scholarly journals Ultrasound follow up: Is an undetected spontaneous expulsion of stone fragments a sign of extracorporeal shock wave treatment failure in kidney stones?

2018 ◽  
Vol 90 (3) ◽  
pp. 166-168
Author(s):  
Grazia Bianchi ◽  
Diego Marega ◽  
Roberto Knez ◽  
Stefano Bucci ◽  
Carlo Trombetta
Keyword(s):  
Treatment Failure ◽  
Average Energy ◽  
Ureteral Stones ◽  
Extracorporeal Shock Wave ◽  
Spontaneous Expulsion ◽  
Extracorporeal Shock Wave Treatment ◽  
Extracorporeal Lithotripsy ◽  
Lost To Follow Up ◽  
Free Status

Introduction. After extracorporeal lithotripsy (SWL), a spontaneous expulsion of fragments is often reported. The aim of this study is to demonstrate the presence of a stone free status or the presence of clinically insignificant residual fragments (CIRFs, defined as “asymptomatic, noninfectious, ≤ 3 mm fragments”) in people with undetected spontaneous expulsion. Materials and methods. Between May and September 2017, we performed a total of 87 treatments. The device used was a Storz Medical Modulith® SLK. All the patients were treated in prone position to reduce respiratory movements and underwent sonography before and four to eight weeks after the treatment. An in line ultrasound targeting was possible with all the stones. People lost to follow up or with ureteral stones were excluded. Patients were divided in groups according to gender, previous treatments, stone diameter and position. Results. We enrolled 73 patients. 57 patients had a single stone and 16 multiple stones. A mean number of 3044 shock waves was administered with a maximum average energy of 0.68mj/mmq. At follow up, 41 patients (56.2%) were found stone free or with CIRFs. The association between undetected expulsion and the presence of CIRFs is considered to be not statistically significant (p = 0.89). Among patients with CIRFs, 25/41 didn’t report expulsion. Taking in account the groups our population was divided in, according to gender (p = 0.36), previous treatments (p = 0.44), stone diameter (p = 0.28) and stone position (p = 0.35), the association between undetected spontaneous expulsion and presence of CIRFs was never statistically significant. Conclusions. An undetected spontaneous expulsion of stone fragments could not be considered a sign of SWL treatment failure. The association between undetected expulsion and presence of CIRFs is never statistically significant if gender of the patients, previous treatments, stone diameter and stone position are considered.

scholarly journals Comparison of an electromagnetic and an electrohydraulic lithotripter: Efficacy, pain and complications

2018 ◽  
Vol 90 (3) ◽  
pp. 169-171 ◽  
Author(s):  
Grazia Bianchi ◽  
Diego Marega ◽  
Roberto Knez ◽  
Stefano Bucci ◽  
Carlo Trombetta
Keyword(s):  
Emergency Room ◽  
Incomplete Data ◽  
Renal Stones ◽  
Ureteral Stones ◽  
Intractable Pain ◽  
X Ray ◽  
Extracorporeal Shock Wave ◽  
Analgesia Requirement ◽  
Lost To Follow Up

Introduction. We analyzed efficacy and complications of extracorporeal shock wave lithotripsy (SWL) and analgesia requirement during the treatment in two groups of patients treated with different lithotripters. Materials and methods. The patients treated were 189, 102 between September 2016 and April 2017 with HMT Lithotron® LITS 172, electrohydraulic, and 87 between May and September 2017 with Storz Medical Modulith® SLK, electromagnetic. The main differences between the lithotripters are: type of energy source, patient position, frequency and number of shock waves. All the patients underwent sonography before and four to eight weeks after the treatment. The targeting was sonographic for renal stones and X-ray for ureteral stones. All the patients received Ketorolac before the treatment with a supplement of Pethidine if needed. People lost to follow-up and with incomplete data were excluded. Results. We enrolled 173 patients, 94 treated with the electrohydraulic lithotripter and 79 with the electromagnetic one. 43 patients (54%) in the electromagnetic group and 31 (33%) in the electrohydraulic group were stone free or presented clinically insignificant residual fragments (CIRFs), defined as asymptomatic, noninfectious, ≤ 3 mm. The association between CIRFs and the kind of lithotripter was statistically significant (p = 0.004). An increased need for analgesia was found in 14.9% of patients in the electromagnetic group and in 81% of patients in the electrohydraulic group (p < 0.001). The access to emergency room (intractable pain, kidney failure, fever, Steintrasse) after the treatment was similar in the two groups (p = 0.37). Conclusions. The best results in stones fragmentation and less analgesia requirement were demonstrated in the electromagnetic lithotripter group. No differences were demonstrated considering the need for emergency room after the treatment

scholarly journals Baseline predictors of antiretroviral treatment failure and lost to follow up in a multicenter countrywide HIV-1 cohort study in Ethiopia

PLoS ONE ◽  
2018 ◽  
Vol 13 (7) ◽  
pp. e0200505 ◽  
Author(s):  
Nigus Fikrie Telele ◽  
Amare Worku Kalu ◽  
Gaetano Marrone ◽  
Solomon Gebre-Selassie ◽  
Daniel Fekade ◽  
...  
Keyword(s):  
Cohort Study ◽  
Treatment Failure ◽  
Antiretroviral Treatment ◽  
Lost To Follow Up ◽  
Hiv 1 ◽  
Antiretroviral Treatment Failure

scholarly journals UPPER URETERIC STONES

2018 ◽  
Vol 25 (01) ◽  
pp. 10-15
Author(s):  
Khalid Hussain ◽  
Attiqur Rehman Khan ◽  
Maria Tariq ◽  
Imran Ameen ◽  
Muhammad Khalid Butt
Keyword(s):  
Shock Wave ◽  
Extracorporeal Shock Wave Lithotripsy ◽  
Shock Wave Lithotripsy ◽  
Pneumatic Lithotripsy ◽  
Extracorporeal Shock Wave ◽  
Male Preponderance ◽  
Dj Stent ◽  
Risk Of Treatment ◽  
Free Status

Objectives: Compare the efficacy of Extracorporeal Shock Wave Lithotripsy withPneumatic Lithotripsy in the management of upper ureteric stones. Settings: Department ofUrology, Lahore General Hospital, Lahore. Duration of Study: From November 2008 to August2009. Results: In our study, the patients were divided into two groups ie; Extracorporeal ShockWave Lithotripsy group (ESWL) and Pneumatic Lithotripsy group (PnL). The mean age inPneumatic Lithotripsy (PnL) was 39+15.23 years, whereas mean age was 40.6+14.62 years inExtracorporeal Shock Wave Lithotripsy group (ESWL). In Extracorporeal Shock Wave Lithotripsygroup (ESWL), 38(76%) patients were male and 12(24%) patients were female while numberwas 34(68%) and 16(32% in Pneumatic Lithotripsy group (PnL) respectively. In both groups,there was male preponderance. In ESWL group, majority of patients were treated as outdoorpatients. 95% of them received intramuscular analgesia where as 5% required intravenoussedation. All patients were followed at two weekly interval up till 6 weeks. Fifty patients requiredmore than 125 sessions of ESWL with mean shock waves 2960+222.23 at at mean energy6.46+0.503kv, 2952+327.77 at 6.45+0.504 kv and 2842+410.03 at 6.76 0.436 kv at 2, 4 and 6weeks respectively. The partial clearance was achieved in 34 patients at 2 weeks, 26 patientsat 4 weeks and 5 patients at 2 weeks. Stone free status at 2 weeks, 4 weeks and 6 weeks were18%, 40% and 84% respectively. In Pneumatic Lithotripsy group (PnL) all of the 50 patientswere given general anesthesia. DJ stent was placed in all patients after the procedure for sixweeks follow up. 42(84%) of patients received shots of Pneumatic Lithotripsy on pulse modewhile in 8(16%) patients, shots were on continuous mode. The partial clearance was achieved in5(10%), 3(6%) and 2(4%) patients at 2, 4 and 6 weeks respectively. Stone free status was 48%,52% and 54% at 2, 4 and 6 weeks respectively. In 20(40%) patients, stone migrated into calyces.Only in 1(2%) patients, there was no effect on stone. All patients in both groups were neededtwo weekly follow up till six weeks. Stone clearance was 84% in Extracorporeal Shock WaveLithotripsy (ESWL) group while it was 54% in Pneumatic Lithotripsy group (PnL), p<0.001.Conclusion: Extracorporeal Shock Wave Lithotripsy offers higher stone free rates with minimalinvasiveness and high safety compared to Pneumatic Lithotripsy, which provides immediatehigh stone free rates, but with high risk of treatment failure.

scholarly journals Comparison of first-line tuberculosis treatment outcomes between previously treated and new patients: a retrospective study in Machakos subcounty, Kenya

2020 ◽  
Author(s):  
Johannes Ndambuki ◽  
Joseph Nzomo ◽  
Lucy Muregi ◽  
Chris Mutuku ◽  
Francis Makokha ◽  
...  
Keyword(s):  
Treatment Failure ◽  
Treatment Outcomes ◽  
Adverse Outcome ◽  
Previous Treatment ◽  
First Line ◽  
Adherence Support ◽  
Previously Treated Patients ◽  
Previously Treated ◽  
Lost To Follow Up

Abstract Background Since 2016, patients with rifampicin-susceptible tuberculosis (TB) have been treated with the 6-month first-line regimen, regardless of treatment history. We assessed treatment outcomes of previously treated and new patients in Machakos subcounty, Kenya. Methods We performed a retrospective cohort study in patients started on first-line treatment between 2016 and 2017. Firth's logistic regression was used to estimate the effect of previous treatment on having a programmatic adverse outcome (either lost to follow-up, death, failure) and treatment failure vs treatment success (either cure or completion). Results Of 1024 new and 79 previously treated patients, 88.1% and 74.7% were treated successfully, 6.5% and 7.6% died, 4.2% and 10.1% were lost to follow-up and 1.2% and 7.6% had treatment failure, respectively. Previous treatment predicted having a programmatic adverse outcome (adjusted odds ratio [aOR] 2.4 [95% confidence interval {CI} 1.4 to 4.2]) and treatment failure (aOR 7.3 [95% CI 2.6 to 20.4]) but not mortality. Similar correlations were found in 334 new and previously treated patients with confirmed baseline rifampicin susceptibility. Conclusion Previously treated patients were more at risk of experiencing a poor treatment outcome, mainly lost to follow-up and treatment failure. Adherence support may reduce lost to follow-up. Rifampicin drug susceptibility testing coverage should increase. More robust retreatment regimens may reduce treatment failure.

scholarly journals Extracorporeal Shock Wave Lithotripsy and Combined Therapy in Children: Efficacy and Long-Term Results

2021 ◽  
Vol 9 ◽  
Author(s):  
Laura Burgos Lucena ◽  
Beatriz Fernández Bautista ◽  
Alberto Parente Hernández ◽  
Ruben Ortiz Rodríguez ◽  
Jose María Angulo Madero
Keyword(s):  
Shock Wave ◽  
Urinary Tract ◽  
Extracorporeal Shock Wave Lithotripsy ◽  
Shock Wave Lithotripsy ◽  
Combined Therapy ◽  
Percutaneous Approach ◽  
Stone Clearance ◽  
Extracorporeal Shock Wave ◽  
Free Status

Background: Extracorporeal shock wave lithotripsy (ESWL) is nowadays the first choice for the treatment of upper urinary tract stones smaller than 2 cm, considering its low complications and high success rate.Aim: To present an update of the current situation of ESWL treatment and to analyse our series of patients and the efficacy of combined lithiasis treatment in different locations and sizes.Patients and Method: Retrospective study including patients with urolithiasis treated with ESWL between 2007 and 2019. Collected data included: gender and age at treatment, presentation symptoms, imaging studies, stone location and size, complications and stone clearance. Success was defined as stone-free status or the presence of clinically insignificant residual fragments (&lt;4 mm after 3 months follow-up). Patients with residual stones larger than 4 mm after 3 months were programmed for another ESWL session or received a combined sandwich therapy, followed by URS or percutaneous approach.Results: Between 2007 and 2019, 37 patients presented a total of 41 lithiasis episodes that were treated with ESWL sessions. Median age at first procedure was 9 years old (1–17) and median follow-up time was 6 years (3–12). Stones were located in the renal pelvis, followed by the lower, middle and upper calyx, proximal ureter, and 51% of our patients had multiple lithiasis. Median stone size was 12 mm (5–45), the main component being calcium oxalate (34%). During immediate postoperative period, 8 patients (19%) presented complications: renal colic, hematuria and urinary tract infection. After the first ESWL, 41% of the patients (n = 17) were stone-free. Out of the 24 residual lithiasis episodes (58%), three patients (7%) underwent a second ESWL session. In the remaining 19 patients, ESWL was combined with URS or percutaneous approach to achieve complete stone clearance. Overall stone free status after combined therapy was 95% (n = 39).Conclusion: These data support that ESWL is an effective minimally invasive technique, with low cost and morbidity, reproducible and safe for the treatment of stone disease in children. Even though lithiasis size seems to be a significant factor in ESWL success, in combination with other lithotripsy procedures it can reach very high rates of stone clearance.

scholarly journals Use of Paclitaxel to Successfully Treat Children, Adolescents, and Young Adults with Kaposi Sarcoma in Southwestern Tanzania

Children ◽  
2021 ◽  
Vol 8 (4) ◽  
pp. 275
Author(s):  
Hamidu Adinani ◽  
Liane Campbell ◽  
Nader Kim El-Mallawany ◽  
Jeremy Slone ◽  
Parth Mehta ◽  
...  
Keyword(s):  
Young Adults ◽  
Treatment Failure ◽  
Kaposi Sarcoma ◽  
Adolescents And Young Adults ◽  
Term Survival ◽  
Middle Income ◽  
Middle Income Countries ◽  
Special Circumstances ◽  
Lost To Follow Up

Treating Kaposi sarcoma (KS) in children, adolescents, and young adults (AYA) remains a challenge in low- and middle-income countries (LMIC) where chemotherapy options and availability are limited. We describe a retrospective cohort review of pediatric patients with KS treated with paclitaxel in Mbeya, Tanzania, between 1 March 2011 and 31 December 2019. Paclitaxel was given to patients who had KS relapse, a contraindication to bleomycin, vincristine, and doxorubicin (ABV), special circumstances in which a clinician determined that paclitaxel was preferable to ABV, or experienced treatment failure, defined as persistent KS symptoms at the completion of treatment. All patients also received multidisciplinary palliative care. Seventeen patients aged 5.1–21.3 years received paclitaxel, of whom 47.1% (8/17) had treatment failure, 29.4% (5/17) received paclitaxel as initial treatment, and 23.5% (4/17) had relapsed. All HIV positive patients (16/17) were given anti-retroviral therapy (ART) and 87.5% (14/16) achieved viral load <1000 cp/mL. At censure, 82.3% (14/17) of patients were alive—71.4% (10/14) achieved complete clinical remission and 28.6% (4/14) achieved a partial response. The median follow up was 37.3 months (range 8.0–83.5, IQR 19.7–41.6), and no patients were lost to follow up. In this cohort, high rates of long-term survival and favorable outcomes were possible with paclitaxel treatment.

scholarly journals Modern Approach to Ureteral Stones

2003 ◽  
Vol 3 ◽  
pp. 853-866 ◽  
Author(s):  
Geert G. Tailly
Keyword(s):  
Renal Colic ◽  
Ureteral Stone ◽  
Ureteral Stones ◽  
Therapy Planning ◽  
Modern Approach ◽  
Adequate Treatment ◽  
Extracorporeal Shock Wave ◽  
Acute Flank Pain ◽  
Imaging Strategy

Urolithiasis is a very common affliction of mankind. In western countries incidence is increasing steadily. An increasing proportion of patients are presenting with ureteral stones, of which renal colic most often is the first complaint and the most common reason for an emergency visit to a urologist. Proper imaging strategy is of paramount importance in the diagnosis of acute flank pain and in the subsequent therapy planning once a ureteral stone is diagnosed. Renal colic during pregnancy poses specific problems, both in imaging and therapy. Apart from the adequate treatment of renal colic, modern therapy of those ureteral calculi that will not pass spontaneously will consist of a judicious combination of ESWL (extracorporeal shock wave lithotripsy), endourology, and laparoscopy. Open surgery should only be reserved for limited and very specific indications. Although beyond the scope of this article, metaphylaxis should take an important role in the follow-up of stone patients in general.

scholarly journals Determinants of first line antiretroviral therapy treatment failure among adult patients on ART at central Ethiopia: un-matched case control study

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Diriba Mulisa ◽  
Mulugeta Tesfa ◽  
Getachew Mullu Kassa ◽  
Tadesse Tolossa
Keyword(s):  
Logistic Regression ◽  
Treatment Failure ◽  
Case Control Study ◽  
Case Control ◽  
First Line ◽  
Matched Case ◽  
Lost To Follow Up ◽  
Matched Case Control Study ◽  
Control Study

Abstract Background In 2018 in Ethiopia, magnitude of human immunodeficiency virus Acquired Immunodeficiency Syndrome treatment failure was 15.9% and currently the number of patient receiving second line antiretroviral therapy (ART) is more increasing than those taking first line ART. Little is known about the predictors of treatment failure in the study area. Therefore; more factors that can be risk for first line ART failure have to identified to make the patients stay on first line ART for long times. Consequently, the aim of this study was to identify determinants of first line ART treatment failure among patients on ART at St. Luke referral hospital and Tulubolo General Hospital, 2019. Methods A 1:2 un-matched case-control study was conducted among adult patients on active follow up. One new group variables was formed as group 1 for cases and group 0 for controls and then data was entered in to Epi data version 3 and exported to STATA SE version 14 for analysis. From binary logistic regression variables with p value ≤0.25 were a candidate for multiple logistic regression. At the end variables with a p-value ≤0.05 were considered as statistically significant. Result A total of 350 (117 cases and 233 controls) patients were participated in the study. Starting ART after 2 years of being confirmed HIV positive (AOR = 3.82 95% CI 1.37,10.6), nevirapine (NVP) based initial ART (AOR = 2.77,95%CI 1.22,6.28) having history of lost to follow up (AOR 3.66,95%CI 1.44,9.27) and base line opportunistic infection (AOR = 1.97,95%CI 1.06,3.63), staying on first line ART for greater than 5 years (AOR = 3.42,95%CI 1.63,7.19) and CD4 less than100cell/ul (AOR = 2.72,95%CI 1.46,5.07) were independent determinants of first line ART treatment failure. Conclusion Lost to follow up, staying on first line ART for greater than 5 years, presence of opportunistic infections, NVP based NNRT, late initiation of ART are determinant factors for first line ART treatment failure. The concerned bodies have to focus and act on those identified factors to maintain the patient on first line ART.

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