One week stenting after pediatric laparoscopic pyeloplasty; is it enough?

INTRODUCTION: The use of ureteric stents for urinary diversion after pediatric dismembered pyeloplasty and its duration remain debatable. Classically, an indwelling Double J ureteric stent has to be left for 4-6 weeks. However, such a duration is not free of stent-related complications, in addition to the need to remove it under general anesthesia in the pediatric age group. OBJECTIVES: This study aims to evaluate the outcome of short-term stenting after laparoscopic pyeloplasty in pediatric sector. METHODS: A prospective randomized study of 37 children (less than 16 years-old) with pelvi-ureteric junction obstruction (PUJO) were managed by laparoscopic pyeloplasty by the same surgeon in the period between April 2015 and September 2017. In group A (18 patients), the DJ was removed after 4 weeks under general anesthesia, while in group B (19 patients), the DJ was fixed to the urethral catheter by a stitch, and it was removed with the urethral catheter after one week in the outpatient office. All patients were followed regularly for symptomatic improvement. Urine culture and sensitivity was done 1 month postoperatively. Abdominal ultrasound was done at 3, 6, 12 months and annually thereafter, while renal isotope scanning was done after 6 months. RESULTS: There were no significant differences between both groups regarding operative duration, postoperative leakage, hospital stay, early postoperative complications. Both groups improved after pyeloplasty with no significant differences regarding symptoms, follow-up ultrasound, and renal scanning. The incidence of irritative symptoms and need for anticholinergics after catheter removal as well as urinary tract infection after 1 month were significantly higher in group A (P-value: 0.004 and 0.029, respectively) (Table). DISCUSSION: To the authors knowledge, this is the first prospective controlled randomized study comparing short-term stenting with the classic 4 weeks stenting after laparoscopic pyeloplasty in the pediatric age group. In addition, the used technique of stenting not only allows stent removal on outpatient basis without anesthesia but also benefits from the pre-operative retrograde study so as not to miss any associated pathology in the ureter. CONCLUSION: Short-term ureteric stenting after laparoscopic pyeloplasty in pediatric age group is safe and not inferior to the standard 4-week stenting. It also avoids the stent-related complications.

Ultrasound-guided axillary brachial plexus block versus local infiltration anesthesia for arteriovenous fistula creation at the forearm for hemodialysis in patients with chronic renal failure.

BACKGROUND: The primary failure rate for arteriovenous fistula (AVF) creation under local anesthesia for hemodialysis is about 30%. Axillary brachial plexus block (BPB) may improve blood flow through blood vessels used in fistula creation; it may improve the AVF blood flow and thus may reduce the primary failure rate after 3 months. METHODS: Hundred and forty patients with chronic renal failure scheduled for AVF creation for hemodialysis were divided into two equal groups; Group 1 (AxBP-G) received ultrasound (US) guided axillary BPB, and Group 2 (LI-G) received local infiltration. We recorded the measurements of the brachial and radial arteries before and after anesthesia and the AVF blood flow in both groups at three different time points. Furthermore, the primary failure rate was recorded in each group and compared. RESULTS: After anesthesia, the mean radial artery blood flow in the AxBP-group was 3.52 ml/min more than the LI-group, and the brachial artery diameter was also 0.68 mm more than in the LI-group, both differences were statistically significant (P < 0.05). There were significant increases (P < 0.05) in the AVF blood flow in the AxBP-group more than the LI-group with mean differences of 29.6, 69.8, and 27.2 ml/min at 4 h, 1 week, and 3 months, respectively. The overall mean of AVF blood flow was 42.21 ml/min more in the AxBP group than the LI-group a difference which is statistically significant (P < 0.001). The primary failure rate was 17% in the AxBP group versus 30% in the LI-group; however, this difference is not significant statistically (P = 0.110). CONCLUSION: The US-guided axillary block increases AVF blood flow significantly more than local infiltration and nonsignificantly decreases the primary failure rate of the AVF after 3 months.

Use of holmium laser for urethral strictures in pediatrics: A prospective study.

INTRODUCTION: The management of urethral strictures is very challenging and requires the wide expertise of different treatment modalities ranging from endoscopic procedures to open surgical interventions. OBJECTIVE: To assess the effectiveness and complications of retrograde endoscopic holmium: yttrium-aluminum-garnet laser (Ho: YAG) urethrotomy (HLU) for the treatment of pediatric urethral strictures. PATIENTS AND METHODS: From January 2010 to January 2013, 29 male pediatric patients with a mean age of 5.9 years and primary urethral strictures 0.5-2 cm long were treated using HLU. The stricture length was <1 cm in 16 (55%) patients and >1 cm in 13 (45%). Fifteen (51.7%) patients had an anterior urethral stricture, while 14 (48.3%) had a posterior urethral stricture. No positive history was found in 14 (48.3%) patients for the stricture disease, while six (20.7%) had straddle trauma and nine (31%) had an iatrogenic stricture. All of the patients were pre-operatively investigated and at 3 and 6 months postoperation by uroflowmetry and voiding cystourethrography (VCUG). If there were suspicious voiding symptoms, selective uroflowmetry and VCUG were performed at 12 months postoperation. RESULTS: The mean operation time was 31.7 min (20-45 min). Twenty-three (79.3%) and 18 (62.1%) patients showed normal urethra on VCUG with improvement of symptoms at 3 and 6 months, respectively. Thus, recurrence was 37.9% after 6 months of follow-up. The mean pre-operative peak urinary flow rate (Qmax) was 6.47 ml/s. The mean postoperative Qmax at 3 and 6 months was 17.17 ml/s and 15.35 ml/s, respectively. The success rate and flowmetry results did not show any statistical significance in relation to site, length and cause of the strictures. The other 11 patients who failed to improve underwent repeated HLU sessions: 4/11 (36.3%) achieved successful outcomes. Among the seven patients with failed HLU for the second time, a third session was conducted. However, only one patient (14.2%) was cured, while open repair was needed for the remaining six. DISCUSSION: One study has previously been published on the management of pediatric urethral strictures using HLU. The present results are similar to short-term studies after a single session of visual internal urethrotomy using cold knife (VIU). In the present study, the length, location and cause of strictures did not significantly affect the results. However, the outcomes with strictures <1 cm were better than strictures >1 cm, although patients with strictures >2 cm were excluded. In the present study, the success rates among patients with second and third sessions of HLU were 36.3% and 14.2%, respectively. This was similar to other studies, which reported low success rate with the second session of VIU. The present study was limited by the relatively short period of follow-up and the small number of patients. However, it was the first prospective study evaluating HLU for pediatric strictures. The use of flowmetry and VCUG for evaluation of all patients added to the strength of the study. CONCLUSION: HLU can be safely used with good success rates for the treatment of primary urethral strictures (<2 cm) in children. Repeat HLU (more than twice) adds little to success.

Outcome of complete primary bladder exstrophy repair: single-center experience.

OBJECTIVE: Reconstruction of bladder exstrophy remains a challenge. We evaluated our experience with complete primary repair in classic bladder exstrophy. METHODS: A retrospective data review was conducted of bladder exstrophy patients presenting at our institution between May 2000 and September 2007. Fifty-one patients (21 females and 30 males) with classic bladder exstrophy were included. Age of presentation ranged from 24h to 14 months. Mean follow up was 3 years (1 month-7 years). Patients were evaluated for continence, upper tract dilatation and cosmetic result. RESULTS: Eight patients (15.6%) had failed closures and six (11.7%) had fistulae. Evaluation of continence excluded 16 patients not followed up at our center. Thirty-seven percent were continent on clean intermittent catheterization after the age of 5 years. Patients became dry only after augmentation cystoplasty. Upper tract changes were mild during our study with all patients having normal serum creatinine. CONCLUSION: Patients may require more than one procedure for reconstruction. In our series, augmentation was required to achieve acceptable dryness. Early promising results with dry intervals in young patients did not translate to continence in older patients.

Surface analysis of new chlorpromazinium plastic membrane electrodes.

New chlorpromazinium (Cp) plastic membrane electrodes of the conventional type were constructed and characterized. They are based on incorporation of Cp-reineckate (CpRn) ion pair, Cp-phosphotungstate (Cp3PT), or Cp-phosphomolybdate (Cp3PM) ion associate into poly(vinyl chloride) membrane. The electrodes exhibited calibration graph slopes of 49.83, 52.87, and 61.30 mV/Cp concentration decade over life spans of 1, 5, and 3 days, respectively. All electrodes proved to be selective for Cp and have been applied to the assay of a pharmaceutical preparation. Energy dispersive spectroscopy (EDS) and X-ray photoelectron spectroscopy (XPS), as well as scanning electron microscopy (SEM) showed that the limitation of the lifetime of the electrodes is attributed to leaching of the ion exchanger from the membrane into the test solution in addition to deformation of the surface.

New conventional coated-wire ion-selective electrodes for flow-injection potentiometric determination of chlordiazepoxide.

New chlordiazepoxide hydrochloride (Ch-Cl) ion-selective electrodes (conventional type) based on ion associates, chlordiazepoxidium-phosphomolybdate (I) and chlordiazepoxidium-phosphotungstate (II), were prepared. The electrodes exhibited mean slopes of calibration graphs of 59.4 mV and 60.8 mV per decade of (Ch-Cl) concentration at 25 degrees C for electrodes (I) and (II), respectively. Both electrodes could be used within the concentration range 3.16 x 10(-6)-1 x 10(-2) M (Ch-Cl) within the pH range 2.0-4.5. The standard electrode potentials were determined at different temperatures and used to calculate the isothermal coefficients of the electrodes, which were 0.00139 and 0.00093 V degrees C(-1) for electrodes (I) and (II), respectively. The electrodes showed a very good selectivity for Ch-Cl with respect to the number of inorganic cations, amino acids and sugars. The electrodes were applied to the potentiometric determination of the chlordiazepoxide ion and its pharmaceutical preparation under batch and flow injection conditions. Also, chlordiazepoxide was determined by conductimetric titrations. Graphite, copper and silver coated wires were prepared and characterized as sensors for the drug under investigation.

Ionization of some derivatives of benzamide, oxamide and malonamide in DMF-water mixture.

The ionization of six compounds of bis-phenolic amides was studied spectrophotochemically in DMF-water mixture. The compounds showed two pK(a) values in the range of 5.97-7.32 for pK(a(1)) and 7.61-8.44 for pK(a(2)). The obtained values of K(a) were normalized using the distribution diagrams of the different species and found to be in the range of 5.81-7.42 for pK(a(1)) and 7.48-8.27 for pK(a2).

Spectrophotometric determination of meclozine HCl and papaverine HCl in their pharmaceutical formulations.

A simple, accurate and highly sensitive spectrophotometric method is proposed for the rapid determination of meclozine and papaverine hydrochlorides using chromotrope 2B (C2B) and chromotrope 2R (C2R). The method consists of extracting the formed ion-associates into chloroform in the case of meclozine HCl and into methylene chloride in case of papaverine HCl. The ion-associates exhibit absorption maxima at 536 and 524 nm for C2B and C2R with meclozine HCl and at 540 and 528 nm with papaverine HCl, respectively. Meclozine can be determined up to 4.0 and 2.6 mg ml(-1), using C2B and C2R, respectively, while papaverine can be determined up to 1.68 and 1.37 mg ml(-1), respectively. The effect of acidity, reagent concentration, time, solvent and stoichiometric ratio of the ion-associates were studied. The molar absorptivity and Sandell sensitivity of the reaction products were calculated. The method was applied to the determination of the drugs in their pure state or pharmaceutical preparations with mean recovery values of 99.63-100.80 and 99.75-100.08% and coefficient of variation 0.945-2.210 and 1.020-1.268 for meclozine HCl and papaverine HCl, respectively.

Bionomics of ticks collected from Sinai Peninsula: 2- abundance, attachment sites, and density estimators of ticks infesting Arabian camels.

Ten camels were examined monthly from January to December 1999, in Beer Lehfen North Sinai Gavernorate. A total of 5468 adult ticks of 6 species and subspecies of genus Hyalomma; H. dromedrii, H. ipmeltatum, H. a. excavatum, H. a. anatolicum, H. schulzei, and H. marginatum rufipes, in addition to 115 Hyalomma nymphs' species were collected. Of these, the first 4 types represented about 96.2% of the total collection. The infestation rate was higher during the period from March to November. The average monthly infestation rate was 22.78+/-3. The large number of the adult ticks were concentrated on tail, brisket, anus, and udder which totaled 68.2%. Attachment sites of males and females were not significantly correlated in most species. Nymphs were localized in few sites, whereas 91.6% of the total nymphs were attached to hump, neck, head (ear), and side. H. dromedarii, H. impeltatum, and H. a. excavatum were found on most of the body sites, tail, brisket, udder, and anus, totaling 79.9%. Males exceeded females in all sites, and were alone on neck and legs. Females were the only stage collected from udder. Both sex of H. a. anatolicum were collected from tail. H. schulzei and H. m. rufipes were concentrated in brisket, udder, anus, and tail.

Observations on the structure and histology of the female genital system of the cattle tick Boophilus annulatus (Say).

Female genital system of Boophilus annulatus was examined grossly on the day of drop-off from the host and grossly and microscopically on 4th day. It consists of an ovary, 2 oviducts, a common oviduct, a connecting tube, a seminal receptacle, a vagina divided into cervical and vestibular parts, 2 accessory glands and Gene's organ. The ovary oocytes undergo excessive growth during the 4 days after drop-off from the host. Oocytes accumulate eosinophilic material during growth and undergo histological changes similar to those seen in other ixodid ticks. Further ultrastructural studies are required to understand the vector capacity of this species in transmitting disease agents.

Conductimetric determination of reproterol HCl and pipazethate HCl and salbutamol sulphate in their pharmaceutical formulations.

A simple and sensitive conductimetric method for the determination of salbutamol sulphate and reproterol and pipazethate hydrochlorides is presented based on their ion associates with phosphotungstic and phosphomolybdic acids. The effect of solvent, molar ratio, reagent concentration and temperature were studied, and the solubility products of the formed ion associates were calculated. The method was applied to the determination of the drugs in their pure state or pharmaceutical preparations with mean recovery values of 99.82-100.54, 99.75-100.12 and 99.95-100.40%, and coefficient of variation 0.28-0.52, 0.16-0.36 and 0.19-0.33 for salbutamol sulphate, reproterol HCl and pipazathate HCl, respectively.

Flow injection potentiometric determination of pipazethate hydrochloride.

New plastic membrane electrodes for pipazethate hydrochloride based on pipazethatium phosphotungstate, pipazethatium phosphomolybdate and a mixture of the two were prepared. The electrodes were fully characterized in terms of composition, life span, pH and temperature and were then applied to the potentiometric determination of the pipazethate ion in its pure state and pharmaceutical preparations under batch and flow injection conditions. The selectivity of the electrodes towards many inorganic cations, sugars and amino acids was also tested.

Haemoglobinometry as a method to determine the blood meal size of two argasid tick species.

A standardized clinical method for measuring haemoglobin has been applied to measure the quantity of blood ingested by Argas persicus and A. hermanni feeding on chicken and pigeons respectively. The blood fed ticks were added to a reagent which converts all haemoglobin to haemoglobincyanide (HiCN) which can be read spectrophotometrically. The validity of this method was established by comparing haemoglobin determination with the size of blood meals measured by weight. Linear relationships with high correlation coefficients were obtained for nymphs, males, and females of A. persicus and A. hermanni showing that both gravimetric (weighing) and HiCN methods gave similar estimates of ingested blood.

Outdoor resting and nectar feeding behaviour of some mosquito species in two villages in Egypt.

Mosquito resting on different host plants were collected from two localities in Egypt, Kafr Tohoria village, Qualubiya governorate and El Abtal village, Ismailia governorate. Collected mosquitoes were identified, classified to their feeding stage and tested for carbohydrate feeding. Results indicated that Cx. pipiens represented 96% and above of collected species in the two localities. The available plants and crops showed different attraction levels for resting female mosquitoes. Most of the collected females were empty. Mosquitoes may be attracted to certain plants due to the presence of some phagostimulant chemicals rather than the presence of the sugars.

The goat warble fly, Przhevalskiana silenus (Brauer) in north Sinai, Egypt.

During monthly visits to North Sinai, a total of 43 living goats out of 2040 (2.11%) were found infested with Przhevalskiana silenus (Brauer). This was mainly in Winter. Besides, nodule caused of P. silenus larvae were recovered from 32 out of 98 (32.65%) slaughtered goats in Al Arish abattoir mainly in Summer. The overall infestation rate among slaughtered goats was 11.68 percent. On the other hand, adult flies were collected by baited traps from Bir Al Abd and Al Hasanah in late Spring and early Summer. It is concluded that myiasis is a real economic problem which affects the livestock.

The effect of the volatile oils of Chenopodium ambrosioides and Thymus vulgaris against the larvae of Lucilia sericata (Meigen).

Nowadays, there are many problems with the use of chemical insecticides as resistance, environmental pollution, toxicity to man and animal... etc. All these required the investigation of a new line for controlling arthropod pests of medical and agricultural importance. The volatile oils of Chenopodium ambrosioides (American wormseed) and Thymus vulgaris (Tyme) proved to be effective against the third stage larvae of Lucilia sericata. The LC50 confidence limits were 70 ppm and 130 ppm for both volatile oils respectively. No doubt, the use of these plant volatile oils, which are widely distributed in the Egyptian flora, more cheap, more safe and without any pollution or hazard, is recommended.

Studies on myiasis producing flies collected by bait traps at Al Marg (Qalyobia Governorate), Egypt.

Myiasis is a real welfare problem. As a disease, it affects man and animals. In a study of myiasis producing flies in Al Marg District, sixteen species of dipterous flies were trapped. The predominant species was Musca domestica followed by Lueilia sericata and the least abundance was Wohlfahrtia magnifica. The overall abundance was in Summer followed by Spring and the least was in Winter. The most attractive bait was liver for members of family Calliphoridae and meat for members of family Muscidae and Family Sarcophagidae.

Studies of wound myiasis among sheep and goats in North Sinai Governorate, Egypt.

Myiasis of man and animals is a real welfare problem of world wide distribution particularly in animal raising countries. Studies of myiasis of sheep and goats in North Sinai resulted in the identification of 21 species of myiasis producing flies. The predominant species was Musca domestica followed by Lucilia sericata and the least abundant was M. albina. In general, sheep were more infested with wound myiasis than goats. The overall infestation rate was high in summer, followed by spring then autumn. The least rate of infestation was winter. As to the different areas examined, the high rate of infestation was in Bir Al-Abd, followed by Al Hasanah, Al Arish, Al Sheikh-Zowaid and lastly Rafah. The factors predisposing to wound myiasis in a descending order of importance in goats were open wound, shearing wound, caseous lymphadenitis, foot rot, faecal staining, ophthalmo or facial eczema, horn fracture, rumen fistula and lastly posterior paralysis. In sheep, the most important cause was caseous lymphadenitis followed by foot rot, then open wound and faecal staining, shearing wound, and ophthalmo or facial eczema otherwise more or less the same as in goats. It is concluded that myiasis among edible animals is a problem of veterinary and economic importance. The clinical features range between mild annoyance to severely disfiguring or fatal. No doubt, poor hygiene, presence of draining wounds, depressed level of farmers' consciousness and immobility presidose to different anatomic types of myiasis which may extend to man.

Oestrid head maggots in slaughtered sheep in Cairo abattoir.

Oestrosis or infestation of sheep, goats, ibex, argali and sometimes man with Oestrus ovis maggots is a real problem in sheep-farming areas allover the world. Parasitism in sheep may be benign, the majority of cases do not terminate fatally, but death may come within a week after appearance of aggravated symptoms. In man, ophthalmomyiasis (sometimes nasopharyngeal) may be benign to destruction of the eye ball or the entire eye in misdiagnosis. In the present study, examination of 1200 slaughtered sheep heads at Cairo abattoir, showed 104 (8.67%) infested with O. ovis maggots. Sheep were parasitized all the year round with more or less maximum number (12.5%) in September. The sex ratio of parasitized sheep (female to male) was 1:2.71. A total of 556 maggots were recovered allover the year with a peak in March (12.6%). The peak for the first instar larvae recovered was September (17.4%), for the second instar was March (15.7%) and for the third instar was June (11.6%). Older sheep were more infested (12.0%) with oestrosis than smaller ones (6.87%). The whole results were discussed.

Neural network approach for solving the maximal common subgraph problem.

A new formulation of the maximal common subgraph problem (MCSP), that is implemented using a two-stage Hopfield neural network, is given. Relative merits of this proposed formulation, with respect to current neural network-based solutions as well as classical sequential-search-based solutions, are discussed.