Clinical assessment of stabilisation of renal function after nephrectomy.

INTRODUCTION AND OBJECTIVE: Nephrectomy leads to derangement of renal function and various adaptive changes by the remaining kidney over a period of time. This study is performed to evaluate the amount of derangement of renal function in donor and radical nephrectomy, how much the remaining kidney adapts over a period of time and the time taken for stabilisation of renal function. METHOD: A total of 60 patients who underwent nephrectomy (Radical/Donor) were followed up for 12 months with serial estimation of renal function and was compared with preoperative renal function. Data was analysed with statistical analysis. RESULT: Patients who underwent radical nephrectomy had 37% initial decline in renal function which was later stabilised at 19% lower than baseline value. Patient who underwent donor nephrectomy had initially 39% decline in renal function which was later stabilised at 24% lower than normal. CONCLUSION: Removal of functional renal tissue led to reduction of renal function. This decline is more evident in the initial post-operative period and then begin to stabilise over months. The greater is the amount of normal tissue removed, the greater is the reduction of renal function and more time it will take to stabilise, increasing overall morbidity of the patient. This study suggests that even patients with normal GFRs should be followed up postoperatively to determine their ultimate renal functional outcomes.

Association of beta-catenin and CD44 in the development of renal cell carcinoma.

INTRODUCTION AND OBJECTIVE: Renal cell carcinoma (RCC) accounts for approximately 3% of all cancers. Approximately 25%-30% of patients present with metastatic disease at the time of diagnosis, and metastatic RCC is a treatment-resistant malignancy. Altered expression of cell adhesion molecules such as CD44 on tumor cells suggests a pathogenetic mechanism for tumor metastasis and may provide prognostic information for particular tumors. These cell matrix interactions of CD44 play a role in tumor cell invasion and metastasis. The Wnt/beta-catenin pathway turned out to be a promising target as it is involved in the regulation of cell proliferation, differentiation and apoptosis induction. METHOD: In this study, the expression of beta-catenin and CD44 was analyzed in primary renal cell carcinoma (RCC) samples to understand their association with development of the disease. For this purpose, immunohistochemical expression analysis of beta-catenin and CD44 was performed in 30 primary RCC histological samples and normal kidney tissues in different subtypes at different clinical stages of Indian patients (year: 2017-2019). RESULT: Most of the patients who presented were diagnosed as clear cell carcinoma and it was observed that expression of CD44 was high in patients with high stage tumors. Also beta-catenin was increased in advanced grade tumors, but there was insignificant correlation between high expression of molecules and survival or recurrence of disease. CONCLUSION: Both cd44 and beta-catenin activation was noted in patients with clear cell carcinoma, more in advanced tumors. Both can be promising targets for treatment in clear cell RCCs.

Association of arsenic with recurrence of urinary bladder cancer.

Arsenic is known to be an important aetiological factor for the development of urinary bladder cancer. It is known to be found excessively in ground water in certain geographical areas, including West Bengal. We have studied patients with recurrent bladder cancer from different areas of this Indian state and correlated arsenic as a causative aetiological factor for development and aggressiveness of the biological behaviour of urinary cancer. We included 31 patients from various parts of West Bengal state with recurrent bladder cancer who were operated in our institute. Their clinical and residential data and their arsenic content of tumour tissue were measured. Statistical analysis was performed to test the association of tissue arsenic with clinicopathological features of recurrent disease. We found very high levels of arsenic in tumour tissue in all residents of the districts with high prevalence of arsenic in the drinking water. We also observed more aggressive clinicopathological progression and early recurrence in patients with high arsenic content. We conclude that arsenic is a causal factor in the clinicopathological progression of recurrent urinary bladder cancer. Measures to decrease the level of arsenic in drinking water should be taken as this may both improve clinicopathological outcomes in the recurrence of urinary bladder carcinoma, as well as reducing its overall incidence.

Physiological aspects of Agni.

Agni is the invariable agent in the process of Paka (digestion, transformation). Ingested food is to be digested, absorbed and assimilated, which is unavoidable for the maintenance of life, and is performed by the Agni. Different examples are available in our classics to indicate that Pitta is the same as Agni, but some doubt arises behind this concept, that Pitta is Agni. Agni is innumerable because of its presence in each and every paramanu of the body. But, the enumeration of the number of Agni varies in various classical Ayurvedic texts. According to the functions and site of action, Agni has been divided into 13 types, i.e. one Jatharagni, five Bhutagni and seven Dhatvagni. Jatharagni is the most important one, which digests four types of food and transforms it into Rasa and Mala. The five Bhutagnis act on the respective bhutika portion of the food and thereby nourish the Bhutas in the body. The seven Dhatvagni act on the respective dhatus by which each Dhatu is broken into three parts. In this way, the entire process of transformation consists of two types of products - PRasad (essence) and Kitta (excrete). The former is taken for nourishment while the latter one is thrown out, which otherwise defiles the body if it stays longer.

Prospective randomized trial comparing efficacy of alfuzosin and tamsulosin in management of lower ureteral stones.

OBJECTIVES: To study the efficacy of alfuzosin compared with tamsulosin in the management of lower ureteral stones. METHODS: A total of 102 patients with stones <1 cm size and located in the lower ureter were enrolled in the present study and randomized into 3 equal groups. Group 1 patients (n = 34) received 0.4 mg tamsulosin daily, group 2 patients (n = 34) received 10 mg alfuzosin daily, and group 3 patients (n = 34) received placebo (control group). The patients were given 75 mg diclofenac injection intramuscularly on demand and were followed up for 4 weeks. RESULTS: The average stone size for groups 1, 2, and 3 was comparable (6.17, 6.70, and 6.35 mm, respectively). Stone expulsion was observed in 28 of 34 patients (82.3%) in group 1, 24 of 34 patients (70.5%) in group 2, and 12 of 34 patients (35.2%) in group 3. The average expulsion time for groups 1, 2, and 3 was 12.3, 14.5, and 24.5 days, respectively. The results of both study groups (groups 1 and 2) were superior to those in the placebo group (P = .003 and P = .001, respectively), but the study failed to show any statistically significant differences between tamsulosin and alfuzosin (P = .25). Alfuzosin was associated with fewer side effects than tamsulosin, especially in terms of retrograde ejaculation. CONCLUSIONS: Medical treatment of lower ureteral calculi with tamsulosin and alfuzosin resulted in a significantly increased stone expulsion rate, decreased expulsion time, and a reduced need for analgesic therapy.