Consultation on kidney stones, Copenhagen 2019 : lithotripsy in percutaneous nephrolithotomy

Purpose: To evaluate the balance between existing evidence and expert opinions on the safety and efficacy of new technological improvements in lithotripsy techniques for percutaneous nephrolithotomy (PCNL). Methods: A scoping review approach was applied to search literature in Pubmed, Embase, and Web of Science. Consensus by key opinion leaders was reached at a 2-day meeting entitled \u201cConsultation on Kidney Stones: Aspects of Intracorporeal Lithotripsy\u201d held in Copenhagen, Denmark, in September 2019. Results: New-generation dual-mode single-probe lithotripsy devices have shown favourable results compared with use of ballistic or ultrasonic lithotripters only. However, ballistic and ultrasonic lithotripters are also highly effective and safe and have been the backbone of PCNL for many years. Compared with standard PCNL, it seems that mini PCNL is associated with fewer bleeding complications and shorter hospital admissions, but also with longer operating room (OR) time and higher intrarenal pressure. Use of laser lithotripsy combined with suction in mini PCNL is a promising alternative that may improve such PCNL by shortening OR times. Furthermore, supine PCNL is a good alternative, especially in cases with complex renal stones and large proximal ureteric stones; in addition, it facilitates endoscopic combined intrarenal surgery (ECIRS). Conclusion: Recent technological improvements in PCNL techniques are promising, but there is a lack of high-level evidence on safety and efficacy. Different techniques suit different types of stones and patients. The evolution of diverse methods has given urologists the possibility of a personalized stone approach, in other words, the right approach for the right patient

Splenectomy for splenomegaly and secondary hypersplenism

Splenomegaly and secondary hypersplenism may be associated with acute and chronic infections, autoimmune states, portal hypertension or splenic vein thrombosis, and a number of infiltrative and neoplastic conditions involving the spleen. Our experience and that of others with these various conditions demonstrates that the decision to perform splenectomy should be based on well-defined and often strictly limited indications. Except for idiopathic splenomegaly, the presence and severity of secondary hypersplenism or severely symptomatic splenomegaly should be well documented. In each case, the potential for palliation and known mean duration of expected response must be weighed against the increased morbidity and mortality of splenectomy (as compared to operation for “primary” hypersplenism) . La splénomégalie avec hypersplénisme secondaire relève de multiples causes: infection aigue ou chronique, états autoimmunologiques, hypertension portale, thrombose de la veine splénique, lésions tumorales spléniques. L'expérience de l'auteur qui rejoint celle de nombreux collègues lui permet d'affirmer que les indications de la splénectomie doivent être bien définies et sont strictement limitées. A l'exception de la splénomégalie idiopathique, l'existence et l'intensité de l'hypersplénisme, l'importance des symptomes provoqués par la splénomégalie doivent être aprréciées avec précision. Dans chaque cas le potentiel de la rémission de l'affection et la durée de la rémission doivent être pris en considération en fonction de l'éventuelle morbidité et de l'éventuelle mortalité de la splénectomie (par comparaison avec la splénectomie pour hypersplénisme primaire). Eplenomegalia e hiperesplenismo secundario pueden estar asociados con infecciones agudas y crónicas, estados autoinmunes (síndrome de Felty, lupus eritematoso sistémico), “esplenomegalia congestiva” por hipertensión portal o trombosis de la vena esplénica y con una variedad de entidades de tipo infiltrativo y neoplásico que afectan al bazo (sarcoidosis, enfermedad de Gaucher, varios desórdenes mieloproliferativos y linfomas). Nuestra experiencia, y aquella de otros autores, con tales condiciones demuestra que la decisión de realizar esplenectomía debe estar fundamentada en indicaciones bien definidas y estrictamente limitadas. Excepto en casos de esplenomegalia idiopática, la presencia y severidad del hiperesplenismo secundario o de esplenomegalia severamente sintomática debe ser bien documentada. En cada caso debe determinarse el potencial de paliación y la duración de la respuesta que se espera obtener frente a la incrementada morbilidad y mortalidad de la esplenectomía (en comparación con la operación que se realiza por hiperesplenismo “primario”).Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/41318/1/268_2005_Article_BF01655279.pd

Observations of large field-aligned flows of thermal plasma in the auroral ionosphere

Large upward field-aligned ion flows have previously been observed in the high latitude ionosphere in response to frictional heating of the local ion population. Results from a recent experiment using the EISCAT radar show similar features but allow, for the first time, determination of the field-aligned profiles of plasma parameters during these events. The upflows occur during frictional heating. The flows are shown to be transient plasma upwellings, from regions where the ion temperature has been elevated by the motion of a convection shear over the observed field line

A statistical study of polar mesosphere summer echoes observed by EISCAT

A comprehensive survey of data on ‘Polar Mesosphere Summer Echoes’, observed by the EISCAT VHF radar during 1988–1993, confirms that (1) these echoes are a summer phenomenon, with a season lasting from June to August; (2) PMSE occur most frequently around noon and midnight, and thus follow a semidiurnal pattern; (3) PMSE occur at a mean height of 85±2 km; (4) there is often a good correlation between the vertical Doppler velocity and the rate of change of echo height, which suggests that the echoing structures move bodily, perhaps in response to gravity waves. Previous results on the lack of correlation between the occurrence of PMSE and noctilucent clouds are reinforced

Characteristics of the high-latitude trough

The EISCAT radar has provided data for a comprehensive study of the high-latitude trough in electron concentration, which occurs in the auroral zone. In this paper the characteristics of the trough are illustrated, the method of its formation is outlined and important features of the trough are described. A large upward velocity along the geomagnetic field line is shown to play a significant role in the formation of the trough. The large ion-neutral difference velocities which initiate the formation of the trough may also drive the plasma into a non-thermal state which should be taken into account during the analysis of incoherent scatter data

Worldwide atmospheric gravity-wave study in the European sector 1985–1990

Four campaigns of the Worldwide Atmospheric Gravity-wave Study (WAGS) have taken place in the European sector. On many occasions the onset of auroral activity in the evening and midnight sector, as indicated by EISCAT measurements of the electric field, was associated after a suitable delay with the detection of periodic ionospheric disturbance travelling southward over the U.K. at speeds between 500 and 1000 m s−1. The velocity and wavelength of the TIDs corresponded to large-scale atmospheric gravity-waves. The characteristic periods of the travelling disturbances were similar to the intrinsic time scales of the auroral activity for periods of 40 min or more, but variations on a time scale of 20 min or less were strongly attenuated. The r.m.s. amplitude of the auroral electric field was proportional to the r.m.s. amplitude of the HF Doppler-shift associated with the gravity-wave. The time-lag between the onset of strong auroral activity and the arrival of the travelling disturbance over the U.K. was usually about an hour, suggesting a source region about 2000 km north. Similar levels of activity in the afternoon did not appear to produce strong waves in the far field. This is possibly due to ion-drag in the daytime ionosphere although the effects of the lower sensitivity of the HF Doppler-network during daytime must also be considered

Plasma flow bursts in the nightside auroral zone ionosphere and their relation to geomagnetic activity

We examine the nature of flows in the nightside auroral zone ionosphere and their relationship with concurrent geomagnetic activity by studying a three-hour interval of ground-based radar, magnetometer array and spacecraft data. We find that the flows are bursty in nature, a characteristic previously reported, and that the bursts are related to a series of substorm electrojet intensifications initiated in the pre-midnight sector