A Novel method of ensuring safe and accurate dilatation during percutaneous nephrolithotomy

ABSTRACT Objective: To report our technique that helps locate the guidewire into the ureter enabling safe dilatation during PCNL. Materials and Methods: Cases in which the guidewire failed to pass into the ureter following successful puncture of the desired calyx were subjected to this technique. A second guidewire was passed through the outer sheath of a 9 Fr. metallic dilator cannula, passed over the first guidewire. The cannula and outer sheath were removed, followed by percutaneous passage of a 6/7.5 Fr ureteroscope between the two guidewires, monitoring its progress through both the endoscopic and fluoroscopic monitors. Once the stone was visualized in the calyx a guidewire was passed through the working channel and maneuvered past the stone into the pelvis and ureter under direct endoscopic vision. This was followed by routine tract dilatation. Results: This technique was employed in 85 out of 675 cases of PCNL carried out at our institute between Jan 2010 to June 2014. The mean time required for our technique, calculated from the point of introduction of the ureteroscope untill the successful passage of the guidewire down into the ureter was 95 seconds. There were no intraoperative or postoperative complications as a result of this technique. Guidewire could be successfully passed into the ureter in 82 out of 85 cases. Conclusions: Use of the ureteroscope introduced percutaneously through the puncture site in PCNL, is a safe and effective technique that helps in maneuvering the guidewire down into the ureter, which subsequently enables safe dilatation.

Benign cystic peritoneal mesothelioma.

A well-defined but rare entity of Benign Cystic Peritoneal Mesothelioma (BCPM) is reported. The aetiology of this neoplasm remains obscure. The presenting features make a precise preoperative diagnosis difficult but information provided by computed tomography and cytology may help. A firm diagnosis can only come from an electronic microscopy or immunohistological examination of the tumour. Diagnostic accuracy and diligent follow up are essential because, although the tumour is considered benign, it does tend towards local recurrence.

Prospective clinical study of surgical management of varicose veins of lower limb and its complications.

Background: Varicose veins of the lower extremities are the most common peripheral vascular disease and their treatment is as old as mankind. This prospective clinical study of surgical management of varicose vein was conducted to study the age, sex and occupational distribution of varicose veins of lower limb. Evaluations of clinical features and surgical methods of treatments that were in practice in the management of varicose veins in terms of recurrence and symptoms improvement were also studied. Methods: Two years prospective study was conducted in our institution from May 2007 to April 2009. During this period 62 cases of varicose veins of lower limbs were admitted to our hospital of which 50 cases were selected and were studies in detail. After thorough clinical examination and relevant investigation they are all subjected to surgical management. Results: Out of 50 cases studied, 21 (42%) had only long saphenous vein involvement, 7 (14%) had short saphenous vein involvement and in 5 (10%) cases both short and long saphenous system were involved. In addition to long saphenous vein involvement, incompetent perforators were present in 17 (34%) cases. Among them prominent veins and pain were the main complain in 38 (78%) patients. Itching and pigmentation were present in 4 (8%) patients. Ankle edema was present in 6 (12%) patients. Pain and ulceration of lower leg were present in 2 (4%) patients. After clinical assessment appropriate surgical procedures were followed for each of patients. These cases were followed for 3 year durations. Out of 50 patients 7 (14%) patients had recurrence of varicose vein. 7 (14%) patient complained of recurrence of pain after 2 years of surgery but no appearance of varicose vein. One patient (2%) complained of persistence of pigmentation after surgery. 2 (4%) patients complained of persistence of ankle edema and there was complete healing of ulcer which was present earlier. Conclusions: Commonest age group of varicose vein of lower limb was 20 to 40 years. Definite relationship exists between the occupation and the incidence of varicose veins. The patients were in the occupation which required standing for long time had the higher chances of varicose vein. Severity of the symptoms is not proportional to the duration of varicose veins. The involvement of long saphenous vein is more common than the short saphenous vein. Since our study shows very low percentage of recurrence and symptoms related to varicose vein the surgical line of treatment is an ideal treatment for varicose vein. For incompetent perforators, sub-fascial ligation appears to be a better method of treatment than extra fascial ligation. Because in the former all the perforators could be visualized and dealt with, while in the latter there were chances of missing one or two perforators. If cases are selected properly with good operative technique the complications are negligible

Effect of organic and inorganic fertilizers on plant height, spread and flower diameter of gaillardia (gaillardia pulchella).

An experiment was conducted to study the effect of organic and inorganic fertilizers on plant height, plant spread and flower diameter of Gaillardia (Gaillardia pulchella). In Gaillardia the plant maximum height was recorded in the plot treated with 100 per cent recommended dose of NPK + press mud at 10 tones ha-1 followed by 75 per cent recommended dose of NPK + press mud at 10 t ha-1 at 45 days and 75 per cent recommended dose of NPK + press mud at 5 tones ha-1 at 15, 30 and 60 days. Highest plant spread was obtained at 30 and 45 days after planting in the treatments which involved 100 per cent recommended dose of NPK + press mud at 10 t ha-1 and at 60 days no significant differences were recorded. The combination of recommended dose of NPK + press mud at 10 t ha-1 produced maximum diameter of flower.

Effect of plant growth promoting rhizobacteria (PGPR) on growth and yield of bitter gourd.

A field study was conducted to determine the effect of plant growth promoting rhizobacteria (PGPR) on growth and yield of bitter gourd. Four PGPR strains (Azospirillum, Phosphorous solubilising bacteria, Pseudomonas flourescens and Bacillus subtilis), one commercial organic product (Aishwarya) and non inoculated control were used. The study revealed that seeds inoculated with Azospirillum (basal @ 5 kg ha-1 + 40 days after sowing (DAS) @ 5 kg ha-1) recorded early germination (6.48 days). The maximum vine length (4.42 m) was recorded in basal @ 2 l/plant application of both Bacillus subtilis and Pseudomonas flourescens @ 2.5 kg ha-1. Number of primary branches was maximum (4.80) in plants applied with phosphorous solubilising bacteria (PSB) as basal @ 5 kg/ha and 40 DAS @ 5 kg/ha. Tap root length (23.57 cm) and secondary root length (39.88 cm) were highest in the plants supplied with Azospirillum (basal @ 5 kg ha-1 + 40 DAS @ 5 kg ha-1) where as, dry root weight (4.64 g) was more in case of double application of Bacillus subtilis basal @ 2 l plant -1 + 40 DAS @ 2 l plant -1. Two time application of Bacillus subtilis basal + 40 DAS @ 2 l plant -1 produced the maximum yield plant -1 and yield plot -1 (2.72 kg and 16.33 kg respectively).