Percutaneous nephrolithotomy for staghorn kidney stones in elderly patients

Purpose  

We retrospectively analyzed the results of percutaneous nephrolithotomy operations for treatment of staghorn kidney stone disease in elderly patients and compared surgical parameters and outcomes with a control group of young adult patients.     

Use of telemedicine and telephone consultation in decision-making and follow-up of burn patients: Initial experience from two burn units

Objective

This study investigated the use of telemedicine in decision-making and follow-up of burn patients.

Methods

The Konya Burn Unit was established in July 2003, and up to December 2009, 187 patients were admitted to this unit, all of them were consulted—via audiovisual transmission of data (telemedicine)—to the same burn surgeon at the Ankara Burn Referral Center of our hospital network. Three basic systems are currently used: live interactive video, store-and-forward images, and telephone. The demographic data and burn criteria of the patients were investigated. Changes in the number of televisits and patient management were analyzed.

Results

During the 66-month timeframe, 525 televisits were performed on 187 patients. There were 126 males (67.4%) and 61 females (32.6%). The mean total burn surface area (percentage of total burn surface area burned) was 23.3 ± 17.8% (range, 3-95%). Nine of the 187 patients (4.8%) died owing to multiorgan failure and sepsis. As a result of these televisits, 21 patients (11.2%) were transferred to our referral center. The number of dead and transferred patients decreased during the study.

Conclusions

Telemedicine is appropriate and cost-effective for treatment and follow-up of patients in burn units with personnel with limited experience.     

Current options in local anesthesia for groin hernia repairs

Inguinal hernia repair is one of the most common procedures in general surgery. All anesthetic methods can be used in inguinal hernia repairs. Local anesthesia for groin hernia repair had been introduced at the very beginning of the last century, and gained popularity following the success reports from the Shouldice Hospital, and the Lichtenstein Hernia Institute. Today, local anesthesia is routinely used in specialized hernia clinics, whereas its use is still not a common practice in general hospitals, in spite of its proven advantages and recommendations by current hernia repair guidelines. In this review, the technical options for local anaesthesia in groin hernia repairs, commonly used local anaesthetics and their doses, potential complications related to the technique are evaluated. A comparison of local, general and regional anesthesia methods is also presented. Local anaesthesia technique has a short learning curve requiring simple training. It is easy to learn and apply, and its use is in open anterior repairs a nice way for health care economics. Local anesthesia has been shown to have certain advantages over general and regional anesthesia in inguinal hernia repairs. It is more economic and requires a shorter time in the operating room and shorter stay in the institution. It causes less postoperative pain, requires less analgesic consumption; avoids nausea, vomiting, and urinary retention. Patients can mobilize and take oral liquids and solid foods much earlier. Most importantly, local anesthesia is the most suitable type of anesthesia in elder, fragile patients and patients with ASA II-IV scores.     

Acellular dermal matrix seeded with adipose-derived stem cells as a subcutaneous implant

Background  

Soft tissue augmentation using autologous materials usually is associated with high resorption rates. To obtain more durable soft tissue filler, acellular dermal matrix (ADM) was seeded with adipose-derived stem cells (ASCs) in this study.     

Percutaneous nephrolithotomy in children: does age matter?

Purpose  

To compare the outcomes of percutaneous nephrolithotomy (PCNL) in 2 age groups.