The prognostic role of D-dimer in hospitalized COVID-19 patients.

INTRODUCTION: In COVID-19 patients, the determination of the relationship between elevated D-dimer level and prognosis and the determination of thrombosis formation in the early stages of the disease are very important. The aim of this study was to investigate the prognostic role of D-dimer levels based on presentation in patients hospitalized with the diagnosis of COVID-19. METHOD: The study was conducted on patients hospitalized with the diagnosis of laboratory-confirmed COVID-19 between March 11 and April 20, 2020. Patients with diseases that could have caused an increase in D-dimer were excluded from the study. RESULTS: The evaluation was made across a total of 1,669 patients, comprising 782 (46.9 %) females and 887 (53.1 %) males. The effects of D-dimer, CRP, ferritin, and troponin on mortality were evaluated with Enter Logistic Regression Analysis, and the model was found to be significant, with an explanatory coefficient of the model at a very good level of 91.3 %. The D-dimer scores were determined to be higher in patients who did not survive. The risk of mortality was seen to be 7.325-fold higher in cases with D-dimer measurement ≥0.5. CONCLUSION: The study results showed that the D-dimer test was an independent risk factor showing mortality in COVID-19 patients (Tab. 6, Ref. 27). Text in PDF www.elis.sk Keywords: D-dimer, SARS-CoV-2, mortality.

A comparison of the effects of lidocaine or magnesium sulfate on hemodynamic response and QT dispersion related with intubation in patients with hypertension.

BACKGROUND: The aim of this study was to investigate the effect of magnesium administered before induction on the hemodynamic response and QT dispersion (QTd) related with intubation in hypertensive patients and to compare it with lidocaine. METHODS: Patients with essential hypertension who were under ≤ 65 years old, scheduled for elective surgery with a Mallampati score of I-II were included in the study. Patients were randomly divided into three groups; group M (n = 20) received magnesium sulfate, group L was prescribed lidocaine, and group C (control group) received saline. Standard 12-lead ECG readings were taken before the induction of anesthesia and at the first and fifth minutes following intubation. RESULTS: There were no statistically significant differences between the groups in terms of age, sex and demographic characteristics. There was no significant difference in the QT interval values before induction and 5 minutes after intubation in all groups. In group M, QTd values were significantly lower at the first and fifth minutes than before induction. There were no statistically significant differences in QTd values at different times in group L and group C. CONCLUSION: QTd is not increased during tracheal intubation in hypertensive patients so there is no need for magnesium sulfate for these patients. But as QTd has been shown to increase during tracheal intubation for coronary artery disease patients, magnesium sulfate might be useful for those patients although future studies are required to confirm this statement.

The prolonged effect of pneumoperitoneum on cardiac autonomic functions during laparoscopic surgery; are we aware?

BACKGROUND: The gynecological laparoscopic surgery requires pneumoperitoneum (PP) with CO2 gas insufflation. CO2 PP may influence cardiac automic function (CAF). This study was conducted to assess its significance and the prolonged effects of CO2 PP on the activity of the cardiac autonomic function 24 hours after the operation by heart rate turbulence (HRT) and heart rate variability (HRV), first time in the literature. PATIENTS AND METHODS: Fifty patients scheduled for elective gynecologic laparoscopy were evaluated. The patients had no preexisting lung or heart disease or pathologic lung function. Conventional general anesthesia with midazolam, propofol, fentanyl, rocuronium, and sevoflurane was administered. ECG recordings were carried out between before 4 h from surgery and the beginning of anesthesia (T1), induction of PP and CO2 evacuation (T2) and a 24-h period postoperatively (T3). The Holter recordings of all patients were analyzed by HRT and HRV. RESULTS: There were significant reductions in in HRV and HRT parameters peri-op period compared to the pre-op values (p < 0.05). In the first 3 h of post-op period, were calculated all HRT and some HRV (SDNN, LF) parameters were also found to be significantly reduced than the values of pre-op period (p < 0.05). CONCLUSIONS: This study described adverse effects of CO2 PP on cardiac autonomic regulation in the early postoperative period according to the long-term HRV and HRT frequency analysis, for the first time in the literature. The early postoperative monitorization may supply efficacious information for arrhythmic complications.

Evaluation of the olfactory memory after spinal anesthesia: a pilot study.

BACKGROUND: The aim of this study was to investigate the effect of spinal anesthesia (SA) on olfactory memory using Brief-Smell Identification TestTM (B-SIT). PATIENTS AND METHODS: This, prospective, clinical study was performed on 40 ASA physical status I-III patients, between 18-65 years of age undergoing a planned elective minor surgery under SA. All participants were preoperatively informed about B-SIT and the mode of application of the test according to the information in the book. B-SIT was applied to each patient preoperatively and the scores were recorded. B-SIT was reapplied to all patients on the 1st and 2nd postoperative days and the scores were recorded. Moreover, development of postdural puncture headache (PDPH) and/or neurological symptoms (such as hearing loss, diplopia) were checked. RESULTS: Postoperative headache was observed in 7 of the participants and 3 of them was diagnosed to have PDPH. No statistically significant difference was observed in the olfactory memory evaluation of the patients suffering from headache and the 3 patients diagnosed with PDPH. No statistically significant difference was observed in the correct odor answer ratio between the preoperative and postoperative 1st and 2nd days (p > 0.05). CONCLUSIONS: We confirm that SA does not affect olfactory memory. Further studies are necessary to confirm the results of our pilot study in a larger sample.

Magnetic resonance imaging contrast agent related pulmonary edema: a case report.

Gadobutrol is a contrast agent often used during magnetic resonance imaging (MRI). The agent has several side effects, some of which can be serious. It has extremely rare life-threatening systemic complications, which can lead to bronchospasm, hypersensitivity reactions and cardiovascular arrest. However, there is no data available on the development of noncardiogenic pulmonary edema following use of gadobutrol. This paper examines the case of a 37-year-old male patient reported to have developed noncardiogenic pulmonary edema after intravenous injection of gadobutrol during MRI.

Comparison of lornoxicam with tramadol in patient-controlled analgesia after gynecological surgery.

BACKGROUND: The aim of this study was to compare the effects of lornoxicam and tramadol in patient-controlled analgesia (PCA) after gynecological surgery. METHODS: Forty-four patients were randomly allocated to one of two groups after elective gynecological surgery. Patients in group I (n = 22) received IV tramadol, and group II patients (n = 2) received IV lornoxicam with a PCA pump. A visual analogue scale (VAS) (0 = no pain, 10 = worst pain), hemodynamic parameters and side-effects were assessed before starting the infusion (baseline), at the 15th and 30th min, 1st, 2nd, 3rd, 4th, 6th, 8th, 12th, 18th, 24th, 36th and 48th hour thereafter, and results were compared. RESULTS: Adequate analgesia was achieved in both groups. VAS values in the tramadol group were lower than those of lornoxiacam at the 15th and 30th minute, 1st, 2nd, 4th, 6th, 8th and 12th hour measurements (p < 0.05). Eight patients (36.3%) in group I and six patients (27.2%) in group II suffered from nausea (p > 0.05). CONCLUSIONS: Tramadol and lornoxicam may be used for pain control after gynecological surgery via PCA. However, we conclude that tramadol has better analgesic efficacy than lornoxicam during the first 12 hours postoperatively.

Effect of perioperative inadvertent hypothermia on the ECG parameters in patients undergoing transurethral resection.

OBJECTIVE: Perioperative inadvertent hypothermia (PIH) (core body temperature to < 36 °C) is a common event during surgery. PIH may result from multiple factors. Elderly urology patients are at greater risk than other patients for hypothermia. PIH may cause adverse postoperative cardiac clinical manifestations. Our study aimed to determine the effects of postoperative alteration of core body temperature on the ECG parameters in patients undergoing transurethral resection. PATIENTS AND METHODS: Fifty-nine patients, 40-83 years of age, who were scheduled for elective Transurethral Resection Prostate and/or Bladder (TUR-P and/or TUR-B) were enrolled in the study. Patients with operation times more than 30 minutes were included. Core temperatures were measured and standard 12-lead ECG readings were taken before surgery and immediately upon arrival in the postanesthesia care unit. RESULTS: 59 patients were included this study. Prevalence of PIH (< 36ºC) was (57.6%). The postoperative temperature was found to be significantly lower than the preoperative of all patients (preop 36.46±0.39; postop 35.68±0.59, paired sample t-test, p<0.001). Also in all patients, postoperative QTc dispersions were found to be significantly longer than the preoperative QTc dispersions (preop 59.66±32.69; postop 74.57±37.47 ms, p<0.05). When we divided the patients; hypothermic and normothermic, postoperative QTc dispersions were significantly different between two groups (68.23±33.43 ms, and 83.20±41.50 ms; p=0.009). CONCLUSIONS: The prevalence of inadvertent intraoperative hypothermia in patients undergoing transurethral resection is relatively high. QTc dispersion of mild hypothermic patients was significantly longer than normothermic patients'.

The effect of desflurane on postoperative olfactory memory.

OBJECTIVE: In this study, we investigated the effects of desflurane 6%, on olfactory memory. PATIENTS AND METHODS: This is a prospective clinical study performed with 40 patients aged 18-60 who had elective surgery and American Society of Anesthesiologists (ASA) physical status I-III. The Brief Smell Identification Test (BSIT) was used for evaluating patients' olfactory memories before and after the surgery. Patients received standard general anesthesia protocol and routine monitoring. For induction, 1.5 mg/kg of fentanyl, 2 mg/kg of propofol, and 0.5 mg/kg of rocuronium bromide were administered. Anesthesia was maintained with the inhalational of anesthetic desflurane (6%). The scores are recorded 30 minutes before the surgery and when the Aldrete Recovery Score reached 10 in the postoperative period. Preoperative and postoperative results were compared and p-values <0.05 were considered statistically significant. RESULTS: The patients' mean age was 41.1±12.0. Preoperative total correct answer rate to odorous substances was 92.7%, and postoperative rate was 92.1%. Percentage of the odor substance identification by the patients revealed no statistically significant difference when pre and post-operative rates have been compared (p-value >0.05). CONCLUSIONS: We have observed for the first time in the literature that general anesthesia using desflurane (6%) did not affect short-term olfactory memory. Further studies will be necessary to confirm our findings with larger sample size.

Comparison of the effects of bispectral index-controlled use of remifentanil on propofol consumption and patient comfort in patients undergoing colonoscopy.

BACKGROUND AND STUDY AIMS: In endoscopic procedures, propofol can be safely administered either alone or in conjunction with remifentanil. The aim of the study is to compare the effects of the administration of propofol alone and the administration of remifentanil in addition to propofol on patient and endoscopist satisfaction, preoperative hemodynamic response, and propofol consumption. MATERIALS AND METHODS: A totally 60 patients were enrolled in the study. Propofol group (Group 1): A 0.4-mg/kg propofol bolus and 1 mg/kg/h maintenance infusion of propofol until a bispectral Index value of 70-75 was achieved. Propofol + remifentanil group (Group 2) received a 0.4 mg/kg propofol bolus dose and maintained with a 0.5 mg/kg/h infusion of propofol + 0.2 mcg/kg/min infusion of remifentanil. The infusion dose of remifentanil was maintained, and the propofol infusion dose was titrated until a BIS value of 70-75 was achieved. RESULTS: In Group 1 (colonoscopic intervention 1 and 5 min) and Group 2 (colonoscopic intervention 10 min.), main blood pressure (MBP) value has a significant decrease. Hypotension occurred in 6 patients in group 1, while 12 patients in group 2. No significant difference was found between the Patient's endoscopist' satisfaction, MBP and heart rate. Propofol consumption was greater in group 1 than in group 2. When the Ramsay sedation levels of Group 1 and Group 2 were compared, a statistically significant difference was observed. CONCLUSIONS: The addition of remifentanil to propofol may be an alternative to the use of alone propofol for sedation in colonoscopic interventions.

Cancer pain, pathophysiology, characteristics and syndromes.

In this study the pathophysiology and characteristics of cancer pain together with cancer pain syndromes and guidelines of management are reviewed. Tumour-associated pain may be nociceptive (somatic or visceral) if the sustaining mechanisms are related to ongoing tissue pathology, or neuropathic when pain is associated with injury to neural tissues. The mechanism by which tumours produce pain include obstruction of lymphatic and vascular channels, distension of a hollow viscous, oedema and tissue inflammation or necrosis. Injury to tissues results in the local release of numerous chemicals that mediate transmission of pain stimulus. Cancer pain syndromes result from one or more of three fundamental causes; direct tumour involvement of tissues, cancer-directed therapy, and mechanisms unrelated to cancer or its treatment. Cancer pain syndromes are also classified as acute or chronic. Cancer pain characteristics provide some of the data essential for syndrome identification. These characteristics include intensity, quality, distribution and temporal relationships. The principles of tumour-directed pain control include modifying the source of pain by treating the cancer and the inflammatory response to cancer, altering the central perception of pain and interfering with nociceptive transmission within the central nervous system.

Postoperative patient-controlled analgesia with intravenous tramadol, intravenous fentanyl, epidural tramadol and epidural ropivacaine+fentanyl combination.

PURPOSE: The aim of this study was to compare the effects of IV tramadol, IV fentanyl, epidural tramadol, and an epidural ropivacaine+fentanyl combination in patient-controlled analgesia (PCA) after lower abdominal surgery. METHODS: Eighty adult patients undergoing lower abdominal surgery were randomly allocated to one of four groups to receive analgesics with PCA pumps. Patients in group I received IV tramadol, group II patients IV fentanyl, group III patients epidural tramadol, and group IV patients an epidural infusion of 0.125% ropivacaine + 2 microg ml(-1) fentanyl combination. Analgesic effectiveness and side-effects were assessed at 1, 2, 3, 4, 5, 6, 8, 12, 16, 20, and 24 hours after surgery. RESULTS: Adequate analgesia was achieved in all groups. The analgesia was highest in group IV (p < 0.05), and lowest in group III patients (p < 0.05). Eleven patients (55%) in group I and eight patients (40%) in group II suffered from nausea/vomiting. CONCLUSION: Although adequate pain relief was achieved with all regimens that were used in the study, intravenous tramadol and intravenous fentanyl are associated with a high incidence of nausea and vomiting.

Absence of bacterial growth in the culture from the epidural catheter of a patient with endometrial carcinoma and febrile neutropenia: a case report and review of the literature.

Infection is a potentially serious complication of long-term epidural (EP) catheterization in cancer patients. Although the use of epidural opioid analgesia is an effective and safe means for pain relief in terminally ill patients, these patients are in need of monitorization for possible infection. This is the first report in which EP catheter cultivation has been assessed in an immunocompromised and febrile neutropenic endometrial cancer patient.

Protein C inhibitor and serum amyloid A in immune thrombocytopaenic purpura.

In immune thrombocytopaenic purpura (ITP), phagocytic cells prematurely destroy platelets opsonized by anti-platelet auto-antibodies, while residual platelets rescued from these autoimmune attacks are hyperfunctioning. The exact pathobiological basis of this phenomenon is unknown. Protein C inhibitor (PCI), a platelet alpha-granule pro-coagulant molecule, is released on activation of platelets. Serum amyloid A (SAA; an acute phase protein), however, inhibits platelet aggregation and modulates platelet adhesion. We aimed to assess circulating soluble plasma PCI and SAA concentrations in 17 patients with newly diagnosed ITP and ten healthy volunteers. Plasma PCI concentrations tended to be higher in ITP patients, despite absolute thrombocytopaenia, than in normal controls. SAA levels were significantly higher in ITP patients compared with the control group. We conclude that secretion of the alpha-granule PCI content of platelets could result from platelet activation, and that PCI may be the link between platelet microparticles and haemostatically active ITP platelets. Increased concentrations of SAA and PCI may interfere with the disordered and compensatory pro-coagulant mechanisms of ITP.

Plasma thrombospondin in immune thrombocytopenic purpura.

Patients with immune thrombocytopenic purpura (ITP) rarely suffer life-threatening haemorrhages despite significant thrombocytopenia, probably because large numbers of hyperfunctioning platelets are present. Thrombospondin is a platelet alpha-granule protein and its plasma level may reflect platelet activation. We assessed circulating thrombospondin levels in 12 newly diagnosed ITP patients (one man; 11 women, aged 36 +/- 16 years) before they were treated for ITP. Twelve healthy people (four men; eight women, aged 31 +/- 11 years) acted as controls. Plasma thrombospondin concentrations were measured using enzyme-linked immunoassays. Thrombospondin concentrations tended to be higher, despite thrombocytopenia, in ITP patients (158.8 +/- 28.2 ng/ml) compared with controls (120.7 +/- 18.2 ng/ml). The difference was not statistically significant, but the relatively high circulating thrombospondin concentrations we observed suggest that residual platelets could be activated in ITP, thus indicating a more benign clinical course compared with aplastic thrombocytopenia.

The effect of delivery on umbilical arterial cord blood gases and lipid peroxides: comparison of vaginal delivery and cesarean section.

Umbilical arterial blood gas analysis is the most objective method to assess fetal well being at birth, is the gold standard assessment of uteroplacental function and fetal oxygenation/acid-base status at birth, and it excludes the diagnosis of birth asphyxia in approximately 80% of depressed newborns at term. This study was designed to determine the effect of the type of delivery on umbilical cord blood gases and on free radical activity together with antioxidation in the fetus. Ninety-six pregnant women between 37 and 42 weeks of gestation were included to the study and randomly assigned to the one of three groups: Group 1 (n = 40) were vaginally delivered, Group 2 (n = 26) had cesarean section with epidural anaesthesia, and Group 3 (n = 30) had cesarean section under general anaesthesia. Umbilical artery blood gas analysis was performed just after the delivery of the fetus together with melondealdehyde and glutathione. The umbilical arterial PO2 was found to be higher in Group 3, and malondealdehyde and glutathione levels were lower in newborns of Group 2. It can be concluded that cesarean section with epidural anaesthesia is safer when lipid peroxides are concerned.

Determination of serum B12 vitamin and folic acid levels in patient with stroke.

The aim of this study is to evaluate whether any relationship between stroke and vitamin B12, folic acid concentration. We examined 50 patients with stroke (male: 26 and female: 24) aged between (mean +/- SD, year) 59 +/- 14 and 16 control subjects (male: 6 and female: 10) aged between (mean +/- SD, year) 53 +/- 11. Patients were classified into two groups as infarct and hemorrhagic by using Computerised Brain Tomography and Cranial Nuclear Magnetic Resonance Imaging techniques. The percentage of patients with infract was 47.5% in female and 52.5% in male while it was 40% in female and 60% in male with hemorrhagic. The vitamin B12 levels of patients with infarct, hemorrhagic and control group were found as mean +/- SEM, 355 +/- 47 pg/ml, 313 +/- 58 pg/ml, 1569 +/- 258 pg/ml and folic acid levels 13.4 +/- 2.6 ng/ml, 7.7 +/- 1.0 ng/ml, 14.8 +/- 4.0 ng/ml, respectively. The significant difference was found between subgroups of patients with stroke and control group in both folic acid and B12 vitamin levels (p < 0.001 and p < 0.0001, respectively). But, there was no significant difference between vitamin B12 and folic acid levels of patients with hemorrhagic and infarct. In order to well understand the effects of these vitamin in patients with stroke, more detailed follow up studies with long period are needed.

Does circumcision have a relationship with ejaculation time? Premature ejaculation evaluated using new diagnostic tools.

The aim of the study is to investigate whether there is an effect of adult circumcision on ejaculation parameters and to research the relationship between intravaginal ejaculation latency time (IELT) and premature ejaculation diagnostic tool (PEDT). Adults who underwent voluntary circumcision between September 2010 and November 2011 were enrolled in this prospective study. The IELT before and 3 months following circumcision was recorded. Also, PEDT was filled out before and 3 months after circumcision. During statistical evaluation, the comparison of situations before and after circumcision was made using IELT averages and PEDT total scores. Furthermore, the correlation between changes in IELT and PEDT has also been evaluated. A total of 30 volunteers (mean age 21.25±0.44) were enrolled in the study. The volunteers' mean and median IELT before were 104.36±66.21 and 88 (26-307) seconds, whereas mean and median IELT after circumcision were 123.56±54.44 and 107.5 (67-300) seconds, respectively. The increase after circumcision was statistically significant (P=0.001). The mean and median PEDT score were 4.26±2.91 and 3 (1-12) before, and 2.63±1.82 and 2 (0-7) after circumcision. Improvement was statistically significant (P<0.0001). No correlation could be found between ejaculation time and PEDT scores. Circumcision during adulthood does not adversely affect ejaculatory function; it may slightly improve. However, it could not be interpreted as a justification for circumcision in men with premature ejaculation (PE).

Dexamethasone added to levobupivacaine in ultrasound-guided tranversus abdominis plain block increased the duration of postoperative analgesia after caesarean section: a randomized, double blind, controlled trial.

OBJECTIVES: When added to local anaesthetics, dexamethasone can prolong the duration of peripheral blocks. Dexamethasone has a long and efficient glucocorticoid structure and presents anti-inflammatory properties. The aim of this study was to determine the effect of dexamethasone on the block duration added to levobupivacaine used for transversus abdominis block (TAP) applied to patients who underwent caesarean section. PATIENTS AND METHODS: Forty-two patients with spinal anaesthesia in an American Society of Anesthesiologists (ASA) I-II risk group were included in the study and divided into two groups. Bilateral 30 ml 0.25% levobupivacaine and 2 ml 0.9% NaCl for the levobupivacaine group and bilateral 30 ml 0.25% levobupivacaine and 2 ml dexamethasone (8 mg) for the dexamethasone group were administered in a TAP block performed with ultrasonography. The time need for the first analgesic in the postoperative period was recorded. The numeric evaluation scale, and the total additional analgesic amounts were recorded. RESULTS: The time before the administration of the first additional analgesic dose was prolonged significantly in the dexamethasone group compared to the levobupivacaine group (p = 0.004). The pain scores were lower in the dexamethasone group for superficial pain. A significant difference for the dexamethasone group was observed in the evaluation of deep pain. The total consumption of tramadol was significantly lower in the dexamethasone group (p = 0.001). CONCLUSIONS: The utilization of dexamethasone, which has a prolonging effect on the transversus abdominis plane block, may be an alternative to epidural opioid analgesia in caesarean section. We observed that dexamethasone added to levobupivacaine in a TAP block applied for analgesia following a caesarean section procedure prolonged the time required for analgesia.

Antiemetic effects of dexamethasone and ondansetron combination during cesarean sections under spinal anaesthesia.

BACKGROUND: Nausea and vomiting are frequently seen in patients undergoing cesarean section (CS) under regional anesthesia. We aimed to compare the antiemetic efficacy of ondansetron and dexamethasone combination with that of the use of each agent alone to decrease the incidence of post-delivery intraoperative nausea and vomiting (IONV) during CS under spinal anesthesia. OBJECTIVE: To compare the antiemetic efficacy of ondansetron and dexamethasone combination with that of the single use of each agent to decrease the incidence of postdelivery IONV during CS under spinal anesthesia. METHODS: A randomized, prospective, double blind study was performed on 90 patients undergoing planned CS under spinal anesthesia. Patients received 4mg ondansetron in Group O, 8mg dexamethasone in GroupD, 4mg ondansetron+8mg dexamethasone in Group OD intravenously within 1-2 minutes after the umbilical cord was clamped. Frequency of postdelivery IONV episodes was recorded. RESULTS: A total of 86 eligible patients were included in the study. There were 29 patients in Group O, 29 patients in Group D and 28 patients in Group OD. There were no statistically significant difference between the groups in terms of baseline characteristics and intraoperative managements. Frequency of intraoperative nausea, retching and vomiting experiences were similar between the groups (p>0.05). CONCLUSION: Single dose 4mg ondansetron, 8mg dexamethasone, or combined use of 8mg dexamethasone+4mg ondansetron, given intravenously is all effective agents for the control of postdelivery IONV. Combined use of dexamethasone and ondansetron for the same indication does not seem to increase the antiemetic efficacy.

[A different approach to the percutaneous nephrostomy by urologists]. / Un abordaje diferente a la nefrostomía percutánea por urólogos.

INTRODUCTION: Percutaneous nephrostomy (PCN) tube placement is generally performed in radiologic departments worldwide. However, there are a few urologist-directed studies about PCN performed with ultrasound guidance. Needle direction using a convex abdominal ultrasound probe might be difficult in unexperienced hands. In order to perform this procedure easily, we propose that a probe placed on flank or intercostal region and a long grooved needle director that never allows needle movement would be useful. We considered a transrectal ultrasound (TRUS) probe was suitable to resolve this issue. MATERIAL AND METHOD: From January 2007 to April 2011, a total of 113 percutaneous renal access (PRA) were performed using a TRUS probe in 102 patients, aged 20 to 84 years old. Because of the insufficient imaging capability of the TRUS probe in obese patients whose body mass index (BMI) greater than 30kg/m(2) were excluded. Forty two PRA were performed under local anesthesia and this group was named local anesthesia (LA) group. Seventy one PRA were performed for nephrostomy insertion under local anesthesia supplemented by deep sedation and this cluster was named deep sedation (DS) group. RESULTS: Targeted calyx puncture and guide wire placement was performed in all patients (100%) but success rate of tube insertion in each group was different. Successful PCN insertion rate was 69.1% (29 of 42 cases) in LA group and 95.8% (68 of 71 cases) in DS group. No major vascular injury and/or adjacent organ injury to bowel, liver, spleen or lung was seen in any patient. CONCLUSION: Guidance of TRUS probe, deep sedation, and modified dilators may offer a high success rate to the urologists with little experience in PCN insertion which they would find it difficult to perform.