Extracorporeal shock wave lithotripsy (ESWL) monotherapy in children: Predictors of successful outcome.

INTRODUCTION AND OBJECTIVES: Although extracorporeal shock wave lithotripsy (ESWL) is the first choice for pediatric renal calculi <2 cm, the success rate after the first session is low. This is in contrast to other minimally invasive procedures like percutanous nephrolithotomy (PCNL) and retrograde intrarenal surgery (RIRS), which have higher rates of success. Therefore, the present study sought to identify predictors of success after one session of ESWL. PATIENTS AND METHODS: A prospective study including 100 children with renal stone burden <2 cm who underwent ESWL at the present institution. The success rate after the first session was analyzed, and the predictors of success were investigated. The success of ESWL monotherapy was defined by absence of any residual fragments after 3 months, on non-contrast spiral computerized tomography (NCCT) scan, without need of any additional intervention. RESULTS: Between January 2013 and October 2015, 100 children were treated with a Dornier Gemini lithotripter at the present institution. The mean patients age and stone size were 6 years (range: 1.8-14) and 13.1 mm (range: 6-20), respectively. After one session, 47% of patients showed complete clearance 3 months postoperative, those patients versus those who required an additional session or auxiliary procedures were younger in age, with smaller stone size and lower density. On multivariate analysis, only patient age was an independent predictor of success (odds ratio (OR) 0.9; P < 0.001). CONCLUSION: Patient's age was an important predictor for response after ESWL monotherapy: not only did children respond better than adults, but age was also an independent predictor within the pediatric group.

Laparoscopic versus open orchiopexy in the management of peeping testis: a multi-institutional prospective randomized study.

OBJECTIVE: Peeping testis is an inconsistently palpable/seen undescended testis that migrates back and forth at the internal inguinal ring. Both open and laparoscopic orchiopexy are effective forms of management. The present study aimed to evaluate the efficacy and safety of both approaches. PATIENTS AND METHODS: Between September 2007 and January 2012, 46 peeping inguinal testes were randomly treated with either open (25 cases) or laparoscopic (21 cases) orchiopexy procedures. Spermatic vessels were preserved for all cases. Operative details, postoperative morbidity and final testicular site and size were recorded. RESULTS: The median age of the children was 2.5 years (range 0.5-12.0). The follow-up period ranged from 1.0 to 5.5 years. Of these testes, 20 in the open surgery group and 19 in the laparoscopic group maintained correct intrascrotal position (P = 0.428). Re-do orchiopexy was indicated for two cases in the surgical group (P = 0.493). No cases of testicular atrophy or hernia were encountered. CONCLUSION: Open and laparoscopic orchiopexy procedures for peeping testes are fairly comparable. However, laparoscopy is relatively more effective, as two re-do orchiopexies were required in the open surgical group.

Reconstruction of long anterior urethral strictures by dorsally quilted penile skin flap.

Objective. To present the results of reconstruction of long (>5 cm), penile, bulbar, and bulbopenile urethral strictures by penile skin flap as dorsal onlay in one-stage procedure. Patients and Methods. Between January, 1998 and December, 2004, 18 patients (aged from 28-65 years) presented with long urethral strictures, 5.6-13.2 cm (penile in 6, bulbar in 2 and combined in 10 cases), those were repaired utilizing long penile skin flaps placed as dorsal onlay flap in one stage (Orandi flap 6 cm in 6 cases, circular flaps 7-10 cm in 8, and spiral flaps 10-15 cm in 4). Followup of all patients after reconstruction included urine flow rate at weekly intervals, RUG at 6-12 weeks, and urethrocystoscopy at 12 and 18 months. Results. The urethral patency was achieved in 77% of patients. The complications were fistula in one patient (5.5%), restricture occurred in 3 patients (16.6%) that required visual internal urethrotomy and two patients (11%) showed curvature on erection that dose not interfere with sexual intercourse. Diverticulum (penile urethra) was seen in one patient (5.5%) containing stones and was excised surgically. There was penile skin loss in 3 patients (16.6%). All patients completed at least one-year followup period. Conclusion. Free penile skin flaps offer good results (functional and cosmetic) in long penile and/or bulbar urethral strictures. Meticulously fashioned longitudinal, circular or spiral penile skin flaps could bridge urethral defects up to 15 cm long.

HPTLC densitometric analysis of arbutin in bulk drug and methanolic extracts of Arctostaphylos uva-ursi.

A high-performance thin layer chromatographic densitometric method for the analysis of arbutin was developed and validated in the present investigation. Arbutin was separated on aluminium-backed silica gel 60 F(254) plates with methanol : chloroform (3:7)% (v/v) as the mobile phase. This system was found to give a compact spot of arbutin at a retention factor (R(f)) value of 0.32 ± 0.02. The limit of detection and limit of quantification were found to be 35.42 and 106.26 ng/spot, respectively. The proposed method with a high degree of precision and accuracy was employed for the analysis of arbutin in the bulk drug and methanolic extract of Arctostaphylos uva-ursi.

Phenolic constituents of Ononis vaginalis roots.

The ether soluble fraction of the roots of Ononis vaginalis Vahl. Symb. afforded three new compounds: 3-hydroxy-4,9-dimethoxycoumestan, maginaldehyde [2-(4-hydroxy-2-methoxyphenyl)-5,6-dimethoxy-3-benzofuran-carboxaldehyde] and 5,7,4'-trihydroxy-4-styrylcoumarin. In addition, four known pterocarpans; 3,4,9-trimethoxypterocarpan, maackiain, medicarpin and trifolirhizin were also isolated. The styrylcoumarin derivative showed significant antiviral activity against Herpes simplex type 1 and weak cytotoxicity.

Bioactive saponins from Swartzia schomburgkii from the suriname rainforest.

Bioassay-guided fractionation of the MeOH extract of Swartzia schomburgkii using the engineered yeast strains 1138, 1140, and 1353 as the bioassay tool resulted in the isolation of five active (2, 4-7) and three inactive (1, 3, 8) saponins. Saponins 4 and 6 are previously unreported. The structures of all of the saponins were established based on 1D and 2D NMR spectral analysis, on acid and alkaline hydrolysis followed by TLC and GC-MS, and by comparison with literature data for known compounds. Three of the isolated compounds (4-6) showed weak cytotoxicity against the M-109 cell line.

DNA-damaging steroidal alkaloids from Eclipta alba from the suriname rainforest1.

Bioassay-guided fractionation of the MeOH extract of Eclipta alba using three yeast strains (1138, 1140, and 1353) resulted in the isolation of eight bioactive steroidal alkaloids (1-8), six of which are reported for the first time from nature. The major alkaloid was identified as (20S)(25S)-22,26-imino-cholesta-5,22(N)-dien-3beta-ol (verazine, 3), while the new alkaloids were identified as 20-epi-3-dehydroxy-3-oxo-5,6-dihydro-4,5-dehydroverazine (1), ecliptalbine [(20R)-20-pyridyl-cholesta-5-ene-3beta,23-diol] (4), (20R)-4beta-hydroxyverazine (5), 4beta-hydroxyverazine (6), (20R)-25beta-hydroxyverazine (7), and 25beta-hydroxyverazine (8). Ecliptalbine (4), in which the 22,26-imino ring of verazine was replaced by a 3-hydroxypyridine moiety, had comparable bioactivity to verazine in these assays, while a second alkaloid (8) showed good activity against Candida albicans. All the alkaloids showed weak cytotoxicity against the M-109 cell line.

Erythroxan diterpenes from Fagonia glutinosa.

Further investigation of the ether extract of the aerial parts of Fagonia glutinosa utilizing the brine shrimp bioassay resulted in the isolation of two new cytotoxic erythroxan diterpenes: 1 alpha, 10 alpha-epoxy-2-oxofagonene (1) and 1 beta, 10 beta-epoxy-2-oxofagonene (2). In addition, two inactive diterpenes, 2-oxofagonene (3) and its previously reported isomer 2-oxo-5-epi-fagonene (4), were also isolated.

Bioactive iridoids and a new lignan from Allamanda cathartica and Himatanthus fallax from the Suriname rainforest.

Bioassay-guided fractionation of the EtOAc extract of both Allamanda cathartica and Himatanthus fallax (Apocynaceae) using the Sc-7 yeast strain resulted in the isolation of the weakly cytotoxic isoplumericin and plumericin. In addition, the new lignan 7(R)-methoxy-8-epi-matairesional and three known compounds, plumieride, matairesinol, and pinoresinol, were isolated from H. fallax.

Lanigerol: a new antimicrobial icetexane diterpene from Salvia lanigera.

Roots of Salvia lanigera Poir. yielded a new icetexane [10,12-dihydroxy-9(10-->20)-abeo-8,11,13-abietatriene], named lanigerol, which had activity (MIC 1 mg/ml) against Gram-positive bacteria.

Antimicrobial isoflavans from Astragalus species.

Two new antimicrobial isoflavans, 1-[(3R)-7,8-dimethoxybenzopyranyl]-4- hydroxybenzoquinone (astragaluquinone) and (3S)-7,1'-dihydroxy-8,3'-dimethoxyisoflavan (8-methoxyvestitol), and the known 7-hydroxy-2',3',4'-trimethoxyisoflavan were isolated from roots of Astragalus alexandrinus and A. trigonus. The structures of the new isoflavans were established by spectroscopic methods.