Outpatient transurethral cystolithotripsy of large bladder stones by holmium laser

Introduction: To assessment of the efficacy and safety of transurethral Cystolithotripsy of large bladder stones by holmium laser in the outpatient setting

Methods: In a prospective study 48 consecutive adult patients with large bladder stones, were enrolled for transurethral Cystolithotripsy. Patients older than 18 years, with bladder stones larger than 2 cm were enrolled. Urethral stricture, active urinary infection, and any anesthetic contraindications for operation, were the exclusion criteria. Demographic characteristics of patients, outcomes and complications related to operation and post operation period, were recorded

Results: Patients mean age was 46 +/- 7.3 years. Male to female ratio was 45/3. Mean body mass index of patients was 28.5 +/- 3.5. Mean stone size was 3.7 +/- 1.6 cm. Mean operation time was 43.5 +/- 15.5 minutes. Nearly complete stone clearance [98.5%] was achieved in all patients. Mean hospital stay was 6.5 +/- 1.3 hours. No major complications were seen. Mean visual analog pain score [VAS] was 4.2 +/- 2.1 and 1.4 +/- 0.6, during and 1 hour after operation, respectively. During follow up of 22.4 +/- 12.5 months, recurrence of bladder stone was not seen. No case of urethral stricture was detected

Conclusion: Transurethral holmium laser lithotripsy is an effective and safe alternative in selected patients with large bladder stones. This procedure can be easily performed in the outpatient setting

Effect of hydroxyurea on thalassemia major and thalassemia intermedia in iranian patients

Hydroxyurea has been used in thatassemia major [T.M.] and thalassemia intermedia patients since 1994 with some success in different centers. The objective was to evaluate the effect and possible side effects of hydroxyurea in these patients. This was a descriptive study done in 2007 after nine years of initiation of Hydroxyurea. Medical records of 1050 patients were reviewed. Patients who had received hydroxyurea for at Least three continuous months were enrolled into the study. Clinical and laboratory data during six months before and six month after starting hydroxyurea were compared. Two hundred ninety seven patients were enrolled of these two hundred forty eight [83.8%] were thalassemia major and forty eight [16.2%] were thatassemia intermedia. Dose of hydroxyurea was 15.5 +/- 6.4mg/kg /day and duration was 5.2 +/- 2 years [ranging 0.5-9 years]. Transfusions were completely stopped in one hundred eleven [44.7%] of thalassemia major patients with a mean Hb of l0g/dl. After 22.5 +/- 18 months, using Desferal was stopped in sixty six [26.6%] patients. The reasons for stopping hydroxiurea were "ineffectiveness" in 20%, "poor compliance" in 12.4% and side effects in 13.4% of patients. The side effects were nausea, palpitation, transient leucopenia and transient raising of creatinin. Hydroxyurea is effective and safe in thalassemia major and thalassemia intermedia patients and saves them from side effects of blood transfusions

Knowledge, attitude, and practice of reproductive behavior in Iranian minor thalassemia couples

To investigate the knowledge, attitude, and practice of reproductive behavior in Iranian minor thalassemia couples in Ghaemshahr City, Mazandaran, Iran. This is a cross-sectional descriptive survey conducted in 2006. Birth rates from 1997-2005 and the number of newly registered patients from at risk couples was recorded. Tools for data collection were a valid questionnaire containing epidemiologic characteristics of couples, knowledge [20 questions], attitude 20 statements, and practice by studying the family file in health centers. Questionnaires were completed by husband and wife separately. Actual versus expected numbers of patients born in that period were compared. The data were analyzed using the Statistical Package for Social Science version 13.00, and p<0.05 was interpreted as significant. Of the 240 at risk couples, 100 were studied. Of them, 82% had good knowledge of thalassemia, and 68.5% had a positive attitude toward thalassemia prevention program. Correlations of knowledge with attitude were significant [p<0.001], and 50% of the couples had unfavorable practice including unplanned pregnancy, fetal abortion without prenatal diagnosis [PND], delivery without PND, and having a child affected by thalassemia major [TM]. Without PND, 4 TM patients were born. Ninety-eight episodes of unfavorable practice were reported. Meanwhile, the contraceptive method used by 12% of couples was unsafe. Suspected TM patients with no prevention program were 25; thus, the birth of 2 TM was prevented [92% reduction]. We achieved great success during the last 9 years in the region, and TM prevention program improved knowledge, attitude, and practice in high-risk couples and carrier families