Journal Issue: No 4, Issue 16, OCT-DEC, 2006
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1812-2027
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Articles
Ureteric complications following renal transplantation: An eight years experience
(Kathmandu University, 2006) BM, Shrestha; CR, Darby; RH, Moore
Objectives: Ureteric complications (UCs) following renal transplantation (RT) cause significant morbidity and
ureteric stents are employed to bridge the vesico-ureteric anastomosis with a view to preventing these complications.
The purpose of this study was to examine the incidence of UCs and outcomes following RT in both stented (STG)
and non-stented groups (NSTG) of RT patients.
Methods: This is a retrospective study of a cohort of 650 consecutive RTs [STG (N=267; 41%) and NSTG (N=383;
59%)] performed over a period of 8 years, where the data were retrieved from a prospectively maintained
computerised database and case-notes.
Results: The overall incidence of UCs was 6.5% (42/650), which consisted of ureteric obstruction (UO) in 4.3%
(28) and ureteric leak (UL) in 2.2%(14) of patients. The incidence of UO was significantly high in the NSTG
compared to the STG (6.3% vs.1.5%; P=0.002). However, the incidence of UL (3.4% vs.1.3%; P=0.1) and post-
transplant urinary tract infection (UTI) (44% vs.41%; P=0.57) were not significantly different between the STG and
NSTG groups. UO and UL were associated with significantly high incidence of UTI (P=0.001 and 0.01,
respectively). All UCs were managed successfully without allograft loss.
Conclusions: Routine stenting of ureteric anastomosis resulted in reduced incidence of UO without concomitant
increased risk of UTI.
Key words: Renal transplantation, vesico-ureteric anastomosis, stent, complications
Ultrasound findings in acute viral hepatitis
(Kathmandu University, 2006) Sudhamshu KC
Aim: Serological markers for the virus remain mainstay of diagnosis of acute viral hepatitis. However, it is not
available in all part of our country. The aim of this study is to find out the sonological findings of the hepatobiliary
system that may aid to clinch the diagnosis of acute viral hepatitis.
Materials and methods: One hundred seventy seven consecutive patients with clinical diagnosis of acute viral
hepatitis from June 2004 to June 2006 attending liver clinic were enrolled in this study. After exclusion of 32
patients 145 patients with definitive diagnosis by serological confirmation were studied.
Result: Hepatitis E (85%) was most common followed by B (10%) and A (5%). Gall bladder finding was more
common than hepato-splenomegaly. Collapsed gall bladder with increased wall thickness and pericholecystic
oedema was present in more than 50% of the patient. In HAV hepatitis it was present in all patients while in HEV
hepatitis it was present in 84% patients.
Conclusions: Gall bladder findings in ultrasound are present in over 80% of enterically transmitted hepatitis virus.
Thus, it can be used to diagnose acute hepatitis when serological tests are not available.
Key words: Ultrasound, gall bladder, acute hepatitis
Effectiveness of combination of permanent and releasable scleral flap sutures in trabeculectomy: A randomized clinical trial
(Kathmandu University, 2006) R, Kumari; BP, Badhu; H, Das
Introduction: Trabeculectomy is a commonly used surgical treatment for glaucoma.
Purpose: To evaluate the effectiveness of combination of permanent and releasable scleral flap sutures to minimize
the immediate postoperative complications of trabeculectomy.
Materials and methods: This study was carried out in Department of Ophthalmology, B P Koirala Institute of
Health Sciences, Dharan, Nepal. Forty one eyes of 34 patients undergoing trabeculectomy were randomized to
undergo either conventional trabeculectomy (Group A= 20 eyes) or trabeculectomy with combination of permanent
and releasable scleral flap sutures (Group B =21 eyes). The parameters studied were intraocular pressure (IOP),
anterior chamber depth (ACD) and surgical complications over a period of 6 weeks.
Results: Significantly higher number of eyes belonging to group A (14 eyes) had shallower anterior chamber than
group B (7 eyes) on first post operative day (p=0.042). Six eyes (30%) in group A had peripheral or central irido-
corneal touch in early postoperative period as compared to only one in Group B. Hypotony was noted in 3 eyes in
each group. Two patients in group A required reformation of anterior chamber. Other surgical complications in the
two groups were similar.
Both the groups had a significant drop in IOP following surgery. However, there was no significant difference in
the IOP between the two groups after 6 weeks (Group A: 10.95 ± 3.03 mmHg vs. Group B: 12.29 ± 4.67 mmHg;
p=0.87). There was a significant drop in IOP following removal of sutures (15.19 ± 6.15 mmHg to 13.19 ± 6.13
mmHg; p=006) in group B.
Conclusion: Use of combination of permanent and releasable scleral flap sutures is a safe technique that
significantly reduces the incidence of immediate postoperative shallow anterior chamber after trabeculectomy.
Key words: Trabeculectomy, Intra ocular pressure, anterior chamber depth, combination of releasable and
permanent scleral flap sutures