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Indications for percutaneous nephrostomy in patients with obstructive uropathy due to malignant urogenital neoplasias
Romero, Frederico R.;Broglio, Marcos;Pires, Silvio R.;Roca, Roberto F.;Guibu, Ione A.;Perez, Marjo D.;
International braz j urol , 2005, DOI: 10.1590/S1677-55382005000200005
Abstract: introduction: urogenital neoplasias frequently progress with obstructive uropathy due to local spreading or pelvic metastases. the urinary obstruction must be immediately relieved in order to avoid deterioration in these patients. the percutaneous nephrostomy is a safe and effective method for relief the obstruction; however the indications of such procedures have been questioned in patients with poor prognosis. material and methods: a retrospective study was performed with 43 patients (29 female and 14 male) with urogenital neoplasias who were undergoing percutaneous nephrostomy during a 54-month period. the median age was 52 years. the primary tumoral site was the uterine cervix in 53.5% of patients, the bladder in 23.3%, the prostate in 11.6% and other sites in 11.6%. results: postoperative complications occurred in 42.3% of the patients. there was no procedure-related mortality. thirty-nine per cent of the patients died during the hospitalization period due to advanced neoplasia. the mortality rate was higher in patients with prostate cancer (p = 0.006), in patients over 52 years of age (p = 0.03) and in those who required hemodialysis before the procedure (p = 0.02). thirty-two per cent of the patients survived long enough to undergo some form of treatment focused on the primary tumor. the survival rate was 40% at 6 months and 24.2% at 12 months. the percentage of the lifetime spent in hospitalization was 17.7%. the survival rate was higher in patients with neoplasia of the uterine cervix (p = 0.007) and in patients with 52 years of age or less (p = 0.008). conclusion: morbidity was high in this patient group; however, the majority of patients could be discharged from hospital and followed at home. patients under 52 years of age and patients with neoplasia of the uterine cervix benefited most from the percutaneous nephrostomy when compared to patients with hormone therapy-refractory prostate cancer, bladder cancer or over 52 years of age.
Percutaneous Nephrolithotomy: Indications and Technique  [cached]
Mustafa Sofikerim
Erciyes Medical Journal , 2008,
Abstract: Percutaneous nephrolithotomy is widely accepted and effective treatment modality for renal stone disease. When compared with other surgical interventions such as open renal surgery, percutaneous nephrolithotomy has lower morbidity and postoperative patient discomfort, so percutaneous nephrolithotomy mostly replaced open surgery in most of the urology clinics in Turkey and worldwide. In this review it is aimed to discuss indications and limitations of percutaneous nephrolithotomy that mean the proper patient selection and also to discuss important points of surgical technique and devices for intrarenal lithotripsy and instruments for kidney drainage after the procudure that all will offer the physicians successfull outcome.
Ultrasound Guided Percutaneous Nephrostomy For Obstructive Uropathy  [PDF]
Abdullah Gedik,?lhan K?l?n?,Aylin Hasanefendio?lu Bayrak,Davut Ak?n
Dicle Medical Journal , 2008,
Abstract: We retrospectively evaluated the indications and complications in our patients that were performed of percutaneous nephrostomy applications with ultrasonography guidance.We evaluated 371 all patients whom applied percutaneous nephrostomy with ultrasonography guidance between January 2002 and December 2005 were evaluated retrospectively. The demographic data, cause of the obstruction, minor and major complications of patients were discussed.In this period, totally 455 Percutaneous nephrostomies (84 bilaterally, 287 unilaterally) in 371 patients (were placed in 113 females (30.45 %) and 258 males) were placed. The male (69.55%) patients whom mean age of the patients were 32.17 year (range 5 months to 85 years). In 17 of 371 (3.73%) patients, it was determined with antegrade pyelography that nephro stomy catheters were not in the kidney). Total success ratio was 96.37%. Causes of the obstructions were malignant diseases in for 76 patients (20.48%) and were benign diseases in for 295 patients (79.52%). The major complications were determined twenty-four of patients (6.46%). Major complications included macroscopic hematuria which needs transfusion (7 patients), septicemia (14 patients), and retroperitoneal colon perforation with needle (3 patients) were observed in 24 of the 371 patients. Minor complications were observed in 51 of the 371 patients (13.74 %). All of the minor complications were macroscopic hematuria that resolved in less than 24 hours. In conclusion, percutaneous nephrostomy with ultrasonography guidance were found as an effective and, safe and successful method for the drainage of upper urinary tract in the obstructive uropaty.
Indications for percutaneous endoscopic gastrostomy and survival in old adults  [cached]
Anna Malmgren,Gunnel W?rn Hede,Brita Karlstr?m,Tommy Cederholm
Food & Nutrition Research , 2011, DOI: 10.3402/fnr.v55i0.6037
Abstract: Background : Many diseases striking old adults result in eating difficulties. Indications for selecting individuals for percutaneous endoscopic gastrostomy (PEG) are unclear and everybody may not benefit from the procedure. Objective : The aim of this study was to evaluate indications for and survival after PEG insertion in patients older than 65 years. Design and Methods : A retrospective analysis including age, gender, diagnosis, indication, and date of death was made in 201 consecutive individuals, 94 male, mean age 79±7 years, who received a nutritional gastrostomy. Results: Dysphagia was present in 86% of the patients and stroke was the most common diagnosis (49%). Overall median survival was 123 days and 30-day mortality was 22%. Patients with dementia and Mb Parkinson had the longest survival (i.e. 244 and 233 days), while those with other neurological diseases, and head and neck malignancy had the shortest (i.e. 75 and 106 days). There was no difference in mortality in patients older or younger than 80 years, except in patients with dementia. Conclusions: Old age should not be a contraindication for PEG. A high 30-day mortality indicates that there is a need of better criteria for selection and timing of PEG insertion in the elderly.
Prone Position in Percutaneous Nephrolithotomyand Postoperative Visual Loss
Mahvash Agah,Mahshid Ghasemi,Fatemeh Roodneshin,Badiozaman Radpay
Urology Journal , 2011,
Abstract: Purpose: To study the simultaneous effects of prone position and anesthesiaon intraocular pressure (IOP) and the time impact on post anesthesia visualloss development in percutaneous nephrolithotomy (PCNL).Materials and Methods: Twenty patients who were candidates for PCNLwere recruited in this study. Intraocular pressure was measured in fiveoccasions:1. Base line; 2. Ten minutes after anesthesia (Supine-I); 3. Ten minutesafter position change to prone (Prone-I); 4. At the end of the operation(Prone-II); and 5. Ten minutes after position change to supine(Supine-II).The data were analyzed by SPSS software using repeated measures ANOVAand paired t test.Results: The participants consisted of 17 (85%) men and 3 (15%) women,with the mean age of 44 years. The duration of the prone position was79.75 ± 22.73 minutes. Intraocular pressure changed significantly in fivepositions (P = .000). It was lower in supine-I than baseline, higher in prone-Ithan base line and supine-I, lower in supine-II than prone-II, and highest inprone-II (P = .000). There was a linear relationship between IOP and proneposition duration (r = 0.67; P = .001).Conclusion: Intraocular pressure dropped significantly after anesthesia andincreased in prone position. There was a linear relationship between IOPrise and the prone position duration, doubled within two hours. Therefore,in PCNL carried out in prone position, it is recommended to observe safetymeasures and necessary precautions for IOP rise and possible post anesthesiavisual loss, particularly in glaucoma.
Ultrasound guided percutaneous nephrostomy for obstructive uropathy in benign and malignant diseases
Sood, G.;Sood, A.;Jindal, A.;Verma, D.K.;Dhiman, D.S.;
International braz j urol , 2006, DOI: 10.1590/S1677-55382006000300004
Abstract: objective: analyze the success rate, complications and overall benefit of ultrasound guided percutaneous nephrostomy (pcn) for the relief of obstructive uropathy in benign and malignant diseases. materials and methods: pcn was performed in 50 kidneys of 32 patients. it was performed in emergency rooms totally under ultrasound guidance by general surgeons. seldinger technique was used in all cases. changes in renal function after the procedure were analyzed using paired t-test. results: the procedure was successfully completed in 42 out of 50 kidneys (84%). there has been no major complication and 28% minor complications. the renal function improved significantly when pcn was performed for benign conditions (mean creatinine 3.52 mg/dl before and 2.18 mg/dl after pcn), however in malignancy there has been no significant improvement in renal function (before pcn mean creatinine 6.39 mg/dl and after pcn 5.41 mg/dl). conclusion: we conclude that pcn can be effectively performed under ultrasound guidance and should be the initial procedure in acutely obstructed kidneys with pyonephrosis and poor renal function. in malignant cases, however, improvement in renal function is possible only if the procedure is carried out at an early stage.
Percutaneous epididymal sperm aspiration (PESA) in men with obstructive azoospermia
Glina, Sidney;Fragoso, Jorge B.;Martins, Fernando G.;Soares, Jonathas B.;Galuppo, Andrea G.;Wonchockier, Roberta;
International braz j urol , 2003, DOI: 10.1590/S1677-55382003000200008
Abstract: objectives: assessing the efficiency of repeated percutaneous epididymal sperm aspiration (pesa) in men with obstructive azoospermia, and also the possibility of cryopreservation of remaining material for future use in intracytoplasmic sperm injection (icsi). method: retrospective study, in which 79 procedures of pesa were assessed in 58 patients (mean age = 45 years), whose partners had mean age of 34 years. vasectomy was the most frequent cause of obstructive azoospermia (n = 46). results: motile spermatozoa were obtained in 65 procedures (82%). pesa was twice repeated for 15 patients, 3 times for 5 patients, and 4 times for 1 patient. spermatozoa were found in 13 (87%) patients in the second attempt, in 4 (80%) patients in the third attempt, and in the only patient that had accomplished 4 procedures. in 30 procedures (37%), we have obtained enough material for cryopreservation. in 12 among the 13 samples thawed (n = 13 patients), motile spermatozoa were found, and icsi was accomplished. four patients that did not use their samples requested the elimination of the material. total rate of pregnancy per transference was 21/55 (38%). in 14 pesa procedures, it was not possible to find spermatozoa; in these cases, the patients opted for accomplishing the procedure of testicular sperm aspiration (tesa). conclusion: pesa is an efficient and simple method of retrieving spermatozoa, allowing repeated procedures. additionally, spermatozoa collected through pesa can be cryopreserved.
Percutaneous epididymal sperm aspiration (PESA) in men with obstructive azoospermia  [cached]
Glina Sidney,Fragoso Jorge B.,Martins Fernando G.,Soares Jonathas B.
International braz j urol , 2003,
Abstract: OBJECTIVES: Assessing the efficiency of repeated percutaneous epididymal sperm aspiration (PESA) in men with obstructive azoospermia, and also the possibility of cryopreservation of remaining material for future use in intracytoplasmic sperm injection (ICSI). METHOD: Retrospective study, in which 79 procedures of PESA were assessed in 58 patients (mean age = 45 years), whose partners had mean age of 34 years. Vasectomy was the most frequent cause of obstructive azoospermia (n = 46). RESULTS: Motile spermatozoa were obtained in 65 procedures (82%). PESA was twice repeated for 15 patients, 3 times for 5 patients, and 4 times for 1 patient. Spermatozoa were found in 13 (87%) patients in the second attempt, in 4 (80%) patients in the third attempt, and in the only patient that had accomplished 4 procedures. In 30 procedures (37%), we have obtained enough material for cryopreservation. In 12 among the 13 samples thawed (n = 13 patients), motile spermatozoa were found, and ICSI was accomplished. Four patients that did not use their samples requested the elimination of the material. Total rate of pregnancy per transference was 21/55 (38%). In 14 PESA procedures, it was not possible to find spermatozoa; in these cases, the patients opted for accomplishing the procedure of testicular sperm aspiration (TESA). CONCLUSION: PESA is an efficient and simple method of retrieving spermatozoa, allowing repeated procedures. Additionally, spermatozoa collected through PESA can be cryopreserved.
Percutaneous Septal Ablation in Hypertrophic Obstructive Cardiomyopathy: From Experiment to Standard of Care  [PDF]
Lothar Faber
Advances in Medicine , 2014, DOI: 10.1155/2014/464851
Abstract: Hypertrophic cardiomyopathy (HCM) is one of the more common hereditary cardiac conditions. According to presence or absence of outflow obstruction at rest or with provocation, a more common (about 60–70%) obstructive type of the disease (HOCM) has to be distinguished from the less common (30–40%) nonobstructive phenotype (HNCM). Symptoms include exercise limitation due to dyspnea, angina pectoris, palpitations, or dizziness; occasionally syncope or sudden cardiac death occurs. Correct diagnosis and risk stratification with respect to prophylactic ICD implantation are essential in HCM patient management. Drug therapy in symptomatic patients can be characterized as treatment of heart failure with preserved ejection fraction (HFpEF) in HNCM, while symptoms and the obstructive gradient in HOCM can be addressed with beta-blockers, disopyramide, or verapamil. After a short overview on etiology, natural history, and diagnostics in hypertrophic cardiomyopathy, this paper reviews the current treatment options for HOCM with a special focus on percutaneous septal ablation. Literature data and the own series of about 600 cases are discussed, suggesting a largely comparable outcome with respect to procedural mortality, clinical efficacy, and long-term outcome. 1. Etiology, Pathogenesis, and Pathophysiology of HCM Hypertrophic cardiomyopathy (HCM [1–70]) is a cardiac condition morphologically characterized by unexplained myocardial hypertrophy. Extent and distribution of wall thickening are highly variable; the interventricular septum is most often involved, while the right ventricle is rarely affected. The prevalence of the disease is considered to be around 0.2%; in >50% of patients HCM has a familiar background [3, 6–8]. Inheritance shows an autosomal-dominant pattern, with an incomplete and highly variable penetrance. Mutations have been found in >2 dozens of genes coding for sarcomeric proteins or those involved in myocardial energy metabolism; the condition therefore has been characterized as a “sarcomeric disease” [42–48]. Histologically, the prominent findings in HCM are myocardial disarray, hypertrophy, and fibrosis [49–59]. Not only the myocardial walls but also the coronary vasculature walls are often thickened which may decrease coronary reserve and lead to myocardial ischemia in the absence of occlusive atherosclerosis. In addition, myocardial bridging is a rather frequent finding, and mitral valve leaflets may be elongated [13–15]. Left ventricular systolic function as expressed by the ejection fraction is normal in the vast majority of patients,
Postoperative Radiotherapy after Radical Prostatectomy: Indications and Open Questions  [PDF]
Pirus Ghadjar,Daniel Zwahlen,Daniel M. Aebersold,F. Zimmermann
Prostate Cancer , 2012, DOI: 10.1155/2012/963417
Abstract: Biochemical relapse after radical prostatectomy occurs in approximately 15–40% of patients within 5 years. Postoperative radiotherapy is the only curative treatment for these patients. After radical prostatectomy, two different strategies can be offered, adjuvant or salvage radiotherapy. Adjuvant radiotherapy is defined as treatment given directly after surgery in the presence of risk factors (R1 resection, pT3) before biochemical relapse occurs. It consists of 60–64?Gy and was shown to increase biochemical relapse-free survival in three randomized controlled trials and to increase overall survival after a median followup of 12.7 years in one of these trials. Salvage radiotherapy, on the other hand, is given upon biochemical relapse and is the preferred option, by many centers as it does not include patients who might be cured by surgery alone. As described in only retrospective studies the dose for salvage radiotherapy ranges from 64 to 72?Gy and is usually dependent on the absence or presence of macroscopic recurrence. Randomized trials are currently investigating the role of adjuvant and salvage radiotherapy. Patients with biochemical relapse after prostatectomy should at the earliest sign of relapse be referred to salvage radiotherapy and should preferably be treated within a clinical trial. 1. Introduction Radical prostatectomy (RP) provides excellent cancer control in patients with localized prostate cancer. However, half of all patients present with one or more risk factors for recurrent disease including higher Gleason Score, extracapsular extension (TNM tumor classification pT3a), invasion of the seminal vesicles (pT3b), or positive resection margins (R1). As a result, the risk of biochemical relapse is approximately 15–40% 5 years after RP [1, 2] and still increasing later [3] with even higher significance for patients with initially markedly elevated prostate-specific antigen (PSA) values [4, 5]. In patients with biochemical relapse, median time to bone metastasis is 8 years [6]. It is more pronounced with PSA doubling time of <12 months, resulting in a 5-year metastatic progression-free survival of less than 20% [7]. From several trials, nomograms have been created to assess the risk of an individual patient for tumor progression [8, 9]. This documents the importance of adequate selection of men after curative intended local treatment of prostate cancer. Postoperative radiotherapy (RT) can be performed directly after RP based on risk factors (adjuvant RT), or it is performed in case of biochemical relapse after RP or in patients who have
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