Seguridad y eficacia de la cirugía retrógrada intrarrenal en pacientes de diferentes grupos de edad

Objectives: To assess the efficacy and safety of retrograde intrarenal surgery (RIRS) to treat renal stones in different age groups of patients. Patients and methods: We performed a retrospective analysis of 947 patients who underwent RIRS for renal calculi between January 2008 and January 2014. Age at RIRS was analysed both as a continuous and categorical variable and patients were categorized into three age groups; aged 60 years (group in, n = 170). We compared the 3 groups with the regard to stone characteristics, operative parameters and postoperative outcomes. Results: The stone-free rate was 78.4% in group 1, 77.5% in group n, and 81.1% in group in (P = .587). A multivariate logistic regression analysis showed that only stone size and stone number had significant influence on the stone-free rates after RIRS. Intraoperative complications occurred 13.7% in group I, 5.6% group n, and 7.6% in group in. Overall complication rates in children were higher than adult patients but the differences were not statistically significant. We found that only operation time was associated with the increased risk of intraoperative complications. Peroperative medical complications developed in 8 patients (.8%) in group n and 2 patients (1.1%) in group III. A 48-year-old man died from septic shock 5 days after the surgery. Conclusions: RIRS was observed to be a safe and effective procedure in all age groups of patients with stone disease, therefore age should not be considered as a limiting factor. (C) 2014 AEU. Published by Elsevier Espana, S.L.U. All rights reserved

Radiation exposure during percutaneous nephrolithotomy; Is there a risk of the patient and the operating team?

Background: The aim of this study was to calculate the radiation amount exposed during percutaneous nephrolithototomy (PCNL) and to make the urologists and other staff sensitive about the radiation risk they were exposed to. Materials and Methods: We measured the radiation exposure during 114 cases of PCNL performed. Thermoluminescent dosimeters (TLD) were placed between the operation table and the patient at the location of kidney and gonads of patients to measure the radiation exposure of patients. TLD were placed at the head, neck, finger and the legs of the operating surgeon to measure the occupational exposure of the urologist. And also two dosimeters were placed to the inner wall of the operating room and two dosimeters were placed to the hall. Results: The mean fluoroscopy screening time was 2.18 minutes (0.15 - 6.12) and the mean operation time was 49 minutes (10-150). The mean radiation exposure for patients was 1.307 milisievert (mSv) at kidney location and 0.562 mSv at gonad location per procedure. Surgeon exposure was 0.021 and 0.003 mSv per procedure for hand and leg, respectively. Radiation amounts exposed inside the room and by the surgeon were statistically significantly lower than measured radiation results compared to patient kidney. Conclusion: According to our findings radiation exposure of the patient and the surgeon is below the annual occupational dose limit recommendations. However, for protecting from stochastic effects of radiation, fluoroscopy should be used as low as possible and lead aprons and thyroid shields must be worn to minimize the radiation exposure

The clinicopathologic observation, c-KIT gene mutation and clonal status of gastrointestinal stromal tumor in the sacrum

<p>Abstract</p> <p>Background</p> <p>It is very rare that gastrointestinal stromal tumor (GIST) occurs in the sacrum. Only one case of GIST occuring in the sacral region, with intracranial metastasis, has been reported in the literature. Moreover, only few cases have been published in literature about its clonal origin.</p> <p>Case presentation</p> <p>In this report, we present a rare case of GIST occuring in the sacrum and describe its clinicopathologic features, c-KIT gene mutation and clonal status. Microscopically, the lesion was composed of spindle cells arranged in cords, knitted and whirlpool patterns. Trabecula of bone were found in the lesion. The cytoplasm of tumor cells were abundant, and the nuclei were fusiform. Mitotic figures were rare. Immunohistochemically, the tumor cells showed positive reactivity for CD117 and CD34. On mutation analysis, a c-KIT gene mutation was found in exon 11. The result of clonal analysis demonstrated that the GIST was monoclonal.</p> <p>Conclusion</p> <p>In summary, we showed that tumor material, phenotypically identical with GISTs was found in the sacrum. It is difficult to differentiate GISTs from other spindle cell tumors, hence the need for immunohistochemistry, the examination of c-KIT gene amplification and sequencing.</p