Patrón crazy paving en una mujer joven: hallazgo inesperado y tratamiento no tradicional en un caso de proteinosis alveolar pulmonar / Crazy paving computed tomography pattern in a young woman: unexpected findings and non-traditional treatment in a pulmonary alveolar proteinosis case

El patrón llamado 'crazy paving' en tomografia computada de tórax (TAC) puede deberse a diferentes condiciones siendo una de ellas la Proteinosis Alveolar Pulmonar (PAP), rara condición que puede llevar a insuficiencia respiratoria y a menudo, a la muerte. Presentamos el caso de una mujer joven con una historia de un año de evolución de disnea progresiva y tos seca que consultó por un cuadro de aparición brusca de fiebre, calofríos, malestar general y falla respiratoria hipoxémica severa (PaO2 = 51,9 mmHg con FiO2 = 0,50) en la cual la TAC de tórax mostraba un patrón de empedrado o 'crazy paving' que significó un desafío diagnóstico resuelto finalmente con una biopsia pulmonar quirúrgica que mostró una PAP. Ante el fracaso del tratamiento tradicional de Lavado Pulmonar Total (LPT) se usó una aproximación terapéutica novedosa consistente en una serie de 4 lavados lobares con un perfluorocarbono, Perflubron (PFC) bajo anestesia local seguido por 5 sesiones de Plasmaféresis. Casi inmediatamente después de este tratamiento la paciente evidenció mejoría radiológica y funcional. La PaO2 fue de 89,9 mmHg respirando aire ambiental y la CVF y el VEF1 aumentaron alcanzado respectivamente el 77 y el 75% de sus valores normales de referencia. Dadas las características químicas y físicas del PFC, pensamos que es una alternativa válida al LPT en estos casos.

Crazy paving computed tomography pattern may be due to a number of causes, one of them being Pulmonary Alveolar Proteinosis, a rare condition leading to respiratory failure and often to death. We present the case of a young woman with a one-year history of progressive dyspnea and dry cough, who consulted for an acute onset of fever, chills, malaise and severe hypoxemic respiratory failure (PaO2 = 51.9 mmHg; FiO2 = 0.50) with a 'crazy paving' pattern on chest CT. This diagnostic challenge was resolved by a surgical lung biopsy that showed a pulmonary alveolar proteinosis. Taking into account that the traditional treatment using whole lung lavage had already failed in this patient, a novel therapeutic approach was settled. A series of 4 lobar lavages with a perfluorocarbon (Perflubron) under local anesthesia followed by 5 plasmapheresis sessions were carried out. The patient showed radiographic and functional improvement almost immediately after this treatment. PaO2 was 89.9 mmHg breathing room air and FVC and FEV1 increased to reach 77 and 75% respectively of their normal reference values. Because of its chemical and physical properties we think this novel therapeutic approach should be a valuable alternative to saline solution for whole lung lavage in these cases.

Impact of cadmium exposure on swine enterocytes.

We tested cadmium (Cd2+) effects on porcine IPEC-J2 cells, which represent an in vitro model of the interaction between intestinal cells and both infectious and non-infectious stressors. Accordingly, we investigated the effects of low (2 µM) to moderate (20 µM) concentrations of Cd2+, in terms of pro-inflammatory gene expression and protein release, as well as of infectivity in a Salmonella typhimurium penetration model. Our data showed a significant (P < .001) increase of intracellular Cd2+ after 3, 6 and 24 h of exposure with respect to levels at 1 h. These data showed the ability of IPEC-J2 to absorb Cd2+ as a function of both time and concentration. Also, the absorption of this heavy metal was related to a significant modulation of important pro-inflammatory messengers. In particular, down-regulation of IL-8 was associated with a significant decrease of Salmonella typhimurium ability to penetrate into IPEC-J2 cells, in agreement with a previous study in which an anti-IL 8 antibody could significantly inhibit Salmonella penetration into the same cells (Razzuoli et al., 2017). This finding demonstrates the ability of Cd2+ to affect the outcome of an important host-pathogen relationship. In conclusion, our study highlighted the ability of an environmental pollutant like Cd2+ to modulate innate immune responses in terms of chemokine release and gene expression, and susceptibility to microbial infections.

Tubeless percutaneous nephrolithotomy without losing the possibility of second-look nephroscopy: The perfect combinationu / Nefrolitectomía percutánea tubeless con posibilidad de reexploración: la combinación perfecta

Objectives: To evaluate an alternative approach to tubeless surgery that allows a second per- cutaneous procedure using the same nephrostomy tract. Methods: Twenty patients underwent percutaneous nephrolithotomy from September 2012 to May 2013 at our institution. Inclusion criteria were: absence of urinary infection, single puncture and operative time less than 2 h. Following the procedure the initially placed ureteral catheter was exteriorized through the working sheath by tying a non-absorbable suture to its end. On postoperative day 1 all patients were studied with non-enhanced CT or X-ray film. If the patient was rendered stone free, the stent was removed along with the urethro-vesical catheter. If a residual stone was present, we recovered the ureteral catheter and used the same nephros- tomy tract for a second endoscopic procedure. Patients were assessed for pain, postoperative complications, length of stay, stone free rate, hematocrit and creatinine variations. Results: Thirteen patients met the inclusion criteria. No major complications related to the stent placement and its exteriorization were seen. Two patients required a second percutaneous procedure successfully achieved recovering the ureteral catheter through the nephrostomy tract. Conclusion: We present a safe and simple modification of tubeless percutaneous nephrolitho- tomy, with its well-known clinical benefits but maintaining a safe path for an eventual second look procedure if necessary.(AU)

Objetivos: Evaluar una sencilla modificación de la nefrolitectomía percutánea tubeless que permita un segundo procedimiento endoscópico utilizando el mismo trayecto percutáneo. Métodos: Veinte pacientes fueron sometidos a nefrolitectomía percutánea en decúbito supino modificado entre septiembre de 2012 y mayo de 2013 en nuestro centro. Los criterios de inclusión para el estudio fueron: ausencia de infección urinaria, punción única y tiempo opera- torio menor de 2 h. Al finalizar el procedimiento se instaló una rienda de sutura en el extremo del catéter ureteral, quedando exteriorizada a través del trayecto de nefrostomía para su recuperación en caso de necesidad. Se realizó tomografía computarizada o radiografía simple a todos los pacientes el primer día postoperatorio. Si el paciente estaba «libre de cálculos¼, el catéter ureteral fue retirado junto con la sonda Foley. En caso de litiasis residual se realizó un segundo procedimiento percutáneo, utilizando el mismo trayecto inicial, exteriorizando el catéter ureteral a través del trayecto de la nefrostomía. En todos los pacientes se objetivaron las complicaciones postoperatorias, la estadía hospitalaria y la presencia de litiasis residual, además de la caída del hematocrito y la creatinina. Resultados: Trece pacientes cumplieron los criterios de inclusión. No hubo complicaciones may- ores relacionadas con la colocación del catéter ureteral y su exteriorización. Dos pacientes requirieron una segunda intervención percutánea, lograda con éxito mediante el uso del catéter ureteral reexteriorizado. Conclusión: Se presenta una modificación segura y sencilla de la nefrolitectomía percutánea tubeless sin renunciar a la posibilidad de recuperar el trayecto de nefrostomía original.(AU)

Non-dioxin-like polychlorinated biphenyls (NDL-PCBs) in eel, trout, and barbel from the River Roya, Northern Italy.

Non-dioxin-like polychlorinated biphenyls (NDL-PCBs) contribute to the dietary intake of total PCBs. They are consumed via ingestion of contaminated fish and fishery products. Thus, it is important to quantify their levels in aquatic organisms in order to evaluate the risks associated with fish consumption by humans. In 2013, an advisory against consumption of fish from the River Roya (IT) was disseminated after NDL PCBs were found to exceed maximum levels set by EU Regulations. We investigated the presence of NDL PCBs in eel, trout and barbel from the River Roya. We found concentrations in the range of 9.2-27.6 ng g(-)(1)ww in barbel, 9.2-97.0 ng g(-1)ww in trout and 9.0-239.5 ng g(-1)ww in eel. The distribution of congeners among different species did not show significant variations and was characterized by a higher proportion of 153, 138 and 180 congeners, according to their high resistance to metabolic degradation.

Nefrolitectomía percutánea tubeless con posibilidad de reexploración: la combinación perfecta / Tubeless percutaneous nephrolithotomy without losing the possibility of second-look nephroscopy: The perfect combination

Objetivos: Evaluar una sencilla modificación de la nefrolitectomía percutánea tubeless que permita un segundo procedimiento endoscópico utilizando el mismo trayecto percutáneo. Métodos: Veinte pacientes fueron sometidos a nefrolitectomía percutánea en decúbito supino modificado entre septiembre de 2012 y mayo de 2013 en nuestro centro. Los criterios de inclusión para el estudio fueron: ausencia de infección urinaria, punción única y tiempo operatorio menor de 2 h. Al finalizar el procedimiento se instaló una rienda de sutura en el extremo del catéter ureteral, quedando exteriorizada a través del trayecto de nefrostomía para su recuperación en caso de necesidad. Se realizó tomografía computarizada o radiografía simple a todos los pacientes el primer día postoperatorio. Si el paciente estaba «libre de cálculos», el catéter ureteral fue retirado junto con la sonda Foley. En caso de litiasis residual se realizó un segundo procedimiento percutáneo, utilizando el mismo trayecto inicial, exteriorizando el catéter ureteral a través del trayecto de la nefrostomía. En todos los pacientes se objetivaron las complicaciones postoperatorias, la estadía hospitalaria y la presencia de litiasis residual, además de la caída del hematocrito y la creatinina. Resultados: Trece pacientes cumplieron los criterios de inclusión. No hubo complicaciones mayores relacionadas con la colocación del catéter ureteral y su exteriorización. Dos pacientes requirieron una segunda intervención percutánea, lograda con éxito mediante el uso del catéter ureteral reexteriorizado. Conclusión: Se presenta una modificación segura y sencilla de la nefrolitectomía percutánea tubeless sin renunciar a la posibilidad de recuperar el trayecto de nefrostomía original

Objectives: To evaluate an alternative approach to tubeless surgery that allows a second percutaneous procedure using the same nephrostomy tract. Methods: Twenty patients underwent percutaneous nephrolithotomy from September 2012 to May 2013 at our institution. Inclusion criteria were: absence of urinary infection, single puncture and operative time less than 2 h. Following the procedure the initially placed ureteral catheter was exteriorized through the working sheath by tying a non-absorbable suture to its end. On postoperative day 1 all patients were studied with non-enhanced CT or X-ray film. If the patient was rendered stone free, the stent was removed along with the urethro-vesical catheter. If a residual stone was present, we recovered the ureteral catheter and used the same nephrostomy tract for a second endoscopic procedure. Patients were assessed for pain, postoperative complications, length of stay, stone free rate, hematocrit and creatinine variations. Results: Thirteen patients met the inclusion criteria. No major complications related to the stent placement and its exteriorization were seen. Two patients required a second percutaneous procedure successfully achieved recovering the ureteral catheter through the nephrostomy tract. Conclusion: We present a safe and simple modification of tubeless percutaneous nephrolithotomy, with its well-known clinical benefits but maintaining a safe path for an eventual second look procedure if necessary

Tubeless percutaneous nephrolithotomy without losing the possibility of second-look nephroscopy: The perfect combination.

OBJECTIVES: To evaluate an alternative approach to tubeless surgery that allows a second percutaneous procedure using the same nephrostomy tract. METHODS: Twenty patients underwent percutaneous nephrolithotomy from September 2012 to May 2013 at our institution. Inclusion criteria were: absence of urinary infection, single puncture and operative time less than 2 h. Following the procedure the initially placed ureteral catheter was exteriorized through the working sheath by tying a non-absorbable suture to its end. On postoperative day 1 all patients were studied with non-enhanced CT or X-ray film. If the patient was rendered stone free, the stent was removed along with the urethro-vesical catheter. If a residual stone was present, we recovered the ureteral catheter and used the same nephrostomy tract for a second endoscopic procedure. Patients were assessed for pain, postoperative complications, length of stay, stone free rate, hematocrit and creatinine variations. RESULTS: Thirteen patients met the inclusion criteria. No major complications related to the stent placement and its exteriorization were seen. Two patients required a second percutaneous procedure successfully achieved recovering the ureteral catheter through the nephrostomy tract. CONCLUSION: We present a safe and simple modification of tubeless percutaneous nephrolithotomy, with its well-known clinical benefits but maintaining a safe path for an eventual second look procedure if necessary.

Resultados perioperatorios de la nefrectomía parcial abierta versus laparoscópica. Experiencia del Hospital Militar de Santiago / Perioperative outcomes of open versus laparoscopic partial nephrectomy. Experience the Military Hospital of Santiago

INTRODUCCIÓN: La nefrectomía parcial laparoscópica (NPL), es una cirugía ampliamente aceptada para lesiones sólidas delriñón y representa una alternativa a la nefrectomía abierta (NPA). El objetivo del trabajo es realizar un análisis comparativo de los resultados perioperatorios y las complicaciones entre ambas técnicas en tumores renales órgano-con nados menores de 7 cm (T1). PACIENTES Y MÉTODOS: Estudio descriptivo comparativo. Se revisaron 74 pacientes entre 2000 y 2013; 25 NPLy 49 NPA. Se analizó: tiempo de isquemia, variación de hematocrito y creatinina, necesidad de reintervención, porcentaje decomplicaciones y transfusión y la presencia de bordes quirúrgicos comprometidos por neoplasia. RESULTADOS: La variaciónde hematocrito preoperatorio menos postoperatorio fue 7.2 puntos (p<0.05). Según tipo de cirugía, 6.3 puntos para NPAvs 9.04 para NPL (p=0.07). La variación de creatinina post-pre según tipo de cirugía, fue NPA: 0.29 vs NPL: 0.09 (p= 0.22). El tiempo de isquemia promedio fue de 20.0 minutos; 18.4 minutos vs 22.3 minutos para NPA y NPL, respectivamente (p=0.26).La tasa de complicaciones fue 20% vs 6,12% para NPL y NPA, respectivamente (p=0.069). De los pacientes sometidos aNPL, 4 presentaron sangrado: 1 hemoperitoneo (4%), 2 hematoma retroperitoneal (8%) y 1 sangrado de lecho operatorio(4%). Además, 1 paciente presentó un pneumotórax. De los pacientes sometidos a NPA, 1 presentó una sepsis de focourinario (2%), 1 sangrado de lecho operatorio (2%) y 1 un hematoma autolimitado (2%). Respecto al resultado oncológico inmediato, 10.96% de las intervenciones tuvo márgenes positivos, 12% vs 10.2% para NPL vs NPA respectivamente. Estadiferencia no alcanzó significancia estadística (p=0.68)...

INTRODUCTION: Laparoscopic partial nephrectomy (LPN) is a widely accepted surgery for solid lesions of the kidney and isan alternative to open nephrectomy (NPA). The objective of this work is to perform a comparative analysis of perioperative outcomes and complications between the two techniques in organ-con ned renal tumors less than 7 cm (T1).PATIENTS AND METHODS: A comparative descriptive study. 74 patients between operated between 2000 and 2013 werereviewed; 25 NPL and 49 NPA. We analyzed ischemia time, creatinine and hematocrit variation, need for reoperation,complications and transfusion rate and the presence of surgical margins involved by neoplasia. RESULTS: The preoperative minus postoperative hematocrit variation was 7.2 points (p <0.05). According to type of surgery, 6.3 points for NPA vs 9.04for NPL (p = 0.07). The change in creatinine by type of surgery was NPA: 0.29 vs NPL : 0.09 (p = 0.22). The mean ischemiatime was 20.0 minutes; 18.4 minutes vs 22.3 minutes for NPA and NPL, respectively (p = 0.26). The complication rate was 20% vs 6.12% for NPL and NPA, respectively (p = 0.069). Of patients undergoing LPN, 4 had bleeding: 1 hemoperitoneum(4%), 2 retroperitoneal hematoma (8%) and 1-surgical-bed bleeding (4%). In addition, 1 patient presented a pneumothorax.In patients undergoing NPA: 1 had urinary sepsis (2%), 1 surgical-bed bleeding (2%) and 1 self-limited hematoma (2%).Regarding the immediate oncological outcome, 10.96% of the interventions had positive margins 12% vs 10.2% for NPL vsNPA respectively. This diference did not reach statistical significance (p = 0.68)...

Litotricia extracorpórea versus ureterolitectomía endoscópica para el manejo de litiasis de uréter distal. Costos asociados. Experiencia del Hospital Militar de Santiago / Extracorporeal shock wave lithotripsy versus endoscopic ureterolithectomy for management of distal ureteral stones. Associated costs. Experience the Military Hospital of Santiago

INTRODUCCIÓN: La ureterolitiasis distal (UD) es una patología prevalente. Su tratamiento quirúrgico es con litotricia extracorpórea(LEC) o ureteroscopía (URS), ambas con tasa libre de cálculo (TLC) sobre 90% y mínimas complicaciones. El objetivode este trabajo es comparar la TLC luego de la primera intervención y su costo asociado. Además, comparar el costo totaltratándolos con LEC o URS. PACIENTES Y MÉTODOS: Estudio descriptivo comparativo, que muestra el costo económicode LEC vs URS para tratamiento de UD entre 2009 y 2013. Se incluyeron 107 pacientes; 47 URS y 60 LEC. Se analizaronnúmero de días hospitalizados, necesidad de reintervención y costo total de atención médica. Los costos se ajustaron alvalor actual de la prestación. Se describió la TLC en ambos procedimientos. Se obtuvo el costo total de hospitalizacióny se compararon las variables de interés. RESULTADOS: l tamaño de litiasis fue 8.21mm versus 7.39mm para URS y LEC,respectivamente (p=0.24). Luego de la primera intervención, la TLC fue 97.8% para URS y 80% para LEC (p=0.007). En LEC,12 pacientes requirieron retratamiento elevando la TLC a 95%, (p=0.13). Se instaló catéter JJ en 53.1% y 18.3% para URS yLEC, respectivamente (p<0.001). El costo de honorarios médicos, insumos y derecho a pabellón, es $460.838 para URS y$1.243.075 para LEC. El número de días de hospitalización post procedimiento fue 1.6 y 1.71 días para URS y LEC, respectivamente(p=0.86). En relación con los costos totales, la LEC en promedio, es un 132% más cara respecto a la URS (p<0.001)...

INTRODUCTION: Distal ureterolithiasis (UD) is a common disorder. Its treatment is surgical either with extracorporeal lithotripsy(LEC) or ureteroscopy (URS), both with a stone free (TLC) over 90% and minimal complications. The aim of this studyis to compare the TLC after the rst intervention and its associated cost. Also, compare the total costs of treatment with LECor URS. PATIENTS AND METHODS: A comparative descriptive study, which shows the economic cost of LEC vs UD URS fortreatments performed between 2009 and 2013. 107 patients were included; 47 URS and 60 LEC. Number of hospitalizationdays, reoperation and total cost of care were analyzed. Costs were adjusted to present charges for the same procedures. TLC was described in both proceedings. The total cost of hospitalization was obtained and the variables of interest werecompared. RESULTS: Stone size was 8.21mm versus 7.39mm URS and LEC, respectively (p = 0.24). After the rst intervention,TLC was 97.8% for URS and 80% for LEC (p = 0.007). In LEC, 12 patients required retreatment raising the TLC to 95% (p = 0.13).JJ catheter was installed in 53.1% URS and 18.3% LEC, respectively (p <0.001). The cost of medical supplies, operation roomand physician fees was $460.838 for URS and $1.243.075 for LEC. The number of hospitalization days post procedure was1.6 and 1.71 days for URS and LEC, respectively (p = 0.86). In relation to total costs, LEC is on average, 132% more expensivewhen compared to URS (p <0.001)...

NDL-PCBs in muscle of the European catfish (Silurus glanis): an alert from Italian rivers.

The non-dioxin-like polychlorinated biphenyls (NDL-PCBs) highly contribute to the PCB dietary intake of total PCBs. Most of the NDL-PCBs are assumed through ingestion of contaminated fish and fishery products. Therefore, it is important to quantify their presence in aquatic organisms to evaluate human risks associated with fish consumption. The European catfish is a top food-chain predator and is considered a reliable bio-monitoring tool reflecting the state of the environmental organic pollution. From 2006 to 2009, 54 European catfish were captured in four sites covering the area of the Po River (North Italy), and their muscles were analysed to determine the levels of 18 PCBs congeners. All samples presented detectable levels of 18 congeners and, on average, results showed an important presence of NDL-PCBs. The sum of the six congeners (28, 52, 101, 138, 153, 180 IUPAC) was used as indicator of the total PCBs concentration. The 33% of the samples analysed exceeded the maximum levels of 125 ng g(-1) set by European regulations in fish. The values measured ranged from 19.7 to 1015.4 ng g(-1) (mean 135.6 ± 149.8 ng g(-1)). The concentrations of NDL-PCBs were not related to fish weight or sex, while a significant variability was found among sites (p<0.05), according to the geographical location of many industrial activities in the catchment area of the Po River. PCB 153 and 138 were present in higher concentrations (40% and 30% respectively). We hypothesise that this is due to their high resistance to metabolic degradation.

Factores predictivos de éxito tras una sesión única de litotricia extracorpórea de cálculos urinarios a las tres semanas de seguimiento / Single-Session Extracorporeal Shock Wave Lithotripsy for Urinary Calculi: Factors Predicting Success after Three Weeks of Follow-Up

Objetivo: Identificar factores predictivos de éxito después de una sesión única de litotricia extracorpórea por ondas de choque (LEOC) a las tres semanas de seguimiento. Material y métodos: Se revisaron los registros clínicos de 116 pacientes con cálculos urinarios únicos sometidos a LEOC entre octubre 2007 y agosto 2009. Las tomografías axiales computarizadas preoperatorias de todos los pacientes fueron revisadas por dos radiólogos en desconocimiento del desenlace clínico. El éxito fue definido como la desaparición completa del cálculo o la persistencia de fragmentos ≤ 2mm en la radiografía simple realizada durante las tres primeras semanas de seguimiento. El impacto de factores clínicos y radiológicos fue evaluado utilizando regresión logística. Resultados: La tasa de éxito de LEOC a las tres semanas de seguimiento fue del 49,1%. Tamaño < 8mm, área del cálculo < 30mm2, localización en el uréter distal, densidad < 1.000 UH y fragmentación intraoperatoria demostraron una significativa asociación con éxito en el análisis univariado (p<0,05). Área del cálculo<30mm2 (OR: 2,9), localización en uréter distal (OR: 3,4) y fragmentación intraoperatoria (OR: 4,2) fueron factores predictivos de éxito en el análisis multivariado (p<0,05). Conclusiones: El área del cálculo y la localización en el uréter distal son útiles en el momento de decidir acerca de la realización de una LEOC. Sin embargo, la resolución exitosa de solamente la mitad de los casos bajo los criterios evaluados recalca la relevancia de informar al paciente de la eventual necesidad de tratamientos adicionales después de una sesión única de LEOC (AU)

Introduction: The aim of this study was to identify predictive factors of success following a single-session of shock wave lithotripsy (SWL) at 3 weeks of follow-up in our center. Material and methods: The medical records of 116 patients with solitary urinary calculi who underwent single-session SWL in our department between October 2007 and August 2009 were reviewed. All preoperative unenhanced computed axial tomographies were reviewed by two radiologists blinded to clinical outcome. Success was defined as complete clearance or the persistence of fragments ≤ 2mm on a plain film at 3 weeks of follow-up. The impact of clinical and radiological factors on success was assessed by univariate and multivariate analyses. Results: The single-session SWL success rate at 3 weeks was 49.1%. Stone size <8mm, stone area < 30mm2, stone location (mid- and distal ureter), stone density <1000 HU and intraoperative fragmentation showed a significant association with SWL success in the univariate analysis (p<0.05). Stone area (OR 2.9), ureteral stone location (OR 3.4) and intraoperative fragmentation (OR 4.2) were the only predictors of success in the multivariate analysis. Conclusions: Stone area and ureteral stone location provide important information when deciding about the indication of a SWL in a patient with stone disease. However, successful resolution of only half of the cases after a single session at 3 weeks in our series undermines the relevance of informing patients about the potential need for additional treatment (AU)

[Single-session extracorporeal shock wave lithotripsy for urinary calculi: factors predicting success after three weeks of follow-up]. / Factores predictivos de éxito tras una sesión única de litotricia extracorpórea de cálculos urinarios a las tres semanas de seguimiento.

INTRODUCTION: The aim of this study was to identify predictive factors of success following a single-session of shock wave lithotripsy (SWL) at 3 weeks of follow-up in our center. MATERIAL AND METHODS: The medical records of 116 patients with solitary urinary calculi who underwent single-session SWL in our department between October 2007 and August 2009 were reviewed. All preoperative unenhanced computed axial tomographies were reviewed by two radiologists blinded to clinical outcome. Success was defined as complete clearance or the persistence of fragments ≤ 2 mm on a plain film at 3 weeks of follow-up. The impact of clinical and radiological factors on success was assessed by univariate and multivariate analyses. RESULTS: The single-session SWL success rate at 3 weeks was 49.1%. Stone size <8 mm, stone area < 30 mm(2), stone location (mid- and distal ureter), stone density <1000 HU and intraoperative fragmentation showed a significant association with SWL success in the univariate analysis (p<0.05). Stone area (OR 2.9), ureteral stone location (OR 3.4) and intraoperative fragmentation (OR 4.2) were the only predictors of success in the multivariate analysis. CONCLUSIONS: Stone area and ureteral stone location provide important information when deciding about the indication of a SWL in a patient with stone disease. However, successful resolution of only half of the cases after a single session at 3 weeks in our series undermines the relevance of informing patients about the potential need for additional treatment.

[Carcinosarcoma of the renal pelvis in a horseshoe kidney: about a case]. / Carcinosarcome du bassinet sur rein en fer à cheval : à propos d'un cas.

Carcinosarcoma of the renal pelvis is a rare tumor, and its development in a horseshoe kidney makes it even more special. This is the first case reported in the literature of a renal pelvis carcinosarcoma developed in a horseshoe kidney and diagnosed on macroscopic hematuria.