Spectrum of management options for pediatric pelvic fracture urethral injury and outcome analysis: 12-year tertiary center experience

IntroductionPediatric pelvic fracture–associated urethral injuries (PFUIs) are relatively rare injuries that occur in secondary to high impact pelvic trauma. There is no consensus yet on the optimal management approach.ObjectivesIn this study, the authors reviewed their experience of pediatric PFUIs and discussed the current spectrum of potential management options.Study designThe authors retrospectively evaluated a cohort of 33 children (≤14 years) treated for PFUI between January 2005 and December 2017.ResultsThe mean age of presentation was 11.2 ± 2.1 years (range 6–14). All the subjects were male. Average stricture length was 2.5 + 1.4 cm. Transperineal anastomotic repair (TPAR) was done in 27 patients; Mitrofanoff procedure was done in three patients; Badenoch's procedure, preputial flap, and transpubic urethroplasty (TPU) was done in 1 patient each. Overall success rate for TPAR was 85%. Minor complications (Clavien grade I and II) were seen in eight cases (24.2%). Average hospital stay was 11.3 days (range 6–15). The mean follow-up duration was 13.8 months (range 9–18).DiscussionAs not many large overview studies were known, this retrospective study is small step for developing a protocol for patients with a pediatric PFUI that needs treatment. The goal of surgery in pediatric PFUI–associated posterior urethral strictures is to achieve a tension-free bulboprostatic anastomosis after excision of the distraction segment. Transperineal anastomotic repair is the best and most commonly performed surgery for pediatric PFUI with 85–98% success rates. The success rates for TPAR may be lower in children because of smaller pelvic cavity, small caliber urethra, and poorly formed elastic spongiosa. Hence, a TPAR should be attempted in every case of posterior urethral stricture post-PFUI. If a tension-free anastomosis is not possible, then procedures depending on local stricture characteristics such as TPU may be required.ConclusionMost pediatric posterior urethral strictures post-PFUI (≤2 cm) can be managed by delayed TPAR with reasonable success rates. Few selected patients may require procedures such as TPU based on local stricture characteristics.Table. Factors affecting choice of surgery and outcome

Neuroprotective efficacy of curcumin in arsenic induced cholinergic dysfunctions in rats

Our recent studies have shown that curcumin protects arsenic induced neurotoxicity by modulating oxidative stress, neurotransmitter levels and dopaminergic system in rats. As chronic exposure to arsenic has been associated with cognitive deficits in humans, the present study has been carried out to implore the neuroprotective potential of curcumin in arsenic induced cholinergic dysfunctions in rats. Rats treated with arsenic (sodium arsenite, 20mg/kg body weight, p.o., 28 days) exhibited a significant decrease in the learning activity, assessed by passive avoidance response associated with decreased binding of (3)H-QNB, known to label muscarinic-cholinergic receptors in hippocampus (54%) and frontal cortex (27%) as compared to controls. Decrease in the activity of acetylcholinesterase in hippocampus (46%) and frontal cortex (33%), staining of Nissl body, immunoreactivity of choline acetyltransferase (ChAT) and expression of ChAT protein in hippocampal region was also observed in arsenic treated rats as compared to controls. Simultaneous treatment with arsenic and curcumin (100mg/kg body weight, p.o., 28 days) increased learning and memory performance associated with increased binding of (3)H-QNB in hippocampus (54%), frontal cortex (25%) and activity of acetylcholinesterase in hippocampus (41%) and frontal cortex (29%) as compared to arsenic treated rats. Increase in the expression of ChAT protein, immunoreactivity of ChAT and staining of Nissl body in hippocampal region was also observed in rats simultaneously treated with arsenic and curcumin as compared to those treated with arsenic alone. The results of the present study suggest that curcumin significantly modulates arsenic induced cholinergic dysfunctions in brain and also exhibits neuroprotective efficacy of curcumin.     

Supratrigonal VVF repair by modified O'Connor's technique: an experience of 26 cases

OBJECTIVE: To report the technical modifications of O'Connor's procedure and their outcome in 26 supratrigonal vesico vaginal fistulae. MATERIALS AND METHODS: Twenty-six cases of supratrigonal VVF (17 primary, 9 recurrent) were operated using the described modifications. It consisted of approaching the bladder transperitoneally, without dissecting the retropubic space, making a short sagittal or parasagittal cystotomy in between stay sutures, liberal use of bladder rotation flaps instead of midline closure, using single layer, continuous, closely placed, interlocking stitches for bladder as well as vaginal approximation and universal use of vascularised tissue interposition. RESULTS: Mean fistula size was 2.8 cm (range 1.0 to 3.7). Mean operative time was 104 minutes, and blood loss was insignificant. Three patients required ureteroneocystostomy. All patients were dry after 2-3 weeks of suprapubic and per urethral catheter drainage. One patient persisted with stress urinary incontinence. No patient on follow up complained of features suggestive of prolonged ileus, peritonitis or adhesive intestinal obstruction. CONCLUSION: Modified O'Connor's repair is safe and achieves excellent functional results. It requires a shorter cystotomy instead of bi-valving of the bladder, thus minimizes tissue trauma, intraoperative blood loss and operating time. It also gives option of tailoring the cystotomy in sagittal or parasagittal line, according to the site and size of the fistula, and thus permits closure of fistula by rotation of bladder flap into the defect without any lateral traction on the bladder edges. Retropubic dissection and drainage of the retropubic space is also not required.     

Attenuation of arsenic neurotoxicity by curcumin in rats

In view of continued exposure to arsenic and associated human health risk including neurotoxicity, neuroprotective efficacy of curcumin, a polyphenolic antioxidant, has been investigated in rats. A significant decrease in locomotor activity, grip strength (26%) and rota-rod performance (82%) was observed in rats treated with arsenic (sodium arsenite, 20 mg/kg body weight, p.o., 28 days) as compared to controls. The arsenic treated rats also exhibited a decrease in the binding of striatal dopamine receptors (32%) and tyrosine hydroxylase (TH) immunoreactivity (19%) in striatum. Increased arsenic levels in corpus striatum (6.5 fold), frontal cortex (6.3 fold) and hippocampus (7.0 fold) associated with enhanced oxidative stress in these brain regions, as evident by an increase in lipid perioxidation, protein carbonyl and a decrease in the levels of glutathione and activity of superoxide dismutase, catalase and glutathione peroxidase with differential effects were observed in arsenic treated rats compared to controls. Simultaneous treatment with arsenic (sodium arsenite, 20 mg/kg body weight, p.o., 28 days) and curcumin (100 mg/kg body weight, p.o., 28 days) caused an increase in locomotor activity and grip strength and improved the rota-rod performance in comparison to arsenic treated rats. Binding of striatal dopamine receptors and TH expression increased while arsenic levels and oxidative stress decreased in these brain regions in co-treated rats as compared to those treated with arsenic alone. No significant effect on any of these parameters was observed in rats treated with curcumin (100 mg/kg body weight, p.o., 28 days) alone compared to controls. A significant protection in behavioral, neurochemical and immunohistochemical parameters in rats simultaneously treated with arsenic and curcumin suggest the neuroprotective efficacy of curcumin.     

The Efficacy and Safety of Neoadjuvant Chemotherapy in Treatment of Locally Advanced Carcinoma Cervix

Objective

A prospective cohort study in a teaching hospital to assess the efficacy and safety of neoadjuvant chemotherapy in the treatment of locally advanced carcinoma cervix.

Method

Neoadjuvant chemotherapy in the form of cisplatin 75 mg/m² and paclitaxel 135 mg/m² on day 1 and repeated at 14 days’ interval for up to a maximum of three courses.

Results

Neoadjuvant chemotherapy in cervical cancer was effective in the downstaging of the disease. Downstaging was observed in 19.23 % of patients after two cycles and in 50 % of patients after three cycle of NACT. Operability increases to 33.3 and 38.4 % after two and three cycles of NACT, respectively. Complete pathological response was observed in 37.5 % of patients after NACT. No significant adverse effect in the feasibility of surgery was observed.

Conclusion

The present study showed that neoadjuvant chemotherapy was an effective and well-tolerated mode of therapy with significantly less morbidity and mortality.