ABSTRACT
Objective: To evaluate the effectiveness and safety of treatment for proximal ureteral stones with pneumatic lithotripsy compared to holmium: yttrium-aluminum-garnet [HO: YAG] laser therapy
Study Design: Randomized control study
Place and Duration of Study: Armed Forces Institute of Urology, Rawalpindi from Sep 2014 to Mar 2015
Material and Methods: This randomized control trial was conducted at Armed Forces institute of Urology Rawalpindi. A total of 73 patients who underwent treatment between Sep 2014 and Mar 2015 were included in the study. Of the patients, 37 had pneumatic lithotripsy [PL group] and 36 had ureteroscopic HO: YAG laser lithotripsy [LL group] using rigid 8 Fr-ureteroscope for the fragmentation of the ureteric stones. Patients were evaluated for stone clearance after 3 weeks, with X-ray KUB, ultrasound and plan CT KUB [where indicated]. All the data were recorded in a proforma and analyzed in SPSS version 11
Results: There was a difference between the two groups according to overall stone clearance rate 83.8% for PL group vs. 86.5% for LL group. Proximal stone migration was seen in 16.2% of cases in PL group while in only 5.5% of cases in LL group. The overall complication rate was 35.1% in PL group while 30.5% in LL group. The mean procedure time was 28.8 +/- 4.5 minutes for PL group while it was 35.5 +/- 8.6 minutes for LL group
Conclusion: The pneumatic and holmium: yttrium-aluminum-garnet laser lithotripsy both are established choices for treatment of ureteral stone but in terms of stone clearance rate and decrease incidence of proximal stone migration HO: YAG lithotripsy is better than pneumatic lithotripsy
ABSTRACT
To compare the efficacy of Alvarado and Teicher scores in the diagnosis of acute appendicitis, using postoperative histopathology as gold standard. Comparative, cross sectional study. Department of surgery, Combined Military Hospital Rawalpindi, from 22nd June 2006 to 26th February 2007. Hundred cases of clinically diagnosed/suspected of acute appendicitis were included in the study by convenience [non-probability] sampling. Selected patients were graded according to Alvarado and Teicher scores, and underwent appendicectomy. All appendicectomy specimens were sent for histopathology reporting. A 2 x 2 table was used to determine sensitivity, specificity, positive and negative predictive values and diagnostic efficacy for both the scoring systems. Using Alvarado and Teicher scores, a sensitivity of 95% and 89.55%, specificity of 69.69% and 66.66%, positive predictive value of 86.48% and 85.71%, negative predictive value of 88.46% and 76.66%, negative appendicectomy rate of 13.5% and 15.49% and diagnostic efficacy of 87% and 83% were found, respectively. Alvarado score has better diagnostic accuracy as compared to Teicher score in the diagnosis of acute appendicitis