Pediatric robot assisted retroperitoneoscopic pyeloplasty: a 5-year experience

PURPOSE: We report our 5-year experience with retroperitoneoscopic robot assisted pyeloplasty for the treatment of ureteropelvic junction obstruction in children using the da Vinci Surgical System. MATERIALS AND METHODS: A total of 65 children (median age 7.9 years, range 1.7 to 17.1) underwent 67 robot assisted retroperitoneoscopic pyeloplasties with the da Vinci Surgical System between 2002 and 2006. Operative data were sampled prospectively, while outcome data were collected from chart review. Retroperitoneal access was modified from standard retroperitoneoscopic access due to the limits of the camera arm movement. RESULTS: Median operative time was 143 minutes (range 93 to 300). Complications occurred in 12 of the 67 procedures (17.9%), with urinary tract infection observed in 2 cases, transient hematuria in 2, displaced Double-J catheter in 3 and postoperative temporary nephrostomy in 4. One case was converted to open surgery due to lack of space and limits in the movement of the camera arm. Four patients (6%) underwent repeat surgery due to a kinking ureter (2 patients), an overlooked aberrant vessel (1) and decreasing differential function on renography necessitating balloon dilation (1). In all other cases followup was uneventful. CONCLUSIONS: Robot assisted retroperitoneoscopic pyeloplasty gives more direct access to the ureteropelvic junction, allowing shorter operative times with results and complication rates comparable to transperitoneal robot assisted pyeloplasty, and laparoscopic and open procedures in children.     

Solitary subcutaneous metastatic deposit from hepatocellular carcinoma

Hepatocellular carcinoma is the most common primary tumour of the liver. Metastasis is frequent in these aggressive tumours and is commonly to the lungs, regional lymph nodes, or bone. Metastasis as a discrete subcutaneous nodule has not been described before. We report a case of hepatocellular carcinoma with a solitary subcutaneous metastatic deposit identified 18 months after the initial hepatic surgery.     

SARS‐CoV‐2 and guttate psoriasis: A case report and review of literature

Guttate psoriasis is a rare dermatological presentation of SARS‐CoV‐2 infection and is seen mainly in patients with an underlying disease psoriasis.     

Induction of ovulation

This review explores the pathophysiology associated with anovulation which affects 30% of cases of infertility. It provides an overview of the evidence based management of different groups of anovulation including role of adjuvant therapies. Anovulation can be effectively managed with induction of ovulation, the aim of which is to restore normal physiological ovulatory function. Weight optimization is the cornerstone of management in functional hypogonadotropic hypogonadism and polycystic ovarian syndrome (PCOS). The aim is to achieve monofollicular development, minimizing the risk of ovarian hyperstimulation and multiple pregnancies. The holistic approach involves induction of ovulation along with health education regarding lifestyle modifications and need for long term hormone replacement therapy in appropriate cases.     

Genetic transformation of Coccidioides immitis facilitated by Agrobacterium tumefaciens

Agrobacterium tumefaciens was used to facilitate genetic transformation of Coccidioides immitis. A gene cassette containing the gene encoding hygromycin phosphotransferase (hph) was cloned into a T-DNA vector plasmid and introduced into A. tumefaciens, and the resultant strain was used for cocultivation with germinated arthroconidia. This procedure produced numerous colonies 60- to >500-fold more resistant to hygromycin than untransformed mycelia. Both polymerase chain reaction and Southern blot analysis of the transformants indicated that all contained hph, usually as a single genomic copy. A transformation frequency of 1 per 10(5) arthroconidia was obtained by varying the germination time prior to cocultivation and altering the bacterium: fungus ratio. This approach requires no special equipment that might complicate biocontainment. Furthermore, transformation does not require digestion of fungal cell walls, further simplifying this procedure. A. tumefaciens-facilitated transformation should make possible the development of tagged mutagenesis and targeted gene disruption technology for C. immitis and perhaps other fungi of medical importance.