Compare Outcomes Of Single Stage Vs Two Stage Urethroplasty For Panurethral Strictures Including Pre-Operative And Post-Operative Course

Aim: The aim of the present study was to compare outcomes of single stage vs two stage urethroplasty for panurethral strictures including pre-operative and post-operative course. Methods: The Observational study was conducted at Dr. D.Y. Patil Medical College and Research Centre, Pimpri for the period of 2 years. The study was conducted in 40 patients randomly dividing into two groups, 20 patients underwent single stage urethroplasty and 20 underwent two staged urethroplasty with or without buccal mucosal graft urethroplasty based on size of urethral plate. Results: In the present study, majority of the patients belonged to 41-50 years age group followed by 31-40 years age group and it was found that age groups were not statistically significant. Majority of the patients had Balanitis xerotica obliterans (LS) etiology followed by Post instrumentation/catheter and the results were not statistically significant. Majority of the patients had 13-15 cms length of stricture. In the present study, 12 and 16 were narrow external uretheral meatus in single and two stage respectively. In the two stage, Johanson’s urethroplasty procedure was done and in single stage, Kulkarni’s full length dorsal onlay BMG urethroplasty procedure was done. In single and two stage, Urethrocutaneous Fistula and Epididymo-orchitis complications were noted. In single stage, success was noted in 16 patients and in two stage, success was noted in 17 patients. Conclusion: The single stage repair in patients with LS had good results with less re-stricture rates. The use of BMG as a substitution in single stage repair had re-stricture rates compared to flaps substitution. The two-stage repair should be limited to complex urethral strictures, failed urethroplasty and obliterated urethral stricture urethral caliber is less than 6F

Volvulus as a complication of chronic intestinal pseudo-obstruction syndrome

Chronic intestinal pseudo-obstruction syndrome (CIPS) is a severe motility disorder of the gastrointestinal tract that presents with continuous or recurrent symptoms and signs of intestinal obstruction without evidence of a structural lesion occluding the intestinal lumen. Mechanical obstruction might occur in these patients as well but is typically difficult to distinguish from an exacerbation of CIPS. We report two pediatric cases in which mechanical obstruction by volvulus mimicked an exacerbation of CIPS, requiring surgical intervention. Conclusion: Awareness of the possibility of true mechanical obstruction in CIPS patients during an exacerbation episode is needed, as this is a severe condition and usually requires surgical intervention

Effects of Interferon-α/β on HBV Replication Determined by Viral Load

Interferons α and β (IFN-α/β) are type I interferons produced by the host to control microbial infections. However, the use of IFN-α to treat hepatitis B virus (HBV) patients generated sustained response to only a minority of patients. By using HBV transgenic mice as a model and by using hydrodynamic injection to introduce HBV DNA into the mouse liver, we studied the effect of IFN-α/β on HBV in vivo. Interestingly, our results indicated that IFN-α/β could have opposite effects on HBV: they suppressed HBV replication when viral load was high and enhanced HBV replication when viral load was low. IFN-α/β apparently suppressed HBV replication via transcriptional and post-transcriptional regulations. In contrast, IFN-α/β enhanced viral replication by inducing the transcription factor HNF3γ and activating STAT3, which together stimulated HBV gene expression and replication. Further studies revealed an important role of IFN-α/β in stimulating viral growth and prolonging viremia when viral load is low. This use of an innate immune response to enhance its replication and persistence may represent a novel strategy that HBV uses to enhance its growth and spread in the early stage of viral infection when the viral level is low

Neuroendocrine factors regulate retinoic acid receptors in normal and hypoplastic lung development

Congenital diaphragmatic hernia (CDH) is characterised by a spectrum of lung hypoplasia and consequent pulmonary hypertension, leading to high morbidity and mortality rates. Moreover, CDH has been associated with an increase in the levels of pulmonary neuroendocrine factors, such as bombesin and ghrelin, and a decrease in the action of retinoic acid (RA). The present study aimed to elucidate the interaction between neuroendocrine factors and RA. In vitro analyses were performed on Sprague-Dawley rat embryos. Normal lung explants were treated with bombesin, ghrelin, a bombesin antagonist, a ghrelin antagonist, dimethylsulfoxide (DMSO), RA dissolved in DMSO, bombesin plus RA and ghrelin plus RA. Hypoplastic lung explants (nitrofen model) were cultured with bombesin, ghrelin, bombesin antagonist or ghrelin antagonist. The lung explants were analysed morphometrically, and retinoic acid receptor (RAR) α, β and γ expression levels were assessed via Western blotting. Immunohistochemistry analysis of RAR was performed in normal and hypoplastic lungs 17.5 days post-conception (dpc). Compared with the controls, hypoplastic lungs exhibited significantly higher RARα/γ expression levels. Furthermore considering hypoplastic lungs, bombesin and ghrelin antagonists decreased RARα/γ expression. Normal lung explants (13.5 dpc) treated with RA, bombesin plus RA, ghrelin plus RA, bombesin or ghrelin exhibited increased lung growth. Moreover, bombesin and ghrelin increased RARα/γ expression levels, whereas the bombesin and ghrelin antagonists decreased RARα/γ expression. This study demonstrates for the first time that neuroendocrine factors function as lung growth regulators, sensitising the lung to the action of RA through up-regulation of RARα and RARγ.P.P.-T. was supported by the Fundação para a Ciência e a Tecnologia (ref. SFRH/BD/73660/2010). R.S.M. was supported by the ON.2 SR&TD Integrated Program (N-01-01-01-24-01-07) (ref. UMINHO/BPD/31/2013). The funding bodies had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript

Endoscopic balloon dilatation for congenital membranous stenosis in the jejunum in an infant.

INTRODUCTION: As endoscopic equipment and instruments have improved, the indications for endoscopic treatment have also been extended. This report presents an applicable procedure of endoscopic balloon dilatation for an infant patient with congenital membranous stenosis in the jejunum. METHODS: We used a 9-mm flexible endoscope and a through-the-scope multidiameter balloon catheter in the endoscopic treatment. RESULTS: Dilatation was performed for dilatation diameters 10, 12, and 15 mm each for 2 min. After carrying out balloon dilatation, the endoscope could be smoothly inserted through the opening. CONCLUSION: In upper jejunal stenosis, endoscopic balloon dilatation was minimally invasive and effective as a treatment modality.The original publication is available at www.springerlink.co

Secretion of Genome-Free Hepatitis B Virus – Single Strand Blocking Model for Virion Morphogenesis of Para-retrovirus

As a para-retrovirus, hepatitis B virus (HBV) is an enveloped virus with a double-stranded (DS) DNA genome that is replicated by reverse transcription of an RNA intermediate, the pregenomic RNA or pgRNA. HBV assembly begins with the formation of an “immature” nucleocapsid (NC) incorporating pgRNA, which is converted via reverse transcription within the maturing NC to the DS DNA genome. Only the mature, DS DNA-containing NCs are enveloped and secreted as virions whereas immature NCs containing RNA or single-stranded (SS) DNA are not enveloped. The current model for selective virion morphogenesis postulates that accumulation of DS DNA within the NC induces a “maturation signal” that, in turn, triggers its envelopment and secretion. However, we have found, by careful quantification of viral DNA and NCs in HBV virions secreted in vitro and in vivo, that the vast majority of HBV virions (over 90%) contained no DNA at all, indicating that NCs with no genome were enveloped and secreted as empty virions (i.e., enveloped NCs with no DNA). Furthermore, viral mutants bearing mutations precluding any DNA synthesis secreted exclusively empty virions. Thus, viral DNA synthesis is not required for HBV virion morphogenesis. On the other hand, NCs containing RNA or SS DNA were excluded from virion formation. The secretion of DS DNA-containing as well as empty virions on one hand, and the lack of secretion of virions containing single-stranded (SS) DNA or RNA on the other, prompted us to propose an alternative, “Single Strand Blocking” model to explain selective HBV morphogenesis whereby SS nucleic acid within the NC negatively regulates NC envelopment, which is relieved upon second strand DNA synthesis

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