A Multimodality Review of Male Urethral Imaging: Pearls and Pitfalls with an Update on Urethral Stricture Treatment

Optimum radiological assessment of the male urethra requires knowledge of the normal urethral anatomy and ideal imaging techniques based on the specific clinical scenario. Retrograde urethrography is the workhorse examination for male urethral imaging, usually utilized as the initial, and often solitary, modality of choice not only in the setting of trauma, but also in the pre- and post-operative evaluation of urethral strictures. There is, however, growing interest in utilization of ultrasound and magnetic resonance for evaluation of the male urethra owing to lack of ionizing radiation and improved delineation of the adjacent tissue. We review the various modalities utilized for imaging of the male urethra for a variety of known or suspected disorders, and provide an update on current treatments of urethral strictures. Additionally, we detail the key information needed by urologists to guide management of urethral strictures. We conclude with a brief discussion of neophallus urethral diseases following female-to-male sexual confirmation surgery.

Intraoperative Evaluation of Effects of Different Gas Mixtures (Oxygen 100%, O2 50%:N2O 50%, Air on Cuff Pressure of PLMA (Proseal LMA)

Introduction:- we study the intra operative evaluation of different gas mixture(oxygen 100%, O2 50%:N2O 50%, AIR on cuff pressure of PLMA. Aims and Objectives:- To study intracuff pressure changes and the change in final volume of gas mixture during inflation and deflation during intraoperative period and postoperative complications. Material and Methods:- This double blind, prospective Study was conducted in Department of Anaesthesiology, Maharishi Markandeshwar Institute of Medical Sciences and Research, Mullana, Ambala following approval from institutional ethical committee and written informed patient consent. The sample size of 120 patient aged 18 to 60 years, belonging to ASA physical status 1 and 2 undergoing surgery in general anesthesia with PLMA as airway device divided into three group on the basis of PMLA cuff gas mixture:-Group O - oxygen 100%, Group ON - Nitrous 50%: Oxygen 50%, Group A – Air. Results and Conclusion:- Combination of N2O and O2 resulted in decreased intracuff pressure and air lead to a slight increase in intracuff pressure with O2 providing relatively stable cuff pressures. Keywords: PLMA,100% Oxygen, Air, Oxygen 50% N2O 50%, Air.

Recommendations From the Society for the Advancement of Transplant Anesthesiology Fellowship Committee: Core Competencies and Milestones for the Kidney/Pancreas Component of Abdominal Organ Transplant Anesthesia Fellowship

The Society for the Advancement of Transplant Anesthesia (SATA) is dedicated to improving patient care in all facets of transplant anesthesia. The anesthesia fellowship training recommendations for thoracic transplantation (heart and lungs) and part of the abdominal organ transplantation (liver) have been presented in previous publications. The SATA Fellowship Committee has completed the remaining component of abdominal transplant anesthesia (kidney/pancreas) and has assembled core competencies and milestones derived from expert consensus to guide the education and overall preparation of trainees providing care for kidney/pancreas transplant recipients. These recommendations provide a comprehensive approach to pre-operative evaluation, vascular access procedures, advanced hemodynamic monitoring, assessment of coagulation and metabolic abnormalities, operative techniques, and post-operative pain control. As such, this document supplements the current liver/hepatic transplant anesthesia fellowship training programs to include all aspects of “Abdominal Organ Transplant Anesthesia” recommended knowledge.

Case Report: Two Cases of Abdominal Aggressive Fibromatosis That Mimicked Abdominal Wall Endometriosis and Review of Literature

Background: Abdominal aggressive fibromatosis (AF) can be confounded with abdominal wall endomentriosis (AWE) because they share considerable similarity. Because of the different patient prognoses and treatment strategies available, accurate pre-operative diagnosis is important.Case Presentation: We here report two cases of abdominal masses presenting as periodic changes in tumor sizes, which occurred in correlation with the menstrual cycle. The clinical findings were highly suggestive of AWE. However, the final pathological findings revealed AF. The estrogen receptor and progesterone receptor expressions were negative in the two cases. The differences between the two diseases have been discussed in detail.Conclusion: A diagnosis of AWE should be scrutinized closely if the patient does not complain of cyclic pain. Fine-needle aspiration cytology is a suitable tool for pre-operative evaluation.

Predictors of Complication Following Cleft Lip and Palate Surgery in a Low-Resource Setting: A Prospective Outcomes Study in Nicaragua

Background Higher rates of postoperative complication following cleft lip or palate repair have been documented in low resource settings, but their causes remain unclear. This study sought to delineate patient, surgeon, and care environment factors in cleft complications in a low-income country. Design Prospective outcomes study. Setting Comprehensive Cleft Care Center. Patients Candidate patients presenting for cleft lip or palate repair or revision. Interventions Patient anthropometric, nutritional, environmental and peri- and post-operative care factors were collected. Post-operative evaluation occurred at standard 1-week and 2-month postoperative intervals. Main Outcome Measures Complication was defined as fistula, dehiscence and/or infection. Results Among 408 patients enrolled, 380 (93%) underwent surgery, of which 208 (55%) underwent lip repair (124) or revision (84), and 178 (47%) underwent palate repair (96) or revision (82). 322 (85%) were evaluated 1 week and 166 (44%) 2 months postoperatively. 50(16%) complications were identified, including: 25(8%) fistulas, 24(7%) dehiscences, 17(5%) infections. Mid-upper arm circumference (MUAC) ≤12.5 cm was associated with dehiscence after primary lip repair (OR = 28, p = 0.02). Leukocytosis ≥11,500 on pre-operative evaluation was associated with dehiscence (OR = 2.51, p = 0.04) or palate revision fistula (OR = 64, p < 0.001). Surgeons who performed fewer previous-year palate repairs had higher likelihood of palate complications, (OR = 3.03, p = 0.01) although there was no difference in complication rate with years of surgeon experience or duration of surgery. Conclusions Multiple patient, surgeon, and perioperative factors are associated with higher rates of complication in a low-resource setting, and are potentially modifiable to reduce complications following cleft surgery.

Hemodialysis AV Fistula: What a Radiologist Should Know?

Hemodialysis works as a lifeline for end stage renal disease patients. Creation and maintenance of vascular access for dialysis is the mammoth task. Due to increased references related to vascular access; number of complications are faced in pre as well as post operative period of vascular access creation. Ultrasound and color Doppler study play a major role in imaging throughout this period. Pre operative vascular mapping is very crucial to help surgeon to determine the proper site and surgical technique for vascular access creation. Early and delayed post operative complications can also be diagnosed with ultrasound and color Doppler study. Here we have tried to cover all the important points which a radiologist should consider during pre operative vascular mapping and post operative evaluation of vascular access as well as any associated complications.

Partial intracapsular tonsillectomy in the treatment of pediatric obstructive sleep apnea/hypopnea syndrome: a prospective study with 5-year follow-up

Objective To assess efficacy and safety of tonsil reduction with bipolar forceps electrocautery as treatment of paediatric obstructive sleep apnea/hypopnea syndrome (OSAHS). Study design Prospective interventional study. Methods Two hundred and sixty-three children aged 4–10 years with OSAHS and an apnea hypopnea index (AHI) > 3 were enrolled from March 2013 to January 2016. Pre-operative evaluation included oropharyngeal clinical examination with fiberoptic nasopharyngoscopy, OSA-18 questionnaire and overnight sleep study. All children were treated with adenoidectomy and tonsillotomy with bipolar forceps. OSA-18 questionnaire and overnight sleep study were performed 30 days after surgery. Results Pre-operative average of the OSA-18 questionnaires was of 70.3 (SD = 9.7); 30-day post-operative score was 23.15 (SD = 8.2; p = 0.045). Pre-operative average Apnea Hypopnea Index (AHI) score was 9.41 (SD = 4.1); 30-day post-operative average of AHI score was of 1.75 (SD = 0.8; p = 0.012). Oxygen Desaturation Index (ODI) rate changed from 7.39 (SD = 4) to 1.34 (30-day post-operative) (SD = 4.7; p = 0.085). NADIR rate changed from 79% (SD = 6.32) to 90% (30-day post-operative) (SD = 5.18; p = 0.00012). Peri- and post-operative complications in our sample were mainly pain (average 75 doses of paracetamol), while bleeding did not occur (0%). All patients received a follow-up examination 5 years after surgery to evaluate tonsil size; at this time-point, a reduction in tonsil size from 3.6 (3–4; SD = 4.2) to 1.3 (1–2; SD = 5.5) was found, while tonsil regrowth was observed in five children (2%). Conclusion This study showed that partial tonsillotomy with bipolar forceps electrocautery associated to adenoidectomy is an effective technique in treating OSAHS symptoms in children and ensures less complications in terms of hemorrhage, postoperative pain and infections compared to traditional adenotonsillectomy. The very low tonsillar regrowth rate reported in this study may support the routine use of this technique.

ANALYSIS AND INTERPRETATION OF SPIROMETRY OF PATIENTS ATTENDING RESPIRATORY MEDICINE OPD IN A TERTIARY CARE CENTER: A RETROSPECTIVE STUDY

OBJECTIVE: To study the various spirometry ndings and look for its association with smoking history and use of biomass fuels. METHODS: Spirometry ndings of 375 patients who attend Respiratory medicine OPD from year 2017- 2019 were studied. RESULTS: Out of 375 patients, 95 patients were diagnosed as COPD, 62 as bronchial asthma, 149 had normal spirometry and 69 had restriction. CONCLUSION: In this study we concluded that spirometry plays an intergral role in the diagnosis of bronchial asthma, COPD and restrictive lung diseases. It gives an overview of the decline of lung function with increasing age, smokers, occupational lung exposures, family history of bronchial asthma. Restrictive patterns were most commonly seen in patients who came for pre operative evaluation.