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1.
Purpose
To investigate the performance of retrograde intrarenal surgery (RIRS) for the 1–2 cm renal stone size range in comparison to smaller stones.Materials and methods
From a data base of 3000 ureteroscopies between 2004 and 2014, 635 consecutive patients underwent RIRS for renal stones. Patients were divided to three groups according to their renal stone size (<10, 10–15, 15–20 mm). Preoperative, operative, stone free rate (SFR) and follow-up data were analyzed and compared.Results
The SFR for the three groups was 94.1, 90.1 and 85%, respectively. Patients with renal stone size above 15 mm had a statistically significantly lower SFR. The efficiency quotient calculated for stones larger and smaller than 15 mm was 83.9 vs. 91.8%, respectively (p < 0.01). The mean operative time and hospital stay were longer for patients with renal stones larger than 15 mm (73.6 ± 29.9 vs. 53 ± 19.4 min, p < 0.01 and 2.2 ± 2 vs. 1.8 ± 1.8 days, p = 0.031, respectively). Moreover, the complication rate was almost two times higher (10 vs 5.4%, p = 0.08). Concomitant ureteral stones and older age were independent predictors of failure in the large stone group.Conclusions
While the overall SFR following RIRS for renal stones up to 2 cm is generally high, the SFR for 15–20 mm stones is significantly lower, with a longer operating time and hospital stay, and a higher complication rate.2.
Purpose
Posterior acoustic shadow width has been proposed as a more accurate measure of kidney stone size compared to direct measurement of stone width on ultrasound (US). Published data in humans to date have been based on a research using US system. Herein, we compared these two measurements in clinical US images.Methods
Thirty patient image sets where computed tomography (CT) and US images were captured less than 1 day apart were retrospectively reviewed. Five blinded reviewers independently assessed the largest stone in each image set for shadow presence and size. Shadow size was compared to US and CT stone sizes.Results
Eighty percent of included stones demonstrated an acoustic shadow; 83% of stones without a shadow were ≤ 5 mm on CT. Average stone size was 6.5 ± 4.0 mm on CT, 10.3 ± 4.1 mm on US, and 7.5 ± 4.2 mm by shadow width. On average, US overestimated stone size by 3.8 ± 2.4 mm based on stone width (p < 0.001) and 1.0 ± 1.4 mm based on shadow width (p < 0.0098). Shadow measurements decreased misclassification of stones by 25% among three clinically relevant size categories (≤ 5, 5.1–10, > 10 mm), and by 50% for stones ≤ 5 mm.Conclusions
US overestimates stone size compared to CT. Retrospective measurement of the acoustic shadow from the same clinical US images is a more accurate reflection of true stone size than direct stone measurement. Most stones without a posterior shadow are ≤ 5 mm.3.
Objective
To make a comparison between the safety and efficacy of micropercutaneous nephrolithotomy (microperc) and retrograde intrarenal surgery (RIRS) for the management of lower pole kidney stones up to 15 mm.Patients and methods
60 patients presenting with solitary lower pole kidney stones up to 15 mm were included in the study between March 2013 and December 2015. Patients were randomized into Microperc or RIRS groups with computer-generated numbers.Results
The mean stone size was 10.6 (5–15) and 11.5 (7–15) mm for Microperc and RIRS groups, respectively (P = 0.213). In the Microperc group, the scopy time was 158.5 s, while in the RIRS group, the scopy time was 26.6 s (P = 0.001). The hospitalization period in the Microperc group was 542 h, while it was 19 h in the RIRS group (P = 0.001). No statistical differences were observed during the operating time, pre-operative–post-operative hemoglobin (Hb), serum creatinine, and estimated glomerular filtration speed (e-GFR) values and stone-free rates. No intraoperative complications were observed in either of the groups, while post-operative complications were observed in six patients in Microperc Group and five patients belonging to the RIRS Group (P = 0.922).Conclusions
Both Microperc and RIRS are safe and effective alternatives, and have similar stone clearance and complication rates for the management of lower pole kidney stones up to 15 mm in diameter. However, prolonged hospital stay and scopy times are the main disadvantages of Microperc and further research is needed to evaluate the renal tubular damages caused by both of these methods.4.
Mattia Fabbri Edoardo Monaco Riccardo Maria Lanzetti Dario Perugia Matteo Guzzini Luca Labianca Andrea Ferretti 《Journal of orthopaedics and traumatology》2017,18(1):17-22
Background
The all-inside graft-link technique for anterior cruciate ligament reconstruction is performed with two cortical suspension devices with adjustable loops on both femur and tibia. This technique requires meticulous graft preparation. The aim of this study was to biomechanically test three different graft configurations resulting from differences in initial graft length.Materials and methods
Thirty bovine digital extensor tendons were arranged in three different ways: “half-quadrupled”, “tripled” and “quadrupled”. The final graft length was 65–75 mm. The specimens were fixed vertical to the loading axis of a tensile testing machine. After a static pre-conditioning of 50 N for 5 min, a load to failure test was performed and data regarding the ultimate failure load (UFL), the stiffness and mode of failure were recorded.Results
The evaluation of UFL showed a significant differences between group means as determined by one-way analysis of variance (F = 21.92, p = 0.002). Post hoc comparisons showed a significantly better UFL of “tripled” (p = 0.007) and “quadrupled” preparations (p = 0.014) compared to the “half-quadrupled” configuration, with no significant differences between “tripled” and “quadrupled” grafts (p = 0.061). No significant differences were found when evaluating the stiffness between the groups. Failure occurred by tendon slippage across the suture in all specimens.Conclusion
The “quadrupled” tendon achieved the best UFL, with even the “tripled” configuration having sufficient biomechanical characteristics to withstand the loads experienced during early rehabilitation. For this reason, with a total semitendinosus length of less than 260 mm it could be better to “triple” instead of “half-quadruple” it to achieve better performance of the graft.5.
Introduction
Reducing the percutaneous nephrolithotomy (PCNL) tract size reduces the morbidity associated with the procedure. Prolonged procedure time is a concern. Modification in technique required is to fragment the stone into smaller particles and remove them using the vacuum cleaner effect. This prospective study compares the efficacy and morbidity of reducing the tract size from the standard 24–16.5 Fr for stones sized from 16 to 30 mm.Methods
123 patients were enrolled in this prospective study and distributed into 2 groups based on the tract size used (group A 16.5/17.5 Fr Miniperc, N = 61 and group B: 22/24 Fr standard PCNL, N = 62). Critical factors assessed were procedure time, fluoroscopy time, blood loss, pain score, stone clearance status and complications.Results
Both the groups were comparable with respect to age, creatinine and stone size. The blood loss (hemoglobin and PCV drop) was significantly less for group A (p < 0.001). Both the groups were comparable with regards to the pain score (p > 0.05). Nephrostomy was placed in 3 patients in group A and 14 patients in group B (p = 0.01). There was no significant difference in the procedure time amongst the 2 groups. A total of 9 patients (4 in group A and 5 in group B) had residual fragments greater than 3 mm.Conclusion
The 16.5 Fr Miniperc tract offers lower morbidity in terms of blood loss and maintains stone clearance comparable to larger 24 Fr tract size. It should be the ideal size used for medium sized renal stones.6.
Purpose
To prospectively evaluate the efficacy and safety of RIRS, SWL and PCNL for lower calyceal stones sized 1–2 cm.Materials and methods
Patients with a single lower calyceal stone with an evidence of a CT diameter between 1 and 2 cm were enrolled in this multicenter, randomized, unblinded, clinical trial study. Patients were randomized into three groups: group A: SWL (194 pts); group B: RIRS (207 pts); group C: PCNL (181 pts). Patients were evaluated with KUB radiography (US for uric acid stones) at day 10 and a CT scan after 3 months. The CONSORT 2010 statement was adhered to where possible. The collected data were analyzed.Results
The mean stone size was 13.78 mm in group A, 14.82 mm in group B and 15.23 mm in group C (p = 0.34). Group C compared to group B showed longer operative time [72.3 vs. 55.8 min (p = 0.082)], fluoroscopic time [175.6 vs. 31.8 min (p = 0.004)] and hospital stay [3.7 vs. 1.3 days (p = 0.039)]. The overall stone-free rate (SFR) was 61.8% for group A, 82.1% for group B and 87.3% for group C. The re-treatment rate was significantly higher in group A compared to the other two groups, 61.3% (p < 0.05). The auxiliary procedure rate was comparable for groups A and B and lower for group C (p < 0.05). The complication rate was 6.7, 14.5 and 19.3% for groups A, B and C, respectively.Conclusions
RIRS and PCNL were more effective than SWL to obtain a better SFR and less auxiliary and re-treatment rate in single lower calyceal stone with a CT diameter between 1 and 2 cm. RIRS compared to PCNL offers the best outcome in terms of procedure length, radiation exposure and hospital stay.ISRCTN 55546280.7.
Adem Tok Fatih Akbulut Ibrahim Buldu Tuna Karatag Onur Kucuktopcu Gokhan Gurbuz Okan Istanbulluoglu Abdullah Armagan Abdulkadir Tepeler Ali Ihsan Tasci 《Urological research》2016,44(2):155-159
The objective of this study was to present the outcomes of comparative clinical study of microperc versus mini-percutaneous nephrolithotomy (mini-PNL) in the treatment of lower calyx stones of 10–20 mm. Patients with lower calyx stones treated with microperc (Group-1) or mini-PNL (Group-2) between 2011 and 2014 were retrospectively analyzed. Demographics of the patients were compared, including age, gender, BMI, stone size, laterality and procedural parameters (operation and fluoroscopy time), and outcomes (success and complication rates). A total of 98 patients were evaluated, assigned to Group-1 (n = 58) and to Group-2 (n = 40). Groups were statistically similar in terms of age, stone size, and BMI (p = 0.3, 0.07, 0.6, respectively). The mean procedure and fluoroscopy duration for Group-1 were 43.02 ± 27.98 min and 112.05 ± 72.5 s, and 52.25 ± 23.09 min and 138.53 ± 56.39 s in Group-2 (p = 0.006 and 0.006). The mean hematocrit drop was significantly higher in Group-2 compared to Group-1 (3.98 vs. 1.96 %; p < 0.001); however, none of the cases required blood transfusion. Overall complication rates exhibited no statistically significant difference (p = 0.57). Stone-free status was similar (86.2 vs. 82.5 %, p = 0.66). The tubeless procedure rate was significantly higher in Group-1 (p < 0.001). In Group-2, duration of hospitalization was significantly longer than in Group-1 (2.63 vs. 1.55 days; p < 0.01). Outcomes of the present retrospective study show that microperc is a treatment option for medium-sized lower calyx stone, being associated with lower blood loss, procedure, reduced fluoroscopy and hospitalization time, and a higher tubeless rate. 相似文献
8.
Purpose
To stratify stage IIB (pT4a PN0) colorectal cancer in terms of histopathologic findings.Methods
We reviewed the medical records of 80 patients who underwent surgery for stage IIB colorectal cancer. The disease-free survival (DFS) and overall survival (OS) rates were evaluated and correlated with the presence or absence of “Tumor Necrosis”, “Crohn’s-like lymphoid reaction”, and “Perineural Invasion”.Results
Patients with “Tumor Necrosis” had significantly lower DFS rates (p < 0.0001), those with “Crohn’s-like lymphoid reaction” had significantly higher DFS rates (p = 0.037), and those with “Perineural Invasion” had significantly lower DFS rates (p < 0.0001). Patients with “Tumor Necrosis” had significantly lower OS rates (p = 0.016), those with “Crohn’s-like lymphoid reaction” had significantly higher OS rates (p = 0.022), and those with “Perineural Invasion” had significantly lower OS rates (p = 0.003).Conclusions
Since stage IIB colorectal cancers accompanied by the pathological findings of “Tumor Necrosis” and “Perineural Invasion”, but with the absence of “Crohn’s-like lymphoid reaction” carried a poor prognosis, the efficacy of adjuvant chemoradiation must be considered for these patients.9.
Yan Song Natalia Hernandez Michael S. Gee Vicki E. Noble Brian H. Eisner 《World journal of urology》2016,34(9):1285-1288
Introduction
While computerized tomography (CT) is the gold standard for diagnosis of ureterolithiasis, ultrasound is a less costly and radiation-free alternative which is commonly used to evaluate patients with ureteral colic. The purpose of this study was to evaluate the frequency with which patients with ureteral stones and renal colic demonstrate hydronephrosis in order to better understand the evaluation of these patients.Methods
Two hundred and forty-eight consecutive patients presenting with ureteral colic and diagnosed with a single unilateral ureteral stone on CT scan in an urban tertiary care emergency department were retrospectively reviewed. Radiology reports were reviewed for stone size, diagnosis, and degree of hydronephrosis.Results
Of the 248 patients evaluated for suspected ureteral stone, 221 (89.1 %) demonstrated any hydronephrosis, while 27 (10.9 %) did not. Hydronephrosis grade, available in 194 patients, was as follows: mild—70.6 %, moderate—27.8 %, and severe—1.5 %. Mean patient age was 47.0 years (SD 15.5), gender distribution was 35.9 % female and 64.1 % male, and mean stone axial diameter was 4.1 mm (SD 2.4). Stone location was as follows: ureteropelvic junction—4.1 %, proximal ureter—21 %, distal ureter—24.9 %, and ureterovesical junction—47.1 %. Axial stone diameter and coronal length (craniocaudal) were both significant predictors of degree of hydronephrosis (ANOVA, p < 0.001 for both). Age (ANOVA, p = NS), stone location (Chi square, p = NS), and gender (Chi square, p = NS) were not associated with degree of hydronephrosis.Conclusions
In patients with ureteral stones and colic, nearly 11 % do not demonstrate any hydronephrosis and a majority (nearly 71 %) will demonstrate only mild hydronephrosis. Stone diameter appears to be related to degree of hydronephrosis, whereas age, gender, and stone location are not. The lower incidence of hydronephrosis for small stones causing renal colic may explain the lower diagnostic accuracy of ultrasound when compared to CT for detecting ureteral stones.10.
Mehmet Balasar Mehmet Mesut Pişkin Cemile Topcu Lütfi Saltuk Demir Mehmet Gürbilek Abdulkadir Kandemir Ahmet Öztürk 《World journal of urology》2016,34(9):1311-1316
Objective
To study kidney injury molecule-1 (KIM-1) biomarker levels, indicating renal tubular damage, in patients with kidney stones and in those who underwent minimally invasive method stone treatment.Patients and methods
Sixty patients with renal stones between 10 and 20 mm were included into the present study. Patients who were divided into three cohorts underwent micropercutaneous nephrolithotomy (microperc), retrograde intrarenal stone surgery (RIRS), and percutaneous nephrolithotomy (PNL). Urine samples were obtained from all participants before, 4 h and 14 days after the procedure. In all the samples obtained, urinary KIM-1 and creatinine (Cr) levels were measured and KIM-1/Cr ratios (ng/mg creatinine) were calculated.Results
Preoperative urine KIM-1/Cr ratio was higher than postoperative 14th day. The bigger the renal stone size, the higher was the ratio (correlation coefficient 0.353, p = 0.006). According to preferred treatment procedure, there was a statistically significant decrease in preoperative and postoperative 4th hour and 14th day urine KIM-1/Cr rates in the RIRS and PNL, yet none in the microperc group (p = 0.010, p = 0.001, p = 0.212, respectively).Conclusion
In renal stone patients, the elevated urine KIM-1/Cr ratio levels increase further according to stone size. KIM-1/Cr ratio is a promising marker might be helpful in monitoring the damage created by stone disease.11.
Faruk Ozgor Abdulkadir Tepeler Fatih Elbir Omer Sarilar Zafer Gokhan Gurbuz Abdullah Armagan Murat Binbay Ali Ihsan Tasci 《World journal of urology》2016,34(8):1169-1173
Purpose
To evaluate and compare effectivity and safety of flexible ureteroscopy (F-URS) and mini-percutaneous nephrolithotomy (mPNL) for 10–20 mm renal stones in obese patients.Methods
Between 2012 and 2015, charts of patients who were treated with F-URS or mPNL for 10–20 mm kidney stone(s) were analyzed. Patients with BMI > 30 kg/m2 were enrolled into the study. Total of 315 patients were treated with mPNL, and 56 patients were matched our inclusion criteria. In the same period, F-URS was performed in 669 patients, and 157 of them had 10–20 mm kidney stones, and their BMI values were >30 kg/m2. The patients were retrospectively matched at a 1:1 ratio to index F-URS–mPNL cases with respect to the patient age, gender, ASA score, BMI and size, number, and location of stone.Results
Gender, age, BMI, stone size, stone number, location of stone(s), and ASA scores were similar between groups. The mean operation time was significantly longer in mPNL group (p: 0.021). However, the mean fluoroscopy time was similar (p: 0.270). Hemoglobin drop requiring blood transfusion and angioembolization was performed in two and one patients after mPNL, respectively. Overall complication rate was significantly higher in mPNL group than F-URS group (30.3 vs. 5.3 %, p: 0.001).Conclusion
Our results demonstrated that both F-URS and mPNL achieve acceptable stone-free rates in obese patients with 10–20 mm renal stones. However, complication rates were significantly lower in F-URS group.12.
Y. M. Fazil Marickar 《Urological research》2009,37(6):345
Gout is well known to be produced by increased uric acid level in blood. The objective of this paper is to assess the relationship between gout and calcium oxalate stone formation in the humans. 48 patients with combination of gout and calcium oxalate stone problem were included. The biochemical values of this group were compared with 38 randomly selected uric acid stone patients with gout, 43 stone patients with gout alone, 100 calcium oxalate stone patients without gout and 30 controls, making a total of 259 patients. Various biochemical parameters, namely serum calcium, phosphorus and uric acid and 24-h urine calcium, phosphorus, uric acid, oxalate, citrate and magnesium were analysed. ANOVA and Duncan’s multiple-range tests were performed to assess statistical significance of the variations. The promoters of stone formation, namely serum calcium (P < 0.05), phosphorus (P < 0.05) and uric acid (P < 0.05) and urine calcium (P < 0.05), uric acid (P < 0.05) and oxalate (P < 0.05) were significantly variable in the different groups. The inhibitor citrate (P < 0.05) was also significantly variable. Multiple-range test showed that the promoters, namely serum calcium (P < 0.05) and urine uric acid (P < 0.05) were in a significantly higher range in the gouty patients, gouty uric acid stone patients and gouty calcium oxalate stone patients compared to the non-gouty patients and controls. Urine oxalate (P < 0.0001) was in the highest range in the gouty calcium oxalate or gouty uric acid stones patients. The inhibitor urine citrate (P < 0.001) was significantly lower in the gouty, gouty uric acid and gouty calcium oxalate patients. Serum uric acid was highest in the non-stone gouty patients, followed by the gouty uric acid stone formers and gouty calcium oxalate stone patients. The high values of promoters, namely uric acid and calcium in the gouty stone patients indicate the tendency for urinary stone formation in the gouty stone patients. There is probably a correlation between gout and calcium oxalate urinary stone. We presume this mechanism is achieved through the uric acid metabolism. The findings point to the summation effect of metabolic changes in development of stone disease. 相似文献
13.
Purpose
To evaluate and compare flexible ureteroscopy (f-URS) and mini-percutaneous nephrolithotomy (mPNL) for 20–30 mm renal stones in obese patients regarding efficacy and safety.Methods
Between May 2011 and June 2017, 254 obese patients who had 20–30 mm kidney stone were consecutively included in the study; 106 patients underwent mPNL and 148 underwent f-URS by the same surgeon. The following parameters were retrospectively assessed: patient and stone characteristics, surgical details, perioperative outcomes, and stone-free rates (SFR).Results
F-URS group was similar to mPNL group in terms of the mean duration of surgery (92.8?±?26.1 vs 87.4?±?31.5 min, P?=?0.137) and the final SFR (89.1 vs 92.5%, P?=?0.381). The f-URS group had significantly shorter postoperative stay (1.0?±?0.8 vs 4.3?±?1.7 days, P?<?0.001) and lower postoperative complications (11.5 vs 26.4%, P?=?0.002). However, the f-URS group had a lower SFR after first session (67.2 vs 87.4%, P?<?0.001) and needed more number of procedures (1.5?±?0.4 vs 1.3?±?0.4, P?<?0.001) than the mPNL group.Conclusions
MPNL has a higher efficacy (higher SFR after first session and lower number of procedures); however, f-URS offers advantages regarding safety (lower complication rate). Therefore, both options can be offered to obese patients with renal stones from 20 to 30 mm in size. Nevertheless, these results must be confirmed by further prospective randomized trials.14.
Francesco Sanguedolce Emanuele Montanari Mario Alvarez-Maestro Nicola Macchione Stephan Hruby Athanasios Papatsoris Panagiotis Kallidonis Luca Villa Patrick Honeck Olivier Traxer Francesco Greco EAU Young Academic Urologists- Endourology Urolithiasis Working Group 《World journal of urology》2016,34(11):1583-1589
Purpose
This is a prospective multicentric comparative study evaluating the performance of XenX—a new dual-purpose device for the prevention of stone fragments migration during ureteroscopic lithotripsy (URS).Methods
Between March 2014 and January 2015, 41 patients undertaking URS + XenX were matched with 41 patients undergoing standard URS. Patients included had unilateral ureteric stone(s) of 0.5–1.5 cm in maximum size. Demographics, complication rates and surgical outcomes were recorded for comparison. A Likert-like 5-grade scoring system was used for surgeons’ evaluation of XenX properties. Cost analysis was performed by comparing weighted mean costs of the relevant procedures.Results
Patients’ characteristics between the two groups were comparable. Lasering time was longer for XenX group (13.59 vs. 5.17 min; p = 0.0001) whilst use of basket and need of JJ stent insertion was more frequent in control group (19.5 vs. 97.6 %; p = 0.0001 and 22 vs. 35 %; p = 0.001, respectively). Intra-operative SFR was significantly higher for XenX group (100 vs. 85.4 %; p = 0.0001), but not at 4-week follow-up, after ancillary procedures were needed in 17.1 % of the control group. Surgeons’ evaluations for XenX were suboptimal for “Ease of Basketing” (2/5) and “Advancement of double J stent” (3/5). The use of XenX increased costs of procedures, but spared the costs associated to ancillary procedures and stent removals.Conclusions
XenX confirmed to be a safe and effective device especially for the treatment of upper ureteric tract stones; moreover, XenX may reduce the risk for the need of auxiliary procedures and for the insertion of a JJ stent.15.
Jae Keun Kim Joon Seong Park Dai Hoon Han Gi Hong Choi Kyung Sik Kim Jin Sub Choi Dong Sup Yoon 《Surgical endoscopy》2016,30(11):4756-4764
Background
A few studies have reported only short-term outcomes of various robotic and laparoscopic liver resection types; however, published data in left lateral sectionectomy (LLS) have been limited. The aim of this study was to compare the long- and short-term outcomes of robotic and laparoscopic LLS.Methods
We retrospectively compared demographic and perioperative data as well as postoperative outcomes of robotic (n = 12) and laparoscopic (n = 31) LLS performed between May 2007 and July 2013. Resection indications included malignant tumors (n = 31) and benign lesions (n = 12) including intrahepatic duct (IHD) stones (n = 9).Results
There were no significant differences in perioperative outcomes of estimated blood loss, major complications, or lengths of stay, but operating time was longer in robotic than in laparoscopic LLS (391 vs. 196 min, respectively) and the operation time for IHD stones did not differ between groups (435 vs. 405 min, respectively; p = 0.190). Disease-free (p = 0.463) and overall (p = 0.484) survival of patients with malignancy did not differ between groups. The 2- and 5-year disease-free survival rates were 63.2 and 36.5 %, respectively. However, robotic LLS costs were significantly higher than laparoscopic LLS costs ($8183 vs. $5190, respectively; p = 0.009).Conclusions
Robotic LLS was comparable to laparoscopic LLS in surgical outcomes and oncologic integrity during the learning curve. Although robotic LLS was more expensive and time intensive, it might be a good option for difficult indications such as IHD stones.16.
Purpose
We performed three-dimensional (3D) surgical simulation of pancreatic surgery, including the size and location of the main pancreatic duct on the resected pancreatic surface.Methods
The subjects of this retrospective analysis were 162 patients who underwent pancreatic surgery. This cohort was sequentially divided into a “without-3D” group (n = 81) and a “with-3D” group (n = 81). We compared the pancreatic duct diameter and its location, using nine sections in a grid pattern, with the intraoperative findings. The perioperative outcomes were also compared between patients who underwent pancreaticoduodenectomy (PD) and those who underwent distal pancreatectomy (DP).Results
There were no significant differences in the main pancreatic duct diameter between the 3D-simulated values and the operative findings. The 3D-simulated main pancreatic duct location was consistent with its actual location in 80 % of patients (65/81). In comparing the PD and DP groups, the intraoperative blood loss was 1174 ± 867 and 817 ± 925 ml in the without-3D group, and 828 ± 739 and 307 ± 192 ml in the with-3D group, respectively (p = 0.024, 0.026).Conclusion
The 3D surgical simulation provided useful information to promote our understanding of the pancreatic anatomy, including details on the size and location of the main pancreatic duct.17.
Shouyu He Hongda Bao Zezhang Zhu Yong Qiu Feng Zhu Hengcai Zhou Xu Sun Bin Wang 《European spine journal》2016,25(2):417-423
Purpose
Previous studies have demonstrated vertebral coplanar alignment (VCA) as an effective surgical option for adolescent idiopathic scoliosis (AIS). The purpose of this study is to analyze the outcome of VCA for the surgical correction of adult idiopathic scoliosis (AdIS).Methods
35 AdIS patients (mean age: 24.2 years) undergoing VCA-instrumentation were reviewed. The main thoracic curve and thoracic kyphosis (TK, T5-T12) were evaluated preoperatively, immediate postoperatively, and at the final follow-up (>1 year). All patients were stratified by the TK modifier before surgery: “+” (TK, >40°), “?” (TK, <10°), and “N” (TK, 10°–40°) for normal. The apical vertebral body-to-rib ratio (AVB-R), rib hump (RH), and rotational angle to sacrum (RAsac) were measured to assess the correction of rotational deformity. Quality of life was evaluated with SRS-20 questionnaires.Results
The main thoracic curve (59.1° vs. 19.3°, P < 0.001) and rotational deformity (AVB-R: 2.4 vs. 1.7 %, P < 0.001, RH: 34.9 vs. 19.1 mm, P < 0.001, RAsac: 19.6° vs. 11.9°, P < 0.001) were significantly reduced with surgery. Sagittal deformity improved significantly in group “+” (51.4° vs. 31.6°, P < 0.001) and group “?” (6.2° vs. 20.1°, P < 0.001), while no significant postoperative change in TK was observed in group “N” (23.5° vs. 26.3°, P = 0.270). Patients were followed for an average of 18.7 months with no significant loss of correction. SRS scores improved greatly from 57.7 preoperatively to 71.6 at the final follow-up.Conclusions
VCA can be effectively used for the correction of the coronal and rotational deformity, with better sagittal profile restoration in adult thoracic idiopathic scoliosis with sagittal malalignment.18.
A. Spek F. Strittmatter A. Graser P. Kufer C. Stief M. Staehler 《World journal of urology》2016,34(9):1297-1302
Purpose
To retrospectively evaluate the accuracy of dual-energy CT (DECT) in the detection of the chemical composition of urinary calculi in correlation with infrared spectroscopic stone analysis.Methods
We reviewed the CT scans of 255 patients who underwent DECT due to a clinical suspicion of urolithiasis. Out of this group, we included 64 patients with clinically symptomatic urolithiasis requiring stone removal. After surgical removal of the stone by ureterorenoscopy, chemical composition was analyzed with infrared spectroscopy. We correlated DECT stone characterization results with chemical stone composition based on dual-energy indices (DEI). A total of 213 renal and ureteral stones could be removed and chemically analyzed.Results
A total of 213 calculi were evaluated. Thirty eight out of sixty four (59 %) patients had >1 stone. DECT was used to differentiate stones by using DEI. Stones harboring calcium (CA) were color-coded in blue, while stones containing uric acid (UA) were colored red. Median DEI in UA-containing stones were 0.001. Non-UA-containing stones had a DEI between 0.073 for pure CA stones and 0.077 containing CA and other substances (p = 0.001; p = 0.03, respectively). Sensitivity of DECT was 98.4 % for differentiation of UA from non-UA-containing calculi. Specificity was 98.1 %. Mean effective radiation dose of DECT was 4.18 mSv (0.44–14.27 mSv), thus comparable to conventional CT scans of the abdomen. Conventional measurement of Hounsfield units did not correlate with stone composition.Conclusion
DECT with image post-processing reliably discriminates UA-containing calculi from all other stones, but the study offered limitations. Discrimination within the non-UA stones cannot be reliably achieved but is clinically insignificant.19.
Introduction
The SOFCOT symposium (2005) on periprosthetic fractures of the femur (PFFs) highlighted a high rate of dislocation (15.6% at 6 months) after change of prosthesis. So far, no study has ever proved the benefit of dual-mobility articulation during PFFs revisions. We conducted a comparative study on two prospective cohorts in order to (1) assess the influence of systematic acetabular revision in favor of a double mobility on dislocation rate (2) and in order to evaluate the rate of morbidity associated with this extra surgical procedure.Hypothesis
A systematic replacement of the cup in favor of a dual-mobility articulation enables to reduce the dislocation rate in PFFs revisions without increasing morbidity.Methodology
We compared two prospective multicenter cohorts over a year (2005 and 2015) using the same methodology. Any fracture around hip prosthesis which occurred 3 months at least after surgery was included. Data collection was clinical and radiological on preoperative, intraoperative and 6 months after surgery. The 2015 “bipolar” group (n = 24) included patients who had a bipolar revision (both femoral and dual-mobility articulation). The 2005 “unipolar” group (n = 25) included patients who had only a femoral implant revision. Patients were comparable by age (p = 0.36), sex (p = 0.91), ASA score (p = 0.36), history of prosthetic revision (p = 1.00), Katz score (p = 0.50) and the type of fracture according to the Vancouver classification (p = 0.55).Results
There was a 4% rate of dislocation in the “bipolar group” while there was 21% rate of dislocation in the “unipolar group” (8% of recurrent dislocation) (p = 0.19). The rate of all-cause complications 6 months after surgery was not significantly different (p = 0.07): 12.5% in the 2015 “bipolar” cohort (one dislocation, one non-symptomatic cup migration and one pseudarthrosis of the major trochanter) versus 35% in the “unipolar” cohort (5 dislocations, 1 major trochanter fracture and 1 femur pseudarthrosis, 1 secondary displacement associated with a superficial infection). The surgical revision after 6 months was not significantly different (1/23 or 4% vs. 4/25 or 16%, p = 0.35).Conclusion
We confirm the low rate of dislocations after fitting a dual-mobility cup in case of revision of the femoral side in case of periprosthetic femoral fracture, as well as the need for additional cases to be carried out upon further studies to significantly confirm the interest of preventing instability after femoral revision.20.