Antegrade Percutaneous Retrieval of Upward Migrated Double-J Stent in Very Small Size Pediatric Patients Under Ultrasonic Guide.

Purpose: To evaluate the safety of antegrade percutaneous retrieval migrated ureteral stent in very small size pediatric patients with ultramini instruments under ultrasonography guide. Materials and Methods: A total number of 10 out of 115 patients who were referred to our center with upward migrated Double-J (DJ) were candidates for antegrade approach from 2017 to 2020. The pyelocalyceal system was punctured in a prone position by using an 18-gauge disposable needle with Chiba tip and visualization of the upper tract by 3.5 MHz ultrasonic guidance. Then 0.038-inch J tipped guide wire was passed through the needle and the tract was dilated up to 6F under ultrasonographic guide. The 8F access sheath was positioned over the 6F dilator. The semirigid 6F ureteroscope was introduced through the sheath and DJ was removed with a grasper. Results: The mean age was 11.4 ± 5.48 months. The mean time from the previous surgery to DJ removal procedure was 6.4 ± 0.84 weeks. The mean operation time was 11.7 ± 1.76 minutes. All the patients were discharged from the hospital within the 1st day. There were no serious complications (grade 3, 4, or 5) according to Clavien-Dindo classification. Conclusion: The antegrade retrieval of upward migrated DJ with ultramini instrument under ultrasonographic guidance in failed cases of retrograde approach is a safe and effective approach in very small size pediatric patients.

Off Clamping Laparoscopic Resection of An Extreme Rare Renal Mesenchymal Tumor: An Angiomyolipoma of Renal Capsule.

Renal mesenchymal tumors are described as neoplasms with vascular, fibrous, and adipose tissues. The renal lipoma is an extremely rare renal mesenchymal tumor, typically originating from renal capsule and it is usually presented as well circumscribed homogenous fat containing mass. Angiomyolipoma (AML) is the most common benign mesenchymal renal tumor which is composed of mature epithelioid cells. The renal AML usually presented as exophytic, non-infiltrative, and fat contain tumor. The well differentiated renal retroperitoneal liposarcoma and lipoma seem to be misdiagnosed by exophytic renal angiomyolipoma but the renal AML usually arises from renal parenchyma with characteristic images. A 37-year-old woman came to our clinic with rapid growth renal mass and pain. The spiral abdominopelvic computed tomography scan (CT-scan) showed well-circumscribed hypoheterodense fat-containing mass near to middle pole of the right kidney with minimal fat stranding without neovascularity and cortical defect. The Patient underwent off-clamping laparoscopic resection of renal mass with pre-operative impression: liposarcoma versus lipoma of the kidney. The cross-section of the surgical specimen revealed irregular lobulated fatty tissue with hemorrhagic streaks. Definite diagnosis was made by immunohistochemistry study. Spindle cells and epithelioid cells are diffusely and strongly positive for α-smooth muscle actin. The perivascular cells and epithelioid cells are positive for HMB-45 and Melanin. The immunostaining pattern was compatible with angiomyolipoma that originated from renal capsule. In our experience, a rapid growing mass that is accompanied by pain draws the attention to malignant process. The renal AML rarely arises from renal capsule without characteristic images so having high doubt may lead to proper pre-operative diagnosis.

Laparoscopic Donor Nephrectomy Is a Safe Surgical Approach in Healthy Obese Kidney Donors: A 10-Year Single-Center Retrospective Study.

OBJECTIVES: A lack of donors continues to be a significant problem. Kidney donors with a body mass index ≥ 30 kg/m² are not suitable for laparoscopic donor nephrectomy; however, some studies have suggested that an obese donor could be an appropriate donor with similar surgical outcomes. Here, we report the results of our 10-year experience of laparoscopic donor nephrectomy, examining the effects of body mass index on the surgical results of laparoscopic donor nephrectomy. MATERIALS AND METHODS: We retrospectively reviewed medical records of patients who underwent laparoscopic donor nephrectomy at the Shahid Beheshti University Medical Science, Urology Center (Tehran, Iran) from 2005 to 2015. The collected information included pretransplant and posttransplant serum levels of hemoglobin and creatinine. We also collected data on surgical outcomes (operation time, cold and warm ischemia, need for blood transfusion, and conversion to open surgery, length of hospital stay, and complication rates) with respect to body mass index categories (≤ 24.9, 25-29.9, and ≥ 30 kg/m²). RESULTS: Of 1083 kidney donors, 732 donors had body mass index of ≤ 24.9 kg/m², 256 had body mass index between 25 and 29.9 kg/m², and 95 had body mass index of ≥ 30 kg/m². Differences among groups were not significant in terms of operation time (P = .558), warm or cold ischemic time (P = .829 and .951, respectively), blood transfusion (P = .873), and length of hospital stay (P = .850). CONCLUSIONS: The laparoscopic approach for donor nephrectomy is a safe and effective method in obese donors without significant postoperative complications.

Percutaneous Endoscopic Treatment of Complicated Delayed Bleeding Postpercutaneous Nephrolithotomy: A Novel Suggestion.

Background: Delayed bleeding after percutaneous nephrolithotomy (PCNL), which may occur within the first 3 weeks postoperatively, is a life-threatening complication that may result from arteriovenous fistula and arterial pseudoaneurysm. Angioembolization is the standard treatment when these patients develop hemodynamic instability despite conservative measures. Contrast hypersensitivity and renal insufficiency, however, contraindicate angiogram and subsequent embolization; in these patients, alternative methods such as the one described in this study may help in resolving the renal hemorrhage. Case Presentation: In this case series, we report the effective management of post-PCNL hemorrhage with nephroscopy and nephrostomy and drainage and tamponade because angioembolization was not feasible. Conclusion: Delayed bleeding after PCNL may be managed conservatively with nephrostomy drainage and tamponade when angioembolization is not feasible.

Endoscopic Dilatation of Meatal Stenosis of Ureterocele in Adult Patients: An Easy and Innovative Technique with Literature Review.

This study presents initial experience in endoscopic meatal dilatation of obstructive ureterocele in adult patients. During cystourethroscopy, we tried to find the orifice of ureterocele, passed a guide wire and introduce an 8 Fr ureteroscope in to the ureterocele orifice, going up to the renal pelvis as under vision dilatation of ureterocele meatus. Two Double-J stent were inserted and remained for six weeks to keep the meatus dilated. Adverse effect of endoscopic management was decreased due to minimal anatomic changes. Patients' symptoms were relieved and no evidence of new onset vesico-ureteral reflux and obstruction were seen after up to one-year follow-up. Endoscopic meatal dilatation of stenotic ureterocele in adult patients is safe and effective thus, trying to find the orifice of ureterocele is suggested.

Cardio-pulmonary fitness test by ultra-short heart rate variability.

OBJECTIVES: It is known that exercise induces cardio-respiratory autonomic modulation. The aim of this study was to assess the cardio-pulmonary fitness by ultra-short heart rate variability. MATERIALS AND METHODS: Study population was divided into 3 groups: Group-1 (n = 40) consisted of military sports man. Group-2 (n = 40) were healthy age-matched sedentary male subjects with normal body mass index [BMI = 19 - 25 kg/m(2)). Group-3 (n = 40) were healthy age-matched obese male subjects [BMI > 29 kg/m(2)). Standard deviation of normal-to-normal QRS intervals (SDNN) was recorded over 15 minutes. Bruce protocol treadmill test was used; and, maximum oxygen consumption (VO(2)max) was calculated. RESULTS: WHEN THE STUDY POPULATION WAS DIVIDED INTO QUARTILES OF SDNN (FIRST QUARTILE: < 60 msec; second quartile: > 60 and < 100 msec; third quartile: > 100 and <140 msec; and fourth quartile: >140 msec), progressive increase was found in VO(2)max; and, SDNN was significantly linked with estimated VO(2)max. CONCLUSION: In conclusion, the results of this study demonstrate that exercise training improves cardio-respiratory autonomic function (and increases heart rate variability). Improvement in cardio-respiratory autonomic function seems to translate into a lower rate of long term mortality. Ultra-short heart rate variability is a simple cardio-pulmonary fitness test which just requires 15 minutes, and involves no exercise such as in the treadmill or cycle test.

Effect of extreme exercise on myocardial function as assessed by tissue Doppler imaging.

BACKGROUND: Response of the human heart to exercise has been studied extensively, but little information is available on the effects of exhaustive exercise on cardiac performance. OBJECTIVES: The aim of this study was to evaluate the effect of severe prolong exercise on both left and right ventricular performance. To maximize the sensitivity of our study we used tissue Doppler imaging. METHODS: Participants in army ranger training program were invited to participate in this prospective study. All patients underwent transthoracic echocardiography using tissue Doppler imaging before and after Ranger training program. RESULTS: A total of 45 consecutive male rangers who completed 8 weeks of training were included in this study. Peak systolic myocardial velocity (S) decreased significantly after training (12.46 +/- 0.54 vs. 9.93 +/- 0.45 cm/s; P < 0.001). In the right ventricle, tissue Doppler measures of systolic and early diastolic function decreased significantly after training compared to pretraining values. CONCLUSION: In conclusion, very strenuous prolonged exercise may result in depressed left ventricular contractile function. This raises the possibility of cardiac fatigue.

Short QT interval: A novel predictor of androgen abuse in strength trained athletes.

OBJECTIVES: To find the relationship between anabolic androgenic steroids (AAS) using and QT interval in athletes. METHODS: Between January 1, 2005 and May 31, 2007, we examined QTc interval duration in 165 consecutive male professional bodybuilders [age: 32.1 +/- 4.6 years]. Of these, 79 were AAS users. The control group included 90 sedentary age and gender matched subjects [none of them were AAS users]. RESULTS: The QTc interval of AAS abusing bodybuilders was significantly shorter compared with QTc interval in AAS-free bodybuilders and control group. Short QTc interval (< or =380 ms) was an independent predictor of AAS abusing in the multivariate analysis. CONCLUSIONS: To the best of our knowledge, there is no published report regarding electrocardiographic diagnosis and screening of AAS abusing athletes. In the present study, we present an easy and applicable method to screen and diagnose AAS abusing among professional bodybuilders. In the presence of QTc interval < or = 380 ms in a bodybuilder, one would predict AAS abusing with 83% sensitivity and 88% specificity.

Significance of cardiac autonomic neuropathy in risk stratification of Brugada syndrome.

AIMS: Risk stratification in Brugada syndrome (BS) is controversial especially in asymptomatic individuals. The aim of this study was to evaluate the significance of cardiac autonomic neuropathy (CAN) in BS. METHODS AND RESULTS: Patients diagnosed with Brugada ECG pattern were enrolled in the study. Four standard cardiac autonomic function tests were performed. The presence of >or=2 abnormal test results were considered definite evidence for the presence of CAN. Types 1, 2, and 3 Brugada ECG pattern were found in 28, 56, and 31 patients, respectively. CAN was detected in 13 (46%) patients with type 1 Brugada ECG pattern. In contrast, none of the type 2 or 3 Brugada patients had CAN. Of 13 patients with CAN, 11 had previous history of cardiac events (84%), whereas only 2 of 15 patients without CAN had history of previous cardiac events (13%; P = 0.01). The most noteworthy finding was that all of the type 1 Brugada patients with CAN were male (CAN was not detected in females). CONCLUSIONS: It was concluded that CAN is an important risk indicator in BS. CAN is more common in men. Male gender, per se, is not an independent risk factor for development of ventricular arrhythmia but also CAN, which is an important risk factor in BS, is more common in men; therefore men are susceptible to the development of cardiac events.