Management of Impacted Ureteric Calculus using Ureteroscopy and Pneumatic Lithotripsy - A Prospective Study.

INTRODUCTION : Urologists have always been at the forefront of minimally invasive surgery, though for the most of 20th century, these procedures were confined to the lower urinary tract. Over the last two decades, introduction of ureteroscopic and percutaneous techniques has extended our minimally invasiveapproach to upper urinary tracts as well. This technology allows urologists to take their endoscopicexpertise as high as pyelocalyceal system, not just for the stone disease, but for a myriad of benign andmalignant process. Impacted stones in the Ureter are difficult to treat as compared to non impacted stones. Impacted stones are those which tend to stay at the same site over a long period of time. The successrate of ESWL is reported to be quite low in such cases and role of ureteroscopic approach is still beingchallenged for impacted ureteric calculi. In addition, although new lithotripsy instruments such aslaser have been developed, the question of optimal treatment for impacted ureteric calculi remainscontroversial. In the present study, we did a prospective evaluation of the effectiveness of ureteroscopic pneumatic lithotripsy for impacted ureteric calculi. AIMS AND OBJECTIVES : To assess the outcome of ureteroscopy and pneumatic lithotripsy for impacted uretericcalculus. To analyse the factors influencing success of ureteroscopy and pneumatic lithotripsy forimpacted ureteric calculus. To evaluate the immediate complications of ureteroscopy for impacted ureteric calculus. MATERIALS AND METHODS : All patients who came to the our outpatient department between November 2004 and January 2007 with history of loin pain and a diagnosis of ureteric calculus were evaluated for the study and taken upfor ureteroscopy after obtaining informed consent. Patients in whom, the guide wire could not benegotiated beyond the calculus at initial attempts were included in the study. Patients with retrocaval ureter, previous history of ureteric stricture, or obstructive megaureter, ordiabetes and patients with recent evidence of urosepsis were excluded from the study. Patients were analyzed with a devised proforma and the clinical findings and investigation findingswere recorded.Diagnosis of ureteric calculus was confirmed in all patients with USG, x ray KUB and IVP and patientswere sub classified accordingly.Ureteroscopy was done with a Wolf 8-9.8 Fr ureteroscope with a 250W Halogen light source, with asingle chip video camera. Pneumatic lithoclast, with 1 mm probe was used for lithotripsy. For those patients in whom ureteroscopy & lithotripsy was unsuccessful were subsequently managedwith ESWL or Open ureterolithotomy.5 F double J stent was kept as and when necessary, and it was removed at the end of 2 weeks after ensuring complete stone clearance. CONCLUSION : Ureteroscopy with pneumatic lithotripsy is efficacious in the management of impacted uretericcalculus. Size and location of the stone are the factors, which influence the success of ureteroscopy. Ureteroscopy is safe with minimal complications, in the management of impacted ureteric calculus

Percutaneous nephrostomy, feasibility of mid and anterior axillary line approach and its complications: an experience

Background: Nephrostomy performed as an emergency procedure to drain the obstructed calyceal system is a lifesaving procedure. Posterolateral approach is usually done to access the avascular plane of Brodel to avoid hemorrhage. This study evaluates the feasibility and complications in percutaneous nephrostomies placed at mid and anterior axillary line entry sites as it was found to be easier approach.Methods: A prospective study with 126 percutaneous nephrostomies performed with Ultrasound guidance, using single puncture technique and 8.5F pigtail catheter.  The complications rates were analyzed according to WHO guidelines. Results: The technical success rate was 98.4%. Three hemorrhagic complications (2.38%) were recorded without any major interventions. Increased incidence (11.9%) of transient hematuria was observed with five cases (3.9%) of infection at entry site. One case (0.79%) of peritoneal breech recorded with no significant intraperitoneal collection. Conclusions: Placement of Percutaneous Nephrostomy tube at mid or the anterior axillary line appears to be a feasible and easy approach, as its complications rates are within acceptable limits with an advantage of increased patient comfort

Structure of poly(propyl ether imine) (PETIM) dendrimer from fully atomistic molecular Dynamics Simulation and by Small Angle X-ray scattering

We study the structure of carboxylic acid terminated neutral poly (propyl ether imine) (PETIM) dendrimer from generation 1 through 6 (G1-G6) in a good solvent (water) by fully atomistic molecular dynamics (MD) simulations. We determine as a function of generation such structural properties as: radius of gyration, shape tensor, asphericity, fractal dimension, monomer density distribution, and end-group distribution functions. The sizes obtained from the MD simulations have been validated by Small Angle X-Ray Scattering (SAXS) experiment on dendrimer of generation 2 to 4 (G2-G4). A good agreement between the experimental and theoretical value of radius of gyration has been observed. We find a linear increase in radius of gyration with the generation. In contrast, Rg scales as ~ N^x with the number of monomers. We find two distinct exponents depending on the generations: x = 0.47 for G1-G3 and x = 0.28 for G3-G6 which reveals their non-space filling nature. In comparison with the amine terminated PAMAM dendrimer, we find Rg of G-th generation PETIM dendrimer is nearly equal to that of (G+1)-th generation of PAMAM dendrimer as observed by Maiti et. al. [Macromolecules,38, 979 2005]. We find substantial back folding of the outer sub generations into the interior of the dendrimer. Due to their highly flexible nature of the repeating branch units, the shape of the PETIM dendrimer deviates significantly from the spherical shape and the molecules become more and more spherical as the generation increases. The interior of the dendrimer is quite open with internal cavities available for accommodating guest molecules suggesting using PETIM dendrimer for guest-host applications. We also give a quantitative measure of the number of water molecules present inside the dendrimer.Comment: 33 page

2-Amino-1-(3-sulfonato­prop­yl)pyridinium monohydrate

In the title compound, C8H12N2O3S·H2O, inter­molecular O—H⋯O and N—H⋯O hydrogen bonds and weak C—H⋯O inter­actions, which form R 1 2(6) and R 2 2(12) ring motifs, link the components into a three-dimensional network

Synthesis of large generation poly(propyl ether imine) (PETIM) dendrimers

Large generation poly(propyl ether imine) (PETIM) dendrimers are synthesized in iterative synthetic cycles of two reductions and two Michael addition reactions. Dendrimers up to sixth generation, containing up to 128 peripheral functionalities, are synthesized. Growth of the PETIM dendrimers, possessing a tertiary amine as the branch juncture and an ether as the linker component, is assessed systematically by routine spectroscopic methods. The peripheries of these dendrimers possess either alcohols, amines, carboxylic acids, esters, or nitriles, thereby opening up possibilities for varied studies involving PETIM dendrimers

Synthesis of large generation poly(propyl ether imine) (PETIM) dendrimers

Large generation poly(propyl ether imine) (PETIM) dendrimers are synthesized in iterative synthetic cycles of two reductions and two Michael addition reactions. Dendrimers up to sixth generation, containing up to 128 peripheral functionalities, are synthesized. Growth of the PETIM dendrimers, possessing a tertiary amine as the branch juncture and an ether as the linker component, is assessed systematically by routine spectroscopic methods. The peripheries of these dendrimers possess either alcohols, amines, carboxylic acids, esters, or nitriles, thereby opening up possibilities for varied studies involving PETIM dendrimers