Outpatient ureteric stent removal following kidney transplantation.

During a kidney transplant, a plastic tube (stent) is placed in the ureter, connecting the new kidney to the bladder, in order to keep the new join open during the initial phase of transplantation. The stent is then removed after a few weeks via a camera procedure (cystoscopy), as it is no longer needed. The present study compared performing this in the operating theatre or in clinic for transplanted patients using a new single-use type of camera with an integrated grasper system. The results have shown that it is safe and cost-effective to do this in clinic, despite patients being susceptible to infection after transplantation.

Aerosols optical depth and Ångström exponent over different regions in Garhwal Himalaya, India.

Aerosol optical depth (AOD) and Ångström exponent (AE) are observed to be important parameters in understanding the status of ambient aerosol concentration over a particular location and depend not only upon the local but also on the large-scale dynamics of the atmosphere. The present article analyses the AOD and AE parameters retrieved with Moderate Resolution Imaging Spectrometer (MODIS) and Multi-angle Imaging Spectro-Radiometer (MISR) instruments onboard satellites, for the upper (Chamoli) and foothill (Dehradun) regions of Garhwal Himalaya in Uttarakhand, India, from 2006 to 2015. Aerosol properties are investigated at monthly, seasonal, and annual scales. The monthly mean values of MODIS-derived AOD and AE were observed to be 0.18 (± 0.14) and 1.05 (± 0.43) respectively over the Dehradun region. The seasonal maximums in AOD with MODIS and MISR were observed as 0.23 ± 0.06 and 0.29 ± 0.07 respectively in the pre-monsoon season, and the minimum values (0.099 ± 0.02) were observed in the post-monsoon season, over the Dehradun region. In contrast, in the Chamoli region, the maximum AOD (MODIS) was 0.21 ± 0.06 observed in the monsoon season and the minimum was 0.036 ± 0.007 in the post-monsoon season. Over a decade, the AE for Chamoli and Dehradun was found to vary from 0.07 to 0.17 and from 0.14 to 0.20 respectively. The median AE for Chamoli and Dehradun was found to be 1.49 and 1.47 respectively, marking the dominance of fine mode particles of anthropogenic origin. Observations show the presence of dust and polluted dust resulting from the long-range transport from the west. The comparison of AOD values from the two sensors shows a significant correlation (0.73) with slightly higher values from MISR over the year. The results obtained are important in understanding the climatic implications due to the atmospheric aerosols over the abovementioned Himalayan region of Uttarakhand, India.

Spinal canal stenosis at the level of Atlas.

We report here a rare case of high cervical stenosis at the level of atlas who presented with progressively deteriorating quadriparesis and respiratory distress. A 10-year-old boy presented with above symptoms of one-year duration with a preceding history of trivial trauma prior to onset of such symptoms. Cervical spine MRI revealed a significant stenosis at the level of atlas from the posterior side with a syrinx extending above and below. High-resolution computed tomography of the above level yielded an ill-defined osseous bar compressing the canal at the level of C(1) posterior arch, which appeared bifid in the midline. The patient was immediately taken up for surgery in view of his respiratory complaints. The child showed an excellent recovery after excision of the posterior arch of atlas and removal of the compressing osseous structure.

An unusual case of bilateral renal enlargement due to primary renal lymphoma.

Primary renal lymphoma is an uncommon variant of extranodal non-Hodgkin's lymphoma. Manifestations are usually nonspecific hematuria, fever, flank pain, and renal insufficiency. Pathological data are scanty; few reports indicate it has a very poor prognosis. We describe a child with bilateral symmetrically palpable kidneys, low-grade pyrexia, and arthralgia. Clinically, diagnosis was missed partly due to the fact that bilateral large renal tumors commonly produce asymmetric renal swelling, renal dysfunction, and hematuria which were absent in this case and partly due to rarity of the condition. However, radiological investigations combined with renal histology helped in establishing diagnosis in the present case.

Isolation and pathotyping of H9N2 avian influenza viruses in Indian poultry.

A total of 1246 faecal and tissue samples collected/received from 119 farms located in various states of India were processed for isolation of avian influenza viruses (AIV) during 2003-2004 as part of a program to monitor AIV infection in Indian poultry population. Avian influenza virus was isolated for the first time in India from poultry farms with history of drop in egg production, respiratory illness and increased mortality in Haryana state. A total of 29 H9N2 AIV isolates were obtained from the states of Punjab, Haryana, Uttar Pradesh, Gujarat, and Orissa and Union Territory Delhi. Subtyping was done by HI, RT-PCR and neuraminidase inhibition assay. Pathotyping of six representative isolates by intravenous pathogenicity index (0.0/3.0) in 6-8 weeks old chicken, trypsin dependency in cell culture and HA cleavage site analysis (335RSSR*GLF341) confirmed that these isolates are low pathogenic. Nucleotide sequence analysis of the HA gene showed that the Indian isolates are very closely related (95.0-99.6%) and shared a homology of 92-96% with H9N2 isolates from Germany and Asian regions other than that of mainland China. Deduced amino acid sequences showed the presence of L226 (234 in H9 numbering) which indicates a preference to binding of alpha (2-6) sialic acid receptors. Two of the six isolates had 7 glycosylation sites in the HA1 cleaved protein and the remaining four had 5 sites. Phylogenetic analysis showed that they share a common ancestor Qa/HK/G1/97 isolate which had contributed internal genes of H5N1 virus circulating in Vietnam. Further characterization of Indian H9N2 isolates is required to understand their nature and evolution.

Genetic analysis of H9N2 avian influenza viruses isolated from India.

H9N2 avian influenza viruses are endemic in domestic poultry in Asia and are grouped into three major sublineages represented by their prototype strains A/Duck/Hong Kong/Y280/97 (Y280-like), A/Quail/Hong Kong/G1/97 (G1-like) and A/Chicken/Korea/38349-p96323/96 (Korean-like). To understand the genetic relationship of Indian viruses, we determined the partial nucleotide sequence of five H9N2 avian influenza viruses isolated from chicken in India during 2003-2004 and compared them with H9N2 sequences available in GenBank. Deduced amino acid sequence analysis revealed that four isolates shared an R-S-S-R/G motif at the cleavage site of HA, representing low pathogenicity in chickens, while one virus harbors an R-S-N-R/G motif at the same position. All the viruses maintained the human-like motif 226Lysine (H3 numbering) at the HA receptor binding site. Phylogenetic analysis showed that 50% of the genes (HA, NA, NP and M) were similar to G1-like viruses, whereas the remaining genes of the Indian isolates formed a separate, not yet defined, sublineage in the Eurasian lineage. Our finding provides evidence of a novel reassortant H9N2 genotype of G1-like viruses circulating in India.

Laparoscopic orchiopexy for the intra-abdominal testis.

Laparoscopic orchiopexy was performed in 3 patients with an intra-abdominal testis. The laparoscopic approach provides better exposure of the spermatic vessels and vas deferens, and is less traumatic compared to the open procedure. In 2 patients the spermatic vessels were dissected after incising the posterior peritoneum but in 1 a strip of peritoneum overlying the vessels was left to avoid inadvertent damage to the spermatic vessels. The testicles could be brought down easily to the scrotum and there was no postoperative atrophy in any of the cases. Preliminary results suggest that the laparoscopic approach is a suitable, minimally invasive alternative to open exploration in patients with salvageable abdominal testes.

Retroperitoneal laparoscopic ureterolithotomy for multiple upper mid ureteral calculi.

A 30-year-old man presented with upper mid ureteral calculi and gross hydroureteronephrosis. The 4 large and 2 small calculi were removed successfully using Gaur's technique of retroperitoneal laparoscopy.

Retroperitoneal laparoscopic varicocelectomy.

Retroperitoneal laparoscopic varicocelectomy was performed in 27 of 29 patients with clinical varicoceles. Postoperative pain was minimal and all patients were discharged from the hospital within 24 hours. The technique is relatively safe and easy to learn, although identification of the internal spermatic vein may sometimes be difficult. It could become a viable alternative to the transperitoneal laparoscopic procedure in patients with pelvic adhesions or those having recurrent varicoceles due to high collaterals.

Retroperitoneal laparoscopic pyelolithotomy.

Retroperitoneal laparoscopic pyelolithotomy was successful in 5 of 8 patients using the recently described balloon technique of retroperitoneal laparoscopy. All patients were considered for this new minimally invasive procedure only on economic grounds. However, with improved technique and instrumentation, the retroperitoneal laparoscopic approach could become a practical alternative for the management of patients with medium sized pelvic stones not amenable to extracorporeal shock wave lithotripsy nor ideally suitable for percutaneous nephrolithotomy, or when both of these facilities are not available.

Laparoscopic renal biopsy via retroperitoneal approach.

Renal biopsy was performed in 17 patients using the balloon technique of endoscopy of the retroperitoneum. There was good exposure of the kidney and a sufficient amount of renal tissue was obtained in all patients with minimum postoperative morbidity. The preliminary results show that this method could become a safe and reliable alternative to open surgical biopsy.

Laparoscopic condom dissection: new technique of retroperitoneoscopy.

The laparoscopic condom dissection is an advancement on the recently described balloon dissection technique of retroperitoneoscopy. It allows a simultaneous balloon dissection and retroperitoneal laparoscopic dissection using a telescope placed inside a condom balloon. In spite of a mild masking effect by the balloon, the clarity of vision was satisfactory, and adequate dissection could be carried out in all five patients in whom the condom was placed deep to the fascia transversalis or Gerota's fascia.

PIP: The laparoscopic condom dissection technique is an advancement on the recently described Gaur balloon technique for retroperitoneal dissection. The condom device allows for controlled expansion into the required operative area. The authors describe their experience using this technique. Under general anesthesia the patient is placed in a lateral position with the kidney bridge elevated. Two techniques are then described. Using technique 1, the condom cannula is inserted deep to the fascia transversalis through a 2-cm incision, after creating a retroperitoneal space by digital dissection. In technique 2, an 11-mm trocar-cannula is inserted into the retroperitoneal space. The cannula with attached condom is then introduced through this channel. A 10-mm telescope is then inserted. The condom is then inflated to 300 mL. A fiberoptic light source may be inserted through the cannula. Superficial dissection of the retroperitoneal structures may be performed through the balloon itself. Technique 1 was performed on 5 patients with success. Technique 2 was performed on 3 patients with unsatisfactory results. In summary, laparoscopic condom dissection is a new technique that requires further evaluation.

Retroperitoneal laparoscopic nephrectomy: initial case report.

Pre-transplant nephrectomy was done in a 25-year-old man for calculous pyelonephritis using a retroperitoneal laparoscopic approach with a newly devised ligature applicator-dissector- kidney retractor.

Friedreich ataxia in Louisiana Acadians: demonstration of a founder effect by analysis of microsatellite-generated extended haplotypes.

Eleven Acadian families with Friedreich ataxia (FA) who were from southwest Louisiana were studied with a series of polymorphic markers spanning 310 kb in the D9S5-D9S15 region previously shown to be tightly linked to the disease locus. In particular, three very informative microsatellites were tested. Evidence for a strong founder effect was found, since a specific extended haplotype spanning 230 kb from 26P (D9S5) to MCT112 (D9S15) was present on 70% of independent FA chromosomes and only once (6%) on the normal ones. There was no evident correlation between haplotypes and clinical expression. The typing of an additional microsatellite (GS4) located 80 kb from MCT112 created a divergence of the main FA-linked haplotype, generating four minor and one major haplotype. A similar split was observed with GS4 in a patient homozygous for a rare 26P-to-MCT112 haplotype. These results suggest that GS4 is flanking marker for the disease locus, although other interpretations are possible.