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Peritoneal dialysis (PD) is an effective treatment for end-stage renal disease. There are several techniques of percutaneous PD catheter placement including trocar or Seldinger techniques. Placement can be performed with fluoroscopy and/or sonography or as a blind percutaneous procedure. Historically, percutaneous PD catheters have been placed in patients even if they had prior abdominal surgeries. The outcomes of percutaneous PD catheter placement in patients with complex abdomen (patients with two or more abdominal surgeries or known adhesions) are unknown. This study was carried out to determine the outcomes of percutaneous PD catheter placements using Seldinger technique with sonography and fluoroscopy in patients with complex abdomen. Preprocedure sonography was also used to identify site of adhesions and blood vessels. The goal was to see if ultrasound and fluoroscopy would support placement of PD catheters in patients with complex abdomens. There were total of 10 catheter placements in 10 patients with complex abdomen. The initial success rate was 100%. The patients had an average of 2.8 abdominal surgeries. The mean BMI was 28.4. There were no incidences of perforation or failed placements. One catheter was replaced due to outflow failure and one patient discontinued PD due to peri-catheter leak. One year catheter survival was 80%. Our study demonstrates benefits of using ultrasonography and fluoroscopy during percutaneous PD catheter placement by the Seldinger technique in patients with complex abdomen.

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StructureNo. R R' Dock score 4-Br 4-CF3 -7.966 4-Br 3-CF3 -7.966 4-OH 3-CF3 -7.921 138 4-Cl 2-Cl -7.893 3 H 3-CF3 -7.851 172 2-OH 2-OH -7.812 4-OH 4-CF3 -7.686 4-OH 4-CH3 -7.595 137 4-Cl H -7.443 4-OH 4-F -7.438 184 2-OH 2,3-di F -7.399 158 4-Cl 2,4-di F -7.354 175 2-OH 4-CH3 -7.353 145 4-Cl 2-OH -7.315 4-OH 3-OH -7.278 4-Br H -7.277 166 2-OH 3-CF3 -7.273 180 2-OH 4-Br -7.265 171 2-OH 4-OH -7.198 4-Br 2-OH -7.191 4-Br 3,4-di Cl -7.161 2-Cl 2-OH -7.147 4-Br 2,3-di F -7.111 154 4-Cl 2-Br -7.075 4-Br 2,3-di Cl -7.072 4-OH 4-Br -7.068 H 2,3-di F -7.035 2-Cl H -7.005 170 2-OH 4-OCH3 -6.976 153 4-Cl 4-Br -6.967 H 2-NO2 -6.954 4-OH 2-OH -6.911 H 3-OH -6.907 150 4-Cl 2-Pyridyl -6.884157 4-Cl 2,3-di F -6.77 139 4-Cl 3-CF3 -6.765 4-OH 2,3-di Cl -6.755 144 4-Cl 4-OH -6.753 2-Cl 2-Pyridyl -6.738 161 4-Cl N-Methyl piperazine -6.715 155 4-Cl 3-OH -6.715 2-Cl 2,3-di Cl -6.712 165 2-OH 2-Cl -6.709 4-OH 4-OH -6.708 4-Br 2-Cl -6.692 4-Br 2,4-di F -6.683 141 4-Cl 3,4-di Cl -6.682 H 2,4-di F -6.669 140 4-Cl 4-Cl -6.66 H 2-Pyridyl -6.649 4-Br 3-OH -6.645 147 4-Cl 2-CH3 -6.641 163 4-Cl Pyrrolidine -6.64 156 4-Cl 4-CF3 -6.633 189 2-OH N-Ethyl piperazine -6.631 2-Cl 4-OCH3 -6.627 159 4-Cl 2-NO2 -6.611 2-Cl 3-Cl -6.598 4-Br 4-Cl -6.594 4-OH H -6.592 H 2-Br -6.588 1 H H -6.583 4-Br 2-Pyridyl -6.582 2 H 2-Cl -6.568 H 2,3-di Cl -6.568 107 2-Cl N-Methyl piperazine -6.562

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Background: Diabetes, a metabolic disease occurs due to decrease or no effect of insulin on blood glucose level. Current oral medication stimulates insulin release, increase glucose absorption and its utilization as well decrease hepatic glucose output. Two major incretin hormones like Glucose dependent insulinotropic polypeptide (GIP) and glucagon like peptide – 1 (GLP -1) stimulate insulin release after meal but their action is inhibited by enzyme dipeptidyl peptidase- IV. Objective: The activity of endogenous GLP-1 and GIP prolong and extend with DPP IV inhibitors which are responsible for stimulation of insulin secretion and regulate blood glucose level. DPP IV inhibitors have shown effectiveness and endurability with neutral effect on weight as well as less chances of hypoglycemia in management of type 2 diabetes. These journeys have been started from Sitagliptin (marketed in 2006) to Evogliptin (marketed in 2015, Korea). Conclusion: Treatment of type 2 diabetes includes lifestyle changes, oral medications, and insulin. Newer and superior therapies are required than presently prescribed drugs. Various heterocyclic derivatives have been tried but due to masking of DASH proteins, CYP enzymes and hERG channel, they showed side effects. Based on these, study has been focused on the development of safe, influential, selective and long-lasting inhibitors of DPP IV.