ABSTRACT
INTRODUCTION: Urinary lithiasis is the main urologic cause of emergency treatment in adult patient. In the past years, the incidence in children population has increased. However, literature about the use of alpha-1 adrenergic blockers in pediatric population with distal ureterolithiasis is still scarce. The drug acts by decreasing ureter contractions, especially in the distal portion, facilitating calculus expulsion. OBJECTIVE: This review has the objective to evaluate the use of alpha-1 adrenergic blockers as medical expulsive treatment in children with distal ureterolithiasis. EVIDENCE ACQUISITION: An electronic literature search was performed using the MEDLINE, COCHRANE, and LILACS databases. We further searched manually the references of the primary studies. Searches were concluded on October 4th, 2014. Articles were selected, independently and in pairs, by the respective titles and summaries. Any divergence was resolved by consensus. EVIDENCE SYNTHESIS: Alpha-1 adrenergic antagonists increased the probability of calculus expulsion by 27% (NNT=4). Calculi smaller than 5mm, increased by 33% (NNT=3). Larger than 5mm, increased by 34% (NNT=3). CONCLUSION: Alpha-1 adrenergic blocker use is related with a greater incidence of expulsion of ureteral calculi, smaller or greater than 5mm, and fewer episodes of pain when compared to ibuprofen. However it is necessary larger samples to enhance the power analysis of the expulsion of ureteral calculi larger than 5mm and the episodes of pain. PATIENT SUMMARY: This review analyzed the outcome of alpha adrenergic antagonist in children with ureteral calculi. We conclude that it is the best medicine for use, since it helps the expulsion of the stone.
Subject(s)
Adrenergic alpha-1 Receptor Antagonists/therapeutic use , Ureterolithiasis/drug therapy , Analgesics, Non-Narcotic/therapeutic use , Child , Female , Humans , Ibuprofen/therapeutic use , Male , Randomized Controlled Trials as Topic , Treatment OutcomeABSTRACT
Introduction: Urinary lithiasis is the main urologic cause of emergency treatment in adult patient. In the past years, the incidence in children population has increased. However, literature about the use of alpha-1 adrenergic blockers in pediatric population with distal ureterolithiasis is still scarce. The drug acts by decreasing ureter contractions, especially in the distal portion, facilitating calculus expulsion. Objective: This review has the objective to evaluate the use of alpha-1 adrenergic blockers as medical expulsive treatment in children with distal ureterolithiasis. Evidence Acquisition: An electronic literature search was performed using the MEDLINE, COCHRANE, and LILACS databases. We further searched manually the references of the primary studies. Searches were concluded on October 4th, 2014. Articles were selected, independently and in pairs, by the respective titles and summaries. Any divergence was resolved by consensus. Evidence Synthesis: Alpha-1 adrenergic antagonists increased the probability of calculus expulsion by 27% (NNT=4). Calculi smaller than 5mm, increased by 33% (NNT=3). Larger than 5mm, increased by 34% (NNT=3). Conclusion: Alpha-1 adrenergic blocker use is related with a greater incidence of expulsion of ureteral calculi, smaller or greater than 5mm, and fewer episodes of pain when compared to ibuprofen. However it is necessary larger samples to enhance the power analysis of the expulsion of ureteral calculi larger than 5mm and the episodes of pain. Patient Summary: This review analyzed the outcome of alpha adrenergic antagonist in children with ureteral calculi. We conclude that it is the best medicine for use, since it helps the expulsion of the stone.
Subject(s)
Child , Female , Humans , Male , Adrenergic alpha-1 Receptor Antagonists/therapeutic use , Ureterolithiasis/drug therapy , Analgesics, Non-Narcotic/therapeutic use , Ibuprofen/therapeutic use , Randomized Controlled Trials as Topic , Treatment OutcomeABSTRACT
Numerical human models for electromagnetic dosimetry are commonly obtained by segmentation of CT or MRI images and complex permittivity values are ascribed to each issue according to literature values. The aim of this study is to provide an alternative semi-automatic method by which non-segmented images, obtained by a MRI tomographer, can be automatically related to the complex permittivity values through two frequency dependent transfer functions. In this way permittivity and conductivity vary with continuity--even in the same tissue--reflecting the intrinsic realistic spatial dispersion of such parameters. A female human model impinged by a plane wave is tested using finite-difference time-domain algorithm and the results of the total body and layer-averaged specific absorption rate are reported.
Subject(s)
Algorithms , Electromagnetic Fields , Image Interpretation, Computer-Assisted/methods , Magnetic Resonance Imaging/methods , Models, Biological , Radio Waves , Radiometry/methods , Adult , Body Burden , Computer Simulation , Electric Impedance , Female , Humans , Magnetic Resonance Imaging/instrumentation , Models, Anatomic , Phantoms, Imaging , Radiation Dosage , Radiation Monitoring/methods , Relative Biological Effectiveness , Risk Assessment/methods , Risk FactorsABSTRACT
Complex permittivity values have a dominant role in the overall consideration of interaction between radiofrequency electromagnetic fields and living matter, and in related applications such as electromagnetic dosimetry. There are still some concerns about the accuracy of published data and about their variability due to the heterogeneous nature of biological tissues. The aim of this study is to provide an alternative semi-automatic method by which numerical dielectric human models for dosimetric studies can be obtained. Magnetic resonance imaging (MRI) tomography was used to acquire images. A new technique was employed to correct nonuniformities in the images and frequency-dependent transfer functions to correlate image intensity with complex permittivity were used. The proposed method provides frequency-dependent models in which permittivity and conductivity vary with continuity--even in the same tissue--reflecting the intrinsic realistic spatial dispersion of such parameters. The human model is tested with an FDTD (finite difference time domain) algorithm at different frequencies; the results of layer-averaged and whole-body-averaged SAR (specific absorption rate) are compared with published work, and reasonable agreement has been found. Due to the short time needed to obtain a whole body model, this semi-automatic method may be suitable for efficient study of various conditions that can determine large differences in the SAR distribution, such as body shape, posture, fat-to-muscle ratio, height and weight.