Genome size data for eight endemic plant species from the Nanda Devi Biosphere Reserve (Western Himalaya)

The Himalaya harbors a large number of plant endemics but information on their genome size is largely lacking. This study aims to fulfill this gap by reporting genome sizes for 8 endemic Himalayan plant species (Impatiens devendrae Pusalkar, Impatiens scabrida DC., Impatiens sulcata Wall., Geranium robertianum L., Geranium wallichianum D.Don ex Sweet, Thalictrum cultratum Wall., Thalictrum elegans Wall. ex Royle, Thalictrum foliolosum DC.) from the Western Indian Himalayan state of Uttarakhand. The study involved collecting leaf tissues from each of the 8 plant species, chopping, staining and estimating nuclear DNA content using CyFlow Cube 8 flow cytometer with 532 nm laser light source and an orange-red fluorescence emission (>590 nm). The CyFlow Cube 13 programme was utilised to obtain the median fluorescence value from PI-stained G0/G1 (quiescent phase/first growth phase) nuclei, devoid of cellular debris. The DNA 2C value of each sample was then estimated by comparing the median fluorescence intensity values of both sample and standard (Solanum lycopersicum L.) using the standard scientific formula. The highest DNA 2C-values were observed in Geranium, which ranged from 5.29 ± 0.02 pg to 2.49 ± 0.02 pg. The genome size of Impatiens species varied from 1.49 ± 0.08 pg to 3.14 ± 0.04 pg while the three species of genus Thalictrum had nearly similar genome sizes varying between 1.53 ± 0.01 pg to 1.96 ± 0.06 pg. The coefficient of variation among nuclei varied from 3.52 % to 5.38 % with 103 to 1811 numbers of stained nuclei. The results and framework presented in the current study can serve as a template for future studies that attempt to estimate the genome sizes of endemic plant species in the Himalaya, a global biodiversity epicentre and one of the least studied biodiversity hotspots of the world.

Hydropower: A low-hanging sour-sweet energy option for India

India is the world's second largest populous nation, fifth largest economy with seventh largest geographical area but experiences high energy poverty. With the lowest per capita energy consumption among world's top ten economies, India ranks at 137 out of 218 nations. Hydropower has the potential to alleviate India's energy asymmetry as well as realize its sustainable growth aspiration of a low-carbon regime. However, hydropower in India has been plagued by debates on human displacement, loss of biodiversity, increased risk of natural disasters, and socio-economic conflicts making it an unpopular energy alternative. Here, we review and address various concerns related to India's hydropower sector, examine scientific evidence, analyze energy policy imperatives, geopolitical considerations, and future directions for a sustainable hydropower policy in India in the context of ongoing climate change. Evidence indicates that besides electricity generation, hydropower infrastructure helps: (i) avert floods, (ii) mitigate the impacts of global warming, and (iii) ensure redistribution of water to arid regions and improve water security. As a part of sustainable hydropower policy, we propose that most of the ecological and social problems associated with hydropower development can be avoided to a great extent through careful planning, proper project design, responsible ownership, and public participation. As short-term measures, we propose: (i) entrepreneurs and planners follow credible and transparent pre-project investigations, (ii) mandatory implementation of environmental management plans, and (iii) better accountability and transparency of statutory bodies as well as hydropower developers. For long-term measures, we suggest: (i) create a 'National Institute of Energy & Environmental Sustainability' to oversee post-project hydropower developmental activities, (ii) streamline various bureaucratic and institutional procedures, and (ii) establish a trans-boundary water management system for seamless and coordinated implementation of hydropower development programs across upstream-downstream nations.

Analysis of neuroendocrine factors in response to conditional stress in zebrafish Danio rerio (Cypriniformes: Cyprinidae)

Challenges in the aquatic environment disrupt the homeostasis mechanisms of many teleost fishes. Induction of stress affects the circulating levels of catecholamine and has an impact on development and reproduction. It is not known how osmotic and hypoxic stress could affect the catecholamine and serotonin levels in zebrafish despite its well-known action in the vertebrate brain. This study thus investigates how serotonin (5-HT), epinephrine (E), norepinephrine (NE), and dopamine (DA) in the brain of female zebrafish respond to hypoxic (air) and osmotic conditions (salinity of 10 ppt). Analysis of zebrafish brain utilizing HPLC with PDA detector using reverse-phase PrimeSep column indicated that osmotic stress, air response and its combination modified 5-HT, NE and E levels. The tested stressors elevated 5-HT (>2.8 μM) while lowering NE (<3.00 μM) and E (<1.02 μM) levels in the brain as opposed to exposure to non-stressed fish. In addition, reproductive markers such as vitellogenin (Vtg1) and estrogen receptor (ERα) mRNA expression in the brain were up-regulated after osmotic stress, whereas air exposure down-regulated ERα mRNA expression but up-regulated Vtg1 compared to non-stressed fish. Overall, the data indicate that acute osmotic stress and air exposure that lowered catecholamine E and NE and elevated 5-HT levels could up-regulate mRNA expression of ERα and Vtg1 genes in the zebrafish brain, thus presenting evidence for a role of neurotransmitters on reproductive signals during acute conditional stress in the brain of wild zebrafish.

Comparison between Mineral Trioxide Aggregate Mixed with Water and Water-based Gel Regarding Shear Bond Strength with Resin-modified Glass Ionomer Cement and Composite

AIM AND OBJECTIVE

To compare between mineral trioxide aggregate (MTA) mixed with water and water-based gel regarding shear bond strength with resin-modified glass ionomer cement (RMGIC) and composite.

METHODS AND MATERIALS

In this study, 40 blocks of cylindrical shape were prepared with acrylic. These blocks were divided into four groups with each group consisting of 10 blocks: group-1A: MTA + distilled water + composite, group-1B: MTA + distilled water + RMGIC, group-2A: MTA + polymer + composite, and group-2B: RMGIC + MTA + polymer. After that, a universal testing machine was used for the measurement of shear bond strength. The acrylic blocks were placed under this machine. A blade with a knife-edge was used to provide a crosshead speed of 1 mm/minute. This was continued till bond of MTA in both forms (distilled water/gel) and restorative material failed.

RESULTS

It was observed that a statistically significant difference was found between MTAw + composite and MTAg + composite resin but no statistically significant difference between MTAw + RMGIC and MTAg + RMGIC with p ≥ 0.05. It was found that a statistically significant difference was present between the RMGIC and composite groups within the same MTA type with p ≤ 0.05.

CONCLUSION

It was concluded from the present study that MTA with a water-based gel has a better shear bond strength than composite resin and RMGIC materials.

CLINICAL SIGNIFICANCE

It has been found that MTA has different properties when it is mixed with polymer and water. Very few studies have been conducted in the past to compare MTA mixed with water and water-based gel regarding the shear bond strength with RMGIC and composite.

Treatment of periodontal disease using xanthan based chlorhexidine gel

People of all ages are suffering from periodontal disease. It causes indirect damage in the oral cavity. It is of interest to evaluate the efficacy of xanthan-based chlorhexidine gel (Xan-CHX) in patients with mild-severe chronic periodontitis. Five patients with 60 sites were divided in two groups. Group A (treated with SRP) and group B (treated with Chlosite i.e., SRP + CHL). The recorded clinical parameters were Plaque index (PI), Gingival index (GI), Bleeding index (BI), and Clinical attachment Level (CAL) with sub gingival plaque subjected to microbial analysis. Significant reduction was observed in both groups. However, group B (treated with Chlosite i.e., SRP + CHL) showed statistically significant improvement on above mentioned parameters as compared to group A. Data suggest that in the treatment of periodontal disease (viz. PI, GI, BI and CAL) combination of SRP and Chlosite showed added benefits over only SRP.

Treatment of periodontal disease using xanthan based chlorhexidine gel

People of all ages are suffering from periodontal disease. It causes indirect damage in the oral cavity. It is of interest to evaluate the efficacy of xanthan-based chlorhexidine gel (Xan-CHX) in patients with mild-severe chronic periodontitis. Five patients with 60 sites were divided in two groups. Group A (treated with SRP) and group B (treated with Chlosite i.e., SRP + CHL). The recorded clinical parameters were Plaque index (PI), Gingival index (GI), Bleeding index (BI), and Clinical attachment Level (CAL) with sub gingival plaque subjected to microbial analysis. Significant reduction was observed in both groups. However, group B (treated with Chlosite i.e., SRP + CHL) showed statistically significant improvement on above mentioned parameters as compared to group A. Data suggest that in the treatment of periodontal disease (viz. PI, GI, BI and CAL) combination of SRP and Chlosite showed added benefits over only SRP.

Comparison of Canal Transportation in TruNatomy, ProTaper Gold, and Hyflex Electric Discharge Machining File Using Cone-beam Computed Tomography

AIM

This study was carried out to compare canal transportation in three new rotary file systems, namely TruNatomy, ProTaper Gold, and Hyflex Electric Discharge Machining file system, using cone-beam computed tomography.

MATERIALS AND METHODS

The study was conducted on 105 extracted teeth consisting of 60 extracted mandibular first molars and 45 mandibular second premolars involving the mesiolingual canal of mandibular first molar and the root canal of second premolar. The teeth were randomly divided into three groups of 35 out of which each group consisted of 20 mandibular first molars and 15 mandibular second premolars. The TruNatomy rotary file was used in group I, ProTaper Gold was used in group II, and Hyflex Electric Discharge Machining was used in group III. Cone-beam computed tomography scan images were obtained both before and after instrumentation. Changes caused by preparation in the coronal, middle, and apical thirds were determined on cone-beam computed tomography scans and analyzed using the Kruskal-Wallis test at p ≤ 0.05 level of significance.

RESULTS

TruNatomy showed least amount of canal transportation as compared with other two file systems at all the three levels of canals. ProTaper Gold showed maximum amount of canal transportation as compared with other two file systems at all the three levels of canals. The Hyflex EDM rotary file system showed transportation, which was more than the TruNatomy file system while it was less than that of ProTaper Gold. The difference was statically significant at the middle one-third level (p = 0.03) and at the coronal level (p = 0.02).

CONCLUSION

The TruNatomy system has least amount of canal transportation as compared with ProTaper Gold and Hyflex EDM system. With potential to preserve tooth structure, this file has an added advantage over other rotary file systems.

CLINICAL SIGNIFICANCE

The TruNatomy file system has been recently introduced with good cyclic fatigue resistance. It is necessary to evaluate the root canal transportation caused by the TruNatomy file.

Geophysical upheavals and evolutionary diversification of plant species in the Himalaya

The Himalaya is one of the youngest and the loftiest mountain chains of the world; it is also referred to as the water tower of Asia. The Himalayan region harbors nearly 10,000 plant species constituting approximately 2.5% of the global angiosperm diversity of which over 4,000 are endemics. The present-day Himalayan flora consists of an admixture of immigrant taxa and diversified species over the last 40 million years. The interesting questions about the Himalayan flora discussed here are: how did the Himalaya achieve high endemic plant diversity starting with immigrant taxa and what were the main drivers of this diversity? This contribution aims to answer these questions and raise some more. We review and analyze existing information from diverse areas of earth and climate sciences, palaeobiology and phytogeography to evolve a bio-chronological record of plant species divergence and evolution in the Himalaya. From the analysis we infer the effects of major environmental upheavals on plant diversity in the region. The understanding developed in the following discussion is based on the idea that Himalaya experienced at least five phases of major geophysical upheavals, namely: (i) mega-collision between India and Eurasian plates, (ii) tectonic uplift in phases and progressive landform elevation, (iii) onset of southwest (SW) Indian monsoon, (iv) spurring of arid conditions in Central Asia, and (v) cyclic phases of cooling and warming in the Quaternary. The geophysical upheavals that were potentially disrupting for the ecosystem stability had a key role in providing impetus for biological diversification. The upheavals produced new geophysical environments, new ecological niches, imposed physical and physiological isolation barriers, acted as natural selection sieves and led to the formation of new species. This contribution aims to develop a comprehensive understanding of the plant biodiversity profile of the Himalaya in the context of complex, interconnected and dynamic relationship between earth system processes, climate and plant diversity.

Novel HDAC8 inhibitors: A multi-computational approach

Abnormal HDAC function triggers irregular gene transcription that hampers the essential cellular activities leading to tumour activation and progression. HDAC inhibition has, therefore, been reported as a potential target for cancer treatment. In the present study, a sequential computational framework was carried out to discover newer lead compounds, namely HDAC8 inhibitors for cancer therapy. Pharmacophoric hypotheses were generated based on hydroxamic acid derivatives reported earlier for HDAC inhibition. The model AAADR.122, demonstrated statistical significance (r² = 0.93, Q² = 0.81) and proved robust on validation with a cross-validated correlation coefficient of 0.89. It was utilized to arrive at novel hits through a virtual screening workflow. The specificity of the process was enhanced further by analysing the crucial interactions of the ligands with key catalytic residues, achieved by induced fit docking (PDB ID: 1T64). On assessment, the filtered leads displayed optimal drug like features. Investigations using density functional theory (DFT) also facilitated the recognition of molecular spots in the leads beneficial for HDAC8 interaction. Overall, two leads were proposed for HDAC8 inhibition with potential anti-cancer activity.

Elevational plant species richness patterns and their drivers across non-endemics, endemics and growth forms in the Eastern Himalaya

Despite decades of research, ecologists continue to debate how spatial patterns of species richness arise across elevational gradients on the Earth. The equivocal results of these studies could emanate from variations in study design, sampling effort and data analysis. In this study, we demonstrate that the richness patterns of 2,781 (2,197 non-endemic and 584 endemic) angiosperm species along an elevational gradient of 300-5,300 m in the Eastern Himalaya are hump-shaped, spatial scale of extent (the proportion of elevational gradient studied) dependent and growth form specific. Endemics peaked at higher elevations than non-endemics across all growth forms (trees, shrubs, climbers, and herbs). Richness patterns were influenced by the proportional representation of the largest physiognomic group (herbs). We show that with increasing spatial scale of extent, the richness patterns change from a monotonic to a hump-shaped pattern and richness maxima shift toward higher elevations across all growth forms. Our investigations revealed that the combination of ambient energy (air temperature, solar radiation, and potential evapo-transpiration) and water availability (soil water content and precipitation) were the main drivers of elevational plant species richness patterns in the Himalaya. This study highlights the importance of factoring in endemism, growth forms, and spatial scale when investigating elevational gradients of plant species distributions and advances our understanding of how macroecological patterns arise.

Anal Canal Gas Gangrene in Aplastic Anaemia: Rare yet Lethal Entity - A Caveat

Gas gangrene is one of the most serious infections of traumatic and surgical wounds. The importance lies in the fact that, if not managed at the right time, the condition is fatal. Though perianal cellulitis and gangrene are commonly reported in immunocompromised patients, we report the case of a patient with gas gangrene involving only the anal canal extending to the rectum, a rare presentation to be reported in literature.  An 18-year-old lady, a patient of aplastic anaemia - immunodeficiency, developed gas gangrene of the anal canal possibly due to faecal contamination of anal fissures. The patient was managed with surgical debridement and intravenous antibiotics.  The clinical manifestations of gas gangrene are due to the liberation of toxins by Clostridium perfringens. The infection spreads rapidly and results in necrosis and devitalisation of tissues, unless intervened surgically. The clinical manifestations are more rapid and a high index of suspicion is needed for the diagnosis.

Mini Totally Extra-Peritoneal Repair of Inguinal Hernia with All 5 mm Ports: An Innovative "555 Technique"

BACKGROUND

Totally extra-peritoneal (TEP) repair of inguinal hernia is now a standard surgical technique. A 12 mm incision in infra-umbilical region for Hasson trocar is must for TEP repair of inguinal hernia. This is the only technique known to laparoscopic surgeons. We have innovated a "555 Technique" for completing Mini TEP repair of inguinal hernia by using all three 5 mm ports.

METHODS

Sixty-one consecutive patients were subjected for TEP repair of inguinal hernia by our innovative "555 Technique" since October 2014. A simple "Manish Retractor" is devised to make extra-peritoneal space with 5 mm trocar. Fifty-nine cases were men and 2 cases were women. The mean age of patients was 44.6 years (range 23-82 years).

RESULTS

Out of 61 cases, 27 were indirect inguinal hernia (23 unilateral, 4 bilateral), 32 direct inguinal hernia (21 unilateral, 11 bilateral), 1 femoral hernia, and 1 obturator hernia. One patient of indirect inguinal hernia had sliding hernia with sigmoid colon. Sixty cases were successfully operated by "555 Technique." There was conversion to trans-abdominal pre-peritoneal repair (TAPP) in 1 case. The average time for insertion of 5 mm trocar in preperitoneal space by our technique was 150 seconds. No complications were noted on 6 months follow-up. Small infra-umbilical scar was cosmetically more acceptable to patients.

CONCLUSION

"555 Technique" is a feasible option without compromising the principles of TEP repair for inguinal hernia. Innovation of simple "Manish Retractor" is the key in completing Mini TEP repair. This technique is simple, less invasive, less morbid, and cost effective as it avoids dependence over costly Hasson trocar with better cosmetic results.

Assessing Potential Conservation and Restoration Areas of Freshwater Fish Fauna in the Indian River Basins

Conservation efforts globally are skewed toward terrestrial ecosystems. To date, conservation of aquatic ecosystems, in particular fish fauna, is largely neglected. We provide a country-wide assessment of Indian river ecosystems in order to identify and prioritize areas for protection and restoration of freshwater fish fauna. Using various biodiversity and anthropogenic attributes, coupled with tools of ecological modeling, we delineated areas for fish fauna conservation and restoration in the 20 major river basins of India. To do this, we used prioritization analyses and reserve selection algorithms to derive conservation value index (CVI) and vulnerability index (VI) of the river basins. CVI was estimated using endemicity, rarity, conservation value, and taxonomic singularity, while VI was estimated using a disturbance index derived from percent geographic area of the basin under human settlements, human population density, predominant land use, and total number of exotic fish species in each basin. The two indices, CVI and VI, were converted into geo-referenced maps, and each map was super-imposed onto species richness and forest cover maps, respectively. After superimposition, areas with high CVI and low VI shade intensities were delineated for conservation, while areas with high CVI and high VI shade intensities were demarcated for restoration. In view of the importance of freshwater fish for human livelihoods and consumption, and ecosystems of India's rivers, we call for urgent attention to the conservation of their fish fauna along with restoration of their degraded habitats.

Biomolecular inflammatory response to surgical energy usage in laparoscopic surgery: results of a randomized study

OBJECTIVE

Use of surgical energy is integral to laparoscopic surgery (LS). Energized dissection (ED) has a potential to impact the biomolecular expression of inflammation due to ED-induced collateral inflammation. We did this triple-blind randomized controlled (RCT) study to assess this biomolecular footprint in an index LS, i.e., laparoscopic cholecystectomy (LC).

METHODS AND PROCEDURES

This RCT was conducted in collaboration with tertiary-level institutions, from January 2014 to December 2014 with institutional review board clearance. Consecutive, unselected, consenting candidates for LC were randomized (after anesthesia induction) into group I (ED) and group II (non-ED). They were managed with compliance to universal protocols for ethics, informed consent, anesthesia, drug usage and clinical pathway with blinded observers. Biomolecular inflammatory markers, i.e., interleukin 6 (IL-6), tumor necrosis factor-alpha (TNF-α) and highly sensitive CRP (HS-CRP), were measured with blood drawn juxta-preoperatively (H0), at 4 h (H4) and at 24 h (H24). The quantitative changes induced by ED on IL-6, TNF-α and HS-CRP at H0, H4 and H24 with their kinetic behavior were the study endpoint. Prospective data were analyzed statistically with a p value of <0.05 being significant.

RESULTS

Two cases from the ED group had biliary injury and hence were withdrawn from analysis. The ED (n = 49) and non-ED (n = 51) groups had similar demographic, clinical and H0 biomolecular variables. There was a significant increase in IL-6, TNF-α and HS-CRP from H0 to H4 in both the groups (p values <0.001). From H4 to H24, all three cytokines showed significant increase in ED group (p < 0.05), whereas in the non-ED group, IL-6 showed significant fall (p = 0.004) and TNF-α showed no significant change (p = 0.063). Both the groups showed H4-H24 elevation of HS-CRP (p = 0.000).

CONCLUSION

Energized dissection adds to the cytokine-mediated postoperative inflammation. The additional ED-induced inflammation can be measured objectively by IL-6 and TNF-α levels.

CLINICAL TRIALS REGISTRY

Clinical Trials Registry, India (REF/2014/06/007153).

Ulcerated primary fibrosarcoma of breast: case report and review of literature

Breast carcinoma is a common condition worldwide but stromal sarcomas of breast are rarity in day to day surgical practice. Out of primary breast sarcomas, fibrosarcoma constitutes only 16% of cases. We report a primary fibrosarcoma of breast in a young female patient which presented as ulcerated growth and fixity to chest wall and multiple ipsilateral axillary lympadenopathy (Stage IIIb). After biopsy confirmation palliation mastectomy was done and patient was sent for chemoradiotherapy.

Climate-induced elevational range shifts and increase in plant species richness in a Himalayan biodiversity epicentre

Global average temperature increase during the last century has induced species geographic range shifts and extinctions. Montane floras, in particular, are highly sensitive to climate change and mountains serve as suitable observation sites for tracing climate-induced biological response. The Himalaya constitute an important global biodiversity hotspot, yet studies on species' response to climate change from this region are lacking. Here we use historical (1849-50) and the recent (2007-2010) data on temperature and endemic species' elevational ranges to perform a correlative study in the two alpine valleys of Sikkim. We show that the ongoing warming in the alpine Sikkim Himalaya has transformed the plant assemblages. This study lends support to the hypothesis that changing climate is causing species distribution changes. We provide first evidence of warmer winters in the region compared to the last two centuries, with mean temperatures of the warmest and the coldest months may have increased by 0.76±0.25°C and 3.65±2°C, respectively. Warming-driven geographical range shifts were recorded in 87% of 124 endemic plant species studied in the region; upper range extensions of species have resulted in increased species richness in the upper alpine zone, compared to the 19(th) century. We recorded a shift of 23-998 m in species' upper elevation limit and a mean upward displacement rate of 27.53±22.04 m/decade in the present study. We infer that the present-day plant assemblages and community structure in the Himalaya is substantially different from the last century and is, therefore, in a state of flux under the impact of warming. The continued trend of warming is likely to result in ongoing elevational range contractions and eventually, species extinctions, particularly at mountaintops.

Elevational gradients in fish diversity in the Himalaya: water discharge is the key driver of distribution patterns

BACKGROUND

Studying diversity and distribution patterns of species along elevational gradients and understanding drivers behind these patterns is central to macroecology and conservation biology. A number of studies on biogeographic gradients are available for terrestrial ecosystems, but freshwater ecosystems remain largely neglected. In particular, we know very little about the species richness gradients and their drivers in the Himalaya, a global biodiversity hotspot.

METHODOLOGY/PRINCIPAL FINDINGS

We collated taxonomic and distribution data of fish species from 16 freshwater Himalayan rivers and carried out empirical studies on environmental drivers and fish diversity and distribution in the Teesta river (Eastern Himalaya). We examined patterns of fish species richness along the Himalayan elevational gradients (50-3800 m) and sought to understand the drivers behind the emerging patterns. We used generalized linear models (GLM) and generalized additive models (GAM) to examine the richness patterns; GLM was used to investigate relationship between fish species richness and various environmental variables. Regression modelling involved stepwise procedures, including elimination of collinear variables, best model selection, based on the least Akaike's information criterion (AIC) and the highest percentage of deviance explained (D(2)). This maiden study on the Himalayan fishes revealed that total and non-endemic fish species richness monotonously decrease with increasing elevation, while endemics peaked around mid elevations (700-1500 m). The best explanatory model (synthetic model) indicated that water discharge is the best predictor of fish species richness patterns in the Himalayan rivers.

CONCLUSIONS/SIGNIFICANCE

This study, carried out along one of the longest bioclimatic elevation gradients of the world, lends support to Rapoport's elevational rule as opposed to mid domain effect hypothesis. We propose a species-discharge model and contradict species-area model in predicting fish species richness. We suggest that drivers of richness gradients in terrestrial and aquatic ecosystems are likely to be different. These studies are crucial in context of the impacts of unprecedented on-going river regulation on fish diversity and distribution in the Himalaya.

Endoscopic varicocelectomy by extraperitoneal route: a novel technique

BACKGROUND

Varicocelectomy for male infertility has been performed laparoscopically by transabdominal preperitoneal (TAPP) approach. Laparoscopic varicocelectomy (LV) has a potential risk of intraperitoneal injuries. LV fails to tackle the possible collateral veins in inguinal canal below the deep inguinal ring. Despite the inherent benefits of retro or extraperitoneal approach for urological procedures, the extraperitoneal varicocelectomy has not been widely practiced. Energy sources have been suspected in potential trauma to vas. Totally extraperitoneal (TEP) approach is a well established procedure for inguinal region. We utilized TEP approach to perform varicocelectomy without using energy source.

METHOD

Between January 2000 and March 2005 16 males having bilateral varicocele, subnormal semen parameters and inability to father a child with reproductively healthy female partner were operated. Varicocelectomy was done by TEP route.

RESULTS

16 males having different grades of varicocele, mean sperm counts of 29.25 million/ml and mean sperm motility of 26% were operated. There was no technical difficulty, visceral injury, conversion, bleeding or need to use energy source. There was no recurrence or reduction in testicular size. Postoperative hydroceles (11 out of 32 varicoceles) resolved within 3 months without any intervention. Mean sperm counts and motility improved to 68.25 million/ml and 63.18% respectively. Pregnancy was reported by 11 couples during a follow up of 2 years.

CONCLUSION

Endoscopic varicocelectomy by extraperitoneal route is a safe procedure.