Review of continent urinary diversion in contemporary urology.

Continent urinary diversion (CUD) continues to be widely accepted by both urologists and patients for urinary reconstruction after cystectomy and some complicated cases of urinary incontinence. Different operative techniques and modifications have been contributed in the last 3 decades. The advantages and disadvantages of each technique have long been debated. Ureterosigmoidostomy is the oldest form of CUD but has lost favor in recent decades. The other 2 broad categories of CUD are cutaneous and orthotopic CUD. This review presents and discusses the current common forms of continent urinary diversions.

Mesenteric ischaemia after endovascular coiling of ruptured cerebral aneurysms.

Three patients were referred to a national neurosurgical centre following CT evidence of subarachnoid haemorrhage. The three patients, who were referred from different institutions within a seven week period, were Fisher grade 3 and WFNS Grade I at all times. Angiography showed a PCOM aneurysm in one case, a ruptured Basilar tip aneurysm and an unruptured ACOM aneurysm in another case, and an ACOM aneurysm in the third case. It was decided that the aneurysms were suitable for endovascular coiling. These patients had unremarkable intraoperative catheterizations and coiling but subsequently deteriorated post-operatively due to mesenteric ischaemia. Two patients required colectomy for mesenteric ischaemia, and the third arrested secondary to sepsis from bowel perforation. We discuss the various causes that may explain this association, and we alert the neurosurgical community for this complication which has not been reported before.

Lateral mass screw fixation of complex spine cases: a prospective clinical study.

The purpose of this paper was to report our experience with lateral mass screw fixation when used in a variety of complex cervical pathologies. A prospective observational study was undertaken of all patients who underwent lateral mass screw fixation for complex spinal pathology. There were 59 patients. Pathology included cervical spondylosis with deformity 58%, rheumatoid arthritis 19%, tumours 15%, multiple level trauma 8%. The median follow-up time was 23 months. The patient's myelopathy scores improved in 64% of patients. 79% reported an improvement in their neck disability scores. 73% had improvement in their visual analogue pain score. Sixty-one per cent had preoperative high signal change on T2WI MRI. Sixty per cent had loss of normal cervical lordosis on presentation or were kyphotic. Sixty-four per cent of patients had grade 3 compression on MRI (Singh). Postoperative alignment was maintained in all cases. No late kyphotic deformity occurred. Lateral mass screw fixation can be used effectively and safely for different cervical spine pathologies with good functional and radiological outcome.

Survival and progression in high grade tumour subset of G2 and G3 pT1 bladder transitional cell carcinoma.

AIMS: The newer 1998 WHO/ISUP grading system for bladder transitional cell carcinoma combined grade 3 (G3) and high grade tumour subset of grade 2 (G2) of the older 1973 WHO grading system into one homogenous high grade group. We evaluated for possible differences in survival and progression between these 2 grades in pT1 bladder tumours. METHODS: From Jan 1(st) 1991-Dec 31(st) 2003, 105 (61 G2 and 44 G3) pT1 bladder tumours fulfilled the 1998 WHO/ISUP high grade criteria. Survival and progression of these tumours were assessed. RESULTS: Of the 44 patients with G3 tumours, 20 are alive versus 22 of the 61 patients with high grade tumour subset of G2 (P=0.04). Of the 44 patients with G3 tumours, 13 progressed versus 12 of the 61 patients with high grade tumour subset of G2 (P=0.02). In multivariate analysis, G3 was a significant predictor of tumour progression (P=0.05) and marginally non-significant predictor of poor patient survival (P=0.056). CONCLUSIONS: A notable difference in survival and progression between high grade tumour subset of G2 and G3 is observed.

Assessment of family physicians' knowledge as an indicator of burn management knowledge among non-burn practitioners in Ismialia, Egypt.

The management of burns within the first hours of injury has a significant impact on mortality and morbidity. In case of burns disasters, most patients are managed by non-burn practitioners. The knowledge held by our local family physicians is thought to be representative of that of non-burn practitioners, as they had not partaken in any courses or training on burn management beyond graduation. With regard to emergency burn management, the knowledge required is: assessment of burn extent and depth, associated injuries, indications of escharotomy, fluid therapy and airway management, as well as safe transportation. The aim of this study therefore was to assess the knowledge of family physicians - as an indicator of that of non-burn practitioners - on emergency burn management, and design accordingly an appropriate burn educational program. An interview questionnaire was distributed to all physicians working in Family Medicine Centers in Ismailia, Egypt, who did not possess a post-graduate degree. A total of twenty-four family physicians (100%) participated in this study. The questionnaire findings showed that, out of a possible score of 25 correct answers, the highest result was 12; achieved by 6 physicians (25%). The highest frequency score was 8 correct responses; obtained by 10 physicians (29.2%). This demonstrated a knowledge deficit among Ismailia's family physicians, and subsequently non-burn practitioners, with regard to burns management, due to gaps in undergraduate teaching.

La prise en charge des brûlures pendant les premières heures après le traumatisme a un impact significatif sur la mortalité et la morbidité du patient. Les médecins de famille peuvent représenter les médecins non-spécialistes en brulurologie car ils n'ont pas pris ni des cours ni des formations sur la gestion des brûlures au-delà du diplôme de Médecine. Ces médecins de famille peuvent donc nous donner un indicateur de connaissance de tous les praticiens non-spécialistes en brulurologie en ce qui concerne la prise en charge d'urgence des brûlures. L'essentiel de connaissance que les médecins non-spécialistes en brulurologie doivent maitriser est l'évaluation de l'étendue et de la profondeur de la brûlure et des traumatismes associées, les indications des incisions de décharge, la thérapie liquidienne et les soins de voies respiratoires ainsi que l'assurance de la sureté du transport. L'objectif de cette étude était donc d'évaluer la connaissance des médecins de famille ­ comme un indicateur de celles des praticiens généralistes en ce qui concerne la prise en charge d'urgence des brûlures ­ et de concevoir un programme éducatif approprié. Pour évaluer la connaissance, une questionnaire d'entrevue a été approvisionné aux médecins qui travaillent aux centres de médecine familiale à Ismaïlia, Égypte, qui ne possédaient aucun diplôme d'études supérieures. Un total de vingt-quatre médecins de famille (100%) ont participé à cette étude. Les résultats du questionnaire ont montré que, d'un maximum de 25 bonnes réponses, le résultat le plus élevé était de 12; réalisé par 6 médecins (25%). Le résultat le plus fréquent était de 8 bonnes réponses; obtenus par 10 médecins (29,2%). Cela démontre que chez les médecins de famille d'Ismaïlia, et par la suite chez tous praticiens non-spécialistes en brulurologie, il y a une manque importante de connaissance en ce qui concerne la prise en charge d'urgence des brûlures en raison de lacunes dans l'enseignement de premier cycle.

Association of intracranial hypertension without ventriculomegaly and Chiari malformation: a dangerous combination.

With the increased use of MRI, tonsillar ectopia, the hallmark of the adult Chiari malformation (ACM) is being more frequently recognized. However, in some cases, the patient's symptoms do not fit with the classical presentation for ACM, but are similar to intracranial hypertension (IH). The latter may be difficult to diagnose in absence of ventricular enlargement. We report a case of ACM and IHWV due to carcinomatous meningitis.

CT and MRI 'ring sign' may be due to demyelination: diagnostic pitfall.

We report a case of acute demyelinating encephalomyelitis (ADEM) in which both CT and MRI showed multiple ring-enhancing lesions suggestive of abscesses or brain tumour. This is a relatively rare phenomenon.

Subdural haemorrhage following endoscopic third ventriculostomy. A rare complication.

Subdural collections or hematomas are frequently observed after shunt placement [7-9, 13], but rarely after ETV [6]. A review of literature revealed 7 cases [1, 5, 6, 10, 12], of which only 1 was symptomatic [5]. We will discuss the causes, management, and methods of prevention of this complication and we will present a case of symptomatic subdural haematoma, following endoscopic third ventriculostomy for illustration.

Rabbit antithymocyte globulin related decrease in platelet count reduced risk of pediatric renal transplant graft thrombosis.

Graft thrombosis is a serious complication in pediatric renal transplantation. We assess a potential protective effect for the decrease in platelet count associated with RATG therapy against pediatric renal transplant graft vascular thrombosis. Between January 1986 and December 1998, 120 kidney transplants were performed in 95 pediatric recipients. Patients were divided into two groups. Group 1 (n = 61), non-RATG group received cyclosporine, azathioprine and steroids, while group 2 (n = 59), RATG group, received in addition, RATG at day 1 and continued for 4-10 days postoperatively. Platelet count prior to transplant, median change in absolute platelet count at 1 and 3 days post-transplant was recorded. Graft thrombosis incidence was examined. Six grafts (5%) developed thrombosis. All were in group 1 (p = 0.028). Median pretransplant platelet count (x10(9)/L) in group 1 was 283 vs. 280 in group 2 (p = 0.921). Median decrease in absolute platelet count (x10(9)/L) from pretransplant levels at one and three days post-transplant for group 1 and 2 was 18 vs. 83 (p

Cranio-orbital approach for complex aneurysmal surgery.

Certain aneurysms of the anterior circulation continue to offer a technical challenge for safe exposure and clipping. The purpose of this paper was to describe the cranio-orbital approach for surgical clipping of complex aneurysms and to evaluate prospectively the associated complications of this approach. Prospective audit of all patients undergoing cranio-orbital approach for aneurysm surgery from 1997 to 2004 by the senior author. Twenty-five patients, eight male and 17 female, median age of 52 years, range 28-73. All patients had a standard pterional approach supplemented by an orbital osteotomy. In the 7-year period 367 patients underwent treatment for their aneurysms (169 clipped and 198 coiled). Of the 169 patients who were operated on, 29 had a skull base approach, of which 25 were cranio-orbital. The aneurysm location was as follows: 16 middle cerebral artery (MCA), three carotid bifurcation, four anterior communicating artery (ACOMM), one ophthalmic and one basilar. There were no approach-related complications. The cranio-orbital craniotomy can be a useful adjunct in the surgical treatment of giant or complex aneurysms. It offers the following advantages over a standard pterional approach: reduces operative distance; allows easy splitting of the sylvian fissure; and provides a wide arc of exposure with multiple working corridors.