Aplicaciones clínicas, experimentales y resultados del uso de diferentes dispositivos de aspiración en la cirugía intrarrenal retrógrada. Revisión sistemática / Experimental and clinical applications and outcomes of using different forms of suction in retrograde intrarenal surgery. Results from a systematic review

Objetivo Identificar los últimos avances en los dispositivos de aspiración para la cirugía retrógrada intrarrenal (CRIR) y la ureteroscopia en el tratamiento de la litiasis, y evaluar los resultados de su aplicación. Procedimiento El 4 de enero de 2023 se realizó una búsqueda bibliográfica sistemática en Scopus, PubMed y EMBASE. Solo se incluyeron artículos en inglés; se aceptaron estudios en la población pediátrica y estudios en adultos. Se excluyeron los estudios duplicados, los informes de casos, las cartas al editor y los resúmenes de congresos. Hallazgos principales Se seleccionaron 21 trabajos. Se han propuesto varios sistemas de aspiración para la CRIR: a través de la vaina de acceso ureteral o directamente por el endoscopio. La inteligencia artificial también puede desempeñar un papel, monitorizando los valores de la presión y del flujo de irrigación. Todas las técnicas propuestas mostraron resultados perioperatorios satisfactorios en cuanto a tiempo quirúrgico, tasa libre de cálculos (TLC) y fragmentos residuales. Además, la reducción de la presión intrarrenal (mediante la aspiración) también se asoció a una tasa de infección menor. Incluso los estudios que incluyen cálculos renales con un diámetro de 20mm o superior informan de una mayor TLC y una reducción de las complicaciones postoperatorias. Sin embargo, la falta de parámetros bien establecidos para la presión de la aspiración y el flujo de líquido impide la estandarización del procedimiento. Conclusión Como ha sido demostrado en los estudios incluidos, el uso de dispositivos de aspiración en el tratamiento quirúrgico de los cálculos urinarios favorece la obtención de una TLC mayor y reduce las complicaciones infecciosas. La CRIR con sistema de aspiración podría sustituir a la técnica tradicional, gracias a sus ventajas asociadas al control de la presión intrarrenal y aspiración del polvo fino. (AU)

Objective To identify the latest advances in suction devices and evaluate their effect in Retrograde intrarenal surgery (RIRS) and ureteroscopy for stones. Basic procedures A systematic literature search was performed on 4th January 2023 using Scopus, PubMed, and EMBASE. Only English papers were included; both pediatric and adult studies were accepted. Duplicate studies, case reports, letters to the editor, and meeting abstracts were excluded. Main findings Twenty-one papers were selected. Several methods have been proposed for suction use in RIRS, such as through the ureteral access sheath or directly to the scope. Artificial intelligence can also regulate this system, monitoring pressure and perfusion flow values. All the proposed techniques showed satisfactory perioperative results for operative time, stone-free rate (SFR), and residual fragments. Moreover, the reduction of intrarenal pressure (induced by aspiration) was also associated with a lower infection rate. Even the studies that considered kidney stones with a diameter of 20mm or higher reported higher SFR and reduced postoperative complications. However, the lack of well-defined settings for suction pressure and fluid flow prevents the standardization of the procedure. Conclusion Aspiration device in the surgical treatment of urinary stones favours a higher SFR, reducing infectious complications, as supported by the included studies. RIRS with a suction system provided to be a natural successor to the traditional technique, regulating intrarenal pressure and aspirating fine dust. (AU)

Experimental and clinical applications and outcomes of using different forms of suction in retrograde intrarenal surgery. Results from a systematic review.

OBJECTIVE: To identify the latest advances in suction devices and evaluate their effect in Retrograde intrarenal surgery (RIRS) and ureteroscopy for stones. BASIC PROCEDURES: A systematic literature search was performed on 4th January 2023 using Scopus, PubMed, and EMBASE. Only English papers were included; both pediatric and adult studies were accepted. Duplicate studies, case reports, letters to the editor, and meeting abstracts were excluded. MAIN FINDINGS: Twenty-one papers were selected. Several methods have been proposed for suction use in RIRS, such as through the ureteral access sheath or directly to the scope. Artificial intelligence can also regulate this system, monitoring pressure and perfusion flow values. All the proposed techniques showed satisfactory perioperative results for operative time, stone-free rate (SFR), and residual fragments. Moreover, the reduction of intrarenal pressure (induced by aspiration) was also associated with a lower infection rate. Even the studies that considered kidney stones with a diameter of 20 mm or higher reported higher SFR and reduced postoperative complications. However, the lack of well-defined settings for suction pressure and fluid flow prevents the standardization of the procedure. CONCLUSION: Aspiration device in the surgical treatment of urinary stones favours a higher SFR, reducing infectious complications, as supported by the included studies. RIRS with a suction system provided to be a natural successor to the traditional technique, regulating intrarenal pressure and aspirating fine dust.

Influencia del sexo en los resultados de la cirugía retrógrada intrarrenal (CRIR). Datos obtenidos del Flexible Ureteroscopy Outcomes Registry (FLEXOR) / Does gender influence retrograde intrarenal surgery (RIRS) outcomes? Data from the Flexible Ureteroscopy Outcomes Registry (FLEXOR)

Introducción y objetivos Si bien la ureteroscopia flexible es una técnica establecida, a día de hoy no existen datos sobre la influencia del sexo del paciente en los resultados y complicaciones. El objetivo de este estudio es evaluar el papel que desempeña el sexo en la realización de la ureteroscopia flexible a partir de una serie grande de pacientes.MétodosEste estudio analizó retrospectivamente los datos del registro multicéntrico FLEXOR de los pacientes tratados de cálculos renales con CRIR desde enero de 2018 hasta agosto de 2021. Se analizaron los datos demográficos, las características de los cálculos, los hallazgos perioperatorios, los resultados y las complicaciones, y se compararon entre grupos estratificados según el sexo.ResultadosUn total de 6.669 pacientes fueron incluidos, el 66,1% eran varones y el 33,9% mujeres. Las características de los cálculos eran comparables entre los grupos. Las mujeres presentaron tasas significativamente más elevadas de fiebre y urocultivo positivo (12 frente a 8% y 37 frente a 34%). Además, las mujeres tuvieron una estancia hospitalaria ligeramente más larga (3,8 vs. 3,5 días; p < 0,001) y más fragmentos residuales después del procedimiento (23,03 vs. 20,97; p = 0,032). Las complicaciones globales fueron ligeramente superiores en las mujeres (15,74 frente a 14%; p = 0,042), debido principalmente a las tasas de fiebre (6,9 frente a 5,7%); el riesgo de sepsis fue similar en ambos grupos. Según un análisis multivariante, los cálculos de mayor tamaño, múltiples y localizados en el polo inferior parecen tener un efecto negativo en la incidencia de los cálculos residuales y las complicaciones.ConclusiónNuestro estudio de la vida real a nivel mundial refleja que el sexo femenino puede estar correlacionado con unas tasas ligeramente mayores de fragmentos residuales y complicaciones generales de bajo grado. ... (AU)

Introduction and objectives As well established flexible ureteroscopy (RIRS). There is still no evidence if gender can have any influence on the outcomes and complication when performing This study aims to evaluate the role that gender has in performing flexible ureteroscopy from a large series of patients.MethodsThis study retrospectively analyzed patients who underwent RIRS for renal stones from January 2018 to August 2021 within the multicentric FLEXOR registry. Demographics, stone characteristics, perioperative findings, results and complications were analyzed and compared between gender groups.ResultsA total of 6669 patients were included, 66.1% were male and 33.9% were female. Stone characterictis was comparable between groups. Female patients had significant higher fever and positive urine culture rates (12% vs. 8% and 37% vs. 34%). Also, females had a slight longer hospital stay (3.8 vs. 3.5 days; P < 0.001) and more residual fragments after the procedure (23.03% vs. 20.97 (P = 0.032). Overall complications were slightly significantly higher in women (15.74% vs. 14% (P = 0.042)) mainly at the expense of fever rates (6.9% vs. 5.7%) whereas the risk of sepsis was similar in both groups. A multivariate analysis showed that larger stone size, multiple and lower pole stones seem to have a negative impact in the incidence of residual stones and complications.ConclusionOur real life global study reflects that female gender may have a correlation with a slightly increased residual fragment rate and overall low grade complications. However, women can safely be treated with RIRS with no increased the rate of sepsis with appropriate care. (AU)

Does gender influence retrograde intrarenal surgery (RIRS) outcomes? Data from the Flexible Ureteroscopy Outcomes Registry (FLEXOR).

INTRODUCTION AND OBJECTIVES: As well established flexible ureteroscopy (RIRS). There is still no evidence if gender can have any influence on the outcomes and complication when performing. This study aims to evaluate the role that gender has in performing flexible ureteroscopy from a large series of patients. METHODS: This study retrospectively analyzed patients who underwent RIRS for renal stones from January 2018 to August 2021 within the multicentric FLEXOR registry. Demographics, stone characteristics, perioperative findings, results and complications were analyzed and compared between gender groups. RESULTS: A total of 6669 patients were included, 66.1% were male and 33.9% were female. Stone characteristics was comparable between groups. Female patients had significant higher fever and positive urine culture rates (12% vs. 8% and 37% vs. 34%). Also, females had a slight longer hospital stay (3.8 vs. 3.5 days; P < 0.001) and more residual fragments after the procedure (23.03% vs. 20.97 (P = 0.032). Overall complications were slightly significantly higher in women (15.74% vs. 14% (P = 0.042)) mainly at the expense of fever rates (6.9% vs. 5.7%) whereas the risk of sepsis was similar in both groups. A multivariate analysis showed that larger stone size, multiple and lower pole stones seem to have a negative impact in the incidence of residual stones and complications. CONCLUSION: Our real life global study reflects that female gender may have a correlation with a slightly increased residual fragment rate and overall low grade complications. However, women can safely be treated with RIRS with no increased the rate of sepsis with appropriate care.

Standardization of retrograde intrarenal surgery with "gravity irrigation" technique leads to low postoperative infection rate regardless of surgeon experience

Objectives: We aimed to evaluate the prevalence and predictive factors of postoperative infections after a standardized low-pressure RIRS technique. The secondary outcome was comparing surgeons’ experience in terms of infective complication and stone-free rate. Methods: A single-center retrospective analysis was conducted on all patients who underwent RIRS for kidney stones between January 2018 and February 2019. Inclusion criteria: adults, stone ≤ 20 mm (unless percutaneous nephrolithotomy contraindica-tions). Concomitant ureteral lithotripsy was allowed. Exclusion criteria: bilateral surgery, active urinary tract infections (UTI), pregnancy, fever at surgery. Low-pressure RIRS and ureteroscopy was achieved with gravity irrigation, a 5 Ch open-ended urethral catheter (ureteral lithotripsy), intravenous furosemide (20 mg), and ureteral access sheath above the ureteral-pelvic junction (RIRS). Results: 236 patients were included in the analysis. Mean age was 55.89±13.96 years. Mean stone diameter was 14.28±5.81mm. 43 (18.2%) patients underwent concomitant ureteral lithotripsy. Mean operative time was 61.10 ± 31.36 minutes. Infective complications occurred in 13 (5.5%) patients. Sepsis occurred in 10 (4.2%) patients and septic shock occurred in 1 (0.4%). One patient (0.4%) required stent substitution. Multivariate logistic regression analysis showed that history of UTI predicted for higher risk of postoperative infections (OR 8.434, CI 95% 2.36–29.46). Outcomes comparison of surgical expertise did not statistically differ in terms of stone-free rate and infective complications. Conclusion: Our standardized RIRS technique achieved a low postoperative infective complication rate. History of UTI was the strongest predictor of postoperative infections (AU)

Role of pre-operative ureteral stent on outcomes of retrograde intra-renal surgery (RIRS): systematic review and meta-analysis of 3831 patients and comparison of Asian and non-Asian cohorts.

PURPOSE: To evaluate the outcomes of pre-stented (PS) versus non-pre-stented (NPS) patients who have undergone retrograde intrarenal surgery (RIRS) for renal calculi with subgroup analysis of Asian and non-Asian cohorts. METHODS: Protocol is registered in PROSPERO, CRD42021261123. Eligible studies identified from four electronic databases. Meta-analysis was done to enumerate the outcomes of RIRS in between PS and NPS. Secondary sub-analysis was done to look for differences in outcomes in Asian and non-Asian cohorts. RESULTS: Fourteen studies involving 3831 patients (4 prospective, 10 retrospective studies) were included. PS patients experienced higher success rates of ureteral access sheath (UAS) insertion than NPS (RR 1.09, 95% CI 1.05-1.13, p < 0.00001). PS patients had lower risk of ureteral injuries from UAS placement (RR 0.69, 95% CI 0.50-0.96, p = 0.03). No significant differences in intra- and postoperative complications between two groups were found. Stone-free rate (SFR) outcomes for residual fragment (RF) cut-off of < 1 mm and < 4 mm favoured the PS patients (RR 1.10, 95% CI 1.04-1.17, p = 0.002 for < 4 mm, RR1.10, 95% CI 1.02-1.19, p = 0.02 for < 1 mm). In the subgroup analysis, PS Asian patients had similar SFR as NPS patients for SFR(< 4 mm) but non-Asian population showed better outcomes in the PS patients for SFR(< 4 mm) (RR 1.31, 95% CI 1.13-1.52, p = 0.0005). CONCLUSIONS: This meta-analysis suggests that pre-stenting results in a higher success for UAS placement, minimising intraoperative ureteric injury, with higher overall SFR for any RF cut-off in PS cohorts. In non-Asian cohort, significant differences occurred at SFR < 4 mm but not for SFR < 1 mm. No difference was seen in our Asian cohort for any SFR cut-off in both PS and NPS patients.

Coeficientes técnicos de produção da priprioca (Cyperus articulatus L. ) em sistema orgânico, na região de Belém (PA) / Technical coefficients of priprioca production (Cyperus articulatus L. ) in organic system at the region of Belém (PA)

Foram elaborados os coeficientes técnicos de produção de priprioca (Cyperus articulatus) em três áreas fornecedoras parceiras da Natura, situadas na região do entorno de Belém, Amazônia Oriental. Para elaboração dos coeficientes técnicos de produção de priprioca, os itens de custo e as atividades que compreendem o cultivo, a colheita e o beneficiamento foram levantados e classificados em: Insumos; Serviços; Equipamentos; e Outros. O detalhamento destas atividades e o valor dos itens foram obtidos e construídos in loco, juntamente com os agricultores. As informações utilizadas neste trabalho consideraram a produção de 1 tonelada de raiz de priprioca, cultivadas anualmente em sete canteiros de 60 m² (1,2 m largura x 50 m comprimento), espaçamento de 0,20 x 0,20 m, em sistema orgânico com rendimento médio de 2,5 kg m2 -1. Os resultados descrevem os materiais consumidos, o tempo de mão-de-obra para realização das operações e os custos, baseados na realidade local. Conclui-se com este trabalho que a elaboração do coeficiente técnico de produção auxilia o agricultor a estimar o custo de produção de uma determinada matéria prima e evidencia as atividades que podem contribuir no lucro como, por exemplo, as boas práticas de produção.

Were prepared the technical coefficients of priprioca (Cyperus articulatus) production in three areas suppliers partner of Natura, situated around Belem, Eastern Amazon. For preparation of technical coefficients of priprioca production, the cost items and activities that comprise the growing, harvesting and processing were collected and classified as: Inputs, Services, Equipment, and Others. The details of these activities and the value of the items were obtained and constructed in situ, together with the farmers. Information used in this study considered the production of one tonne of priprioca root cultivated annually in seven plots of 60 m² (1,2 m wide x 50 m length) 0,20 x 0,20 m, in an organic system average yield of 2,5 kg m2 -1. The results describe the materials consumed, the time of manpower to carry out the operations and costs, based on local realities. Were conclude with this work that the preparation of the technical coefficient production helps farmers to estimate the cost of production and highlights the activities that can contribute to profit, for example, good manufacturing practices.

A simplified method for anal ultrasonography: assessment of patient satisfaction and the simplicity of the procedure.

BACKGROUND: Anal endosonography reliably visualizes and identifies anal sphincter abnormalities. However, dedicated probes are quite expensive. We evaluated a simple and less-costly procedure for anal endosonography involving the insertion of the endoscope through a disposable anoscope filled with standard ultrasound gel in terms of patient satisfaction and the simplicity of the procedure in comparison with the standard technique in a unit that already had echoendoscopes available. METHODS: The two techniques were used in 35 subjects without anal abnormalities and data on the simplicity of the procedures, patient discomfort, the quality of images, and the time needed to perform the procedures were compared. RESULTS: All the variables under investigation scored significantly better with the modified technique compared to the standard one. No differences in thickness of either the internal or the external anal sphincter were found between the two methods. CONCLUSIONS: This simple and less-costly adaptation of anal ultrasonography allows good quality examinations to be performed with better patient comfort in units with echoendoscopes already available, avoiding the need for a more expensive dedicated probe.

Colon and gastric metastases from a primary signet-ring cell carcinoma of the urinary bladder.

Signet-ring cell carcinoma is a relatively rare neoplasm that rarely occurs in the urinary bladder. We report a case of a 60-year-old man who presented with gross haematuria. Cystoscopy revealed a white sessile tumour of the anterior bladder wall. The histological diagnosis showed a primary signet-ring cell carcinoma of the bladder (T3bN0M0). Eighteen months after radical cystectomy, the patient developed colon and stomach metastases. This case represents the first description of a primary signet-ring cell carcinoma of the urinary bladder with gastrointestinal metastases.

[Mandibular atrophy and a screw-retained implant-supported prosthesis]. / Atrophie mandibulaire et prothèse implantoportée, fixe, vissée. Etude préliminaire de 7 cas.

Prosthetic care for mandibular atrophy has raised many difficult problems, particularly in the most severe cases. The solution to most of these problems lies in the use of osteointegrated implants. Good results were obtained by using a small number of implants associated with adjustable overdenture prostheses or, alternatively, by using a larger number of implants (5 or 6) associated with a screw fixed prosthesis with posterior cantilever. Cantilever prostheses can provide support for the mental foramen zones and the posterior zones of the mandibular body where bone resorption is important after application of adjustable plates to the fibromucosa.

An alternative method for direct custom tray construction using a visible light-cured resin.

The use of a properly made tray is highly desirable for impression making. To avoid the extra time required for tray fabrication, the alternative techniques of the putty wash or "reline" technique and intraoral fabrication of a custom tray by relining a stock tray with self-curing resin are proposed. This article illustrates a new technique of direct custom tray fabrication used for impression making for fixed prosthodontics. The proposed technique allows the direct fabrication of custom trays with light-cured resin and is time-saving, efficient, and inexpensive.

In vivo plaque formation on cast ceramic (Dicor) and conventional ceramic.

This study compared plaque accumulation on glazed and nonglazed metal ceramic porcelain surfaces with shaded and nonshaded Dicor cast ceramic surfaces. Plaque accumulation on natural teeth was also measured at 4, 12, 24, and 48 hours. Bacterial cultures were prepared from each sample to establish the aerobic and anaerobic charge. Plaque accumulation between 12 and 24 hours was measured on different materials. No significant differences were discovered between the plaque-retaining capacities of metal ceramic porcelain and Dicor ceramic surfaces. There was less plaque accumulation on glazed surfaces than on nonglazed surfaces.

Thermal distortion of different materials in crown construction.

This study compared the thermal distortion of all-ceramic crowns with porcelain-fused-to-metal crowns. The materials exhibited different responses: metal ceramic crowns stabilized after an initial loss of marginal precision, and the all-ceramic crowns continued to distort with each firing cycle.

Resistance to fracture of metal ceramic and all-ceramic crowns.

This study evaluated the fracture resistance of three types of all-ceramic crowns and compared these to the fracture values of metal ceramics. Uniform metal ceramic specimens; veneered, cast glass-ceramic; and porcelain fused to two different dispersion-strengthened ceramic cores (Hi-Ceram and In-Ceram) were investigated. The metal ceramic specimens demonstrated a significantly higher resistance to fracture than did the Hi-Ceram or veneered glass-ceramic units but did not significantly differ from the In-Ceram specimens. The metal ceramic crowns showed cracks only in the ceramic layer, whereas the all-ceramic specimens underwent global fracture.

[Ethical, medico-legal and deontological aspects of dentistry in HIV infection]. / Aspetti etici, medico-legali e deontologici dell'odontoiatra nella infezione HIV.

Medical behaviour toward HIV infected patients is often complicated by fear, confusion and lack of knowledge. Since frequently pathological manifestations in the oral area are early signs warning of HIV infection, dentists must deepen their knowledge in this field in order to be able to help diagnose for early treatment as well to cope with connected ethical, medico-legal and deontological aspects.

Multidisciplinary team approach to the pediatric burn patient.

Burn trauma is the most devastating injury the body can sustain. Each year, 100,000 victims will sustain burn injuries serious enough to require hospitalization; 35% of these victims are children. The Shriners Hospitals for Crippled Children Burns Institute, Cincinnati Unit (SBI-Cincinnati), is a 30-bed hospital with all of the support systems of a major university medical center. SBI-Cincinnati uses a multidisciplinary team approach to family-centered care. The primary nurse and physician collaborate with the rest of the health care team to manage all aspects of care. This approach assures that coordination of care occurs and allows the family the opportunity to maintain a unique role as the primary caregiver.