The association of stone opacity in plain radiography with percutaneous nephrolithotomy outcomes and complications

Purpose: To investigate the influence of stone opacity in plain radiography on stone free rate and complications of percutaneous nephrolithotomy (PCNL). Materials and Methods: A number of 101 patients who underwent PCNL between July-September 2015 were prospectively included. Stone opacity was judged on preoperative plain Kidney-Ureter-Bladder X-ray. Stone free rate was evaluated two weeks after the operation by ultrasonography and KUB. Results: There were 61 patients with opaque stones and 40 patients with non-opaque stones. The age, body mass index, preoperative creatinine, history of stone surgery, and stone size was not statistically different between patients with opaque and non-opaque stones. Neither operation duration nor access numbers were statistically significant between opaque and non-opaque stones. The frequency of stone free patients in opaque stones and nonopaque stones were 55/61 (90) and 30/40 (75) respectively (P = .04) The magnitude of hemoglobin drop in opaque stones and non-opaque stones were 1.9 ± 1.2 mg/dL versus 2.9 ± 1.7 mg/dL (P = .005). Conclusion: The stone free rate is lower and the magnitude of bleeding is higher in PCNL of non-opaque stones when compared to opaque stones if rigid instruments are used for nephroscopy

Management of ureteropelvic junction obstruction in horseshoe kidneys by an assortment of laparoscopic options

Introduction: We report our experience with laparoscopic management of ureteropelvic junction obstruction in horseshoe kidneys. Methods: Between February 2004 and March 2014, 15 patients with horseshoe kidneys and symptomatic ureteropelvic junction obstruction underwent laparoscopic management at our national referral centre. Depending on the anatomy and presence of obtrusive vessels or isthmus, we performed either dismembered, Scardino or Foley YV pyeloplasty, or Hellstrom vessel transposition. Patients were initially evaluated by ultrasonography, then diuretic scintiscan at 4 to 6 months, and followed by yearly clinical and sonographic exams. Results: This study included 11 male and 4 female patients between the ages of 4 to 51 year (average 17.7). The left kidney was involved in 12 patients (80). Operation time was 129 minutes (range: 90-186), and patients were discharged within 2.8 days (range: 1-6). Although 8 (53.3) patients had crossing vessels, of which 6 required transposing, the Hellstrom technique was solely used in 3 cases, of which notably 1 case failed to resolve and required laparoscopic Hynes within the next year. Eight cases underwent dismembered pyeloplasty, 2 Foley YV, 1 Scardino flap and 1 required isthmectomy and vessel suspension. At the mean follow-up of 60 (range: 18-120) months, the overall success rate was 93.3. Conclusions: To our knowledge, this represents the largest report on laparoscopic pyeloplasty for horseshoe kidneys, providing the longest follow-up. Our findings confirm prior reports supporting laparoscopy and furthermore show that despite the prevalence of crossing vessels, transposition alone is seldom sufficient. © 2015 Canadian Urological Association

Comparative study on some biochemical characteristics of surimi from common carp and silver carp and proteins recovered using an acid-alkaline process

Some biochemical characteristics of common carp (Cyprinus carpio) and silver carp (Hypophthalmichthys molitrix) surimi prepared by a conventional washing method and protein isolated using alkaline-acid-aided processes were investigated. Solubility of protein in silver carp and common carp were found to be highest by using the conventional washing method. Decreases in myoglobin and lipid contents in both fish were found in the alkaline- or acid-aided process when compared to the conventional process (p0.05). In protein patterns of Sodium dodecyl sulphate-polyacrylamide gel electrophoresis (SDS-PAGE), the lowest intensity of the myosin heavy chains (MHC) band was found in silver carp by the conventional washing process

Feasibility of implementing public-private partnership (PPP) in the development of hospital services and optimizing resource allocation in Iran

Background: In recent decades, many countries have utilized public-private partnership (PPP) as a development initiative to reform their healthcare sectors. The present study examines the feasibility of implementing public-private partnerships for development of hospital services in Shiraz, Iran. Methods: This was a descriptive study of questionnaires carried out on one of Iran's major southern cities (Shiraz) in 2016. Research population comprised of the hospitals affiliated to the Shiraz University of Medical Sciences (SUMS), private hospitals, charities, and healthcare investors. A total of 56 participants were chosen by convenience sampling. Data were collected using a researcher-made questionnaire. The questions' range were defined from 1 to 5. Data analysis was performed in SPSS21 using the Mann-Whitney test, T test, and Chi square test at 0.05 significance level. Results: The participants from the public sector had a significantly higher level of acquaintance with the concept of PPP and significantly more inclination to participate in such projects (P < 0.05). The mean values of the determinants of successful implementation of PPPs for hospital services were presented from the public and private participants' viewpoints as follows: public sector rated the capacity-creating (2.60 ± 0.39) and the social-cultural (2.58 ± 0.40) component as having a better condition than other determinants however, the private sector rated the financial-capital (2.64 ± 0.46) as the best. Analysis of the mean scores of determinants of implementation of PPP from the viewpoint of public and private sectors showed a significant difference in their views in terms of financial-capital and social-cultural dimensions (P < 0.05). Conclusions: According to the participants, the requirements for implementation of public-private partnerships for hospital services are not properly met. For any progress to be made in this regard, Iranian authorities and policymakers should devise a new platform for attracting private participation and improving hospitals' readiness to engage in PPP projects. © 2020 The Author(s)

Delayed versus same-day percutaneous nephrolithotomy in patients with aspirated cloudy urine.

INTRODUCTION: We present our experience in continuing percutaneous nephrolithotomy (PCNL) versus delayed PCNL when purulent fluid is aspirated during access to the pyelocaliceal system. MATERIALS AND METHODS: This randomized controlled study was carried out on patients who had purulent urine in the pyelocaliceal system at the initial puncturing during PCNL. Patients with recent untreated urinary tract infection, thick or foul pus in aspirated urine, fever, and immunocompromised condition were excluded. Thirty-one patients were randomly divided into 2 groups. In group 1, PCNL was continued, but in group 2, nephrostomy tube was placed and PCNL was performed 10 days later after documented sterile nephrostomy urine. The preoperative and postoperative findings were compared. RESULTS: There were 16 and 15 patients in groups 1 and 2, respectively. All patients had negative urine cultures for microorganisms, preoperatively. The purulent aspirated fluid was infected in 43.8 and 40.0 of the patients in groups 1 and 2, respectively. Postoperative fever was seen in 25.0 and 26.7 of the patients, respectively. No statistical differences were observed between the two groups in terms of bacteriuria, bacteremia, positive calculus cultures, or stone-free rates, and duration of hospitalization between groups 1 and 2, respectively. More analysis with linear regression model showed that postoperative positive blood culture (P < .001), fever (P = .001), and postoperative positive urine culture (P = .02) correlated with duration of hospitalization. CONCLUSION: In the absence of untreated recent UTI and aspiration of thick or foul pus, continuing PCNL can be safe while purulent urine is encountered

Comparison of qualitative characteristics of fish paste produced from minced kilka (Clupeonella cultriventris) and silver carp (Hypophthalmichthys molitrix)

The aim of this study was to determine the qualitative characteristics of ready-made fish paste made from minced meat (Clupeonella cultriventris) and silver carp (Hypophthalmichthys molitrix) and its shelf-life at a refrigerated temperature.This compilation was performed in five treatments including amounts 100, 75, 50 and 25 percent of processed fish meat were cured. The treatments were packed in heat-resistant glass after pasteurization. Samples were stored at 4oC for 40 days.The amount of TVB-N in the experimental treatments during the course of the change was increased that this factor varied between15.25-31.25 mg/100 g of meat in experimental treatments. This factor was in the 100% rolled silver carp treatment until the end of the shelf life in the standard range. The amount of tybarbibacteric acid increased during storage period varied between 0.13- 2.11mg malondialdehyde/1000g in experimental treatments, but this factor was in the 100% treatment of silver carp paste after the end of the maintenance period in the standard range (less than 1.8 mg/100gr), in other treatments, after 30 days, was more than standard limitation. The pH changes in treatments did not significantly decrease (P>0.05), this factor varied between 5.05 to 5.93 in the experimental period. Total bacterial counts, psychrophilic bacteria and coliform and molds were not observed in experimental treatments during storage period. Microbial contamination was not observed during the storage period in the refrigerator in the experimental treatments. The taste and texture in silver carp treatment (100%) were better than other treatments. The ash, protein and fat in 5 treatments did not significantly change during storage (p>0.05). The moisture content was not significantly increased in all five treatments during storage (p>0.05). Results showed treatment of processed carp (100%) was better than other treatments (p<0.05)

Comparing the Efficacy of Tolterodine and Gabapentin Versus Placebo in Catheter Related Bladder Discomfort after Percutaneous Nephrolithotomy: A Randomized Clinical Trial

Purpose: The purpose of this study was to compare the efficacy of tolterodine and gabapentin vs placebo in catheter related bladder discomfort (CRBD) following percutaneous nephrolithotomy (PCNL). Materials and Methods: This study was a double-blind parallel group randomized clinical trial. Patients who were candidates of PCNL were enrolled. Patients were randomized to treatment groups of tolterodine 2 mg orally (PO) (group T, n = 50), gabapentin 600 mg PO (group G, n = 50), and placebo (group P, n = 70) 1 hour before operation using balanced block randomization. The primary endpoint of interest was visual analog pain scale in 1, 3, 12, and 24 hours after the operation. Secondary endpoints included rescue analgesic use (opioid and nonopioid). Results: The frequency of severe CRBD in 1,12, and 24 hours after the operation was 4, 4, and 6 in group T vs 4, 0, and 2 in group G vs 47, 14, and 6 in the P group (p < 0.001). The number of paracetamol injections for CRBD in the T and G groups was significantly lower than the placebo group (1.8 ± 0.8 vs 1.8 ± 0.7 vs 3.6 ± 0.7, p < 0.001). Likewise the number of pethidine injections in the T and G groups was significantly lower than the placebo group (0.42 ± 0.54 vs 0.68 ± 0.62 vs 2.4 ± 0.64, p < 0.001). In patients with history of Double-J insertion, the severity of CRBD was lower in all treatment groups. Conclusions: Preoperative administration of oral tolterodine or gabapentin reduces postoperative CRBD and the need for rescue analgesics as much as 24 hours after surgery. Patients with history of Double-J insertion experience less CRBD. © Copyright 2018, Mary Ann Liebert, Inc

Comparing the Efficacy of Tolterodine and Gabapentin Versus Placebo in Catheter Related Bladder Discomfort after Percutaneous Nephrolithotomy: A Randomized Clinical Trial

Purpose: The purpose of this study was to compare the efficacy of tolterodine and gabapentin vs placebo in catheter related bladder discomfort (CRBD) following percutaneous nephrolithotomy (PCNL). Materials and Methods: This study was a double-blind parallel group randomized clinical trial. Patients who were candidates of PCNL were enrolled. Patients were randomized to treatment groups of tolterodine 2 mg orally (PO) (group T, n = 50), gabapentin 600 mg PO (group G, n = 50), and placebo (group P, n = 70) 1 hour before operation using balanced block randomization. The primary endpoint of interest was visual analog pain scale in 1, 3, 12, and 24 hours after the operation. Secondary endpoints included rescue analgesic use (opioid and nonopioid). Results: The frequency of severe CRBD in 1,12, and 24 hours after the operation was 4, 4, and 6 in group T vs 4, 0, and 2 in group G vs 47, 14, and 6 in the P group (p < 0.001). The number of paracetamol injections for CRBD in the T and G groups was significantly lower than the placebo group (1.8 ± 0.8 vs 1.8 ± 0.7 vs 3.6 ± 0.7, p < 0.001). Likewise the number of pethidine injections in the T and G groups was significantly lower than the placebo group (0.42 ± 0.54 vs 0.68 ± 0.62 vs 2.4 ± 0.64, p < 0.001). In patients with history of Double-J insertion, the severity of CRBD was lower in all treatment groups. Conclusions: Preoperative administration of oral tolterodine or gabapentin reduces postoperative CRBD and the need for rescue analgesics as much as 24 hours after surgery. Patients with history of Double-J insertion experience less CRBD. © Copyright 2018, Mary Ann Liebert, Inc