Material properties of urethral stents for hypospadias repair

Introduction: Despite the prevalence of hypospadias surgery and the near ubiquitous use of postoperative urethral stents, there has been no evaluation of the material properties of commonly used choices. Our study sets out to close this gap with an evaluation and comparison of the material properties of four urethral stents commonly used after hypospadias surgery. Study Design: Thermal analysis and mechanical analysis of the Zaontz Urethral Stent, the Firlit-Kluge Urethral Stent, the Koyle Diaper Stent, and the Bard Premature Infant Feeding Tube were performed. Results: Thermal analysis shows that all four compositions tested are rubbery polymers at body temperature, with glass transition temperatures far below human body temperatures. The Zaontz and Koyle stents are thermoplastic elastomers with strong melting transitions above body temperature, but the Firlit-Kluge stent is completely amorphous at body temperature and is likely chemically cross-linked to generate the polymer network. The Bard feeding tube was by far the stiffest, with a Young's Modulus of 14.0±0.78 (compared to the Zaontz stent at 4.12±0.56, the Firlit-Kluge stent at 4.92±0.63, and the Koyle stent at 4.09±0.49.) The Firlit-Kluge stent was the strongest, with 84.3±2.83 MPa required to fracture it compared to the Zaontz stent at 65.5±2.57, the Koyle stent at 66.8±3.16, and then Bard feeding tube at 34.6±1.89. Discussion: While there is little information associating urethral stent type with outcomes after hypospadias surgery, material properties may account for findings of prior studies. Stiffer stents may contribute to decreased postoperative comfort, while a stent that is too soft and extensible may have issues with dislodgement, kinking and breaking. Conclusion: This study provides a foundation for future work optimizing urethral stents, designing support for regenerative medicine applications, and improving hypospadias outcomes.

Modified Infant Feeding Tube as an Indigenous Endotracheal Tube in Unanticipated Congenital Subglottic Stenosis

Introduction: In neonates with an unanticipated difficult airway, there is an increased probability of failed intubation even with highly trained hands while performing direct laryngoscopy. Aims: We describe our experience of using a modified infant feeding tube (IFT) as an indigenous endotracheal tube (ETT) in a series of paediatric surgical patients with congenital subglottic stenosis (SGS). Material and Methods: A retrospective study was performed in our institute from January 2018 to December 2019. ETT with modified 6 and 8 French (Fr) sized IFT’s were used. A stylet obtained from the VP shunt system was used to aid in intubation. Results: Out of 12,500 admissions in our department, there were 5 pediatric cases with SGS which were managed using modified IFT. Four were neonates and 1 infant (M:F = 2:3). Modified IFT(s) were used after failed intubation with ETT of size 2.5 mm in 4 patients (non-availability of ETT of size 2 mm), while in one neonate, even 2 mm ETT could not be negotiated due to SGS. In all the 5 children, successful intubation was finally performed with modified 8 French (Fr) IFT in 3, and with modified 6 Fr IFT in two cases. The surgical procedure was completed in 4 neonates out of 5 cases, while in one infant it was deferred due to the clinical condition of the patient and significant SGS. Conclusion: All 5 patients with SGS were managed without performing a tracheostomy. Modified IFT(s) is an effective alternative if smaller sized ETT(s) cannot be negotiated or unavailable in difficult neonatal and paediatric airway. This modified IFT as ETT has to be an important part of the emergency airway tray. It should not be considered as a replacement for routine use of standard ETT.

Upper Limb Ischemia in Preterm Infant Leading to Autoamputation of Hand – a Case Report

Acute limb ischemia(ALI) in a paediatric patient is a rare condition but may result in limb loss and life long complications. We present here a case of a 34 weeks premature infant, with birth weight 1530 grams, who was having respiratory distress at time of birth. Infant was referred to advanced pediatric center for further management, where he was kept in neonatal ICU. He was put on C-PAP and oxygen support and an infant feeding tube for feeding. On 21st day infant developed ischemia of the right upper limb. Color Doppler flow study was done which revealed thrombosed right radial and ulnar artery and biphasic flow in brachial artery. He was put on low molecular weight heparin and was advised referral to higher center for further management. Patient developed dry gangrene of right hand and wrist resulting in the autoamputation of the hand and wrist after a period of 15 day from development of gangrene. In order to prevent such complications there should well trained staff to detect early ischemic changes in the limb so that timely treatment can be started and the long term chronic complications can be prevented.

Kluth type I3 and intra-abdominal variants of esophageal atresia: A case series

Background: Esophageal atresia (EA) encompasses a group of congenital anomalies (one in 2500 live births) comprising an interruption in the continuity of the esophagus combined with or without a persistent communication with the trachea. It is confirmed by passing no. 10 sterile, blunt‑tipped red rubber catheter into the esophagus, which gets failed to pass beyond 10 cm. Case Series: We describe two male neonates in whom the infant feeding tube could be passed to 18-20 cm in the upper esophageal pouch. A babygram with a blunt-tipped soft red rubber catheter in situ confirmed the esophageal atresia (EA) with the long upper pouch in the first case and EA with obstruction at the gastroesophageal junction in the second one. Conclusion: The importance of recognizing rare Kluth variants of EA is stressed. A low threshold for performing a red rubber catheter test is stressed.

Evaluation of the role of cyanoacrylate glue in the management of fistula-in-ano

Background: Fistula in ano is a common problem in patients presenting to surgical OPD. Various procedures have been described for the treatment of anal fistula, including fistulectomy, fistulotomy and use of a cutting seton. Surgical treatment of anal fistula is associated with a significant risk of recurrence and faecal incontinence due to damage to anal sphincter. The introduction of cyanoacrylate glue to close fistula tracts using an occlusive material and with no risk of incontinence (as there is no sphincter damage). The study was designed to evaluate the role of cyanoacrylate glue in the management of fistula in ano.Methods: Here, 40 patients were enrolled in study as day cases. Patients were examined clinically and subjected to MRI pelvis where internal opening couldn’t be palpated on digital rectal examination (DRE). Fistula tract was mapped using fistula probe and washed with diluted hydrogen peroxide and normal saline. The excess granulation tissue at the external opening was curetted. The glue was then injected slowly into fistulous tract through 8 F infant feeding tube. Patients were further examined in the OPD until 6-months.Results: Here, 32 patients got healed after first instillation of glue with stoppage of discharge from the fistulous tract. The other 2 patients required second instillation of glue and showed no signs of discharge thereafter. While 6/40 continued to discharge even after instillation of glue.Conclusions: Cyanoacrylate glue can be offered as a sphincter sparing alternative to conventional procedure in patients with anal fistula.

Dermo traction as a solution to major skin defects: a prospective study in a tertiary care hospital of South Odisha

<p class="abstract"><strong>Background:</strong> Soft tissue loss with exposure of underlying tissue is a challenge to all Orthopedics surgeons. The present prospective study described dermo-traction technique using infant feeding tube or prolene suture as an alternative method for the wound closure.</p><p class="abstract"><strong>Methods:</strong> This prospective study described 30 cases where dermo-traction technique was used for the closure of the wound using infant feeding tube or prolene suture. Study was conducted in Orthopaedics Department of MKCG Medical College, Berhampur from June 2016 to May 2018. Patients requiring skin grafting for their major soft tissue defects or in whom skin grafting or fasciocutaneous flap could not be done were included in study.<strong></strong></p><p class="abstract"><strong>Results:</strong> Out of 30 patients,<strong> </strong>2 were lost to follow-up. Average age of study participants was 39.1 years. Male constituted 67.8%. 78.5% of patients had wound in leg, 14.3% in thigh region, rest had on ankle. 82.1% had an open fracture wound, 10.7% had post-operative wound dehiscence and 7.1% soft tissue injury. Average wound healing time was 15.3days with average 5 tightening session of suture. Wounds healed eventually in 26 patients and 2 patients had an infection. Among 26 patients 9 patients had delayed primary and 17 had secondary closure of wound.</p><p class="abstract"><strong>Conclusions:</strong> It can be concluded that gradual closure of the wounds with soft tissue defects can be achieved by applying dermo-traction technique using prolene suture or infant feeding tube with average 15 days of time. So dermo-traction using infant feeding tube or prolene suture is a simple, inexpensive, effective and technically sound alternate solution for closure of wound.</p><p class="abstract"> </p>

New Onset Intraparenchymal Hemorrhage Following Infant Feeding Tube-Guided Evacuation of Chronic Subdural Hematoma: A Report of Two Cases

Chronic subdural hematoma (CSDH) is one of the most common neurosurgical conditions and is usually treated by simple burr-hole drainage. Prognosis is usually good unless complications occur. Use of infant feeding tube (IFT) for irrigation of hematoma in case of CSDH with septum is a common practice. However, it poses a significant risk. We present two cases of intraparenchymal hemorrhage as a complication of CSDH evacuation in which IFT was used for irrigation.

A clinical trial of feeding tube with metallic guide wire insertion for ‘Ksharsutra’ technique in a case of fistula in ano.

‘Kshar-sutra’ therapy in cases of fistula in ano, despite a long medical history of credentials & conduct, still possess a challenge to medical fraternity in terms of finding a satisfactory cure of the disease. ‘Ksharsutra’ is a popular treatment modality in India for the management of fistula in ano. It works by the action of excision, scraping, draining, penetrating, debridement & sclerosing as well as healing simultaneously without surgical excision. The conventional method to insert a ksharsutra by using a metallic probe through an external opening may cause pain and discomfort to the patients. In some cases, this intervention is not possible without general anesthesia. The Ksharsutra may be inserted through an external opening by using an infant feeding tube (no.5 or 6) with the metallic guide wire to finding out the track easily & keep it in the track steady without causing pain as a day care procedure.

The role of tourniquet in myomectomy: an observational study

Background: Leimymoma is one of the commonest benign tumours encountered in women during the reproductive age. One quarter of these women may be symptomatic. When surgical management is indicated, myomectomy may be considered as the procedure of choice. Myomectomy can be complicated by severe intraoperative haemorrhage. One of the methods to reduce blood loss during myomectomy is the mechanical application of tourniquet.Methods: A prospective observational single arm study was done with 24 women who underwent open myomectomy to determine the utility of tourniquet in reducing blood loss during the procedure. Women of reproductive age group, having symptomatic fibroid, not responding to medical therapy, not completed their family and with total uterine size not exceeding 20 weeks were included in the study while those with pregnancy, concomitant adenomyosis, cervical or broad ligament fibroid, bleeding diathesis were excluded. The 7-French pediatric feeding tube was used as tourniquet. Our primary end point was intra-operative blood loss. Secondary outcome measures included operative morbidity and blood transfusion rates.Results: It was seen that application of the tourniquet considerably reduced the amount of blood loss and made resection of the myoma much easier. 83.3% patients had a blood loss less than 200ml and the rest between 200ml and 400ml. For majority of the patients (75%) the postoperative change of PCV was between 1 and 2%.Conclusions: The infant feeding tube form of tourniquet is cheap, safe, readily available, effectively reduces blood loss during myomectomy while not adding to the complications due to the operation.