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

The comparison between two methods of basic life support instruction: Video self-instruction versus traditional method

Introduction: Medical education is changing and evolving. Teachers need to re-evaluate their medical teaching practice to enhance student learning. The data about the ideal training method of Basic Life Support (BLS) is lacking. The goal of this study was to analyse the use and performance of video self-instruction (VSI) method in BLS, in order to develop an efficient BLS training method. Methods: Eighty-one undergraduate medical interns were enrolled in a prospective clinical study in 2011. They were divided into VSI group and traditional group. We provided the first group with a DVD containing a 20-minute training video while the second group took part in a 4-hour training class of BLS. Subjects participated in a pre-test and post-test based on 2010 American Heart Association Resuscitation guideline. Results: The average scores of VSI group and the traditional group before training were 8.85±2.42 and 8.57±2.22 respectively (p=0.592). After training, the average scores of the VSI and the traditional group were 20.24±0.83 and 18.05±1.86 respectively. VSI group achieved slightly better scores compared with the traditional group (p<0.001). Conclusions: Training through VSI achieves more satisfying results than the traditional lecture method. VSI method can be considered a useful technique in undergraduate educational programs. Developing VSI can increase significantly the access to the BLS training. © 2015, Medcom Limited. All rights reserved

The relationship between the findings of transvaginal dynamic sonography with patient�s signs and symptoms after mid-urethral sling surgery using TVT tape

Introduction: Stress urinary incontinence is a major problem affecting economic - social aspects and private lives of many women. Different surgical techniques such as TVT are used to treat the problem. This study was performed with aim to investigate the relationship between the findings of transvaginal dynamic sonography with patient�s signs and symptoms after Mid-urethral sling surgery using TVT tape. Methods: In this study, all women aged between 17 to 88 years who underwent TVT surgery for treatment of urinary incontinence at Tehran Hasheminejad Hospital during the past 2 years (2011-2013) and at least three months had passed of their surgery were entered to the study. A questionnaire for evaluation of age, body mass index, parity, irritative and obstructive symptoms was completed by the urologist. Then, a radiologists performed transvaginal ultrasound for the patients to determine the distance of tape from the urethra and bladder neck. Data was analyzed using SPSS statistical software (version 16) and non-parametric tests. PResults: Among 190 patients, 22 cases (10) had irritative symptoms, 14 (?) obstructive symptoms, and 17 (8.9) with symptoms of incontinence urgency. The sonography showed that mean distance of tape (c shape) from urethra was 3 ± 0.3 mm and mean distance of tape (c shape) from bladder neck was 11.3 ± 0.3 mm; there was no significant relationship between the prevalence of irritative symptoms and variables (P=0.14). Conclusion: There is no significant relationship between the findings of dynamic trans-vaginal ultrasound with patient�s signs and symptoms after Mid-urethral sling surgery using TVT tape to treat urinary incontinence in women. © 2015, Mashhad University of Medical Sciences. All rights reserved

Co-eruptive, endogenous edifice growth, uplift during 4 years of eruption at Sangay Volcano, Ecuador

We report sustained uplift throughout Volcan Sangay's most recent period of eruption (2019–22), moderated only by transient excursions during some of its largest explosions. Volcan Sangay (Amazonia, Ecuador), has been erupting since 2019, impacting both local communities and distant cities with ash fall and lahars. We analyzed ascending and descending Sentinel-1 radar imagery, constructing a robust network of interferograms spanning this eruptive period to measure relative ground displacements across the volcano. Our time series reveals a consistent uplift pattern (∼68 mm/yr) on the western and northern flanks of the volcano, which we attribute to volume increases in a body of magma located within the volcano's edifice beneath its western flank. This source appears to be vertically extensive, and is best fit by a quadrangular magma pathway, dipping towards the west and increasing in volume by 1.1 × 10⁶ m³ between 2019 and 2022. We additionally identify non-magmatic deformation, including subsidence of fresh deposits and downslope displacement (∼50 mm/year) in the southeastern sector of the volcano. Co-eruptive uplift at Sangay is a rare observation of endogenous growth during an eruption and indicates that stratovolcano edifice stability is sensitive to both magma flux into the edifice and shallow controls on eruption rate

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

Milk and dairy products: good or bad for human health? An assessment of the totality of scientific evidence

Background: There is scepticism about health effects of dairy products in the public, which is reflected in an increasing intake of plant-based drinks, for example, from soy, rice, almond, or oat. Objective: This review aimed to assess the scientific evidence mainly from meta-analyses of observational studies and randomised controlled trials, on dairy intake and risk of obesity, type 2 diabetes, cardiovascular disease, osteoporosis, cancer, and all-cause mortality. Results: The most recent evidence suggested that intake of milk and dairy products was associated with reduced risk of childhood obesity. In adults, intake of dairy products was shown to improve body composition and facilitate weight loss during energy restriction. In addition, intake of milk and dairy products was associated with a neutral or reduced risk of type 2 diabetes and a reduced risk of cardiovascular disease, particularly stroke. Furthermore, the evidence suggested a beneficial effect of milk and dairy intake on bone mineral density but no association with risk of bone fracture. Among cancers, milk and dairy intake was inversely associated with colorectal cancer, bladder cancer, gastric cancer, and breast cancer, and not associated with risk of pancreatic cancer, ovarian cancer, or lung cancer,while the evidence for prostate cancer risk was inconsistent.Finally,consumption of milk and dairy products was not associated with all-cause mortality. Calcium-fortified plant-based drinks have been included as an alternative to dairy products in the nutrition recommendations in several countries. However, nutritionally, cow’s milk and plant-based drinks are completely different foods,and an evidence-based conclusion on the health value of the plant-based drinks requires more studies in humans. Conclusion: The totality of available scientific evidence supports that intake of milk and dairy products contribute to meet nutrient recommendations, and may protect against the most prevalent chronic diseases, whereas very few adverse effects have been reported

A922 Sequential measurement of 1 hour creatinine clearance (1-CRCL) in critically ill patients at risk of acute kidney injury (AKI)

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