula repair, one can also correct associated problems like anorectal stenosis or urethral stricture, and a mislocated rectum can be relocated within the sphincter complex.

Percutaneous suprapubic cystolithotripsy for vesical calculi in children.

BACKGROUND: The majority of vesical calculi in adults can now be treated per-urethrally with the use of ultrasonic or pneumatic lithotripsy. However, the use of these devices is restricted in pediatric patients by the narrow caliber of the urethra. A percutaneous suprapubic approach to the bladder circumvents the problem of urethral caliber in these situations. PATIENTS AND METHODS: Thirty-eight children presenting with bladder stones underwent percutaneous suprapubic cystolithotripsy (PCCL) between November 1989 and April 1996. The age ranged from 1.5 to 7 years. The stone size ranged from 0.8 to 2.4 cm. Seven of these were recurrent stones, and five of the patients were female. The procedure was done under general anesthesia, and the equipment was the same as for upper tract endourology. The bladder was distended with saline and a suprapubic puncture made. The nephroscope was introduced after tract dilation and the stone removed, intact if small or after fragmentation if >1 cm. The procedure was done without fluoroscopy. A suprapubic catheter was left in for 48 hours. RESULTS: All patients had an uneventful recovery following stone removal. The average hospital stage was 3 days. Here, the access provided by percutaneous suprapubic cystostomy has been combined with the experience gained in upper-tract endourology to perform procedures that would otherwise require open operation because of nonavailability of urethral access. CONCLUSION: Extension of endourologic procedures to the lower tract reduces morbidity and hospital stay and thus the cost of treatment. Percutaneous suprapubic cystolithotripsy, in our experience, is a safe and cost-effective alternative to open surgery in children.

In vivo tuberculoma creation and its radioimmunoimaging.

Since tubercular lesions form an important differential diagnosis in our country, tuberculoma models in mice have been created and imaged using iodine-125 radiolabelled antimycobacterial monoclonal antibodies for the aetiopathological diagnosis.

Pedicled omental grafts in the revascularization of ischemic lower limbs in Buerger's disease.

Pedicled omentum, after lengthening, was transferred to the ischemic lower limbs of 12 patients with Buerger's disease to assess its capacity to improve the blood supply to these compromised extremities. The immediate (after one month) and long-term (9-12 months) results were encouraging. After one month, rest pain had diminished in 83% of cases, claudication was relieved in 75% of cases, temperature became normal in all cases (100%) and ischemic ulcers either healed or showed signs of healing in 83% of cases. During long-term follow up (after 9-12 months), the results deteriorated slightly, but they remained promising. Rest pain had disappeared in 80% of cases. Claudication was still relieved in 70% of cases, temperature was still improved in 60% and ulcers had healed completely in 67% of cases.

Amebic necrosis of bowel.

Ten cases of amebic necrosis of bowel have been presented. The pathology of amebic bowel necrosis has been discussed in detail, and diagnostic criteria have been mentioned. The treatment of choice in these cases is wide excisional surgery.

Thyroid lymphography.

We have presented the lymphographic findings in 13 patients with thyroid enlargement due to various disorders and discussed the diagnostic accuracy of this procedure. It is possible to diagnose uncommon thyroid diseases such as Hashimoto's disease and retrosternal goiter by thyroid lymphography. We recommend more regular use of this useful diagnostic aid.

Results of immediate reconstruction following surgery for advanced cases of cancer of the cheek, jaw and lip.

Results of immediate reconstruction of the defects resulting from excision of cancer of the cheek, lower jaw, upper jaw and lip in 13 patients using temporal island, deltopectoral and cervicoacromial flaps have been described. The surgical techniques have been outlined. Previous radiotherapy is not a contraindication for primary excisional and reconstructive procedures although the incidence of postoperative gangrene of the flap was greater in these cases.

Continuous postoperative peritoneal lavage in diffuse peritonitis using balanced saline antibiotic solution.

Results of postoperative peritoneal lavage using balanced saline and antibiotic solution in 30 patients with diffuse peritonitis have been presented. The results of this study show that such lavage is a significantly useful adjunctive treatment in the management of diffuse peritonitis. It appreciably reduces the mortality and morbidity. Its adjunctive use in suitable cases along with surgery can be safely advocated in clinical practice.