ABSTRACT
OBJECTIVE: To investigate the medium to long-term outcomes of robotic-assisted kidney transplantation (RAKT) and propensity-matched comparison with open kidney transplant (OKT). MATERIALS AND METHODS: We retrospectively reviewed 342 patients from database, who underwent RAKT and OKT from January 2015 to May 2022, at our center. Various demographic, intraoperative, and postoperative parameters were evaluated. Statistical analysis including propensity matching using nearest neighbor algorithm was performed to ensure comparability between the RAKT and OKT groups. The statistical analyses were performed using SPSS v.22.0 (IBM Corp, Armonk, NY) and STATA 13 (Stata Corp, College Station, TX). All statistical tests were two-sided, and a significance level of P < .05 was considered statistically significant. RESULTS: After applying exclusion criteria, 196 RAKT patients and 102 OKT patients were included in the analysis. Propensity score matching resulted in the inclusion of 173 patients in the RAKT group. In the propensity-matched comparison of intra/perioperative parameters, RAKT showed significant reductions in total surgical time (Pâ¯<â¯.001), wound length (Pâ¯<â¯.001), blood loss (Pâ¯<â¯.001), blood transfusion rate (Pâ¯<â¯.001), pain score (Pâ¯<â¯.001), and analgesia requirement (Pâ¯<â¯.001). Graft survival and patient survival rates were comparable in RAKT and OKT groups at the end of 60months. CONCLUSION: RAKT offers several advantages over OKT in terms of reduced operative time, blood loss, pain, and analgesia requirements. RAKT shows comparable graft and patient survival rates to OKT in the medium to long term.
Subject(s)
Kidney Transplantation , Robotic Surgical Procedures , Humans , Kidney Transplantation/methods , Robotic Surgical Procedures/methods , Learning Curve , Retrospective Studies , Pain , Treatment OutcomeABSTRACT
We report a case of spontaneous cerebrospinal fluid (CSF) rhinorrhea in a patient on maintenance hemodialysis. There was no previous history of trauma or surgery. Secondary hyperparathyroidism due to progression of chronic kidney disease (CKD) and a rise in intracranial pressure resulted in spontaneous cerebrospinal fluid rhinorrhea. He underwent endoscopic endonasal repair with theco-peritoneal shunt; CSF leak stopped completely and the patient is doing well on one year follow up.
ABSTRACT
BACKGROUND: Neuromyelitis optica (NMO) is an immune-mediated inflammatory demyelinating disorder of the central nervous system with a predilection for the optic nerves and the spinal cord. Immunopathological evidence suggests that the target antigen of the disease is aquaporin-4. An IgG antibody against this protein has been explored as a molecular marker for the disease and as a diagnostic tool due to its high sensitivity and specificity in various populations. OBJECTIVE: To assess the value of NMO-IgG testing in Indian patients with clinical and magnetic resonance imaging features consistent with NMO and longitudinally extensive transverse myelitis (LETM). MATERIALS AND METHODS: Forty-five patients with clinical and magnetic resonance imaging features consistent with NMO, LETM, and MS were tested for serum NMO-IgG. Of these patients, 22 patients satisfied revised (2006) Wingerchuk criteria for NMO (excluding NMO-IgG status) and 11 patients had LETM. Twelve patients satisfied the revised (2010) McDonald criteria for multiple sclerosis (MS). RESULTS: Of the 21 patients, satisfying the criteria for NMO and for whom the test results were available, 17 were positive for NMO-IgG (80.9%), and of the 11 patients having LETM, 6 (54.5%) were positive for NMO-IgG. In one patient with NMO, the test result was not available. None of the 12 patients satisfying McDonald criteria for MS showed NMO-IgG seropositivity. CONCLUSION: Our study suggests that it is worthwhile to pursue NMO-IgG testing as a diagnostic tool for patients with clinical and Magnetic Resonance Imaging (MRI) features consistent with NMO and LETM in the Indian population.
