ABSTRACT
Ho: YAG laser lithotripsy is widely used for urinary stone treatment, but concerns persist regarding its thermal effects on renal tissues. This study aimed to monitor intrarenal temperature changes during kidney stone treatment using retrograde intrarenal surgery with Ho: YAG laser. Fifteen patients were enrolled. Various laser power settings (0.8 J/10 Hz, 1.2 J/12 Hz) and irrigation modes (10 cc/min, 15 cc/min, 20 cc/min, gravity irrigation, and manual pump irrigation) were used. A sterile thermal probe was attached to a flexible ureterorenoscope and delivered into the calyceal system via the ureteral access sheath. Temperature changes were recorded with a T-type thermal probe with ± 0.1 °C accuracy. Laser power significantly influenced mean temperature, with a 4.981 °C difference between 14 W and 8 W laser power (p < 0.001). The mean temperature was 2.075 °C higher with gravity irrigation and 2.828 °C lower with manual pump irrigation (p = 0.038 and p = 0.005, respectively). Body mass index, laser power, irrigation model, and operator duty cycle explained 49.5% of mean temperature variability (Adj. R2 = 0.495). Laser power and operator duty cycle positively impacted mean temperature, while body mass index and specific irrigation models affected it negatively. Laser power and irrigation rate are critical for intrarenal temperature during Ho: YAG laser lithotripsy. Optimal settings and irrigation strategies are vital for minimizing thermal injury risk. This study underscores the need for ongoing research to understand and mitigate thermal effects during laser lithotripsy.
Subject(s)
Kidney Calculi , Kidney , Lasers, Solid-State , Lithotripsy, Laser , Humans , Pilot Projects , Lithotripsy, Laser/methods , Lithotripsy, Laser/instrumentation , Kidney Calculi/surgery , Kidney Calculi/therapy , Male , Middle Aged , Female , Lasers, Solid-State/therapeutic use , Kidney/surgery , Kidney/physiopathology , Adult , Aged , Body Temperature , Monitoring, Intraoperative/methods , Monitoring, Intraoperative/instrumentation , Therapeutic Irrigation/methods , Therapeutic Irrigation/instrumentationABSTRACT
In this study, we aimed to investigate the morphometric and morphologic structures of the confluens sinuum (CS) and related structures with a silicone painting technique. We studied 30 cadavers. Twelve of them were washed with alcohol and filled with a silicone painting technique via the vena jugularis interna, internal carotid artery, and vertebral artery. The other 18 were autopsied postmortem. The CS and related structures were dissected under microscope. Their anatomy was investigated, and variations were noted. The diameters of the sinus sagittalis superior (SSS), CS, occipital sinus (OS), sinus rectus (SR), and bilateral transverse sinus (TS), and the angle between SSS and SR were measured. The mean diameters were 11.7 mm for SSS, 22.3 mm for CS, 5.25 mm for OS, 7.5 mm for SR, and 9.7 (right) and 9.1 mm (left) for TS. The angle between the SR and SSS was 58°. There was no difference in the bilateral venous structures that drained to the SSS and TS. There was an extra drainage to the CS from the left side in 4 cases. The right TS was located superiorly in 7 cases compared with the left TS, and this process was correlated with the type of CS. A septum in the SSS was detected in 2 cases. In addition, we encountered an OS in 80% of the cases. We conclude that the septum inside the CS affects the dominancy of the TS, the angle between the SSS and SR, and the other venous variations.
Subject(s)
Cranial Sinuses/anatomy & histology , Adult , Anatomic Variation , Cadaver , Carotid Artery, Internal/anatomy & histology , Cephalometry/methods , Female , Humans , Jugular Veins/anatomy & histology , Male , Middle Aged , Photography/methods , Replica Techniques , Silicones/chemistry , Superior Sagittal Sinus/anatomy & histology , Transverse Sinuses/anatomy & histology , Vertebral Artery/anatomy & histologyABSTRACT
BACKGROUND/AIMS: The aim of this study was to clarify whether folinic acid has any choleretic effect in humans, as observed by Kajiyama et al. in both clinical and experimental studies. METHODS: The choleretic effect of folinic acid was analyzed prospectively in a subgroup of patients who had external biliary catheters with periampullary tumors causing complete biliary obstruction. Folinic acid (50mg/day) was administered twice with a 24-hour interval between each dose. Daily bile volume was then recorded on the three consecutive days following the first dose of folinic acid. Mean bile flows (basal output=mean bile volume of four days) before and after (fifth, sixth and seventh days) the initiation of folinic acid administration were then compared. RESULTS: Mean bile volumes were determined as baseline output: 669.20+/-235.18, 5th day=: 668.63+/-235.26, sixth day: 670.45+/-235.08, and seventh day: 670.00+/-235.11. No significant difference in daily bile volumes before and after folinic acid administration was detected (p>0.05). CONCLUSION: No choleretic effect of intravenous folinic acid administration was observed in this prospective clinical study. This finding was contrary to our previous study on this subject.
