Urinary lithiasis and extracorporeal shock wave lithotripsy: new approachments

While ESWL is generally considered safe and effective, new methods are being created as result of continuous lithotripsy research to enhance the procedure's results. The aim is to conduct a complete and structured analysis of the most current extracorporeal lithotripsy systems in the management of kidney stones, and collect and evaluate the complications associated with using conventional ones.Medicin

An examination of the modifiable technical factors of ESWL on effective and efficient urinary stone fragmentation

There are pressures from the medical community to reduce total shock numbers during extracorporeal shockwave lithotripsy (ESWL) to reduce renal damage. This in vitro study looked at the modifiable factors of the technique to increase the effectiveness and efficiency. This is important as faster, more efficient, stone elimination would reduce symptom duration and limit the adverse effects of an acute episode of renal colic. Furthermore this would reduce the likelihood of incomplete fragmentation of the stones leading to readmission. An in vitro model for the kidney was designed. This enabled the systematic scientific study of fragmentation and its relationship with the parameters studied: shock rate, shock power1, power ramping2, and coupling gel consistency to discover which technical factor settings allow the most effective and efficient urolith fragmentation. Mathematical models, theories and hypotheses pertaining to these phenomena were employed. Each effect was tested individually by setting up the model kidney and using the ESWL machine to fragment a mock kidney stone. The results of 534 completed tests showed that shock rate had less impact on stone fragmentation than power in this model. The rate experiments showed no statistical difference between the rates tested; however our observational evidence showed that stone fragments after ESWL to be smaller and more dust-like at the lower rates (60 and 70 shockwaves per minute (SW/min)) than the larger more sand-like particles when the testing was completed at faster rates (90 and 100 SW/min). This may be of clinical significance. While examining power, the most effective and efficient power was 80%, however again the clinical significance of using higher powers may outweigh the time savings. The requirement of a gas free coupling cannot be stressed enough as the tests conducted without gas in the coupling medium required both fewer shocks and lower powers (p<0.001). In conclusion, the results showed that diligent care during the ESWL procedure to choose the most effective and efficient shock rate and power, and the conscientious removal of gas from the coupling medium before treatment, improved the results of stone fragmentation

Patterns of injury and violence in Yaoundé Cameroon: an analysis of hospital data.

BackgroundInjuries are quickly becoming a leading cause of death globally, disproportionately affecting sub-Saharan Africa, where reports on the epidemiology of injuries are extremely limited. Reports on the patterns and frequency of injuries are available from Cameroon are also scarce. This study explores the patterns of trauma seen at the emergency ward of the busiest trauma center in Cameroon's capital city.Materials and methodsAdministrative records from January 1, 2007, through December 31, 2007, were retrospectively reviewed; information on age, gender, mechanism of injury, and outcome was abstracted for all trauma patients presenting to the emergency ward. Univariate analysis was performed to assess patterns of injuries in terms of mechanism, date, age, and gender. Bivariate analysis was used to explore potential relationships between demographic variables and mechanism of injury.ResultsA total of 6,234 injured people were seen at the Central Hospital of Yaoundé's emergency ward during the year 2007. Males comprised 71% of those injured, and the mean age of injured patients was 29 years (SD = 14.9). Nearly 60% of the injuries were due to road traffic accidents, 46% of which involved a pedestrian. Intentional injuries were the second most common mechanism of injury (22.5%), 55% of which involved unarmed assault. Patients injured in falls were more likely to be admitted to the hospital (p &lt; 0.001), whereas patients suffering intentional injuries and bites were less likely to be hospitalized (p &lt; 0.001). Males were significantly more likely to be admitted than females (p &lt; 0.001)DiscussionPatterns in terms of age, gender, and mechanism of injury are similar to reports from other countries from the same geographic region, but the magnitude of cases reported is high for a single institution in an African city the size of Yaoundé. As the burden of disease is predicted to increase dramatically in sub-Saharan Africa, immediate efforts in prevention and treatment in Cameroon are strongly warranted

Medical Robotics

The first generation of surgical robots are already being installed in a number of operating rooms around the world. Robotics is being introduced to medicine because it allows for unprecedented control and precision of surgical instruments in minimally invasive procedures. So far, robots have been used to position an endoscope, perform gallbladder surgery and correct gastroesophogeal reflux and heartburn. The ultimate goal of the robotic surgery field is to design a robot that can be used to perform closed-chest, beating-heart surgery. The use of robotics in surgery will expand over the next decades without any doubt. Minimally Invasive Surgery (MIS) is a revolutionary approach in surgery. In MIS, the operation is performed with instruments and viewing equipment inserted into the body through small incisions created by the surgeon, in contrast to open surgery with large incisions. This minimizes surgical trauma and damage to healthy tissue, resulting in shorter patient recovery time. The aim of this book is to provide an overview of the state-of-art, to present new ideas, original results and practical experiences in this expanding area. Nevertheless, many chapters in the book concern advanced research on this growing area. The book provides critical analysis of clinical trials, assessment of the benefits and risks of the application of these technologies. This book is certainly a small sample of the research activity on Medical Robotics going on around the globe as you read it, but it surely covers a good deal of what has been done in the field recently, and as such it works as a valuable source for researchers interested in the involved subjects, whether they are currently “medical roboticists” or not

Down Syndrome

Down syndrome, the most cutting-edge book in the field congenital disorders. This book features up-to-date, well referenced research and review articles on Down syndrome. Research workers, scientists, medical graduates and pediatricians will find it to be an excellent source for references and review. It is hoped that such individuals will view this book as a resource that can be consulted during all stages of their research and clinical investigations. Key features of this book are: Common diseases in Down syndrome Molecular Genetics Neurological Disorders Prenatal Diagnosis and Genetic Counselling Whilst aimed primarily at research workers on Down syndrome, we hope that the appeal of this book will extend beyond the narrow confines of academic interest and be of interest to a wider audience, especially parents, relatives and health-care providers who work with infants and children with Down syndrome