ABSTRACT
BACKGROUND: Extracorporeal shock wave lithotripsy (ESWL) represents noninvasive management of urolithiasis. Since the first HM3 model, technological progress has improved the efficacy and safety of this treatment. The current study aimed to evaluate the role of ESWL as a first-line emergency therapy of renal colic due to ureteral stone with impaired renal function. METHODS: This prospective study enrolled all the patients admitted from the emergency room with acute renal colic meeting the following criteria: serum creatinine level ranging from 1.5 to 2.5 mg/dl, hydronephrosis, ureteral stones 6 to 15 mm in size, body mass index less than 30, normal renal function at baseline, and no evidence of urinary tract infection. The patients were submitted to a single-session emergency treatment using Dornier Litothripter S. Follow-up assessment, performed at 24 and 72 h, included radiologic and ultrasound examinations with renal function serum assessment. The end points were a decrease in creatinine level and a stone-free condition. RESULTS: A total of 40 patients were eligible for the study. The mean creatinine level at admission was 1.93 +/- 0.26 mg/dl. After the treatment, renal function recovery occurred for 34 subjects (85%), with a significant global decrease in creatinine levels (p = 0.00). The global stone-free rate 72 h after SWL was 67.5% (27/40). The patients with residual fragments were managed using re-SWL (n = 7) and endoscopic technique (n = 6). CONCLUSIONS: Emergency SWL represents an effective tool in the treatment of ureteral stones with hydronephrosis and slight renal impairment. Although complete stone clearance after one treatment still remains a difficult target, the actual role of SWL in the management of acute obstruction is to obtain ureteral canalization and renal function recovery.
Subject(s)
Lithotripsy/methods , Ureteral Calculi/complications , Ureteral Calculi/therapy , Ureteral Obstruction/etiology , Ureteral Obstruction/therapy , Adult , Colic/blood , Colic/etiology , Colic/therapy , Creatinine/blood , Electromagnetic Phenomena , Emergency Medical Services/methods , Female , Humans , Kidney Diseases/blood , Kidney Diseases/etiology , Kidney Diseases/therapy , Male , Middle Aged , Prospective Studies , Treatment Outcome , Ureteral Calculi/blood , Ureteral Obstruction/bloodABSTRACT
In Argentine, water municipal supplies disinfection is carried out by chlorine. We have isolated Aeromonas hydrophila from a chlorinated water supply in Buenos Aires that fulfilled Argentinean microbiological quality standards. It is an aquatic organism that could produce cytotoxins and enterotoxins associated with acute gastroenteritis and wound infections in human and hemorrhagic septicaemia of fish, reptiles and amphibians. The isolated strain produced protein bands at isoelectric point in the range of 4.6-5.3 lightly labile at 56 degrees C and heat labile at 100 degrees C non cholera antitoxin reactive in electrofocusing assay (IEF) and showed hemolytic activity thermolabile at 56 degrees C and 100 degrees C in 5% rabbit erythrocytes in phosphate buffered saline. A cytotoxic effect thermolabile at 56 degrees C and 100 degrees C and a cytotonic activity were demonstrated in Vero cell cultures. Survival assay of A. hydrophila and indicator organisms would show no correlation between their contamination sources. Biofilms production could explain the persistence of this gram negative pathogen organism in chlorinated tap water. A water system supply maintenance program and pasteurisation may be performed in spite of water chlorination.
