Temperature profiles during ureteroscopy with thulium fiber laser and holmium:YAG laser: Findings from a pre-clinical study.

OBJECTIVE: The aim of this study was to investigate temperature profiles in both the renal pelvis and parenchyma during Thulium Fiber Laser (TFL) and Holmium:yttrium-aluminium-garnet (Ho:YAG) laser activation in an ex-vivo porcine model. METHODS: Three porcine kidneys with intact renal pelvis and proximal ureters were used in the study. A temperature sensor was inserted through a nephrostomy tube into the renal pelvis and a second sensor was inserted directly into the renal parenchyma. Temperatures were recorded during continuous laser activation for 180 s, and for an additional 60 s after deactivation. TFL (150 µm and 200 µm) and Ho:YAG (270 µm) laser delivered power at settings of 2.4 W, 8 W, 20 W and 30 W. RESULTS: Intrapelvic temperatures correlated directly to power settings. Higher power produced higher temperatures. For example, using a 150 µm fiber at 2.4 W resulted in a 2.6 °C rise from baseline (p = 0.008), whereas using the same fiber at 20 W produced a rise in temperature of 19.9 °C (p = 0.02). Larger laser fibers caused significantly higher temperatures compared to smaller fibers using equivalent power settings, e.g. mean temperature at 20 W using 150 µm was 39.6 °C compared to 44.9 °C using 200 µm, p < 0.001. There was a significant increase in parenchymal temperatures when applying 20 W and 30 W of laser power with the two larger fibers. CONCLUSION: In this ex-vivo study, renal temperatures correlated directly to power settings. Higher power produced higher temperatures. Furthermore, larger laser fibers caused higher temperatures. These findings could help guide selection of safe power settings for ureteroscopic lithotripsy, but future clinical studies are needed for confirmation.

Natural and clinical course of renal cell carcinoma--better prospect for the patients.

The many improvements in diagnostic and therapeutic tools over the last half-century have changed the prospects for patients with renal cell carcinoma (RCC). Higher survival rates and less morbidity have been achieved. The disease is, however, still unpredictable and represents many unsolved problems. In this paper we focus on determinants of the natural and clinical course of RCC and the changes in regard to this over the last decades.

[Giant urinary bladder stone]. / Kjempestein i urinblaeren.

We report a 660 gram stone in the urinary bladder of an otherwise healthy 69 year old male. The stone gave rise to only minor subjective symptoms, but urograms revealed dilatation of both the ureters. The stone was removed by open cystolithotomy. Giant bladder stones are rare in modern urologic practice. In earlier centuries, however, bladder stone formation was a common urinary tract disease with need for surgery. A brief survey of historical lithotomy methods is given.

Nephrectomy - indications, complications and postoperative mortality in 646 consecutive patients.

OBJECTIVE: To gain information about the indications for and complications of conventional nephrectomy, also to create standards for future evaluation of nephrectomies performed by minimal invasive techniques. METHODS: We present a historical 20 years' series of 646 consecutive nephrectomies performed in the period of 1978-1997. Malignant disease led to the operation in 437 cases, of which 98 were urothelial tumors in the renal pelvis or ureter. 209 kidneys were removed due to benign conditions. The incidence of nephrectomy for benign conditions has declined from 75 in the first 5-year period to 32 in the last. RESULTS AND DISCUSSION: Postoperative complications occurred in 100 patients (15.5%). Nephrectomy for malignant disease had a significantly higher rate of complications than operations for benign conditions (p<0.001), especially hemorrhagic complications and pneumonias were more frequent. There were no differences as a result of the operative approach. Reoperation was carried out in 3.0% of the cases. Overall mortality rate (<30 days) was 3.1%.

[Postoperative tetanus after gangrenous ileus]. / Postoperativ tetanus etter strangulasjonsileus.

Tetanus has become an uncommon disease in developed countries. Tetanus is caused by exotoxins from the bacteria Clostridium tetani. This microbe, which is obligate anaerobe, is present in soil, and animal and human faeces. The condition usually appears after contamination of wounds. However, reports have been published of tetanus occurring after both acute and selective gastrointestinal surgery. We present a case of severe postoperative tetanus in a 57 year-old woman who underwent bowel resection after strangulation of the ileum. The patient was treated on an intensive care unit and was artificially ventilated for 64 days. Seven months later she had fully recovered. Clinical presentation, diagnosis, treatment, and complications are discussed in the report. The diagnosis of tetanus is made by clinical observation. Nowadays, lack of suspicion of this condition may cause delay in administering proper treatment. Women and older men are often inadequately immunized. Doctors should therefore examine the immunization status of these groups of patients regularly.

[Avulsion fractures of the anterior superior iliac spine. Lex coincidentia--again!]. / Avulsjonsfrakturer av spina iliaca anterior superior. Lex coincidentia--igjen!

Avulsion fractures of the pelvic apophyses are fairly uncommon injuries. Most of these fractures occur in adolescent athletes. Traditionally they have been treated non-operatively with good results. We describe two cases of avulsion of the anterior superior iliac spine, which occurred coincidentally during a running competition at a Lille-hammer school in June 1996. The two fifteen years old boys were both treated with open reduction and internal fixation of the fragment. After three weeks they could walk normally. After 7-8 weeks they had resumed their usual sports activities, without any limitation of their sporting ability. Only a few case reports have been published dealing with operative treatment of avulsion fractures. It seems, however, that operative treatment might reduce the time to full recovery. For this reason, operative treatment of avulsion fractures should be considered for athletes and for other patients requiring a short period of rehabilitation.