Treatment of renal stones by extracorporeal shockwave lithotripsy - An update

Aim: Despite the extensive experience with minimal invasive stone therapy, there are still different views on the ideal management of renal stones. Materials and Methods: Analysis of the literature includes more than 14,000 patients. We have compared these data with long-term results of two major stone centers in Germany. The results have been compared concerning the anatomical kidney situation, stone size, stone localization and observation time. Results: According to the importance of residual fragments following extracorporeal shock wave lithotripsy (ESWL), we have to distinguish between clinically insignificant residual fragments and clinically significant residual fragments (CIRF). 24 months following ESWL stone passage occurs as a continous process, and if there are no clinical symptoms, any endoscopic procedure should be considered as overtreatment. According to these results, stone-free rates of patients increase in longer follow-up periods. Newer ESWL technology has increased the percentage of CIRF. Conclusion: We consider ESWL in most patients with renal calculi as first-line treatment, except in patients with renal calculi bigger than 30 mm in diameter. Copyright (C) 2001 S. Karger AG, Basel

Adaptive polarization separation

A broadband adaptively controlled polarization separation network is discussed. Two transmitted signals vertically and horizontally polarized are received as elliptically polarized signals. If there is any vertical polarization on the other signal the separation network provides two signals. The separation is done automatically by the use of two sets of crosscouplers which couple a single line to the other line to complete the polarization decoupling operation

Triggers and maintenance of multiple shifts in the state of a natural community

Ecological communities can undergo sudden and dramatic shifts between alternative persistent community states. Both ecological prediction and natural resource management rely on understanding the mechanisms that trigger such shifts and maintain each state. Differentiating between potential mechanisms is difficult, however, because shifts are often recognized only in hindsight and many occur on such large spatial scales that manipulative experiments to test their causes are difficult or impossible. Here we use an approach that focuses first on identifying changes in environmental factors that could have triggered a given state change, and second on examining whether these changes were sustained (and thus potentially maintained the new state) or transitory (explaining the shift but not its persistence). We use this approach to evaluate a community shift in which a benthic marine species of filter feeding sea cucumber (Pachythyone rubra) suddenly came to dominate subtidal rocky reefs that had previously supported high abundances of macroalgae, persisted for more than a decade, then abruptly declined. We found that a sustained period without large wave events coincided with the shift to sea cucumber dominance, but that the sea cucumbers persisted even after the end of this low wave period, indicating that different mechanisms maintained the new community. Additionally, the period of sea cucumber dominance occurred when their predators were rare, and increases in the abundance of these predators coincided with the end of sea cucumber dominance. These results underscore the complex nature of regime shifts and illustrate that focusing separately on the causes and maintenance of state change can be a productive first step for analyzing these shifts in a range of systems

Current state of laparoscopic and robotic surgery

Minimally invasive surgical innovation has exploded in recent times. Currently, conventional laparoscopy is most widely adopted as the costs are relatively low. However, robotics and single port surgery are leading a revolution in surgery for wealthy health-care systems. We explore the historical and contemporary areas of this evolution

Dismembered and non-dismembered retroperitoneoscopic pyeloplasty for the treatment of ureteropelvic junction obstruction in children

Purpose: Open dismembered pyeloplasty according to Anderson-Hynes (AHP) is the gold standard treatment for ureteropelvic junction obstruction in children. However, during the last decade, the management has been revolutionized with introduction of laparoscopy and endourology yielding comparable results and less morbid outcomes. Methods: Between 1997 and 2010, dismembered and non-dismembered retroperitoneoscopic pyeloplasty was performed in 41 children with a median age of 130month (range 5-192). 20 children underwent a dismembered pyeloplasty (Anderson-Hynes) and 21 children were operated by a non-dismembered pyeloplasty (Y-V-Plasty). Results: The mean operation time was 120min (range 52-257). Intraoperative findings revealed in 29 cases a significant crossing vessel. Based on a furosemide nephrogram and subjective complaints, the success rate was 88% with a median follow-up of 69month (range 14-142). The 5 failures (2 Y-V-Plasty, 3 AHP) have been treated by open AHP (n=2), Laser endopyelotomy (n=2) and Lap-AHP (n=1) without further problems. Conclusion: With increasing improvement of the suture techniques, the laparoscopic pyeloplasty represents in experienced hands an alternative method with comparable success rates to the open technique. In our opinion, retroperitoneoscopic pyeloplasty is technically possible and feasible even in infants. We found in our series no statistically significant difference between dismembered and non-dismembered pyeloplast

Laparoscopic Radical Nephrectomy: The New Gold Standard Surgical Treatment for Localized Renal Cell Carcinoma

We will try to demonstrate that laparoscopic radical nephrectomy could be the new gold standard treatment for renal cell carcinoma with the aid of the current reports exploring the advantages and disadvantages of laparoscopic radical nephrectom overopen surgery

A REPRESENTAÇÃO DOS DITONGOS NA ESCRITA DE CRIANÇAS DO QUARTO ANO DO ENSINO FUNDAMENTAL

O objetivo deste trabalho é discutir como crianças do quarto ano do Ensino Fundamental representam na escrita os ditongos. Consideraremos neste trabalho apenas a representação dos ditongos verdadeiros, ou seja, os que nunca sofrem o processo de monotongação ou nunca variam com hiato. As produções analisadas foram feitas através de um reconto e houve uma coleta de dados que nos permitiu desenvolver um perfil ortográfico das crianças em estudo, através da representação desse fenômeno presente na escrita dos alunos. Nossa análise baseouse na categorização proposta por Lazzarotto-Volcão (2012) e nas teorizações de Câmara Jr. (1969) e Bisol (2001). Através da análise dos resultados, percebeu-se que não há muitos problemas para representação de ditongos na escrita das crianças e que esses estão mais relacionados aos aspectos fonético-fonológicos da língua

Approach to endoscopic extraperitoneal radical prostatectomy (EERPE): the impact of previous laparoscopic experience on the learning curve

BACKGROUND: We report our approach regarding the technique of endoscopic extraperitoneal radical prostatectomy (EERPE) and analyze the learning curve of two surgeons after thorough technical training under expert monitoring. The purpose of this study was to investigate the influence of expert monitoring on the surgical outcome and whether previous laparoscopic experience influences the surgeon's learning curve. METHODS: EERPE was performed on 120 consecutive patients by two surgeons with different experience in laparoscopy. An analysis and comparison of their learning curve was made. RESULTS: Median operation time: 200 (110-415) minutes. Complications: no conversion, blood transfusion (1.7%), rectal injury (3.3%). Median catheterisation time: 6 (5-45) days. Histopathological data: 55% pT2, 45% pT3 with a positive surgical margin rate of 6.1% and 46%, respectively. After 12 months, 78% of the patients were continent, 22% used 1 or more pad. Potency rate with or without PDE-5-inhibitors was 66% with bilateral and 31% with unilateral nerve-sparing, respectively. Operation time was the only parameter to differ significantly between the two surgeons. CONCLUSION: EERPE can be learned within a short teaching phase. Previous laparoscopic experience is reflected by shorter operation times, not by lower complication rates or superior early oncological data