Laparoscopic pyeloplasty: status and review of literature.

The ideal treatment for ureteropelvic junction (UPJ) obstruction should have the highest success rate, enable treatment of all types of obstruction, allow removal coexisting renal stones, and be minimally invasive. Open pyeloplasty offers all these features except the last (minimal invasiveness), whereas endourology techniques guarantee only the last one. Different techniques of pyeloplasty can be applied laparoscopically, although the best results are seen with dismembered pyeloplasty (Anderson-Hynes technique). Various methods of tissue approximation have been devised to avoid the difficult-to-master, time-consuming conventional suturing technique. Laparoscopic (antegrade) stenting is preferred by some surgeons, but we consider retrograde stenting is superior, as this rules out the presence of associated distal-ureteral obstruction. The transperitoneal approach has the advantages of a larger working space and readily identifiable anatomic landmarks. However, access to the renal pelvis requires considerable mobilization and retraction of the overlying loops of bowel. The retroperitoneal approach has the perceived disadvantage of a somewhat limited working space and absence of readily identifiable intra-abdominal anatomic structures such as the liver and spleen. However, the retroperitoneal approach has the advantage of greater familiarity, better detection of crossing vessels, direct and rapid access to the UPJ, and less risk of ileus. The robot-assisted technique has made suturing easier and may allow expansion of advanced laparoscopic procedures to surgeons without expertise in advanced laparoscopic surgery. The optimal length of follow-up after pyeloplasty is still unclear. Although most failures occur within the first 2 years, failures continue to appear after 5 and 10 years.

Endoscopic surgery of the vidian nerve. Preliminary report.

The anatomy, surgical technique, and difficulties of endoscopic vidian neurectomy are described. The procedure was carried out on 12 patients: 8 had resistant secretomotor rhinopathy and 4 had recurrent nasal polyposis. This technique is a minor surgical procedure with symptomatic relief and minimal postoperative morbidity.

Tropical splenomegaly syndrome: who gets oesophageal varices?

Of sixty eight patients with tropical splenomegaly syndrome (TSS), 12 had asymptomatic oesophageal varices (OV). All 12 had massive splenomegaly (Hackett's stage 4 or 5). Eight of the 12 were multiparous females, mainly of Rwandese origin. Endoscopic appearance of the varices suggested that TSS varices were not likely to bleed. None of the patients with the varices had abdominal collaterals belonging to the portal system.

Laparoscopic pyeloplasty: evolution of a new gold standard.

OBJECTIVES: To report our series of laparoscopic dismembered pyeloplasty for the treatment of primary and secondary ureteropelvic junction obstruction and to review the current status of this procedure. METHODS: A total of 170 consecutive cases of laparoscopic pyeloplasty (156 for primary and 14 for secondary ureteropelvic junction obstruction) were performed or supervised by a single surgeon (C.G.E). A four-port extraperitoneal approach was used in all but 3 cases, which were performed transperitoneally. RESULTS: The median operative time was 140 minutes. The complication rate was 7.1%, and the conversion rate was 0.6%, with no conversion in the last 161 cases. The median postoperative hospital stay was 3 nights. Crossing vessels were encountered in 42% of cases, and in 11 patients, coexisting renal calculi were successfully removed. At a median follow-up of 12 months, the success rate was 96.2%. CONCLUSIONS: Laparoscopic dismembered pyeloplasty produces functional results comparable to that of open surgery with the advantages of a minimally invasive procedure. Our results are consistent with previous series and support the view that laparoscopic pyeloplasty is moving rapidly toward replacing open surgery as the gold standard in the treatment of ureteropelvic junction obstruction.

Microfissures of the temporal bone: do they have any clinical significance?

Microfissures extending from the inner ear to the middle ear are a common temporal bone finding. Recently they have been implicated as a possible cause of sudden sensorineural hearing loss. We examined 34 temporal bones and related the presence or absence of microfissures to sudden sensorineural hearing loss. No relationship was found.

Life cycle of Hepatozoon mehlhorni sp. nov. in the viper Echis carinatus and the mosquito Culex pipiens.

Hepatozoon mehlhori sp. nov. and its developmental stages from the tissues of the Egyptian viper Echis carinatus and the mosquito Culex pipiens are described. The erythrocytic parasites were differentiated into the small form (trophozoite) measuring 14.5 +/- 0.6 x 4 +/- 0.12 micron and the mature form (gametocyte) measuring 17.2 +/- 1.6 x 5.4 +/- 0.5 micron. Merogony took place in the pulmonary endothelial cells and in the parenchyma cells of the liver and spleen of the infected vipers. Two types of meront were found. The large meronts (macromeronts) were 30.2 +/- 1.73 x 22.6 +/- 1.2 microns in size and yielded 16-40 (average, 28) micromerozoites measuring 17.2 +/- 0.7 x 5 +/- 0.15 microns. The small meronts (micromeronts) measured 18.2 +/- 0.6 x 13.5 +/- 0.5 microns and yielded 2-14 (average, 8) macromerozoites that were 15.1 +/- 0.12 x 6.2 +/- 0.8 microns in size. After syzygy in the haemocoel of the mosquito, the microgamont produced four uniflagellate microgametes (6.4 +/- 0.3 x 4.5 +/- 0.5 microns in size, with a short flagellum measuring 3.2 +/- 0.1 microns); on the 3rd day post-infection (p.i.)., one of these fertilized the macrogamete, giving rise to the zygote. The oocyst developed from the zygote on the 5th day p.i. and measured 135 +/- 2.6 x 120 +/- 1.8 microns. About 11-60 (average, 35) sporoblasts were formed by centripetal invaginations from each oocyst on the 8th day p.i. and developed into sporocysts on the 14th day p.i. Inside each sporocyst, 5-12 (average, 8) sporozoites, each measuring 12.6 +/- 1.2 x 4.1 +/- 0.3 microns, developed on the 16th day p.i. According to the above-mentioned characteristics the parasite was recorded as being a new species and was named Hepatozoon mehlhorni. Experimental transmission was accomplished by i.p. inoculation of the infectious stages (sporozoites) into uninfected vipers and led to the appearance of blood stages at 4-6 weeks p.i.

Fine structure studies of microgametogenesis of Eimeria adenoeides (Eimeriidae, Sporozoa) infecting turkeys in Egypt.

The Ultrastructure of microgametogenesis of Eimeria adenoeides was studied in the intestinal epithelium of experimentally infected turkeys' Meleagris gallopavo gallopavo. Microgamonts were recognizable by the presence of peripherally arranged nuclei and the presence of two centrioles between each nucleus and the limiting membrane of the gamont. A nuclear spindle apparatus and an intranuclear centrocone directed toward the centriole were observed. Each young microgamont was surrounded by a very narrow parasitophorous vacuole which widened during development and contained a few intravacuolar folds. Differentiation of the microgamete began when elevations of the limiting membrane appeared above the centrioles. This event was accompanied by the segregation of nuclear content into a dense osmiophilic portion and an electron-pale portion. A gradual protrusion of the dense portion of the nucleus and developing flagella into the parasitophorous vacuole was proceeded. Microgametes had an anterior perforatorium, a dense elongate nucleus, with an anteriorly positioned mitochondrion in a small groove of the nucleus. Usually two flagella could be detected per each mature microgamete.

Studies on Eimeria species naturally infecting Gerbillus pyramidum (1) Exogenous stages.

Exogenous stages of two new Eimerian species, naturally infecting the Egyptian gerbil Gerbillus pyramidum were described and diagnosed in the present study. (1) The subspherical type of oocysts was 20 x 17 microns (length x width) in average. These are colourless and enveloped within an even double-layered oocyst wall. Sporulated oocysts containing four sporocysts each averaged in 10 x 8 microns, and a small spherical oocyst residual body was also observed. This type is termed Eimeria pyramidi after the species name of its host. (2) The second type of oocysts was elongated in shape measured congruent to 21 x 16 microns. These are colourless and enclosed within smooth double layered oocyst wall. Sporulated oocysts of this type were lacking oocyst residual bodies. This type is termed Eimeria gerbilli after the generic name of its host. Both types of described oocysts lack micropyle and polar cap.