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1.
Medicina (Kaunas) ; 57(10)2021 Oct 13.
Artigo em Inglês | MEDLINE | ID: mdl-34684137

RESUMO

Background and Objectives: In this study, we aimed to evaluate predictive factors of postoperative fever (POF) after ureterorenoscopic lithotripsy (URSL). Materials and Methods: A total of 594 consecutive patients who underwent URSL for urinary stone disease at Gifu Municipal Hospital and Chuno Kosei Hospital between April 2016 and January 2021 were enrolled in this study. In all patients, antibiotics were routinely administered intraoperatively and the next day after surgery. We used rigid and/or flexible ureterorenoscopes depending on the stone location for URSL. Stones were fragmented using a holmium: YAG laser. The fragments of the stone were manually removed as much as possible using a stone basket catheter. A ureteral stent was placed at the end of the surgery in all cases. Results: The median age and body mass index (BMI) in all patients were 62 years and 23.8 kg/m2, respectively. The median operation duration was 52 min. The most common URSL-related complication was POF in 28 (4.7%) patients. In these patients, the rates of antibiotic administration and ureteral stent insertion before surgery were significantly higher than in those without POF. In multivariate analysis, BMI was associated with POF after URSL. There were no significant differences in predicting POF after surgery in patients who had bacteriuria or received antibiotics before surgery. Conclusions: A low BMI was significantly associated with POF after URS or URSL.


Assuntos
Litotripsia , Cálculos Ureterais , Cálculos Urinários , Índice de Massa Corporal , Humanos , Litotripsia/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Resultado do Tratamento , Cálculos Ureterais/cirurgia , Ureteroscopia/efeitos adversos
2.
J Acoust Soc Am ; 150(2): 1013, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34470261

RESUMO

During clinical procedures, the lithotripter shock wave (LSW) that is incident on the stone and resultant stress field is often asymmetric due to the respiratory motion of the patient. The variations of the LSW-stone interaction and associated fracture pattern were investigated by photoelastic imaging, phantom experiments, and three-dimensional fluid-solid interaction modeling at different lateral locations in a lithotripter field. In contrast to a T-shaped fracture pattern often observed in the posterior region of the disk-shaped stone under symmetric loading, the fracture pattern gradually transitioned to a tilted L-shape under asymmetric loading conditions. Moreover, the model simulations revealed the generation of surface acoustic waves (SAWs), i.e., a leaky Rayleigh wave on the anterior boundary and Scholte wave on the posterior boundary of the stone. The propagation of SAWs on the stone boundary is accompanied by a progressive transition of the LSW reflection pattern from regular to von Neumann and to weak von Neumann reflection near the glancing incidence and, concomitantly, the development and growth of a Mach stem, swirling around the stone boundary. The maximum tensile stress and stress integral were produced by SAWs on the stone boundary under asymmetric loading conditions, which drove the initiation and extension of surface cracks into the bulk of the stone that is confirmed by micro-computed tomography analysis.


Assuntos
Cálculos Renais , Litotripsia , Humanos , Cálculos Renais/terapia , Litotripsia/efeitos adversos , Imagens de Fantasmas , Som , Microtomografia por Raio-X
3.
J Dig Dis ; 22(10): 572-581, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34436824

RESUMO

OBJECTIVE: Pancreatic stones result from chronic pancreatitis and can occur in the main pancreatic duct, pancreatic branches or parenchyma. Although extracorporeal shock wave lithotripsy (ESWL) is considered the first-line treatment, per-oral pancreatoscopy (POP) has emerged as a useful method for treating pancreatic stones. The aim of this systematic review and meta-analysis was to determine the efficacy and safety of POP-guided lithotripsy, electrohydraulic lithotripsy (EHL) and laser lithotripsy (LL), in patients with pancreatolithiasis. METHODS: Literature review was conducted in PubMed, OVID, MEDLINE and Cochrane Library databases for studies published up to August 2020. RESULTS: Altogether 15 studies were analyzed, of which 11 were retrospective and four were prospective. The studies comprised 370 patients, of whom 66.4% were male. The patients underwent 218 EHL and 155 LL. The pooled technical and clinical success rate of the overall POP was 88.1% and 87.1%. For EHL-POP, the pooled technical success rate was 90.9% (95% CI 87.2%-95.2%) and the pooled clinical success rate was 89.8% (95% CI 87.2%-95.2%). While for LL-POP, the pooled technical and clinical success rate was 88.4% (95% CI 85.9%-95.1%) and 85.8% (95% CI 80.6%-91.6%). In total 43 adverse events occurred (12.1%; 95% CI 8.7%-15.5%). CONCLUSION: POP-guided lithotripsy has a high rate of technical and clinical success for managing pancreatolithiasis with a low complication rate. Both EHL-POP and LL-POP achieve similar efficacy in the endoscopic therapy of pancreatolithiasis. Further large randomized controlled trials are needed to compare EHL-POP and LL-POP with ESWL and evaluate whether POP may replace ESWL as the first-line management of pancreatolithiasis.


Assuntos
Litotripsia , Pancreatopatias , Humanos , Litotripsia/efeitos adversos , Masculino , Pancreatopatias/terapia , Estudos Prospectivos , Estudos Retrospectivos , Resultado do Tratamento
4.
Medicine (Baltimore) ; 100(31): e26172, 2021 Aug 06.
Artigo em Inglês | MEDLINE | ID: mdl-34397789

RESUMO

ABSTRACT: There are needs to evaluate the risk factors for urinary infection after retrograde upper urinary lithotripsy, to provide insights into the management and nursing care of patients with retrograde upper urinary lithotripsy.Patients who received retrograde upper urinary lithotripsy with a Foley 20 urinary tube insertion from June 1, 2019 to December 31, 2020 in our hospital were selected. Patients were grouped urinary infection and no infection group according to the culture results of urine, and the clinical data of the 2 groups of patients were collected and compared. Single factor and logistic regression analysis were used to analyze the risk factors of urinary tract infection after retrograde upper urinary lithotripsy.Four hundred ten patients with retrograde upper urinary lithotripsy were included, of whom 62 patients had the urinary tract infection, the incidence of urinary tract infection was 15.12%. There were significant differences in the gender, age, diabetes, stone diameter, duration of urinary tube insertion and duration of surgery between infection and no-infection group (all P < .05). The Escherichia coli (62.90%) was the most commonly seen bacterial in patients with urinary tract infection. Female (odds ratio [OR]: 1.602, 95% confidence interval 95% [CI]: 1.132∼2.472), age >50 years (OR: 2.247, 95% CI: 1.346∼3.244), diabetes (OR: 2.228, 95% CI: 1.033∼3.451), stone diameter ≥2 cm (OR: 2.152, 95% CI: 1.395∼3.099), duration of urinary tube insertion ≥3 days (OR: 1.942, 95% CI:1.158∼2.632), duration of surgery ≥90 minutes (OR: 2.128, 95% CI: 1.104∼3.846) were the independent risk factors for the postoperative urinary tract infection in patients with retrograde upper urinary lithotripsy (all P < .05).The incidence of urinary tract infection in patients undergoing retrograde upper urinary lithotripsy was high, counteractive measures targeted on those risk factors are needed to prevent and reduce the postoperative urinary infection in clinical settings.


Assuntos
Cálculos Renais/terapia , Litotripsia/efeitos adversos , Cálculos Ureterais/terapia , Infecções Urinárias/epidemiologia , Infecções Urinárias/etiologia , Fatores Etários , Diabetes Mellitus/epidemiologia , Feminino , Humanos , Incidência , Litotripsia/métodos , Litotripsia/enfermagem , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Fatores de Risco , Fatores Sexuais , Fatores de Tempo , Cateterismo Urinário
5.
J Hepatobiliary Pancreat Sci ; 28(9): 778-787, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34242478

RESUMO

BACKGROUND: Endoscopic intervention combined with extracorporeal shock wave lithotripsy (ESWL) is recommended as the first line therapy for large pancreatic stones, yet both can cause adverse events. The aim of the study was to identify the risk factors for post-procedural pancreatitis. METHODS: Consecutive patients with chronic pancreatitis and pancreatic stones treated with both ESWL and subsequent endoscopic retrograde cholangiopancreatography (ERCP) from October 2016 to December 2019 were prospectively enrolled. Multivariate logistic analyses were performed to detect risk factors for post-ESWL and post-ERCP pancreatitis (PEP). RESULTS: A total of 714 patients (507 males, 45.60 ± 12.52 years) were included in this study. A total of 80 patients (11.2%) developed post-ESWL pancreatitis,while 33 patients (4.6%) suffered from PEP. Steatorrhea (P = .018), multiple stones (P = .043), and stones located at the head combined with the body or tail of the pancreas (P = .015) were identified as independent protective factors for post-ESWL pancreatitis. The history of acute exacerbations (P = .013), post-ESWL pancreatitis (P < .001) and stricture dilation during ERCP (P = .002) were identified as risk factors for PEP. CONCLUSIONS: More attention should be paid to patients with post-ESWL pancreatitis, as well as a history of acute exacerbations and stricture dilation during ERCP to prevent PEP. (ClincialTrials.gov number, NCT04619511).


Assuntos
Litotripsia , Pancreatite Crônica , Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Humanos , Litotripsia/efeitos adversos , Masculino , Ductos Pancreáticos , Pancreatite Crônica/complicações , Pancreatite Crônica/terapia , Resultado do Tratamento
7.
JACC Cardiovasc Interv ; 14(12): 1352-1361, 2021 06 28.
Artigo em Inglês | MEDLINE | ID: mdl-34167675

RESUMO

OBJECTIVES: The study sought to compare short-term outcomes in patients with femoropopliteal artery calcification receiving vessel preparation with intravascular lithotripsy (IVL) or percutaneous transluminal angioplasty (PTA) prior to drug-coated balloon (DCB) for symptomatic peripheral artery disease. BACKGROUND: Endovascular treatment of calcified peripheral artery lesions is associated with suboptimal vessel expansion and increased complication risk. Although initial results from single-arm studies with IVL have been reported, comparative evidence from randomized trials is lacking for most devices in the presence of heavy calcification. METHODS: The Disrupt PAD III (Shockwave Medical Peripheral Lithoplasty System Study for PAD) randomized trial enrolled patients with moderate or severe calcification in a femoropopliteal artery who underwent vessel preparation with IVL or PTA prior to DCB or stenting. The primary endpoint was core lab-adjudicated procedural success (residual stenosis ≤30% without flow-limiting dissection) prior to DCB or stenting. RESULTS: In patients receiving IVL (n = 153) or PTA (n = 153), procedural success was greater in the IVL group (65.8% vs. 50.4%; p = 0.01) and the percentage of lesions with residual stenosis ≤30% (66.4% vs. 51.9%; p = 0.02) was greater in the IVL group, while flow-limiting dissections occurred more frequently in the PTA group (1.4% vs. 6.8%; p = 0.03). Post-dilatation (5.2% vs. 17.0%; p = 0.001) and stent placement (4.6% vs. 18.3%; p < 0.001) were also greater in the PTA group. The rates of major adverse events (IVL: 0% vs. PTA: 1.3%; p = 0.16) and clinically driven target lesion revascularization (IVL: 0.7% vs. PTA: 0.7%; p = 1.0) at 30 days were comparable between groups. CONCLUSIONS: IVL is an effective vessel preparation strategy that facilitates definitive endovascular treatment in calcified femoropopliteal arteries in patients with peripheral artery disease. (Shockwave Medical Peripheral Lithoplasty System Study for PAD [Disrupt PAD III]; NCT02923193).


Assuntos
Angioplastia com Balão , Litotripsia , Doença Arterial Periférica , Calcificação Vascular , Angioplastia com Balão/efeitos adversos , Materiais Revestidos Biocompatíveis , Artéria Femoral/diagnóstico por imagem , Humanos , Litotripsia/efeitos adversos , Doença Arterial Periférica/diagnóstico por imagem , Doença Arterial Periférica/terapia , Artéria Poplítea/diagnóstico por imagem , Estudos Prospectivos , Resultado do Tratamento , Calcificação Vascular/diagnóstico por imagem , Calcificação Vascular/terapia , Grau de Desobstrução Vascular
8.
Int J Urol ; 28(10): 992-999, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34189773

RESUMO

In this meta-analysis we assessed whether the diameter of ureteral stents (4.7-5-Fr, 6-Fr) has an impact on the rate of occurrence of urinary tract symptoms and complications after successful URS and intracorporeal lithotripsy. A systematic review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. A rigorous search for relevant studies published in MEDLINE, Embase, and the Cochrane Controlled Trials Register was conducted to find informative randomized controlled trials. The reference lists of relevant articles were also manually searched and reviewed. The protocol was prospectively registered at PROSPERO (CRD42020202164). All statistical evaluations were performed using RevMan software version 5.3.0. Seven articles comprising 547 patients were included in the meta-analysis. After placement of ureteral stents with different diameters for approximately 1 week, we found that ureteral stents with smaller diameters (4.7-5-Fr) were associated with significant improvements in the main domain scores on the Ureteral Stent Symptom Questionnaire, such as urinary symptoms (mean difference -4.47, 95% confidence interval -5.87 to -3.08; P < 0.00001) and body pain (mean difference -2.48, 95% confidence interval -4.37 to -0.59; P = 0.01), but poor outcomes in stent migration compared to ureteral stents with a 6-Fr diameter (odds ratio 3.00, 95% confidence interval 1.06-8.51; P = 0.04). However, there were no significant differences in Ureteral Stent Symptom Questionnaire scores with regard to work performance (mean difference -0.56, 95% confidence interval -2.52 to 1.40; P = 0.58), general health (mean difference -2.29, 95% confidence interval -4.95 to 0.37; P = 0.09), additional problems (mean difference -0.43, 95% confidence interval -1.02 to 0.15; P = 0.15), and complications such as fever (odds ratio 0.75, 95% confidence interval 0.24-2.39; P = 0.63). Ureteral stents with a diameter of 4.7-5-Fr have better outcomes than those with a diameter of 6-Fr, based on the Ureteral Stent Symptom Questionnaire pain and urinary tract symptoms scores. However, they are more prone to migration compared to those with a larger diameter.


Assuntos
Litotripsia , Ureter , Cálculos Ureterais , Humanos , Litotripsia/efeitos adversos , Stents/efeitos adversos , Inquéritos e Questionários , Ureter/cirurgia , Cálculos Ureterais/cirurgia , Ureteroscopia/efeitos adversos
9.
Ultrasound Med Biol ; 47(8): 2286-2295, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34078545

RESUMO

Burst wave lithotripsy (BWL) is a technology under clinical investigation for non-invasive fragmentation of urinary stones. Under certain ranges of ultrasound exposure parameters, this technology can cause cavitation in tissue leading to renal injury. This study sought to measure the focal pressure amplitude needed to cause cavitation in vivo and determine its consistency in native tissue, in an implanted stone model and under different exposure parameters. The kidneys of eight pigs were exposed to transcutaneous BWL ultrasound pulses. In each kidney, two locations were targeted: the renal sinus and the kidney parenchyma. Each was exposed for 5 min at a set pressure level and parameters, and cavitation was detected using an active cavitation imaging method based on power Doppler ultrasound. The threshold was determined by incrementing the pressure amplitude up or down after each 5-min interval until cavitation occurred/subsided. The pressure thresholds were remeasured postsurgery, targeting an implanted stone or collecting space (in sham). The presence of a stone or sham surgery did not significantly impact the threshold for tissue cavitation. Targeting parenchyma instead of kidney collecting space and lowering the ultrasound pulse repetition frequency both resulted in an increased pressure threshold for cavitation.


Assuntos
Cálculos Renais/terapia , Litotripsia/métodos , Animais , Feminino , Rim/lesões , Cálculos Renais/diagnóstico por imagem , Litotripsia/efeitos adversos , Pressão , Suínos , Ultrassonografia
10.
Hinyokika Kiyo ; 67(4): 133-139, 2021 Apr.
Artigo em Japonês | MEDLINE | ID: mdl-34107608

RESUMO

Retrograde ureterorenoscopic lithotripsy is one of the first-line therapies for urolithiasis. In some cases, however, thisapproach may be difficult to adopt because of factorss uch asrenal/ureteral anatomic abnormalities or urinary diversion. This study aims to investigate the safety and efficacy of retrograde ureterorenoscopic lithotripsy in patients with the above-mentioned conditions. We retrospectively investigated all such patients who underwent retrograde ureterorenoscopic lithotripsy from May 2009 to December 2019 at our hospital. "Stone free"was defined as the total absence of residual fragments, and "success"wasdefined asthe absence of hydronephrosisand residual fragmentsgreater than 4 mm at the end of 4 weeks. Complications were classified according to the modified Clavien-Dindo classification system. Twenty-one procedureswere performed in 19 patientswhos e conditionswere horseshoe kidney, ureteral duplex, cross-fused renal ectopia, cutaneous ureterostomy, ileal conduit, ureterocystoneostomy, and cystostomy. The median age was 67 (40-93) years, the median stone diameter was 9.6 (5.0-16.0) mm, the median operation time was 63 (12-158) minutes, and the complete stone-free rate and success rate were 42.9 and 71.4%, respectively. The complication rate was 19.0% ; however, no serious complications were observed. In conclusion, retrograde ureterorenoscopic lithotripsy is an effective and safe procedure for patientss uffering from urolithiasis with renal/ureteral anatomic abnormalitiesor previousurinary diversion.


Assuntos
Cálculos Renais , Litotripsia , Cálculos Ureterais , Derivação Urinária , Idoso , Humanos , Cálculos Renais/terapia , Litotripsia/efeitos adversos , Estudos Retrospectivos , Resultado do Tratamento , Cálculos Ureterais/terapia , Ureteroscopia/efeitos adversos
11.
Catheter Cardiovasc Interv ; 98(4): E540-E547, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34051136

RESUMO

OBJECTIVE: We sought to determine the safety and performance of intravascular lithotripsy in the treatment of severe calcified atherosclerotic lesions. BACKGROUND: The modification of severe calcified atherosclerotic lesions with noncompliant or specialty balloons, as well as orbital or rotational atherectomy has limitations and may be ineffective, increasing the risk of periprocedural complications and worsening long-term results. Intravascular lithotripsy has recently been shown to be a safe and feasible alternative to the above methods. METHODS: All consecutive patients treated with Shockwave Medical Intravascular Lithotripsy (S-IVL) between May 2019 and June 2020 were included in current analysis. Device safety and efficacy were the critical endpoints of the study. The primary safety endpoint was 30-day major adverse cardiac events (MACE). In turn, device and clinical success were the primary performance endpoints. RESULTS: In total, 46 patients undergoing percutaneous coronary intervention were treated with S-IVL before stent deployment (65% male; age, 71 ± 7 years). Device success was achieved in 45 (97.8%) patients with reduction of diameter stenosis from 80% to 5.2% with an acute gain of 2.5 mm. Clinical success was demonstrated in 95.6% of cases. During the 30-day follow-up, one sudden death was recorded, regarded as probable subacute stent thrombosis. During 6-month follow up one target lesion and target vessel revascularizations occurred. The rate of MACE after 6 month was 6.2%. CONCLUSIONS: S-IVL appears to be a safe and effective treatment modality in coronary calcium modification to optimize stent expansion. In selected cases this device obviates the need for more complex lesion preparation strategies such as atherectomy.


Assuntos
Aterectomia Coronária , Doença da Artéria Coronariana , Litotripsia , Calcificação Vascular , Idoso , Aterectomia Coronária/efeitos adversos , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/terapia , Estudos de Viabilidade , Feminino , Humanos , Litotripsia/efeitos adversos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Calcificação Vascular/diagnóstico por imagem , Calcificação Vascular/terapia
13.
Int J Clin Pract ; 75(8): e14293, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-33930234

RESUMO

AIM: Extracorporeal shockwave lithotripsy is a commonly used method to break down kidney stones in urology clinics. This study aims to investigate whether or not listening to music is effective against state anxiety in patients undergoing kidney stone treatment with this method. METHODS: A total of 80 patients (50 males, 30 females) undergoing extracorporeal shockwave lithotripsy for the first time at our clinic were included in the study. The first group (24 patients) listened to instrumental classical music through headphones 20 minutes before the procedure, while the second group (28 patients) listened to instrumental classical music during the procedure. The third group (28 patients) was the control group and consisted of patients who did not listen to music before or during the procedure. Patients were administered a state-trait anxiety inventory test to measure state anxiety after the process, and their results were compared. RESULTS: While there was a significant difference in state-trait anxiety inventory scores between patients who listened to music before/during the procedure and the control group, there was no significant difference between patients who listened to music before and those who listened to music during the procedure. Assessment of randomisation showed groups achieved homogeneity. CONCLUSION: Among the groups homogeneously distributed according to age and gender, significantly lower anxiety scores of groups that listened to music compared with the control group have provided supporting data to be open-minded and exploratory about increasing patient tolerability and comfort during these potentially pain-inducing procedures.


Assuntos
Litotripsia , Musicoterapia , Música , Ansiedade/etiologia , Feminino , Humanos , Litotripsia/efeitos adversos , Masculino , Dor
14.
J Int Med Res ; 49(4): 3000605211002003, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33794678

RESUMO

OBJECTIVE: The long-term effect of extracorporeal shock wave lithotripsy (SWL) is still controversial. A previous meta-analysis showed no association between new-onset hypertension and entire upper urinary urolithiasis after SWL. Recently, there have been some reports on this topic. Therefore, we aimed to examine the association between new-onset hypertension and nephrolithiasis after SWL therapy. METHODS: Embase, the Cochrane Central Search Library, and PubMed were used to search for reports on new-onset hypertension and patients with nephrolithiasis after SWL. A meta-analysis of the association between new-onset hypertension and nephrolithiasis after SWL was carried out. The data of relevant research were synthesized and the relative risk was computed. RESULTS: Seven eligible studies were included in our meta-analysis. There was a significant association between nephrolithiasis after SWL and new-onset hypertension. The overall relative risk with a 95% confidence interval was 1.21 (1.11-1.31) in a fixed-effects model. CONCLUSION: Our meta-analysis suggests an association between new-onset hypertension and patients with nephrolithiasis after SWL, which is in contrast with the finding of a previous meta-analysis.


Assuntos
Hipertensão , Cálculos Renais , Litotripsia , Urolitíase , Humanos , Hipertensão/etiologia , Cálculos Renais/etiologia , Cálculos Renais/terapia , Litotripsia/efeitos adversos , Urolitíase/etiologia
16.
J Invasive Cardiol ; 33(6): E417-E424, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33893792

RESUMO

OBJECTIVES: To assess the clinical and angiographic outcomes of coronary intravascular lithotripsy (IVL) use in an all-comers population with moderate-to-severely calcified coronary lesions. BACKGROUND: IVL has been shown to modify coronary calcific plaques with minimal vascular complications. METHODS: This was a retrospective, observational study of patients treated with IVL. The primary endpoint was in-hospital major adverse cardiovascular event (MACE), which included cardiac death, myocardial infarction (MI), and target-vessel revascularization (TVR). Secondary endpoints were clinical success (stent expansion with <30% in-stent residual stenosis and no in-hospital MACE) and angiographic success. RESULTS: Between August 2019 and December 2019, a total of 50 calcified lesions were treated in 45 patients using the Shockwave C2 IVL catheter (Shockwave Medical). They were further studied in 3 treatment subgroups: (1) primary IVL group with de novo lesions (n = 23 lesions); (2) secondary IVL group in which non-compliant balloon dilation failed (n = 15 lesions); and (3) tertiary IVL group with IVL to underexpanded stents (n = 12 lesions). The mean diameter stenosis of calcified lesions was 63.2 ± 10.2% at baseline, and decreased to 33.5 ± 10.9% immediately post IVL (P<.001) and 15 ± 7.1% post stenting (P<.001). Mean minimal lumen diameter was 1.1 ± 0.3 mm at baseline, and increased to 1.90 ± 0.5 mm post IVL (P<.001) and 2.80 ± 0.50 mm post stenting (P<.001). In-hospital and 30-day MACE occurred in 3 and 4 patients, respectively. Overall, clinical success and angiographic success were achieved in 90% and 94% of cases, respectively. CONCLUSIONS: IVL appears to be a safe, effective, and feasible strategy for calcium modification in an all-comers cohort with high success rate, minimal procedural complications, and low MACE rates.


Assuntos
Litotripsia , Calcificação Vascular , Humanos , Litotripsia/efeitos adversos , Sistema de Registros , Estudos Retrospectivos , Stents , Resultado do Tratamento , Calcificação Vascular/diagnóstico , Calcificação Vascular/terapia
17.
Comput Math Methods Med ; 2021: 6668415, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33815566

RESUMO

Purpose: Relieving obstruction and protecting renal function are the main therapeutic purposes of obstructive uropathy which often involve surgical treatment, and the ureter catheter is one of the surgical instruments commonly used in surgery. We aimed to explore the innovative use of a ureter catheter in the surgery of obstructive uropathy. Methods: We used a ureteral catheter to innovate the surgical procedure of the most common causes of obstructive uropathy: ureteral calculi and stricture, establishing an internal circulation system (ICS), proposing a three-step dilatation method, and reviewing their effects on patients. Furthermore, we introduced a simple real-time intrapelvic pressure measurement device to monitor intrarenal pressure during operation. Results: Postoperative laboratory examination showed that blood CRP, leukocyte neutrophil level, changes in the hemoglobin, urine occult blood, and positive rate of urine culture in the ICS group are significantly lower than those in the control group, corresponding to a lower incidence of bleeding and infection-related complications clinically. A three-month follow-up revealed 1/3 rate of ureteral stricture in the ICS group comparing to the control. We applied the three-step dilatation in patients with severe stenosis in which the balloon could not pass; the overall effective rate was 90.9%. The pressure of the renal pelvis was displayed on the monitor in real time. The surgeon could estimate the degree of filling of the renal pelvis and adjust the intake volume through the data. Conclusion: The innovative application of ureteral catheters in the operation of obstructive uropathy can realize the real-time monitor of intraoperative renal pelvis pressure, reduce the incidence of lithotripsy postoperative complications, and expand the indications of balloon dilatation in ureteral stricture, which has certain clinical significance.


Assuntos
Obstrução Ureteral/cirurgia , Ureteroscopia/instrumentação , Cateteres Urinários , Biologia Computacional , Dilatação/efeitos adversos , Dilatação/instrumentação , Feminino , Humanos , Invenções/estatística & dados numéricos , Litotripsia/efeitos adversos , Litotripsia/instrumentação , Litotripsia/métodos , Masculino , Pessoa de Meia-Idade , Modelos Anatômicos , Tomografia Computadorizada por Raios X , Ureteroscopia/efeitos adversos , Ureteroscopia/métodos , Urolitíase/diagnóstico por imagem , Urolitíase/cirurgia
18.
BMC Gastroenterol ; 21(1): 176, 2021 Apr 17.
Artigo em Inglês | MEDLINE | ID: mdl-33865311

RESUMO

BACKGROUND: Extracorporeal shock wave lithotripsy (ESWL) is a relatively safe and convenient mode of treatment for ureteral and renal stones, despite its relative safety; ESWL is not without its complications. We present a case of a patient we managed for small bowel obstruction and strangulation due to an adhesive internal hernia after ESWL was done because of right ureteral calculi. CASE PRESENTATION: We report a case of a 59-year-old patient who presented with severe abdominal pain a few hours after ESWL because of a right upper ureteric calculus. The abdominal pain increased in severity in time and became more generalized. The patient had one episode of gross hematochezia as she was being prepped for emergency laparotomy. Intra-op, she had a strangulated internal hernia because of an omental-mesenteric adhesion. CONCLUSION: This case report hopes to highlight the potential of complications like acquired IH due to adhesions in patients with a history of ureteral calculi, and also the complications that may come about post-ESWL. Patients who present with signs of persistent abdominal pain post-ESWL should be vigilantly observed. If symptoms persist, increase in intensity or there is a general deterioration of the patients' hemodynamic status, even in light of negative MDCT findings, prompt surgical intervention is crucial for definitive diagnosis as well as management.


Assuntos
Tratamento por Ondas de Choque Extracorpóreas/efeitos adversos , Hérnia Interna/patologia , Obstrução Intestinal/terapia , Cálculos Ureterais/terapia , Feminino , Humanos , Obstrução Intestinal/etiologia , Litotripsia/efeitos adversos , Litotripsia/métodos , Pessoa de Meia-Idade , Cálculos Ureterais/complicações
20.
World J Gastroenterol ; 27(4): 358-370, 2021 Jan 28.
Artigo em Inglês | MEDLINE | ID: mdl-33584068

RESUMO

BACKGROUND: A previous study showed that irrigation with 100 mL saline reduced residual common bile duct (CBD) stones, which potentially cause recurrent stones after endoscopic retrograde cholangiopancreatography. AIM: To determine whether saline irrigation can improve CBD clearance after lithotripsy. METHODS: This prospective self-controlled study enrolled patients receiving mechanical lithotripsy for large (> 1.2 cm) CBD stones. After occlusion cholangiography confirmed CBD stone clearance, peroral cholangioscopy (POC) was performed to determine clearance scores based on the number of residual stones. The amounts of residual stones spotted via POC were graded on a 5-point scale (score 1, worst; score 5, best). Scores were documented after only stone removal (control) and after irrigation with 50 mL and 100 mL saline, respectively. The stone composition was analyzed using infrared spectroscopy. RESULTS: Between October 2018 and January 2020, 47 patients had CBD clearance scores of 2.4 ± 1.1 without saline irrigation, 3.5 ± 0.7 with 50 mL irrigation, and 4.6 ± 0.6 with 100 mL irrigation (P < 0.001). Multivariate analysis showed that CBD diameter > 15 mm [odds ratio (OR) = 0.08, 95% confidence interval (CI): 0.01-0.49; P = 0.007] and periampullary diverticula (PAD) (OR = 6.51, 95%CI: 1.08-39.21; P = 0.041) were independent risk factors for residual stones. Bilirubin pigment stones constituted the main residual stones found in patients with PAD (P = 0.004). CONCLUSION: Irrigation with 100 mL of saline may not clear all residual CBD stones after lithotripsy, especially in patients with PAD and/or a dilated (> 15 mm) CBD. Pigment residual stones are soft and commonly found in patients with PAD. Additional saline irrigation may be required to remove retained stones.


Assuntos
Cálculos Biliares , Litotripsia , Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Ducto Colédoco/diagnóstico por imagem , Ducto Colédoco/cirurgia , Cálculos Biliares/diagnóstico por imagem , Cálculos Biliares/terapia , Humanos , Litotripsia/efeitos adversos , Estudos Prospectivos
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