scholarly journals Contact Pneumatic Ureterolithotripsy Using LMA StoneBreaker Lithotriptor and Search for Opportunities to Increase Effectiveness

Health of Man ◽  
2021 ◽  
pp. 26-31
Author(s):  
Serhii Vozianov ◽  
Vasyl Chernenko ◽  
Volodymyr Savchuk ◽  
Dmytro Chernenko ◽  
Serhii Sokolenko ◽  
...  
Keyword(s):  
Mineral Composition ◽  
Intraoperative Complications ◽  
Ureteral Stones ◽  
Modified Technique ◽  
Group I ◽  
Minimum Number ◽  
Stone Migration ◽  
Group Ii ◽  
Standard Contact ◽  
Group 1

The objective: to evaluate the effectiveness of portable pneumatic contact lithotripter LMA StoneBreaker in endoscopic contact ureterolithotripsy of ureteral stones of different localization depending on their density and search for opportunities to increase it. Materials and methods. Contact pneumatic ureterolithotripsy was performed in 89 patients (49 men, 40 women), 39 (43.8%) patients (I group) underwent standard contact pneumoureterolithotripsy, and 50 (56.2%) patients (11 group) – modified (with prior fixation of the stone in the ureter loop Dormia), which allowed urethrolithotripsy in situ and prevented the migration of stones and their fragments proximally. The number of strokes required to initiate fragmentation, complete fragmentation, and total ureterolithotripcy time for stones of different localization and density were determined. The integrity of the stones was determined by computed tomography in units of Haunsfield (HU). The mineral composition of stone fragments after their removal was diagnosed by X-ray diffraction analysis. The effectiveness of the applied methods was evaluated in groups of patients by complete (100%) removal of stone fragments from the ureter and by the number of cases of retrograde migration of stones into the renal cavity. Results. No intraoperative complications were observed. The number of strokes for the initial and complete disintegration of the stone, regardless of the method of ureterolithotripsy and their localization, depended on their density, ie its mineral composition. The minimum number of strokes for start and complete fragmentation of the stone was recorded in patients with a stone density of 480+54 HU and diagnosed as phosphates. Oxalate and uric acid stones, as well as their combinations (density 1310–1580 HU) required the maximum number of blows. Stone migration was noted in 8 (8.99%) patients. Thanks to intraoperative stone fixation was able to reduce the average time of lithotripsy (from 15,65±6.9 min to 12.3±6,15 min) and reduce the frequency of retrograde stone migration from 15.4% (in 6 patients of group 1) to 4% (2 patients of ІI group). The dependence of lithotripsy efficiency on stone localization is established. It was highest in patients with stones of the lower third of the ureter (95% in patients of group 1 and 100% of patients in group II) and with low density (480–840 HU). The lowest efficacy was observed in patients whose stones were localized in the upper third of the ureter (66.3% in group I and 90% in group II) and had a high density (more than 1200 HU). Due to the fixation of the stone with modified pneumoureterolithotripsy, the overall effectiveness of the method increased from 84.6% to 96%. Conclusions. Traneurethral contact pneumoureterolithotrysis using a portable pneumatic lithotripter LMA Stonebreaker – is effective, safe, minimally costly and easy to use. The effectiveness of contact pneumatic ureterolithotripsy depends on the location and density of the stone. The number of strokes required for the initial and complete fragmentation of the stone directly depends on the density of the stone and does not depend on its location and method of performing pneumoureterolithotripsy. The use of a modified technique with fixation of the stone in the ureter during the process of lithotripsy reduces the time of the operation and increases its effectiveness.

scholarly journals Simultaneous saline irrigation during retrograde rigid ureteroscopic lasertripsy for the prevention of proximal calculus migration

2013 ◽  
Vol 7 (1-2) ◽  
pp. 65 ◽  
Author(s):  
Lu Sun ◽  
Fang-li Peng
Keyword(s):  
Operative Time ◽  
Upper Urinary Tract ◽  
Excretory Urography ◽  
Ureteral Stones ◽  
Saline Irrigation ◽  
Irrigation Method ◽  
Group I ◽  
Significant Difference ◽  
Stone Migration ◽  
Group Ii

Objective: To analyze the clinical efficacy of Simultaneous saline irrigation method in treating upper-mid ureteral stone migration and overall efficiency during ureteroscopic lasertripsy. Methods: We prospectively evaluated 78 patients with a total of 95 upper-mid ureteral stones, which were treated with holmium: YAG lasertripsy. These patients were randomized into two groups. In group I (39 cases with 44 ureteral stones), conventional ureteroscopic lasertripsy was performed in like manner. While in group II (39 cases with 51 ureteral stones), the Simultaneous saline irrigation method was used during lasertripsy. There was no significant difference between the groups with regards to stone site, size or state of the upper urinary tract by spiral computed tomography or excretory urography. Data were analyzed regarding stone migration, lengths of time, and ureteral clearing for various stages of each procedure. Results: One patients (2%) occurred upward stone migration in group II, while in group I it occurred in eight patients (20%).The operative time in group I ranged between 35 to 55 minutes (mean, 44.8±5.3), while in group II it ranged between 40 to 69 minutes (mean, 50.4±3), The operative time was no significant difference between the groups  (p<0.05). Ureteral perforation, urinoma, and urosepsis were not seen in both groups. Conclusion：Simultaneous saline irrigation method demonstrated a statistically significant advantage over the conventional methods. Operation can be performed persistently under clear vision, and the calculus can not be moved upwards, the fragmentation easily to be flushed out. Our data suggest that this method is simple，safe and effective in preventing proximal stone migration during ureteroscopic lasertripsy.

scholarly journals Recovery Status in Children after General Anaesthesia: Role of Pre-emptive Local Anaesthetic Infiltration

2009 ◽  
pp. 38-44
Author(s):  
Md Maqsud Isa ◽  
Rubina Yasmin ◽  
Nur Syeeda ◽  
Suraiya Enam ◽  
Md Manowarul Isiam ◽  
...  
Keyword(s):  
Oxygen Saturation ◽  
General Anaesthesia ◽  
Local Anaesthetic ◽  
Local Infiltration ◽  
Group I ◽  
Mean Pressure ◽  
Recovery Status ◽  
Group Ii ◽  
Operative Recovery ◽  
Group 1

This prospective clinical study was carried out in the dept. of Anaesthesia, Analgesia and Intensive Care Medicine, BSMMU. Dhaka during the period of January 04 to September 04. The study was done to emphasize the importance of giving analgesics preemptively instead of waiting for the child to complain or express their pain and to improve post operative recovery status and associated response by reducing the immediate post operative pain with simple local anaesthetic infiltration. The children scheduled for elective herniotomy operation through a hernial incision under general anaesthesia were recruited in this study. Immediate recovery status in children was compared with preemptive (group-1 and without preemptive (group-II) local infiltration of 0.25% bupivacaine in herniotomy operation. No. of patients was 20 in each group. Pulse, systolic, diastolic and mean pressure, oxygen saturation, pain (scored by TPPPS), anaesthetic recovery (scored by steward recovery system) and mental status if the children were observed postoperatively at different time interval up to one hour. Pulse, systolic, diastolic, mean pressure were stable in group-1 then group-II. Oxygen saturation in both the groups were in clinically acceptable range but in group-11 5 mins after extubation fall more than that of group- l and statistically significant. Pain score (TPPPS) in group-1 was lower all the time period but in group-II the score was high, all the children required rescue pethidine within 10 mins after extubation, mean dose reqd, in group-II was 23.6+3.6mg. Steward recovery score in both group was not significant at early period but after 10 mins. P value become significant The mental state of group-I was calm & quite only 3 were excited, on the other hand in group-11 all children were excited & irritable and required rescue pethidine. So preemptive local infiltration of 0.25 bupivacaine improved the recovery status in children by reducing the immediate postoperative pain and there by decrease in postoperative morbidity. Journal of BSA, Vol. 18, No. 1 & 2, 2005 p.38-44

scholarly journals The impact of ureteral Double-J stent insertion following ureterorenoscopy in patients with ureteral stones accompanied by perirenal fat stranding

2018 ◽  
Vol 90 (1) ◽  
pp. 15
Author(s):  
Ercan Ogreden ◽  
Ural Oguz ◽  
Erhan Demirelli ◽  
Erdal Benli ◽  
Özkan Özen
Keyword(s):  
Ureteral Stone ◽  
Ureteral Stones ◽  
Stent Insertion ◽  
Female Ratio ◽  
Group I ◽  
Dj Stent ◽  
Group Ii ◽  
Fat Stranding ◽  
The Impact ◽  
Perirenal Fat

Objective: To evaluate the impact of ureteral stent insertion following semirigid ureterorenoscopy (URS) in patients with perirenal fat stranding (PFS) due to ureteral stones. Material and methods: Data of 600 patients who underwent URS were analyzed retrospectively. Seventy-two patients detected to have PFS accompanying ureteral stone were included. Patients who did not undergo double J (DJ) stent insertion following semirigid URS were classified as Group I (n: 52), while those who underwent stent insertion were classified as Group II (n: 20). Side distribution; localization of the stones, stone size, presence of fever, urinary tract infection (UTIs) and urosepsis rates were compared in the two groups. Results: The average age of the patients was 44.4 (20-71) years. Male/female ratio and side of the stone location showed similar distribution in both groups (p > 0.05). Fever occurred in 23 cases (44.2%) in Group I and in 15 cases (75%) in Group II (p = 0.038). UTIs occurred in 15 cases (28.9%) in Group I and in 12 cases (60%) in Group II (p = 0.03). Urosepsis presented in 3 (5.8%) and 5 (25%) of the patients in Group I and II, respectively (p = 0.033). Conclusions: According to our results, ureteral DJ stent insertion following URS in patients with PFS due to ureteral stone caused an increase on postoperative infection related complications.

scholarly journals Do stone size and impaction influence therapeutic approach to proximal ureteral stones?

2009 ◽  
Vol 66 (2) ◽  
pp. 129-133 ◽  
Author(s):  
Slobodan Radulovic ◽  
Aleksandra Vuksanovic ◽  
Dragica Milenkovic-Petronic ◽  
Bozo Vavic
Keyword(s):  
Therapeutic Approach ◽  
Ureteral Stone ◽  
Treatment Success ◽  
Ureteral Stones ◽  
Stone Size ◽  
Extracorporeal Shock Wave ◽  
Group I ◽  
Significant Difference ◽  
Group Ii ◽  
Proximal Ureteral Stone

Background/Aim. Primary therapeutic approach to lumbar ureteral stones is still contraversial. The aim of the study was to investigate the influence of stone impaction and size on the effectiveness of proximal ureteral stone lithotripsy. Methods. A total of 123 patients with proximal ureteral stones were investigated in this prospective study performed in a 10- month period. The patients were divided into the group I - 86 patients treated with extracorporeal shock wave lithotripsy (ESWL) and the group II - 37 patients treated with 'Swiss' Lithoclast. In the group I, 49 stones (57%) were classified as impacted, while 20 stones (23.3%) were larger than 100 mm2. In the group II, 26 stones (70.3%) were impacted, and 11 stones (29.7%) were larger than 100 mm2. Stones were defined as impacted by the radiographic, echosonographic as well as endoscopic findings in the group II of patients. Stone size was presented in mm2. Chemical composition of stones were almost the same in both groups of the patients. Results. Generally, there was no statistically significant difference in the treatment success between the groups. However, stones larger than 100 mm2 were statistically more successfully treated endoscopically, while there was no statistical difference in the treatment success of impacted stones between these two groups. Conclusion. ESWL can by considered as primary first therapeutic approach in treatment of all proximal ureteral stones except for stones larger than 100 mm2 that should primarily be treated endoscopically.

scholarly journals Factors associated with urinoma accompanied by ureteral calculi

2019 ◽  
Vol 91 (1) ◽  
pp. 11-15
Author(s):  
Ercan Öğreden ◽  
Ural Oǧuz ◽  
Mehmet Karadayı ◽  
Erhan Demirelli ◽  
Alptekin Tosun ◽  
...  
Keyword(s):  
Serum Creatinine ◽  
Ureteral Stone ◽  
Ureteral Calculi ◽  
Ureteral Stones ◽  
Stone Size ◽  
Macroscopic Hematuria ◽  
Factors Associated ◽  
Group I ◽  
Group Ii ◽  
Tract Infections

Objective: Urinoma is a rare entity and mainly occurs due to acute obstruction such as ureteral stone. We aimed to demonstrate factors associated with urinoma accompanied by ureteral calculi. Material and methods: Data of 550 patients who were diagnosed with ureteral stone by computed tomography (CT) were analyzed retrospectively. In 20 patients perirenal urinoma was associated with ureteral calculi (group I), whereas in other 530 patients no urinoma was detected (group II). Gender, age, size, side and localization of the stone, hydronephrosis, fever, sepsis, urinary tract infections (UTIs), hematuria, serum creatinine, blood urea nitrogen (BUN), white blood cell (WBC), C-reactive protein (CRP), presence of diabetes mellitus (DM), hypertension (HT) and cronic kidney disease (CKD) of the two groups were compared. Results: The average age of the patients were 46.2 (20-71) and 44.9 (10-82) years in group I and group II, respectively (p > 0.05). According to our results leukocytosis, microscopic and macroscopic hematuria, UTIs, increase of serum creatinine, BUN and CRP, diagnosis of DM and HT were significantly associated with urinoma (p < 0.05). In addition, patients with distal ureteral stones are more prone to urinoma (p = 0.001). An interesting finding of the study was that the stone size in group I (median 5 mm [range 3-8]) was significantly smaller than in group II (9.3 mm [4-25]; p = 0.001). Conclusions: Small stone size, distal localisation of the stone in ureter, leukocytosis, hematuria, UTIs, increase of serum creatinine, BUN and CRP, presence of DM and HT are associated with perirenal urinoma.

scholarly journals CHEMICAL CHARACTERIZATION OF GLYCOPEPTIDES FROM HUMAN γM-GLOBULINS

1968 ◽  
Vol 128 (4) ◽  
pp. 699-713 ◽  
Author(s):  
Joseph M. Davie ◽  
C. Kirk Osterland
Keyword(s):  
Molecular Weight ◽  
Sialic Acid ◽  
Gel Filtration ◽  
Chemical Characterization ◽  
Carbohydrate Composition ◽  
Total Percentage ◽  
Group I ◽  
Group Ii ◽  
Group 1

A survey of human pathological macroglobulins revealed that γM can be divided into at least two groups on the basis of carbohydrate composition. Differences between the two groups exist in the total percentage of carbohydrate (10.69 ± 1.49% for group 1, 7.71 ± 0.65% for group II) which is attributable to variation in hexose content. Glycopeptides from macroglobulins of each group were purified from pronase digests and characterized chemically. Macroglobulins from each group contain three types of oligosaccharides. Glycopeptide I for each group consisted of mannose, galactose, and NAG with a ratio of 3:2:1 for group I and a ratio of 2:1:2 for group II. Glycopeptide II consisted of mannose, galactose, and NAG (9:1:2) for group I, and mannose, fucose, galactose, and NAG (2:1:3:2) for group II. Glycopeptide III in both groups consisted of mannose, fucose, galactose, NAG, and sialic acid with a ratio of 6:2.5:2.5:5.5:2 for group I and a ratio of 5:1:1:6:1 for group II. Molecular weight estimations by gel filtration indicates that there are 10 glycopeptides I and II and 20 units of glycopeptide III per molecule of γM.

scholarly journals Rationale of specialized medical care for patients with chronic heart failure in the Russian Federation

2020 ◽  
Vol 1 (3) ◽  
pp. 44-53
Author(s):  
I. V. Fomin ◽  
N. G. Vinogradova
Keyword(s):  
Heart Failure ◽  
Medical Care ◽  
Clinical Severity ◽  
Adherence To Treatment ◽  
Group I ◽  
Patients With Heart Failure ◽  
Group Ii ◽  
Overall Mortality ◽  
Group 1

Objectives: to determine the causes of ineffective observation and poor prognosis in patients undergoing ADHF, in real clinical practice and to consider the basics of the formation of specialized medical care for patients with heart failure (HF).Materials and methods: the study was conducted based on the City Center for the treatment of heart failure (center HF), N. Novgorod. The study consistently included 942 patients with heart failure (HF) at the age of 18 years and older who underwent ADHF and received inpatient treatment in center HF between March 4, 2016 and March 3, 2017. Based on the decisions of patients to continue outpatient monitoring in center HF, two groups of patients were distinguished: patients who continued to be monitored in center HF (group I, n = 510) and patients who continued to be monitored in outpatient clinics at the place of residence (group II, n = 432). The assessment of adherence to treatment, overall mortality, survival and re-admission to a depth of two years of observation was carried out. Statistical data processing was performed using Statistica 7.0 for Windows and the software package R.Results: all patients in the study groups had high comorbidity. Group 2 patients turned out to be statistically significantly older, more often had III functional class (FC) HF, lower the baseline test score of 6-minute walk, and higher the baseline clinical assessment scale. After 2 years of follow-up in group II, there was a significant deterioration in adherence to basic therapy of HF compared with group I. According to the results of multifactorial proportional risk Cox models, it was shown that observation of patients in the group 1 is an independent factor increasing the risk of overall mortality by 2.8 times by the end of the second year of observation. Survival after two years of follow-up was: in group I — 89.8 %, and in group II — 70.1 % of patients (OR = 0.3, 95 % CI 0.2 – 0.4; p1/2 < 0.001). After two years of follow-up, the proportion of re-hospitalized patients in group II was greater (78.0 % of patients) versus group 1 (50.6 % of patients, OR = 3.5, 95 % CI 2.6 – 4.6; p1/2 <0.001). The independent risk of re-hospitalization according to multinominal logit regression was 3.4 times higher in group II and 2.4 times for III – IV FC HF. Conclusions: the inclusion of patients with HF in the system of specialized medical care improves adherence to treatment, prognosis of life and reduces the risk of repeated hospitalizations. Patients of an older age and with an initially greater clinical severity refused specialized supervision in center HF.

scholarly journals The Role of Antegrade Ureterolithotripsy in the Treatment of Large Impacted Proximal Ureteral Stones

Health of Man ◽  
2021 ◽  
pp. 93-98
Author(s):  
Vladyslav Ozhogin
Keyword(s):  
Ureteral Stones ◽  
Total Percentage ◽  
Antegrade Approach ◽  
Group I ◽  
The Status ◽  
Proximal Ureter ◽  
Group Ii ◽  
High Level ◽  
Jj Stent

The objective: optimization of approaches to the choice of endoscopic ureterolithorpsy method in the presence of large stones of the proximal ureter. Materials and methods. For the period 2017–2020 y. the study included 136 patients with large stones of the proximal ureter, who were performed one of two methods of ureterolithotripsy: rULT (group I) or m-aULT (group II). In group I 73 (53,7%) patients were operated, in group II – 63 (46,3%) patients. The age of patients ranged from 18 to 81 years, the average age was 52,7 years (54±10,5). The age of patients in group II ranged from 25 to 77 (63±10,5) years; the size of a concrement from 10 to 20 (14±3,5 mm). In group I, the age of patients ranged from 18 to 91 (63,5±10 years); the size of a concrement from 7 to 20 (12±5,5 mm). Results. The average time of m-AULT was 58,5±15,4 min, while the status of stone free was achieved in all 100% of patients. The operation ended with the installation of nephrostomy drainage in 11 (17,5%) cases, nephrostomy drainage and internal ureteral JJ-stent – in 33 (52,4%), in 19 (30,2%) cases – tubeless drainage method with the installation of ureteral stent. And the total percentage of stenting in staghorn stones of the proximal ureter, after lithotripsy and litholapaxy was 82,6% (52 patients). RULT surgery in 92% (67 patients) of cases ended with drainage of the kidney by JJ-stent, in 6 (8%) patients the operation ended without drainage. Conclusions. Analyzing the results, it was noted that the antegrade approach is a safe and effective method of treatment for proximal ureterolithiasis in the group with large stones of the proximal ureter, where the effectiveness of RULT (SFR up to 86,3±3,9%) is significantly inferior to AULT, and minimizing the size of instruments m-aULT) reduces the number and degree of complications associated with the size of the coiled tract, while providing a high level of SFR (96,8±4,4%).

scholarly journals Technique for Optimizing Morganian Cataract Phacoemulsification

2018 ◽  
Vol 15 (2S) ◽  
pp. 160-165
Author(s):  
O. L. Fabrikantov ◽  
E. S. Pirogova ◽  
S. I. Nikolashin
Keyword(s):  
Surgical Intervention ◽  
Sagittal Plane ◽  
Intraoperative Complications ◽  
Standard Technique ◽  
Posterior Capsule ◽  
Anterior Capsule ◽  
Group I ◽  
Group Ii ◽  
Improved Technology ◽  
Capsular Bag

Purpose: to optimize the technique of hypermature Morganian cataract phacoemulsification.Patients and methods. 18 patients (18 eyes) with hypermature Morganian cataract were examined. Group I included 8 patients who underwent surgical intervention according to the improved technology using the iridocapsular retractors. Group II included the retrospective results of phacoemulsification with IOL implantation performed according to a standard technique in 10 patients. The optimizing surgical technique in patients of group I consisted in the consecutive usage of four iridocapsular retractors: when creating a capsulorhexis — to stabilize the capsular bag during the circular rupture of the anterior capsule; during the nucleus phacoemulsification — to stabilize the complex: capsular bag, nucleus, capsular ring — in the sagittal plane and additional (together with the capsular ring) support of the capsular bag fornices.Results. No complications were noted in patients of group I. In patients of group II there were two ruptures of the posterior capsule (20%), two cases of re-implantation of a capsular ring because of the stop of its edge into the fold of the capsular bag fornix, one rupture of the anterior capsulorhexis border without its transition to the posterior capsule. In group I there were no any complications in the postoperative period. In group II we noted two corneal oedemata, Descemet membrane folds, which were jugulated by the conservative treatment on the 4–5th days postoperatively.Conclusion. The optimizing technique of hypermature Morganian cataract phacoemulsification with the use of four iridocapsular retractors and capsular ring allowed reducing the number of intraoperative complications in comparison with the standard technique and making the surgical intervention more effective and safe. 

scholarly journals Comparison of tolterodine and Solifancine in treatment of female with overactive bladder

2021 ◽  
Vol 10 (6) ◽  
pp. 2138
Author(s):  
Nermeen Mohamed Hefila ◽  
Tamer Mamdouh And el dayem ◽  
Hisham Adel Elfazari
Keyword(s):  
Overactive Bladder ◽  
Maternity Hospital ◽  
P Value ◽  
Detrusor Muscle ◽  
Urinary Urgency ◽  
Urinary Frequency ◽  
Group I ◽  
Significant Difference ◽  
Group Ii ◽  
Group 1

Background: OAB (overactive bladder) is primarily a neuromuscular problem in which the detrusor muscle contracts inappropriately during bladder filling (i.e., storage phase). These contractions often occur regardless of the amount of urine in the bladder. The aim of this work is to study the effect of Solifenacin in comparison to Tolterodine in treatment of females with idiopathic over active bladder.Methods: This study included 50 patients who presented between March 2020 and February2021 to the outpatients clinic at El-Shatby maternity Hospital, Alexandria university. The patients were complaining of urinary urgency usually with urinary frequency, nocturia with or without urge incontinence. All cases were divided in two groups one of them receive Solifenacin5mg twice daily and the otherreceiveTolterodine2mg twice daily.Results: Both groups showed significant decrease in frequency number per day with p value <0.001ingroup I with Solifenacin which mean statistically significant difference between two groups. When the percentage of symptoms severity were compared between both groups, group 1 showed 53% reduction in symptoms severity while group II showed 6.67% reduction which cleared significant difference statistically in group I (p=0.001). The percentage of reduction of severity of symptoms was compared between the two groups, it showed about 60%reduction in symptoms severity in group 1while in group II only 9.7% reduction. This was statistically significant with (p<0.001) in group I with Solifenacin.Conclusions: This study suggests that Solifenacin10mg/day is more effective than Tolterodine4mg/day in reducing OAB incontinence episodes.

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