Early effects of percutaneous nephrolithotomy on glomerular filtration rate and determining the potential risk factors responsible for acute postoperative renal function impairment

In this study, the early effects of percutaneous nephrolithotomy [PCNL] on glomerular filtration rate [GFR] was assessed in different postoperative times and likewise, we determined the correlation of different variables with significant postoperative GFR drop after PCNL. Patient records of 486 cases that had undergone PCNL from January 2010 to October 2011 were reviewed retrospectively. GFR in six hours, one, two and three days after PCNL and in the discharge day were calculated and then compared with preoperative level. Correlation between different variables [Perioperative hemorrhage, co-morbidities, previous stone surgery, renal anomaly, number of access, stone burden and location] and risk of acute postoperative renal function impairment [GFR drop greater than 25%] were assessed. Mean preoperative GFR was 87.85 +/- 29.41ml/min/1.73m[2] which decreased to 86.18 +/- 28.77, 78.45 +/- 28.74, 78.79 +/- 26.94, 84.24 +/- 29.71 and 86.18 +/- 28.77 in 6, 24, 48 and 72 hours after surgery and discharge day post PCNL, respectively. GFR significantly decreased in one and two days after surgery [p value<0.0001 and p value <0.05] but returned to near preoperative values in 3th post PCNL day. Among different variables, only perioperative bleeding [Cut-off point for serum hemoglobin drop was 2.8 mg/dL] was concomitant with significant postoperative renal function impairment. Our findings revealed that co-morbidities, large or multiple stones, multiple punctures and previous history of stone surgery have no significant impact on surgical outcomes. Postoperative GFR returned to near preoperative values in a few days after operation. Avoidance of significant perioperative bleeding is an important point to prevent post PCNL renal insufficiency

possibility of access to the kidneys from posterior axillary line in supine position for percutaneous nephrolithotomy

To evaluate the possibility of access to the kidneys from posterior axillary line [PAL] in supine position for percutaneous nephrolithotomy. 102 consecutive patients who were candidated for abdominal CT scan, enrolled in this study. In cases of impossible access, the point on the posterior surface of body which permitted safe access was determined and the percent of movement toward body midline [relative to PAL] was calculated [M.PER]. Percutaneous access was simulated from upper and middle calyces of the kidney in 13% and 75% of cases, respectively. Access to the lower region was possible in 90% of right and 79% of left lower calyces, respectively [p=0.03]. In cases with impossible access from PAL, the M.PER for a safe access was 46-47% for upper region and 34-38% for middle and lower calyces of the kidney [P = 0.0001]. Access to upper calyces from PAL was limited in some cases regarding to the presence of solid organs. Presence of colon made access impossible in the lower right and left calyces in about 10% and 20% of cases, respectively. In upper region, more deviation toward midline was necessary to establish a safe access compared with middle and lower calyces

Neurologic Complications in Percutaneous Nephrolithotomy

PURPOSE: Percutaneous nephrolithotomy (PCNL) has been the preferred procedure for the removal of large renal stones in Iran since 1990. Recently, we encountered a series of devastating neurologic complications during PCNL, including paraplegia and hemiplegia. There are several reports of neurologic complications following PCNL owing to paradoxical air emboli, but there are no reports of paraplegia following PCNL. MATERIALS AND METHODS: We retrospectively reviewed the medical records of patients who had undergone PCNL in 13 different endourologic centers and retrieved data related to neurologic complications after PCNL, including coma, paraplegia, hemiplegia, and quadriplegia. RESULTS: The total number of PCNL procedures in these 13 centers was 30,666. Among these procedures, 11 cases were complicated by neurologic events, and four of these cases experienced paraplegia. All events happened with the patient in the prone position with the use of general anesthesia and in the presence of air injection. There were no reports of neurologic complications in PCNL procedures performed with the patient under general anesthesia and in the prone position and with contrast injection. CONCLUSIONS: It can be assumed that using room air to opacify the collecting system played a major role in the occurrence of these complications. Likewise, the prone position and general anesthesia may predispose to these events in the presence of air injection.

Transcatheter closure of atrial septal defect with amplatzer septal occluder in adults: immediate, short, and intermediate-term results

The transcatheter closure of the atrial septal defect [ASD] has become an alternative technique to surgical procedures. The aim of this study was to assess the immediate, short, and intermediate-term results of the transcatheter closure of the secundum ASD with the Amplatzer Septal Occluder [ASO] in adult Iranian patients. Between December 2004 and July 2008, the transcatheter closure of the ASD using the ASO was attempted in 58 consecutive, adult patients. The mean age of the patients was 37.1 +/- 12.7 years [range = 19 - 75 years]. All the procedures were performed under local anesthesia with transthoracic or transesophageal echocardiography and fluoroscopic guidance. The stretched diameter of the ASD was determined with a balloon sizing catheter, and device selection was based on and matched to the stretched diameter of the septal defect. Transthoracic echocardiography was performed immediately after the release of the device and before discharge. Further follow-up at one month, six months, and yearly thereafter included physical examination, electrocardiography, and transthoracic echocardiography. The mean ASD diameter, as measured by esophageal echocardiography, was 24.8 +/- 5.4 mm [range = 13 - 34 mm]. The mean stretched diameter, as measured by the balloon catheter, was 27.1 +/- 6.4 mm [range = 12.5 - 39 mm]. Deployment of the ASO was successful in 52 [89.6%] patients and failed in 6 [10.4%]. Four patients experienced severe complications, 1 had tamponade requiring drainage, 2 had device embolization to the left atrium and right ventricular outflow tract, and 1 had late wire fracture [surgical removal and repair of the ASD]. The position of two large devices [34 mm and 36 mm] was considered unsuitable and unstable after implantation and resulted in the removal of these devices. Minor complications included transient complete atrioventricular block in 1 patient, paroxysmal supra tachycardia in 3 patients, atrial flutter in 1 patient, and angina pectoris with transient ST elevation in 2 patients. The mean follow-up period was 32.5 +/- 18.5 months. Echocardiography at 24 hours, 1 month, 6 months, and 12 months after the procedure showed residual shunts in 11 [21%], 3 [5.8%], 2 [3.8%], and 2 [3.8%] patients, respectively. At follow-up [12.8 months to 48.5 months, mean +/- SD = 32.5 +/- 18.5 months], complete closure was documented in 50 [96.2%] of the 52 cases. At the end of the follow-up, 2 [3.8%] patients had residual shunts: The shunt was moderate in 1 [1.9%] patient and small in the other [1.9%]. The overall success rate of the transcatheter closure of the ASD was 86% [50 of 58 cases]. The transcatheter closure of the secundum ASD in our adult patient population using the ASO was associated with high degrees of success, minimal procedural complication rates, and excellent short and midterm results. The use of this device, however, requires thorough attention in that the procedure may be ineffective or the device may embolize. Further experience and long-term follow-up are required before a widespread clinical use can be recommended

Study of urethritis among subjects regardless to religious rites

Sexually transmitted diseases [STD] in young population of Iran and the frequency of sexual behaviors is a major public health problem in the country. The aim of this study was to study urethritis [the most common STD in Khuzestan] among subjects regardless of religious [Islamic] rites. In this prospective study conducted from 2005 to 2007 in Amirkabir Hospital in Ahvaz, 1199 adult men with symptomatic urethritis were studied. One thousand and forty six subjects declared that they respect religious rites [Group-I] and 153 subjects declared that they were not much concerned about religious rites and they were included in Group-II. Urethritis was diagnosed based on clinical and laboratory examinations. Subjects were placed in two groups and compared. Extracted data from questionnaires were analyzed in SPSS 13 software using chi-square and exact Fisher tests. Of total 1199 subjects, 44 patients were diagnosed having urethritis, among them gonococcal urethritis was detected in 16[36.5%] and Chlamydia in 28[63.7%]. Mean age of the patients was 28.2 +/- 9.4 years with the range of 18-47 years. Incidence of urethritis in Group-I was 2% [21/1046] and in Group-II 15.03% [23/153]. Frequency of Men having sex with men [MSM], extramarital contact, HIV seropositivity, Injecting drug use [IDU], and imprisonment among Group-I and Group-II was [1.2%, 1.4%, 0.8%, 0.6%, 0.8%] and [8.2%, 8.2%, 4.6%, 3.6%, 12.4%] respectively. Subjects who are not concerned about religious rites have high frequency of unsafe sexual contact like homosexuality, extramarital contact. HIV infection and IDU as compared to those who respects religious rites