A Comparative Study of Continuous Versus Interrupted Suturing Technique in Creating a Vascular Access for Hemodialysis: An Institutional-Based Experience.

Background Arteriovenous fistulas (AVFs) are considered the first and best access for patients with end-stage renal disease who need permanent vascular access for hemodialysis over arteriovenous grafts and central venous catheters for reasons that have been well-established. Poor early patency rates pose the biggest challenge in creating vascular access as they cause increased morbidity and economic/psychological concerns among patients. To minimize such effects, it is critical to use a patient-centered approach and carefully choose patients for AVF access creation. This study aimed to compare the primary patency of distal vascular access provided by continuous suturing versus that provided by interrupted suturing. Methodology This prospective study was conducted in the urology department of a superspecialty, tertiary care center from November 2021 to November 2022. Patency was assessed immediately after surgery (on the table), one month later, and six months later by palpating thrill and auscultating bruit. A total of 50 patients between the ages of 18 and 70 years who met the inclusion criteria were randomly assigned to two groups of 25 each. Results The baseline characteristics of both groups were comparable. At six months (p = 0.09), the continuous suturing group was observed to be somewhat better than the interrupted suturing group, with no significant difference in immediate and one-month patency rates. When compared to the continuous suturing group, the primary patency failure rate was significantly higher in the interrupted suturing group. Conclusions Thus, under appropriate circumstances, continuous sutures can be performed with greater ease, resulting in anastomosis that is as patent as that performed with interrupted sutures.

Assessing the environmental impact due to photolytic degradation of ethane-bis(pentabromophenyl) in plastics.

Photolytic degradation of brominated flame retardants is one of the potential decomposition pathways in the environment, and for some flame retardants such as ethane-bis(pentabromophenyl) (EBP), also called decabromodiphenyl ethane, there are concerns that degradation products may be harmful. In this paper, we present photolytic studies of EBP in high-impact polystyrene (HIPS) and polypropylene impact copolymer (PP) using accelerated weatherometry. The half-life of photolytic debromination of EBP in HIPS was estimated to be more than 200 years, which can be contrasted with half-lives of minutes for photolysis conducted on dilute EBP solutions. Perhaps more importantly, there was no subsequent debromination to the octabrominated congeners or lower. No evidence of debromination was seen in PP, which confirms the importance of matrix effects. We also saw no evidence of accelerated resin photooxidation caused by EBP. These studies demonstrate that EBP is much more photolytically stable in resins than structurally-similar decabromodiphenyl ether, and a read-across comparison between the two flame retardant molecules for this degradation pathway is misleading.

A Comparative Study of Antegrade Air Pyelogram and Retrograde Air Pyelogram for Initial Puncture Access during Percutaneous Nephrolithotomy.

INTRODUCTION: Access into the collecting system is considered to be the most critical step for Percutaneous Nephrolithotomy (PCNL). AIM: The present study provides a comparative view into antegrade air pyelography and retrograde air pyelography procedures for percutaneous renal access. MATERIALS AND METHODS: A cross-sectional study was conducted on 100 patients with radiopaque renal calculi indicated for PCNL procedure. These patients were randomly assigned to two groups namely antegrade air pyelogram group (Group I) and retrograde air pyelogram group (Group II). In antegrade air pyelogram group, the collecting system was delineated by targeting the renal stone using a 22 gauge spinal needle where the patients were in the prone position. In another group, the collecting system was delineated by retrograde air pyelogram under fluoroscopy guidance. The method of tract dilatation and stone extraction were the same in both groups for comparison of outcome and complication. RESULTS: The mean age of patients was 41.7±13 and 41.4±13.6 years in Group-I and Group-II respectively. The male to female ratio in Groups I and II was 35/15 (70.00%) and 38/12 (76.00%) respectively. In Group-I the average duration of access was 2.66±1.0 minutes after prone positioning whereas it was recorded to be 19.48±5.0 minutes in Group-II, after lithotomy followed by prone positioning of the patient. Duration of radiation exposure was almost similar in both groups. Additional procedural cost was significantly higher in Group II. CONCLUSION: Our study indicated that access for PCNL using antegrade air pyelogram can be a cost-effective and acceptable alternative to retrograde air pyelogram with decreased access time.

Pediatric Percutaneous Nephrolithotomy-Experience of a Tertiary Care Center.

OBJECTIVE: To present the experience of pediatric percutaneous nephrolithotomy (PCNL) of our center. MATERIALS AND METHODS: This study was conducted from 1995 to 2015, on patients <15 years of age having renal and upper ureteral stones who underwent PCNL. Stones were classified as per Guy's stone score (GSS). Standard bull's eye technique was used for subcostal puncture. To avoid supracostal puncture, puncture was done in full inspiration or by oblique tract. If these maneuvers failed, then supracostal puncture was done. Tract was dilated to 24F. RESULTS: Six hundred sixty PCNLs were performed on 639 patients. Puncture was subcostal in 87.6% cases with tract dilated as much as 24F. Pelvicaliceal system was most commonly accessed through middle calix (73.94%). Upper caliceal puncture (23.78%) was more frequently used in complete (82.35%) and partial staghorn (51%) stones. Two tracts were made in 16 (2.42%) cases, because of large stone burden. Average operative time was significantly longer in complex (45.43 minutes) compared to simple stones (29.39 minutes). Overall success rate was 94.39%, but it was significantly lower in partial (91.37%) and complete staghorn stones (82.35%). Complications were present in 21.66% cases and were classified according to Clavien grading. Majority of patients (97.9%) had minor complications (Clavien grade 1 & 2). On multivariate analysis, GSS ≥2, stone size >200 mm2, and multiple caliceal, partial, and complete staghorn stones were predictors of failure and complications. CONCLUSION: PCNL is a minimally invasive surgical technique for removal of renal and upper ureteral stones, which have low morbidity rate, high success rate, and short hospital stay. Although the uses of smaller instruments are on the rise, procedure can still be safely performed in children using adult instruments. Supracostal approach if done cautiously does not increase morbidity rate.

Long-term Functional, Urodynamic, and Metabolic Outcome of a Modified Orthotopic Neobladder Created With a Short Ileal Segment: Our 5-year Experience.

OBJECTIVE: To assess the long-term functional, urodynamic, and metabolic outcomes of our modified neobladder. MATERIALS AND METHODS: In this prospective study from January 2010 to October 2014, 42 consecutive male patients with bladder tumor underwent radical cystectomy and orthotopic urinary diversion with modified ileal neobladder using 25 cm ileal segment. During follow-up, functional outcome, urodynamic studies, metabolic parameters, and renal parameters were assessed at regular intervals. Complications were graded as early (<3 months) or late (>3 months). RESULTS: There were no perioperative deaths. At a mean follow-up of 27.2 months, good or satisfactory daytime and nighttime continence were achieved in 100% and 93.8% of patients, respectively. Mean maximal bladder capacity was 588 mL at 3 years. Mean resting pressure and voiding pressures were 20.1 cm H2O and 34.6 cm H2O at 3 years, respectively. Good bladder compliance was achieved in all patients by 1 year. Mean maximum urine flow rate (Qmax) was 18.5 mL at 3 years. Postvoid residual volume was insignificant in all the patients and none of the patients were on clean intermittent self-catheterization. None of the patients developed severe metabolic acidosis. Vitamin B12 levels were within normal range in all patients. Early complications were seen in 12 patients (28.6%), whereas late complications were observed in 5 patients (12%). CONCLUSION: Our results demonstrate that our modified technique of using a short ileal segment to create a near-spherical, compliant, low-pressure reservoir provides an acceptable, safe, and functional alternative to the standard Hautmann neobladder.

Retro-renal colon: role in percutaneous access.

INTRODUCTION: Upper urinary tract is accessed for various procedures. The maximum numbers of procedures are carried out in prone position. Perforation of the colon is a well-known complication. The incidence of retrorenal colon varies from 10-20% in prone position, but the chances of injury is around <1%. These facts lead us to review the occurrence of retrorenal colon. The CT scan is imaging test of choice. OBJECTIVE: The aim of this study was to find out the occurrence of retrorenal colon at our centre and potential risk of injury to colon when kidney is punctured at various levels by percutaneous route. MATERIALS AND METHODS: It is a hospital-based descriptive type of observational study. We reviewed CT abdomen in supine and prone position in patients with different problems from January 2013 to December 2013. Inclusion and exclusion criteria applied. Colon posterior to the line as described by Prassopoulos and coworkers is regarded as retrorenal colon and being at risk. RESULTS: A total number of 700 patients were included, 350 each in supine and prone position. Patients had CT scan as a part of workup for pain abdomen in 27% cases, calculus disease in 25% cases, carcinoma bladder in 16% cases and rest were of different diagnoses. Retrorenal colon was found in 2% patients in supine and 6.8% patients in prone position. CONCLUSION: Considering the low incidence, the sample size in our study is small. We recommend multicentric large population-based study to establish the true incidence of retrorenal colon and chances of injury to colon.

Occult renal cell carcinoma manifesting as nasal mass and epistaxis.

Metastasis of renal cell carcinoma (RCC) to the nasal cavity and paranasal sinuses is rare, with fewer than 50 cases described in the literature. Nasal metastasis as the initial presentation of RCC is even rarer. Metastases to the nasal cavity usually represent advanced disease with poor outcome. The authors report a case of metastatic RCC presenting with right nasal cavity mass and epistaxis, followed by a brief review of the relevant literature.

Xylanase and laccase based enzymatic kraft pulp bleaching reduces adsorbable organic halogen (AOX) in bleach effluents: a pilot scale study.

In present study, xylanase and laccase were produced in a cost-effective manner up to 10 kg substrate level and evaluated in elemental chlorine free bleaching of Eucalyptus kraft pulp. Compared to the pulp pre-bleached with xylanase (15%) or laccase (25%) individually, the ClO2 savings were higher with sequential treatment of xylanase followed by laccase (35%) at laboratory scale. The sequential enzyme treatment when applied at pilot scale (50 kg pulp), resulted in improved pulp properties (50% reduced post color number, 15.71% increased tear index) and reduced AOX levels (34%) in bleach effluents. The decreased AOX level in effluents will help to meet AOX discharge limits, while improved pulp properties will be value addition to the paper.

Sigmoid orthotopic neobladder after radical cystectomy for bladder tumour: an Indian experience.

OBJECTIVE: To determine the long-term results of constructing a sigmoid neobladder after radical cystectomy for transitional cell carcinoma (TCC) of the urinary bladder. PATIENTS AND METHODS: The study included 170 patients with TCC of the bladder and a normal sigmoid colon. After radical cystectomy the neobladder was formed by completely detubularizing an isolated sigmoid colon segment. Subsequently patients were followed by clinical, biochemical, radiological and urodynamic assessments. RESULTS: Four patients died soon after surgery; the neobladder-related delayed complications were death in three patients, loss of five renal units, and electrolyte imbalance in five patients. Uretero-intestinal anastomotic narrowing was another frequent delayed complication. Most (97%) patients had nocturnal incontinence, and most voided with a good stream with a minimal postvoid residual urine volume. CONCLUSION: The sigmoid neobladder, despite some limitations, is the best option for diverting urine after radical cystectomy.