Kidney stone management in the era of miniaturized percutaneous nephrolithotomy: does it improve safety? a prospective cohort study.

to compare the safety and the efficacy of standard percutaneous nephrolithotomy (sPCNL) vs. mini PCNL (mPCNL). Methods: The authors conducted a prospective single-centre cohort study over a 2-year period of all consecutive patients who underwent sPCNL or mPCNL for 2-4 cm renal stones. Patients with active urinary tract infection, abnormal coagulopathy state, malformative uropathies and multitract-access procedures were excluded. In total, 90 patients underwent sPCNL using a 30 Fr access sheath with 24 Fr nephroscope while 52 patients underwent mPCNL using a mPCNL system: 12 Fr nephroscope and a 16.5/17.5F access sheath. Blood loss estimation was assessed postoperatively after 6 h by considering haemoglobin drop and blood transfusion if required. Stone free rate at 1 month was defined by the absence of stone or residual fragments less than or equal to 3 mm on computed tomography scan. Results: Stone characteristics were comparable in both treatment arms. The mean stone size was comparable for sPCNL and mPCNL groups (32.6±10.8 mm vs. 29.4±11.8 mm). Operative time was longer in the mPCNL group (124±40.4 min vs. 95.8±32.3 min, P<0.001). According to the Clavien-Dindo classification, no statistical difference was found between the groups in terms of complication rate (P=0.092). However, the mean of haemoglobin drop and transfusion rate were significantly in favour of mPCNL (1.43±1.5 vs. 0.88±1.4 g/dcl, P=0.04). Hospital stay was found to be significantly shorter for patients undergoing mPCNL (4.4±3.9 vs. 2.7±1.7 days, P<0.001). The success rate in the sPCNL group was higher than mPCNL group in terms of stone clearance at one month (69.4% vs. 62.7%, P=0.06). Conclusion: Both sPCNL and mPCNL have shown good outcomes in this indication. Although the stone free rate was equal for both techniques, hospital stay, bleeding and transfusion rate are much lower with the use of mPCNL.

Developing learning objectives in postgraduate medical education for family medicine (Tunisia).

Introduction-Aim: The third cycle of medical studies (TCMS) lasts 3 years for the specialty of family medicine (FM) in Tunisia. The members of the FM committee of the Faculty of Medicine of Monastir (FMM) aimed to detail the learning objectives (LO) of residents in FM. METHOD: We used the Delphi method in 2 rounds including a group of experts called FM Learning Objectives Writing Group (FMLOWG) at the FMM. The FMLOWG included 74 university hospital physicians and FM internship supervisors. These members actively participated in the 10 meetings held during the month of March 2022. Three points were discussed: the identification of LOs; the development of training titles and the proposal of the teaching methods to be adopted. The writing was subdivided into 5 domains of LO: transversal, public health, typical population and by system. RESULTS: We identified 1359 LOs for FM residency, for which 552 were LOs per system (40.5%). The learning included 618 training session titles. Residents will have an academic training day every 3 weeks during 9 months for each TCMS year. CONCLUSION: A detailed, MF-specific consensus has been developed by majority of medical specialties. It will be a learning base for learners, a reference for supervisors and TCMS teachers.

Giant recurrent liposarcoma of the retroperitoneum - A surgical challenge: A case report.

INTRODUCTION: Sarcomas are a rare entity with heterogeneous clinical behavior. We herein present the case of a giant retroperitoneal dedifferentiated liposarcoma and aim to remind the clinical, histological, and therapeutic features of this rare tumor. PRESENTATION OF CASE: An 80-year-old patient was complaining of significant abdominoscrotal swelling. On physical examination, a 25-cm swelling extending from the right iliac fossa to scrotums, was observed. CT scan revealed a retroperitoneal fatty mass with necrotic areas. Ultrasonography-guided biopsy was carried. Pathological report demonstrated a dedifferentiated sarcoma. An en bloc resection of the tumor was performed through a right iliac incision extended to the scrotum. After one year of follow up, the patient had a 30-cm local recurrence. After complete resection, the patient died two days after the procedure due to neurological distress. DISCUSSION: 'Giant' liposarcomas over 20kg are extremely rare. CT-Scan and MRI are very useful for defining their size and limits. The resection of a retroperitoneal sarcoma of remarkable size is a challenge for the surgeon owing to the anatomical site that makes it hard to obtain safe margin and to the adherences with the contiguous organs. Dedifferentiated histologic subtypes and negative surgical margins are associated with poor prognosis. This explains the high rate of local recurrence after surgical excision. CONCLUSION: In rare cases, retroperitoneal dedifferentiated liposarcomas can extend through the inguinal canal to the scrotum. Surgical resection obtaining negative margins, remains the curative treatment that reduces the risk of recurrence. Careful follow-up to detect early recurrence is essential for optimal care.