OBJECTIVE: Bladder autoaugmentation with detrusorectomy is done to improve bladder capacity and compliance in neurogenic bladders, to achieve constant low bladder pressure, preventing sequelae such as renal failure. Some reports discourage its application however citing that effects are short term and failure rates are high. We compared the pre and post-operative urodynamic profile of high risk patients undergoing autoaugmentation or enterocystoplasty to determine if it can still be used as a treatment option for neurogenic bladders.

MATERIALS AND METHODS: A retrospective study using the database of our spina bifida foundation was performed. Out of 382 patients, 45 underwent augmentation cystoplasty. Twenty seven (27) had followed evaluation protocol and were included in the study. The median age was 8.6 years at the time of surgery and the median years of follow up was 3.5 years. Urodynamic parameters, as well as symptom and bladder/sphincter profiles, pre- and post-operatively were compared between the two groups.

RESULTS: In the autoaugmentation group there was a 42.45% mean increase in capacity, and mean increase in compliance of 181.1% versus a 190.3% increase in capacity, and 479% increase in compliance in the enterocystoplasty group. The difference is statistically significant. There was no difference in the end filling pressure, leak point pressures, reflux, number of postoperative UTIs and incontinence. One patient in the autoaugmentation needed redo with an enterocystoplasty. Complication rates were comparable in both groups.

CONCLUSION: Autoaugmentation cystoplasty is still a viable option for surgical management of neurogenic bladders. Our data showed that in patients who underwent detrusorectomy, there was improvement of urodynamic parameters, bladder and upper tract profiles, UTIs and incontinence, which were comparable to the gold standard.

Human ; Male ; Female ; Adult ; Young Adult ; Adolescent ; Child ; Child Preschool ; Urinary Bladder, Neurogenic

: Transurethral incision of ureterocele (TUI-U) is a simple, quick, less invasive, and less expensive,and an effective procedure for the management of ureteroceles. Several studies have already shownits utility for primary management of ureteroceles but it has also been associated with the need foradditional surgery. The authors reviewed charts of patients from their database to describe the outcomesof TUI-U done in ureteroceles associated with the upper pole moiety of a duplex system. They alsolooked into preoperative patient characteristics and post TUI-U outcomes that could influence theneed for subsequent surgeries. MATERIALS AND METHODS: The authors identified patients from their duplex system database who presentedwith a ureterocele and underwent TUI-U. They reviewed the patient records of 25 patients who wereincluded in the study to determine the outcomes of TUI-U in duplex system ureteroceles. Chi squareand Mann Whitney U tests were used to determine whether preoperative patient features and postTUI-U outcomes were associated with secondary surgery. RESULTS: Out of 65 patients who had duplex system ureteroceles, 25 patients (38.4%) underwent TUI-U at a mean age of 1.51 years old. TUI-U alone was successful in improving the prevalent signs andsymptoms of 15 patients (60%) in this group, while 10 patients (40%) had to undergo subsequentsurgical procedures. Breakthrough urinary tract infection (UTI) post TUI-U was the only patientfactor noted to be significantly associated with a secondary surgery for duplex system ureterocele(p=0.027). CONCLUSION TUI-U as primary treatment for duplex system ureteroceles is not yet widely accepteddue to reported rates of morbidities and need for secondary surgery. Present data however show thatTUI-U can be used as a primary procedure and even as a definitive procedure for this subset ofpatients with remarkable results in terms of symptoms resolution and improvement of upper tract profiles.

Humans ; Stroke

Echocardiography, Transesophageal ; Electrodes, Implanted ; Heart Septal Defects, Atrial ; diagnostic imaging ; Humans ; Intraoperative Complications ; diagnostic imaging ; Male ; Middle Aged ; Pacemaker, Artificial

INTRODUCTIONThis study aimed to determine the reproducibility and usability of anterior segment images taken from a smartphone stabilised on a slit-lamp with those taken from a custom-mounted slit-lamp camera.

MATERIALS AND METHODSThis was a prospective, single- blind comparative digital imaging validation study. Digital photographs of patients with cataract were taken using a smartphone camera (an iPhone 5) on a telescopic mount and a Canon EOS 10D anterior segment camera. Images were graded and compared according to the Lens Opacification Classification System III (LOCS III).

RESULTSA total of 440 anterior segment images were graded independently by 2 ophthalmologists, 2 residents and 2 medical students. Intraclass correlation (ICC) between the iPhone and anterior segment camera images were fair for nuclear opalescence (NO) and nuclear colour (NC), and excellent for cortical (C) and posterior subcapsular (PSC) (NO: ICC 0.40, 95% CI, 0.16 to 0.57; NC: ICC 0.47, 95% CI, 0.16 to 0.66; C: ICC 0.76, 95% CI, 0.71 to 0.81; PSC: ICC 0.81, 95% CI, 0.76 to 0.85). There was no difference in grader impression of confidence and images usability between both cameras (P = 0.66 and P = 0.58, respectively).

CONCLUSIONAnterior segment images taken from an iPhone have good reproducibility for retro-illuminated images, but fair reproducibility for NO and NC under low light settings. There were no differences in grader confidence and subjective image suitability.

Cataract ; diagnostic imaging ; Humans ; Ophthalmology ; Photography ; methods ; Prospective Studies ; Reproducibility of Results ; Single-Blind Method ; Slit Lamp Microscopy ; methods ; Smartphone

Acanthamoeba Keratitis/epidemiology* ; Hospitals ; Humans ; Referral and Consultation ; Retrospective Studies ; Singapore/epidemiology*

The Japanese encephalitis virus (JEV), a leading cause of encephalitis, exists as quasispecies in clinical isolates. Using a limiting dilution method combined with immunohistochemistry to detect viral antigens, 10 biological clones were isolated and purified from a clinical JEV isolate (CNS138/9) derived from an autopsy brain. These biological clones were tested for neurovirulence in SK-N-MC and NIE-115 neuronal cells, and a 2-week-old, footpad-infected, JE mouse model. Nine clones were found to be neurovirulent; one clone neuroattenuated. Although further studies are needed to determine genotypic differences, if any, in these clones, the limiting dilution purification and neurovirulence testing methods described herein should be useful for phenotypic studies of quasispecies of neurotropic viruses in general, and JEV and other flaviviruses in particular.

Recent evidence supports the role of aggressive local treatment in the oligometastatic setting. In this review, we discuss the top 10 lessons we have learned from trials in oligometastatic cancers. Major lessons learned pertain to definitions of oligometastatic disease, outcomes, toxicity, costs, and the combination of ablative therapies with systemic therapy, including immunotherapy. Barriers to accrual for trials and upcoming phase III trials are also reviewed. These lessons may help to inform clinical practice and may be the basis for future research in the oligometastatic space.