scholarly journals The Value of Hounsfield Unit in Retrograde Intrarenal Surgery Versus Percutaneous Nephrolithotomy for the Treatment of Renal Stone of 2-3 cm: A Single-center Prospective Pilot Study

2021 ◽  
Vol 5 (3) ◽  
pp. 1-10
Author(s):  
Yuzhuo Li ◽  
Keyword(s):  
Hounsfield Unit ◽  
Renal Stones ◽  
Positive Relation ◽  
Clinical Procedures ◽  
Efficacious Treatment ◽  
Stone Free Rate ◽  
Stay Time ◽  
Selection Of

Background: To determine whether the Hounsfield Unit (HU) value of no-contrast computer computed tomography (NCCT) might offer better guidance in the selection of RIRS or PCNL in renal stones of 2-3 cm. Methods: A total of 158 patients with kidney stones (2-3 cm) who underwent PCNL/RIRS from March 2016 to January 2019 were enrolled in this study. Age, gender, stone sizes, locations, average HU value of stones, surgery time, hospital stay time, stone-free rate, and complications at the time of hospitalization and 3-month follow-up were measured to identify the surgery efficiency. Results: Upon consideration of the HU value, the mean surgery time was significantly decreased in RIRS comparing to the control RIRS (cRIRS) group (47.73 ± 15.52 vs. 72.41 ± 27.71 min, P < 0.05). Statistically, the surgery time was strongly influenced by the HU values both in RIRS (OR 93.8, P < 0.01) and PCNL (OR 8.21, P < 0.05). HU values proved to have a strong positive relation with surgery time in RIRS while a low positive relation in PCNL (P < 0.05). Conclusion: Overall, for renal stones of 2-3 cm, RIRS might be a safe and efficacious treatment option if the HU value and other parameters could be comprehensively accounted for. Individual precision surgery might provide ideal treatment and prognosis for patients requiring long-term continuous clinical procedures.

Forecast and Guiding role of using Hounsfield unit in retrograde intrarenal surgery for the treatment of renal stone of 2-3 cm: A single center prospective study

2020 ◽  
Author(s):  
Yuzhuo Li ◽  
Qiqi He ◽  
Fei wang ◽  
Junsheng Bao ◽  
Li Yang ◽  
...  
Keyword(s):  
Hounsfield Unit ◽  
Renal Stones ◽  
Single Center ◽  
Retrograde Intrarenal Surgery ◽  
Residual Stone ◽  
Clinical Procedures ◽  
Efficacious Treatment ◽  
Single Center Study ◽  
Stay Time ◽  
Invasive Techniques

Abstract Retrograde intrarenal surgery (RIRS) and percutaneous nephrolithotomy (PCNL) are both important minimally invasive techniques for the treatment of renal stones. With the progress of technology, the application of procedures has been extended. Current surgery choices are made base on stone size, burden and its locations that might limit the predictability and removal of post-operative residual stones. Despite these surgery techniques are maturely used in clinical practice, the patients’ selection have not been standardized in borderline stone. Some patients might suffer several sessions of surgery if intervene decision are not well-designed. In this single-center study, we aimed to determine whether the Hounsfield Unit (HU) value of no-contrast computer computed tomography (NCCT) might offer better guidance in the selection of RIRS or PCNL in renal stones of 2-3 cm, not only in facilitating the stone disintegration, also in providing the potential optimal and less session of setting with great outcomes. A total of 158 patients with kidney stones (2-3 cm) who underwent PCNL/RIRS from March 2016 to January 2019 were enrolled in this study. Gender, stone sizes, locations, average HU value of stone, surgery time, hospital stay time, stone free rate and complications at the time of hospitalization and 3 month follow-up were measured to identify the surgery efficiency. Upon consideration of HU value, the mean surgery time were significantly decreased in RIRS comparing to cRIRS group (47.73 ± 15.52 versus 72.41 ± 27.71 min, p<0.05). Statistically, the surgery time was strong influenced by the HU values both in RIRS (OR: 93.8, p<0.01) and PCNL (OR, 8.21, p<0.05). HU values proved to have a strong positive relation with surgery time in RIRS while a low positive related in PCNL (p<0.05). Overall, for renal stones of 2-3 cm, RIRS proved to be a safe and efficacious treatment option if HU value and other parameters could be comprehensively accounted. Considering HU value before 2-3cm kidney stone lithotripsy seems to be necessary, which might save the surgery time and reduce the potential risk of renal injury, as even if residual stone were detected post-op, ESWL could also be employed and work efficiently. Some patients might not have to perform several sessions of RIRS. Taken together, individual precision surgery might provide ideal treatment and prognosis for patients requiring long-term continuous clinical procedures.

scholarly journals Active surveillance in patients with a PSA >10 ng/mL

2014 ◽  
Vol 8 (9-10) ◽  
pp. 702 ◽  
Author(s):  
Paul Toren ◽  
Lih-Ming Wong ◽  
Narhari Timilshina ◽  
Shabbir Alibhai ◽  
John Trachtenberg ◽  
...  
Keyword(s):  
Active Surveillance ◽  
Specific Antigen ◽  
Sufficient Evidence ◽  
Hazard Ratios ◽  
Diagnostic Biopsy ◽  
Selection Of Patients ◽  
Baseline Psa ◽  
Selection Of

Introduction: The use of prostate-specific antigen (PSA) in active surveillance (AS) for prostate cancer is controversial. Some consider it an unreliable marker and others as sufficient evidence to exclude patients from AS. We analyzed our cohort of AS patients with a PSA over 10 ng/mL.Methods: We included patients who had clinical T1c–T2a Gleason ≤6 disease, and ≤3 positive cores with ≤50% core involvement at diagnostic biopsy and ≥2 total biopsies. Patients were divided into 3 groups: (1) those with baseline PSA >10 ng/mL, (2) those with a PSA rise >10 ng/mL during follow-up; and (3) those with a PSA <10 ng/mL throughout AS. Adverse histology was defined as biopsy parameters exceeding the entry criteria limits. We further compared this cohort to a concurrent institutional cohort with equal biopsy parameters treated with immediate radical prostatectomy.Results: Our cohort included 698 patients with a median follow-up of 46.2 months. In total, 82 patients had a baseline PSA >10 ng/mL and 157 had a PSA rise >10 ng/mL during surveillance. No difference in adverse histology incidence was detected between groups (p = 0.3). Patients with a PSA greater than 10 were older and had higher prostate volumes. Hazard ratios for groups with a PSA >10 were protective against adverse histology. Larger prostate volume and minimal core involvement appear as factors related to this successful selection of patients to be treated with AS.Conclusion: These results suggest that a strict cut-off PSA value for all AS patients is unwarranted and may result in overtreatment. Though lacking long-term data and validation, AS appears safe in select patients with a PSA >10 ng/mL and low volume Gleason 6 disease.

Adductor Spastic Dysphonia: 1 1/2 Years after Recurrent Laryngeal Nerve Resection

1981 ◽  
Vol 90 (1) ◽  
pp. 2-6 ◽  
Author(s):  
Arnold E. Aronson ◽  
Lawrence W. DeSanto
Keyword(s):  
Recurrent Laryngeal Nerve ◽  
Laryngeal Nerve ◽  
Physical Effort ◽  
Patients Âgés ◽  
Reduced Volume ◽  
Follow Up Studies ◽  
Long Term Follow Up ◽  
Selection Of

After recurrent laryngeal nerve resection for adductor spastic dysphonia, the voices of 37 patients (ages 39 to 79 years) were assessed 24 hours, 1 month, 6 months, and 1 year after surgery, and those of 33 patients up to 1 1/2 years after surgery. By 24 hours after surgery, 97% of patients had improved and 3% had failed; by 1 month, 97% were still improved while 3% had failed; by 6 months, 92% had maintained improvement while 8% had failed; by 1 year, 68% were still improved but 32% had failed; and by 1 1/2 years, 61% were still improved while 39% had failed. The patients whose voices improved varied from one another in both type and degree of residual dysphonia. The typical postsurgical voice was free of spasm, with some breathiness, hoarseness, and reduced volume being present. The voices of some patients approached normalcy. To most patients, relief from the physical effort to phonate was as important as the improved voice. Continued long-term follow-up studies and careful, collaborative selection of surgical candidates are needed.

MP62-11 EXTRACORPOREAL SHOCK-WAVE LITHOTRIPSY (ESWL) FOR RENAL STONES IS ASSOCIATED WITH DECREASED KIDNEY FUNCTION AFTER LONG TERM FOLLOW-UP

2017 ◽  
Vol 197 (4S) ◽  
Author(s):  
Christian Fankhauser ◽  
Josias Grogg ◽  
Alexander Holenstein ◽  
Qing Zhong ◽  
Johann Steurer ◽  
...  
Keyword(s):  
Shock Wave ◽  
Kidney Function ◽  
Extracorporeal Shock Wave Lithotripsy ◽  
Shock Wave Lithotripsy ◽  
Renal Stones ◽  
Extracorporeal Shock Wave ◽  
Long Term Follow Up

Long Term Follow-Up of Pediatric SCD Patients with Abnormal High Velocities on Transcranial Doppler: Monocenter Experience in Creteil, France.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 1656-1656
Author(s):  
Francoise Bernaudin ◽  
Suzanne Verlhac ◽  
Lena COIC ◽  
Emmanuelle Lesprit ◽  
Pierre Brugieres ◽  
...  
Keyword(s):  
Stroke Risk ◽  
Color Doppler ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Vascular Abnormalities ◽  
Long Term Follow Up ◽  
Risk Patients ◽  
Selection Of

Abstract Abnormal high velocities are predictive of high stroke risk which can be significantly reduced by transfusion program (Adams and al). They are related to stenosis, severe anemia or tissue hypoxia. We hypothesized that high velocities observed in patients with normal MRA and normalized on transfusion program (TP), were anemia related and could be safely decreased with hydroxyurea (HU)-therapy. Patients and Methods: since 1992, 291 pediatric SCD patients (235 SS, 40 SC, 3 Sb0, 11 Sb+) were systematically explored once a year by TCD. The newborn screened cohort (n=149) had the first TCD exploration between 12 and 18 months age. TCD was performed with a real-time imaging unit, using a 2 MHz sector transducer with color Doppler capabilities. When abnormal high velocities (defined as mean maximum velocities > 200 cm/sec in MCA, ACA or ICA) were observed, TCD was controlled and the patient treated with TP and cerebral imaging (MRI/MRA) was performed within 3 months. In patients with severe stenosis, TP was pursued or transplantation performed. In patients with normal MRA and transfusion-normalized velocities, a progressive switch towards HU therapy was applied and TCD controlled once a trimester. Results: among the stroke-free patients (n=281), abn. high velocities were detected in 25 patients (all SS:11% of incidence in SS patients). In the newborn screened population, velocities became abnormal in 10 patients at the median age of 5.7 years (range 1.4 – 12.5 y). The first MRI/MRA (n=24/25) performed in the 3 months following the detection of high velocities showed MRI/silent infarcts in 9/24 (38%): only 1/11 among the newborn screened cohort had silent infarcts in contrast with 8/13 older patients secondary referred in our center. MRA detected severe vascular abnormalities in 10 and mild in 3 patients. Mean velocities (2.69 m/sec) were significantly higher (p=0.002) in the 7 patients with abn. MRI and MRA than in the 10 patients (2.11m/sec) who had normal MRI and MRA. One stroke occurred in a very young 1.6 y old girl just before the second TCD evaluation (first abn. TCD had been observed at 1.5 y) and before the beginning of the TP. Long-term outcome: no stroke was observed following the initiation of the TP. With a median follow-up of 4.4 years (0.5 to 11.4 y.), velocities remained abnormal in 11/25 patients: 7 of them had abnormal MRA and among the 4 patients with normal MRA at first exploration MRA became abnormal in 2 cases showing that abnormal TCD can precede the occurrence of cerebral vasculopathy. TP was maintained in 7 patients and safely stopped in 4 patients transplanted with genoidentical donor. Velocities normalization (defined as < 170 cm/sec) was observed in 13/25 patients in a median delay of 0.75 years (0.25 – 2.3 years). TP was stopped in 10 patients with normal MRA and therapy was switched towards HU in 7 patients with abstention in 3. However, abnormal TCD relapsed in 4 patients who were again placed on TP. Conclusion: abnormal high velocities concerned 11% of SS patients and were predictive of MRA and MRI lesions occurrence. TP was efficient to prevent the stroke risk and normalized velocities in about 50% of patients but relapses were observed in 4/7 patients following TP stop and HU switch. Only few patients with high velocities history did not develop cerebral vasculopathy. Also, early TCD allows a selection of very high risk patients justifying the research of suitable donors.

The utility of preoperative diffusion tensor imaging in the surgical management of brainstem cavernous malformations

2015 ◽  
Vol 122 (3) ◽  
pp. 653-662 ◽  
Author(s):  
Bruno C. Flores ◽  
Anthony R. Whittemore ◽  
Duke S. Samson ◽  
Samuel L. Barnett
Keyword(s):  
Diffusion Tensor ◽  
Medial Longitudinal Fasciculus ◽  
Medial Lemniscus ◽  
Cavernous Malformations ◽  
Fiber Tracts ◽  
The Mean ◽  
Cerebellar Peduncle ◽  
Selection Of

OBJECT Resection of brainstem cavernous malformations (BSCMs) may reduce the risk of stepwise neurological deterioration secondary to hemorrhage, but the morbidity of surgery remains high. Diffusion tensor imaging (DTI) and diffusion tensor tractography (DTT) are neuroimaging techniques that may assist in the complex surgical planning necessary for these lesions. The authors evaluate the utility of preoperative DTI and DTT in the surgical management of BSCMs and their correlation with functional outcome. METHODS A retrospective review was conducted to identify patients who underwent resection of a BSCM between 2007 and 2012. All patients had preoperative DTI/DTT studies and a minimum of 6 months of clinical and radiographic follow-up. Five major fiber tracts were evaluated preoperatively using the DTI/DTT protocol: 1) corticospinal tract, 2) medial lemniscus and medial longitudinal fasciculus, 3) inferior cerebellar peduncle, 4) middle cerebellar peduncle, and 5) superior cerebellar peduncle. Scores were applied according to the degree of distortion seen, and the sum of scores was used for analysis. Functional outcomes were measured at hospital admission, discharge, and last clinic visit using modified Rankin Scale (mRS) scores. RESULTS Eleven patients who underwent resection of a BSCM and preoperative DTI were identified. The mean age at presentation was 49 years, with a male-to-female ratio of 1.75:1. Cranial nerve deficit was the most common presenting symptom (81.8%), followed by cerebellar signs or gait/balance difficulties (54.5%) and hemibody anesthesia (27.2%). The majority of the lesions were located within the pons (54.5%). The mean diameter and estimated volume of lesions were 1.21 cm and 1.93 cm3, respectively. Using DTI and DTT, 9 patients (82%) were found to have involvement of 2 or more major fiber tracts; the corticospinal tract and medial lemniscus/medial longitudinal fasciculus were the most commonly affected. In 2 patients with BSCMs without pial presentation, DTI/DTT findings were important in the selection of the surgical approach. In 2 other patients, the results from preoperative DTI/DTT were important for selection of brainstem entry zones. All 11 patients underwent gross-total resection of their BSCMs. After a mean postoperative follow-up duration of 32.04 months, all 11 patients had excellent or good outcome (mRS Score 0–3) at the time of last outpatient clinic evaluation. DTI score did not correlate with long-term outcome. CONCLUSIONS Preoperative DTI and DTT should be considered in the resection of symptomatic BSCMs. These imaging studies may influence the selection of surgical approach or brainstem entry zones, especially in deep-seated lesions without pial or ependymal presentation. DTI/DTT findings may allow for more aggressive management of lesions previously considered surgically inaccessible. Preoperative DTI/DTT changes do not appear to correlate with functional postoperative outcome in long-term follow-up.

Prolactin-Secreting Adenomas: Surgical Results and Long-Term Follow-up

Neurosurgery ◽  
1989 ◽  
Vol 24 (5) ◽  
pp. 736-743 ◽  
Author(s):  
Giulio Maira ◽  
Carmelo Anile ◽  
Laura De Marinis ◽  
Antonino Barbarino
Keyword(s):  
Empty Sella ◽  
Surgical Removal ◽  
Total Removal ◽  
Efficacious Treatment ◽  
Transsphenoidal Microsurgery ◽  
Long Term Follow Up ◽  
Grade Ii ◽  
Adenomatous Tissue

ABSTRACT Transsphenoidal surgery is an efficacious treatment for patients with prolactin (PRL)-secreting adenomas, even if disrupted pituitary-hypothalamic relationships may persist and/or a recurrence of the PRL-secreting tumor can occur. In this paper, we analyze the long-term follow-up of 119 consecutively treated women who underwent transsphenoidal microsurgery for PRL-secreting adenomas. Apparent total removal of the tumor was achieved in 98 patients who had enclosed tumors (58 with Grade-I tumors and 40 with Grade II). In the remaining patients, the removal was considered partial. Persistent normal basal PRL levels were achieved in 61 patients who had apparent total removal of the adenoma (44 with Grade I tumors and 17 with Grade II). Of the remaining 37 patients in whom surgical removal of the adenomatous tissue was thought to be total, 30 had persistent nonevolutive, high PRL levels ranging from 21 to 196 ng/ml, without clinical and radiological signs of tumor regrowth, and 7 with PRL levels ranging from 56 to 560 ng/ml had a recurrence of the PRL-secreting tumor. These data seem to indicate that a slightly elevated postsurgical PRL value does not imply that tumoral tissue is still present. Nontumoral conditions (i.e., a secondary empty sella) could induce functional hyperprolactinemia.

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