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Rhizobium are nitrogen-fixing bacteria which possess the nif gene that codes for the nitrogenase enzyme involved in the reduction of atmospheric dinitrogen (N2) to ammonia. Thirty rhizobial strains were identified from ten groundnut plant root nodules collected from semi-arid regions of Rajasthan, India. The isolates were initially identified on the basis of morphological, biochemical, and molecular characteristics. These rhizobium strains were further screened for plant growth promoting activities. Twenty-eight strains were able to produce indole acetic acid, nine strains could solubilize phosphate, and twenty-nine strains exhibited positive results for siderophore and ammonia production. All the bacterial strains were able to efficiently nodulate the groundnut under pot conditions and based on multiple PGP activities six strains were selected for field evaluation. Field experiments confirmed the effectiveness of these selected rhizobium strains resulted in significantly higher nodule number, nodule dry weight, grain yield, and yield components of inoculated plants. Inoculation of the rhizobium strain GN223 followed by GN221 resulted in high yield and field efficiency. Isolation of effective microbial strains is the prerequisite to increase the yield which is evident from the field data of the present study. Hence, these strains might serve as proficient inoculants.
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Fabaceae/microbiología , Rhizobium/clasificación , Microbiología del Suelo , Inoculantes Agrícolas , Clima Desértico , Fabaceae/crecimiento & desarrollo , India , Fijación del Nitrógeno , Raíces de Plantas/microbiología , Rhizobium/aislamiento & purificación , Rhizobium/fisiología , SimbiosisRESUMEN
Understanding the impact of the disease on quality of life is crucial in patient management. In this cross-sectional study, general and oral health-related quality of life questionnaires, and thorough examinations of oral and ocular dryness were performed in age- and sex-matched patients with primary Sjögren's syndrome (pSS group), non-Sjögren's syndrome sicca (non-SS group) and healthy controls. General and oral health-related quality of life were investigated with the 36-Item Short Form Health Survey and the 14-Item Oral Health Impact Profile questionnaires, respectively. Subjective symptoms of xerostomia and ocular dryness were recorded using the Summated Xerostomia Inventory and Ocular Surface Disease Index, respectively. Clinical examinations included evaluation of clinical oral dryness scores, candida counts, unstimulated and stimulated saliva secretory rates, tear osmolarity, tear film break-up time, Schirmer I test and ocular surface staining. Both patient groups had pronounced signs and symptoms of xerostomia and ocular dryness. Even though the non-SS patients had less severe clinical signs than the pSS patients, they demonstrated much poorer general and oral health-related quality of life. In conclusion, non-SS patients require more attention in order to improve their quality of life.
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Salud Bucal/estadística & datos numéricos , Calidad de Vida , Enfermedades de las Glándulas Salivales/complicaciones , Síndrome de Sjögren/complicaciones , Adulto , Anciano , Estudios de Casos y Controles , Síndromes de Ojo Seco/complicaciones , Femenino , Estado de Salud , Humanos , Persona de Mediana Edad , Encuestas y Cuestionarios , Adulto JovenRESUMEN
Background In cooperative patients with cervical spine injury, awake fiberoptic intubation is an excellent option for elective and semi urgent situations. It allows documentation of neurologic examination before and after intubation and surgical positioning. We have compared anesthesia of airway by nerve block and the local anesthesia atomizer undergoing awake fiberoptic intubation in cervical spine injury patients, in terms of the intubation time and discomfort. Objective To compare the intubation time and discomfort in patient with cervical spine injury with anticipated difficult airway potential to aggravate pre-existing injury undergoing awake fiberoptic intubation, based on cough and gag scores, between anesthesia of airway by (transtracheal and bilateral superior laryngeal) nerve block with local anesthetic agent and the local anesthesia atomizer. Method After institutional ethical approval and having informed written consent, 30 patients scheduled for elective surgery who require awake fiberoptic intubation, were included in the study. Patients were allotted by computer-generated random series into two groups; Group N received nerve block (transtracheal and bilateral recurrent laryngeal nerve block) and Group A received atomized lignocaine. Result The time taken for awake fiberoptic intubation was significantly lower in nerve blocks group as compared with the atomizer group [Group N: 90.2±11.7secs and Group A: 210.4±10.6 secs (p=0.041)]. Atomizer group had an increased coughing and gagging episodes than nerve block group [Group N: one patient, Group A: 11 patients (p=0.006)]. Ease of intubation and patient comfort were significantly better in nerve block group. Demographic and hemodynamic parameters were comparable in the two groups. Conclusion The nerve blocks (bilateral superior laryngeal and transtracheal recurrent laryngeal) provides adequate airway anesthesia, lesser patient discomfort, and faster intubation to aid in awake fiberoptic intubation in patients with anticipated difficult airway as compared to topical anesthesia using atomizer.
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Anestesia Local/métodos , Vértebras Cervicales/lesiones , Tecnología de Fibra Óptica/métodos , Intubación Intratraqueal/métodos , Bloqueo Nervioso/métodos , Traumatismos Vertebrales/cirugía , Vigilia , Adolescente , Adulto , Anestésicos Locales/farmacología , Vértebras Cervicales/cirugía , Femenino , Humanos , Nervios Laríngeos , Lidocaína/farmacología , Masculino , Persona de Mediana Edad , Adulto JovenRESUMEN
PURPOSE: Transrectal prostate biopsies are inaccurate and, thus, the prevalence of clinically significant prostate cancer in men undergoing biopsy is unknown. We determined the ability of different histological thresholds to denote clinically significant cancer in men undergoing a more accurate biopsy, that of transperineal template prostate mapping. MATERIALS AND METHODS: In this multicenter, cross-sectional cohort of men who underwent template prostate mapping biopsies between May 2006 and January 2012, 4 different thresholds of significance combining tumor grade and burden were used to measure the consequent variation with respect to the prevalence of clinically significant disease. RESULTS: Of 1,203 men 17% (199) had no previous biopsy, 38% (455) had a prior negative transrectal ultrasound biopsy, 24% (289) were on active surveillance and 21% (260) were seeking risk stratification. Mean patient age was 63.5 years (SD 7.6) and median prostate specific antigen was 7.4 ng/ml (IQR 5.3-10.5). Overall 35% of the patients (424) had no cancer detected. The prevalence of clinically significant cancer varied between 14% and 83% according to the histological threshold used, in particular between 30% and 51% among men who had no previous biopsy, between 14% and 27% among men who had a prior negative biopsy, between 36% and 74% among men on active surveillance, and between 47% and 83% among men seeking risk stratification. CONCLUSIONS: According to template prostate mapping biopsy between 1 in 2 and 1 in 3 men have prostate cancer that is histologically defined as clinically significant. This suggests that the commonly used thresholds may be set too low.
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Biopsia con Aguja/instrumentación , Próstata/patología , Neoplasias de la Próstata/epidemiología , Medición de Riesgo/métodos , Anciano , Estudios Transversales , Egipto/epidemiología , Diseño de Equipo , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Neoplasias de la Próstata/diagnóstico , Reproducibilidad de los Resultados , Suiza/epidemiología , Reino Unido/epidemiologíaRESUMEN
In this study, we investigated inter-individual differences in sensitivity to mono-sodium glutamate (MSG) and elucidated the familiarity to umami taste in two European populations. The study consisted of two parts: (1) a survey based on questionnaire and (2) psychophysical screening for inter-individual variation of MSG sensitivity. The psychophysical tests revealed that 3.2% of the German participants and 4.6% of the Norwegian participants were potential non-tasters of MSG. In conclusion, our study confirms inter-individual differences in sensitivity to MSG in humans.
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Percepción del Gusto , Adolescente , Adulto , Femenino , Aditivos Alimentarios/metabolismo , Preferencias Alimentarias/fisiología , Alemania , Humanos , Masculino , Persona de Mediana Edad , Noruega , Glutamato de Sodio/metabolismo , Encuestas y Cuestionarios , Adulto JovenRESUMEN
Achieving reimbursement for regenerative medicine products is potentially a greater challenge than gaining US FDA approval, making it a decisive factor in the success or failure of small businesses. However, the mechanisms by which reimbursement is achieved are still seen as something of a 'black box', especially to those outside of the USA. This report aims to provide insights into the mechanisms of reimbursement and variety of payers in the USA, and to act as a starting point for a successful US reimbursement strategy. Fundamental concepts such as coverage, payment and coding are explained and linked with the factors that potentially determine the successful reimbursement of regenerative medicine products, including cost of goods and clinical study design. Finally, important considerations for the design of clinical studies that satisfy both the payers and the FDA are discussed and the key elements of a successful company strategy identified.
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Aprobación de Drogas/economía , Medicina Regenerativa/economía , Medicina Regenerativa/tendencias , Mecanismo de Reembolso , Comercio , Aprobación de Drogas/legislación & jurisprudencia , Accesibilidad a los Servicios de Salud , Humanos , Medicare , Estados Unidos , United States Food and Drug AdministrationRESUMEN
There are three mammalian HP1 genes, Cbx5 (encoding HP1alpha), Cbx1 (encoding HP1beta) and Cbx3 (encoding HP1gamma). Despite their high degree of sequence homology mutational analysis has revealed different phenotypes indicating that they possess different functions. Notably, the Cbx1 mutation is lethal in its homozygous condition. The Cbx1 null phenotype is therefore more severe than the Suv(3)9h1/h2 double-mutant mouse, indicating that the essential function of the Cbx1 gene product, HP1beta, is likely to lie outside its interaction with the heterochromatic H3K9me3 determinant of the "histone code" imposed by the Suv(3)9h1/h2 HMTases. Comparisons of HPI mutants in flies and fungi with corresponding mutations in Suv(3)9 genes show that HP1 mutations are invariably more severe than mutation in Suv(3)9 genes. The implications of these data for HP1 function are discussed.
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Proteínas Cromosómicas no Histona/metabolismo , Histonas/metabolismo , Animales , Homólogo de la Proteína Chromobox 5 , Proteínas Cromosómicas no Histona/genética , Histonas/genética , Ratones , MutaciónRESUMEN
AIM: To study the effect of biosurfactant on aqueous phase solubility and biodegradation of chlorpyrifos. METHODS AND RESULTS: A Pseudomonas sp. (ChlD), isolated from agricultural soil by enrichment culture technique in the presence of chlorpyrifos, was capable of producing biosurfactant (rhamnolipids) and degrading chlorpyrifos (0.01 g l(-1)). The partially purified rhamnolipid biosurfactant preparation, having a CMC of 0.2 g l(-1), was evaluated for its ability to enhance aqueous phase partitioning and degradation of chlorpyrifos (0.01 g l(-1)) by ChlD strain. The best degradation efficiency was observed at 0.1 g l(-1) supplement of biosurfactant, as validated by GC and HPLC studies. CONCLUSION: The addition of biosurfactant at 0.1 g l(-1) resulted in more than 98% degradation of chlorpyrifos when compared to 84% in the absence of biosurfactant after 120-h incubation. SIGNIFICANCE AND IMPACT OF THE STUDY: This first report, to the best of our knowledge, on enhanced degradation of chlorpyrifos in the presence of biosurfactant(s), would help in developing bioremediation protocols to counter accumulation of organophosphates to toxic/carcinogenic levels in environment.
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Cloropirifos/metabolismo , Pseudomonas/metabolismo , Tensoactivos/metabolismo , Biotransformación , Cloropirifos/química , Cromatografía de Gases , Cromatografía Líquida de Alta Presión , Glucolípidos/aislamiento & purificación , Glucolípidos/metabolismo , Solubilidad , Tensoactivos/aislamiento & purificaciónRESUMEN
INTRODUCTION: Peyronie's disease is a common cause of sexual dysfunction. We assess the technique of plaque excision and dermal grafting for the treatment of Peyronie's disease. METHODS: A total of 11 patients, aged 38-55 years, were operated for Peyronie's disease. All patients had stable plaque on the dorsum or dorsolateral aspect of the penile shaft. All patients had penile curvature, nine (81.8 percent) had painful erections, six (54.5 percent) had penile pain and three (27.3 percent) had erectile dysfunction. All suffered difficulty in intercourse. We performed plaque excision and dermal grafting. Main outcome measures were relief of penile pain, relief of painful erection, performance of satisfactory coitus and straight penis while erection. RESULTS: All patients had relief of penile pain and painful erection. Nine (81.8 percent) patients had straight penis and had satisfactory coitus. Two (18.2 percent) patients suffered postoperative erectile dysfunction which was mild and responded to Sildenafil tabs. CONCLUSION: Although experience with this technique is limited, the initial results are encouraging. We found this technique feasible with satisfactory results.
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Induración Peniana/cirugía , Induración Peniana/terapia , Pene/anatomía & histología , Pene/fisiopatología , Trasplante de Piel/métodos , Adulto , Humanos , Masculino , Persona de Mediana Edad , Dolor , Erección Peniana , Pene/fisiología , Estudios Retrospectivos , Trasplante Autólogo , Trasplante Heterotópico , Resultado del Tratamiento , Procedimientos Quirúrgicos Urológicos Masculinos/efectos adversos , Procedimientos Quirúrgicos Urológicos Masculinos/métodosRESUMEN
BACKGROUND: There is an increasing necessity to extract the maximum amount of information, beyond even a cancer diagnosis, from prostate biopsies. Thus, maintaining site-specific information regarding individual biopsy cores might be critical. AIM: To evaluate the applicability of employing tissue ink to maintain the identity of individual prostatic biopsy cores. METHOD: In this ongoing study, 12 core prostate biopsy specimens are sent to the laboratory in individual pots labelled according to anatomical site. The specimens are placed in two separate multi-compartment cassettes. They are inked with different colours to identify the site of origin from each lobe. The cassettes are then processed with a single paraffin block for each side; the six cores from each side can be mounted on a single slide. RESULTS: The different colours used adhere well to the biopsy cores, thus maintaining the identity of each core. Six cores from each side are embedded in a single paraffin block and examined on a single slide, making it cost-effective, while maintaining high quality, accurate histopathological information. CONCLUSION: Differential inking of prostate biopsy cores is an easily applicable method that is cost-effective and provides tumour location information. Prostate biopsy data archived to maintain individual core information might be used to determine applicability of such information to predict extra-capsular extension by correlating with imaging and radical prostatectomy findings, and for treatment planning.
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Biopsia con Aguja/métodos , Próstata/patología , Neoplasias de la Próstata/patología , Coloración y Etiquetado/métodos , Anciano , Anciano de 80 o más Años , Colorantes , Humanos , Inmunohistoquímica , Tinta , Masculino , Persona de Mediana EdadRESUMEN
Hemangiomas of the urinary tract are rare lesions, and those of the glans penis are even rarer. A 23-year-old man with a hemangioma of the glans penis treated successfully with intralesional sclerotherapy is presented. Other options for the management of this disorder are discussed.
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Hemangioma Cavernoso/patología , Hemangioma Cavernoso/cirugía , Neoplasias del Pene/patología , Pene/patología , Pene/cirugía , Adulto , Humanos , Masculino , Neoplasias del Pene/cirugía , Soluciones Esclerosantes , EscleroterapiaRESUMEN
Bilateral single system ureteral ectopia (BSSEU) is one of the rarest entities in urology, with less than 80 cases reported so far. Incontinence resulting from the underlying anomaly can be devastating to the child. It is generally agreed that suitable urinary continence and long dry intervals are seldom obtainable because of poorly developed trigone and bladder neck area. We herein report a case of BSSEU managed by bilateral ureteric reimplantation, achieving satisfactory continence and bladder capacity without the need for urinary diversion or bladder neck reconstruction.
RESUMEN
OBJECTIVE: To assess the success of buccal mucosal graft (BMG) urethroplasty by the dorsal onlay technique in long anterior urethral stricture (> 2 cm long) through the midline perineal incision. MATERIALS AND METHODS: From January 1998 to December 2003, 43 patients with long anterior urethral strictures were managed by dorsal onlay BMG urethroplasty. After voiding trial, they were followed up at 3 months with uroflowmetry, retrograde urethrogram (RGU) and American Urological Association symptoms score (AUA symptoms scores). Successful outcome was defined as normal voiding with a maximum one attempt of visual internal urethrotomy (VIU) after catheter removal. Patients were further followed-up with uroflowmetry at 3 months interval and RGU every 6 months interval. RESULTS: Mean stricture length was 4.8 cm (range 3 to 9 cm) and mean follow up was 48 months (range 12 to 84 months). Only five patients were found to develop stricture at anastomotic site, during follow-up. Two of them voided normally after single attempt of VIU. Other three patients (6.9%) required further open surgery or repeat VIU during follow up and were considered as failure. CONCLUSION: Dorsal onlay BMG urethroplasty is a simple technique with good surgical outcome.
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Mucosa Bucal/trasplante , Colgajos Quirúrgicos , Uréter/cirugía , Estrechez Uretral/cirugía , Adulto , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Resultado del TratamientoRESUMEN
OBJECTIVE: To assess the success of buccal mucosal graft (BMG) urethroplasty by the dorsal onlay technique in long anterior urethral stricture (> 2 cm long) through the midline perineal incision. MATERIALS AND METHODS: From January 1998 to December 2003, 43 patients with long anterior urethral strictures were managed by dorsal onlay BMG urethroplasty. After voiding trial, they were followed up at 3 months with uroflowmetry, retrograde urethrogram (RGU) and American Urological Association symptoms score (AUA symptoms scores). Successful outcome was defined as normal voiding with a maximum one attempt of VIU after catheter removal. Patients were further followed-up with uroflowmetry at 3 months interval and RGU every 6 months interval. RESULTS: Mean stricture length was 4.8 cm (range 3 to 9 cm) and mean follow up was 48 months (range 12 to 84 months). Only five patients were found to develop stricture at anastomotic site, during follow-up. Two of them voided normally after single attempt of VIU. Other three patients (6.9 percent) required further open surgery or repeat VIU during follow up and were considered as failure. CONCLUSION: Dorsal onlay BMG urethroplasty is a simple technique with good surgical outcome.
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Adulto , Humanos , Masculino , Persona de Mediana Edad , Mucosa Bucal/trasplante , Colgajos Quirúrgicos , Uréter/cirugía , Estrechez Uretral/cirugía , Estudios de Seguimiento , Resultado del TratamientoAsunto(s)
Quistes/patología , Quistes/cirugía , Papiloma/patología , Enfermedades del Pene/patología , Neoplasias Cutáneas/patología , Adulto , Biopsia con Aguja , Quistes/congénito , Diagnóstico Diferencial , Humanos , Inmunohistoquímica , Masculino , Moco/metabolismo , Papiloma/cirugía , Enfermedades del Pene/congénito , Enfermedades del Pene/cirugía , Neoplasias Cutáneas/cirugía , Procedimientos Quirúrgicos Urológicos Masculinos/métodosRESUMEN
Effect of cumulative doses of estradiol -17beta (E2-7, 14 and 28 mg/kg body weight) and 17alpha, 20beta-dihydroxy-4-pregnen-3-one (17alpha,20betaP-7, 14 and 28 mg/kg body weight) on total phospholipids (TP) and various phospholipids- phosphatidylcholine (PC), phosphatidylserine (PS), phosphatidylinositol (PI) and phosphatidylethanolamine (PE) on liver plasma and ovary were investigated during the reproductively active preparatory and prespawning phases of the annual reproductive cycle in the freshwater female catfish, H. fossilis. The effect of E2 on TP was generally stimulatory and has pronounced effect than 17alpha,20betaP during both the phases. The levels of PC was promoted high during prespawning phase by E2 comparatively very less than by 17alpha, 20betaP in studied tissues during both the phases. The levels of PS after E2 treatments was maximum in all tissues during prespawning phase whereas 17alpha,20betaP was effective only in liver during this phase. The PI was elevated in liver during preparatory phase but its elevation was in all studied tissues during prespawning phase after E2 treatments. The levels of PI was most effective in ovary during preparatory phase in response to 17alpha,20betaP. The levels of PE was declined in liver but elevated in ovary after E2 treatments during both the phases. Treatments of E2 during preparatory phase showed greater number of vitellogenic oocytes as compared to 17alpha,20betaP treatments. The present finding has demonstrated that estradiol-17beta has more pronounced effects than the 17alpha,20beta P in regulation of different phospholipids and ovarian recrudescence during reproductively active phases and among the phospholipids the PC is the main phospholipids of vitellogenin/ovarian lipids in H. fossilis.
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Bagres/crecimiento & desarrollo , Estradiol/farmacología , Hidroxiprogesteronas/farmacología , Ovario/efectos de los fármacos , Fosfolípidos/metabolismo , Reproducción , Animales , Femenino , Ovario/crecimiento & desarrollo , Ovario/metabolismoRESUMEN
A retrospective analysis of 252 cases of vesicovaginal fistulae was done to analyse its etio-pathology and management in an Indian population. After a thorough evaluation, different techniques of fistula closure were used for repair and the results were listed. The main outcome measures were the etiology of the fistula, need for tissue interposition and cure rate per repair as well as the overall cure rate. We compared our results with literature and concluded that simple and small fistulae should be repaired with layered closure. All complicated fistulae should be repaired with tissue interposition or tissue graft. This is the first study from India compiling 10 years of experience on vesicovaginal fistula.
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Procedimientos Quirúrgicos Ginecológicos , Fístula Vesicovaginal/diagnóstico , Fístula Vesicovaginal/cirugía , Adolescente , Adulto , Femenino , Humanos , India , Persona de Mediana Edad , Complicaciones Posoperatorias/epidemiología , Estudios Retrospectivos , Resultado del Tratamiento , Fístula Vesicovaginal/etiologíaRESUMEN
OBJECTIVE: To analyse the incidence, symptomatology, diagnosis and therapeutic aspects of Youssef syndrome (post caesarean vesicouterine fistula), and to review relevant published work. METHODS: A retrospective study from the urosurgical unit of a tertiary care referral hospital was carried out. In a retrospective analysis of urogenital fistulae over 10 years, we identified 14 patients with uterovesical fistulae, resulting from caesarean section. All the patients were evaluated by history, physical examination, radiological tests and cystoscopy. All patients underwent transperitoneal repair of these fistulae with omental interposition. Results of surgery were evaluated by absence of cyclic haematuria, stoppage of urinary incontinence, and achievement of fertility. RESULTS: A total of 12 patients who had minimum follow up was included in the present study. The results showed that 50% of the fistulae resulted from emergency caesarean operation with 58% of patients presenting after their second caesarean section. The mean age of the patients was 19 years (range 15-29) and mean duration of symptoms was 7 months (range 3-16). Menouria and amenorrhoea were predominant presenting symptoms. The results of surgical treatment were excellent with good continence and resolution of the cyclic haematuria. Three pregnancies (37.5%) which resulted in elective caesarean section were recorded. CONCLUSION: Vesicouterine fistulae, despite being infrequent, are no longer a rare diagnosis and are most commonly secondary to lower segment caesarean section. With patient history and selected investigations diagnosis is relatively easy. The surgical repair of these fistulae is standard treatment, especially with delayed fistulae with achievement of total continence, and complete resolution of cyclic haematuria. Meticulous practice of obstetric and surgical principles during caesarean section can prevent the formation of these fistulae.
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Cesárea/efectos adversos , Fístula Vesicovaginal/etiología , Adolescente , Adulto , Femenino , Humanos , Epiplón/trasplante , Embarazo , Estudios Retrospectivos , Síndrome , Fístula Vesicovaginal/cirugíaRESUMEN
OBJECTIVE: To establish the safety and efficacy of ureteroscopic lithotripsy (URSL) under sedoanalgesia. PATIENTS AND METHODS: This study was conducted at Department of Urology (Banaras Hindu University, India) among 124 patients with ureteral stones, between July 2000 and August 2003. Majority of the patients (59.68%) presented with lower ureteric calculi, 24.19% presented with upper ureteric calculi and 16.13% had middle ureteric calculi. All patients were given injection diclofenac sodium (75 mg) promethazine hydrochloride (12.5 mg) deep intramuscular 30 minutes the before procedure. Injection midazolam 0.03 mg/kg body weight slowly given intravenously immediately before the procedure for achieving sedation. Injection fentanyl 50 mcg intravenously given slowly just before introducing the ureteroscope into ureter for achieving intravenous analgesia. Patients were observed for few hours after completion of procedure and oral questions were asked as per proforma, which included tolerance, intensity of pain and percentage of pain experienced by the patients. Patients were discharged thereafter. RESULTS: 87.10% of patients opined that the procedure was acceptable. Only 4.84% opined this procedure was painful. According to present pain intensity score (PPI) in this study 79.03 patients experienced only mild pain, 11.29% cases rated procedure as discomforting, 6.45 rated procedure as distressing and only 3.23% rated as horrible procedure. As per visual analogue scale for assessment of pain 80.65 of cases rated only 20% pain score (in a scale of 0-100). 9.68% cases rated 30% and 6.45% rated 50%. Only two patients in middle ureteric group rated 100% pain. Overall success rate in fragmenting stone was 91.94, where as for lower ureteric calculi it was 97.30%; for upper and, middle ureteric calculi it was 86.66% and 80%, respectively. CONCLUSION: Ureteroscopic lithotripsy can be performed on day care basis under sedoanalgesia which is fairly tolerated by the patients with unremarkable complications and difficulty.
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Litotricia/métodos , Cálculos Ureterales/terapia , Ureteroscopía , Adolescente , Adulto , Anciano , Analgesia , Femenino , Humanos , Hipnóticos y Sedantes/administración & dosificación , Masculino , Midazolam/administración & dosificación , Persona de Mediana Edad , Estudios Prospectivos , SeguridadRESUMEN
OBJECTIVES: To evaluate the effectiveness of combination (povidone iodine and 50% dextrose) renal pelvic instillation sclerotherapy (RPIS) as a minimally invasive therapy for chyluria resistant to conservative treatment. METHODS: A total of 50 patients with chyluria and hematochyluria (28 men and 22 women) were included in the study. Initially, all were offered conservative antifilarial drug therapy and dietary fat restriction. Intravenous urography was done in all cases to document normal renal functional status. In the patients in whom chyluria persisted after 3 weeks of conservative therapy, cystoscopic lateralization was done and a 5F open-ended ureteral catheter was positioned under local anesthesia. The same was left attached to a 16F Foley catheter for 3 days of RPIS. A solution of 5 mL of 5% povidone iodine and 5 mL of 50% dextrose was instilled twice a day with the patient in the Trendelenburg position for 3 days. In cases of bilateral efflux, the dominant side was treated first. The opposite side was subjected to a similar instillation sclerotherapy schedule after 6 weeks if chyluria persisted. RESULTS: Of the 50 patients, only 4 responded to conservative therapy. The remaining 46 patients underwent combination RPIS. The mean follow-up was 24 months. Complete remission of chyluria or hematochyluria occurred in 40 (87%) and persisted in 6 patients (13%). Of the 6 patients in whom symptoms persisted, 2 developed chyluria on the side opposite the one treated with RPIS. Another 2 patients developed recurrence on the same side after remaining asymptomatic for 6 months after RPIS. All four of these patients subsequently underwent chylolymphatic disconnection and nephropexy (two open and two laparoscopic) with a successful outcome. The final 2 patients with persistent symptoms were lost to follow-up. CONCLUSIONS: Combination sclerotherapy using a 5% povidone iodine and 50% dextrose solution is a safe and cost-effective minimally invasive therapy for chyluria refractory to conservative treatment.