RESULTSIn all, 102 patients underwent radical cystectomy with orthotopic neobladder reconstruction in the study period; their mean (range) follow-up was 73 (36-144) months. Neobladder substitution was with an ileocaecal segment in 35 patients, sigmoid colon in 34 and ileum in 33. Early complications occurred in 32 patients (31%) although open surgical intervention was required in only nine (9%). The death rate after surgery was 3.9%. Late complications occurred in 31 patients (30%) and were primarily caused by uretero-enteric and vesico-urethral strictures (9% each). Most patients had daytime (89%) and night-time (78%) continence. The mean maximum pouch capacity (mL) and pouch pressure at capacity (cmH 2 O) were 562.5 and 23 (ileocaecal), 542 and 17.8 (sigmoid) and 504 and 19.1 (ileal), respectively; the mean postvoid residual was 29, 44 and 23 mL, respectively. Nine patients with ileocaecal neobladders, and 20 and seven with sigmoid and ileal neobladders, required clean intermittent catheterization. Twentyfour patients had recurrence of disease, of whom 20 died. CONCLUSIONSOrthotopic neobladder reconstruction requires complex surgery but has an acceptable early and late complication rate in properly selected patients. It provides satisfactory continence without compromising cure rates.

Objective To report the experience in one centre of the efficacy and safety of retroperitoneal laparoscopic procedures (RLPs procedures (90.6%). The operative duration was 0.5-5.5 h, depending on the difficulty of the procedure and the presence or absence of adhesions. The overall incidence of complications was 12.9%, but decreased to 9% for the last 100 procedures. There were only five major complications, e.g. avulsion of the ureter, torn renal pelvis, colonic injury and severe hypotension, but none were related to balloon dissection. The mean blood loss was 37.7 mL and the reason for transfusion in three patients was not operative blood loss but displacement of the ligature in two and severe hypotension after removing a phaeochromocytoma in one. The mean duration of analgesic use was 2.5 days, the hospital stay 3 days and return to work 14 days. Conclusion Retroperitoneal laparoscopy using the balloon technique is a reasonably safe, efficient and reliable minimally invasive procedure. The efficiency, efficacy and safety of RLPs depend more on experience than on the type of access technique, type of balloon or medium used to inflate the balloon. Balloon rupture causes no tissue damage, and expansion to < 800 mL in adults is safe if the retroperitoneal space has not previously been invaded. The use of nitrous oxide for pneumo-insufflation in the retroperitoneal space is safe if proper precautions are taken.

Our 10-year experience of retroperitoneal laparoscopic pyelolithotomy, a rarely performed minimally invasive operative procedure, is presented. The results are compared with our own experience of percutaneous nephrolithotomy for larger renal stones. Forty-two patients with a mean age of 39.12 years underwent 43 retroperitoneal laparoscopic pyelolithotomies using Gaur's balloon technique. The total number of stones was 65 (44 pelvic and 21 calyceal) and they ranged in size between 5 and 48 mm. Two patients had chronic renal failure due to bilateral impacted renal calculi. Forty-eight percutaneous nephrolithotomies performed in the same unit during the last 2 years in patients with non-staghorn calculi > 2 cm were included for a comparative study. The open conversion rate and the drainage period for retroperitoneal laparoscopic pyelolithotomy were much higher. However, the operative time, blood loss, analgesic intake, hospital stay, residual stone rate, re-treatment rate and major complication rates were lower, compared with percutaneous nephrolithotomy.

<p class="abstract"><strong>Background:</strong> Recently it has been observed that psoriasis can be successfully controlled by use of vitamin D. This has attracted the curiosity into research on psoriasis and vitamin D as well as role of calcium supplements in the control of psoriasis. Studies have shown that psoriasis risk factor is hypocalcemia. The objective of the study was to analyse serum calcium levels in patients of psoriasis and correlation with severity of psoriasis in comparison with control subjects without psoriasis.</p><p class="abstract"><strong>Methods:</strong> This study recruited 80 subjects, of psoriasis (age and sex control subjects without psoriasis) attending Skin and STD department, Government Medical College Amritsar, Punjab. Both patients and controls studied during period of 2 year from June 2015 to May 2017.<strong></strong></p><p class="abstract"><strong>Results:</strong> Serum calcium levels were significantly lower in psoriasis patients than in controls. Serum calcium levels values in patients of mild severity (PASI &lt;10), moderate severity (PASI: 11-20) and severe (PASI &gt;21) were 9.00±0.20, 8.93±0.24 &amp; 8.98±0.22 respectively.</p><p class="abstract"><strong>Conclusions:</strong> Serum calcium levels were found lower in psoriasis patients and there were no correlation with severity of psoriasis. Hypocalcemia is a risk factor of psoriasis.</p>

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