TRANSPERITONEAL LAPAROSCOPIC URETEROLITHOTOMY FOR LARGE DISTAL URETERIC STONE

Objective: This study is aim to share our experience (in videos) in Laparoscopic ureterolithotomy for large distal ureteric stone with transperitoneal approach. Material & methods: A 37 years old male has been diagnosed with a right hydronephrosis due to proximal ureterolithiasis and stone at left calyx inferior, first and stone migrated to right distal ureter on 12 hours prior surgery, in Hasan Sadikin Hospital Bandung. He underwent laparoscopic ureterolithotomy with transperitoneal approach. Results: We successfully perform laparoscopic ureterolithotomy with transperitoneal approach on a 37 years old male patient who diagnosed with a right hydronephrosis due to distal ureterolithiasis and stone at left calyx inferior. Duration of operation was 45 minutes. Patient was discharged at 2nd postoperative day without any complications. Conclusion: A transperitoneal laparoscopic ureterolithotomy for distal ureteric stone is a safe and feasible technique that should be an options on every patients who is planning to undergo distal ureterolithotomy especially large stone. Keywords: Transperitoneal, laparoscopy, distal ureterolithotomy

Feeding practices among tribal mothers of malnutrition prevalent region of Amravati District in India

Introduction: Due to lack of intra- and post-natal care, the feeding practices can lead to a number of morbidities in the infancy period. Infant care in the community is influenced by cultural practices prevalent in the specific area apart from medical and economic reasons. Objectives: The objectives of this study were to understand prevalent feeding practices among tribal mothers having children <3 years of age and to explore reasons behind these practices. Methods: This community-based cross-sectional descriptive study was done in the northern tribal region of Amravati district. A total of 312 mothers were selected randomly for the study. Data were collected through face-to-face interviews of mothers who had a child of age <3 years using the structured interview. Results: Nearly 35% of mothers gave colostrum to the baby after 1 h of birth. While 39% of mothers were not found to be feed colostrum to the baby due to family tradition or advice of the elders, and 68% rejected colostrum feeding because they thought it was not clean. As high as 90% of the mothers initiated complementary feeding to the baby between 6 and 8 months of age, whereas 59% of children suffered from illness during 6 months immediately preceding the study. Conclusion: Inappropriate feeding practices need to be corrected to ameliorate the nutritional and health status of infants in a tribal region in India

EFFECT OF TESTICULAR TORSION ON SPERMATOZOA IN CONTRALATERAL EPIDIDYMIS

Objective: To determine the abnormality of spermatozoa in the contralateral epididymis after unilateral testicular torsion. Material & method: Twenty wistar rats were divided into two groups i.e. Group B (sham procedure) Group A (torsio and orchiectomy 24 hours later), and contralateral epididymectomy was performed a month later. Spermatozoa in the contralateral epididymis are extracted and analyzed by an experienced biologist. Data were analyzed using Chi-square or Fischer exact test. Results: Sperm morphology changes in group B is higher than Group A (6,6% vs 0,5%, p = 0,009). Conclusion: Unilateral testicular torsion causes sperm abnormal morphology in the contralateral epididymis. Keywords: Unilateral testicular torsion, contralateral epididimal spermatozoa

Value of tumor’s depth and width in predicting survival rate in non-muscle- invasive (pT1) bladder cancer

Background: Bladder cancer is classified according to traditional American Joint Committee on Cancer TNM staging. In the absence of nodal (N stage) or distant metastases (M stage), the depth of tumor invasion (T stage) is the most important determination to be made: whether the tumor is invading into or beyond the lamina propria (muscle-invasive bladder cancer) or not (non- muscle-invasive bladder cancer). This study investigated the association between the cutoff value of tumor depth and width and survival rate in non-muscle- invasive (pT1) bladder cancer. Methods: This was a retrospective cohort design of randomly selected, single- centered study. The subjects were patients with pT1 urothelial carcinoma who were diagnosed on transurethral resection of bladder specimens at a tertiary hospital in West Java, Indonesia. The research sample was taken by consecutive sampling from 2015 to 2019. Results: Sixty-four patients from were included in this study. A tumor depth >2 mm resulted in a hazard ratio (HR) of 1.41 (95% confidence interval [CI], 1.27–3.94; p<0.007), with significant difference. A tumor width >2.4 mm also increased HR significantly (3.27; 95% CI, 1.69–5.87; p<0.006). The presence of lymphovascular invasion (LVI) in patients with bladder cancer resulted in an HR of 3.66 (95% CI, 1.5–4.77; p<0.001), with statistically significant difference in overall survival (OS). Conclusion: Tumor invasion depth, tumor width, and LVI appear to be predictive of poor prognosis in terms of OS in patients with pT1 bladder cancer

Laparoscopic Transperitoneal Approach for Vesicovaginal Fistula Repair: the First Experience

Objective: To report our first experience in transperitoneal laparoscopic repair of vesicovaginal fistula in Dr. Hasan Sadikin Hospital. Method: A 31-year-old female presented with vesicovaginal fistula after cesarean section. Patient complained of urinary incontinence since 5 years ago. After a failed trial of conservative treatment with catheter drainage, a transperitoneal laparoscopic repair was performed. Initially, cystoscopy was performed to confirm the fistula location and for bilateral ureteric catheterization. A 4-port technique was performed with the patient in lithotomy position and slightly Trendelenburg. Without opening the bladder, the fistula tract was excised and the bladder was separated from the anterior vaginal wall. Both the bladder and vaginal walls were then closed separately using intracorporeal suturing, interposed with the omentum. Result: Total operative time was 270 minutes. Normal diet was resumed on day 1, drain was removed on the first day after surgery, and the patient was discharged on the second day with an indwelling catheter. Surgical wound showed good cosmetic result and no leakage was identified from cystogram after 2 weeks. The catheter was removed after 2 weeks. Conclusion: Laparoscopic transperitoneal repair of vesicovaginal fistula with omentum inteposition is feasible in Dr. Hasan Sadikin Hospital with good outcome, short hospital stay, and good cosmetic result.  Keywords: laparoscopy, vesicovaginal fistul

Bohring Opitz Syndrome: A case of a rare genetic disorder

Bohring-Opitz syndrome (BOS) is a rare genetic disorder, characterized by feeding difficulties, developmental delay, microcephaly, micrognathia, limb anomalies, and typical phenotypic facial features. The cause of the syndrome is identified as de novo heterogeneous mutations in the ASXL1 gene, but other mutations have been described in some patients. Most patients die in early childhood due to infections and comorbidities. As molecular confirmation by genetic studies is not always possible, this syndrome is diagnosed on the basis of distinctive clinical features. We report a case of the 6-month-old male child having gastroesophageal reflux and physical features of microcephaly, sloping forehead, sparse hair, craniosynostosis, telecanthus, hypertelorism, prominent eyes, posteriorly rotated ears, high-arched palate, micrognathia, pes planus, and typical BOS posture. A multidisciplinary approach is required for managing these patients

Partial Restoration of Mutant Enzyme Homeostasis in Three Distinct Lysosomal Storage Disease Cell Lines by Altering Calcium Homeostasis

A lysosomal storage disease (LSD) results from deficient lysosomal enzyme activity, thus the substrate of the mutant enzyme accumulates in the lysosome, leading to pathology. In many but not all LSDs, the clinically most important mutations compromise the cellular folding of the enzyme, subjecting it to endoplasmic reticulum–associated degradation instead of proper folding and lysosomal trafficking. A small molecule that restores partial mutant enzyme folding, trafficking, and activity would be highly desirable, particularly if one molecule could ameliorate multiple distinct LSDs by virtue of its mechanism of action. Inhibition of L-type Ca2+ channels, using either diltiazem or verapamil—both US Food and Drug Administration–approved hypertension drugs—partially restores N370S and L444P glucocerebrosidase homeostasis in Gaucher patient–derived fibroblasts; the latter mutation is associated with refractory neuropathic disease. Diltiazem structure-activity studies suggest that it is its Ca2+ channel blocker activity that enhances the capacity of the endoplasmic reticulum to fold misfolding-prone proteins, likely by modest up-regulation of a subset of molecular chaperones, including BiP and Hsp40. Importantly, diltiazem and verapamil also partially restore mutant enzyme homeostasis in two other distinct LSDs involving enzymes essential for glycoprotein and heparan sulfate degradation, namely α-mannosidosis and type IIIA mucopolysaccharidosis, respectively. Manipulation of calcium homeostasis may represent a general strategy to restore protein homeostasis in multiple LSDs. However, further efforts are required to demonstrate clinical utility and safety

Comparison of Tissue Preservation using Formalin and Ethanol as Preservative Formula

Background: Tissue preservation can be performed through embalming, by providing the chemical embalming fluid to the human remains. Formalin’s preservative formula is the foundation for modern methods of embalming. Unfortunately, this preservative formula has several disadvantages. While Ethanol’s preservative formula is a considerable agent to replace formalin’s preservative formula. The aim of this study was to compare the tissue preservation using formalin and ethanol as preservative formula.Methods: This study was carried out from September–October 2014 in the Laboratory of the Department of Anatomy, Faculty of Medicine, Universitas Padjadjaran. The study used the laboratory experimental method with consecutive sampling of 16 Wistar Rats. Thirty two soleus muscles and thirty two colons were collected and divided into two groups. Each group consisted of 16 soleus muscles and 16 colons. Group 1 was preserved with formalin’s preservative formula and Group 2 was preserved with ethanol’s preservative formula. The two groups were preserved for six weeks. The tissue’s color, consistency, odor and the growth of bacteria were determined before and after treatment.Results: Tissues preserved with ethanol’s preservative formula had better tissue preservation in the aspect of color and odor, compared with formalin’s preservative formula. Both preservative formulas showed no growth of bacteria in tissues but failed to retain the consistency. All the data were analyzed with Chi-square test.Conclusions: Ethanol’s preservative formula preserves better quality of tissue compared to formalin’s preservative formula. [AMJ.2016;3(3):359–63] DOI: 10.15850/amj.v3n3.880

Remodeling the Proteostasis Network to Rescue Glucocerebrosidase Variants by Inhibiting ER-Associated Degradation and Enhancing ER Folding

Gaucher’s disease (GD) is characterized by loss of lysosomal glucocerebrosidase (GC) activity. Mutations in the gene encoding GC destabilize the protein’s native folding leading to ER-associated degradation (ERAD) of the misfolded enzyme. Enhancing the cellular folding capacity by remodeling the proteostasis network promotes native folding and lysosomal activity of mutated GC variants. However, proteostasis modulators reported so far, including ERAD inhibitors, trigger cellular stress and lead to induction of apoptosis. We show herein that lacidipine, an L-type Ca2+ channel blocker that also inhibits ryanodine receptors on the ER membrane, enhances folding, trafficking and lysosomal activity of the most severely destabilized GC variant achieved via ERAD inhibition in fibroblasts derived from patients with GD. Interestingly, reprogramming the proteostasis network by combining modulation of Ca2+ homeostasis and ERAD inhibition remodels the unfolded protein response and dramatically lowers apoptosis induction typically associated with ERAD inhibition