Holmium:YAG Lasertripsy with semirigid ureterorenoscope for upper-ureteral stones >2 cm

BACKGROUND AND PURPOSE: Shockwave lithotripsy (SWL) has a variable but low success rate for impacted stones of the upper ureter. Ureterorenoscopic stone manipulation is another option, the appropriateness of which decreases with increasing size of the stone. This report examines the feasibility and effectiveness of ureterorenoscopic holmium:YAG lasertripsy (URSL) for impacted upper-ureteral stone >2 cm. PATIENTS AND METHODS: Twenty-six patients with impacted upper-ureteral stones >2 cm were treated with URSL using a 6/7.5F semirigid tapered ureterorenoscope and holmium:YAG laser under spinal anesthesia. Double-J ureteral stents were placed in all patients owing to the large stone burden and edema of the intraluminal mucosa. Success was defined as stone-free status on radiography at 1 month. Demographics, stone parameters, and outcomes were analyzed. RESULTS: The retrograde accessibility rate of these stones was 96.2% (25 of 26). The stone-free rate achieved after one sitting was 84% (21 of 25). After an auxiliary treatment, the total stone free-rate reached 100%. In only one patient, who had a sharply angulated ureter, did access with the ureterorenoscope fail; this patient received open surgery. There were no intraoperative or postoperative complications. CONCLUSIONS: Although 16% of patients need an auxiliary treatment, the holmium:YAG laser combined with a semirigid ureterorenoscope can be considered the first choice for large impacted upper-ureteral stones.     

Case Report: Capnocytophaga canimorsus <Emphasis Type="Italic">A Novel Pathogen for Joint Arthroplasty</Emphasis>

We report the case of a 59-year-old man with Waldenstrom’s macroglobulinemia and active alcohol use who presented with bilateral knee pain 5 years after a bilateral staged TKA. Cultures of synovial fluid and periprosthetic tissue specimens from both knees yielded, after prolonged anaerobic incubation, a catalase- and oxidase-positive gram-negative bacillus, which was identified as Capnocytophaga canimorsus by 16S ribosomal RNA PCR analysis. C canimorsus, an organism that is commonly found in dog and cat saliva, is a rare cause of various infections in immunocompromised and healthy individuals. However, a review of the medical literature indicates C canimorsus has not been reported previously to cause infection after joint arthroplasty. The patient was immunocompromised by cytotoxic chemotherapy, corticosteroids, and alcohol use. The patient was managed successfully with bilateral two-stage exchange and 6 weeks of intravenous ertapenem therapy. Because of its fastidious and slow-growing characteristics, C canimorsus may be an unrecognized cause of culture-negative joint arthroplasty infections, especially in cases when dog and cat exposure is evident in the clinical history. One of the authors (ADH) has received funding from Stryker Orthopaedics, Mahway, NJ, DePuy Orthopaedics, Inc, Warsaw, IN, and Zimmer, Inc, Warsaw, IN.     

<Emphasis Type="Italic">EGFR</Emphasis> and <Emphasis Type="Italic">p53</Emphasis> Status of Pulmonary Pleomorphic Carcinoma: Implications for <Emphasis Type="Italic">EGFR</Emphasis> Tyrosine Kinase Inhibitors Therapy of an Aggressive Lung Malignancy

Background  

Pleomorphic carcinomas of the lung are uncommon malignant tumors composed of carcinomatous and sarcomatous components and are distinguished from other non-small-cell lung carcinomas by a more aggressive clinical course with early distant metastases and far worse survival. Epidermal growth factor receptor (EGFR) and p53 are common genes involved in the pathogenesis of non-small-cell lung carcinomas, but their roles in pleomorphic carcinomas are unclear. The potential clinical activity of EGFR-targeted therapy is also unknown.     

Minimally invasive surgery for achalasia in patients >40 years: more favorable than anticipated

Purpose  

The efficacy of Heller myotomy in patients >40 years—a significant predictor suggesting a favorable response to pneumatic dilation—has been questioned. The aim of our study was to evaluate the results obtained in patients aged <40 and >40 years undergoing minimally invasive surgery (MIS) for achalasia.