Stentless laparoscopic pyeloplasty: a single center experience

To assess the effectiveness of laparoscopic stentless pyeloplasty for congenital ureteropelvic junction obstruction. This was a prospective comparative study conducted over a period of 5 years. The study included 35 cases of primary ureteropelvic junction obstruction [UPJO] with mean age of 2[.5 years, divided in two groups- Group A [stent-less, 18 patients] and Group B [stented, 17 patients]. Follow up ranged from one to 4years [mean 2 years]. Transperitoneal laparoscopic Anderson- Hyene's pyeloplasty was standard for both the groups. Perioperative and postoperative complications were prospectively collected and analyzed by Statistical Package for Social Sciences [SPSS] 17 version using Pearson chi square test. Both the groups were comparable with respect to preoperative differential renal function [DRF] and time required for maximum activity in minutes [t[max].min]. Average post operative DRF was significantly higher than preoperative DRF in both the groups. Average t[max] was significantly lower after pyeloplasty than pre operative t[max]. Mean operative time, mean duration of urethral catheter, and mean duration of drain removal were comparable in both the groups. However bothersome irritative lower urinary tract symptoms [LUTS] and hematuria were significantly more in group B patients [P < 0.0001 and <0.013 respectively]. In experienced hands, laparoscopic stentless pyeloplasty is as effective method for treating UPJO as its stented counterpart. It is cost effective, avoids stent-related morbidity, and could be performed without compromising the success rate. However, more randomized studies are needed to evaluate the safety of stentless pyeloplasty

study to evaluate the effect of ratio of donor kidney weight to recipient body weight on renal graft function

To study the effect of the ratio of donor kidney weight [dkw] to recipient body weight [rbw] on short and long term graft function in live donor kidney transplant patients. It was a prospective study of 79 live donor kidney transplant recipients. Patients were divided into three groups depending on the ratio of dkw in grams to rbw in kilograms. Serum creatinine in milligrams percent on the day of surgery, 7[th] day, 1 month, 6 months, 1 year, and 3 years after the surgery was recorded and their means compared. The comparison showed that the decrease in mean creatinine level was more in group three patients as compared with group 2 and one patients at 7 days [1.04, 1.44 and 1.59 in group 3, 2 and 1 respectively] and 30 days [1.12, 1.36 and 1.45 in group 3,2 and 1 respectively], showing that higher dkw/rbw ratio is beneficial with respect to the early graft function. However this decrease was not statistically significant [P value -0.256 and 0.358 respectively on 7[th] and 30[th] day]. Furthermore long-term function was not different among these three groups. The ratio of dkw to rbw does not have a significant effect on long-term graft function inspite of an early improvement in the function with increased dkw to rbw ratio

Posterior fossa extradural haematoma following thrombolysis therapy for acute myocardial infarction

Intracranial haemorrhage [ICH] is one of the dreaded complications following thrombolytic therapy for acute myocardial infarction [AMI].3,6,17,24,28,29 Haemorrhage can occur in varied locations but predominantly it is intraparenchymal.[8] Trauma is the commonest cause of extradural haematoma [EDH] but in rare instances it can occur spontaneously due to vascular malformation of dura[11,23], infections of air sinuses or middle ear[4,5,7,14], coagulopathies[10,13,18] or tumours.[16] Thrombolysis for AMI leading to EDH has not been reported until date to the best of our knowledge. We here report a patient who developed posterior fossa EDH after thrombolysis. Early CT scan and high degree of suspicion enabled the patient to have good outcome