Role of color Doppler ultrasound in the diagnosis of nonpalpable testes

Purpose Color Doppler ultrasound has been used for the diagnosis of torsion of testes. The purpose of this study was to evaluate the sensitivity of this noninvasive tool in detecting impalpable testes.Patients and methods Twenty-five children with nonpalpable testes were treated at the Department of Pediatric Surgery, Institute of Medical Science, Banaras, between 2007 and 2009. Color Doppler ultrasound was used for detecting the position, size, and vascularity of nonpalpable testes. These patients were subsequently revaluated by laparoscopy.Results Out of 25 cases, 15 cases were unilateral and 10 cases were bilateral (a total of 35 nonpalpable testes). The color Doppler ultrasound study successfully localized 30 of the 35 nonpalpable testes, which were confirmed by subsequent laparoscopic examination. The sensitivity of color Doppler in locating testes was 85.71% (95% confidence interval = 0.64–0.97).Conclusion Color Doppler ultrasound is an effective noninvasive method for the initial diagnosis of impalpable testes and for planning its subsequent management.Keywords: color Doppler ultrasound, laparoscopy, nonpalpable teste

Inter Vehicle Distance based connectivity aware routing in vehicular adhoc networks

Connectivity in vehicular traffic environment has witnessed significant attention due to the direct impact on the performance of most of the traffic safety applications of intelligent transport system. Various parameters such as density, speed, direction, link quality and inter vehicle distance (IVD) have been utilized for measuring connectivity. IVD has greater impact on connectivity and controls the impact of other parameters. Usage of real time IVD for measuring connectivity has not received sufficient attention in VANETs. This paper proposes IVD based connectivity aware routing (Ivd-CAR) for enhancing connectivity aware data dissemination. IVD calculation is robust and can effectively handle instantaneous GPS failure. Two localization techniques; namely, cooperative localization and Geometry based Localization are developed. Standard deviation of real time IVDs of a forwarding path is derived. Distribution of IVDs of a forwarding path is employed for estimating connectivity. Segment vehicle based next hop vehicle selection is utilized for incorporating network load, link quality and direction into consideration while selecting forwarding path. Simulations are carried out in ns2 to evaluate the performance of Ivd-CAR in realistic traffic environment. Comparative analysis of simulation results attests the superiority of Ivd-CAR to the state-of-the-art techniques: CSR and A-CAR

Minimizing the postoperative complications of severe hypospadias using a simple technique

Background The aim of this study was to decrease complication rates in proximal hypospadias surgery.Methods A simple method of stenting using a polypropylene stent has been developed for the most severe form of hypospadias during the period from January 2008 to January 2011 in the Department of Pediatric Surgery. The total number of patients was 46. The patients were classified into group 1 (n= 23), in which a polypropylene stent was used, and group 2 (n= 23), in which a polypropylene stent was not used.Results In group 1, complications occurred in three patients (13.04%), whereas in group 2 it occurred in 12 patients (52.2%). The difference in the total number of complications between groups was highly significant (P < 0.001). In group 1, no patient needed redo surgery, and in group 2 four patients (17.39%) needed redo surgery (P < 0.05). All other patients responded to repeated dilatation in the follow-up.Conclusion Although the sample size was small, this simple modification can decrease the complication rate significantly in the most severe form of hypospadias. Keywords: polypropylene stent, proximal hypospadias, surgical complications, urethroplast

Fuzzy Fibers: Uncertainty in dMRI Tractography

Fiber tracking based on diffusion weighted Magnetic Resonance Imaging (dMRI) allows for noninvasive reconstruction of fiber bundles in the human brain. In this chapter, we discuss sources of error and uncertainty in this technique, and review strategies that afford a more reliable interpretation of the results. This includes methods for computing and rendering probabilistic tractograms, which estimate precision in the face of measurement noise and artifacts. However, we also address aspects that have received less attention so far, such as model selection, partial voluming, and the impact of parameters, both in preprocessing and in fiber tracking itself. We conclude by giving impulses for future research

Subgenual Cingulum Microstructure Supports Control of Emotional Conflict

This is the final version of the article. Available from Oxford University Press via the DOI in this record.Major depressive disorder (MDD) is associated with specific difficulties in attentional disengagement from negatively valenced material. Diffusion MRI studies have demonstrated altered white matter microstructure in the subgenual cingulum bundle (CB) in individuals with MDD, though the functional significance of these alterations has not been examined formally. This study explored whether individual differences in selective attention to negatively valenced stimuli are related to interindividual differences in subgenual CB microstructure. Forty-six individuals (21 with remitted MDD, 25 never depressed) completed an emotional Stroop task, using happy and angry distractor faces overlaid by pleasant or unpleasant target words and a control gender-based Stroop task. CBs were reconstructed in 38 individuals using diffusion-weighted imaging and tractography, and mean fractional anisotropy (FA) computed for the subgenual, retrosplenial, and parahippocampal subdivisions. No significant correlations were found between FA and performance in the control gender-based Stroop task in any CB region. However, the degree of interference produced by angry face distractors on time to identify pleasant words (emotional conflict) correlated selectively with FA in the subgenual CB (r= -0.53;P= 0.01). Higher FA was associated with reduced interference, irrespective of a diagnosis of MDD, suggesting that subgenual CB microstructure is functionally relevant for regulating attentional bias toward negative interpersonal stimuli.P.A.K. was funded by the Higher Education Funding Council for Wales (HEFCW) and an Academy of Medical Sciences and Wellcome Trust Starter Grant (AJ17102004). M.M. received an EPSRC Doctoral Training Grant. This work was also supported by a Marie Curie fellowship to Marcel Meyer and received funding from the European Union Seventh Framework Programme (FP7/2007-2013) under grant agreement no. 267171. D.K.J. was funded by HEFCW and received grants from the MS Society, a Wellcome Trust New Investigator Award, a Wellcome Trust Multi User Equipment Grant and Medical Research Council, and Wellcome Trust project grants. A.N.D. was supported by the Wellcome Trust PhD schemes. N.L. was funded by HEFCW. A.D.L. was funded by HEFCW. He also received grants from the ESRC, Wellcome Trust, and NISCHR. Funding to pay the Open Access publication charges for this article was provided by The Wellcome Trust

Holographic aspects of three dimensional QCD from string theory

We study two aspects of 3D QCD with massless fermions in a holographic set-up from string theory, based on D3/D7 branes; parity anomaly and baryons as baby Skyrmions. We first give a novel account of parity anomaly of 3D QCD with odd number of flavors from the IR holographic viewpoint by observing a subtle point in D7 brane embeddings with a given fixed UV theory. We also discuss its UV origin in terms of weakly coupled D-brane pictures. We then focus on the parity-symmetric case of even number of N_F flavors, and study baryons in the holographic model. We identify the monopoles of U(N_F) gauge theory dynamically broken down to U(N_F/2)x U(N_F/2) in the holographic 4 dimensional bulk as a holographic counter-part of 3D baby-Skyrmions for baryons in large N limit, and work out some details how the mapping goes. In particular, we show that the correct baryon charges emerge from the Witten effect with a space-varying theta angle.Comment: 33 pages, 10 figures; v2: references added with comments, typos corrected; v3: more references added; v4: holographic baryon profile and the analysis of its baryon charge is significantly revised, correcting errors in the previous discussio

Pediatric carcinoma of rectum - Varanasi experience

Background : Primary gastrointestinal system malignancies constitute approximately 2% of pediatric neoplasm and of these; colorectal carcinoma is the second most common malignancy. This is one of the rarer diseases in children. Aim : We reviewed our records to study the clinical features, outcome and the follow-up of this condition with evaluation of the prognostic factors. Settings and Design: Tertiary care Pediatric Surgery centre. Retrospective study. Materials and Methods : The data of all patients with diagnosis of colorectal carcinoma from January 1986 to January 2006 were reviewed. The confirmation of the diagnosis was by biopsy from the lesion. The age, sex, family history, clinical features, response to the treatment and follow-up were studied. Results : There were four male patients. All had bleeding per rectum as the presenting complaint. Three patients had advanced disease at presentation. All the patients had signet cell adenocarcinoma. The two patients expired and one was lost to follow-up. One patient is alive after one year of follow up and is receiving treatment. Conclusion : Colorectal cancer in children though rare can be a reality, hence any children presenting with pain in abdomen along with doubtful history of constipation and rectal bleeding should be examined carefully with special emphasis on digital rectal examination

Double coin in esophagus at same location and same alignment - a rare occurrence: a case report

Coin is the most common foreign body swallowed by pediatric age group. The multiple coin swallowing is extremely rare and very few cases had been reported in English literature. Most of them were present at different site and had different alignment in the esophagus. The location of the coin (trachea vs. esophagus) is commonly determined by the alignment of the coin on radiographic studies. A 4-year-girl was presented to us with history of coin ingestions one day back without any respiratory distress. On radiological study there was suspicion of two coins on same location and alignment. The diagnosis was confirmed after removal. The both coin was removed successfully by esophagoscopy. Unexpected second foreign bodies in pediatric esophageal coin ingestions are rare and it is mandatory to do post operative radiography after removal to exclude duplex coin or tracheal coin. We are presenting this case because of its rarity, difficulty in diagnosis especially when proper history is not available

Single-Stage Repair versus Traditional Repair of High Anorectal Malformations, Functional Results’ Correlation with Kelly’s Score and Postoperative Magnetic Resonance Imaging Findings

Introduction: Posterior sagittal anorectoplasty (PSARP) is the standard treatment for anorectal malformations. In the present study, the clinical evaluation of anal continence was carried out using Kelly’s scoring system and the results of primary PSARP or abdomino-PSARP were compared with the traditional three-stage procedure and the functional outcome was correlated with the findings of MRI, which was used as an objective method of evaluation.Patients and methods: A total of 40 patients with intermediate and high anorectal malformations were studied and were divided into two groups on the basis of a random number table. The patients in group A were treated with a single-stage operation, whereas the patients in group B were treated with a standard staged operation (either PSARP or abdominoperineal pull-through). After clinical evaluation using the Kelly score, patients were divided into three clinical groups irrespective of whether they were operated in one stage or in three stages. All patients were subjected to MRI at the age of 3 years and the findings were correlated with the clinical scoring system.Result: Patients were categorized according to their Kelly’s scores as follows: group 1: clinically good (score 5–6); group 2: clinically fair (score 3–4); and group 3: clinically poor (score 0–2). The proportions of good development of the muscles (puborectalis, external sphincter muscle, and levator muscle hammock) were 78.9% in group 1, 40% in group 2, and none in group 3. Development of muscles was found to be a significant factor for anal continence. Other significant factors for anal continence are rectal diameter and anorectal angle.Conclusion: Clinical assessment using the Kelly score was similar for the single-stage operation and the staged procedure, and this was supported by MRI findings. Therefore, we recommend the single-stage procedure to achieve a better outcome in intermediate and high anorectal malformation.Keywords: Anorectal Malformations, MRI, Posterior Sagittal Anorectoplast