Comparison of efficacy and safety of flexible ureteroscopy and mini-percutaneous nephrolithotomy for 2-3 cm renal calculi in women: a single-center study.

OBJECTIVE: This study aimed to compare the efficacy and safety of flexible ureteroscopic lithotripsy (FURSL) and mini-percutaneous nephrolithotomy (mPCNL) in the treatment of 2-3 cm renal calculi in women. PATIENTS AND METHODS: Clinical data of 186 patients who underwent mPCNL (n=96) and FURSL (n=90) surgery in our hospital from June 2018 to February 2023 were collected. Several parameters were assessed and compared between the two groups, including operation duration, length of hospital stay, cost of hospitalization, pain intensity measured by the visual analogue scale (VAS), patient comfort assessed using the Bruggrmann Comfort Scale (BCS), decrease in hemoglobin levels, changes in blood urea nitrogen (BUN), fluctuations in serum creatinine (Scr), hypersensitive C-reactive protein (hs-CRP) levels, complication rates, immediate post-operative stone-free rate (RSFR), and long-term stone-free rate (LSFR). RESULTS: The comparative analysis of patient age, body mass index (BMI), stone size, computed X-ray tomography (CT) value of stones, number of stones, and comorbidities revealed no statistically significant differences between the mPCNL and FURSL groups (p>0.05). The mPCNL cohort exhibited a markedly lower duration of operation (p<0.001) and BCS score (p<0.001) compared to the FURSL cohort. Nonetheless, the mPCNL cohort demonstrated significantly higher hospitalization expenses (p<0.001), length of hospital stay (p<0.001), VAS score for pain (p<0.001), and level of hemoglobin decrease (p<0.001) in comparison to the FURSL cohort. Moreover, the immediate post-operative stone-free rate (RSFR) was significantly higher in the mPCNL group (p=0.007). The long-term stone-free rate (LSFR), however, showed no significant difference between the two groups (p=0.160). Furthermore, the FURSL group exhibited significantly fewer overall complications in contrast to the mPCNL group (p=0.006). CONCLUSIONS: mPCNL and FURSL are both safe and effective surgical methods for treating 2-3 cm renal calculi in women. However, FURSL holds distinct advantages, including minimally invasive procedure, accelerated recovery, reduced cost, and lower incidence of complications.

A retrospective hospital-based study of coronary risk factors in Taiwan. Analysis of patients with established diagnoses.

In Taiwan over the past decades there has been enormous economic growth and rapid westernization of people's life style, as well as a concomitant rise in coronary heart disease (CHD) mortality and morbidity. Studying the effects of such a degree of socioeconomic development on the coronary risk factors of the Chinese population, an ethnic group long regarded as having a low incidence of CHD, may provide some insight into the etiology of coronary atherosclerosis. Coronary risk factors among 1,449 patients (759 with CHD) were retrospectively studied. Diagnosis was established by angiography or a definite history of myocardial infarction in approximately 60% of the patients, and for the remainder, at least by noninvasive testing. The frequencies of dyslipidemia and nonlipid risk factors in patients with and without CHD were determined and compared. The lipid levels of subjects with or without CHD were close to or approaching those reported from the United States. Socioeconomic development and changes in dietary patterns seem influential in this regard. Among risk factors, high-density lipoprotein cholesterol (HDL-C), smoking, diabetes mellitus, hypertension and family history in males and, in females, total cholesterol, HDL-C, diabetes mellitus and hypertension, were significantly and independently correlated with CHD. These risk factors are similar to those found in the West; however, there is an important association of serum HDL-C concentrations with CHD, irrespective of gender. This issue requires further study in Chinese populations in other Asian countries.

Low-serum, high-density lipoprotein cholesterol concentration is an important coronary risk factor in Chinese patients with low serum levels of total cholesterol and triglyceride.

The significance of low-serum high-density lipoprotein concentrations (<35 mg/dl) with respect to coronary atherogenesis in Chinese patients with low levels of total serum cholesterol (<200 mg/dl) and triglycerides (<250 mg/dl) was assessed. Persons with such a lipid profile pattern were still at high risk, and high-density lipoprotein. like smoking, appeared to be the most predictive independent coronary risk factor.

Mitral valve aneurysm and infective endocarditis: report of four cases.

From March 1992 to March 1994, four cases of mitral valve aneurysm were diagnosed at National Taiwan University Hospital. Mitral valve infective endocarditis was documented in three patients, while aortic valve infective endocarditis was found in the other. The diagnosis of mitral valve aneurysm was based on characteristic echocardiographic findings. The mitral valve aneurysms in these four cases were all visualized by transesophageal but not transthoracic echocardiography. At the time of diagnosis, three patients with a history of mitral valve endocarditis had perforated mitral valve aneurysms and severe mitral regurgitation. Although not found before surgery, the remaining patient with a history of aortic valve endocarditis was noted to have an unperforated mitral valve aneurysm one month after aortic valve replacement. All three patients with severe mitral regurgitation underwent mitral valve replacement and the patient with an unperforated mitral valve aneurysm was managed conservatively and obtained a stable clinical condition. In conclusion, mitral valve aneurysm usually appears to be associated with infective endocarditis and transesophageal echocardiography is more helpful in the diagnosis of mitral valve aneurysm than transthoracic echocardiography. Furthermore, unperforated mitral valve aneurysms may be managed conservatively with careful follow-up.

Apical segmental dysfunction in hypertrophic cardiomyopathy: progression into end-stage heart failure with sudden cardiac death.

Apical segmental dysfunction is an unusual finding in hypertrophic cardiomyopathy (HCM). It is characterized by a poor clinical course and a high incidence of malignant ventricular tachyarrhythmias. Long-term prognosis of patients with HCM and apical segmental dysfunction is still unclear. We report 2 cases of apical segmental dysfunction in HCM in whom progressive apical dilatation and congestive heart failure developed. Both patients died suddenly, and intractable ventricular tachyarrhythmias were documented in 1 case during resuscitation. This report provides further evidence that apical segmental dysfunction might predict a subgroup of patients with HCM who are likely to develop end-stage heart failure and are at high risk of sudden cardiac death.

Morphologic characterization and quantitative assessment of mitral regurgitation with ruptured chordae tendineae by transesophageal echocardiography.

To compare the accuracy of transesophageal echocardiography (TEE) with that of transthoracic echocardiography (TTE) in the detection of morphologic characteristics and in the quantitative assessment of the severity of mitral regurgitation with ruptured chordae tendineae, 40 patients with ruptured chordae tendineae (group 1) and 20 patients with moderate or severe mitral regurgitation due to other causes (group 2) were studied. All echocardiograms were recorded before cardiac surgery. Cardiac catheterization was performed in 55 patients (92%). TEE showed greater sensitivity and negative predictive value than TTE (100 vs 65%, and 100 vs 56%, respectively; p < 0.005) in the diagnosis of ruptured chordae tendineae. Visualization of the ruptured chordae (termed snake-tongue sign) was highly sensitive and specific (93 and 95%, respectively) for establishing the diagnosis of ruptured chordae tendineae. The severity of mitral regurgitation in group 1 patients evaluated by TTE color flow mapping was underestimated by 2 grades in 1 patient and by 1 grade in 6 patients, and overestimated by 1 grade in 1 patient, compared with left ventriculography. In contrast, by TEE color flow mapping it was underestimated by 1 grade in 1 and overestimated by 1 grade in 1 patient. TEE color flow mapping showed better correlation with angiography than did TTE color flow mapping (r = 0.82 vs r = 0.49).

Metastasis of hepatocellular carcinoma to the heart: unusual patterns in three cases with antemortem diagnosis.

Unusual patterns of cardiac metastasis were noted in three cases of hepatocellular carcinoma (HCC): one patient was noted to have a large right ventricular (RV) tumor mass with intracavitary growth and myocardial invasion; the second had massive pulmonary and left atrial (LA) metastasis; and the third patient had a right atrial tumor mass with concomitant RV and LA involvement. Tumor implantation to the RV without right atrial involvement and extensive myocardial invasion is unusual in HCC. The LA involvement is probably related to tumor growth from the pulmonary veins following massive metastasis to the lung, direct invasion of the atrial septum or tumor implantation via a subclinical right-to-left shunt through the patent foramen ovale. To the best of our knowledge, such unusual intracavitary metastases in HCC have not been reported previously. Cardiac metastasis, without local gross recurrence, may be one of the presentations after lobectomy in patients with HCC.