Detubularized isolated ureterosigmoidostomy in a complicated common cloaca: A case report

Urinary incontinence in a child secondary to a severe congenital anatomical disorder or due to complication of a previous surgery can be difficult to manage. Decisions can be especially hard when a redo procedure is being considered. We present one such case where a 6 year old girl previously operated for cloaca was brought with incontinence and after much consideration of options available, underwent a modified ureterosigmoidostomy to aid in her continence. The modification used was detubularized isolated ureterosigmoidostomy, described by Atta et al in 1996

Commonly reported isokinetic parameters do not reveal long-term strength deficits of the Triceps surae complex following operative treatment of Achilles tendon rupture

Isokinetic strength assessments are common outcome measures following operatively treated Achilles tendon (AT) ruptures. However, there is a lack of clarity on whether commonly reported outcome measures (such as peak joint moment) are sufficient to describe the extent of long-term functional deficits following AT rupture and repair. The present study conducted a comprehensive isokinetic evaluation of the Triceps surae complex in 12 participants who previously underwent AT rupture and repair. Testing occurred 4.4 (±2.6) years following surgery, and consisted of maximal isokinetic strength assessments of the plantarflexors at two angular velocities (30 and 60 °∙s-1) with the knee in flexed and straight positions. Differences between injured and non-injured limbs were tested through discrete and statistical parametric mapping analysis. Average joint moment showed significant main effects between injured and non-injured limbs, but common isokinetic parameters such as peak moment and angle of peak moment did not. The normalised moment curves showed a significant main effect of limb, angular velocity and knee joint position on joint moment throughout different portions of the range of motion. Temporal analysis revealed a significantly greater ability of the non-injured limb to sustain plantarflexor moments across a range of testing conditions. Participants who had undergone operative treatment of AT ruptures did not display inter-limb differences in discrete isokinetic strength outcomes that are often used in the literature. Instead, temporal analyses were required to highlight the reduced capacity of the injured limb to generate end-range joint moments and to sustain higher levels of joint moment for longer periods

Hyperbaric oxygen improves engraftment of ex-vivo expanded and gene transduced human CD34+ cells in a murine model of umbilical cord blood transplantation

Delayed engraftment and graft failure represent major obstacles to successful umbilical cord blood (UCB) transplantation. Herein, we evaluated the use of hyperbaric oxygen (HBO) therapy as an intervention to improve human UCB stem/progenitor cell engraftment in an immune deficient mouse model. Six-to eight-week old NSG mice were sublethally irradiated 24 hours prior to CD34+ UCB cell transplant. Irradiated mice were separated into a non-HBO group (where mice remained under normoxic conditions) and the HBO group (where mice received two hours of HBO therapy; 100% oxygen at 2.5 atmospheres absolute). Four hours after completing HBO therapy, both groups intravenously received CD34+ UCB cells that were transduced with a lentivirus carrying luciferase gene and expanded for in vivo imaging. Mice were imaged and then sacrificed at one of 10 times up to 4.5 months post-transplant. HBO treated mice demonstrated significantly improved bone marrow, peripheral blood , and spleen (p=0.0293) retention and subsequent engraftment. In addition, HBO significantly improved peripheral, spleen and bone marrow engraftment of human myeloid and B-cell subsets. In vivo imaging demonstrated that HBO mice had significantly higher ventral and dorsal bioluminescence values. These studies suggest that HBO treatment of NSG mice prior to UCB CD34+ cell infusion significantly improves engraftment

Round worm migration along ventriculoperitoneal shunt tract: a rare complication.

Though a ventriculoperitoneal shunt has been associated with myriads of unusual complications, so has been that with roundworms. A case of a three-year-old boy is presented who had an unusual complication of roundworm migration along the shunt tract that presented as shunt tract infection

Case Report - Round Worm Migration Along Ventriculoperitoneal Shunt Tract: A Rare Complication

Though a ventriculoperitoneal shunt has been associated with myriads of unusual complications, so has been that with roundworms. A case of a three-year-old boy is presented who had an unusual complication of roundworm migration along the shunt tract that presented as shunt tract infection

Case Report - Round Worm Migration Along Ventriculoperitoneal Shunt Tract: A Rare Complication

Though a ventriculoperitoneal shunt has been associated with myriads of unusual complications, so has been that with roundworms. A case of a three-year-old boy is presented who had an unusual complication of roundworm migration along the shunt tract that presented as shunt tract infection

Gastric volvulus in children: Experience of 6 years at a tertiary care centre

Background: The aim of the study was to review the cases of all children who had gastric volvulus from 2002 to 2007 at a tertiary care centre in India and to compare the outcome of management with the reported series on gastric volvulus in a paediatric age group. Materials and Methods: This was a retrospective study of eight children with an age range between 10 days and 2 years who were managed for gastric volvulus between 2002 and 2007. The records of these patients were reviewedfor clinical features, investigations, management and outcome. Results: All patients were less than 3 years of age with female preponderance (n = 5). Three patients had acute presentation and three had acute-on-chronicsymptoms, while two had chronic gastric volvulus. The commonest symptom was abdominal distension. Two patients were diagnosed by barium studies and six had clinical suspicion because of their symptoms and were conÞ rmed intra-operatively. Seven had secondary gastric volvulus of organo axial type with associated pathologies as congenital diaphragmatic hernia (n = 5), Para oesophageal hiatus hernia (n = 2), and one had primary gastric volvulus in a postoperative period in an operated case for a tracheo-oesophageal Þ stula (n = 1). Seven patients were symptom free at followup; one patient succumbed due to septicaemia in the immediate post-operative period which was not related to the pathology of gastric volvulus. Conclusion: Gastric volvulus is a rare condition in children and requires prompt diagnosis and urgent intervention in acute presentation where it mimics acute abdomen and strong clinical suspicion.Key words: Acute presentation, children, gastric volvulu

Intestinal obstruction in children due to Ascariasis: A tertiary health centre experience

Background: Ascariasis is the infestation by the largest intestinal nematode of man, a common problem in the tropics attributed to poor hygienic and low socioeconomic conditions. The aim of this research is to analyse the presentation, diagnosis and management of bowel obstruction caused by Ascaris lumbricoides, with special emphasis on the role of conservative management. Materials and Methods: This is a single centre, two consultant based 5 year retrospective study of childhood intestinal obstruction due to worms. Diagnosis in the suspected patients was based on history of passage of worms per mouth or rectum and on x-ray and ultrasonography findings. Only the patients of intestinal obstruction with documented evidence of roundworm infestation were included in the study and were followed for one year. Results: One hundred and three children with intestinal obstruction due to Ascaris lumbricoides were treated in the past five years at our centre. Abdominal pain was the most common presentation seen in 96 children followed by vomiting in 77 children. 20 children had history of vomiting worms and another 43 had history of passing worms in stool. Abdominal tenderness was present in 50 children, 48 had abdominal distension of varying degree, 50 had abdominal mass due to worm bolus, and 16 had or developed abdominal guarding or rigidity. All the children were managed as for acute intestinal obstruction along with hypertonic saline enema. The aim of management was "to starve the worm and hydrate the patient". 87 patients (84.47%) responded favourably and were relieved of the obstruction by the conservative management, 16 children (15.53%) had abdominal guarding or rigidity and underwent emergency exploration. Conclusion: Roundworm obstruction should be considered in the differential diagnoses of all cases of intestinal obstruction in children. Clinical history and examination along with X-ray and ultrasonography are very helpful for diagnosis of this surgical emergency. Most cases of intestinal obstruction due to Ascaris can be managed conservatively; however emergency surgery is needed in patients with abdominal guarding and rigidity

Role of magnetic resonance urography in diagnosis of duplex renal system: Our initial experience at a tertiary care institute

Aim: To determine diagnostic value of magnetic resonance urography in cases of duplex renal system. Method: Twenty cases between five month to nine years with suspected or known duplex renal system were evaluated by ultrasound (USG), micturating cystourethrography (MCU), intravenous urography (IVU) and magnetic resonance urography (MRU). The findings of these diagnostic imaging studies were then compared with each other and against the results of final diagnosis established at surgery. Results: Duplex renal system could be identified in two of these cases on USG, was diagnosed in four in IVU and could be diagnosed in all cases with MRU. Conclusion: MRU is superior and far accurate than IVU, MCU and USG in diagnosing duplex renal system

Grizzlies and gazelles: Duty factor is an effective measure for categorizing running style in English Premier League soccer players

English Premier League soccer players run at multiple speeds throughout a game. The aim of this study was to assess how well the duty factor, a dimensionless ratio based on temporal variables, described running styles in professional soccer players. A total of 25 players ran on an instrumented treadmill at 12, 16, and 20 km/h. Spatiotemporal and ground reaction force data were recorded for 30 s at each speed; video data (500 Hz) were collected to determine footstrike patterns. In addition to correlation analysis amongst the 25 players, two groups (both N = 9) of high and low duty factors were compared. The duty factor was negatively correlated with peak vertical force, center of mass (CM) vertical displacement, and leg stiffness (kleg) at all speeds (r ≥ −0.51, p ≤ 0.009). The low duty factor group had shorter contact times, longer flight times, higher peak vertical forces, greater CM vertical displacement, and higher kleg (p < 0.01). Among the high DF group players, eight were rearfoot strikers at all speeds, compared with three in the low group. The duty factor is an effective measure for categorizing soccer players as being on a continuum from terrestrial (high duty factor) to aerial (low duty factor) running styles, which we metaphorically refer to as “grizzlies” and “gazelles,” respectively. Because the duty factor distinguishes running style, there are implications for the training regimens of grizzlies and gazelles in soccer, and exercises to improve performance should be developed based on the biomechanical advantages of each spontaneous running style