Ureteroscopic Lithotripsy Using Swiss Lithoclast for Treatment of Ureteral Calculi: 12-Years Experience

Ureteroscopic lithotripsy using Swiss Lithoclast was performed in 411 cases from January 1996 to September 2007 in a single hospital. Medical records of 341 cases, in which Swiss Lithoclast was successfully applied, were available for this retrospective study. We used 9.5Fr and 10Fr Storz rigid ureteroscopes. A success was defined as being free of stone-related symptoms and residual stones larger than 2 mm. Sixty one stones were located in the upper ureter, 49 stones were in the mid ureter, and 231 stones were in the lower ureter. The overall success rate was 93.5%. The success rate of upper ureter stone (80.3%) was significantly lower compared with those of mid (93.8%) and lower (96.9%) ureter stones (P=0.001). The higher the calculi was located within the ureter, the more chance of upward migration there was (P<0.001). The success rate in male patients was lower than in female patients without a statistical significance (P=0.068). The success rate decreased as the size of the stone increased (P<0.001), and as the degree of hydronephrosis increased (P=0.03). Perforation rates were 4.9%, 4.1%, and 2.6% from upper to lower ureter stone group. Ureteroscopic lithotripsy using Swiss Lithoclast is a safe and useful treatment modality for ureteral calculi

Creativity, Tourism and Economic Development in a Rural Context: the Case of Prince Edward County

Located on Lake Ontario, Prince Edward County, Ontario, Canada is equidistant (about 200km) from both Ottawa and Toronto. Described by its own web site as ?A beautiful island adventure, the County is a mecca for artists, nature lovers and anyone looking for a beautiful island adventure ... for a weekend break or for life. Renowned for its sailing, fishing and giant sand dunes, the County also offers live theatre, artists&apos; studios and galleries, unique regional cuisine and a flourishing wine region.? Prince Edward County is an outstanding example of a rural community that has leveraged its natural resources with a focus on the creative economy including gastronomy, enology, culture and heritage, and the visual arts to create not only a desirable tourist destination but also vibrant regional economic development. In this paper, we use a combination of quantitative and qualitative data to examine the underlying intentions and strategy of this development focus along with the actual performance, growth, and underlying economic and demographic changes in the region. We demonstrate the impact of both planned, intended changes and serendipitous events, conditioned on a willingness to adapt, in creating lasting advantage for the region. We conclude by offering insights on what other rural communities can learn from the Prince Edward County case in terms of revitalizing their tourist economies and enhancing overall regional economic development. Keywords: rural development strategies, creative class, creative economy, Prince Edward Count

Randomized controlled trial comparing three different modalities of lithotrites for intracorporeal lithotripsy in pcnl

Purpose: To compare the efficiency (stone fragmentation and removal time) and complications of three models of intracorporeal lithotripters in percutaneous nephrolithotomy (PCNL). Materials and Methods: Prospective, randomized controlled trial at nine centers in the North America from 2009 to 2016. Patients were randomized to one of three lithotripter devices: the Cyberwand, a dual probe ultrasonic device; the Swiss Lithoclast Select, a combination pneumatic and ultrasonic device; and the StoneBreaker, a portable pneumatic device powered by CO2 cartridges. Since the StoneBreaker lacks an ultrasonic component, it was used with the LUS‐II ultrasonic lithotripter to allow fair comparison with combination devices. Results: 270 patients were enrolled, 69 were excluded after randomization. 201 patients completed the study: 71 in the Cyberwand group, 66 in the Lithoclast Select, and 64 in the StoneBreaker group. The baseline patient characteristics of the three groups were similar. Mean stone surface area was smaller in the StoneBreaker group at 407.8mm2 vs 577.5mm2 (Lithoclast Select) and 627.9mm2 (Cyberwand). The stone clearance rate was slowest in the StoneBreaker group at 24.0 mm2/min vs 28.9 mm2/min and 32.3 mm2/min in the Lithoclast Select and Cyberwand groups respectively. After statistically adjusting for the smaller mean stone size in the StoneBreaker group, there was no difference in the stone clearance rate among the three groups (p=0.249). Secondary outcomes, including complications and stone free rates, were similar between the groups. Conclusions: The Cyberwand, Lithoclast Select, and the StoneBreaker lithotripters have similar adjusted stone clearance rates in PCNL for stones > 2cm. The safety and efficacy of these devices are comparable

Maryland Guard Gallop

80.7568.742 – “Maryland Guard Gallop”: Charles Denstedt: Miller & Beacham: 1861: Piano Solo

Orbital Edema Secondary to a Sphenoidal Mass as the Presenting Symptom of High-Risk Precursor B-Cell Acute Lymphoblastic Leukemia

Introduction: Acute lymphoblastic leukemia (ALL) is the most common childhood malignancy, known to present with ocular manifestations in rare cases. Case Presentation: We describe the case of a 9-year-old previously healthy male who developed a 2-day history of periocular swelling and was found on MRI to have a large sphenoidal mass. Further work up showed involvement of the spinal cord, iliac crests, and kidneys. His initial blood work showed no hematological abnormalities. A bone marrow biopsy taken from the iliac crest demonstrated &gt;90% B lymphoblasts and flow cytometry was positive for CD19. Overall, his investigations were consistent with a diagnosis of precursor B-cell ALL (pre B-ALL). His neuro-ophthalmic exam showed right-sided subtle periocular edema, decreased palpebral fissure height, and proptosis. Posterior exam showed mild nasal elevation of the right optic disc without vessel obscuration and mild tortuosity of the peripheral vessels. He otherwise had no overt signs of afferent or efferent dysfunction despite the proximity of the mass to his optic nerve and globe. Conclusion: This case demonstrates that high-risk pre B-ALL, a childhood cancer not commonly associated with orbital manifestations, can present with orbital edema and normal leukocyte count in an otherwise healthy child

Classification and standardized reporting of percutaneous nephrolithotomy (PCNL): International Alliance of Urolithiasis (IAU) Consensus Statements

Background: The aim of this study was to reach a consensus in the classification and standardized reporting for the different types of PCNLs. Methods: The RAND/UCLA appropriateness methodology was used to reach a consensus. Thirty-two statements were formulated reviewing the literature on guidelines and consensus on PCNLs, and included procedure specific details, outcome measurements and a classification for PCNLs. Experts were invited to two rounds of input, the first enabled independent modifications of the proposed statements and provided the option to add statements. The second round facilitated scoring of all statements. Each statement was discussed in the third round to decide which statements to include. Any suggestion or disagreement was debated and discussed to reach a consensual agreement. Results: Twenty-five recommendations were identified to provide standardized reporting of procedure and outcomes. Consensual scoring above 80% were strongly agreed upon by the panel. The top treatment related outcomes were size of sheath used (99.1%) and position for PCNL (93.5%). The highest ranked Outcome Measures included definition of postoperative hospital length of stay (94.4%) and estimated blood loss (93.5%). Conclusions: The consensus statements will be useful to clarify operative technique, in the design of clinical trials and standardized reporting, and presentation of results to compare outcomes of different types of PCNLs