Different Aspect of Transperitoneal Laparoscopic Pyelolithotomy for Management of Pelvic Stones Larger than 20 mm: a Cuasi-Experimental Study in Male Patients

Background: We study different aspect of laparoscopic pyelolithotomy (LP) in patients with large renal pelvis stone regarding success rate, complications as well as the recurrence free status. Material and methods: From July 2015 to January 2019, 32 patients underwent LP for single large renal pelvis stone ($\ge$2 cm). Patient characteristics, preoperative and postoperative hemoglobin, creatinine as well as possible complications based on Clavien classification were recorded. Stone free status was evaluated using computed tomography scan one month after the surgery. Any particle bigger than 4 mm was considered as significant residual stone. During the next one years after the operation, renal ultrasonography was performed for all patients every six month to find any stone recurrence. Results: Mean operation time was 134.55$\pm$31.41 minutes. Patients were hospitalized 3.36$\pm$1.13 days in the LP group. Patients showed hemoglobin decrease of 1.50$\pm$1.05 (P=0.2). Stone free rate was 93.75\% and Mean overall stone free status estimated to be 32 months. Conclusion: PCNL has been the treatment of choice for large renal pelvis stones; however, in expert hands, LP is an appropriate substitute with superior stone free rate, less bleeding and remarkably less stone recurrence

Different Aspects of Penile Amputation; Surgery, Forensics, and Psychiatry (Case Report and Short Review)

Penile amputation (PA) is a rare genitourinary injury. Three main etiologies of PA consist of iatrogenic, accidental, and self-mutilation. Eighty-seven percent of the self-mutilated patients suffer from psychiatric disorders. Nowadays, microsurgical techniques with neurovascular anastomosis are the best approach for PA. This paper insists on psychiatric and legal consequences, which may involve health-care team. A 25-year-old male patient presented to our emergency department with self-inflicted PA. As he had a history of some psychiatric problems, psychiatric consultation was requested. The patient did not accept any surgical interventions. We informed his relatives completely; however, they did not agree with surgical intervention because they predicted that he might repeat amputation again. According to the forensic medicine specialist consultation, we took the coroner's warrant for emergency surgical intervention and transferred the patient to the operating room without any consent. Microsurgical penile replantation was performed. There was no leakage in retrograde pericatheter urethrography on the 3rd postoperative week, and the urethral catheter was removed. The patient was able to void normally, and cystostomy tube was removed at the same time. Consent for all medical procedures is an important part of national and international human right law and medical ethics. Physicians should inform patients about their problem and take a reliable consent. If the patient was unreliable for informed consent, relatives could do it. However, in an emergency, there is an exception in the law that let surgeons do the operation without consent for these cases

Estudio experimental y numérico de la estabilidad de la pendiente aguas arriba en un embalse de presas de tierra en condiciones de extracción rápida

The rapid ‎drawdown of the dam reservoir is one of the most common situations occurring in the lifetime of a dam. For this reason, one of the main factors in the design of the upstream slope is the rapid drainage of the reservoir. In this case, the upstream slope is in a critical condition and the slope may be unstable. When the water surface in the reservoir is drawdown suddenly, the water level in the dam body does not decrease at the same time as the reservoir water level. The analysis of seepage from the earth dam body and calculation of the water loss play an important role in calculating the amount of pore water pressure, and, consequently, the stability analysis of the dam body. In addition, any seepage analysis is dependent on the hydraulic properties of the dam materials. In order to investigate the effect of hydraulic conductivity on the rapid drawdown of water level and the seepage, an experimental model was constructed of an earth dam. By accurate measurement of hydraulic parameters of the materials in saturated and unsaturated media, the flow through this model was modeled using a disk penetrometer by seep/w software. The results were then compared with the observed data.The rapid ‎drawdown of the dam reservoir is one of the most common situations occurring in the lifetime of a dam. For this reason, one of the main factors in the design of the upstream slope is the rapid drainage of the reservoir. In this case, the upstream slope is in a critical condition and the slope may be unstable. When the water surface in the reservoir is drawdown suddenly, the water level in the dam body does not decrease at the same time as the reservoir water level. The analysis of seepage from the earth dam body and calculation of the water loss play an important role in calculating the amount of pore water pressure, and, consequently, the stability analysis of the dam body. In addition, any seepage analysis is dependent on the hydraulic properties of the dam materials. In order to investigate the effect of hydraulic conductivity on the rapid drawdown of water level and the seepage, an experimental model was constructed of an earth dam. By accurate measurement of hydraulic parameters of the materials in saturated and unsaturated media, the flow through this model was modeled using a disk penetrometer by seep/w software. The results were then compared with the observed data

Castleman Disease Presenting as Renal Hilar Mass

Background: We report a case of unicentric Castleman disease, a rare type of benign proliferation of lymphoid tissue. We present an uncommon disease that was managed effectively using laparoscopy. Case Presentation: A 32-year-old woman presented with left-sided flank pain. A large retroperitoneal mass was detected in the left renal hilum close to the renal vessels. Laparoscopic removal of the mass was effectively performed. The pathologic examination was in favor of a rare type of benign proliferation of lymphoid tissue compatible with Castleman disease. The patient was cured with no evidence of recurrence in 1-year follow-up. Conclusion: Transperitoneal laparoscopic approach is feasible and effective in the management of this disease and is curative

Chromium and lead levels and alteration in DDPH inhibition in patients with breast cancer undergoing chemotherapy

Background: Recently the carcinogenic and toxic effects of some heavy metals such as chromium (Cr), and lead (Pb) through the mechanism of oxidative stress have been reported. Due to the various consequences of chemotherapeutic treatments on body hemostasis, the present study aimed to evaluate the effect of Adriamycin 60 mg/m2 and Cytoxan 600 mg/m2 (AC) chemotherapy on the serum levels of Cr, Pb, and the percent α-diphenyl-β-picrylhydrazyl (DPPH) inhibition. Methods: This study was performed on 50 patients with breast cancer at two separate sampling times, the first at the initiation of chemotherapy and the last at the end of three courses of the AC chemotherapy treatment. Serum levels of Cr and Pb were measured using atomic absorption spectrophotometry. The percent DPPH inhibition ( I) and also the effect of age and stage of the disease on the mentioned variables were evaluated. Statistical comparison of the obtained results before and after chemotherapy was performed using paired sample t-test. Intra-group evaluation of age and disease stages was done using an independent sample t-test. Results: A significant decrease was observed in the percent DPPH inhibition after 3 courses of chemotherapy (p<0.001). Cr and also Pb were significantly higher in patients with breast cancer after AC chemotherapy (p<0.001). Conclusion: According to the results, AC chemotherapy in patients with breast cancer is associated with higher levels of Cr and Pb, which can eventually lead to worsened oxidative stress status in affected patients. However, it seems that these changes do not necessarily depend on age and the stage of the disease. &#160

Numerical investigation of groundwater balance and artificial recharge in the Kerman-Baghin Aquifer

In the present paper, the behavior of Kerman-Baghin aquifer has been investigated using the MODFLOW program and GMS 10.3 software. The piezometer data during October 2011 are applied for steady state condition of groundwater modeling. Then, the model is calibrated for 66 months for unsteady condition using observational information, and it is validated for 24 months. Finally, the results are compared with the available observed data and show acceptable accuracy in calibration and validation steps. After validating the model, the status of the aquifer is estimated for a period of 5 years. Management scenarios including 10, 20 and 30 percent reduction in groundwater abstraction as well as artificial recharge at eight selected aquifer sites have been investigated. The location of artificial recharge sites is selected based on seven parameters of land slope, distance from waterways, distance from faults, electrical conductivity, hydraulic conductivity, geology of the area and groundwater depth (thickness of unsaturated area). These parameters are combined with the index overlay method by Arc GIS 10.3 software. The results show that by continuing the current situation, the Kerman-Baghin aquifer could face an average annual deficit of more than 52 million cubic meters. It may cause various problems in the near future including abstraction water from groundwater sources and reducing water quality. The results of implementing different scenarios show that, the best scenario can be obtained by 10% reducing water withdrawal with artificial recharge in four zones 1, 2, 10 and 12

Sleep Pattern, Duration and Quality in Relation with Glycemic Control in People with Type 2 Diabetes Mellitus

Sleep disturbances have been shown to be associated with diabetes control, but the relation between planned wakings or napping with glycemic indices has not been evaluated yet. This study evaluated the relation between sleep quality, duration, and pattern, including daytime napping of people with diabetes and their glycemic control. A cross-sectional correlation research design was used for this study. We enrolled 118 people with type 2 diabetes receiving oral agents without major complications at the Shahid Bahonar Center, Kerman. The age, weight, height, serum HbA1c, as well as other glycemic indices and lipid profile were measured. BMI was also calculated. All participants were requested to fill in the Pittsburgh Sleep Quality Index (PSQI) questionnaire to evaluate their sleep quality. In addition, they were inquired about their sleep schedule during day and night. Pearson correlation and multiple regression analyses were conducted to examine the correlation between HbA1c and sleep pattern variables. The variables were also compared between participants with or without napping using t-test. All analyses were performed with the SPSS version 19 (SPSS, Chicago, IL, USA). The mean age was 58±11 years and mean HbA1c (%) was 7.8±11 (62±13 mmol/mol). Sleep duration and the number of sleep segments significantly predicted HbA1c (F (2,114)=5.232, P=0.007, R2=0.084). A one-hour increment in sleep duration was associated with a 0.174% (1.4 mmol/mol) decrement in HbA1c. PSQI score did not contribute to the regression model. Moreover, participants who napped (66%) had a lower HbA1c (7.6±1) compared to others (8.1±1.3) (P=0.04). We concluded that napping and segmented sleep are associated with a better glycemic control in type 2 diabetes and there is a linear correlation between sleep duration and better glycemic control

Overall Survival and Functional Results of Prostate-Sparing Cystectomy

Purpose: To compare two matched groups of men with bladder transitional cell carcinoma (TCC) who underwent prostate-sparing cystectomy (PSC) or conventional radical cystoprostatectomy (CRC). Materials and Methods: Twenty-three men who have undergone PSC with the diagnosis of EODGGHU�7&&��7D±7���IURP������WR������LQ�7HKUDQ��,UDQ�ZHUH�LQFOXGHG�LQ�WKH�VWXG\�DV�WKH�H[- perimental group. The control group composed of 27 men with comparable tumor characteristics and age range, who had non-nerve-sparing radical cystoprostatectomy and orthotopic ileal W pouch reconstruction in the same center. All the procedures were performed by the same surgical group under the supervision of different attending staff. Results: Mean follow-up period was 39 months in PSC and 35 months in CRC group. The 5-year overall survival was 47% and 30% in PSC and CRC groups, respectively. Median survival was 48 months in PSC and 36 months in CRC group, using Kaplan-Meier survival analysis (P > .05). Impotence was observed in 16.6% in PSC and in 83.3% in CRC group (P� ��������0HDQ�,QWHUQDWLRQDO�,QGH[�RI�(UHFWLOH�)XQFWLRQ���VFRUH�RI�WKH�36&�JURXS�ZDV� 19.8 compared with 5.7 in the CRC group (P = .003). Only one patient in each group was completely incontinent. Urethral anastomosis stricture occurred in 2 patients in CRC group. Conclusion: Patients who underwent PSC did not show decreased overall survival compared to CRC, which provided better functional results. Keywords: urinary bladder neoplasms, transitional cell carcinoma, cystectomy, male, prognosis, adverse effect

Percutaneous Nephrolithotomy Using Split Amplatz Sheath: A Randomized Clinical Trial

Purpose: To compare the outcome of percutaneous nephrolithotomy (PCNL) using split or intact Amplatz sheath. Materials and Methods: Seventy two patients who underwent PCNL were randomly divided into two groups; PCNL using intact (group 1) and split (group 2) Amplatz sheath. Preoperative data, operative time, largest extracted stone size, fluoroscopy and lithotripsy time, and serum biochemistry tests before and after PCNL were evaluated. Results: Preoperative features and stone size were not significantly different between the groups. There were no significant differences in complications and postoperative changes in hemoglobin and serum electrolytes. Stone free rate in group 2 (88.1%) was insignificantly higher than group 1 (83.3%) (p = .05), but in staghorn stones and stones larger than 1000 mm2, stone free rate in group 2 was significantly higher than group 1 (82% vs. 72%). The mean extracted stone size in group 2 (150 ± 49mm2) was significantly larger than group 1 (40 ± 16 mm2) (p < .005). The mean operative, lithotripsy and fluoroscopy times were significantly longer in group 1. Conclusion: Using split Amplatz sheath in PCNL facilitates extraction of larger stone fragments which could contribute to shorter fluoroscopy, lithotripsy and operative times