Complex urethral disruptions: In pursuit of a successful reconstruction

OBJECTIVES: We analyzed the methods and outcomes of urethroplasty in men with complex urethral disruptions. METHODS: The medical records of 40 men with complex urethral disruptions were analyzed. Surgical methods were individualized according to stricture location, severity and length of the stricture, bladder neck characteristics and presence of complicating factors. Patients were divided into four groups based on the above characteristics. RESULTS: End-to-end urethroplasty performed in six patients with short bulbar strictures (<3 cm) was successful in all. Elaborated perineal repair was performed in 10 patients with intermediate (3-6 cm) strictures with or without complicating factors. Elaborated perineal repair with urethral substitution was performed in nine patients with long segment stricture (>6 cm). Abdominal transpubic repair was successfully applied to patients with rectourethral fistula or lacerated bladder neck. Success rate of anastomotic urethroplasty was 95% while over all success rate was 85%. CONCLUSION: Guidelines for urethral reconstruction of complex urethral disruptions are predicated on stricture length, location, bladder neck characteristics and associated complicating factors. End-to-end urethroplasty with stricture excision is highly reliable for short strictures for which previous operative repair have failed. Elaborated perineal repair is extremely versatile for intermediate and longer strictures with associated complicating factors. Abdominal transpubic urethroplasty is effective for patients with rectourethral fistula or lacerated bladder neck.     

Management of progressive exophthalmos

The present study reveals our experience in the medical management of 30 cases of progressive/malignant exophthalmos, employing costicosteroid, b-blocker, diuretic and a preparation containing proteolytic enzymes. There was encouraging improvement in terms of symptoms, proptosis and optic nerve compression, while reduction of ophthalmoplegia was not so satisfactory. However, none of the patients needed decompression surgery.     

Spontaneous gallbladder perforation—An unusual presentation of carcinoma of the pancreas

A 50 year old man with a two month history of upper abdominal pain and a one month history of anorexia and weight loss, presented with icterus and evidence of peritonitis. Laparotomy revealed biliary peritonitis which had been caused by a rupture of the fundus of the gallbladder. The common bile duct was dilated and there was a large growth in the head of the pancreas with multiple hepatic metastases. A cholecysto-jejunostomy and gastrojejunostomy were done and the patient had an uneventful recovery.     

Pharmacokinetics of orally administered norethisterone enanthate in rabbit, monkey, and women

Norethisterone enanthate (NET-En), an established intramuscular long-acting contraceptive agent, has previously been shown to be effective in inhibiting fertility in two rodent species even 4 days after oral ingestion. Pharmacokinetics of NET and NET-En were studied after oral and intramuscular doses in two animal species and a few women. The results suggest that the NET-En was absorbed within a day in all the species after oral dose. The estimates of relative bioavailability ranged from 13 to 51% in rabbits, monkeys, and women. The elimination half-life was 5–10 days. The presence of the active component, NET, in the circulation over the experimental period of 15 days suggests that NET-En could be useful as a long-acting oral pill. The suppression of progesterone levels during the luteal phase of menstrual cycle in women also supports this finding.     

An estimate of phylogenetic relationships among culicine mosquitoes using a restriction map of the rDNA cistron

Restriction maps of the rDNA cistron of twelve species of mosquitoes in six genera of the subfamily Culicinae were constructed using eight 6 bp recognition restriction enzymes. Anopheles albimanus was used as an outgroup. The size of the rDNA cistron ranged from 8.5 kb in Aedes katherinensis to 12.9 kb in Ae. polynesiensis. A total of twenty-six sites were scored; eighteen were polymorphic among ingroup taxa. The proportion of polymorphic nucleotide sites (Pnuc) was 0.059 and the heterozygosity per nucleotide site (Hnuc) was 0.028. Wagner and Fitch Parsimony, Dollo Parsimony and Nei-Li distance/neighbour-joining methods were used to construct phylogenetic trees. The rDNA RFLP dataset did not provide a well-supported phylogeny among culicine taxa. The RFLP phylogenies are incongruent with the morphology character based and molecular phylogenies and derived relationships did not correspond with current taxonomic classifications. The lack of resolution was due to homoplasy arising from frequent independent loss or gain of restriction sites among unrelated taxa.     

Results of penetrating keratoplasty in vascularized corneas.

A retrospective longitudinal study of 105 penetrating keratoplasties for vascularized corneal opacities was done. The results of cases with an etiology of healed trachoma or healed corneal ulcers were compared. The vascularization was graded from Grade I to V depending on the quadrant and type of vascularization. Graft clarity of 2+ or more in cases of trachomatous opacity was achieved in 93% of cases and that after postinfectious opacity in 71.8%. Prognosis was poor in cases where deep vascularization was present in more than two quadrants or more than 180 degrees.     

Destructive ocular myiasis in a noncompromised host

A case of destructive ocular myiasis resulting in complete loss of the globe in two days time is documented. To the best of our knowledge this is the first report of such a severe involvement in a healthy and non-compromised host. Mechanical removal and good local hygiene helped heal the wound. The larvae were isolated to be that of Chrysomyia bezziana (screwworm fly). This is possibly the first report of destructive ocular myiasis caused by Chrysomyia bezziana from the Indian subcontinent and the second in world literature. Infestation of human eyes with larvae of flies (myiasis) has been reported. Serious consequences of destructive myiasis are seen in emaciated and diseased patients. Only one report of total destruction of the globe by maggots of Chrysomyia bezziana exists in the literature. As in previous communications, the patient in this report had no predisposing factors both systemic and local. We here in document a case of orbital myiasis leading to rapid destruction of the globe within two days in a healthy and a non-compromised patient.     

Species differences in the hydrolysis of 2-cyanoethylene oxide, the epoxide metabolite of acrylonitrile

The carcinogenic effects of acrylonitrile in rats are believedto be mediated by its DNA-reactive epoxide metabolite, 2-cyanoethyleneoxide (CEO). Previous studies have shown that conjugation withglutathione is the major detoxication pathway for both acrylonitrileand CEO. This study investigated the role of epoxide hydrolasein the hydrolysis of CEO by HPLC analysis of the products from[2,3-¹⁴C]CEO. CEO is a relatively stable epoxide with a half-lifeof 99 min at 37°C in sodium phosphate buffer (0.1 M), pH7.3. Incubation with hepatic microsomes or cytosols from maleF-344 rats or B6C3F1 mice did not enhance the rate of hydrolysisof CEO (0.69 nmol/min). Human hepatic microsomes significantlyincreased the rate of hydrolysis of CEO, whereas human hepaticcytosols did not. Human hepatic microsomal hydrolysis activitywas heat-sensitive and potently inhibited by 1,1,1-trichloropropeneoxide (IC₅₀ of 23 µM), indicating that epoxide hydrolasewas the catalyst. The hydrolysis of CEO catalyzed by hepaticmicrosomes from six individuals exhibited normal saturationkinetics with K_M ranging from 0.6 to 3.2 mM and V _max from 8.3to 18.8 nmol hydrolysis products/min/mg protein. Pretreatmentof rodents with phenobarbital or acetone induced hepatic microsomalhydrolysis activity toward CEO, whereas treatment with ß-naphthoflavone,dexamethasone or acrylonitrile itself was without effect. Thesedata show that humans possess an additional detoxication pathwayfor CEO that is not active in rodents (but is inducible). Thepresence of an active epoxide hydrolase hydrolysis activitytoward CEO in humans should be considered in assessments ofcancer risk from acrylonitrile exposure.