Vesicocervical fistula: an unusual complication of vesicocaginal fistula repair

A rare case of vesicocervical fistula following repair of a vesicovaginal fistula is presented. The patient complained of cyclical menouria since the first repair done 15 years ago and gradually worsening urinary incontinence. A laparoscopic assisted repair of the fistula was performed and the patient is fully continent at 12-months follow up.An erratum to this article can be found at     

Common environmental allergens causing respiratory allergy in India

Respiratory allergy affects all age groups but the children are the worst affected by the respiratory allergy. Bioparticles from different biological sources are the main cause of allergy. Pollen grains, fungal spores, insect and other materials of biological origin form the most important allergen load in the air. For the efficient diagnosis of the allergy and its effective treatment it is very important to know about the prevalence, seasonal and annual variations of aeroallergens of the area. India being the climatically diversed country, there is diversity in the flora and fauna of different parts of the country. Atmospheric surveys carried out in different parts of India reveal that,Alanus nitida, Amarantus spinosus, Argemone mexicana Cocos nucifera, Betula utilis, Borasus flabellifer, Caraica papaya, Cedrus deodara, Cassia fistula, Parthenium, Chenopodium album,Dodonaea viscosa, Malotus phillipensis, Plantago ovata, Prosopis juliflora, Ricinus communis, Holoptelea intergifolia are the allergenically important pollens of the country. Among the fungal aeroallergens,Altemaria, Candida aibieans, Aspergillus versicolor, Aspergillus terreus, Aspergillus japonicus, Cladosporium cladosporoides, Fusarium roseum, Ganoderma lucidum,Neurospora sitophila Helminthosporium, Ustilago trtici, Uromyses are important allergens. Dust mitesD. farinae,D.pteronyssinus are also important source of inhalant allergens particularly in the coastal areas of the country. Cockroaches, beetles, weevils, mosquitoes, house flies also contribute towards the aeroallergen load and are allergenically implicated. Avoidance of the indoor and outdoor aeroallergens is recommended for better management of respiratory allergy.     

von Hippel-Lindau disease with bilateral multiple renal cell carcinoma managed by right radical nephrectomy and left repeat partial nephrectomy

von Hippel-Lindau (VHL) disease is an autosomal dominant disorder characterized by cysts and cystadenoma in the kidney, pancreas and epididymis and angiomas of the central nervous system and retina as well as renal cell carcinoma (RCC), phaeochromocytoma, islet tumors of the pancreas, and endolympatic sac tumors. VHL for its multicentric-characteristic and bilateralism often puts the surgeon in challenging situation. We present a case of VHL with bilateral RCC and retinal angiomas managed with right radical nephrectomy and left repeat partial nephrectomy.     

Pseudohypospadias with bilateral vesicoureteric reflux: consequences of inappropriate management of stricture urethra

A 17-year-old male boy presented with clinical features of pseudohypospadias (small penile stump with absent distal penile urethra) associated with very small capacity bladder and bilateral grade IV vesicoureteric reflux following suprapubic urinary diversion for multiple urethro-cutaneous fistula and periurethral abscess which developed as a consequence of inappropriate initial management of urethral trauma. This case highlights the importance of the initial management of urethral trauma and the management of its rare complication.     

Ca2+-dependent large conductance K+ currents in thalamocortical relay neurons of different rat strains

Mutations in genes coding for Ca²⁺ channels were found in patients with childhood absence epilepsy (CAE) indicating a contribution of Ca²⁺-dependent mechanisms to the generation of spike-wave discharges (SWD) in humans. Since the involvement of Ca²⁺ signals remains unclear, the aim of the present study was to elucidate the function of a Ca²⁺-dependent K⁺ channel (BK_Ca) under physiological conditions and in the pathophysiological state of CAE. The activation of BK_Ca channels is dependent on both voltage and intracellular Ca²⁺ concentrations. Moreover, these channels exhibit an outstandingly high level of regulatory heterogeneity that builds the basis for the influence of BK_Ca channels on different aspects of neuronal activity. Here, we analyse the contribution of BK_Ca channels to firing of thalamocortical relay neurons, and we test the hypothesis that BK_Ca channel activity affects the phenotype of a genetic rat model of CAE. We found that the activation of the β₂-adrenergic receptor/protein kinase A pathway resulted in BK_Ca channel inhibition. Furthermore, BK_Ca channels affect the number of action potentials fired in a burst and produced spike frequency adaptation during tonic activity. The latter result was confirmed by a computer modelling approach. We demonstrate that the β₂-adrenergic inhibition of BK_Ca channels prevents spike frequency adaptation and, thus, might significantly support the tonic firing mode of thalamocortical relay neurons. In addition, we show that BK_Ca channel functioning differs in epileptic WAG/Rij and thereby likely contributes to highly synchronised, epileptic network activity.     

Spontaneous regression of an untreated lung cancer

Spontaneous regression of malignancies have been documented, but it is a rare phenomenon. Most of such cases have been neuroblastoma, renal cell carcinoma or lymphoid tissue malignancies. This phenomenon has been recorded in few cases of Lung cancer also. Here we present a case of small cell lung cancer which was diagnosed with certainty. Patient did not take any treatment except the symptomatic one. As patient kept on living, and also improving, he was further investigated. Follow up X-Ray chest, Computed tomography scan showed total clearance of the tumour. Immuno-histochemistry of previous histology slides reconfirmed the diagnosis of Lung cancer. Though 8 cases of spontaneous regression of lung cancer have been reported in world literature, this is the first case which diagnosis and regression of lung cancer are confirmed without any doubts by various modalities. Many theories have been propagated to explain this phenomenon but none is proven so far. If mechanism of this phenomenon could be known, we can hope to find the cure of cancer.     

Sonographic Prediction of Scar Dehiscence in Women with Previous Cesarean Section

Purpose

To estimate the risk of uterine dehiscence/rupture in women with previous cesarean section (CS) by comparing the thickness of lower uterine segment (LUS) and myometrium with trans-abdominal (TAS) and trans-vaginal sonography (TVS).

Method

In this case-control study, in 100 pregnant women posted for elective CS (with or without previous CS; group 1 and group 2 respectively), the thickness of LUS and myometrium was measured sonographically (TAS and TVS). Intra-operatively, LUS was graded (grades I–IV), and its thickness was measured with calipers. The primary outcome of the study was correlation between echographic measurements (TAS and TVS) and features of LUS (grades I–IV) at the time of CS. Secondary outcomes were correlation between myometrial thickness, number of previous CS, and inter-delivery interval with LUS (grades I–IV).

Results

Sonographic measurements of LUS and myometrium were significantly different between the two groups (both TAS and TVS p value = 0.000 each). However, the number of previous CS (p = 0.440) and inter-delivery interval (p = 0.062) had no statistically significant correlation with thickness of LUS.

Conclusions

Sonographic evaluation of LUS scar and myometrial thickness (both with TAS and TVS) is a safe, reliable, and non-invasive method for predicting the risk of scar dehiscence/rupture. Specific guidelines for TOLAC, after sonographic assessment of women with previous CS, are need of the hour.Keyword: Transabdominal ultrasonography, Transvaginal ultrasonography, Cesarean section, Pregnancy, Cesarean scar