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Background : Filariasis is an endemic problem in various Indian states. We evaluated the results of long-term follow up (10-20 years) of patients with filarial chyluria. Methods : We conducted a retrospective analysis of 160 patients treated for filarial chyluria who presented to the Banaras Hindu University Hospital from 1982 to 1992. Eighty-four patients (52.5%) were treated using diethylcarbamazine (DEC) and a fat restricted diet and 76 patients (47.5%) underwent surgery. To examine the long-term effects of filarial chyluria we analysed data on posttreatment recurrence, weight gain, dietary freedom, chyluria free period and a number of other associated factors.Results : Previous history of filariasis or its complication was documented in 19% of patients. In 71% of cases, cystoscopy showed that chylous efflux was predominant in the left ureteric orifice. The long-term remission rate was 62% in the conservatively managed group (DEC + fat restricted diet), whereas 90% of patients in the operated group were cured. Postoperative recurrence rate was 10%. There was more weight gain and dietary freedom along with a longer chyluria free period in the operated group relative to the conservatively managed group. Conclusions : Definitive surgical ablation of lymphatic urinary fistula is better than conservative medical management because it has a higher success rate, more dietary freedom and, therefore, better patient acceptability.

OBJECTIVE To assess the ability of artificial neural networks (ANNs) to predict optimum renal stone fragmentation in patients being managed by extracorporeal shock wave lithotripsy (ESWL). PATIENTS AND METHODS The study included 82 patients with renal stones who were being treated by ESWL. Data (input and output values) from 60 patients in whom there was optimum fragmentation of stones by ESWL were used for training the ANN. These data mainly included the 24‐h urinary variables, the radiological features of the stone disease and the ESWL settings used. The predictability of the trained ANN was tested on 22 subsequent patients, by supplying the input variables of the 22 patients into the trained ANN and recording the output values (predicted values). After subjecting these patients to ESWL, the actual results (observed values) were recorded. The predicted and the observed values were then compared. RESULTS In the 22 patients in whom predictability was tested, the trained ANN predicted optimum fragmentation at ≤ 13 000 shocks/stone (as per study protocol) in 17 and optimum fragmentation at> 13 000 shocks/stone in the other five. In the 17 patients (test set) where the trained ANN had predicted optimum fragmentation at ≤ 13 000 shocks/stone, the optimum fragmentation was at that value, although the predicted and observed values were not identical. The overall correlation between the predicted and the observed values was 75.5% (correlation coefficient 0.7547) in these 17 patients. Of the other five patients, none had optimum fragmentation at < 13 000 shocks/stone, as predicted by the trained ANN, giving complete accuracy for this factor. CONCLUSION This was a pilot study, i.e. an initial attempt to use an ANN in this regard, and although there were few patients, such that it is not possible to make final recommendations, the overall predictability was ≈ 75%. An encouraging outcome of the study was that the trained ANN identified patients unlikely to benefit from ESWL. Using a larger dataset and identifying more significant variables, while eliminating inputs with a negative effect, the efficiency and utility of this ANN can probably be enhanced and in future it might be possible to predict stone fragmentation with reasonable accuracy.

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