Testicular Vein Syndrome and Its Treatment with a Laparoscopic Approach

A laparoscopic approach was found to be safe and effective for the treatment of a patient with testicular vein syndrome

Prevalence and Antibiotic Susceptibility of Gram Negative Nonfermenting bacilli Isolates Obtained from Different Clinical samples in a tertiary care hospital

Background: Non-fermenting gram-negative bacilli (NFGNB) have emerged as  an important healthcare associated pathogens . Infections caused by these bacteria are almost always secondary to some predisposing factors in patients such as burns, prolonged antimicrobial therapy, immunosuppression etc. The aims and objective  of the study was to isolate, identify and characterize the prevalence of NFGNB along with their antimicrobial sensitivity pattern among the patients attending a tertiary care centre in north India. Materials and Methods This Prospective study was conducted between  October 2018 to December 2018 in the Department of Microbiology, Patna Medical College, Patna. A total of 1131 clinical samples were collected from patients admitted in ICU and various wards of the hospital. All the samples were collected and processed and identified as per standard microbiological guidelines.. Isolates which produced an alkaline/alkaline (K/K) reaction were provisionally identified as non-fermenters and were included in this study Antimicrobial susceptibility testing was performed by Kirby Bauer disc diffusion method on Mueller Hinton agar as per CLSI guidelines using commercially available discs.Results: A Total of 143 NFGNB were isolated from 1151culture positive clinical samples accounting for an isolation rate of 12.42% . 92 (64.33%) isolates were obtained from male patients and 51(35.66%) were isolated from female patients. Maximum NFGNB 53 (37.06%) were obtained from age group of 41 to 60 years..  58 (40.55%) NFGNB isolates were obtained from high-risk areas. Urine was the most common specimen (28.67%) . Acinetobacter baumannii was the predominant isolate, 68 (47.55%) followed by Pseudomonas aeruginosa 63 44.05%) and Burkholderia cepacia complex 7 (4.89%). P. aeruginosa, A. baumannii and  A. lwoffii  isolates were 100% sensitive to polymyxin B and colistin, 74.6% sensitivity was reported towards imipenem and  meropenem ,while  less sensitivity was reported towards cephalosporins.  A. baumannii isolates showed 43 (63.2%)  to Imipenem  and  meropenem. B. cepacia showed very good sensitivity (100%) towards cefepime , imipenem (100%) , meropenem (100%), Cotrimoxazole (100%) and Piperacillin-tazobactum (71.4%). S. maltophilia were resistant towards ceftazidime, cefepime.Conclusion: It may be concluded that growth of NFGNB cannot be underestimated. NFGNB are now emerging as important pathogens causing a wide range of nosocomial infections. Identification of NFGNB and monitoring of their susceptibility profiles are essential due to their variable sensitivity patterns and to help in proper management of the infections . Improved antibiotic stewardship and infection control measures should be implemented to prevent nosocomial infections and spread of drug resistant

Graft nephrectomy: The SGPGI experience

Background: Graft nephrectomy is often considered a hazardous procedure with high morbidity and occasional mortality, and this may pose a technical challenge. The aim of this study was to evaluate the indications, etiology and complications following graft nephrectomy. Materials and Methods: From 1988 to 2001, among total of 1,019 live related renal transplants carried at our center, 46 underwent graft nephrectomy. Patients were divided into 2 groups depending on timing of graft re-moval. The early group included 27 patients (within 2 months of transplantation) while in late group (graft re-moval after 2 months of transplantation) there were 19 patients. The 2 groups were compared in terms of indica-tion, etiology and complications. Results: In early group the indications for graft removal were acute rejection, thrombosis/infarction and hyper-acute rejection, while in late group the indications were pain, hematuria, fever, hypertension and infection along with chronic failure. Overall, the external iliac artery in-jury occurred in I and 4 patients in early and late group respectively. Major blood loss occurred in I and 6 pa-tients in early and late graft removal respectively. There were 2 deaths in early group due to ftdminant pneumoni-tis that progressed to sepsis and disseminated intravascu-lar coagulation. There were 9 major wound infections all in early group except in 2 patients of late group. Respira-tory infections occurred in 14 patients in early group and 1 in late group. In early group patients had CNS compli-cations in form of seizures, clinical depression and delusional psychosis in 12 patients. Conclusions: Our experience highlights the risk in-volved in graft nephrectomies. Severe acute rejection and thrombosis lead to early graft nephrectomies. Pain, hematuria, infection and hypertension in setting of chronic rejection are predominant causes for the delayed graft ne- phrectomies. Early graft nephrectomy, though technically easy, is associated with systemic complications; late graft nephrectomy is technically more demanding with relatively increased risk of vascular and visceral injuries

Contemporary use of ultrasonic versus standard electrosurgical dissection in laparoscopic nephrectomy: Safety, efficacy and cost

Objective: To assess the safety, efficacy and cost-effectiveness of ultrasonic dissection (USD) compared with standard monopolar electrosurgery (ES) in laparoscopic nephrectomy (LN). Patients and methods: Retrospective analysis of patients’ records who underwent elective LN was performed. Patients were divided in to two groups: USD and ES groups depending on the energy source used during LN. The preoperative (demographics, indication for surgery), intraoperative (conversion to open surgery, operative time, estimated blood loss [EBL], complications), and postoperative (morbidity/mortality, volume of drainage, hospital stay, cost) data were collected and analysed. Results: Between February 2004 and February 2008, 136 patients were included. The indications for nephrectomy were: inflammatory (51 patients), non-inflammatory (64), and tumours (21). The two groups were similar for preoperative data. The conversion rate to open surgery (12.5%) and mean operative time did not differ significantly between the groups. However, intraoperative mean EBL was significantly less with USD, at 140.8 mL vs 182.6 mL for ES. There were no differences in postoperative parameters and morbidity. USD was significantly more expensive than ES (59 000 vs 26 000 Indian Rupees). Conclusions: ES is a safe and feasible tool like USD in LN when used with caution. USD facilitates completion of difficult cases and reduces intraoperative blood loss. However, the majority of LNs can be completed safely with ES. ES is sturdy and cheap; therefore, selective use of USD appears to be the most cost-effective policy in the developing world. Keywords: Ultrasonic scalpel, Harmonic dissection, Monopolar electrosurgery, Laparoscopic nephrectomy, Cos

Laparoscopic transperitoneal pyelopyelostomy and ureteroureterostomy of retrocaval ureter: Report of two cases and review of the literature

We report two cases of retrocaval ureter that were successfully treated by a laparoscopic transperitoneal approach. Presentation of both these cases was with flank pain. Ureteroureterostomy using an intracorporeal suture technique was performed for one, and pyelopyelostomy for the other case. Operative time was 120 min and 110 min, respectively. Pyelopyelostomy was technically easier to perform than ureteroureterostomy that required an extra fourth port insertion to facilitate dissection. With increasing experience with the intracorporeal suturing laparoscopic technique of either pyelopyelostomy or ureteroureterostomy should be the first choice for retrocaval ureter