Is there significance of the choice of prone versus supine position in the treatment of proximal ureter stones with extracorporeal shock wave lithotripsy?

OBJECTIVE: To determine whether there is a significance of the choice of prone versus supine position in the treatment of proximal ureter stones with extracorporeal shock wave lithothripsy (ESWL). METHODS: Ninety-six patients with proximal ureter stones underwent ESWL. The procedure was performed in the supine position in 48 of them (group 1) and in the prone position in the other 48 patients (group 2). Stone-free rates, repeat ESWL rates, shocks per patient and shocks per session were compared in both groups. RESULTS: The mean session number per patients was 1.64+/-0.75 in group 1 and 1. 33+/-0.59 in group 2 (p = 0.224). The stone-free rates 3 months after ESWL were 88.3% in group 1 and 90.6% in group 2. The difference between the results was statistically insignificant (p<0.05). Therefore, these two parameters were similar in both groups. On the other hand, the number of shocks per session was 4,863.54+/-2, 114.85 in group 1 and 3,704.16+/-1,726.75 in group 2. This difference was statistically significant (p = 0.011). The patients tolerated the supine position better in general. Patients in the prone position experienced discomfort on inspiration and expiration and pain localized to the lumbar vertebrae. CONCLUSION: These results suggest that the supine position decreases the number of shocks per session in the treatment of proximal ureter stones with ESWL and this will be cost-effective.     

Gastric emptying time and the effect of cisapride in cirrhotic patients with autonomic neuropathy

GOALS To investigate the relationships between gastric emptying and autonomic dysfunction in hepatic cirrhosis and to assess the effects of cisapride on gastric emptying in cirrhotic patients.STUDY Twenty-four cirrhotic patients (8 patients in each Child-Pugh classification) and 25 healthy controls were enrolled. All the patients had viral (B or C) hepatitis. Patients with DM, alcoholic cirrhosis, active peptic ulcer, gastric malignancy and pyloric obstruction were excluded by esophagogastroduodenoscopy. Parasympathetic and sympathetic functions were assessed by the criteria set forth by Ewing and Clark. Drugs affecting GI motility and smoking were discontinued 48 hours and 12 hours prior to the study respectively. A solid-phase of gastric emptying study was conducted by scintigraphic method for the calculation of gastric half-emptying time (GET1/2). RESULTS The study revealed that 9 patients with Child-Pugh B and C cirrhosis had autonomic neuropathy and none of Child-Pugh A cirrhosis had autonomic neuropathy. Prolonged GET1/2 was noted in cirrhotics compared with the control group (p < 0.05). However, there was significant difference between 9 patients (Child B-C) with autonomic neuropathy compared with patients 15 patients without autonomic neuropathy. Again there was a significant difference in GET1/2 between Child A cirrhotic and Child B-C cirrhotic whether they had autonomic neuropathy or not. Cisapride decreased GET1/2 significantly in cirrhotic patients (Child B-C cirrhotic). Clearly, patients with autonomic neuropathy in Child B-C cirrhosis had significantly reduced GET1/2 after cisapride administration. Even though cisapride decreased GET1/2 in patients with Child B-C cirrhosis without autonomic neuropathy, this was not significant. CONCLUSION Autonomic neuropathy in advanced cirrhosis from viral hepatitis may cause prolonged gastric emptying. Cisapride can shorten gastric emptying time in such patients.     

Effects of selective Cox-2 inhibitor, rofecoxib, alone or combination with furosemide on renal functions and renal Cox-2 expression in rats

Background  

Nonsteroidal anti-inflammatory drugs act by inhibiting the rate-limiting enzymes cyclooxygenase-1 (Cox-1) and cyclooxygenase-2 (Cox-2), which are important in prostanoid formation. The aim of this experimental study was to examine the effects of selective Cox-2 inhibitor, rofecoxib, with or without furosemide, on urine and serum electrolytes, creatinine clearance, plasma renin activity (PRA), and Cox-2 expression in the renal cortex.     

Washout rates of Tc-99m tetrofosmin in asymmetric septal hypertrophy

The aim of this study was to evaluate the washout rate of Tc-99m tetrofosmin in asymmetric septal hypertrophy (ASH). As Tc-99m tetrofosmin accumulation and retention depend on sarcolemmal and/or mitochondrial function, the presence or absence of abnormalities in the washout rate of Tc-99m tetrofosmin could provide information about sarcolemmal and/or mitochondrial damage noninvasively. The study group consisted of 18 patients with ASH and 10 healthy subjects. After intravenous injection of 1110 MBq (30 mCi) Tc-99m tetrofosmin, tomographic images were obtained 1 hour later (early image) and again 4 hours later (delayed image). Using tomographic images, the distribution and washout of tetrofosmin in the left ventricle was examined quantitatively. Short-axis SPECT images were divided into 5 segments (anterior, septal, lateral, inferior wall and apex) in early and delayed images, and the mean radioactivity counts were measured in each segment by drawing regions of interest. Washout rates of apex, anterior, septal, lateral and inferior walls were 0.34 +/- 0.06, 0.37 +/- 0.07, 0.36 +/- 0.07, 0.33 -/+ 0.08, 0.33 +/- 0.07 in ASH and 0.20 +/- 0.05, 0.23 +/- 0.05, 0.22 +/- 0.03, 0.21 +/- 0.03, 0.22 +/- 0.03 in the normal group, respectively. In ASH, the washout rates of all myocardial segments were significantly increased as compared to those of the normal controls (p < 0.05). The findings of the present study suggest that there could be dysfunction of sarcolemma and/or mitochondria in the entire left ventricle which would be important in the pathophysiology of this disease. Also our study revealed that Tc-99m tetrofosmin washout was higher in NYHA II-III patients compared to NYHA I patients and the degree of Tc-99m tetrofosmin washout corresponded well with the thickness of the interventricular septum and posterior walls.     

Prevalence of human immunodeficiency virus infection in children with tuberculosis

This prospective study was carried out in the pediatric ward and outpatient department of a tertiary care centre to estimate the prevalence of HIV seropositivity in children with tuberculosis. Two hundred and fifty consecutive children below 12 years of age with (pulmonary and extrapulmonary) tuberculosis diagnosed between March 1999 and July 2000 were screened for HIV infection. A patient was labeled as HIV positive if two consecutive ELISA tests were found positive using different antigen/principle. Supplemental western blot test was also done. Parents of seropositive children were also screened for HIV infection and tuberculosis. Total 5 cases were HIV positive giving a seroprevalence of 2%. All the five patients had disseminated tuberculosis. We suggest regular screening of children with disseminated/miliary tuberculosis for HIV co-infection.