Nuevos modelos conceptual y matemático para el contorno de la onda de volumen de pulso arterial / New conceptual and mathematical forms for the contour of volume wave of arterial pulse

Introducción: El análisis del contorno de la onda de volumen de pulso arterial ha sido útil para el diagnóstico no invasivo de enfermedades cardiovasculares, pero los orígenes patofisiológicos que contribuyen a este contorno no están totalmente explicados. El objetivo de este trabajo fue hallar el nivel de coincidencia de un nuevo modelo conceptual simple, basado en las fuerzas hemodinámicas, con respecto a un nuevo modelo matemático aplicado a las diferentes clases de ondas de volumen de pulso arterial en dedos de miembros inferiores. Métodos: la propuesta del modelo conceptual se basó en que este contorno es la suma de pares de gradientes de fuerzas hemodinámicas de acción, provenientes del corazón, la aorta y el distrito arterial periférico, y las de reacción, provenientes de la pared arterial músculo-elástica bajo estudio. El modelo matemático fue diseñado como un problema de programación no lineal, para hallar las 6 incógnitas numéricas de cada par de gradientes, bajo restricciones no lineales basadas en sus relaciones temporales. Se registraron los contornos desde los dedos de miembros inferiores, en pacientes en los que se pudieran observar las 4 clases de contornos de onda de volumen de pulso arterial conocidos. Se analizó la calidad de ajuste de 4 403 contornos de onda de volumen de pulso arterial experimentales, contra su onda de volumen de pulso arterial resultante del modelo matemático, desde 123 registros de 14 pacientes (7 mujeres). Resultados: La clase III fue la predominante, las clases I y II fueron frecuentes en pacientes con menos riesgo cardiovascular y la clase IV, en los de mayor riesgo...

Introduction: The analysis of volume wave contour of arterial pulse has been useful for non-invasive diagnosis of cardiovascular diseases, but the pathophysiological origins contributing to this contour are not totally explained. The objective of present paper was to find the coincidence level of a new simple conceptual form, based on the hemodynamic strengths regarding a new mathematical form applied to different classes of volume waves of arterial pulse in toe fingers. Methods: The proposal of conceptual form was based on that this contour is the addition of pairs of action hemodynamic strengths gradients from the heart, aorta and the peripheral arterial zone and of the reactions coming from study musculoelastic arterial wall. The mathematical form was designed as a non-lineal programming problem to find the six numeral unknown quantities of each pair of gradients, under non-lineal restriction based on its temporary relations. The contours from toe fingers were registered in patients with four potential classes of volume wave known contours of arterial pulse. The fitting quality of 4 403 experimental above mentioned contours was analyzed versus the arterial pulse volume resulting from mathematical form of 123 registries of 14 patients (7 women). Results: There was predominance of III class, the I and II ones were frequent in patients with less cardiovascular risk and the IV class in those of great risk. The 64 percent of the wave volume of arterial pulse had a quality fitting > 95 percent and the 36 percent had the presence of oscillating waves from skeletal muscle. Conclusions: The coincidence of both forms is accepted to characterize in a morphologic way the contour of any class of wave volume of arterial pulse

Clinical analysis of mini-PNL and standard PNL for calculi within horseshoe kidney / 第二军医大学学报

Objectives: To evaluate the outcome of mini-PNL and standard PNL in horseshoe kidney. Methods: A total of 14 patients with horseshoe kidney were offered PCNL from January 2007 to December 2010 in our department. The male/female ratio was 2.5(10/4). The mean age was 38 years (range 29-55). All underwent color Doppler sonography, plain x-ray of kidney, ureter, and bladder, intravenous urography and CT. The left-to-right ratio was 1.8(9/5). All 14 patients had multiple stones or complex renal calculi, including 1 with staghorn stones. Mean stone size was 4.2cm(2-6.5cm). 10 patients had a history of failed extracorporeal shock wave lithotripsy. All percutaneous renal surgery was performed in one session under ultrasonography guidance. Among the treatments, 4 were mini-PNL, 10 were standard PNLs. Results: All surgery was successfully performed in one session under ultrasonography guidance by F18 tract or F24 tract. The stone-free rate after one-session operation was 78.6%(11/14). mini-PNL group was 75%(3/4), while PNL group was 80%(8/10). 3 cases received ESWL to remove the residual calculi, no second-session operation. 9 were performed in one tract and 5 in two tracts. 9 in upper calix, 7 in middle and 3 in lower. Mean operative time was 112.5±67.5min, mini-PNL operative time was longer than that of standard PNL (135±45min vs102.5±75min, respectively). Conversely, there was an advantage for miniperc over standard PNL in terms of a significantly reduced hematocrit drop (2.8±0.4g/dl VS 4.2±0.8g/dl, respectively). No mini-PNL patients required blood transfusions, whereas 3 did in the standard PNL group. Postoperative rate of surgery-related infection was 14.4%(2/14). No pleural or abdominal injury occurred. Conclusion: Both treatments have their own advantage. Mini-PNL and standard PNL are both effective and safe for calculi within horseshoe kidneys.

Para uma comunicação mais efetiva / Towards a more effective communication

O presente artigo aborda as diversas formas por meio das quais os seres humanos aprendem a limitar os impulsos do mundo externo e como manipulam dentro de si mesmos os impulsos selecionados. A comunicação intrapessoal serve-se de uma língua, única para cada pessoa, capaz de caracterizá-la. Este artigo procura responder as seguintes questões: como se estabelecem as intenções, as expectativas e os desejos por trás da comunicação? O que se passa no interior de uma pessoa ao assimilar seletivamente os estímulos do mundo, do próprio corpo e da própriamente, manipulando-os para devolver algum comportamento por gestos ou palavras? Como interagem os componentes da mente processando o que entra e o que sai da pessoa?.

This article details the many ways by which people learn to limitate impulses from out sideworld and how they manipulate the selected incoming stimuli within themselves. The in nerdialogue uses a language that is unique for each person. This article aims to answer these following questions: how do the intentions, expectations and desires that lies behind communication establish themselves? What happens inside a person in the process of selective assimilation of the stimuli that comes from the world, the body and the mind, manipulating them to return some reaction by gestures or words? How do mind’s components interact with each other in processing what comes in and what goes out of it?.

Percutaneous Nephrolithotomy Combined with Pneumatic and Ultrasonic Lithotripsy for Complex Renal Calculi:Report of 150 Cases / 中国微创外科杂志

Objective To evaluate the clinical efficacy of percutaneous nephrolithotomy (PNL) in combination with pneumatic and ultrasonic lithotripsy in the treatment of complex renal calculi. Methods Under general anesthesia,an ureteral stent was placed into the patient by cystoscopy. With the prone position,percutaneous access was established by inserting an access needle into the intended calix under the guidance of ultrasonography or fluoroscopy. Afterwards,combined pneumatic and ultrasonic probes were used by nephroscopy for lithotripsy. Results A single tract was used in 137 patients,while two or three tracts were created in the other patients (11 and 2 respectively). One-step procedure to remove the stones was achieved in 119 patients,while a second intervention was performed in 27,and three procedures was carried out in 4. The mean time of the operations were (88?34) min. After the operation,one patient developed infectious shock,and then was cured by anti-shock therapy;two patients showed secondary hemorrhage in two weeks postoperation,and was cured by conservative therapy. In this series,the rate of stone clearance was 84.7% (127/150);23 cases had residual stones,10 of them received ESWL (the stone was removed completely in 7 of the 10 cases),and the other 13 were treated by oral medicines. Six months after the operation,follow-up examination showed a stone-free rate of 89.3% (134/150). Conclusion Combination of ultrasonic and pneumatic intracorporeal lithotripsy is effective and safe for complex renal calculi,which is intractable by open surgery.

Current Indications for Open Stone Surgery in the Fully Equipped Stone Center / 대한비뇨기과학회지

We retrospectively reviewed 913 stone treatment cases except the cases of spontaneous passage from March in 1992 to February in 1995. The operations performed for urinary stone consisted of 42 ureterolithotomies, 3 pyelolithotomies, 17 PNLs, 67 URS. The others of 762 cases were treated by extracorporeal shockwave lithotripsy (ESWL). .Forty-five open surgery were performed among 913 stone treatment procedures (4.9%). The indications of open surgery for lower ureteral stone included failed URS with and without prior ESWL and abnormalities limiting endoscopic access. Anatomic factors that required open surgery included duplicating system with ureterocele and duplicating system with ureteral polyp. The indications of open surgery for upper ureteral and ureteropelvic junction stone included failed ESWL, desire for one session success (short treatment time available by patient), poor economics for ESWL, unrelieved intractable pain, bilateral ureteral stone with anuria, suspicious malignancy, stone combined with ureteral stricture below. Open stone surgery has become more complex procedure. Patients undergoing open surgery, were usually combined by anomalies or obstruction requiring surgical correction, suspicious cancer or no definite preoperative diagnosis, need to relieve obstruction as soon as possible, the cases picked up by patient for their preference. We think the open surgery still can offer more benefit to the patient with above listing conditions.

Study on the Effectiveness of Extracorporeal Shock Wave Lithotripsy for the Lower Ureteral Stones and Large Volume Renal Stones / 대한비뇨기과학회지

Since the advent of extracorporeal shock wave lithotripsy(ESWL) provided an opportunity for a non-invasive method of treating urinary stones, it has been widely accepted that the ESWL is highly effective modality as the first line treatment method for the most urinary stones. However, there are still some controversies in establishing therapeutic strategy for the cases of large volume renal stones and lower ureteral stones. To evaluate the effectiveness of ESWL for these stones, comparative study about ESWL was performed with percutaneous nephrolithotomy(PNL) for the large volume renal stones and with ureteroscopic stone removal(URS) for the lower ureteral stones. For renal stone larger than 2.5 cm in long axis and lower ureteral stone, a total of 538 patients (542 organs) underwent treatment with ESWU using EDAP LT-01 machine) as outpatientbasis, PNL and URS under general anesthesia with admission from February in 1988to July in 1995. The patients were 318 in male and 220 in female. The average age of patient was 44.4 years, with the range of 10 to 81 years. The selection of treatment modality were decided largely by patients with their preference among the given options and with their economic status. They were analysed with respect to stone free rate, auxiliary procedure, complication, treatment duration and cost. The results were as follows ; 1. For renal stone larger than 2.5 cm in long axis, ESWL was undergone in 77 cases. The stone free rate was 63.6%(47.4% for the staghorn stones, 69.0% for the large renal stones excluding staghorn calculi). Mean time lost from work was 15.9+/-9.7 days(19.4+/-10.8 days for the staghorn stones, 14.8+/-9.1 days for the large renal stones excluding staghorn calculi). Mean treatment expense was 1,065,320 won. Complications that need additional treatment were occurred in 20.8%(21.2% for the staghorn stones, 20.7% for the large renal stones excluding staghorn calculi). PNL was performed in 42 cases. The stone free rate was 78.6%(55.6% for the staghorn stones, 84.8% for the large renal stones excluding staghorn calculi). Mean time lost from work was 19.8+/-3.7 days(20.4+/-4.7 days for the staghorn stones, 17.1+/-3.2 days for the large renal stones excluding staghorn calculi). Mean treatment expense was 911,390 won. Complications that need additional treatment were occurred in 28.6%(33.3% for the staghorn stones, 27.3% for the large renal stones excluding staghorn calculi) (Table 1). 2. For lower ureteral stone, ESWL was undergone in 214 cases. The stone free rate was 97.2%. Mean time lost from work was 3.2+/-2.1 days. Mean treatment expense was 645,680 won. Complications that need additional treatment were occurred in 4.7%. URS was performed in 209 cases. The stone free rate was 96.7%. Mean time lost from work was 10.8+/-3.2 days. Mean treatment expense was 701,850 won. Complications that need additional treatment were occurred in 7.2% (Table 2). For large volume renal stones excluding staghorn calculi, ESWL monotherapy resulted 15.8% less stone free rate than PNL monotherapy. For lower ureteral stone, ESWL was as effective as URS with respect to stone free rate and treatment expense. Moreover, time lost from work of ESWL cases was shorter than that of URS cases. Conclusively, it could be suggested that ESWL monotherapy is effective and preferentially applicable method for the lower ureteral stones and large volume renal stones excluding staghorn calculi. Whereas, it is not effective for the staghorn calculi.

Role or Percutaneous Nephrolithotomy in the Era of Extracorporeal Shock Wave Lithotripsy / 대한비뇨기과학회지

Since the introduction of extracorporeal shock wave lithotripsy(ESWL), percutaneous nephrolithotomy(PNL) has been performed in limited cases of the patients requiring a stone procedure. The roles of PNL in the era of ESWL were reviewed through analysis of 86 patients treated with PNL. From July 1987 to December 1994, 86 patients(89 renal units) underwent percutaneous extraction of renal or upper ureteral stone. From July 1987 to January 1990, PNL was performed as the first choice for the treatment of 69 cases out of 119 renal or upper ureteral stone, and PNL was done in 58.0% (69/119) of the cases. From February 1990 to December 1994 when ESWL was available at our hospital, PNL was done in 20 cases of ESWL resistant stone or large volume stone, and PNL was done in 1.5%(20/1,362) of renal or upper ureteral stone. In the era of ESWL in our hospital, ESWL were performed in 94.5% of renal or upper ureteral stone, open surgery in 3.0%, PNL in 1.5% and conservative treatment in 1.0%. Initial success rate of PNL was 86.9%(60/69 cases) and subsequently when ESWL was available at our hospital, it became 95.0%(19/20 cases), probably due to accumulated experiences. Subsequently decreased complications of PNL such as persistent urinary leakage, prolonged hematuria, ureteral perforation and paralytic ileus. Though the introduction of ESWL in our hospital also brought about dramatic ally decreased use of PNL, PNL continues to have a primary role in the management of renal or upper ureteral stone in limited cases such as patients refusing ESWL, ESWL resistant stone or large volume stone.

Analysis of the Results of Percutaneous Nephrolithotomy for Staghorn Calculi: Based on Stone Surface Area / 대한비뇨기과학회지

Though high stone free rates were reported with ESWL monotherapy or anatrophic nephrolithotomy, percutaneous nephrolithotomy with or without ESWL appears to be the procedure of choice for most staghorn calculi. A total of 41 patients with staghorn calculi underwent percutaneous nephrolithotomy(PNL) alone or primary percutaneous debulking followed by extracorporeal shock wave lithotripsy(ESWL) of residual stone fragments. For the objective analysis of the results of PNL stone removal rate was calculated with stone surface area which was determined by computer analyzer. For staghorn calculi smaller than 2000 mm2(38/41), a mean stone removal rate of about 90% was achieved in the PNL. When stone surface area exceeded 2000 mm2(3,41), the mean stone removal rate was 78.8%. The stone removal rates stratified by stone surface area were not significantly different. The stone free rate was 31.7% in the PNL only but 75.6% in the PNL with or without ESWL. The higher mean stone removal rate and stone free rate was achieved in the kidneys with non-dilated collecting system than those with hydronephrosis, but it was not statistically significant.

35 Cases of Percutaneous Stone Extraction / 대한비뇨기과학회지

On a standpoint of commonly available ESWL for the treatment of urinary stone, percutaneous stone extraction had the role of cooperation to it, and sometimes it could be the first procedure of choice. We have performed percutaneous extraction of the renal and upper ureteral stones in 35 renal unite. The overall success rate was 78.4%, average operation time was 81 minutes, mean fluoroscopic exposure time was 11 minutes, average postoperative hospital stay was 7 days. Causes of failure were as followings ; five inadequate calyceal puncture, one ureteral perforation, one impacted stone, and one downward stone migration. The complications were inappropriate position of the nephrostomy tube, prolonged hematuria through nephrostomy tube, and partial ureteral avulsion. They were not serious but resolved by conservative management.

Percutaneous Nephrolithotomy in a Child / 대한비뇨기과학회지

Percutaneous removal of renal and ureteral calculi has become an established and successful procedure in adults. We have performed percutaneous extraction of renal stone, in 4-year-old girl. She was discharged without specific complication and IVP was checked postoperatively at 3 months later. We report a case of renal stone treated by percutaneous nephrolithotomy.

Experience of Percutaneous Nephrolithotomy / 대한비뇨기과학회지

Sixteen patients with renal and pelvis stones were treated by eighteen percutaneous nephrolithotomy(PNL) from December, 1986 to March, 1988 in Chonbuk National University Hospital. We discussed our experience with regard to the failures and complications of PNL. With accumulation of experiences, operation efficiencies were increased from 62.6 per cent early in this series to 75.0 per cent in the recent cases. The most common cause of failure was inability to find stone because of bleeding. No patient required nephrectomy, but five patients underwent open surgery for stone removal because of unsuccessful PNL(four in kidney, one in pelvis). Major complications occurred in 7 patients ;hemorrhage in four cases, urine extravasation into the retroperitoneal cavity, colon perforation, and remnant stone in a case respectively. We concluded that percutaneous nephrolithotomy appears to be a preferable procedure to open stone surgery and a useful alternative to ESWL.

Experience of Percutaneous Nephrolithotomy / 대한비뇨기과학회지

Sixteen patients with renal and pelvis stones were treated by eighteen percutaneous nephrolithotomy(PNL) from December, 1986 to March, 1988 in Chonbuk National University Hospital. We discussed our experience with regard to the failures and complications of PNL. With accumulation of experiences, operation efficiencies were increased from 62.6 per cent early in this series to 75.0 per cent in the recent cases. The most common cause of failure was inability to find stone because of bleeding. No patient required nephrectomy, but five patients underwent open surgery for stone removal because of unsuccessful PNL(four in kidney, one in pelvis). Major complications occurred in 7 patients ;hemorrhage in four cases, urine extravasation into the retroperitoneal cavity, colon perforation, and remnant stone in a case respectively. We concluded that percutaneous nephrolithotomy appears to be a preferable procedure to open stone surgery and a useful alternative to ESWL.

Management of Urinary Calculi in Patients with a Solitary Kidney / 대한비뇨기과학회지

New therapies, percutaneous nephrostolithotomy(PNL), transurethral ureteroscopy (URS) and extracorporeal shock wave lithotripsy(ESWL), are revolutionizing the treatment of urinary tract calculi. Little are known, however, about the efficacy of managing the calculi in patients with a solitary kidney. We study 17 such calculi to determine which techniques can be utilized safely. effectively and efficiently in patients with a solitary kidney. Of 6 calculi treated by PNL, successful evacuation of the stones was achieved in 5 stones. Of 2 calculi treated by URS, successful evacuation of the stones in 1 stone. In the ESWL series of 9 calculi including the 2 stone fragmentation was record. In 2 staghorn stones, combination of PNL and ESWL were done. No significant complications were related in patients with a solitary kidney. Results and morbidity did not differ significantly from the treatment of calculi in patients with both kidneys. It is suggested that endourologic manipulation and ESWL in stone patients with a solitary renal unit are also as effective and safe as in patients with both renal unit, even though staghorn calculi, it may be handled safely by a combination of the 2 techniques as patients with both renal unit.

Combined Treatment of Staghorn Calculi by Percutaneous Nephrolithotomy and Extracorporeal Shock Wave Lithotripsy / 대한비뇨기과학회지

On the 59 cases of staghorn calculi treated at our institution with either ESWL monotherapy or initial percutaneous nephrolithotomy followed by ESWL between July 1987 and June 1988, 50 cases(22 complete and 28 partial staghorns) have adequate follow up. Using a retrospective cohort design, patients were matched for age, sex, stone size, stone complexity, renal function, urinary tract infection and urinary tract obstruction. Twenty five pairs of combination therapy and ESWL monotherapy patients with complete data were matched. The groups were not significantly different in the matching parameters. A significantly higher stone free rate follows combination therapy versus ESWL monotherapy for complete staghorns(25% vs. 0% in the case of 1 time ESWL treatment : 76% vs. 40% at 3 months follow up visit but the difference is slight for partial staghorns(54% vs. 47% in the case of 1 time ESWL treatment ; 85% vs. 73% at 3 months follow up visit). Both have similar length of hospital stay for complete staghorns(15 days vs. 14 days), but a significantly longer hospital stay follows combination therapy for partial staghorns(13 days vs. 6 days). The morbidity of the combination approach is not greater than that of ESWL monotherapy(40% vs. 36%), where as the need for axillary procedures is significantly lower in this group(16% vs. 36%). Our results indicate that virtually all staghorn calculi are best treated with initial percutaneous nephrolithotomy followed by ESWL. This approach allows for chemolysis and secondary procedures. But small volume partial staghorns in nondilated systems may be considered for ESWL monotherapy with ureteral stenting.

Percutaneous Nephrolithotomy: 52 Cases / 대한비뇨기과학회지

A percutaneous nephrostomy tract was used as a conduit to the kidney and upper ureter for extraction of calculi. We have performed percutaneous extraction of renal and upper ureter stones in 52 cases with the use of the percutaneous equipment and ultrasonic lithotrite. Overall success rate was 86.5% and average operating time was 90 minutes and mean hospitalization was 6.9 days. The advantage of this technique are that a skin incision of only 1 cm. is required to remove the stone, hospital days are fewer than with open procedures and postoperative morbidity is minimal. We conclude that percutaneous nephrolithotomy can be the primary choice of treatment in upper urinary tract stones.

Clinical Observation on Percutaneous Nephrolithotomy / 대한비뇨기과학회지

We have performed percutaneous removal of renal and upper ureteral stones in 26 patients with ACMI percutaneous nephroscope between August 1986 and July 1987. Overall success rate was 73 percent. Removal was successful for 65 percent of the targeted renal stones and 100 percent of the upper ureteral stones with grasping forceps, baskets, ultrasonic lithotripsy, electrohydraulic lithotripsy or a combination of theses procedures. 24 cases were treated in one session, 2 in a two sessions. There was no mortality and the incidence of complications was low. Average post-operative hospitalization time was 5.7 days. The advantages of this technique are that a skin incision of only 2cm is required to remove the stone, hospital days are fewer than the open procedures, rapid recovery, quicker return to work and few significant complications. We conclude that percutaneous techniques are an effective way to handle the majority of renal and ureteral stones.

Early Experience of Percutaneous Nephrolithotomy / 대한비뇨기과학회지

A development of percutaneous nephrostomy has laid the foundation for a major advance in the treatment of urolithiasis. The percutaneous, nephrolithotomy has already, become an accepted alternative to conventional surgery. With the use of a variety of instruments, calculi can be either removed intact or if too large, fragmented in situ and extracted. We have performed percutaneous extraction of renal and upper ureteral stones in 50 patients via Storz percutaneous universal nephroscope. An overall success rate of 74% including 60% in initial, 88% in subsequent period, an acceptable incidence of complication, a rapid convalescence, sooner return to work, minimal postoperative pain and a cost effectiveness were obtained. We conclude that percutaneous nephrolithotomy can be the primary choice of treatment in renal and upper ureteral stones.

Percutaneous Nephrolithotripsy: Clinical Experience of 54 Cases / 대한비뇨기과학회지

We have performed percutaneous extraction of renal and upper ureter stones in 54 cases with use of the Storz percutaneous universal nephroscope(26Fr). With the patient under general anesthesia, a percutaneous tract was dilated up to 24Fr and the stone was immediately removed at one session. A variety of grasping and fragmentation techniques under fluoroscopic and endoscopic control were used to extract stones. Overall success rate was 65%. With increasing proficiency from accumulation of experience, rate of stone extraction has been increasing from 40% early in the series to 83% in the most recent cases. The advantage of this technique is that only 1 to 2cm skin incision is required to remove the stone with minimal postoperative morbidity, rapid convalescence, and sooner return to work. We conclude that percutaneous nephrolithotripsy appears to be an appropriate alternative to an open operation in most patients with symptomatic urolithiasis.

Percutaneous Nephrolithotripsy / 대한비뇨기과학회지

Recently, the modern surgical practice for the renal stone is being increasingly supplemented through the development of new technique. For example, hypothermic renal surgery, partial nephrectomy and extended pyelolithotomy were carried out by the ""therapy with the knife"". The percutaneous Nephrolithotripsy is one of the minimal invasive procedure to the renal stone surgery all over the world recently. This method is known as a safe, simple and reliable procedure for renal stone surgery, and they realize this technique as enormous advantage for patients; short hospital stay, minimal morbidity and rapid return to work etc. Three cases of renal stone through percutaneous nephrolithotripsy were carried out with much favour the first procedure in Korea. The first and third case were excellent result, but the second case was perforated on the uretero-pelvic junction of the kidney. There after, on the fifth postoperative day pyeloureteroplasty was performed with the splint of double J catheter. All the Patients were performed as the one session puncture, dilatation with telescopic dilator and lithotripsy with ultrasound lithotriptor. The two patients had 6th and 7th hospital day postoperatively.