Supine Endoscopically-Combined Intrarenal Surgery (ECIRS) for encrusted ureteral stent with staghorn calculi, ureterolithiasis and cystolithiasis

@#A forgotten and encrusted ureteral stent poses as a management dilemma especially when the encrustations are so severe that they involve the entire length of the ureteral stent. These can lead to staghorn formation, high volume ureterolithiasis and giant cystolithiasis which are all encasing the ureteral stent, This may lead to significant morbidity and mortality as a result of chronic urinary obstruction, recurrent urinary tract infection, and renal dysfunction and renal failure. During the acute phase of the pandemic, a 31-year-old pregnant female, with 9 weeks age of gestation, underwent insertion of an indwelling ureteral stent for an obstructing renal pelvic calculus. She was lost to follow-up only to return two years later, with right flank and lower abdominal pains. Non-contrast CT showed encasement of the ureteral stent with a staghorn calculus on the proximal coil, extensive encrustations on the upper and middle segments, and a giant cystolithiasis at the distal coil of the ureteral stent. She underwent a supine endoscopically-combined intrarenal surgery (ECIRS), allowing retrograde retrieval of the ureteral stent after all the encrustations had been removed. There was minimal blood loss and no intraoperative and postoperative complications.Encrusted ureteral stents with large stone burden may be treated effectively and safely with an endoscopically-combined intrarenal surgery. This combined antegrade and retrograde approaches to the urinary tract allows synchronous treatment of all calcifications around the forgotten ureteral stent, without resorting to open surgery.

Enfermedad por reflujo gastroesofágico / Gastroesophageal reflux disease

La enfermedad por reflujo gastroesofágico (ERGE) es una de las causas de consulta más frecuentes en atención primaria y en gastroenterología Más el 40 por ciento de la población general experimenta pirosis y regurgitación ocasional debido a ERGE. Es una entidad nosológica compleja, y la fisiología y patogénesis aún no están totalmente aclaradas. Sin embargo, alteraciones a nivel del esfínter esofágico inferior, de la motilidad esofágica o del vaciamiento gástrico pueden producir o empeorar la ERGE. Hay diversos enfoques diagnósticos y terapéuticos; sin embargo, el uso de inhibidores de la bomba de protones a permanencia y la fundoplicatura (cirugía antirreflujo), son las opciones más efectivas

Gastroesophageal reflux disease (GERD) is one of the most frequent causes of consultation in primary care and gastroenterology. Over 40 percent of the general population experiences occasional heartburn and regurgitation due to GERD. It is a complex disease and physiology and pathogenesis are not yet completely defined. However, abnormalities in the lower esophageal sphincter, esophageal motility or gastric emptying can cause or worsen GERD. There are various diagnostic and therapeutic approaches; however, the use of proton-pump inhibitor fundoplication permanence and (antireflux surgery), are the most effective options

Correlation between Endoscopically Suspected Esophageal Metaplasia and Barrett’s Esophagus: A Single Center Experience.

Background: Barrett’s esophagus (BE) is defined as a suspect endoscopic finding followed by pathologically proven specific intestinal metaplasia as opposed to the normal squamous epithelium of the esophagus. A new BE classification, the Prague C and M criteria, was proposed in 2006 to define the extent of BE based on the circumference (C) and maximum diameter (M) of the lesion. AIM: In this study, we adopted Prague C and M criteria to record endoscopically suspected esophageal metaplasia (ESEM); biopsies were subsequently taken to determine any correlation between ESEM and histologically proven BE. The risk factors of BE were also investigated. Methods: This was an observational study. From June 2006 to June 2009, 62 cases of ESEM were enrolled with subsequent standardized random biopsies (four pieces were taken every 2 cm from the four quarters of the esophagus). BE was defined by histological verification of specialized intestinal metaplasia (SIM). Data were analyzed to identify correlations between ESEM and BE. Logistic regression models were used to investigate the relationship between age, gender, hiatal hernia, long-segment metaplasia (LS defined as maximal extension greater than 3 cm from the SCJ), and BE. A multi-variate regression model was also used. Results: A total of 6836 subjects who underwent endoscopic examination were enrolled from June 2006 to June 2009. Of these, 42 BE subjects were confirmed among 62 ESEM cases; the prevalence of BE among cases that received endoscopy was 0.61%. Long-segment ESEM was more prevalent than short segment (LS: SS = 43:19). Several factors such as age, gender, hiatal hernia, and LS were analyzed using a regression model; this model revealed that only LS ESEM predicted BE with borderline significance (p = 0.07). However, a multi-variate regression model including all the factors revealed that males with ESEM were significantly associated with BE (p = 0.015). Conclusion: This study was performed in single center and used Prague C and M criteria to record ESEM. The use of Prague C and M criteria to record ESEM yielded a histological verification of BE rate of 67.7%. A standardized random quadruple biopsy to validate BE should be routinely performed. LS metaplasia was a single predictor of BE with borderline significance and male sex was a significant predictor of BE.

Los grandes síndromes craneofaciales: Su tratamiento con distracción ósea / Distraction osteogenesis as treatment for craniofacial deformities

La distracción ósea es una técnica quirúrgica con la que diferentes deformidades craneofaciales se pueden corregir. Las craneosinostosis y su compleja expresión clínica en la cara y en el cráneo, hoy en día son factibles de tratarse utilizando diferentes osteotomías donde se incluye el frontal, órbitas, los malares y el maxilar, para luego realizar el avance planificado con distracción ósea. Cuando este procedimiento se hace en forma asistida con métodos endoscópicos se produce menor morbilidad bajando en forma muy importante la tasa de complicaciones y resolviendo en forma muy satisfactoria la deformidad frontal, el exorbitismo, la hipoplasia malar y la re trusión del tercio medio en estos pacientes. Como la distracción es un proceso gradual, la resistencia de los tejidos blandos al avance se puede vencer fácilmente lográndose grandes avances en sentido anteropostero que fluctúan entre 16 y 32 mm., en el frontal y entre 9 y 16 mm., en el maxilar. Los avances óseos se mantienen por el hueso neo- formado sobre las líneas de osteotomías y los cambios estético-funcionales son muy satisfactorios.

Distraction osteogenesis is a surgical technique for treating different craniofacial deformities. The sophisticated clinical expression of craniosynostosis in the face, as well as in the skull can be corrected using different osteotomies, in which we can include the frontal bone, orbits, the malar bones and the maxillae. Once the osteotomy has been completed, we can use the distraction devices to achieve the planned bone advancement. This procedure can be also performed with endoscopic techniques producing less morbility, with minimal complications, simultaneously producing a highly satisfactory correction of the frontal deformity, the exorbitismus, the malar and the mid- face retrusion in these patients. As the distraction procedure is gradual, soft tissues resistance against the advancement can be easily superated achieving larger antero posterior bone advancement that can vary between 16 to 32 mm in the frontal area and between 9 to 16 mm in the maxillae. The new position of the bones are maintained in place for new bone formation areas over the osteotomy lines. The aesthetic and functional changes after the procedure have been highly satisfactory in these patients.

Results of endoscopically guided foley catheterization as a treatment of urethral rupture / 대한비뇨기과학회지

Endoscopically guided Foley catheterization was performed as an initial management of 32 patients with anterior urethral rupture and 7 patients with posterior urethral rupture during 6 years from December 1985 to April 1992. The duration of indwelling of the catheter was proportion to the degree and extent of the rupture. As a complication, urethral stricture was developed in 12 patients with anterior urethral rupture (8 patients with partial rupture and 4 patients with complete rupture), and 2 patients with posterior urethral rupture. The complication could be treated with endoscopic internal urethrotomy and some sounding with ease. We suggest that initial procedure have some profit as availability. simplicity. economy, reproducibility and diagnostic accuracy. And so, we would like to recommend this procedure as a initial management of urethral rupture.