Ureteral stricture rate after endoscopic treatments for urolithiasis and related risk factors: systematic review and meta-analysis.

PURPOSE: We aimed to accurately determine ureteral stricture (US) rates following urolithiasis treatments and their related risk factors. METHODS: We conducted a systematic review and meta-analysis following the PRISMA guidelines using databases from inception to November 2023. Studies were deemed eligible for analysis if they included ≥ 18 years old patients with urinary lithiasis (Patients) who were subjected to endoscopic treatment (Intervention) with ureteroscopy (URS), percutaneous nephrolithotomy (PCNL), or shock wave lithotripsy (SWL) (Comparator) to assess the incidence of US (Outcome) in prospective and retrospective studies (Study design). RESULTS: A total of 43 studies were included. The pooled US rate was 1.3% post-SWL and 2.1% post-PCNL. The pooled rate of US post-URS was 1.9% but raised to 2.7% considering the last five years' studies and 4.9% if the stone was impacted. Moreover, the pooled US rate differed if follow-ups were under or over six months. Patients with proximal ureteral stone, preoperative hydronephrosis, intraoperative ureteral perforation, and impacted stones showed higher US risk post-endoscopic intervention with odds ratio of 1.6 (P = 0.05), 2.6 (P = 0.009), 7.1 (P < 0.001), and 7.47 (P = 0.003), respectively. CONCLUSIONS: The overall US rate ranges from 0.3 to 4.9%, with an increasing trend in the last few years. It is influenced by type of treatment, stone location and impaction, preoperative hydronephrosis and intraoperative perforation. Future standardized reporting and prospective and more extended follow-up studies might contribute to a better understanding of US risks related to calculi treatment.

Comparative analysis of robot-assisted simple prostatectomy: the HUGO™ RAS system versus the DaVinci® Xi system.

BACKGROUND: Robot-Assisted Simple Prostatectomy (RASP) has emerged as a promising alternative in the treatment of benign prostatic obstruction (BPO). However, there is currently a lack of comparative studies evaluating different robotic platforms for performing RASP. Therefore, we aimed to compare perioperative and functional outcomes of RASP performed using the HUGO™ RAS System versus the DaVinci® Xi System. METHODS: Forty consecutive cases of RASP performed between May 2021 and March 2023 with the HUGO™ RAS and the DaVinci® Xi at OLV Hospital (Aalst, Belgium) were included in this retrospective study. All surgeries were performed by three experienced surgeons using the same approach. Baseline characteristics, peri-operative and functional outcomes were collected and compared between the two groups. RESULTS: The population was equally divided between the two groups with 20 patients in each group. There were no significant differences in preoperative patient characteristics between the two groups, except for the presence of bladder stones prior to the surgery (p = 0.03). No significant differences in total operative time and console time between the two groups were reported (p = 0.3). No cases required conversion to open surgery or additional port placement. During one case performed with the HUGO™ RAS, a malfunctioning monopolar curved shear had to be replaced. However, there was no statistically significant differences in terms of technical robotic problems between the groups (p = 0.3). There was no significant difference between the two groups in perioperative and functional outcomes (all p ≥ 0.2). CONCLUSIONS: We did not observe any statistically significant difference in perioperative and functional outcomes in case of RASP performed with the HUGO™ RAS System and with the DaVinci® Xi System. These findings provide compelling support for considering the HUGO™ RAS as a promising tool for robot-assisted procedures, thereby expanding the utilization of robotics for benign conditions.

Platelet-rich plasma injections for chronic plantar fasciopathy: a systematic review.

INTRODUCTION: There is an increasing interest in platelet-rich plasma (PRP) injection as a treatment for chronic plantar fasciopathy (PF). We wished to evaluate the evidence for the use of PRP in PF/fasciitis. SOURCES OF DATA: We performed a systematic review on the effects of PRP in PF. In June 2014, we searched Medline, Cochrane, CINAHL and Embase databases using various combinations of the commercial names of each PRP preparation and 'plantar' (with its associated terms). We only included prospectively designed studies in humans. AREAS OF AGREEMENT: Eight articles met the inclusion criteria, three of them were randomized. All studies yielded a significantly greater improvement in symptoms between baseline and last follow-up assessment. None of the papers recorded major complications. AREAS OF CONTROVERSY: Only three randomized studies were identified; none of them had a true controlled group treated with placebo and one of the three studies had a very short (6 week) follow-up. A non-randomized study evaluating PRP versus corticosteroids (CCS) injections, and a randomized controlled trial comparing PRP and dextrose prolotherapy reported no statistical significant differences at 6 months. Most studies did not have a control group and imaging evaluation. GROWING POINTS AND AREAS FOR RESEARCH: Evidence for the use of PRP in PF shows promising results, and this therapy appears safe. However, the number of studies available is limited and randomized placebo-controlled studies are required. Characterizing the details of the intervention and standardizing the outcome scores would help to better document the responses and optimize the treatment.

Radiation tolerance of the rat rectum to fractionated X-rays and pi-mesons.

A 2.5 cm segment of the rectum of female F344 rats was irradiated with up to 10 fractions of X-rays or pions. Transient signs of acute proctitis were followed by chronic rectal injury starting at about 2 months. Recto-vaginal fistulas were frequently observed in animals with severe chronic injury. Two patterns of chronic injury were observed, an early type consisting of deep ulcers and fistulas, and a late type characterized by vascular injury, fibrosis and mucosal cysts. In a 4-fraction X-ray experiment, the influence of a low-residue diet was compared with a regular diet, showing no significant differences in pathology or survival. Isoeffective doses were determined for the occurrence of severe rectal injury at 250 days. Fitting the data to an LQ-model yielded an alpha/beta ratio of 13 Gy for pions, and 6.5 Gy for X-rays. Increasing the overall treatment time from 9 days to one month gave a significant rise in isoeffective doses for chronic injury. This suggests that the more delayed types of injury did not develop independently from the acute mucosal changes. The RBE of pions for rectal injury at 250 days was 1.2 for single doses, increasing to about 1.4-1.5 at a dose per fraction of 4 Gy. These values are similar to those obtained in other acute and late responding tissues.

Dosimetry comparison and characterisation of an Al K ultrasoft x-ray beam from an MRC cold-cathode source.

Ultrasoft x-rays of 0.3-5 keV have provided a unique tool for the investigation of intracellular mechanisms of radiation action in biological organisms, including mammalian cells. However, their use presents unique practical problems in dosimetry and experimental design. Detailed interpretation of the biological results requires reliable dosimetry and well characterised monoenergetic beams. This paper presents a comparison between two fundamentally different dosimetric techniques, namely the ionisation current in an extrapolation chamber and photon counts in a proportional counter. Agreement within 7% was obtained when these two methods were applied to an Al K x-ray beam (1.5 keV) from an MRC cold-cathode transmission target discharge tube as previously used in many biological experiments. Photographic film was calibrated as a relative dosimetric technique and used for investigation of the intensity uniformity of the radiation field. These techniques provide a comprehensive characterisation of the beam in the position of the biological cells, including photon flux (or absorbed dose rate), spectral purity (showing much less than 1% bremsstrahlung relative to characteristic Al x-rays) and uniformity over the irradiation area (within about 5% for mammalian cell irradiations).

Asystole during treatment with amiodarone in a patient with persistent atrial tachycardia.

During treatment with amiodarone, digoxin and nadolol, asystole occurred repeatedly in a patient with chronic persistent automatic atrial tachycardia. Asystole did not occur after discontinuation of drug therapy, and rechallenge with amiodarone alone produced marked overdrive suppression of all pacemakers resulting in asystole. Amiodarone serum level was within therapeutic range. The possible electrophysiologic mechanisms by which amiodarone might suppress both normal and abnormal pacemakers are discussed. The occurrence of asystole at therapeutic serum concentration of amiodarone suggests that this drug should be used with caution.

Preclinical studies of dynamic treatment modes in pion therapy.

Preliminary results on a system for delivering dynamic pion radiotherapy treatments are reported. The desired treatment volume is scanned across a small, focused pion beam using a computer-controlled treatment couch. A computer-controlled rangeshifting device modulates the stopping pion depth distribution in coordination with the couch motion to conform the dose to the shape of the treatment volume. For certain shaped tumors, the system can result in substantial normal tissue dose sparing and better field flatness as compared to irradiation by static treatments with broad terms. The characteristics of this new system, plus preliminary results for typical dose distributions as measured with thermoluminescent dosimeters (TLDs), are presented.

Calculation of pion dose distributions in water.

Techniques for calculating negative pion beam depth and off-axis dose distributions in a water phantom have been developed at the Clinton P. Anderson Meson Physics Facility in Los Alamos. The superposition of the unmodulated depth-dose curve produced modulated depth-dose curves. The addition of the collimator neutron dose, which has been shown to depend on field size, to the modulated depth-dose curve yields the collimated depth-dose distributions. Off-axis dose distributions under a collimator are produced by calculating the distortion of the uncollimated beam caused by multiple Coulomb scattering and beam phase space. Several comparisons of calculated and measured distributions are shown with agreement of normally +/- 3% of peak dose of +/- 3 mm for a particular dose contour. These distribution are them modified by computerized tomographic data to give patient isodose distributions.

Pulmonary stronglyoidiasis complicating therapy with corticosteroids. Report of a case with secondary bacterial infections.

We report a case of pulmonary strongloidiasis which occurred after high-dose corticosteroid therapy. Our patient responded very well to treatment with thiabendazole, despite the fact that the steroids were contined throughout his entire hospital course. Further complications included pseudomonas meningitis and Klebsiella pneumoniae pneumonia, both of which resolved with appropriate treatment.

Dose outside the treatment volume for irradiation with negative pions.

Irradiation of humans with negative pions requires a knowledge of the absorbed dose and radiation quality outside the primary pion beam. In conjunction with early clinical trials at LAMPF, experimental data have been obtained with microdosimetric techniques and multiwire proportional counters. Theoretical calculations have been made for the neutron contribution to the dose and are consistent with these data. Measurements were made with in 40 cm x 51 cm x 76 cm water phantom for a negative pion beam of initial momentum of 170 MeV/c, deltap = +/- 3MeV/c. The absorbed dose outside the treatment volume is the result of: (1) neutrons and photons from the pion interactions,(2) treatment room background and (3) peripheral muons, electrons and pions in the primary beam. The first two components are nearly isotropic and are congruent to 0.02% of the peak dose at a distance of 24 cm from the treatment volume; the third component is anisotropic and varies from 0.01 to 0.1% of the peak dose. Collimation of the bean increases the dose outside the treatment volume typically by 50%.

Polymorphism of chenodeoxycholic acid.

Polymorphism of chenodeoxycholic acid was studied by differential thermal analysis and X-ray diffraction. Four polymorphic forms (three crystalline and one amorphous) were characterized.