Safety and Outcomes of using ureteric access sheath (UAS) for treatment of Pediatric renal stones: Outcomes from 2 tertiary endourology centers.

OBJECTIVE: To look at the safety and outcomes of using ureteral access sheath (UAS) for pediatric renal stones. The use of UAS is variable in urological practice with very little clinical work on their use in pediatric kidney stone disease. PATIENTS AND METHODS: Data was retrospectively collected from 2 large European tertiary endourology centers for all pediatric patients (≤16 years) with renal stones who underwent flexible ureteroscopy and lasertripsy (FURSL) via UAS. Data was collected on patient details, stone demographics and clinical outcomes of the FURSL procedure. RESULTS: Forty-eight patients with a mean age of 10.7 years were treated with FURSL for a mean single and cumulative stone size of 10.4 mm and 15 mm respectively, with two-third having multiple stones and stones in the lower pole. The initial and final stone free rate (SFR) was 66.7% and 100% respectively with 1.3 procedures/patient. One patient each had intra-operative grade 1 ureteric injury and post-operative UTI, with no other injuries or complications noted. Over a mean follow-up of 17 months, no other complications were noted. CONCLUSION: Ureteral access sheath is safe for treatment of pediatric renal stones with excellent outcomes and are especially useful for larger or multiple stones. While there does not seem to be any medium-term sequalae, to avoid risk of ureteral injury, we would suggest using the smallest size sheath possible. We would argue these procedures are best done in specialist high-volume endourology units for optimal results.

Effect of patient education on asthma management.

Patients need to understand their asthma to be able to react appropriately. At least 30 minutes is needed by a trained asthma professional to teach asthma self-management effectively. Many patients accept symptoms and attacks unnecessarily through insufficient knowledge of their condition and treatment. In this small study, those who were educated by a trained asthma nurse had a significantly higher knowledge of their condition and management. Most of those who were educated by a trained asthma nurse had symptoms less frequently. Those who were educated by a trained asthma nurse had no time off work whereas 49% of the control group had time off work.

Tuberculosis chemoprophylaxis practices in metropolitan clinics.

A survey of tuberculosis chemoprophylaxis policies was conducted from September 1977 through January 1978 of all metropolitan programs in the United States that reported more than 100 cases of tuberculosis during 1976. Twenty-eight programs were surveyed, and all responded. Uniform practice was found with regard to the dosage of isoniazid administered, duration of treatment, and most other indications for preventive therapy recommended by the American Thoracic Society and the U.S. Public Health Service Center for Disease Control. One third of the programs surveyed administered chemoprophylaxis to pregnant women, and one third regularly dispensed more than a one-month supply of isoniazid to patients. Three programs (11%) routinely monitored hepatic function by serum laboratory tests during chemoprophylaxis. Four programs (14%) regularly or occasionally used bacillus Calmette-Guérin vaccine for prevention of tuberculosis. Although large metropolitan programs generally followed the guidelines of the American Thoracic Society and the Center for Disease Control for tuberculosis chemoprophylaxis, some major variances in practice were reported.

Psychotic symptoms and age of onset in affective disorders.

Prevalence of hallucinations and delusions was studied in 1,763 patients with unipolar major depression, bipolar affective disorder, and schizoaffective disorder. The authors found that the presence of psychotic features was negatively associated with age of onset for the group as a whole, and bipolar affective disorder (manic or mixed type) specifically. The clinical implications of the findings are discussed.