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Percutaneous nephrolithotomy (PCNL) in children has becomemore widely used due to its high efficacy and safety and to the development of miniaturized instruments. A supine approach is promising due to advantages such as better ventilation, reproducibility, and ergonomics. The purpose of the present study is to describe our surgical technique with special considerations in the pediatric population. We used an oblique supine position supported by one silicone gel positioning pad under the hip and another under the ipsilateral flank. The anatomical landmarks used to guide the puncture were the 11th and 12th ribs, the posterior axillary line, and the iliac crest. Initially, a ureteral catheter was introduced endoscopically. A retrograde pyelography was performed to guide the puncture, which was performed using a biplanar technique. A hydrophilic guide wire was then advanced through the needle. Dilation was performed with Alken telescopic dilators until 14 Ch. Fragmentation was performed either with a 13 Ch semirigid cystoscope or a flexible ureteroscope using a holmium: yttrium aluminum garnet (Ho:Yag) laser.We left a double J catheter. Supine PCNL in the pediatric population has comparable efficacy in terms of stone free rate to that of the prone approach as well as less complications. Certain considerations in children are careful padding and placement of the patient close to the edge of the table. Puncture should be guided by ultrasound to reduce radiation exposure. Miniaturized equipment is not widely available, so adaptation of adult equipment for the pediatric population is sometimes necessary.
La nefrolitotomía percutánea en niños se ha vuelto ampliamente utilizada por su alta efectividad, seguridad, y por la miniaturización de los instrumentos endoscópicos. El abordaje en supino es prometedor por sus ventajas, como mejor ventilación, reproducibilidad, y ergonomía. El propósito es describir nuestra técnica quirúrgica con las consideraciones especiales a tener en cuenta en la población pediátrica. Todos nuestros pacientes han sido intervenidos bajo la siguiente técnica quirúrgica: en una posición oblicua en supino, utilizando soportes de silicona ubicados debajo de la cadera y del flanco ipsilateral, se marcan los reparos anatómicos: las costillas once y doce, la línea axilar posterior y la cresta ilíaca. Inicialmente se introduce un cateter ureteral por vía endoscópica, con el cual se realiza una pielografía retrógrada para guiar la punción con una técnica biplanar. Se avanza una guía hidrofílica y, sobre esta, los dilatadores telescopados de Alken hasta un tracto de 14 Ch. Se realiza la fragmentación con un cistoscopio semirígido de 13 Ch o con un ureteroscopio flexible utilizando el láser Ho:Yag. Se deja un cateter JJ. La nefrolitotomía percutánea en la población pediátrica es comparable en términos de tasa libre de cálculos al abordaje en prono, con menos complicaciones. Una consideración importante en niños es una adecuada posición, cerca al eje de la mesa. La punción debe ser guiada por ultrasonido para disminuir la exposición a radiación. La disponibilidad de equipos miniaturizados es limitada, por lo cual usualmente es necesario adaptar los equipos de adultos.
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Humanos , Criança , Nefrolitotomia Percutânea , Urografia , Cistoscópios , Ureteroscópios , Cateteres Urinários , MiniaturizaçãoRESUMO
Gallstones are a major health problem & have been recognized since antiquity. Gallstones are generally classified into pure cholesterol, pigment and mixed type. Knowing the chemical composition of gallstones is essential for determining etiopathogenesis of gallstone disease. Fourier Transform Infrared Spectroscopy (FTIR) method is the most widely used technique in chemical analysis of gall stones. Reports on chemical analysis of gallstones are available from different endemic regions of India. However, no reports are available about the composition and etiopathogenesis of gallstones in Himachal Pradesh. METHODSGallstones from 400 patients of cholelithiasis were collected after cholecystectomy at Indira Gandhi Medical College Hospital (I.G.M.C.), Shimla, between June 2016 to June 2018, and were subjected to chemical analysis by FTIR method. The data was further correlated with regard to age, gender, socio-economic status, various life style factors like diet, obesity, physical activity, with stone number and colour. RESULTSChemical analysis of gall stones revealed that pure cholesterol, mixed and pigment variety were 94 %, 2 % and 4 % respectively. Majority of the patients were below the age of 50 years (66 %). Male to female ratio was 2.7:1. Both sexes had predominantly pure cholesterol stones. Most of the patients belonged to the lower middle class (56.5 %) & all socio-economic classes showed predominantly pure cholesterol stones. Similarly, there was no predilection of any type of stone to a particular physical work category. 53.5 % patients were non-vegetarians and 46.5 % were vegetarians. There was no correlation between diet and BMI with type of stones. In our study, 66 % of patients had multiple stones. Multiple stones were seen in all varieties of stones. Pure cholesterol stones showed a variety of colours contrary to traditional classification. CONCLUSIONSIn Himalayan population, the predominant type of gall stones were pure cholesterol stones. Mixed stones and pigment containing stones were found in much smaller frequencies. This result is in contrast to that of rest of the Indian subcontinent from where larger percentage of pigment and mixed stones has been reported. And pure cholesterol stones showed maximum variation in colours contrary to our expectation.
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Non-Alcoholic Fatty Liver Disease (NAFLD) is the hepatic pandemic of the 21st century. It is the amassing of fats in the hepatic tissue without significant alcohol intake that results in hepatic steatosis. Patients with gall bladder stones may have associated NAFLD as these ailments share similar factors like obesity, hypertriglyceridemia and diabetes mellitus. However, few, if any, reports are available about the association of NAFLD with gallstones in the hilly population. Hence, this study was conducted to find out the prevalence of NAFLD in patients with gall bladder stone disease.METHODSThis study was done in the Department of Surgery, Indira Gandhi Medical College, Shimla, from June 2017 to May 2019. A total of 300 patients of ultrasound proven gall bladder stones was studied for NAFLD by Fibroscan (transient elastography). Transient elastography (TE) is a noninvasive method that has been shown to be useful for the detection of liver steatosis and fibrosis. NAFLD was diagnosed based on the value of CAP (Controlled Attenuation Parameter) & degree of fibrosis was assessed based on liver stiffness measurement (LSM) value on TE. Steatosis was graded as S0, S1, S2, and S3 while fibrosis was graded as F0-F1, F1, F2, F3, and cirrhosis. Minimum cut-off CAP value for diagnosing NAFLD was 214 dB/m & significant fibrosis was taken with LSM value >7.5 kPa.RESULTSPatients of gall stone disease showed significant liver steatosis, suggestive of NAFLD in 189 patients (63%), based on CAP value; however, 111 patients (37%) did not have significant steatosis. In patients with NAFLD, 57 (30%) had mild steatosis (s1) while 39 (20.53%) & 24 (12.63%) had moderate (s2) and severe (s3) steatosis respectively. Similarity, 72 (24%) patients had significant fibrosis while 228 (76%) patients had no to insignificant fibrosis on TE, 51 (17%) patients had moderate fibrosis, while 14 (4.5%) and 8 (2.5%) patients had severe fibrosis & cirrhosis respectively.CONCLUSIONSHigh prevalence of NAFLD in patients of gall stone disease was observed. Most of the patients had mild NAFLD i.e. grade S1 steatosis & in addition, fibrosis was present in 24% patients of NAFLD with gall stone disease.
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Purpose: The aim is to study the diversity in the composition of kidney stones and its association with the basic biochemical metabolic panel in patients with kidney stone disease (KSD). Methods: A cross-sectional prospective study enrolling consecutive patients with KSD attending a tertiary care hospital in Mangalore (India) was undertaken. Mineral compositions of kidney stones were analyzed using attenuated total reflection-Fourier transform infrared spectroscopy. Kidney stones were classified into different groups according to the composition. Metabolic status was assessed to analyze possible association with the kidney stone. Results: A total of 369 patients (male 305 and female 64) in the age group of 43.05 ± 14.3 years were included in the study and showed a high diversity of kidney stone types with >50% with mixed compositions. A significant association was found between pure stone type and gender as well with age group (P < 0.001). Serum calcium levels in the calcium oxalate stone formers were significantly higher (P < 0.001) than others. Similarly, uric acid stone formers showed higher random blood sugar, blood urea, uric acid, and serum creatinine levels (P < 0.001). Urine pH was also found to be a contributing factor for the stone formation (P < 0.001). Stone recurrence did not differ significantly concerning stone composition as well as metabolic status. Conclusion: The study reports a high diversity of the kidney stone types among patients. This finding highlights the increased cases of mixed stones that may be because of various lifestyle factors resulting in altered metabolic status. This finding warrants mechanistic studies to understand the etiology of stone formation. This will enable to develop novel noninvasive interventional strategies and proper preventive strategies to reduce the risk of KSDs.
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Nutrition has been widely recognized to have certain levels of influence on the risk of kidney stone formation. Thus, this case-control study was conducted to determine the association of dietary intake and lifestyles factors with kidney stone disease. Sociodemographic data, dietary intake, supplements intake, smoking and alcohol habit, medical history, physical activity and anthropometric data were obtained using interviewer-administered pre-tested questionnaires among 81 patients who had been diagnosed with kidney stone disease and 81 patients without kidney stone disease at Universiti Kebangsaan Malaysia Medical Centre. The results indicated that body mass index and hip circumference were higher among cases as compared to controls in both men and women (p < 0.05). Energy, macronutrients and micronutrients intake were higher for case subjects compared to control subjects for all significant parameters (p < 0.05). Results showed positive association of kidney stone with consumption of nuts (≥1 time/week) for men and women while consumption of eggs (1-3 times/month) and beans (1-6 times/week) showed positive association for women. Analysis of multivariate found the risk factor among women was diabetes mellitus [Adjusted OR = 27.6 (95% CI = 1.43-53.3)] (p < 0.05). Whilst, plain water intake of at least 6 glasses [Adjusted OR = 0.001 (95% CI = 0.000-0.08)] (p < 0.05) and 8 glasses per day [Adjusted OR = 0.001 (95% CI = 0.000-0.02)] (p < 0.05) reduced the risk among women. The risk factors for men were smoking habits [Adjusted OR = 16.2 (95% CI = 1.29-203)] (p < 0.05), consumption of carbonated drink 1-3 times per month [Adjusted OR = 6.25 (95% CI = 1.04-40.7)] (p < 0.05) and 1-6 times per week [Adjusted OR = 12.5 (95% CI = 1.41-111)] (p < 0.05). Unhealthy dietary and lifestyles factors increased the risk of kidney stone disease and various risk factors were found for different sexes.
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Cálculos RenaisRESUMO
Introduction: Gall stone disease (GSD) is a common surgical problem. Surgical treatment of asymptomatic GSD is still controversial. Complicated GSD has varied presentation and contributes substantially to healthcare costs and may be life threatening. The present study is aimed to know the effect of gall stone presentation on treatment outcome. Methodology: This is a retrospective study conducted in a tertiary health care centre. All patients who underwent cholecystectomy (open or laparoscopic) were included in the study and were grouped in uncomplicated (Group A) and complicated group (Group B), depending upon their presentation. Treatment outcome was analysed for various measures i.e. type of admission (emergency or elective), length of hospital stay, postoperative complications, type of surgery and mortality. Observations: Out of the 202 patients, 109 (53.9%) were in group A and 93 (46.1%) were in group B. Acute cholecystitis comprised 30.1% of complicated GSD, whereas gall stone pancreatitis, choledocholithiasis, mucocele, empyema gall bladder, perforation and gall stone ileus comprised 6.9%, 2.9%, 3.9%, 0.9%, 0.4% and 0.4% respectively. Comparatively, patients with uncomplicated GSD were admitted electively, were mostly managed laparoscopically and had lower incidence of post-operative complications and hence shorter length of hospital stay and lower treatment cost. Conclusion: Most of the patients who present early in course of GSD have better treatment outcome. We recommend early elective laparoscopic surgery for all patients who present with initial symptoms of GSD.
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The surgical management of kidney-stone disease has undergone dramatic changes over the past 20 years. The introduction and development of percutaneous renal surgery, extracorporeal shock-wave lithotripsy, ureteroscopy, and technical advances in the available modalities for intracorporeal lithotripsy have led to a revolution in the surgicalmanagement of kidney-stone disease. The indications for open kidney-stone surgery have been narrowed significantly, and for the most part open surgery has become a second or third line treatment option. In this article, the authors attempt to better define acceptable indications for open kidney-stone surgery, to review commonly accepted advantages of open stone procedures and to establish expected results and outcomes following open surgery for kidney-stone disease