Role of Long-Chain Cyanoacrylate as an Adjunct Interposition Layer in Repair of Hypospadias and Urethrocutaneous Fistula in Children: A Novel Technique.

Purpose Hypospadias is an anomaly wherein the urethral opening is ectopically located on the ventral aspect of the penis. The most common complications after hypospadias repair are urethrocutaneous fistula (UCF) and meatal stenosis. Long Chain Cyanoacrylate (LCCA) tissue adhesive promises safety, feasibility, and durability due to its tensile strength and bacteriostatic and hemostatic properties. We conducted this study to ascertain whether LCCA tissue adhesive can prove a more effective adjunct to traditional suturing techniques. Methods Patients were divided into two groups. Group A underwent surgery with conventional reconstruction of the neourethral tube along with the buttressing layer using Buck's fascia or Tunica Vaginalis. In addition to the traditional procedure of Group A, Group B patients were administered a layer of LCCA tissue adhesive as an adjunct between the neourethral suture line and the buttressing layer. Patients were followed up for six months and were evaluated for complications like UCF, meatal stenosis, hematoma, skin infection, glans dehiscence, and flap necrosis. Results Thirty-eight children in the age group 1-6 years were studied, of which 20 were in Group A and 18 in Group B. Among patients of Group A seven (35%) developed complications. In contrast, only four (22.2%) patients developed complications in Group B. The statistical significance in the complication rates between the two groups could not be achieved due to the modest sample size. However, the numerical and proportional reduction in the number of complications was noted. Conclusion LCCA adhesive as an adjunct numerically reduces the number of complications compared to traditional suturing alone in patients undergoing surgery for hypospadias and UCF.

Chemical abscess post vein of Galen aneurysmal malformation embolisation with ethylene vinyl alcohol copolymer.

Vein of Galen aneurysmal malformation (VGAM) is a rare congenital malformation characterised by arteriovenous fistulas between primitive choroidal arteries and the median prosencephalic vein, the embryonic precursor to the vein of Galen. Endovascular techniques have changed the management of these patients with improved prognosis. An eight-month-old with VGAM managed by endovascular embolisation using ethylene vinyl alcohol copolymer (EVOH) developed a chemical abscess - a rare complication. It was managed conservatively and showed promising clinical outcome. Contribution: Chemical abscesses following EVOH embolisation are scarce - with imaging differentials, which include brain abscess and onyx granuloma. Knowledge and successful identification of this entity are essential as its management as prognoses differ. Chemical abscess is managed conservatively and has a good prognosis.

Role of qualitative contrast-enhanced ultrasound in the diagnosis of malignant breast lesions.

Background: Carcinoma breast is the commonest cancer among women. Various authors have studied breast cancer with Contrast-Enhanced Ultrasound (CEUS) with promising results. Despite promising results, the additional cost of post-processing software limits its availability. In this study, we evaluated the utility of CEUS in differentiating malignant from benign breast lesions on regular ultrasound equipment without the use of dedicated software. Methods: We performed CEUS in 121 women with 121 breast lesions. CEUS was done by creating a custom preset on existing ultrasound equipment with the help of an application specialist authorized by the vendor. Lesions were evaluated qualitatively without the use of any commercial software. The pattern of enhancement i.e. homogenous, heterogeneous, peripheral, or no enhancement, and the number of penetrating vessels i.e., few or multiple were recorded. Results were compared with histopathological diagnosis. Results: There were a total of 121 breast lesions. The study showed sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of 86.67 %, 54.10 %, 65 %, and 80.49% respectively for differentiating benign vs malignant lesions on the basis of the pattern of contrast enhancement. Using penetrating vessels for differentiating malignant lesions from benign lesions, the sensitivity, specificity, PPV, and NPV were found to be 64%, 67.86%, 78.05%, and 51.35% respectively. Conclusion: CEUS is useful in differentiating malignant from benign breast lesions. It can be easily performed by creating a custom preset on standard ultrasound equipment without the use of expensive software.

The Role of Otorhinolaryngological Manifestations of Mild Covid-19 Disease in Hilly Terrain: Lessons Learnt at a Secondary Care Hospital.

We conducted the study to find the prevalence of ENT symptoms amongst mild Covid-19 patients from the hilly region of North India and attempted to propose a solution to curb the spread of Covid-19 through early identification, isolation, and treatment. A retrospective, cross-sectional study at a secondary healthcare center in a hilly region of North India covered 423 mildly symptomatic Covid-19 patients from April 2020 to March 2022. These patients were telephonically contacted or called in person at the outpatient department to answer a preset questionnaire with various parameters such as age, gender, ENT symptoms, and time to recover. The data obtained were statistically analyzed. 207 out of 423 mild Covid-19 patients complained of different ENT symptoms. Cough was the most common ENT symptom and was reported by 162 patients. Dizziness was the least common ENT symptom and was reported by 9 patients. Recovery time for tinnitus was maximum (persistent till six months in 5 patients). A high index of suspicion for Covid-19 disease in patients with ENT symptoms must be practiced. As the Covid-19 restrictions are gradually relaxed, widespread community education for strict adherence to Covid-19 appropriate behaviour and sensitization of General Practitioners a well as Otorhinolaryngologists regarding the importance of ENT symptoms in mild Covid19 disease will play a pivotal role in the early identification, isolation, and treatment of mild Covid-19 disease, which eventually may curb the future waves.

Endosalpingiosis of urinary bladder: report on a rare entity.

A case of endosalpingiosis of the urinary bladder is presented with imaging features on sonography and CT. Patient presented with right flank pain, dysuria and haematuria. She had h/o right renal calculus and abdominal hysterectomy 15 years ago. On sonography a polypoidal filling defect was noted and possibility of a bladder neoplasia was suggested. On cystoscopy and removal of the lesion and subsequent histo-pathological analysis revealed the diagnosis of endosalphingiosis. This report emphasizes the need for evaluation of all clinical inputs while considering the differential diagnosis of an intraluminal bladder lesion. Imaging appearance and aetio-pathology of the rare intra vesical lesion is highlighted.