Silicone ring tourniquet versus pneumatic cuff tourniquet in carpal tunnel release: a randomized comparative study.

BACKGROUND: The aim of the present study was to compare the pain levels resulting from the use of a silicone ring tourniquet (SRT) to those resulting from the use of a classic pneumatic cuff tourniquet (PT) in patients undergoing carpal tunnel release under local anesthesia. MATERIALS AND METHODS: Fifty patients that underwent carpal tunnel release under local anesthesia were randomized using the technique of stratified randomization by minimization. A forearm tourniquet was applied: a standard PT was used in 25 patients, and an SRT was used in the other 25 patients (the model of SRT used was selected according to the standard systolic blood pressure). Patient demographics and complications were recorded. Pain levels were assessed with the visual analogue scale and were recorded (a) just after tourniquet application, (b) 5 min after tourniquet application, and (c) just before tourniquet removal. RESULTS: There was no statistical significant difference in patient demographics between the two groups. The mean tourniquet time was similar for both groups (p = 1.000). The difference between the mean final pain level and the mean initial pain level was statistically significant for the SRT group (p = 0.010) and highly statistically significant for the PT group (p < 0.001). The mean final pain level for the PT group was higher than that for the SRT group (p = 0.043). CONCLUSIONS: According to the findings of this study, in patients who underwent carpal tunnel release under local anesthesia, the pain levels at the end of the operation and those just before the removal of the tourniquet were higher in the PT group than in the SRT group of patients.

Distal ureteral calculi: ureteroscopy vs. ESWL. A prospective analysis.

Two groups of 50 consecutive patients each, with distal ureteric calculi, were treated by ureteroscopy or in situ ESWL (Dornier HM-4 lithotriptor) in order to establish the effectiveness of ESWL at the distal portion of the ureter. In comparison to ureteroscopy, ESWL for distal ureteral calculi was performed on an outpatient basis, required less time, patients had more rapid convalescence and the procedure was simpler and safer. The overall success rate was 100% for ureteroscopy and 92% for ESWL. Our observations showed that in situ ESWL with the Dornier HM-4 lithotriptor is the method of choice for the treatment of distal ureteral calculi.

Experience in 3,500 patients with urinary stones treated with the Dornier HM-4 bath-free lithotriptor.

During a 3-year period, hundreds of patients underwent ESWL treatment with the Dornier HM-3 and HM-4 lithotriptors operating at our institution. Our experience in 3,500 patients treated with the HM-4 bath-free lithotriptor is reported. Patients with radiolucent or cystine stones, stones larger than 3 cm or staghorn calculi, multiple stones with a total burden of more than 3 cm and those not amenable to follow-up were excluded from the study. The overall stone-free rate was 70.7% and 81% at 1 and 3 months, respectively. The stone-free rates at 1 and 3 months were further determined by the exact location of each stone within the urinary tract. Stone-free rates at 3 months ranged from 90.84% for renal pelvic stones to 71.08% for lower calyceal stones, while the stone-free rates for ureteral calculi ranged from 80.85% for upper third unstented ureteral stones to 92.92% for lower ureteral stones. The overall complication rate was 6.02% with a 1.2% post-ESWL intervention rate (ureteroscopy or placement of percutaneous nephrostomy or stent).

Synchronous bilateral multilocular renal cell carcinoma. A rare case.

A rare case of multilocular primary renal cell carcinoma (two sites in each kidney) in a 48-year-old woman is presented. The preoperative diagnosis was based on the computerized tomography findings. The patient underwent bilateral total nephrectomy and subsequently maintained renal dialysis.

Extracorporeal shock wave lithotripsy in paraplegic and quadriplegic patients.

As it is known, paraplegic and quadriplegic patients are at an increased risk for urolithiasis. We have studied the effectiveness of extracorporeal shock wave lithotripsy (ESWL) in 15 patients with spinal cord dysfunction who were treated in our ESWL unit. A total of 23 treatments were performed. The number of shock waves ranged between 1500 and 3000 per treatment. Only 1 and 3 patients were stone-free at one-month and 3-month follow-up, respectively. Ten of 15 patients with long-term follow-up of 6 to 20 months were stone-free. The remaining 5 patients with residual fragments had staghorn calculi or stones larger than 2.5 cm. We conclude that ESWL is an effective and well tolerated method for this population but the fragment clearance is delayed and below that for unselected patients.

Post-operative pain after knee arthroscopy and related factors.

The aim of this study was to explore the intensity of post-arthroscopy knee pain during the first 24 hours, and to study the influence of pre-operative pain, tourniquet time and amount of surgical trauma on post-arthroscopy pain. In 78 male patients that underwent elective arthroscopic menisectomy or diagnostic arthroscopy of the knee, preoperative and post-operative pain were registered using the Visual Analogue Scale. Variance for repeated measures and for independent observations was analysed. Supplementary analgesia was required for 23% of the patients, more often in the recovery room and between 2 and 8 hours postoperatively. Of all factors analyzed, only time was statistically significant in determining the level of post-operative pain. Supplementary analgesia was required only in patients that underwent operative arthroscopy, and more often in patients with tourniquet time of more than 40 minutes. In conclusions, post-operative time is the most significant factor related to the post-arthroscopy knee pain.

The contribution of transrectal ultrasonography in the early diagnosis of prostate cancer.

Two hundred twenty asymptomatic males, aged 55 to 75 years old, underwent transrectal ultrasonography of the prostate as part of a screening examination. Fifteen prostate adenocarcinomas were detected, 5 of which were nonpalpable. The biopsies were performed under sagittal ultrasound guidance. Serum prostatic specific antigen and prostatic acid phosphatase levels were also obtained from each patient. Nine of the patients were staged as B2, one patient as D2, 4 patients as A1 and one as A2. The use of transrectal ultrasonography as a screening tool must be further evaluated in a multicenter trial with a large number of patients.

Primary transitional cell carcinoma of anterior male urethra: a rare case.

We report a rare case of primary transitional cell carcinoma in a man aged 56 years old. Approximately 600 cases of primary carcinoma of the male urethra have been accumulated until today (1). The 30 to 50 per cent of these neoplasms originate in the anterior urethra and only the 15 per cent are of the transitional cell type (2).