Minimally Invasive Robotic-Assisted Cystolithotomy in a Complicated Urinary Diversion: A Feasible and Safe Approach.

Urinary diversion following radical cystectomy and neoadjuvant chemotherapy is the gold standard for the management of muscle-invasive bladder cancer. Urinary diversions are at an increased risk of urolithiasis as a result of various factors. Traditional surgical intervention has included open cystolithotomy which has given way to minimally invasive techniques as of late. We describe a case of a robotic-assisted cystolithotomy from a neobladder in a 54-year-old female patient with muscle-invasive bladder cancer. This is the first description of a robotic-assisted removal of a stone in an orthotopic neobladder. This approach has many advantages, especially in the removal of larger stones. Further study is needed to investigate the efficacy and success of this approach.

Ureteroarterial Fistula: A Diagnosis Which Is Not Always Black and White.

Ureteroiliac artery fistulas are a rare, life-threatening condition that requires a high index of suspicion for prompt diagnosis. Presurgical diagnosis is challenging as this condition can lie hidden despite advanced imaging modalities. We present two cases of patients presenting with gross hematuria and exsanguination in the setting of a ureteroiliac artery fistula. These cases highlight the difficulties in timely diagnosis and treatment in a multidisciplinary team.

First-year results of an expanded humanitarian aid programme for haemophilia in resource-constrained countries.

INTRODUCTION: The gaps in haemophilia treatment around the world are enormous; approximately 60% of an estimated 475 000 individuals are not identified. Of the 187 000 diagnosed, 30% (57 000) access clotting factor replacement therapy. Since 1996, humanitarian aid distributed by the World Federation of Hemophilia (WFH) has played a minor, yet vital role providing life-saving clotting factor to countries in emergency situations. Donated amounts have been small and sporadic, often salvaging short-dated products, providing little opportunity to leverage donations with governments. In 2015, a prospective donation programme of 100 million I.U. per year of extended half-life factor VIII and IX over 10 years was established, necessitating the development of new logistics and training programmes by WFH. AIM: To measure the impact of a greatly expanded haemophilia humanitarian aid program. MATERIALS AND METHODS: In 2016, the first full year of the expanded programme, WFH, distributed products to 58 countries with factor VIII usage <1 I.U. per capita, a level incompatible with long-term survival and far below the 4 I.U. FVIII per capita minimum established in Europe. RESULTS: The scope of the programme and utilization data for 2016 indicate primarily use for acute bleeding, orthopaedic and emergency surgeries. Compared to 2014, 2016 data showed substantial increases in patients served (5.9-fold, from 2119 to 14 579), surgeries performed (37-fold) and bleeds treated (6.9-fold). Patients on prophylaxis rose from 0 to 852, including 458 children under 10 years old. DISCUSSION: The expanded humanitarian aid programme impacts an estimated 10% of individuals with haemophilia previously unable to access treatment. CONCLUSION: This programme represents an unprecedented public-private partnership to deliver medicines to individuals with no access. Further, the programme offers the prospective opportunity to engage governments to take more responsiblity for increasing training, medical management, and product supply in 58 resource constrained countries.

The matrix protein gene sequence analysis reveals close relationship between peste des petits ruminants virus (PPRV) and dolphin morbillivirus.

The gene encoding the matrix protein of peste des petits ruminants virus (PPRV) has been cloned and its nucleotide sequence determined. This gene is 1466 nucleotides long and contains an open reading frame (ORF) capable of encoding a basic protein of 335 amino acid residues with a predicted molecular weight of 38,057 Da. This ORF starts at position 33-35 and ends with the codon TAA at position 1038-1040 thus leaving a long untranslated region (426 nucleotides) at the 3' end of the messenger RNA. This fragment is very G/C rich (68.5%) and in contrast to the ORF region appears to be least conserved in the M gene sequence of the morbilliviruses. A comparison of the PPRV M protein with those of other viruses in the group confirms the previously noted high degree of conservation for this protein sequence. The percent of identity within the group ranges from 76.7 to 86.9%, the highest being with the dolphin morbillivirus matrix protein.

Specialty care for patients with epilepsy must become standard of care. Promotion of Specialty Care for Epilepsy Group.

Epilepsy is a complex, common disorder with severe consequences for patients. The authors believe that a significant percentage of patients are receiving suboptimal care. The national standard of care needs to be upgraded to include the notion that patients with less than total seizure control or those suffering from any medication side-effects should be given the opportunity to receive specialty care by physicians with specific expertise in the field of epilepsy.

Long-term sequelae of group B streptococcal meningitis in infants.

The long-term outcome and admission features predictive of outcome were determined for 61 patients with group B streptococcal meningitis treated between 1974 and 1979. Infection was rapidly fatal in 13 patients (21%). Among the 48 survivors, 38 (79%) 3 years of age or older were available for comprehensive evaluation. Excluding five who had died before age 3 years, the mean age at evaluation was 6.0 years (range 3.3 to 9.0 years). Among survivors, 11 (29%) had severe neurologic sequelae, eight (21%) had mild to moderate deficits, and 19 (50%) were functioning normally. Analysis of predictive features revealed a significant risk of death or severe impairment among infants who at hospital admission were comatose or semicomatose, had decreased perfusion, total peripheral WBC less than 5,000/mm3, absolute neutrophil count less than 1000/mm3, and CSF protein greater than 300 mg/dl (P less than or equal to 0.05). These data indicate that, although mortality from group B streptococcal meningitis has declined, approximately half of the survivors of acute infection have some degree of morbidity when evaluated at ages permitting the detection of language delay and borderline or mild mental retardation.

Species distribution of non-group D alpha-hemolytic streptococci in maternal genital and neonatal blood cultures.

At our hospital (Jefferson Davis Hospital, Houston, Tex.) since 1979, non-group D alpha-hemolytic streptococci have been isolated with increasing frequency from neonatal blood cultures with clinical findings of sepsis. A total of 47 such isolates were identified to the species level by the scheme of Facklam and were compared with 57 genital isolates from 167 maternity patients. Among the genital isolates, S. sanguis II and S. MG-intermedius accounted for 53 and 28%, respectively, and both were significantly less common in neonatal cultures (23 and 11%, respectively; P less than 0.05). Among neonatal isolates, S. mitis was the single most frequent species (35%), in contrast to its rare occurrence in maternal cultures (3.4%; P less than 0.001). The disparity between the prevalence of S. mitis in neonatal compared with maternal cultures suggests that this species of non-group D alpha-hemolytic streptococci may have increased virulence in neonatal hosts.

Amebic liver abscess in children.

Five children with amebic liver abscesses are presented, and the distinctive clinical and laboratory features for these and 119 other children are described. The majority (91%) were less than 3 years old, and 77% had an isolated abscess in the right hepatic lobe. Each child presented with a history of fever and gastrointestinal symptoms, and two-thirds presented with cough or difficulty breathing. Most (81%) patients had hepatomegaly on physical examination and some had a well-defined mass. Hematologic abnormalities including anemia, neutrophilia and an increased ratio (greater than 0.15) of immature neutrophils to total neutrophils were commonly observed at the time of admission. Of interest, intravenous pyelograms revealed deviation of the right kidney due to hepatomegaly in each of three children studied. All patients evaluated had one or more filling defects demonstrated by liver-spleen scan or abdominal ultrasound. Most patients underwent either an open (9%) or closed (77%) drainage procedure. Fifty-six children (46%) died, in some cases before specific therapy was instituted. Of those who recovered all received therapy with metronidazole or a combination of chloroquine with emetine or dehydroemetine.