Laparoscopy-assisted live donor nephrectomy: a modified cost-effective approach for developing countries

BACKGROUND AND PURPOSE: Because of the prohibitive cost of laparoscopic disposable instruments such as the PneumoSleeve, Endocatch, and vascular staples, laparoscopic live-donor nephrectomy has not gained wide acceptance in many developing countries. To circumvent this problem, we have developed a cost-saving approach, which is described herein and compared with the open method. PATIENTS AND METHODS: Forty-nine patients underwent laparoscopic live-donor nephrectomy at our institute, of which two were performed by the hand-assisted technique, five by the technique described by Fabrizio et al and forty-two by our modified cost-saving laparoscopy-assisted technique (LD). The latter patients were compared with 50 patients who had a standard open donor nephrectomy (OD) through a rib-resecting (12th rib) flank incision. Our technique is similar to the procedure described by Fabrizio et al except for a 6- to 8-cm incision placed in the subcostal region to retrieve the kidney after the renal vessels are cut and ligated as in the open procedure. The costs of the various techniques at our institute were compared. RESULTS: The LD and OD groups were similar in terms of age, weight, side of nephrectomy, and number of renal vessels. The operative time was longer in the LD group than in the OD group (180.7 +/- 18 minutes v 101.5 +/- 10.4 minutes), whereas the mean intraoperative blood loss was less (85.5 +/- 21.35 v 220 +/- 22.5 mL; P < 0.001). Warm ischemia time and recipient outcomes were comparable in the two groups. Patients in the LD group had lower postoperative narcotic (tramadol hydrochloride) requirement (155.3 +/- 53.3 mg v 251.8 +/- 63.1 mg; P < 0.001) and earlier discharge from the hospital (3.14 v 5.7 days; P < 0.001). The mean expense incurred was US$175 v US$160 in the LD and OD groups, respectively. The cost of the hand-assisted and standard laparoscopic techniques was significantly higher than that of our modified technique. CONCLUSIONS: Our modified technique of laparoscopy-assisted live-donor nephrectomy avoids the use of costly disposables yet offers the advantages of lesser morbidity and small incision of LD. It is cost effective and is an alternative to open nephrectomy in the developing world.     

Assessment of voiding outcome, sexual function and quality of life two years following KTP/YAG hybrid laser prostatectomy

OBJECTIVE: To assess the long-term outcome of patients undergoing KTP/YAG hybrid laser treatment for bladder outlet obstruction due to benign prostatic enlargement, in terms of symptomatic relief, complications, sexual function, patient satisfaction and acceptance of procedure. PATIENTS AND METHODS: The study recruited 148 patients prospectively. The hybrid laser treatment involved performing an initial bladder neck incision using KTP laser at 34 W followed by 4/6 point coagulation using NdYAG laser at 60 W. Patients were followed up till 2 years and assessed using uroflowmetry, International Prostate Symptom Score (IPSS), Patient Satisfaction Score (PSS), BPH impact index (BII) and the Danish Prostate Symptom Score (DAN-PSS) sexual function questionnaire. RESULTS: 137 patients were followed up for 2 years. There was a significant improvement in the maximum flow rate, IPSS and Quality of Life Scale (QLS). The mean BII (2.9) and the mean PSS (1.9) were low suggesting overall satisfaction with the procedure. The complications included urethral stricture (0.73%), bladder neck obstruction (2.15%) and retreatment (3.6%). 79.4% had a significant decrease in the ejaculate and 32.8% had a significant change in the strength of erections. On comparing the two groups (sexual function affected vs. not affected), the age, BII, IPSS and PSS were significantly higher (p < 0.05) in the group of patients that were affected. CONCLUSIONS: Following KTP/YAG hybrid laser prostatectomy the outcome for voiding is good and durable for up to 2 years. The patient satisfaction level following the procedure is high and the procedure well accepted. However, significant interference with sexual function occurs, which appears to be occurring in tandem with a poor voiding outcome.     

DNA nanotherapy for pre-neoplastic cervical lesions

ObjectiveThis study aims to test the hypothesis that targeted nanoparticle delivery of DNA encoding HPV16-regulated diphtheria toxin (DT-A) will result in the death of HPV16-infected cells.Materials and methodsPlasmid constructs containing a HPV16 Long Control Region (LCR) DNA sequence upstream of DT-A or luciferase reporter (Luc) DNA sequences were used to formulate poly(β-amino ester) nanoparticles. The effect on tumor growth of HPV/DT-A-nanoparticle injection directly into HPV16⁺ CaSki human cervical cancer cell-derived xenografts in mice was determined. To evaluate the ability of the HPV16 LCR regulatory sequence to activate gene expression specifically in HPV16-infected cells, mice underwent bioluminescent optical imaging following intraperitoneal injection of HPV/Luc-nanoparticles. The use of Lutrol F127, a thermal-sensitive gel, to target delivery of nanoparticles and subsequent gene expression to cervical epithelial cells was evaluated in ex vivo cultures of mouse cervix and following intravaginal delivery of nanoparticle/gel in mice, as well as in ex vivo cultures of surgical LEEP samples.ResultsThe selected HPV16 LCR regulatory sequence activates gene expression in both HPV16-infected cells and non-infected cells. However, in the cervix, it is specifically active in epithelial cells. Following exposure of cervical cells to HPV/DT-A-nanoparticles mixed with Lutrol F127 gel, DT-A is expressed and cells die.ConclusionsAn HPV16 DNA sequence that targets gene expression specifically to HPV16-infected cells remains to be discovered. Topical application of a Lutrol F127 thermal gel/nanoparticle mix is illustrative of how to restrict exposure of cells to therapeutic nanoparticles, thereby allowing for targeted DNA delivery to cervical pre-cancerous lesions.     

Tunable electrical properties of carbon dot doped photo-responsive azobenzene–clay nanocomposites

The development of photo-responsive nanocomposite materials is important in the fabrication of optoelectronic devices. In this work, we fabricated a carbon dot doped azobenzene–clay nanocomposite which possesses different ac conductivity with and without UV treatment. At first, azobenzene nanoclusters were synthesised and then successfully used to make an azobenzene–clay nanocomposite. It was observed that there is a small change in the ac conductivity of the azobenzene–clay nanocomposite with and without UV treatment. However, this change in ac photoconductivity can be enhanced in the azobenzene–clay nanocomposite by doping with electron-rich cysteine and methionine carbon dots. Hence, ac conductivity properties of the carbon-doped azobenzene–clay nanocomposite can be tuned using UV light. Impedance measurements were determined using Electrochemical Impedance Spectroscopy. Mechanistic insight into the phenomenon is also discussed in the paper. Thus fabrication of tunable carbon dot doped photo-responsive azobenzene–clay nanocomposites will lead to the use of carbon dot doped azobenzene–clay nanocomposites in photo-switchable optoelectronic devices.

We demonstrate successful fabrication of an azobenzene–clay nanocomposite doped with electron-rich cysteine and methionine carbon dots with photo-switchable ac conductivity.     

MR Geyser Sign in chronic rotator cuff tears

Acromio-clavicular (AC) joint cysts are rare presentation of chronic shoulder pathology. These cysts may be observed secondary to either degenerative changes in the AC joint with an intact rotator cuff (type 1 cyst) or following a chronic rotator cuff tear (type 2 cyst). The latter phenomenon is known as Geyser Sign and is described by ultrasound, conventional arthrogram and magnetic resonance imaging (MRI). We present a case of chronic rotator cuff tear presenting with a large type 2 cyst and Geyser Sign on MRI.     

180-W XPS GreenLight Laser Vaporisation Versus Transurethral Resection of the Prostate for the Treatment of Benign Prostatic Obstruction: 6-Month Safety and Efficacy Results of a European Multicentre Randomised Trial—The GOLIATH Study

Background

The comparative outcome with GreenLight (GL) photoselective vaporisation of the prostate and transurethral resection of the prostate (TURP) in men with lower urinary tract symptoms due to benign prostatic obstruction (BPO) has been questioned.

Objective

The primary objective of the GOLIATH study was to evaluate the noninferiority of 180-W GL XPS (XPS) to TURP for International Prostate Symptom Score (IPSS) and maximum flow rate (Q_max) at 6 mo and the proportion of patients who were complication free.

Design, setting, and participants

Prospective randomised controlled trial at 29 centres in 9 European countries involving 281 patients with BPO.

Intervention

180-W GL XPS system or TURP.

Outcome measurements and statistical analysis

Measurements used were IPSS, Q_max, prostate volume (PV), postvoid residual (PVR) and complications, perioperative parameters, and reintervention rates. Noninferiority was evaluated using one-sided tests at the 2.5% level of significance. The statistical significance of other comparisons was assessed at the (two-sided) 5% level.

Results and limitations

The study demonstrated the noninferiority of XPS to TURP for IPSS, Q_max, and complication-free proportion. PV and PVR were comparable between groups. Time until stable health status, length of catheterisation, and length of hospital stay were superior with XPS (p < 0.001). Early reintervention rate within 30 d was three times higher after TURP (p = 0.025); however, the overall postoperative reintervention rates were not significantly different between treatment arms. A limitation was the short follow-up.

Conclusions

XPS was shown to be noninferior (comparable) to TURP in terms of IPSS, Q_max, and proportion of patients free of complications. XPS results in a lower rate of early reinterventions but has a similar rate after 6 mo.

Trial registration

ClinicalTrials.gov, identifier NCT01218672.     

Indian council of medical research tubal sterilization with filshie clip: A multicentre study of the ICMR task force on female sterilization

Female sterilization by the application of Filshe Clip Mark IV has been studied, on a prospective multicentric basis in 869 women for a period of two years. Sixty involuntary pregnancy following ligation were reported giving a failure rate of 8.6 per 100 women at the end of 24 months. Method failures were observed to be evenly distributed throughout the period of observation except in puerperal ligation in whom majority of the pregnancies occurred after six months following ligation. Failure rate was significantly higher in post-abortal ligations as compared to interval ligations. Due to unexpectedly higher failures rate further recruitment of study subjects was discontinued. Information on the status of the clip was available in only 30 of the sixty failures and the clips were in situ in only 4 cases, indicating improper application of clips. In view of high failure rates attributable to improper clip application, the method does not appear to be suitable for programmatic conditions in our country.     

Epidemiological study of ocular trauma in an urban slum population in Delhi, India

Purpose: To study the epidemiology and clinical profile of victims of ocular trauma in an urban slum population. Materials and Methods: This cross-sectional study, conducted on 500 families each in three randomly selected urban slums in Delhi, collected demographic data for all members of these families, and clinical data for all those who suffered ocular trauma at any time, that required medical attention. Data was managed on SPSS 11.0. Results: Of 6704 participants interviewed, 163 episodes of ocular trauma were reported by 158 participants (prevalence = 2.4%, confidence interval = 2.0 to 2.7) Mean age at trauma was 24.2 years. The association between the age of participants and the history of ocular trauma was significant ( P P = 0.028). Of 6704 participants, 1567 (23.4%) were illiterate, and no association was seen between education status and trauma, when adjusted for sex and age at injury. A significant association was noted between ocular trauma and workplace (Chi-square = 43.80, P P = 0.041) and source (Chi-square = 10.88, P = 0.028) of ocular trauma. No association was found between visual outcome and the time interval between trauma and first consultation (Chi-square = 0.50, P = 0.78), between receiving treatment and the best corrected visual acuity (Chi-square = 0.81, P = 0.81), and between the person consulted and blinding ocular trauma (Chi-square = 1.88, P = 0.170). Conclusion: A significant burden of ocular trauma in the community requires that its prevention and early management be a public health priority.