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Sample records for flexible ureteroscopic lithotripsy

  1. Flexible ureteroscopic lithotripsy for the treatment of upper urinary tract calculi in infants.

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    Li, Jun; Xiao, Jing; Han, Tiandong; Tian, Ye; Wang, Wenying; Du, Yuan

    2017-01-01

    We evaluated the clinical value of flexible ureteroscopic lithotripsy for the treatment of upper urinary tract calculi in infants. Fifty-five infants with upper urinary tract calculi were included in this study: 41 males and 14 females. Retrograde intrarenal surgery was performed by an 8 Fr/30 cm flexible ureterorenoscope (POLY®) combined with a holmium laser. CT scanning or radiography of the kidneys, ureters, and bladder region was performed one month after the operation to confirm the clearance of calculi. All the 55 infants with calculi in 74 sides underwent 66 flexible ureteroscopic lithotripsy procedures. The median operation time was 30 min. The median amount of flushing fluid was 500 mL. The stone-free rate after a single session treatment was 94.6%, within which 10 infants underwent simultaneous bilateral flexible ureteroscopy lithotripsy. Catheters were retained in 45 infants for 24-48 h after the operation. Continuous high fever due to reflux was present in two cases. Flushing fluid extravasation was found in one infant. Some patients with minor complications, such as mild hematuria, irritation symptoms, and low fever, recovered without treatment. The duration of hospitalization time after the operation was approximately 1-5 days. Flexible ureteroscopic lithotripsy is a safe, highly efficient, minimally invasive, and reproducible operation for removal of upper urinary tract calculi in infants. This technique is a convenient method for postoperative management of patients that enhances their rapid recovery. It is a promising option for therapy of infants ineffectively treated by extracorporeal shockwave lithotripsy.

  2. Outcomes of flexible ureteroscopic lithotripsy with holmium laser for upper urinary tract calculi

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    Marcello Cocuzza

    2008-03-01

    Full Text Available OBJECTIVE: To assess the perioperative and financial outcomes of flexible ureteroscopic lithotripsy with holmium laser for upper tract calculi in 44 patients. MATERIALS AND METHODS: Between February 2004 and September 2006, 44 patients treated for upper tract stone with flexible ureteroscopic lithotripsy were evaluated. Renal stones were associated with collecting system obstruction in 15 (34% patients, failed extracorporeal shock-wave lithotripsy (SWL occurred in 14 (32% patients, unilateral multiple stones in 18 (41% patients, and multiple bilateral stones in 3 (7%. In 29 (66% patients, the stone was located in the inferior calyx. Perioperative and financial outcomes were also evaluated. RESULTS: 50 procedures were performed in 44 patients. The mean stone burden on preoperative CT scan was 11.5 ± 5.8 mm. The mean operative time was 61.3 ± 29.4 min. The stone free rate was 93.1% after one procedure and 97.7% after a second procedure, with overall complication rate of 8%. Therapeutic success occurred in 92% and 93% of patients with lower pole stones and SWL failure, respectively. Treatment failure of a single session was associated with presence of a stone size larger than 15 mm (p = 0.007, but not associated with inferior calyx location (p = 0.09. Surgical disposables were responsible for 78% of overall costs. CONCLUSION: Flexible ureteroscopy using holmium laser is a safe and effective option for the treatment of upper urinary tract calculi. In addition, it can be considered an attractive option as salvage therapy after SWL failure or kidney calculi associated with ureteral stones. Stone size larger than 15 mm is associated with single session treatment failure.

  3. The comparative study of clinical efficacy between the flexible ureteroscope combination of rigid ureteroscope and the percutaneous nephrolithotomy holmium laser lithotripsy for the treatment of renal pelvis stones%输尿管软镜联合硬镜与经皮肾镜钬激光治疗肾盂大结石临床疗效对比研究

    Institute of Scientific and Technical Information of China (English)

    杨健; 傅发军

    2013-01-01

    目的 输尿管软镜联合硬镜与经皮肾镜钬激光治疗肾盂大结石临床疗效对比研究.方法 回顾和分析本院2010年7月~2012年8月应用输尿管软镜联合硬镜碎石术治疗肾盂大结石33例与采用经皮肾镜钬激光治疗肾盂大结石37例的治疗效果对比.结果 采用输尿管软镜结合硬镜碎石术治疗肾盂大结石的碎石率为95.3%,高于经皮肾镜钬激光法碎石术的90.5%.输尿管软镜结合硬镜的碎石排净时间为12d,显著少于经皮肾镜钬激光碎石术的14d.结论 采用输尿管软镜结合硬镜碎石术治疗肾盂大结石临床效果相比于经皮肾镜钬激光碎石术较好.%Objectives The comparison of clinical efficacy studies between the flexible ureteroscope combination of rigid ureteroscope and the percutaneous nephrolithotomy holmium laser lithotripsy for the treatment of renal pelvis stones.Methods To review and analysis the contrast between the flexible ureteroscope combination of rigid ureteroscope lithotripsy for the treatment of renal pelvis stones in 33 cases,and the percutaneous nephrolithotomy holmium laser lithotripsy for treatment of the renal pelvis stones in 37 cases at our hospital in July 2010 to August 2012.Results The flexible ureteroscope combination of rigid ureteroscope lithotripsy for the treatment of renal pelvis stones gravel was 95.3%,higher than the 90.5% from the ureteroscopic combined with the transcutaneous nerve holmium laser lithotripsy.The flexible ureteroscope combined with the rigid ureteroscope lithotripsy gravel clear time is 12d,significantly less than the 14d for the percutaneous nephrolithotomy holmium laser lithotripsy.Conclusions The clinical effect of flexible ureteroscope combined with rigid ureteroscope lithotripsy for the treatment of renal pelvis stones is better than the percutaneous nephrolithotomy holmium laser lithotripsy.

  4. Effect of alpha1-blockers on stentless ureteroscopic lithotripsy

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    Jianguo Zhu

    2016-02-01

    Full Text Available ABSTRACT Objective To evaluate the clinical efficiency of alpha1-adrenergic antagonists on stentless ureteroscopic lithotripsy treating uncomplicated lower ureteral stones. Materials and Methods From January 2007 to January 2013, 84 patients who have uncomplicated lower ureteral stones treated by ureteroscopic intracorporeal lithotripsy with the holmium laser were analyzed. The patients were divided into two groups, group A (44 patients received indwelled double-J stents and group B (40 patients were treated by alpha1-adrenergic antagonists without stents. All cases of group B were treated with alpha1 blocker for 1 week. Results The mean operative time of group A was significantly longer than group B. The incidences of hematuria, flank/abdominal pain, frequency/urgency after surgery were statistically different between both groups. The stone-free rate of each group was 100%. Conclusions The effect of alpha1-adrenergic antagonists is more significant than indwelling stent after ureteroscopic lithotripsy in treating uncomplicated lower ureteral stones.

  5. Acupoint Massage in Relieving Pain after Ureteroscopic Holmium Laser Lithotripsy

    Institute of Scientific and Technical Information of China (English)

    Xia Wei-qin

    2014-01-01

    Objective: To observe the effect of acupoint massage in relieving pain after ureteroscopic holmium laser lithotripsy. Methods: Ninety-two patients undergone ureteroscopic holmium laser lithotripsy were enrolled and randomized into a treatment group and a control group, 46 in each group. Patients in the control group were given regular nursing care, while patients in the treatment group were intervened by acupoint massage in addition to the regular nursing care. The pain was evaluated by visual analogue scale (VAS) at 6 h, 12 h, and 24 h after operation, and compared between the two groups. Results:There was no significant difference in comparing the VAS score at 6 h after operation between the two groups (P>0.05). The VAS scores in the treatment group at 12 h and 24 h after operation were significantly lower than those in the control group (both P Conclusion: Acupoint massage can effectively relieve the pain after ureteroscopic holmium laser lithotripsy, reduce the use of analgesics, and promote the recovery.

  6. Clinical factors associated with postoperative hydronephrosis after ureteroscopic lithotripsy

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    Kim, Sun Woo; Ahn, Ji Hoon; Yim, Sang Un; Cho, Yang Hyun; Shin, Bo Sung; Chung, Ho Seok; Yu, Ho Song; Oh, Kyung Jin; Kim, Sun-Ouck; Jung, Seung Il; Kang, Taek Won; Kwon, Dong Deuk; Park, Kwangsung

    2016-01-01

    Purpose This study aimed to determine the predictors of ipsilateral hydronephrosis after ureteroscopic lithotripsy for ureteral calculi. Materials and Methods From January 2010 to December 2014, a total of 204 patients with ureteral calculi who underwent ureteroscopic lithotripsy were reviewed. Patients with lack of clinical data, presence of ureteral rupture, and who underwent simultaneous percutaneous nephrolithotomy (PNL) were excluded. Postoperative hydronephrosis was determined via computed tomographic scan or renal ultrasonography, at 6 months after ureteroscopic lithotripsy. Multivariable analysis was performed to determine clinical factors associated with ipsilateral hydronephrosis. Results A total of 137 patients were enrolled in this study. The mean age of the patients was 58.8±14.2 years and the mean stone size was 10.0±4.6 mm. The stone-free rate was 85.4%. Overall, 44 of the 137 patients (32.1%) had postoperative hydronephrosis. Significant differences between the hydronephrosis and nonhydronephrosis groups were noted in terms of stone location, preoperative hydronephrosis, impacted stone, operation time, and ureteral stent duration (all, p<0.05). On multivariable analysis, increasing preoperative diameter of the hydronephrotic kidney (adjusted odds ratio [OR], 1.21; 95% confidence interval [CI], 1.12–1.31; p=0.001) and impacted stone (adjusted OR, 3.01; 95% CI, 1.15–7.61; p=0.031) independently predicted the occurrence of postoperative hydronpehrosis. Conclusions Large preoperative diameter of the hydronephrotic kidney and presence of impacted stones were associated with hydronephrosis after ureteroscopic stone removal. Therefore, patients with these predictive factors undergo more intensive imaging follow-up in order to prevent renal deterioration due to postoperative hydronephrosis. PMID:27617316

  7. Pre-Emptive Tramadol Could Reduce Pain after Ureteroscopic Lithotripsy

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    Denčić, Nataša; Jovičić, Jelena; Mirković, Jelena; Durutović, Otaš; Milenković-Petronić, Dragica; Lađević, Nebojša

    2014-01-01

    Purpose Optimal analgesia in ambulatory urology patients still remains a challenge. The aim of this study was to examine if the pre-emptive use of intravenous tramadol can reduce pain after ureteroscopic lithotripsy in patients diagnosed with unilateral ureteral stones. Materials and Methods This prospective pilot cohort study included 74 patients diagnosed with unilateral ureteral stones who underwent ureteroscopic lithotripsy under general anesthesia in the Urology Clinic at the Clinical Center of Serbia from March to June 2012. All patients were randomly allocated to two groups: one group (38 patients) received intravenous infusion of tramadol 100 mg in 500 mL 0.9%NaCl one hour before the procedure, while the other group (36 patients) received 500 mL 0.9%NaCl at the same time. Visual analogue scale (VAS) scores were recorded once prior to surgery and two times after the surgery (1 h and 6 h, respectively). The patients were prescribed additional postoperative analgesia (diclofenac 75 mg i.m.) when required. Pre-emptive effects of tramadol were assessed measuring pain scores, VAS1 and VAS2, intraoperative fentanyl consumption, and postoperative analgesic requirement. Results The average VAS1 score in the tramadol group was significantly lower than that in the non-tramadol group. The difference in average VAS2 score values between the two groups was not statistically significant; however, there were more patients who experienced severe pain in the non-tramadol group (ptramadol did reduce early postoperative pain. The patients who received pre-emptive tramadol were less likely to experience severe post-operative pain. PMID:25048508

  8. Flexible Ureteroscopic Management of Horseshoe Kidney Renal Calculi

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    Jie Ding

    2015-08-01

    Full Text Available ABSTRACTPurpose:To evaluate the clinical efficacy of flexible ureteroscope (F-URS combined with holmium laser lithotripter in treating renal calculi in horseshoe kidney.Materials and Methods:From November 2010 to December 2013, the medical history and charts of sixteen patients (mean age 42.9±11.6 years, range 26-66 years, including 13 males and 3 females were analyzed retrospectively. Mean stone burden was 29±8 mm (range 17-42 mm2. Mean stone digitized surface area (DSA was 321±94 mm2 (range 180-538 mm2. Under spinal anesthesia in a modified lithotomy position with the head down, rigid ureteroscope was placed firstly into the ureter to reach the level of the pelvis, a zebra guide wire was inserted and following the removal of the rigid ureteroscope, an ureteral access sheath was positioned along the guide wire, then passed the URF P-5 flexible ureteroscope into the renal cavities over the guidewire. After locating the stones, holmium laser lithotripsy was performed.Results:The average operative time was 92±16 minutes (range 74-127 min.. No major complications were encountered. Ten patients obtained stone-free status with one session, four obtained stone-free status after two sessions. Single session stone-free rate was 62.5%, overall stone-free rate was 87.5%. Two patients have small residual stones in the lower pole.Conclusions:F-URS combined with holmium laser lithotripter and nitinol basket, is safe and effective in dealing with moderate stone diameter (<30 mm in HSKs with high clearance rates and low complication rates.

  9. Miniature ureteroscope tip designs for use in thulium fiber laser lithotripsy

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    Kennedy, Joshua D.; Wilson, Christopher R.; Irby, Pierce B.; Fried, Nathaniel M.

    2017-02-01

    A miniature ureteroscope has the potential to eliminate need for full anesthesia and dilation, increase comfort and safety of laser lithotripsy via ureteroscopy, and reduce hospital costs via an office based procedure. A prototype, 4.5 Fr (1.5-mm-OD), five channel ureteroscope tip was developed, housing a 200-μm-ID central channel for insertion of small, 100-μm-core fibers and four surrounding channels, each with 510-μm-ID for instrumentation, irrigation, imaging, and illumination, respectively. Common urological instruments (including fibers, guidewires, and stone baskets) were inserted through tip's working channels to demonstrate feasibility. Low irrigation rates were measured, revealing a need for manual pump-assisted irrigation. Imaging was conducted using 3k, 6k, and 10k pixel miniature flexible endoscopes with 0.4, 0.6, and 0.9 mm outer diameters, respectively. The 3k pixel endoscope with integrated illumination was inserted through the prototype unimpeded, and successfully demonstrated ability to differentiate between hard tissues (e.g. kidney stones) and soft tissues (e.g. ureter wall), for visibility and safety during potential clinical application. Based on both image quality and instrument diameter, the 6k pixel endoscope provided an optimal solution for miniature ureteroscopy.

  10. Risk factors of a decreased stone free rate after flexible ureteroscopic lithotripsy%输尿管软镜碎石术后结石清除率降低的风险因素分析

    Institute of Scientific and Technical Information of China (English)

    钟文; 赖贺; 赵志健; 曾国华

    2016-01-01

    目的:评估影响输尿管软镜碎石术(flexible ureteroscopic lithotripsy,FUL)术后结石清除率(stone freerate,SFR)的风险因素.方法:分析260例FUL患者临床资料,将患者特征(年龄、性别、BMI、病史等)、结石特点(大小、位置和相关肾脏解剖、成分等)、FUL参数(输尿管通道鞘、灌注、碎石时间和手术时间等)作为潜在风险因素分组进行单因素分析,随后通过多因素逻辑回归分析,计算Odds比值(OR)和95%可信区间(95% CI),以确定FUL术后SFR降低的独立风险因素.结果:本组FUL术后SFR为73.5%.多因素逻辑回归分析中,结石大小(OR=8.636,95%CI:4.594~16.236,P<0.001)、肾下盏结石(OR=9.892,95%CI:4.463~21.923,P<0.001)、经皮肾镜取石(PCNL)术后残留结石(OR=4.632,95%CI:1.715~12.512,P=0.002)及感染性结石(OR=2.302,95%CI:1.000~5.305,P=0.050)被确定为FUL术后SFR降低的独立风险因素.结论:对于大负荷结石、肾下盏结石、PCNL术后残留结石、感染性结石,FUL术后SFR将会有降低的风险.

  11. Extraction of a long-forgotten ureteral stent by ureteroscopic pneumatic lithotripsy

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    江军; 朱方强; 姜庆; 王洛夫

    2004-01-01

    @@ A long-forgotten ureteral stent is occasionally encountered in urological practice. It can be complicated by encrustation and may pose a management and legal dilemma. Here, we report on a long-forgotten ureteral stent that had completely calcified after 30 months in a patient with chronic renal insufficiency due to obstructive uropathy. The stent was extracted successfully by means of ureteroscopic pneumatic lithotripsy.

  12. Rigid ureteroscopic lithotripsy versus percutaneous nephrolithotomy for large proximal ureteral stones: A meta-analysis

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    Hu, Henglong; Lu, Yuchao; Zhang, Jiaqiao; Qin, Baolong; Wang, Yufeng; Zhang, Zongbiao

    2017-01-01

    Object To compare the safety and efficacy of rigid ureteroscopic lithotripsy (rigid URSL) and percutaneous nephrolithotomy (PCNL) in treating large proximal ureteral stones. Methods A systematic search of PubMed, EMBASE, Cochrane Library, and Web of Science databases was performed to find out relevant studies. After literature screening according to the predetermined inclusion and exclusion criteria, data of eligible studies was extracted and then a meta-analysis was conducted via RevMan 5.3 software. Results Five randomized controlled trials (RCTs), one prospective and four retrospective cohort studies involving 837 patients were included. Patients underwent rigid URSL were associated with shorter operation time (WMD, -23.66min; 95%CI, −45.00 to -2.32; p = 0.03), shorter hospital stay (WMD, -2.76d; 95%CI, −3.51 to −2.02; phematuria (RR, 0.38; 95%CI, 0.25 to 0.57; p < 0.0001). No significant difference was observed in terms of incidence of embolization, pain and ureterostenosis. When cohort studies or studies in which flexible ureteroscopy was used as an intraoperative auxiliary procedure were excluded, we both found that most of the results kept stable. Conclusions Both PCNL and rigid URSL are safe for patients with large proximal ureteral stones while PCNL is more effective in stone clearance. PMID:28182718

  13. Pneumatic versus laser ureteroscopic lithotripsy: a comparison of initial outcomes and cost.

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    Demir, Aslan; Karadağ, Mert Ali; Ceçen, Kurşat; Uslu, Mehmet; Arslan, Omer Erkam

    2014-11-01

    To audit the cost of laser versus pneumatic semirigid ureteroscopic lithotripsy and to analyze their relative initial outcomes and cost. Hundred and eighty-seven patients who underwent semirigid ureteroscopic lithotripsy were analyzed retrospectively in terms of age and sex of the patients; location and size of the stones; the type of probe and ancillary equipment such as guide wire, basket catheter, JJ stent requirements; irrigation amount; operation time; the cost of the anesthesia and further treatments such as a JJ stent removal operation and shock wave lithotripsy requirements and their costs. Two groups were formed based on this type of lithotripters, pneumatic and laser lithotripsy. Operation times (min.) in terms of the stone size, for stones 100 mm(2) were 20.75 ± 10.78 and 25.82 ± 14.23, respectively (p = 0.007). Operation times for the pneumatic and laser groups were 33.05 ± 11.36 and 15.25 ± 6.14, respectively (p pneumatic and laser groups were 89.6 % (n = 69) and 98.2 % (n = 108), respectively (p = 0.01). The mean cost of the operations for each of the study groups was 261.5 ± 66.13 and 311.7 ± 51.97 US$, respectively (p = 0.001). The mean cost in terms of the stone size, for stones 100 mm(2), was 272.86 ± 53.05 and 323.71 ± 66.88 US$, respectively (p = 0.01). It seems that usage of laser lithotripsy (LL) in patients with ureteral stones is more effective than pneumatic lithotripsy (PL) in terms of operation time and SF rate. On the other hand, the mean cost of LL seems to be more expensive than PL. Urologists should think these parameters before the choice of these two treatment modalities. The higher the effectiveness, the greater the cost.

  14. 铂立组合式输尿管软镜联合钬激光碎石术治疗肾结石的疗效观察%Curative observation of polyscope modular flexible ureteroscope combined with Holmium laser lithotripsy in the treatment of renal calculi

    Institute of Scientific and Technical Information of China (English)

    鄢俊安; 邓国贤; 郑霁; 宋思吉; 李前伟; 姚基伟; 代林勇; 李为兵; 周占松

    2014-01-01

    Objective To evaluate the curative effect of polyscope modular flexible ureteroscope combined with Holmium laser lithotrip-sy in the treatment of renal calculi. Methods 53 patients with renal calculi were performed CTU to detect the position of renal calculi before operation. The patients were treated with polyscope modular flexible ureteroscope combined with Holmium laser, and the double J tube were routinely indwelled 4 to 12 weeks after surgery. Results All the 52 patients has successfully completed the operation in the frist stage. The mean operative time was about 38 minutes. 6 patients were treated with flexible ureteroscope for second stage operation. One week after oper-ation, the review showed that there were residual calculi existed in 24 cases and there were 56 cases of post-operative infection, including 17 cases of sepsis or sepsis shock. Conclusion Polyscope modular flexible ureteroscope can be used for all kinds of kidney stones surgery and is characterized by safety and mild tissue injury. But we should pay more attention to the post-operative infection especially urosepsis.%目的:探讨使用铂立组合式输尿管软镜联合钬激光治疗肾结石的疗效。方法58例肾结石患者,经术前尿路造影( CTU)定位,采用输尿管软镜联合钬激光碎石,术后留置双J管4~12周。结果52例一期完成手术,平均手术时间38 min左右,6例行二期软镜治疗,术后1周复查有24例结石残留,56例术后发生感染,其中17例脓毒症/脓毒症休克。结论铂立组合式输尿管软镜能较好完成各类肾结石手术,损伤小,但伴发的感染尤其是脓毒症要引起足够重视。

  15. Efficacy and safety of flexible ureteroscope lithotripsy and percutaneous nephro-lithotomy lithotripsy for renal calculus <2 cm:a Meta-analysis%输尿管软镜碎石术与经皮肾镜取石术治疗直径<2 cm肾结石的有效性和安全性的 Met a分析

    Institute of Scientific and Technical Information of China (English)

    张克; 张雁钢; 王靖宇; 任瑞民

    2015-01-01

    目的:系统评价输尿管软镜碎石术与经皮肾镜取石术在治疗肾结石(直径<2 cm )方面的有效性和安全性。方法计算机检索Pubmed、ScienceDirect、Ovid、Springer、Wiley Online Library、The Cochrane Library、CNKI、CBM、VIP及万方数据库,全面收集有关输尿管软镜碎石术和经皮肾镜取石术比较治疗肾结石的临床对照试验。由2位研究者独立进行文献筛选、资料提取和评价纳入研究的方法学质量,采用RevMan 5.2软件进行 Meta分析。结果纳入11篇研究,共计1060例患者。 Meta分析结果显示:输尿管软镜碎石术的清石率低于经皮肾镜取石术[OR=0.44,95% CI(0.29~0.67),P=0.0001],而在术中出血[MD=-72.78,95% CI(-80.77~-64.79),P<0.00001]、平均血红蛋白下降量[MD=-0.90,95% CI(-1.41~0.40),P=0.0005]、是否输血[OR=0.07,95% CI(0.02~0.27),P=0.0002]等方面则优于经皮肾镜碎石术。结论在结石清除率方面,输尿管软镜取石术低于经皮肾镜取石术,而在手术时间、术中出血量、是否输血等方面,输尿管软镜碎石术则优于经皮肾镜取石术。%Objective To evaluate the efficacy and safety of flexible ureteroscope lithotripsy (FURS) and percutaneous nephrolithotomy lithotripsy (PCNL) for patients with renal calculus (diameter <2 cm) .Methods Controlled clinical trials on FURS and PCNL for the treatment of kidney stones were searched in Pubmed ,ScienceDirect ,Ovid ,Springer ,Wiley Online Library ,Cochrane Library ,CNKI ,CBM ,VIP and Wanfang Database .Data collected were screened ,extracted and evaluated by two independent researchers .And then a Meta‐analysis was performed using RevMan 5 .2 software .Results A total of 11 studies were included ,and 1 060 cases were involved .Meta‐analysis showed that PCNL was better than FURS in stone clear‐ance rate [OR= 0 .44 ,95% CI (0

  16. Evaluation of the mechanisms of damage to flexible ureteroscopes and suggestions for ureteroscope preservation

    Institute of Scientific and Technical Information of China (English)

    P. Sooriakumaran; R. Kaba; H. O. Andrews; N. P. N. Buchholz

    2005-01-01

    Aim: To investigate the causes and costs of flexible ureteroscope damage, and to develop recommendations to limit damage. Methods: The authors analysed repair figures and possible causes of damage to 35 instruments sent for repair to a leading UK supplier over a 1-year period, and calculated cost figures for maintenance of the instruments as opposed to repair and replacement costs. Results: All damages were handling-induced and therefore did not fall under the manufacturer's warranty: 28 % were damaged by misfiring of the laser inside the instrument; 72 %, mainly crushing and stripping of the ureteroscope shaft tube, were likely to have occurred during out-of-surgery handling, washing and disinfection. Seventeen (4 %) instruments were not repaired and consequently taken out of service due to the extensive costs involved. Eighteen (51%) ureteroscopes were repaired at an average cost of 10 833 USD. Conclusion: Damages to flexible ureteroscopes bear considerable costs. Most damages occur during handling between surgical procedures.Thorough adherence to handling procedures, and courses for theater staff and surgeons on handling flexible instruments may help to reduce these damages and prove a cost-saving investment. The authors provide a list of recommended procedural measures that may help to prevent such damages.

  17. Clinical efficacy of flexible ureteroscopic lithotripsy in the treatment of renal stones complicated with urinary tract infection%输尿管软镜治疗肾结石合并复杂尿路感染的疗效分析

    Institute of Scientific and Technical Information of China (English)

    徐明曦; 达骏; 张明; 董国勤; 卢慕峻; 姚海军; 张克; 王忠

    2015-01-01

    目的:评价输尿管软镜碎石取石术治疗肾结石伴难治性尿路感染的疗效和安全性。方法回顾分析2011年10月至2014年6月15例感染性肾结石应用输尿管软镜下钬激光碎石取石治疗的临床资料,与同期行输尿管软镜手术且无明显尿路感染患者进行对照。感染组15例患者术前均有尿路感染及发热症状,术前根据尿培养选用敏感抗生素治疗2周,尿中白细胞仍维持在100个/μL以上。手术使用Storz Flex‐X2 F7.5输尿管软镜进行碎石取石术,钬激光功率设置为0.8~1.0 J /5~10 Hz ,术中留置F6双J管。术后观察体温变化、血常规及KUB。术后2周复查尿常规及尿路CT 平扫,评估尿路感染控制情况及排石效果。术后2~4周拔除双J管。结果所有患者均一次碎石成功。术中发现感染组15例患者肾盂内尿液浑浊、伴有絮状物,其中有2例结石被脓苔样组织包裹。术中用钬激光碎石,用套石篮取出碎石,取净脓苔样组织,平均手术时间(30±21)(15~50) min ,术后结石清除率为93.3%(14/15);有2例(13.3%)出现术后发热,均在术后6 h内发生,最高体温在39℃以下,抗炎对症治疗后好转。结论敏感抗生素保护下行输尿管软镜碎石取石术是治疗感染性肾结石的安全有效的方法,其结石清除率高、并发症低,但术中需低压冲洗,且术后仍有出现发热的风险,需要密切关注。%ABSTRACT:Objective To study the efficacy and safety of flexible ureteroscopic lithotripsy for renal stones complicated with recurrent urinary tract infection (UTI) .Methods Clinical data of 15 patients with renal stones and recurrent UTI (UTI group) were retrospectively reviewed .The patients were treated with flexible ureteroscopic lithotripsy during Oct .2011 to June 2014 .A group of 15 patients with renal stones but without any sign of UTI were included as controls .All

  18. Management of calculus anuria using ureteroscopic lithotripsy as a first line treatment: its efficacy and safety.

    Science.gov (United States)

    Savić, Slaviša; Vukotić, Vinka; Lazić, Miodrag; Savić, Nataša

    2014-05-06

    To present our experience with emergency ureteroscopic lithotripsy (URSL) for ureteral calculi associated with acute kidney injury (AKI). We retrospectively evaluated the 61 patients consisted of 90 ureteral units (UU), who underwent URSL. The cause of anuria was bilateral calculus obstructions in 29 cases, and unilateral calculus obstruction with, absent, nephrectomized contralateral kidney in 32 cases. In the case of bilateral synchronous ureteric calculi same-session bilateral ureteroscopy (SBBU) was done. The duration of anuria varied between 12 to 72 hours. At the end of the procedure, ureteral stent was systematically left in place in all patients. Surgery was performed 6-12 hours after admission to hospital. Patients were followed at least 1 month postoperatively. The stone free rates (SFR) were determined as baseline, on the first post-operative day, and as overall on the 30 days after procedure. The greatest success was achieved in the distal localization of stones up to 10 mm (93%). Renal function returned in 51 (83.6%) patients within 7 days. In 18 (29.5%) patients [18 (20%) UU] we performed second procedure as extracorporeal shockwave lithotripsy in 16.7% and open surgery in 2.2%. In 43 (70.5%) patients URSL was a successful therapeutic approach in dealing with pain, obstruction and calculus. Calculus anuria is a medical emergency that requires rapid diagnosis and prompt treatment for the purpose of decompression. URSL is the proper method of choice for selected patients and can be performed safely and has high success rates with minimal morbidity.

  19. Large subcapsular hematoma following ureteroscopic laser lithotripsy of renal calculi in a spina bifida patient: lessons we learn

    Directory of Open Access Journals (Sweden)

    Vaidyanathan S

    2016-08-01

    Full Text Available Subramanian Vaidyanathan,1 Azi Samsudin,2 Gurpreet Singh,3 Peter L Hughes,4 Bakul M Soni,1 Fahed Selmi1 1Regional Spinal Injuries Center, Southport and Formby District General Hospital, Southport, UK; 2Department of Urology, Whiston Hospital, Prescot, UK; 3Department of Urology, 4Department of Radiology, Southport and Formby District General Hospital, Southport, UK Introduction: Paraplegic patients are at greater risk of developing complications following ureteroscopic lithotripsy because of urine infection associated with neuropathic bladder, difficulties in access due to altered anatomy of urinary bladder and urethra, spinal curvature, spasticity, and contractures. We report the occurrence of large subcapsular hematoma following ureteroscopy and discuss lessons we learn from this case.Case report: A 48-year-old male patient with spina bifida underwent ureteroscopy with laser lithotripsy and ureteric stenting for left ureteric stone and staghorn calculus with hydronephrosis; laser lithotripsy was repeated after 3 months; both procedures were performed by a senior urologist and did not result in any complications. Ureteroscopic laser lithotripsy was performed 5 months later by a urological trainee; it was difficult to negotiate the scope as vision became poor because of bleeding (as a result of the procedure. Postoperatively, hematuria persisted; temperature was 39°C. Cefuroxime was given intravenously followed by gentamicin for 5 days; hematuria subsided gradually; he was discharged home. Ten days later, this patient developed temperature, the urine culture grew Pseudomonas aeruginosa, and ciprofloxacin was given orally. Computed tomography (CT of the urinary tract, performed 4 weeks after ureteroscopy, revealed a 9×7 cm subcapsular collection on the left kidney compressing underlying parenchyma. Percutaneous drainage was not feasible because of severe curvature of spine. Isotope renogram revealed deterioration in left renal function from 30

  20. Defining the Costs of Reusable Flexible Ureteroscope Reprocessing Using Time-Driven Activity-Based Costing.

    Science.gov (United States)

    Isaacson, Dylan; Ahmad, Tessnim; Metzler, Ian; Tzou, David T; Taguchi, Kazumi; Usawachintachit, Manint; Zetumer, Samuel; Sherer, Benjamin; Stoller, Marshall; Chi, Thomas

    2017-09-20

    Careful decontamination and sterilization of reusable flexible ureteroscopes used in ureterorenoscopy cases prevent the spread of infectious pathogens to patients and technicians. However, inefficient reprocessing and unavailability of ureteroscopes sent out for repair can contribute to expensive operating room (OR) delays. Time-driven activity-based costing (TDABC) was applied to describe the time and costs involved in reprocessing. Direct observation and timing were performed for all steps in reprocessing of reusable flexible ureteroscopes following operative procedures. Estimated times needed for each step by which damaged ureteroscopes identified during reprocessing are sent for repair were characterized through interviews with purchasing analyst staff. Process maps were created for reprocessing and repair detailing individual step times and their variances. Cost data for labor and disposables used were applied to calculate per minute and average step costs. Ten ureteroscopes were followed through reprocessing. Process mapping for ureteroscope reprocessing averaged 229.0 ± 74.4 minutes, whereas sending a ureteroscope for repair required an estimated 143 minutes per repair. Most steps demonstrated low variance between timed observations. Ureteroscope drying was the longest and highest variance step at 126.5 ± 55.7 minutes and was highly dependent on manual air flushing through the ureteroscope working channel and ureteroscope positioning in the drying cabinet. Total costs for reprocessing totaled $96.13 per episode, including the cost of labor and disposable items. Utilizing TDABC delineates the full spectrum of costs associated with ureteroscope reprocessing and identifies areas for process improvement to drive value-based care. At our institution, ureteroscope drying was one clearly identified target area. Implementing training in ureteroscope drying technique could save up to 2 hours per reprocessing event, potentially preventing expensive OR delays.

  1. Large subcapsular hematoma following ureteroscopic laser lithotripsy of renal calculi in a spina bifida patient: lessons we learn.

    Science.gov (United States)

    Vaidyanathan, Subramanian; Samsudin, Azi; Singh, Gurpreet; Hughes, Peter L; Soni, Bakul M; Selmi, Fahed

    2016-01-01

    Paraplegic patients are at greater risk of developing complications following ureteroscopic lithotripsy because of urine infection associated with neuropathic bladder, difficulties in access due to altered anatomy of urinary bladder and urethra, spinal curvature, spasticity, and contractures. We report the occurrence of large subcapsular hematoma following ureteroscopy and discuss lessons we learn from this case. A 48-year-old male patient with spina bifida underwent ureteroscopy with laser lithotripsy and ureteric stenting for left ureteric stone and staghorn calculus with hydronephrosis; laser lithotripsy was repeated after 3 months; both procedures were performed by a senior urologist and did not result in any complications. Ureteroscopic laser lithotripsy was performed 5 months later by a urological trainee; it was difficult to negotiate the scope as vision became poor because of bleeding (as a result of the procedure). Postoperatively, hematuria persisted; temperature was 39°C. Cefuroxime was given intravenously followed by gentamicin for 5 days; hematuria subsided gradually; he was discharged home. Ten days later, this patient developed temperature, the urine culture grew Pseudomonas aeruginosa, and ciprofloxacin was given orally. Computed tomography (CT) of the urinary tract, performed 4 weeks after ureteroscopy, revealed a 9×7 cm subcapsular collection on the left kidney compressing underlying parenchyma. Percutaneous drainage was not feasible because of severe curvature of spine. Isotope renogram revealed deterioration in left renal function from 30% to 17%. Follow-up CT revealed reduction in the size of subcapsular hematoma, no hydronephrosis, and several residual calculi. Risk of subcapsular hematoma following ureteroscopic lithotripsy can be reduced by avoiding prolonged endoscopy and performing ureteroscopy under low pressure. When a paraplegic patient develops features of infection after ureteroscopy, renal imaging should be carried out promptly

  2. Which ureteral access sheath is compatible with your flexible ureteroscope?

    Science.gov (United States)

    Al-Qahtani, Saeed M; Letendre, Julien; Thomas, Alexandre; Natalin, Ricardo; Saussez, Thibaud; Traxer, Olivier

    2014-03-01

    Our aim is to evaluate different ureteral access sheaths (UASs), which are available in the international market and their compatibility with different available flexible ureteroscopes (F-URSs) to help the urologist choose the proper ureteral access sheath for his or her endoscope before commencing the procedure. A total of 21 UASs and 12 F-URSs were evaluated. Measurements were obtained in French (F) units considering different characteristics for each UAS and each F-URS. Insertion test without friction between F-URS and UAS was considered as a successful test and was referred as (YES). All UASs and F-URSs were successfully submitted to the insertion test. All F-URSs that were inserted into UASs without friction had an internal diameter of at least 12F. Different lengths of UAS did not influence the test outcome. This study was able to establish a correlation table between different UASs and different flexible ureteroscopes. As of now, the 12/14F UAS is considered the universal UAS that accepts all F-URSs that are available in the endourology field. Nevertheless, we are expecting a significant change with the new standard size 10/12F UAS as well as huge advances in minimizing the size of different endoscopes.

  3. Treatment of lower urethral calculi with extracorporeal shock-wave lithotripsy and pneumatic ureteroscopic lithotripsy: a comparison of effectiveness and complications

    Institute of Scientific and Technical Information of China (English)

    钟惟德; 曾广翘; 蔡岳斌; 戴奇山; 胡建波; 魏鸿蔼

    2003-01-01

    Objective To determine the efficacy and incidence of complications of extracorporeal shock-wave lithotripsy (ESWL) compared with pneumatic ureteroscopic lithotripsy (URSL) in the treatment of lower uretheral calculi. Methods From August 1997 to June 1999, 210 patients with lower ureteric calculi were treated with ESWL and the other 180 with URSL. The stones were fragmented with pneumatic lithotripter. The outcome was assessed by evacuation, retreatment and complication rates.Results ESWL for lower ureteric calculi resulted in a stone evacuation rate of 78.1%, compared with 93.3% for URSL (P<0.05). ESWL had a retreatment rate of 11.9% and a perforation rate of 0, while URSL caused perforation of ureters in 3.3% of patients and a refreatment of 2.2%. Conclusion For the management of lower ureteric calculi, ESWL provides a non-invasive, simple and safe option, and URSL has a higher stone evacuation rate but causes ureter perforation more frequently than ESWL does. Both ESWL and URSL have their respective advantages. It is recommended, however, that URSL be extensively developed for better treatment efficacy, given that the operator has an adequate technical background.

  4. Frequency of Stent Placement after Ureteroscopic Lithotripsy in a University and a State Hospital

    Directory of Open Access Journals (Sweden)

    Huseyin Celik

    2016-03-01

    Full Text Available Objective: The aim of this study was to compare frequen­cy of ureteral stent placement after ureteroscopic litho­tripsy in a university and a state hospital of two different cities, which are endemic in terms of stone and often ure­terolithotripsy was performed for urolithiasis treatment. Methods: The patients who applied in to urology clinic of Inonu University Turgut Ozal Medical Center (TOMC and urology clinic of Osmaniye State Hospital (OSH between January 2014 and May 2014 were evaluated retrospec­tively. The patients who underwent ureteroscopic lithotrip­sy due to ureteral stone, were evaluated stone locations, stone sizes, grades of pelvicaliectasia and ureteral stent placement status. Results: About 92 patients were enrolled into the study from the both hospital. After the endoscopic ureteral stone treatment, Double J stent was placed in 85 patients in TOMC (92.3% and 82 patients in OSH (89.1%. Stent im­plantation rate in the university hospital was higher than the state hospital but this was not statistically significant. There was a statistically meaningful difference in mean operative time between the 2 groups. Conclusion: Double J stent placament is recently per­formed too often after the endoscopic ureteral stone treat­ment. According to our study, university hospitals have a higher rate of incidence of double j stent placement ac­cording to state hospitals. It can be reason for that, uni­versity hospitals as the last line treatment centers, more complicated cases that refer to these centers. But in this matter, prospective, multicenter and larger series studies are needed.

  5. Efficacy and safety of retrograde flexible ureteroscopic lithotripsy with holmium:YAG laser in the treatment of renal stones%逆行软性输尿管镜下钬激光碎石术治疗肾结石的有效性与安全性分析

    Institute of Scientific and Technical Information of China (English)

    曾国华; 李佳胜; 赵志健; 刘陈黎; 刘旸; 曾滔; 刘永达; 陈文忠; 吴文起

    2015-01-01

    Objective To evaluate the efficacy and safety of retrograde flexible ureteroscopic lithotripsy ( RFUL) with holmium:YAG laser for the treatment of renal stones with a large series.Methods The data of 466 patients who underwent RFUL with holmium:YAG laser for the treatment of kidney stones between January 2013 and December 2013 were collected.The maximum diameter of stone was 23 ±16 mm.The stone free rate, complications, retreatment rate were evaluated.Results Out of the 466 patients, the mean operative time and postoperative hospital stay were 33.5 ±18.8 min and 2.3 ±2.0 d.The stone free rate was 67.6% ( 315/466 ) after single procedure, which increased to 69.5% ( 324/466 ) via re-treatments after 3 months.The retreatment rate was 4.3%(20/466), with a total of 493 RFUL procedures performed and 1.06 times per patient.There were 67 (14.4%) cases undergoing complications.Five cases had false passage of ureter orifice causing slight ureteral wall injuries.Steinstrasse occurred in 9 cases, ureteral perforation in 3 cases and perirenal hematoma in 1 case.Overall postoperative fever rate was 10.7%(50/466) with urosepsis in 16 cases (3.4%).When the stone size was≤10, 11-20, 21-30, 31-40, and >40 mm, the stone free rates after a single procedure were 97.0% ( 65/67 ) , 84.2% ( 160/190 ) , 63.1%(70/111), 29.2%(14/48), 12.0%(6/50) (P<0.001), and the postoperative fever rates were 1.5%(1/67), 9.5%(18/190), 13.5% (15/111), 14.6% (7/48), 18.0% (9/50), respectively. The postoperative fever rates were 19.3%(27/140) and 7.1%(23/326) (P<0.001) in the patient with positive and negative preoperative urine leukocyte, and 22.0% ( 22/100 ) and 7.7% ( 28/366 ) ( P <0.001) in patients with positive and negative preoperative urine culture.Conclusions RFUL with holmium:YAG laser is a safe and effective treatment for kidney stones.The postoperative fever rate would increase and stone free rate would reduce with the increased stone size.%目的:评价逆行软性输尿管镜下钬激

  6. Pneumatic lithotripsy through ureteroscope for treating ureteral calculi%输尿管镜气压弹道碎石术治疗输尿管结石

    Institute of Scientific and Technical Information of China (English)

    林飞鹤; 谢春发; 高海亮; 蔡伯基; 蔡道广

    2015-01-01

    Objective To evaluate the efficacy and safety of the pneumatic lithotripsy through ureteroscope for the treatment of ureteral calculi.Methods A total of 920 patients underwent ureteroscopic lithotripsy using pneu-matic lithotripsy 259 upper,375 middle,and 286 lower ureteral stone were treated.Results The overall successful fragmentation rate for all levels of ureteral stones in a single session achieved 94.0% (864 /920),failure rate 6.0%(56 /920).28 cases failed because of ureteral stricture.24 cases of stone moved up into the kidney.All worst -cases were in dewelled shock wave lithotripsy ESWL.Conclusion Ureteroscopic lithotripsy using pneumatic lithotripsy is a highly effective,minimally invasive and safe therapy for ureteral calculi.It is indicated as a first choice for treatment patients with ureteral stones,especially for the ones with the middle and lower uneteral stones.Develop particularly suitable for basic hospital.%目的:总结分析经尿道输尿管镜气压弹道碎石术治疗输尿管结石的疗效及其安全性。方法应用输尿管镜气压弹道碎石术治疗920例输尿管结石,其中输尿管上段结石259例,输尿管中段结石375例,输尿管下段结石286例。结果920例输尿管结石单次成功率94%(864/920),失败率6%(56/920)。失败原因:28例因输尿管口畸形狭窄而上镜失败,24例碎石过程中部分结石进入肾内,52例失败病例在留置双 J管条件下术后辅助冲击波体外碎石治疗。4例因既往有输尿管手术史或多次 ESWL 史,结石远端输尿管明显扭曲或狭窄,术中输尿管镜试图扩张通过而发生穿孔。结论输尿管镜气压弹道碎石术治疗输尿管结石有效,微创、安全、经济,是治疗输尿管结石特别是输尿管中、下段结石的首选治疗方法,特别适合在基层医院开展。

  7. Flexible ureteroscope in the treatment of residual calculus after open surgery%输尿管软镜治疗开放手术残余结石

    Institute of Scientific and Technical Information of China (English)

    杨健; 傅发军

    2012-01-01

    目的 观察输尿管软镜治疗开放手术后残余结石的临床效果,探讨输尿管软镜在治疗术后残余结石中的应用价值.方法 选取我院2010年6月~2011年10月收治的106例开放手术治疗肾、输尿管结石后残余结石患者作为研究对象,所有患者均采用输尿管软镜钬激光碎石联合套石篮取石术,按照结石直径大小分为两组,A组(结石直径0.05).A组56例患者单次碎石成功47例,单次碎石成功率为83.9%,其余9例患者行再次碎石后均成功,总成功率为100.0%;B组50例患者单次碎石成功36例,单次碎石成功率为72.0%,其余14例患者行再次碎石后均成功,总成功率为100.0%,两组患者单次碎石成功率差异有高度统计学意义(P0.05),且两组均无并发症发生.结论 输尿管软镜治疗开放手术后残余结石效果理想,具有安全性高的特点,尤其适合结石直径小的患者,值得推广应用.%Objective To observe the clinical effects of flexible ureteroscope in the treatment of residual calculus after open surgery, and to explore the value of flexible ureteroscope in the treatment of postoperative residual calculus. Methods 106 cases of patients with residual calculus after open surgical treatment of kidney stones and urctera] calculus were selected as the objects of the study in our hospital from June 2010 to October 2011. All patients were treated with flexible ureteroscope holmium laser lithotripsy combined with stone basket lithotripsy. According to calculus diameters, all patients were divided into two groups, group A (calculus diameters 0.05). Among 56 patients of group A, 47 cases were successful in cmshing calculus In the first surgery, the success rate was 83.9%, and the other 9 patients were successful in crushing calculus in the second surgery, the total success rate was 100.0%. Among 50 patients of group B, 36 cases were successful In crushing calculus in the first surgery, the success rate was 72.0%, and the other

  8. 输尿管软镜钬激光碎石术后尿源性脓毒血症5例分析及对策%Analysis of 5 cases of urine-induced sepsis afterflexible ureteroscope holmium laser lithotripsy and countermeasures

    Institute of Scientific and Technical Information of China (English)

    毛俊彪; 袁平成; 桂定文; 彭伟; 陈小刚; 张青汉

    2015-01-01

    目的::探讨输尿管软镜钬激光碎石术后尿源性脓毒血症的预防措施,以降低发生率.方法:回顾性分析输尿管软镜钬激光碎石术后出现尿源性脓毒血症5例患者的临床资料:2例诊断为肾盂结石,3例诊断为肾盏结石.结石大小1.5~2.5 cm.术前血常规、肝肾功能、胸片、心电图等均正常,尿常规检查3例正常,2例白细胞5~12个/Hp,术前尿培养4例为阴性,1例患者第一次尿培养为大肠埃希菌,给予敏感抗生素治疗后复查尿培养阴性.患者均在全麻下行输尿管软镜钬激光碎石术.结果:5例患者术后出现不同程度尿脓毒血症,经选用敏感抗生素,并对症支持治疗,患者均痊愈出院.结论:尿源性脓毒血症是输尿管软镜钬激光碎石术后严重的并发症之一.术前充分准备,术中控制手术时间,术后严密监测,以及尽早选用敏感抗生素是防治输尿管软镜钬激光碎石术后尿源性脓毒血的关键.%Objective:To investigate prevention measures of urine-induced sepsis after flexible ureteroscope holmium la-ser lithotripsy in order to reduce the incidence.Methods:The clinical data of 5 cases of urine-induced sepsis after flexible ure-teroscope holmium laser lithotripsy were retrospectively analyzed.Two patients were diagnosed as having pyelolith,and three having calyceal calculus.Stone size was ranged from 1.5-2.5 cm.Blood routine test,hepatorenal function,chest radio-graphy,electrocardiogram before operation were normal.Urinalysis of three patients was normal,and leukocyte count of u-rinalysis was 5-12/Hp in two patients.Urine culture before operation was negative in 4 patients.The first urine culture was positive for Escherichia coli in one patient,and re-examination of urine culture was negative after sensitive antibiotic admin-istration.All patients were subjected to flexible ureteroscope holmium laser lithotripsy under general anesthesia.Results:Five patients had sepsis to varying

  9. Ureteroscope pneumatic lithotripsy for 204 cases of ureteral calculi%输尿管镜气压弹道碎石术治疗输尿管结石204例效果观察及治疗策略

    Institute of Scientific and Technical Information of China (English)

    张力; 胡兴平; 王凯

    2012-01-01

    Objective To investigate the effect of ureteroscope pneumatic lithotripsy for ureteral calculi. Methods Pneumatic lithotripsy under ureteroscopy was used to treat 204 cases of ureteral calculi, including 16 cases (8% ) in middle ureter and 188 cases (92% ) in lower ureter, in which 6 cases were in the wall of urinary bladder. Results The operation time varied from 15 to 116 min (45 min on average). The success rate of ureteroscope pneumatic lithotripsy was 98.0% (200 cases). The intraoperative stone free rate was 96. 6%. Stones in 2 cases transferred to kidney. Thus the surgery ended in failure. Some stones in 3 cases transferred to kidney after ureteroscope pneumatic lithotripsy (diameterIS3 mm). Stones in 1 case were exceptionally hard which could not be shattered by pneumatic lithotripsy probe and transferred to surgery. In another case, due to severe local mucosal edema with hemorrhage caused by swelling in the opening of the wall of urinary bladder, we could not find the front opening of ureter and insert a guide wire into it. This case was then cured by both surgery and ureteroscope pneumatic lithotripsy. Postoperative hematuria was observed by naked eye or microscope in all the cases, and disappeared 2-3 days after operation. No complications such as perforation and infection were found in any cases. Conclusions Ureteroscope pneumatic lithotripsy for ureteral calculi is effective, safe, with small damage of tissue, fewer complications, which can be used as the top choice for ureteral calculi in middle and lower ureter.%目的 观察输尿管镜气压弹道碎石术治疗输尿管结石的效果.方法 应用输尿管镜下气压弹道碎石治疗输尿管结石204例,其中输尿管中段结石16例(占8%),输尿管下段结石188例(占92%),膀胱壁内段结石6例.结果 204例手术时间15 ~116分钟,平均45分钟;碎石成功率98.0%(200例),术中结石排净率96.6%,2例结石漂移至肾脏,未能完成手术;3例碎石后,

  10. Ureteroscopic pneumatic lithotripsy for treatment of complicated ureteral calculi%输尿管镜气压弹道碎石术治疗复杂性输尿管结石

    Institute of Scientific and Technical Information of China (English)

    王文生; 薛建; 俞小明; 张钢; 李鑫; 李保国; 唐科伟

    2011-01-01

    目的 探讨输尿管镜气压弹道碎石术治疗复杂性输尿管结石的疗效.方法 采用输尿管镜气压弹道碎石术治疗复杂性输尿管结石56例,其中输尿管上段结石15例,中下段结石41例,体外冲击波碎石术(ESWL)失败25例,合并高热8例.结果 56例患者中,中下段结石均一次完全粉碎,成功率100.0%(41/41).上段结石一次完全粉碎10例,成功率66.7%(10/15).3例结石术中移位至肾脏,后辅以ESWL治疗1~2次,1例进镜困难终止手术,1例因输尿管穿孔改行开放手术.术后4周结石总清除率87.5%(49/56).8例合并高热者均急诊手术,7例一次结石粉碎成功,1例结石移位至肾脏,但梗阻均经手术得以解除,术后高热停止.输尿管穿孔发生率为1.8%(1/56).结论 输尿管镜气压弹道碎石术治疗复杂性输尿管结石安全、有效.%Objective To evaluate the therapeutic efficacy of ureteroscopic pneumatic lithotripsy for treatment of complicated ureteral calculi. Methods Clinical data of 56 cases with complicated ureteral calculi who were treated with ureteroscopic pneumatic lithotripsy was reviewed. Among them 15 cases were proximal ureteral calculi,41 cases were middle and distal ureteral calculi. Treatment by extracorporeal shockwave lithotripsy (ESWL) failed in 25 cases,8 cases complicated with fever. Results In 41 cases with middle and distal ureteral calculi, successful lithotripsy was achieved after the first treatment session,the success rate was 100.0% (41/41). In 15 cases with proximal ureteral calculi ,successful lithotripsy was achieved in 10 cases after the first treatment session,the success rate was 66.7%(l0/15). Calculi migrated to kidney in 3 cases who treated by ESWL for 1-2 times. The failure was due to ureteral kink in 1 case and due to ureteral perforation that required surgical repair in another case. Forty-nine cases were calculi-free after 4 weeks,the calculi-free rate was 87.5%(49/56). Emergency operation was performed in 8

  11. Comparative study on ureteroscopic lithotripsy and laparoscopic ureterolithotomy for treatment of unilateral upper ureteral stones Estudo comparativo entre litotripsia e ureterolitotomia laparoscópica no tratamento de cálculos unilaterais altos

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    You-qiang Fang

    2012-03-01

    Full Text Available PURPOSE: To compare the curative effects of ureteroscopic lithotripsy and laparoscopic ureterolithotomy for unilateral upper ureteral stones, and to explore optimal surgical indications and skills. METHODS: Fifty cases of unilateral upper ureteral stones were randomly divided into two groups: one group underwent ureteroscopic holmium laser lithotripsy under epidural or lumbar anesthesia (n=25, and another group underwent laparoscopic ureterolithotomy under general anesthesia (n=25. Double-J stent was routinely indwelled in both groups. Operating time, postoperative hospitalization time, stone clearance rate and perioperative complications were compared. RESULTS: Operation was successfully performed in all 50 cases, and no open surgery was converted in any case. In the ureteroscopy and laparoscopy groups, the mean operating time was 49.0±10.7 min and 41.8±8.0 min (t=2.68, P=0.00999, respectively, their hospitalization time was 2.8±1.3 days vs. 2.9±0.8 days (t =-0.40, P=0.69413, and stone clearance rate was 88.0% (22/25 vs. 100% (25/25. Stone moved to the renal pelvis in three cases in the ureteroscopy group, and residual stones were removed by extracorporeal shock-wave lithotripsy (ESWL. All patients were followed up for more than three months, and no serious complications such as ureterostenosis occurred. CONCLUSIONS: Laparoscopic ureterolithotomy has a higher stone clearance rate and shorter operation time compared with ureteroscopic lithotripsy. Laparoscopic ureterolithotomy is one safe and effective treatment on unilateral upper ureteral stones.OBJETIVO: Comparar os efeitos curativos da litotripsia ureteroscópica e a ureterolitotomia laparoscópica para cálculos unilaterais altos e pesquisar as indicações e resultados. MÉTODOS: Cinquenta casos de cálculos unilaterais altos foram distribuídos aleatoriamente em dois grupos: um grupo submetido a litotripsia ureteroscópica com laser holmium sob anestesia epidural ou lombar (n=25 e

  12. Combined electrohydraulic and holmium: YAG laser ureteroscopic nephrolithotripsy of large (>2 cm) renal calculi.

    Science.gov (United States)

    Mariani, Albert J

    2008-10-01

    Percutaneous nephrolithotripsy (PCL) is a standard treatment for renal calculi >2 cm. Modern flexible ureteroscopes and accessories employing the complementary effects of electrohydraulic lithotripsy (EHL) and Ho:YAG laser lithotrites can treat these renal calculi in a minimally invasive fashion with similar or superior results. To assess the safety and efficacy of ureteroscopic nephrolithotripsy monotherapy for the management of >2 cm renal calculi in the community setting. Fifty nine patients with 63 renal calculi ranging from 20 to 97 mm (mean 44 mm) in length and 175 to 3300 mm2 (mean 728 mm2) area underwent staged ureteroscopic nephrolithotripsy monotherapy. Obesity (BMI > 30) was present in 54% and 19% were morbidly obese (BMI > 40). An infectious etiology was present in 49% and hard stone components in 89%. All patients presented with hematuria, pain, and/or recurrent urinary tract infection (UTI). Lithotripsy was performed with a single deflection flexible ureteroscope and predominantly EHL. Laser drilling was employed (n = 6) to weaken very hard stones prior to EHL. Low intrarenal pressure was maintained by continuous bladder drainage and placement of a stiff safety wire. Visibility was maintained using manual pulsatile irrigation. All patients were rendered pain and infection-free. No patient required a blood transfusion and there was no change in serum creatinine. Mobile stone-free status was achieved in 60/63 (95%) with a mean of 1.7 nephrolithotripsy stages and 0.38 secondary or ancillary procedures. Outpatient management was sufficient for 121/131 (92%) of the procedures. Operative time averaged 46 min/stage and 79 min/calculus. Complications included endotoxic shock (3), fever (5), ureteral fragments requiring treatment (11), delayed extubation (2), delayed pneumonia (1), and urinary retention (1). Staged ureteroscopic nephrolithotripsy of large renal calculi is feasible with low morbidity and stone clearance rates that compare favorably with PCL. It

  13. Combined electrohydraulic and holmium: YAG laser ureteroscopic nephrolithotripsy of large (>2 cm renal calculi

    Directory of Open Access Journals (Sweden)

    Albert J Mariani

    2008-01-01

    Full Text Available Percutaneous nephrolithotripsy (PCL is a standard treatment for renal calculi> 2 cm. Modern flexible ureteroscopes and accessories employing the complementary effects of electrohydraulic lithotripsy (EHL and Ho:YAG laser lithotrites can treat these renal calculi in a minimally invasive fashion with similar or superior results. Objective: To assess the safety and efficacy of ureteroscopic nephrolithotripsy monotherapy for the management of> 2 cm renal calculi in the community setting. Materials and Methods: Fifty nine patients with 63 renal calculi ranging from 20 to 97 mm (mean 44 mm in length and 175 to 3300 mm2 (mean 728 mm2 area underwent staged ureteroscopic nephrolithotripsy monotherapy. Obesity (BMI > 30 was present in 54% and 19% were morbidly obese (BMI > 40. An infectious etiology was present in 49% and hard stone components in 89%. All patients presented with hematuria, pain, and/or recurrent urinary tract infection (UTI. Lithotripsy was performed with a single deflection flexible ureteroscope and predominantly EHL. Laser drilling was employed (n = 6 to weaken very hard stones prior to EHL. Low intrarenal pressure was maintained by continuous bladder drainage and placement of a stiff safety wire. Visibility was maintained using manual pulsatile irrigation. Results: All patients were rendered pain and infection-free. No patient required a blood transfusion and there was no change in serum creatinine. Mobile stone-free status was achieved in 60/63 (95% with a mean of 1.7 nephrolithotripsy stages and 0.38 secondary or ancillary procedures. Outpatient management was sufficient for 121/131 (92% of the procedures. Operative time averaged 46 min/stage and 79 min/calculus. Complications included endotoxic shock (3, fever (5, ureteral fragments requiring treatment (11, delayed extubation (2, delayed pneumonia (1, and urinary retention (1. Conclusion: Staged ureteroscopic nephrolithotripsy of large renal calculi is feasible with low morbidity

  14. Treatment of 88 Cases with Ureteral Calculi by Using Ureteroscopic Pneumatic Ballistic Lithotripsy%输尿管镜气压弹道碎石术治疗88例输尿管结石

    Institute of Scientific and Technical Information of China (English)

    阚乃尧; 杜耀安; 乔羽; 陈健

    2011-01-01

    Objective To evaluate the efficacy of ureteroscopic pneumatic ballistic lithotripsy for ureteral calculi. Methods A retrospective analysis was made in 88 cases treated by ureteroscopic pneumatic ballistic lithotripsy from June 2006 to November 2010. There are 9 cases of bilateral ureteral calculi ,7 cases of isolated renal and 14 cases of acute obstructive renal failure. Results The locations of ureteral calculi were in the upper portion in 20 sides,in the middle portion in 28 sides,in the lower portion in 50 sides. The total success rate of one stage for patients was 91.8% (75.0% in upper portion,92.8% in middle portion,98.0% in lower portion). The mean operation time was 56 minutes( range from 20 to 100 minutes). 3 cases were changed into open operation. 5 cases needed auxiliary ESWL. In the patients with acute obstructive renal failure, the serum Bun and Cr levels decreased at different degree or return to normal. Conclusion The ureteroscopic pneumatic ballistic lithotripsy is safe,effective and less invasive, and is the first choice in the treatment of lower and middle ureteral calculi, which can treat the bilateral ureteral calculi simultaneously;it can rapidly remove the obstruction for the patients with obstructive acute renal failure.%目的 探讨输尿管镜气压弹道碎石术治疗输尿管结石的效果.方法 回顾性分析2004年6月-2010年11月88例输尿管镜气压弹道碎石术治疗输尿管结石的临床资料.其中孤立肾7例,双侧结石9例,急性梗阻性肾功能衰竭14例.结果 输尿管结石位于上、中、下段分别为20侧、28侧、50侧.一次性碎石91.8%,其中上段75.0%,中段92.8%,下段98.0%.3例改开放手术,体外震波碎石术(ESWL)5例.手术时间20~100 min,平均56 min.急性肾功能衰竭患者血BUN,Cr恢复正常或接近正常.结论 输尿管镜气压弹道碎石术安全、高效、损伤小,可作为输尿管中下段结石的首选方法,能同时处理双侧结石.对梗阻性急

  15. Ureteroscopic holmium laser lithotripsy in treatment of patients with acute obstructive renal impairment%输尿管镜钬激光碎石术治疗急性梗阻性肾功能衰竭

    Institute of Scientific and Technical Information of China (English)

    段永顺; 倪少滨; 陈起引; 赵忠山

    2011-01-01

    目的 探讨上尿路结石引起的急性梗阻性肾衰的治疗方法.方法 采用输尿管镜直视下取石、钬激光碎石或将结石推入肾盂,体外冲击渡碎石(ESWL)治疗急性梗阻性肾衰32例(62侧).所有患者输尿管镜检查术前未曾放置输尿管支架或肾盂引流管.结果 30例输尿管中下段结石经输尿管镜直视下取碎石成功,碎石成功率93.7%.2例输尿管上段结石被推入肾盂,行ESWL治疗后1个月,结石排净.术后患者肾功能恢复正常或接近正常,尿量恢复,结石排净率100%.结论 输尿管镜下取石、钬激光碎石治疗结石引起的急性梗阻性肾衰是一种安全、有效、创伤小、术后恢复快且可同时处理双侧输尿管的手术方式,可作为上尿路梗阻并发急性肾功能衰竭的首选治疗方法.%Objective To evaluate the efficacy and safety of holmium laser for treatment ureteric stones in patients with acute obstructive renal impairment.Methods Thirty-two patients were included in this study.None of the patients had a ureterie stent or nephrostomy tube before the ureteroseopy.All patients were treated with holmium laser.Results 30 patients with ureter stones in middle and inferior segment were free of stones by ureteroscopic lithotripsy.The success rate for treatment of ureteral stones lithotripsy and calculus removal was 93.7%.Ureter stones located in superior segment in two patients were sent back pelvis.Extracorporeal shock-wave lithotripsy were performed.The two patients were free of any stone fragmens a month later.In all patients, including the five with obstructive anuria,the renal impairment resolved or improved as evidenced by normalization or fall in blood urea and creatinine.100% of the patients were free of any stone fragments postoperatively.Conclusion A holmium laser was a safe and effective modality of ureteroscopic lithotripsy in patients with significant renal impairment or even obstructive anuria.It also had merits of small

  16. Combined electrohydraulic and holmium:YAG laser ureteroscopic nephrolithotripsy of large (greater than 4 cm) renal calculi.

    Science.gov (United States)

    Mariani, Albert J

    2007-01-01

    Percutaneous nephrolithotripsy is standard treatment for renal calculi larger than 2 cm. Modern flexible ureteroscopes and accessories using the complimentary effects of electrohydraulic lithotripsy and holmium:YAG laser lithotrites can treat large (greater than 4 cm) branched renal calculi in a minimally invasive fashion with similar or superior results. This report is an assessment of the safety and efficacy of ureteroscopic nephrolithotripsy monotherapy for the management of large (greater than 4 cm) branched renal calculi in the community setting. A total of 16 patients with 17 branched renal calculi ranging from 41 to 97 mm (mean 65) in length and 560 to 2,425 mm2 (mean 1,169) in area underwent staged ureteroscopic nephrolithotripsy monotherapy. Obesity (body mass index greater than 30) was present in 81% and 38% were morbidly obese (body mass index greater than 40). An infectious etiology was present in 81% and hard stone components were present in 94%. All patients presented with hematuria, pain and/or recurrent urinary tract infection. Lithotripsy was performed with a single deflection flexible ureteroscope and predominantly electrohydraulic lithotripsy. Laser drilling was used (in 4) to weaken hard stones before electrohydraulic lithotripsy. Low intrarenal pressure was maintained by continuous bladder drainage and placement of a stiff safety wire. Visibility was maintained using manual pulsatile irrigation. All patients were rendered pain and infection-free. No patient required a blood transfusion and there was no change in serum creatinine. Mobile stone-free status was achieved in 15 of 17 renal units (88%) with a mean of 2.4 stages and 36 of 40 (90%) procedures performed on an outpatient basis. Operative time averaged 49 minutes per stage and 115 minutes per calculus. There were 3 patients admitted for fever and 1 patient (90 years old) admitted for pneumonia 3 days postoperatively. There were also 3 patients with calculi larger than 75 mm who required

  17. Utility of Flexible Ureterorenoscopy and Laser Lithotripsy in the Treatment of Multiple Intrarenal Stones

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    Hasan Yılmaz

    2017-09-01

    Full Text Available Objective: We aimed to determine the safety and efficacy of flexible ureterorenoscopy and Holmium laser lithotripsy in treating multiple intrarenal stones. Materials and Methods: We identified 32 consecutive patients with multiple intrarenal stones who underwent flexible ureterorenoscopy and/or laser lithotripsy performed by a single surgeon. Informed consent was obtained from all participants before treatment. Each patient was evaluated in terms of stone location, stone number, stone size, stone burden (cumulative stone length, body mass index, operative time, stone-free rate, and perioperative complications. Results: The median age of the patients was 38 years [interquartile range (IQR, 34.25-52.00]. The patients had a total of 75 intrarenal calculi. The average number of stones per patient was 2.50 (IQR, 2.0-3.0. The median total stone burden per patient was 23.0 mm (IQR, 19.0-28.0 mm. Twenty-one patients (65.5% had stone burdens >20 mm, and 11 (34.5% had burdens ≤20 mm. The overall final stone-free rate was 78.1%. The stone-free rates for patients with stone burdens ≤20 mm and >20 mm were 81.8% (9/11 and 76.2% (16/21, respectively (p=0.544. A perioperative complication (urinary leakage occurred in one patient. Postoperative complications were recorded in four (12.5% patients; a urinary tract infection in one, pain requiring parenteral medication in two, and hematuria in one. Conclusion: Flexible ureterorenoscopy combined with laser lithotripsy may be an effective treatment option for patients with multiple intrarenal stones; we noted only a few minor complications. The success rate was higher in patients with stone burdens ≤20 mm.

  18. First clinical evaluation of a new single-use flexible ureteroscope (LithoVue™)

    DEFF Research Database (Denmark)

    Doizi, Steeve; Kamphuis, Guido; Giusti, Guido

    2017-01-01

    patients included underwent flexible ureteroscopy and were 18 years or older. Deflection and image quality pre- and post-use and maneuverability were rated with a Likert scale. RESULTS: A total of 40 procedures were performed (five per institution). The indication for FURS was treatment of renal stones...

  19. Should flexible ureteroscope be added to our armamentarium to treat stone disease?

    Directory of Open Access Journals (Sweden)

    Anand Dharaskar

    2008-01-01

    Full Text Available The field of Urology in Medicine has witnessed tremendous advancement in technology and in accordance with it. Endourology has taken a leap ahead in terms of stone management. Most of the stones could be treated with semi-rigid ureteroscopy, percutaneous nephrolithotomy (PNL and ESWL and some would need Flexible ureteroscopy. Flexible ureteroscopy has been primarily indicated to treat ESWL resistant renal stones but with changes in the technology of incorporating secondary active deflection and availability of laser fibres, its horizon for indications to treat stones is being widened. Though Flexible ureteroscopy is being used to treat stones of various sizes and locations, its cost effectiveness is debatable. Should it be used ubiquitously to treat stones amenable to PNL or ESWL is a big question we need to answer. As of now true indications of Flexible ureteroscopy are limited and there is an urgent need for a randomized trial to compare its efficacy with ESWL and PNL for renal and upper ureteric stones.

  20. Withdraw of the Ureteroscope Causes Fragmented Ureter Stones to Disperse

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    Onder Canguven

    2013-09-01

    Full Text Available Introduction Ureteroscopy has improved from the first use of ureteroscope in the 1970's. Although the success rate increased in the last years, (1 new treatment techniques are being developed for impacted and large proximal ureter stones (2. Pneumatic lithotripsy has high efficiency with low complication rates (2. However, in case of steinstrasse and large (> 1 cm ureter stones, fragmented small stones may obstruct insertion of a ureteroscope after initial lithotripsy. In order to triumph over this issue, multiple ureteroscopic passages and manipulations needed for extraction of these small stones by forceps or basket catheters. The overall incidence of stricture was found upto 14.2% when the fragments were removed with a grasping forceps or a basket (3. We present our technique to disperse small fragmented stones in order to contact non-fragmented rest stone. Materials and Methods Ureteral lithotripsy was performed with an 8-9.8F semirigid ureteroscope using a pneumatic lithotripter (Swiss LithoClast, EMS, Nyon, Switzerland. The stone was fragmented into small pieces as small as 2-3 mm. by pneumatic lithotripter. Eventually, these fragmented stones interfered with vision and the lithotripter to get in touch with the rest stone. After fragmenting distal part of the large stone, the ureteroscope was pulled back out of ureter. While pulling back, the operating channel was closed and irrigation fluid was flowing in order not to decrease pressure behind the stones. Simultaneously, a person tilted the operating table to about 30° in reverse Trendelenburg position. When the ureteroscope was out of ureteral orifice, the operating channel was opened and irrigation fluid was stopped. This maneuver aided decreasing pressure in the bladder more rapidly in addition to feeding tube. Stone dust and antegrade fluid flow were easily seen out of the ureteral orifice. Ureteroscope was re-inserted after 30-60 seconds. While reaching the rest of the stone, small

  1. [Flexible ureterorenoscopy and laser lithotripsy for upper urinary tract stones in neurologic patients with severe motor disability].

    Science.gov (United States)

    Madec, F-X; Suply, E; Luyckx, F; Nedelec, M; Chowaniec, Y; Branchereau, J; Le Normand, L; Glemain, P

    2017-05-01

    The study's objective was to evaluate the effectiveness and morbidity of flexible ureterorenoscopy and laser lithotripsy for upper urinary tract stones in patients with a nervous system pathology including severe motor disability. Between 2006 and 2013, we retrospectively analyzed 83 flexible ureterorenoscopy to treat 63 kidneys in 42 patients. Stone free (SF) kidneys defined as an absence of stones on computerized tomography, renal ultrasound, X-ray or direct ureterorenoscopy, were considered a surgical success. Complications were classified according to the Clavien-Dindo system. Success rates were 49.2 %, 57.1 % and 58.7 %, respectively after first, second and third flexible ureterorenoscopy procedure. Clearance after one procedure was achieved in 64.3 % of cases involving less than 20mm stones. No major complication (Clavien-Dindo>2) was described (0 %). Complication rates were 44.7 %, with 31.6 % Clavien-Dindo 2. The main complication was urosepsis, which occurred in 27.6 % of cases. Flexible ureteroscopy and laser lithotripsies for upper urinary tract stones in neurologic patients with severe motor disability are associated with a lower success rate and some frequent low grade complications compared to overall population. In clinical practice, the indications of flexible ureterorenoscopy for these patients seem restricted. 5. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  2. Ureteroscopic pneumatic lithotripsy in the treatment of upper urinary tract obstruction by ureteral cal-culi during pregnancy%输管尿镜下气压弹道碎石术治疗妊娠期输尿管结石引起上尿路梗阻

    Institute of Scientific and Technical Information of China (English)

    郑卓敏; 庄泽平; 连乐林; 黄芸珊; 陈燕东

    2016-01-01

    Objective To evaluate the feasibility and clinical efficacy of ureteroscopic pneumatic lithotrips in the treatment of upper urinary tract obstruction by ureteral calculi in pregnant women.Methods Thirty six women diagnosed with upper urinary tract obstruction by ureteral calculi during pregnancy were char-acterized with persistent and recurrent severe renal colic.Ureteroscope-guided pneumatic lithotripsy was per-formed.Results The ureteral calculi were successfully treated in 32 patients by ureteroscopic pneumatic litho-trips.Double-J ureteral stents were retained in four patients complicated with pyonephrosis,who were treated with extracorporeal shock wave lithotripsy after parturition.Renal colic and fever were absent after surgery.No abortion,prematurity,fetal death,ureter perforation or avulsion was noted.All pregnant women had full-term delivery and all newborns were healthy.Conclusion Ureteroscopic pneumatic lithotripsy could effectively and safely alleviate renal colic and treat obstruction in pregnant women with upper urinary tract obstruction by ure-teral calculi.%目的:探讨利用输尿管镜气压弹道碎石术治疗妊娠期输尿管结石引起上尿路梗阻的可行性及临床效果。方法对36例持续性或反复发作剧烈肾绞痛的妊娠期输尿管结石引起上尿路梗阻患者,采用输尿管镜下气压弹道碎石术治疗,观察手术疗效及安全性。结果输尿管镜下气压弹道碎石术一次性碎石成功32例,4例输尿管上段结石患者因合并脓肾予留置双 J 管,待患者妊娠结束后行体外冲击波碎石。术后所有患者的肾绞痛、发热等症状消失。36例均未出现流产、早产或死胎,无出现输尿管穿孔、撕脱等并发症,所有孕妇均足月分娩,新生儿发育均正常。结论输尿管镜下气压弹道碎石术治疗妊娠期输尿管结石引起上尿路梗阻能有效缓解患者疼痛,解除梗阻,且安全性高。

  3. Intracorporeal lithotripsy with the holmium:YAG laser

    Science.gov (United States)

    Denstedt, John D.; Razvi, Hassan A.; Chun, Samuel S.; Sales, Jack L.

    1995-05-01

    A variety of devices are currently available for intracorporeal stone fragmentation. Recently a new wavelength of laser, the Holmium:YAG, has demonstrated a variety of potential urologic applications including ablation of soft tissue lesions as well as stone fragmentation. This laser has a wavelength of 2100 nm and operates in a pulsed mode. Energy is delivered through a 400 um quartz end-firing fiber. In this presentation we review our clinical experience with the Holmium:YAG laser for the treatment of renal and ureteral calculi. Over a 23 month period, 63 patients underwent 67 procedures. Seven procedures consisted of percutaneous nephrolithotripsy for large or staghorn renal calculi. Sixty procedures were performed for ureteral stones. Procedures for proximal ureteral stones (6) employed a retrograde approach using flexible ureteroscopes (8.5 or 9.8). Stones in the mid ureter (12) and distal ureter (42) were approached transurethrally using a 6.9 rigid ureteroscope. Complete stone fragmentation without the need for additional procedures was achieved in 82% of cases. Treatment failures included 1 stone migration into the renal pelvis during laser activation, 6 patients who had incomplete fragmentation and 3 patients in which laser malfunction precluded complete fragmentation. Stone analysis available in 23 patients revealed calcium oxalate monohydrate (15), calcium oxalate dihydrate (2), cystine (2), uric acid (3) and calcium phosphate (1). A single complication of ureteral perforation occurred when the laser was fired without direct visual guidance. Radiographic follow-up at an average of 16 weeks is available in 22 patients and has identified 2 patients with ureteral strictures that are not believed to be related to laser lithotripsy. In summary, we have found the Holmium:YAG laser to be a reliable and versatile device for intracorporeal lithotripsy. Its safety and efficacy make it a suitable alternative for performing intracorporeal lithotripsy of urinary

  4. 系统评价非复杂性输尿管镜碎石术后不安置D-J管的可行性与有效性%Systematic review on feasibility and validity of non-D-J tube placement following uncomplicated ureteroscopic lithotripsy

    Institute of Scientific and Technical Information of China (English)

    钟强; 姜庆; 郑昌建; 赵春雷; 林艳君

    2012-01-01

    Objective To systematically review the feasibility and the validity of non-D-J tube placement following ureteroscopic litho-tripsy for ureteral calculi. Methods All randomized clinical trials of non-D-J tube placement after ureteroscopic lithotripsy were identified with Cochrane Library、PubMed、Embase、VIP、WangFang and CNKI. The quality of the included randomized trials and extracted data was assessed by two reviewers independently. Meta analysis was performed with RevMan 5. 0 soft ware. Results Twelve randomized trials ( including 1 071 patients ) were collected and divided into test group ( non-D-J tube placement ) and control group ( D-J tube placement ). The me-ta-analysis showed that the operation time was shortened in test group ( P =0. 000 2 ), the risk of postoperative frequent /urgent micturition was decreased by 41% , ( P <0. 000 01 ), hematuria by 51% (P = 0.007) and dysuria by 48%( P =0. 008 ) compared with those in control group. There was no statistical difference in mean hospital duration, stone discharge rate and postoperative ureterostenosis between test and control group ( P =0. 16 ). Conclusion Non-D-J tube placement after ureteroscopic lithotripsy is better than D-J tube placement in operation duration and postoperative complication,howerver, it has no influence on mean hospital time, stone discharge rate and postoperative ureterostenosis.%目的 系统评价非复杂输尿管镜下输尿管结石碎石术后不安置D-J管的可行性与有效性.方法 检索Cochrane Library、PubMed、EMbase、维普、万方及CNKI等在线数据库,搜索相关的所有随机对照试验,由两位评价员独立进行评价和资料提取,统计学分析采用RevMan 5.0软件处理.结果 共纳入12个随机对照试验(共1 071例),分为试验组(不安置D-J管)和对照组(安置D-J管),Meta分析结果显示,与对照组比较,试验组的手术时间短(P=0.000 2),术后尿频/尿急的发生风险减少了41%(P<0.000 01),

  5. Effects of Nursing Intervention on Quality of Life of Patient with Ureteral Stones Underwent Holmium: YAG Laser Ureteroscopic Lithotripsy%护理干预对输尿管镜钬激光碎石术患者生活质量的影响

    Institute of Scientific and Technical Information of China (English)

    钱彦; 瞿青云; 沈敏; 张涛; 吴宗林

    2012-01-01

    目的:探讨护理干预对输尿管镜钬激光碎石术患者生活质量的影响.方法:采取前瞻性随机对照的方法,从2008年5月到2010年12月,共有123例接受榆尿管镜钬激光碎石术的输尿管结石患者被随机分成对照组和护理干预组.使用世界卫生组织生存质量测定量表简表评价输尿管镜钬激光碎石术对患者生活质量的影响.结果:非护理干预组和护理干预组的世界卫生组织生存质量测定量表简表的生活质量评分手术后比手术前有明显改善(P<0.05).输尿管镜钬激光碎石术后,护理干预组患者的生活质量优于非护理干预组.结论:护理干预能明显改善输尿管镜钬激光碎石术患者的生活质量.%Objective: To investigate the effects of nursing intervention on quality of life of patient with ureteral stones underwent holmium: YAG laser ureteroscopic lithotripsy. Methods: From May in 2008 to December in 2010, a total of 123 consecutive patients admitted from a waiting list for surgery for ureteral stones were prospectively randomized to either nursing intervention or non-nursing intervention. Pre-and postoperative WHOQOL-BREF outcome data were obtained. Results; The WHOQOL-BREF in non-nursing intervention and nursing intervention group had significantly improved at post-operation compared to pre-operation. There was significant difference on WHOQOL-BREF scores in two groups at post-operation. Conclusions: Nursing intervention can improve the quality of life of patients with ureteral stones underwent holmium: YAG laser ureteroscopic lithotripsy. Improving the nursing after the procedure makes good prognosis.

  6. 输尿管镜下气压弹道碎石术治疗复杂性输尿管结石影响因素分析%Influencing factors analysis of ureteroscopic pneumatic ballistic lithotripsy in the treatment of complicated ureteral calculi

    Institute of Scientific and Technical Information of China (English)

    左泽平; 方军; 宇洪涛; 钱俊杰; 朱金海

    2015-01-01

    Objective To investigate the influencing factors of ureteroscopic pneumatic ballistic lithotripsy ( URSL) in the treatment of complicated ureteral calculi. Methods From June 2009 to July 2013, clinical data of 132 cases with complicated ureteral calculi at Tongling People’s Hospital were retrospectively analyzed. Among them, the successful operation for 111 cases as group A and 21 failed cases as group B , test was used to investigate the effect of treatment and influencing factors of patients in two groups. Results When the course of disease was more than 8 weeks, incarceration stones, stone size had significant difference (all P values 8周 vs≤8周)、结石嵌顿与否、结石大小(>1.2 cm vs≤1.2 cm)等指标两组患者比较差异有统计学意义(P值均<0.05),是影响URSL治疗输尿管结石疗效的主要因素。结论病程长、结石嵌顿、结石较大等因素直接影响URSL的效果;采取有效的干预措施,可减少输尿管镜碎石术的失败比例。

  7. 输尿管硬镜下钬激光碎石取石术治疗输尿管上段结石112例%Study on treatment of upper ureteral calculi using rigid ureteroscope and holmium:YAG laser lithotripsy (report of 112 cases)

    Institute of Scientific and Technical Information of China (English)

    徐汉新; 吴兆春; 黄海

    2014-01-01

    Objective To investigate clinical effect and safety of holmium: YAG laser lithotripsy under ureteroscopy for managing upper ureteral calculi. Methods The clinical data of 112 cases of ureter calculi treated by ureteroscope with Holmium laser lithotripsy were retrospectively analyzed. Among these patients, 63 were male, and 49 were female. The age of the patients varied between 18~87 years with a mean age of 46.7 years. The largest diameter of the largest stone was 0.7~2.2 cm (1.2±0.5 cm). There are 5 cases of bilateral upper ureteral calculi, and the total number of left upper ureteral calculi was 61, and the right side was 46. There were 26 cases affiliated with ureteral polypus, and 31 cases with ESWL treatment history preoperative. All the cases had different degrees of hydronephrosis. Results The overall successful operation rate for all level of ureteral stones in single procedure was 88.4% (99/112). The operation time ranged 15~80 min (33.6 ±16.8 min), and the postoperative hospital stay was 3~14 d (4.7 ±2.1 d). No complications occurred such as severe hematouria, ureteral perforation, ureteral avulsion and ureteral stone street in this post cohort operation. There were three cases with urinary tract infection and suffered fever. Urosepsis occurred in one case , and cured by timely anti-infection treatment. Conclusion Rigid ureterorenoscopy using Ho:YAG laser lithotripsy for upper ureteral calculi can be an effective and safely performed technique.%目的:探讨输尿管硬镜下钬激光碎石取石术治疗输尿管上段结石的临床效果及安全性。方法应用输尿管硬镜下钬激光碎石取石术治疗112例输尿管上段结石患者。男63例,女49例,年龄18~87岁(46.7±13.6岁),左侧61例,右侧46例,双侧5例。结石长径0.7~2.2 cm (1.2±0.5 cm)。26例合并输尿管息肉,31例曾行体外冲击波碎石术,所有患侧肾脏均合并不同程度肾积水。结果手术成功率88.4

  8. Clinical curative effect observation of "rule of three three" in the treatment for lower residual stones after flexible ureteroscope%“三三法则”促进输尿管软镜碎石术后残余结石排出的临床疗效观察

    Institute of Scientific and Technical Information of China (English)

    王丹; 陈刚; 任洪艳

    2015-01-01

    Objective To observe and assess the effect about bundles of cure "Rule of three three" in the treatment for residual stones after Flexible Ureteroscope.Methods 120 patients with a single stone after urinary lithotripsy were divided into two groups according to the different indwelling time.Two cases of the control group were rejected because of severe hematuria.The control group (n=58) was subjected to the regular education (drinking water 3 000 ml per day with moderate exercise);The experiment group (n=60) was subjected to the "Rule of three three" (drinking 3 cups of water in thc morning、midday and night,with contralateral position 30 minutes,hot towel applying and gently tapping the kidney region 30 minutes).Results The calculi discharge rate and the net rate of experiment group [86.67% (52/60),55.00% (33/60)] were higher than the control group [53.45%(32/58),18.97%(11/58)] 14 days after surgery.The difference was statistically significant (P < 0.01).Further analysis showed that the discharge rate of residual stones in lower renal calyx in experiment group [86.67%(26/30)] was higher than the control group [32.14%(9/28)].The difference was statistically significant (P < 0.01).Conclusions The bundles of cure called "rule of three three" can improve the discharge rate of residual calculi after flexible ureteroscope and increase the discharge rate of residual stones in lower renal calyx significantly.%目的 观察集束化治疗方案“三三法则”在输尿管软镜碎石术后促进残余结石排出的效果.方法 选取泌尿系单一结石并行输尿管软镜碎石术后患者120例,按前后对照的方法分为2组.对照组60例,其中2例因严重血尿退出,最后实际入组58例,采用常规指导(饮水3 000 ml/d,适量运动);实验组60例,采用“三三法则”指导(每日早、中、晚3个时间段各饮水3杯,300 ml/杯,饮水后30 min健侧卧位30 min,同时热敷并轻叩患肾区30 min).记录2

  9. The nursing cooperation in flexible ureteroscopy and holmium laser lithotripsy%输尿管软镜下钬激光碎石术的护理配合

    Institute of Scientific and Technical Information of China (English)

    孙莉娟

    2011-01-01

    Objective To explore the nursing cooperation in flexible ureteroscopy and holmium laser lithotripsy. Methods The effect of tour nursing with 20 patients that underwent flexible ureteroscopy and holmium laser lithotripsy was summarized. Results All cases were operated successfully, the tour nursing cooperation was very good, and the patients returned to ward safely after operation. Conclusion The operating room nurses should know the information of patients before operation, be familiar with various types of endoscopic surgical instruments, equipment use and maintenance, know the process of surgery, and get fully prepared before surgery to ensure the surgical process to go to smoothly.%目的 探讨输尿管软镜下钬激光碎石术的护理配合.方法总结20例行输尿管软镜下钬激光碎石术的手术巡回护理的效果.结果本组病例均顺利完成手术,术中巡回护士配合达到预期结果,患者术后安返病房.结论手术室护士术前必须充分了解患者的病情,熟悉各类腔镜手术器械及仪器的使用与维护,了解手术操作过程,做好各种术前准备,术中才能配合默契,有利于手术的顺利进行.

  10. 经皮肾镜/输尿管镜取石术中、术后感染性休克15例报告%Treatment of Septic Shock during and after Percutaneous Nephrolithotomy or Ureteroscopic Lithotripsy: Report of 15 Cases

    Institute of Scientific and Technical Information of China (English)

    葛成国; 靳风烁; 江军; 王洛夫; 李家宽; 万江华; 兰卫华; 张尧

    2011-01-01

    Objective To summarize our experience on septic shock during and after percutaneous nephrolithotomy (PCNL) or ureteroscopic lithotripsy (URL) for upper urinary tract stones.Methods From January 2004 to April 2009,432 cases of PCNL and 645 cases of URL were carried out in our hospital.Among them, 15 patients (4 men and 11 women) developed septic shock ( 11 cases in PCNL group and 4 in URL group); 14 of them had the complication after the operations, and the other developed septic shock during the surgery.Antishock measures was immediately conducted with intensive fluid resuscitation to establish stable circulation and then broad-spectrum carbapenem (meropenem or imipenem) to control infection.Low-dose-Solu Medrol (30 mg) were intravenously injected in case of significant intoxication.Low-dose hydrocortisone was administered in the patients with vasopressor-dependent severe septic shock.And mechanical ventilation was used for patients who developed pulmonary infection or respiratory insufficiency.Results The septic shock occurred intraoperatively in 1 case, and thus the operation was stopped immediately and the patient was transferred to ICU for further treatment.One patient waked up and showed hypotension and tachycardia after the surgery.After liquid resuscitation, the dopamine and phenylephrine were administrated to help returning the blood pressure to a safe range.The tracheal cannula still remained and the patient was transferred to ICU immediately.The other thirteen patients developed septic shock 2 - 8 hours postoperatively, 5 of them, who had symptoms of sepsis, were delivered to ICU.No case died.All the patients' vital signs were stable within 3 to 5 days, and thus vasoactive drugs were gradually stopped.Their body temperature, levels of serum creatinine and BUN, and blood routine tests then returned to a normal range in 3 - 8 days.Severe pulmonary infection occurred in 8 cases, of which 4 cases who showed respiratory failure were given endotracheal

  11. 输尿管软镜钬激光碎石术后全身炎症反应综合征的风险因素评估%Risk factors of systemic inflammatory response syndrome following flexible ureteroscopic lithotripsy

    Institute of Scientific and Technical Information of China (English)

    钟文; 赖贺; 赵志健; 曾国华

    2016-01-01

    目的:探讨输尿管软镜钬激光碎石术(FUL)术后发生全身炎症反应综合征(SIRS)的风险因素.方法:分析2012年10月~2014年11月间260例患者临床资料,按术后是否发生SIRS分组,单因素分析比较年龄、性别、BMI、结石大小、尿路感染、肾积水、灌注、输尿管通道鞘、手术时间、结石成分等风险因素,随后通过多因素逻辑回归分析,计算Odds比值(OR)和95%可信区间(95%C1)以确定FUL术后SIRS的独立风险因素.结果:FUL术后SIRS发生率8.1%(21/260).在单因素分析中,SIRS与患者性别(P<0.01)、结石大小(P=0.001)、灌注速度(P<0.01)及灌注量(P <0.01)有显著相关性.多因素逻辑回归分析确定结石大小(OR=1.691,95%CI:0.879~3.255)、小口径输尿管通道鞘(OR=2.293,95%CI:0.730~7.200)、灌注速度(OR=1.161,95%CI:1.096~1.230)及感染性结石(OR=3.331,95%CI:0.971~11.426)为FUL术后SIRS的独立风险因素.结论:结石大负荷、感染性结石是FUL术后SIRS危险因素,具有这些危险因素的患者FUL时应控制手术时间,必要时分期手术;FUL术中宜使用低压低流灌注,并使用大口径输尿管通道鞘提供引流,用以降低FUL术中肾盂内压.

  12. Subcapsular hematoma after ureteroscopy and laser lithotripsy.

    Science.gov (United States)

    Chiu, Peter Ka-Fung; Chan, Chun-Ki; Ma, Wai-kit; To, Kim-Chung; Cheung, Fu-Keung; Yiu, Ming-kwong

    2013-09-01

    Renal hematoma after ureteroscopic lithotripsy (URSL) using holmium:yttrium-aluminum-garnet (Ho:YAG) laser is a rare complication. We aimed to review our center's experience of post-URSL subcapsular hematoma. From 2007 to 2012, 1114 URSLs using 7.5F semi-rigid ureteroscopes were performed. Patients with post-URSL symptomatic renal hematoma were reviewed. Perioperative information on patients' preoperative morbidity, renal function, stone characteristics, and degree of hydronephrosis were reviewed. Operative information, postoperative presentation of symptoms, changes in blood parameters, CT findings, and subsequent management were documented. Post-URSL subcapsular hematoma was diagnosed in 4 of 1114 (0.36%) patients, who ranged in age from 43 to 63 years. Preoperative imaging showed that all four patients had obstructing proximal ureteral stones ranging in size from 0.7 to 2.1 cm, and three of them had thin renal cortices. Pressure bags were not used, and Double-J ureteral stents were inserted in all cases. All four patients had the triad of loin pain, fever, and significant hemoglobin drop necessitating transfusion. Three patients presented within 2 days of URSL, and one patient presented on day 20. One patient was treated conservatively and recovered with bed rest and antibiotics. Urgent angiography was performed on one patient in view of a significant drop in hemoglobin, but no embolization was needed. One patient underwent ultrasonography-guided drainage of the hematoma, and another had an emergency open clot evacuation because of significant compression on the kidney by the hematoma. Follow-up CT scans confirmed the resolution of the hematoma in all cases. Post-URSL subcapsular hematoma is a rare but potentially serious complication. A high index of suspicion is needed when patients present with significant loin pain and fever after URSL for obstructing proximal ureteral stones with thin renal cortices. The management of post-URSL subcapsular hematomas needs

  13. 输尿管软镜下钬激光碎石术治疗肾盏内小结石%Flexible Ureteroscopy Combined with Holmium Laser Lithotripsy for Small Renal Calix Calculi

    Institute of Scientific and Technical Information of China (English)

    王彭; 于江; 尉春晓; 曲华伟; 陈修德; 张建军

    2013-01-01

    Objective To evaluate the efficacy of the flexible ureteroscopy with Holmium laser lithotripsy for renal calculi.Methods From May 2011 to Jan 2013, 21 cases of renal calculi(sized between 0.5 to 1.5cm in diameter , 72 calculi in total ) were treated by flexible ureteroscopy with Holmium laser lithotripsy in our hospi-tal.Observe the ureteric orifice and then a ureteric access sheath was placed and a Olympus URF -V flexible ureteroscopy with Holmium laser lithotripsy was used to perform the procedure , and a F5 double-J stent would be setup at the end of procedure for 4 weeks.Result In 2 cases the ureteric access sheath was failed to be placed.20 cases out of 21 (95.2%) had stone clearance at 4 weeks post primary operation , and the total stone clearance rate was 100% ( 21/21 ) .The average operation time was 42 minutes ( 18 ~65 mins ) .No serious complication occurred .Conclusion Flexible ureteroscopy combined holmium laser lithotripsy is a safe and effec-tive procedure for renal calculi , it has high clearance rate of stones and less complication and morbidity , it is the best option for managing small renal calculi .%目的:评价输尿管软镜联合钬激光治疗肾盏内小结石的效果。方法2011年5月至2013年1月21例输尿管软镜钬激光碎石病例。术前均行逆行造影检查,明确输尿管及集合系统解剖位置正常。共52枚结石,结石直径0.5~1.5 cm。探查输尿管口置入斑马导丝,导丝引导下置入 F12输尿管软镜鞘,经鞘置入日本Olympus URF-V输尿管软镜,抵达目标肾盏行钬激光碎石。留置5 F双J管一根4周。结果2例无法置入输尿管软镜鞘,斑马导丝引导下置入输尿管软镜。钬激光碎石成功率100.0%(21/21)。4周后结石清除率为95.2%(20/21)。总的结石清除率为100.0%(81/86)。平均手术时间为42分钟(18~65分钟)。术后平均住院时间3.8天(3~5天)。无严重并发症。结论输尿

  14. 输尿管软镜下钬激光碎石术治疗上尿路结石——附126例报告%Treatment of Upper Urinary Calculi with Holmium Laser Lithotriptor under Flexible Ureteroscope (Appended with Report of 126 Cases)

    Institute of Scientific and Technical Information of China (English)

    周振宇; 何朝晖; 杨江根; 曾国华

    2013-01-01

    Objective To evaluate the clinical effect of holmium laser with flexible ureteroscope on upper urinary calculi.Methods All 126 patients of upper urinary calculi were treated with Holmium laser lithotriptor under flexible ureteroscope in our hospital.Of them,75 patients had calculi in the right side and 51 patients in the left side.The calculi were in the kidney for 64 patients,in the upper ureteral for 33 patients,and both in the upper ureteral and kidney for 29 patients.The diameter of the calculi ranged 0.6-2.0 cm,mean 1.33 cm.After ureter dilation and placement of ureteral access sheath,the stone were fragmented and removed with 200μm Ho ∶ YAG laser fiber,energy 0.8-1.0 J,frequency 5-10 Hz.Results The successful rate of stone fragmentation after single session was 92.86% (117/126).Mean operation time was 48 min(23-71 min).Six patients had low fever after the operation.Neither ureteral perforation nor pyonephrosis was observed.Conclusions The therapy of Holmium laser lithotriptor under flexible ureteroscope is safe and effective for upper urinary calculi,especially for upper ureteral,pelvis,middle calyx and upper calyx stones.%目的 探讨输尿管软镜下钬激光碎石术治疗上尿路结石的疗效.方法 上尿路结石患者126例,其中右侧结石75例,左侧结石51例.输尿管上段结石33例,输尿管上段合并肾结石29例,肾结石64例.结石大小0.6 ~2.0 cm,平均1.33 cm.经输尿管硬镜扩张后留置输尿管扩张鞘寻找结石,采用输尿管软镜下钬激光碎石术治疗,光纤直径200μm,能量0.8~1.0J,频率5~10Hz.结果 单次碎石成功117例(占92.86%),手术时间25~ 75 min,平均48 min.术后6例出现低热,无脓肾、输尿管穿孔等并发症.结论 输尿管软镜下钬激光碎石术治疗上尿路结石安全有效,尤其适用于输尿管上段、肾盂、肾中盏及肾上盏结石.

  15. 输尿管软镜在中晚期妊娠合并症状性结石16例中治疗体会%Through flexible ureteroscope in middle and late pregnancy complicated with symptomatic gallstone treatment experience 16 cases

    Institute of Scientific and Technical Information of China (English)

    范先明; 郭昭建; 林剑锋; 王世先; 涂建平; 叶振扬; 郑健忠; 梁福律

    2014-01-01

    目的 探讨输尿管软镜治疗中晚期妊娠合并症状性结石的可行性与临床疗效.方法 回顾性分析中晚期妊娠合并症状性结石16例患者的临床资料,所有患者均解痉、镇痛等保守治疗无效,采用输尿管软镜进行治疗.结果 10例一期成功碎石,3例术中发现为结石性脓肾,单纯放置D-J管引流,1例因结石较大,改行经皮肾穿刺造瘘术.术后症状消失,肾集合系统分离完全消失13例,3例好转.1例合并脓肾的患者再次出现严重感染,拔出D-J管,改行经皮肾穿刺造瘘持续引流.所有患者均足月分娩,无因操作而引起早产、脓毒血症、感染性休克等严重并发症.结论 输尿管软镜治疗中晚期妊娠合并症状性结石,临床效果较好、手术创伤较小,是一种安全、有效的方法.%Objective To explore through flexible ureteroscope in the treatment of middle and late pregnancy complicated with symptomatic gallstone feasibility and clinical efficacy.Methods Retrospectively analyzed the clinical data of middle and late pregnancy patients with symptoms of calculi:all patients were performed antispasmodic,analgesic and other conservative treatments,through flexible ureteroscope for treatment.Results Ten cases of success found in gravel,3 cases performed surgery for calculous pyonephrosis simply place the D-J tube drainage,1 case due to larger stones,but changed to percutaneous renal puncture and fistulation.Symptoms disappeared after surgery,13 cases of separation disappeared completely and 3 cases renal collecting system improved.One case of severe infection complicated with pyonephrosis appeared again,pull the D-J tube,but changed to percutaneous renal puncture nephrostomy drainage.All patients were term delivery and not due to operation resulting from prematurity,sepsis,septic shock and other serious complications.Conclusion Through flexible ureteroscope in the treatment of middle and late pregnancy complicated with symptomatic

  16. [Ureterorenoscopy (URS) in treatment of ureteral calculi. II. Ureteroscopic treatment of calculus debris after ESWL].

    Science.gov (United States)

    Fernandez De la Maza, S; Noldus, J; Huland, H

    1999-03-01

    We were interested in the efficacy and morbidity of the ureteroscopy (URS) in the treatment of "steinstrasse" after ESWL. From 1991 to 1996, 27 patients with "steinstrasse" were treated with a total of 32 ureteroscopic procedures. The URS alone had a stonefree success rate of 43.7% (n = 14). URS combined with ESWL was effective in 43.7% (n = 14), leading to an overall success rate of 87.4%. In 4 cases (12.6%) a second therapy was necessary (in 3 cases a second URS + ESWL and in one patient a nephrectomy due to septic pyonephrosis. The overall rate of auxiliary ESWL after URS was 53.1%. Mean operating time was 72 minutes (20-180 min). The rate of complications was 21.8% (n = 7) and mainly due to ureteral perforations or postoperative fever but none suffered from late complications like ureteral stricture. All treated patients received a double-J-stent and antibiotics. The treatment of "steinstrasse" in the middle portion of the ureter proved to be more difficult due to the anatomical position of the ureter and lasted in a longer operating time as the upper or distal "steinstrasse". The stone extraction and the lithoclast-lithotripsy alone or in combination were the most frequent used ureteroscopic procedures to eliminate stone fragments. The URS alone or in combination with the ESWL for the treatment of "steinstrasse" is a highly effective and safe approach.

  17. Ureteroscopy and holmium:YAG laser lithotripsy: an emerging definitive management strategy for symptomatic ureteral calculi in pregnancy

    Science.gov (United States)

    Watterson, James D.; Girvan, Andrew R.; Beiko, Darren T.; Nott, Linda; Wollin, Timothy A.; Razvi, Hassan A.; Denstedt, John D.

    2003-06-01

    Objectives: Symptomatic urolithiasis in pregnancy that does not respond to conservative measures has traditionally been managed with ureteral stent insertion or percutaneous nephrostomy (PCN). Holmium:yttrium-aluminum-garnet (YAG) laser lithotripsy using state-of-the-art ureteroscopes represents an emerging strategy for definitive stone management in pregnancy. The purpose of this study was to review the results of holmium laser lithotripsy in a cohort of patients who presented with symptomatic urolithiasis in pregnancy. Methods: A retrospective analysis was conducted at 2 tertiary stone centers from January 1996 to August 2001 to identify pregnant patients who were treated with ureteroscopic holmium laser lithotripsy for symptomatic urolithiasis or encrusted stents. Eight patients with a total of 10 symptomatic ureteral calculi and 2 encrusted ureteral stents were treated. Mean gestational age at presentation was 22 weeks. Mean stone size was 8.1 mm. Stones were located in the proximal ureter/ureteropelvic junction (UPJ) (3), mid ureter (1), and distal ureter (6). Results: Complete stone fragmentation and/or removal of encrusted ureteral stents were achieved in all patients using the holmium:YAG laser. The overall procedural success rate was 91%. The overall stone-free rate was 89%. No obstetrical or urological complications were encountered. Conclusions: Ureteroscopy and holmium laser lithotripsy can be performed safely in all stages of pregnancy providing definitive management of symptomatic ureteral calculi. The procedure can be done with minimal or no fluoroscopy and avoids the undesirable features of stents or nephrostomy tubes.

  18. The Post-Ureteroscopic Lesion Scale (PULS)

    DEFF Research Database (Denmark)

    Schoenthaler, Martin; Buchholz, Noor; Farin, Erik

    2014-01-01

    The Post-Ureteroscopic Lesion Scale (PULS) offers a simple grading system for the description of ureteral lesions after ureteroscopy. In this article, we present the results of a video-based multicenter evaluation of the inter-rater reliability of clinically important PULS grades 0-3....

  19. Cost-effective analysis of pneumatic and laser lithotripsy techniques in ureteral stones

    Directory of Open Access Journals (Sweden)

    Mehmet Bilgehan Yüksel

    2013-03-01

    Full Text Available Objective: Ureteroscopic lithotripsy (URSL is a commontreatment alternative in ureteral stones. We aimedto evaluate pneumatic and laser lithotripsy techniques,which are used for fragmentation of stones.Materials and methods: The data of 100 patients whounderwent URSL by using pneumatic and laser lithotriptorswere analyzed. The sample divided in 2 groups, eachincluding 50 patients. URSL was performed in lithotomyposition under general anesthesia. The absence of residualstone at second week urinary system graphy wasaccepted as the criteria of success. We evaluated thepresence of differences in terms of efficiency and costeffectivityof pneumatic and laser lithotripsy techniques.Results: The mean ages were 42 and 45 years, respectively.The mean operation time was 43.1 min in pneumaticgroup and 40 min in laser group. Stone-free rates werefound 93.9% and 78%, respectively. The stone migrationrate was determined 16% in pneumatic group and 4.1% inlaser group. Complication rates were 4.1% in pneumaticgroup and 8% in laser group. The cost analysis showedthat pneumatic lithotriptor device cost 10000 TL and laserlithotriptor system cost 76000 TL. Nevertheless, the SocialSecurity Administration paid the same cost for bothlithotripsy techniques.Conclusion: Higher stone-free and lower stone migrationrates were determined in laser lithotripsy application.Therefore, low incidence of the requirement of subsequentsecondary treatments for residual stones in lasertreatment decreased the treatment costs. Nevertheless,the cost is significantly higher in laser technique. It requiresmore detailed studies.Key words: Ureteral stone, ureteroscopy, lithotripsy, efficiency,cost

  20. Application of Ureteroscope in Emergency Treatment with Persistent Renal Colic Patients during Pregnancy.

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    Shilin Zhang

    Full Text Available Although the application of ureteroscopy in the treatment of ureteral calculi during pregnancy has been on the rise, for persistent renal colic patients without ultrasound-detected ureteral calculi, it may represent a clinical dilemma due to the potential risks for both mother and fetus.The aim of the present study is to present our experience with the application of the ureteroscope in the emergency treatment of persistent renal colic patients during pregnancy.From March 2009 to September 2014, a total of 117 pregnant women who received ureteroscopy for persistent renal colic were retrospectively analyzed. Patients were divided into three groups according to duration of the persistent renal colic: Group A (within 12 hours; 24 cases; Group B (12 to 24 hours; 76 cases; and Group C (more than 24 hours; 17 cases. The stone-free rate, complications, and other qualitative data were analyzed.Of the 117 patients, 31 patients who were found not to have renal or ureteral calculi received ureteroscopic double-J (DJ stent insertion, whereas 86 patients who were found with ureteral calculi received ureteroscopic lithotripsy (URSL and DJ stent insertion. Among them, 24 patients (27.9% were found with ureteral calculi by ureteroscopy rather than ultrasound. In addition, 73 patients (84.9% had complete fragmentation of calculi; 12 patients (10.3% had a threatened abortion (the rates of threatened abortion in Groups A, B and C were 8.3% vs. 6.5% vs. 29.4%; Group C compared with Groups A and B, p<0.05, and one patient (1.2% had urosepsis (in Group C. However, these complications were cured with conservative treatment, without postpartum infant and maternal complications.For pregnant patients with persistent renal colic/ureteral calculi and hydronephrosis, ureteroscopic DJ stent insertion and URSL are effective and safe options when conservative treatment fails, even if no urinary calculi were found by ultrasound. At the same time, for patients with persistent

  1. Treatment of ureteral calculus obstruction with laser lithotripsy in an Atlantic bottlenose dolphin (Tursiops truncatus).

    Science.gov (United States)

    Schmitt, Todd L; Sur, Roger L

    2012-03-01

    An adult female bottlenose dolphin (Tursiops truncatus) presented with acute anorexia secondary to progressive azotemia (blood urea nitrogen = 213 mg/dl, creatinine [Cr] = 9.5 mg/dl) and electrolyte abnormalities (K = 7.4 mEq/L). It was later diagnosed with postrenal obstruction secondary to bilaterally obstructing ureteral calculi seen on ultrasound. Treatment of the obstruction required two endoscopic procedures, cystoscopy for ureteral stent placement and ureteroscopy to perform intracorporeal lithotripsy on the obstructing calculi. Before the first procedure, the dolphin's azotemia was stabilized with aggressive fluid therapy, peritoneal dialysis, and treatment for acidosis. Diuresis subsequent to the fluid therapy enabled passage of the right obstructing urolith. For both endoscopic procedures, the dolphin was placed in left lateral recumbency due to the peritoneal dialysis catheter in the right retroperitoneal region. For the first procedure, a 12-French (Fr) flexible cystoscope was inserted retrograde into the bladder via the urethra, whereupon a calculus was seen obstructing the left ureteral orifice. A 4.8-Fr, 26-cm double-pigtail ureteral stent was placed up the left ureter to relieve the postrenal obstruction. Inadvertent proximal migration of the left ureteral stent occurred during the procedure. However, renal parameters (serum Cr = 5.8, K = 5.4) improved significantly by the next day. For the second procedure, 28 hr later, ureteroscopy was performed to treat the calculus and replace the existing stent with a longer stent. The left ureteral calculus was pulverized into tiny fragments by using a holmium:yttrium-aluminum-garnet laser inserted through a 6.9-Fr semirigid ureteroscope. The migrated stent was visualized in the distal left ureter and replaced with a 90-cm single-pigtail ureteral stent that was sutured exterior to the urogenital slit and removed 3 days later. Renal function normalized over the next several days, and the dolphin recovered over

  2. Ureteroscopic removal of forgotten ureteral stent

    Science.gov (United States)

    Kawahara, Takashi; Ishida, Hiroaki; Kubota, Yoshinobu; Matsuzaki, Junichi

    2012-01-01

    A 69-year-old female had a right ureteral stent placed due to ureteral stricture resulting from cervical cancer in March 2008. The ureteral stent migrated to the ureter and was not exchanged. A new ureteral stent was inserted, and was exchanged every 3 months. The patient was referred to our department to remove the forgotten ureteral stent. In January 2012, her old ureteral stent was removed ureteroscopically, and no ureteral stent encrustation was found. PMID:22707678

  3. Ureteroscopic skills with and without Roboflex Avicenna in the K-box(®) simulator.

    Science.gov (United States)

    Proietti, Silvia; Dragos, Laurian; Emiliani, Esteban; Butticè, Salvatore; Talso, Michele; Baghdadi, Mohammed; Villa, Luca; Doizi, Steeve; Giusti, Guido; Traxer, Olivier

    2017-01-01

    The aim of this study was to evaluate the acquisition of basic ureteroscopic skills with and without Roboflex Avicenna by subjects with no prior surgical training. Ten medical students were divided in two groups: Group 1 was trained with Roboflex Avicenna and Group 2 with flexible ureteroscope alone, using the K-box(®) simulator model. Participants were scored on their ability to perform or not two exercises, recording the time. In addition, the participants were evaluated on the quality of their performance for the following parameters: respect of the surrounding environment, flow of the operation, orientation, vision centering and stability. The first exercise was completed only by three and four out of five of students in Group 1 and Group 2, respectively. Stability with the scope was significantly more accurate in the first group compared with the second (P = 0.02). There were no differences in timing, flow or orientation between groups. Although not significant, a tendency of respecting the surrounding tissue and maintaining centered vision was perceived more in the first group. As for the second exercise, there were no differences between groups in regard of orientation, flow, respecting the surrounding tissue, stability or the ability of maintaining centered vision. Although not significant, the second group had a tendency of performing the exercise faster. According to these preliminary results, the acquisition of basic ureteroscopic skills with and without robotic fURS in the K-box(®) simulator, by subjects with no prior surgical training, is similar.

  4. Ureteroscopic management of chronic unilateral hematuria: a single-center experience over 22 years.

    Directory of Open Access Journals (Sweden)

    Motoo Araki

    Full Text Available OBJECTIVE: To analyze the short and long term safety and efficacy of ureteroscopic evaluation and management of chronic unilateral hematuria. METHODS: We retrospectively reviewed patients with chronic unilateral hematuria from 1987 to 2008. The distal to middle ureter was evaluated with a semi-rigid ureteroscope without a guidewire. Subsequently, the flexible ureteroscope was advanced into the upper ureter to the renal pelvis using a low-pressure automated irrigant system (Uromat™. Lesions identified ureteroscopically were treated with diathermy fulguration. RESULTS: One hundred and four (56 male, 48 female patients were identified, with a median age of 37 (14-80 years and median follow-up of 139 (34-277 months. The median preoperative duration of gross hematuria was 5 (1-144 months. Endoscopic findings included 61 (56% minute venous rupture (MVR; a venous bleeding without clear abnormalities, 21 (20% hemangioma (vascular tumor-like structure, 3 (3% varix (tortuous vein, 1 (1% calculus and 18 (17% no lesions. The incidence of "no lesions" was less in the recent 12 years (9% than the first 10 years (27%, while the incidence of MVR increased from 40 to 66% (p<0.05. All patients were treated endoscopically. Immediate success rate was 96% (100% in the recent 12 years. Long-term recurrent gross hematuria rate was 7%. Six resolved spontaneously and only 1 required ureteroscopy, revealing a different bleeding site. CONCLUSION: Ureteroscopy and diathermy fulguration is highly useful for evaluation and treatment of chronic unilateral hematuria. Sophisticated technique and improved instrumentation contributes to a better outcome.

  5. Ureteroscopy and Laser Lithotripsy for Treatment of Ureteral Stones in Pregnants: Single Center Experience

    Directory of Open Access Journals (Sweden)

    Mustafa Okan İstanbulluoğlu

    2016-03-01

    Full Text Available Objective: To report our ureteroscopic laser lithotrip­sy experiences in the treatment of symptomatic ureter stones in pregnants which do not respond to conservative treatment Methods: A total of 6 pregnants aged between 22-33 years in second or third trimester were studied. Holmium-YAG laser lithotripsy was performed with 6.5 F semirigid uretroscope. Results: The diagnosis of ureter stone was made with ab­dominal ultrasonography in 5 patients and with magnetic resonance in one patient. Adequate stone fragmentation was performed in 2 mid-ureter and 4 distal-ureter stones. J stent was applied in one patient after the fragmenta­tion process. The mean operation time was 24.8 ± 10.0 minutes after the entry of bladder with ureteroscope un­der spinal anesthesia. No urologic, anesthetic or obstetric complication was seen and all patients gave healthy birth at term. Conclusion: Fine calibrated ureteroscopes for the treat­ment of ureter stones in pregnants are fast and effective treatment modalities which decrease the operation time and remove difficulties in entering the ureter.

  6. Prospective analysis of a complete retrograde ureteroscopic technique with holmium laser stent cutting for management of encrusted ureteral stents.

    Science.gov (United States)

    Thomas, Alexandre; Cloutier, Jonathan; Villa, Luca; Letendre, Julien; Ploumidis, Achilles; Traxer, Olivier

    2017-03-14

    To propose and evaluate a new endoscopic technique using only a retrograde ureteroscopic approach for the removal of heavily encrusted ureteral stents. Data from 51 consecutive patients with encrusted and retained ureteral stents were prospectively collected. Description of the successive steps of surgery is detailed. The Holmium-YAG laser properties offer the opportunity for fragmentation of stent-attached encrustation and the ability to cut the stent itself. Reducing the length of the stent is critical to creating space in the ureter and to allow free access for ureteroscopes or ureteral access sheath placement. The primary outcome of this study was the feasibility and the safety of this retrograde intra-renal approach. Some factors of encrustation and outcomes are also discussed in comparison with lithotripsy, percutaneous, laparoscopic, open surgery or a combination of these techniques. The removal of the encrusted stent was possible with only this retrograde technique in 98% of patients. The transection of the encrusted stent with the Holmium-YAG laser was useful in 71% of the patients. Mean operative time was 110 minutes and mean hospital stay was 2.33 days. Postoperative complications were mainly non-obstructive pyelonephritis (10%). The most significant predictor of this life threatened complication was the presence of struvite stones with the encrusted stent (p=0,018). Contrariwise, operative time, BMI, gender and encrustation rate were not associated with postoperative pyelonephritis. Cystine stone disease or pregnancy both led to faster stent encrustation. Retrograde ureteroscopic surgery is efficient and safe for removing retained stents and associated stone burdens. The Holmium-YAG laser is essential to perform the encrustation removal and sectioning of the stent.

  7. Treatment of ureteral stones: A prospective randomized controlled trial on comparison of Ho:YAG laser and pneumatic lithotripsy

    Directory of Open Access Journals (Sweden)

    Robab Maghsoudi

    2008-01-01

    Full Text Available Objectives: To study the treatment of ureteric stones by HO:YAG laser lithotripsy and pneumatic lithotripsy and to evaluate the results of the two treatment modalities to assess effectiveness and complications. Materials and Methods: Over 1-year period, a total of 79 patients with 82 ureteral stones were randomized into two groups. In group 1 (39 cases with 41 ureteral stones ureteroscopic HO:YAG laser lithotripsy was performed using a rigid 8 Fr-ureteroscope (LL group. In group 2 (40 cases with 41 ureteral stones pneumatic lithotripsy was performed in like manner. Efficacy safety and complications in both groups were analyzed. Results: A total of 79 patients with 82 calculi were treated. Two cases in LL group and one in PL group had bilateral ureteral stones. Mean stone size was 12.07 mm in LL group and 10.2 mm in PL group. Stones located in lower ureter in 30 cases on LL group and 29 cases in PL group. Proximal migration of stone occurred in 1 case on LL group and in 3 cases on PL group. Successful fragmentation occurred in 37 cases on LL group and in 30 cases on PL group. Stone-free rate after 1 month in the base of Kidney Ureter Bladder (KUB and sonography was 95% in LL group and 80.5% in PL group. Ureteral perforation, urinoma, and urosepsis were not seen in both groups. Conclusion: HO:YAG laser has advantages over PL in high efficacy of stone fragmentation and a low-retrograde migration of ureteral stone treatment. Other complication of ureteral stone treatment with LL and PL are the same and very rare.

  8. Flexible robotic retrograde renoscopy: description of novel robotic device and preliminary laboratory experience.

    Science.gov (United States)

    Desai, Mihir M; Aron, Monish; Gill, Inderbir S; Pascal-Haber, Georges; Ukimura, Osamu; Kaouk, Jihad H; Stahler, Gregory; Barbagli, Federico; Carlson, Christopher; Moll, Fredric

    2008-07-01

    To describe a novel flexible robotic system for performing retrograde intrarenal surgery. Remote robotic flexible ureterorenoscopy was performed bilaterally in 5 acute swine (10 kidneys). A novel 14F robotic catheter system, which manipulated a passive optical fiberscope mounted on a remote catheter manipulator was used. The technical feasibility, efficiency, and reproducibility of accessing all calices were assessed. Additionally, laser lithotripsy of calculi and laser ablation of renal papillae were performed. The robotic catheter system could be introduced de novo in eight ureters; two ureters required balloon dilation. The ureteroscope could be successfully manipulated remotely into 83 (98%) of the 85 calices. The time required to inspect all calices within a given kidney decreased with experience from 15 minutes in the first kidney to 49 seconds in the last (mean 4.6 minutes). On a visual analog scale (1, worst to 10, best), the reproducibility of caliceal access was rated at 8, and instrument tip stability was rated at 10. A renal pelvic perforation constituted the solitary complication. Histologic examination of the ureter showed changes consistent with acute dilation without areas of necrosis. A novel robotic catheter system is described for performing retrograde ureterorenoscopy. The potential advantages compared with conventional manual flexible ureterorenoscopy include an increased range of motion, instrument stability, and improved ergonomics. Ongoing refinement is likely to expand the role of this technology in retrograde intrarenal surgery in the near future.

  9. Outcome analysis of holmium laser and pneumatic lithotripsy in the endoscopic management of lower ureteric calculus in pediatric patients: a prospective study

    Directory of Open Access Journals (Sweden)

    Ankur Jhanwar

    Full Text Available ABSTRACT Objective: To analyse outcomes of holmium laser and pneumatic lithotripsy in treatment of lower ureteric calculus in pediatric patients. Materials and methods: Prospective study conducted between August 2013 and July 2015. Inclusion criteria were lower ureteric calculus with stone size ≤1.5cms. Exclusion criteria were other than lower ureteric calculus, stone size ≥1.5cms, congenital renal anomalies, previous ureteral stone surgery. Patients were divided into two groups. Group A underwent pneumatic and group B underwent laser lithotripsy procedure. Patient's baseline demographic and peri-operative data were recorded and analysed. Post operatively X-ray/ultrasound KUB (Kidney, ureter and bladder was performed to assess stone free status. Results: A total of 76 patients who met the inclusion criteria to ureteroscopic intracorporeal lithotripsy were included. Group A and B included 38 patients in each. Mean age was 12.5±2.49 in Group A and 11.97±2.74 years in Group B respectively (p=0.38. Overall success rate was 94.73% in Group A and 100% in Group B, respectively (p=0.87. Conclusion: Holmium Laser lithotripsy is as efficacious as pneumatic lithotripsy and can be used safely for the endoscopic management of lower ureteric calculus in pediatric patients. However, holmium laser requires more expertise and it is a costly alternative.

  10. Extraction of trapped double J in ureteroscope: a novel technique.

    Science.gov (United States)

    Akhavizadegan, Hamed

    2017-08-07

    Urological endoscopes and percutaneous devices are expensive and their maintenance and cleaning need special attention. Sometimes urologists can help repairing their devices. During taking out a Double J, Double J was trapped in the working channel of ureteroscope unintentionally. It was not possible to take it out by pushing methods. Finally, Double J was pulled out by a changed nephrostomy needle to a small curve hook. Using the hand-made hook to pull out a trapped Double J from ureteroscope does not destroy the device.

  11. Flexibility.

    Science.gov (United States)

    Humphrey, L. Dennis

    1981-01-01

    Flexibility is an important aspect of all sports and recreational activities. Flexibility can be developed and maintained by stretching exercises. Exercises designed to develop flexibility in ankle joints, knees, hips, and the lower back are presented. (JN)

  12. 输尿管软镜钬激光碎石术治疗上尿路结石疗效分析%Application of flexible ureteroscopy in treatment of upper urinary tract stones

    Institute of Scientific and Technical Information of China (English)

    郝宗耀; 刘明; 樊松; 张贤生; 施浩强; 周骏; 梁朝朝

    2016-01-01

    Objective To evaluate the safety and efficacy of flexible ureteroscopic technology in the treatment of upper urinary tract stones .Methods A retrospective analysis was performed in 131 cases diagnosed with upper urinary tract stones using flexible ureteroscope . Results All 130 cases accepted holmium laser lithotripsy .No significant residual stones were found in 126 cases(96.9%).The mean op-erative time was 30~150 min,and the mean postoperative hospital stay was 2d.No ureteral perforation ,avulsion,severe bleeding ,urosepsis and other serious complications appeared .Conclusion The flexible ureteroscopy for diagnosis and treatment of upper urinary tract diseases is safe and effective ,especially for failure of extracorporeal shock wave lithotripsy or high -risk of percutaneous nephrolithotomy ,which could be used as one of the preferred clinical treatment options .%目的 探讨输尿管软镜钬激光碎石术治疗上尿路结石的疗效.方法 回顾性分析131例上尿路结石患者应用输尿管软镜钬激光碎石术的治疗效果.结果 130例患者顺利完成输尿管软镜钬激光碎石术,术后复查无明显结石残余126例(96.9%),手术时间为30~150 min,术后平均住院天数为2 d.未出现输尿管穿孔、撕脱、大出血、脓毒血症等严重并发症.结论 输尿管软镜钬激光碎石术对上尿路结石的诊治是安全、有效的,尤其对于体外冲击波碎石失败或经皮肾镜取石困难的上尿路结石的治疗有独特优势,可作为临床首选治疗方法之一.

  13. The Application of Pediatric Ureteroscope for Seminal Vesiculoscopy

    Directory of Open Access Journals (Sweden)

    Shulin Guo

    2015-01-01

    Full Text Available To describe a novel technique of transurethral seminal vesiculoscopy using a pediatric ureteroscope in the diagnosis and management of persistent hematospermia, a retrospective study was carried out for 20 patients with recurrent hematospermia whom we evaluated and treated using a 6–7.5F (6F front end and 7.5F rear end pediatric ureteroscope from August 2009 to September 2013. For the 20 patients, the age ranges from 25 to 48 years with a mean age of 36 years. The duration of the hematospermia ranges from 6 to 48 months with a mean duration of 18 months. Transurethral seminal vesiculoscopy was successfully performed in the 20 cases and the mean operative time was 35 min (ranges from 25 to 90 min. Among the 20 patients, 11 patients were found to have seminal vesiculitis, five were with seminal vesicle stone, one was with prostatic utricle stone, one was with prostate cyst, and one was with ejaculatory duct obstruction. The mean follow-up period was 7 months (ranged from 6 to 12 months. Hematospermia in 19 cases disappeared after the surgery and only in one patient the hematospermia recurred 6 months after the surgery. The cure rate was 95%. This study indicated that transurethral seminal vesiculoscopy could be performed easily using a semirigid pediatric ureteroscope with few complications and is an effective therapeutic approach for persistent hematospermia.

  14. Retroperitoneal laparoscopic pyelolithotomy combined with holmium laser lithotripsy under flexible cystoscopy in treatment of complicated nephrolithiasis%后腹腔镜肾盂切开取石联合膀胱软镜钬激光碎石取石术治疗复杂性肾结石

    Institute of Scientific and Technical Information of China (English)

    肖亚; 付卫华; 张艮甫; 王平贤; 范明齐; 冯嘉瑜; 钟晓; 黄赤兵

    2014-01-01

    Objective To evaluate the efficacy and safety of retroperitoneal laparoscopic pyelolithotomy ( RLP) combined with holmium laser lithotripsy under flexible cystoscopy in the treatment of complicated nephrolithiasis. Methods The retrospective analysis was made on the clinical data of 37 patients who underwent RLP and holmium laser lithotripsy under flexible cystoscopy for complicated nephrolithiasis from January 2013 to January 2014. The clinic parameters involved basic data of patients,operational time,blood loss,post-operative hospital stay,the status of stone-free,perioperative complications,and the follow-up data of patients were observed. Results No patient was converted to open surgery. The mean stone size was (2. 8 ± 0. 9) cm in diameter,operational time was (89 ± 24) min,blood loss was (21. 3 ± 7. 7) mL,post-operative hospital stay was (6. 8 ± 1. 7) d,the stone removal rate in one session was 94. 6%. One case occurred urinary leakage,1 case occurred fever after operation,who were all recovered through conservative treatment. All cases were followed up at the sixth months after operation. Conclusion RLP combined with holmium laser lithotripsy under flexible cystoscopy is effective and safe for the treatment of com-plicated nephrolithiasis.%目的:分析后腹腔镜肾盂切开取石联合膀胱软镜钬激光碎石取石术治疗复杂性肾结石的有效性和安全性。方法2012年1月至2014年1月对37例复杂性肾结石患者行后腹腔镜下肾盂切开取石联合膀胱软镜钬激光碎石取石术;统计并分析患者基本资料、手术时间、术中出血量、术后住院时间、一期清石率、围手术期并发症、术后复查等情况。结果37例患者顺利完成手术。平均结石直径(2.8±0.9) cm,手术时间(89±24) min,术中出血量(21.3±7.7) mL,术后住院时间(6.8±1.7) d,一期清石率为94.6%,围手术期1例发热,1例尿漏,经保守治疗均痊愈。术后6个月对所有患者进行随访,肾功能

  15. 输尿管软镜联合钬激光碎石术治疗孤立肾结石的疗效及安全性%Safety and efficacy of flexible ureteroscopy and holmium laser lithotripsy for the treatment of renal stones in patients with a solitary kidney

    Institute of Scientific and Technical Information of China (English)

    张寅生; 肖河; 纪志刚; 刘广华; 张学斌

    2016-01-01

    目的 探讨输尿管软镜联合钬激光碎石术治疗孤立肾结石的安全性及有效性.方法 回顾性分析北京协和医院泌尿外科2014年5月-2016年6月采用输尿管软镜联合钬激光碎石术治疗的17例孤立肾结石患者的临床资料.其中男性10例,女性7例,年龄32~ 67岁,平均45.8岁.左侧9例,右侧8例.功能性孤立肾6例,解剖性孤立肾11例.其中肾盂结石8例,上中盏结石5例,下盏结石4例.结石平均直径为(1.2±0.3) cm.临床主要表现为:无症状10例、腰痛5例、发热2例,人院后完善血尿常规、肝肾功能、凝血功能、心电图、胸部X线片等术前相关检查,同时行清洁中段尿培养.结果 手术时间为(74.2±23.6) min,术中出血量为5~15 ml,平均8 ml,住院时间为3~12 d,平均4.5d.术后1例出现尿脓毒血症,经积极抗感染治疗后痊愈.其余患者无严重并发症发生.17例患者术前肌酐78~421 μmol/L,平均(161 ±103) μmol/L,术后1个月复查肌酐85 ~ 341 μmol/L,平均(124±63)μmol/L,与术前比较差异有统计学意义(P<0.05).一期结石完全清除率为82.3%(14/17),二期结石清除率达94.1%.结论 输尿管软镜联合钬激光碎石术治疗孤立肾结石,具有创伤小、出血少、并发症少、术后恢复快等优点,是一种安全、有效的方法.%Objective To investigate the safety and efficacy of flexible ureteroscopy and holmium laser lithotripsy for the treatment of renal stones in patients with a solitary kidney.Methods Between May 2014 and June 2016,Clinical records of 17 cases of stones in a solitary kidney who underwent flexible ureteroscopy and holmium laser lithotripsy were reviewed.10 of these cases were male and the others female;mean age of these cases was 45.8 (32-67) years.9 were on the left side while 8 were on the right.6 cases were with functional solitary kidney (with the GFR of the contralateral kidney less than 10ml/min),while 11 others were with anatomical solitary

  16. Extracorporeal shock wave lithotripsy in childhood

    Energy Technology Data Exchange (ETDEWEB)

    Kroovand, R.L.; Harrison, L.H.; McCullough, D.L.

    1987-10-01

    Extracorporeal shock wave lithotripsy is the treatment of choice for the majority of upper urinary calculi in adults. Technical limitations, including patient size and concerns over post-treatment stone fragment passage, have made the application of extracorporeal shock wave lithotripsy in children less clearly defined. We report the successful application of the Dornier lithotriptor in the management of 18 children (22 kidneys) with upper urinary calculi.

  17. Lithotripsie

    Science.gov (United States)

    Schwarze, Werner

    Der Einsatz von akustischen Stoßwellen in der Medizin ist ohne Zweifel eine der jüngsten Entwicklungen in der Medizintechnik. Es handelt sich dabei um ein völlig neues Instrumentarium in der Hand des Mediziners, welches vorher nicht existierte. Vergleichbar vielleicht mit der Erfindung, Röntgenstrahlen als Handwerkszeug zu benutzen, um Diagnostik und später auch Therapie zu betreiben, ohne den betreffenden Körper öffnen zu müssen.

  18. Combined percutaneous and transurethral lithotripsy for forgotten ureteral stents with giant encrustation.

    Science.gov (United States)

    Rabani, Seyed Mohammadreza

    2012-01-01

    Ureteral stents are widely used in many urologic practices. However, stents can cause significant complications including migration, fragmentation, and encrustation and it may possibly be forgotten. Successful management of a retained, encrusted stent requires combined endourological approaches. To present our experience with the approaches for treating forgotten ureteral stents associated with giant stone formation. Seventy four patients with forgotten ureteral stents were managed by different open (nephrolithotomy and/or cystolithotomy), or endoscopic procedures in our center. Among these, 11 patients had severe encrustation (stones larger than 35 mm within the bladder or kidney) and seven patients of this group, presented at our department between July 2007 and December 2010. Combined endourological procedures percutaneous nephrolithotripsy (PCNL), cystolithotripsy (CLT), transurethral lithotripsy (TUL) were performed in one or 2 separate sessions. In these 7 patients the whole of the stents, especially both ends were encrusted. Initially, cystolithotripsy, retrograde ureteroscopy and TUL were performed in the dorsal lithotomy position. Following this, a gentle attempt was made to retrieve the stent with the help of an ureteroscopic grasper. In some cases the stent was grasped by a hemostat clamp out of the urethral meatus with a gentle traction to facilitate lithotripsy in the ureter and even in the kidney. Finally, a ureteric catheter was placed adjacent to the stent for injection of radio-contrast material to delineate the renal pelvis and the calyces. Then in the same session or later in another session the patient was placed in the prone position and PCNL of the upper coil of the encrusted stent along with calculus was done and the stent was removed. In 5 out of seven patients, the initial indication for stent placement was for urinary stone disease after open nephrolithotomy and pyeloplasty in other centers and in two patients after TUL. All patients

  19. Infarction of middle third posterior cortex of kidney: a complication of extended pyelolithotomy, intra-operative electrohydraulic lithotripsy and extraction of calyceal stones under vision using stone basket and flexible cystoscope in a spinal cord injury patient – a case report

    Science.gov (United States)

    2009-01-01

    Background Spinal cord injury produces multiple systemic and metabolic alterations. A decrease in micro vascular blood flow to liver, spleen and muscle has been described following spinal cord injury. Case presentation We present a 46-year-old male patient with C-4 complete tetraplegia, who developed a large stag horn calculus with branches in upper, middle and lower calyces of left kidney. This patient underwent Gil-Vernet extended pyelolithotomy and required intra-operative electrohydraulic lithotripsy and retrieval of stones from upper, middle and lower calyces using flexible cystoscope and stone basket. Computed tomography, performed eighteen days after surgery, showed multiple areas of non-enhancing cortex posteriorly and in the upper pole, suggestive of focal infarction. Magnetic resonance imaging of left kidney confirmed the presence of an area of infarction in middle third of posterior cortex, but there was no evidence of trauma to posterior division of renal artery. Therefore, we postulate that compression of renal parenchyma by Gil-Vernet retractors during surgery, and firm pressure that was applied over the middle of kidney for prolonged periods while several attempts were being made to retrieve fragments of calculi from renal calyces, led to ischaemia and subsequently, infarction of mid-third posterior cortex of left kidney. Conclusion This case illustrates importance of gentle handling of kidney during extended pyelolithotomy in order to prevent subtle renal trauma, which may be detected only by advanced imaging studies. Further, spinal cord physicians should take a pragmatic approach to management of stones located inside renal calyces. Both spinal cord injury patients and their physicians should remember that in our enthusiasm to achieve complete clearance of stones embedded deeply within renal calyces, we could produce irreversible injury to kidney, as indeed happened in this patient. Therefore, emphasis should be placed on prevention of struvite

  20. Erbium: YAG laser lithotripsy mechanism.

    Science.gov (United States)

    Chan, Kin Foong; Lee, Ho; Teichman, Joel M H; Kamerer, Angela; McGuff, H Stan; Vargas, Gracie; Welch, Ashley J

    2002-08-01

    We tested the hypothesis that the mechanism of long pulse erbium:YAG laser lithotripsy is photothermal. Human urinary calculi were placed in deionized water and irradiated with erbium:YAG laser energy delivered through a sapphire optical fiber. Erbium:YAG bubble dynamics were visualized with Schlieren flash photography and correlated to acoustic emissions measured by a polyvinylidene fluoride needle hydrophone. The sapphire fiber was placed either parallel or perpendicular to the calculus surface to assess the contribution of acoustic transients to fragmentation. Stones were irradiated using desiccated stone irradiated in air, hydrated stone irradiated in air and hydrated stone irradiated in water. Ablation crater sizes were compared. Uric acid stones were irradiated in water and the water was assayed for cyanide. During the early phase of vapor bubble expansion, acoustic transients had minimal effects on calculus fragmentation. Fragmentation occurred due to direct absorption of laser energy transmitted to the calculus through the vapor channel between the sapphire fiber tip and calculus. The forward axial expansion of the bubble occurred more rapidly than the radial expansion. A parallel oriented fiber on the calculus surface produced no fragmentation but generated larger amplitude acoustic transients compared to perpendicular orientation. In perpendicular orientation the erbium:YAG laser did not generate any collapse acoustic waves but fragmentation occurred. Crater width was greatest for desiccated stones irradiated in air (p <0.03). Cyanide production increased as erbium:YAG irradiation of uric acid calculi increased, (r2 = 0.98). The erbium:YAG laser fragments stones through a photothermal mechanism.

  1. Differences in Ureteroscopic Stone Treatment and Outcomes for Distal, Mid-, Proximal, or Multiple Ureteral Locations

    DEFF Research Database (Denmark)

    Perez Castro, Enrique; Osther, Palle J S; Jinga, Viorel

    2014-01-01

    Ureteroscopy has traditionally been the preferred approach for treatment of distal and midureteral stones, with shock wave lithotripsy used for proximal ureteral stones.......Ureteroscopy has traditionally been the preferred approach for treatment of distal and midureteral stones, with shock wave lithotripsy used for proximal ureteral stones....

  2. Treatment of Special Renal Colic with Ureteroscope and Holmium YAG Laser

    Institute of Scientific and Technical Information of China (English)

    沈明顺; 刘军

    2002-01-01

    Objective To investigate the method of emergent relief of special renal colicand treatment of ureter diseases causing renal colic. Methods By analyzing 63 cases of special re-nal colic treated with ureteroscope and Holmium YAG laser. Results 61 cases of renal colic were re-lieved in a short period of time and the ariginal ureter diseases causing renal colic were cured. Conclu-sion Special renal colic could be treated with ureteroscope and Holmium YAG laser in a quick and ef-fective manner.

  3. 输尿管软镜联合钬激光碎石术后双J管留置时间与并发症研究%Complication and indwelling time of Double-J ureteral stents after flexible ureteroscopy (FURS)and holmium laser lithotripsy

    Institute of Scientific and Technical Information of China (English)

    高子剑; 刘龙; 孙永明; 段中阳; 李昕

    2014-01-01

    Objective To evaluate the relationship of complication and indwelling time of Double-J ureteral stents after flexible uret-eroscopy (FURS)and holmium laser lithotripsy.Methods Ninety patients with renal calculi (0.05).Conclusions After flexible ureteroscopy (FURS)and holmi-um laser lithotripsy,shortening postoperative indwelling time(2 weeks)of Double-J internal ureteral stents could be safe.This could de-crease the incidence of complications,which will not prevent the residual stone discharge and the recovery of renal function.%目的:研究输尿管软镜联合钬激光治疗碎石术后双J管留置时间与并发症关系。方法将该院从2011-2013年收入的90例肾结石患者(结石<2.0 cm)随机分成2组均行输尿管软镜联合钬激光治疗碎石术。术后观察分析2组留置双J管时间(留置2周和4周)与并发症发生情况的关系。所有患者记录在其拔除双J管前并发症的发生;分别于拔除双J管后1周和1月复查尿常规;拔管后1个月复查彩超、腹部平片检查残石率,并行99 Tc m-DTPA核素肾图检查,记录患侧肾脏肾小球滤过率(GFR)。结果2组均出现不同程度的并发症,拔除双J管前2组患者出现下尿路刺激症状(LUTS)分别为33例(70.2%)和40例(93.0%),腰腹痛分别为13例(27.7%)和21例(48.8%),肉眼血尿分别为36例(76.6%)和42例(97.7%),双J管上移分别为0例(0.0%)和2例(4.7%),拔管管壁钙盐沉积或拔管困难分别为4例(8.5%)和11例(25.6%)。并发症的发生率随留置时间延长均明显升高,差异有统计学意义(P<0.05)。拔除双J管1个月后复查彩超及腹部平片,提示无泌尿系结石残留,或残留结石直径<3 mm,2组的结石残石率无统计学意义。2组患者拔管后1周及1个月复查尿常规大致正常。2组比较,患侧肾脏的肾小球滤过率

  4. Laser lithotripsy with the Ho:YAG laser: fragmentation process revealed by time-resolved imaging

    Science.gov (United States)

    Schmidlin, Franz R.; Beghuin, Didier; Delacretaz, Guy P.; Venzi, Giordano; Jichlinski, Patrice; Rink, Klaus; Leisinger, Hans-Juerg; Graber, Peter

    1998-07-01

    Improvements of endoscopic techniques have renewed the interest of urologists in laser lithotripsy in recent years. Laser energy can be easily transmitted through flexible fibers thereby enabling different surgical procedures such as cutting, coagulating and lithotripsy. The Ho:YAG laser offers multiple medical applications in Urology, among them stone fragmentation. However, the present knowledge of its fragmentation mechanism is incomplete. The objective was therefore to analyze the fragmentation process and to discuss the clinical implications related to the underlying fragmentation mechanism. The stone fragmentation process during Ho:YAG laser lithotripsy was observed by time resolved flash video imaging. Possible acoustic transient occurrence was simultaneously monitored with a PVDF-needle hydrophone. Fragmentation was performed on artificial and cystine kidney stones in water. We observed that though the fragmentation process is accompanied with the formation of a cavitation bubble, cavitation has only a minimal effect on stone fragmentation. Fragment ejection is mainly due to direct laser stone heating leading to vaporization of organic stone constituents and interstitial water. The minimal effect of the cavitation bubble is confirmed by acoustic transients measurements, which reveal weak pressure transients. Stone fragmentation with the Holmium laser is the result of vaporization of interstitial (stone) water and organic stone constituents. It is not due to the acoustic effects of a cavitation bubble or plasma formation. The fragmentation process is strongly related with heat production thereby harboring the risk of undesired thermal damage. Therefore, a solid comprehension of the fragmentation process is needed when using the different clinically available laser types of lithotripsy.

  5. [Ureterorenoscopy combined with extracorporeal shockwave lithotripsy].

    Science.gov (United States)

    González Cabrera, L A; Oro Ortiz, J

    1989-01-01

    In May 1986, extracorporeal shock wave lithotripsy and endourologic procedures became available in the treatment of lithiasis at the "Hermanos Ameijeiras" Hospital. The present study describes our experience and the results achieved during a 12-month period using endourologic procedures. During this period 65 URS procedures were performed to treat post-ESWL ureteral obstruction, and 22 to push the stone up to the kidney for subsequent ESWL treatment.

  6. Massive steinstrasse without lithotripsy: a rare case report

    Science.gov (United States)

    Abdulmajed, Mohamed Ismat; Anandaram, Pallavoor Sudarsanam; Wyn Jones, Vaughan; Shergill, Iqbal Singh

    2013-01-01

    The accumulation of ureteric stone fragments causing ureteric blockage is known as ‘Steinstrasse’ or ‘Stone Street’ and is usually described as a complication of shock-wave lithotripsy (SWL). We herein present a rare case of massive Steinstrasse in a young male patient with no previous history of urolithiasis or lithotripsy. PMID:26328081

  7. Extracorporeal shock wave lithotripsy of biliary and pancreatic stones

    NARCIS (Netherlands)

    R. den Toom (Rene)

    1993-01-01

    textabstractThe aim of the study was to answer the following questions: Is extracorporeal shock wave lithotripsy for gallbladder stones a safe and effective therapy? (Chapter 2) Is simultaneous treatment with extracorporeal shock wave lithotripsy and the solvent methyl te.rt-butyl ether feasible, sa

  8. 输尿管软镜在泌尿外科疾病诊断及治疗中的应用%Flexible Ureteroscopy in the Diagnosis and Treatment of Urinary System Diseases

    Institute of Scientific and Technical Information of China (English)

    田雨; 卢剑; 肖春雷; 马潞林; 田晓军; 侯小飞; 赵磊; 王国良; 洪锴

    2013-01-01

    vision. For patients with ureteral stenosis, a percutaneous renal access was established so that to insert flexible ureteroscope. Results One-session success of lithotripsy was achieved in 12 patients without occurrence of ureteral perforation or tear, nor blood transfusion. Four patients had fever after the procedure, and then was improved by anti-inflammation, no patients developed suppurative kidney or other severe complications. Re-examination by KUB on the second day after the surgery showed no displacement of double-J tube, but visible granular high density in the kidney or ureter running area in three patients. In one month after the operation, B-ultrasonography confirmed that all residual stones were discharged spontaneously. Renal pelvis exploration was made on 6 patients, in which, one-session success was achieved in 5; in the other patient, a second exploration was carried out one month later for difficulty in inserting ureteroscope in the first time. Three patients developed ureteral stenosis, after operation for bladder cancer, one of them received flexible ureteroscopy by retrogradely inserting the ureteroscope through a percutaneous fistula, and the other two had flexible ureteroscope inserted antrogradely through the skin nephrostomy. Conclusions Flexible ureteroscopy is safe, minimally invasive, and flexible. It provides a complete exploration of the entire upper urinary tract system, as well as therapies if necessary.

  9. Holmium laser lithotripsy of bladder calculi

    Science.gov (United States)

    Beaghler, Marc A.; Poon, Michael W.

    1998-07-01

    Although the overall incidence of bladder calculi has been decreasing, it is still a significant disease affecting adults and children. Prior treatment options have included open cystolitholapaxy, blind lithotripsy, extracorporeal shock wave lithotripsy, and visual lithotripsy with ultrasonic or electrohydraulic probes. The holmium laser has been found to be extremely effective in the treatment of upper tract calculi. This technology has also been applied to the treatment of bladder calculi. We report our experience with the holmium laser in the treatment of bladder calculi. Twenty- five patients over a year and a half had their bladder calculi treated with the Holmium laser. This study was retrospective in nature. Patient demographics, stone burden, and intraoperative and post-operative complications were noted. The mean stone burden was 31 mm with a range of 10 to 60 mm. Preoperative diagnosis was made with either an ultrasound, plain film of the abdomen or intravenous pyelogram. Cystoscopy was then performed to confirm the presence and determine the size of the stone. The patients were then taken to the operating room and given a regional or general anesthetic. A rigid cystoscope was placed into the bladder and the bladder stone was then vaporized using the holmium laser. Remaining fragments were washed out. Adjunctive procedures were performed on 10 patients. These included transurethral resection of the prostate, transurethral incision of the prostate, optic internal urethrotomy, and incision of ureteroceles. No major complications occurred and all patients were rendered stone free. We conclude that the Holmium laser is an effective and safe modality for the treatment of bladder calculi. It was able to vaporize all bladder calculi and provides a single modality of treating other associated genitourinary pathology.

  10. Superior Mesenteric Artery Dissection after Extracorporeal Shockwave Lithotripsy

    Directory of Open Access Journals (Sweden)

    Christos Bakoyiannis

    2012-01-01

    Full Text Available The use of shockwave lithotripsy is currently the mainstay of treatment in renal calculosis. Several complications including vessel injuries have been implied to extracorporeal shockwave lithotripsy. We report an isolated dissection of the superior mesenteric artery in a 60-year-old male presenting with abdominal pain which occurred three days after extracorporeal shockwave lithotripsy. The patient was treated conservatively and the abdominal pain subsided 24 hours later. The patient's history, the course of his disease, and the timing may suggest a correlation between the dissection and the ESWL.

  11. Patient and personnel exposure during extracorporeal lithotripsy

    Energy Technology Data Exchange (ETDEWEB)

    Glaze, S.; LeBlanc, A.D.; Bushong, S.C.; Griffith, D.P.

    1987-12-01

    Extracorporeal shock wave lithotripsy (ESWL) has provided a nonsurgical approach to treatment of renal stones. The Dornier lithotripter uses dual image intensified x-ray systems to center the stone before treatment. Three imaging modes are offered: a fluoroscopic mode and two video spot filming modes. The average entrance exposure to the stone side of the typical patient at our facility is 2.6 X 10(-3) C kg-1 (10 R) (range: 0.5-7.7 X 10(-3) C kg-1 (2-30 R)) which is comparable and often much less than that reported for percutaneous lithotripsy. Recommendations are made for minimizing patient exposure. Scattered radiation levels in the lithotripter room are presented. We have determined that Pb protective apparel is not required during this procedure provided x-ray operation is temporarily halted should personnel be required to lean directly over the tub to attend to the patient. If the walls of the ESWL room are greater than 1.83 m (6 feet) from the tub, shielding in addition to conventional construction is not required.

  12. Patient and personnel exposure during extracorporeal lithotripsy.

    Science.gov (United States)

    Glaze, S; LeBlanc, A D; Bushong, S C; Griffith, D P

    1987-12-01

    Extracorporeal shock wave lithotripsy (ESWL) has provided a nonsurgical approach to treatment of renal stones. The Dornier lithotripter uses dual image intensified x-ray systems to center the stone before treatment. Three imaging modes are offered: a fluoroscopic mode and two video spot filming modes. The average entrance exposure to the stone side of the typical patient at our facility is 2.6 X 10(-3) C kg-1 (10 R) [range: 0.5-7.7 X 10(-3) C kg-1 (2-30 R)] which is comparable and often much less than that reported for percutaneous lithotripsy. Recommendations are made for minimizing patient exposure. Scattered radiation levels in the lithotripter room are presented. We have determined that Pb protective apparel is not required during this procedure provided x-ray operation is temporarily halted should personnel be required to lean directly over the tub to attend to the patient. If the walls of the ESWL room are greater than 1.83 m (6 feet) from the tub, shielding in addition to conventional construction is not required.

  13. State of the art extracorporeal shock wave lithotripsy

    Energy Technology Data Exchange (ETDEWEB)

    Kandel, L.B. (State Univ. of New York at Stony Brook, Stony Brook, NY (US)); Harrison, L.H.; McCullough, D.L. (Wake Forest Univ. Medical Center, Winston-Salem, NC (US))

    1987-01-01

    This book contains 16 chapters. Some of the topics that are covered are: Extracorporeal Shock Wave Lithotripsy Development; Laser-Generated Extracorporeal Shock Wave Lithotripter; Radiation Exposure during ESWL; Caliceal Calculi; and Pediatric ESWL.

  14. Successful endoscopic treatment of colonic gallstone ileus using electrohydraulic lithotripsy.

    Science.gov (United States)

    Zielinski, Martin D; Ferreira, Lincoln E; Baron, Todd H

    2010-03-28

    The surgical management of gallstone ileus is complex and potentially highly morbid. Initial management requires enterolithotomy and is generally followed by fistula resection at a later date. There have been reports of gallstone extraction using various endoscopic modalities to relieve the obstruction, however, to date, there has never been a published case of endoscopic stone extraction from the colon using electrohydraulic lithotripsy. In this report, we present the technique employed to successfully perform an electrohydraulic lithotripsy for removal of a large gallstone impacted in the sigmoid colon. A cavity was excavated in an obstructing 4.1 cm lamellated stone in the sigmoid colon using electrohydraulic lithotripsy. A screw stent retractor and stent extractor bored a larger lumen which allowed for guidewire advancement and stone fracture via serial pneumatic balloon dilatation. The stone fragments were removed. Electrohydraulic lithotripsy is a safe and effective method to treat colonic obstruction in the setting of gallstone ileus.

  15. PNEUMATIC LITHOTRIPSY VERSUS HOLMIUM:YAG LASER LITHOTRIPSY I N THE MANAGEMENT OF URETERAL STONES

    Directory of Open Access Journals (Sweden)

    Sebastiano Cimino

    2013-04-01

    Full Text Available Background: Pneumatic lithotripsy (PL and Holmium:YAG laser lithotripsy (LL are two valid mini-invasive approaches in the treatment of urologic stones disease. The aim of this study was to compare stone free rates between these two treatment options. Material and methods: From January 2010 to January 2011, 120 consecutive patients with single and primary ureteral stones were prospectively enrolled in this prospective study. The study was single-blinded and none of the patients knew which approach for stone fragmentation would be used. Results: The ureteral stone-free rate (SFRs in the PL group was 80.7% and 86.1 % in the LL group (p=0.002. The mean operating time was 60 (± 25 minutes in the LL group and 61 (± 21 minutes in the PL group, without significant differences (p=0.68. Multivariate logistic analysis revealed that stone location was not significantly predictive of SFRs (p=0.47. None of the patients had blood transfusions and no other severe complications appeared in either group. Conclusions: In our study LL was significantly associated with a stone 80.7% in the PL group and 86.1% in the LL group (p<0.05. Also, Holmium:YAG laser lithotripsy was demonstrated to be the more efficacious endoscopic procedure for the treatment of ureteral stones, allowing stones to be successfully fragmented, with few complications.

  16. Percutaneous ultrasonic lithotripsy of symptomatic renal calculi in children

    Energy Technology Data Exchange (ETDEWEB)

    Papanicolaou, N.; Pfister, R.C.; Yoder, I.C.; Young, H.H. II; Herrin, J.T.

    1986-01-01

    Percutaneous ultrasonic lithotripsy of upper urinary tract lithiasis is a well-established procedure in adults. We successfully applied this technique to completely remove symptomatic renal calculi in two children with idiopathic hypercalciuria. The procedure was well tolerated and no complications occurred. Both patients were discharged within 4 days of the lithotripsy. This method is an alternative to surgery for the removal of large or impacted calculi from the upper urinary tracts of pediatric patients. (orig.).

  17. Calculus migration characterization during Ho:YAG laser lithotripsy by high-speed camera using suspended pendulum method.

    Science.gov (United States)

    Zhang, Jian James; Rajabhandharaks, Danop; Xuan, Jason Rongwei; Chia, Ray W J; Hasenberg, Thomas

    2017-04-12

    Calculus migration is a common problem during ureteroscopic laser lithotripsy procedure to treat urolithiasis. A conventional experimental method to characterize calculus migration utilized a hosting container (e.g., a "V" grove or a test tube). These methods, however, demonstrated large variation and poor detectability, possibly attributed to the friction between the calculus and the container on which the calculus was situated. In this study, calculus migration was investigated using a pendulum model suspended underwater to eliminate the aforementioned friction. A high-speed camera was used to study the movement of the calculus which covered zero order (displacement), first order (speed), and second order (acceleration). A commercialized, pulsed Ho:YAG laser at 2.1 μm, a 365-μm core diameter fiber, and a calculus phantom (Plaster of Paris, 10 × 10 × 10 mm(3)) was utilized to mimic laser lithotripsy procedure. The phantom was hung on a stainless steel bar and irradiated by the laser at 0.5, 1.0, and 1.5 J energy per pulse at 10 Hz for 1 s (i.e., 5, 10, and 15 W). Movement of the phantom was recorded by a high-speed camera with a frame rate of 10,000 FPS. The video data files are analyzed by MATLAB program by processing each image frame and obtaining position data of the calculus. With a sample size of 10, the maximum displacement was 1.25 ± 0.10, 3.01 ± 0.52, and 4.37 ± 0.58 mm for 0.5, 1, and 1.5 J energy per pulse, respectively. Using the same laser power, the conventional method showed calculus movement and other causes of experimental variation will be conducted as a future study.

  18. Extracorporeal shock-wave lithotripsy of gallstones. Results and perspectives

    Energy Technology Data Exchange (ETDEWEB)

    Staritz, M.; Rambow, A.; Meyer zum Bueschenfelde, K.H.; Floth, A.; Hohenfellner, R.; Mildenberger, P.; Thelen, M.; Goebel, M.

    1987-12-01

    Recently extracorporeal shock-wave lithotripsy became a noteworthy alternative in the treatment of choledocolithiasis and cholecystolithiasis, in particular since the introduction of the second-generation shock-wave technique which allows to dispense with the positioning of the patient in the water bath required sofar and to place the patient on an examination table in freely movable way so as to position the gall stone to be disintegrated in the focus of the shock waves. Despite the beneficial treatment results, extracorporeal shock-wave lithotripsy still needs further improvement as a method especially in terms of the option of 'pulverizing' the stones. (orig./TRV)

  19. Characterization and modification of cavitation pattern in shock wave lithotripsy

    NARCIS (Netherlands)

    Arora, Manish; Ohl, Claus-Dieter; Liebler, Marko

    2004-01-01

    The temporal and spatial dynamics of cavitation bubble cloud growth and collapse in extracorporeal shock wave lithotripsy (ESWL) is studied experimentally. The first objective is obtaining reproducible cloud patterns experimentally and comparing them with FDTD-calculations. Second, we describe a met

  20. Stenting and extracorporeal shock wave lithotripsy in chronic pancreatitis

    DEFF Research Database (Denmark)

    Holm, M; Matzen, Peter

    2003-01-01

    BACKGROUND: Early observational studies of endoscopic treatment and extracorporeal shock wave lithotripsy (ESWL) reported considerable or complete relief of pain in 50%-80% of patients with chronic pancreatitis. There is no consensus on the measurement of pain, making comparison of observational...

  1. Extracorporeal shockwave lithotripsy of gallbladder stones : an experimental study

    NARCIS (Netherlands)

    H. Vergunst (Henk)

    1991-01-01

    textabstractThe objective of this study was to determine the physical characteristics and biological effects of the lithotriptor to enbaoce further clinical studies on the role of ESWL in the treatment of symptomatic cholelithiasis, using a newly developed electromagnetic lithotripsy system

  2. Management of retained encrusted urethral catheter with extracorporeal shockwave lithotripsy

    Directory of Open Access Journals (Sweden)

    Sameh Anwar Kunzman

    2002-01-01

    Full Text Available We report a case of non-deflating heavily encrusted Foley catheter successfully removed by extracorporeal shockwave lithotripsy (ESWL. To our knowledge this is the first case of using ESWL to remove encrusted foley catheter retained in the bladder.

  3. Initial Content Validation Results of a New Simulation Model for Flexible Ureteroscopy: The Key-Box.

    Science.gov (United States)

    Villa, Luca; Şener, Tarik Emre; Somani, Bhaskar K; Cloutier, Jonathan; Butticè, Salvatore; Marson, Francesco; Doizi, Steeve; Proietti, Silvia; Traxer, Olivier

    2017-01-01

    We sought to test the content validity of a new training model for flexible ureteroscopy: the Key-Box. Sixteen medical students were randomized to undergo a 10-day training consisting of performing 10 different exercises aimed at learning specific movements with the flexible ureteroscope, and how to catch and release stones with a nitinol basket using the Key-Box (n = 8 students in the training group, n = 8 students in the nontraining control group). Subsequently, an expert endourologist (O.T.) blindly assessed skills acquired by the whole cohort of students through two exercises on ureteroscope manipulation and one exercise on stone capture selected among those used for the training. A performance scale (1-5) assessing different steps of the procedure was used to evaluate each student. Time to complete the exercises was measured. Mann-Whitney Rank Sum test was used for comparisons between the two groups. Mean scores obtained by trained students were significantly higher compared with those obtained by nontrained students (all p six (75%) nontrained students were not able to finish one out of the two exercises on ureteroscope manipulation and the exercise on stone capture, respectively. The mean time to complete the three exercises was 76.3, 69.9, and 107 and 172.5, 137.9, and 168 seconds in the trained and nontrained groups, respectively (all p Box(®) seems to be a valid easy-to-use training model for initiating novel endoscopists to flexible ureteroscopy.

  4. Stent Position Is More Important than ?-Blockers or Anticholinergics for Stent-Related Lower Urinary Tract Symptoms after Ureteroscopic Ureterolithotomy: A Prospective Randomized Study

    OpenAIRE

    Lee, Sun Ju; Yoo, Changhee; Oh, Cheol Young; Lee, Yong Seong; Cho, Sung Tae; Lee, Seong Ho; Yang, Dae Yul; Lee, Sang Kon; Cho, Jin Seon

    2010-01-01

    Purpose To evaluate the clinical factors that impact ureteral stent-related lower urinary tract symptoms (LUTS) after ureteroscopic ureterolithotomy, including the stent position and medication. Materials and Methods Fifty-three patients who underwent ureteroscopic ureterolithotomy with indwelling a stent were distributed into three groups. On demand analgesics were given to the group 1 (n=18). Daily tamsulosin 0.2 mg was added for group 2 (n=15) and daily tamsulosin 0.2 mg and tolterodine 4 ...

  5. [Endoscopic contact lithotripsy--modern alternative in the therapy of patients with large stones of the common bile duct].

    Science.gov (United States)

    Ohorodnyk, P V; Kolomiĭtsev, V I; Kushniruk, O I; Deĭnychenko, A H; Khrystiuk, D I

    2013-09-01

    The peculiarities of therapeutic ERCP and contact lithotripsy in patients with choledocholithiasis were studied. 6516 patients (age from 11 to 94 years old) with choledocholithiasis were examined Endoscopic sphincterotomy/balloon dilation with stone extraction was effective in 5507 (84.5%), in 539 (8.8%)--we achieved bile ducts clearance by using mechanical or electrohydraulic lithotripsy. Additional usage of contact lithotripsy increased the effectiveness of therapeutic ERCP to 93.2%. Contact lithotripsy decreased number of specific for ERCP complication from 7.83% to 1.57% in patients with large (> 25mm) stones. Electrohydraulic lithotripsy was successful in destruction of hard bile stones, when mechanical lithotripsy failed.

  6. [Severe pulmonary contusion after extracorporeal shock wave lithotripsy].

    Science.gov (United States)

    Samkaoui, M A; Ziadi, A; Harifi, G; El Adib, A Rhassan; Younous, S

    2009-03-01

    Extracorporeal shock wave lithotripsy (ESWL) is a simple and effective treatment of urinary stones. Renowned less aggressive than surgery, it knew a wide success and constitutes therefore the treatment of first intention of the majority of the kidney stones. Nevertheless, traumatic renal and extrarenal complications notably in lung can arise after ESWL. We report the case of a 28-year-old patient who had a pulmonary contusion following a lithotripsy for a left kidney stone and whose evolution was favourable after two weeks in intensive care unit. Through this observation and the analysis of the rare reported cases in the literature, we insist on the different varieties of pulmonary complications of the ESWL, the hypothesis explaining the mechanisms of their arising as well as the precautions to take to avoid them.

  7. [Extracorporeal shockwave lithotripsy on the Sonolith-3000 apparatus].

    Science.gov (United States)

    Tkachuk, V N; Veroman, V Iu; Komiakov, B K; Bannikov, V V; Sapelkin, A V; Ivanov, A O; Iudkevich, B A; Kalashian, R K

    1991-01-01

    The authors observed 812 patients with nephrolithiasis who underwent 876 sessions of shock-wave lithotripsy on Sonolith-3000 lithotriptor supplied with an ultrasonic system of the stone localization. The size of nephroliths ranged from 0.7 to 4.2 cm. Large-size nephroliths required repeated sessions and pretreatment establishment of the stent. The procedure proceeded without anesthesia. Subsequent renal colic was reported in 126 (15.5%), an exacerbation of pyelonephritis in 45 (5.5%), subcapsular hematoma in 4 (0.5%) of the patients. 790 patients showed clinical response (97.3%), with a complete destruction of the stone in 446 (54.9%) and partial one in 344 (42.4%) cases. 27 subjects were treated in outpatient setting. According to the authors, lithotripsy is contraindicated in urinary tract obstruction below the stone, renal failure, chronic pyelonephritis in the active phase of inflammation, marked impairment of cardiac rhythm.

  8. Renal pelvic stones: choosing shock wave lithotripsy or percutaneous nephrolithotomy

    Directory of Open Access Journals (Sweden)

    Robert Marcovich

    2003-06-01

    Full Text Available Introduction of minimally invasive techniques has revolutionized the surgical management of renal calculi. Extracorporeal shock wave lithotripsy and percutaneous nephrolithotomy are now both well-established procedures. Each modality has advantages and disadvantages, and the application of each should be based on well-defined factors. These variables include stone factors such as number, size, and composition; factors related to the stone's environment, including the stone's location, spatial anatomy of the renal collecting system, presence of hydronephrosis, and other anatomic variables, such as the presence of calyceal diverticula and renal anomalies; and clinical or patient factors like morbid obesity, the presence of a solitary kidney, and renal insufficiency. The morbidity of each procedure in relation to its efficacy should be taken in to account. This article will review current knowledge and suggest an algorithm for the rational management of renal calculi with shock wave lithotripsy and percutaneous nephrolithotomy.

  9. Extracorporeal piezoelectric lithotripsy for retained bile duct stones.

    Science.gov (United States)

    Weber, J; Adamek, H E; Riemann, J F

    1992-05-01

    Extracorporeal piezoelectric shock wave lithotripsy (EPL) was performed in 35 patients with endoscopically non-extractable stones. With this lithotripter, stones are visualized by ultrasound and shock waves are produced by a piezoelectric acoustic generator. The stones could be localized in 32 out of 35 patients. Fragmentation was achieved in 91.4% and complete stone removal in 77.1%. These results show that piezoelectric lithotripsy is also a useful method for the treatment of complicated bile duct stones, as already demonstrated for the electrohydraulically and electromagnetically generated shock waves systems. The piezoelectric system is especially useful in elderly and frail patients because no general anesthesia is needed and only 14% of cases require analgesia or sedation.

  10. Patient information leaflets for extracorporeal shock wave lithotripsy: questionnaire survey

    OpenAIRE

    Askari, A.; Shergill, I.

    2012-01-01

    Objectives To compare the level of information provided in extracorporeal shock wave lithotripsy (ESWL) patient information leaflets in the London and East of England Deaneries Design All trusts in the London and East of England Deanery who offer an ESWL service were contacted and leaflets were compared Setting London and East of England Deanery Participants Alan Askari, Iqbal Shergill Main outcome measures Examination of key information that was communicated to ESWL patients via leaflets Res...

  11. Renal pelvic stones: choosing shock wave lithotripsy or percutaneous nephrolithotomy

    OpenAIRE

    Robert Marcovich; Smith, Arthur D.

    2003-01-01

    Introduction of minimally invasive techniques has revolutionized the surgical management of renal calculi. Extracorporeal shock wave lithotripsy and percutaneous nephrolithotomy are now both well-established procedures. Each modality has advantages and disadvantages, and the application of each should be based on well-defined factors. These variables include stone factors such as number, size, and composition; factors related to the stone's environment, including the stone's location, spatial...

  12. Brushite Stone Disease as a Consequence of Lithotripsy?

    OpenAIRE

    2010-01-01

    The incidence of calcium phosphate (CaP) stone disease has increased over the last three decades; specifically, brushite stones are diagnosed and treated more frequently than in previous years. Brushite is a unique form of CaP, which in certain patients can form into large symptomatic stones. Treatment of brushite stones can be difficult since the stones are resistant to shock wave and ultrasonic lithotripsy, and often require ballistic fragmentation. Patients suffering from brushite stone di...

  13. Kidney changes after extracorporeal shock wave lithotripsy; MR evaluation

    Energy Technology Data Exchange (ETDEWEB)

    Yoshioka, Hiroyasu; Shindo, Hiroshi; Mabuchi, Nobuhisa; Kawakami, Akira; Fujii, Koichi; Hamada, Tatsumi; Ishida, Osamu; Umekawa, Toru; Kohri, Kenjiro (Kinki Univ., Osakasayama, Osaka (Japan). School of Medicine)

    1991-02-01

    MRI was performed before and after extracorporeal shock wave lithotripsy (ESWL) to determine the effects of ESWL on the kidney and perinephric tissues. Of the 40 kidneys studied, 24 showed one or more changes on MRI: loss of the corticomedullary junction (n=15), subcapsular fluid (n=14), subcapsular hematoma (n=1), thickening of bridging septa (n=8), high intensity area in the muscle (n=8). These relatively subtle changes detected on MRI may not be apparent with other imaging techniques. (author).

  14. Pediatric extracorporeal shock wave lithotripsy: Predicting successful outcomes.

    Science.gov (United States)

    McAdams, Sean; Shukla, Aseem R

    2010-10-01

    Extracorporeal shock wave lithotripsy (ESWL) is currently a first-line procedure of most upper urinary tract stones ionizing radiation, perhaps utilizing advancements in ultrasound and magnetic resonance imaging. This report provides a review of the current literature evaluating the patient attributes and stone factors that may be predictive of successful ESWL outcomes along with reviewing the role of pre-operative imaging and considerations for patient safety.

  15. Successful endoscopic treatment of colonic gallstone ileus using electrohydraulic lithotripsy

    Institute of Scientific and Technical Information of China (English)

    Martin; D; Zielinski; Lincoln; E; Ferreira; Todd; H; Baron

    2010-01-01

    The surgical management of gallstone ileus is complex and potentially highly morbid.Initial management requires enterolithotomy and is generally followed by fistula resection at a later date.There have been reports of gallstone extraction using various endoscopic modalities to relieve the obstruction,however,to date,there has never been a published case of endoscopic stone extraction from the colon using electrohydraulic lithotripsy.In this report,we present the technique employed to successfully perform an...

  16. Extracorporeal piezoelectric lithotripsy for complicated bile duct stones.

    Science.gov (United States)

    Weber, J; Adamek, H E; Riemann, J F

    1991-02-01

    Today, common bile duct stones are extracted endoscopically. After endoscopic sphincterotomy, nearly 90% of all stones can be removed with a Dormia basket or a mechanical lithotripter. Problems are encountered if there are larger stones or a duct stenosis. New conservative therapies do serve as an alternative to surgical intervention for those few patients in whom endoscopic measures have failed. Stone fragmentation can be achieved by extracorporeal shock wave lithotripsy, and remaining fragments can be removed endoscopically. So far, authors of most reports on the successful disintegration of common bile duct stones used the Dornier lithotripter. Stone localization is thus achieved with x-rays, and the shock waves are generated by an underwater spark discharge. We report on our experiences and results with extracorporeal piezoelectric shock wave lithotripsy (EPL) in 19 patients with complicated bile duct stones. With this lithotripter, stones are visualized by ultrasound, and shock waves are produced by a piezoelectric acoustic generator. Fragmentation was achieved in 84.2%, and complete stone removal in 78.9%. These results show that piezoelectric lithotripsy is also a useful method for the treatment of complicated bile duct stones, as has already been proved for the electrohydraulic- and electromagnetic-generated shock waves systems. However, the renunciation of general anesthesia and the need for analgesia or sedation in only 25% of the treatments render this lithotripter system attractive, especially for elderly and frail patients.

  17. [The combination of extracorporeal lithotripsy and percutaneous nephrostomy in the treatment of obstructive ureteral urate calculi].

    Science.gov (United States)

    Del Boca, C; Ferrari, C; Dotti, E; Corsi, G; Guardamagna, A; Giuberti, A C; Colloi, D

    1994-04-01

    The authors report their experience with combined percutaneous nephrostomy and extracorporeal shock-wave lithotripsy to treat obstructive uratic ureteral stones. The role of nephrostomy is stressed as a diagnosis and treatment method before, during and after lithotripsy. Thus, the method proved especially useful to drain obstructed kidneys and restore peristalsis, to evacuate septic urine, to facilitate the elimination of lithiasic fragments, to perform anterograde pyelography before, during and after lithotripsy and finally to allow pharmacological litholysis. Fourteen patients were successfully treated with combined extracorporeal lithotripsy and percutaneous nephrostomy and the results compared with those obtained with other techniques--e.g., ureteroscopy, whose value appears lower because the method requires general anesthesia and is more traumatic to the ureter. The authors conclude that combined extracorporeal lithotripsy and percutaneous nephrostomy make the best technique to treat obstructive uric acid stones thanks to their positive results, low invasiveness and to patients compliance.

  18. The value of ultrasound-monitoring calculi drifting in transureteroscopic pneumatic lithotripsy for upper ureteral calculi%输尿管镜气压弹道碎石治疗输尿管上段结石时B超监测结石漂移的价值探讨

    Institute of Scientific and Technical Information of China (English)

    曹刚; 郑如华; 金永有; 陈尧康; 虞利民

    2014-01-01

    目的:探讨输尿管镜气压弹道碎石术(URSL)治疗输尿管上段结石时B超监测结石漂移的临床价值。方法对40例输尿管上段结石患者行URSL治疗时采用床边B超实时监测术中结石漂移情况。结果原位碎石成功32例(80.0%),结石一次清除23例(57.5%),碎石失败8例(20.0%)。进镜时B超发现结石整枚漂移9例(9/40),其中1例移入肾内;碎石时B超早于输尿管镜发现结石整枚漂移12例(12/36),其中2例移入肾内;结石粉碎后B超发现有结石碎片逆向漂移16例(16/32),其中5例共7枚碎片漂移入肾内,其余漂移碎片最后均被输尿管镜证实并在B超引导下成功清除。结论 URSL治疗输尿管上段结石时,B超监测能早于输尿管镜发现结石漂移,有助于减少结石漂移入肾内的风险。%Objective To evaluate the application of ultrasound- monitoring calculi drifting in transureteroscopic pneu-matic lithotripsy (URSL) for upper ureteral calculi. Methods From January 2010 to December 2012, a total of 40 patients with upper ureteral calculi underwent pneumatic lithotripsy through rigid ureteroscope, and intraoperative drifting stones were moni-tored by bedside ultrasonography(US) in our hospital. Results Among 40 cases of ureteral calculi, rate of successful fragmen-tation in situ was 80.0%(32/40), and the stones were cleared away immediately after a single procedure in 23 patients (57.5%) and 8 patients failed, among whom calculi integral drifted into the kidney pelvis in 3 cases. Before ureteroscope entering ureter and calculi were found, calculi integral drifting were detected by US in 9 patients(9/40). During stones broke, 12 cases with cal-culi integral drifting and 16 cases with calculi debris drifting were detected by US in time, and a total of 7 calculi debrises drifted into the kidney in 5 patients, the others debrises were cleaned away under ultrasound- guidance. Al the drifting stones

  19. Pneumatic v electrokinetic lithotripsy in treatment of ureteral stones.

    Science.gov (United States)

    Vorreuther, R; Klotz, T; Heidenreich, A; Nayal, W; Engelmann, U

    1998-06-01

    Recently, a new device (Combilith) for electrokinetic lithotripsy (EKL) has become available which is very similar to the well-known device for pneumatic (ballistic) lithotripsy (Swiss Lithoclast). The Lithoclast uses air pressure to push a projectile within the handpiece against the end of a metal probe, which is thereby accelerated and thrown like a jackhammer against the stone. In principle, the same stroking movement of a small metal probe is provided by EKL; the difference is that instead of a projectile, a magnetic core within the handpiece is accelerated by the electromagnetic principle. This paper compares the clinical efficacy and the features of the two devices. Testing the devices on a stone model, taking into account stone propulsion, the systems turned out to equally effective regarding stone disintegration. However, stone displacement was more pronounced with the Lithoclast applied on easily breaking stones. In a second experiment, an optoelectronic movement-measuring apparatus (Zimmer camera) was employed to measure the range and velocity of the movement of the probe tip without any contact. The linear acceleration velocity ranged from 5 to a maximum of 12.5 m/sec with both systems, but the maximum height of the stroke was 2.5 mm with the Lithoclast and 1 mm with EKL. After the initial break-up of soft stones, further impact of the probe tip against the stone resulted merely in propulsion; thus, the greater probe stroke height is the cause of the stone displacement. In a clinical trial, 22 ureteral stones were treated with the Lithoclast and 35 with the EKL. The two devices were equally effective in terms of stone disintegration and safety margin. Fixation using a Dormia basket was necessary in 12 cases (8 Lithoclast, 4 EKL). Although a difference in probe stroke height was noted when comparing pneumatic and electrokinetic lithotripsy, there were no clinically significant differences in the efficacy of stone fragmentation or stone-free rates. At the

  20. Extracorporeal shock-wave lithotripsy: a comparative study of electrohydraulic and electromagnetic units.

    Science.gov (United States)

    Matin, S F; Yost, A; Streem, S B

    2001-12-01

    We determined the results of shock wave lithotripsy with a newer electromagnetic lithotriptor and compared them with those in a contemporary series of cases managed by an electrohydraulic lithotriptor using identical treatment and followup criteria at a single center. Between 1995 and 1999, 356 patients (375 renal units, 483 upper urinary tract stones) meeting study inclusion criteria were treated with an MFL 5000 electrohydraulic shock wave lithotripsy unit (Dornier Medical Systems, Inc., Marietta, Georgia). From 1999 to 2000, 173 patients (175 renal units; 218 upper urinary tract stones) meeting identical study inclusion criteria were treated using an electromagnetic Modulith SLX shock wave lithotripsy unit (Karl Storz Lithotripsy, Atlanta, Georgia). In each group stone-free results were determined by plain abdominal x-ray and renal ultrasound 1 month after lithotripsy and efficiency quotients were developed. Baseline patient and stone characteristics were compared by the Wilcoxon rank sum and Fisher exact tests. All variables significant at p electromagnetic lithotripsy units (0.45 and 0.42, respectively, p = 0.43). Electrohydraulic lithotripsy resulted in a higher stone-free rate at 1 month, although it was associated with a higher rate of auxiliary measures. Ultimately the efficiency quotients were equivalent, implying that these 2 contemporary energy sources are acceptable. According to single center treatment and followup criteria they are equally efficacious.

  1. CT appearance of renal hemorrhage after extracorporeal shock wave lithotripsy

    Energy Technology Data Exchange (ETDEWEB)

    Kanazawa, Susumu; Araki, Toru; Takamoto, Hitoshi; Hata, Kazuhiro

    1988-07-01

    Computed Tomography (CT) was performed in three patients who were suspicious of renal hemorrhage after extracorporeal shock wave lithotripsy (ESWL). Post-ESWL scans demonstrated subcapsular hematoma in all three cases, and intrarenal hemorrhage in two cases, one of which had fluid collection in the pararenal space and hemorrhage in the posterior pararenal space on CT. Thickening of gerota fascia and bridging septa in the perirenal space was visualized on CT in all of them. CT demonstrated clearly the anatomic distribution and extent of renal hemorrhage, and it is important to comprehend the imaging anatomy of the perirenal area for CT evaluation.

  2. Outcome of simple use of mechanical lithotripsy of difficult common bile duct stones

    Institute of Scientific and Technical Information of China (English)

    Wen-Hsiung Chang; Cheng-Hsin Chu; Tsang-En Wang; Ming-Jen Chen; Ching-Chung Lin

    2005-01-01

    AIM: The usual bile duct stone may be removed by means of Dormia basket or balloon catheter, and results are quite good. However, the degree of difficulty is increased when stones are larger. Studies on the subject reported many cases where mechanical lithotripsy is combined with a second technique, e.g. electrohydraulic lithotripsy (EHL),where stones are crushed using baby-mother scope electric shock. The extracorporeal shock-wave lithotripsy (ESWL)or laser lithotripsy also yields an excellent success rate of greater than 90%. However, the equipment for these techniques are very expensive; hence we opted for the simple mechanical lithotripsy and evaluated its performance.METHODS: During the period from August 1996 to Decemberz 2002, Mackay Memorial Hospital treated 304 patients suffering from difficult bile duct stones (stone >1.5 cm or stones that could not be removed by the ordinary Dormia basket or balloon catheter). These patients underwent endoscopic papillotomy (EPT) procedure, and stones were removed by means of the Olympus BML-4Q lithotripsy. A follow-up was conducted on the post-treatment conditions and complications of the patients.RESULTS: Out of the 304 patients, bile duct stones were successfully removed from 272 patients, a success rate of about 90%. The procedure failed in 32 patients, for whom surgery was needed. Out of the 272 successfully treated patients, 8 developed cholangitis, 21 developed pancreatitis,and 10 patients had delayed bleeding, and no patient died.Among these 272 successful removal cases, successful bile duct stone removal was achieved after the first lithotripsy in 211 patients, whereas 61 patients underwent multiple sessions of lithotripsy. As for the 61 patients that underwent multiple sessions of mechanical lithotripsy, 6 (9.8%) had post-procedure cholangitis, 12 (19.6%) had pancreatitis,and 9 patients (14.7%) had delayed bleeding. Compared with the 211 patients undergoing a single session of mechanical lithotripsy, 3 (1

  3. Brushite stone disease as a consequence of lithotripsy?

    Science.gov (United States)

    Krambeck, Amy E; Handa, Shelly E; Evan, Andrew P; Lingeman, James E

    2010-08-01

    The incidence of calcium phosphate (CaP) stone disease has increased over the last three decades; specifically, brushite stones have been diagnosed and treated more frequently than in previous years. Brushite is a unique form of CaP, which in certain patients can form into large symptomatic stones. Treatment of brushite stones can be difficult since the stones are resistant to shock wave and ultrasonic lithotripsy, and often require ballistic fragmentation. Patients suffering from brushite stone disease are less likely to be rendered stone free after surgical intervention and often experience stone recurrence despite maximal medical intervention. Studies have demonstrated an association between brushite stone disease and shock wave lithotripsy (SWL) treatment. Some have theorized that many brushite stone formers started as routine calcium oxalate (CaOx) stone formers who sustained an injury to the nephron (such as SWL). The injury to the nephron leads to failure of urine acidification and eventual brushite stone formation. We explore the association between brushite stone disease and iatrogenic transformation of CaOx stone disease to brushite by reviewing the current literature.

  4. Endoscopic-assisted electrohydraulic shockwave lithotripsy in standing sedated horses.

    Science.gov (United States)

    Röcken, Michael; Fürst, Anton; Kummer, Martin; Mosel, Gesine; Tschanz, Theo; Lischer, Christoph J

    2012-07-01

    To report use of transendoscopic electrohydraulic shockwave lithotripsy for fragmentation of urinary calculi in horses. Case series. Male horses (n = 21). Fragmentation of cystic calculi (median, 6 cm diameter; range, 4-11 cm diameter) was achieved by transurethral endoscopy in standing sedated horses using an electrohydraulic shockwave fiber introduced through the biopsy channel of an endoscope. The fiber was advanced until it contacted the calculus. Repeated activation of the fiber was used to disrupt the calculus into fragments calculus removal was achieved in 20 horses (95%) with mean total surgical time of 168.6 minutes (range, 45-450). In the 20 horses with single calculi, 1-6 sessions were required to completely fragment the calculus. Except for 1 horse, in which perineal urethrotomy was eventually performed for complete fragment removal, fragments calculi were excreted via the urethra. Postoperative complications included hematuria because of severe mucosal erosion (n = 2), dysuria because of a trapped urethral fragment (2), small amount of urinary debris (1). One horse was euthanatized because of bladder rupture. Complete clearance of calculi and urinary debris was confirmed endoscopically 20 (3-45) days after the last session. Telephone follow-up (mean, 18.8 months; range, 7-24 months) revealed that horses had returned to previous activity levels without recurrence of clinical signs. Transendoscopic electrohydraulic lithotripsy appears to be an effective method for fragmentation of low-density calcium carbonate cystic calculi in male horses. Copyright 2012 by The American College of Veterinary Surgeons.

  5. Liver fibrosis after extracorporeal shock-wave lithotripsy of gallbladder stones - A case report

    NARCIS (Netherlands)

    P.W. Plaisier; J.F. Hamming (Jaap); R.L. van der Hul (René); R. den Toom (Rene); H.A. Bruining (Hajo)

    1994-01-01

    textabstractWe encountered significant liver fibrosis in a healthy young patient undergoing laparoscopic cholecystectomy for symptomatic gallstone disease. Twelve months prior to cholecystectomy the patient underwent multiple extracorporeal shock-wave lithotripsy (ESWL) sessions with adjuvant oral b

  6. Comparing the Efficacy and Safety of Ultrasonic Versus Pneumatic Lithotripsy in Percutaneous Nephrolithotomy: A Randomized Clinical Trial.

    Science.gov (United States)

    Radfar, Mohammad Hadi; Basiri, Abbas; Nouralizadeh, Akbar; Shemshaki, Hamidreza; Sarhangnejad, Reza; Kashi, Amir Hossein; Narouie, Behzad; Soltani, Amir Mohammad; Nasiri, Mahmoudreza; Sotoudeh, Mehdi

    2017-02-01

    Percutaneous nephrolitotomy (PCNL) is the preferred treatment for large renal stones. There is a need for more comparative data for different lithotripters used in PCNL. To evaluate the comparative safety and efficacy of ultrasonic and pneumatic lithotripsy in patients undergoing PCNL. This randomized clinical trial was conducted at Labbafinejad University Hospital, Tehran, Iran. A total of 180 patients were selected and divided randomly into two groups: 88 patients to pneumatic and 92 to ultrasonic lithotripsy. Standard fluoroscopy-guided PCNL was performed using pneumatic or ultrasonic lithotripsy. The primary outcome was the procedure success rate. We also evaluated other outcome measures including operation time, stone fragmentation and removal time (SFRT), length of hospital stay, and postoperative complications. We used SPSS software version 18.0 for data analysis. The two groups were similar in baseline characteristics. There were no significant differences between the groups in stone fragmentation and removal time (p=0.63), stone free rate (p=0.44), and hospital stay (p=0.66). SFRT for hard stones was shorter using pneumatic lithotripsy (ppneumatic and ultrasonic lithotripsy. SFRT was significantly shorter using pneumatic lithotripsy for hard stones, and ultrasonic lithotripsy for soft stones. We found no significant differences in the success rate and complications of percutaneous nephrolitotomy using pneumatic and ultrasonic lithotripsy. Ultrasonic and pneumatic lithotripsy differed in the time for stone fragmentation and removal for hard and soft stones. Copyright © 2017 European Association of Urology. Published by Elsevier B.V. All rights reserved.

  7. Patient information leaflets for extracorporeal shock wave lithotripsy: questionnaire survey

    Science.gov (United States)

    Askari, A; Shergill, I

    2012-01-01

    Objectives To compare the level of information provided in extracorporeal shock wave lithotripsy (ESWL) patient information leaflets in the London and East of England Deaneries Design All trusts in the London and East of England Deanery who offer an ESWL service were contacted and leaflets were compared Setting London and East of England Deanery Participants Alan Askari, Iqbal Shergill Main outcome measures Examination of key information that was communicated to ESWL patients via leaflets Results 12 trusts responded across the two deaneries. There was significant variation in the amount of information provided in the leaflets with some leaflets not containing an adequate level of instruction or information to patients Conclusions The authors propose that a national standardised information leaflet should be incorporated with the British Association of Urological Surgeons (BAUS) procedure specific information leaflet for ESWL procedures PMID:22666532

  8. Stenting and extracorporeal shock wave lithotripsy in chronic pancreatitis

    DEFF Research Database (Denmark)

    Holm, M; Matzen, Peter

    2003-01-01

    BACKGROUND: Early observational studies of endoscopic treatment and extracorporeal shock wave lithotripsy (ESWL) reported considerable or complete relief of pain in 50%-80% of patients with chronic pancreatitis. There is no consensus on the measurement of pain, making comparison of observational...... studies difficult, and little attention has been paid to the type and amount of analgesics used by patients before and after decompressive treatment. METHODS: We performed a retrospective study of all patients with chronic pancreatitis and large-duct disease and receiving decompressing treatment between 1...... November 1994 and 31 July 1999. Primary parameters were type and amount of analgesics used. RESULTS: Forty-nine patients with chronic pancreatitis and large-duct disease received stenting of the pancreatic duct (28 patients), ESWL (6 patients) or both (15 patients). After a median follow-up of 21 months...

  9. TREATMENT OF CYSTINE CALCULUS WITH EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY

    Institute of Scientific and Technical Information of China (English)

    2006-01-01

    Objective To evaluate the effectiveness of ESWL for treating patients with cystine calculus.Methods Of 31 patients, 20 were subjected to ESWL only, 6 were subjected to combination therapy of PCNL and ESWL, 2 Pneumatic Lithotriptor-ESWL, 3 Laser lithotripsy-ESWL. Results For 14 renal stones, the fragmentation after ESWL monotherapy was 85. 7% and 14.3% after twice ESWL sessions. For 17 ureter calculus, the fragmentation after ESWL monotherapy was 82.3% and 11.7% after twice ESWL sessions. One patient (5. 8% ) failed and changed to open surgery. Conclusion ESWL is an effective and reliable method for treating patients with cystine calculus, however, better effects and shorter treatment time could be obtained by the combination of ESWL with other therapy options.

  10. Two-part silicone mold. A new tool for flexible ureteroscopy surgical training

    Directory of Open Access Journals (Sweden)

    Bruno Marroig

    Full Text Available ABSTRACT Introduction and objectives: Flexible ureteroscopy is a common procedure nowadays. Most of the training programs use virtual reality simulators. The aim of this study was to standardize the building of a three-dimensional silicone mold (cavity of the collecting system, on the basis of polyester resin endocasts, which can be used in surgical training programs. Materials and Methods: A yellow polyester resin was injected into the ureter to fill the collecting system of 24 cadaveric fresh human kidneys. After setting off the resin, the kidneys were immersed in hydrochloric acid until total corrosion of the organic matter was achieved and the collecting system endocasts obtained. The endocasts were used to prepare white color two-part silicone molds, which after endocasts withdrawn, enabled a ureteroscope insertion into the collecting system molds (cavities. Also, the minor calices were painted with different colors in order to map the access to the different caliceal groups. The cost of the materials used in the molds is $30.00 and two days are needed to build them. Results: Flexible ureteroscope could be inserted into all molds and the entire collecting system could be examined. Since some anatomical features, as infundular length, acute angle, and perpendicular minor calices may difficult the access to some minor calices, especially in the lower caliceal group, surgical training in models leads to better surgical results. Conclusions: The two-part silicone mold is feasible, cheap and allows its use for flexible ureteroscopy surgical training.

  11. Flexible Flatfoot

    Science.gov (United States)

    ... this page. Please enable Javascript in your browser. Flexible Flatfoot What Is Flatfoot? Flatfoot is often a ... may develop as a result of a flatfoot. Flexible Flatfoot Flexible flatfoot is one of the most ...

  12. Impact of retrograde flexible ureteroscopy and intracorporeal lithotripsy on kidney functional outcomes

    Directory of Open Access Journals (Sweden)

    Nicolas Hoarau

    2015-10-01

    Full Text Available ABSTRACT Objective: The aim of the study was to evaluate renal function and to identify factors associated with renal function deterioration after retrograde intrarenal surgery (RIRS for kidney stones. Materials and Methods: We retrospectively analyzed patients with renal stones treated by RIRS between January 2010 and June 2013 at a single institute. We used the National Kidney Foundation classification of chronic kidney disease (CKD to classify Glomerular Filtration Rate (GFR in 5 groups. The baseline creatinine level was systematically pre-operatively and post-operatively evaluated. All patients had a creatinine blood measurement in June 2013. A change toward a less or a more favorable GFR group following RIRS was considered significant. Results: We included 163 patients. There were 86 males (52.8% and 77 females (47.3% with a mean age of 52.8±17 years. After a mean follow-up of 15.5±11.5 months, median GFR was not significantly changed from 84.3±26.2 to 84.9±24.5 mL/min (p=0.675. Significant renal function deterioration occurred in 8 cases (4.9% and significant renal function amelioration occurred in 23 cases (14.1%. In univariate analysis, multiple procedures (p=0.023; HR: 5.4 and preoperative CKD (p=0.011; HR: 6.8 were associated with decreased renal function. In multivariate analysis these factors did not remain as predictive factors. Conclusion: Stone management with RIRS seems to have favorable outcomes on kidney function; however, special attention should be given to patients with multiple procedures and preoperative chronic kidney disease.

  13. Percutaneous transhepatic lithotripsy using a choledochoscope: long-term follow-up in 14 patients.

    Science.gov (United States)

    Hayashi, N; Sakai, T; Yamamoto, T; Inagaki, R; Ishii, Y

    1998-11-01

    The purpose of our study was to estimate the long-term prognosis of patients with bile duct stones who undergo electrohydraulic lithotripsy guided by choledochoscopy. Since 1987, at our institution, 14 patients with bile duct stones have been treated using percutaneous electrohydraulic lithotripsy guided by choledochoscopy. The procedure was performed 5-7 days after biliary drainage using a 5-mm choledochoscope placed through an 18- to 20-French sheath. All patients underwent follow-up CT, sonography, or both every 6-12 months after treatment. No complications occurred in the 14 patients who underwent treatment. During a mean follow-up period of 4.8 years (range, 2-9 years), two (14%) of the 14 patients developed recurrent common bile duct stones, and another two (14%) developed recurrent small intrahepatic stones; all patients remained asymptomatic. Percutaneous electrohydraulic lithotripsy can be safely performed using a 5-mm choledochoscope. Recurrent calculi may be seen in 28% of patients.

  14. Fragmentation of common bile duct and pancreatic duct stones by extracorporeal shock-wave lithotripsy

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Ham Gyum [Ansan Junior College, Seoul (Korea, Republic of); Son, Soon Yong; Lee, Won Hong [Asan Medical Center, Seoul (Korea, Republic of)

    1998-06-01

    To determine its usefulness and safety of extracorporeal shock-wave lithotripsy in common bile duct and pancreatic duct stones, we analyzed the results of 13 patients with common bile duct stones and 6 patients with pancreatic duct stones which were removed by endoscopic procedures using the balloon or basket, who was performed the extracorporeal shock-wave lithotripsy using the ultrasonography for stone localization with a spark gap type Lithotriptor(Dornier MPL 9000, Germany). Fragmentation and complete clearance of the common bile duct and pancreatic duct stones were obtained in 19 of 19 patients(100%). Apart from transient attacks of fever in 2 of 13 patients with common bile duct stones(15%) and mild elevation of serum amylase and lipase in 2 of 6 patients with pancreatic duct stones(33%), no other serious side effects were observed. In our experiences, extracorporeal shock-wave lithotripsy is a safe and useful treatment for endoscopically unretrievable common bile duct and pancreatic duct stones.

  15. Retroperitoneal laparoscopic pyelolithotomy versus extra corporeal shock-wave lithotripsy for management of renal stones

    Directory of Open Access Journals (Sweden)

    Chander Jagdish

    2010-01-01

    Full Text Available Aim: The purpose of this study was to evaluate the role of retroperitoneal laparoscopic pyelolithotomy (RPPL and its comparison with extra corporeal shock wave lithotripsy in the management of renal calculi. Materials and Methods: The study was carried out in the Department of surgery, Maulana Azad Medical College, New Delhi, India. The study included 86 cases of solitary renal calculi in the retroperitoneoscopic (RPPL group and 82 cases in the shock wave lithotripsy (SWL group. The parameters compared were stone clearance, hospital stay, number of postoperative visits, mean time to resume normal activities, number of man days lost, and analgesic requirement. Results : The RPPL group showed better stone clearance, fewer hospital visits, low analgesic requirement, fewer number of man days lost, and early resumption of normal activities, as compared to the SWL group. Conclusions : Shock wave lithotripsy, being a noninvasive modality, is an established procedure all over the world. However RPPL achieves comparable or better results in high volume centers.

  16. Large Bowel Obstruction Due to a Big Gallstone Successfully Treated with Endoscopic Mechanical Lithotripsy

    Directory of Open Access Journals (Sweden)

    Marco Balzarini

    2015-01-01

    Full Text Available Colonic gallstone ileus in an uncommon mechanical bowel obstruction caused by intraluminal impaction of one or more gallstones. The surgical management of gallstone ileus is complex and is potentially of high risk. There have been reports of gallstone extractions using various endoscopic modalities to relieve the obstruction. In this report we present the technique employed to successfully perform a mechanical lithotripsy and extraction of a large gallstone embedded in a sigmoid colon affected by diverticular stenosis. We passed through the stenosis with a 11.3 mm videoscope with 3.7 mm channel. A large lithotripsy extraction basket was used to catch and break up the stone and fragments were removed using the same basket. The patient was discharged asymptomatic three days after the procedure. Using appropriate devices mechanical lithotripsy is a safe and effective method to treat colonic obstruction and avoid surgery in the setting of gallstone ileus even in case of big stones.

  17. Comparative Study between Slow Shock Wave Lithotripsy and Fast Shock Wave Lithotripsy in the Management of Renal Stone

    Directory of Open Access Journals (Sweden)

    AKM Zamanul Islam Bhuiyan

    2013-01-01

    Full Text Available Background: Renal calculi are frequent causes of ureteric colic. Extracorporeal shock wave lithotripsy is the most common treatment of these stones. It uses focused sound waves to break up stones externally. Objective: To compare the efficiency of slow and fast delivery rate of shock waves on stone fragmentation and treatment outcome in patients with renal calculi. Materials and Methods: This prospective study was done in the department of Urology, National Institute of Kidney diseases and Urology, Sher-e-Bangla Nagar, Dhaka from July 2006 to June 2007. Total 90 patients were treated using the Storz Medical Modulith ® SLX lithotripter. Patients were divided into Group A, Group B and Group C – each group having 30 subjects. Group A was selected for extracorporeal shockwave lithotripsy (ESWL by 60 shock waves per minute, Group B by 90 shock waves per minute and Group C by 120 shock waves per minute. Results: Complete clearance of stone was observed in 24 patients in Group A and 13 patients in both Group B and Group C in first session. In Group A only 3 patients needed second session but in Group B and Group C, 12 and 8 patients needed second session. In Group A only one patient needed third session but third session was required for 3 patients in Group B and 5 patients in Group C for complete clearance of stone. In Group A, subsequent sessions were performed under spinal anesthesia and in Group B under sedation and analgesia (p>0.001. Mean number of sessions for full clearance of stones in group A was 1.37 ± 0.85, in Group B was 1.8 ± 0.887 and in Group C was 2.0 ± 1.083. Significant difference was observed in term of sessions among groups (p>0.05. In first follow-up, complete clearance of stones was seen in 24 patients in Group A and 13 in both Group B and Group C. In second follow-up, 3 patients in Group A, 12 in Group B and 8 in Group C showed complete clearance of stones. It was observed that rate of stone clearance was higher in Group A

  18. Extracorporeal shock-wave lithotripsy of bile duct stones

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Jong Tae; Kim, Myung Joon; Yoo, Hyung Sik; Suh, Jung Ho; Lee, Moo Sang; Jo, Jang Hwan; Kim, Byung Ro [Yonsei University College of Medicine, Seoul (Korea, Republic of)

    1989-12-15

    During the past one and half year, we performed ESWL therapy in 13 patients with common bile duct and intrahepatic duct stones, applying Lithostar-R (Siemens co. West Germany) and analyzed their results. In 13 patients, 9 residual common bile duct stones and 7 intrahepatic duct stones were selected postoperatively. The size of stones were ranged from 0.7 cm to 3.5 cm in diameter. 2 stones were multiple and the remained 14 were single in number. The visualization of stones were done with fluoroscopy after the injection of contrast media via cholangiographic T-tube or ERCP. ESWL were applied continuously until stone disintegration was visible, or upto maximum number of 3500 discharge of shock wave. If not disintegrated upto 3500, patients were underwent second or third lithotripsy session with interval of one week. Our results showed that among 9 common bile duct stones, 4 were completely disintegrated and passed out spontaneously, but 3 partially fragmented and removed by the additional procedure. 2 were failed. Among 7 intrahepatic stones, 3 completely and 2 partially were succeeded. One stone partially fragmented were retained without removal and other one were failed. Skin petechia in all patients were revealed on the entry port of shock wave, but no serous complication was not occurred.

  19. Drugs for Pain Management in Shock Wave Lithotripsy

    Directory of Open Access Journals (Sweden)

    Christian Bach

    2011-01-01

    Full Text Available Objective. With this review, we provide a comprehensive overview of the main aspects and currently used drugs for analgesia in shockwave lithotripsy. Evidence Acquisition. We reviewed current literature, concentrating on newer articles and high-quality reviews in international journals. Results. No standardized protocols for pain control in SWL exist, although it is crucial for treatment outcome. General and spinal anaesthesia show excellent pain control but are only recommended for selected cases. The newer opioids and nonsteroidal anti-inflammatory drugs are able to deliver good analgesia. Interest in inhalation anaesthesia with nitrous oxide, local anaesthesia with deep infiltration of the tissue, and dermal anaesthesia with EMLA or DMSO has recently rekindled, showing good results in terms of pain control and a favourable side effect profile. Tamsulosin and paracetamol are further well-known drugs being currently investigated. Conclusion. Apart from classically used drugs like opioids and NSARs, medicaments like nitrous oxide, paracetamol, DMSA, or refined administration techniques for infiltration anaesthesia show a good effectiveness in pain control for SWL.

  20. Pediatric extracorporeal shock wave lithotripsy: Predicting successful outcomes

    Directory of Open Access Journals (Sweden)

    Sean McAdams

    2010-01-01

    Full Text Available Extracorporeal shock wave lithotripsy (ESWL is currently a first-line procedure of most upper urinary tract stones <2 cm of size because of established success rates, its minimal invasiveness and long-term safety with minimal complications. Given that alternative surgical and endourological options exist for the management of stone disease and that ESWL failure often results in the need for repeat ESWL or secondary procedures, it is highly desirable to identify variables predicting successful outcomes of ESWL in the pediatric population. Despite numerous reports and growing experience, few prospective studies and guidelines for pediatric ESWL have been completed. Variation in the methods by which study parameters are measured and reported can make it difficult to compare individual studies or make definitive recommendations. There is ongoing work and a need for continuing improvement of imaging protocols in children with renal colic, with a current focus on minimizing exposure to ionizing radiation, perhaps utilizing advancements in ultrasound and magnetic resonance imaging. This report provides a review of the current literature evaluating the patient attributes and stone factors that may be predictive of successful ESWL outcomes along with reviewing the role of pre-operative imaging and considerations for patient safety.

  1. Intraluminal bubble dynamics induced by lithotripsy shock wave

    Science.gov (United States)

    Song, Jie; Bai, Jiaming; Zhou, Yufeng

    2016-12-01

    Extracorporeal shock wave lithotripsy (ESWL) has been the first option in the treatment of calculi in the upper urinary tract since its introduction. ESWL-induced renal injury is also found after treatment and is assumed to associate with intraluminal bubble dynamics. To further understand the interaction of bubble expansion and collapse with the vessel wall, the finite element method (FEM) was used to simulate intraluminal bubble dynamics and calculate the distribution of stress in the vessel wall and surrounding soft tissue during cavitation. The effects of peak pressure, vessel size, and stiffness of soft tissue were investigated. Significant dilation on the vessel wall occurs after contacting with rapid and large bubble expansion, and then vessel deformation propagates in the axial direction. During bubble collapse, large shear stress is found to be applied to the vessel wall at a clinical lithotripter setting (i.e. 40 MPa peak pressure), which may be the mechanism of ESWL-induced vessel rupture. The decrease of vessel size and viscosity of soft tissue would enhance vessel deformation and, consequently, increase the generated shear stress and normal stresses. Meanwhile, a significantly asymmetric bubble boundary is also found due to faster axial bubble expansion and shrinkage than in radial direction, and deformation of the vessel wall may result in the formation of microjets in the axial direction. Therefore, this numerical work would illustrate the mechanism of ESWL-induced tissue injury in order to develop appropriate counteractive strategies for reduced adverse effects.

  2. Flexible supercapacitors

    Institute of Scientific and Technical Information of China (English)

    Shan Shi; Chengjun Xu; Cheng Yang; Jia Li; Hongda Du; Baohua Li; Feiyu Kang

    2013-01-01

    Flexible supercapacitors show a great potential for applications in wearable,miniaturized,portable,largescale transparent and flexible consumer electronics due to their significant,inherent advantages,such as being flexible,lightweight,low cost and environmentally friendly in comparison with the current energy storage devices.In this report,recent progress on flexible supercapacitors,flexible electrodes and electrolytes is reviewed.In addition,the future challenges and opportunities are discussed.

  3. Sialendoscopic Pneumatic Lithotripsy for Salivary Calculi: A New Technique and a Long-term Clinical Experience.

    Science.gov (United States)

    Serbetci, Erhun; Celikoyar, M Mazhar; Altundag, Aytug

    2017-07-01

    We report our results comprising a series of 34 cases of sialolithiasis that were approached sialendoscopically with conventional instruments (ie, basket and/or forceps) and for which stone removal was unsuccessful and so were thereafter treated with pneumatic lithotripsy. Intraductal pneumatic lithotripsy was able to fragment 30 of 34 (88%) salivary calculi in total. No major complications occurred. All 30 treated glands returned to normal function without any symptoms. We believe that the success of sialendoscopy is closely related to the success of salivary stone fragmentability.

  4. Peel-away鞘在处理女性输尿管石街及下段结石中的应用%Treatment of the ureteral steinstrasse or distal ureteral stones through ureteroscopic lithotripsy using peel-away sheath

    Institute of Scientific and Technical Information of China (English)

    刘建河; 夏术阶; 鲁军; 陈辉榕

    2006-01-01

    目的:总结Peel-away鞘在处理女性输尿管石街及输尿管下段结石中的经验.方法:对ESWL术后输尿管石街形成及输尿管下段结石的15例女性患者,应用输尿管镜在Peel-away鞘辅助下进行取石.结果:所有患者均一次性取尽输尿管内结石,且无输尿管穿孔、狭窄及大出血等并发症发生.结论:在女性患者中采用Peel-away鞘辅助输尿管镜处理输尿管下段结石,可以最大程度地避免由于输尿管镜频繁进出输尿管而引起的损伤,并且缩短手术时间,降低输尿管损伤的风险.

  5. Strategies for prevention and treatment of urosepsis after percutaneous nephrolithotomy and ureteroscopic lithotripsy%上尿路腔内取石术并发尿源性脓毒血症的防治策略

    Institute of Scientific and Technical Information of China (English)

    关晓峰; 黎承杨; 邓耀良

    2016-01-01

    目的 总结经皮肾镜取石术和输尿管镜取石术治疗上尿路结石导致尿源性脓毒血症的防治经验.方法 回顾性分析13例经皮肾镜取石术和输尿管镜取石术后并发尿源性脓毒血症患者的临床资料,所有患者均进行积极地抗感染及抗休克治疗.结果 经过积极的抗感染及抗休克治疗,所有患者生命体征逐渐平稳,均治愈出院.结论 尿源性脓毒血症是上尿路腔内取石术最严重的并发症之一,早期预防、诊断及适当的干预可减少其发生率.

  6. Experience in diagnosis and treatment of urosepsis following ureteroscopic lithotripsy of upper urinary tract calculi%上尿路结石术后尿源性脓毒血症的诊治研究

    Institute of Scientific and Technical Information of China (English)

    程应生; 杨代俊; 郑攀丰; 张志炎

    2015-01-01

    目的:分析上尿路结石尿源性脓毒血症临床特点,为预防尿源性脓毒血症发生及早期诊断、治疗提供依据.方法:回顾性分析2003年4月~2014年4月23例患者行输尿管镜取石术(URL)和经皮肾镜取石术(PCNL)术后并发脓毒血症的临床资料.结果:23例均及时诊断尿源性脓毒血症,并进行相应的处理,无一例死亡.结论:对上尿路结石腔内手术后并发尿源性脓毒血症的患者,术前控制感染,术中预防,正确救治,可减少尿源性脓毒血症的发生率,提高抢救成功率.

  7. Gallbladder Dynamics Before and After Extracorporeal Shock Wave Lithotripsy

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Myung Hea; Suk, Jae Dong; Moon, Dae Hyuk; Kim, Myung Hwan; Min, Young Il [Asian Medical Center, Ulsan University College of Medicine, Seoul (Korea, Republic of)

    1991-03-15

    Extracorporeal shock wave lithotripsy (ESWI.) with adjunctive oral litholytic therapy has proven to be a useful treatment in selected patients with gallbladder stones. To study the effect of ESWL on gallbladder dynamics, {sup 99m}Tc-DISIDA hepatobiliary scintigraphy was done for 25 patients with symptomatic gallstones and 10 normal controls. Of these 25 patients, 15 were treated with ESWL and adjunctive oral litholytic agents (ESWL group) and 10 were treated only with oral litholytic agents (UDCA group). After overnight fast and gallbladder visualization on a routine hepatobiliary scintigraphy with 7 mCi of {sup 99m}Tc-DISIDA, subjects were given fatty meal and imaged with a gamma camera interfaced to a computer (I frame/minute for 70 minutes). A gallbladder time-activity curve was generated and latent period (LP), ejection period (EP), ejection fraction (EF) and ejection rate (ER) were calculated, ESWL group were studied before, l day after and 2 weeks after ESWL, and UDCA group were studied before and 2 weeks after starting oral medication Mean basal EF was significantly reduced in patients but other parameters were not reduced. In ESlVL group, mean EF and mean ER at 1 day after ESWL were reduced. In 3 of them, gallbladder was not visualized at all. Two weeks after ESWL, however, all parameters were recovered to basal level. In UDCA group, all parameters were not changed significantly during medication. We can conclude that ESWL has such immediate adverse effect on gallbladder dynamics as reducing contractility and nonvisualization of gallbladder but it has no long-term effect.

  8. Steinstrasse predictive factors and outcomes after extracorporeal shockwave lithotripsy

    Directory of Open Access Journals (Sweden)

    Jarques Lucio II

    2011-08-01

    Full Text Available PURPOSE: Urinary stone disease is a common medical problem. Extracorporeal shockwave lithotripsy (SWL has been applied with high success and low complication rates. Steinstrasse (SS is a possible complication after SWL. The aim of the present study was to prospectively evaluate the factors and outcomes associated with SS after SWL. MATERIALS AND METHODS: We have prospectively evaluated 265 SWL sessions (2005-2009. Two lithotriptors were used randomly: Siemens Lithostar and Dornier Compact S. All patients had imaging exams after 30 and 90 days or according to symptoms. RESULTS: SS was observed in 14 (5.3% out of 265 SWL procedures (n = 175 patients, 51.5% women/48.5% men, mean ± SD age = 46.3 ± 15.5 years. SS was more common after SWL for pelviureteral calculi rather than caliceal stones (p = 0.036. There was a trend toward more occurrences of SS after SWL for larger stone area (> 200 mm², p = 0.072. Preoperative ureteral stent didn't prevent SS. SWL machine, intensity, number of pulses and frequency were not associated with SS formation. Post-SWL pain, fever and gravel elimination were factors associated with SS (p = 0.021; p = 0.011; p = 0.078. When SS occurred, treatment modalities included Medical Expulsive Therapy (MET, ureteroscopy and SWL. CONCLUSIONS: Steinstrasse is an uncommon event after SWL and seems to occur more frequently with larger pelviureteral stones. Impaction of stones is more frequent in the middle ureter. All patients should be followed after SWL, but SS should be specially suspected if there is macroscopic gravel elimination, flank pain and/or fever. When SS occurs, treatment should be promptly introduced, including medical expulsive therapy, surgical approach or SWL in selected cases. Further prospective studies are awaited to evaluated preventive measures for SS occurrence.

  9. Strategic flexibility

    OpenAIRE

    Kim, KiHyung

    2014-01-01

    A flexible system is defined as one that can change the entity's stance, capability or status reacting to a change of the entity's environment. Flexibility has gathered the attention of academic researchers and industry practitioners as an efficient approach to cope with today's volatile environment. As the environments become more unpredictable and volatile, it is imperative for a flexible system to respond quickly to a change in its circumstance. How much flexibility is embedded into the sy...

  10. Ureteropyeloscopy and homium: YAG laser lithotripsy for treatment of ureteral calculi (report of 356 cases)

    Science.gov (United States)

    Wu, Zhong; Din, Qiang; Jiang, Hao-wen; Zen, Jing-cun; Yu, Jiang; Zhang, Yuanfang

    2005-07-01

    Objective: To evaluate the efficacy and safety of holmium YAG laser lithotripsy for the treatment of ureteral calculi. Methods: A total of 356 patients underwent ureteropyeloscopic lithotripsy using holmium YAG laser with a semirigid uretesopyeloscope, 93 upper, 135 middle, and 128 lower ureteral stones were treated. Results: The overall successful fragmentation rate for all ureteral stones in a single session achieved 98% (349/356). The successful fragmentation rate stratified by stone location was 95% 88/93 in the upper ureter, 99% (134/135) in the mid ureter , and 99%(127/128) in the distal ureter. 12 cases with bilateral ureteral stones which caused acute renal failure and anuria were treated rapidly and effectively by the holmium YAG laser lithotripsy. No complications such as perforation and severe trauma were encountered during the operations. 2 weeks 17months (with an average of 6.8 month ) follow up postoperatively revealed that the overall stone-free rate was 98%(343/349) and no ureteral stenosis was found. Conclusions Holmium YAG laser lithotripsy is a highly effective, minimally invasive and safe therapy for ureteral calculi. It is indicated as a first choice of treatment for patients with ureteral calculi, especially for the ones with mid- lower levels of ureteral calculi.

  11. Extracorporeal shock waves lithotripsy of urinary organs in patients with one kidney

    Directory of Open Access Journals (Sweden)

    Zogović Jezdimir

    2002-01-01

    Full Text Available Extracorporeal Shock Waves Lithotripsy (ESWL is a method of choice in the treatment of lithiasis. Surgical treatment is reduced to minimum, which in our case means 1-2%. Contraindications for using this method are: blood coagulation disorders, manifest tuberculosis, pregnancy, over obesity. Thanks to appropriate indications and technique which is used in an adequate way as well as to various endurological manipulations, removal of a stone by this method is safe, trauma is minimised, which is very important for patients with one kidney. During the last three years, usually in hospital conditions, 57 patients were treated in this way. Removal of a stone was performed by Extracorporeal Shock Waves Lithotripsy as mono therapy in 30 (53% patients; Extracorporeal Shock Waves Lithotripsy by using Double-J catheter in 16 (28% patients; Extracorporeal Lithotripsy with urine derivation by percutaneous nephrostome in 11 (19% patients. Endurological methods were used in 27 patients. Disintegration of stone was performed in the proper way. Full success was reached. Two patients had incrustation of ureteral catheter which had to be removed by surgery. In two other patients with inferior function of one kidney, after brief obstruction, hemodialisis was performed. Our results confirm that this method is nonaggressive, tech nically perfect for disintegration of urineorgans stone on all levels followed by small complications which are often solved by endoscopie manipulations.

  12. Percutaneous yttrium aluminum garnet-laser lithotripsy of intrahepatic stones and casts after liver transplantation

    DEFF Research Database (Denmark)

    Schlesinger, Nis Hallundbaek; Svenningsen, Peter; Frevert, Susanne

    2015-01-01

    Bile duct stones and casts (BDSs) contribute importantly to morbidity after liver transplantation (LT). The purpose of this study was to estimate the clinical efficacy, safety, and long-term results of percutaneous transhepatic cholangioscopic lithotripsy (PTCSL) in transplant recipients and to d...

  13. Cavitation cluster dynamics in shock-wave lithotripsy: Part 1. Free field

    NARCIS (Netherlands)

    Arora, M.; Junge, L.; Ohl, C.D.

    2005-01-01

    The spatiotemporal dynamics of cavitation bubble growth and collapse in shock-wave lithotripsy in a free field was studied experimentally. The lithotripter was equipped with two independently triggerable layers of piezoceramics. The front and back layers generated positive pressure amplitudes of 30

  14. Retrograde intrarenal stone surgery for extracorporeal shock-wave lithotripsy-resistant kidney stones

    DEFF Research Database (Denmark)

    Jung, Helene; Nørby, Bettina; Osther, Palle Jörn

    2006-01-01

    ) for extracorporeal shock-wave lithotripsy (ESWL)-resistant kidney stones. MATERIAL AND METHODS: A total of 38 consecutive patients (18 males, 20 females) participated in the study. All patients had undergone ESWL prior to RIRS without success. In all cases the stones could be reached with the endoscope. Calculi...

  15. SELECTIVE EVALUATION OF TWO URINARY ENZYMES (NAG AND AAP BEFORE AND AFTER UNILATERAL SHOCK WAVE LITHOTRIPSY

    Directory of Open Access Journals (Sweden)

    M. R. Nikoobakht

    2006-09-01

    Full Text Available Biological effects extracorporeal shock wave lithotripsy (ESWL is not precisely known. We have evaluated two urinary enzymes activity N-acetyl-B-D-glucosamine (NAG and alanine amino peptidase (AAP before and after unilateral ESWL as markers for renal parenchymal damage. Forty eight patients with kidney stones (mean age 39 who had presented for the first time or at least one year after their previous lithotripsy underwent ESWL. Urinary specimens were collected before and after first, third and seventh days of lithotripsy and NAG, AAP were evaluated. These enzymes displayed the greatest activity 24 hours after ESWL with significant difference compared to the control group, (P < 0.05 versus 0.02. Elevation of urinary enzymes activity correlated with stone size particularly stones larger than 2 cm. These data suggest that there is some tubular and parenchymal damage induced by ESWL that needs time to get improved. The higher urinary enzyme activity in patients with larger stones ( > 2 cm is probably related to injury resulting from passage of smaller stones, produced after lithotripsy of a large stone, and it is suggested that these patients are treated with a safer procedure.

  16. Flexible Ablators

    Science.gov (United States)

    Stackpoole, Margaret M. (Inventor); Ghandehari, Ehson M. (Inventor); Thornton, Jeremy J. (Inventor); Covington, Melmoth Alan (Inventor)

    2017-01-01

    A low-density article comprising a flexible substrate and a pyrolizable material impregnated therein, methods of preparing, and devices using the article are disclosed. The pyrolizable material pyrolizes above 350 C and does not flow at temperatures below the pyrolysis temperature. The low-density article remains flexible after impregnation and continues to remain flexible when the pyrolizable material is fully pyrolized.

  17. Flexible Software for Flexible Scheduling

    Science.gov (United States)

    Economou, Frossie; Jenness, Tim; Tilanus, Remo P. J.; Hirst, Paul; Adamson, Andy J.; Rippa, Mathew; Delorey, Kynan K.; Isaak, Kate G.

    The JAC Observation Management Project (OMP) provides software for the James Clerk Maxwell (JCMT) and the United Kingdom Infrared (UKIRT) telescopes that manages the life-cycle of flexibly scheduled observations. Its aim is to increase observatory efficiency under flexible (queue) scheduled observing, without depriving the principal investigator (PI) of the flexibility associated with classical scheduling.

  18. A prospective study examining the incidence of bacteriuria and urinary tract infection after shock wave lithotripsy with targeted antibiotic prophylaxis.

    Science.gov (United States)

    Honey, R John D'A; Ordon, Michael; Ghiculete, Daniela; Wiesenthal, Joshua D; Kodama, Ronald; Pace, Kenneth T

    2013-06-01

    Controversy exists regarding antibiotic prophylaxis before shock wave lithotripsy. The AUA (American Urological Association) guideline recommends universal antibiotic prophylaxis, whereas the EAU (European Association of Urology) guideline recommends prophylaxis only for select patients. We evaluated the use of targeted antibiotic prophylaxis in preventing urinary tract infections in patients undergoing shock wave lithotripsy. A prospective single cohort study was performed during 6 months with patients undergoing shock wave lithotripsy. All patients underwent urine dipstick and culture before shock wave lithotripsy. Targeted antibiotic prophylaxis was provided at the discretion of the treating urologist. All patients had a urine culture performed after shock wave lithotripsy and completed a survey documenting fevers or urinary symptoms. The primary outcome was the incidence of urinary tract infections, urosepsis and asymptomatic bacteriuria after shock wave lithotripsy. The secondary outcome was the sensitivity and specificity of urinary dipstick leukocytes and nitrites. A total of 526 patients were enrolled in the study. Of the 389 patients included in the determination of the primary outcome, urinary tract infection developed in only 1 (0.3%), urosepsis did not develop in any patients and asymptomatic bacteriuria developed in 11 (2.8%). Eight (2.1%) patients were administered antibiotic prophylaxis. The specificity of urine dipstick nitrites was high (95%) while the sensitivity was poor (9.7%). In our cohort study using targeted antibiotic prophylaxis the rates of urinary tract infection after shock wave lithotripsy and rates of asymptomatic bacteriuria were extremely low, with no development of urosepsis. This finding questions the need for universal antibiotic prophylaxis before shock wave lithotripsy. Copyright © 2013 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  19. The double wire technique: an alternative method for difficult ureteroscopic access.

    Science.gov (United States)

    Bostanci, Yakup; Ozden, Ender; Atac, Fatih; Yakupoglu, Yarkin Kamil

    2012-12-01

    We read with great interest the study report by Ji et al. (Urol Res, doi: 10.1007/s00240-012-0476-0 , 2012) about the impact of the intentional ureteral stenting on the success rate of calculus extraction by second ureteroscopy, when the initial ureteroscopy failed. Actually, sometimes ureteral stone treatment pose challenging problems for the urologists. This study has filled an important gap on this field. If flexible ureteroscopy and laser lithotripter are not available pre-existing stent may improve the success rate of a subsequent ureteroscopy for impacted ureteral stones. Because, post-stent ureteroscopy has the advantage of working through a dilated ureter. We would like to add some additional comments and suggestions in addition to the authors' discussion, which is noteworthy in several respects.

  20. Forgiveness Flexibility

    Directory of Open Access Journals (Sweden)

    Tuğba Seda Çolak

    2016-01-01

    Full Text Available Forgiveness flexibility is the skill to minimize the negative effect of an event by using cognitive, affective and behavioral skills while taking a stand at the end of an injurious process. A number of studies were conducted to test the flexibility of the structure of forgiveness. The theoretical structure, structural validity and the confirmatory factor analysis supported the theoretical structure of forgiveness flexibility. The criterion validity evaluated in similar manners was found high. Forgiveness flexibility designed as a three dimensional structure and its sub-dimensions was confirmed theoretically as the recognition of forgivenessand the internalization of forgiveness through insight and its practice.

  1. Conflicting flexibility

    NARCIS (Netherlands)

    De Jong, P.; Schaap, A.

    2011-01-01

    New buildings are designed for first users. For a sustainable approach there are many advantages in designing in flexibility and adjustability in order to enable and facilitate the other sequential users. For the first investor this flexibility is translated into improved exit values due to

  2. The efficacy of extracorporeal shock wave lithotripsy on single dense calcified gallstones according to computed tomography

    Energy Technology Data Exchange (ETDEWEB)

    Mori, Takao (Mie Univ., Tsu (Japan). School of Medicine); Shimono, Kazuko; Moriyama, Shigeru; Masuda, Touru; Ikeda, Tetsuya; Umegae, Satoru; Nagata, Norikazu

    1993-05-01

    The efficacy and complications of extracorporeal shock wave lithotripsy (ESWL) for single gallstones were compared between 15 patients with a CT-lucent stone and 18 patients with a dense calcified stone. In all of five patients with a stone smaller than 10 mm in diameter, complete or sufficient clearance was observed, regardless of calcification. However, in 28 patients with a stone larger than 11 mm in diameter, the rates of complete or sufficient clearance were lower in those with a dense calcified stone (64%) than in those with a computed tomography (CT) lucent stone (93%). There was no difference in the rate of complications between patients with a CT-lucent stone and those with a dense calcified stone. These results thus suggest that extracorporeal shock wave lithotripsy may be safely employed for patients with a single calcified gallstone. (author).

  3. Acceleration of lithotripsy using cavitation bubbles induced by second-harmonic superimposition

    Science.gov (United States)

    Osuga, Masamizu; Yasuda, Jun; Jimbo, Hayato; Yoshizawa, Shin; Umemura, Shin-ichiro

    2016-07-01

    Shock wave lithotripsy potentially produces residual stone fragments too large to pass through ureters and significant injury to the normal tissue surrounding the stone. Previous works have shown that the collapse of cavitation bubbles induced by high-intensity focused ultrasound can produce small stone fragments via cavitation erosion. However, the erosion rate is hypothesized to be reduced by ultrasound attenuation by excessively generated bubble clouds. If so, it is important to generate the bubbles only on the stone surface. The effects of peak-negative-enhanced (PNE) and peak-positive-enhanced (PPE) waves obtained by second-harmonic superimposition were investigated to control cavitation bubbles. With the PNE waves, the bubbles were generated only on the stone surface and the maximum erosion rate was 232 ± 32 mg/min. All the fragments were smaller than 2 mm, which makes them pass through ureters naturally. The proposed method shows the potential to significantly improve the speed of lithotripsy.

  4. Radiation dose to patient and personnel during extracorporeal shock wave lithotripsy

    Energy Technology Data Exchange (ETDEWEB)

    Bush, W.H.; Jones, D.; Gibbons, R.P.

    1987-10-01

    Radiation dose to the patient and personnel was determined during extracorporeal shock wave lithotripsy treatment of 60 patients. Surface radiation dose to the patient's back from the fluoroscopy unit on the side with the kidney stone averaged 10 rem (100 mSv.) per case, although the range was wide (1 to 30 rem). The surface dose from the opposing biplane x-ray unit was less, averaging 5.5 rem (55 mSv.) per case but again with a wide range (0.1 to 21 rem). Exit dose at the lower abdomen averaged 13 mrem. (0.13 mSv.) per case and estimated female gonad dose averaged 100 mrem. (1.2 mSv.). Radiation dose to personnel working in the extracorporeal shock wave lithotripsy suite averaged less than 2 mrem. (0.02 mSv.) per case, making it a procedure that is safe in regard to radiation exposure.

  5. [A case of gallstone ileus treated with electrohydraulic lithotripsy guided by colonoscopy].

    Science.gov (United States)

    Shin, Kyung Hwa; Kim, Dong Uk; Choi, Moon Gi; Kim, Won Jin; Ryu, Dong Yup; Lee, Bong Eun; Kim, Gwang Ha; Song, Geun Am

    2011-02-01

    A 63-year-old woman was admitted to the hospital with abdominal pain and nausea. Her abdomen was distended with obstructive bowel sounds on exam. There was diffuse abdominal tenderness but no palpable masses. Abdominal computed tomography (CT) scan revealed a large gallstone in the ileum. Surgical intervention was deferred given patient's known significant liver cirrhosis (Child-Pugh class B). Instead colonoscopy was performed and a large gallstone was found to be impacted at the ileocecal valve. The gallstone was fragmented using electrohydraulic lithotripsy (EHL) and then retrieved with snare and forceps. The patient made a full recovery and was eventually discharged home. This is the first reported case of an impacted gallstone at the ileocecal valve with successful colonoscopic treatment using electrohydraulic lithotripsy in Korea. This case highlights the potential therapeutic benefits for colonscopic retrieval of a gallstone impacted at the ileocecal valve in well selected individuals.

  6. Impaction of a lithotripsy basket during endoscopic lithotomy of a common bile duct stone

    Institute of Scientific and Technical Information of China (English)

    Nobutada; Fukino; Takatsugu; Oida; Atsushi; Kawasaki; Kenji; Mimatsu; Youichi; Kuboi; Hisao; Kano; Sadao; Amano

    2010-01-01

    The treatments for common bile duct (CBD) stones are being continually developed. Impaction of the lithotripsy basket during endoscopic removal of CBD stones was seen in 5.9% patients. We report the case of a 66-yearold woman who underwent surgery for the removal of an impacted biliary basket. She was admitted to our hospital with a complaint of right upper abdominal pain. Magnetic resonance cholangiopancreatography revealed a CBD stone (20 mm × 15 mm). We diagnosed her with choledocholithiasis and performe...

  7. Extra corporeal shockwave lithotripsy resulting in skin burns--a report of two cases.

    Science.gov (United States)

    Rao, Sandhya R; Ballesteros, Natalia; Short, Kerry L; Gathani, Krishna K; Ankem, Murali K

    2014-01-01

    Severe skin injury after extracorporeal shock wave lithotripsy (ESWL) is rare. We describe two patients who suffered full thickness skin burns following ESWL for renal calculi. One patient was treated conservatively and the other underwent debridement with skin grafting. We speculate that failure of the thermostatic mechanism of the lithotripter, leading to overheating of the water-filled cushion, resulted in this very rare adverse event. Proper preoperative patient counseling regarding the risk of serious burn injuries will help to avoid potential litigation.

  8. Effect of urine pH on the effectiveness of shock wave lithotripsy: A pilot study

    OpenAIRE

    Ahmad Majzoub; Ammar Al-Ani; Tawiz Gul; Hatem Kamkoum; Khalid Al-Jalham

    2016-01-01

    Aim: Shock wave lithotripsy (SWL) is a well-established modality in the treatment of urolithiasis. Studying the effect of urine pH on SWL success is appealing as pH can be manipulated before SWL to insure a better outcome. Materials and Methods: This is a prospective study performed at a tertiary medical center. Patients presenting to the SWL unit with a single renal stone

  9. The Efficacy of Percutaneous Nephrolithotomy Using Pneumatic Lithotripsy vs. the Holmium Laser: a Randomized Study.

    Science.gov (United States)

    Liu, Chaoying; Zhou, Houyong; Jia, Weisheng; Hu, Hua; Zhang, Heng; Li, Longkun

    2017-08-01

    The objective of the study is to compare the efficacy of percutaneous nephrolithotomy using holmium laser vs pneumatic lithotripsy. From August 2010 to March 2014, 200 patients with double kidney and single kidney stones without previous operations or other diseases were randomized into two groups according to the type of lithotripter used: pneumatic (n = 100) and laser (n = 100). The preoperative, intraoperative, and post-operative follow-up findings were analyzed and compared. The average stone size was similar in both the pneumatic and holmium laser lithotripsy groups (202.8 ± 52.6 mm(2) vs. 200.3 ± 50.8 mm(2)). No significant difference was found between the operation time for the two groups (55.9 ± 16.5 min vs. 62.4 ± 17.6 min). The concentrations of creatinine in both groups increased 2-24 h after the operation and decreased to a normal level 1-4 days after the operation in both groups. Renal diuretic scan revealed that the peak and the renal index were both abnormal after the operation but became normal 4 days after the operation in both groups. No significant difference of creatinine concentration or the diuresis renogram was observed between the two groups. However, two cases in the holmium laser group had almost lost the renal function of the operated kidney 1 year later. Both pneumatic and holmium laser lithotripsy can be associated with acute renal injury in some patients after the operation without any significant difference. However, some infrequent severe renal function damage in laser lithotripsy should be noted.

  10. Herpes zoster reactivation after extracorporeal shock wave lithotripsy: A case report

    Directory of Open Access Journals (Sweden)

    Krishnamoorthy Hariharan

    2016-01-01

    Full Text Available Herpes zoster is a reactivated varicella-zoster virus (VZV infection of the sensory nerve ganglion, peripheral nerve, and its branches. Mechanical trauma to the nervous system can reactivate VZV. It is well known that extracorporeal shock wave lithotripsy (SWL can produce mechanical damage to the tissue. We report a rare case of herpes zoster reactivation after SWL for treatment of 1.2 cm size renal stone in a 63-year-old male patient.

  11. Electromagnetic and Electrohydraulic Shock Wave Lithotripsy-Induced Urothelial Damage: Is There a Difference?

    Science.gov (United States)

    Mustafa, Mahmoud; Aburas, Honood; Helo, Fatima M; Qarawi, Lailah

    2017-02-01

    To evaluate and compare the acute effect of electromagnetic and electrohydraulic extracorporeal shockwave lithotripsy (SWL) on the urothelial layers of kidney and ureter. Fifty patients, 29 males (58%) and 21 females (42%), with an average age of 51.68 years (range: 37-70) who underwent SWL application in two different centers were included. Twenty-eight patients (56%) were treated with electrohydraulic and 22 (44%) were treated with electromagnetic lithotripsy. Urinary cytologic examinations were done immediately before and after SWL therapy and 10 days later. The average numbers of epithelial cells, red blood cells (RBC), and myocytes were counted under 40 × magnification. There were significant differences in the number of epithelial cells and RBC before and after immediate application of SWL: 1.66 and 14.9 cells/field, (p = 0.001), 5.44 and 113.45 cells/field, respectively (p = 0.001). The number of RBC was significantly higher in patients treated with electromagnetic lithotripsy than those treated with electrohydraulic: 141.9 and 93.4 cells/field, respectively (p = 0.02). No myocyte or basement membrane elements were detected in any of the cytologic examinations. Cytologic examinations done after 10 days of SWL therapy revealed recovery of all abnormal cytologic findings. The acute increments in the number of epithelial cells and RBC after SWL were statistically significant but it was not permanent. SWL-induced urinary urothelial lesion is limited to the mucosal layer and there was no evidence of damage to the basal membrane or muscle layer. Electromagnetic lithotripsy caused high numbers of RBC than the electrohydraulic device on the postimmediate urine cytologic examination.

  12. Photothermal ablation is the primary mechanism in holmium:YAG laser lithotripsy of urinary calculi

    Science.gov (United States)

    Glickman, Randolph D.; Teichman, Joel M. H.; Corbin, Nicole S.; Vassar, George J.; Weintraub, Susan T.; Chan, Kin Foong; Welch, Ashley J.

    1999-09-01

    Because of the >= 250 microsecond(s) pulsewidth emitted by the Ho:YAG laser used in clinical lithotripsy, it is unlikely that stress confinement occurs within the irradiated stones. Experimental data supports a thermal mechanism for Ho:YAG laser stone ablation. Previous work has shown that stone fragmentation occurs soon after the onset of the laser pulse, is uncorrelated to cavitation bubble formation or collapse, and is associated with low pressures. Moreover, lithotripsy proceeds fastest with desiccated stones in air (data based on laser ablation of calcium oxalate monohydrate stones), indicating that direct absorption of the laser radiation by the stone material is required for the most efficient ablation. Lowering the initial temperature of calculi reduces the stone mass-loss following 20 J of delivered laser energy: 2.2 +/- 1.1 mg vs 5.2 +/- 1.6 mg for calcium oxalate monohydrate (COM) stones (-80 vs 23 degree(s)C), and 0.8 +/- 0.4 mg vs 2.2 +/- 1.1 mg for cystine stones (-80 vs 23 degree(s)C), p cystine; Ca2O7P2 from calcium hydrogen phosphate dihydrate, and cyanide and alloxan from uric acid. All of these observations are most consistent with a photothermal breakdown process induced by Ho:YAG laser lithotripsy.

  13. Stone/tissue differentiation for Holmium laser lithotripsy using autofluorescence: Clinical proof of concept study.

    Science.gov (United States)

    Lange, Birgit; Jocham, Dieter; Brinkmann, Ralf; Cordes, Jens

    2017-04-01

    Holmium laser lithotripsy is the gold standard for intracorporeal fragmentation of urinary calculi. Usually, a visible beam is superimposed on the IR treatment laser as an aiming beam to guide the surgeon. In vitro tests showed that this aiming beam (532 nm, power proof of concept study with eight patients. For this, a modulated excitation/detection scheme (lock-in technique) was implemented. A frequency-doubled, diode-pumped solid-state laser module (532 nm, modulation frequency 66 Hz, average power 0.3 mW) was coupled via a dichroic mirror with the Holmium lithotripsy laser into the treatment fiber. The fluorescence signal entering the treatment fiber was detected via another dichroic mirror with a photodiode and a lock-in amplifier. In most instances (94%), the calculus of a patient gave a signal which was at least twice the maximum signal of ureteral tissue. The results of our proof of concept study indicate that measuring the fluorescence signal of a green aiming beam could be used to implement a feedback loop for Holmium laser lithotripsy. Preventing the laser being fired on tissue, this would increase the safety of the procedure. Lasers Surg. Med. 49:361-365, 2017. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

  14. Therapy and Prevention of Postoperative Urosepsis of Ureter Endoscopic Lithotripsy for “Non-infection”

    Institute of Scientific and Technical Information of China (English)

    Jun Shen; Fa Sun; Fang-min Chen; Zhi-ping Wu; Sheng-wen Li

    2016-01-01

    Objective To analyze the risk factors causing postoperative urosepsis in ureter endoscopic lithotripsy without infection preoperatively, in order to make a more effective and safer preventive and therapeutic strategy. Methods From January 2010 to January 2015, 5 ureteral calculus patients undergoing ureter endoscopic lithotripsy with holmium laser were retrospectively enrolled in this clinical study. These patients suffered urosepsis postoperatively confirmed by the clinical presentations and laboratory results, while they had no infection in their blood and urine preoperatively. Without delay, 5 patients were treated by anti-inflammation and anti-shock. Results The vasopressor drug was stopped gradually after 12-36 hours. The body temperature was recovered to normal in 2 or 3 days, and the blood and urine test results were not abnormal in 7 days. At last, 5 patients were all cured. Conclusions Stone and operation themselves are potential factors to cause urosepsis after ureter endoscopic lithotripsy. Especially for patients who had not presented infection preoperatively, careful preparation preoperatively, corrective manipulation, low pressure irrigation, drainage and controlling time during operation, and early diagnosis, appropriate treatment postoperatively are the key to cure and prevent urosepsis.

  15. Therapy and Prevention of Postoperative Urosepsis of Ureter Endoscopic Lithotripsy for Non-infection.

    Science.gov (United States)

    Shen, Jun; Sun, Fa; Chen, Fang-Min; Wu, Zhi-Ping; Li, Sheng-Wen

    2016-03-20

    Objective To analyze the risk factors causing postoperative urosepsis in ureter endoscopic lithotripsy without infection preoperatively, in order to make a more effective and safer preventive and therapeutic strategy.Methods From January 2010 to January 2015, 5 ureteral calculus patients undergoing ureter endoscopic lithotripsy with holmium laser were retrospectively enrolled in this clinical study. These patients suffered urosepsis postoperatively confirmed by the clinical presentations and laboratory Results, while they had no infection in their blood and urine preoperatively. Without delay, 5 patients were treated by anti-inflammation and anti-shock.Results The vasopressor drug was stopped gradually after 12-36 hours. The body temperature was recovered to normal in 2 or 3 days, and the blood and urine test Results were not abnormal in 7 days. At last, 5 patients were all cured.Conclusions Stone and operation themselves are potential factors to cause urosepsis after ureter endoscopic lithotripsy. Especially for patients who had not presented infection preoperatively, careful preparation preoperatively, corrective manipulation, low pressure irrigation, drainage and controlling time during operation, and early diagnosis, appropriate treatment postoperatively are the key to cure and prevent urosepsis.

  16. Extracorporeal shock wave lithotripsy in the treatment of renal and ureteral stones

    Directory of Open Access Journals (Sweden)

    Fábio César Miranda Torricelli

    2015-02-01

    Full Text Available The use of certain technical principles and the selection of favorable cases can optimize the results of extracorporeal shock wave lithotripsy (ESWL. The aim of this study is to review how ESWL works, its indications and contraindications, predictive factors for success, and its complications. A search was conducted on the Pubmed® database between January 1984 and October 2013 using "shock wave lithotripsy" and "stone" as key-words. Only articles with a high level of evidence, in English, and conducted in humans, such as clinical trials or review/meta-analysis, were included. To optimize the search for the ESWL results, several technical factors including type of lithotripsy device, energy and frequency of pulses, coupling of the patient to the lithotriptor, location of the calculus, and type of anesthesia should be taken into consideration. Other factors related to the patient, stone size and density, skin to stone distance, anatomy of the excretory path, and kidney anomalies are also important. Antibiotic prophylaxis is not necessary, and routine double J stent placement before the procedure is not routinely recommended. Alpha-blockers, particularly tamsulosin, are useful for stones >10mm. Minor complications may occur following ESWL, which generally respond well to clinical interventions. The relationship between ESWL and hypertension/diabetes is not well established.

  17. Flexible Sigmoidoscopy

    Science.gov (United States)

    ... Task Force (USPSTF). Most doctors recommend colonoscopy to screen for colon cancer because colonoscopy shows the entire colon and can remove colon polyps. However, preparing for and performing a flexible sigmoidoscopy may take less time and you may ...

  18. 体外冲击波碎石致尿脓毒症的临床分析%Treatment of urosepsis induced by extracorporeal shock wave lithotripsy: analysis of 4 cases

    Institute of Scientific and Technical Information of China (English)

    齐桓; 罗超; 刘成山

    2012-01-01

    Objective To evaluate the strategy for management of urosepsis after extracorporeal shock wave lithotripsy (ESWL). Methods The clinical data were analyzed in 4 cases of urosepsis caused by ESWL during the period from January, 2008 to October 2011. Results Two of the patients had kidney stones and two had ureteral stones. Analysis of urine bacterial culture revealed the presence of E, coli in 2 cases, Klebsiella pneumoniae in 1 case and Pseudomonas putida combined E. coli in 1 case. All the 4 patients were monitored for ECG, blood pressure and oxygen saturation, and received fluid replacement and anti-inflammatory therapy. The vital signs of the patients became stable after 5-11 days (mean 6.75 days). Three patients underwent ureteroscopic lithotripsy; and 1 patient had emergency ureteral stent indwelling. All the 4 patients were cured and discharged. Conclusions ESWL is more likely to cause urosepsis in patients with ureteral stones and urinary infection, for which early nonsurgical interventions should be administered immediately after the diagnosis is established.%目的 提高体外冲击波碎石(ESWL)术后并发尿脓毒症的临床认识及诊疗水平.方法 对经ESWL后并发尿脓毒症的4例患者的临床资料进行回顾性分析.4例肾结石或输尿管结石患者在接受ESWL术后6~36 h内出现尿脓毒症的临床表现,尿细菌培养2例为大肠埃希菌感染,1例肺炎克雷伯杆菌,1例大肠埃希菌并恶臭假单胞菌.结果 4例患者经心电、血压及氧饱和度监测,吸氧、补液、抗炎、升压等治疗,分别在术后5~11 d(平均6.75 d)生命体征恢复平稳,3例行输尿管镜下气压弹道碎石,1例紧急行膀胱镜下DJ管置入引流肾盂液体,经保守治疗11d后结石排岀,4例病人均痊愈出院.结论 ESWL术前伴有泌尿系感染的患者更易发生尿脓毒症;临床发现尿脓毒症时需要及早诊断,积极治疗,以保守治疗为主.

  19. 经皮肾镜碎石手术的护理配合%Nursing Cooperation of Percutaneous Lithotripsy

    Institute of Scientific and Technical Information of China (English)

    滕昭慧

    2016-01-01

    目的探讨经皮肾镜弹道碎石术的护理配合。方法对20例肾结石患者进行微创肾镜弹道碎石清石。结果碎石成功,1例Ⅱ期手术,均治愈出院,无并发症。结论充分的术前准备,良好的配合是手术成功的关键。%Objective To explore the nursing of percutaneous nephrolithotomy lithotripsy via coordination.Methods Included 20 patients with renal calculi by minimally invasive nephrolithotomy lithotripsy stone clearance. Results Successful lithotripsy in column 1 of the second stage operation, all patients were cured without complications. Conclusion The sufficient preoperative preparation, good coordination is the key to successful operation.

  20. Lung contusion and cavitation with exudative plural effusion following extracorporeal shock wave lithotripsy in an adult: a case report

    Directory of Open Access Journals (Sweden)

    Nouri-Majalan Nader

    2010-08-01

    Full Text Available Abstract Introduction Among the complications of extracorporeal shock wave lithotripsy are perinephric bleeding and hypertension. Case presentation We describe the case of a 31-year-old Asian man with an unusual case of hemoptysis and lung contusion and cavitation with exudative plural effusion due to pulmonary trauma following false positioning of extracorporeal shock wave lithotripsy. Differential diagnoses included pneumonia and pulmonary emboli, but these diagnoses were ruled out by the uniformly negative results of a lung perfusion scan, Doppler ultrasound, and culture of bronchoalveolar lavage and plural effusion, and because our patient showed spontaneous improvement. Conclusions False positioning of extracorporeal shock wave lithotripsy can cause lung trauma presenting as pulmonary contusion and cavitation with plural effusion.

  1. Evaluation of pneumatic versus holmium:YAG laser lithotripsy for impacted ureteral stones.

    Science.gov (United States)

    Binbay, Murat; Tepeler, Abdulkadir; Singh, Avinash; Akman, Tolga; Tekinaslan, Erdem; Sarilar, Omer; Baykal, Murat; Muslumanoglu, Ahmet Yaser

    2011-12-01

    We prospectively analyzed and compared the effectiveness and complications of pneumatic lithotripter with a holmium:yttrium-aluminum-garnet (Ho:YAG) laser for the ureterorenoscopic management of impacted ureteral stones. From January 2006 to January 2008, we performed retrograde endoscopic treatment in 288 patients with ureteral stones in our clinic. The patients with impacted stones were randomized into two groups according to the lithotripter used to fragment the stone: pneumatic (n = 40) and laser (n = 40). The preoperative, operative, and post-operative follow-up findings were analyzed and compared. The average stone size was similar in both groups (118.8 ± 58.3 mm(2) vs. 110.7 ± 54.4 mm(2)). The calculi were located in the distal ureter in most of the patients in both groups (65% in pneumatic group and 52.5% in laser group). The operation time was significantly diminished in the laser group (P = 0.001). The stone-free rates after a single ureteroscopic procedure were 80 and 97.5% in the pneumatic and laser groups, respectively (P = 0.03). Auxiliary treatments were needed in seven patients in the pneumatic group, while only one patient in the laser group (P = 0.05) needed this treatment. After the additional procedures, a 100% success rate was achieved in both groups. The rate of double J stent insertion was significantly higher in the pneumatic group (P = 0.01). In the pneumatic group, four cases of stone up-migration and one case of post-operative stricture were seen, whereas only one case of stone up-migration was noted in the laser group. Our comparative study has shown that the use of Ho:YAG as an intracorporeal lithotripter during ureteroscopic management of impacted ureteral stones is highly efficient with high success rates, regardless of the stone location.

  2. Piping Flexibility

    Science.gov (United States)

    1978-01-01

    A NASA computer program aids Hudson Engineering Corporation, Houston, Texas, in the design and construction of huge petrochemical processing plants like the one shown, which is located at Ju'aymah, Saudi Arabia. The pipes handling the flow of chemicals are subject to a variety of stresses, such as weight and variations in pressure and temperature. Hudson Engineering uses a COSMIC piping flexibility analysis computer program to analyze stresses and unsure the necessary strength and flexibility of the pipes. This program helps the company realize substantial savings in reduced engineering time.

  3. Effect of renal shock wave lithotripsy on the development of metabolic syndrome in a juvenile swine model: a pilot study.

    Science.gov (United States)

    Handa, Rajash K; Liu, Ziyue; Connors, Bret A; Alloosh, Mouhamad; Basile, David P; Tune, Johnathan D; Sturek, Michael; Evan, Andrew P; Lingeman, James E

    2015-04-01

    We performed a pilot study to assess whether renal shock wave lithotripsy influences metabolic syndrome onset and severity. Three-month-old juvenile female Ossabaw miniature pigs were treated with shock wave lithotripsy (2,000 shock waves at 24 kV with 120 shock waves per minute in 2) or sham shock wave lithotripsy (no shock waves in 2). Shock waves were targeted to the upper pole of the left kidney to model treatment that would also expose the pancreatic tail to shock waves. Pigs were then instrumented to directly measure arterial blood pressure via an implanted radiotelemetry device. They later received a hypercaloric atherogenic diet for about 7 months. Metabolic syndrome development was assessed by the intravenous glucose tolerance test. Metabolic syndrome progression and severity were similar in the sham treated and lithotripsy groups. The only exception arterial blood pressure, which remained relatively constant in sham treated pigs but began to increase at about 2 months towards hypertensive levels in lithotripsy treated pigs. Metabolic data on the 2 groups were pooled to provide a more complete assessment of metabolic syndrome development and progression in this juvenile pig model. The intravenous glucose tolerance test revealed substantial insulin resistance with impaired glucose tolerance within 2 months on the hypercaloric atherogenic diet with signs of further metabolic impairment at 7 months. These preliminary results suggest that renal shock wave lithotripsy is not a risk factor for worsening glucose tolerance or diabetes mellitus onset. However, it appears to be a risk factor for early onset hypertension in metabolic syndrome. Copyright © 2015 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  4. AB094. Upper urinary stone management in China

    Science.gov (United States)

    Wang, Shaogang; Liu, Jihong; Ye, Zhangqun

    2015-01-01

    Objective To give an overview of the contemporary management for upper urinary stones in China. Methods Contemporary treatment methods, especially novel or developing modality with Chinese characteristics, for upper urinary stones in China has been reviewed and introduced. Results Urolithiasis is one of the most prevalent diseases in the urologic clinic and usually affects people aged 20 to 60 years. In recent years, the overall morbidity of urolithiasis in Chinese population has increased with a significant reduction of lower urinary stone and an increase of upper urinary stone. Upper urinary stone may induce more severe complications and have been considered to be the main cause of nephrectomy besides urinary tumor. The management of upper urinary stone can be challenging somehow. Extracorporeal shock wave lithotripsy (ESWL) is usually the first choice for patients with simple upper urinary stone sized 2 cm or less. Recent years, according to the mechanism of lithecbole by vibration and body position, some Chinese urologists have developed a novel machine, external physical vibration lithecbole (EPVL), which can facilitate removal of urinary stone after ESWL or endoscopic lithotripsy. The combination of EPVL therapy with ESWL or endoscopic lithotripsy significantly improves the stone-free rate. Percutaneous nephrolithotomy (PCNL) is increasingly employed as a major modality for patients with large and complex upper urinary stone. The minimally invasive PCNL (mPCNL), which was performed with a miniature endoscope by way of a small size tract (12-20 F), could decrease morbidity, especially uncontrolled hemorrhage. However, its efficiency of removing stone fragments is lower. The Chinese urologists have modified PCNL technique by using an 8/9.8 F rigid ureteroscope through the 14-18 F percutaneous tract under the guidance of ultrasound or X-ray. The results from a series of studies demonstrate that Chinese mPCNL is a safe, feasible and efficient method for treating

  5. Flexibility conflict?

    NARCIS (Netherlands)

    Delsen, L.W.M.

    2002-01-01

    The chapter deals with the presupposed conflict of interests between employers and employees resulting from a decoupling of operating hours and working times. It starts from the notion that both long operating hours and flexibility are relative concepts. As there is some discretion, the ultimate

  6. Flexible Consumption

    DEFF Research Database (Denmark)

    Holm Jacobsen, Peter; Pallesen, Trine

    This report presents the first findings from our qualitative study of consumer behaviour vis-à-vis flexible consumption. The main of objective of this report is to present our first round of data from Bornholm, and to assist the design of products/services designed in WP6. In the report, we adopt...

  7. Can infundibular height predict the clearance of lower pole calyceal stone after extracorporeal shockwave lithotripsy?

    Directory of Open Access Journals (Sweden)

    M. Arzoz-Fabregas

    2009-04-01

    Full Text Available PURPOSE: To evaluate the efficacy of extracorporeal shock wave lithotripsy (SWL on lower calyceal calculi in relation to the renal anatomical factors and determine which of these factors can be used to select patients who will benefit from SWL. MATERIAL AND METHODS: We analyzed retrospectively 78 patients with single radiopaque lower calyceal stones treated with SWL. The patients were evaluated 3 months after lithotripsy with a simple abdominal X-ray and a kidney ultrasound scan. The success of the treatment, removal of all fragments, was correlated with renal anatomical factors measured in the pre-treatment intravenous urography: infundibulopelvic angle, lower infundibulum width, lower infundibulum length, ratio length/width, infundibulum height, and number of minor calyces in the lower calyceal group. RESULTS: Three months after SWL treatment, 39 patients were stone-free (NR group and 39 had residual fragments (R group. Both groups presented no differences in relation to infundibulopelvic angle, width and length of the lower calyceal infundibulum, length/width ratio of the lower infundibulum or number of lower calyces. Height of the infundibulum, described as the distance between the line passing through the lowest part of the calyx containing the calculus and the highest point of the lower lip of renal pelvis, was the only parameter in which significant differences (p = 0.002 were found between the NR and R groups. CONCLUSIONS: Lower Infundibular height could be a good measurement tool for deciding which patients with lower calyceal lithiasis would benefit from SWL treatment. Height of less than 22 mm suggests a good outcome from lithotripsy.

  8. Long-term effects of pediatric extracorporeal shockwave lithotripsy on renal function

    Directory of Open Access Journals (Sweden)

    Akin Y

    2014-04-01

    Full Text Available Yigit Akin,1 Selcuk Yucel21Department of Urology, Harran University School of Medicine, Sanliurfa, Turkey; 2Department of Urology, Acibadem University School of Medicine, Istanbul, TurkeyIntroduction: Extracorporeal shock wave lithotripsy (ESWL is a well-known and successful treatment modality. In addition, it can be used in premature infants. ESWL is used to treat kidney and ureter stones in children. However, although it is a preferred noninvasive treatment in that setting, there is debate about its long-term effects on growing kidneys in children.Objectives: To investigate the long-term effects of pediatric ESWL on renal function in light of updated literature.Methods: PubMed and Medline were searched for studies on ESWL in a pediatric population with keywords including efficacy, child, kidney calculi, ureter calculi, lithotripsy, injury, vascular trauma, and shock waves. The research was limited to the English literature during a period from 1980 to 2014. In total, 3,000 articles were evaluated, but only 151 papers were considered. Only the manuscripts directly related to the reviewed subjects were included in the current study.Results: However, the acute effects of ESWL in kidney are well-described. Although there are limited studies on the long-term effects of ESWL in children, there is a widespread opinion that ESWL is not affecting renal functions in the long-term.Conclusion: ESWL is a safe, effective, and noninvasive treatment option in children. Although ESWL can cause some acute effects in the kidney, there is no long-term effect on the growing kidneys of children.Keywords: child, lithotripsy, nephrolithiasis, renal injury, vascular trauma

  9. Extra corporeal shockwave lithotripsy resulting in skin burns – a report of two cases

    Directory of Open Access Journals (Sweden)

    Sandhya R. Rao

    2014-12-01

    Full Text Available Severe skin injury after extracorporeal shock wave lithotripsy (ESWL is rare. We describe two patients who suffered full thickness skin burns following ESWL for renal calculi. One patient was treated conservatively and the other underwent debridement with skin grafting. We speculate that failure of the thermostatic mechanism of the lithotripter, leading to overheating of the water-filled cushion, resulted in this very rare adverse event. Proper preoperative patient counseling regarding the risk of serious burn injuries will help to avoid potential litigation.

  10. Extracorporeal Shock-wave Lithotripsy Success Rate and Complications: Initial Experience at Sultan Qaboos University Hospital

    Directory of Open Access Journals (Sweden)

    Mohammed S. Al-Marhoon

    2013-07-01

    Full Text Available Objective: To assess the efficacy and safety of extracorporeal shock wave lithotripsy with Modularis Vario Siemens in the management of patients with renal and ureteral stones.Methods: Between 2007 and 2009, 225 outpatients were treated with Siemens Modularis Vario lithotripter at Sultan Qaboos University Hospital. Stone size, location, total number of shockwaves, stone-free rate, complications and adjunctive interventions were investigated. Chi-Square and Logistic Regression analyses were used, with p<0.05 set as the level of significance.Results: Of the 225 initial consecutive patients who underwent extracorporeal shock wave lithotripsy, 192 (85% had renal stones and 33 (15% had ureteric stones. The mean±SD stone size was 11.3 ± 4.5 mm, while the mean age of the patients was 39.9 ± 12.8 years with 68.5% males. The mean renal stone size was 11.6 ± 4.7 mm; a mean of 1.3 sessions was required. The mean ureteric stone size was 9.9 ± 3 mm; and a mean of 1.3 sessions was required. Treatment success (defined as complete clearance of ureteric stones, stone-free or clinically insignificant residual fragments of <4 mm for renal stones was 74% for renal stones and 88% for ureteric stones. Additional extracorporeal shock wave lithotripsy and ureteroscopy were the most adjunctive procedures used for stone clearance. Complications occurred in 74 patients (38.5% with renal stones and 13 patients (39.4% with uretetric stones. The most common complication was loin pain (experienced by 16.7% with renal stones and 21% with ureteric stones. Severe renal colic mandating admission occurred in 2% of patients with renal stones and 6% of patients with ureteric stones. In patients with renal stone, steinstrasse occurred in 3.6% and infection post extracorporeal shock wave lithotripsy in 0.5%. Using Multivariate Logistic Regression analysis, factors found to have significant effect on complete stone clearance were serum creatinine (p=0.004 and the number of

  11. Emphysematous pyelonephritis: A rare life-threatening complication after extracorporeal shock wave lithotripsy

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Su Ho; Chung, Dong Jin; Yeo, Dong Myung; Sonh, Dong Wan; Hahn, Sung Tae [Yeouido St. Mary' s Hospital, College of Medicine, The Catholic University of Korea, Seoul (Korea, Republic of)

    2015-09-15

    Emphysematous pyelonephritis (EPN), caused by extracorporeal shock wave lithotripsy (ESWL), has not been reported in the literature; and the mechanism of this disease is unknown. Although many studies have conjectured about the various causes of EPN, ESWL was not one of them. The patient in this report was a 65-year-old woman with a past medical history of diabetes; the patient underwent an ESWL that caused the EPN. To the best of our knowledge, this is the first report of an EPN case that was caused by ESWL.

  12. Flexible isotopy classification of flexible links

    OpenAIRE

    Björklund, Johan

    2012-01-01

    In this paper we define and study flexible links and flexible isotopy in projective space. Flexible links are meant to capture the topological properties of real algebraic links. We classify all flexible links up to flexible isotopy using Ekholms interpretation of Viros encomplexed writhe.

  13. Flexible Capitalism

    DEFF Research Database (Denmark)

    Approaching “work” as at heart a practice of exchange, this volume explores sociality in work environments marked by the kind of structural changes that have come to define contemporary “flexible” capitalism. It introduces anthropological exchange theory to a wider readership, and shows how...... the perspective offers new ways to enquire about the flexible capitalism’s social dimensions. The essays contribute to a trans-disciplinary scholarship on contemporary economic practice and change by documenting how, across diverse settings, “gift-like” socialities proliferate, and even sustain the intensified...... flexible commoditization that more commonly is touted as tearing social relations apart. By interrogating a keenly debated contemporary work regime through an approach to sociality rooted in a rich and distinct anthropological legacy, the volume also makes a novel contribution to the anthropological...

  14. Influence of ultrasonic adsorption lithotripsy by percutaneous nephroscope on inflammation mediators and stress hormones of patients with infectious renal calculi

    Institute of Scientific and Technical Information of China (English)

    Dong Lu; Xiao-Lei Jiang; Ming-Hui Wu; Yun-Jun Wu; Qiang Yuan

    2016-01-01

    Objective:To investigate the influence of ultrasonic adsorption lithotripsy by percutaneous nephroscope on inflammation mediators and stress hormones of the patients with infectious renal calculi. Methods:A total of 62 patients with infectious renal calculi in our hospital from January 2014 to June 2015 were selected as the study object,and they were randomly divided into control group(pneumatic ballistic lithotripsy by percutaneous nephroscope group) 31 cases and observation group(ultrasonic adsorption lithotripsy by percutaneous nephroscope group) 31 cases,then the serum expression levels of inflammation mediators and stress hormones of two groups before the treatment and at 12 h-24 h and 48 h after the treatment were compared. Results:The serum expression levels of inflammation mediators and stress hormones of two groups before the treatment were compared,all P>0.05,and the serum expression levels of observation group at 12 h-24 h and 48 h after the treatment were significantly lower than those of control group,while the expression levels of two groups after the treatment were all significantly higher than those before the treatment,all P<0.05. Conclusions:The inflammation mediators and stress hormones of patients with infectious renal calculi who are treated with pneumatic ballistic lithotripsy by percutaneous nephroscope are relatively lower,and it shows that the trauma and bad stress for the body are better controlled, so its clinical application value are relatively higher.

  15. High- vs low-power holmium laser lithotripsy: a prospective, randomized study in patients undergoing multitract minipercutaneous nephrolithotomy.

    Science.gov (United States)

    Chen, Shushang; Zhu, Lingfeng; Yang, Shunliang; Wu, Weizhen; Liao, Lianming; Tan, Jianming

    2012-02-01

    To determine the efficacy and safety of high-power holmium: yttrium aluminum-garnet (Ho:YAG) laser lithotripsy for multitract modified minimally invasive percutaneous nephrolithotomy (MPCNL) in the treatment of patients with large staghorn renal calculi. A randomized, prospective study was conducted. Two-hundred seventy-three consecutive patients (291 renal units) with large staghorn renal calculi were randomized to undergo multitract MPCNL with 30-W low-power or 70-W high-power Ho:YAG laser lithotripsy. Both groups were compared in terms of perioperative findings and postoperative outcomes, including procedure time, stone-free rate, length of hospital stay, transfusion rates, renal function recovery, and other complications. The average patient age was 49.2 years (range 22-73) and mean stone size was 5.54±0.7 cm. The 2 groups had some comparable perioperative findings and outcome, including tracts required per operated renal unit (n), blood loss, postoperative fever, postoperative hospital stay, stone-free rate, and improvement of operated renal function. The operation time in the high-power group was significantly shorter than that in the low-power group (129.20±17.2 vs 105.18±14.2, Ppower Ho:YAG laser lithotripsy can greatly decrease the operative time without increasing the intraoperative complications or delaying postoperative renal function recovery when compared with low-power Ho:YAG laser lithotripsy. Copyright © 2012 Elsevier Inc. All rights reserved.

  16. Dependence of calculus retropulsion dynamics on fiber size and radiant exposure during Ho:YAG lithotripsy.

    Science.gov (United States)

    Lee, Ho; Ryan, Robert T; Kim, Jeehyun; Choi, Bernard; Arakeri, Navanit V; Teichman, Joel M H; Welch, A J

    2004-08-01

    During pulsed laser lithotripsy, the calculus is subject to a strong recoil momentum which moves the calculus away from laser delivery and prolongs the operation. This study was designed to quantify the recoil momentum during Ho:YAG laser lithotripsy. The correlation among crater shape, debris trajectory, laser-induced bubble and recoil momentum was investigated. Calculus phantoms made from plaster of Paris were ablated with free running Ho:YAG lasers. The dynamics of recoil action of a calculus phantom was monitored by a high-speed video camera and the laser ablation craters were examined with Optical Coherent Tomography (OCT). Higher radiant exposure resulted in larger ablation volume (mass) which increased the recoil momentum. Smaller fibers produced narrow craters with a steep contoured geometry and decreased recoil momentum compared to larger fibers. In the presence of water, recoil motion of the phantom deviated from that of phantom in air. Under certain conditions, we observed the phantom rocking towards the fiber after the laser pulse. The shape of the crater is one of the major contributing factors to the diminished recoil momentum of smaller fibers. The re-entrance flow of water induced by the bubble collapse is considered to be the cause of the rocking of the phantom.

  17. The value of extracorporeal shock-wave lithotripsy in the management of bile duct stones.

    Science.gov (United States)

    Lee, S H; Fache, J S; Burhenne, H J

    1990-10-01

    We evaluated the role of biliary extracorporeal shock-wave lithotripsy in treating 70 symptomatic patients with bile duct stones in whom endoscopic or percutaneous radiologic attempts at basket extraction had failed. Forty-four patients had common bile and/or common hepatic duct stones, 21 patients had cystic duct stones, and five patients had intrahepatic duct stones. A total of 43 patients (61%) had complete elimination of stone fragments during the initial treatment period. If patients in whom stones were successfully fragmented yet not totally eliminated on initial hospital treatment but who were asymptomatic at follow-up times of 8-22 months are included, the overall successful treatment rate was 83%. Stones were cleared in 26 of 44 common bile/hepatic duct stone patients, spontaneously in seven patients and after endoscopic or percutaneous radiologic intervention in 19 patients. Fifteen (71%) of 21 patients had cystic duct stones successfully cleared. The fragments in two of five patients with intrahepatic duct stones also were cleared. Five patients (7%) had minor side effects. Seven (10%) of 70 patients went on to have surgery. Complications after 30 days occurred in five patients (7%); two required repeated endoscopy with fragment extraction, two required placement of an endoprosthesis, and one died. We conclude that biliary extracorporeal shock-wave lithotripsy is valuable as an adjuvant to standard interventional techniques for removing bile duct stones.

  18. Observations of the collapses and rebounds of millimeter-sized lithotripsy bubbles.

    Science.gov (United States)

    Kreider, Wayne; Crum, Lawrence A; Bailey, Michael R; Sapozhnikov, Oleg A

    2011-11-01

    Bubbles excited by lithotripter shock waves undergo a prolonged growth followed by an inertial collapse and rebounds. In addition to the relevance for clinical lithotripsy treatments, such bubbles can be used to study the mechanics of inertial collapses. In particular, both phase change and diffusion among vapor and noncondensable gas molecules inside the bubble are known to alter the collapse dynamics of individual bubbles. Accordingly, the role of heat and mass transport during inertial collapses is explored by experimentally observing the collapses and rebounds of lithotripsy bubbles for water temperatures ranging from 20 to 60 °C and dissolved gas concentrations from 10 to 85% of saturation. Bubble responses were characterized through high-speed photography and acoustic measurements that identified the timing of individual bubble collapses. Maximum bubble diameters before and after collapse were estimated and the corresponding ratio of volumes was used to estimate the fraction of energy retained by the bubble through collapse. The rebounds demonstrated statistically significant dependencies on both dissolved gas concentration and temperature. In many observations, liquid jets indicating asymmetric bubble collapses were visible. Bubble rebounds were sensitive to these asymmetries primarily for water conditions corresponding to the most dissipative collapses.

  19. [Percutaneous nephrostomy associated with extracorporeal shockwave lithotripsy in the treatment of renoureteral lithiasis].

    Science.gov (United States)

    Larrea Masvidal, E; García Serrano, C; Hernández Silverio, D; Castillo Rodriguez, M; Valdes Gómez, A C; Báez Hernández, D; Ramirez Hernández, L

    1993-01-01

    From a series of 5000 cases that had undergone extracorporeal shock wave lithotripsy at the Hospital Clinico Quirúrgico "Hermanos Ameijeiras" from March, 1986 to April, 1988, 220 cases that required percutaneous nephrostomy due to obstructive hydronephrosis from stone fragments were studied. We analyzed the clinical, radiological and ultrasound features of these cases, as well as the criteria for performing percutaneous nephrostomy. We identified the risk factors that made the procedure necessary, particularly urinary tract infection. No important complications ascribable to the foregoing procedure were observed. Performing the procedure early improved patient clinical course and reduced cost of treatment. To eliminate stone fragments completely, percutaneous nephrostomy was combined with other procedures in 198 cases (90%). The stone fragments were passed spontaneously in 10 cases (4.5%) following diversion. At 2 months 190 cases (86%) were completely stone free, 18 (8%) had residual stones and 12 (6%) required open surgery. The foregoing results show that percutaneous nephrostomy is a very useful procedure in septic-obstructive complications following extracorporeal shock wave lithotripsy and acquiring the skill to perform it is essential.

  20. [Treatment of renoureteral lithiasis using extracorporeal shockwave lithotripsy. Experience in Cuba].

    Science.gov (United States)

    Larrea Masvidal, E; García Serrano, C; Hernández Silverio, D; Castillo Rodríguez, M; Casals Armada, J; Valdés Gómez, C; Báez Hernández, D

    1989-01-01

    Herein we present our experience in 5,000 cases of reno-ureteral lithiasis submitted to treatment at the Extracorporeal Lithotripsy Unit of Hermanos Ameijeiras Hospital in Havana, Cuba, from April 1986 and during a period spanning 30 months. Treatment was exclusively by extracorporeal shock wave lithotripsy (ESWL) in 85.5% of the patients and in combination with other procedures in 14.5% (endoscopic maneuvers in 5.9%, percutaneous nephrostomy 4.4%, open surgery 3.6%, and percutaneous nephrolithotripsy 0.6%). Complications were observed in 7% of the cases: ureteric obstruction (6.4%) with or without infection, perirenal hematoma (0.4%), and obstructive anuria (0.2%); acute urinary infection of different clinical types, some of which were very severe, were observed concomitantly in 2.6% of these patients. Two months following treatment, 86% of the cases were completely stone-free. At 6 months 96.2% were completely stone-free; the remaining 3.8% were classed as residual lithiasis. The pathologic conditions that put patients at high therapeutic risk and the possible complications that could arise were identified. The efficacy of the Dornier HM-3 lithotripter and the health care system that permits its extensive use are highlighted.

  1. Comparison of Ultrasonic and Pneumatic Intracorporeal Lithotripsy Techniques during Percutaneous Nephrolithotomy

    Directory of Open Access Journals (Sweden)

    Tolga Karakan

    2013-01-01

    Full Text Available Objectives. To compare the effectiveness and safety of ultrasonic and pneumatic lithotripters in the treatment of renal stone disease. Materials and Methods. A total of 227 consecutive percutaneous nephrolithotomy procedures for renal calculi were performed. In 107 patients ultrasonic lithotriptors were used (group I and in 83 patients pneumatic lithotriptors were used (group II. In the remaining 37 patients, stones were managed with both pneumatic and ultrasonic lithotripters. Follow-up studies included intravenous urography (IVU and/or computed tomography (CT. Results. The mean operative time and duration of hospitalization were similar between the groups. In the ultrasonic treatment group, 100 (96.9% patients were stone-free on postoperative day 1 and 5 (4.6% went on to undergo an additional treatment modality, resulting in a total stone-free rate of 97.2%. In the pneumatic lithotripsy group, 68 (81.9% patients were stone-free after the primary procedure on the first day and 15 (18.1% went on to undergo an additional treatment modality, resulting in a stone-free rate of 91.5%. The final stone-free rates at 3 months postoperatively in groups I, II, and III were 97.2%, 91.5%, and 87.9%, respectively (P=0.826. Conclusions. We conclude that both ultrasonic and pneumatic lithotripters are effective and safe for intracorporeal lithotripsy. However, the ultrasonic lithotripter provides higher stone-free rates with similar morbidity compared with pneumatic devices.

  2. Disseminated tuberculosis after extracorporeal shock-wave lithotripsy in an AIDS patient presenting with urosepsis.

    Science.gov (United States)

    Tourchi, Ali; Ebadi, Maryam; Hosseinzadeh, Alireza; Shabaninia, Mahsa

    2014-03-01

    Haematogenous dissemination of undiagnosed urinary tuberculosis after performing extracorporeal shock-wave lithotripsy (ESWL) is extremely rare. Herein, we report a 41-year-old male who presented with urosepsis to the emergency room; catheterization was performed and retention resolved. He had a tattoo on his left arm and a five-year history of intravenous drug use. Blood tests indicated anaemia, leukocytosis, elevated CRP and ESR and mild hyponatraemia; haematuria, moderate bacteriuria and 2+ proteinuria on urinanalysis were observed. Chest X-ray revealed lesions suggestive of miliary tuberculosis, which was confirmed by chest CT scan. Brain CT and MRI suggested brain involvement in the setting of tuberculosis. On further investigations, HIV infection and hepatitis C seropositivity were detected and the patient remained in a coma for five days with a Glasgow Coma Scale of 6/15. Finally, the diagnosis of haematogenous dissemination of tuberculosis following lithotripsy was established. Anti-tuberculosis and anti-retroviral therapy were prescribed and monthly follow-up visits were scheduled. In conclusion, in a patient diagnosed with ureterolithiasis, a thorough history and physical examination, with specific attention to HIV and tuberculosis predisposing factors, should be carried out and preoperative screening tests considering the possibility of urinary tuberculosis are required. Finally, if urinary tuberculosis is detected, ESWL must be postponed until after appropriate treatment of tuberculosis.

  3. Flexible Capitalism

    DEFF Research Database (Denmark)

    Approaching “work” as at heart a practice of exchange, this volume explores sociality in work environments marked by the kind of structural changes that have come to define contemporary “flexible” capitalism. It introduces anthropological exchange theory to a wider readership, and shows how...... the perspective offers new ways to enquire about the flexible capitalism’s social dimensions. The essays contribute to a trans-disciplinary scholarship on contemporary economic practice and change by documenting how, across diverse settings, “gift-like” socialities proliferate, and even sustain the intensified...

  4. Extracorporeal shock wave lithotripsy in the treatment of renal pelvicalyceal stones in morbidly obese patients

    Directory of Open Access Journals (Sweden)

    V. A. Mezentsev

    2005-04-01

    Full Text Available INTRODUCTION: Management of urolithiasis in morbidly obese patients is usually associated with higher morbidity and mortality compared to non-obese patients. In morbidly obese patients, since the kidney and stone are at a considerable distance from the skin (compared to non-obese patients difficulty may be found in positioning the patient so that the stone is situated at the focal point of the lithotripter. OBJECTIVE: To evaluate the outcomes and cost-efficiency of extracorporeal shock wave lithotripsy (ESWL in the treatment of renal pelvicalyceal stones sized between 6 and 20 mm in morbidly obese patients. MATERIALS AND METHODS: Using various aids, such as mobile overtable module, extended shock pathway and abdominal compression 37 patients with body mass index more than 40 kg/m2 were treated using the Siemens Lithostar-plus third generation lithotripter. The size of renal pelvicalyceal stones was between 6 and 20 mm. Treatment costs for shock wave lithotripsy were calculated. RESULTS: The overall stone free rate at 3 months of 73% was achieved. The mean number of treatments per patient was 2.1. The post-lithotripsy secondary procedures rate was 5.4%. No complications, such as subcapsular haematoma or acute pyelonephritis were recorded. The most effective (87% success rate and cost-efficient treatment was in the patients with pelvic stones. The treatment of the patients with low caliceal stones was effective in 60% only. The cost of the treatment of the patients with low calyceal stones was in 1.8 times higher than in the patients with pelvic stones. CONCLUSION: We conclude that ESWL with the Siemens Lithostar-plus is the most effective and cost-efficient in morbidly obese patients with pelvic stones sized between 6 and 20 mm. 87% success rate was achieved. The increased distance from the skin surface to the stone in those patients does not decrease the success rate provided the stone is positioned in the focal point or within 3 cm of it on the

  5. Nephrolithiasis in "back-to-back" kidneys.

    Science.gov (United States)

    Klaassen, Zachary; King, Ray S; King, Sherita A; Bates, William B; Madi, Rabii

    2013-12-01

    A 57-year-old woman presented with a 1-week history of left lower quadrant pain and nausea and vomiting. Computed tomography without contrast demonstrated a left 2.3-cm calculus at the ureteropelvic junction and a 6-mm lower pole calculus. The kidneys were in the pelvis and oriented "back-to-back," with the lateral portions of the kidneys fused in the midline. To our knowledge, this is the first description of this renal fusion anomaly. The patient underwent robotic pyelolithotomy of the ureteropelvic junction calculus and subsequent flexible ureteroscopic laser lithotripsy of the lower pole calculus and ureteral stent placement through the assistant working port.

  6. Ultrasound-Guided Extracorporeal Shock Wave Lithotripsy of Pancreatic Ductal Stones: Six Years’ Experience

    Directory of Open Access Journals (Sweden)

    Werner Johanns

    1996-01-01

    Full Text Available Extracorporeal shock wave lithotripsy (ESWL and endoscopic sphincterotomy (EST was performed in 35 patients suffering from pancreatic duct stones. Calculi disintegration and resolution of obstruction were achieved in all cases. Completely stone-free ducts were achieved in 16 patients (46% while some peripheral asymptomatic stone material remained in 19 (54%. Dilation of the main pancreatic duct was reduced in 29 patients (83%. Twelve patients (34% became completely asymptomatic and 17 (49% reported a marked reduction of pain. Pancreatogenic steatorrhea ceased and 18 patients (51% gained weight. Pathological glucose tolerance returned to normal in one patient. No major complications were observed. The combination of ESWL and EST is a successful, nonoperative, new treatment in pancreatic stone disease.

  7. Fragmentation process during Ho:YAG laser lithotripsy revealed by time-resolved imaging

    Science.gov (United States)

    Beghuin, Didier; Delacretaz, Guy P.; Schmidlin, Franz R.; Rink, Klaus

    1998-01-01

    The stone fragmentation process induced during Ho:YAG laser lithotripsy was observed by time-resolved flash video imaging. Possible acoustic transient occurrence was simultaneously monitored with a PVDF needle hydrophone. We used artificial and cystine kidney stones. We observed that, although the fragmentation process is accompanied with the formation of a cavitation bubble, cavitation has a minimal incidence on stone fragmentation. Fragment ejection is mainly due to a direct laser stone heating and vaporization of stone organic constituents and interstitial water. The minimal effect of the cavitation bubble for fragmentation is confirmed by acoustic transients measurements, which reveal weak pressure transients. This is in contrast with the fragmentation mechanisms induced by laser of shorter pulse duration.

  8. Study of cavitation bubble dynamics during Ho:YAG laser lithotripsy by high-speed camera

    Science.gov (United States)

    Zhang, Jian J.; Xuan, Jason R.; Yu, Honggang; Devincentis, Dennis

    2016-02-01

    Although laser lithotripsy is now the preferred treatment option for urolithiasis, the mechanism of laser pulse induced calculus damage is still not fully understood. This is because the process of laser pulse induced calculus damage involves quite a few physical and chemical processes and their time-scales are very short (down to sub micro second level). For laser lithotripsy, the laser pulse induced impact by energy flow can be summarized as: Photon energy in the laser pulse --> photon absorption generated heat in the water liquid and vapor (super heat water or plasma effect) --> shock wave (Bow shock, acoustic wave) --> cavitation bubble dynamics (oscillation, and center of bubble movement , super heat water at collapse, sonoluminscence) --> calculus damage and motion (calculus heat up, spallation/melt of stone, breaking of mechanical/chemical bond, debris ejection, and retropulsion of remaining calculus body). Cavitation bubble dynamics is the center piece of the physical processes that links the whole energy flow chain from laser pulse to calculus damage. In this study, cavitation bubble dynamics was investigated by a high-speed camera and a needle hydrophone. A commercialized, pulsed Ho:YAG laser at 2.1 mu;m, StoneLightTM 30, with pulse energy from 0.5J up to 3.0 J, and pulse width from 150 mu;s up to 800 μs, was used as laser pulse source. The fiber used in the investigation is SureFlexTM fiber, Model S-LLF365, a 365 um core diameter fiber. A high-speed camera with frame rate up to 1 million fps was used in this study. The results revealed the cavitation bubble dynamics (oscillation and center of bubble movement) by laser pulse at different energy level and pulse width. More detailed investigation on bubble dynamics by different type of laser, the relationship between cavitation bubble dynamics and calculus damage (fragmentation/dusting) will be conducted as a future study.

  9. Shock Wave Lithotripsy Does Not Impair Renal Function in a Swine Model of Metabolic Syndrome

    Science.gov (United States)

    Johnson, Cynthia D.; Connors, Bret A.; Evan, Andrew P.; Phillips, Carrie L.; Liu, Ziyue

    2015-01-01

    Abstract Purpose: To determine whether shock wave lithotripsy (SWL) may be a risk factor for renal functional impairment in a swine model of metabolic syndrome (MetS). Materials and Methods: Nine-month-old female Ossabaw pigs were fed an excess calorie atherogenic diet to induce MetS. At 15 months of age, the MetS pigs were treated with 2000 SWs or an overtreatment dose of 4000 SWs targeted at the upper pole calyx of the left kidney (24 kV at 120 SWs/min using the unmodified Dornier HM3 lithotripter; n=5–6 per treatment group). Serum creatinine (Cr) and blood urea nitrogen (BUN) levels were measured in conscious pigs before and ∼60 days after SWL to provide a qualitative assessment of how well both kidneys were filtering (glomerular filtration rate [GFR]). Bilateral renal function was assessed at ∼65 days post-SWL in anesthetized pigs with GFR and effective renal plasma flow (ERPF) quantified by the renal clearance of inulin and para-amino hippurate, respectively. Results: Cr and BUN values were within normal limits before SWL and remained unchanged after lithotripsy in both the 2000 SW- and 4000 SW-treated pigs. GFR and ERPF of kidneys treated with SWL at either SW dose were similar to the contralateral nontreated kidney. Chronic histological changes in the SW-treated pole of the kidney included interstitial fibrosis, sclerotic glomeruli, and dilated and atrophic tubules. Conclusions: Our results are consistent with the view that a single SWL session does not result in renal impairment, even in the presence of MetS. PMID:25285417

  10. Abdominal fat distribution on computed tomography predicts ureteric calculus fragmentation by shock wave lithotripsy.

    Science.gov (United States)

    Juan, Hsu-Cheng; Lin, Hung-Yu; Chou, Yii-Her; Yang, Yi-Hsin; Shih, Paul Ming-Chen; Chuang, Shu-Mien; Shen, Jung-Tsung; Juan, Yung-Shun

    2012-08-01

    To assess the effects of abdominal fat on shock wave lithotripsy (SWL). We used pre-SWL unenhanced computed tomography (CT) to evaluate the impact of abdominal fat distribution and calculus characteristics on the outcome of SWL. One hundred and eighty-five patients with a solitary ureteric calculus treated with SWL were retrospectively reviewed. Each patient underwent unenhanced CT within 1 month before SWL treatment. Treatment outcomes were evaluated 1 month later. Unenhanced CT parameters, including calculus surface area, Hounsfield unit (HU) density, abdominal fat area and skin to calculus distance (SSD) were analysed. One hundred and twenty-eight of the 185 patients were found to be calculus-free following treatment. HU density, total fat area, visceral fat area and SSD were identified as significant variables on multivariate logistic regression analysis. The receiver-operating characteristic analyses showed that total fat area, para/perirenal fat area and visceral fat area were sensitive predictors of SWL outcomes. This study revealed that higher quantities of abdominal fat, especially visceral fat, are associated with a lower calculus-free rate following SWL treatment. Unenhanced CT is a convenient technique for diagnosing the presence of a calculus, assessing the intra-abdominal fat distribution and thereby helping to predict the outcome of SWL. • Unenhanced CT is now widely used to assess ureteric calculi. • The same CT protocol can provide measurements of abdominal fat distribution. • Ureteric calculi are usually treated by shock wave lithotripsy (SWL). • Greater intra-abdominal fat stores are generally associated with poorer SWL results.

  11. Treatment of cystine stones: combined approach using open pyelolithotomy, percutaneous pyelolithotripsy, extracorporeal shock wave lithotripsy and chemolysis

    DEFF Research Database (Denmark)

    Aabech, J; Andersen, J T

    1993-01-01

    Treatment of cystine stones in the urinary tract can be difficult because of a high frequency of recurrence, resistance to Extracorporeal Shock Wave Lithotripsy (ESWL), difficulty in localization and access to peripheral stones during Percutaneous Nephrolithotripsy (PCNL), and the insufficient...... effect of oral chemolysis. We present two cases of urinary cystine calculi treated with a combination of pyelolithotomy, PCNL, ESWL and percutaneous irrigation chemolysis, using N-acetylcysteine and Tromethamine-E....

  12. Influence of ureter mirror holmium laser lithotripsy on blood rheology and oxidative stress in patients with upper ureteral calculi

    Institute of Scientific and Technical Information of China (English)

    Guo-Dong Chen; Jian Dong; Jun Ding; Guo-Bo Li; Chen-Xi Zhou

    2016-01-01

    Objective:To explore the influence of ureter mirror holmium laser lithotripsy on blood rheology and oxidative stress in patients with upper ureteral calculi.Methods:A total of 113 cases patients who underwent surgical treatment of ureter mirror holmium laser lithotripsy were divided into observation group (n=76) and the control group (n=37) according to different therapeutic methods. Patients in the observation group were treated by ureteroscopy holmium laser lithotripsy treatment and patients in control group were treated by open surgery treatment. Venous blood was collected ro test the blood rheology and oxidative stress indicators respectively in the preoperative and postoperative 1 d, 7 d after treatment.Results:The postoperative backlog of red blood cells increased performance first decreased after treatment in two groups, the plasma viscosity and whole blood viscosity, high shear viscosity of whole blood were increased after the stable trend, the postoperative hematocritg, plasma viscosity, whole blood viscosity, high shear viscosity of whole blood were significantly lower than the control group in the observation group 1 d and 7 d after operation; The postoperative Cor, MDA in two groups showed a rising trend, SOD showed a decreasing trend, the difference was statistically significant; MDA in observation group 1 d and 7 d after operation was significantly lower than the control group, SOD was significantly higher than control group in the same point in time.Conclusions:Patients with upper ureteral calculi treated by surgical treatment may cause abnormal blood rheology and oxidative stress. And compared with open surgery, ureteroscopy holmium laser lithotripsy is of smaller side effect, and is beneficial for postoperative recovery.

  13. Ureteroscopy and holmium laser lithotripsy: Is this procedure safe in pregnant women with ureteral stones at different locations?

    Directory of Open Access Journals (Sweden)

    Senol Adanur

    2014-06-01

    Full Text Available Objectives: The aim of this study was to assess the safety and effectiveness of ureteroscopy and Holmium: Yttrium-Aluminum-Garnet lithotripsy for the treatment of ureteral stones with different localizations in symptomatic pregnant women. Methods: A retrospective analysis was performed on 19 pregnant patients referred to our center between January 2005 and December 2012 with symptomatic hydronephrosis requiring surgical intervention. 7.5 F and 9.5 F semirigid ureterorenoscopy with Holmium laser lithotripsy was used for treatment in all patients. Complications were stratified according to modified Clavien criteria. Results: The mean age of patients was 25.4 (18-41 years, and the mean gestation duration was 24.8 (7-33 weeks. Six cases (31.5% had a history of stone. Solitary kidney secondary to previous nephrectomy was observed in 2 patients and 1 patient had a hypoplastic kidney. Abdominal ultrasonography was used as the main diagnostic tool. Mean stone size was 9.2 mm (6-13. The location of the stones was the lower, middle, and upper ureter in 8 (42.1%, 5 (26.3% and 6 (31.5% cases, respectively. All stones were fragmented with Holmium laser lithotripsy. Of the 19 patients, 11 (57.8% required doublr J stent insertion peroperatively. Intraoperative urological and obstetric complications were not observed. Postoperatively two complications were noted. According to Clavien criteria a complication was level 1, and the other was level 2. Conclusions: For treatment of pregnant women with symptomatic ureteral stones in every location, Holmium laser lithotripsy with a semirigid ureteroscopy can be used as judicious treatment. This approach is effective and safe with an acceptable complication rate.

  14. Design, Prototyping and Control of a Flexible Cystoscope for Biomedical Applications

    Science.gov (United States)

    Sozer, Canberk; Ghorbani, Morteza; Alcan, Gokhan; Uvet, Huseyin; Unel, Mustafa; Kosar, Ali

    2017-07-01

    Kidney stone and prostate hyperplasia are very common urogenital diseases all over the world. To treat these diseases, one of the ESWL (Extracorporeal Shock Wave Lithotripsy), PCNL (Percutaneous Nephrolithotomy), cystoscopes or open surgery techniques can be used. Cystoscopes named devices are used for in-vivo intervention. A flexible or rigid cystoscope device is inserted into human body and operates on interested area. In this study, a flexible cystoscope prototype has been developed. The prototype is able to bend up to ±40°in X and Y axes, has a hydrodynamic cavitation probe for rounding sharp edges of kidney stone or resection of the filled prostate with hydrodynamic cavitation method and contains a waterproof medical camera to give visual feedback to the operator. The operator steers the flexible end-effector via joystick toward target region. This paper presents design, manufacturing, control and experimental setup of the tendon driven flexible cystoscope prototype. The prototype is 10 mm in outer diameter, 70 mm in flexible part only and 120 mm in total length with flexible part and rigid tube. The experimental results show that the prototype bending mechanism, control system, manufactured prototype parts and experimental setup function properly. A small piece of real kidney stone was broken in targeted area.

  15. AB109. Upper urinary stone management in China

    Science.gov (United States)

    Wang, Shaogang; Liu, Jihong; Ye, Zhangqun

    2015-01-01

    Objective Urolithiasis is one of the most prevalent diseases in the urologic clinic and usually affects people aged 20 to 60 years. In recent years, the overall morbidity of urolithiasis in Chinese population has increased with significant reduction in patients with lower urinary stone and an increase in patients with upper urinary stone. Upper urinary stone may induce more severe complications and have been considered to be the main cause of nephrectomy besides urinary tumor. Methods The management of upper urinary stone may still challenging somehow. Extracorporeal shock wave lithotripsy (ESWL) usually is the first choice for the patients with simple upper urinary stone of 2 cm and down. Recent years, according to the mechanism of lithecbole by vibration and body position, some Chinese urologists have developed a novel machine, external physical vibration lithecbole (EPVL), which can facilitate removal of urinary stone after ESWL or endoscopic lithotripsy. The combination of EPVL therapy with ESWL or endoscopic lithotripsy significantly increases the stone-free rate. Percutaneous nephrostolithotomy (PCNL) is increasingly employed as a major modality for patients with large and complex upper urinary stone. The minimally invasive PCNL (mPCNL), which was performed with a miniature endoscope by way of a small size tract (12-20 F), could decrease morbidity, especially uncontrolled hemorrhage but have the disadvantages of low efficiency to remove stone fragment. The Chinese urologists have modified PCNL technique by using an 8/9.8 F rigid ureteroscope through the 14-18 F percutaneous tract under ultrasound or X-ray guidance. The results from a series of studies demonstrate that Chinese mPCNL is safe, feasible and efficient for treating upper urinary stone with a low complicate rate. Results With the development of techology, the flexible ureteroscope have become the main actors in clinical practice over the past several years. Flexible ureteroscopy allows entry into

  16. Flexible Electronics Research Facility

    Data.gov (United States)

    Federal Laboratory Consortium — The Flexible Electronics Research Facility designs, synthesizes, tests, and fabricates materials and devices compatible with flexible substrates for Army information...

  17. High-grade ureteroscopic biopsy is associated with advanced pathology of upper-tract urothelial carcinoma tumors at definitive surgical resection.

    Science.gov (United States)

    Clements, Thomas; Messer, Jamie C; Terrell, John D; Herman, Michael P; Ng, Casey K; Scherr, Douglas S; Scoll, Benjamin; Boorjian, Stephen A; Uzzo, Robert G; Wille, Mark; Eggener, Scott E; Lucas, Steven M; Lotan, Yair; Shariat, Shahrokh F; Raman, Jay D

    2012-04-01

    Accurate assessment of upper-tract urothelial carcinoma (UTUC) pathology may guide use of endoscopic vs extirpative therapy. We present a multi-institutional cohort of patients with UTUC who underwent surgical resection to characterize the association of ureteroscopic (URS) biopsy features with final pathology results. URS biopsy data were available in 238 patients who underwent surgical resection of UTUC. Biopsies were performed using a brush biopsy kit, mechanical biopsy device, or basket. Stage was classified as a positive brush, nonmuscle-invasive (biopsy, 88/238 (37%) patients had a positive brush, 140 (59%) had a diagnosis of non-MI, and 10 (4%) had MI disease. Biopsy results showed low-grade cancer in 140 (59%) and high-grade cancer in 98 (41%). Pathologic evaluation at surgical resection demonstrated non-MI tumors in 140 (59%) patients, MI in 98 (41%), and high-grade disease in 150 (63%). On univariate analysis, high URS biopsy grade was associated with high-grade (positive predictive value [PPV] 92%, Pbiopsy stage, however, was associated with surgical pathology grade (P=0.005), but not MI (P=0.16) disease. On multivariate analysis, high URS grade, but not biopsy stage, was associated with high final pathology grade (hazard ratio [HR] 16.6, 95% confidence interval [CI] 7.0-39.5, Pbiopsy grade, but not stage, is associated with adverse tumor pathology. This information may play a valuable role for risk stratification and in the appropriate selection of endoscopic management vs surgical extirpation for UTUC.

  18. New-generation flexible ureterorenoscopes are more durable than previous ones.

    Science.gov (United States)

    Traxer, Olivier; Dubosq, Francis; Jamali, Karim; Gattegno, Bernard; Thibault, Philippe

    2006-08-01

    To determine the deterioration in the maximal active deflection and flow capabilities of a new-generation flexible ureteroscope (URS). We performed 50 ureterorenoscopies using the same URS: a Karl Storz 11278 AU1 Flex-X, which is capable of a 270 degree active deflection in the ventral and dorsal directions. Postoperatively, we evaluated the maximal active ventral and dorsal deflection, irrigation flow at 100 cm H2O, and the number of broken optical fibers. The URS was used for a total of 76 hours, 15 minutes (average 95 minutes per procedure). The maximal ventral deflection had deteriorated from 270 degrees to 208 degrees at the last procedure. The maximal dorsal deflection had decreased from 270 degrees to 133 degrees. The irrigation flow at 100 cm H2O had decreased from 50 mL/min initially to 40 mL/min at the last procedure. The number of broken image fibers had reached six at the 50th procedure. One repair was necessary at the 50th procedure because of a laser perforation of the working channel. The need for repair occurs less frequently with the new-generation of URSs, especially when they are used by an experienced endourologist. In the future, improvements in the durability of the flexible URS will still be key for widespread use of the technique and especially to limit damage by the laser to the working channel.

  19. Balance and flexibility.

    Science.gov (United States)

    2003-12-01

    The 'work-life balance' and flexible working are currently key buzz terms in the NHS. Those looking for more information on these topics should visit Flexibility at www.flexibility.co.uk for a host of resources designed to support new ways of working, including information on flexible workers and flexible rostering, the legal balancing act for work-life balance and home working.

  20. Variation Coefficient of Stone Density: A Novel Predictor of the Outcome of Extracorporeal Shockwave Lithotripsy.

    Science.gov (United States)

    Yamashita, Shimpei; Kohjimoto, Yasuo; Iguchi, Takashi; Nishizawa, Satoshi; Iba, Akinori; Kikkawa, Kazuro; Hara, Isao

    2017-04-01

    Although previous studies have indicated that stone heterogeneity can affect extracorporeal shockwave lithotripsy (SWL) outcomes, there is no established measurement of stone heterogeneity on CT imagery. We investigated whether variation coefficient of stone density (VCSD) can predict shockwave success. We conducted a retrospective review of 245 patients with urinary calculi who had undergone SWL. We compared the predictive powers of treatment success between VCSD and other parameters associated with CT attenuation. In addition, we performed logistic regression analysis to identify the factors contributing to treatment success. Treatment success was determined within 3 months after first treatment using noncontrast CT. The treatment success rate was 47.8% (117/245 cases). From receiver operating characteristic curves for treatment success, area under curve of VCSD (0.7181) was larger than that of mean stone density (MSD) (0.6384, p = 0.09) and standard deviation of stone density (0.5412, p < 0.01). Multivariate analysis revealed that MSD (p = 0.028) and VCSD (p < 0.001) independently predicted the outcome. Categorized by stone location, VCSD was the independent significant predictor for SWL outcomes in both kidney (p = 0.047) and ureteral calculi (p < 0.001). We found that VCSD can be a novel predictor of SWL success. The development of nomograms or scoring systems, including VCSD, can assist in the decision process for patients and minimize unnecessary delay in treatment of urolithiasis.

  1. Transurethral lithotripsy with holmium-YAG laser of a large exogenous prostatic calculus.

    Science.gov (United States)

    Hasegawa, Masanori; Ohara, Rei; Kanao, Kent; Nakajima, Yosuke

    2011-04-01

    Prostatic calculi are classified into two types, endogenous and exogenous calculi, based on their origin. Endogenous calculi are commonly observed in elderly men; however, exogenous prostatic calculi are extremely rare. We report here the case of a 51-year-old man who suffered incontinence and pollakiuria with a giant exogenous prostatic calculus almost completely replacing the prostatic tissue. X-rays and computed tomography demonstrated a large calculus of 65 × 58 mm in the small pelvic cavity. The patient underwent a transurethral lithotripsy with a holmium-YAG laser and a total of 85 g of disintegrated stones was retrieved and chemical stone analysis revealed the presence of magnesium ammonium phosphate. The incontinence improved and the voiding volume increased dramatically, and no stone recurrence in the prostatic fossa occurred at the 2 years follow-up. The etiology of this stone formation seemed to be based on some exogenous pathways combined with urinary stasis and chronic urinary infection due to compression fracture of the lumbar vertebra.

  2. Patients' selection for treatment of caliceal diverticular stones with extracorporeal shock wave lithotripsy

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Won Hong; Lee, Hee Jeong; Son, Soon Yong; Kang, Seong Ho; Cho, Cheong Chan; Ryu, Meung Sun [AMC, Seoul (Korea, Republic of); Kim, Seung Kook [Kwang-Ju Health College, Kwang-Ju (Korea, Republic of)

    2001-06-01

    Symptoms of caliceal diverticular stones are commonly associated with pain, recurrent urinary tract infection and hematuria. The aim of this study is to select the proper patient for the application of more successful extracorporeal shock wave lithotripsy(ESWL) as a treatment of caliceal diverticular stone. 16 patients with caliceal diverticular stones were treated with ESWL, and all patients had single caliceal diverticulum. The diagnosis of caliceal diverticulum with stones was made by intraveneous pyelography to all patients. On these intravenous pyelogram, we also classified diverticular type, whether the diverticular neck is connected with urinary tract patently, diverticular site and stone number and size. All patients were followed after ESWL by plain film of the kidneys, ureters and bladder and interviewed. Of all patients 44% was shown stone-free completely, also 83% was rendered symptom-free. All patients whose diverticular neck connected with urinary tract patently on the intraveneous pyelogram became stone-free. Of solitary stone 60% and multiple stones (more than 2) 17% became symptom-free. The patients with infection before ESWL 75% had residual stones, of these patients 33% had slightly flank pain, and 25% of patients with stones recurred become stone-free. We propose that more successful ESWL for patients with caliceal diverticular stones select satisfactory patients including that the diverticular neck is connected with urinary tract patently, solitary stone and no infection simultaneously.

  3. Renal damage after extracorporeal shock-wave lithotripsy detected by magnetic resonance imaging

    Energy Technology Data Exchange (ETDEWEB)

    Torii, Shinichiro; Machida, Toyohei; Ooishi, Yukihiko; Tashiro, Kazuya; Mochizuki, Atsushi; Yoshigoe, Fukuo

    1988-08-01

    The acute effects of extracorporeal Shock-wave lithotripsy (ESWL) on morphology of the renal parenchyma were evaluated by Magnetic Resonance Imaging (MRI) in 15 kidneys, before and immediately after (within 24 hours) ESWL in 11 cases. The renal parenchymal damages were observed by MRI as the changes of signal itensity of renal cortex and medulla, perirenal fluid, loss of corticomedullar differentiation, and other renal traumas. Loss of corticomedullar differentiation was seen in 9/11 cases and peripheral fluid of the kidney was seen in 4/11 cases. Irregular and edematous changes of renal capsula were seen in 5/11 cases. Obvious abnormal findings indicated renal trauma were not observed in this study. Several MRI findings may transient and reversible changes and the morpholigic changes detected by MRI may attributed to renal parenchymal obstruction and edema and decreasing of renal capillary flow, such as in renal contusion. It is concluded that MRI is very sensitive and the best technique to detect the effects and clinical trouble of ESWL.

  4. Renal morphology and function immediately after extracorporeal shock-wave lithotripsy

    Energy Technology Data Exchange (ETDEWEB)

    Kaude, J.V.; Williams, C.M.; Millner, M.R.; Scott, K.N.; Finlayson, B.

    1985-08-01

    The acute effects of extracorporeal shock-wave lithotripsy (ESWL) on morphology and function of the kidney were evaluated by excretory urography, quantitative radionuclide renography (QRR), and magnetic resonance imaging (MRI) in 33 consecutive patients. Excretory urograms demonstrated an enlarged kidney in seven (18%) of 41 treatments and partial or complete obstruction of the ureter by stone fragments after 15 (37%) of 41 treatments. Total effective renal plasma flow (ERPF) was not changed after ESWL, but the percentage ERPF of the treated kidney was decreased by more than 5% in 10 (30%) of 33 cases. QRR images showed partial parenchymal obstruction in 10 (25%) of 41 teated kidneys and total parenchymal obstruction in 9 (22%). MRI disclosed one or more abnormalities in 24 (63%) of 38 treated kidneys. Treated kidneys were normal by all three imaging methods in 26% and abnormal by one or more tests in 74% of cases. The morphologic and functional changes are attributed to renal contusion resulting in edema and extravasation of urine and blood into the interstitial, subcapsular, and perirenal spaces.

  5. Extracorporeal Shock Wave Lithotripsy in the Management of Chronic Calcific Pancreatitis: A Meta-Analysis

    Directory of Open Access Journals (Sweden)

    Freeman ML

    2005-01-01

    Full Text Available CONTEXT: Main pancreatic duct stones may contribute to pain in chronic pancreatitis. Extracorporeal shock wave lithotripsy (ESWL has been used alone or in combination with endoscopic therapy for fragmentation of stones. Published studies have shown mixed efficacy due to small sample size. OBJECTIVE: Systematic analysis of all published data evaluating ESWL with or without endoscopic therapy in pancreatic duct clearance and symptom relief. METHODS: Two investigators independently reviewed the computer databases. 31 potential studies were identified. Only studies using ESWL with or without endoscopic therapy were included. Completeness of the search was confirmed by an expert. Studies were independently coded by two investigators and differences rectified by mutual consent. MAIN OUTCOME MEASURES: Pain at follow-up and duct clearance. RESULTS: Seventeen studies published between 1989 and 2002 were included. Sixteen had a measure of pain at follow-up and duct clearance. All studies were case series with a total of 588 subjects, and included varying number of subjects undergoing endoscopic pancreatic sphincterotomy and stone extraction. The mean effect size (weighted correlation coefficient for pain was 0.6215 and for duct clearance was 0.7432; thus indicating a large effect. All studies showed homogeneity suggesting similar effect size irrespective of the combinations of therapy. CONCLUSIONS: ESWL is effective in clearance of stones from the pancreatic duct and in relief of pain. Published studies showed homogeneity of the effect size of ESWL both in pancreatic duct clearance and relief of pain.

  6. Effect of Diuretics on Ureteral Stone Therapy with Extracorporeal Shock Wave Lithotripsy

    Directory of Open Access Journals (Sweden)

    Zomorrodi A

    2008-01-01

    Full Text Available To evaluate the effect of diuretics on ureteral stone fragmentation and clearance during therapy with extra corporeal shock wave lithotripsy (ESWL, we studied 87 patients with ureteral stone at different levels and treated with ESWL. The patients were randomized into two groups treated by standard ESWL; the treatment protocol included 3500 shock wave per patient in each session, energy of the shock in two groups was 13 to 9 kv per patient, and the number of sessions was 3 per patient. The first group included 43 patients who received only ESWL, while the second group of 44 patients received as well 40 mg of furosemide. Stone fragmentation rate was 81% and 93.1% and stone clearance rate was 68.2% and 88.4% for the first and the second groups, respectively. With diuretics, fragmentation was18.8% more in the middle ureteral stones, 16.9% more in the upper tract stones, and 5.4% more in the distal stones. Moreover, clearance of fragmented stones was 38%, 28%, 15.4% more at middle and upper and distal ureteral stone, respectively. We conclude that the stone fragmentation and clearance were higher with ESWL and diuretics than without diuresis. Diuresis is safe and has some advantage at increasing the effect of ESWL on ureteral stones especially the middle ureteral calculi.

  7. Abdominal fat distribution on computed tomography predicts ureteric calculus fragmentation by shock wave lithotripsy

    Energy Technology Data Exchange (ETDEWEB)

    Juan, Hsu-Cheng; Chou, Yii-Her [Kaohsiung Medical University Hospital, Department of Urology, Kaohsiung (China); Lin, Hung-Yu [Kaohsiung Medical University, Graduate Institute of Medicine, Kaohsiung (China); E-Da Hospital/ I-Shou University, Department of Urology, Kaohsiung (China); Yang, Yi-Hsin [Kaohsiung Medical University, Institute of Oral Health Sciences, Kaohsiung (China); Shih, Paul Ming-Chen [Kaohsiung Municipal Hsiao-Kang Hospital, Department of Radiology, Kaohsiung (China); Kaohsiung Medical University, Department of Radiology, Kaohsiung (China); Chuang, Shu-Mien [Yuh-Ing Junior College of Health Care and Management, Kaohsiung (China); Shen, Jung-Tsung [Kaohsiung Municipal Hsiao-Kang Hospital, Department of Urology, Kaohsiung (China); Juan, Yung-Shun [Kaohsiung Medical University Hospital, Department of Urology, Kaohsiung (China); Kaohsiung Medical University, Graduate Institute of Medicine, Kaohsiung (China); Kaohsiung Medical University, Department of Urology, Faculty of Medicine, Kaohsiung (China)

    2012-08-15

    To assess the effects of abdominal fat on shock wave lithotripsy (SWL). We used pre-SWL unenhanced computed tomography (CT) to evaluate the impact of abdominal fat distribution and calculus characteristics on the outcome of SWL. One hundred and eighty-five patients with a solitary ureteric calculus treated with SWL were retrospectively reviewed. Each patient underwent unenhanced CT within 1 month before SWL treatment. Treatment outcomes were evaluated 1 month later. Unenhanced CT parameters, including calculus surface area, Hounsfield unit (HU) density, abdominal fat area and skin to calculus distance (SSD) were analysed. One hundred and twenty-eight of the 185 patients were found to be calculus-free following treatment. HU density, total fat area, visceral fat area and SSD were identified as significant variables on multivariate logistic regression analysis. The receiver-operating characteristic analyses showed that total fat area, para/perirenal fat area and visceral fat area were sensitive predictors of SWL outcomes. This study revealed that higher quantities of abdominal fat, especially visceral fat, are associated with a lower calculus-free rate following SWL treatment. Unenhanced CT is a convenient technique for diagnosing the presence of a calculus, assessing the intra-abdominal fat distribution and thereby helping to predict the outcome of SWL. (orig.)

  8. Treatment of urinary lithiasis following kidney transplantation with extracorporeal shock-wave lithotripsy

    Institute of Scientific and Technical Information of China (English)

    LI Sha-dan; WANG Qing-tang; CHEN Wei-guo

    2011-01-01

    Background The incidence of urinary lithiasis following kidney transplantation is very low, and decision-supporting data are not available. The aim of this study was to review the diagnosis and treatment of urinary lithiasis following kidney transplantation, which is of realistic significance to reduce urinary lithiasis following kidney transplantation, prolong the survival of renal allografts.Methods The incidence, diagnosis and treatment of urinary lithiasis in ten patients following kidney transplantation were analyzed retrospectively. Seven out of these patients had stones sized approximately 0.4-1.1 cm, and they were treated with low-voltage, low-frequency extracorporeal shock-wave lithotripsy (ESWL). Two patients had stones sized <0.3 cm and they underwent cystoscopy and ureteroscopy. The ureteral catheter endoscopes were inserted in a retrograde manner to mobilize stones repeatedly. After elimination of obstruction, a ureteral double J stent was indwelt.One patient had a pelvic stone (1.2 cm), which was removed surgically.Results The major clinical manifestations were hematuria, oliguria or anuria. Some patients were asymptomatic and they were diagnosed through laboratory tests and imaging examinations, e.g., ultrasonography. After elimination of obstruction, subjective symptoms disappeared in all patients, and the function of renal allografts recovered. A six-month follow-up indicated no remnant stones or lithiasis relapse.Conclusions The diagnosis and treatment of renal allograft lithiasis are challenging. After prompt and appropriate treatment, the prognosis was satisfactory, and permanent renal functional impairment did not occur in most patients.

  9. Extracorporeal lithotripsy renal: magnetic resonance and ultrasonography study. Rion postlitofragmentacion: estudio mediante resonancia magnetica y ecografia

    Energy Technology Data Exchange (ETDEWEB)

    Vilar, J.; Torrijo, C.; Marti-Bonmati, L.; Caballero, E.; Palop, M.C.; Sanjuan, C.

    1993-10-01

    Our aim is to identify, by means of ultrasound and magnetic resonance (MR), the renal disorders and complications produced by extracorporeal lithotripsy (ECL). Thirty candidates for ECL to treat kidney calculi were selected randomly. All the studies were carried out in duplicate, prior to and after ECL. In MR (o.5 T), coronal and axial images were obtained at different potentiations. A qualitative assessment was done with ultrasound and MR on the basis of changes in the renal morphology (size, corticomedullary definition) and the alterations in the extrarenal space (subcapsular as well as perirenal). The quantitative MR evaluation consisted of the measurement of the signal intensity in regions of interest (ROI's) located in cortex and renal medulla in T1 sequences and a great ROI including the entire renal parenchyma in T2 sequences. ECL with piezoelectric equipment shows a low incidence of short-term complications. Qualitative image disturbances appeared in 12 cases (40%), consisting of a loss of the corticomedullary definition in 4 (13.3%), extrarenal collections in 4 cases (13.3%) and alterations in the perirenal area in another 4 cases (13.3%). Quantitative changes, defined as modifications in the signal intensity in MR T2 sequences, were present in 8 cases (26.6%). None of these alterations had short-term clinical impact, and all are directly related to the intensity of the shock waves applied. Author (9 refs.)

  10. Clinical application of plasma shock wave lithotripsy in treating impacted stones in the bile duct system

    Institute of Scientific and Technical Information of China (English)

    Zhi Xu; Li-Xin Wang; Neng-Wei Zhang; Chun-Sheng Hou; Xiao-Feng Ling; Yao Xu; Xiao-Si Zhou

    2006-01-01

    AIM: To verify the safety and efficacy of plasma shock wave lithotripsy (PSWL) in fragmenting impacted stones in the bile duct system.METHODS: From September 1988 to April 2005, 67 patients (26 men and 41 women) with impacted stones underwent various biliary operations with tube (or T-tube)drainage. Remnant and impacted stones in the bile duct system found by cholangiography after the operation were fragmented by PSWL and choledochofiberscopy. A total of 201 impacted stones were fragmented by PSWL setting the voltage at 2.5-3.5 kV, and the energy output at 2-3 J for each pulse of PSWL. Then the fragmented stones were extracted by choledochofiberscopy. The safety and efficacy of PSWL were observed during and after the procedure.RESULTS: One hundred and ninety-nine of 201 impacted stones (99.0%) in the bile duct system were successfully fragmented using PSWL and extracted by choledochofiberscopy. The stone clearance rate for patients was 97% (65/67). Ten patients felt mild pain in the right upper quadrant of the abdomen, and could tolerate it well.Eleven patients had a small amount of bleeding from the mucosa of the bile duct. The bleeding was transient and stopped spontaneously within 2 min of normal saline irrigation. There were no significant complications during and after the procedure.CONCLUSION:PSWL is a safe and effective method for fragmenting impacted stones in the bile duct system.

  11. Reduced Pain and Anxiety with Music and Noise-Canceling Headphones During Shockwave Lithotripsy.

    Science.gov (United States)

    Karalar, Mustafa; Keles, Ibrahim; Doğantekin, Engin; Kahveci, Orhan Kemal; Sarici, Hasmet

    2016-06-01

    We assessed the effects of music and noise-canceling headphones (NCHs) on perceived patient pain and anxiety from extracorporeal shockwave lithotripsy (SWL). Patients with renal calculi scheduled for SWL were prospectively enrolled. All 89 patients between the ages of 19 and 80 years were informed about this study and then randomized into three groups: Group 1 (controls), no headphones and music; Group 2, music with NCHs (patients listened to Turkish classical music with NCHs during SWL); and Group 3, music with non-NCHs (patients listened to Turkish classical music with non-NCHs during SWL). Hemodynamic and respiratory parameters were recorded before and just after the SWL session. All patient visual analog scale (VAS) and State-Trait Anxiety Inventory (STAI) scores were recorded just after the SWL procedure. There were significant differences in VAS scores among the groups (5.1, 3.6, and 4.5, respectively, p Music therapy during SWL reduced pain and anxiety. Music therapy with NCHs was more effective for pain and anxiety reduction. To reduce pain and anxiety, nonpharmacologic therapies such as music therapy with NCHs during SWL should be investigated further and used routinely.

  12. The effect of music therapy during shockwave lithotripsy on patient relaxation, anxiety, and pain perception.

    Science.gov (United States)

    Akbas, Alpaslan; Gulpinar, Murat Tolga; Sancak, Eyup Burak; Karakan, Tolga; Demirbas, Arif; Utangac, Mehmet Mazhar; Dede, Onur; Sancaktutar, Ahmet A; Simsek, Tuncer; Sahin, Basak; Resorlu, Berkan

    2016-01-01

    To research the effect of listening to music during shock wave lithotripsy (SWL) on the patient's pain control, anxiety levels, and satisfaction. The study comprised 400 patients from three hospitals. Half of patients listened to music during their first SWL session but not during their second session. The other half had no music for the first session but the second session was accompanied by music. During all sessions, with and without music, pulse rates, blood pressure, State-Trait Anxiety Inventory-State Anxiety scores (STAI-SA), Visual Analog Scale (VAS scores for pain), willingness to repeat procedure (0 = never to 4 happily), and patient satisfaction rates (0 = poor to 4 = excellent) were assessed. There was no statistical difference between the two groups in terms of blood pressure and pulse rates. In both groups, the STAI-SA and VAS pain scores were lower in the session when music was listened to (p music and their satisfaction was greater. Music lowered the anxiety and pain scores of patients during SWL and provided greater satisfaction with treatment. Completing this procedure while the patient listens to music increases patient compliance greatly and reduces analgesic requirements.

  13. Quantitative evaluation of stone fragments in extracorporeal shock wave lithotripsy using a time reversal operator

    Science.gov (United States)

    Wang, Jen-Chieh; Zhou, Yufeng

    2017-03-01

    Extracorporeal shock wave lithotripsy (ESWL) has been used widely in the noninvasive treatment of kidney calculi. The fine fragments less than 2 mm in size can be discharged by urination, which determines the success of ESWL. Although ultrasonic and fluorescent imaging are used to localize the calculi, it's challenging to monitor the stone comminution progress, especially at the late stage of ESWL when fragments spread out as a cloud. The lack of real-time and quantitative evaluation makes this procedure semi-blind, resulting in either under- or over-treatment after the legal number of pulses required by FDA. The time reversal operator (TRO) method has the ability to detect point-like scatterers, and the number of non-zero eigenvalues of TRO is equal to that of the scatterers. In this study, the validation of TRO method to identify stones was illustrated from both numerical and experimental results for one to two stones with various sizes and locations. Furthermore, the parameters affecting the performance of TRO method has also been investigated. Overall, TRO method is effective in identifying the fragments in a stone cluster in real-time. Further development of a detection system and evaluation of its performance both in vitro and in vivo during ESWL is necessary for application.

  14. Comparison of Pneumatic and Laser Lithotripsy in the Endoscopic Treatment of Upper Ureteral Stones

    Directory of Open Access Journals (Sweden)

    Ozer Guzel

    2016-04-01

    Full Text Available Aim: We aimed to compare the success rate of the use of a pneumatic and a holmium laser lithotripter for endoscopic treatment of upper ureteral calculi with semirigid uretero-renoscopy (URS. Material and Method: A total of 74 patients were included in this study. The patients were divided into two groups; a ballistic lithotripter was used for group 1 containing 33 and a Holmium-YAG laser lithotripter for the remaining 41 patients in group 2. Both groups were compared in terms of stone size the duration of the operation, postoperative hospitalization time, stone-free rate and complications. Results: The mean age of the patients was 47.6. The mean stone size in groups 1 and 2 were 16.4mm and 11.0mm, respectively (p=0.043. The mean stone-free rate groups 1 and 2 were 78.7% and 80.5% respectively at the approximately 1 month follow-up (p=0.391. In group 1 two patients and in group 2 two patients had a minor complication (ClavienI-II. In group 1 three patients had major complications due to ureteral perforation (Clavien 3a and 3b. No major complications (Clavien III-V occurred in Group 2. Discussion: Based on these findings laser lithotripsy can be regarded as safer. If laser lithotripter is available in medical centers, we argue that it should be the first choice for the treatment of upper ureteral stones.

  15. Analysis of the safety profile of treatment with a large number of shock waves per session in extracorporeal lithotripsy.

    Science.gov (United States)

    Budía Alba, A; López Acón, J D; Polo-Rodrigo, A; Bahílo-Mateu, P; Trassierra-Villa, M; Boronat-Tormo, F

    2015-06-01

    To assess the safety of increasing the number of waves per session in the treatment of urolithiasis using extracorporeal lithotripsy. Prospective, comparative, nonrandomized parallel study of patients with renoureteral lithiasis and an indication for extracorporeal lithotripsy who were consecutively enrolled between 2009 and 2010. We compared group I (160 patients) treated on schedule with a standard number of waves/session (mean 2858,3±302,8) using a Dornier lithotripter U/15/50 against group II (172 patients) treated with an expanded number of waves/session (mean, 6728,9±889,6) using a Siemens Modularis lithotripter. The study variables were age, sex, location, stone size, number of waves/session and total number of waves to resolution, stone-free rate (SFR) and rate of complications (Clavien-Dindo classification). Student's t-test and the chi-squared test were employed for the statistical analysis. The total rate of complications was 11.9% and 10.46% for groups I and II, respectively (P=.39). All complications were minor (Clavien-Dindo grade I). The most common complications were colic pain and hematuria in groups I and II, respectively, with a similar treatment intolerance rate (P>.05). The total number of waves necessary was lower in group II than in group I (P=.001), with SFRs of 96.5% and 71.5%, respectively (P=.001). Treatment with an expanded number of waves per session in extracorporeal lithotripsy does not increase the rate of complications or their severity. However, it could increase the overall effectiveness of the treatment. Copyright © 2014 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.

  16. Local anesthesia for extracorporeal shock wave lithotripsy: a study comparing eutetic mixture of local anesthetics cream and lidocaine infiltration

    DEFF Research Database (Denmark)

    Honnens de Lichtenberg, M; Miskowiak, J; Mogensen, P

    1992-01-01

    A study of the anesthetic efficacy of a eutetic mixture of local anesthetics (EMLA cream) versus lidocaine infiltration in extracorporeal shock wave lithotripsy (ESWL) was done. A total of 46 patients had 30 gm. of EMLA cream applied to the skin over the kidney and 45 had subcutaneous infiltration...... analgesics were not significantly different between the 2 groups. There were no significant differences between the groups with regard to post-ESWL skin changes. Therefore, EMLA cream can be recommended for ESWL provided it is applied correctly....

  17. Evaluation of shock wave lithotripsy injury in the pig using a narrow focal zone lithotriptor

    Science.gov (United States)

    Connors, Bret A.; McAteer, James A.; Evan, Andrew P.; Blomgren, Philip M.; Handa, Rajash K.; Johnson, Cynthia D.; Gao, Sujuan; Pishchalnikov, Yuri A.; Lingeman, James E.

    2012-01-01

    OBJECTIVE To assess renal injury in a pig model after treatment with a clinical dose of shock waves using a narrow focal zone (≈ 3 mm) lithotriptor (Modulith SLX, Karl Storz Lithotripsy). MATERIALS AND METHODS The left kidney of anaesthetized female pigs were treated with 2000 or 4000 shock waves (SWs) at 120 SWs/min, or 2000 SWs at 60 SWs/min using the Storz SLX. Measures of renal function (glomerular filtration rate and renal plasma flow) were collected before and 1 h after shock wave lithotripsy (SWL) and the kidneys were harvested for histological analysis and morphometric quantitation of haemorrhage in the renal parenchyma with lesion size expressed as a percentage of functional renal volume (FRV). A fibre-optic probe hydrophone was used to determine acoustic output and map the focal width of the lithotriptor. Data for the SLX were compared with data from a previously published study in which pigs of the same age (7–8 weeks) were treated (2000 SWs at 120 or 60 SWs/min) using an unmodified Dornier HM3 lithotriptor. RESULTS Treatment with the SLX produced a highly focused lesion running from cortex to medulla and often spanning the full thickness of the kidney. Unlike the diffuse interstitial haemorrhage observed with the HM3, the SLX lesion bore a blood-filled core of near-complete tissue disruption devoid of histologically recognizable kidney structure. Despite the intensity of tissue destruction at the core of the lesion, measures of lesion size based on macroscopic determination of haemorrhage in the parenchyma were not significantly different from kidneys treated using the HM3 (2000 SWs, 120 SWs/min: SLX, 1.86 ± 0.52% FRV; HM3, 3.93 ± 1.29% FRV). Doubling the SW dose of the SLX from 2000 to 4000 SWs did not significantly increase lesion size. In addition, slowing the firing rate of the SLX to 60 SWs/min did not reduce the size of the lesion (2.16 ± 0.96% FRV) compared with treatment at 120 SWs/min, as was the case with the HM3 (0.42 ± 0.23% FRV vs 3

  18. Efficacy of Combined Endoscopic Lithotomy and Extracorporeal Shock Wave Lithotripsy, and Additional Electrohydraulic Lithotripsy Using the SpyGlass Direct Visualization System or X-Ray Guided EHL as Needed, for Pancreatic Lithiasis

    Directory of Open Access Journals (Sweden)

    Ken Ito

    2014-01-01

    Full Text Available Introduction. To evaluate the efficacy of combined endoscopic lithotomy and extracorporeal shock wave lithotripsy (ESWL, and additional electrohydraulic lithotripsy (EHL as needed, for the treatment of pancreatic duct stones, we retrospectively evaluated 98 patients with chronic pancreatitis and pancreatic lithiasis. Methods. For the management of main pancreatic duct (MPD stones in 98 patients, we performed combined endoscopic treatment (ET/ESWL therapy as the first treatment option. When combined ET/ESWL was unsuccessful, EHL with the SpyGlass Direct Visualization system or X-ray guided EHL was performed. Outpatient ESWL was reserved as one of the final treatment options. Results. Fragmentation was successful in 80 (81.6% patients as follows: combined ET/ESWL: 67 cases; SpyGlass EHL: 4 cases; X-ray guided EHL: 3 cases; and outpatient ESWL: 6 cases. Successful outcome was obtained by combined ET/ESWL in 67 of the 98 patients (74.5%, by EHL in 7 of 14 patients (7.1%, and by outpatient ESWL in 6 of 6 patients (6.1%. Negotiating the guidewire through a severe MPD stricture was significantly associated with a higher rate of stone fragmentation (P=0.0003. Conclusions. In cases where combined ET/ESWL was not successful for stone clearance, EHL using the SpyGlass system or X-ray guided EHL was effective in cases where the guidewire could be negotiated through the MPD stricture and it increased the fragmentation rate.

  19. Extracorporeal shock wave lithotripsy for pancreatic and large common bile duct stones

    Institute of Scientific and Technical Information of China (English)

    Manu Tandan; D Nageshwar Reddy

    2011-01-01

    Extraction of large pancreatic and common bile duct (CBD) calculi has always challenged the therapeutic endoscopist. Extracorporeal shockwave lithotripsy (ESWL) is an excellent tool for patients with large pancreatic and CBD calculi that are not amenable to routine endotherapy. Pancreatic calculi in the head and body are targeted by ESWL, with an aim to fragment them to < 3 mm diameter so that they can be extracted by subsequent endoscopic retrograde cholangiopancreatography (ERCP). In our experience, complete clearance of the pancreatic duct was achieved in 76% and partial clearance in 17% of 1006 patients. Short-term pain relief with reduction in the number of analgesics ingested was seen in 84% of these patients. For large CBD calculi, a nasobiliary tube is placed to help target the calculi, as well as bathe the calculi in saline - a simple maneuver which helps to facilitate fragmentation.The aim is to fragment calculi to < 5 mm size and clear the same during ERCP. Complete clearance of the CBD was achieved in 84.4% of and partial clearance in 12.3% of 283 patients. More than 90% of the patients with pancreatic and biliary calculi needed three or fewer sessions of ESWL with 5000 shocks being delivered at each session. The use of epidural anesthesia helped in reducing patient movement. This, together with the better focus achieved with newer third-generation generation lithotripters, prevents collateral tissue damage and minimizes the complications. Complications in our experience with nearly 1300 patients were minimal, and no extension of hospital stay was required. Similar rates of clearance of pancreatic and biliary calculi with minimal adverse effects have been reported from the centers where ESWL is performed regularly. In view of its high efficiency, non-invasive nature and low complication rates, ESWL can be offered as the first-line therapy for selected patients with large pancreatic and CBD calculi.

  20. Routine liver function tests and serum amylase determinations after biliary lithotripsy: are they necessary?

    Science.gov (United States)

    Goodacre, B W; Malone, D E; Fache, J S; Rawat, B; Burhenne, H J

    1990-10-01

    Shock-wave-induced soft-tissue damage after biliary extracorporeal shock-wave lithotripsy (BESWL) has been reported. Every patient treated in Vancouver has, therefore, had liver function tests and serum amylase levels measured before and within 6 days after BESWL. All patients had symptomatic cholecystolithiasis with normal pre-BESWL biochemistry. Analysis of 311 patients after treatment with the Siemens Lithostar unit showed elevation of one or more laboratory value in 19% (60/311). Serum aspartate transaminase level was most frequently abnormal (38 cases). The majority of abnormalities were mild, less than two times normal levels. Clinically significant complications occurred in five patients (three pancreatitis, one cholecystitis, one common bile duct obstruction); four of these occurred 1 week or more after treatment. The results of routine laboratory tests could not be used to predict complications. No correlation was seen between abnormal values and number of shock waves administered or peak shock-wave pressure. Of 112 patients surveyed at the time of post-BESWL enzyme measurement, 49 (44%) reported a degree of pain, which was severe in eight cases. Presence of severe pain correlated strongly (p less than .001) with abnormal laboratory findings, however not with the degree of abnormality. As results of these laboratory tests are nonspecific, have not been shown to correlate with the degree of severity of BESWL-induced tissue damage, and do not predict complications, the tests are of little value in the absence of clinical signs and symptoms. These conclusions, however, apply only to the Siemens Lithostar Plus with patients treated in the steep left posterior oblique position. Cost savings can be expected if routine post-BESWL biochemical tests are abandoned.

  1. Urine cytology to evaluate urinary urothelial damage of shock-wave lithotripsy.

    Science.gov (United States)

    Mustafa, Mahmoud; Pancaroglu, Kuddusi

    2011-06-01

    Our aim is to study the prospective trial where urine cytology was used to detect the acute urothelial mucosal damage in patients who undergo extracorporeal shock waves lithotripsy (SWL). The study included 48 consecutive patients (28 male, 20 female) with mean age of 49.02 years (range 18-66) who were treated with SWL due to renal stones (30 patients) or upper ureter stones (18 patients). The mean calculi diameter was 12.44 mm (range 5-20). Urinary cytologic examinations were done for all patients immediately before and after SWL therapy and 10 days latter. The average numbers of transitional cells, red blood cells and myocytes were counted under 40 × magnification. In overall patients the average numbers of transitional cells at the cytologic examinations done immediately before and after SWL therapy were 1.6 and 7.53 cell/field, respectively (p = 0.001). The increment in transitional cells at cytologic examination after SWL was significantly influenced only by number of shock waves applied (p = 0.003). No muscle cell was detected in all cytologic examinations. The cytologic examinations which were done after 10 days of SWL therapy showed recovery from all cytologic abnormalities. The acute increment in number of transitional cells after the SWL is not clinically important and it is a temporary change. Urothelial lesion is limited to mucosal layer and there is no evidence of damage to basal membrane or deeper muscle layer. SWL safety on urothelial and muscular layer was demonstrated. However, evaluation of larger series with use of other lithotripters is necessary before reaching any definitive conclusions.

  2. Comparison of tamsulosin with extracorporeal shock wave lithotripsy in treating distal ureteral stones

    Institute of Scientific and Technical Information of China (English)

    ZHANG Meng-yuan; DING Sen-tai; L(U) Jia-ju; LUE Yan-he; ZHANG Hui; XIA Qing-hua

    2009-01-01

    Background Tamsulosin,an alpha-1 receptor antagonist,has been demonstrated effective in promoting distal ureteral stone passage and in reducing pain associated with stone expulsion.This study aimed to evaluate the effect of tamsulosin in comparison with nifedipine and extracerporeal shock wave lithotripsy (ESWL) on the expulsion rate of distal ureteral stones at different sizes.Methods We assigned 314 patients to three categories:Ⅰ,the stone with maximal diameter of 4.0-5.9 mm;Ⅱ,6.0-7.9mm,and Ⅲ,8.0-9.9 mm.Patients in each category were randomly subdivided into three treatment subgroups:group A (nifedipine group),group B (tamsulosin group),and group C (ESWL group).Stone-free rate and the dose of analgesics were recorded weekly during the 4-week follow-up period.Results Three hundred and three patients completed the study.The results showed that nifedipine and tamsulosin treatments promoted a small (4-8 mm,categories Ⅰ and Ⅱ) stone expulsive rate that was comparable with ESWL treatment.Nonetheless,when the stone diameter was 8.0-9.9 mm,ESWL showed a greater stone free rate than nifedipine and tamsulosin treatments;no significant difference existed between the latter two therapies.Although the ESWL treatment group required the least analgesics,tamsulosin treatments required less pain medication than nifedipine (P <0.05).Conclusions Tamsulosin treatment is recommended for patients with the stone diameter smaller than 8 mm because of its feasibility,effectiveness and safety.ESWL is more appropriate than tamsulosin therapy for the patients whose stones are larger than 8 mm.

  3. Chemical decomposition of urinary stones during holmium-laser lithotripsy: II. Evidence for photothermal breakdown

    Science.gov (United States)

    Glickman, Randolph D.; Teichman, Joel M. H.; Vassar, George J.; Weintraub, Susan T.; Chan, Kin Foong; Pfefer, T. Joshua; Welch, Ashley J.

    1999-06-01

    Because of the greater than or equal to 250 microsecond pulsewidth emitted by the Ho:YAG laser used in clinical lithotripsy, it is unlikely that stress confinement occurs within the irradiated stones. Experimental data supports a thermal mechanism for Ho:YAG laser stone ablation. Stone fragmentation occurs soon after the onset of the laser pulse, is uncorrelated to cavitation bubble formation or collapse, and is associated with low pressures (cf. part I). The mass- loss of desiccated calcium oxalate monohydrate (COM) stones exposed to 150 J from the Ho:YAG laser in air was 40 plus or minus 12 mg (mean plus or minus 1 s.d.); for hydrated stones in air was 25 plus or minus 9 mg; and for hydrated stones in water was 17 plus or minus 3 mg, p less than .001. These differences indicate that direct absorption of the laser radiation by the stone is required for the most efficient ablation. Lowering the initial temperature of COM or cystine stones also reduced the stone mass-loss following 20 J of delivered laser energy: 2.2 plus or minus 1.1 mg vs 5.2 plus or minus 1.6 mg for COM stones (-80 vs 23 degrees Celsius), and 0.8 plus or minus 0.4 mg vs 2.2 plus or minus 1.1 mg for cystine stones (-80 vs 23 degrees Celsius), p less than or equal to .05. Finally, chemical analysis of the laser-induced stone fragments revealed the presence of thermal breakdown products: CaCO3 from COM; free sulfur and cysteine from cystine; Ca2O7P2 from calcium hydorgen phosphate dihydrate, and cyanide from uric acid.

  4. [Percutaneous nephrolitholapaxy combined with extracorporeal shockwave lithotripsy in the treatment of staghorn lithiasis].

    Science.gov (United States)

    Larrea Masvidal, E; García Serrano, C; Castillo Rodríguez, M; Hernández Silverio, D; Casals Armada, J; Valdés Gómez, C; Báez Hernández, D

    1990-05-01

    From December, 1988 to July, 1989, 41 patients with renal or juxtapyelic ureteral calculi were submitted to percutaneous litholapaxy (PCN) at the Stone Center of the Hermanos Amerijeiras Hospital in Havana. This series comprise our early experience utilizing this procedure. PCN was initially limited to pelvic and juxtapyelic ureteric calculi with dilated renal cavities. It was subsequently used in combination with extracorporeal lithotripsy (ESWL) in the treatment of staghorn stones. The present study analyzed the results achieved with PCN in 30 patients with staghorn calculi; 21 (70%) incomplete staghorns and 9 (30%) complete staghorns. Posteriorly, 6 additional borderline staghorns were completely removed by PCN and are not included in the present study. PCN was performed to reduce stone mass and for placement of a large renal drain to permit subsequent ESWL. At two months following treatment, 86.6% of the patients were completely stone-free. The remaining 13.4% with stone remnants presented anatomic and functional renal conditions that allow us to predict complete elimination within a short period of time. Since 6 months had not elapsed in these cases, these were not considered as residual fragments. One patient presented massive absorption of fluids. This was the only observed major and non-lethal complication. Episodes of fever were observed in 23% post-PCN. No patient presented severe sepsis. In our view, PCN combined with ESWL is one of the currently available therapeutic options in the treatment of staghorn calculi. This approach permits adequate resolution of cases that would have otherwise required surgery.

  5. Shock Wave Lithotripsy: Effects on the Pancreas and Recurrent Stone Disease

    Science.gov (United States)

    Krambeck, Amy E.; Rohlinger, Audrey L.; Lohse, Christine M.; Patterson, David E.; Gettman, Matthew T.

    2007-04-01

    Long-term effects of shockwave lithotripsy (SWL) are unknown; however, we recently found an association between SWL and diabetes mellitus in a population based case control cohort. To further study the association between SWL and diabetes mellitus, we determined the immediate impact of SWL on the pancreas as well as the long-term natural history of stone disease following treatment. Chart review identified 630 patients treated with SWL at our institution in 1985. Questionnaires focusing on recurrent stone episodes after SWL were sent to 578 patients alive in 2004. To further assess impact of SWL on the pancreas, pancreatic enzyme measurements were performed on 24 symptomatic stone patients treated in 2006 with ureteroscopy (n=12) and SWL (n=12). Serum amylase and lipase were evaluated pre and post SWL. A⩾5 U/L increase in either lab value was considered significant. Among patients in the long-term SWL treatment group, the questionnaire response rate was 58.9% (288/489). Recurrent stone events were noted in 154 (53.5%) of the survey respondents. Characteristics associated with stone recurrences were: gender (p=0.004), age at SWL (p=0.022), BMI (p=0.007), SWL complications (p=0.009), and lower pole SWL (p=0.025). Recurrent stone disease was also associated with the development of diabetes mellitus (p=0.020). In the contemporary group of treated stone patients, pancreatic enzyme analysis demonstrated an increase in serum amylase and lipase in 3 (25.0%) SWL patients and 1 (8.3%) ureteroscopy patient (p=0.273). In conclusion, over half of the patients treated with SWL will develop recurrent stone events. We found a strong association between recurrent stone disease and the development of diabetes mellitus at long-term follow-up. Although not statistically significant due to small number, data in a contemporary treatment cohort suggest the possibility that the pancreas can be adversely affected by SWL.

  6. Noninvasive management of obstructing ureteral stones using electromagnetic extracorporeal shock wave lithotripsy.

    Science.gov (United States)

    Sighinolfi, M C; Chiara, S M; Micali, S; Salvatore, M; De Stefani, S; Stefano, D S; Saredi, G; Mofferdin, A; Grande, M; Bianchi, G; Giampaolo, B

    2008-05-01

    Extracorporeal shock wave lithotripsy (ESWL) represents noninvasive management of urolithiasis. Since the first HM3 model, technological progress has improved the efficacy and safety of this treatment. The current study aimed to evaluate the role of ESWL as a first-line emergency therapy of renal colic due to ureteral stone with impaired renal function. This prospective study enrolled all the patients admitted from the emergency room with acute renal colic meeting the following criteria: serum creatinine level ranging from 1.5 to 2.5 mg/dl, hydronephrosis, ureteral stones 6 to 15 mm in size, body mass index less than 30, normal renal function at baseline, and no evidence of urinary tract infection. The patients were submitted to a single-session emergency treatment using Dornier Litothripter S. Follow-up assessment, performed at 24 and 72 h, included radiologic and ultrasound examinations with renal function serum assessment. The end points were a decrease in creatinine level and a stone-free condition. A total of 40 patients were eligible for the study. The mean creatinine level at admission was 1.93 +/- 0.26 mg/dl. After the treatment, renal function recovery occurred for 34 subjects (85%), with a significant global decrease in creatinine levels (p = 0.00). The global stone-free rate 72 h after SWL was 67.5% (27/40). The patients with residual fragments were managed using re-SWL (n = 7) and endoscopic technique (n = 6). Emergency SWL represents an effective tool in the treatment of ureteral stones with hydronephrosis and slight renal impairment. Although complete stone clearance after one treatment still remains a difficult target, the actual role of SWL in the management of acute obstruction is to obtain ureteral canalization and renal function recovery.

  7. Impact of pulse duration on Ho:YAG laser lithotripsy: fragmentation and dusting performance.

    Science.gov (United States)

    Bader, Markus J; Pongratz, Thomas; Khoder, Wael; Stief, Christian G; Herrmann, Thomas; Nagele, Udo; Sroka, Ronald

    2015-04-01

    In vitro investigations of Ho:YAG laser-induced stone fragmentation were performed to identify potential impacts of different pulse durations on stone fragmentation characteristics. A Ho:YAG laser system (Swiss LaserClast, EMS S.A., Nyon, Switzerland) with selectable long or short pulse mode was tested with regard to its fragmentation and laser hardware compatibility properties. The pulse duration is depending on the specific laser parameters. Fragmentation tests (hand-held, hands-free, single-pulse-induced crater) on artificial BEGO stones were performed under reproducible experimental conditions (fibre sizes: 365 and 200 µm; laser settings: 10 W through combinations of 0.5, 1, 2 J/pulse and 20, 10, 5 Hz, respectively). Differences in fragmentation rates between the two pulse duration regimes were detected with statistical significance for defined settings. Hand-held and motivated Ho:YAG laser-assisted fragmentation of BEGO stones showed no significant difference between short pulse mode and long pulse mode, neither in fragmentation rates nor in number of fragments and fragment sizes. Similarly, the results of the hands-free fragmentation tests (with and without anti-repulsion device) showed no statistical differences between long pulse and short pulse modes. The study showed that fragmentation rates for long and short pulse durations at identical power settings remain at a comparable level. Longer holmium laser pulse duration reduces stone pushback. Therefore, longer laser pulses may result in better clinical outcome of laser lithotripsy and more convenient handling during clinical use without compromising fragmentation effectiveness.

  8. Effect of urine pH on the effectiveness of shock wave lithotripsy: A pilot study.

    Science.gov (United States)

    Majzoub, Ahmad; Al-Ani, Ammar; Gul, Tawiz; Kamkoum, Hatem; Al-Jalham, Khalid

    2016-01-01

    Shock wave lithotripsy (SWL) is a well-established modality in the treatment of urolithiasis. Studying the effect of urine pH on SWL success is appealing as pH can be manipulated before SWL to insure a better outcome. This is a prospective study performed at a tertiary medical center. Patients presenting to the SWL unit with a single renal stone <2 cm in size were included in this study. In addition to standard laboratory and radiologic investigations, urine pH measurement was performed on all patients before their procedure. The number of sessions performed, and the stone-free rate (SFR) were assessed. Patients were divided into two groups according to stone clearance. Group 1 was stone-free, whereas Group 2 had residual stones after three sessions of SWL. Data was also classified according to different pH ranges. Influential factors were compared among the study groups and pH ranges. A total of 175 patients were included in this study. The SFR was 54.3%. The mean number of sessions performed was 2.2 ± 0.8. Group 1 included 95 patients, whereas Group 2 had eighty patients. Among all studied factors, stone size (P = 0.03) and skin to stone distance (P = 0.04) significantly affected SFR with SWL. Urine pH was not found to have a statistically significant influence on SWL outcome (P = 0.51). Urine pH was not found in this study population to influence the effectiveness of SWL. Further experimental studies are required to help investigate this notion.

  9. Treatment of upper urinary tract stones with extracorporeal shock wave lithotripsy (ESWL Sonolith vision

    Directory of Open Access Journals (Sweden)

    Nakamura Kogenta

    2011-12-01

    Full Text Available Abstract Background The aim was to retrospectively assess the results of treatment of upper urinary tract stones with the Sonolith vision manufactured by EDAP, and purchased in 2004. Methods The subjects were 226 Japanese patients who underwent extracorporeal shock wave lithotripsy (ESWL alone as an initial treatment and could be followed up for at least 3 months, selected from 277 candidate patients who underwent this therapy between 2004 and 2006. Treatment effect was evaluated by kidney, ureter, and bladder X-ray or renal ultrasonography at 1 and 3 months after treatment. A stone-free status or status of stone fragmentation to 4 mm or smaller was considered to indicate effective treatment. Results At 3 months after treatment, the stone-free rate was 69.4% and the efficacy rate was 77.4% for renal stones, while these rates were 91.5 and 93.3%, respectively for ureteral stones. Assessment of treatment effect classified by the location of stones revealed a stone-free rate of 94.6% and an efficacy rate of 94.6% for lower ureteral stones (4.0 mm or smaller, 1 subject; 4.1-10.0 mm, 31 subjects; 10.1-20.0 mm, 5 subjects: number of treatment sessions, 1 or 2 sessions [mean: 1.03 sessions]. Complications of this therapy included renal subcapsular hematoma and pyelonephritis in 1 case each. Conclusions ESWL with the Sonolith vision manufactured by EDAP produced a treatment effect equivalent to those achieved with other models of ESWL equipment. ESWL seems to be an effective first-line treatment also in patients who have lower ureteral stones 10 mm or larger but do not wish to undergo TUL, if measures such as suitable positioning of the patient during treatment are taken.

  10. Clinical application of the ureteroscope assistant placement of peritoneal dialysis catheters%输尿管镜辅助下腹膜透析管置入技术的应用

    Institute of Scientific and Technical Information of China (English)

    朱微; 燕翔; 蒋春明; 张苗

    2012-01-01

    To evaluate the clinical feasibility,safety and effect of the ureteroscope assistant placement of peritoneal dialysis catheters in patients with end stage renal disease (ESRD). Methodology: Thirty two consecutive ESRD patients underwent ureteroscope assistant placement of peritoneal dialysis catheters. Informed consent form was signed by patients under principle of voluntary. All patients were eligible to receive local infiltration anesthesia. Ureteroscopic monitoring was performed via a peer-away sheath through an incision near the umbilicus. A catheter was passed through the peer-away sheath into the true pelvis. A subcutaneous tunnel was created and a point in left lower quadrant was selected as the exit site of the catheter. Results; All the catheters were successfully placed and the mean time of operation was (42 ±15) minutes. The dose of additional local anesthetics during procedure is 20% lidocaine (13 ±5) milliliter. Blood loss was very little in operation. Only 4 cases presented the ascites with little red blood cells which lasted (16 ±5) hours. During mean follow-up period of 12 months, there were no catheter-related complications, such as catheter migration, obstruction,and dialysate leakage. Conclusion:The ureteroscope assistant placement of peritoneal dialysis catheters is worthy to be popularized for it's safty and effectiveness in end stage renal disease ( ESRD) patients.%目的:探讨输尿管镜辅助下腹膜透析管置人技术的临床应用安全性和疗效. 方法:自愿选择腹膜透析替代治疗的终末期肾病患者32例,局麻下采用经皮微创穿刺技术,使用Peer-Away鞘建立腹腔通道,以输尿管镜进入腹腔内定位,并引导腹膜透析管置于膀胱直肠窝或子宫直肠窝,近端建立皮下隧道并经左下腹戳洞引出.结果:全部患者腹膜透析管均放置成功,手术时间(42±15) min,术中用20%盐酸利多卡因(13±5)ml,出血极少,仅4例术后出现淡血

  11. Invertible flexible matrices

    Science.gov (United States)

    Justino, Júlia

    2017-06-01

    Matrices with coefficients having uncertainties of type o (.) or O (.), called flexible matrices, are studied from the point of view of nonstandard analysis. The uncertainties of the afore-mentioned kind will be given in the form of the so-called neutrices, for instance the set of all infinitesimals. Since flexible matrices have uncertainties in their coefficients, it is not possible to define the identity matrix in an unique way and so the notion of spectral identity matrix arises. Not all nonsingular flexible matrices can be turned into a spectral identity matrix using Gauss-Jordan elimination method, implying that that not all nonsingular flexible matrices have the inverse matrix. Under certain conditions upon the size of the uncertainties appearing in a nonsingular flexible matrix, a general theorem concerning the boundaries of its minors is presented which guarantees the existence of the inverse matrix of a nonsingular flexible matrix.

  12. Global Sourcing Flexibility

    DEFF Research Database (Denmark)

    Ørberg Jensen, Peter D.; Petersen, Bent

    2013-01-01

    sourcing flexibility. Here we draw on prior research in the fields of organizational flexibility, international business and global sourcing as well as case examples and secondary studies. In the second part of the paper, we discuss the implications of global sourcing flexibility for firm strategy......Recent studies show that flexibility is a key concern for firms that engage in the global sourcing of services. In this conceptual paper, we seek to explore two central aspects of global sourcing flexibility: In the first part of the paper, we provide a definition of the construct of global...... and operations against the backdrop of the theory-based definition of the construct. We discuss in particular the importance of global sourcing flexibility for operational performance stability, and the trade-off between specialization benefits, emerging from location and service provider specialization, versus...

  13. Call centres: constructing flexibility

    OpenAIRE

    Arzbächer, Sandra; Holtgrewe, Ursula; Kerst, Christian

    2002-01-01

    "The development of call centres as a flexible interface between firms and their environments has been seen as exemplary or even symptomatic of flexible capitalism (Sennett 1998). We are going to point out that they do not just stand for organisational change but also for changes of institutions towards deregulation. Employers and managers hoped for gains of flexibility, decreasing labour costs, and market gains by an expanded 24-hour-service. Surveillance and control by flexib...

  14. Pneumatic flexible shaft couplings

    OpenAIRE

    2007-01-01

    Main effort of every design engineer is reduction of torsional oscillation in any mechanical system. At present this problem can be solved by means of a suitable modification of dynamic properties of flexible shaft couplings according to dynamics in the given systems. But the dynamic properties of nowadays-applied flexible couplings arenot unchangeable because of aging and fatigue processes occurring in flexible coupling elements. Result of this fact causes detuning of mechanical system. Taki...

  15. Comparison of Extracorporeal Shock Wave Lithotripsy for Urolithiasis Between Children and Adults: A Single Centre Study

    Science.gov (United States)

    Assad, Salman; Rahat Aleman Bhatti, Joshua; Hasan, Aisha; Shabbir, Muhammad Usman; Akhter, Saeed

    2016-01-01

    Objective To retrospectively evaluate the effectiveness of extracorporeal shock wave lithotripsy (ESWL) for urolithiasis and compare the results between children and adults. Materials and methods From January 2011 to January 2015 (four years), ESWL was performed in 104 children and 300 adults for urolithiasis. MODULITH® SLX-F2 lithotripter (Storz Medical AG, Tägerwilen, Switzerland) equipment was used for ESWL. The stone-free rates, the number of ESWL sessions required, complication rates and ancillary procedures used were evaluated in a comparative manner. Results The mean age ± standard deviation (SD) of children was 7.84±4.22 years and of adults was a 40.22±1.57 years. Mean ± SD of the stone size was 1.28±61 cm in the adults while 1.08 ± 0.59 cm in the children. In adults, the complications included steinstrasse in six (1.98%) patients, fever in 15 (4.95%), hematuria in 19 (6.28%) and sepsis in six (1.98%) patients. In children, steinstrasse was observed in two (1.9%), mild fever in two (1.9%), hematuria in six (5.7%) and sepsis was seen in four (3.8%) patients. The overall complication rate in the adults and in the children, it was found to be 46/300 (15%) and in the children, it was seen to be 14/104 (13%). No statistical difference was found in post-ESWL complications between children and adults (P>0.05). Ancillary procedures including double J (DJ) stent were used in 13 (12.5%) children and 87 (29%) adults. There was a better stone clearance rate in children i.e. 79% as compared to 68% in adults (X2: P=0.036). Conclusion Children can achieve high stone-free rates after ESWL with a lower need for repeat ancillary procedures as compared to adults. However, there is a difference in the post-ESWL complications between these groups. PMID:27800291

  16. 后腹腔镜与输尿管镜技术用于感染性输尿管上段结石取石碎石的比较%Comparison between retroperitoneal laparoscopic ureterolithotomy and ureteroscopic lithotripsy in treating obstructive upper ureteral stones with urosepsis

    Institute of Scientific and Technical Information of China (English)

    马进荣; 蒋君涛; 孙晓文; 李维国; 张捷; 郭三维; 阮渊; 夏术阶

    2016-01-01

    目的 比较腹腔镜输尿管切开取石术与输尿管镜钬激光碎石术治疗有上尿路感染病史的梗阻性输尿管上段结石的疗效和安全性.方法 回顾性分析189例有上尿路感染病史的梗阻性输尿管上段结石患者的临床资料,统计两种手术方式的结石清除率、术后并发症,特别是感染并发症情况,评价两种手术方式的疗效和安全性.结果 腹腔镜手术组患者81例,输尿管镜手术组患者108例.两组患者的年龄、性别比例无统计学差异.腹腔镜手术组患者的结石直径[(16.1±1.4) mm vs.(10.4±1.6)mm]、手术时间[(78.5±12.6)min vs.(37.3±14.7)min,P<0.05]、住院时间[(7.6±1.5)d vs.(4.7±1.8)d,P<0.05)]均明显大于输尿管镜手术组患者(P<0.05).腹腔镜手术组术后1月时的结石清除率为98.8%,输尿管镜组为88.9%,差异具有统计学意义(P<0.05).腹腔镜手术组患者术后高热(>38.5℃)的发生率明显低于输尿管镜手术组(4.9% vs.11.1%,P<0.05).结论 对于有明确上尿路感染病史的梗阻性输尿管上段结石患者,腹腔镜切开取石术较输尿管镜手术结石清除率高,术后感染并发症少,但手术时间、住院时间较长.

  17. PROSPECTIVE STUDY TO COMPARE THE EFFICACY OF ANALGESIC AGENTS USED FOR THE PAIN MANAGEMENT DURING EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY

    Directory of Open Access Journals (Sweden)

    Abhirudra

    2016-05-01

    Full Text Available BACKGROUND Extracorporeal shock wave lithotripsy (ESWL is well known for its non-invasiveness, effectiveness and minimal morbidity for the management of renal stones. Some generation of lithotripters were associated with significant pain, needing anaesthesia. In modern lithotripters, pain is insignificant making lithotripsy an outpatient procedure (day care. AIMS The present study is aimed to compare the clinical efficacy between four drugs. METHODS AND MATERIALS This was a prospective study of 1000 patients with normal BMI (25-30 who underwent ESWL in the Year 2012-15 at our institute. All the patients with renal stones were randomly divided into 4 groups. Dornier Compact Sigma lithotripsy machine was used in all the patients. Group A was given IM diclofenac sodium (1 mg/kg, 60 minutes before the procedure. In group B, 10 g of EMLA cream; and in group C, 15 g of diclofenac diethylamine gel; in group D placebo (electrode gel was applied locally. STATISTICAL ANALYSIS Visual analogue scale (VAS was used to assess the severity of pain for initial 5-10 minutes and after the procedure. A P value of less than 0.05 was considered to be statistically significant. Statistical analysis was done using one way ANOVA and results were compared between four groups. RESULTS All four groups were having comparable age, weight, stone size, number of shock waves delivered and maximum voltage used. In group A total 250 patients (M/F: 177/73, group B 250 patients (M/F: 129/121, group C 250 patients (M/F: 158/92, group D 250 patients (M/F: 162/88. With regard to pain scores, the responses were better in group B. According to location of the stones, majority of the stones were located in pelvis (41.5%, followed by upper (30.5% and middle calyx (16.8% and least in the lower calyx (11.2%. Overall stone free rate in our study was 75.5%, with least clearance in lower calyceal stones. 112 patients were stented prior to the procedure. Ureteroscopy and RIRS (Retrograde

  18. A new nomogram for prediction of outcome of pediatric shock-wave lithotripsy.

    Science.gov (United States)

    Dogan, Hasan Serkan; Altan, Mesut; Citamak, Burak; Bozaci, Ali Cansu; Karabulut, Erdem; Tekgul, Serdar

    2015-04-01

    Despite the fact that shock-wave lithotripsy (SWL) remains a very good treatment option for smaller stones, it is being challenged by endourologic treatment modalities, which offer similar or even higher success rates in a shorter time, with minimal morbidity and invasiveness. The present study aimed to bring a new and practical insight in order to predict the outcomes of pediatric SWL and to provide objective information about pediatric SWL outcomes. To design a nomogram for predicting the outcomes of pediatric shock-wave lithotripsy. The study was conducted with a retrospective design and included 402 renal units who underwent SWL between January 2009 and August 2013. Patients with known cystine stone disease and cystinuria, with internal or external urinary diversion, were excluded. Analysis was performed on 383 renal units. Postoperative imaging was performed by plain abdominal graphy and ultrasonography with 3-month intervals. Patients who were completely free of stones were considered to be a success and statistical analysis was done regardingly Multivariate analysis was conducted by logistic regression analysis and a nomogram was developed. The male/female distribution was 216/167, with a mean age of 48 ± 40 months and a mean stone size of 9 ± 3.5 mm. The overall stone-free rate was 70% (270/383) and efficacy quotient was 0.57. Mean follow-up was 11 ± 11 months (3-54 months). The number of shock waves and amplitude of energy were higher in failed cases. Multivariate analysis showed that gender, stone size, number of stones, age, location of the stone, and history of previous intervention were found to be the independent prognostic factors for assessing the stone clearance rates. A nomogram was developed using these parameters. In this nomogram, the points achieved from each parameter are summed and total points correspond to the risk of failure in percent. A previous nomogram study by Onal et al. showed that younger age (issue is concern about the

  19. Reversibly Bistable Flexible Electronics

    KAUST Repository

    Alfaraj, Nasir

    2015-05-01

    Introducing the notion of transformational silicon electronics has paved the way for integrating various applications with silicon-based, modern, high-performance electronic circuits that are mechanically flexible and optically semitransparent. While maintaining large-scale production and prototyping rapidity, this flexible and translucent scheme demonstrates the potential to transform conventionally stiff electronic devices into thin and foldable ones without compromising long-term performance and reliability. In this work, we report on the fabrication and characterization of reversibly bistable flexible electronic switches that utilize flexible n-channel metal-oxide-semiconductor field-effect transistors. The transistors are fabricated initially on rigid (100) silicon substrates before they are peeled off. They can be used to control flexible batches of light-emitting diodes, demonstrating both the relative ease of scaling at minimum cost and maximum reliability and the feasibility of integration. The peeled-off silicon fabric is about 25 µm thick. The fabricated devices are transferred to a reversibly bistable flexible platform through which, for example, a flexible smartphone can be wrapped around a user’s wrist and can also be set back to its original mechanical position. Buckling and cyclic bending of such host platforms brings a completely new dimension to the development of flexible electronics, especially rollable displays.

  20. Organizational flexibility estimation

    OpenAIRE

    Komarynets, Sofia

    2013-01-01

    By the help of parametric estimation the evaluation scale of organizational flexibility and its parameters was formed. Definite degrees of organizational flexibility and its parameters for the Lviv region enterprises were determined. Grouping of the enterprises under the existing scale was carried out. Special recommendations to correct the enterprises behaviour were given.

  1. Flexible magnetoimpidence sensor

    KAUST Repository

    Kavaldzhiev, Mincho

    2015-05-01

    Recently, flexible electronic devices have attracted increasing interest, due to the opportunities they promise for new applications such as wearable devices, where the components are required to flex during normal use[1]. In this light, different magnetic sensors, like microcoil, spin valve, giant magnetoresistance (GMR), magnetoimpedance (MI), have been studied previously on flexible substrates.

  2. Flexible 'zoning' aids adaptability.

    Science.gov (United States)

    Corben, Simon

    2013-09-01

    Simon Corben, business development director at Capita Symonds' Health team, examines how 'clever use of zoning' when planning new healthcare facilities could improve hospital design, increase inherent flexibility, and reduce lifetime costs, and argues that a 'loose-fit, non-bespoke approach' to space planning will lead to 'more flexible buildings that are suitable for conversion to alternative uses'.

  3. Flexible ferroelectric organic crystals

    Science.gov (United States)

    Owczarek, Magdalena; Hujsak, Karl A.; Ferris, Daniel P.; Prokofjevs, Aleksandrs; Majerz, Irena; Szklarz, Przemysław; Zhang, Huacheng; Sarjeant, Amy A.; Stern, Charlotte L.; Jakubas, Ryszard; Hong, Seungbum; Dravid, Vinayak P.; Stoddart, J. Fraser

    2016-10-01

    Flexible organic materials possessing useful electrical properties, such as ferroelectricity, are of crucial importance in the engineering of electronic devices. Up until now, however, only ferroelectric polymers have intrinsically met this flexibility requirement, leaving small-molecule organic ferroelectrics with room for improvement. Since both flexibility and ferroelectricity are rare properties on their own, combining them in one crystalline organic material is challenging. Herein, we report that trisubstituted haloimidazoles not only display ferroelectricity and piezoelectricity--the properties that originate from their non-centrosymmetric crystal lattice--but also lend their crystalline mechanical properties to fine-tuning in a controllable manner by disrupting the weak halogen bonds between the molecules. This element of control makes it possible to deliver another unique and highly desirable property, namely crystal flexibility. Moreover, the electrical properties are maintained in the flexible crystals.

  4. Flexible ferroelectric organic crystals

    Science.gov (United States)

    Owczarek, Magdalena; Hujsak, Karl A.; Ferris, Daniel P.; Prokofjevs, Aleksandrs; Majerz, Irena; Szklarz, Przemysław; Zhang, Huacheng; Sarjeant, Amy A.; Stern, Charlotte L.; Jakubas, Ryszard; Hong, Seungbum; Dravid, Vinayak P.; Stoddart, J. Fraser

    2016-01-01

    Flexible organic materials possessing useful electrical properties, such as ferroelectricity, are of crucial importance in the engineering of electronic devices. Up until now, however, only ferroelectric polymers have intrinsically met this flexibility requirement, leaving small-molecule organic ferroelectrics with room for improvement. Since both flexibility and ferroelectricity are rare properties on their own, combining them in one crystalline organic material is challenging. Herein, we report that trisubstituted haloimidazoles not only display ferroelectricity and piezoelectricity—the properties that originate from their non-centrosymmetric crystal lattice—but also lend their crystalline mechanical properties to fine-tuning in a controllable manner by disrupting the weak halogen bonds between the molecules. This element of control makes it possible to deliver another unique and highly desirable property, namely crystal flexibility. Moreover, the electrical properties are maintained in the flexible crystals. PMID:27734829

  5. Flexible Carbon Aerogels

    Directory of Open Access Journals (Sweden)

    Marina Schwan

    2016-09-01

    Full Text Available Carbon aerogels are highly porous materials with a large inner surface area. Due to their high electrical conductivity they are excellent electrode materials in supercapacitors. Their brittleness, however, imposes certain limitations in terms of applicability. In that context, novel carbon aerogels with varying degree of flexibility have been developed. These highly porous, light aerogels are characterized by a high surface area and possess pore structures in the micrometer range, allowing for a reversible deformation of the aerogel network. A high ratio of pore size to particle size was found to be crucial for high flexibility. For dynamic microstructural analysis, compression tests were performed in-situ within a scanning electron microscope allowing us to directly visualize the microstructural flexibility of an aerogel. The flexible carbon aerogels were found to withstand between 15% and 30% of uniaxial compression in a reversible fashion. These findings might stimulate further research and new application fields directed towards flexible supercapacitors and batteries.

  6. Hypovolemic Shock Caused by Massive Renal Hematoma After a Third Consecutive Extracorporeal Shockwave Lithotripsy Session: A Case Report.

    Science.gov (United States)

    Sermeus, Loic; Vander Eeckt, Kathy; Ost, Dieter; Van Den Branden, Marcel

    2016-01-01

    Extracorporeal shockwave lithotripsy (SWL) is a commonly used technique for treating urinary calculi. Although noninvasive, highly effective, and widely accepted, SWL is not without complications. Next to fragmenting the calculi, the surrounding tissue is damaged, which can result in renal hematoma, a well-described complication. In most cases, the collateral tissue damage is mild and resolves with conservative treatment. However, rarely, severe complications may arise. Here we present a case of a 46-year-old male who developed a massive hematoma, both subcapsular and retroperitoneal, after a third consecutive SWL session, resulting in hypovolemic shock. Different probable causes are proposed, of which one cause, the length of the interval between SWL sessions, is not yet studied properly. Probably, short intervals keep the damaged tissue from healing sufficiently, as proposed in our case. Possibly, life-threatening situations can be avoided if more evidence-based guidelines are available.

  7. /sup 99m/Tc-DTPA renography before and after extracorporeal shock wave lithotripsy for renal calculi

    Energy Technology Data Exchange (ETDEWEB)

    Ohtake, Eiji; Murata, Hajime; Kanemura, Mikio; Yokoyama, Masao

    1988-09-01

    This study was undertaken to evaluate /sup 99m/Tc-DTPA renography before and after extracorporeal shock wave lithotripsy (ESWL). Twelve patients with renal calculi were examined in this study. In three patients, bilateral kidneys were treated with ESWL. Sequential renal images of the vascular phase, and the functional and excretory phases were taken using a gamma camera (ZLC 7500, Siemens), after intravenous injection of 555 MBq of /sup 99m/Tc-DTPA. Renograms were generated using data stored every 10 seconds for a period of 30 minutes by computer (Scintipac-2400, Shimadzu). Some treated kidneys were enlarged and/or showed uniform retention of radioactivity on sequential images, within a week after ESWL. Renogram patterns after ESWL were varied in each patient. The renogram findings after ESWL seemed to be affected by the presence or absence of stone fragments in the urinary tract.

  8. [Focused lithotripsy in the treatment of tendinosis calcarea of the shoulder: results at 2 months and one year].

    Science.gov (United States)

    Sarrat, P; Cohen, M; Carrasset, S; Godde, J; Franceschi, J P; Aswad, R

    2004-10-01

    The authors report their experience with extracorporeal lithotripsy in 30 patients with calcific tendinosis of the rotator cuff. This technique is based upon the utilization of high-energy shockwaves (6000 shocks in 3 sessions Day 1, D8, D30) under continuous ultrasound localization of the lesion (EPOS Ultra1). Calcification were evaluated at plain film, US and CT to characterize their length and features. Complete or partial resorption of calcifying deposits within 2 months and one year was observed in 27.5% and 25% of cases respectively. Clinical improvement results are encouraging at two months (50%), but reduced at one year (28.5%), consistent with the rate of resorption of calcifications. This painful, long, and expensive technique seems to be disappointing in the treatment of the calcific tendinosis.

  9. Local anesthesia for extracorporeal shock wave lithotripsy: a study comparing eutetic mixture of local anesthetics cream and lidocaine infiltration

    DEFF Research Database (Denmark)

    Honnens de Lichtenberg, M; Miskowiak, J; Mogensen, P

    1992-01-01

    A study of the anesthetic efficacy of a eutetic mixture of local anesthetics (EMLA cream) versus lidocaine infiltration in extracorporeal shock wave lithotripsy (ESWL) was done. A total of 46 patients had 30 gm. of EMLA cream applied to the skin over the kidney and 45 had subcutaneous infiltration...... anesthesia with 20 ml. 1% lidocaine with epinephrine. All patients received an intravenous dose of morphine just before ESWL. The patients were comparable with regard to age, sex, weight, morphine dosage, number of shock waves given and duration of treatment. Median pain score and the amount of supplementary...... analgesics were not significantly different between the 2 groups. There were no significant differences between the groups with regard to post-ESWL skin changes. Therefore, EMLA cream can be recommended for ESWL provided it is applied correctly....

  10. Is stone radiodensity a useful parameter for predicting outcome of extracorporeal shockwave lithotripsy for stones < 2 cm?

    Directory of Open Access Journals (Sweden)

    Mina S. Krishnamurthy

    2005-02-01

    Full Text Available PURPOSE: Several factors determine the success of extracorporeal shockwave lithotripsy (SWL for kidney stones: stone size, stone location within the collecting system, stone type, and the SWL machine used. It has been suggested that stone radiodensity, as determined either by plain radiography or computed tomography attenuation values, may be an independent predictor of SWL success. We examined the outcome of SWL for solitary stones less than or equal to 2 cm located within the renal pelvis, based on their radiodensity. MATERIALS AND METHODS: 211 patients with solitary renal pelvic stones measuring less than or equal to 2 cm were treated on a Dornier Doli 50 lithotriptor under general anesthesia. The radiodensity of the stone was determined to be either less than, equal to, or greater than the radiodensity of the ipsilateral 12th rib. Stone-free rates (SFR were determined at 3 months by kidney, ureters and bladder (KUB plain X-rays. Patients requiring re-treatment or auxiliary procedures were considered failures of SWL. RESULTS: Follow-up SFR information was available in all 211 patients. Stone composition was available in 158 (75% treated patients, but no correlation was found between stone radiodensity and stone composition. For stones 12th rib compared to a SFR of 71% if the stone radiodensity was < 12th rib. However, these differences in SFRs were not statistically significant. CONCLUSIONS: On the Doli machine, stone radiodensity alone does not predict lithotripsy treatment outcome for stones < 1 cm within the renal pelvis. This parameter is probably only useful as the stone size becomes larger than 1 cm, and should be used in conjunction with other stone parameters to select appropriate therapy.

  11. The effect of intravenous aminophylline on stone free status after transureteral lithotripsy (TUL: a randomized double blind clinical trial study

    Directory of Open Access Journals (Sweden)

    A barzegarnezhad

    2015-10-01

    Full Text Available Background: The third common urinary tract disease was renal stone, after the UTI and pathologic states of kidney. TUL is most useful and effective for removing the stones of inferior ureter. In other hand aminophylline can decrease urinary tract spasm. Then, combination of TUL and aminophylline help us to reduce the complication of TUL. Methods and materials: We have study on 87 case of renal colic who referred to Imam Khomeini hospital of sari and Tooba clinic. This study was a double blind systematic randomized clinical trial that patients were divided to two group as 1 and 2: group one includes patients who received aminophylline and group 2 were selected as our control samples. Our sample size was calculated by statistic analysis according to recent studies. Result: The average of TUL time was 5.12± 1.77 min in group 1 and 6.59± 3.47 min in group 2(p0.05. ESWL was used in one patient of group 1 because of remaining of stone, but 7 patients of group 2 did not response to Transureter lithotripsy, then they needed ESWL. Complication were not seen in patient who received Aminophylline and mean arterial pressure and heart rate was equal in two group. Conclusion: The difference of TUL Time between two groups was meaningful. As you know, aminophylline has an antispasmotic effect on urinary tract and tract with smooth muscle, and according to our finding, usage of aminophylline can reduce the complication of TUL and increase success rate of Lithotripsy in this patient. In other hand, it complications was few.

  12. A Pilot Study to Evaluate Haemostatic Function, following Shock Wave Lithotripsy (SWL) for the Treatment of Solitary Kidney Stones.

    Science.gov (United States)

    Hughes, Stephen Fôn; Thomas-Wright, Samantha Jayne; Banwell, Joseph; Williams, Rachel; Moyes, Alyson Jayne; Mushtaq, Sohail; Abdulmajed, Mohamed; Shergill, Iqbal

    2015-01-01

    The number of patients undergoing shock wave lithotripsy (SWL) in the UK for solitary unilateral kidney stones is increasing annually. The development of postoperative complications such as haematuria and sepsis following SWL is likely to increase. Comparing a range of biological markers with the aim of monitoring or predicting postoperative complications following SWL has not been extensively researched. The main purpose of this pilot-study was to test the hypothesis that SWL results in changes to haemostatic function. Subsequently, this pilot-study would form a sound basis to undertake future investigations involving larger cohorts. Twelve patients undergoing SWL for solitary unilateral kidney stones were recruited. From patients (8 male and 4 females) aged between 31-72 years (median-43 years), venous blood samples were collected pre-operatively (baseline), at 30, 120 and 240 minutes postoperatively. Specific haemostatic biomarkers [platelet counts, prothrombin time (PT), activated partial thromboplastin time (aPTT), fibrinogen, D-dimer, von Willebrand Factor (vWF), sE-selectin and plasma viscosity (PV)] were measured. Platelet counts and fibrinogen concentration were significantly decreased following SWL (p = 0.027 and p = 0.014 respectively), while D-dimer and vWF levels significantly increased following SWL (p = 0.019 and p = 0.001 respectively). PT, APTT, sE-selectin and PV parameters were not significantly changed following SWL (p>0.05). Changes to specific biomarkers such as plasma fibrinogen and vWF suggest that these represent a more clinically relevant assessment of the extent of haemostatic involvement following SWL. Analysis of such markers, in the future, may potentially provide valuable data on "normal" response after lithotripsy, and could be expanded to identify or predict those patients at risk of coagulopathy following SWL. The validation and reliability will be assessed through the assessment of larger cohorts.

  13. A Pilot Study to Evaluate Haemostatic Function, following Shock Wave Lithotripsy (SWL for the Treatment of Solitary Kidney Stones.

    Directory of Open Access Journals (Sweden)

    Stephen Fôn Hughes

    Full Text Available PURPOSE: The number of patients undergoing shock wave lithotripsy (SWL in the UK for solitary unilateral kidney stones is increasing annually. The development of postoperative complications such as haematuria and sepsis following SWL is likely to increase. Comparing a range of biological markers with the aim of monitoring or predicting postoperative complications following SWL has not been extensively researched. The main purpose of this pilot-study was to test the hypothesis that SWL results in changes to haemostatic function. Subsequently, this pilot-study would form a sound basis to undertake future investigations involving larger cohorts. METHODS: Twelve patients undergoing SWL for solitary unilateral kidney stones were recruited. From patients (8 male and 4 females aged between 31-72 years (median-43 years, venous blood samples were collected pre-operatively (baseline, at 30, 120 and 240 minutes postoperatively. Specific haemostatic biomarkers [platelet counts, prothrombin time (PT, activated partial thromboplastin time (aPTT, fibrinogen, D-dimer, von Willebrand Factor (vWF, sE-selectin and plasma viscosity (PV] were measured. RESULTS: Platelet counts and fibrinogen concentration were significantly decreased following SWL (p = 0.027 and p = 0.014 respectively, while D-dimer and vWF levels significantly increased following SWL (p = 0.019 and p = 0.001 respectively. PT, APTT, sE-selectin and PV parameters were not significantly changed following SWL (p>0.05. CONCLUSIONS: Changes to specific biomarkers such as plasma fibrinogen and vWF suggest that these represent a more clinically relevant assessment of the extent of haemostatic involvement following SWL. Analysis of such markers, in the future, may potentially provide valuable data on "normal" response after lithotripsy, and could be expanded to identify or predict those patients at risk of coagulopathy following SWL. The validation and reliability will be assessed through the assessment of

  14. Painful Flexible Flatfoot.

    Science.gov (United States)

    Sheikh Taha, Abdel Majid; Feldman, David S

    2015-12-01

    Flatfoot is commonly encountered by pediatric orthopedic surgeons and pediatricians. A paucity of literature exists on how to define a flatfoot. The absence of the medial arch with a valgus hindfoot is the hallmark of this pathology. Flatfoot can be flexible or rigid. This review focuses on the diagnosis and treatment of the flexible flatfoot. Most flatfeet are flexible and clinically asymptomatic, and warrant little intervention. If feet are symptomatic, treatment is needed. Most patients who require treatment improve with foot orthotics and exercises. Only feet resistant to conservative modalities are deemed surgical candidates. The presence of a tight heel cord is often found in patients who fail conservative management.

  15. Flexible Support Stanchion

    Energy Technology Data Exchange (ETDEWEB)

    Rudland, D.L.; /Fermilab

    1987-05-11

    Figure 1 shows the assembly drawing of the Central Calorimeter Cryostat Flexible Support Stanchion. Figures 2 and 3 show the Flexible Support STanchion in detail. These Stanchions support the cryostat safely, reduce the heat load to the cryostat from the ambient by a factor of more than ten, provide a spring like action that reduce the loads created by thermal contraction of the cryostat and position the cryostate accurately. Table 1 shows all of the details of the Flexible Support system for the C.C. Cryostat.

  16. Does stone entrapment with ″Uro-Net″ improve Ho:YAG laser lithotripsy efficiency in percutaneous nephrolithotomy and cystolithopaxy?: an in vitro study.

    Science.gov (United States)

    Marchini, Giovanni Scala; Rai, Aayushi; De, Shubha; Sarkissian, Carl; Monga, Manoj

    2013-01-01

    to test the effect of stone entrapment on laser lithotripsy efficiency. Spherical stone phantoms were created using the BegoStone® plaster. Lithotripsy of one stone (1.0 g) per test jar was performed with Ho:YAG laser (365 µm fiber; 1 minute/trial). Four laser settings were tested: I-0.8 J,8 Hz; II-0.2J,50 Hz; III-0.5 J,50 Hz; IV-1.5 J,40 Hz. Uro-Net (US Endoscopy) deployment was used in 3/9 trials. Post-treatment, stone fragments were strained though a 1mm sieve; after a 7-day drying period fragments and unfragmented stone were weighed. Uro-Net nylon mesh and wire frame resistance were tested (laser fired for 30s). All nets used were evaluated for functionality and strength (compared to 10 new nets). Student's T test was used to compare the studied parameters; significance was set at p wire frame had worst injuries with setting IV; setting III had an intermediate outcome; 42% of nets were rendered unusable and excluded from strength analysis. There was no difference in mean strength between used functional nets and non-used devices (8.05 vs. 7.45 lbs, respectively; p = 0.14). Setting IV was the most efficient for lithotripsy (1.9 ± 0.6 mg/s; p < 0.001) with or without net stabilization; setting III was superior to I and II only if a net was not used. Laser lithotripsy is not optimized by stone entrapment with a net retrieval device which may be damaged by high energy laser settings.

  17. Does Stone Entrapment With "Uro-Net" Improve Ho:YAG Laser Lithotripsy Efficiency in Percutaneous Nephrolithotomy and Cystolithopaxy?: an In Vitro Study

    Directory of Open Access Journals (Sweden)

    Giovanni Scala Marchini

    2013-07-01

    Full Text Available Purpose to test the effect of stone entrapment on laser lithotripsy efficiency. Materials and Methods Spherical stone phantoms were created using the BegoStone® plaster. Lithotripsy of one stone (1.0g per test jar was performed with Ho:YAG laser (365µm fiber; 1 minute/trial. Four laser settings were tested: I-0.8J,8Hz; II-0.2J,50Hz; III-0.5J,50Hz; IV-1.5J,40Hz. Uro-Net (US Endoscopy deployment was used in 3/9 trials. Post-treatment, stone fragments were strained though a 1mm sieve; after a 7-day drying period fragments and unfragmented stone were weighed. Uro-Net nylon mesh and wire frame resistance were tested (laser fired for 30s. All nets used were evaluated for functionality and strength (compared to 10 new nets. Student's T test was used to compare the studied parameters; significance was set at p < 0.05. Results Laser settings I and II caused less damage to the net overall; the mesh and wire frame had worst injuries with setting IV; setting III had an intermediate outcome; 42% of nets were rendered unusable and excluded from strength analysis. There was no difference in mean strength between used functional nets and non-used devices (8.05 vs. 7.45 lbs, respectively; p = 0.14. Setting IV was the most efficient for lithotripsy (1.9 ± 0.6 mg/s; p < 0.001 with or without net stabilization; setting III was superior to I and II only if a net was not used. conclusions Laser lithotripsy is not optimized by stone entrapment with a net retrieval device which may be damaged by high energy laser settings.

  18. Flexible Word Classes

    DEFF Research Database (Denmark)

    2013-01-01

    • First major publication on the phenomenon • Offers cross-linguistic, descriptive, and diverse theoretical approaches • Includes analysis of data from different language families and from lesser studied languages This book is the first major cross-linguistic study of 'flexible words', i.e. words...... that cannot be classified in terms of the traditional lexical categories Verb, Noun, Adjective or Adverb. Flexible words can - without special morphosyntactic marking - serve in functions for which other languages must employ members of two or more of the four traditional, 'specialised' word classes. Thus......, flexible words are underspecified for communicative functions like 'predicating' (verbal function), 'referring' (nominal function) or 'modifying' (a function typically associated with adjectives and e.g. manner adverbs). Even though linguists have been aware of flexible world classes for more than...

  19. Flexible displays, rigid designs?

    DEFF Research Database (Denmark)

    Hornbæk, Kasper

    2015-01-01

    Rapid technological progress has enabled a wide range of flexible displays for computing devices, but the user experience--which we're only beginning to understand--will be the key driver for successful designs....

  20. Flexibility in insulin prescription

    Directory of Open Access Journals (Sweden)

    Sanjay Kalra

    2016-01-01

    Full Text Available This communication explores the concept of flexibility, a propos insulin preparations and insulin regimes used in the management of type 2 diabetes. The flexibility of an insulin regime or preparation is defined as their ability to be injected at variable times, with variable injection-meal time gaps, in a dose frequency and quantum determined by shared decision making, with a minimal requirement of glucose monitoring and health professional consultation, with no compromise on safety, efficiency and tolerability. The relative flexibility of various basal, prandial and dual action insulins, as well as intensive regimes, is compared. The biopsychosocial model of health is used to assess the utility of different insulins while encouraging a philosophy of flexible insulin usage.

  1. Music does not reduce alfentanil requirement during patient-controlled analgesia (PCA) use in extracorporeal shock wave lithotripsy for renal stones.

    Science.gov (United States)

    Cepeda, M S; Diaz, J E; Hernandez, V; Daza, E; Carr, D B

    1998-12-01

    To evaluate the impact of music on opioid requirements and pain levels during renal lithotripsy using alfentanil patient-controlled analgesia (PCA), we conducted a prospective, blinded, randomized controlled trial. Patients undergoing lithotripsy were instructed in PCA use and asked to rate their anxiety and select their preferred type of music. They were then premedicated with morphine and ketorolac and randomly allocated into two groups. Group 1 (n = 97) had music started 10 min before the procedure and maintained until 10 min after its conclusion. Group 2 (n = 96) had music begun at the conclusion of lithotripsy and continued for 10 min. Pain intensity, alfentanil requirement, side effects, quality of analgesia, patient satisfaction, and acceptance of the technique were evaluated. Demographics, alfentanil requirement, pain levels, side effects, quality of analgesia, and patient satisfaction were similar in both groups. The addition of music did not provide any benefit. This result raises the possibility that some nonpharmacologic therapies have minimal impact in settings where the painful stimulus is moderate to severe and adequate pharmacotherapy is available.

  2. The clinical application of ureteroscope in the laparoscopic cholecystolithotomy%腹腔镜联合输尿管硬镜在保胆取石术中的临床应用

    Institute of Scientific and Technical Information of China (English)

    肖海波; 胡晋太

    2013-01-01

    Objective:To investigate the feasibility,superiority and surgical techniques of laparoscope-ureteroscope combination in the cholecystolithotomy.Methods:Sixty cases undergoing minimaly-invasive cholecystolithotomy by the same surgeon during Jun.2010 and Oct.2012 were randomly divided into two groups.30 cases undergoing laparoscopic cholecystolithotomy were in the control group while the other 30 cases undergoing laparoseopic cholecystolithotomy combined with ureteroscope were in the observation group.The operation time,recovery time of gastrointestinal function,blood loss,postoperative complications were comparatively analyzed between the two groups.Results:Twenty-nine operations were successful in the control group.1 case was converted to laparotomy because gallstones incarcerated in the neck of gallbladder and removal of calculus failed.All the operations in the observation group were successful.Postoperative follow-up time was 6-12 months.1 case recurred in the control group,CT and color Doppler ultrasound showed choledocholithiasis.No recurrence was found in the observation group.No bile leakage,bleeding or gallbladder carcinoma were observed after operations.The operation time,intraoperative blood loss,gastrointestinal function recovery time and postoperative recurrence between two groups were significantly different (P < 0.05).Conclusions:The laparoscopic cholecystolithotomy combined with ureteroscope is safe and feasible,and has obvious advantages.However,the operation skills remain to be further researched.%目的:探讨腹腔镜联合输尿管硬镜行保胆取石术的可行性、优越性及手术技巧.方法:随机将2010年6月至2012年10月同一术者施行的60例微创保胆手术分为两组,30例行完全腹腔镜保胆取石术(对照组),30例行腹腔镜联合输尿管硬镜保胆取石术(观察组),对比分析两组患者手术时间、胃肠功能恢复时间、术中出血量、术后并发症等.结果:对照组中29例成功完成

  3. COUPLING EFFECT OF FLEXIBLE JOINT AND FLEXIBLE LINK ON DYNAMIC SINGULARITY OF FLEXIBLE MANIPULATOR

    Institute of Scientific and Technical Information of China (English)

    GAO Zhihui; YUN Chao; BIAN Yushu

    2008-01-01

    The coupling effect of the flexible joint and the flexible link on the dynamic singularity of the flexible manipulator is addressed. Firstly, the dynamic equations of a flexible manipulator with a flexible joint and a flexible link are derived. Secondly, the relationship and property between the flexible joint and the flexible link are analyzed. It shows that the flexible joint's amplitude will increase abruptly, thereby the dynamic singularity occurs if the frequency of a flexible joint is near or equal to some natural frequency of a flexible link. Finally, some numerical simulations which will verify the correctness of the theoretical analysis, are carried out. The results are fundamental for the design of a flexible manipulator and for the avoidance of the dynamic singularity.

  4. Establishment of double channels by ureteroscope in the treatment of posterior completely urethral rupture%用输尿管镜建立双通道治疗后尿道完全断裂的临床疗效

    Institute of Scientific and Technical Information of China (English)

    王江

    2016-01-01

    目的:探讨急诊内镜下尿道会师术治疗后尿道完全断裂的临床疗效。方法:收治后尿道完全断裂患者5例,均使用输尿管镜建立双通道治疗,观察患者的手术时间、出血量、术后恢复情况。结果:5例患者均置管成功,无中转开放手术;手术时间10~60 min,平均28 min;出血20~200 mL,平均80 mL;术后留置尿管3~4周,1例发生尿道狭窄,经尿道扩张后,症状缓解,均无勃起功能障碍。结论:用输尿管镜建立双通道治疗后尿道完全断裂效果显著,安全性高,能够有效降低并发症发生率。%Objective:To explore the clinical curative effect of urethral realignment under emergency endoscopy in the treatment of posterior completely urethral rupture.Methods:5 patients with posterior completely urethral rupture were selected.They were given establishment of double channels by ureteroscope.The operation time,bleeding amount and postoperative recovery of patients were observed.Results:5 patients were catheter successfully without conversion to open surgery.The operation time was 10 to 60 minutes,and the average was 28 minutes.The bleeding was 20 to 200 mL,and the average was 80 mL.The postoperative indwelling catheter was 3 to 4 weeks.1 case had urethral stricture.After urethral dilatation,the symptoms were relief,and they were no erectile dysfunction.Conclusion:Establishment of double channels by ureteroscope in the treatment of posterior completely urethral rupture has a significant effect.The safety is high.It can effectively reduce the incidence of complications.

  5. Ureteroscopic Management of Bulbous Urethral Disruption Placing Catheter (Report of 13 Cases)%输尿管镜下尿道置管治疗尿道球部断裂疗效观察(附13例报告)

    Institute of Scientific and Technical Information of China (English)

    李宏岩; 李海; 张茁; 周裔

    2011-01-01

    Objective:To investigate the approach and safety of ureteroscopic management of bulbous urethral disruption placing catheter. Methods: 13 cases with bulbous urethral disruption were placed catheter via urethra u-sing ureteroscopy. Clinical data were analyzed retrospectively. Results: 11 of 13 cases obtained normal urination after extubation, one stage successful rate was 84. 61% (11/13). Better maximum flow rate of urine was(14. 7±3. 2)ml/s. And the average time for whole surgery was(17. 7±3. 2)min. Removing stricture and end to end reanasto-mosis was done in 1 cases after operation in 6 months(7. 69%). Conclusions:For some of the patients with bulbous urethral disruption ureteroscopic placing catheter appears to be efficacious and safe.%目的:探讨输尿管镜下尿道置管术治疗尿道球部断裂的方法与安全性.方法:回顾性分析应用输尿管镜下尿道置管术治疗前尿道断裂患者13例的临床资料.结果:拔管后正常排尿11例,一次性手术治愈占84.61%,最大尿流率(MFR)为(14.7±3.2)ml/ s,平均手术时间为(17.7±3.2)min;术后尿道出血2例,占15.38%;6个月年后因尿道狭窄行开放手术1例,占7.69%.结论:在有效地控制治疗适应证的前提下,输尿管镜下尿道置管术治疗尿道球部断裂是安全、有效的方法.

  6. Flexible magnetoimpedance sensor

    Energy Technology Data Exchange (ETDEWEB)

    Li, Bodong; Kavaldzhiev, Mincho N.; Kosel, Jürgen, E-mail: jurgen.kosel@kaust.edu.sa

    2015-03-15

    Flexible magnetoimpedance (MI) sensors fabricated using a NiFe/Cu/NiFe tri-layer on Kapton substrate have been studied. A customized flexible microstrip transmission line was employed to investigate the MI sensors's magnetic field and frequency responses and their dependence on the sensors's deflection. For the first time, the impedance characteristic is obtained through reflection coefficient analysis over a wide range of frequencies from 0.1 MHz to 3 GHz and for deflections ranging from zero curvature to a radius of 7.2 cm. The sensor element maintains a high MI ratio of up to 90% and magnetic sensitivity of up to 9.2%/Oe over different bending curvatures. The relationship between the curvature and material composition is discussed based on the magnetostriction effect and stress simulations. The sensor's large frequency range, simple fabrication process and high sensitivity provide a great potential for flexible electronics and wireless applications. - Highlights: • A flexible magnetoimpedance (MI) sensor is developed. • Studies are carried out using a flexible microstrip transmission line. • An MI ratio of up to 90% is obtained. • The effect of magnetostriction is studied.

  7. Flexible magnetoimpedance sensor

    KAUST Repository

    Li, Bodong

    2015-03-01

    Flexible magnetoimpedance (MI) sensors fabricated using a NiFe/Cu/NiFe tri-layer on Kapton substrate have been studied. A customized flexible microstrip transmission line was employed to investigate the MI sensors\\'s magnetic field and frequency responses and their dependence on the sensors\\'s deflection. For the first time, the impedance characteristic is obtained through reflection coefficient analysis over a wide range of frequencies from 0.1 MHz to 3 GHz and for deflections ranging from zero curvature to a radius of 7.2 cm. The sensor element maintains a high MI ratio of up to 90% and magnetic sensitivity of up to 9.2%/Oe over different bending curvatures. The relationship between the curvature and material composition is discussed based on the magnetostriction effect and stress simulations. The sensor\\'s large frequency range, simple fabrication process and high sensitivity provide a great potential for flexible electronics and wireless applications.

  8. Pneumatic flexible shaft couplings

    Directory of Open Access Journals (Sweden)

    Jaroslav HOMIŠIN

    2007-01-01

    Full Text Available Main effort of every design engineer is reduction of torsional oscillation in any mechanical system. At present this problem can be solved by means of a suitable modification of dynamic properties of flexible shaft couplings according to dynamics in the given systems. But the dynamic properties of nowadays-applied flexible couplings arenot unchangeable because of aging and fatigue processes occurring in flexible coupling elements. Result of this fact causes detuning of mechanical system. Taking into consideration the above-mentioned situation, we suggest for mechanical systems application of a newly developed pneumatic couplings that have constant characteristicfeatures during the whole current operation and thus they have a positive influence on the system running.

  9. Designing structural supply chain flexibility

    OpenAIRE

    Mulinski, Ksawery Jan

    2012-01-01

    In a continuously changing business environment the role of supply chain flexibility is constantly increasing. A flexible supply chain can ensure survival in quickly changing market conditions as well as enable sustainable growth. This thesis explores the topic of supply chain flexibility with focus on structural flexibility due to scarcity of previous research in that area. The purpose of the research is to answer a question: how can companies design structural supply chain flexibility? In a...

  10. The Effectiveness of Prophylactic Antibiotics with Oral Levofloxacin against Post-Shock Wave Lithotripsy Infectious Complications: A Randomized Controlled Trial.

    Science.gov (United States)

    Hsieh, Cheng-Hsing; Yang, Stephen Shei-Dei; Chang, Shang-Jen

    2016-06-01

    To evaluate the efficacy of prophylactic antibiotics in reduction of infections after shock wave lithotripsy (SWL) in patients undergoing shock wave lithotripsy (SWL). The study was a randomized control trial. Between 2012 and 2014, patients with pre-operative sterile urine undergoing SWL were randomly assigned by the randomization ratio of 1:1 to receive prophylactic antibiotics with single-dose oral levofloxacin (500 mg) or no treatment (control group), respectively. Urinalysis and urine cultures were obtained between post-operative day five and seven, respectively. Pyuria was defined as ≥10 white blood cells per high power field (WBC/hpf). Significant bacteriuria was defined as ≥10(5) colony forming units per milliliter (CFU/mL) uropathogens. Febrile urinary tract infection (fUTI) was defined as body temperature higher than 38.0°C with pyuria or significant bacteriuria within seven days after SWL treatment. Initially, 274 patents underwent randomization with 135 and 139 patients in the levofloxacin and control group, respectively. A total of 206 patients (106 with placebo and 100 with levofloxacin) with complete follow-up of urinalysis were eligible for analysis. The rates of post-operative pyuria were not significantly different in patients with and without prophylaxis (8% versus 4.7%, p = 0.33). Moreover, there was also no significant difference in rates of bacteriuria in patients with and without prophylaxis (1% versus 0%, p = 0.49). Patients without follow-up urinalysis and urine culture received telephone survey. Among them, there was only one patient reporting post-SWL fever in the levofloxacin group (0.7%) compared with none (0%) in the control group (p = 0.49). As the results of the interim analysis revealed no benefit of levofloxacin in preventing post-SWL pyuria, bacteriuria, and fUTI, we terminated the study early before the pre-planned sample size was achieved. The incidence of asymptomatic and fUTI is low in patients with pre

  11. Thin flexible intercalation anodes

    Energy Technology Data Exchange (ETDEWEB)

    Levy, S.C.; Cieslak, W.R.; Klassen, S.E.; Lagasse, R.R.

    1994-10-01

    Poly(acrylonitrile) fibers have been pyrolyzed under various conditions to form flexible carbon yarns capable of intercalating lithium ions. These fibers have also been formed into both woven and non woven cloths. Potentiostatic, potentiodynamic and galvanostatic tests have been conducted with these materials in several electrolytes. In some tests, a potential hold was used after each constant current charge and discharge. These tests have shown some of these flexible materials to reversibly intercalate lithium ions to levels that are suitable for use as a practical battery anode.

  12. Effect of extracorporeal shock wave lithotripsy for the postoperative residual bilestone of choledocholithiasis%体外冲击波对胆总管术后残留结石的碎石效应

    Institute of Scientific and Technical Information of China (English)

    潘爱国; 张殿忠; 徐家宽; 宋东惠

    2002-01-01

    Objective To explore the effect of extracorporeal shock wave lithotripsy(ESWL) for the postoperative residual bilestone of choledocholithiasis.Method Inject contrast medium of biligrafin via T tube.After accurate apposition with X ray,take lithotripsy with extracorporeal shock wave. In some cases T tube washing and transcutaneous choledochoscope were used to take out bilestones.Results The lithotripsies were successful in all the 48 patients and the lithotriptic rate was 100% .The removing rate of bilestones was over 90% with washing method.Choledochoscope was used in 6 cases,and 48 patients were completely healed.In them 24 suffered from slight expanding pain in right upper abdomen or nausea and no any complications and sequelae in others.Conclusion ESWL is an effect method to heal patients with the postoperative residual bilestones of choledocholithiasis.

  13. Flexible energy systems

    DEFF Research Database (Denmark)

    Lund, Henrik

    2003-01-01

    The paper discusses and analyses diffent national strategies and points out key changes in the energy system in order to achieve a system which can benefit from a high percentage of wind and CHP without having surplus production problems, introduced here as a flexible energy system....

  14. Flexible Classroom Furniture

    Science.gov (United States)

    Kim Hassell,

    2011-01-01

    Classroom design for the 21st-century learning environment should accommodate a variety of learning skills and needs. The space should be large enough so it can be configured to accommodate a number of learning activities. This also includes furniture that provides flexibility and accommodates collaboration and interactive work among students and…

  15. Flexible Language Interoperability

    DEFF Research Database (Denmark)

    Ekman, Torbjörn; Mechlenborg, Peter; Schultz, Ulrik Pagh

    2007-01-01

    of the language. In this paper, we present a highly flexible yet efficient approach to hosting multiple programming languages on an object-oriented virtual machine. Our approach is based on extending the interface of each class with language-specific wrapper methods, offering each language a tailored view...

  16. Flexible Mental Calculation.

    Science.gov (United States)

    Threlfall, John

    2002-01-01

    Suggests that strategy choice is a misleading characterization of efficient mental calculation and that teaching mental calculation methods as a whole is not conducive to flexibility. Proposes an alternative in which calculation is thought of as an interaction between noticing and knowledge. Presents an associated teaching approach to promote…

  17. Flexible cultural repertoires

    DEFF Research Database (Denmark)

    Lindegaard, Marie Rosenkrantz; Zimmermann, Francisca

    2017-01-01

    rejection of crime-involved youth. Young men who perform flexible cultural repertoires, by incorporating and shifting between gang and decent repertoires, experience low victimization due to their adaptation to crime-involved youth. Findings emphasize the importance of detailed investigations of the way...

  18. Flexible metal bellows

    CERN Multimedia

    1975-01-01

    A set of flexible metal bellows being fatigue-tested by repeated offset motion. Such bellows assemblies were used in the SPS vacuum system at places where , for instance, beam stoppers and collimators had to be moved frequently in and out of the beam path.

  19. Flexible Query Answering Systems

    DEFF Research Database (Denmark)

    This book constitutes the refereed proceedings of the 12th International Conference on Flexible Query Answering Systems, FQAS 2017, held in London, UK, in June 2017. The 21 full papers presented in this book together with 4 short papers were carefully reviewed and selected from 43 submissions...

  20. New-onset diabetes mellitus after shock wave lithotripsy for urinary stone: a systematic review and meta-analysis.

    Science.gov (United States)

    Deng, Tuo; Liao, Banghua; Tian, Ye; Luo, Deyi; Liu, Jiaming; Jin, Tao; Wang, Kunjie

    2015-06-01

    The purpose of the study was to evaluate the association between shock wave lithotripsy (SWL) for urinary stone and new-onset diabetes mellitus (DM). A comprehensive data collection was performed in the Pubmed database, Embase database, Chinese Biomedical database, Chinese National Knowledge Infrastructure database and VIP database. Difference in incidence of new-onset DM after SWL between cases and controls was evaluated by odds ratio (OR) with its 95% confidence interval (CI). And summary adjusted risk ratios (RRs) and 95% CIs were calculated to assess the strength of association between SWL and new-onset DM, and then subgroup analyses were conducted. Five studies were included in this meta-analysis. The incidence of new-onset DM after SWL is not higher than that in the population who do not receive SWL [OR = 1.59, 95% CI (0.92, 2.74), P = 0.10]. And statistical association between SWL and new-onset DM could not be found significantly [RR = 1.33, 95% CI (0.83, 2.13), P = 0.24], either. However, body mass index (BMI) [RR = 1.09, 95% CI (1.04, 1.14), P urinary stone and new-onset DM.

  1. Complications of Extracorporeal Shock Wave Lithotripsy for Urinary Stones: To Know and to Manage Them—A Review

    Directory of Open Access Journals (Sweden)

    Alessandro D’Addessi

    2012-01-01

    Full Text Available To identify the possible complications after extracorporeal shock wave lithotripsy (SWL and to suggest how to manage them, the significant literature concerning SWL treatment and complications was analyzed and reviewed. Complications after SWL are mainly connected to the formation and passage of fragments, infections, the effects on renal and nonrenal tissues, and the effects on kidney function. Each of these complications can be prevented adopting appropriate measures, such as the respect of the contraindications and the recognition and the correction of concomitant diseases or infection, and using the SWL in the most efficient and safe way, tailoring the treatment to the single case. In conclusion, SWL is an efficient and relatively noninvasive treatment for urinary stones. However, as with any other type of therapy, some contraindications and potential complications do exist. The strictness in following the first could really limit the onset and danger of the appearance of others, which however must be fully known so that every possible preventive measure be implemented.

  2. Development of a urinary lithiasis localizer mechanism to couple ultrasound and extracorporeal lithotripsy equipment in canine model

    Directory of Open Access Journals (Sweden)

    Enrico Andrade

    2006-10-01

    Full Text Available INTRODUCTION: Due to the evolution of extracorporeal lithotripsy equipment (ESWL and presently, the fact that most part of the equipment does not present ultrasound to localize urinary calculi, a system that allows adapting ultrasound equipment to ESWL equipment was developed, disposing only of fluoroscopy. Thus, this equipment was developed and was tested in urinary stones in canine models, to check its precision in relation to fluoroscopy. METHOD: Seven male dogs were utilized with the introduction, in the bladder through the ureteral route, of chalkstones, with initial localization by fluoroscopy, with a further ultrasound coincidence check localization of the vesical stones, being submitted to ESWL with a 3-hour, 21 days and 60 days follow-up after the procedure. RESULTS: Success of localization in all animals was verified presenting elimination of stones in the first micturitions, after ESWL. No complications were verified in those animals for 60 days. CONCLUSION: We verified that this equipment can lead to an update of the equipment that use only fluoroscopy, increasing in this way, their technical capacity in the treatment of urinary calculi, mainly in cases of non-radiopaque stones.

  3. Treatment of Kidney Stones Using Extracorporeal Shock Wave Lithotripsy (ESWL and Double-J Stent in Infants

    Directory of Open Access Journals (Sweden)

    Mehdi Younesi Rostami

    2012-01-01

    Full Text Available Background. Extracorporeal shock wave lithotripsy (ESWL has progressively acquired popularity as being the gold standard treatment for upper urinary tract lithiasis in infants since 1980. Our aim was to evaluate the outcome of ESWL for kidney stones and the use of double-J stent in infants. Material and Methods. A prospective clinical trial study performed on 50 infants with renal calculi at pelvic admitted in the Urology ward of Shafa Hospital, Sari, Iran, between 2001 and 2010. Main outcome measure of our study was clearing stones after one or more consecutive sessions of ESWL. Results. The study included 50 patients with renal calculi at pelvic. Among them, there were 35 (70% boys and 15 (30% girls with the age ranging from 1 to 13 months (mean of 7 month ± 3 days. All of them were treated by standard ESWL using Simons Lithostor plus machine. The stone sizes ranged from 6 mm to 22 mm. Double-J stents were placed in 11 infants (22% with stones larger than 13 mm. Most of the patients required only one ESWL session. Conclusion. Since there were no complications following ESWL treatment, we can conclude that, in short term, ESWL is an effective and safe treatment modality for renal lithiasis in infants. In addition, we recommend double-J stent in infants with stones larger than 13 mm.

  4. Changes in Urolithiasis Referral Patterns for Shock Wave Lithotripsy over a Decade: Was There Adherence to AUA/EAU Guidelines?

    Science.gov (United States)

    Noureldin, Yasser A; Elkoushy, Mohamed A; Andonian, Sero

    2015-09-01

    The primary objective was to assess changes in referral patterns of urolithiasis for shock wave lithotripsy (SWL) over a decade. The secondary objective was to evaluate the effect of the number of years of practice of referring physicians on these referral patterns. A retrospective review of SWL database was performed for consecutive referrals for SWL at a tertiary stone center between December 1999 and December 2013. Patient demographics and stone characteristics were assessed. The stone location at the time of referral was used as the reference. Retreatments were excluded. In addition, years of practice of the referring physicians were calculated. The 2007 AUA/EAU guidelines on urolithiasis were considered as a reference. A total of 8,992 SWL treatments were included. After December 2007, there was a significant increase in the percentage of renal pelvic stones referred for SWL (23.0 vs. 27.1%, p 10 mm (5.1 vs. 2.9%, p 0.05). Furthermore, percentage of stones referred for SWL by urologists practicing for less than 10 years significantly decreased after December 2007 (29.5 vs. 22.8%, p EAU guidelines on management of ureteral stones.

  5. Stenting or not prior to extracorporeal shockwave lithotripsy for ureteral stones? Results of a prospective randomized study.

    Science.gov (United States)

    Sfoungaristos, Stavros; Polimeros, Nikolaos; Kavouras, Adamantios; Perimenis, Petros

    2012-06-01

    To determine the need for pre-treatment stenting in patients undergoing extracorporeal shockwave lithotripsy (ESWL) for ureteral stones sized 4-10 mm. A prospective randomized study was conducted between September 2009 and March 2011. Included 156 patients randomized in stented and non-stented groups and underwent a maximum of 3 ESWL sessions. Radiographic follow-up was used to assess the stone fragmentation and clearance. Results were compared in terms of stone-free rates, post-treatment morbidity and complications. Overall efficacy was 76.9%. Stone-free rates were statistically significantly lower (P = 0.026) in the stented group (68.6%) compared to the non-stented ones (83.7%). Furthermore, stenting was significantly correlated with post-treatment lower urinary tract symptoms (P ≤ 0.001), need for more ESWL sessions (P = 0.019) and possibility for operation due to ESWL failure (P = 0.026). A multivariate analysis was conducted to identify the parameters which may predict complete stone removal after ESWL. Stone size (P = 0.026), stone location (P = 0.011) and stenting (P = 0.007) were the most significant factors. ESWL is an efficient and safe treatment for 4- to 10-mm ureteral stones. Pre-treatment stenting is limiting stone-free rates and is significantly influencing post-ESWL morbidity and quality of life in a negative manner, while it contributes minimally to the prophylaxis of complications.

  6. Symptomatic small non-obstructing lower ureteric calculi: comparison of ureteroscopy and extra corporeal shock wave lithotripsy.

    Directory of Open Access Journals (Sweden)

    Andankar M

    2001-07-01

    Full Text Available OBJECTIVE: To compare the success, efficacy and complications of ureteroscopy (URS and extra corporeal shock wave lithotripsy (ESWL for the treatment of symptomatic small non obstructing lower ureteric calculi. SUBJECTS AND METHODS: This prospective non-randomised study was conducted simultaneously at two urological referral centres, included 280 patients with symptomatic small (4-10 mm lower ureteric calculi (situated below the sacroiliac joint, with good renal function on intravenous urography. Patients were offered both the treatment options. One hundred and sixty patients chose ureteroscopy, whereas 120 patients were treated by ESWL. Standard techniques of ureteroscopy and ESWL were employed. Patients were followed-up to assess the success rates and complications of the two procedures. RESULTS: Ureteroscopy achieved complete stone clearance in one session in 95% of patients. In six patients ureteroscopy had failed initially and was later accomplished in second session improving the success rate to 98.7%. Two patients had a proximal migration of calculus that needed ESWL. Of the 120 patients treated by ESWL, 90% achieved stone free status at three months. Ureteroscopy was needed for twelve patients (10% where ESWL failed to achieve stone clearance. There were no significant ESWL related complications. ESWL was administered on outpatient basis, while patients needed hospitalisation and anaesthesia for ureteroscopy. CONCLUSION: ESWL can be the primary mode of treatment for symptomatic small non-obstructing lower ureteric calculi as it is minimally invasive and safe. Ureteroscopy can be offered to patients who demand immediate relief or when ESWL fails.

  7. Adding flexibility to physician training.

    Science.gov (United States)

    Mahady, Suzanne E

    2011-05-02

    Demographic changes among junior doctors are driving demand for increased flexibility in advanced physician training, but flexible training posts are lacking. Suitable flexible training models include flexible full-time, job-share and part-time positions. Major barriers to establishing flexible training positions include difficulty in finding job-share partners, lack of funding for creating supernumerary positions, and concern over equivalence of educational quality compared with full-time training. Pilot flexible training positions should be introduced across the medical specialties and educational outcomes examined prospectively.

  8. Aggregating energy flexibilities under constraints

    DEFF Research Database (Denmark)

    Valsomatzis, Emmanouil; Pedersen, Torben Bach; Abello, Alberto

    2016-01-01

    The flexibility of individual energy prosumers (producers and/or consumers) has drawn a lot of attention in recent years. Aggregation of such flexibilities provides prosumers with the opportunity to directly participate in the energy market and at the same time reduces the complexity of scheduling...... the energy units. However, aggregated flexibility should support normal grid operation. In this paper, we build on the flex-offer (FO) concept to model the inherent flexibility of a prosumer (e.g., a single flexible consumption device such as a clothes washer). An FO captures flexibility in both time...

  9. The Efficacy of Medical Expulsive Therapy (MET) in Improving Stone-free Rate and Stone Expulsion Time, After Extracorporeal Shock Wave Lithotripsy (SWL) for Upper Urinary Stones: A Systematic Review and Meta-analysis.

    Science.gov (United States)

    Skolarikos, Andreas; Grivas, Nikolaos; Kallidonis, Panagiotis; Mourmouris, Panagiotis; Rountos, Thomas; Fiamegos, Alexandros; Stavrou, Sotirios; Venetis, Chris

    2015-12-01

    In this meta-analysis, we included randomized studies on medical expulsive therapy implemented following shock wave lithotripsy for renal and ureteral stones. Pooled results demonstrated the efficacy of α-blockers, nifedipine, Rowatinex, and Uriston in increasing stone clearance. In addition, the time to stone elimination, the intensity of pain, the formation of steinstrasse, and the need for auxiliary procedures were reduced mainly with α-blockers. Expulsion rate was not correlated with the type of α-blocker, the diameter, and the location of stone. Our results show that medical expulsive therapy for residual fragments after shock wave lithotripsy should be implemented in clinical practice.

  10. Obtaining patient feedback in an outpatient lithotripsy service is facilitated by use of a touch-screen tablet (iPad™) survey.

    Science.gov (United States)

    Turney, B W; Reynard, J M

    2014-08-01

    There is now a requirement for every doctor in the UK to obtain patient feedback for revalidation. This can be an onerous and time-consuming task. The objective of this study was to evaluate a novel electronic patient feedback method in an outpatient lithotripsy service setting. Between September 2013 and January 2014, 100 patients attending an outpatient lithotripsy service in Oxford were asked to complete a selection of pre-approved NHS questions about the service they had received. Questions were presented on a tablet device (iPad™) and answered using the touch screen. Departmental staff were unaware of the questions in the survey. Patients were asked to complete the survey by an independent research nurse. Questions were created online in a free-to-use web-based survey application and presented on the tablet device in a user-friendly format via an application. Data were uploaded via wifi™ to the online system. Data were viewed, automatically analysed and displayed graphically. The age range of the patients surveyed was 20-80 years of age. All 100 patients completed the survey without difficulty. All patients answered every question. Data could be automatically viewed, analysed and presented graphically. This method of collecting patient feedback proved to be rapid and efficient. The feedback highlighted a high patient satisfaction with the lithotripsy service. A touch screen tablet device is an efficient and effective method of collecting truly objective patient feedback. This method of patient feedback could be employed in other clinical environments to collect data for revalidation purposes.

  11. FLEXIBLE GEIGER COUNTER

    Science.gov (United States)

    Richter, H.G.; Gillespie, A.S. Jr.

    1963-11-12

    A flexible Geiger counter constructed from materials composed of vinyl chloride polymerized with plasticizers or co-polymers is presented. The counter can be made either by attaching short segments of corrugated plastic sleeving together, or by starting with a length of vacuum cleaner hose composed of the above materials. The anode is maintained substantially axial Within the sleeving or hose during tube flexing by means of polystyrene spacer disks or an easily assembled polyethylene flexible cage assembly. The cathode is a wire spiraled on the outside of the counter. The sleeving or hose is fitted with glass end-pieces or any other good insulator to maintain the anode wire taut and to admit a counting gas mixture into the counter. Having the cathode wire on the outside of the counter substantially eliminates the objectional sheath effect of prior counters and permits counting rates up to 300,000 counts per minute. (AEC)

  12. Flexible Metasurface Holograms

    CERN Document Server

    Burch, James; Chen, Xianzhong; Di Falco, Andrea

    2016-01-01

    Metasurface holograms are typically fabricated on rigid substrates. Here we experimentally demonstrate broadband, flexible, conformable, helicity multiplexed metasurface holograms operating in the visible range, offering increased potential for real life out-of-the-lab applications. Two symmetrically distributed holographic images are obtained when circularly polarized light impinges on the reflective-type metasurface positioned on non- planar targets. The two off-axis images with high fidelity are interchangeable by controlling the helicity of incident light. Our metasurface features the arrangement of spatially varying gold nanorods on a flexible, conformable epoxy resist membrane to realize a Pancharatnam- Berry phase profile. These results pave the way to practical applications including polarization manipulation, beam steering, novel lenses, and holographic displays.

  13. Flexible Laser Metal Cutting

    DEFF Research Database (Denmark)

    Villumsen, Sigurd; Jørgensen, Steffen Nordahl; Kristiansen, Morten

    2014-01-01

    This paper describes a new flexible and fast approach to laser cutting called ROBOCUT. Combined with CAD/CAM technology, laser cutting of metal provides the flexibility to perform one-of-a-kind cutting and hereby realises mass production of customised products. Today’s laser cutting techniques...... possess, despite their wide use in industry, limitations regarding speed and geometry. Research trends point towards remote laser cutting techniques which can improve speed and geometrical freedom and hereby the competitiveness of laser cutting compared to fixed-tool-based cutting technology...... such as punching. This paper presents the concepts and preliminary test results of the ROBOCUT laser cutting technology, a technology which potentially can revolutionise laser cutting....

  14. Flexible training under threat.

    Science.gov (United States)

    Houghton, Anita; Eaton, Jennifer

    2002-10-01

    As the number of women in medicine and the general demand for a better work-life balance rises, flexible training is an increasingly important mechanism for maintaining the medical workforce. The new pay deal, together with entrenched cultural attitudes, are potential threats. Ways forward include more substantive part-time posts, more part-time opportunities at consultant level, and using positive experiences as a way of tackling attitudes in the less accepting specialties.

  15. Flexible Land Administration

    DEFF Research Database (Denmark)

    Enemark, Stig

    2014-01-01

    Security of tenure is widely considered to be the missing piece of the puzzle when it comes to eradication of poverty. And, as explained in the previous issue of Geoinformatics, the European Union is now placing land rights at the heart of EU development policy. This article presents a way forwar...... in terms of building flexible and "fit-for-purpose" land administration systems in developing countries. This will ensure security of tenure for all and sustainable management of the use of land....

  16. More flexibility for DESY

    CERN Multimedia

    2003-01-01

    In the future, budgeting at DESY will be more efficient. The 16 associated research centers are to be granted a wider margin in matters of finance and human resources. The Budget Committee of the German Bundestag has agreed to abstain from mandatory staff appointments. The current pre-determined "job pyramid" will be replaced by a more flexible mechanism, so that the conclusion of fixed labor contracts can more closely follow the needs of research (1 page).

  17. Industrial Fuel Flexibility Workshop

    Energy Technology Data Exchange (ETDEWEB)

    none,

    2006-09-01

    On September 28, 2006, in Washington, DC, ITP and Booz Allen Hamilton conducted a fuel flexibility workshop with attendance from various stakeholder groups. Workshop participants included representatives from the petrochemical, refining, food and beverage, steel and metals, pulp and paper, cement and glass manufacturing industries; as well as representatives from industrial boiler manufacturers, technology providers, energy and waste service providers, the federal government and national laboratories, and developers and financiers.

  18. Flexible Land Administration

    DEFF Research Database (Denmark)

    Enemark, Stig

    2014-01-01

    Security of tenure is widely considered to be the missing piece of the puzzle when it comes to eradication of poverty. And, as explained in the previous issue of Geoinformatics, the European Union is now placing land rights at the heart of EU development policy. This article presents a way forwar...... in terms of building flexible and "fit-for-purpose" land administration systems in developing countries. This will ensure security of tenure for all and sustainable management of the use of land....

  19. Flexible Data Link

    Science.gov (United States)

    2015-04-01

    reconfiguring the waveform characteristics (on-the-fly) based on the engagement environment. Therefore, flexibility was the highest priority in the design of...the aircraft to a ground antenna . Utilizing the threshold system requirements (100 km range), we calculate the multipath of the aircraft as it...approaches the ground antenna . Figure 3: Multipath scenario #1 The calculation of the reflected path (denoted as A + C in Figure 3) is found through the

  20. A Case of Septic Shock caused by Achromobacter xylosoxidans in an Immunocompetent Female Patient after Extracorporeal Shock Wave Lithotripsy for a Ureteral Stone.

    Science.gov (United States)

    Lee, Jae Hyuk; Lee, So Yon; Park, In Young; Park, So Yeon; Lee, Jin Seo; Kang, Goeun; Kim, Jae Seok; Eom, Joong Sik

    2016-03-01

    Achromobacter xylosoxidans can cause various types of infections, but its infection in humans is rare. A. xylosoxidans has been reported as a rare etiological agent of infections including primary bacteremia, catheter-related bloodstream infection, endocarditis, otitis, and pneumonia, particularly in immunocompromised hosts. We encountered a case of septic shock caused by A. xylosoxidans in a 52-year-old, immunocompetent woman with no underlying disease, who received extracorporeal shock wave lithotripsy to remove a left upper ureteral stone. She was treated with antibiotics to which the organism was susceptible but died as a result of septic shock.

  1. Extracorporeal shock wave lithotripsy of urinary calculi. Results from the first 306 patients treated at the Copenhagen Municipal Stone Center with a second generation lithotriptor

    DEFF Research Database (Denmark)

    Andersen, J T; Mogensen, P

    1991-01-01

    The first Danish experience with Extracorporeal Shock Wave Lithotripsy (ESWL) using a second generation Lithotriptor (Siemens Lithostar) is reported. 306 patients underwent 392 treatments for 363 stones. There were 339 renal calculi including 5 staghorn calculi and 54 ureteral calculi. Treatments...... were performed under local analgesia (82%) or epidural or general anesthesia (18%) when invasive procedures had to be done in connection with the treatment. Stone fragmentation was achieved with 2487 +/- 1262 shocks. The first months stone clearance rate was 45%; 26% had fragments less than 6 mm; 29...

  2. 气压弹道和钬激光治疗输尿管单个结石效果的比较%A study on pneumatic lithotripsy versus holmium laser lithotripsy for the treatment of single ureteral stone

    Institute of Scientific and Technical Information of China (English)

    刘武; 钱坤

    2015-01-01

    ObjectiveThe aim of this study was to analyze the stone-free (SF) rates between pneumatic lithotripsy (PL) and holmium laser lithotripsy (HLL) for the treatment of single ureteral stones and to evaluate potentially single ureteral stones. MethodsFrom January2010 to August2014,131 consecutive patients with single stones were prospectively enrolled, and117 patients were brought into at last, which were divided into PL group(n=57) and HLL group(n=60). Uni- and multivariate logistic regression were performed to estimate predictive factors of a SF status.ResultsThe SF rate in the PL group was80.7 and86.1% in the HLL group. Success rates with regard of stone position were not significantly different between groups. At uni-variate logistic regression, middle ureteral stone (OR3.33,P=0.04), distal ureteral stone (OR4.4,P=0.02), HLL (OR3.05,P=0.04) and Hounsfield units (HUs) (OR1.07,P=0.03) were significantly predictive factors of a SF status. At a multivariate logistic regression, middle ureteral stone, distal ureteral stone, HLL and HUs ≥1200 were significantly associated with a SF status. Conclusion HLL significantly influences the SF status after ureteroscopy, allowing a higher SF rate when compared to PL. HUs may significantly influence this success rate.%目的:对比气压弹道和钬激光治疗输尿管单个结石的无石(SF)率,评价影响SF状态潜在的预测指标。方法:前瞻性选择2010年1月~2014年8月的131个患有输尿管单个结石的患者,最终纳入117人,将其分为气压弹道碎石组(PL组,57人)和钬激光碎石组(HLL组,60人)。应用单变量和多元线性回归分析,评价SF状态潜在的预测指标。结果:PL组的SF率是80.7%,而HLL组的SF率是86.1%,有显著差异。两组的相同位置的输尿管结石的碎石成功率无显著差异。通过单变量线性回归分析,确定输尿管中段结石(OR 3.33,P=0.04)、输尿管下段结石(OR 4.4,P=0.02

  3. Designing structural supply chain flexibility

    NARCIS (Netherlands)

    Mulinski, Ksawery Jan

    2012-01-01

    In a continuously changing business environment the role of supply chain flexibility is constantly increasing. A flexible supply chain can ensure survival in quickly changing market conditions as well as enable sustainable growth. This thesis explores the topic of supply chain flexibility with focus

  4. Flexible Scheduling: Making the Transition

    Science.gov (United States)

    Creighton, Peggy Milam

    2008-01-01

    Citing literature that supports the benefits of flexible scheduling on student achievement, the author exhorts readers to campaign for flexible scheduling in their library media centers. She suggests tips drawn from the work of Graziano (2002), McGregor (2006) and Stripling (1997) for making a smooth transition from fixed to flexible scheduling:…

  5. Designing structural supply chain flexibility

    NARCIS (Netherlands)

    Mulinski, Ksawery Jan

    2012-01-01

    In a continuously changing business environment the role of supply chain flexibility is constantly increasing. A flexible supply chain can ensure survival in quickly changing market conditions as well as enable sustainable growth. This thesis explores the topic of supply chain flexibility with focus

  6. First experience with blind lithotripsy of ureteral calculi by ruby laser

    Science.gov (United States)

    Pupkova, Ludmila S.; Reznikov, Leonid L.; Sokolovsky, Alexander A.; Mursin, A. G.; Soms, Leonid N.; Berenberg, Vladimir A.; Polikarpov, Sergey S.; Parkhomchuk, N. A.; Voskresensky, M. A.

    1994-05-01

    For the last two years we have applied continuous dual-wavelength Nd:YAG 20 - 60 W power laser to various urologic operations. Transmission of laser irradiation via a flexible quartz fiber permitted operating at any depth of the wound. High-intensity irradiation of 1.06 mkm wavelength was effective in making thin incisions into a variety of tissues, including skin, subcutaneous fat, aponeurosis, muscles, urinary bladder wall, prostate gland, renal pelvis, renal capsule and parenchyma, and urethra. The incisions were especially effective if the contact method was used. Operational access was accomplished in 3 - 5 minutes. At the same time, hemostasis occurred in small diameter vessels. More reliable hemostasis could be achieved by means of 1.32 mkm wavelength. With the present laser device, we carried out 57 different urologic operations in our clinic. Examples of such operations include prostatectomy, pyelolithotomy, ureterolithotomy, nephrectomy, resection of renal cysts, condylomata acuminata of the urogenital organs, and papilloma of the urethra and bladder. The results suggest that a combination of these two wavelengths may prove most effective. Advantages of this approach include a decreased blood loss and decreased surgical time, asepsis, good short- and long-term results, and no complications.

  7. Predictive value of low tube voltage and dual-energy CT for successful shock wave lithotripsy: an in vitro study.

    Science.gov (United States)

    Largo, Remo; Stolzmann, Paul; Fankhauser, Christian D; Poyet, Cédric; Wolfsgruber, Pirmin; Sulser, Tullio; Alkadhi, Hatem; Winklhofer, Sebastian

    2016-06-01

    This study investigates the capabilities of low tube voltage computed tomography (CT) and dual-energy CT (DECT) for predicting successful shock wave lithotripsy (SWL) of urinary stones in vitro. A total of 33 urinary calculi (six different chemical compositions; mean size 6 ± 3 mm) were scanned using a dual-source CT machine with single- (120 kVp) and dual-energy settings (80/150, 100/150 Sn kVp) resulting in six different datasets. The attenuation (Hounsfield Units) of calculi was measured on single-energy CT images and the dual-energy indices (DEIs) were calculated from DECT acquisitions. Calculi underwent SWL and the number of shock waves for successful disintegration was recorded. The prediction of required shock waves regarding stone attenuation/DEI was calculated using regression analysis (adjusted for stone size and composition) and the correlation between CT attenuation/DEI and the number of shock waves was assessed for all datasets. The median number of shock waves for successful stone disintegration was 72 (interquartile range 30-361). CT attenuation/DEI of stones was a significant, independent predictor (P waves with the best prediction at 80 kVp (β estimate 0.576) (P waves ranged between ρ = 0.31 and 0.68 showing the best correlation at 80 kVp (P < 0.001). The attenuation of urinary stones at low tube voltage CT is the best predictor for successful stone disintegration, being independent of stone composition and size. DECT shows no added value for predicting the success of SWL.

  8. The Effect of Pre-Procedure Anxiety on Pain Perception During First Session of Shock Wave Lithotripsy

    Directory of Open Access Journals (Sweden)

    Fırat Saraçoğlu

    2016-03-01

    Full Text Available Introduction Although shock wave lithotripsy (SWL is a common noninvasive procedure, it can be very painful and a serious source of anxiety which may affect pain perception. The aim of this study was to evaluate the association between patient’s anxiety and SWL-related pain. Materials and Methods A total of 54 patients, who underwent the first session of SWL treatment between January and April 2014 due to a single renal pelvic stone with a diameter less than 20 mm, were included in the study. All patients were particularly informed about the procedure and, then, the validated Hospital Anxiety and Depression scale was administered in order to identify the anxiety level before the procedure. All relevant data, such as age, sex, stone size, body mass index (BMI, anxiety score, visual analog scale (VAS score, skin-to-stone distance, and total energy were recorded. Results The mean age of the study population was 41.11±16.35 years. The mean stone size, anxiety level before procedure, VAS score during SWL, BMI, skin-to-stone distance and energy level were 10.69±4.75 mm (5-20 mm, 5.2±3.87; 6.5±2.46; 25.77±4.16; 7.23±2.10 cm; 56.53±16.74 joule, respectively. Anxiety prior to procedure, energy level and the number of total shock wave had a significant effect on VAS score (p0.05. Conclusion According to our results, reducing patient anxiety, if any, can provide some additional pain control during SWL procedure and can improve patient compliance

  9. Poly(methyl methacrylate) particles for local drug delivery using shock wave lithotripsy: In vitro proof of concept experiment.

    Science.gov (United States)

    Shaked, Eliav; Shani, Yoav; Zilberman, Meital; Scheinowitz, Mickey

    2015-08-01

    To leverage current local drug delivery systems methodology, there is vast use of polymeric particles serving as drug carriers to assure minimal invasive therapy with little systemic distribution of the released drug. There is an increasing interest in poly(methyl methacrylate) (PMMA) serving as carriers in drug delivery. The study aims to develop PMMA carriers for localized drug delivery and release system, combining innovative biomaterial technology and shock wave lithotripsy (SWL), and to study the effect of SWL on various concentrations of PMMA particles. We prepared PMMA particles that contain horseradish peroxidase (HRP) using a double emulsion technique, and investigated the mechanism of in vitro drug release from the carriers following exposure to SWL. We investigated the correlation between production method modifications, concentrations of the carriers subjected to SWL, and shock wave patterns. We successfully produced PMMA particles as drug carriers and stimulated the release of their contents by SWL; their polymeric shell can be shattered externally by SWL treatment, leading to release of the encapsulated drug. HRP enzyme activity was maintained following the encapsulation process and exposure to high dose of SWL pulses. Increased shock wave number results in increased shattering and greater fragmentation of PMMA particles. The results demonstrate a dose-response release of HRP; quantitation of the encapsulated HRP from the carriers rises with the number of SWL. Moreover, increased concentration of particles subjected to the same dose of SWL results in a significant increase of the total HRP release. Our research offers novel technique and insights into new, site-specific drug delivery and release systems.

  10. What is the impact of extracorporeal shock wave lithotripsy on semen parameters? A systematic review and meta-analysis.

    Science.gov (United States)

    Radfar, Mohammad H; Simforoosh, Nasser; Sotoudeh, Mehdi; Ramezani, Mehdi H; Mollakoochakian, Mohammad J; Nikravesh, Maryam; Shemshaki, Hamidreza

    2017-02-03

    Extracorporeal shock wave lithotripsy (ESWL) is an important tool for the management of urolithiasis. The effects of shockwaves on tissues are established. The aim of this meta-analysis is to evaluate the microscopic semen characteristics of young men before and after ESWL treatment for lower ureteral calculi. Literature searches were performed following the Cochrane guidelines. We conducted a systematic review and meta-analysis that included six trials that investigated the effects of ESWL on semen parameters, including sperm concentration, motility, and hematospermia. Meta-analyses were performed using fixed and random-effects models with tests for publication bias and heterogeneity. Significant worsening was detected in sperm concentration and motility after ESWL between case and control groups (mean difference -17.23, 95% confidence interval -22.53 to -11.93, p<0.00001, mean difference -10.82, 95% confidence interval -18.56 to -3.07, p = 0.006). Rate of microscopic and macroscopic hematospermia was significantly higher after ESWL between case and control groups [risk ratio (RR) 40.00, 95% confidence interval 10.11-158.30, p<0.00001, RR 14.33, 95% confidence interval 2.82-72.90, p = 0.001]. All parameters recovered after 3 months. This study showed sperm concentration, motility, and rate of hematospermia (microscopic and macroscopic) were affected by ESWL that was used for the treatment of lower ureteral stone. Long-term studies with a focus on male fertility (i.e., pregnancy rates) after ESWL are warranted.

  11. Listening to music during shock wave lithotripsy decreases anxiety, pain, and dissatisfaction : A randomized controlled study.

    Science.gov (United States)

    Cakmak, Ozgur; Cimen, Sertac; Tarhan, Huseyin; Ekin, Rahmi Gokhan; Akarken, Ilker; Ulker, Volkan; Celik, Orcun; Yucel, Cem; Kisa, Erdem; Ergani, Batuhan; Cetin, Taha; Kozacioglu, Zafer

    2017-05-17

    We analyzed the effects of music on pain, anxiety, and overall satisfaction in patients undergoing a shock wave lithotripsy (SWL) procedure. A total of 200 patients scheduled to undergo SWL were included in this study. Group 1 consisted of 95 patients who listened to music during the SWL session while group 2 included 105 patients who did not listen music during the procedure. State-Trait Anxiety Inventory (STAI) was used to assess state and trait anxiety (STAI-S/T). A visual analog scale (VAS) was used at the end of the session in order to assess pain, willingness to repeat the procedure, and overall patient satisfaction. Hemodynamic parameters including systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate (HR) were recorded before and after the session. No statistically significant difference was found between the two groups in terms of stone characteristics, SWL parameters, pre-SWL STAI-T/S scores, and pre-SWL hemodynamic parameters. Post-SWL STAI-S scores were found to be lower in patients who listened to music (p = 0.006). At the end of the SWL, VAS scores of pain, satisfaction, and willingness to repeat procedure were significantly different in favor of the music group (p = 0.007, p = 0.001, p = 0.015, respectively). SBP, DBP, and HR were significantly higher in patients who did not listen to music (p = 0.002, p = 0.024, p = 0.001, respectively). Music can be an ideal adjunctive treatment modality for patients undergoing SWL treatment. It has the potential to enhance patient compliance and treatment satisfaction by reducing the procedure-related anxiety and pain perception.

  12. Measuring and Comparing Energy Flexibilities

    DEFF Research Database (Denmark)

    Valsomatzis, Emmanouil; Hose, Katja; Pedersen, Torben Bach

    2015-01-01

    Flexibility in energy supply and demand becomes more and more important with increasing Renewable Energy Sources (RES) production and the emergence of the Smart Grid. So-called prosumers, i.e., entities that produce and/or consume energy, can offer their inherent flexibilities through so......-called demand response and thus help stabilize the energy markets. Thus, prosumer flexibility becomes valuable and the ongoing Danish project TotalFlex [1] explores the use of prosumer flexibility in the energy market using the concept of a flex-offer [2], which captures energy flexibilities in time and...... induced by time and amount individually, and by their com- bination. To this end, we introduce several flexibility measures that take into account the combined effect of time and energy on flex-offer flexibility and discuss their respective pros and cons through a number of realistic examples....

  13. Flexible Volumetric Structure

    Science.gov (United States)

    Cagle, Christopher M. (Inventor); Schlecht, Robin W. (Inventor)

    2014-01-01

    A flexible volumetric structure has a first spring that defines a three-dimensional volume and includes a serpentine structure elongatable and compressible along a length thereof. A second spring is coupled to at least one outboard edge region of the first spring. The second spring is a sheet-like structure capable of elongation along an in-plane dimension thereof. The second spring is oriented such that its in-plane dimension is aligned with the length of the first spring's serpentine structure.

  14. Flexible composite radiation detector

    Science.gov (United States)

    Cooke, D. Wayne; Bennett, Bryan L.; Muenchausen, Ross E.; Wrobleski, Debra A.; Orler, Edward B.

    2006-12-05

    A flexible composite scintillator was prepared by mixing fast, bright, dense rare-earth doped powdered oxyorthosilicate (such as LSO:Ce, LSO:Sm, and GSO:Ce) scintillator with a polymer binder. The binder is transparent to the scintillator emission. The composite is seamless and can be made large and in a wide variety of shapes. Importantly, the composite can be tailored to emit light in a spectral region that matches the optimum response of photomultipliers (about 400 nanometers) or photodiodes (about 600 nanometers), which maximizes the overall detector efficiency.

  15. Composite Flexible Blanket Insulation

    Science.gov (United States)

    Kourtides, Demetrius A. (Inventor); Pitts, William C. (Inventor); Goldstein, Howard E. (Inventor); Sawko, Paul M. (Inventor)

    1991-01-01

    Composite flexible multilayer insulation systems (MLI) were evaluated for thermal performance and compared with the currently used fibrous silica (baseline) insulation system. The systems described are multilayer insulations consisting of alternating layers of metal foil and scrim ceramic cloth or vacuum metallized polymeric films quilted together using ceramic thread. A silicon carbide thread for use in the quilting and the method of making it are also described. These systems are useful in providing lightweight insulation for a variety of uses, particularly on the surface of aerospace vehicles subject to very high temperatures during flight.

  16. Flexible plasma linear antenna

    Science.gov (United States)

    Zhao, Jiansen; Wang, Shengzheng; Wu, Huafeng; Liu, Yue; Chang, Yongmeng; Chen, Xinqiang

    2017-02-01

    In this work, we introduce a type of plasma antenna that was fabricated using flexible materials and excited using a 5-20 kHz alternating current (ac) power supply. The results showed that the antenna characteristics, including the impedance, the reflection coefficient (S11), the radiation pattern, and the gain, can be controlled rapidly and easily by varying both the discharge parameters and the antenna shapes. The scope for reconfiguration is greatly enhanced when the antenna shape is changed from a monopole to a helix configuration. Additionally, the antenna polarization can also be adjusted by varying the antenna shapes.

  17. Percutaneous papillary large balloon dilation during percutaneous cholangioscopic lithotripsy for the treatment of large bile-duct stones: a feasibility study.

    Science.gov (United States)

    Han, Jee Young; Jeong, Seok; Lee, Don Haeng

    2015-03-01

    When access to a major duodenal papilla or endoscopic retrograde cholangiopancreatography has failed, percutaneous transhepatic cholangioscopic lithotripsy (PTCS-L) may be useful for removing common bile duct (CBD) stones. However, the feasibility and usefulness of percutaneous transhepatic papillary large-balloon dilation (PPLBD) during PTCS-L for the removal of large CBD stones has not been established. We aimed to determine the safety and efficacy of PPLBD for the treatment of large CBD stones. Eleven patients with large CBD stones in whom the access to the major papilla or bile duct had failed were enrolled prospectively. Papillary dilation was performed using a large (12-20 mm) dilation balloon catheter via the percutaneous transhepatic route. Post-procedure adverse events and efficacy of the stone retrieval were measured. The initial success rate of PPLBD was 100%. No patient required a basket to remove a stone after PPLBD. Electrohydraulic lithotripsy was required in 2 (18.2%) patients. The median time to complete stone removal after PPLBD was 17.8 min and no adverse events occurred after PPLBD. Asymptomatic hyperamylasemia was not encountered in any patients. This study indicates that PPLBD is safe and effective for removal of large CBD stones.

  18. Impacted anterior urethral calculus complicated by a stone-containing diverticulum in an elderly man: outcome of transurethral lithotripsy without resection of the diverticulum.

    Science.gov (United States)

    Zhou, Tie; Chen, Guanghua; Zhang, Wei; Peng, Yonghan; Xiao, Liang; Xu, Chuangliang; Sun, Yinghao

    2013-01-01

    The prevalence of lower urinary tract symptoms (LUTS) is about 20% in men aged 40 or above. Other than benign prostatic hyperplasia (BPH), urethral diverticulum or calculus is not uncommon for LUTS in men. Surgical treatment is often recommended for urethral diverticulum or calculus, but treatment for an impacted urethral calculus complicated by a stone-containing diverticulum is challenging. An 82-year-old man had the persistence of LUTS despite having undergone transurethral resection of prostate for BPH. Regardless of treatment with broad spectrum antibiotics and an α-blocker, LUTS and post-void residual urine volume (100 mL) did not improve although repeated urinalysis showed reduction of WBCs from 100 to 10 per high power field. Further radiology revealed multiple urethral calculi and the stone configuration suggested the existence of a diverticulum. He was successfully treated without resecting the urethral diverticulum; and a new generation of ultrasound lithotripsy (EMS, Nyon, Switzerland) through a 22F offset rigid Storz nephroscope (Karl Storz, Tuttingen, Germany) was used to fragment the stones. The operative time was 30 minutes and the stones were cleanly removed. The patient was discharged after 48 hours with no immediate complications and free of LUTS during a 2 years follow-up. When the diverticulum is the result of a dilatation behind a calculus, removal of the calculus is all that is necessary. Compared with open surgery, ultrasound lithotripsy is less invasive with little harm to urethral mucosa; and more efficient as it absorbs stone fragments while crushing stones.

  19. Asymmetric Flexible Supercapacitor Stack

    Directory of Open Access Journals (Sweden)

    Leela Mohana Reddy A

    2008-01-01

    Full Text Available AbstractElectrical double layer supercapacitor is very significant in the field of electrical energy storage which can be the solution for the current revolution in the electronic devices like mobile phones, camera flashes which needs flexible and miniaturized energy storage device with all non-aqueous components. The multiwalled carbon nanotubes (MWNTs have been synthesized by catalytic chemical vapor deposition technique over hydrogen decrepitated Mischmetal (Mm based AB3alloy hydride. The polymer dispersed MWNTs have been obtained by insitu polymerization and the metal oxide/MWNTs were synthesized by sol-gel method. Morphological characterizations of polymer dispersed MWNTs have been carried out using scanning electron microscopy (SEM, transmission electron microscopy (TEM and HRTEM. An assymetric double supercapacitor stack has been fabricated using polymer/MWNTs and metal oxide/MWNTs coated over flexible carbon fabric as electrodes and nafion®membrane as a solid electrolyte. Electrochemical performance of the supercapacitor stack has been investigated using cyclic voltammetry, galvanostatic charge-discharge, and electrochemical impedance spectroscopy.

  20. Laparoscopic - assisted transpyelic rigid nephroscopy - simple alternative when flexible ureteroscopy is not available

    Directory of Open Access Journals (Sweden)

    Marcos Tobias-Machado

    Full Text Available ABSTRACT Introduction: In special situations such as malrotated or ectopic kidneys and UPJ stenosis treatment of renal lithiasis can be challenging. In these rare cases laparoscopy can be indicated. Objective: Describe the Laparoscopic-assisted rigid nephroscopy performed via transpyelic approach and report the feasibility. Patients and methods: We present two cases of caliceal lithiasis. The first is a patient that ESWL and previous percutaneous lithotripsy have failed, with pelvic kidney where laparoscopic dissection of renal pelvis was carried out followed by nephroscopy utilizing the 30 Fr rigid nephroscope to remove the calculus. Ideal angle between the major axis of renal pelvis and the rigid nephroscope to allow success with this technique was 60-90 grades. In the second case, the kidney had a dilated infundibulum. Results: The operative time was 180 minutes for both procedures. No significant blood loss or perioperative complications occurred. The bladder catheter was removed in the postoperative day 1 and Penrose drain on day 2 when patients were discharged. The convalescence was completed after 3 weeks. Patients were stone free without symptons in one year of follow-up. Conclusions: Laparoscopic-assisted rigid nephroscopy performed via tranpyelic approach can be done safely with proper patient selection and adherence to standard laparoscopic surgical principles. This approach is an alternative in cases where flexible endoscope is not available and when standard procedure is unlikely to produce a stone-free status.

  1. Laparoscopic - assisted transpyelic rigid nephroscopy - simple alternative when flexible ureteroscopy is not available

    Science.gov (United States)

    Tobias-Machado, Marcos; Hidaka, Alexandre Kiyoshi; Nunes-Silva, Igor; Chagas, Carlos Alberto; Leal, Leandro Correa; Pompeo, Antonio Carlos Lima

    2016-01-01

    ABSTRACT Introduction: In special situations such as malrotated or ectopic kidneys and UPJ stenosis treatment of renal lithiasis can be challenging. In these rare cases laparoscopy can be indicated. Objective: Describe the Laparoscopic-assisted rigid nephroscopy performed via transpyelic approach and report the feasibility. Patients and methods: We present two cases of caliceal lithiasis. The first is a patient that ESWL and previous percutaneous lithotripsy have failed, with pelvic kidney where laparoscopic dissection of renal pelvis was carried out followed by nephroscopy utilizing the 30 Fr rigid nephroscope to remove the calculus. Ideal angle between the major axis of renal pelvis and the rigid nephroscope to allow success with this technique was 60-90 grades. In the second case, the kidney had a dilated infundibulum. Results: The operative time was 180 minutes for both procedures. No significant blood loss or perioperative complications occurred. The bladder catheter was removed in the postoperative day 1 and Penrose drain on day 2 when patients were discharged. The convalescence was completed after 3 weeks. Patients were stone free without symptons in one year of follow-up. Conclusions: Laparoscopic-assisted rigid nephroscopy performed via tranpyelic approach can be done safely with proper patient selection and adherence to standard laparoscopic surgical principles. This approach is an alternative in cases where flexible endoscope is not available and when standard procedure is unlikely to produce a stone-free status. PMID:27564304

  2. The Flexibility Hypothesis of Healing.

    Science.gov (United States)

    Hinton, Devon E; Kirmayer, Laurence J

    2017-03-01

    Theories of healing have attempted to identify general mechanisms that may work across different modalities. These include altering expectations, remoralization, and instilling hope. In this paper, we argue that many forms of healing and psychotherapy may work by inducing positive psychological states marked by flexibility or an enhanced ability to shift cognitive sets. Healing practices may induce these states of cognitive and emotional flexibility through specific symbolic interventions we term "flexibility primers" that can include images, metaphors, music, and other media. The flexibility hypothesis suggests that cognitive and emotional flexibility is represented, elicited, and enacted through multiple modalities in healing rituals. Identifying psychological processes and cultural forms that evoke and support cognitive and emotional flexibility provides a way to understand the cultural specificity and potential efficacy of particular healing practices and can guide the design of interventions that promote resilience and well-being.

  3. Flexible cultural repertoires

    DEFF Research Database (Denmark)

    Lindegaard, Marie Rosenkrantz

    2016-01-01

    Despite extensive studies of street culture and the risks of offending and victimization in urban marginalized areas, little is known about the role of cultural repertoires for variation in victimization risks among young men not involved in crime. Based on two ethnographic studies, conducted...... varying cultural repertoires, in particularly heterogeneous flexible repertoires, influence offending and victimization patterns among young men in high-risk settings....... independently of the authors in neighbouring township areas of Cape Town, we offer insights into patterns of victimization among young men not involved in crime who live and attend school in the townships. Young men who perform decent cultural repertoires are highly exposed to victimization due to their moral...

  4. Conformational flexibility of aspartame.

    Science.gov (United States)

    Toniolo, Claudio; Temussi, Pierandrea

    2016-05-01

    L-Aspartyl-L-phenylalanine methyl ester, better known as aspartame, is not only one of the most used artificial sweeteners, but also a very interesting molecule with respect to the correlation between molecular structure and taste. The extreme conformational flexibility of this dipeptide posed a huge difficulty when researchers tried to use it as a lead compound to design new sweeteners. In particular, it was difficult to take advantage of its molecular model as a mold to infer the shape of the, then unknown, active site of the sweet taste receptor. Here, we follow the story of the 3D structural aspects of aspartame from early conformational studies to recent docking into homology models of the receptor. © 2016 Wiley Periodicals, Inc. Biopolymers (Pept Sci) 106: 376-384, 2016.

  5. A new robot for flexible ureteroscopy: development and early clinical results (IDEAL stage 1-2b).

    Science.gov (United States)

    Saglam, Remzi; Muslumanoglu, Ahmet Yaser; Tokatlı, Zafer; Caşkurlu, Turhan; Sarica, Kemal; Taşçi, Ali İhsan; Erkurt, Bülent; Süer, Evren; Kabakci, Ahmet Sinan; Preminger, Glenn; Traxer, Olivier; Rassweiler, Jens J

    2014-12-01

    An improved armamentarium has had a significant impact on the emerging role of flexible ureteroscopy (FURS) for the management of nephrolithiasis; however, FURS still represents a challenging technique. To examine a robotic device designed for FURS for its impact on ergonomics and outcome of the procedure based on the IDEAL (idea, development, evaluation, assessment, long-term study) framework. Roboflex Avicenna consists of a surgeon's console and a manipulator for the flexible ureterorenoscope. Following experimental evaluation of the prototype (IDEAL stage 1) and receipt of ethical approval, seven surgeons treated 81 patients (mean age: 42 yr [range: 6-68]) with renal calculi (mean volume: 1296±544 mm(3) [range: 432-3100 mm3]) in an observational study (IDEAL stage 2). Robotic FURS was performed with the Roboflex Avicenna robotic device. Numerical data were analysed with the Mann-Whitney test, and categorical variables were analysed using the chi-square test or Fisher exact test. P values <0.05 were considered statistically significant. Mean robot docking time was 59.6±45 s. Mean operative time was 74min (range: 40-182). Mean fragmentation speed was 29.1±6.1 mm3/min. Ergonomics based on a validated questionnaire showed significant advantage for robotic FURS (total score: 5.6 vs 31.3; p<0.01). A 10/12F-access sheath was used in 72 patients. Two cases required secondary FURS, one because of malfunction of the flexible digital ureteroscope and another because of larger residual fragments. In the remaining 79 cases, complete stone disintegration was accomplished. Roboflex Avicenna provides a suitable and safe platform for robotic FURS with significant improvement of ergonomics. Future studies should evaluate its impact on the clinical outcome of FURS. Robotic flexible ureteroscopy (FURS) was performed with the Roboflex Avicenna robotic device. Results showed that Roboflex Avicenna provides a suitable and safe platform for robotic FURS with significant improvement

  6. Comparison of EMS ultrasonic pressure ballistic lithotripsy and holmium laser lithotripsy in ther-apy of complex renal calculi%EMS 超声-气压弹道碎石与微通道钬激光碎石治疗复杂性肾结石对比研究

    Institute of Scientific and Technical Information of China (English)

    安家利

    2016-01-01

    目的:比较 EMS 超声-气压弹道碎石与微通道钬激光碎石治疗复杂性肾结石的临床疗效。方法选择2012年1月至2015年1月收治的400例复杂性肾结石患者作为研究对象,根据其治疗方式分为两组,每组200例,观察组给予 EMS 超声-气压弹道碎石术治疗,对照组给予微通道钬激光碎石术治疗,比较两组患者临床疗效、围术期情况及并发症发生率。结果观察组碎石时间、造瘘管留置时间、住院时间均低于对照组(P ﹤0.05);观察组鹿角形结石患者术后5 d、1个月清除率分别高于对照组(P ﹤0.05);两组患者术后并发症发生率比较差异均未见统计学意义(P ﹥0.05)。结论 EMS 超声-气压弹道碎石术治疗复杂性肾结石效果显著,能促进患者早期康复,值得临床重视。%Objective To compare the clinical curative effect of EMS ultrasonic pressure ballistic lithotripsy and holmium laser lithotripsy in therapy of complex renal calculi. Methods From January 2012 to January 2015,400 patients with complex renal calculi were selected as the research objects,and were divided into two groups according to different treatment methods with 200 cases in each group. The observation group were treated by the EMS ultrasonic and pneumatic lithotripsy,control group were trea-ted by micro channel holmium laser lithotripsy. The clinical curative effect,confining operation period and the incidence of complications were compared between the two groups. Results The lithotripsy time,making the fistula indwelling time and hospitalization time in observation group were lower than those in the control group(P ﹤ 0. 05);the clearance rates of patients with staghorn calculi in observation group 5 d,one month after operation were higher than those in control group(P ﹤ 0. 05);the postopera-tive complication rate after operation had no significant difference between the two groups(P ﹥ 0. 05). Conclusions EMS

  7. Outcome of shock wave lithotripsy as monotherapy for large solitary renal stones (>2 cm in size without stenting

    Directory of Open Access Journals (Sweden)

    Shanmugasundaram Rajaian

    2010-01-01

    Full Text Available Purpose : To evaluate the outcome of shock wave lithotripsy (SWL as monotherapy for solitary renal stones larger than 2 cm without ureteral stenting. Materials and Methods : Our retrospective study included patients with solitary renal radio opaque stones larger than 2 cm treated with SWL using electromagnetic Dornier Compact S lithotripter device (Wessling, Germany for a period of 3 years (September 2002-2005. Stone clearance was assessed at 1 week, 1 month, and 3 months with plain X-rays of kidney, ureter, and bladder region, ultrasonography, and tomograms. Stone-free status, morbidity of the procedure, and fate of clinically insignificant residual fragments (CIRF were studied. A stone-free state was defined as no radiologic evidence of stone. Success was defined as complete clearance + CIRF. Results : Fifty-five patients, aged 11-65 years (mean 49.8 underwent SWL. Of them, only two were children. Male-to-female ratio was 3:1. The stone size was 21-28 mm (average 24 mm. The mean number of shocks were 3732 (range 724-12,100 and average energy level was 14 kV (range 11-16 kV. The mean follow-up was 18 months (range 3-22 months. Over all, stone-free status was achieved in 50% and success in 81% at 3 months. Stone clearance was not affected by stone location. Stones 26 mm (P = -0.10. Of 54 patients, 39 developed steinstrasse with mean length of 3.2 cm (range 1.4-6.2 cm and only four required intervention. Effectiveness quotient (EQ for SWL monotherapy for solitary renal stones more than 2 cm was 25.3%. The EQ for stones <25 mm and those more than 25 mm were 28.4% and 10% (P = -0.12, respectively. There was a lesser trend of difference between stones with size <25 and more than 25 mm. During the last review, the overall stone-free rate was 67.2%. Conclusions : SWL monotherapy was safe but significantly less effective for solitary renal stones larger than 2 cm. It can only be suggested to those who refuse surgical intervention. Pretreatment DJ

  8. Comparison of extracorporeal shock wave lithotripsy running models between outsourcing cooperation and rental cooperation conducted in Taiwan.

    Science.gov (United States)

    Liu, Chih-Kuang; Ko, Ming-Chung; Chen, Shiou-Sheng; Lee, Wen-Kai; Shia, Ben-Chang; Chiang, Han-Sun

    2015-02-01

    We conducted a retrospective study to compare the cost and effectiveness between two different running models for extracorporeal shock wave lithotripsy (SWL), including the outsourcing cooperation model (OC) and the rental cooperation model (RC). Between January 1999 and December 2005, we implemented OC for the SWL, and from January 2006 to October 2011, RC was utilized. With OC, the cooperative company provided a machine and shared a variable payment with the hospital, according to treatment sessions. With RC, the cooperative company provided a machine and received a fixed rent from the hospital. We calculated the cost of each treatment session, and evaluated the break-even point to estimate the lowest number of treatment sessions to make the balance between revenue and cost every month. Effectiveness parameters, including the stone-free rate, the retreatment rate, the rate of additional procedures and complications, were evaluated. Compared with OC there were significantly less treatment sessions for RC every month (42.6±7.8 vs. 36.8±6.5, p=0.01). The cost of each treatment session was significantly higher for OC than for RC (751.6±20.0 USD vs. 684.7±16.7 USD, p=0.01). The break-even point for the hospital was 27.5 treatment sessions/month for OC, when the hospital obtained 40% of the payment, and it could be reduced if the hospital got a greater percentage. The break-even point for the hospital was 27.3 treatment sessions/month for RC. No significant differences were noticed for the stone-free rate, the retreatment rate, the rate of additional procedures and complications. Our study revealed that RC had a lower cost for every treatment session, and fewer treatment sessions of SWL/month than OC. The study might provide a managerial implication for healthcare organization managers, when they face a situation of high price equipment investment. Copyright © 2012. Published by Elsevier B.V.

  9. Building Highly Flexible Polyelectrolyte Nanotubes

    Institute of Scientific and Technical Information of China (English)

    2004-01-01

    @@ Flexibility of polyelectrolyte nanotubes is necessary if they are to be exploited in applications such as developing photoelectric devices with strong mechanical properties. In a recent attempt, high flexibility has been observed from such nanotubes prepared by a research team headed by Prof. Li Junbai of the CAS Institute of Chemistry (ICCAS).

  10. On flexible and rigid nouns

    DEFF Research Database (Denmark)

    Rijkhoff, Jan

    2008-01-01

    , Non-Verb, Modifier), there are also flexible word classes within the rigid lexical category Noun (Set Noun, Sort Noun, General Noun). Members of flexible word classes are characterized by their vague semantics, which in the case of nouns means that values for the semantic features Shape...

  11. On flexible and rigid nouns

    DEFF Research Database (Denmark)

    Rijkhoff, Jan

    2010-01-01

    This article argues that in addition to the major flexible lexical categories in Hengeveld’s classification of parts of speech systems (Contentive, Non-Verb, Modifier), there are also flexible word classes within the rigid lexical category Noun (Set Noun, Sort Noun, General Noun). Members...

  12. Function Machines & Flexible Algebraic Thought.

    Science.gov (United States)

    Davis, Gary E.; McGowen, Mercedes A.

    This paper explores how college students understand ideas of functions, and which representations are productive for them in promoting their ability to work flexibly across representations. The study used pre- and post-test scores, and triangulations via student self evaluations, to generate a hypothesis related to flexible thinking and success in…

  13. Sensor Technologies on Flexible Substrates

    Science.gov (United States)

    Koehne, Jessica

    2016-01-01

    NASA Ames has developed sensor technologies on flexible substrates integrated into textiles for personalized environment monitoring and human performance evaluation. Current technologies include chemical sensing for gas leak and event monitoring and biological sensors for human health and performance monitoring. Targeted integration include next generation EVA suits and flexible habitats.

  14. Retirement Flexibility and Portfolio Choice

    NARCIS (Netherlands)

    Adema, Y.; Bonenkamp, J.; Meijdam, A.C.

    2011-01-01

    This paper explores the interaction between retirement flexibility and portfolio choice in an overlapping-generations model. We analyse this interaction both in a partial-equilibrium and general-equilibrium setting. Retirement flexibility is often seen as a hedge against capital-market risks which

  15. Flexible Coupling Corrects Shaft Misalinements

    Science.gov (United States)

    Mayo, R. A.

    1983-01-01

    Proposed flexible coupling provides nearly error free measurements of shaft rotation in presence of misalinements between shaft and position sensing transducer. Intended to be used in situations in which input or output shaft is mounted on flexible joint. Its function is to insure equal input and output angular velocities by forcing input and output shafts to remain parallel.

  16. Functional aspects of protein flexibility

    DEFF Research Database (Denmark)

    Teilum, Kaare; Olsen, Johan G; Kragelund, Birthe B

    2009-01-01

    Proteins are dynamic entities, and they possess an inherent flexibility that allows them to function through molecular interactions within the cell, among cells and even between organisms. Appreciation of the non-static nature of proteins is emerging, but to describe and incorporate...... this into an intuitive perception of protein function is challenging. Flexibility is of overwhelming importance for protein function, and the changes in protein structure during interactions with binding partners can be dramatic. The present review addresses protein flexibility, focusing on protein-ligand interactions....... The thermodynamics involved are reviewed, and examples of structure-function studies involving experimentally determined flexibility descriptions are presented. While much remains to be understood about protein flexibility, it is clear that it is encoded within their amino acid sequence and should be viewed...

  17. [Flexible root posts].

    Science.gov (United States)

    Vadachkoriia, N R; Mandzhavidze, N A; Gumberidze, N Sh

    2009-02-01

    The article discusses the current state of restoration techniques of root canal treatment. Nowadays, technical progress allows manufacturers to develop flexible fiberglass posts, aspiring not only to an excellent aesthetics and mechanical properties (first of all, in comparison with metal and cast posts), but also to maintenance of their radio density and a wide range of forms. Growth of fiberglass posts popularity testifies to their clinical efficiency that also is confirmed by results of long-term researches. Introduction of fiberglass posts in a dental practice has rendered huge influence on restoration techniques of root canal treatment. Convincing factors of fiberglass posts superiority provide restoration the appearance similar with the natural dentition; possess close to dentine elasticity; creation of monolithic structure with hard tooth tissues and composite cement, posts, in case of need, can be easily adjusted on length, adhesive linkage of posts gives them additional stability. Modern researches have confirmed that only elastic, namely carbon fiber and the fiberglass posts made of modern technologies possess similar physical properties, as tooth structure. They can create reliable biomimetic design; solve a complex of aesthetic and functional restoration problems.

  18. Orthogonal flexible Rydberg aggregates

    Science.gov (United States)

    Leonhardt, K.; Wüster, S.; Rost, J. M.

    2016-02-01

    We study the link between atomic motion and exciton transport in flexible Rydberg aggregates, assemblies of highly excited light alkali-metal atoms, for which motion due to dipole-dipole interaction becomes relevant. In two one-dimensional atom chains crossing at a right angle adiabatic exciton transport is affected by a conical intersection of excitonic energy surfaces, which induces controllable nonadiabatic effects. A joint exciton-motion pulse that is initially governed by a single energy surface is coherently split into two modes after crossing the intersection. The modes induce strongly different atomic motion, leading to clear signatures of nonadiabatic effects in atomic density profiles. We have shown how this scenario can be exploited as an exciton switch, controlling direction and coherence properties of the joint pulse on the second of the chains [K. Leonhardt et al., Phys. Rev. Lett. 113, 223001 (2014), 10.1103/PhysRevLett.113.223001]. In this article we discuss the underlying complex dynamics in detail, characterize the switch, and derive our isotropic interaction model from a realistic anisotropic one with the addition of a magnetic bias field.

  19. Orthogonal flexible Rydberg aggregates

    CERN Document Server

    Leonhardt, K; Rost, J M

    2015-01-01

    We study the link between atomic motion and exciton transport in flexible Rydberg aggregates, assemblies of highly excited light alkali atoms, for which motion due to dipole-dipole interaction becomes relevant. In two one-dimensional atom chains crossing at a right angle adiabatic exciton transport is affected by a conical intersection of excitonic energy surfaces, which induces controllable non-adiabatic effects. A joint exciton/motion pulse that is initially governed by a single energy surface is coherently split into two modes after crossing the intersection. The modes induce strongly different atomic motion, leading to clear signatures of non-adiabatic effects in atomic density profiles. We have shown how this scenario can be exploited as an exciton switch, controlling direction and coherence properties of the joint pulse on the second of the chains [K.~Leonhardt {\\it et al.}, Phys.~Rev.~Lett. {\\bf 113} 223001 (2014)]. In this article we discuss the underlying complex dynamics in detail, characterise the ...

  20. Acute pancreatitis and development of pancreatic pseudo cyst after extra corporeal shock wave lithotripsy to a left renal calculus: A rare case with review of literature

    Directory of Open Access Journals (Sweden)

    Prasad Mylarappa

    2014-01-01

    Full Text Available Extracorporeal shock wave lithotripsy (SWL is considered the standard of care for the treatment of small upper ureteric and renal calculi. A few centers have extended its use to the treatment of bile duct calculi and pancreatic calculi. The complication rates with SWL are low, resulting in its wide spread acceptance and usage. However, some of the serious complications reported in 1% of patients include acute pancreatitis, perirenal hematoma, urosepsis, venous thrombosis, biliary obstruction, bowel perforation, lung injury, rupture of aortic aneurysm and intracranial hemorrhage. To our knowledge, only six cases of acute pancreatitis or necrotizing pancreatitis following SWL have been documented in the literature. Herein, we report a rare case of acute pancreatitis and formation of a pseudo cyst following SWL for left renal pelvic calculus.

  1. Flexible Blades for Wind Turbines

    Science.gov (United States)

    Collins, Madeline Carlisle; Macphee, David; Harris, Caleb

    2016-11-01

    Previous research has shown that windmills with flexible blades are more efficient than those with rigid blades. Flexibility offers passive pitch control, preferable to active pitch control which is costly and requires maintenance. Flexible blades morph such that the blade more closely resembles its design point at part load and over load. The lift-to-drag ratios on individual blades was investigated. A mold was designed and machined from an acrylic slab for the casting of blades with a NACA 0012 cross section. A flexible blade was cast from silicone and a rigid blade was cast from polyurethane. Each of these blades was tested in a wind tunnel, cantilever mounted, spanning the whole test section. The angle of attack was varied by rotating the mount. All tests were performed at the same wind speed. A load cell within the mount measured forces on the blade, from which the lift and drag forces were calculated. The stall point for the flexible blade occurred later than for the rigid blade, which agrees with previous research. Lift-to-drag ratios were larger for the flexible blade at all angles of attack tested. Flexible blades seem to be a viable option for passive pitch control. Future research will include different airfoil cross sections, wind speeds, and blade materials. Funding from NSF REU site Grant EEC 1358991 is greatly appreciated.

  2. Comparing non contrast computerized tomography criteria versus dual X-ray absorptiometry as predictors of radio-opaque upper urinary tract stone fragmentation after electromagnetic shockwave lithotripsy.

    Science.gov (United States)

    Hameed, Diaa A; Elgammal, Mohammed A; ElGanainy, Ehab O; Hageb, Adel; Mohammed, Khaled; El-Taher, Ahmed Mohamed; Mostafa, Mostafa Mohamed; Ahmed, Abdelfatah Ibrahim

    2013-11-01

    The objective of this study was to assess the value of dual X-ray absorptiometry (DXA) in comparison to non contrast computed tomography (NCCT) density as possible predictors of upper urinary tract stone disintegration by shock wave lithotripsy (SWL). This study included 100 consecutive patients, with solitary renal stone 0.5-2 cm or upper ureteral stone up to 1 cm. DXA to calculate stone mineral density (SMD) and stone mineral content (SMC) was done. NCCT was performed to measure Hounsfield units (HU). SWL was performed with an electromagnetic lithotripsy, plain X-ray documented disintegration after SWL. Successful treatment was defined as stone free or complete fragmentation after 1 or 2 sessions of SWL. The impact of patients age, sex, body mass index, stone laterality, location, volume, length, mean SMC and SMD, HU and Hounsfield density (HD), skin to stone distance (SSD) and number of shock waves were evaluated by univariate and multivariate analysis. Only 76 patients were available for follow-up. Success of disintegration was observed in 50 out of 76 patients (65.8 %). On multivariate analysis, SMC and number of shock wave were the significant independent factors affecting SWL outcome (p = 0.04 and p = 0.000, respectively). SMC as detected by DXA is a significant predictor of success of stone disintegration by SWL. SMC measured by DXA is more accurate than HU measured by CT. Patients with high stone mineral content (SMC greater than 0.65 g) should be directly offered another treatment option.

  3. Evaluation of long-term side effects after shock-wave lithotripsy for renal calculi using a third generation electromagnetic lithotripter.

    Science.gov (United States)

    Pirola, Giacomo Maria; Micali, Salvatore; Sighinolfi, Maria Chiara; Martorana, Eugenio; Territo, Angelo; Puliatti, Stefano; Bianchi, Giampaolo

    2016-10-01

    To assess the incidence of long-term side effects after shock-wave lithotripsy treatment performed with an electromagnetic Dornier Lithotripter S device. A specific follow-up was undertaken on a cohort of 100 selected patients that underwent SWL for a single renal stone in our center from 2002 to 2004. Previous and current data were compared using the Student t test. Factors associated with the incidence of hypertension and diabetes mellitus were determined. Ten years after treatment, mean serum creatinine level and glomerular filtration rate remained similar to previous values (serum creatinine level: 0.96 ± 0.22 vs. 0.92 ± 0.19 mg/dL; glomerular filtration rate: 92.8 ± 17.8 vs. 88.1 ± 21.7 mL/min). There were marked increases in blood cholesterol, blood pressure, and blood glucose levels, while smoking decreased. Age, glomerular filtration rate, body mass index, blood glucose and blood pressure at the time of treatment were significantly associated with the presence of hypertension and diabetes mellitus at follow-up; blood cholesterol was associated with diabetes mellitus development. After 10 years, overall renal function appeared to have been unaffected by shock-wave lithotripsy treatment. The increased rate of hypertension and diabetes mellitus were consistent with the incidence in the global population. This is the first report on the long-term safety of a third generation electromagnetic lithotripter, and indicates that there are no long-term sequelae.

  4. Swarming: flexible roaming plans.

    Science.gov (United States)

    Partridge, Jonathan D; Harshey, Rasika M

    2013-03-01

    Movement over an agar surface via swarming motility is subject to formidable challenges not encountered during swimming. Bacteria display a great deal of flexibility in coping with these challenges, which include attracting water to the surface, overcoming frictional forces, and reducing surface tension. Bacteria that swarm on "hard" agar surfaces (robust swarmers) display a hyperflagellated and hyperelongated morphology. Bacteria requiring a "softer" agar surface (temperate swarmers) do not exhibit such a dramatic morphology. For polarly flagellated robust swarmers, there is good evidence that restriction of flagellar rotation somehow signals the induction of a large number of lateral flagella, but this scenario is apparently not relevant to temperate swarmers. Swarming bacteria can be further subdivided by their requirement for multiple stators (Mot proteins) or a stator-associated protein (FliL), secretion of essential polysaccharides, cell density-dependent gene regulation including surfactant synthesis, a functional chemotaxis signaling pathway, appropriate cyclic (c)-di-GMP levels, induction of virulence determinants, and various nutritional requirements such as iron limitation or nitrate availability. Swarming strategies are as diverse as the bacteria that utilize them. The strength of these numerous designs stems from the vantage point they offer for understanding mechanisms for effective colonization of surface niches, acquisition of pathogenic potential, and identification of environmental signals that regulate swarming. The signature swirling and streaming motion within a swarm is an interesting phenomenon in and of itself, an emergent behavior with properties similar to flocking behavior in diverse systems, including birds and fish, providing a convenient new avenue for modeling such behavior.

  5. Flexible armored blanket development

    Energy Technology Data Exchange (ETDEWEB)

    Roth, E.S.

    1978-05-01

    An exploratory development contract was undertaken on December 23, 1977 which had as its purpose the development and demonstration of a flexible armored blanket design suitable for providing ballistic protection to nuclear weapons during shipment. Objectives were to design and fabricate a prototype blanket which will conform to the weapon shape, is troop-handleable in the field, and which, singly or in multiple layers, can defeat a range of kinetic energy armor piercing (AP) ammunition potentially capable of damaging the critical portion of the nuclear weapon. Following empirical testing, including the firing of threat ammunition under controlled laboratory and field test conditions, materials were selected and assembled into two blanket designs, each weighing approximately 54 kg/m{sup 2} (11 lbs/ft{sup 2}) and estimated to cost from $111 to $180 per ft{sup 2} in production. A firing demonstration to evidence blanket performance against terrorist/light infantry weapons, heavy infantry weapons, and aircraft cannon was conducted for representatives of the DOD and interested Sandia employees on April 12, 1978. The blankets performed better than anticipated defeating bullets up to 7.62 mm x 51 mm AP with one layer and projectiles up to 23 mm HEI with two layers. Based on these preliminary tests it is recommended that development work be continued with the following objectives: (1) the selection by the DOD of priority applications, (2) the specific design and fabrication of sufficient quantities of armored blankets for field testing, (3) the evaluation of the blankets by DOD operational units, with reports to Sandia Laboratories to enable final design.

  6. Guideline Implementation: Processing Flexible Endoscopes.

    Science.gov (United States)

    Bashaw, Marie A

    2016-09-01

    The updated AORN "Guideline for processing flexible endoscopes" provides guidance to perioperative, endoscopy, and sterile processing personnel for processing all types of reusable flexible endoscopes and accessories in all procedural settings. This article focuses on key points of the guideline to help perioperative personnel safely and effectively process flexible endoscopes to prevent infection transmission. The key points address verification of manual cleaning, mechanical cleaning and processing, storage in a drying cabinet, determination of maximum storage time before reprocessing is needed, and considerations for implementing a microbiologic surveillance program. Perioperative RNs should review the complete guideline for additional information and for guidance when writing and updating policies and procedures.

  7. Flexible Learning in a Digital World.

    Science.gov (United States)

    Collis, Betty; Moonen, Jef

    2002-01-01

    Defines flexible learning and describes components of flexible learning in higher education, including technology, pedagogy or instructional approach, implementation strategies, and institutional framework. Considers factors constraining learning flexibility; changing student characteristics; and the need for lifelong learning, particularly in the…

  8. AB059. A novel technique of suctioning flexible ureteroscopy with automatic control of renal pelvic pressure

    Science.gov (United States)

    Song, Le-Ming; Deng, Xiao-Lin

    2015-01-01

    Objective Flexible ureteroscopy is rapidly becoming a first line therapy for many patients with renal and ureteral calculi. Currently the medical infusion devices cannot monitor the renal pelvic pressure. We introduce a novel technique of flexible ureteroscopy with a suction system to treat upper urinary calculi and automatically control renal pelvic pressure. Methods We performed flexible URSs for patients with the help of a self-designed intelligent system including an irrigation and suctioning platform and a transparent ureteral access sheath (UAS) with a pressure-sensitive tip, which can precisely regulate the infusion flow and control the vacuum suctioning by computerized real-time recording and monitoring of RPP through pressure feedback, ensuring a stable RPP. The outer body diameter of the UAS was 15 F; the diameter of the working channel was 11.55 F; 
the length of the UAS was 20-45 cm. On the platform, RPP control value was set at −2 mmHg, RPP warning value was set at 20 mmHg, and RPP limit value was set at 30 mmHg. Intraoperatively, holmium laser was used to powderize the stone at 0.8 J/pulse with a frequency of 20 pulses/s (Lumenis, fiber diameter 200 um). In the process of powderizing lithotripsy using the laser, the scope body was moved back and forth slightly in an uninterrupted fashion in the sheath, with a distance of about 2-3 mm, to facilitate small gravel particles inside the sheath gap to be sucked out automatically. Gravel particles larger than sheath gap but less than UAS in diameter were sucked out by withdrawing the scope intermittently without a need of stone basketing. We retrospectively reviewed 37 patients with renal or ureteral calculus received the flexible URS from November 2014 to January 2015. Results The procedure was successfully performed in all patients with a clear operating field view. The mean stone size was 15.9±5.2 mm (rang: 8-35 mm). The mean operative time was 24.8±15.9 [13-49] min. The stone-free rates at

  9. A positive mood, a flexible brain

    OpenAIRE

    Betzel, Richard F.; Satterthwaite, Theodore D.; Gold, Joshua I.; Bassett, Danielle S.

    2016-01-01

    Flexible reconfiguration of human brain networks supports cognitive flexibility and learning. However, modulating flexibility to enhance learning requires an understanding of the relationship between flexibility and brain state. In an unprecedented longitudinal data set, we investigate the relationship between flexibility and mood, demonstrating that flexibility is positively correlated with emotional state. Our results inform the modulation of brain state to enhance response to training in h...

  10. Cost-effectiveness of extracorporeal shock wave lithotripsy in a poor resource setting: The Okada, Nigeria experience

    Directory of Open Access Journals (Sweden)

    Kenneth C Eze

    2016-01-01

    Full Text Available Background: The first extracorporeal shock wave lithotripsy (ESWL used in Nigeria was at Igbinedion Hospital and Medical Research Centre (IHMRC, Okada in 1992 and it functioned for 6 consecutive years. The objectives of this study were to analyze the cost-effectiveness of the procedure and highlight the associated factors that led to its failure. Methods: A retrospective study of medical records and publications associated with the use of ESWL at IHMRC, Okada, for the period of 1992 to 1998. The study was conducted between January 2003 and November 2008. Unclassified authentic information relating to the use of ESWL and treatment of upper urinary tract stones was obtained from the IHMRC Okada and some government hospitals on hospital bills. Relevant documents in public domains related to the national and international wages and emoluments of medical workers and socioeconomic development of Nigeria within the time the ESWL functioned were studied. Result: A total of 32 patients were treated with 51 treatment sessions which is an average of nine patients per year and an average of two treatment sessions per patient were involved. The reasons for the low patronage were the extremely low stone formation rate of Nigerians, poverty, and out-of-pocket payment system. In addition, each treatment session of ESWL at Okada cost an average of $681.8 compared to $227.3 for open nephrolithotomy in a nearby high profile teaching hospital. The IHMRC, Okada, paid an average annual salary of ₦180,000 ($8,181.8 for each medical consultant compared to ₦120,000 ($5,454.5 paid by federal teaching hospitals in Nigeria within the period. Expatriate consultant doctors from Europe and USA who initially manned the lithotriptor at IHMRC, Okada, were paid much higher salaries. Average annual income of $5,909 for each of the 6 years amounting to a total of $34,771.7 for the six years was realized which could not maintain staff salaries in the hospital leading to staff

  11. Aggregating and Disaggregating Flexibility Objects

    DEFF Research Database (Denmark)

    Siksnys, Laurynas; Valsomatzis, Emmanouil; Hose, Katja

    2015-01-01

    In many scientific and commercial domains we encounter flexibility objects, i.e., objects with explicit flexibilities in a time and an amount dimension (e.g., energy or product amount). Applications of flexibility objects require novel and efficient techniques capable of handling large amounts...... energy data management and discuss strategies for aggregation and disaggregation of flex-objects while retaining flexibility. This paper further extends these approaches beyond flex-objects originating from energy consumption by additionally considering flex-objects originating from energy production...... and aiming at energy balancing during aggregation. In more detail, this paper considers the complete life cycle of flex-objects: aggregation, disaggregation, associated requirements, efficient incremental computation, and balance aggregation techniques. Extensive experiments based on real-world data from...

  12. Two-dimensional flexible nanoelectronics

    National Research Council Canada - National Science Library

    Akinwande, Deji; Petrone, Nicholas; Hone, James

    2014-01-01

    .... With the discovery of hexagonal boron nitride as an ideal dielectric, the materials are now in place to advance integrated flexible nanoelectronics, which uniquely take advantage of the unmatched...

  13. Flexible Transparent Electronic Gas Sensors.

    Science.gov (United States)

    Wang, Ting; Guo, Yunlong; Wan, Pengbo; Zhang, Han; Chen, Xiaodong; Sun, Xiaoming

    2016-07-01

    Flexible and transparent electronic gas sensors capable of real-time, sensitive, and selective analysis at room-temperature, have gained immense popularity in recent years for their potential to be integrated into various smart wearable electronics and display devices. Here, recent advances in flexible transparent sensors constructed from semiconducting oxides, carbon materials, conducting polymers, and their nanocomposites are presented. The sensing material selection, sensor device construction, and sensing mechanism of flexible transparent sensors are discussed in detail. The critical challenges and future development associated with flexible and transparent electronic gas sensors are presented. Smart wearable gas sensors are believed to have great potential in environmental monitoring and noninvasive health monitoring based on disease biomarkers in exhaled gas.

  14. Flexible sensors based on nanoparticles.

    Science.gov (United States)

    Segev-Bar, Meital; Haick, Hossam

    2013-10-22

    Flexible sensors can be envisioned as promising components for smart sensing applications, including consumer electronics, robotics, prosthetics, health care, safety equipment, environmental monitoring, homeland security and space flight. The current review presents a concise, although admittedly nonexhaustive, didactic review of some of the main concepts and approaches related to the use of nanoparticles (NPs) in flexible sensors. The review attempts to pull together different views and terminologies used in the NP-based sensors, mainly those established via electrical transduction approaches, including, but, not confined to: (i) strain-gauges, (ii) flexible multiparametric sensors, and (iii) sensors that are unaffected by mechanical deformation. For each category, the review presents and discusses the common fabrication approaches and state-of-the-art results. The advantages, weak points, and possible routes for future research, highlighting the challenges for NP-based flexible sensors, are presented and discussed as well.

  15. Flexible protection for metal bellows

    Science.gov (United States)

    Kimble, K. G.

    1970-01-01

    RTV silicone is used with a braided wire sheath surrounding the metal bellows in fluid transfer systems. It demonstrated best overall performance in flexibility and shock absorbing tests, high temperature, low temperature, and salt spray.

  16. 经脐单孔联合硬膜外穿刺针输尿管镜下疝囊高位结扎术治疗儿童腹股沟斜疝%Trans-umbilical single-port ureteroscopic assisted high ligation of inguinal hernia sac with epidural puncture needle in treatment of indirect inguinal hernia in children

    Institute of Scientific and Technical Information of China (English)

    刘立成; 张艳华; 董蕤; 韩艳波; 陈俊慧; 高建; 张海涛; 马文民

    2015-01-01

    目的:评价经脐单孔联合硬膜外穿刺针输尿管镜下疝囊高位结扎术治疗儿童腹股沟斜疝的安全性与确切性。方法回顾性分析2012年5月至2013年12月,河北省滦县人民医院应用经脐单孔联合硬膜外穿刺针输尿管镜下疝囊高位结扎术治疗儿童腹股沟斜疝126例的临床资料。结果本组患者手术过程均顺利,手术时间5~18 min,切口无需缝合。术后1~2 d 出院。随访10~17个月,无复发。结论经脐单孔联合硬膜外穿刺针输尿管镜下疝囊高位结扎术治疗儿童腹股沟斜疝,在缝合过程中疝囊可获得输尿管镜钳的夹持固定,疝囊高位结扎确切,硬膜外穿刺针穿刺缝合过程中无需刺破腹膜,精确疝囊结扎,可同时发现及处理对侧隐性腹股沟疝,值得临床推广。%Objective To evaluate the safety and feasibility of trans-umbilical ureteroscopic assisted high ligation of hernia sac with epidural puncture needle in treatment of indirect inguinal hernia in children. Methods During May 2012 and December 2013,126 children who underwent trans-umbilical single-port ureteroscopic high ligation of hernia sac with an epidural puncture needle in Luanxian People's Hospital,were retrospectively analyzed in this study.Results All operations were successful completed.It took 5 to 18 minutes for the operations.No suture was needed for incision closure.Postoperative hospital stay was1 to 2 days.During the follow-up of 10 to 17 months,there was no no recurrence.Conclusions With trans-umbilical ureteroscopic high ligation of hernia sac combined with epidural puncture needle,hernia sac can be clamped and fixed by ureteroscopic forceps when suturing;and hernia sac high ligation can exactly performed without peritoneum puncturing,when the epidural puncture needle is used to suture;also,it is easy to find and deal with contralateral occult hernia during operation.It is worth the clinical promotion.

  17. FLEXIBLE FLATFOOT IN CHILDREN (REVIEW)

    OpenAIRE

    Владимир Маркович Кенис; Юрий Алексеевич Лапкин; Руслан Халилович Хусаинов; Андрей Викторович Сапоговский

    2014-01-01

    Flatfoot is one of the most common musculoskeletal conditions in the daily practice of pediatric orthopedists. Despite of numerous studies, diagnostic criteria and principles of management remain controversial. Flexible flatfoot - is visually detectable decrease in the height of the longitudinal arch of the foot, which can be spontaneously corrected by active or passive motion and not accompanied by any contracture of foot and ankle. Flexible flatfoot is a benign condition which is normal for...

  18. Value of Flexibility - Phase 1

    Science.gov (United States)

    2010-09-25

    flexibility could also change the calculus of how we determine when to start a new program vice modifying an existing one. Flexibility could even help...decades ago by Steward as a ‖framework for formally identifying and tracking relationships between design variables‖ [ Steward , 1981]. Keese [2007...Paper presented at the 6th Conference on Systems Engineering Research, Los Angeles, CA. Shreve, S. E. (2004). Stochastic calculus for finance. New

  19. Flexible packaging for PV modules

    Science.gov (United States)

    Dhere, Neelkanth G.

    2008-08-01

    Economic, flexible packages that provide needed level of protection to organic and some other PV cells over >25-years have not yet been developed. However, flexible packaging is essential in niche large-scale applications. Typical configuration used in flexible photovoltaic (PV) module packaging is transparent frontsheet/encapsulant/PV cells/flexible substrate. Besides flexibility of various components, the solder bonds should also be flexible and resistant to fatigue due to cyclic loading. Flexible front sheets should provide optical transparency, mechanical protection, scratch resistance, dielectric isolation, water resistance, UV stability and adhesion to encapsulant. Examples are Tefzel, Tedlar and Silicone. Dirt can get embedded in soft layers such as silicone and obscure light. Water vapor transmittance rate (WVTR) of polymer films used in the food packaging industry as moisture barriers are ~0.05 g/(m2.day) under ambient conditions. In comparison, light emitting diodes employ packaging components that have WVTR of ~10-6 g/(m2.day). WVTR of polymer sheets can be improved by coating them with dense inorganic/organic multilayers. Ethylene vinyl acetate, an amorphous copolymer used predominantly by the PV industry has very high O2 and H2O diffusivity. Quaternary carbon chains (such as acetate) in a polymer lead to cleavage and loss of adhesional strength at relatively low exposures. Reactivity of PV module components increases in presence of O2 and H2O. Adhesional strength degrades due to the breakdown of structure of polymer by reactive, free radicals formed by high-energy radiation. Free radical formation in polymers is reduced when the aromatic rings are attached at regular intervals. This paper will review flexible packaging for PV modules.

  20. Flexible solar-array mechanism

    Science.gov (United States)

    Olson, M. C.

    1972-01-01

    One of the key elements of the flexible rolled-up solar array system is a mechanism to deploy, retract, and store the flexible solar-cell arrays. The selection of components, the design of the mechanism assembly, and the tests that were performed are discussed. During 6 months in orbit, all mission objectives were satisfied, and inflight performance has shown good correlation with preflight analyses and tests.

  1. Flexible Learning Spaces Evaluation Report

    OpenAIRE

    Bullimore, A.; Reader, K.; Sultany, A

    2013-01-01

    City University, London is tackling the challenge of ensuring the learning spaces provided are able to meet the anticipated increase in technology usage and prevalent pedagogies. There is no longer a standard classroom design that will achieve this goal and therefore it is imperative to pilot and explore a variety of flexible learning spaces. This report feeds back on an\\ud evaluation of two flexible learning space approaches piloted in the autumn term of 2012 as alternatives to traditional c...

  2. Developmental constraints on behavioural flexibility.

    Science.gov (United States)

    Holekamp, Kay E; Swanson, Eli M; Van Meter, Page E

    2013-05-19

    We suggest that variation in mammalian behavioural flexibility not accounted for by current socioecological models may be explained in part by developmental constraints. From our own work, we provide examples of constraints affecting variation in behavioural flexibility, not only among individuals, but also among species and higher taxonomic units. We first implicate organizational maternal effects of androgens in shaping individual differences in aggressive behaviour emitted by female spotted hyaenas throughout the lifespan. We then compare carnivores and primates with respect to their locomotor and craniofacial adaptations. We inquire whether antagonistic selection pressures on the skull might impose differential functional constraints on evolvability of skulls and brains in these two orders, thus ultimately affecting behavioural flexibility in each group. We suggest that, even when carnivores and primates would theoretically benefit from the same adaptations with respect to behavioural flexibility, carnivores may nevertheless exhibit less behavioural flexibility than primates because of constraints imposed by past adaptations in the morphology of the limbs and skull. Phylogenetic analysis consistent with this idea suggests greater evolutionary lability in relative brain size within families of primates than carnivores. Thus, consideration of developmental constraints may help elucidate variation in mammalian behavioural flexibility.

  3. Oxide Heteroepitaxy for Flexible Optoelectronics.

    Science.gov (United States)

    Bitla, Yugandhar; Chen, Ching; Lee, Hsien-Chang; Do, Thi Hien; Ma, Chun-Hao; Qui, Le Van; Huang, Chun-Wei; Wu, Wen-Wei; Chang, Li; Chiu, Po-Wen; Chu, Ying-Hao

    2016-11-30

    The emerging technological demands for flexible and transparent electronic devices have compelled researchers to look beyond the current silicon-based electronics. However, fabrication of devices on conventional flexible substrates with superior performance are constrained by the trade-off between processing temperature and device performance. Here, we propose an alternative strategy to circumvent this issue via the heteroepitaxial growth of transparent conducting oxides (TCO) on the flexible mica substrate with performance comparable to that of their rigid counterparts. With the examples of ITO and AZO as a case study, a strong emphasis is laid upon the growth of flexible yet epitaxial TCO relying muscovite's superior properties compared to those of conventional flexible substrates and its compatibility with the present fabrication methods. Besides excellent optoelectro-mechanical properties, an additional functionality of high-temperature stability, normally lacking in the current state-of-the-art transparent flexitronics, is provided by these heterostructures. These epitaxial TCO electrodes with good chemical and thermal stabilities as well as mechanical durability can significantly contribute to the field of flexible, light-weight, and portable smart electronics.

  4. 输尿管镜碎石术后患者并发尿脓毒血症的诊治体会%The diagnosis and treatment experience of Ureteroscopy lithotripsy postoperative patients concurrent urosepsis

    Institute of Scientific and Technical Information of China (English)

    申智勇; 陈绪龙; 钟渠梁; 石家齐

    2015-01-01

    Objective To discuss the aetiological agent,prevention and treatment of the ureteroscopy lithotripsy concurrence urosepsis.Methods Retrospective analysis of 180 cases with ureteroscopy lithotripsy postoperative clinical data of 8 cases in urosepis patients.Results Eight patients with early active anti-infection,anti-shock treatment,eight patients were recovered and discharged,curative effect is satisfied.Conclusion Ureteroscopy lithotripsy postoperative patients concurrent urosepsis is dangerous,early detection,early diagnosis,early treatment is the key.%目的 探讨输尿管镜碎石术后并发尿脓毒血症的发病原因、防治措施及诊治体会.方法 回顾性分析180例输尿管镜碎石术后8例发生尿脓毒血症的患者临床资料.结果 8例患者经早期积极抗感染、抗休克等治疗后,均痊愈出院,疗效满意.结论 上尿路腔内碎石术后一旦发生尿源性脓毒血症,快速凶险,若不及早诊断抢救,往往具有极高的病死率.早预防、早发现、早诊断、早治疗是关键.

  5. FLEXIBLE BUDGET OF SPORT COMPETITIONS

    Directory of Open Access Journals (Sweden)

    Dragan Vukasović

    2009-11-01

    Full Text Available Manager of sport competition has right to decide and also to take responsibility for costs, income and financial results. From economic point of wiev flexible budget and planning cost calculations is top management base for analyzing success level of sport competition. Flexible budget is made before sport competition with few output level, where one is always from static plan-master plan. At the end of competition when we have results, we make report of plan executing and we also analyzing plan variances. Results of comparation between achieved and planning level of static budget can be acceptable if achieved level is approximate to budget level or if we analyzing results from gross or net income. Flexible budget become very important in case of world eco- nomic crises

  6. Inorganic semiconductors for flexible electronics.

    Energy Technology Data Exchange (ETDEWEB)

    Sun, Y.; Rogers, J. A.; Center for Nanoscale Materials; Univ. of Illinois

    2007-08-03

    This article reviews several classes of inorganic semiconductor materials that can be used to form high-performance thin-film transistors (TFTs) for large area, flexible electronics. Examples ranging from thin films of various forms of silicon to nanoparticles and nanowires of compound semiconductors are presented, with an emphasis on methods of depositing and integrating thin films of these materials into devices. Performance characteristics, including both electrical and mechanical behavior, for isolated transistors as well as circuits with various levels of complexity are reviewed. Collectively, the results suggest that flexible or printable inorganic materials may be attractive for a range of applications not only in flexible but also in large-area electronics, from existing devices such as flat-panel displays to more challenging (in terms of both cost and performance requirements) systems such as large area radiofrequency communication devices, structural health monitors, and conformal X-ray imagers.

  7. Global Flexibility, synecdoche of progress

    Directory of Open Access Journals (Sweden)

    Clara Selva Olid

    2014-06-01

    Full Text Available The purpose of this article is to explore the flexibility, its uses, types and new concepts to address and empower the global flexibility as an integral tool to facilitate change, adapt to the environment in an advantageous manner and innovate. In times of economic, social, technological and global chances, like today, partners and organizations are claimed to increase their polyvalence and versatility, in order to move towards new organizational and dedication models. In this context and given the need to have a construct that broadly and inherently meets and baste transversely to the different stakeholders of the organization, its structures and forms and mediation between them emerges global flexibility. Despite the challenge of proposing and permeabilising a new construct, no less what it provides, as it is presented as a natural tool to empower wellbeing within organizational and social life.

  8. Wearable Flexible Sensors: A Review

    KAUST Repository

    Nag, Anindya

    2017-05-18

    The paper provides a review on some of the significant research work done on wearable flexible sensors (WFS). Sensors fabricated with flexible materials have been attached to a person along with the embedded system to monitor a parameter and transfer the significant data to the monitoring unit for further analyses. The use of wearable sensors has played a quite important role to monitor physiological parameters of a person to minimize any malfunctioning happening in the body. The paper categorizes the work according to the materials used for designing the system, the network protocols and different types of activities that were being monitored. The challenges faced by the current sensing systems and future opportunities for the wearable flexible sensors regarding its market values are also briefly explained in the paper.

  9. Studies Of Residual Flexibility And Vibration Testing

    Science.gov (United States)

    Admire, John R.; Tinker, Michael L.; Bookout, Paul S.; Ivey, Edward W.

    1995-01-01

    Collection of reports presents theoretical and experimental studies in which concept of residual flexibility applied to modal vibration testing and verification of mathematical models of vibrations of flexible structure constrained by another structure. "Residual flexibility" denotes that part of interface flexibility due to mode shapes out of frequency range of test. Studies directed toward assessing residual-flexibility approach as substitute for fixed-base vibrational testing of payloads installed in spacecraft.

  10. 无危险因素患者体外碎石后出现感染并发症的前瞻性研究%Prospective investigation of infectious incidence after shock wave lithotripsy in patients without risk factors

    Institute of Scientific and Technical Information of China (English)

    李冬霞; 郑浩; 郑小青; 韦胜威

    2016-01-01

    Objective To investigate the infectious complications of extracorporeal shock wave lithotripsy in patients without associated risk factors. Methods We performed a prospective cohort study between March 2011 and August 2014. The patients who subjected to extracorporeal shock wave lithotripsy and were not found infectious risk factors were included in the study. All patients underwent urine culture three days before the procedure and seven days after lithotripsy. No patient received antibiotics. Results 122 patients with a mean age of 52±10 years met inclusion criteria. A total of nine patients (7.4%) underwent extracorporeal shock wave lithotripsy with a previously placed Double-J stent. After lithotripsy urine culture was positive in seven patients (6.1%), of whom one (0.87%) presented with symptomatic urinary infection and the remaining showed no symptoms. Urosepsis did not develop in any case. The age in the patient was an independent risk factor for bacteriuria afterlithotripsy. Conclusion The incidence of infectious complications after extracorporeal shock wave lithotripsy in patients without risk factors is low. This leads us to conclude that without defined risk factors antibiotic prophylaxis is not justified. Elder patients were more at risk for bacteriuria after extracorporeal shock wave lithotripsy and more at risk developing infectious complications.%目的:探讨无危险因素的病人在体外冲击波碎石术(ESWL)后感染并发症的发生率及预防性使用抗生素的必要性。方法纳入2011年5月~2014年8月的患者进行前瞻性队列研究。将无明确相关危险因素并接受体外碎石的肾结石或输尿管结石患者纳入。患者分别于碎石的3天前及7天后作尿培养。没有对患者使用抗生素。结果共122名患者(52±10岁)纳入研究范围。总共9名患者(7.4%)体外碎石前留置了双J管,7名(6.1%)患者碎石术后尿培养结果阳性,1名(0.87%)出

  11. Polymer electronics a flexible technology

    CERN Document Server

    Technology, Rapra

    2009-01-01

    The worldwide market for polymer electronic products has been estimated to be worth up to £15 billion by 2015 and the opportunity for new markets could be as high as £125 billion by 2025.'The rapid development of polymer electronics has revealed the possibility for transforming the electronics market by offering lighter, flexible and more cost effective alternatives to conventional materials and products. With applications ranging from printed, flexible conductors and novel semiconductor components to intelligent labels and large area displays and solar panels, products that were previously un

  12. Lost and Found in Flexibility

    DEFF Research Database (Denmark)

    Bødker, Susanne; Christiansen, Ellen

    2002-01-01

    'New work' is characterized by mobility and flexibility and a growing need to facilitate social awareness. The paper discusses how to augment the environment with social awareness and suggest 'awareness-in-transition' as a lable for awareness in mobile work in flexible work environments......, and as locus for building social awareness in the 'new work'. A transition (e.g. taking information from a whiteboard in a meeting room to the desktop of a personal computer)--besides the immediate implications at the functional level--has important interpersonal, intra-personal, and organizational...

  13. Flexible Stamp for Nanoimprint Lithography

    DEFF Research Database (Denmark)

    Nielsen, Theodor; Pedersen, Rasmus H.; Hansen, Ole

    2005-01-01

    The design, fabrication and performance of a flexible silicon stamp for homogenous large area nanoimprint lithography (NIL) are presented. The flexible stamp is fabricated by bulk semiconductor micro machining of a 4-inch silicon wafer and consists of thick anchor like imprint areas connected...... by membranes. The bending stiffness difference between the imprint areas and the membranes ensures that the deformation of the stamp during the imprint process mainly takes place in the membranes, leaving the imprint structures unaffected. By this design the strong demand to the parallelism between stamp...

  14. Balancing energy flexibilities through aggregation

    DEFF Research Database (Denmark)

    Valsomatzis, Emmanouil; Hose, Katja; Pedersen, Torben Bach

    2014-01-01

    One of the main goals of recent developments in the Smart Grid area is to increase the use of renewable energy sources. These sources are characterized by energy fluctuations that might lead to energy imbalances and congestions in the electricity grid. Exploiting inherent flexibilities, which exist...... in both energy production and consumption, is the key to solving these problems. Flexibilities can be expressed as flex-offers, which due to their high number need to be aggregated to reduce the complexity of energy scheduling. In this paper, we discuss balance aggregation techniques that already during...

  15. Global Analysis of Flexible Risers

    DEFF Research Database (Denmark)

    Banke, Lars

    1996-01-01

    and thus resists the loading from the environment in a more suitable way.A flexible pipe is a composite structure, built up of several layers each having a specific function. Due to the flexibility, the response of the pipe in wave induced motions are governed by a complex hydroelastic set of differential...... parameters.The idea is to divide the riser system of riser and end fitting system into a global system including the riser and a local system of the bending stiffener and the end fitting. The forces at top of the riser shall be used as input for the design of the local system.This report introduces a non...

  16. Robotic steering of flexible endoscopes

    NARCIS (Netherlands)

    Rozeboom, Esther

    2016-01-01

    Flexible endoscopes were originally designed for non-invasive inspection of body cavities and hollow organs. Today, they are also used for complex minimal invasive interventions. Control of the endoscope is difficult and complexity rises with interventional procedures. Endoscopists suffer from long

  17. Flexible Bistable Cholesteric Reflective Displays

    Science.gov (United States)

    Yang, Deng-Ke

    2006-03-01

    Cholesteric liquid crystals (ChLCs) exhibit two stable states at zero field condition-the reflecting planar state and the nonreflecting focal conic state. ChLCs are an excellent candidate for inexpensive and rugged electronic books and papers. This paper will review the display cell structure,materials and drive schemes for flexible bistable cholesteric (Ch) reflective displays.

  18. Lifelong Open and Flexible Learning

    DEFF Research Database (Denmark)

    Bang, Jørgen

    2006-01-01

    and Flexible (LOF) learning embracing characteristics as: open learning, distance learning, e-learning, online learning, open accessibility, multimedia support, virtual mobility, learning communities, dual mode (earn & learn) approaches, and the like.In my presentation I will focus on the EADTU strategies...

  19. Flexible Learning: A Luddite View

    Science.gov (United States)

    Baggaley, Jon

    2011-01-01

    This article reflects on the flexible learning concept through the eyes of the 19th-century industrial activists known as the Luddites. During a period of economic uncertainty, the Luddite perspective provides a sensitive justification for a change-free educational environment, and for a backlash in favour of "inflexible learning" (IL). The…

  20. Flexibility in Language and Thought

    Science.gov (United States)

    Srinivasan, Mahesh

    2011-01-01

    Many words can be used flexibly: a book can be physically heavy, but also have provocative content, a "chicken" might live in a coop, but could also be tasty to eat. What do the uses of "polysemous" words such as these reveal about the structure of language and thought? Paper 1 examined 4-year-old children's representations of polysemous words…

  1. Creep behaviour of flexible adhesives

    NARCIS (Netherlands)

    Straalen, IJ.J. van; Botter, E.; Berg, A. van den; Beers, P. van

    2004-01-01

    Since flexible adhesives are used more and more in structural applications, designers should have a better understanding of its behaviour under various conditions as ultimate load, fatigue load, long-term load and environmental conditions. This paper focuses on long-term load conditions and its effe

  2. Flexible working motivates all staff.

    Science.gov (United States)

    2001-04-01

    A recent survey has demolished the myth that work-life balance is only of interest to women with children. The survey, commissioned by Lloyds TSB on behalf of the Employers for Work Life Balance organisation, shows that young workers and men are equally interested in flexible working arrangements that allow them to pursue interests outside of work.

  3. Flexible fixation and fracture healing

    DEFF Research Database (Denmark)

    Schmal, Hagen; Strohm, Peter C; Jaeger, Martin

    2011-01-01

    to the bone surface than external fixator bars. External fixators have the advantage of being less expensive, highly flexible, and technically less demanding. They remain an integral part of orthopaedic surgery for emergent stabilization, for pediatric fractures, for definitive osteosynthesis in certain...

  4. Drops spreading on flexible fibers

    Science.gov (United States)

    Somszor, Katarzyna; Boulogne, François; Sauret, Alban; Dressaire, Emilie; Stone, Howard

    2015-11-01

    Fibrous media are encountered in many engineered systems such as textile, paper and insulating materials. In most of these materials, fibers are randomly oriented and form a complex network in which drops of wetting liquid tend to accumulate at the nodes of the network. Here we investigate the role of the fiber flexibility on the spreading of a small volume of liquid on a pair of crossed flexible fibers. A drop of silicone oil is dispensed at the point of contact of the fibers and we characterize the liquid morphologies as we vary the volume of liquid, the angle between the fibers, and the length and bending modulus of the fibers. Drop morphologies previously reported for rigid fibers, i.e. a drop, a column and a mixed morphology, are also observed on flexible fibers with modified domains of existence. Moreover, at small inclination angles of the fibers, a new behavior is observed: the fibers bend and collapse. Depending on the volume, the liquid can adopt a column or a mixed morphology on the collapsed fibers. We rationalize our observations with a model based on energetic considerations. Our study suggests that the fiber flexibility adds a rich variety of behaviors that can be crucial for industrial applications.

  5. FLEXIBLE FLATFOOT IN CHILDREN (REVIEW

    Directory of Open Access Journals (Sweden)

    Владимир Маркович Кенис

    2014-06-01

    Full Text Available Flatfoot is one of the most common musculoskeletal conditions in the daily practice of pediatric orthopedists. Despite of numerous studies, diagnostic criteria and principles of management remain controversial. Flexible flatfoot - is visually detectable decrease in the height of the longitudinal arch of the foot, which can be spontaneously corrected by active or passive motion and not accompanied by any contracture of foot and ankle. Flexible flatfoot is a benign condition which is normal for childhood. But this term is also used to describe a painful deformity with marked limitation of dorsiflection and “not physiological” flatfoot with unfavorable course and prognosis. Despite of the awareness of the parents, flexible flatfoot does not lead to pain and should not be followed by any kind of treatment. Special shoe modifications and orthopedic insoles are useless in the attempt to improve the foot, but can influence negatively psychological condition and self-estimation. Proper diagnosis of flexible flatfoot is necessary in order to avoid unnecessary treatment and to reveal patients with adverse prognosis and rigid forms of flatfoot which need special approach.

  6. Functional flexibility and team performance

    NARCIS (Netherlands)

    Molleman, E.; Slomp, J.

    1999-01-01

    This study deals with workforce flexibility defined in terms of 'multifunctionality' and 'redundancy'. These concepts refer, respectively, to the number of different tasks a worker has mastered and the number of workers that are qualified to do a specific task. A third factor to be considered is wor

  7. Taming Time with Flexible Work.

    Science.gov (United States)

    Stamps, David

    1995-01-01

    Because of increasing incidence of burnout among midlevel managers, many companies are reducing workload schedules, an arrangement that would have been unthinkable 10 years ago. Surveys have made the case that flexible work arrangements increase employee happiness and, therefore, productivity. (JOW)

  8. Protein stability, flexibility and function

    DEFF Research Database (Denmark)

    Teilum, Kaare; Olsen, Johan G; Kragelund, Birthe B

    2011-01-01

    Proteins rely on flexibility to respond to environmental changes, ligand binding and chemical modifications. Potentially, a perturbation that changes the flexibility of a protein may interfere with its function. Millions of mutations have been performed on thousands of proteins in quests for a de......Proteins rely on flexibility to respond to environmental changes, ligand binding and chemical modifications. Potentially, a perturbation that changes the flexibility of a protein may interfere with its function. Millions of mutations have been performed on thousands of proteins in quests...... for a delineation of the molecular details of their function. Several of these mutations interfered with the binding of a specific ligand with a concomitant effect on the stability of the protein scaffold. It has been ambiguous and not straightforward to recognize if any relationships exist between the stability...... of a protein and the affinity for its ligand. In this review, we present examples of proteins where changes in stability results in changes in affinity and of proteins where stability and affinity are uncorrelated. We discuss the possibility for a relationship between stability and binding. From the data...

  9. Easy and flexible mixture distributions

    DEFF Research Database (Denmark)

    Fosgerau, Mogens; Mabit, Stefan L.

    2013-01-01

    We propose a method to generate flexible mixture distributions that are useful for estimating models such as the mixed logit model using simulation. The method is easy to implement, yet it can approximate essentially any mixture distribution. We test it with good results in a simulation study...

  10. [The characteristics or urolithiasis in flight personnel and the treatment results using a method of extracorporeal shockwave lithotripsy on the Russian lithotripter Urat-P2].

    Science.gov (United States)

    Garilevich, B A; Avdeĭchuk, Iu I

    1995-01-01

    Urolithiasis occurs more frequently in the pilots than in the ground-service personnel. To decrease a damaging effect of the focused shock waves on the renal tissue while using remote lithotripsy technique, a new domestic-certified lithotriptor "URAT-P2" which shows a significantly low energy of shock wave with sufficient effectiveness of crushing the renal stones, is devised. Urolithiasis in the pilots is apparent at the early stages of its development and its complicated forms are less common than in the subjects of other professions. The stones are predominantly located in the renal calyces (73,3% of cases), in the left kidney and urethra in 63,3% of cases and there were urate stones in 40% of cases. The clinical use of the URAT-P2 complex in 30 pilots indicated that it holds advantages over the production domestic-certified lithotriptor. The stones are crushed in all the patients but the complications associated with a negative effect of the focused shock waves on the renal tissue are absent. The use of the new lithotriptor for treating urolithiasis in the pilots will allow one to improve the treatment response and to maintain professional worthiness of the pilots for a long time.

  11. SHOCK WAVE LITHOTRIPSY TARGETING OF THE KIDNEY AND PANCREAS DOES NOT INCREASE THE SEVERITY OF METABOLIC SYNDROME IN A PORCINE MODEL

    Science.gov (United States)

    Handa, Rajash K.; Evan, Andrew P.; Connors, Bret A.; Johnson, Cynthia D.; Liu, Ziyue; Alloosh, Mouhamad; Sturek, Michael; Evans-Molina, Carmella; Mandeville, Jessica A.; Gnessin, Ehud; Lingeman, James E.

    2014-01-01

    Purpose To determine whether shock wave lithotripsy (SWL) treatment of the kidney of metabolic syndrome (MetS) pigs worsens glucose tolerance or increases the risk of developing diabetes mellitus. Materials and Methods Nine-month-old female Ossabaw miniature pigs were fed a hypercaloric atherogenic diet to induce MetS. At 15 months of age, pigs were treated with 2000 SWs or 4000 SWs (24 kV at 120 SWs/min) using the unmodified Dornier HM3 lithotripter. SWs were targeted to the upper pole calyx of the left kidney so as to model treatment that would also expose the tail of the pancreas to SWs. Intravenous glucose tolerance tests (IVGTTs) were performed on conscious, fasting pigs before SWL and at 1 month and 2 months post-SWL with blood samples taken for glucose and insulin measurement. Results Pigs fed the hypercaloric atherogenic diet were obese, dyslipidemic, insulin resistant and glucose intolerant—consistent with the development of MetS. Assessment of insulin resistance, glucose tolerance and pancreatic beta cell function from fasting plasma glucose and insulin levels, and the glucose and insulin response profile to IVGTTs, were similar before and after SWL. Conclusions The MetS status of SWL treated pigs was unchanged 2 months following treatment of the kidney with 2000 high-amplitude SWs or overtreatment with 4000 high-amplitude SWs. These findings do not support a single SWL treatment of the kidney as a risk factor for the onset of diabetes mellitus. PMID:24657667

  12. A comparative study of artificial neural network and multivariate regression analysis to analyze optimum renal stone fragmentation by extracorporeal shock wave lithotripsy

    Directory of Open Access Journals (Sweden)

    Goyal Neeraj

    2010-01-01

    Full Text Available To compare the accuracy of artificial neural network (ANN analysis and multi-variate regression analysis (MVRA for renal stone fragmentation by extracorporeal shock wave lithotripsy (ESWL. A total of 276 patients with renal calculus were treated by ESWL during December 2001 to December 2006. Of them, the data of 196 patients were used for training the ANN. The predictability of trained ANN was tested on 80 subsequent patients. The input data include age of patient, stone size, stone burden, number of sittings and urinary pH. The output values (predicted values were number of shocks and shock power. Of these 80 patients, the input was analyzed and output was also calculated by MVRA. The output values (predicted values from both the methods were compared and the results were drawn. The predicted and observed values of shock power and number of shocks were compared using 1:1 slope line. The results were calculated as coefficient of correlation (COC (r2 . For prediction of power, the MVRA COC was 0.0195 and ANN COC was 0.8343. For prediction of number of shocks, the MVRA COC was 0.5726 and ANN COC was 0.9329. In conclusion, ANN gives better COC than MVRA, hence could be a better tool to analyze the optimum renal stone fragmentation by ESWL.

  13. Effectiveness of oral litholysis therapy for improving glucose intolerance and malnutrition in patients with poor results following endoscopic therapy and extracorporeal shock wave lithotripsy for calcified pancreatic stones.

    Science.gov (United States)

    Ashizawa, Nobuo; Hamano, Koichi; Noda, Aiji

    2015-10-01

    We report a case of pancreatolithiasis in which glucose intolerance and malnutrition were significantly improved after starting oral litholysis therapy (OLT) with use of trimethadione. A 43-year-old female with multiple calcified stones in the main and peripheral pancreatic ducts had experienced recurrent and severe attacks of pain for 7 years (from 21 to28 years of age). Impaired glucose tolerance was first noted at the age of 32 years. We started OLT after interventional endoscopic therapy combined with extracorporeal shock wave lithotripsy failed because of kink and stenosis of the main pancreatic duct (MPD). Over the next 9 years, a significant decrease in total pancreatic calcified stone volume was shown by computer analysis of follow-up computed tomography images. Larger stones completely disappeared without attacks of pain. In addition, both glucose intolerance and insulin secretion were significantly ameliorated, followed by improvement of malnutrition. OLT may induce intraductal decompression by dissolving stones in the peripheral ducts as well as the MPD, with resulting preservation of endocrine function and improvement of malnutrition. Since the present results were obtained in a single case, further clinical trials are necessary to evaluate the value of performing OLT under various conditions to eliminate stones.

  14. Plain radiography, renography, and [sup 99m]Tc-DMSA renal scintigraphy before and after extracorporeal shock wave lithotripsy for urolithiasis

    Energy Technology Data Exchange (ETDEWEB)

    Munck, O.; Gerquari, I.; Moeller, J.T.; Jensen, L.I.; Thomsen, H.S. (Dept. of Clinical Physiology, Dept. of Nuclear Medicine, Dept. of Diagnostic Radiology, Herlev Hospital, Copenhagen Univ. (Denmark))

    1992-11-01

    Eighteen patients were evaluated before and 5 weeks after the first treatment with extracorporeal shock wave lithotripsy (ESWL) using abdominal plain radiography, [sup 131]I-hippuran probe renography, and [sup 99m]Tc-dimercaptosuccinic acid scintigraphy. In 6 patients no urolithiasis was present on the post ESWL plain radiograph, in 7 the size had decreased, and in 5 the stone mass was unchanged. The renograms were within normal range in the 6 patients who were cured by ESWL, whereas this was the case for only 4 of the 12 who still had renal calculi. In 2 patients pelvic stones had descended into the ureter after ESWL, and the renograms indicated obstruction. Another 3 patients had ureteral stones, whereas in the remaining 7 patients only pelvic stones were found on the plain radiographs. In no patient did the scintigrams reveal scars. It is concluded that abdominal plain radiography of the urinary tract and probe renography are complementary and sufficient in the monitoring of patients with urolithiasis post ESWL. (orig.).

  15. Long-term incidence and risk factors for recurrent stones following percutaneous nephrostolithotomy or percutaneous nephrostolithotomy/extracorporeal shock wave lithotripsy for infection related calculi.

    Science.gov (United States)

    Streem, S B

    1995-03-01

    A study was done to determine the long-term incidence and cause of recurrent stones following percutaneous nephrostolithotomy alone (13 patients) or combined with extracorporeal shock wave lithotripsy (31) for management of documented infection related struvite renal calculi. The patients were followed for 12 to 111 months (mean 41.7) to censorship or time of new stone formation. Of these patients 12 (27%) had recurrent stones at 12 to 61 months (mean 32.3) after treatment. As determined by a Kaplan-Meier estimate, the risk of new stone formation 5 years after treatment was 36.8%. Potential risk factors for recurrence, including history of stones, associated anatomical abnormalities, procedure used, radiographic status at completion of treatment and recurrent infection during followup, were analyzed with Cox's proportional hazards model. Of these potential risk factors, only an associated anatomical abnormality was found to influence significantly the rate of recurrent stone formation (p = 0.005). We conclude that continued surveillance for recurrent stones is mandatory even for patients initially rendered stone-free and those who maintain sterile urine. In addition, because the presence of a significant anatomical or functional urinary tract abnormality places a patient at much higher risk for recurrence, we suggest that subsequent studies be stratified as to the presence or absence of these abnormalities.

  16. Extracorporeal shock waves lithotripsy versus retrograde ureteroscopy: is radiation exposure a criterion when we choose which modern treatment to apply for ureteric stones?

    Directory of Open Access Journals (Sweden)

    Catalin Pricop

    2014-10-01

    Full Text Available The aim of this study is to compare two major urological procedures in terms of patient exposure to radiation. We evaluated 175 patients, that were subjected to retrograde ureteroscopy (URS and extracorporeal shock waves lithotripsy (ESWL for lumbar or pelvic ureteral lithiasis, at two urological departments. The C-arm Siemens (produced in 2010 by Siemens AG, Germany was used for ureteroscopy. The radiological devices of the lithotripters used in this study in the two clinical centers had similar characteristics. We evaluated patient exposure to ionizing radiation by using a relevant parameter, the air kerma-area product (PKA; all values in cGy cm2, calculated from the radiation dose values recorded by the fluoroscopy device. PKA depends on technical parameters that change due to anatomical characteristics of each case examined, such as body mass index (BMI, waist circumference, and stone location. For the patients subjected to ESWL for lumbar ureteral lithiasis the mean of PKA (cGy cm2 was 509 (SD=180, while for those treated for pelvic ureteral lithiasis the mean of PKA was 342 (SD=201. In the URS group for lumbar ureteral lithiasis, the mean of PKA (cGy cm2 was 892 (SD=436, while for patients with pelvic ureteral lithiasis, the mean of PKA was 601 (SD=429. The patients treated by URS had higher exposure to ionizing radiation dose than patients treated by ESWL. The risk factors of higher radiation doses were obesity, exposure time, and localization of the stones.

  17. Integrated flexible capacity and inventory management under flexible capacity uncertainty

    OpenAIRE

    Paç, Mehmet Fazıl

    2006-01-01

    Cataloged from PDF version of article. In a manufacturing environment with volatile demand, inventory management can be coupled with dynamic capacity adjustments for handling the fluctuations more effectively. In this study we consider the integrated management of inventory and flexible capacity management under seasonal stochastic demand and uncertain labor supply. The capacity planning problem is investigated from the workforce planning perspective. We consider a manufactu...

  18. Research of perioperative nursing for upper urinary tract calculi treated by C-arm X-ray guided ;percutaneous nephroscope and ureteroscope%C型臂X线定位经皮肾输尿管镜治疗上尿路结石的围手术期护理研究

    Institute of Scientific and Technical Information of China (English)

    潘萍; 李燕玲

    2015-01-01

    目的:研究C型臂X线定位经皮肾输尿管镜治疗上尿路结石的围手术期护理。方法50例上尿路结石患者,采用随机数字表法分为护理组与对照组,各25例。两组患者均采取X线定位下经皮肾镜、输尿管镜治疗上尿路结石,对照组患者采取临床基础护理措施,护理组患者在对照组护理基础上进行综合护理干预,比较两组各项临床指标。结果护理组患者手术用时、住院时间、术后并发症发生率均低于对照组(P<0.05);一次性结石清除率高于对照组(P<0.05)。结论对于C型臂X线定位经皮肾镜、输尿管镜治疗上尿路结石手术患者采取综合护理干预可显著提高患者一次性结石清除率,有助于降低术中、术后疼痛情况及手术并发症,具有临床应用及推广价值。%Objective To research perioperative nursing for upper urinary tract calculi treated by C-arm X-ray guided percutaneous renal ureteroscope. Methods A total of 50 upper urinary tract calculi patients were divided by random number table into nursing group and control group, with 25 cases in each group. Both groups received C-arm X-ray guided p percutaneous nephroscope and ureteroscope for treatment. The control group received basic clinical nursing measures, and the nursing group received additional comprehensive nursing intervention. Clinical indexes of the two groups were compared. Results The nursing group had all lower operation time, hospital stay, and incidence of postoperative complications than the control group (P<0.05), and it had higher one-time calculi clearance rate than the control group (P<0.05). Conclusion Implement of comprehensive intervention for upper urinary tract calculi treated by C-arm X-ray guided percutaneous renal ureteroscope can remarkably improve one-time calculi clearance rate, and it is helpful to reducing intraoperative and postoperative pain and postoperative complications. This method contains value of

  19. WAGE FLEXIBILITY IN THE CONTEMPORARY SOCIETY

    Directory of Open Access Journals (Sweden)

    TECULESCU Silviu Alexandru

    2010-12-01

    Full Text Available The paper follows to offer the most efficient solutions for the attainment by Romania of the economic development level associated to the Western European countries. It proposes the division of the flexibility of labour market in three components, namely: internal flexibility, external flexibility and wage flexibility. The analysis performed within the present study will emphasize the wage flexibility. Wage flexibility can be classified in four components: a plans of individual and group incentives; b plans of assigning wages out of productivity; c plans of distribution of profits and, respectively, d plans of suggestions. The labour market flexibility, in general, and especially the wage flexibility contributes to the increase of employee motivation at the workplace, aspect which leeds to the growth of labour productivity, through this one being put the bases of the medium- and long-term economic development.

  20. ULTRA BARRIER TOPSHEET (UBT) FOR FLEXIBLE PHOTOVOLTAICS

    Energy Technology Data Exchange (ETDEWEB)

    DeScioli, Derek

    2013-06-01

    This slide-show presents 3M photovoltaic-related products, particularly flexible components. Emphasis is on the 3M Ultra Barrier Solar Films. Topics covered include reliability and qualification testing and flexible photovoltaic encapsulation costs.

  1. Understanding flexible and distributed software development processes

    OpenAIRE

    Agerfalk, Par J.; Fitzgerald, Brian

    2006-01-01

    peer-reviewed The minitrack on Flexible and Distributed Software Development Processes addresses two important and partially intertwined current themes in software development: process flexibility and globally distributed software development

  2. Flexible Temperature Sensors on Fibers

    Directory of Open Access Journals (Sweden)

    Marcin Sloma

    2010-08-01

    Full Text Available The aim of this paper is to present research dedicated to the elaboration of novel, miniaturized flexible temperature sensors for textronic applications. Examined sensors were manufactured on a single yarn, which ensures their high flexibility and good compatibility with textiles. Stable and linear characteristics were obtained by special technological process and applied temperature profiles. As a thermo-sensitive materials the innovative polymer compositions filled with multiwalled carbon nanotubes were used. Elaborated material was adapted to printing and dip-coating techniques to produce NTC composites. Nanotube sensors were free from tensometric effect typical for other carbon-polymer sensor, and demonstrated TCR of 0.13%/K. Obtained temperature sensors, compatible with textile structure, can be applied in rapidly developing smart textiles and be used for health and protections purposes.

  3. Flexible spintronic devices on Kapton

    DEFF Research Database (Denmark)

    Bedoya-Pinto, Amilcar; Donolato, Marco; Gobbi, Marco;

    2014-01-01

    of bending angle (r = 5 mm) have been achieved without degradation of the device performance, reaching room-temperature tunneling magnetoresistance ratios of 12% in bended Co/Al2O3/NiFe junctions. In addition, a suitable route to pattern high-quality nanostructures directly on the polyimide surface......Magnetic tunnel junctions and nano-sized domain-wall conduits have been fabricated on the flexible substrate Kapton. Despite the delicate nature of tunneling barriers and zig-zag shaped nanowires, the devices show an outstanding integrity and robustness upon mechanical bending. High values...... is established. These results demonstrate that Kapton is a promising platform for low-cost, flexible spintronic applications involving tunnel junction elements and nanostructurization. ...

  4. Thin, Flexible IMM Solar Array

    Science.gov (United States)

    Walmsley, Nicholas

    2015-01-01

    NASA needs solar arrays that are thin, flexible, and highly efficient; package compactly for launch; and deploy into large, structurally stable high-power generators. Inverted metamorphic multijunction (IMM) solar cells can enable these arrays, but integration of this thin crystalline cell technology presents certain challenges. The Thin Hybrid Interconnected Solar Array (THINS) technology allows robust and reliable integration of IMM cells into a flexible blanket comprising standardized modules engineered for easy production. The modules support the IMM cell by using multifunctional materials for structural stability, shielding, coefficient of thermal expansion (CTE) stress relief, and integrated thermal and electrical functions. The design approach includes total encapsulation, which benefits high voltage as well as electrostatic performance.

  5. The evolution of flexible parenting.

    Science.gov (United States)

    Royle, Nick J; Russell, Andrew F; Wilson, Alastair J

    2014-08-15

    Parenting behaviors, such as the provisioning of food by parents to offspring, are known to be highly responsive to changes in environment. However, we currently know little about how such flexibility affects the ways in which parenting is adapted and evolves in response to environmental variation. This is because few studies quantify how individuals vary in their response to changing environments, especially social environments created by other individuals with which parents interact. Social environmental factors differ from nonsocial factors, such as food availability, because parents and offspring both contribute and respond to the social environment they experience. This interdependence leads to the coevolution of flexible behaviors involved in parenting, which could, paradoxically, constrain the ability of individuals to rapidly adapt to changes in their nonsocial environment. Copyright © 2014, American Association for the Advancement of Science.

  6. Advanced solderless flexible thermal link

    Science.gov (United States)

    Williams, Brian G.; Jensen, Scott M.; Batty, J. Clair

    1996-10-01

    Flexible thermal links play an important role int he thermal management of cryogenically cooled components. The purpose of these links is to provide a means of transferring heat from a cooled component to a cooler reservoir with little increase in temperature. The standard soldered approach although effective proves to be time consuming and contributes to added thermal impedances which degrade the performance of the link. For system with little tolerance for temperature differences between cooled components and a cooling source this is undesirable. The authors of this paper have developed a technique by which thin metal foil or braided wire can be attached to metal end blocks without any solder using the swaging process. Swaging provides a fast, simple method for providing a low thermal impedance between the foils and blocks. This paper describes the characteristics of these thermal links in terms of length, mass, thermal resistance, flexibility, and survivability.

  7. Lost and Found in Flexibility

    DEFF Research Database (Denmark)

    Bødker, Susanne; Christiansen, Ellen

    2002-01-01

    'New work' is characterized by mobility and flexibility and a growing need to facilitate social awareness. The paper discusses how to augment the environment with social awareness and suggest 'awareness-in-transition' as a lable for awareness in mobile work in flexible work environments, and as l...... studies, the authors develop a requirements specification framework and a revised list of challenges for developers of Information Systems that support social awareness in 'New work'......., and as locus for building social awareness in the 'new work'. A transition (e.g. taking information from a whiteboard in a meeting room to the desktop of a personal computer)--besides the immediate implications at the functional level--has important interpersonal, intra-personal, and organizational...

  8. Superhydrophobicity enhancement through substrate flexibility.

    Science.gov (United States)

    Vasileiou, Thomas; Gerber, Julia; Prautzsch, Jana; Schutzius, Thomas M; Poulikakos, Dimos

    2016-11-22

    Inspired by manifestations in nature, microengineering and nanoengineering of synthetic materials to achieve superhydrophobicity has been the focus of much work. Generally, hydrophobicity is enhanced through the combined effects of surface texturing and chemistry; being durable, rigid materials are the norm. However, many natural and technical surfaces are flexible, and the resulting effect on hydrophobicity has been largely ignored. Here, we show that the rational tuning of flexibility can work synergistically with the surface microtexture or nanotexture to enhance liquid repellency performance, characterized by impalement and breakup resistance, contact time reduction, and restitution coefficient increase. Reduction in substrate areal density and stiffness imparts immediate acceleration and intrinsic responsiveness to impacting droplets (∼350 × g), mitigating the collision and lowering the impalement probability by ∼60% without the need for active actuation. Furthermore, we exemplify the above discoveries with materials ranging from man-made (thin steel or polymer sheets) to nature-made (butterfly wings).

  9. Flexible Adaptation in Cognitive Radios

    CERN Document Server

    Li, Shujun

    2013-01-01

    This book provides an introduction to software-defined radio and cognitive radio, along with methodologies for applying knowledge representation, semantic web, logic reasoning and artificial intelligence to cognitive radio, enabling autonomous adaptation and flexible signaling. Readers from the wireless communications and software-defined radio communities will use this book as a reference to extend software-defined radio to cognitive radio, using the semantic technology described. Readers with a background in semantic web and artificial intelligence will find in this book the application of semantic web and artificial intelligence technologies to wireless communications. For readers in networks and network management, this book presents a new approach to enable interoperability, collaborative optimization and flexible adaptation of network components. Provides a comprehensive ontology covering the core concepts of wireless communications using a formal language; Presents the technical realization of using a ...

  10. Flexible pile thermal barrier insulator

    Science.gov (United States)

    Anderson, G. E.; Fell, D. M.; Tesinsky, J. S. (Inventor)

    1978-01-01

    A flexible pile thermal barrier insulator included a plurality of upstanding pile yarns. A generally planar backing section supported the upstanding pile yarns. The backing section included a plurality of filler yarns forming a mesh in a first direction. A plurality of warp yarns were looped around said filler yarns and pile yarns in the backing section and formed a mesh in a second direction. A binder prevented separation of the yarns in the backing section.

  11. CRISIS FOCUS Uncertainty and Flexibility

    Institute of Scientific and Technical Information of China (English)

    2008-01-01

    As the world continued to watch the unfolding financial and economic crises this month, Robert Zoellick, President of the World Bank, arrived in China for discussions on how the country can help support the global economy and the efforts it has taken to strengthen its own recovery. Zoellick, who had seen many uncertainties in 2009, called for China to be flexible with its macroeconomic policy. He made the following comments at a press conference in Beijing on December 15. Edited excerpts follow:

  12. Organisationsprinzipien zielgerichteter Bewegungen flexibler Greiforgane

    OpenAIRE

    Martin, Franziska

    2010-01-01

    Flexible grasping organs like the trunk of elephants and the grasping tail of spider monkeys have to deal with a high degree of movement freedom in their goal-directed movements. The aim of this study was to find the basic organisation principles they apply in order to lower the coordination expense of their movements. Therefore, in hypothesis I a reduction of the degree of movement freedom was postulated whereas hypothesis II assumed a specialization of movements towards one side. Since trun...

  13. Flexible Photonic Cellulose Nanocrystal Films

    OpenAIRE

    Guidetti, G.; Atifi, S; Vignolini, S; Hamad, WY

    2016-01-01

    The fabrication of self-assembled cellulose nanocrystal (CNC) films of tunable photonic and mechanical properties using a facile, green approach is demonstrated. The combination of tunable flexibility and iridescence can dramatically expand CNC coating and film barrier capabilities for paints and coating applications, sustainable consumer packaging products, as well as effective templates for photonic and optoelectronic materials and structures. CelluForce Inc., Biotechnology and Biologica...

  14. Flexible Execution of Cognitive Procedures.

    Science.gov (United States)

    1987-06-30

    Rosenbloom. P. (1988). Symbolic Architectures. In Posner, M. (Ed.), FoundatiCns of Cogniive Science . Cambridge. MKA MIT Press. In preparation. Nii. P. , 1986...Procedures 00 Technical Report PCG-5 14 Kurt VanLehn and William Ball Departments of Psychology and Computer Science Carnegie-Mellon University...Psychology and Computer Science Carnegie-Mellon University Pittsburgh, PA 15213 U.S.A 30 June 1987 Running head: Flexible Execution of Cognitive

  15. Flexible manufacturing system (FMS) evaluation

    Energy Technology Data Exchange (ETDEWEB)

    Setter, D.L.

    1993-02-01

    The applicability of the flexible manufacturing system (FMS) concept to automate machining and inspecting a family of stainless steel and aluminum hardware for electrical components has been evaluated. FMS was found to be appropriate and justifiable and a project was initiated to purchase and implement an FMS system. System specifications and procurement methodologies were developed that resulted in a conventional competitive bid procurement A proposal evaluation technique was developed consisting of 40% price, 40% technical compliance, and 20% supplier management capabilities.

  16. UNITY OF THE ORGANIZATIONAL FUNCTIONS FLEXIBILITY

    OpenAIRE

    George MOLDOVEANU; Cosmin DOBRIN

    2012-01-01

    The paper has the goal to analyse the correlation of the flexibility of all organizational functions. Based upon theoretical and practical studies, the decrease of flexibility into an "activity area" of organizations implies a diminution on a large scale of the flexibility of the processing system as a law expression of the decreasing outputs within economy. Therefore, at the level of each organizational function there are several major directions ensuring the flexibility of the "ensemble".

  17. Design of satellite flexibility experiments

    Science.gov (United States)

    Kaplan, M. H.; Hillard, S. E.

    1977-01-01

    A preliminary study has been completed to begin development of a flight experiment to measure spacecraft control/flexible structure interaction. The work reported consists of two phases: identification of appropriate structural parameters which can be associated with flexibility phenomena, and suggestions for the development of an experiment for a satellite configuration typical of near-future vehicles which are sensitive to such effects. Recommendations are made with respect to the type of data to be collected and instrumentation associated with these data. The approach consists of developing the equations of motion for a vehicle possessing a flexible solar array, then linearizing about some nominal motion of the craft. A set of solutions are assumed for array deflection using a continuous normal mode method and important parameters are exposed. Inflight and ground based measurements are distinguished. Interrelationships between these parameters, measurement techniques, and input requirements are discussed which assure minimization of special vehicle maneuvers and optimization of data to be obtained during the normal flight sequence.

  18. [Flexibility and safety in hospitals].

    Science.gov (United States)

    Fara, G M; Barni, M

    2011-01-01

    The paper explains the reasons according to which the newly-planned hospitals must adopt the concept of advanced flexibility (structural, technological, organizational, diagnostic and therapeutic), in order to avoid the risk of being already obsolete at the moment of their opening, and this due to the fact that too much time elapses in this Country between the moment of planning a new hospital and the moment of the start of its activity. Flexibility is needed at different levels: at low or medium levels for what concerns administrative spaces and also patient rooms (except, in this latter case, when differential intensity of care is adopted); at advanced levelfor what concerns diagnostic and therapeutic areas, which must be rapidly adaptable to new solutions offered by advances in technology and organization. From a different standpoint, flexibility applies also to the fact that hospital must increasingly become a node of a large net including territorial health services: the latter devoted to take care of chronicity, while hospitals should concentrate on acute pathology. Of course the territory surrounding the hospital, through its outpatient service and consultories, is in charge also for first level diagnosy and therapy, leaving the hospital to more sophisticated activities.

  19. The Flexibility of Ectopic Lipids

    Directory of Open Access Journals (Sweden)

    Hannah Loher

    2016-09-01

    Full Text Available In addition to the subcutaneous and the visceral fat tissue, lipids can also be stored in non-adipose tissue such as in hepatocytes (intrahepatocellular lipids; IHCL, skeletal (intramyocellular lipids; IMCL or cardiac muscle cells (intracardiomyocellular lipids; ICCL. Ectopic lipids are flexible fuel stores that can be depleted by physical exercise and repleted by diet. They are related to obesity and insulin resistance. Quantification of IMCL was initially performed invasively, using muscle biopsies with biochemical and/or histological analysis. 1H-magnetic resonance spectroscopy (1H-MRS is now a validated method that allows for not only quantifying IMCL non-invasively and repeatedly, but also assessing IHCL and ICCL. This review summarizes the current available knowledge on the flexibility of ectopic lipids. The available evidence suggests a complex interplay between quantitative and qualitative diet, fat availability (fat mass, insulin action, and physical exercise, all important factors that influence the flexibility of ectopic lipids. Furthermore, the time frame of the intervention on these parameters (short-term vs. long-term appears to be critical. Consequently, standardization of physical activity and diet are critical when assessing ectopic lipids in predefined clinical situations.

  20. The Flexibility of Ectopic Lipids.

    Science.gov (United States)

    Loher, Hannah; Kreis, Roland; Boesch, Chris; Christ, Emanuel

    2016-09-14

    In addition to the subcutaneous and the visceral fat tissue, lipids can also be stored in non-adipose tissue such as in hepatocytes (intrahepatocellular lipids; IHCL), skeletal (intramyocellular lipids; IMCL) or cardiac muscle cells (intracardiomyocellular lipids; ICCL). Ectopic lipids are flexible fuel stores that can be depleted by physical exercise and repleted by diet. They are related to obesity and insulin resistance. Quantification of IMCL was initially performed invasively, using muscle biopsies with biochemical and/or histological analysis. ¹H-magnetic resonance spectroscopy (¹H-MRS) is now a validated method that allows for not only quantifying IMCL non-invasively and repeatedly, but also assessing IHCL and ICCL. This review summarizes the current available knowledge on the flexibility of ectopic lipids. The available evidence suggests a complex interplay between quantitative and qualitative diet, fat availability (fat mass), insulin action, and physical exercise, all important factors that influence the flexibility of ectopic lipids. Furthermore, the time frame of the intervention on these parameters (short-term vs. long-term) appears to be critical. Consequently, standardization of physical activity and diet are critical when assessing ectopic lipids in predefined clinical situations.

  1. 输尿管镜下尿道会师牵引术联合膀胱穿刺造瘘治疗尿道断裂15例临床体会%The Clinical Experience of Urethral Reunion Traction Operation in Ureteroscopic Combined with Bladder Puncture Fistulation to Treat 15 Cases of Urethral Disruption

    Institute of Scientific and Technical Information of China (English)

    廖国龙; 曾志宇; 吴子云; 曲仕浩; 朱黎; 江伟东

    2015-01-01

    Objective:To summarize the clinical experience of treating urethral disruption by urethral reunion traction operation in ureteroscope combined with bladder puncture fistulation.Method:15 cases with urethral disruption who received urethral reunion traction operation combined with bladder puncture fistulation were selected and the clinical data was summarized. Result:15 cases all successed,the mean operation time was(22±8)minutes,the amount of bleeding in operation was(18±4)mL,the average time of urethral sustained traction was(8±2)days,and the hospitalization time was(12±2)days.After a follow up of 12 months,the treatment effect was satisfactory,and no obvious urinary incontinence and erectile dysfunction.2 patients with dysuria were cured by urethral dilation. Conclusion:The operation of urethral reunion traction operation in ureteroscope combined with bladder puncture fistulation to treat urethral disruption is effective for treating urethral disruption and it is worth popularizing.%目的:总结输尿管镜下尿道会师牵引术联合膀胱穿刺造瘘治疗尿道断裂的临床体会。方法:急诊行输尿管镜下尿道会师牵引术联合膀胱穿刺造瘘治疗15例尿道断裂患者,总结其临床资料。结果:15例患者手术均获成功,手术时间平均(22±8)min,术中出血量平均(18±4)mL,尿管持续牵引平均(8±2)d,平均住院时间(12±2)d。术后随访12个月,治疗效果满意,未出现明显尿失禁及勃起功能损害。其中2例拔尿管后出现排尿困难,经定期尿道扩张后治愈。结论:输尿管镜下尿道会师牵引术联合膀胱穿刺造瘘治疗尿道断裂,操作简单,创伤小,术后恢复快,值得临床推广。

  2. 经尿道肾镜下气压弹道碎石术治疗成人膀胱结石%Transurethral Nephroscope Pneumatic Lithotripsy to Treat Adult Bladder Calculus

    Institute of Scientific and Technical Information of China (English)

    季辉华; 李云飞; 张少峰

    2011-01-01

    目的 探讨经尿道肾镜下气压弹道碎石术治疗成人膀胱结石的疗效.方法 回顾性分析我院2007 ~2010年经尿道肾镜下气压弹道碎石术治疗膀胱结石70例患者的临床资料.结果 膀胱结石均一次碎石取石,成功率100%,手术时间15 ~100 min.术后无膀胱大出血及膀胱穿孔等并发症.结论 经尿道肾镜下气压弹道碎石术治疗膀胱结石,通道大,生理盐水冲洗循环好,视野清楚,碎石取石效率高,手术时间短,膀胱损伤小,适合临床推广应用.%Objective To evaluate the efficacy of treating bladder calculus with transurethral nephro-scope pneumatic lithotripsy. Methods To analyze retrospectively 70 clinical cases of treating bladder calculus with transurethral nephroscope Pneumatic lithotripsy in our hospital from 2007 to 2010. Results All bladder calculus were removed only once and the successful rate was 100%. The time of operation was 15 to 100 minutes. There had no complications such as bladder bleeding and bladder perforation after treatment. Conclusion Treatment of bladder calculus with transurethral nephroscope pneumatic lithotripsy has many advantages such as large channel,good cycle of saline wash,clear vision,high efficiency,short operative time and small bladder injury,was suitable for clinical application.

  3. In vitro fragmentation efficiency of holmium: yttrium-aluminum-garnet (YAG) laser lithotripsy--a comprehensive study encompassing different frequencies, pulse energies, total power levels and laser fibre diameters.

    Science.gov (United States)

    Kronenberg, Peter; Traxer, Olivier

    2014-08-01

    To assess the fragmentation (ablation) efficiency of laser lithotripsy along a wide range of pulse energies, frequencies, power settings and different laser fibres, in particular to compare high- with low-frequency lithotripsy using a dynamic and innovative testing procedure free from any human interaction bias. An automated laser fragmentation testing system was developed. The unmoving laser fibres fired at the surface of an artificial stone while the stone was moved past at a constant velocity, thus creating a fissure. The lithotripter settings were 0.2-1.2 J pulse energies, 5-40 Hz frequencies, 4-20 W power levels, and 200 and 550 μm core laser fibres. Fissure width, depth, and volume were analysed and comparisons between laser settings, fibres and ablation rates were made. Low frequency-high pulse energy (LoFr-HiPE) settings were (up to six times) more ablative than high frequency-low pulse energy (HiFr-LoPE) at the same power levels (P fragmentation volume, fissure width, and fissure depth (all P fragmentation measurements. Laser fibre diameter did not affect fragmentation volume (P = 0.81), except at very low pulse energies (0.2 J), where the large fibre was less efficient (P = 0.015). At the same total power level, LoFr-HiPE lithotripsy was most efficient. Pulse energy was the key variable that drove fragmentation efficiency. Attention must be paid to prevent the formation of time-consuming bulky debris and adapt the lithotripter settings to one's needs. As fibre diameter did not affect fragmentation efficiency, small fibres are preferable due to better scope irrigation and manoeuvrability. © 2013 The Authors. BJU International © 2013 BJU International.

  4. Financial Flexibility in North Carolina Schools.

    Science.gov (United States)

    Suarez, Tanya M.; Polen, Deborah A.

    This paper explores educational financial flexibility with a focus on the specific issues surrounding local flexibility in North Carolina school districts. Strategies that states have used to increase local financial flexibility include waivers, reduction of budget categories, block grants, and school-based budgeting. The North Carolina system of…

  5. Shaft-Guidance for Flexible Endoscopes

    NARCIS (Netherlands)

    Loeve, A.J.

    2012-01-01

    Flexible endoscopes (long, slender, flexible instruments with a camera and light at the distal end, having working channels to introduce flexible instruments) are used for diagnostic and therapeutic interventions inside the human digestive system and inside the abdomen. Though used for their flexibi

  6. Towards Measuring Investment in Flexible Foundry Manufacturing

    Directory of Open Access Journals (Sweden)

    Rhythm Suren Wadhwa

    2012-07-01

    Full Text Available Manufacturing flexibility is an important instrument to ensure the success of manufacturing systems in the modern day competitive and uncertain environment. The major hindrance in integrating flexibility into decision making process is that it is difficult to measure and be compared to future indefinable manufacturing scenarios. This paper presents a methodical concept utilizing real options to evaluate flexible foundry manufacturing system.

  7. Increase in flexibility with latest technologies

    Energy Technology Data Exchange (ETDEWEB)

    Fuebi, Michael; Krull, Florian Felix [RWE Technology GmbH, Essen (Germany); Ladwig, Michael [Alstom (Switzerland) AG, Baden (Switzerland)

    2012-07-01

    Flexibility demands on conventional power plants rise to ensure grid stability within a power generation mix with drastically increasing capacities of renewable power generation sources such as wind farms and photovoltaics. In this paper flexibility requirements for a power plant portfolio are discussed. Through selected examples of projects from RWE's current investment programme, comprising around 13 GW of efficient and flexible power plant capacity in Germany, the Netherlands, Turkey and the UK, application of the latest technologies to fulfil flexibility requirements is presented. Further, the potential of smart retrofits in terms of combined flexibility and efficiency gains is illustrated by means of an existing power plant unit retrofit project. (orig.)

  8. Designing for Flexibility in the Traditional University

    Directory of Open Access Journals (Sweden)

    Betty Collis

    2004-01-01

    Full Text Available Instructors in traditional universities are expected to respond to the needs of an increasingly diverse student body by making more flexibility available in their courses. Based on a systematic analysis of flexibility options, various tools to help instructors in the design of their course Web environments for more flexibility have been built into the CMS (Course Management System used at the University of Twente since 1997. It is our experience that instructors use the tools to increase course flexibility with regard to the efficiency and logistics of participation but do relatively less with respect to increasing course flexibility when this involves new pedagogies.

  9. 输尿管镜钬激光治疗儿童输尿管末端囊肿的疗效分析%Analysis of therapeutic effect of ureteroscopic holmium laser treat for ureter cyst of children

    Institute of Scientific and Technical Information of China (English)

    涂磊; 赵夭望; 刘李; 彭潜龙; 殷波; 宁峰; 刘小青

    2014-01-01

    Objetive To evaluate the effect of ureteroscopic holmium laser treat the ureter cyst of chil-dren. Methods The clinical data of 22 cases of ureter cyst patients for children from March 201 0 to March 201 4 were analyzed retrospectively.These patients are receive ultrasound,urinary tract CT,Intravenous urina-ry tract imaging examination,Bladder retrograde urethrography before diagnosis of ureter cyst,and then accept the operation of ureteroscopy holmium laser incision.The age of 22 cases from 3 months to 1 5 years old,which girl 15 cases (68.2%)and boy 7 cases (31.8%);9 cases (40.9%)on the left side of,11 cases (50.0%) on the right side,and 2 cases (9.1%)with double side;20 cases (90.9%)of cyst open in the bladder,2 ca-ses(9.1%)of cyst open in the bladder neck of internal urethral orifice;16 cases (72.7%)of hydronephrosis or ureterectasia;7 cases (31 .8%)patients with duplex kidney,both these ureter of duplex kidney are com-bined with Y shape and last opening in the bladder for the end of ureter cyst;4 cases (18.2%)with Vesi-coureteral reflux,1 case (4.5%)complicated stone,13 cases (59.1%)children with urinary tract infec-tions.All patients received the operation of ureteroscopy holmium laser incision.Operative time was 1 4~46 min,average 28 ±1 0 min,blood loss was about 2~1 0 mL,hospitalization time was 2 to 5 days,with an aver-age was 3.1 ±1 .0 days. Results 21 cases were followed after surgery,one patient was lost,follow-up period from 3 to 31 months.The followed children were review ultrasound and urine routine examination.20 cases without recurrence of ureterocele,1 0 cases of children the symptoms of recurrent urinary tract infection com-pletely disappeared,1 2 patients with hydronephrosis or ureterectasia has been significantly improved,and 1 case combined stone without recurrence after operation,One patient perform ureteral reimplantation because of severe vesicoureteral reflux. Conclusion Holmium laser treatment for children ureterocele has many advanta

  10. Energy Flexibility in the Power System

    DEFF Research Database (Denmark)

    Ma, Zheng; Billanes, Joy Dalmacio; Jørgensen, Bo Nørregaard

    2017-01-01

    Energy flexibility can address the challenges of large scale integration of renewable energy resources and thereby increasing imbalance in the power system. Flexible power system can provide reliable supply, low electricity cost and sustainability. Various situations and factors influence...... the adoption of the flexibility solutions, such as flexible electricity generation, demand-response, and electricity storage. This paper tries to analyze the current energy flexibility solutions and the factors that can influence the energy flexibility adoption. This paper takes Philippines as case study...... to provide an overview of the current condition of the Philippines’ power system and discuss the energy flexibility in the Philippines’ power system. A further discussion and recommendation is conducted in the end of the paper....

  11. Retrograde Intrarenal Surgery versus Percutaneous Lithotripsy to Treat Renal Stones 2-3 cm in Diameter

    Directory of Open Access Journals (Sweden)

    Kursad Zengin

    2015-01-01

    Full Text Available Objective. Retrograde intrarenal surgery (RIRS performed using a flexible ureterorenoscope marked the beginning of a new era in urology. Today, even staghorn stones are successfully treated via RIRS. The recommended treatment for larger stones is percutaneous nephrolithotomy (PNL. However, the question of whether PNL or RIRS should be the first-line treatment option for larger stones remains controversial. In this study, we contribute to the debate by comparing the success and complication rates of PNL and RIRS that were used to treat renal pelvis stones 2-3 cm in diameter. Materials and Methods. The medical records of 154 patients (74 PNL, 80 RIRS were retrospectively evaluated. PNL patients were placed in Group 1 and RIRS patients in Group 2. Results. The complete stone-free rates were 95.5% in the PNL group and 80.6% in the RIRS group 1 month postoperatively (P=0.061. The respective complication rates (evaluated using the Clavien system were 13.5% and 8.8% (P=0.520. Conclusions. RIRS affords a comparable success rate, causes fewer complications than PNL, and seems to be a promising alternative to PNL when larger stones are to be treated. Prospective randomized controlled trials are needed to confirm these findings.

  12. Retrograde Intrarenal Surgery versus Percutaneous Lithotripsy to Treat Renal Stones 2-3 cm in Diameter

    Science.gov (United States)

    Zengin, Kursad; Tanik, Serhat; Sener, Nevzat Can; Albayrak, Sebahattin; Tuygun, Can; Bakirtas, Hasan; Imamoglu, M. Abdurrahim; Gurdal, Mesut

    2015-01-01

    Objective. Retrograde intrarenal surgery (RIRS) performed using a flexible ureterorenoscope marked the beginning of a new era in urology. Today, even staghorn stones are successfully treated via RIRS. The recommended treatment for larger stones is percutaneous nephrolithotomy (PNL). However, the question of whether PNL or RIRS should be the first-line treatment option for larger stones remains controversial. In this study, we contribute to the debate by comparing the success and complication rates of PNL and RIRS that were used to treat renal pelvis stones 2-3 cm in diameter. Materials and Methods. The medical records of 154 patients (74 PNL, 80 RIRS) were retrospectively evaluated. PNL patients were placed in Group 1 and RIRS patients in Group 2. Results. The complete stone-free rates were 95.5% in the PNL group and 80.6% in the RIRS group 1 month postoperatively (P = 0.061). The respective complication rates (evaluated using the Clavien system) were 13.5% and 8.8% (P = 0.520). Conclusions. RIRS affords a comparable success rate, causes fewer complications than PNL, and seems to be a promising alternative to PNL when larger stones are to be treated. Prospective randomized controlled trials are needed to confirm these findings. PMID:25821828

  13. Flexible experimental FPGA based platform

    DEFF Research Database (Denmark)

    Andersen, Karsten Holm; Nymand, Morten

    2016-01-01

    This paper presents an experimental flexible Field Programmable Gate Array (FPGA) based platform for testing and verifying digital controlled dc-dc converters. The platform supports different types of control strategies, dc-dc converter topologies and switching frequencies. The controller platform...... interface supporting configuration and reading of setup parameters, controller status and the acquisition memory in a simple way. The FPGA based platform, provides an easy way within education or research to use different digital control strategies and different converter topologies controlled by an FPGA...

  14. International Expansion through Flexible Replication

    DEFF Research Database (Denmark)

    Jonsson, Anna; Foss, Nicolai Juul

    2011-01-01

    to local environments and under the impact of new learning. To illuminate these issues, we draw on a longitudinal in-depth study of Swedish home furnishing giant IKEA, involving more than 70 interviews. We find that IKEA has developed organizational mechanisms that support an ongoing learning process aimed......, etc.) are replicated in a uniform manner across stores, and change only very slowly (if at all) in response to learning (“flexible replication”). We conclude by discussing the factors that influence the approach to replication adopted by an international replicator....

  15. Mundari as a flexible language

    DEFF Research Database (Denmark)

    Hengeveld, Kees; Rijkhoff, Jan

    2005-01-01

    by a critical evaluation of the three criteria Evans & Osada (E&O - this volume) use to establish the lack of word class distinctions in a language (section 3). In section 4 we present evidence to support our claim that Mundari has ‘flexible’ basic lexemes (i.e. there is no fundamental distinction between nouns...... and verbs), thus disputing E&O’s claim that Mundari has clearly definable classes of verbs and nouns. The last section is concerned with a set of grammatical features which correlate with the presence of flexible lexemes in a language. It is concluded that Mundari displays all of the predicted features...

  16. Flexible Envelope Request Notation (FERN)

    Science.gov (United States)

    Zoch, David R.; Lavallee, David; Weinstein, Stuart

    1991-01-01

    The following topics are presented in view graph form and include the following: scheduling application; the motivation for the Flexible Envelope Request Notation (FERN); characteristics of FERN; types of information needed in requests; where information is stored in requests; FERN structures; generic requests; resource availability for pooled resources; expressive notation; temporal constraints; time formats; changes to FERN; sample FERN requests; the temporal relationship between two steps; maximum activity length to limit step delays; alternative requests; the temporal relationship between two activities; and idle resource usage between steps.

  17. Flexible high-speed CODEC

    Science.gov (United States)

    Segallis, Greg P.; Wernlund, Jim V.; Corry, Glen

    1993-08-01

    This report is prepared by Harris Government Communication Systems Division for NASA Lewis Research Center under contract NAS3-25087. It is written in accordance with SOW section 4.0 (d) as detailed in section 2.6. The purpose of this document is to provide a summary of the program, performance results and analysis, and a technical assessment. The purpose of this program was to develop a flexible, high-speed CODEC that provides substantial coding gain while maintaining bandwidth efficiency for use in both continuous and bursted data environments for a variety of applications.

  18. Versatile Flexible Graphene Multielectrode Arrays.

    Science.gov (United States)

    Kireev, Dmitry; Seyock, Silke; Ernst, Mathis; Maybeck, Vanessa; Wolfrum, Bernhard; Offenhäusser, Andreas

    2016-12-23

    Graphene is a promising material possessing features relevant to bioelectronics applications. Graphene microelectrodes (GMEAs), which are fabricated in a dense array on a flexible polyimide substrate, were investigated in this work for their performance via electrical impedance spectroscopy. Biocompatibility and suitability of the GMEAs for extracellular recordings were tested by measuring electrical activities from acute heart tissue and cardiac muscle cells. The recordings show encouraging signal-to-noise ratios of 65 ± 15 for heart tissue recordings and 20 ± 10 for HL-1 cells. Considering the low noise and excellent robustness of the devices, the sensor arrays are suitable for diverse and biologically relevant applications.

  19. The flexibility of optical metrics

    CERN Document Server

    Bittencourt, Eduardo; Smolyaninov, Igor; Smolyaninova, Vera N

    2015-01-01

    We firstly revisit the importance, naturalness and limitations of the so-called optical metrics for describing the propagation of light rays in the limit of geometric optics. We then exemplify their flexibility and nontriviality in some nonlinear material media and in the context of nonlinear theories of the electromagnetism, both underlain by curved backgrounds, where optical metrics could be flat and impermeable membranes only to photons could be conceived, respectively. Finally, we underline and discuss the relevance and potential applications of our analyses in a broad sense, ranging from material media to compact astrophysical systems.

  20. Versatile Flexible Graphene Multielectrode Arrays

    Directory of Open Access Journals (Sweden)

    Dmitry Kireev

    2016-12-01

    Full Text Available Graphene is a promising material possessing features relevant to bioelectronics applications. Graphene microelectrodes (GMEAs, which are fabricated in a dense array on a flexible polyimide substrate, were investigated in this work for their performance via electrical impedance spectroscopy. Biocompatibility and suitability of the GMEAs for extracellular recordings were tested by measuring electrical activities from acute heart tissue and cardiac muscle cells. The recordings show encouraging signal-to-noise ratios of 65 ± 15 for heart tissue recordings and 20 ± 10 for HL-1 cells. Considering the low noise and excellent robustness of the devices, the sensor arrays are suitable for diverse and biologically relevant applications.

  1. Fully Integral, Flexible Composite Driveshaft

    Science.gov (United States)

    Lawrie, Duncan

    2014-01-01

    An all-composite driveshaft incorporating integral flexible diaphragms was developed for prime contractor testing. This new approach makes obsolete the split lines required to attach metallic flex elements and either metallic or composite spacing tubes in current solutions. Subcritical driveshaft weights can be achieved that are half that of incumbent technology for typical rotary wing shaft lengths. Spacing tubes compose an integral part of the initial tooling but remain part of the finished shaft and control natural frequencies and torsional stability. A concurrently engineered manufacturing process and design for performance competes with incumbent solutions at significantly lower weight and with the probability of improved damage tolerance and fatigue life.

  2. Urinary stone characteristics of patients treated with extracorporeal shock wave lithotripsy in Cipto Mangunkusumo Hospital Jakarta, 2008–2014: a gender analysis

    Directory of Open Access Journals (Sweden)

    Endrika Noviandrini

    2015-12-01

    Full Text Available Background: The incidence of urinary stone patient in Indonesia has increased every year in both genders. Data showed that urolithiasis was higher in male rather than female. The aimed of this study was to describe the characteristics of urinary stone found in patient who underwent extracorporeal shock wave lithotripsy (ESWL at Cipto Mangunkusumo Hospital, Jakarta from 2008–2014. Methods: Data obtained from ESWL medical record Cipto Mangunkusumo Hospital, Jakarta from 2008–2014. We obtained 5,174 out of 6,020 data due to incompleteness data record. We sorted data records by gender, age, stone location, stone opacity, size of the stone, and history of ESWL, and analyzed by statistic tools (SPSS v 20 for Mac.Results: From 5,174 records, we found that the incidence of urinary stones was two times higher in male rather than female (66.3%:33.64%, occurred mostly in productive age (65.2% male, 65.9% female. Unilateral kidney stone was most common location found for both gender (50.2% male, 57.2% female, and most frequent site located in calyx inferior (24.8% male, 28.9% female. About 72.9% stone was radiopaque (73.7% male and 71.5% female. The mean size of the stone in male and female was 11.34±7.15 mm and 11.90±7.54 mm, respectively. This study also showed that 79.3% patients came for first ESWL.Conclusion: Urinary stone founds two times higher in male than female, and mostly occurs on their productive ages. Unilateral kidney stone in calyx inferior become the most common stone found in both gender. Most of the stone has radiopaque opacity.

  3. Adjunctive medical therapy with α-blocker after extracorporeal shock wave lithotripsy of renal and ureteral stones: a meta-analysis.

    Directory of Open Access Journals (Sweden)

    Mingchao Li

    Full Text Available Although some trials assessed the efficacy and safety of the α-blocker in facilitating renal and ureteral stones expulsion after extracorporeal shock wave lithotripsy (ESWL, the role of the α-blocker in facilitating upper urinary calculi expulsion after ESWL remain controversial.To determine the efficacy and safety of the α-blocker in facilitating renal and ureteral stones expulsion after ESWL.A literature search was carried out using the PubMed database, EMBASE and the Cochrane Library database to identify relevant studies. Two reviewers independently extracted data and assessed methodological quality. Pooled effect estimates were obtained using a fixed- and random-effects meta-analysis.The meta-analysis included 23 RCTs, α-blocker significantly enhanced expulsion rate of upper urinary tract calculi after ESWL (P<0.00001; RR 1.21; 95% CI 1.12-1.31, significantly promoted steinstrasse expulsion (P=0.03; RR 1.25; 95% CI 1.03-1.53, significantly shortened the discharge time of upper urinary tract calculi (P=0.0001; MD -2.12; 95% CI -3.20--1.04, significantly reduced the patient's pain VAS score (P=0.001; RR -1.0; 95% CI -1.61--0.39. Compared with the control group, dizziness (P=0.002; RR 5.48; 95% CI 1.91-15.77, anejaculation (P=0.02; RR 12.17; 95% CI 1.61-91.99 and headache (P=0.04; RR 4.03; 95% CI 1.04-15.72 in the α-blocker group was associated with a higher incidence.Treatment with α-blocker after ESWL appears to be effective in enhancing expulsion rate of upper urinary tract calculi, shortening the discharge time of upper urinary tract calculi, reducing the patient's pain. The side effects of α-blocker were light and few.

  4. The efficacy of performing shockwave lithotripsy before retrograde intrarenal surgery in the treatment of multiple or large (≥1.5 cm) nephrolithiasis: A propensity score matched analysis

    Science.gov (United States)

    Shim, Myungsun; Park, Myungchan

    2017-01-01

    Purpose To investigate the effect of performing shockwave lithotripsy (SWL) before retrograde intrarenal surgery (RIRS) on the treatment outcomes of patients with nephrolithiasis. Materials and Methods The data of 189 patients with renal stones who underwent RIRS from July 2007 to July 2014 was reviewed retrospectively. Patients with stones larger than 1.5 cm were recommended to undergo SWL before RIRS. Patients were divided into 2 groups based on whether the preoperative SWL was performed (group 1, n=68) or not (group 2, n=121). The cohorts of the 2 groups cohorts were matched 1:1 using propensity score analysis. Patient, stone characteristics, operative parameters, and stone-free rates were compared. Results Patients in groups 1 and 2 were matched with respect to stone size, number, and location, leaving 57 patients in each group. After matching, no differences were identified between the 2 groups regarding age, body mass index, sex, stone composition, density and multiplicity. Compared to group 2 patients, patients in group 1 had fewer number of procedures performed (1.10 vs. 1.26, p=0.045) and higher stone-free rate (89.4% vs.73.6%, p=0.039). In multivariate analysis, Non lower calyceal location (odd ratio [OR], 8.215; 95% confidence interval [CI], 1.782–21.982; p=0.041), stone size (OR, 6.932; 95% CI, 1.022–18.283; p<0.001), and preoperative SWL (OR, 2.210; 95% CI, 1.058–7.157; p=0.019) were independent factors predicting a stone-free state after RIRS. Conclusions Performing SWL before RIRS may favor stone eliminations during surgery and increase the stone-free rate in selected patients. PMID:28097265

  5. Optimal Skin-to-Stone Distance Is a Positive Predictor for Successful Outcomes in Upper Ureter Calculi following Extracorporeal Shock Wave Lithotripsy: A Bayesian Model Averaging Approach.

    Directory of Open Access Journals (Sweden)

    Kang Su Cho

    Full Text Available To investigate whether skin-to-stone distance (SSD, which remains controversial in patients with ureter stones, can be a predicting factor for one session success following extracorporeal shock wave lithotripsy (ESWL in patients with upper ureter stones.We retrospectively reviewed the medical records of 1,519 patients who underwent their first ESWL between January 2005 and December 2013. Among these patients, 492 had upper ureter stones that measured 4-20 mm and were eligible for our analyses. Maximal stone length, mean stone density (HU, and SSD were determined on pretreatment non-contrast computed tomography (NCCT. For subgroup analyses, patients were divided into four groups. Group 1 consisted of patients with SSD<25th percentile, group 2 consisted of patients with SSD in the 25th to 50th percentile, group 3 patients had SSD in the 50th to 75th percentile, and group 4 patients had SSD≥75th percentile.In analyses of group 2 patients versus others, there were no statistical differences in mean age, stone length and density. However, the one session success rate in group 2 was higher than other groups (77.9% vs. 67.0%; P = 0.032. The multivariate logistic regression model revealed that shorter stone length, lower stone density, and the group 2 SSD were positive predictors for successful outcomes in ESWL. Using the Bayesian model-averaging approach, longer stone length, lower stone density, and group 2 SSD can be also positive predictors for successful outcomes following ESWL.Our data indicate that a group 2 SSD of approximately 10 cm is a positive predictor for success following ESWL.

  6. Diuresis and inversion therapy to improve clearance of lower caliceal stones after shock wave lithotripsy: A prospective, randomized, controlled, clinical study

    Directory of Open Access Journals (Sweden)

    Abul-fotouh Ahmed

    2015-01-01

    Full Text Available Objective: To improve the clearance of lower caliceal stones (LCSs after shock wave lithotripsy (SWL using a combination of intra-operative forced diuresis and inversion therapy. Materials and Methods: One hundred and fifty-seven consecutive patients with symptomatic, single LCSs of 5-20 mm size were prospectively randomized into two groups. The first (study group, SG underwent SWL at the time of the maximum diuresis with the patient in the Trendelenburg position with an angle of 30 degree, while the second group (control group, CG underwent standard SWL. After the last SWL session, patients were followed-up regularly using plain abdominal X-ray and renal ultrasound. The primary endpoint of the study was the stone-free rate (SFR at 12 weeks. Results: A total of 141 patients completed the study treatment protocol and follow-up: 69 patients in SG and 72 patients in CG. Both groups were comparable in baseline data. SG showed significantly higher SFR at all follow-up time points. At week 12, 78.3% of SG were rendered stone free, whereas only 61.1% were stone free in CG (P = 0.030. Also, there was a significantly higher SFR for larger stones (>10 mm and stones with higher attenuation value (>500 Hounsfield units in SG than CG. Mild non-significant complications were reported in both groups. Conclusion: SWL with intraoperative forced diuresis and inversion seems to be an effective measure with minimal extra cost to improve LCS clearance post-SWL.

  7. An Evaluation of Electroacupuncture at the Weizhong Acupoint (BL-40 as a Means of Relieving Pain Induced by Extracorporeal Shock Wave Lithotripsy

    Directory of Open Access Journals (Sweden)

    Wei-Ta Chen

    2014-01-01

    Full Text Available Background. Extracorporeal shock wave lithotripsy (ESWL is the preferred option for urolithiasis treatment. However, intensities of pain may be induced and the sedative anesthetic or analgesics were usually needed. The aim of this study was to develop an improved acupuncture-assisted anesthesia approach in pain relief. Methods. We conducted a single-blind, randomized controlled study in China Medical University Hospital. Patients treated by ESWL due to upper urolithiasis were randomly divided into control group, sham-EA group, and 100 Hz EA group. The high frequency electroacupuncture (EA was applied at the Weizhong acupoint (100 Hz EA group for 20 minutes prior to the ESWL. In the sham-EA group, the same procedures were performed as those of 100 Hz EA group but no electric current was given to stimulate the acupoints. In the control group, no action was taken before operation. The information including the numbers and dosage of analgesic requirements, pain score, vital signs, and the satisfaction of procedure was collected. Results. A total of 74 subjects were recruited and we found that the interval to the first request analgesic, the number/total dosage of additional analgesic, recovery time from anesthesia, and the satisfaction were all better in both the 100 Hz EA and the sham-EA group. The 100 Hz EA also showed better relief of painful sensations by delaying the onset of pain. Conclusions. The 100 Hz EA and the sham-EA can effectively relieve pain due to ESWL as well as reducing the dosage of opium analgesic used.

  8. Comparison of two different running models for the shock wave lithotripsy machine in Taipei City Hospital: self-support versus outsourcing cooperation.

    Science.gov (United States)

    Huang, Chi-Yi; Chen, Shiou-Sheng; Chen, Li-Kuei

    2009-10-01

    To compare two different running models including self-support and outsourcing cooperation for the extracorporeal shock wave lithotripsy (SWL) machine in Taipei City Hospital, we made a retrospective study. Self-support means that the hospital has to buy an SWL machine and get all the payment from SWL. In outsourcing cooperation, the cooperative company provides an SWL machine and shares the payment with the hospital. Between January 2002 and December 2006, we used self-support for the SWL machine, and from January 2007 to December 2008, we used outsourcing cooperation. We used the method of full costing to calculate the cost of SWL, and the break-even point was the lowest number of treatment sessions of SWL to make balance of payments every month. Quality parameters including stone-free rate, retreatment rate, additional procedures and complication rate were evaluated. When outsourcing cooperation was used, there were significantly more treatment sessions of SWL every month than when utilizing self-support (36.3 +/- 5.1 vs. 48.1 +/- 8.4, P = 0.03). The cost of SWL for every treatment session was significantly higher using self-support than with outsourcing cooperation (25027.5 +/- 1789.8 NT$ vs. 21367.4 +/- 201.0 NT$). The break-even point was 28.3 (treatment sessions) for self-support, and 28.4 for outsourcing cooperation, when the hospital got 40% of the payment, which would decrease if the percentage increased. No significant differences were noticed for stone-free rate, retreatment rate, additional procedures and complication rate of SWL between the two running models. Besides, outsourcing cooperation had lower cost (every treatment session), but a greater number of treatment sessions of SWL every month than self-support.

  9. On the concept of flexibility: A dual control perspective

    NARCIS (Netherlands)

    A.C.J. de Leeuw (A. C J); H.W. Volberda (Henk)

    1996-01-01

    textabstractOrganizational flexibility has recently received much attention from researchers, management consultants and practitioners. In general, the term 'flexibility' has a positive connotation: flexible organizations are the better ones. However, the meaning of flexibility as well as its

  10. On the concept of flexibility : A dual control perspective

    NARCIS (Netherlands)

    de Leeuw, A.C.J.; Volberda, H.W.

    Organizational flexibility has recently received much attention from researchers, management consultants and practitioners, In general, the term 'flexibility' has a positive connotation: flexible organizations are the better ones. However, the meaning of flexibility as well as its relation to the

  11. Graphene based flexible electrochromic devices.

    Science.gov (United States)

    Polat, Emre O; Balcı, Osman; Kocabas, Coskun

    2014-10-01

    Graphene emerges as a viable material for optoelectronics because of its broad optical response and gate-tunable properties. For practical applications, however, single layer graphene has performance limits due to its small optical absorption defined by fundamental constants. Here, we demonstrated a new class of flexible electrochromic devices using multilayer graphene (MLG) which simultaneously offers all key requirements for practical applications; high-contrast optical modulation over a broad spectrum, good electrical conductivity and mechanical flexibility. Our method relies on electro-modulation of interband transition of MLG via intercalation of ions into the graphene layers. The electrical and optical characterizations reveal the key features of the intercalation process which yields broadband optical modulation up to 55 per cent in the visible and near-infrared. We illustrate the promises of the method by fabricating reflective/transmissive electrochromic devices and multi-pixel display devices. Simplicity of the device architecture and its compatibility with the roll-to-roll fabrication processes, would find wide range of applications including smart windows and display devices. We anticipate that this work provides a significant step in realization of graphene based optoelectronics.

  12. Wetting of flexible fibre arrays.

    Science.gov (United States)

    Duprat, C; Protière, S; Beebe, A Y; Stone, H A

    2012-02-23

    Fibrous media are functional and versatile materials, as demonstrated by their ubiquity both in natural systems such as feathers and adhesive pads and in engineered systems from nanotextured surfaces to textile products, where they offer benefits in filtration, insulation, wetting and colouring. The elasticity and high aspect ratios of the fibres allow deformation under capillary forces, which cause mechanical damage, matting self-assembly or colour changes, with many industrial and ecological consequences. Attempts to understand these systems have mostly focused on the wetting of rigid fibres or on elastocapillary effects in planar geometries and on a fibre brush withdrawn from an infinite bath. Here we consider the frequently encountered case of a liquid drop deposited on a flexible fibre array and show that flexibility, fibre geometry and drop volume are the crucial parameters that are necessary to understand the various observations referred to above. We identify the conditions required for a drop to remain compact with minimal spreading or to cause a pair of elastic fibres to coalesce. We find that there is a critical volume of liquid, and, hence, a critical drop size, above which this coalescence does not occur. We also identify a drop size that maximizes liquid capture. For both wetting and deformation of the substrates, we present rules that are deduced from the geometric and material properties of the fibres and the volume of the drop. These ideas are applicable to a wide range of fibrous materials, as we illustrate with examples for feathers, beetle tarsi, sprays and microfabricated systems.

  13. Flexible thin film magnetoimpedance sensors

    Energy Technology Data Exchange (ETDEWEB)

    Kurlyandskaya, G.V., E-mail: galina@we.lc.ehu.es [Universidad del País Vasco, UPV/EHU, Departamento de Electricidad y Electrónica, P.O. Box 644, Bilbao 48080 (Spain); Ural Federal University, Laboratory of Magnetic sensoric, Lenin Ave. 51, 620083 Ekaterinburg (Russian Federation); Fernández, E. [BCMaterials UPV-EHU, Vizcaya Science and Technology Park, 48160 Derio (Spain); Svalov, A. [Universidad del País Vasco, UPV/EHU, Departamento de Electricidad y Electrónica, P.O. Box 644, Bilbao 48080 (Spain); Ural Federal University, Laboratory of Magnetic sensoric, Lenin Ave. 51, 620083 Ekaterinburg (Russian Federation); Burgoa Beitia, A. [Universidad del País Vasco, UPV/EHU, Departamento de Electricidad y Electrónica, P.O. Box 644, Bilbao 48080 (Spain); García-Arribas, A. [Universidad del País Vasco, UPV/EHU, Departamento de Electricidad y Electrónica, P.O. Box 644, Bilbao 48080 (Spain); BCMaterials UPV-EHU, Vizcaya Science and Technology Park, 48160 Derio (Spain); Larrañaga, A. [SGIker, Servicios Generales de Investigación, Universidad del País Vasco (UPV/EHU), 48080 Bilbao (Spain)

    2016-10-01

    Magnetically soft thin film deposited onto polymer substrates is an attractive option for flexible electronics including magnetoimpedance (MI) applications. MI FeNi/Ti based thin film sensitive elements were designed and prepared using the sputtering technique by deposition onto rigid and flexible substrates at different deposition rates. Their structure, magnetic properties and MI were comparatively analyzed. The main structural features were sufficiently accurately reproduced in the case of deposition onto cyclo olefine polymer substrates compared to glass substrates for the same conditions. Although for the best condition (28 nm/min rate) of the deposition onto polymer a significant reduction of the MI field sensitivity was found satisfactory for sensor applications sensitivity: 45%/Oe was obtained for a frequency of 60 MHz. - Highlights: • [FeNi/Ti]{sub 3}/Cu/[FeNi/Ti]{sub 3} films were prepared by sputtering at different deposition rates. • Polymer substrates insure sufficiently accurate reproducibility of the film structure. • High deposition rate of 28 nm/min insures the highest values of the magnetoimpedance sensitivity. • Deposition onto polymer results in the satisfactory magnetoimpedance sensitivity of 45%/Oe.

  14. Flexible network wireless transceiver and flexible network telemetry transceiver

    Science.gov (United States)

    Brown, Kenneth D.

    2008-08-05

    A transceiver for facilitating two-way wireless communication between a baseband application and other nodes in a wireless network, wherein the transceiver provides baseband communication networking and necessary configuration and control functions along with transmitter, receiver, and antenna functions to enable the wireless communication. More specifically, the transceiver provides a long-range wireless duplex communication node or channel between the baseband application, which is associated with a mobile or fixed space, air, water, or ground vehicle or other platform, and other nodes in the wireless network or grid. The transceiver broadly comprises a communication processor; a flexible telemetry transceiver including a receiver and a transmitter; a power conversion and regulation mechanism; a diplexer; and a phased array antenna system, wherein these various components and certain subcomponents thereof may be separately enclosed and distributable relative to the other components and subcomponents.

  15. Endoscopic laser lithotripsy for complicated bile duct stones: is cholangioscopic guidance necessary? Litotripsia endoscópica a laser para cálculos difíceis de via biliar: a colangioscopia é necessária?

    Directory of Open Access Journals (Sweden)

    Ralf Jakobs

    2007-06-01

    Full Text Available BACKGROUND: Endoscopic papillotomy is successful in more than 95% of the cases of choledocholithiasis. For patients with difficult bile duct stones not responding to mechanical lithotripsy, different methods for stone fragmentation have been developed. AIM: To compare the results of laser lithotripsy with a stone-tissue recognizing system, when guided by fluoroscopy only or by cholangioscopy. METHODS: Between 1992 and 2002 we have treated 89 patients with difficult bile duct stones by endoscopic retrograde cholangiopancreatography and laser lithotripsy. Unsuccessful extracorporeal shock-wave lithotripsy and electrohydraulic were also performed before laser in 35% and 26% of the cases, respectively. RESULTS: Laser was effective in 79.2% of 72 patients guided by cholangioscopy and in 82.4% of 17 cases steered by fluoroscopy. The median number of impulses in the latter was 4,335 and 1,800 with the former technique. Two parameters influenced the manner of laser guidance. In cases of stones situated above a stricture, cholangioscopic control was more effective (64.7% vs. 31.9%. When the stones were in the distal bile duct, fluoroscopic control was more successful. CONCLUSION: In cases of difficult stones in the distal bile duct, laser lithotripsy under fluoroscopic control is very effective and easily performed. Cholangioscopic guidance should be recommended just in cases of intrahepatic stones or in patients with stones situated proximal to a bile duct stenosis. In these cases, cholangioscopy should be performed either endoscopically or percutaneously.RACIONAL: A papilotomia endoscópica é efetiva em mais de 95% dos casos de coledocolitíase . Para pacientes com cálculos de difícil extração (gigantes ou proximais a uma estenose, que não respondem à litotripsia mecânica, diferentes métodos de fragmentação foram desenvolvidos. OBJETIVO: Comparar os resultados da litotripsia à laser com um sistema de reconhecimento cálculo-tecido, quando

  16. 点触式探针超声碎石清石治疗硬结石的临床研究%Clinical study of point contact probe ultrasound lithotripsy in treatment of hard stone

    Institute of Scientific and Technical Information of China (English)

    黄永斌; 王军起; 聂锐志; 张海涛; 刘兆飞; 徐向军; 黄金辉

    2015-01-01

    目的:探讨点触式探针与平面探针超声碎石清石效率的安全性和点触式探针的优越性.方法:将72例含钙尿路结石随即分成2组,观察组35例,对照组37例.两组分别用点触式超声探针和原平面超声探针行经皮肾镜和经尿道超声碎石清石术.对坚硬结石,先用气压弹道将结石碎成小块,再用超声探针碎石清石.术中准确记录碎石时间,并观察两种探针对尿路黏膜损伤情况.术后测量每例结石的体积,并计算各探针的碎石速度.结果:平面探针对坚硬结石击碎困难,8例需要先用气压弹道将结石碎成小块后,再行超声碎石清石.点触式探针对坚硬结石仍可击碎,其碎石清石速度明显高于平面探针(P<0.05),是原超声探针的2.2倍.对照组出现多例轻微的黏膜吸附伤,无需处理,观察组未出现尿路黏膜吸附伤和刺伤.结论:点触式探针比平面探针碎石清石速度快,可不借助于气压弹道辅助碎石,碎石清石效率高,安全性好,值得推广应用.%Objective: The objective of this research is to examine the safety of lithotripsy using ultrasound sector probe and the superiority of point contact probe.Method In the study, 72 patients with calcium urolithiasis were divided into 2 groups, of which 35 cases are in the observation group. Patients in both groups are treated with point contact probe and sector probe through percutaneous nephrolithotomy and transurethral. For hard stone, they are broken into small fragments with pneumatic ballistic lithotripsy at first, following ultrasound probe lithotripsy. The exact time in every treatment was recorded, and urinary mucosa injury was examined. The volumes of stone were measured and speeds of probe were calculated. Results It is found that sector probe is less effective treating hard stones, with 8 cases pneumatic ballistic lithotripsy being conducted at first. Compare to this, operations using point contact probe can break hard stones

  17. Simulation and analysis of flexibly jointed manipulators

    Science.gov (United States)

    Murphy, Steve H.; Wen, John T.; Saridis, George M.

    1990-01-01

    Modeling, simulation, and analysis of robot manipulators with non-negligible joint flexibility are studied. A recursive Newton-Euler model of the flexibly jointed manipulator is developed with many advantages over the traditional Lagrange-Euler methods. The Newton-Euler approach leads to a method for the simulation of a flexibly jointed manipulator in which the number of computations grows linearly with the number of links. Additionally, any function for the flexibility between the motor and link may be used permitting the simulation of nonlinear effects, such as backlash, in a uniform manner for all joints. An analysis of the control problems for flexibly jointed manipulators is presented by converting the Newton-Euler model to a Lagrange-Euler form. The detailed structure available in the model is used to examine linearizing controllers and shows the dependency of the control on the choice of flexible model and structure of the manipulator.

  18. Strength, flexibility, and maturity in adolescent athletes.

    Science.gov (United States)

    Pratt, M

    1989-05-01

    The relationship between lower-extremity strength and flexibility and maturational status as measured by Tanner staging (TS) was assessed in 84 male high school athletes. The sum of one-repetition maximum lifts for knee extension and flexion was determined and flexibility was measured with the American Alliance of Health, Physical Education, Recreation, and Dance sit-and-reach test. Chronologic age, body weight, and percent fat were also recorded. Strength and flexibility were compared for each maturational and chronologic age category. Maturational age was better correlated with strength and flexibility than was chronologic age. All correlations were significant. Multiple regression analysis demonstrated significant correlations of TS and age with strength and flexibility. Tanner staging had greater predictive value than age for strength and flexibility. After adjusting for age, the relationship between TS and strength remained significant.

  19. Flexible Working Time Arrangements in Bulgaria

    OpenAIRE

    Beleva, Iskra

    2009-01-01

    The objective of this paper is to analyze the flexible working time arrangements in Bulgaria, using a life-course perspective. Two important features have to be outlined, namely: underdeveloped flexible forms of employment in the country, including working time arrangement, and lack of previous analysis on flexible working time arrangements from the angle of life-course perspective. The author describes the regulatory framework, collective agreements at national and company level as a frame w...

  20. Flexibility in 21st Century Power Systems

    Energy Technology Data Exchange (ETDEWEB)

    Cochran, J.; Miller, M.; Zinaman, O.; Milligan, M.; Arent, D.; Palmintier, B.; O' Malley, M.; Mueller, S.; Lannoye, E.; Tuohy, A.; Kujala, B.; Sommer, M.; Holttinen, H.; Kiviluoma, J.; Soonee, S. K.

    2014-05-01

    Flexibility of operation--the ability of a power system to respond to change in demand and supply--is a characteristic of all power systems. Flexibility is especially prized in twenty-first century power systems, with higher levels of grid-connected variable renewable energy (primarily, wind and solar). This paper summarizes the analytic frameworks that have emerged to measure this characteristic and distills key principles of flexibility for policy makers.

  1. Interpretive Flexibility in Mobile Health:

    DEFF Research Database (Denmark)

    Agger Nielsen, Jeppe; Mathiassen, Lars

    2013-01-01

    a growing body of evidence supports the use of mobile technologies, the diverse implications of mobile health have yet to be fully documented. Objective: Our objective was to examine a large-scale government-sponsored mobile health implementation program in the Danish home care sector and to understand how...... stakeholders in the Danish home care sector (government bodies, vendors, consultants, interest organizations, and managers) helped initiate and energize the change process, and government funding supported quick and widespread technology adoption. However, although supported by the same government-sponsored...... of debate as technology use arrangements ran counter to existing norms and values in individual agencies. Conclusions: Government-sponsored programs can have both positive and negative results, and managers need to be aware of this and the interpretive flexibility of mobile technology. Mobile technology...

  2. Flexible polymer waveguide tunable lasers.

    Science.gov (United States)

    Kim, Kyung-Jo; Kim, Jun-Whee; Oh, Min-Cheol; Noh, Young-Ouk; Lee, Hyung-Jong

    2010-04-12

    A flexible polymeric Bragg reflector is fabricated for the purpose of demonstrating widely tunable lasers with a compact simple structure. The external feedback of the Bragg reflected light into a superluminescent laser diode produces the lasing of a certain resonance wavelength. The highly elastic polymer device enables the direct tuning of the Bragg wavelength by controlling the imposed strain and provides a much wider tuning range than silica fiber Bragg gratings or thermo-optic tuned polymer devices. Both compressive and tensile strains are applied within the range from -36000 microepsilon to 35000 microepsilon, so as to accomplish the continuous tuning of the Bragg reflection wavelength over a range of up to 100 nm. The external feedback laser with the tunable Bragg reflector exhibits a repetitive wavelength tuning range of 80 nm with a side mode suppression ratio of 35 dB.

  3. Mundari as a flexible language

    DEFF Research Database (Denmark)

    Hengeveld, Kees; Rijkhoff, Jan

    2005-01-01

    In this paper we intend to show that Mundari is one of the languages without distinct classes of verbs and nouns as far as its basic, non-derived vocabulary is concerned. Our contribution is organized as follows. Section 2 briefly presents a typology of parts-of-speech (PoS) systems, followed...... and verbs), thus disputing E&O’s claim that Mundari has clearly definable classes of verbs and nouns. The last section is concerned with a set of grammatical features which correlate with the presence of flexible lexemes in a language. It is concluded that Mundari displays all of the predicted features...... of a language that does not clearly distinguish between separate classes of nouns and verbs....

  4. Alignment of flexible protein structures.

    Science.gov (United States)

    Shatsky, M; Fligelman, Z Y; Nussinov, R; Wolfson, H J

    2000-01-01

    We present two algorithms which align flexible protein structures. Both apply efficient structural pattern detection and graph theoretic techniques. The FlexProt algorithm simultaneously detects the hinge regions and aligns the rigid subparts of the molecules. It does it by efficiently detecting maximal congruent rigid fragments in both molecules and calculating their optimal arrangement which does not violate the protein sequence order. The FlexMol algorithm is sequence order independent, yet requires as input the hypothesized hinge positions. Due its sequence order independence it can also be applied to protein-protein interface matching and drug molecule alignment. It aligns the rigid parts of the molecule using the Geometric Hashing method and calculates optimal connectivity among these parts by graph-theoretic techniques. Both algorithms are highly efficient even compared with rigid structure alignment algorithms. Typical running times on a standard desktop PC (400 MHz) are about 7 seconds for FlexProt and about 1 minute for FlexMol.

  5. Adhesion Transition of Flexible Filaments

    Science.gov (United States)

    Evans, Arthur; Lauga, Eric

    2009-03-01

    As forays into fabrication and self-assembly venture to increasingly small length scales, the role of adhesion events between material elements of the system must be closely scrutinized. This area of study is typically dominated by investigations into capillary adhesion, but relatively recent interest in carbon nanotubes and biomimetic devices have spurred interest in intermolecular forces as another source of micro- and nano-scale adhesion. We present here a far-field model for ``dry'' adhesion. We consider a small number N of flexible beams interacting with each other via a typical Lennard-Jones 6-12 potential, and describe the behavior of the system as the ratio of bending rigidity to beam-beam attraction is reduced. Applications ranging from fibrillar systems to the comparatively stiff carbon nanotubes are discussed.

  6. Lifelong Open and Flexible Learning

    DEFF Research Database (Denmark)

    Bang, Jørgen

    2006-01-01

    and Flexible (LOF) learning embracing characteristics as: open learning, distance learning, e-learning, online learning, open accessibility, multimedia support, virtual mobility, learning communities, dual mode (earn & learn) approaches, and the like.In my presentation I will focus on the EADTU strategies......EADTU members are universities that are dedicated to off-campus target groups using distance teaching methods as well as associations consisting of universities with mainly mainstream on-campus students but also offering education for off-campus students. Consequently our focus is on Lifelong Open...... for creating a synergy network in e-learning – eventually leading to a European Learning Space that supports virtual mobility of students, staff and courses, adds an e-dimension to the Bologa process and facilitates collaboration between universities and the corporate sector....

  7. Genetic flexibility of regulatory networks.

    Science.gov (United States)

    Hunziker, Alexander; Tuboly, Csaba; Horváth, Péter; Krishna, Sandeep; Semsey, Szabolcs

    2010-07-20

    Gene regulatory networks are based on simple building blocks such as promoters, transcription factors (TFs) and their binding sites on DNA. But how diverse are the functions that can be obtained by different arrangements of promoters and TF binding sites? In this work we constructed synthetic regulatory regions using promoter elements and binding sites of two noninteracting TFs, each sensing a single environmental input signal. We show that simply by combining these three kinds of elements, we can obtain 11 of the 16 Boolean logic gates that integrate two environmental signals in vivo. Further, we demonstrate how combination of logic gates can result in new logic functions. Our results suggest that simple elements of transcription regulation form a highly flexible toolbox that can generate diverse functions under natural selection.

  8. Interpretive Flexibility in Mobile Health:

    DEFF Research Database (Denmark)

    Agger Nielsen, Jeppe; Mathiassen, Lars

    2013-01-01

    Background: Mobile technologies have emerged as important tools that health care personnel can use to gain easy access to client data anywhere. This is particularly useful for nurses and care workers in home health care as they provide services to clients in many different settings. Although...... a growing body of evidence supports the use of mobile technologies, the diverse implications of mobile health have yet to be fully documented. Objective: Our objective was to examine a large-scale government-sponsored mobile health implementation program in the Danish home care sector and to understand how......-sponsored program, mobile technology proved to have considerable interpretive flexibility with variation in perceived nature of technology, technology strategy, and technology use between agencies. What was first seen as a very promising innovation across the Danish home care sector subsequently became the topic...

  9. High Performance Electronics on Flexible Silicon

    KAUST Repository

    Sevilla, Galo T.

    2016-09-01

    Over the last few years, flexible electronic systems have gained increased attention from researchers around the world because of their potential to create new applications such as flexible displays, flexible energy harvesters, artificial skin, and health monitoring systems that cannot be integrated with conventional wafer based complementary metal oxide semiconductor processes. Most of the current efforts to create flexible high performance devices are based on the use of organic semiconductors. However, inherent material\\'s limitations make them unsuitable for big data processing and high speed communications. The objective of my doctoral dissertation is to develop integration processes that allow the transformation of rigid high performance electronics into flexible ones while maintaining their performance and cost. In this work, two different techniques to transform inorganic complementary metal-oxide-semiconductor electronics into flexible ones have been developed using industry compatible processes. Furthermore, these techniques were used to realize flexible discrete devices and circuits which include metal-oxide-semiconductor field-effect-transistors, the first demonstration of flexible Fin-field-effect-transistors, and metal-oxide-semiconductors-based circuits. Finally, this thesis presents a new technique to package, integrate, and interconnect flexible high performance electronics using low cost additive manufacturing techniques such as 3D printing and inkjet printing. This thesis contains in depth studies on electrical, mechanical, and thermal properties of the fabricated devices.

  10. Business Models for Power System Flexibility

    DEFF Research Database (Denmark)

    Boscan, Luis; Poudineh, Rahmatallah

    2016-01-01

    -enabling business models, adding new activities to the existing supply chain. Ranging from technological to market-based innovation, this chapter reviews the latest developments in these emerging models. The main conclusion is that when flexibility becomes scarce in the system, new players with their innovative......As intermittent, renewable resources gain more share in the generation mix, the need for power system flexibility increases more than ever. Parallel to this, technological change and the emergence of new players bringing about innovative solutions are boosting the development of flexibility...... business models will play an important role in ensuring sufficiency and efficiency of flexibility services....

  11. Material challenge for flexible organic devices

    Directory of Open Access Journals (Sweden)

    Jay Lewis

    2006-04-01

    Full Text Available Outside of the active device layers, there are a variety of requisite functional layers in flexible organic electronic devices. Whether the application is in displays, lighting, integrated circuits, or photovoltaics, there are materials challenges in implementing flexible and/or organic devices into practical applications. We highlight two topics that are common to most flexible electronic technologies. First, we describe the difficulty in developing suitable permeation barriers on polymer substrates, the approaches being taken to solve this problem, and their current status. Second, we highlight the limited mechanical ruggedness of brittle inorganic films and present approaches for improving overall device flexibility.

  12. Technology modernization assessment flexible automation

    Energy Technology Data Exchange (ETDEWEB)

    Bennett, D.W.; Boyd, D.R.; Hansen, N.H.; Hansen, M.A.; Yount, J.A.

    1990-12-01

    The objectives of this report are: to present technology assessment guidelines to be considered in conjunction with defense regulations before an automation project is developed to give examples showing how assessment guidelines may be applied to a current project to present several potential areas where automation might be applied successfully in the depot system. Depots perform primarily repair and remanufacturing operations, with limited small batch manufacturing runs. While certain activities (such as Management Information Systems and warehousing) are directly applicable to either environment, the majority of applications will require combining existing and emerging technologies in different ways, with the special needs of depot remanufacturing environment. Industry generally enjoys the ability to make revisions to its product lines seasonally, followed by batch runs of thousands or more. Depot batch runs are in the tens, at best the hundreds, of parts with a potential for large variation in product mix; reconfiguration may be required on a week-to-week basis. This need for a higher degree of flexibility suggests a higher level of operator interaction, and, in turn, control systems that go beyond the state of the art for less flexible automation and industry in general. This report investigates the benefits and barriers to automation and concludes that, while significant benefits do exist for automation, depots must be prepared to carefully investigate the technical feasibility of each opportunity and the life-cycle costs associated with implementation. Implementation is suggested in two ways: (1) develop an implementation plan for automation technologies based on results of small demonstration automation projects; (2) use phased implementation for both these and later stage automation projects to allow major technical and administrative risk issues to be addressed. 10 refs., 2 figs., 2 tabs. (JF)

  13. THE FLEXIBILITY-AUTOMATION CORRESPONDENCE TO A VIRTUAL COMMERCIAL SOCIETY

    Directory of Open Access Journals (Sweden)

    Liliana Doble

    2012-01-01

    Full Text Available Design and operation of FMS is based on system requirement can be as productive and flexible as necessary, i.e. obtaining controlled correspondence between the degree of flexibility and automation of system.The flexibility of a FMS (Flexible Manufacturing Systems is determined by two important criteria: Flexible hardware structure of the system; Flexible software structure. Flexible hardware structure of the CS system (calculation system is determined to its turn according to three components: Flexibility of technological subsystem; Flexibility subsystem of storage, transport and handling;Flexibility of informational subsystem.

  14. The impact of enterprise systems on process flexibility and organisational flexibility

    Science.gov (United States)

    Qu, Wen Guang; Ding, Yajing; Shou, Yongyi; Zhou, Honggeng; Du, Hong

    2014-09-01

    In light of the current dynamic business environment, companies nowadays need to respond rapidly to changes. Companies often invest heavily in enterprise systems in the hope that these can improve their flexibility in coping with such changes. However, previous studies have shown that the impact of enterprise systems on flexibility can be either positive or negative. To resolve this inconsistency in the existing research, this paper suggests that a company's flexibility should be distinguished between process level and organisational level. Specifically, this paper proposes that enterprise systems will affect process flexibility negatively but affect organisational flexibility positively. The analysis results show that enterprise systems have different effects on process and organisational flexibility. Furthermore, industry clockspeed sets a boundary for the effect on process flexibility but not for that on organisational flexibility. Research and practical implications of this study are discussed.

  15. Dynamic Model of a Rotating Flexible Arm-Flexible Root Mechanism Driven by a Shaft Flexible in Torsion

    Directory of Open Access Journals (Sweden)

    S.Z. Ismail

    2006-01-01

    Full Text Available This paper presents a dynamic model of a rotating flexible beam carrying a payload at its tip. The model accounts for the driving shaft and the arm root flexibilities. The finite element method and the Lagrangian dynamics are used in deriving the equations of motion with the small deformation theory assumptions and the Euler-Bernoulli beam theory. The obtained model is a nonlinear-coupled system of differential equations. The model is simulated for different combinations of shaft and root flexibilities and arm properties. The simulation results showed that the root flexibility is an important factor that should be considered in association with the arm and shaft flexibilities, as its dynamics influence the motor motion. Moreover, the effect of system non-linearity on the dynamic behavior is investigated by simulating the equivalent linearized system and it was found to be an important factor that should be considered, particularly when designing a control strategy for practical implementation.

  16. Combining Flexible Ureteroscopy and Rigid Ureteroscopy for Trausurethral Seminal Vesiculoscopy in the Diagnosis and Treatment of Persistent Hemospermia%联合软性和硬性输尿管镜行精囊镜检在顽固性血精诊疗中的应用

    Institute of Scientific and Technical Information of China (English)

    孟军; 张志宏; 王义; 贺利军; 那彦群

    2015-01-01

    目的:探讨联合应用软性和硬性输尿管镜行精囊镜检查在顽固性血精诊疗中的应用。方法回顾性分析该中心2012年6月-2014年12月间收治的23例顽固性血精患者的临床资料,完善相关检查后,联合应用奥林巴斯半硬性输尿管镜(F8/9.8 Olympus )及软性输尿管镜(F5.3/8.4 Olympus URF-P5)行经前列腺小囊的精囊镜手术治疗。结果23例患者均顺利完成手术,手术时间21~65 min,平均时间(35.1±8.2)min。单纯性精囊炎症7例(30.4%),精囊炎合并前列腺小囊结石5例(21.7%),合并精囊结石6例(26.1%),合并前列腺小囊开口狭窄2例(8.7%),合并射精管瘢痕狭窄2例(8.7%),合并射精管囊肿1例(4.3%),均给予相应处理。术后随访6月,1例复发抗炎对症治疗后消失。结论联合应用软性和硬性输尿管镜行精囊镜检查能直视下观察到精囊腔内的情况,有助于明确顽固性血精的病因并进行相关治疗,充分利用了现有设备和成熟的输尿管镜技术,是可行的诊断和治疗顽固性血精的方法。%Objective To evaluate the role of trans-utricular seminal vesiculoscopy using flexible combined with rigid ureteroscope in the diagnosis and treatment of persistent hemospermia. Methods A retrospective analysis was conducted on the clinical data of 23 cases with persistent hematospermia admitted in Peking University Wu Jieping Urology Center from June 2012 to December 2014. After related examinations, trans-utricular seminal vesiculoscopy was performed in all patients by using a F8/9.8 semi-rigid ureteroscope ( Olympus ) combined with a F5 . 3/8 . 4 flexible ureteroscope ( Olympus URF-P5 ) . Results All the 23 patients accomplished the surgery successfully with the average operative duration of (35.1±8.2)minutes (ranged from 21 to 65minutes). Among them, simple seminal vesiculitis was in 7 cases (30.4%), seminal vesiculitis combined with prostatic utricle

  17. Studies of a flexible heliac configuration

    Energy Technology Data Exchange (ETDEWEB)

    Hender, T.C.; Cantrell, J.L.; Harris, J.H.; Carreras, B.A.; Lynch, V.E.; Lyon, J.F.; Fabregas, J.A.; Guasp, J.; Lopez-Fraguas, A.; Navarro, A.P.

    1987-07-01

    This paper documents a detailed study of the Flexible Heliac configuration. The remarkable flexibility of this device - which allows variation of the rotational transform, shear, and magnetic well depth over a relatively wide range - is described. Engineering considerations of error fields, finite cross-section conductors, and plasma coil clearances are also discussed.

  18. Flexible benefit plans in Dutch organisations

    NARCIS (Netherlands)

    Hillebrink, C.

    2006-01-01

    Flexible benefit plans give employees a greater say over the composition of their benefits than traditional Dutch benefit plans. These arrangements developed in a time of further individualisation, increasing flexibility in the workplace, and a tight labour market in the Netherlands. By giving

  19. Semiconductor films on flexible iridium substrates

    Science.gov (United States)

    Goyal, Amit

    2005-03-29

    A laminate semiconductor article includes a flexible substrate, an optional biaxially textured oxide buffer system on the flexible substrate, a biaxially textured Ir-based buffer layer on the substrate or the buffer system, and an epitaxial layer of a semiconductor. Ir can serve as a substrate with an epitaxial layer of a semiconductor thereon.

  20. Designing Flexible Software for the "Electronic Board."

    Science.gov (United States)

    Hativa, Nira

    1984-01-01

    Argues that software for electronic boards should address a variety of teaching styles, student abilities and ages, class textbooks, teaching objectives, and learning environments for flexibility of use. The software features that contribute to flexibility include frequent stops, options for going backwards, inter- and intra-unit jumps, and…