Extracorporeal Shock Wave Lithotripsy (ESWL) Versus Uretero–Renoscopic Lithotripsy (URSL) For Management Of Upper Ureteric Calculi, Our Experience At Tertiary Care Hospital.

Background: Urinary stones are the third most common affliction of urinary tract, exceeded only by urinary tract infections and pathological conditions of prostate (BPH and Prostate cancer). Extracorporeal Shock Wave Lithotripsy (ESWL) and Uretero-renoscopic Lithotripsy (URSL) are among various treatment options available. Aims and Objectives:To compare ESWLand URSLprocedural and post procedural characteristics including outcome. Methods: A Prospective study was conducted in the department of Urology, SKIMS, on 100 patients with proximal Ureteric stone, from September 2015 to July 2017.By random selection, fifty patients were subjected to ESWL and another fifty to URSL. Various parameters were recorded on preformed proforma designed for the comparative study. Results: In our study, Parameters like Age and Gender distribution, symptoms at presentation and duration of symptoms, number of stones, laterality of stones (right/left) and grade of Hydronephrosis or Hydroureteronephrosis were uniformly distributed in the two groups (URSL VS ESWL). Spinal anaesthesia (SA) or General Anaesthesia(GA) was required in URSL group only, while as local anaesthesia and sedation was required in some patients in ESWLgroup. 72% and 88% patients achieved stone clearance in ESWLand URSLgroup respectively, (p=0.046). DJ stent was used in 20% of URSL patients and none in ESWL group. Procedure time was relatively less for URSL (p=0.001). Although statistically insignificant, Post procedure hematuria and urosepsis were higher in URSL group, where as pain/colic and fever was slightly higher in ESWL group. Steinstrasse was significantly higher in ESWL group (p=0.008). Hospital stay was significantly higher in URSL group (p<0.001). Cost involvement was higher in ESWLgroup (p=0.016). Conclusion: Although ESWL is regarded as the preferred choice of treatment for upper Ureteric stone, URSL is a safe alternative, with an advantage of obtaining an earlier or immediate stone free status in patients with stone size >10mm. In patients with smaller stones (<10mm), ESWL may be considered a reasonable alternative to URSL.

Errors in Case No. 2012Hun-Ma551·561 relating to the use of modern medical devices by oriental medical doctors

Our country has a dual medical system and as the importance of medical devices in medical practice has grown, oriental medical doctors have sought to use modern medical devices to broaden the scope of their oriental medical practice. Case No. 2012Hun-Ma551·561, which supports the use of modern medical devices by oriental medical doctors contains 3 important errors. First, its finding that a slit lamp microscope automatically provides examination results is erroneous. Second, the Court also mistakenly finds that medical service technologists, etc. Act does not prohibit the usage of devices in the instant case; thus, there is no need for the regulation of said devices. Finally, its finding lacks the proper procedure of considering the opinions of related professional groups. Thus, Case No. 2012Hun-Ma551·561 should not be considered a precedent supporting the use of modern medical devices by the oriental medical practitioners.

Los desórdenes depresivos mentales desde la óptica de la medicina tradicional china en occidente / Mental depressive disorders from the perspective of traditional Chinese medicine in the West

Los síndromes depresivos mentales, diagnosticados o no, constituyen un padecimiento frecuente que afecta los sistemas de salud y será la segunda causa de discapacidad en 2020. La depresión en un padecimiento en el que la persona presenta un estado de ánimo bajo por causas diversas (Biológicas y Socioambientales) pero con efectos y predisposición individual, que se sostiene en un rango de tiempo y en el que predominan la tristeza desde una intensidad leve hasta una marcada desesperación. Se puede acompañar por un rango de síntomas, que incluyen los trastornos del sueño, déficit de concentración, fatiga, agitación, baja autoestima, somatización, pérdida del interés general y la anhedonia; Es una enfermedad de que puede llegar a la gravedad de los pensamientos de muerte y el suicidio. Desde la visión de la Medicina Tradicional China, los síntomas depresivos parten de la alteración del equilibrio Yin - Yang y la dinámica de la energía, y en el que especialmente el órgano hígado y las funciones espirituales de cada órgano, juegan un papel fundamental en su origen. La depresión se incluye como origen o comorbilidad asociada de las enfermedades crónico degenerativas, en las que múltiples factores confluyen hacia un estado inflamatorio persistente que causa un daño en las estructuras cerebrales que modulan la conducta y los estados de ánimo. Lo cual desde la MTC, se puede explicar como un desbalance entre las energías patógena y la anti patógena. Los tratamientos desde la MTC incluyen la acupuntura corporal, la cráneo acupuntura con enfoque regular la dinámica de las funciones espirituales, la electro acupuntura, entre otros.

Urinothorax - A Rare Cause of Pleural Effusion.

Urinothorax is a rare cause of pleural effusion, which is mostly seen secondary to obstructive uropathy. We report a patient who had nephrolithasis and underwent percutaneous nephrostomy for treatment of hydroureteronephrosis. The patient developed right-sided pleural effusion, five days after percutaneous nephrostomy, which was later diagnosed as urinothorax. Although rare, urinothorax should be considered in the differential diagnosis of causes of pleural effusion, especially in patients with obstructive uropathy, any form of instrumentation of urinary tract or blunt abdominal trauma.The importance of recognizing this entity lies in the fact that the condition is completely reversible following relief of urinary tract obstruction.