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Fiber-reinforced composite tubes offer numerous advantages over traditional metal tubes, including lower weight, higher strength and stiffness, corrosion resistance, and fatigue resistance. These tubes have the potential to act as energy absorbers, making it crucial to understand the factors influencing their energy-absorbing characteristics. This study focuses on experimentally investigating the crashworthiness of woven glass/epoxy composite tubes by analyzing the effects of the inner diameter and the extent of overlapping dropped-off plies. Circular cross-sectional tubes with different diameters (20, 25, and 30mm) and varying extents of ply overlap (0, ¼, ½, ¾, and 1 times the circumference) are subjected to impact loading and quasi-static compressive loading. The length-to-diameter ratio remains constant across all cases. The investigation examines the influence of the inner diameter and the extent of overlapping plies on parameters such as mean crushing force, energy absorption, specific energy absorption, crush force efficiency, and stroke efficiency, and compares the damage and failure mechanisms observed in different composite tube configurations. The results highlight that specimens with smaller diameters and a half overlap exhibit maximum crush load efficiency, contrary to specimens with larger diameters and full overlap. This study emphasizes the significance of considering the extent of overlapping and its geometry to tailor the energy absorption characteristics of composite tubes for specific applications. [ABSTRACT FROM AUTHOR]

Objective: To study the clinical profile of the cases of esophageal atresia (EA) and/or tracheoesophageal fistula (TEF) and various factors affecting the surgical and early postoperative management and their outcome. Materials and Methods: A prospective analysis of 127 cases of EA from February 2004 to May 2006 was performed. Waterston prognostic criteria were used for grading. Results: EA with TEF was the commonest type in 117 cases (92%). Associated congenital anomalies were present in 52 (41%) patients, the commonest being the cardiac anomalies, which was followed by the gastrointestinal anomalies. VACTERL was found in 6 (5%) cases. Prematurity, associated congenital anomalies, gap between esophageal ends and preoperative respiratory status were the significant factors affecting the survival ( P = < 0.001). Primary extrapleural repair was the surgical approach in most of the patients. Azygos vein was preserved in 46 cases and no retropleural drainage was used in 27 cases. Staged procedures were performed in 19 cases, including 6 cases of isolated esophageal atresia. Pneumonitis and sepsis were the most common early postoperative complications (42%). Hypoxia and cardiorespiratory arrest were the most common causes of mortality (11 cases). Anastomotic leak complicated 13 cases, including 9 major and 4 minor leaks. Major leak followed by sepsis caused 7 deaths. Survival as per Waterston criteria was 100% in group A, 83% in group B and 22% in group C. Conclusion Factors affecting the survival are major or life-threatening associated anomalies, long gap, pneumonia and sepsis at presentation or that acquired during hospitalization and major leaks. The high incidence of low birth weight, delayed diagnosis, poor referral, low-socio economic status and lack of advanced neonatological back up are important contributory factors to poor outcome.

Aims and Objectives: Delayed management of anorectal malformation (ARM) increases the surgical and functional complications for the patient. We defined "delayed presentation of ARM" and reviewed our patients with ARM to find out the incidence and causes of delayed presentation. Materials and Methods: Patients satisfying the criteria of "delayed presentation of ARM" were involved. Detailed information of each patient including the mode of presentation, associated anomalies, plan of management and follow-up was obtained from the hospital records. Results: Between 2003 and 2006, 43 patients satisfied our criteria of "delayed presentation of ARM". There were 21 males and 22 females. Seventeen of these males presented with low-type ARM. Eleven of them were managed by a single-stage procedure. These "delayed presenters" had to live with constipation, inadequate weight gain and parental anxiety for a greater time. Analysis of the outcomes showed more functional complications in patients who had undergone failed perineal surgery previously. In females with low ARM, the procedure of choice was anterior sagittal anorectoplasty (ASARP). Single stage surgery provides good outcomes for most of low type of ARMs. High-type ARMs in males and females were managed by a staged procedure. Conclusion: "Delayed presentation of ARM" is a major group of ARM in our setup. The management and results of their treatment are not different from those of the early presenters. The most common cause of delayed ARM is wrong advice given by the health care providers followed by inadequate treatment elsewhere. Corrective surgeries taking second attempt in perineum always produces poor outcomes.

Objective: The objective of this study is to report the technical nuances of glans wings creation in anatomical plane facilitating liberal glans wings mobilization with preservation of glanular vessels for tension-free glansplasty in surgery of hypospadias in primary and redo cases. Materials and methods: Eighty-six primary hyposapdias and 7 cases of distal hypospadias, operated elsewhere and presented with glans and urethroplasty dehiscence, undergoing tubularized-incised-plate (TIP) repair were included after ethical approval. Technical points of glans wings creation in the subfascial plane included (i) creation of Buck's fascia window, just proximal and lateral to the point of bifurcation of corpus spongiosum, (ii) creation of subfascial- pret unica I plane on the tunica albuginea of corpora cavernosa up to ventral limit of laid open glanular meatus, (iii) release of pillars of corpus spongiosum off the glans base keeping the basal lamina propria covering the vascular arcade intact, (iv) release of glans base off the tip of corpora cavernosa and composite flap of corpus spongiosum pillars with Buck's fascia off the corpora cavernosa, (v) approximation of glans wings over the tubularized-inci sed-plate covered with dartos, and (vi) approximation of fasciospongioplasty flaps at hypospadiac meatus. Outcome measurement included (i) intra and postoperative problems and (ii) elimination of glans dehiscence. Results: There occurred 1 injury to the tunica albuginea of ventral corpora cavernosa and 1 button-hole injury to subcoronal mucosal collars. Flaps for fasciospongioplasty were short in 11. One glans dehiscence occurred in flat glans. Conclusions: This technique is effective in creating glans wings in the anatomical plane with the preservation of glanular vessels and flaps for fasciospongioplasty eliminating the possibility of glans dehiscence in both fresh and redo cases. [ABSTRACT FROM AUTHOR]

Copyright of Experientia is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: Considered to be a variant of hypospadias, chordee without hypospadias is a congenital curvature of the penis where the meatus is properly located on the tip of the glans penis, yet a ventral curvature is associated with abnormalities of the ventral fascial tissues or corpus spongiosum, or both. Methods for surgical correction are varied depending on the type of chordee. Objective: To present our management strategies and their results. Materials and methods: We diagnosed and treated seven patients of chordee without hypospadias between 2000 and 2004. Age ranged from 5 to 7 years. As per Devine and Horton classification 6 patients were type I or epithelial urethra and one patient was type V or congenital short urethra). In type I the extent of attenuated urethra was distal penile in 4 patients and mid-penile in 2 patients. Urethral transection and interposition urethroplasty with inner preputial onlay over the bare tunica albugenia was done in one patient with type V and 4 patients with distal penile epithelial urethra. Excision of hypoplastic urethra and Asopa's tube urethroplasty was done in 2 cases of type I with mid-penile extension. Results: Out of 5 cases that underwent interposition urethroplasty, two formed fistula. One fistula healed spontaneously and the other needed closure. Both cases of Asopa's tube urethroplasty developed meatal stenosis and one of them also developed junctional stenosis that needed dilatations. Conclusion: Use of vascularised inner prepucial skin for interposition urethroplasty with as onlay over the bare tunica albugenia is effective tool for single stage repair of chordee without hypospadias where curvature is secondary to either congenital short urethra or the urethra is replaced by an epithelial tube only to variable extents. [ABSTRACT FROM AUTHOR]

Introduction: Anatomy of striated sphincters and its three-dimensional (3-D) visualization in anorectal malformations are well reported but the configuration and 3-D visualization of sphincters in pouch colon is not well documented. This communication reports the configuration of striated muscle complex in cases of pouch colon. Patients and methods: The study was conducted in 2 females and 4 male patients of pouch colon. Preoperative study was conducted by CT imaging of striated muscle complex by obtaining 3 mm slices with 0.5 mm overlap. The selective images of striated sphincters from each slice was transferred to 3-D doctor Software for visualization of entire muscle complex. Intra operative study was conducted by preservation and dissection of bladder bowel fistula under magnification and histology. During PSARP contraction of split-opened striated muscle was recorded and studied in slow motion reproduction. Results: Striated sphincters were well developed in 5 patients of pouch colon and the configuration was similar to the pattern described for anorectal malformations. In one patient sphincter was poorly developed with ribbon thin striated muscle complex. In all patients longitudinal muscle coat was present around the fistula and the thickening of circular muscle was also recorded on histology. Conclusion: Study of anatomy and muscle contraction in pouch colon indicates that parasagittal muscle, vertical muscle complex and levator ani are well developed in most cases and form a single functional unit. Colovesical fistula is surrounded by longitudinal muscle coat and internal sphincter like thickening of circular muscle is present, which may be preserved during PSARP. [ABSTRACT FROM AUTHOR]

Aim: To assess impact of primary fulguration v/s diversion on renal outcome in patients with Posterior Urethral Valve (PUV). Material and Methods: Patients with PUV admitted in Department of Pediatric Surgery, KGMU, Lucknow between January 2000 - Jan 2007, were included. They were divided into three groups according to their renal profile. Group I (n=41) - normal serum creatinine at presentation; Group II (n=33) - elevated serum creatinine at presentation responding to catheter drainage; Group III (n=38) - elevated serum creatinine not responding to catheter drainage. The patients were further subdivided according to urological ultrasound (hydronephrosis, echogenic kidney) and/or MCU (VUR) findings. Renal outcome and improvement of radiological abnormalities were evaluated. Results: 112 patients of PUV were admitted in department from 1998-2006. Of the 41 patients in Group I 26 were treated by primary fulguration and 15 by vesicostomy followed by delayed fulguration and vesicostomy closure. All have normal renal profile after mean follow up of 40 months. The radiological abnormalities resolved in 55% of cases. In Group II 20 patients were treated by primary fulguration and 13 by vesicostomy followed by delayed fulguration and vesicostomy closure. After mean follow up of 31 months, 30 patients have normal renal profile although upper tract abnormalities resolved in only 38% of cases. In Group III patients (n=38), 21 were treated by diversion (vesicostomy=13, pyelostomy-3, ureterostomy=5), 9 by primary fulguration and 8 patients expired. After mean follow up of 36 months, only 15% patients had improvement in renal profile and upper tract abnormalities resolved only in 10% of patients. In all three groups, the improvements of renal and radiological abnormalities were not dependent upon treatment done. Conclusion- Primary fulguration is preferred option in all patients with PUV and proximal urinary diversion does not affect the renal outcome. The least improvement is expected in children who have an elevated serum creatinine that is not responsive to catheterizing. [ABSTRACT FROM AUTHOR]

Aims and objectives: To study the long-term results of coloplasty for congenital short colon in term of continence & quality of life. Material and Method: Case records of patients of ARM with pouch colon, who had completed all stages of surgery (window colostomy, coloplasty with ileostomy and ileostomy closure) before 2000 in the Department of Pediatric Surgery CSSMU Lucknow were reviewed. The patients were sent a questionnaire and reviewed when they reported in OPD or replied. Result: between 1971- 2000, 210 patients of Pouch colon were admitted. Out of these 102 patients completed all stages of surgery. Out of these, 43 patients could be followed up. Coloplasty without excision of sac (group 1) was done in 31 patients & Surgery with excision of sac (group 2) was done in 12 patients. Kelly score measured continence. Continence in coloplasty without excision of sac are good in 5 (15 %), fair in 22 (71%) and poor in 4 (14%) cases. Continence in surgery with excision of sac are good in 3 (25%) fare in 6 (50%) and poor in 3 (25%) cases. Mucosal prolapse was present in 9 (31%) of group 1 & 5 (41%) of group 2 patients & incidence of anal stenosis was 1 (3%) in group 1 and 5 (41%) in group 2. Follow-up Barium enema showed significant dilatation in 3 (9%) cases of group 1. Conclusion: This study evaluates the long-term result of patients of pouch colon & shows the significance of preserving the sac during the definitive surgery of pouch colon. Overall it was seen that the quality of life of patients with congenital short colon undergoing coloplasty was not different from other patients of high anorectal malformation. [ABSTRACT FROM AUTHOR]

Copyright of Experientia is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objectives: To report the anatomical variations in axial pattern vessels of penile dartos in hypospadias.Methods: Eighty hypospadias undergoing repair with tubularized incised plate urethroplasty were studied with preoperative examination of visible vein through penile skin. Course of vein proximal to root of penis was studied with vein viewer. Modified penile degloving beginning at preputial edge, splitting inner preputial urothelium off the preputial dartos and proceeding to penile shaft in subdartos plane was performed. Axial pattern veins visible on penile dartos were studied. Axial pattern penile dartos arteries were studied by recording arterial pulsations. If arterial pulsations were not seen, arterial mapping on penile dartos completed with use of Doppler and images recorded. Variations in axial pattern dartos vessels were analyzed.Results: In 32 hyposapadias of 1 group, median superficial vein along the dorsal midline of penile dartos drained into left saphenous vein. In this group, dorsolateral vessels were not seen on either side in 20 cases. Unilateral dorsolateral vessel in 7 and bilateral dorsolateral vessels in five were seen. In 48 hypospadias of other group, median superficial vein was not seen. Bilateral dorsolateral vessels in 11, unilateral dorsolateral vessels in 27 and no definite pattern in 10 were seen. In both groups, superficial median artery was not discovered. Vessels were longitudinally oriented. Penile dartos was equally distributed.Conclusion: In hypospadias, penile dartos vessels have axial pattern course longitudinally but not identical to normal. Eight patterns can be identified which can be diagnosed on careful clinical examination of penis. [ABSTRACT FROM AUTHOR]

Cryptorchidism or undescended testis is one of the most common anomalies encountered in paediatric urology and is estimated to affect 1 to 4 per cent of full term and upto 30 per cent of preterm male neonates. The associated problems of sub-fertility or infertility and malignant transformation have been recognized for long. Fertility is impaired after both unilateral and bilateral cryptorchidism. The reported paternity rates in adults are about two-third for unilateral undescended testis and less than one-third for bilateral disease. Over the last fve decades, the concepts related to cryptorchidism have changed dramatically as knowledge about its effects has accrued from research conducted worldwide. The recommended age of orchidopexy has fallen progressively from adolescence to less than one year. The realization that the infantile testes are not in a state of 'suspended animation' and the recognition of the defect in the androgen dependent transformation of gonocytes into adult dark spermatogonia in cryptorchidism have been recognized as the primary cause of sub-fertility in these patients. This has paved the way for hormone therapy in an attempt to simulate the 'post-natal gonadotropin surge' or 'mini-puberty'. This review summarizes the current knowledge about the various factors affecting the fertility status in cryptorchidism with a particular focus on the derangements in the development and maturation of the germ cells and the role of surgery, hormone therapy and antioxidants in reversing these changes. [ABSTRACT FROM AUTHOR]

Objective: To study the possibility of creating mucosal valve mechanism at ureteric orifice without obstructing the urine outflow but preventing the urine backflow into the ureters., Materials and Methods: Ethical waiver was obtained from the institutional ethical committee. Prospective experimental study was conducted on the post-mortem specimen of intact bladder with urethra and bilateral ureters retrieved from the already slaughtered lamb available in the meat market. Feeding tube inserted via urethral opening into the bladder lumen and bladder inflated with saline demonstrated no reflux of urine via transverse cut opening of ureters. Bladder lumen opened, ureteric orifices incised backwards to eliminate the obliquity. After closing the bladder opening, saline inflation test demonstrated bilateral reflux of saline via cut openings of bilateral ureters. Bladder was re-opened. The upper limb of horizontal U started 10 mm lateral and 8 mm above the refluxing ureteric orifice. Distal most curvature of horizontal U was kept 5 mm medial to ureteric orifice continuing along the lower limb of horizontal U terminating 10 mm lateral and 8 mm below the refluxing ureteric orifice, mucosal flaps from superior and inferior incision mobilized and edges joined to cover the ureteric orifice creating a flap valve mechanism. Influx of saline via cut end of ureters demonstrated no obstruction. Bladder was closed. Saline inflation test and contrast study demonstrated abolition of reflux on flap side and persistence of reflux on another side., Results: Five such experiments were conducted. On the side where the valve was created, Vesicoureteral reflux was abolished in four but in one minimal reflux still persisted., Conclusion: Creating a mucosal flap valve around the ureteric orifice can prevent reflux in 80% of cases without obstruction and without the necessity of ureteric mobilization or creating submucosal tunnel., Competing Interests: There are no conflicts of interest., (Copyright: © 2022 Journal of Indian Association of Pediatric Surgeons.)

Aim: To evaluate the role of nebulized N-acetyl cysteine (NAC) in liquefying the airway secretions and improving the outcome of patients of esophageal atresia with tracheoesophageal fistula (EA + TEF)., Methods: It was a non-randomized interventional study. Two milliliters of 10% NAC was given in a nebulized form (2:5 dilution, every six hourly) to patients of ET + TEF, along with regular suction of upper esophageal pouch. The group was compared with control, which comprised patients of EA + TEF receiving only saline nebulization. The consistency of the secretions was compared by hand held consistometer in unit of time (seconds) required to cross a predetermined distance along with gravity., Results: Sixty patients were assessed. Of these, 30 patients were present in both groups. The study group showed significant (p = 0.01-0.0001) decrease in consistency of secretions from the control group after day 2 of NAC nebulization. Patients' discharge was significantly (p = 0.01) earlier in cases. There was no significant (p = 0.41) difference in mortality between the groups. No specific adverse effects were observed in the study group., Conclusion: It appears that nebulized NAC decreases the consistency of secretions in EA + TEF patients. It is interesting to note that the group of patients that received NAC was discharged earlier than the control group and had a higher survival rate than the control group. Whether this is directly attributable to the use of NAC is unknown. A prospective double-blinded randomized clinical trial is warranted to confirm these results., Level of Evidence: Level II, prospective comparative study (non-randomized)., (Copyright © 2020 Elsevier Inc. All rights reserved.)

High numbers of autologous human primary keratinocytes (HPKs) are required for patients with burns, wounds and for gene therapy of skin disorders. Although freshly isolated HPKs exhibit a robust regenerative capacity, traditional methodology fails to provide a sufficient number of cells. Here we demonstrated a well characterized, non-cytotoxic and inert hydrogel as a substrate that mimics skin elasticity, which can accelerate proliferation and generate higher numbers of HPKs compared to existing tissue culture plastic (TCP) dishes. More importantly, this novel method was independent of feeder layer or any exogenous pharmaceutical drug. The HPKs from the hydrogel-substrate were functional as demonstrated by wound-healing assay, and the expression of IFN-γ-responsive genes (CXCL10, HLADR). Importantly, gene delivery efficiency by a lentiviral based delivery system was significantly higher in HPKs cultured on hydrogels compared with TCP. In conclusion, our study provides the first evidence that cell-material mechanical interaction is enough to provide a rapid expansion of functional keratinocytes that might be used as autologous grafts for skin disorders.

Intussusception is the most common cause of intestinal obstruction in infants and children. This condition is frequent in children and presents with the classic triad of cramping abdominal pain, bloody diarrhoea and a palpable tender mass. Small bowel intussusceptions are much less common, with jejuno-ileal and duodeno-jejunal intussusceptions being the rarest types of all. Multiple simultaneous intussusception is a peculiar variety of intussusception. The authors report the simultaneous occurrence of jejuno-jejunal and ileo-ileal intussusception in a patient. As this is an extremely uncommon entity, it is being reported with a brief review of the relevant literature.

Background: Anterior urethral valves (AUVs) are rare congenital anomalies causing lower urinary tract obstruction in children. Although they are referred to as valves, these obstructive structures often occur in the form of a diverticulum. The urethra in these cases shows saccular or bulbar dilatation known as anterior urethral diverticulum (AUD). They typically occur where there is a defect in the corpus spongiosum, leaving a thin-walled urethra. This segment of the urethra balloons out during voiding, simulating a mass that is sometimes visible along the ventral wall of the penis. The swelling is fluctuant and urine dribbles from the meatus on compression. The present study highlights the clinical approach in identifying the condition and its treatment options, especially for those, presenting with urethral diverticula., Materials and Methods: We have studied children with congenital anterior urethral valves and diverticula. Six patients of AUVs with diverticula were admitted during the period of 2000-2007 and were prospectively evaluated. The mean age of presentation was 16 months (15 days to 4 years). Straining at micturition and a palpable penile swelling were the most common presenting features. The diagnosis was established by voiding cystourethrogram (VCUG) and supported by ultrasonography (USG). All patients were treated with single-stage open surgical excision except one who died preoperatively due to urosepsis. Initial lay opening of the penoscrotal urethra and delayed repair were done in one patient., Results: The surgical outcome was successful in all but one patient, who died of delayed presentation with severe back pressure changes, urinary ascitis and urosepsis. On long-term follow-up, all patients demonstrated good stream of urine. The renal functions were normal and the patients had no evidence of urinary infections., Conclusion: We propose that, the patients of AUVs, if not excessively delayed for treatment are otherwise well in terms of general condition as opposed to patients of posterior urethral valves. The diagnosis is easily established by VCUG and the severity is revealed by a sonogram. Open surgical excision is the method of choice for patients with a urethral diverticulum; however, cystoscopic fulguration is also feasible in selected patients. The outcome is excellent with minimal morbidity and mortality.

Distal migration of ventriculoperitoneal shunt is rare. We present this unusual complication in 5 patients. The lower end of the shunt was extruded from right lumbar region, cervical area, umbilicus and rectum. The cause of such extrusion is not known. The patients were managed by shunt removal followed by shunt replacement on the opposite side., ((c) 2008 S. Karger AG, Basel.)