[ effect of bupivacaine 0.5% versus lidocaine 2% injection for pain control in patients after percutaneous nephrolithotomy [PCNL]]

Controlling pain in the post-operative period is still one of the challenging issues for anaesthesiologists as it tremendously helps patients to return to their daily life as soon as possible. In this survey we have tried to compare the efficacy of 0.5% bupivacaine and 2% lidocaine with normal saline for controlling pain after PCNL. In a double blind clinical trial, 60 patients were enrolled being divided into 3 groups. 0.5% Bupivacaine in a dose of 0.5 mg/kg diluted in 20 cc normal saline was injected, into the insertion site and also the tract of the PCNL probe in group one. In our second group, 2% lidocaine [4mg/kg] diluted in 20 cc normal saline, and in the third group, just 20cc NS were injected in the same manner and direction. VAS was measured at 0, 3, 6, 9, 12, 15, and 18 hours post-operatively in order to evaluate pain control. The mean VAS measured 0, 3, and 6 hours post-operatively in the bupivacaine and lidocaine groups was less than the normal saline group [P<0/05]. The average time to injection of the first dose of pethedine was longer in the bupivacaine and lidocaine groups than the normal saline group. [p<0/05]. Injection of 0.5% bupivacaine and 2% lidocaine in the puncture site of PCNL is effective for pain control after PCNL surgery according to our results

Assessment of atorvastatin effectiveness on serum PSA level in hypercholesterolemic males

The previous large retrospective studies demonstrated that treatment with Statins reduces both the incidence of prostate cancer by 50% and serum Prostate Specific Antigen [PSA] level up to 40%. However the main problem in those studies was the absence of control groups of men with hypercholesterolemia without Statin treatment. We performed a small prospective controlled clinical trial to assess the influence of the treatment with Atorvastatin on serum PSA in men with hypercholesterolemia referred to our educational and treatment center from October 2007 to March 2008. In this study, among the newly diagnosed males with hypercholesterolemia [LDL > 130 mg/dl], 40 patients with LDL more than 190 mg/dl were selected as a case group and were treated with Atorvastatin [20 mg/day]. Among the same population and in the same period, another 40 patients with LDL between 130 and 190 mg/dl were selected as first control group and were treated only with low fat diet. Another 40 patients with normal serum cholesterol and without any treatment were selected as second control group. The lipid profile and serum PSA level of patients of all groups were tested at the first and third months after the therapy. After completion of data, the mean serum lipids and PSA level were measured in both visits and compared with each other by paired t-test. Also the mean PSA change in two visits between three groups was compared by ANOVA and Tukey HSD test. There was not any significant difference in mean baseline PSA between hypercholesterolemic and normocholesterolemic patients [P=0.547]. In case group, mean PSA and LDL was reduced by 14.1% [P<=0001] and 30% [P=0.0001] respectively by second visit. In first control group, mean PSA was not changed significantly [P=0.337], whereas mean LDL in this group was reduced by 9.6% [P= 0.0001]. Similarly in the second control group mean PSA was not changed significantly [P=0.309] by second visit. In addition, mean change of PSA in case group was compared with first and second control groups that was significantly different [P=0.0001] whereas mean change of PSA between two control groups was not significantly different [P=0.615]. The results of this study showed that: 1] Short term treatment with Atorvastatin can reduce serum PSA level, and 2] This reduction is more likely to be due to direct effect and is not related to lowering serum cholesterol levels. Thus, if results of this study are confirmed by large prospective randomized clinical trials with longer follow up period, it will be possible that Atorvastatin could be used in long term as a safe chemoprophylactic agent against prostate cancer in high risk patients

Acute renal failure and bilateral kidney infiltration as the first presentation of non-Hodgkin lymphoma

Diffuse bilateral infiltration of the kidneys by lymphoma is probably the rarest cause of renal insufficiency. Moreover, acute renal failure as the initial manifestation of the lymphoma is reported only in a few cases. A 44-year-old man complaining of bilateral flank pain and weakness for 2 months was admitted with acute renal failure. Ultraonography revealed hyperechoic bilaterally enlarged kidneys and an enlarged spleen. Fat pad aspiration was negative for amyloidosis and serum protein electrophoresis was normal. Needle biopsy of the kidney and pathologic examination showed diffuse infiltration of the interstitium with lymphocytes and atypical cells. Bone marrow aspiration and biopsy were negative for malignant cells. Open kidney biopsy was performed and infiltrated cells positive for CD20 and negative for CD3 markers were observed based upon which diagnosis of diffuse large B-cell type non-Hodgkin lymphoma was made

Decreasing the complications of PCNL with alternative techniques including complete supine PCNL and subcostal approach

To assess the incidence of complications during percutaneous nephrolithotomy. We studied the files of patients at our urology research center in Rasht, Iran from 2007-2008. One hundred and seventy four patients with symptomatic renal and upper ureteric calculi were selected with the technique of non-probability convenient sampling. Complications of surgery were evaluated and divided into 3 categories: peri-operative, early, and late complications of surgery. Perioperative complications included bleeding, transfusion, extravasation, and injury to adjacent organs. Early complications following surgery included post operative bleeding, post operative transfusion, extravasation, infection, and residual stones. Late complications included injury to adjacent organs. All patients were subjected to PCNL. The data was analyzed on SPSS version 10. Regardless of position, the pelvicaliceal system could be successfully approached in all patients. The mean age of patients was 44.71 +/- 13.16 years. The mean stone size in was 26.64 +/- 14.39 mm. The mean operation time was 95.14 +/- 26.57 minutes. The stone free rate was 85.7%. Peri operative complications included transfusion due to bleeding 5.7%, and extravasation 3.4%. Early complications included transfusion due to bleeding 5.1%, extravasation 2.3%, infection 2.9% and residual calculi 14.3%. Late complications were not seen. No mortality was recorded. The most common stone site was pelvic stone [34.4%]. Stone sites in 45.9% of our patients was in the right kidney while 54.1% was left-sided. PCNL is a valuable treatment option for kidney stones. Potential advantages include less hospital stay with lower cost, lower discomfort and pain, and a lower complication rate. Also PCNL can be applied to many patients with kidney stones. We recommend a subcostal approach and also the use of complete supine PCNL [csPCNL] in decreasing the complications of PCNL

Vasal irrigation with sterile water and saline solution for acceleration of postvasectomy azoospermia

Vasectomy is the safest and most reliable method of all the contraception methods, but azoospermia is not achieved immediately by this method. We decided to determine whether irrigation of the vas deferens with sterile water or hypertonic saline solution irrigation during vasectomy would reduce the time needed to obtain azoospermia. A total of 126 fertile men presented for vasectomy were divided in 3 groups. No-scalpel vasectomy was done for all of the participants and irrigation of the vas deferens was carried out during the procedure in 2 groups with either sterile water or hypertonic saline solution [9 g/L sodium chloride solution]. Forty-two participants underwent vasectomy without irrigation. Semen analysis was performed at 4, 8, 12, and 16 weeks after vasectomy. Azoospermia was achieved in all of the men with sterile water after 12 weeks, while at the end of the study [16 weeks] it was achieved in 37 [88.1%] of those with saline solution and in 11 [26.2%] of those without irrigation. There were significant differences in the rates of azoospermia between the participant with sterile water and saline solution at 8 weeks [38.1% versus zero; P < .001], 12 weeks [100% versus 30.9%; P < .001], and 16 weeks [100% versus 88.1%; P = .02]. No pregnancy developed during the follow-up and no complication was reported. Vasal irrigation with sterile water and hypertonic saline solution during vasectomy were effective in removing sperm from the distal vas and increasing the rate at which men achieved azoospermia. Sterile water was a promising option with no complications

New method in laparoscopic surgery of xanthogranulomatous pyelonephritis

Laparoscopic surgery for Xanthogranulomatous pyelonephritis [XGP] is a difficult one so it seems that our experience may be helpful in other similar surgeries. The patient was a 75 years old woman who had right flank pain, several stones were observed in her kidney via IVU [Intra Venous Urogram]. The patient underwent transperitoneal laparoscopic nephrectomy and on pathology, XGP was reported. Total nephrectomy is the treatment of choice for XGP, but it is usually contraindicated for laparoscopic or retroperitoneoscopic techniques. We propose that in laparoscopic surgery of XGP, the ureter should be preserved until the end of procedure in order to use it as a handle. Also the adhesion of the superoposterior of kidney should not be free before ligaturing the pedicle. We suggest that in laparoscopic surgery of XPG, in case of difficulties in dissection of artery and vein, we could initially clamp and cut the vein, then ligator and cut the artery

Diagnostic accuracy of C-reactive protein and erythrocyte sedimentation rate in patients with acute scrotum

Our aim was to investigate the diagnostic efficacy of C-reactive protein [CRP] and erythrocyte sedimentation rate [ESR] in patients with acute scrotum. One hundred and twenty patients with an acute scrotum were evaluated and assigned into 3 groups: 46 had acute epididymitis [group 1], 23 had spermatic cord torsion [group 2], and 51 had other noninflammatory causes of acute scrotum. Serum samples of all patients taken at the time of admission were tested for CRP levels and ESR. An at least 4-fold increase in the serum CRP levels was seen in 44 patients [95.6%] in group 1 [mean, 67.77 +/- 47.80 mg/L]. In contrast, only 1 patient in group 2 had a significant increase in serum CRP level [mean, 9.0 +/- 4.90 mg/L]. The patients in group 3 did not experience any significant increase of CRP levels [mean, 7.0 +/- 2.2 mg/L]. The patients with epididymitis had higher CRP and ESR values than others [P <.001; P <.001]. The best cutoffs were 24 mg/L for CRP and 15.5 mm/h for ESR to differentiate between epididymitis and noninflammatory causes of acute scrotum. The sensitivity and specificity were 93.4% and 100% for CRP and 95.6% and 85.1% for ESR, respectively. Based on our findings, serum levels of CRP and ESR can provide helpful information easily and rapidly for differentiation between epididymitis and other causes of acute scrotum. We suggest CRP and ESR be measured before making a decision of surgical exploration