ABSTRACT
ABSTRACT Introduction: The main aim of stone surgery is to establish stone free status. Performing flexible nephroscopy is an effective tool in this manner. The aim of this study was to evaluate the role of retrograde flexible nephroscopy for detection of residual fragments following percutaneous nephrolithotomy (PNL) in comparison with antegrade approach. Materials and Methods: Data of 137 patients underwent ECIRS was collected prospectively. In all cases following stone clearance, collecting system was checked for residual fragments. First antegrade than retrograde flexible nephroscopy was performed and success rates to reach all calices and detection of residual fragments were noted. All patients underwent CT and success rate of antegrade and retrograde approaches were compared. PPV and NPV of retrograde approach to detect residual fragments were calculated. Results: Antegrade and retrograde nephroscopy successfully accessed all of the calices in 101 (73.7%) and 130 (94.9%) patients respectively (p<0.0001). Residual fragments were observed in 18 (13.1%) patients following antegrade flexible nephroscopy. Retrograde approach identified residual stones in 17 more cases. These cases were treated with flexible nephroscopy or secondary percutaneous tract. Postoperative CT revealed residual stones in 10 (7.3%) patients. PPV and NPV of retrograde flexible nephroscopy were 83.3% and 96.2%. Conclusions: Flexible nephroscopy effectively detects residual fragments following PNL. Retrograde approach was more successful than antegrade approach to reach all calices. We recommend performing retrograde flexible nephroscopy following PNL especially in complex cases as it has the potential to increase SFR, decrease the need for second look surgery and unnecessary postoperative imaging.
Subject(s)
Humans , Male , Female , Adult , Kidney Calculi/surgery , Endoscopy/methods , Nephrolithotomy, Percutaneous/methods , Kidney Calculi/diagnostic imaging , Tomography, X-Ray Computed/methods , Prospective Studies , Reproducibility of Results , Treatment Outcome , Endoscopy/instrumentation , Equipment Design , Nephrolithotomy, Percutaneous/instrumentation , Kidney Calices/surgery , Middle AgedABSTRACT
Poejo is an aromatic and medicinal plant native to highland areas of south Brazil, in acid soils with high Al3+ concentration. The main objective of the present work was to evaluate the effect of liming on the extraction yield of essential oil of three chemotypes of poejo (Cunila galioides Benth). For this purpose, the experiments were performed in a greenhouse, using 8-litre pots. The treatments were four dosages of limestone (0, 3.15, 12.5, and 25 g.L-1) and a completely random experimental design was used, with four replications and three chemotypes, set up in a 3 × 4 factorial arrangement. The parameters evaluated were dry weight of aerial parts, essential oil content and chemical composition of essential oil. Results showed that liming affects the biomass production, essential oil yield and chemical composition, with cross interaction verified between chemotype and limestone dosage. For the higher dosage lower biomass production, lower yield of essential oil as well as the lowest content of citral (citral chemotype) and limonene (menthene chemotype) was observed. In the ocimene chemotype, no liming influence was observed on the essential oil yield and on the content of major compounds. The dosage of 3.15 g.L-1 can be considered the best limestone dosage for the production of poejo for the experimental conditions evaluated.
O poejo é uma espécie aromática e medicinal, autóctone do sul do Brasil, encontrada em regiões de campos nativos de altitude, onde os solos se caracterizam por apresentar elevada acidez e altas concentrações de Al3+. O presente trabalho objetivou avaliar o efeito da calagem na produção de biomassa e de óleo essencial de três quimiotipos (QT) de poejo (Cunila galioides Benth.). O experimento foi conduzido em casa de vegetação utilizando-se recipientes com capacidade de oito litros. Os tratamentos consistiram de quatro dosagens de calcário dolomítico (0; 3,15; 12,5; 25 g.L-1 de substrato) e o delineamento experimental foi completamente casualisado, utilizando-se três quimiotipos de poejo (citral, menteno e ocimeno), quatro tratamentos e quatro repetições, em esquema fatorial 3 × 4. Foram avaliados o peso de matéria seca da parte aérea das plantas, o teor de óleo essencial e a composição química dos componentes majoritários presentes no óleo. Os resultados mostraram efeito da calagem na produção de biomassa, no teor e na composição química do óleo, ocorrendo efeito de interação entre quimiotipo e dosagem de calcário. Na maior dosagem, observou-se a menor produção de biomassa média, o teor de óleo essencial foi significativamente menor, assim como os componentes citral (QT-citral) e limoneno (QT-menteno). Para o quimiotipo ocimeno, as dosagens de calcário não influenciaram o teor e os componentes majoritários do óleo essencial, mas prejudicaram a produção de biomassa em doses elevadas. A calagem com 3,15 g.L-1 de substrato, elevando o pH para 5,0, pode ser considerada a melhor dosagem de calcário e a mais adequada faixa de pH para a produção de poejo, nas condições experimentais avaliadas.