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Second Procedure (second + procedure)
Selected AbstractsCardiopulmonary, blood and peritoneal fluid alterations associated with abdominal insufflation of carbon dioxide in standing horsesEQUINE VETERINARY JOURNAL, Issue 3 2003F. G. LATIMER Summary Reasons for performing study: Abdominal insufflation is performed routinely during laparoscopy in horses to improve visualisation and facilitate instrument and visceral manipulations during surgery. It has been shown that high-pressure pneumoperitoneum with carbon dioxide (CO2) has deleterious cardiopulmonary effects in dorsally recumbent, mechanically ventilated, halothane-anaesthetised horses. There is no information on the effects of CO2 pneumoperitoneum on cardiopulmonary function and haematology, plasma chemistry and peritoneal fluid (PF) variables in standing sedated horses during laparoscopic surgery. Objectives: To determine the effects of high pressure CO2 pneumoperitoneum in standing sedated horses on cardiopulmonary function, blood gas, haematology, plasma chemistry and PF variables. Methods: Six healthy, mature horses were sedated with an i.v. bolus of detomidine (0.02 mg/kg bwt) and butorphanol (0.02 mg/kg bwt) and instrumented to determine the changes in cardiopulmonary function, haematology, serum chemistry and PF values during and after pneumoperitoneum with CO2 to 15 mmHg pressure for standing laparoscopy. Each horse was assigned at random to either a standing left flank exploratory laparoscopy (LFL) with CO2 pneumoperitoneum or sham procedure (SLFL) without insufflation, and instrumented for measurement of cardiopulmonary variables. Each horse underwent a second procedure in crossover fashion one month later so that all 6 horses had both an LFL and SLFL performed. Cardiopulmonary variables and blood gas analyses were obtained 5 mins after sedation and every 15 mins during 60 mins baseline (BL), insufflation (15 mmHg) and desufflation. Haematology, serum chemistry analysis and PF analysis were performed at BL, insufflation and desufflation, and 24 h after the conclusion of each procedure. Results: Significant decreases in heart rate, cardiac output and cardiac index and significant increases in mean right atrial pressure, systemic vascular resistance and pulmonary vascular resistance were recorded immediately after and during sedation in both groups of horses. Pneumoperitoneum with CO2 at 15 mmHg had no significant effect on cardiopulmonary function during surgery. There were no significant differences in blood gas, haematology or plasma chemistry values within or between groups at any time interval during the study. There was a significant increase in the PF total nucleated cell count 24 h following LFL compared to baseline values for LFL or SLFL at 24 h. There were no differences in PF protein concentrations within or between groups at any time interval. Conclusions: Pneumoperitoneum with CO2 during standing laparoscopy in healthy horses does not cause adverse alterations in cardiopulmonary, haematology or plasma chemistry variables, but does induce a mild inflammatory response within the peritoneal cavity. Potential relevance: High pressure (15 mmHg) pneumoperitoneum in standing sedated mature horses for laparoscopic surgery can be performed safely without any short-term or cumulative adverse effects on haemodynamic or cardiopulmonary function. [source] Energy Group optimization for forward and inverse problems in nuclear engineering: application to downwell-logging problemsGEOPHYSICAL PROSPECTING, Issue 2 2006Elsa Aristodemou ABSTRACT Simulating radiation transport of neutral particles (neutrons and ,-ray photons) within subsurface formations has been an area of research in the nuclear well-logging community since the 1960s, with many researchers exploiting existing computational tools already available within the nuclear reactor community. Deterministic codes became a popular tool, with the radiation transport equation being solved using a discretization of phase-space of the problem (energy, angle, space and time). The energy discretization in such codes is based on the multigroup approximation, or equivalently the discrete finite-difference energy approximation. One of the uncertainties, therefore, of simulating radiation transport problems, has become the multigroup energy structure. The nuclear reactor community has tackled the problem by optimizing existing nuclear cross-sectional libraries using a variety of group-collapsing codes, whilst the nuclear well-logging community has relied, until now, on libraries used in the nuclear reactor community. However, although the utilization of such libraries has been extremely useful in the past, it has also become clear that a larger number of energy groups were available than was necessary for the well-logging problems. It was obvious, therefore, that a multigroup energy structure specific to the needs of the nuclear well-logging community needed to be established. This would have the benefit of reducing computational time (the ultimate aim of this work) for both the stochastic and deterministic calculations since computational time increases with the number of energy groups. We, therefore, present in this study two methodologies that enable the optimization of any multigroup neutron,, energy structure. Although we test our theoretical approaches on nuclear well-logging synthetic data, the methodologies can be applied to other radiation transport problems that use the multigroup energy approximation. The first approach considers the effect of collapsing the neutron groups by solving the forward transport problem directly using the deterministic code EVENT, and obtaining neutron and ,-ray fluxes deterministically for the different group-collapsing options. The best collapsing option is chosen as the one which minimizes the effect on the ,-ray spectrum. During this methodology, parallel processing is implemented to reduce computational times. The second approach uses the uncollapsed output from neural network simulations in order to estimate the new, collapsed fluxes for the different collapsing cases. Subsequently, an inversion technique is used which calculates the properties of the subsurface, based on the collapsed fluxes. The best collapsing option is chosen as the one that predicts the subsurface properties with a minimal error. The fundamental difference between the two methodologies relates to their effect on the generated ,-rays. The first methodology takes the generation of ,-rays fully into account by solving the transport equation directly. The second methodology assumes that the reduction of the neutron groups has no effect on the ,-ray fluxes. It does, however, utilize an inversion scheme to predict the subsurface properties reliably, and it looks at the effect of collapsing the neutron groups on these predictions. Although the second procedure is favoured because of (a) the speed with which a solution can be obtained and (b) the application of an inversion scheme, its results need to be validated against a physically more stringent methodology. A comparison of the two methodologies is therefore given. [source] Practical questions in liver metastases of colorectal cancer: general principles of treatmentHPB, Issue 4 2007Héctor Daniel González Abstract Liver metastases of colorectal cancer are currently treated by multidisciplinary teams using strategies that combine chemotherapy, surgery and ablative techniques. Many patients classically considered non-resectable can now be rescued by neoadjuvant chemotherapy followed by liver resection, with similar results to those obtained in initial resections. While many of those patients will recur, repeat resection is a feasible and safe approach if the recurrence is confined to the liver. Several factors that until recently were considered contraindications are now recognized only as adverse prognostic factors and no longer as contraindications for surgery. The current evaluation process to select patients for surgery is no longer focused on what is to be removed but rather on what will remain. The single most important objective is to achieve a complete (R0) resection within the limits of safety in terms of quantity and quality of the remaining liver. An increasing number of patients with synchronous liver metastases are treated by simultaneous resection of the primary and the liver metastatic tumours. Multilobar disease can also be approached by staged procedures that combine neoadjuvant chemotherapy, limited resections in one lobe, embolization or ligation of the contralateral portal vein and a major resection in a second procedure. Extrahepatic disease is no longer a contraindication for surgery provided that an R0 resection can be achieved. A reverse surgical staged approach (liver metastases first, primary second) is another strategy that has appeared recently. Provided that a careful selection is made, elderly patients can also benefit from surgical treatment of liver metastases. [source] Upscaling of elastic properties for large scale geomechanical simulationsINTERNATIONAL JOURNAL FOR NUMERICAL AND ANALYTICAL METHODS IN GEOMECHANICS, Issue 11 2004F. Chalon Abstract Large scale geomechanical simulations are being increasingly used to model the compaction of stress dependent reservoirs, predict the long term integrity of under-ground radioactive waste disposals, and analyse the viability of hot-dry rock geothermal sites. These large scale simulations require the definition of homogenous mechanical properties for each geomechanical cell whereas the rock properties are expected to vary at a smaller scale. Therefore, this paper proposes a new methodology that makes possible to define the equivalent mechanical properties of the geomechanical cells using the fine scale information given in the geological model. This methodology is implemented on a synthetic reservoir case and two upscaling procedures providing the effective elastic properties of the Hooke's law are tested. The first upscaling procedure is an analytical method for perfectly stratified rock mass, whereas the second procedure computes lower and upper bounds of the equivalent properties with no assumption on the small scale heterogeneity distribution. Both procedures are applied to one geomechanical cell extracted from the reservoir structure. The results show that the analytical and numerical upscaling procedures provide accurate estimations of the effective parameters. Furthermore, a large scale simulation using the homogenized properties of each geomechanical cell calculated with the analytical method demonstrates that the overall behaviour of the reservoir structure is well reproduced for two different loading cases. Copyright © 2004 John Wiley & Sons, Ltd. [source] The Permanency of Pulmonary Vein Isolation Using a Balloon Cryoablation CatheterJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 7 2010HUMERA AHMED B.A. Chronic PV Isolation With the Cryoballoon.,Background: Because of its technical feasibility and presumed safety benefits, balloon cryoablation is being increasingly employed for pulmonary vein (PV) isolation. While acute isolation has been demonstrated in most patients, little data are available on the chronic durability of cryoballoon lesions. Methods and Results: Twelve atrial fibrillation patients underwent PV isolation using either a 23-mm or 28-mm cryoballoon. For each vein, after electrical isolation was verified with the use of a circular mapping cathether, 2 bonus balloon ablation lesions were placed. Gaps in balloon occlusion were overcome using either a spot cryocatheter or a "pull-down" technique. A prespecified second procedure was performed at 8,12 weeks to assess for long-term PV isolation. Acute PV isolation was achieved in all PVs in the patient cohort (n = 48 PVs), using the cryoballoon alone in 47/48 PVs (98%); a "pull-down" technique was employed for 5 PVs (1 right superior pulmonary vein, 2 right inferior pulmonary veins, and 2 left inferior pulmonary veins). The gap in the remaining vein was ablated with a spot cryocatheter. During the second mapping procedure, 42 of 48 PVs (88%) remained isolated. One vein had reconnected in 2 patients, while 2 veins had reconnected in another 2 patients. All PVs initially isolated with the "pull-down" technique remained isolated at the second procedure. Conclusions: Cryoballoon ablation allows for durable PV isolation with the use of a single balloon. With maintained chronic isolation in most PVs, it may represent a significant step toward consistent and lasting ablation procedures. (J Cardiovasc Electrophysiol, Vol. pp. 731-737, July 2010) [source] Mechanisms of Recurrent Atrial Fibrillation: Comparisons Between Segmental Ostial Versus Circumferential Pulmonary Vein IsolationJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 8 2007LI-WEI LO M.D. Background: Electrical isolation of pulmonary veins (PVs) is an effective therapy for atrial fibrillation (AF). Both segmental ostial PV ablation and circumferential ablation with PV,left atrial (LA) block have been implicated to eliminate AF. However, the mechanism of the recurrent AF after undergoing either strategy remains unclear. Methods and Results: Of the 73 consecutive patients with symptomatic AF that underwent PV isolation and had recurrences of AF, Group 1 consisted of 46 patients (age 56 ± 13 years old, 35 males) who underwent PV isolation by segmental ostial PV ablation and Group 2 consisted of 27 patients (age 51 ± 11 years old, 24 males) who underwent circumferential ablation with PV,LA block. In Group 1, the earliest ectopic beat or ostial PV potentials were targeted. In Group 2, circumferential ablation with PV,LA block was performed by encircling the extraostial regions around the left and right PVs. During the first procedure, all patients had PV,AF. There was no difference in the non-PV ectopy between Group 1 and Group 2. During the second procedure, the incidence of an LA posterior wall ectopy initiating AF was significantly lower (20% vs. 0%, P = 0.01) in Group 2. There was no difference in the PV ectopy initiating AF during the second procedure. Conclusion: Circumferential ablation of AF with PV,LA block may eliminate the LA posterior wall ectopy and decrease the incidence of LA posterior wall ectopy initiating AF during the second procedure. [source] An automated method for peak detection and matching in large gas chromatography-mass spectrometry data setsJOURNAL OF CHEMOMETRICS, Issue 8-10 2006Sarah J. Dixon Abstract A new approach for peak detection and matching has been developed and applied to two data sets. The first consisted of the Gas Chromatography-Mass Spectrometry (GC-MS) samples of 965 human sweat samples obtained from a population of 197 individuals. The second data set contained 500 synthetic chromatograms, and was generated to validate the peak detection and matching methods. The size of both of the data sets (around 500,000 detectable peaks over all chromatograms in data set 1, and around 100,000 in data set 2) would make it unfeasible to check manually whether peaks are matched. In the method described, the first procedure involves pre-processing the data before carrying out the second procedure of peak detection. The final procedure of peak matching consists of three stages: (a) finding potential target peaks in the full data set over all chromatograms; (b) matching peaks in the chromatograms to these targets to form clusters of spectra associated with each target; (c) merging targets where appropriate. Peak detection and matching were applied to both data sets, and the importance of stage (c) of peak matching described. In addition to the analysis of the synthetic chromatograms, the method was also validated by shuffling the original order of the sweat chromatograms and performing the methods independently on the newly shuffled data. Copyright © 2007 John Wiley & Sons, Ltd. [source] Monitoring surgical performance: an application to total hip replacementJOURNAL OF EVALUATION IN CLINICAL PRACTICE, Issue 3 2009David J. Biau MD Abstract Rationale, aims and objectives, Inadequate surgical implantation of a hip replacement may result in decreased patient satisfaction and reduced implant survival. The objective was to monitor surgical performance in hip replacement. Method, The study took place at a teaching centre. All primary total hip replacements were prospectively included in the series. For each hip replacement, intraoperative technical errors, cup and stem fixation and position, and postoperative complications were recorded. If all items rated were correct, the procedure was considered as correct. The Cumulative Sums (CUSUM) test was used to monitor the performance of the centre. A 90% proportion of successful procedures was considered as adequate performance and a 75% proportion of successful procedures was deemed as inadequate performance. Meetings were conducted to discuss the results of monitoring. Results, Eighty-three total hip replacements were monitored. Overall, 28 procedures (34%) were considered inadequate. The most potent reasons for inadequate performance were cup positioning and stem fixation. The CUSUM test signalled after the second procedure that performance was inadequate. After the first meeting, despite an improvement was seen, the CUSUM test raised an alarm indicating inadequate performance. The study was stopped after the second meeting because of funding reasons before it could be demonstrated that performance had reached the desired level. Conclusion, This study has demonstrated that implementing a dedicated system to monitor surgical performance in a teaching hospital improves the quality of implantation of total hip replacements. Nonetheless, the target of ninety percent of adequate primary total hip replacement could not be reached and efforts should be continued. [source] Transcatheter Closure of Congenital Ventricular Septal Defects: Experience with Various DevicesJOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 1 2003RAMESH ARORA D.M. Transcatheter closure of congenital ventricular septal defect (VSD) using various devices is gaining acceptance in selected cases of perimembranous and muscular defects, avoiding the inherent risks of cardiopulmonary bypass. The procedure was attempted in 137 patients having congenital defects using Rashkind Umbrella Device (RUD) in 29 patients, Amplatzer ventricular septal occluder (AVSO) in 107 patients, and Detachable Coil in one. All patients were selected using stringent criteria by detailed transthoracic echocardiography and/or transesophageal echocardiography. The location of VSD was perimembranous in 91 patients and was muscular trabecular in 46 patients. Seven patients had left ventricle (LV) to right atrium (RA) communication. Thirty-five patients with perimembranous and two with muscular VSD had aneurysm formation. The patients were 3 to 33 years old, and the diameter of VSD ranged from 3 to 12 mm. The pulmonary to systemic flow ratio was ,2:1 in 47 (34.3%) patients. The procedure was successful in 130 (94.8%) patients, with a success rate of 86.2% with RUD and 97.1% with AVSO. Residual shunt at 24 hours was seen in eight (32%) patients with RUD and in one patient (0.9%) with AVSO. Three (2.8%) developed transient bundle branch block, and two (1.9%) patients had complete heart block. New tricuspid stenosis and tricuspid regurgitation was observed in one patient each with AVSO. After immediate balloon dilatation, the mean pressure gradient across tricuspid valve decreased from 11 to 3 mmHg in the patient with tricuspid stenosis. On a follow-up of 1 to 66(mean 35.2 ± 10.7)months, the device was in position in all. None developed late conduction defect, aortic regurgitation, infective endocarditis, or hemolysis. At 9-month follow-up, the mean pressure gradient across the tricuspid valve was 3 mmHg in the patient with tricuspid stenosis. Complete occlusion of the shunt was achieved in 129 (99.2%) patients. One patient with RUD having persistent residual shunt underwent a second procedure with AVSO. Three out of 107 patients with AVSO had an unsuccessful procedure where the defect was perimembranous with a superior margin of defect less than 3 mm away from the aortic valve, and the specially designed perimembranous AVSO had to be retrieved because of hemodynamic compromise due to significant acute aortic regurgitation, whereas in all others, the defect was either ,3 mm away from the aortic valve or had aneurysm formation. All seven patients with LV to RA communication showed complete abolition of the shunt. Thus, in properly selected cases of perimembranous and muscular ventricular septal defects, the transcatheter closure is safe and efficacious using appropriate devices. The success rate is higher with AVSO compared with the previously used devices, as well as more successful for the muscular defects than those that are perimembranous in location. (J Interven Cardiol 2003;16:83,91) [source] Ultrastructural characterization of the new NG97ht human-derived glioma cell line using two different electron microscopy technical proceduresMICROSCOPY RESEARCH AND TECHNIQUE, Issue 4 2009Camila Maria Longo Machado Abstract On the basis of transmission electron microscopy observations in tumor cell lines, oncologists have made innumerous diagnostic and therapeutical progresses. Following this path, the UNICAMP immunopathologies laboratory established the NG97 cell line derived from a human astrocytoma grade III, which when injected to the athymic nude mouse flank developed a grade IV astrocytoma. In this study, we focused on ultrastructural characterization of the NG97 cells after being recovered from xenotransplant (NG97ht). These cells in culture were assayed by two different electron microscopy procedures to characterize ultrastructures related to grade IV astrocytomas and to observe their structures through cell subcultivation. Additionally, comparative morphological descriptions of different cell passages in these technical procedures could be a useful tool for improving electron microscopy cell lineage protocols. Results from many cell passage observations showed ultrastructural similarities, which suggest malignant and glioblastoma phenotypes. In the first procedure, NG97ht cells were harvested and then incorporated into agarose before subjecting them to electron microscopy protocols, whereas in the second one, monolayer cells grew first on cover slides. Comparison among protocols revealed that organelles, cytoplasmatic extensions, spatial conformation of filopodia, and cell attachment to substrate were more preserved in the second procedure. Furthermore, in this latter procedure, a unique ellipsoidal structure was observed, which was already described when dealing with gliosarcoma cell line elsewhere. Therefore, these analyses demonstrated a morphological characterization of a new NG97ht cell line using electron transmission microscopy. Moreover, it has been shown that the second procedure provides more detailed information compared with the first. Microsc. Res. Tech, 2009. © 2008 Wiley-Liss, Inc. [source] Safety and Acceptability of Implantation of Internal Cardioverter-Defibrillators Under Local Anesthetic and Conscious SedationPACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 8 2007DAVID J. FOX B.M.Sc., M.B.Ch.B., M.R.C.P. Background: Implantation and testing of implantable defibrillators (ICDs) using local anesthetic and conscious sedation is widely practiced; however, some centers still use general anesthesia. We assessed safety and patient acceptability for implantation of defibrillators using local anesthetic and conscious sedation. Methods: The records of 500 consecutive device implants from two UK cardiac centers implanted under local anesthetic and conscious sedation from January 1996 to December 2004 were reviewed. Procedure time, left ventricular ejection fraction (LVEF) sedative dosage (midazolam), analgesic dosage (fentanyl or diamorphine), requirement for drug reversal, and respiratory support were recorded. Patient acceptability of the procedure was also assessed. Results: Of 500 implants examined, 387 were ICDs, 88 were biventricular ICDs, and 25 were generator changes. Patients with biventricular-ICDs had significantly longer (mean ± SD) procedure times 129.7 ± 7.6 minutes versus 63.3 ± 32.3 minutes; P < 0.0001 and lower LVEF 24.4 ± 8.4% versus 35.7 ± 15.4%; P < 0.0001. There were no differences in the doses (mean ± SD) of midazolam 8.9 ± 3.5 mg versus 8.0 ± 3.1 mg; P = NS, diamorphine 4.3 ± 2.0 mg versus 3.8 ± 1.7 mg; P = NS or fentanyl 94.4 ± 53.7 mcg versus 92.2 ± 48.6 mcg; P = NS, between the two groups. There were no deaths or tracheal intubations in either group. Acceptability was available for 373 of 500 (75%) patients, 41 of 373 (11%) described "discomfort," but from these 41 patients only 14 of 373 (3.8%) declined a second procedure under the same conditions. Conclusions: Implantation of defibrillators under local anesthetic and sedation is safe and acceptable to patients. General anesthesia is no longer routinely required for implantation of defibrillators. [source] Multimodal management of urolithiasis in renal transplantationBJU INTERNATIONAL, Issue 3 2005Ben Challacombe OBJECTIVE To report the largest single series of renal transplant patients (adults and children) with urolithiasis, assess the risk factors associated with urolithiasis in renal transplant recipients, and report the outcome of the multimodal management by endourological and open procedures. PATIENTS AND METHODS The records of all patients undergoing renal transplantation between 1977 and 2003 were reviewed. In all, 2085 patients had a renal transplant at our centre and 21 (17 adults and four children) developed urinary tract calculi. Their mode of presentation, investigations, treatments, complications and outcomes were recorded. Investigations included one or more of the following; ultrasonography (US), plain abdominal X-ray, intravenous urography, nephrostogram and computed tomography. Management of these calculi involved extracorporeal shock wave lithotripsy (ESWL), flexible ureteroscopy and in situ lithotripsy, percutaneous nephrolithotomy (PCNL), open pyelolithotomy and open cystolitholapaxy. RESULTS Thirteen patients had renal calculi, seven had ureteric calculi and one had bladder calculi. The incidence of urolithiasis was 21/2085 (1.01%) in the series. Urolithiasis was incidentally discovered on routine US in six patients, six presented with oliguria or anuria, including one with acute renal failure, four with a painful graft, three with haematuria, one with sepsis secondary to obstruction and infection and in one, urolithiasis was found after failure to remove a stent. Ten patients (63%) had an identifiable metabolic cause for urolithiasis, two by obstruction, two stent-related, one secondary to infection and in six no cause was identifiable. Thirteen required more than one treatment method; 13 (69%) were treated by ESWL, eight of whom required multiple sessions; eight required ureteric stent insertion before a second procedure and four required a nephrostomy tube to relieve obstruction. Two patients had flexible ureteroscopy and stone extraction, three had a PCNL and one had open cystolithotomy. PCNL failed in one patient who subsequently had successful open pyelolithotomy. All patients were rendered stone-free when different treatments were combined. CONCLUSIONS The incidence of urolithiasis in renal transplant patients is low. There is a high incidence of metabolic causes and therefore renal transplant patients with urolithiasis should undergo comprehensive metabolic screening. Management of these patients requires a multidisciplinary approach by renal physicians, transplant surgeons and urologists. [source] Pterygium surgery long term follow-upACTA OPHTHALMOLOGICA, Issue 2009T WOOD Purpose To determine if a pterygium surgical procedure consisting of minimal conjunctival removal, excision of the hypertrophic subconjunctival fibrovascular tissue, application of mitomycin 0.25 mg/ml for 1 minute combined with temporary nasal tarsorrhaphy, and postoperative dexamethasone/antibiotic drops achieved the following: safely simplified pterygium removal, controlled the early side effects of mitomycin, reduced the rate of recurrence, and eliminated the need for conjunctival transplantation. Methods Twenty eyes of 19 patients underwent the procedure with mitomycin; fifteen were primary and 5, recurrent. These were compared to a previous group of 28 eyes in 26 patients that underwent pterygium/tarsorrhaphy surgery without mitomycin; twenty had primary and 8 had recurrent pterygia. Postoperatively, all eyes in both groups were treated with dexamethasone/antibiotic drops. Results In the mitomycin group (average follow-up 25 months), 19 of 20 eyes healed uneventfully. At 12 months, there had been no recurrences in the mitomycin group. In the non-mitomycin group (average follow-up 43 months), 9 (32%) recurred within 12 months; four (44%) of these required a second procedure at an average of 9 months. At 23 and 33 months, 2 (10%) eyes treated with mitomycin presented with asymptomatic, one mm recurrences that required no additional treatment. Conjunctival healing, as reflected in the time from surgery until tarsorrhaphy opening, was significantly longer in the mitomycin group, 37 vs. 17 days (P = .001). Conclusion The described technique provided a safe and successful approach to pterygium management. [source] Upper pole access for complex lower pole renal calculiBJU INTERNATIONAL, Issue 6 2004Monish Aron Authors from New Delhi assessed the efficacy of superior pole access for complex lower pole calyceal calculi; they found this to be the best way of approaching such complex stones, allowing faster and better clearance with a single puncture. The second paper in this section is from authors from the UK who set out to describe the frequency of renal symptoms and complications in patients with tuberous sclerosis complex, and to relate the history of renal haemorrhage with renal lesions identified on renal scan. OBJECTIVES To assess the efficacy of superior pole access for complex lower pole calyceal calculi. PATIENTS AND METHODS In all, 102 patients with complex inferior calyceal calculi were included in a prospective unrandomized study. Complex inferior calyceal calculi were defined as multiple calculi in two or more inferior calyces of the lower polar group, with each calyx draining through a separate infundibulum and at an acute angle to each other. In 33 patients (32%; group 1) an inferior calyceal puncture was made and in 69 (68%; group 2) access was obtained through a superior calyceal puncture. The stone-free rates, decrease in haemoglobin, operative duration, requirement for additional tracts and second procedures in the two groups were compared. RESULTS Stone clearance rates and blood loss values were better in group 2, although they were not significantly different. The mean operative duration, number of tracts required and the re-look procedure rate was significantly less in group 2. Two patients (3%) in group 2 had hydrothorax related to supracostal puncture and required chest tube insertion. CONCLUSIONS Superior calyceal puncture (supracostal or infracostal) affords optimum access to complex inferior calyceal stones, providing faster and better clearance with a single puncture, and less requirement for second-look procedures. [source] | ||||||||||