Serum Vitamin D level in Jordanian patients with exfoliation syndrome and exfoliative glaucoma / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To compare the level of serum Vitamin D in patients with exfoliation syndrome (XFS) and exfoliative glaucoma (XFG) with that in control subjects. METHODS: Serum levels of 25 - hydroxy Vitamin D ( Vitamin D ) were measured using liquid chromatography. Variables like age, sex and medical history of hypertension, diabetes mellitus and ischemic heart disease were reported. RESULTS:This study included a total of 55 patients with XFS/XFG and 60 control subjects. Patients with XFS/XFG were significantly older than control subjects (mean age:71.8y vs 67. 5y, P = 0. 002). Gender distribution was similar. The prevalence rates of diabetes, hypertension, and ischemic heart disease were not significantly different between the two groups. The mean of Vitamin D was 14.7 ng/mL for patients with XFS/XFG and 14. 9 ng/mL for control subjects with no significant difference. Although Vitamin D level was lower in the XFS/XFG group but multivariate analysis did not show significant difference in Vitamin D deficiency between the two groups after adjusting for age,gender,and medical conditions. CONCLUSION:The outcomes of our study are different from those in the literature. Vitamin D levels were low in both the XFS/XFG group and the control group being lower in the first one but that difference was not statistically significant. XFS and Vitamin D deficiency share common associations with certain systemic diseases. Further studies with larger numbers are needed to elaborate more on these associations and to support further the controversial literature.

Evaluation of emergency extracorporeal shock wave lithotripsy for obstructing ureteral stones

PURPOSE: To assess the efficacy of extracorporeal shockwave lithotripsy (ESWL) for ureteral calculi during acute renal colic. MATERIALS AND METHODS: From January 2002 to March 2007, 108 patients were treated by ESWL for obstructing ureteral stones causing acute renal colic. ESWL was performed within 24 hours of the onset of renal colic. RESULTS: The mean age of the patients was 39.5 years (11-72 years). Male/female ratio was 85/23. Mean stone size was 8.45 mm (4-20 mm). They were located in the pelvic (n = 53), iliac (n = 28) or lumbar (n = 27) region. Fragmentation after a single session was complete in 56 patients (52 percent), incomplete in 28 (26 percent), and absent in 24 (22 percent). Patients presenting incomplete fragmentation underwent a second (n = 28) or even a third session (n = 11). Of the 24 patients in whom ESWL had no impact on the stone, 21 underwent ureteroscopy, and in one case open ureterolithotomy for a patient with a hard 17 mm stone, while spontaneous passage occurred in two patients with small stones. CONCLUSION: Emergency ESWL for obstructing ureteral stones has a satisfactory success rate and very low morbidity. The stone-free rate of retreating ureteral calculi with ESWL decreases significantly after failed initial treatment. Stone size may be the main predictive factor for retreatment. We suggest that no more than 3 treatments should be given for a particular stone due to minimal improvement in the subsequent cumulative treatment success rate.

Extracorporeal shockwave lithotripsy versus ureteroscopy for distal ureteric calculi: efficacy and patient satisfaction

OBJECTIVE: We compared the efficacy of extracorporeal shock wave lithotripsy (ESWL) and ureteroscopy (URS) for the treatment of distal ureteral calculi with respect to patient satisfaction. MATERIALS AND MHETODS: This is a prospective study where a total of 212 patients with solitary, radiopaque distal ureteral calculi were treated with ESWL (n = 92) using Dornier lithotriptor S (MedTech Europe GmbH) or URS (n = 120). Patient and stone characteristics, treatment parameters, clinical outcomes, and patient satisfaction were assessed for each group. RESULTS: The 2 groups were comparable in regard to patient age, sex, stone size, and side of treatment. The stone-free status for ESWL and URS at 3 months was 81.5 percent and 97.5 percent, respectively (p < 0.0001). In addition, 88 percent of patients who underwent ESWL versus 20 percent who underwent URS were discharged home the day of procedure. Minor complications occurred in 3.3 percent and 8.3 percent of the ESWL and URS groups, respectively (p = 0.127). No ureteral perforation or stricture occurred in the URS group. Postoperative flank pain and dysuria were more severe in the URS than ESWL group, although the differences were not statistically significant (p = 0.16). Patient satisfaction was high for both groups, including 94 percent for URS and 80 percent for ESWL (p = 0.002). CONCLUSIONS: URS is more effective than ESWL for the treatment of distal ureteral calculi. ESWL was more often performed on an outpatient basis, and showed a trend towards less flank pain and dysuria, fewer complications and quicker convalescence. Patient satisfaction was significantly higher for URS according to the questionnaire used in this study.