Objective: To evaluate the management methods of female urethral stricture (FUS) and analyze the outcomes of surgical treatments. A meta-analysis was done in an attempt to identify the best approach of urethroplasty and the graft-of-choice. Materials and Methods: A systematic search of Pubmed/Medline and Embase databases was performed according to the Preferred Reporting Items For Systematic Review And Meta-Analysis statement, for articles reporting on FUS management in the last decade. The Newcastle-Ottawa scale was used to assess the quality of 28 included non-randomized studies. The data on FUS management was summarized and pooled success rates (taken as symptom improvement and no need for further instrumentation) were compared. The secondary outcome was to establish a diagnostic modality of choice and define a "successful-outcome" of repair. Results: The outcome was separately reported for 554 women undergoing surgical intervention for FUS in the literature. The criteria defining FUS were varied. A combination of tests was used for diagnosis as none was singularly conclusive. A total of 301 patients had previous urethral instrumentations. The pooled success rate of urethral dilatation (234 women) was 49% at a mean follow-up of 32 months; flap urethroplasty (108 cases) was 92% at a mean followup of 42 months; buccal mucosal graft (BMG) urethroplasty (133 cases) was 89% at a mean follow-up of 19 months; vaginal graft augmentation (44 cases) was 87% at a mean follow-up of 15 months; and labial graft reconstruction (19 cases) was 89% at a mean follow-up of 18.4 months. The dorsal approach of graft augmentation met with 88% (95% confidence interval [CI] 0.79-0.95) success compared with 95% (95% CI 0.86-1) for the ventral approach. Conclusion: FUS is a rare condition requiring a meticulous diagnostic workup using multiple tests. All urethroplasties have shown better pooled success rates (86%-93%) compared with dilatation (49%). BMG is equally effective as vaginal graft urethroplasty.

No abstract

No abstract

Osteoarticular tuberculosis is a relatively uncommon type of extrapulmonary tuberculosis. It is an important cause of mortality and morbidity and accounts for approximately 10-15% of all extrapulmonary forms of tuberculosis. The diagnosis is difficult and hence often late. The disability resulting from osteoarticular tuberculosis is directly related to the time of detection of disease and initiation of treatment. A prospective study of 36 patients suspected with osteoarticular tuberculosis was done from August 2010 to December 2012 was done at St. stephens hospital Delhi. For the purpose of this study, a diagnosis of osteoarticular TB was based on a combination of suggestive clinical features, in conjunction with typical radiological findings associated with osteoarticular TB. The specimens were subjected to ZN staining, Real Time PCR, Bac-T alert culture & Accuprobe. The sensitivity of real time PCR was 100%, specificity was 58.8%, positive predictive value was 73%, negative predictive value was 100%, efficiency was 80.5% considering culture as gold standard. As shown by the study, each diagnostic test including Real time PCR has its own disadvantages and shortcomings and does not provide 100% accuracy in diagnosing osteoarticular tuberculosis, therefore, strong clinical suspicion and correlation along with radiological and laboratory evidence is a must in establishing a diagnosis.

Aim of study was to use the allogenic bone graft with or without vancimpregnation in osteoreconstrutive surgery and compare the results with respect to:  Efficacy and safety in prevention of graft related and surgical site infection.  Effect on bone healing and osteointegration. Materials & Methods: In our study a total of 30 patients who required allogenic bone grafting for varied indications and gave informed consent for participation in the study were included. Patients with active osteoarticular infection at the proposed surgical site and with any medical contraindication to the use of vancomycin were excluded from the study. Broadly three indications for which allogenic bone graft was used included fractures, benign osteolytic lesions and miscellaneous indications which included allograft use for lumbar spinal fusion and for augmenting acetabular reconstruction. Observation & Result Infection: An overall infection rate of 3.3% (1 out of 30 cases) was found in this study which is much lower than what is mentioned in the literature as infection rates ranging from 4-12% have been reported by different workers Osteointegration: The overall success rate in terms of adequate osteointegration in our study was 83.33% (5 failure cases out of 30) with 12 cases (80%) out of 15 in study group and 13 cases (86.7%) out of 15 achieving adequate osteointegration and there was no significant difference (p value=1) between the two groups. Bone Healing: Fractures: In cases of fractures a good overall union rate of 88.8% was obtained with 16 out of 18 patients achieving adequate union. The two failure cases brought down the union rate to about 77.7% in the study group as compared to 100% union rate in the control group but this difference was not statistically significant with p value of 0.384 Thus vancomycin impregnation was not found to affect fracture union in our study. Benign bone lesion: A total of eight patients (3 each of SBC and GCT and 2 of ABC) were included. After random allocation five patients (2 each of SBC and GCT and 1 of ABC) came under the study group and three patients (1 patient each of SBC, GCT and ABC) under control group. The mean age of patients in the study group and control groups was 25.2 years and 34.1 years respectively and thus were comparable. There was no significant difference in terms of lesion healing between the two groups (p value= 0.684) as all the eight patients (100%) showed adequate healing as defined by Neer's classification [1] .