Aim:Radiocephalic arteriovenous fistula (AVF) at wrist is the vascular access of choice for dialysis. In the absence of a suitable vein at the wrist, a brachiocephalic fistula at elbow is usually constructed. In order to avoid the complication of vascular steal syndrome associated with the brachiocephalic fistula, an alternative operative technique involving the creation of radio-median cubital vein / radiocephalic fistula at elbow was evaluated.Settings and Design:Retrospective study.Materials and Methods:Between January 1990 and October 2005, 320 patients underwent creation of radio-median cubital vein / radiocephalic AVF at elbow as a primary procedure or following failure of a fistula at the wrist. A transverse skin incision was made 4cm below the elbow crease, centering in line with the brachial artery pulsation. The median cubital vein / cephalic vein was anastomosed to the radial artery in end to side fashion. The surgical complications and patency of the fistulae were analyzed in the immediate and late postoperative period.Results:Mean operative time was 55 ± 7.15 min. There were no major intraoperative complications. Immediate patency and a palpable distal radial pulse were present in all the patients. Mean time to fistula maturation was 26 ± 5.2 days. No patient developed a vascular steal syndrome at a median follow-up of 54 months (range 12–168 months) Early fistula failure was seen in 16 (5%) patients whereas eight (2.5%) fistulas failed at a later date. Pseudoaneurysm of the arterialized vein at the fistula site developed in only one (0.3%) patient. Pseudoaneurysm proximal to the anastomosis developed in three (0.9%) patients. Sixteen (5%) patients requested for closure of the fistula following successful renal transplant due to unsightly dilated veins and continuous noisy murmur disturbing their sleep.Conclusions:The radio-median cubital vein / radiocephalic AV fistula at elbow is safe and is a better vascular access procedure for hemodialysis than brachiocephalic fistula because it leads to the dilatation of both the cephalic and the basilic veins with no incidence of vascular steal phenomenon in our experience. Patency and flow rates are similar to brachiocephalic fistula.

No abstract

Objective:Previous pharmacokinetic studies have demonstrated bioequivalence of Imusporin (microemulsion preparation of cyclosporine, Cipla) to the innovator product Neoral (Novartis, Switzerland). This study was done to evaluate the clinical efficacy and safety of Imusporin in patients who have already undergone renal transplant and have stable graft function maintained on cyclosporine preparation other than Imusporin.Materials and Methods:Twenty-two renal allograft recipients (mean age of 31.77 years, range 18-53 years), with stable graft function, previously on Neoral or Bioral were switched over to Imusporin after recording their relevant baseline clinical and biochemical parameters. These were repeated on 1, 4, 7, 15, 30 and 90 days after the start of therapy. Change in dosage required to maintain C2 levels at each visit were analyzed by paired sample t-test. Safety of the drug was assessed by the type and severity of adverse events developed during the therapy. Cost analysis was done assuming an average maintenance immunosuppression dose of 150 mg/day of cyclosporine.Results:Twenty-one patients completed the study. One patient was lost to follow-up. Mean C2 value before switchover was 894 ± 208 ng/ml, which was not significantly different from the mean values of C2 after switchover therapy (P>0.30). Change in dosage required to maintain C2 levels was not significantly different from the baseline dose of 2.34 mg/ kg body weight (P>0.1). No patient developed graft rejection after switchover therapy at a median follow-up of 16 months (14-18 months). Mean baseline SCr was similar to SCr at day 90 (1.38 vs. 1.37 mg/dl, P=0.930). No severe adverse events were reported. Mild side-effects included headache (4), somnolence (2), dry mouth (5) and generalized fatigue (6). Use of Imusporin (Cipla, India) results in an annual savings of Rs. 19892 over Neoral (Novartis, Switzerland) and Rs. 2263 over Bioral (Panacea Biotech, India).Conclusions:Imusporin is clinically as safe and efficacious as other cyclosporine preparations available while significantly reducing the cost of treatment.

Aim:To present our experience of laparoscopic nephrectomies done for benign and malignant conditions; and the impact of learning curve on outcome.Settings and Design:Retrospective study.Materials and Methods:Between January 2000 and September 2006, 396 laparoscopic nephrectomies were performed at our institute for various benign and malignant conditions. These included 250 simple nephrectomies, 48 nephroureterectomies, 95 radical nephrectomies, two partial nephrectomies and one hemi-nephrectomy. For the purpose of self-evaluation, we have divided our experience into two groups. Group 1 (learning phase) comprised the first 100 cases; Group 2 (consolidation phase) comprised cases performed after the initial learning phase. Retrospective evaluation of the case records was done to evaluate the differences in the operative and postoperative outcome.Statistical Analysis Used:Student's ‘t’ test using SPSS 14.0 software.Results:Demographic profile of the patients and relative indications of procedures performed were similar in the two groups. Mean operative time in Group 1 was 262 ± 37 min, which reduced to 184 ± 44 min in Group 2 (P<0.001). Mean operative blood loss was 310 ± 58 ml and 198 ± 88 ml (P<0.001); and blood transfusion was required in 38% and 13.5% of patients (P<0.001) of Group 1 and Group 2 respectively. There was a significant reduction in the intraoperative and postoperative complications from 16% in Group 1 to 3.4% in Group 2 (P<0.001). Similarly, conversion to an open procedure was required in 17% cases of Group 1 and 5.4% cases of Group 2 (P<0.01).Conclusions:Laparoscopic nephrectomy is a viable option which can be performed safely with increasing experience.

Objective:To report our experience in managing various benign and malignant renal tumors with nephron-sparing surgery.Materials and Methods:Records of patients who underwent nephron-sparing surgery (NSS) either through open or laparoscopic approach between May 1997 and June 2006 at our institution were reviewed. Patient and tumor-related characteristics, treatment modality and complications were noted.Results:There were 26 patients (29 renal units), including three with bilateral lesions who underwent nephron-sparing surgery. Mean age at surgery was 47.0 years (range 16-67 years). Mean tumor size was 4.7 cm (range 2-7.5 cm). Mean warm ischemia time was 41 min and 32.5 min, operative time 158 min and 186 min and blood loss 200ml and 85 ml in open (n=24) and laparoscopic approach (n=2) respectively. Complications were seen in five (19.2%) patients of whom two had postoperative bleeding requiring nephrectomy in one and angioembolization in another. One patient with persistent urinary leak required intervention. Local wound infection in one patient and incisional hernia in another were surgically managed. Histopathological profile revealed 13 (44.8%) benign lesions which included angiomyolipoma (eight), simple cyst (two), cortical adenoma (one), metanephric adenoma (one) and myelolipoma (one). The remaining 16 (55.2%) malignant lesions included renal cell carcinoma (15) and metastatic adenocarcinoma (one). At a mean follow-up of 38.6 months (range 1-91) no patient had local recurrence or distant metastasis. Cancer-specific survival was 100% and overall survival was 92.3%.Conclusions:Nephron-sparing surgery is a safe and effective alternative to nephrectomy in both benign and malignant lesions of the kidney.

No abstract

Introduction: Traditionally, cephalometric analysis has been carried out using a hand-tracing manual method. In imaging, picture archiving and communication systems (PACS) are information management systems used for the capture and measurement of medical and dental radiographs. Although not customized for lateral cephalometry, this study aimed to evaluate the cephalometric measurements made on screen with Nemoceph NX 2006 software using PACS compared with the conventional hand-tracing method. Material and methods: All the subjects were positioned in the cephalostat with the sagittal plane at right angles to the path of the X-rays and to the Frankfort plane parallel to the floor. That digital cephalogram was sent to printer via Image Dent software to print the hard copy through Laser printer and it is also transferred to the personal computer of Department of Orthodontics and Dentofacial Orthopaedics by PACS (picture archiving and communication systems) method. Results: In this study the total time taken in manual tracing is 30 min, while digital tracing takes around 35 min. So, Time taken in manual tracing is less than digital tracing that might be because only few parameters has been included in this study. The results showed no statistically significant differences in any of the assessed measurements (p> 0.05). Conclusion: Conventional and computerized methods showed consistency in all angular and linear measurements. The computer program Nemotech dental studio NX 2006 can be used reliably as an aid in diagnosing, planning, monitoring and evaluating orthodontic treatment both in clinical and research settings.

No abstract