A comparison between an in vitro ureteroscopic stone size estimation and the stone size measurement with the help of a scale on stone baskets.

INTRODUCTION: Endoscopic treatment of ureter stones and renal calculi relies on the surgeon's estimation of the stone size for both lithotripsy and removal of stones or stone fragments. We therefore compared precision and reliability of the endoscopic estimation of stone size by the surgeon with measurements on a scale on a stone basket. MATERIALS AND METHODS: Two surgeons (one high experienced and one low experienced) first estimated, then measured the size of 12 stones differing in size and color using different stone baskets (2.5, 3.0, 4.0 Ch) each via a semirigid renoscope in an artificial ureter under water repeatedly on two different days. All together, we had 288 measurements and 288 estimations. RESULTS: On the whole, the accuracy of the estimation diminished with bigger stones. There is an increasing underestimation with increasing stone size. Factors, which significantly influence the estimation, are the operating surgeon, the color of the stone, the time sequence, and the size of the closed basket, which was held beside the stone. The accuracy of the measurement of the stone baskets is not as good as the estimation. The small 2.5-Ch basket is the most accurate in measuring big stones (>6 mm), the 3.5 Ch in intermediate stones (3-6 mm), the big basket (4.0 Ch) in small stones (<3 mm). CONCLUSION: This first attempt at validation of a scale on stone baskets shows different results for each basket which could be systematically improved. Until now, the estimation of the surgeons is better than the measurement, but it is also influenced by factors like the surgeon or the color of the stone.

Impact of childhood trauma on hypothalamus-pituitary-adrenal axis activity in alcohol-dependent patients.

AIMS: Studies in animals and humans suggest that early life stress alters hypothalamus-pituitary-adrenal (HPA) axis activity. The same alterations are related to the symptoms and course of alcohol dependence. This study examined relationships between childhood trauma and HPA axis activity in alcohol-dependent patients controlling for psychopathology and characteristics of dependence. METHODS: Thirty-eight consecutive patients (42% female) were examined at admission to detoxification (t1) and 14 days later (t2). Morning plasma levels of cortisol and adrenocorticotropin-releasing hormone (ACTH) were determined. Participants completed the Childhood Trauma Questionnaire (CTQ) and measures of anxiety, depression, and posttraumatic stress disorder. RESULTS: Sexual abuse was related to higher levels of cortisol during acute withdrawal (r = 0.38, p = 0.02). Levels of ACTH were negatively correlated with the CTQ total score (t2: r = -0.42, p < 0.01), emotional abuse (t2: r = -0.33, p = 0.04), emotional neglect (t2: r = -0.33, p = 0.04), and physical neglect (t2: r = -0.33, p = 0.05) controlling for psychopathology and characteristics of dependence. CONCLUSIONS: Our findings suggest, that childhood trauma is related to blunted ACTH and increased cortisol during withdrawal in alcohol-dependent patients. Early life stress might be a confounding variable in studies of HPA function in alcohol dependence and future studies should examine potential clinical consequences of these relationships.