Smooth muscle tissue engineering for hybrid tubular organs: scanning electron microscopic investigations of cell interactions with collagen scaffolds

Tissue engineering of transplantable tubular tissue necessitates a composite approach to assembling the individual components. In the engineering of tubular structures (gastrointestinal, urogenital and vascular tissues) there is a demand for smooth muscle tissue in addition to the primary organ‐specific tissue. This study aims to investigate the interaction of smooth muscle cells on bovine collagen scaffolds cross‐linked with glutaraldehyde under in vitro conditions, using scanning electron microscopy. The density of tissue generated over the 8 week period was demonstrated in terms of: (a) scaffold coverage and attachment; (b) cell density; (c) cell viability deep inside the scaffolds; and (d) cell differentiation. Copyright © 2009 John Wiley & Sons, Ltd.     

Advances in pharmacological strategies for the prevention of cataract development

Cataractous-opacification of the lens is one of the leading causes of blindness in India. The situation can be managed by surgical removal of the cataractous lens. Various pharmacological strategies have been proposed for the prevention and treatment of cataract. Information on possible benefits of putative anticataract agents comes from a variety of approaches, ranging from laboratory experiments, both in vitro and in vivo, to epidemiological studies in patients. This review deals with the various mechanisms, and possible pharmacological interventions for the prevention of cataract. The article also reviews research on potential anticataractous agents, including aldose reductase inhibitors, glutathione boosters, antiglycating agents, vitamins and various drugs from indigenous sources.     

Frasier syndrome in a pre-menarchal girl: laparoscopic resection of gonadoblastoma

Frasier syndrome (FS) is characterized by male pseudohermaphroditism, slowly progressing nephropathy, and frequent development of gonadoblastoma. These patients are, however, often diagnosed when evaluated for primary amenorrhea. We report the case of FS in a pre-menarchal girl at the age of 6 years. Ultrasound examinations were performed and were inconclusive as to the presence or size of the gonads. Diagnostic laparoscopy was performed and the presence of bilateral streak gonads was documented and a bilateral salpingo-oophorectomy was performed. The postoperative course was uneventful. Histological examination of the streak gonads confirmed the presence of gonadoblastoma. To our knowledge, this is the first case in the literature of a pre-menarchal patient diagnosed with FS and a laparoscopic bilateral gonadoblastoma resection. Laparoscopic aspects regarding safe streak gonad removal in the pediatric population have been elaborated.     

Tisseel for management of traumatic postpartum haemorrhage

Introduction  Following the introduction of haemostatic agents, new opportunities are available when facing problematic bleeding. We report the first case of traumatic postpartum hemorrhage successfully controlled with a fibrin sealant. Case presentation  26-year nulliparous patient had a rotational forceps delivery and developed multiple vaginal lacerations. Haemostasis could not be achieved after suturing, vaginal packing and IV tranaxemic acid. She lost approx. 3,500 ml blood and received 4 U transfusion. Tisseel was used as a thin layer on vaginal wall and bleeding settled. She had good recovery and perineum healed well. Conclusion  Tisseel consists of a two-component fibrin biomatrix to stop diffuse bleeding. When the tissues are very oedematous, it can be difficult to insert sutures. We tried this innovative option with very effective results. The absence of long-term complications is reassuring and we recommend its use in similarly extreme situations.     

Ventricular Septal Rupture in a 4-Year-Old Child Following Blunt Chest Injury

We report on a 4-year-old child who developed rupture of the ventricular septum after a blunt chest injury. The symptoms appeared more than 12 h later with progressive deterioration in his hemodynamic status. The diagnosis was made by echocardiography and the large defect in the muscular part of the ventricular septum was successfully closed at surgery.     

Risk factors for renal injury in patients with meningomyelocele

PATIENTS AND METHODS: Thirty operated patients of myelodysplasia were clinically evaluated for the age at presentation, the extent of lesion and neurological deficit. Urological assessment was done with urine cultures, serum creatinine, radiological (ultrasound of kidney, ureters and bladder, voiding cystourethrogram) and urodynamic (water cystometry) parameters. An objective scoring for bladder (Galloway, et al.) was applied. Dimercapto-succinic acid (DMSA) scan was done in all the patients for evidence of renal scars. The results of above investigations were correlated with presence or absence of renal scars (renal injury) on DMSA scan. None of the patients had received any prior bladder care. RESULTS: Twenty one patients had no renal scars and 9 patients had evidence of renal scarring. Patients with renal scars were older at presentation, they had greater degree of hydroureteronephrosis (P < or = 0.001) and vesicoureteric reflux (P < or = 0.005). The incidence of high leak pressures (>25 cm of water, P < or = 0.05), unacceptable bladder volumes (maximum cystometric capacity < 60% for age, P < or = 0.005) and high risk Galloway's score (> 5, P < or = 0.05) was high in patients with associated renal scarring as compared to their nonscarred counterparts. Three of these patients had serum creatinine >1 mg/dl (P < or = 0.005). The incidence of urinary complaints and positive urine cultures was also higher in these patients (NS). CONCLUSION: Increasing age, evidence of hydroureteronephrosis and vesicoureteric reflux, high leak pressures, low bladder volume and high combined Galloway score (>5) define a high risk bladder in our population and predispose to renal injury in patients of myelodysplasia. Early referral for bladder risk assessment and management of all myelodysplasia patients is recommended.     

Acute T lymphoid and megakaryoblastic bi-lineal leukemia in a child

A 1 1/2-year-old boy presented with fever, anemia, petechial rash and hepatosplenomegaly. Bone marrow examination showed two morphologically distinct blasts (small and large) which were confirmed on immunophenotyping to be of T-lymphoid and megakaryocytic lineages respectively. Patient was refractory to therapy. This is a rare combination of bi-lineal leukemia in a child.