Modified telescopic sheath method for exchange of luminally encrusted ureteral stents.

A novel telescopic access sheath technique has been described to maintain access to the ureter in cases of stent encrustation, placing a suture on the externalised distal end of the stent followed by advancing a sheath over to peel off encrustations and maintain access in the ureter, as well as application of this technique in a child. Herein we present a modification of the telescopic sheath technique that allows exchange of luminally encrusted stents without requiring passage of the sheath into the ureter or ureteroscopy alongside the stent.

Retrograde ureteral sheathed forceps technique to retrieve a proximally migrated stent in a young infant.

Ureteral stents are commonly externalised retrogradely by cystoscopy and exchanged under imaging guidance. When a ureteral stent has migrated proximally into the ureter, it may be snared by ureteroscopy or antegrade percutaneous access; however, ureteroscopy can be challenging in young infants where there is difficulty visualizing the ureteral orifice or a small-calibre ureter. The presented case describes a radiologic technique for retrieval of a proximally migrated ureteral stent in a young infant using a 0.025-in. hydrophilic wire, 4-Fr angiographic catheter, 8-Fr vascular sheath and cystoscopic forceps, without requiring transrenal antegrade access or surgical ureteral meatotomy.

Adenosine deaminase modulates metabolic remodeling and orchestrates joint destruction in rheumatoid arthritis.

Rheumatoid Arthritis (RA) is a chronic autoimmune disease associated with inflammation and joint remodeling. Adenosine deaminase (ADA), a risk factor in RA, degrades adenosine, an anti-inflammatory molecule, resulting in an inflammatory bias. We present an integrative analysis of clinical data, cytokines, serum metabolomics in RA patients and mechanistic studies on ADA-mediated effects on in vitro cell culture models. ADA activity differentiated patients into low and high ADA sets. The levels of the cytokines TNFα, IFNγ, IL-10, TGFß and sRANKL were elevated in RA and more pronounced in high ADA sets. Serum metabolomic analysis shows altered metabolic pathways in RA which were distinct between low and high ADA sets. Comparative analysis with previous studies shows similar pathways are modulated by DMARDs and biologics. Random forest analysis distinguished RA from control by methyl-histidine and hydroxyisocaproic acid, while hexose-phosphate and fructose-6-phosphate distinguished high ADA from low ADA. The deregulated metabolic pathways of High ADA datasets significantly overlapped with high ADA expressing PBMCs GEO transcriptomics dataset. ADA induced the death of chondrocytes, synoviocyte proliferation, both inflammation in macrophages and their differentiation into osteoclasts and impaired differentiation of mesenchymal stem cells to osteoblasts and mineralization. PBMCs expressing elevated ADA had increased expression of cytokines and P2 receptors compared to synovial macrophages which has low expression of ADA. Our data demonstrates increased cytokine levels and distinct metabolic signatures of RA based on the ADA activity, suggests an important role for ADA in the pathophysiology of RA joints and as a potential marker and therapeutic target in RA patients.

A multi-analysis approach for estimating regional health impacts from the 2017 Northern California wildfires.

Smoke impacts from large wildfires are mounting, and the projection is for more such events in the future as the one experienced October 2017 in Northern California, and subsequently in 2018 and 2020. Further, the evidence is growing about the health impacts from these events which are also difficult to simulate. Therefore, we simulated air quality conditions using a suite of remotely-sensed data, surface observational data, chemical transport modeling with WRF-CMAQ, one data fusion, and three machine learning methods to arrive at datasets useful to air quality and health impact analyses. To demonstrate these analyses, we estimated the health impacts from smoke impacts during wildfires in October 8-20, 2017, in Northern California, when over 7 million people were exposed to Unhealthy to Very Unhealthy air quality conditions. We investigated using the 5-min available GOES-16 fire detection data to simulate timing of fire activity to allocate emissions hourly for the WRF-CMAQ system. Interestingly, this approach did not necessarily improve overall results, however it was key to simulating the initial 12-hr explosive fire activity and smoke impacts. To improve these results, we applied one data fusion and three machine learning algorithms. We also had a unique opportunity to evaluate results with temporary monitors deployed specifically for wildfires, and performance was markedly different. For example, at the permanent monitoring locations, the WRF-CMAQ simulations had a Pearson correlation of 0.65, and the data fusion approach improved this (Pearson correlation = 0.95), while at the temporary monitor locations across all cases, the best Pearson correlation was 0.5. Overall, WRF-CMAQ simulations were biased high and the geostatistical methods were biased low. Finally, we applied the optimized PM2.5 exposure estimate in an exposure-response function. Estimated mortality attributable to PM2.5 exposure during the smoke episode was 83 (95% CI: 0, 196) with 47% attributable to wildland fire smoke.Implications: Large wildfires in the United States and in particular California are becoming increasingly common. Associated with these large wildfires are air quality and health impact to millions of people from the smoke. We simulated air quality conditions using a suite of remotely-sensed data, surface observational data, chemical transport modeling, one data fusion, and three machine learning methods to arrive at datasets useful to air quality and health impact analyses from the October 2017 Northern California wildfires. Temporary monitors deployed for the wildfires provided an important model evaluation dataset. Total estimated regional mortality attributable to PM2.5 exposure during the smoke episode was 83 (95% confidence interval: 0, 196) with 47% of these deaths attributable to the wildland fire smoke. This illustrates the profound effect that even a 12-day exposure to wildland fire smoke can have on human health.

The Comprehensive Fire Information Reconciled Emissions (CFIRE) inventory: Wildland fire emissions developed for the 2011 and 2014 U.S. National Emissions Inventory.

Wildland fire emissions from both wildfires and prescribed fires represent a major component of overall U.S. emissions. Obtaining an accurate, time-resolved inventory of these emissions is important for many purposes, including to account for emissions of greenhouse gases and short-lived climate forcers, as well as to model air quality for health, regulatory, and planning purposes. For the U.S. Environmental Protection Agency's 2011 and 2014 National Emissions Inventories, a new methodology was developed to reconcile the wide range of available fire information sources into a single coherent inventory. The Comprehensive Fire Information Reconciled Emissions (CFIRE) inventory effort utilized satellite fire detections as well as a large number of national, state, tribal, and local databases. The methodology and results for CONUS and Alaska were documented and compared against other fire emissions databases, and the efficacy of the overall effort was evaluated. Results show the overall spatial pattern differences and relative seasonality of wildfires and prescribed fires across the country. Prescribed burn emissions occurred primarily in non-summer months were concentrated in the Southeast, Northwest, and lower Midwest, and were relatively consistent year to year. Wildfire emissions were much more variable but occurred primarily in the summer and fall. Overall, CFIRE represents a third of total emitted PM2.5 across all sources in the National Emissions Inventory, with prescribed fires accounting for nearly half of all CFIRE emissions. Compared with other wildland fire emissions inventories derived solely from satellite detections, the CFIRE inventory shows markedly increased emissions, reflecting the importance of the multiple national and regional databases included in CFIRE in capturing small fires and prescribed fires in particular. Implications: Wildland fire emissions inventories need to incorporate multiple sources of fire information in order to better represent the full range of fire activity, including prescribed burns and smaller fires. For the 2011 and 2014 U.S. National Emissions Inventory, a methodology was developed to collect, associate, and reconcile fire information from satellite data as well as a large number of national, regional, state, local, and tribal fire information databases across the country. The resulting emissions inventory shows the importance of this type of integration and reconciliation when compared against other emissions inventories for the same period.

Wildfire and prescribed burning impacts on air quality in the United States.

Air quality impacts from wildfires have been dramatic in recent years, with millions of people exposed to elevated and sometimes hazardous fine particulate matter (PM 2.5 ) concentrations for extended periods. Fires emit particulate matter (PM) and gaseous compounds that can negatively impact human health and reduce visibility. While the overall trend in U.S. air quality has been improving for decades, largely due to implementation of the Clean Air Act, seasonal wildfires threaten to undo this in some regions of the United States. Our understanding of the health effects of smoke is growing with regard to respiratory and cardiovascular consequences and mortality. The costs of these health outcomes can exceed the billions already spent on wildfire suppression. In this critical review, we examine each of the processes that influence wildland fires and the effects of fires, including the natural role of wildland fire, forest management, ignitions, emissions, transport, chemistry, and human health impacts. We highlight key data gaps and examine the complexity and scope and scale of fire occurrence, estimated emissions, and resulting effects on regional air quality across the United States. The goal is to clarify which areas are well understood and which need more study. We conclude with a set of recommendations for future research. IMPLICATIONS: In the recent decade the area of wildfires in the United States has increased dramatically and the resulting smoke has exposed millions of people to unhealthy air quality. In this critical review we examine the key factors and impacts from fires including natural role of wildland fire, forest management, ignitions, emissions, transport, chemistry and human health.

Preventing the O in OHVIRA (Obstructed Hemivagina Ipsilateral Renal Agenesis): Early Diagnosis and Management of Asymptomatic Herlyn-Werner-Wunderlich Syndrome.

INTRODUCTION: Herlyn-Werner-Wunderlich syndrome (HWWS) is a rare variant of Mullerian ductal anomaly associated with ipsilateral renal agenesis. Most patients are diagnosed after menarche with complications of uterovaginal obstruction, genitourinary infection and pelvic adhesions. Patients often undergo additional operations for misdiagnosis or treatment of complications. Our institution manages several HWWS patients diagnosed before symptoms by screening for antenatally-diagnosed renal agenesis. This study aims to improve the presymptomatic management of HWWS patients. METHODS: We carried out retrospective case review of patients diagnosed with HWWS from 2010 to 2017 on patient demographics, symptoms, clinical course and operative management and summarize the sparse literature published to date. RESULTS: There were 8 patients with HWWS but only 2 symptomatic patients presented acutely with hematocolpos requiring urgent vaginal surgery. The other six patients had early diagnosis through postnatal ultrasound screening. No patient required further operation for diagnosis or complications related to obstructed hemivagina. CONCLUSION: Our case series and literature review show that the majority of prepubertal patients with HWWS do not require early gynecological surgery. We recommend that female babies with renal agenesis should be screened for HWWS syndrome with ultrasound. Early diagnosis and presymptomatic elective surgery may prevent urogynecological complications that cause fertility and renal impairment. STUDY DESIGN: Case series, level IV evidence.

Methods, availability, and applications of PM2.5 exposure estimates derived from ground measurements, satellite, and atmospheric models.

Fine particulate matter (PM2.5) is a well-established risk factor for public health. To support both health risk assessment and epidemiological studies, data are needed on spatial and temporal patterns of PM2.5 exposures. This review article surveys publicly available exposure datasets for surface PM2.5 mass concentrations over the contiguous U.S., summarizes their applications and limitations, and provides suggestions on future research needs. The complex landscape of satellite instruments, model capabilities, monitor networks, and data synthesis methods offers opportunities for research development, but would benefit from guidance for new users. Guidance is provided to access publicly available PM2.5 datasets, to explain and compare different approaches for dataset generation, and to identify sources of uncertainties associated with various types of datasets. Three main sources used to create PM2.5 exposure data are ground-based measurements (especially regulatory monitoring), satellite retrievals (especially aerosol optical depth, AOD), and atmospheric chemistry models. We find inconsistencies among several publicly available PM2.5 estimates, highlighting uncertainties in the exposure datasets that are often overlooked in health effects analyses. Major differences among PM2.5 estimates emerge from the choice of data (ground-based, satellite, and/or model), the spatiotemporal resolutions, and the algorithms used to fuse data sources.Implications: Fine particulate matter (PM2.5) has large impacts on human morbidity and mortality. Even though the methods for generating the PM2.5 exposure estimates have been significantly improved in recent years, there is a lack of review articles that document PM2.5 exposure datasets that are publicly available and easily accessible by the health and air quality communities. In this article, we discuss the main methods that generate PM2.5 data, compare several publicly available datasets, and show the applications of various data fusion approaches. Guidance to access and critique these datasets are provided for stakeholders in public health sectors.

A statistical model for predicting PM2.5 for the western United States.

A new statistical model for predicting daily ground level fine scale particulate matter (PM2.5) concentrations at monitoring sites in the western United States was developed and tested operationally during the 2016 and 2017 wildfire seasons. The model is site-specific, using a multiple linear regression schema that relies on the previous day's PM2.5 value, along with fire and smoke related variables from satellite observations. Fire variables include fire radiative power (FRP) and the National Fire Danger Rating System Energy Release Component index. Smoke variables, in addition to ground monitored PM2.5, include aerosol optical depth (AOD) and smoke plume perimeters from the National Oceanic and Atmospheric Administration's Hazard Mapping System. The overall statistical model was inspired by a similar system developed for British Columbia (BC) by the BC Center for Disease Control, but it has been heavily modified and adapted to work in the United States. On average, our statistical model was able to explain 78% of the variance in daily ground level PM2.5. A novel method for implementation of this model as an operational forecast system was also developed and was tested and used during the 2016 and 2017 wildfire seasons. This method focused on producing a continuously-updating prediction that incorporated the latest information available throughout the day, including both updated remote sensing data and real-time PM2.5 observations. The diurnal pattern of performance of this model shows that even a few hours of data early in the morning can substantially improve model performance. Implications: Wildfire smoke events produce significant air quality impacts across the western United States each year impacting millions. We present and evaluate a statistical model for making updating predictions of fine particulate (PM2.5) levels during smoke events. These predictions run hourly and are being used by smoke incident specialists assigned to wildfire operations, and may be of interest to public health officials, air quality regulators, and the public. Predictions based on this model will be available on the web for the 2019 western U.S. wildfire season this summer.

Machine Learning-Based Integration of High-Resolution Wildfire Smoke Simulations and Observations for Regional Health Impact Assessment.

Large wildfires are an increasing threat to the western U.S. In the 2017 fire season, extensive wildfires occurred across the Pacific Northwest (PNW). To evaluate public health impacts of wildfire smoke, we integrated numerical simulations and observations for regional fire events during August-September of 2017. A one-way coupled Weather Research and Forecasting and Community Multiscale Air Quality modeling system was used to simulate fire smoke transport and dispersion. To reduce modeling bias in fine particulate matter (PM2.5) and to optimize smoke exposure estimates, we integrated modeling results with the high-resolution Multi-Angle Implementation of Atmospheric Correction satellite aerosol optical depth and the U.S. Environmental Protection Agency AirNow ground-level monitoring PM2.5 concentrations. Three machine learning-based data fusion algorithms were applied: An ordinary multi-linear regression method, a generalized boosting method, and a random forest (RF) method. 10-Fold cross-validation found improved surface PM2.5 estimation after data integration and bias correction, especially with the RF method. Lastly, to assess transient health effects of fire smoke, we applied the optimized high-resolution PM2.5 exposure estimate in a short-term exposure-response function. Total estimated regional mortality attributable to PM2.5 exposure during the smoke episode was 183 (95% confidence interval: 0, 432), with 85% of the PM2.5 pollution and 95% of the consequent multiple-cause mortality contributed by fire emissions. This application demonstrates both the profound health impacts of fire smoke over the PNW and the need for a high-performance fire smoke forecasting and reanalysis system to reduce public health risks of smoke hazards in fire-prone regions.

Air-Quality Impacts and Intake Fraction of PM2.5 during the 2013 Rim Megafire.

The 2013 Rim Fire was the third largest wildfire in California history and burned 257 314 acres in the Sierra Nevada Mountains. We evaluated air-quality impacts of PM2.5 from smoke from the Rim Fire on receptor areas in California and Nevada. We employed two approaches to examine the air-quality impacts: (1) an evaluation of PM2.5 concentration data collected by temporary and permanent air-monitoring sites and (2) an estimation of intake fraction (iF) of PM2.5 from smoke. The Rim Fire impacted locations in the central Sierra nearest to the fire and extended to the northern Sierra Nevada Mountains of California and Nevada monitoring sites. Daily 24-h average PM2.5 concentrations measured at 22 air monitors had an average concentration of 20 µg/m3 and ranged from 0 to 450 µg/m3. The iF for PM2.5 from smoke during the active fire period was 7.4 per million, which is slightly higher than representative iF values for PM2.5 in rural areas and much lower than for urban areas. This study is a unique application of intake fraction to examine emissions-to-exposure for wildfires and emphasizes that air-quality impacts are not only localized to communities near large fires but can extend long distances and affect larger urban areas.

Effect of Thermal and Structural Disorder on the Electronic Structure of Hybrid Perovskite Semiconductor CH3NH3PbI3.

In this Letter, we investigate the temperature dependence of the optical properties of methylammonium lead iodide (MAPbI3 = CH3NH3PbI3) from room temperature to 6 K. In both the tetragonal (T > 163 K) and the orthorhombic (T < 163 K) phases of MAPbI3, the band gap (from both absorption and photoluminescence (PL) measurements) decreases with decrease in temperature, in contrast to what is normally seen for many inorganic semiconductors, such as Si, GaAs, GaN, etc. We show that in the perovskites reported here, the temperature coefficient of thermal expansion is large and accounts for the positive temperature coefficient of the band gap. A detailed analysis of the exciton line width allows us to distinguish between static and dynamic disorder. The low-energy tail of the exciton absorption is reminiscent of Urbach absorption. The Urbach energy is a measure of the disorder, which is modeled using thermal and static disorder for both the phases separately. The static disorder component, manifested in the exciton line width at low temperature, is small. Above 60 K, thermal disorder increases the line width. Both these features are a measure of the high crystal quality and low disorder of the perovskite films even though they are produced from solution.

Band Gap Tuning of CH3NH3Pb(Br(1-x)Clx)3 Hybrid Perovskite for Blue Electroluminescence.

We report on the structural, morphological and optical properties of AB(Br(1-x)Cl(x))3 (where, A = CH3NH3(+), B = Pb(2+) and x = 0 to 1) perovskite semiconductor and their successful demonstration in green and blue emissive perovskite light emitting diodes at room temperature. The bandgap of perovskite thin film is tuned from 2.42 to 3.16 eV. The onset of optical absorption is dominated by excitonic effects. The coulomb field of the exciton influences the absorption at the band edge. Hence, it is necessary to explicitly account for the enhancement of the absorption through the Sommerfield factor. This enables us to correctly extract the exciton binding energy and the electronic bandgap. We also show that the lattice constant varies linearly with the fractional chlorine content satisfying Vegards law.

Undescended testis: Level of knowledge among potential referring health-care providers.

AIM: Studies report that most boys with undescended testis(UDT) are referred and operated beyond the recommended age of 1 year, possibly due to lack of awareness of treatment guidelines. We investigate the level of knowledge of UDT among potential referring health-care providers. METHOD: We devised a survey on the clinical features and appropriate management of UDT. Using convenience sampling, we approached health-care professionals with regular contact with paediatric patients and final year medical students. Respondents were allowed to remain anonymous. They were categorised according to specialty and level of experience/training. RESULTS: Of 1179 approached, 203 responded. Thirty-six (24%) of 149 qualified doctors had never seen a case of UDT. Median score was 6 (range 1-9). There was no significant difference in scores when comparing specialty. Mean scores decreased significantly in trend according to level of experience. When questioned regarding timings of referral and orchidopexy, 24% of qualified doctors would not refer until 9 months of age, and 66% thought orchidopexy should be done after 1 year old. Half would stop examining for UDT after 2 years old. CONCLUSIONS: Inexperience with UDT and outdated knowledge may contribute to delays in referral for UDT. Many would stop examining for UDT at 2 years old, placing undue reliance on accurate physical examination in early childhood and indicating lack of awareness of the ascending testis. Community health initiatives must emphasise recent changes in guidelines for management of UDT.

Undescended testis: 513 patients' characteristics, age at orchidopexy and patterns of referral.

OBJECTIVE: Undescended testis (UDT) affects 1-6% of males. Current recommendations are to correct maldescent by 1 year of age. We identify the population characteristics of children referred and managed for UDT, age at referral and orchidopexy, and patterns of referral. DESIGN, SETTING AND PATIENTS: Retrospective 5-year review of all patients operated for UDT from 2007 to 2011 in our institution. Patient demographics, neonatal diagnosis of UDT, age at referral, referral source and age at first orchidopexy were recorded. Data are reported as median (range). RESULTS: There were 513 boys with 576 undescended gonads; 450 (88%) had unilateral UDT. Congenital (present at birth) UDT was diagnosed in 287 (56%) children. Seventy-nine (15%) were premature births, 41 (8%) had associated major genitourinary abnormalities. Median age at referral was 1.1 (0-16.2) years; median age at first orchidopexy was 1.6 (0-17.2) years. When corrected for age, those with a history of prematurity and associated major genitourinary malformations were referred and operated on earlier. There was no difference in age at referral and orchidopexy when comparing unilateral versus bilateral maldescent, and palpability of UDT. Of those with congenital UDT, 70% were operated at beyond 1 year of age. Those referred from public tertiary hospitals were younger than those referred from community clinics (p<0.0001) and private healthcare institutions (p=0.003). CONCLUSIONS: Despite early diagnosis in many patients with UDT, most are referred and operated after 1 year of age, even in congenital UDT. Premature babies, those with major genitourinary anomalies, and those seen in public tertiary hospitals are referred earlier. Community health initiatives must emphasise prompt referral to allay the impact of delayed surgery.

An unusual variant of urethral duplication: an addition to the Effman classification.

A rare association of horseshoe kidney with pyelic fusion with crossed single ureter along with a rare unusual variant of complete urethral duplication is described. We review the available literature on this rare association and present its management.

Separating Charges at Organic Interfaces: Effects of Disorder, Hot States, and Electric Field.

Charge separation at organic-organic (O-O) interfaces is crucial to how many organic-based optoelectronic devices function. However, the mechanism of formation of spatially separated charge carriers and the role of geminate recombination remain topics of discussion and research. We review critically the contributions of the various factors, including electric fields, long-range order, and excess energy (beyond the minimum needed for photoexcitation), to the probability that photogenerated charge carriers will be separated. Understanding the processes occurring at the O/O interface and their relative importance for effective charge separation is crucial to design efficient solar cells and photodetectors. We stress that electron and hole delocalization after photoinduced charge transfer at the interface is important for efficient free carrier generation. Fewer defects at the interface and long-range order in the materials also improve overall current efficiency in solar cells. In efficient organic cells, external electric fields play only a small role for charge separation.

Anomalies associated with anorectal malformations according to the Krickenbeck anatomic classification.

PURPOSE: We evaluated the incidence of congenital anomalies associated with anorectal malformations (ARMs) in relation to the anatomic type of ARM as defined by the Krickenbeck classification. METHODS: We reviewed 99 children with ARM in our institution from 2002 to 2011. Data were collected on patient demographics, type of ARM, and associated congenital anomalies, which were categorized according to organ systems. Statistical analysis was performed for comparison between groups using 'perineal fistula' as the base group. RESULTS: There were 62 (63%) male patients. The majority had perineal fistulas (35, 35%). Seventy-seven (78%) had at least one associated malformation. The most frequent malformations seen were genitourinary (28, 28%) and spinal anomalies (26, 26%). Those with rectovesical fistula had the highest proportion of genitourinary malformations (Odds Ratio [OR], 41.3; 95% confidence interval [CI], 4.7-363.4). Those with cloaca (OR, 49.5; 95% CI, 3.4-718.9) and those with rectovestibular fistula (OR, 12.4; 95% CI, 2.3-65.6) were most likely to have major spinal abnormalities, with tethered cord seen in all groups. The rectovestibular group was also most likely to have other associated malformations (OR, 8.6; 95% CI, 2.2-32.8). CONCLUSION: More than 75% of children with anorectal malformation have other associated malformations. Genitourinary anomalies are the most common. Major spinal anomalies are seen in all groups, affecting nearly half of those with rectovestibular fistula and those without fistula. The incidence of associated malformations in the rectovestibular group is higher than described in the literature. Thorough systematic evaluation of all infants with ARM should be done regardless of type of ARM.

Role of preoperative 3D CT reconstruction for evaluation of patients with esophageal atresia and tracheoesophageal fistula.

OBJECTIVE: The role of preoperative contrast-enhanced computerized tomography (CT) of chest with three-dimensional (3D) reconstructions was evaluated in neonates with esophageal atresia and tracheoesophageal fistula. METHODS: This was a prospective study which investigated 30 cases of esophageal atresia with tracheoesophageal fistula. All patients were evaluated preoperatively with contrast-enhanced spiral CT using a low-dose CT protocol. 3D CT reconstruction images were evaluated for the type of esophageal atresia, the distance between the upper and lower esophageal pouches, origin, level and position of the fistula, and the presence or absence of any other cardiac, pulmonary or mediastinal lesions and the findings were correlated with the findings at surgery. The radiation dose for each patient was calculated using the formula-Effective dose (E) = DLP × (E/DLP)age. RESULTS: All the 30 cases had type-C esophageal atresia with tracheoesophageal fistula as per Gross classification. The exact site of the fistula could be identified only in 26 (80 %) cases. The mean gap between the upper pouch and lower fistula was 0.95 ± 0.57 cm (range 0.2-2.8 cm) on CT scan and 1.38 ± 0.61 cm (range 0.5-3.2 cm) at surgery. On statistical analysis, the correlation was found to be significant (p < 0.0001). In addition, lung pathology (consolidation), cardiac pathology and vertebral anomaly were also detected on CT scan in some cases. The mean radiation dose for the neonates who underwent CT chest was calculated to be 1.79 mSv which is significantly high. CONCLUSION: Though preoperative CT scan of chest has many advantages, it involves significant exposure to ionizing radiation and risk of radiation-induced cancer in the future. Additionally in 20 % of cases, the fistula could not be located on CT scan. The most common variety of esophageal atresia and tracheoesophageal fistula is Gross type C (86 %) that has low to intermediate gap (97 %) and can be anastomosed primarily. Thus, CT scan can provide good anatomical delineation, but may not help in surgical decision making. Hence, performing CT in these cases would unnecessarily expose the neonates to ionizing radiation. Therefore, there is no role for CT scan in the routine preoperative assessment of EA with distal TEF.

Mini-vesicostomy in the management of PUV after valve ablation.

AIM: To determine the usefulness of infra-umbilical mini-vesicostomy in infants with posterior urethral valves (PUV), in developing countries. This new technique facilitates clean intermittent catheterization (CIC) and overnight bladder drainage, which have been effectively used for the treatment of valve bladders in the developed world. METHODS: A retrospective analysis of the records of three infants who underwent a mini-vesicostomy between 2005-2009 was done. All were put on CIC in the neonatal period. Monitoring of renal parameters, bladder function and structural changes in the bladder was done before and after 4 years of CIC. RESULTS: All three showed a decrease in upper tract dilatation, improvement in cortical function and improvement of bladder compliance at the end of 4 years. Two patients are on CIC through vesicostomy and can pass a good stream of urine per urethraly, and in one the vesicostomy has been closed. CONCLUSION: Mini-vesicostomy is a useful option to allow CIC on a long-term basis in children with PUV. There were no complications with this technique in this small group of patients, and it has been well accepted by their families.