An unusual sequel of submandibular gland calculus-A case report.

Sialolithiasis in sub-mandibular gland is a common condition. Sub-mandibular fistula as a sequel of sub-mandibular sialolithiasis is a rare entity. We report a case of an unusually large sub-mandibular gland calculus causing a cutaneous fistula.

Holmium laser cystolithotripsy in children: initial experience.

INTRODUCTION: Management of vesical calculi in children poses an interesting challenge to the urologist. The treatment options currently available include open surgery, transurethral pneumatic cystolithotripsy, percutaneous suprapubic cystolithotomy and shockwave lithotripsy (SWL). Holmium: YAG (Ho: YAG) laser cystolithotripsy represents a novel modality of treatment that is minimally invasive. MATERIALS AND METHODS: From July 1999 to January 2003 we treated 23 children with vesical calculi using transurethral Ho: YAG laser lithotripsy. The indications for cystolithotripsy were stone size < or = 4 cm (N=19), or multiple stones with combined stone burden < or = 4 cm (N=4). The mean patient age was 7.8 (range 2-12) years and the mean stone size was 2.7 (range 0.9-4) cm. Access was obtained with an 8F ureteroscope and holmium laser energy (0.6-1.8 J/pulse at 5-12 Hz) was applied through a 550-mum. end-firing fibre under video guidance. The calculi were pulverized to tiny fragments about 2-3 mm in size. An 8F urinary catheter was placed for one night in all patients. Post-operatively the children were evaluated at 3 and 18 months with radiological imaging and uroflowmetry to confirm stone-free status and exclude urethral stricture formation. RESULTS: The mean duration of the endoscopic procedure was 38 (range 19-62) minutes while the mean length of hospital stay was 2.2 (range 2-3) days. All the children were rendered stone-free following a single operative session. Laser-induced major complications were not observed in any of the children. At the mean follow-up of 42 (range 26-69) months none of the children developed stone recurrence, urinary tract infections or urethral strictures. CONCLUSIONS: Transurethral Ho: YAG laser lithotripsy was found to be an efficient and safe modality for the treatment of vesical calculi in children.

Transverse aortic arch aneurysms--a challenge ahead.

Deep Hypothermia and Circulatory Arrest (DHCA) is widely used to repair complex congenital heart lesions in children. We report our experience of DHCA in seven patients of transverse aortic arch aneurysm repair. Anaesthesia consisted of Nitrous Oxide, Oxygen, morphine 1 to 1.5 mg kg-1, halothane and pancuronium. Core cooling on cardiopulmonary bypass was used. At 19 +/- 0.64 degrees C (rectal) temperature, Total Circulatory Arrest (TCA) was established. Thiopentone 30 mg.kg-1 and hydrocortisone hemisuccinate 400 mg was administered before arrest. Head was packed with ice during cooling and patients were placed in steep Trendelenberg's position before opening the aneurysm sac. Mean cardiopulmonary bypass time was 151.4 +/- 8.7 minutes. Mean duration of circulatory arrest was 38.6 +/- 6.9 minutes (range, 15 to 77 minutes). Permanent neurological deficit was found in two patients. Tracheostomy was performed in one of these patients for prolonged ventilation. Two patients died of persistent bleeding, low cardiac output and hypoxia due to right lung collapse.