Ixora coccinea L. - A reliable source of nanocellulose for bio-adsorbent applications.

Nanocellulose, a subset of nanomaterials made from cellulose, one of the world's most plentiful natural resources, has the potential to offer environmentally friendly, renewable, and sustainable building blocks with enhanced properties for a variety of applications in the nanotechnology field. This article describes the impact of glutaraldehyde (GA) on glycerol plasticized nanocellulose derived from I. coccinea L. plant root. Using a variety of characterization techniques, including Fourier Transform Infrared Spectroscopy (FTIR), X-ray Powder Diffraction (XRD), Scanning Electron Microscopy (SEM), AFM, tensile and Brunauer-Emmett-Teller (BET) analysis, the effect of GA on glycerol plasticized nano-cellulose was investigated. The tensile modulus of the GA-crosslinked, 2 % glycerol-plasticized nanocellulose scaffolds is higher (88.82 MPa) than that of the regular nanocellulose scaffolds (78.8 MPa). The scaffold Young's modulus has been increased to 86.3 MPa. The results of the BET study proved that the surface area of the GA crosslinked nano-cellulose scaffold improved to129.703 m2/g. The larger surface area in turn results in a greater number of contact sites between consecutive fibers. This enhances the utility of the scaffold as a bio-adsorbent for waste water treatment. The absorbance of textile black dye and methylene blue dye in sunlight using nanocellulose composites as photocatalyst revealed a significant decrease in dye concentration after each hour, demonstrating the composites' bio-adsorbent property. The non-toxic nature, inertness, increased crystallinity index values, and good mechanical qualities are other characteristics of the GA-treated nanocellulose encourages its uses as product packaging, bioengineering materials, tissue engineering, and insulation coatings.

Supine Endoscopically-Combined Intrarenal Surgery (ECIRS) for encrusted ureteral stent with staghorn calculi, ureterolithiasis and cystolithiasis

@#A forgotten and encrusted ureteral stent poses as a management dilemma especially when the encrustations are so severe that they involve the entire length of the ureteral stent. These can lead to staghorn formation, high volume ureterolithiasis and giant cystolithiasis which are all encasing the ureteral stent, This may lead to significant morbidity and mortality as a result of chronic urinary obstruction, recurrent urinary tract infection, and renal dysfunction and renal failure. During the acute phase of the pandemic, a 31-year-old pregnant female, with 9 weeks age of gestation, underwent insertion of an indwelling ureteral stent for an obstructing renal pelvic calculus. She was lost to follow-up only to return two years later, with right flank and lower abdominal pains. Non-contrast CT showed encasement of the ureteral stent with a staghorn calculus on the proximal coil, extensive encrustations on the upper and middle segments, and a giant cystolithiasis at the distal coil of the ureteral stent. She underwent a supine endoscopically-combined intrarenal surgery (ECIRS), allowing retrograde retrieval of the ureteral stent after all the encrustations had been removed. There was minimal blood loss and no intraoperative and postoperative complications.Encrusted ureteral stents with large stone burden may be treated effectively and safely with an endoscopically-combined intrarenal surgery. This combined antegrade and retrograde approaches to the urinary tract allows synchronous treatment of all calcifications around the forgotten ureteral stent, without resorting to open surgery.

Analysis of the clinical efficacy and safety of percutaneous nephrolithotomy in patients with anatomical variations: A single center retrospective study

Introduction and Objective@#Percutaneous Nephrolithotomy (PCNL) is the standard of care for renal stones >2cm. Kidneys with anatomical disparities resulting from fusion (horseshoe), malrotation, ectopic location (allografts) and bifid collecting systems present as a challenge because variations in vasculature, calyceal rotation and intervening viscera may make percutaneous access treacherous. Reported here is the authors’ experience with PCNL in these types of kidneys. @*Methods@#A chart review was done on all patients who underwent PCNL at the National Kidney and Transplant Institute (NKTI) from 2012-2016. Those with anatomical variations were identified and analyzed. Patient demographics (age, gender, co-morbidity) and stone characteristics (Guy’s stone score, laterality) were summarized. Intraoperative parameters such as location of puncture site (upper, mid, inferior calyces), number of tracts (single vs. multiple), operative time, estimated blood loss (EBL), and length of hospital stay (LOS) were analyzed. The primary endpoints were stone-free and complication rates according to the Clavien-Dindo (CD) classification.@*Results@#A total of 1,657 PCNLs were performed during the study period, of which 42 had anatomical variants. The mean age was 45.2±8.8 (R= 28-65) with a male to female ratio of 3:1. There were 18 horseshoe (42.9%), 15 bifid (35.7%), 7 malrotated (16.7%) and 2 renal allografts (4.8%.); Laterality- wise, 28 (67%) were left-sided, 12 (29%) were right-sided and 2 (5%) had right-sided pelvic kidneys (allografts). The Guy stone scores were 3 and 4 in 13 (30%) and 29 (70%) patients, respectively. The mean stone diameter was 3.8±0.6 cms. (R=2.5-5.5). Majority, n=37 (88%) were treated with an upper pole access. Thirty-six (86%) needed a single tract and while six (14%) required multiple tracts (bifid pelvis). The mean operative time was 111.5±28.1 mins. (R=65-188), EBL was 461±278.4 cc (R=200-1300). LOS was 3.6±0.94 days (R=2-7). The stone-free rate was 95%. Twenty-five (59.5%) complications were documented. Fifteen (35.7%) had fever: Grade I CD, and 10 (23.8%) required transfusion: Grade II CD. There was no mortality.@*Conclusion@#PCNL still persists as the treatment of choice for nephrolithiasis in kidneys with variations in anatomy or position. A high stone clearance rate can be achieved while minimizing complications.

Endoscopic management of Urolithiasis on a pediatric patient with a solitary kidney and an Ileal conduit

@#Management of nephrolithiasis in patients with urinary diversions pose a unique therapeutic challenge for the following reasons: 1) retrograde ureteral access is difficult to perform through a bowel diversion and 2) percutaneous renal access becomes challenging because of inability to do a retrograde pyelogram. For this reason, image-guided access through a combined ultrasound and fluoroscopic guidance are both necessary. This clinical problem becomes even more complicated when dealing with a solitary functioning kidney. Treatment should be precise in order to avoid any complications that may progress to renal failure. Presented here is a 15-year-old male adolescent who had previously undergone a radical cystectomy with an ileal conduit for a rhabdomyosarcoma of the bladder last 2008, and complained of flank pain, fever and foul-smelling urine. Imaging studies showed left obstructive hydronephrosis with ureterolithiasis and nephrolithiasis, and an atrophic contralateral kidney. A preliminary nephrostomy tube drainage was done to recover renal function, followed later by percutaneous endoscopic stone management. Discussed here are the challenges involved in his therapy as well as the advantages of a stepwise approach including the short-term outcomes.

Hydroperitoneum: A unique complication of Supine Percutaneous Nephrolithotomy on an Ectopic Solitary Pelvic Kidney

@#A 47-year-old male complained of anuria for 2 days with elevated creatinine of 14 mg/dL on admission. Patient underwent emergent hemodialysis. Non-contrast CT showed a solitary ectopic pelvic kidney with a 2 cm. pelvolithiasis and a 1 cm upper pole calyceal stone with obstructive hydronephrosis. He therefore underwent ultrasound-guided nephrostomy tube placement. Once clinically stable, the patient underwent a multi-tract supine PCNL. Intraoperatively, the authors noted tense abdominal distention accompanied by hypotension during the procedure. A diagnosis of compartment syndrome secondary to hydroperitoneum was considered. An indwelling stent and a nephrostomy tube were placed. An abdominal pigtail drain was placed removing three liters of fluid. The patient remained intubated for 3 days. He underwent blood transfusion. He required two 2 sessions of hemodialysis postoperatively. The patient was discharged in stable condition on postoperative day 22. Hydroperitoneum is a potential complication of PCNL in ectopic pelvic kidneys. Its prompt recognition, followed by immediate aspiration of intraabdominal fluid and drain placement is life-saving.

Comparative analysis of blood loss and transfusion requirements among patients with Staghorn Calculus undergoing Percutaneous Nephrolithotomy versus Open Stone Surgery in National Kidney and Transplant Institute: 2018-2019

BACKGROUND@#Percutaneous nephrolithotomy (PCNL) is the standard of care for the treatment of renal stones >2cm and staghorn calculi. This minimally invasive procedure however has intraoperative hemorrhage as one of its most dreaded complications.@*OBJECTIVE@#To analyze the rate of hemorrhage and transfusion requirements among patients undergoing either PCNL or open stone surgery (OSS).@*METHODS@#This was a retrospective study conducted at the National Kidney and Transplant Institute Medical Records Department. Data were collected for the period of January 2018 to December 2019.@*RESULTS@#One hundred forty cases were included, 102 patients in the PCNL group and 38 in the OSS. The mean age 50.84±11.89 vs. 50.50±10.09 with male to female ratio of 1.2:1 for PCNL and open surgery, respectively. The most common comorbidity was hypertension (89, 63.6%). As regards stone size, majority had >4 cm stone size (61; 43.9%). In PCNL, there was no significant change noted in the hemoglobin (14.69±13.3 vs 12.03±1.91, p= 0.099) as compared to OSS, where there was significant decline (12.77±2.64 vs. 11.06±2.52; = .000. The number of packed red cell units for transfusion was also significantly higher in OSS compared to PCNL group (.526±.861 vs. 159±.502, p .020.)@*CONCLUSION@#In the treatment of staghorn calculi, PCNL incurs less blood loss and lower transfusion requirements compared to open stone surgery.

Nephron-sparing surgery for bilateral sporadic giant angiomyolipomas

@#A 40-year-old female complains of right flank plain associated with progressive abdominal enlargement. She had stable vital signs and normal renal function. CT urogram revealed bilateral flank masses suggestive of bilateral giant angiomyolipomas. She was counseled on the various treatment options and opted to undergo open surgical excision. She underwent an open clamp-less partial nephrectomy with no intraoperative events. Operative time was 120 minutes and estimated blood loss was 250cc. She was discharged in good clinical condition on postoperative day 4. Final histopathological analysis revealed angiomyolipoma. Genetic testing was positive for mosaic variant of tuberous sclerosis. After a year of follow up, she remains stable and is maintained on everolimus. Open ischemia-free partial nephrectomy may be done safely for giant renal angiomyolipomas. Radical nephrectomy should be reserved for the last option because the presence of contralateral disease may also require surgical excision in the future.

Laparoscopic ureteral reimplantation for a distal ureteral injury detected after laparoscopic radical prostatectomy

@#Distal ureteral injury is a rare complication of laparoscopic radical prostatectomy (LRP). The authorsreport such a case which was repaired successfully with an exclusively laparoscopic approach. Theyalso describe the advantages of the flank position when performing this minimally invasive approach.@*THE CASE@# 61-year-old Filipino male, with a PSA of 10 ng/cc, diagnosed with localized prostatecancer undergoes LRP, utilizing a posterior approach to the seminal vesicles. Intraoperatively, alarge intravesical median lobe was noted which was dissected meticulously after the division of thebladder neck. The excision of the 60gm prostate was completed in the conventional manner followedby a urethrovesical anastomosis. Blood loss was minimal with no apparent intraoperative events.Histopathology confirmed prostate cancer, Gleason score (4+3) with negative margins. Postoperatively,he had progressively high pelvic drain output and noticeably a relatively low urethral catheter output.CT urogram done on POD 8 showed a distal left ureteral disruption with intraabdominal extravasation.The authors performed a laparoscopic left ureteroneocystostomy on POD 9. The patient did wellafter the repair. After removing the indwelling catheter on postoperative day 14, he was dischargedin a good clinical condition. The ureteral stent was removed one month after the reimplantation.Follow-up CT urogram showed unobstructed flow through the reimplanted left ureter. Follow-upPSA at this time was 0.01ng/cc.@*CONCLUSION@#Ureteral injury following LRP is a devastating complication which may go undiagnosedintraoperatively. Prompt recognition, followed by a timely minimally invasive repair through alaparoscopic approach is needed to correct this problem.

Analysis of risk factors for pulmonary complications in patients undergoing Upper Pole Prone Percutaneous Nephrolithotomy (uPPCNL): A single center experience

INTRODUCTION@#To determine the risk factors contributing to pulmonary complications among patients who undergo upper pole prone percutaneous nephrolithotomy (uPPCNL). This will serve as a guide to urologists who utilize uPPCNL among their patients, so that they may monitor them more closely for these events.@*METHODS@#A retrospective chart review was done on all patients who underwent uPPCNL from January 2015 to December 2017. Patient characteristics (age, gender, BMI, co-morbidity) and stone demographics (Stone size, Guy’s Stone score, laterality, stone location) were summarized as well as intraoperative parameters inclusive of operative time, number of tracts, estimated blood loss, and length of hospital stay. Point biserial correlation and Pearson Chi-square for independent tests were used to identify the independent predictors of pulmonary complications.@*RESULTS@#Nine hundred ninety-two patients underwent uPPCNL during the study period. Fifty-two (5.2%) had pulmonary complications. Sixty-seven pulmonary complications were tallied because some had two complications at one time. The most common was pleural effusion 35(48%), followed by atelectasis in 16(30%), hospital-acquired pneumonia 14(27%) and acute respiratory distress syndrome 2(4%). Forty-one (78.8%) and 11(21.2%) required medical and surgical interventions, respectively. Higher Guy’s stone scores, larger stone size, and longer hospital stay were significant predictors for developing pleural effusion. Patients with higher preoperative serum creatinine and longer hospital stay were significantly associated with surgical management (p < 0.05).@*CONCLUSION@#The incidence of pulmonary complications after uPPCNL is low and only a minority need surgical management. When risk factors are present, these patients need to be monitored closely so that a timely intervention may be done to avoid life-threatening consequences.

Supine PCNL (sPCNL): Challenging the “standard” prone (pPCNL)

@#Recently, the global endourology scene has witnessed a resurgence of interest in supine PCNL (sPCNL). The number of urologists who are attracted to this “simplified method” of PCNL is growing and its promoters are suggesting to abandon the standard prone approach. Debates on the two positions have become commonplace in endourology scientific meetings. The advocates consistently emphasize that when compared to the prone position, sPCNL has multiple advantages for the surgeon, the anesthesia team and the patient. In spite of these, it is evident that many still favor prone PCNL (pPCNL) because of its time-tested proven efficacy and safety. In fact, up to this present day, majority of PCNLs are still done in the prone position. This review article intends to analyze the “current state of affairs” of the two PCNL positions, describing their advantages and disadvantages. Presently, applying the principles of “what is safe and efficacious in one’s hands” dictates the choice of which technique is utilized to treat a patient. Conversely, it is more clinically sound if this choice was made instead, in consideration of, the interplay of the following factors such as the patient’s clinical demographics, the anatomical features of the renal collecting system, the stone burden and characteristics and ultimately, the physician’s training, skills and experience.

Analysis of clinical outcomes of Tubeless Standard-Sized PCNL (TSPCNL) for large volume renal stones: A single center retrospective study

OBJECTIVE@#To describe the outcomes of standard-sized tubeless PCNL (TSPCNL) in terms of clinical efficacy (stone-free rate, operative time and length of hospital stay) and safety (transfusion rate, infection and complications).@*METHODS@#A chart review was done on all patients who underwent standard-sized PCNL from 2017 to 2019. All cases of TSPCNL were identified. The patient and stone demographics were analyzed including intraoperative and postoperative outcomes. Complications were analyzed using the Clavien-Dindo classification.@*RESULTS@#Seventy-nine consecutive cases of prone, single-tract, upper pole access, tubeless PCNL were identified and analyzed. The mean age was 52.74±11.26 with a female to male ratio of 1:1.4. The Guy’s Stone Score showed 12 (15.2%) Grade 1; 23 (29.1%) Grade 2, 11(13. 9%) Grade 3 and 33 (41.8%) Grade 4 renal stones. Mean stone size was 33.7±14.1mm. The stone-free rate was 98.73%. The mean hemoglobin change was 13.6±13.9 g/L. The mean creatinine change was 2.65±23 umol/L. The mean length of hospital stay was 2.46±1.84 days. Twenty-four (30.4%) experienced significant pain, which required analgesics in the form of opioid derivatives. According to the modified Clavien-Dindo classification, 6/79 (7.6%) had Grade 1; 4/79 (5.1%) had Grade 2 and 2/79 (2.5%) had Grade 3 complications. There was no mortality.@*CONCLUSION@#The authors’ experience adds to the growing evidence that TSPCNL is a reasonable, efficient and safe approach for large volume nephrolithiasis. Clear indications are needed prior to nephrostomy tube placement after standard-sized PCNL.

Clinical and pathological outcomes of laparoscopic radical prostatectomy in a large volume center in the Philippines: A ten-year experience

INTRODUCTION@#Currently, there are limited studies on laparoscopic radical prostatectomy (LRP) in the country. The authors report the clinical and oncological outcomes of LRP over a 10-year experience in a large volume center in the Philippines.@*METHODS@#This retrospective study included 101 patients treated consecutively with LRP from 2008 to 2017. Patient demographics, preoperative prostate features, perioperative data and complications were summarized to determine surgical outcomes. Histopathological results were analyzed to determine oncological efficacy.@*RESULTS@#The mean age was 64.8-7.1 years (R:46-84), BMI was 25.3±3.0 kg/m2 (R:18.7-34.1), prostate volume was 41.1+21.2g (R:7.9-133) and preoperative PSA was 21.5+19.9 ng/mL (R:2.0-100). Operative time was 276.1+70.0 mins. (R:165-475) and estimated blood loss was 604.7+478.4 mL (R: 100-3700). Five (5%) required conversion to open. Time to oral intake was 1.3+0.7 days (R:1-5). Bowel function returned in 2.0+0.9 days (R: 1-4). The drain was removed after 3.7+1.2 days (R:0-9) in 89 patients while 12 patients were discharged with the surgical drain. The length of stay was 4.5+1.8 days (R: 3-14). Pathologically, 26 (25.7%) had extracapsular extension and 14 (13.8%) had seminal vesicle involvement. Three out of 44 (6.8%) who had pelvic lymphadenectomy had nodal metastasis. Thirty (29.7%) had positive surgical margins, the most common site being the apex (17, 56.6%). Thirty-one (30.6%) had Grade I to III complications. There was no mortality.@*CONCLUSION@#Laparoscopic radical prostatectomy continues to be a feasible minimally invasive alternative treatment for localized prostate cancer with an acceptable safety profile and high oncological efficiency.

Clinical outcomes of removing the better functioning kidney during laparoscopic donor nephrectomy: A retrospective five-year single-center study

OBJECTIVE@#The primordial principle in living kidney donation is leaving the better functioning kidney (BFK) with the donor. However, when laparoscopic donor nephrectomy (LDN) is utilized, certain conditions may warrant removing the BFK. These include lesser complex vasculature, renal calculi, or left-sidedness. Reported here are the long-term outcomes of removing the BFK among living donors.@*METHODS@#Chart review was done on all donor nephrectomy patients over a five-year period. Patients whose BFK were removed via LDN were identified. Clinical indications, patient demographics, perioperative and postoperative outcomes were summarized. Creatinine and eGFR at one-day, one-month and one-year follow-up were used to determine renal functional outcomes.@*RESULTS@#Between January 2011 to December 2015, 810 donor nephrectomies were performed: 366 (45.2%) and 444 (54.8%) had open donor nephrectomy and LDN, respectively. BFK was removed in 26 (5.8%) in the LDN and none in the open group. Mean age was 28.9+7.5 (18-49), with a male to female ratio of 4:1. The clinical indications were less complex vasculature in 18 (69%), left-sided BFK in 7 (27%) and renal calculi in 1 (3.8%). The mean operative time was 173 +25 (130–272) minutes, with a mean blood loss of 111 +96 (50-200)cc. The mean length of stay was 3.0+0.2 (2.8-4) days. Grade 1 complications were seen in 5 (19%) patients. There was no mortality. The eGFR after 1 year is 79.4+14.1 (54-91) cc/min.@*CONCLUSION@#Removing the BFK during LDN does not impact negatively on the safety and renal functional outcomes of living kidney donors.

Comparative analysis of the efficacy and safety profile of upper calyceal versus lower calyceal access in the percutaneous nephrolithotomy (PCNL): A retrospective cross-sectional study

@#<p style="text-align: justify;"><strong>INTRODUCTION:</strong> The goal of PCNL is to achieve a high stone-free rate while minimizing complications. Its success results from an interplay of patient, stone and renal anatomical characteristics, the access site and the level of surgical expertise. Data comparing upper versus lower calyceal PCNL as regard to efficacy and safety are limited.<br /><strong>OBJECTIVE:</strong> To compare the clinical efficacy and safety outcomes of upper versus lower calyceal access in patients who underwent PCNL at St. Luke's Medical Center.<br /><strong>METHODS:</strong> A retrospective chart review was done on patients who underwent PCNL at SLMC from January 2010-January 2015. The patients were classified based on the renal access site: Group 1 (upper calyceal) and Group 2 (lower calyceal). The stones were classified according to Guy Stone score and complications were summarized using the modified Clavien classification.<br /><strong>RESULTS:</strong> A total pf 91 patients underwent PCNL during the study period. Of these, only 84 patients were analyzed. Seven were excluded due to lack or incomplete postoperative imaging on follow up. Forty-one were included in Group 1, while 43 were included in Group 2. According to the Guy Stone score, the stones in Group 1 were 21(IV), 6(III), 7(II) and 6(I) while in Group 2, 18(IV), 5(III), 8(II), 12(I) (p-value=0.52) with a mean stone volume of 38.2± 44.24cm3 and 28.0± 31.04cm3 in Groups 1 and 2 respectively (p-value= 0.23). Success rate was 80.5% and 83.7% for Groups 1 and 2 (p-value=0.70), respectively and mean stone clearance rates of 98.5% and 95.8% (p-value=0.13),respectively. The mean operative time was 181.0±82.26 and 169.5±52.12mins for Groups 1 and 2 (p-value=0.451),respectively. A total of 36 complications (13 from Group 1 and 23 from Group 2) were evaluated. Fever (Grade 1) occurred in 10 (24%) and 17(39%) for Groups 1 and 2, respectively. Blood transfusion (Grade 2) was observed in 4(9%) patients and 3(7%) in Groups 1 and 2, respectively. Two patients (5%) in Group 2 required postoperative double-J sent insertion due to ureteral stone migration (Grade 3). There was no significant difference noted among the groups as regards complication rates (p-value=0.097) and length of hospital stay (p-value=0.687). There was no mortality in either group.<br /><strong>CONCLUSION:</strong> Based on our experience, both upper and lower calyceal access PCNL achieve equivalent efficacy and comparable safety profile in the treatment of complex renal stones.</p>

The clinical safety and efficacy of upper pole access percutaneous nephrolithotomy (uPPCNL) for inferior pole stones

OBJECTIVE: Traditionally, percutaneous nephrolithotomy (PCNL) for a lower pole stones are directly removed through an inferior polar access. The authors preferentially treated inferior pole calculi with an upper polar access and evaluated the clinical outcomes.METHODS: Between January 2010 and April 2016, 32 patients with inferior calyceal stones were treated uPPCNL. All stones were diagnosed using an unenhanced CT scan. The efficacy (stone-free rate) was determined by comparing the preoperative and postoperative imaging. Clinical safety was assessed based on intraoperative parameters pertaining to operative time, blood loss, urinary extravasation, calyceal injury, pelvic perforation and other untoward events. These complications were summarized using the Clavien-Dindo grading system.RESULTS: The male to female ratio is 1.1:1. All stones included in the study were pure inferior calyceal in location. The average stone size was 1.65±0.84cm (Range:0.6-4.4) with a mean durility of 936±298HU (Range: 350-1500). Stone-free rate was 96.8% (31/32) after a single session of PCNL. The mean operative time was 97±43 minutes (Range:40-230). According to the Clavien-Dindo classification, 26(81.3%) had no complication, 5 (15.6%) had Grade 1 (fever), and 1 (3.1%) had Grade 2.CONCLUSION: uPPCNL is effective and safe for patients with inferior calyceal stones and confers the following advantages 1) shorter skin-to-calyceal distance 2) straight line to the UPJ and inferior pole 3) a panoramic view of the collecting system 4) less stone migration 5) minimal torque of the nephroscope. This minimally invasive procedure achieves a high stone clearance rate with acceptably low complication rates.

The clinical safety and efficacy of upper pole access percutaneous nephrolithotomy (uPPCNL) for inferior pole stones

@#<p style="text-align: justify;"><strong>OBJECTIVE:</strong> Traditionally, percutaneous nephrolithotomy (PCNL) for a lower pole stones are directly removed through an inferior polar access. The authors preferentially treated inferior pole calculi with an upper polar access and evaluated the clinical outcomes.<br /><strong>METHODS:</strong> Between January 2010 and April 2016, 32 patients with inferior calyceal stones were treated uPPCNL. All stones were diagnosed using an unenhanced CT scan. The efficacy (stone-free rate) was determined by comparing the preoperative and postoperative imaging. Clinical safety was assessed based on intraoperative parameters pertaining to operative time, blood loss, urinary extravasation, calyceal injury, pelvic perforation and other untoward events. These complications were summarized using the Clavien-Dindo grading system.<br /><strong>RESULTS:</strong> The male to female ratio is 1.1:1. All stones included in the study were pure inferior calyceal in location. The average stone size was 1.65±0.84cm (Range:0.6-4.4) with a mean durility of 936±298HU (Range: 350-1500). Stone-free rate was 96.8% (31/32) after a single session of PCNL. The mean operative time was 97±43 minutes (Range:40-230). According to the Clavien-Dindo classification, 26(81.3%) had no complication, 5 (15.6%) had Grade 1 (fever), and 1 (3.1%) had Grade 2.<br /><strong>CONCLUSION:</strong> uPPCNL is effective and safe for patients with inferior calyceal stones and confers the following advantages 1) shorter skin-to-calyceal distance 2) straight line to the UPJ and inferior pole 3) a panoramic view of the collecting system 4) less stone migration 5) minimal torque of the nephroscope. This minimally invasive procedure achieves a high stone clearance rate with acceptably low complication rates.</p>

[Acute appendicitis: preference for second ultrasound instead of CT or MRI]. / Acute appendicitis: liever tweede echo dan CT of MRI.

OBJECTIVE: To assess whether additional CT or MRI, rather than a repeat ultrasound investigation, is the most appropriate diagnostic approach for patients with clinical suspicion of appendicitis following an inconclusive first ultrasound. DESIGN: Descriptive study. METHOD: Retrospective data analysis of patients admitted to ER with clinical suspicion of acute appendicitis, on whom at least one ultrasonography had been performed. RESULTS: A total of 328 patients were included of which 81 patients had an inconclusive first ultrasonography. Twenty-five patients underwent a second ultrasound test, and in 17 patients a correct diagnosis could be made. The positive and negative predictive value of a second ultrasonography, following an inconclusive first one was 97% and 99% respectively. CONCLUSION: Following an inconclusive first ultrasonography in patients suspected of having acute appendicitis, a second ultrasound after an observation period can be considered, rather than opting for additional CT or MRI imaging.

Asociación de gastrosquisis y artrogriposis múltiple congénita / Gastroschisis and arthrogryposis: clinical case

Introducción: La gastrosquisis (GQ) es un defecto congénito de cierre de la pared abdominal, a la derecha de la inserción del cordón umbilical. Una cantidad variable del intestino, y en ocasiones, otros órganos abdominales, se hernian fuera de la pared abdominal, sin cobertura membranosa. La Artrogriposis Múltiple Congénita (AMC) comprende un grupo de trastornos reumáticos caracterizados por contracturas articulares múltiples en que se afectan los músculos dorsales y de las extremidades superiores e inferiores. Objetivo: Describir una rara asociación de estas dos malformaciones congénitas. Caso clínico: Recién nacido con GQ clásica Se realizó cierre primario del defecto de pared abdominal en las primeras horas de vida, con buena evolución postoperatoria. Al nacimiento, se apreció además Artrogriposis de articulaciones distales de ambos miembros superiores y atrofia muscular en ellos asociada a paresia severa de miembros superiores. Conclusiones: Recientemente se ha señalado que la asociación entre GQ y AMC pueda ser más frecuente de lo que clásicamente se ha descrito. Aunque la etiología de estas dos afecciones no está clara, el fenómeno que causa la disrupción o accidente vascular podría explicar la coexistencia de estas dos patologías.

Introduction: Gastroschisis is a congenital abdominal wall closure defect, usually to the right of the umbilical cord insertion. A variable amount of the intestine and occasionally other abdominal organs herniate outside of the abdominal wall without a covering membrane. Arthrogryposis Multiplex Congenital (AMC) consists of a group of rheumatic disorders characterized by multiple joint contractures that may affect back muscles and upper and lower extremities. Objective: To describe a rare association of these two birth defects. Case report: Newborn with classical Gastroschisis; primary closure of the abdominal wall defect was performed in the first hours of life, with good results. At birth, Arthrogryposis in distal joints of both upper limbs and muscle atrophy associated with severe upper limb paresis were observed. Conclusions: It has recently been suggested that the association between Gastroschisis and AMC may be more common than previously described. Although the etiology of these conditions is unclear, the phenomenon that causes the disruption or stroke could explain the coexistence of both pathologies.

Terazosin, Pygeum africanum and combination in the management of prostatic obstruction: a comparative study

The efficacy of a combination of alpha adrenergic antagonist (Terazosin) and Pygeum Africanum in the management of prostatic obstruction was measured and compared with that of a single pharmacologic agent using Terazosin in one group and Pygeum Africanum in the other. Ninety-seven patients completed the treatment course. Terazosin was prescribed at an initial dose of 1 mg tablet at bedtime increased to a maximum of 4 mg. Pygeum Africanum and placebo were taken at 2 capsules each twice daily while the combination followed the same dosage. Duration of treatment lasted for 6 weeks. Assessment was based according to 2 parameters. Objective data consisted of diurnal and nocturnal frequency, urine flow rate and residual volume. The other parameters consisted of subjective symptoms evaluated qualitatively by the patient. In all parameters, there was no significant difference between the placebo pre-treatment and post-treatment values. On the contrary, results of the combination Pygeum Africanum and Terazosin, and both as monotherapy showed significant therapeutic effects (p0.05). The combination therapy, however, revealed the highest mean values in all objective parameters, and patients claimed marked improvement in all subjective symptoms, thereby making it the most effective treatment for Benign Prostatic Hyperplasia. Dose related side-effects were encountered within Terazosin. Dizziness and hypotension were common complaints. On the contrary, Pygeum Africanum appeared to be well-tolerated.