Prospective study comparing the safety and efficacy of totally tubeless percutaneous nephrolithotomy vs standard percutaneous nephrolithotomy

Background: To evaluate the feasibility and safety of totally tubeless percutaneous nephrolithotomy (PCNL) Vs standard PCNL.Methods: From August 2014 to January 2016, 66 patients underwent PCNL in our institute. Of this group, 35 patients underwent traditional nephrostomy drainage following PCNL. A tubeless procedure was performed in the remaining 31 patients. These  groups were compared with respect to age, stone burden, intraoperative events, postoperative pain, analgesic requirements, soakage, postoperative change in hemoglobin, hospitalization time and complication rates.Results: Two groups were comparable with respect to age, stone burden (2.03 cm Vs. 2.12 cm) and intraoperative events. The mean pain score (day2 - 4.95 vs. 2.95) (day3 - 4.33 vs. 1.44) and analgesic requirement (mg diclofenac) (day2 - 140.22 vs. 65.31) (day3 - 124.44 vs. 43.89) was significantly less for group 2 on day 2 and 3. There was significant problem of soakage from nephrostomy tract in group 1. Patients in group 2 returned faster to normal activities but there was no difference found in drop in hemoglobin, complication rates even in subset of patients with large stone burden. No patient required readmission in the follow-up for pain, obstruction or infection in group 2. One patient developed urinoma which resolved conservativelyConclusions: In selected cases totally tubeless PCNL is feasible and safe

Predictors of malignancy in pancreatic head mass: a prospective study

A prospective study of patients presented with pancreatic head mass was conducted in a tertiary care referral hospital, Manipal, India from May 2006 to November 2008. The study population was divided into malignant and benign groups based on the final histopathology report. A univariate and multivariate analysis of potential predictive factors for malignancy were conducted. Results: A total of 102 patients with pancreatic head mass were included in the study after fulfilling the inclusion/exclusion criteria. 78 were malignant and 24 were benign. There was significant weight loss (p<0.001) and high mean bilirubin levels (p=0.002) in the malignant group. Mean CA 19-9 was significantly higher in the malignant group (290.7 vs. 30.3 U/ml; p<0.001). Sensitivity and specificity of CA 19-9 for detecting malignancy in pancreatic head mass at a cut off of 35U/ml was 86% and 79% respectively. CA 19-9 positivity rate was higher with increasing cut off values of 100, 200 and 300U/ml but such high levels occurred in fewer patients. All the non-jaundiced patients (100%) with raised CA 19-9 levels were found to be malignant compared to 86% malignancy in jaundiced patients. In multivariate analysis, a combination of weight loss > 10% of body weight and bilirubin > 3 mg/dl and CA 19-9 > 35U/ml had specificity and positive predictive value of 100% for predicting malignancy in pancreatic head mass. Conclusion: The presence of weight loss and jaundice and raised CA 19-9 levels together in a patient with pancreatic head mass can be predictive of malignancy. A very high CA 19-9 level can be an indicator of malignancy in a pancreatic head mass. A raised CA 19-9 level may be more predictive of malignancy in non-jaundiced patients than in jaundiced patients.Key words: Pancreatic Carcinoma, CA 19-9 Antige

Prospective study comparing the safety and efficacy of totally tubeless percutaneous nephrolithotomy vs standard percutaneous nephrolithotomy

Background: To evaluate the feasibility and safety of totally tubeless percutaneous nephrolithotomy (PCNL) Vs standard PCNL.Methods: From August 2014 to January 2016, 66 patients underwent PCNL in our institute. Of this group, 35 patients underwent traditional nephrostomy drainage following PCNL. A tubeless procedure was performed in the remaining 31 patients. These  groups were compared with respect to age, stone burden, intraoperative events, postoperative pain, analgesic requirements, soakage, postoperative change in hemoglobin, hospitalization time and complication rates.Results: Two groups were comparable with respect to age, stone burden (2.03 cm Vs. 2.12 cm) and intraoperative events. The mean pain score (day2 - 4.95 vs. 2.95) (day3 - 4.33 vs. 1.44) and analgesic requirement (mg diclofenac) (day2 - 140.22 vs. 65.31) (day3 - 124.44 vs. 43.89) was significantly less for group 2 on day 2 and 3. There was significant problem of soakage from nephrostomy tract in group 1. Patients in group 2 returned faster to normal activities but there was no difference found in drop in hemoglobin, complication rates even in subset of patients with large stone burden. No patient required readmission in the follow-up for pain, obstruction or infection in group 2. One patient developed urinoma which resolved conservativelyConclusions: In selected cases totally tubeless PCNL is feasible and safe