Surgical management of cirsoid aneurysms

Summary. Summary.   Background: Cirsoid aneurysms (arteriovenous fistulas) of the scalp are rare lesions. They are infrequently encountered in neurosurgical practice. These lesions are difficult to manage because of their complex vascular anatomy, high shunt flow and cosmetic disfigurement. We report our experience in the surgical management of these lesions.   Methods: We treated 11 patients with cirsoid aneurysms surgically. All except one patient were males who were in the second and third decades of life. History of trauma was present in 6 patients. In one patient, the lesion had been present since birth. Occipital and frontal regions were the sites commonly involved. Superficial temporal, occipital and posterior auricular arteries were the most frequent feeding arteries. The size ranged from 3 cms to 12 cms. Following investigations were done: CT, MRI, MRA, angiography and Doppler studies.   Findings: Excision of the lesion was done in 8 patients and en bloc resection of the lesion with the scalp with reconstruction was done in the remaining three. One among the three patients who underwent en bloc resection had undergone prior surgery. None of the patients underwent preoperative endovascular treatment. One patient had undergone intralesional injection of sclerosing agents twice. Superficial scalp necrosis occurred in two patients but was treated successfully. All the patients except one had good cosmetic results and there was no recurrence during an average follow up of 18 months.   Interpretation: Surgical excision with good cosmetic results is feasible in patients with cirsoid aneurysms.     

Pure red cell aplasia of pregnancy: a distinct clinical entity

Summary. We describe a 31-year-old patient with pure red cell aplasia of pregnancy, successfully managed with regular blood transfusions. In vitro studies showed specific inhibition of day 14 erythroid colonies (BFU-E) using serum and purified immunoglobulin G (IgG) obtained from the patient at diagnosis (before blood transfusion). The inhibition of BFU-E disappeared when haematological remission occurred 3 weeks after delivery and she remains clinically well with a normal haemoglobin 4 years later.     

Modified Pfannenstiel approach for radical retropubic prostatectomy

Radical retropubic prostatectomy is traditionally performed using a vertical midline incision and occasionally using a transverse Pfannenstiel incision. We describe a technique for performing radical retropubic prostatectomy using a modified Pfannenstiel approach. This involves a Y incision of the rectus sheath, instead of a pure transverse incision, and provides both excellent exposure and better cosmetic results.     

Radical retropubic prostatectomy in Hispanic patients

BACKGROUND: Hispanics are the largest minority group in the U.S. Most studies assessing race as a predictor of biochemical disease recurrence after radical retropubic prostatectomy (RRP) have focused on African-American patients. To the authors' knowledge, little has been published to date regarding radical prostatectomy in Hispanic patients. Hispanics represent 29% of the patients in the current study. The authors analyzed the presentation and outcome of Hispanic males managed with radical prostatectomy. METHODS: In the current study, 1163 RRPs were performed. Patients were categorized by ethnicity as Hispanics, white non-Hispanics, African-Americans, and other ethnicities. African-American and other minority group patients were excluded from the analysis because of the small number in the current series. A comparative analysis of Hispanics and white non-Hispanics was performed. RESULTS: RRP was performed in 1163 patients. Two hundred seven Hispanic and 518 white non-Hispanic patients met the study criteria. The mean follow-up was 46.9 months. Twenty-three percent of the Hispanic patients received neoadjuvant therapy. RRP Gleason scores of 2-6, 7, and 8-10 were found in 45% of patients, 38% of patients, and in 17% of patients, respectively. Lymph node metastases were present in 3%, seminal vesicle invasion in 13%, and extraprostatic extension in 23% of Hispanic patients. Adjuvant hormonal therapy was administered to 6% of the Hispanic patients. The biochemical disease recurrence rate was 12%. The mean time to biochemical disease recurrence was 29.7 months. A comparison between the Hispanic and the white non-Hispanic groups showed no significant differences in the analyzed variables. CONCLUSIONS: Hispanic patients managed with radical prostatectomy for prostate carcinoma were found to have similar presentation, pathologic findings, and outcome as the white non-Hispanic patients.     

Reorganization of water distribution system of Greater Jammu using computer software OPT DIS

Water supply in old Jammu city is not evenly distributed due to undulating terrain and increase in population density. A study was undertaken to suggest measures for improvement to the distribution system. The paper presents results of analysis carried out using computer package OPT DIS developed at NEERI for optimal design of distribution sytem including system augmentation and reorganization measures needed for the design year 2021. The analysis of zone 1 of the distribution network indicates that seven pipes need alteation to cater to the demand for the year 2006 and fifteen pipes need replacement for the year 2021. New pipelines (13 nos.) are to be provided in parallel to the existing pipes in Upper Reach and 28 pipes in Lower Reach to ensure the service standards of 225 lpcd with minimum residual head of 17 m. Efficient algorithm for augmentations of water supply systems comprising combination of dead-end and loop network are having much wider application in developing countries. The software OPT DIS developed at NEERI was found to be extremely powerful and user friendly for addressing such systems with varying demand pattern, peaking factor, pipe condition, water supply modes and design horizones.