Outcome groups and a practical tool to predict success of shock wave lithotripsy in daily clinical routine.

PURPOSE: To improve outcome prediction of extracorporeal shock wave lithotripsy (SWL) by development of a model based on easily available clinical and radiographical predictors and suitable for daily clinical use. MATERIALS AND METHODS: We evaluated predictive factors for SWL success in 517 consecutive patients suffering from urinary calculi who underwent SWL between 2010 and 2018. Analyses included descriptive statistics, receiver operating characteristic statistics and logistic regression. Predictive value was improved by combining parameters using model selection and recursive partitioning. RESULTS: Of the 517 patients, 310 (60.0%) had a successful SWL. Best individual predictor of SWL success was mean attenuation (MAV), with an area under the curve (AUC) of 0.668, and an optimal cutpoint (OC) of 987.5 HU. The best multivariable model, including MAV, stone size, skin to stone distance (SSD), presence of an indwelling stent, and four interaction effects, yielded an AUC of 0.736. Recursive partitioning would categorize patients into three outcome groups with high (76.9%), intermediate (41%) and low (10%) success probability. High probability of SWL success (76.9%) was found for patients with a stone with MAV ≤ 987 HU or with MAV > 987 HU but stone size ≤ 11 mm and SSD (45°) ≤ 88 mm. CONCLUSION: A model based on four established predictors, and provided as an Excel®-Tool, can clearly improve prediction of SWL success. In addition, patients can be classified into three defined outcome groups based on simple cutpoint combinations. Both tools improve informed decision-making in daily clinical practice and might reduce failure rates.

[A (new) revolution in the treatment of benign prostatic hyperplasia? Aqua-ablation and prostate embolization]. / (Wieder) eine Revolution in der Therapie des benignen Prostatasyndroms? Aquaablation und Prostataembolisation.

Surgical treatment of benign prostatic obstruction (BPO) is one of the most common procedures in urology. Numerous alternative methods have been developed in recent years to overcome the potential limitations of transurethral resection of the prostate (TURP) while providing comparable effectiveness and less morbidity. In a randomized study with a currently available follow-up of 3 years, the Aquabeam® system has shown comparable functional results with a lower rate of adverse events compared to TURP. Sufficient functional results were also found in a cohort study in patients with prostate volumes up to 150 ml. However, the rate of transfusions raises the question of optimal coagulation. Further cohort studies with short-term follow-up confirmed the results of the randomized studies. Prostate artery embolization (PAE) has been compared to TURP in several randomized trials. In randomized studies, the reduction of BPO-associated symptoms after PAE is only slightly inferior to that after TURP. In contrast, the improvement of functional parameters after embolization is inferior to that after TURP. This is primarily due to the inferior desobstruction. In addition, long-term results from randomized studies are lacking, so that no final assessment has yet been possible with regard to the durability of the desobstruction. In summary, both Aquabeam® and PAE are potential alternatives to standard methods, which-in case of adequate patient selection-can supplement the operative armamentarium in the wider concept of an individualized therapy of BPO.

[Novel surgical techniques for treatment of benign prostatic hyperplasia]. / Neue operative Techniken zur Therapie des benignen Prostatasyndroms.

In recent years new surgical techniques to treat benign prostatic hyperplasia have been introduced into urological practice and evaluated in clinical studies. Complications of standard procedures, e.g. transurethral resection of the prostate (TURP), can be avoided while maintaining equivalent clinical outcomes. The main goal is preservation of erectile and ejaculatory function. Furthermore, outpatient treatment associated with a rapid patient recovery would be desirable. This article presents the course of the interventions, the mechanisms of action and current clinical evidence for novel mechanical approaches of recanalization, water-based ablation as well as prostate artery embolization. Initial study results partially indicate that in the future practically all patients can be offered an individualized surgical technique, which provides optimal symptomatic and functional improvements with a minimized risk of complications.

Advanced non-contrasted computed tomography post-processing by CT-Calculometry (CT-CM) outperforms established predictors for the outcome of shock wave lithotripsy.

OBJECTIVES: To evaluate the predictive value of advanced non-contrasted computed tomography (NCCT) post-processing using novel CT-calculometry (CT-CM) parameters compared to established predictors of success of shock wave lithotripsy (SWL) for urinary calculi. MATERIALS AND METHODS: NCCT post-processing was retrospectively performed in 312 patients suffering from upper tract urinary calculi who were treated by SWL. Established predictors such as skin to stone distance, body mass index, stone diameter or mean stone attenuation values were assessed. Precise stone size and shape metrics, 3-D greyscale measurements and homogeneity parameters such as skewness and kurtosis, were analysed using CT-CM. Predictive values for SWL outcome were analysed using logistic regression and receiver operating characteristics (ROC) statistics. RESULTS: Overall success rate (stone disintegration and no re-intervention needed) of SWL was 59% (184 patients). CT-CM metrics mainly outperformed established predictors. According to ROC analyses, stone volume and surface area performed better than established stone diameter, mean 3D attenuation value was a stronger predictor than established mean attenuation value, and parameters skewness and kurtosis performed better than recently emerged variation coefficient of stone density. Moreover, prediction of SWL outcome with 80% probability to be correct would be possible in a clearly higher number of patients (up to fivefold) using CT-CM-derived parameters. CONCLUSIONS: Advanced NCCT post-processing by CT-CM provides novel parameters that seem to outperform established predictors of SWL response. Implementation of these parameters into clinical routine might reduce SWL failure rates.

Frequency of dermatological side effects of continuous subcutaneous insulin infusion in children and adolescents with type 1 diabetes.

BACKGROUND: The incidence of type 1 diabetes is rising, particularly in young infants. The treatment with continuous subcutaneous insulin infusion (CSII) offers certain benefits and has gained popularity. Insulin-pump therapy could be associated with cutaneous-adverse effects. The purpose of our study was to investigate the frequency and characterization of skin-related complications in patients with CSII. METHODS: In a single center setting, 54 patients (28 male, 26 female) on CSII therapy aged between 3 and 20 years participated in our study. Data including duration of diabetes, duration of CSII, pump model, catheter material, frequency of catheter switch and hygiene procedures at time of puncture were collected through a standardized questionnaire and photographs of affected areas of the skin were made. Statistical analysis was done to verify an association with gender, patients' age, HbA1c values, and body mass index. RESULTS: Our observation revealed skin complications at the site of catheter insertion in 43% (8 f, 15 m) of our patients. A frequent occurrence of scars (24%, 6 f, 7 m), lipohypertrophic areas (20%, 4 f, 7 m) and eczema (11%, 1 f, 5 m) was observed. Furthermore, 6% (1 f, 2 m) showed changes in pigmentation and 6% (1 f, 2 m) lipoatrophy. The catheter localization had to be switched due to skin-complications in 24% (6 f, 7 m) whereas none of our patients discontinued insulin-pump therapy. CONCLUSION: Skin-related complications during CSII are frequent and regular examination of the insertion sites is crucial. To verify the occurrence of lipoatrophy associated with insulin pump therapy - an otherwise rare complication - larger studies would be needed.

A lithospheric instability origin for Columbia River flood basalts and Wallowa Mountains uplift in northeast Oregon.

Flood basalts appear to form during the initiation of hotspot magmatism. The Columbia River basalts (CRB) represent the largest volume of flood basalts associated with the Yellowstone hotspot, yet their source appears to be in the vicinity of the Wallowa Mountains, about 500 km north of the projected hotspot track. These mountains are composed of a large granitic pluton intruded into a region of oceanic lithosphere affinity. The elevation of the interface between Columbia River basalts and other geological formations indicates that mild pre-eruptive subsidence took place in the Wallowa Mountains, followed by syn-eruptive uplift of several hundred metres and a long-term uplift of about 2 km. The mapped surface uplift mimics regional topography, with the Wallowa Mountains in the centre of a 'bull's eye' pattern of valleys and low-elevation mountains. Here we present the seismic velocity structure of the mantle underlying this region and erosion-corrected elevation maps of lava flows, and show that an area of reduced mantle melt content coincides with the 200-km-wide topographic uplift. We conclude that convective downwelling and detachment of a compositionally dense plutonic root can explain the timing and magnitude of Columbia River basalt magmatism, as well as the surface uplift and existence of the observed melt-depleted mantle.

Monte Carlo calculation of the efficiency calibration curve and coincidence-summing corrections in low-level gamma-ray spectrometry using well-type HPGe detectors

Well-type high-purity germanium (HPGe) detectors are well suited to the analysis of small amounts of environmental samples, as they can combine both low background and high detection efficiency. A low-background well-type detector is installed in the Modane underground Laboratory. In the well geometry, coincidence-summing effects are high and make the construction of the full energy peak efficiency curve a difficult task with an usual calibration standard, especially in the high energy range. Using the GEANT code and taking into account a detailed description of the detector and the source, efficiency curves have been modelled for several filling heights of the vial. With a special routine taking into account the decay schemes of the radionuclides, corrections for coincidence-summing effects that occur when measuring samples containing 238U, 232Th or 134Cs have been computed. The results are found to be in good agreement with the experimental data. It is shown that triple coincidences effect on counting losses accounts for 7-15% of pair coincidences effect in the case of 604 and 796 keV lines of 134Cs.

Development of a perioperative nursing diagnoses flow sheet.

Traditionally, health care professionals in the preoperative, intraoperative, and postoperative phases of care have used perioperative records that focus on the technical aspects of the care provided (eg, blood pressure, pulse measurements; equipment used) and leave room for only short narratives to document nursing care. Such formats often do not document the multitude of activities or interventions perioperative nurses provide. The question raised at the DePaul Health Center, St Louis, was: "Where do we document our nursing diagnoses and plan of care?" The response was to create a nursing diagnosis task force that investigated the feasibility of a form professional nurses could use in all phases of patient care. This investigation led to the development, implementation, and universal use of a perioperative nursing diagnoses flow sheet within the surgical services department.

Pathologic Cuticular Changes of Winter Impoundment Shell Disease Preceding and During Intermolt in the American Lobster, Homarus americanus.

Cuticular lesions from twenty-four market sized lobsters (Homarus americanus) with winter impoundment shell disease were examined. Histological descriptions of cuticular lesions were correlated with the substage of molt for each lobster, because cuticle components and inflammatory mechanisms vary in each. A lesion severity grading system was developed and applied to four specific substages of the five-stage (A-E) molting cycle. Lesions present in substage C4, in which the membranous layer is deposited, and D0 (passive premolt) were divided into five grades, ranging from mild erosions (Grade I) to severe ulceration (Grade V) of the cuticle. Cuticular lesions from lobsters in C4/D0 were compared with cuticular lesions from lobsters in substages C2/C3. Defensive mechanisms exhibited by animals in all substages were epicuticle deposition, melanization, inflammatory cell infiltration, and pseudomembrane formation. In addition, animals in C4 and D0 showed proliferation of the membranous layer in affected foci. The lesion grading scheme presented in this paper can be used to describe and compare both inter- and intraspecies crustacean shell lesions.

Effect of separating bull semen into X and Y chromosome-bearing fractions on the sex ratio of resulting embryos.

Seventy-six, day 12 to day 15 bovine embryos, collected from 14 donors which had been inseminated with either X or Y chromosome-bearing spermatozoa fractions of semen separated by a thermal convection counterstreaming sedimentation and forced convection galvanization process, were processed for sexing by chromosomal analysis. Fifty-seven embryos were sexed; 20 from Y chromosome-bearing and 37 from X chromosome-bearing fractions of semen. Statistical analysis of the sexing data indicated that there was no significant difference in the male: female ratio for donors receiving male fractions compared to those receiving female fractions. The Y chromosome-bearing fractions produced a male: female ratio that was indistinguishable from the expected 1:1 ratio. However, the X chromosome-bearing fractions of semen produced a highly significant deviation from the expected 1:1 ratio towards the male.

Persistent lymphocytosis in cattle: its cause, nature and relation to lymphosarcoma.

Studies in well-characterized cattle populations strongly support the view that the bovine leukemia virus (BLV) is the causative agent of the adult (enzootic) form of bovine lymphosarcoma and persistent lymphocytosis (PL), and that host genetic factors play an important role in the development of these two conditions. On the other hand, the available information indicates that the genetic factors controlling the development of PL are frequently independent of those controlling the development of lymphosarcoma. There is no evidence that clinically normal cattle with PL harbor malignant cells or have any other clinical abnormality. In these animals lymphocytosis results from the expansion of two distinct subpopulations of non-neoplastic B lymphocytes, one of which is free of BLV. Long-term studies have shown that the large majority of cattle with PL do not develop lymphosarcoma even when kept to advanced age. These data indicate that PL is not a disease nor a preclinical stage of lymphosarcoma. Rather PL should be considered as a benign response to BLV infection which, although frequently associated with lymphosarcoma, is independant of it.

Results of surgical treatment in 65 dogs with osteosarcoma.

Clinical and necropsy findings were obtained from case records for 65 dogs treated surgically for osteosarcoma at the University of Pennsylvania Small Animal Hospital between July, 1952, and July, 1973, inclusive. The median age of the dogs was 6 years. There were 39 males and 26 females. All but 5 of the 65 dogs weighed more than 16 kg. Sixty-two of the osteosarcomas arose from the limbs and 3 from the ribs. The median duration of presurgical clinical signs was 6 weeks, with a range of 1 day to 24 weeks. There were no statistical correlations between the postsurigical survival times and the age, sex, or breed of the dog, the site of the osteosarcoma, or the duration of the presurgical clinical signs. Of the 40 dogs with known lung metastases, 11 also had hypertrophic pulmonary osteoarthropathy. The median survival time was 18 weeks, with a range of 3 to greater than 578 weeks. Twenty-six percent were alive 6 months potoperatively, 13.8% were still alive at 9 months, and 10.7% survived more than 1 year. The total median duration of the disease was 24 weeks (range, 8 greater than 578 weeks).

Serological diagnosis of infection with the putative bovine leukemia virus.

We report on an accurate, rapid and inexpensive test for the identification of animals infected with the Bovine C-type virus (BLV). The test involves the detection of serum antibodies to BLV using the immunofluorescent (IF) technique on acetone-fixed, infected cells. The specificity of the test was demonstrated by the fact that virus was found by electron microscopy in 90% of cattle showing positive reactions. In contrast, virus was not found despite extensive examination in antibody negative animals. Thus, the presence of IF antibody is an accurate indicator of current rather than past BLV infection. In order for the IF test to be specific it is of critical importance that the target cells used are infected only with BLV. BLV antibodies can also be detected by the immunoprecipitation (Ouchterlony) technique. However, a significant proportion of BLV infected animals showing positive reactions in the IF test failed to show precipitin antibodies to the virus. Likewise, BLV infection was demonstrated by both the IF test and electron microscopy in many animals with persistently normal levels of blood lymphocytes. Thus, neither the precipitin test nor the blood lymphocyte count (Bendixen's key) can be used to rule out BLV infection.

Seroepidemiological evidence for horizontal transmission of bovine C-type virus.

Thirty colostrum-deprived calves from leukemia-free herds were foster nursed for 10 weeks on cows infected with bovine C-type virus (BLV) from multiple-case herds or on cows from leukemia-free herds. After weaning, the calves were raised in continuous contact with BLV-infected animals of approximately the same ages. Sera collected at 6 to 18 and 43 to 48 months of age were examined for the presence of antibodies to BLV by the immunofluorescent antibody test. At 6 to 18 months of age, only 1 of the 30 calves from leukemia-free herds had a detectable antibody response to BLV. By 43 to 48 months of age the number of antibody-positive animals had risen to 17. The foster dam's herd of origin did not significantly affect the rate of BLV infection. These results indicate that BLV can be horizontally transmitted from infected to noninfected animals.

Further studies on the antigenic properties and distribution of the putative bovine leukemia virus.

The C-type viruses found in long-term cultures. New Bolton Center (NBC) cell lines, of peripheral lymphocytes from leukemic cattle and in short-term cultures of bovine buffy coat(BC) cells share an immunofluorescent(IF)antigen detected in the cytoplasm of infected cells as well as an antigen demonstrable in gel diffusion experiments. Therefore the viruses from these cultures most likely represent different isolates of the putative bovine leukemia virus (BLV). The BLV precipitin antigen is analogous to the group specific (gs) antigens of the leukemia viruses of other species in that it is soluble, ether resistant, and apparently located within the virion. These observations, together with results showing that the specificity of the BLV precipitin antigen differs from that of the gs antigen of other mammalian leukemia viruses, indicate that the former antigen represents the intraspecies (gs-1) determinant of BLV. Antibodies to the precipitin viral antigen were found in 82% of cattle with leukemia and in 40% of clinically normal adult cattle in multiple-case herds. These groups of animals also had fluorescent antibodies to the virus, but with significantly higher frequencies (100% and 76%, respectively). On the other hand, in leukemia-free herds, precipitating antibodies were not found and the incidence of fluorescent antibodies was only 3%.