Preliminary diagnostic reference levels for endoscopic retrograde cholangio-pancreatography in Greece

The main objective of this study was to determine the preliminary Diagnostic Reference Levels (DRLs) in terms of Kerma Area Product (KAP) and fluoroscopy time (Tf) during Endoscopic Retrograde Cholangio-Pancreatography (ERCP) procedures. Additionally, an investigation was conducted to explore the statistical relation between KAP and Tf. Data from a set of 200 randomly selected patients treated in 4 large hospitals in Greece (50 patients per hospital) were analyzed in order to obtain preliminary DRLs for KAP and Tf during therapeutic ERCP procedures. Non-parametric statistic tests were performed in order to determine a statistically significant relation between KAP and Tf. The resulting third quartiles for KAP and Tf for hospitals (A, B, C and D) were found as followed: KAPA = 10.7 Gy cm^2, TfA = 4.9 min; KAPB = 7.5 Gy cm^2, TfB = 5.0 min; KAPC = 19.0 Gy cm^2, TfC = 7.3 min; KAPD = 52.4 Gy cm^2, TfD = 15.8 min. The third quartiles, calculated for the total 200 cases sample, are: KAP = 18.8 Gy cm^2 and Tf = 8.2 min. For 3 out of 4 hospitals and for the total sample, p-values of statistical indices (correlation of KAP and Tf) are less than 0.001, while for the Hospital A p-values are ranging from 0.07 to 0.08. Using curve fitting, we finally determine that the relation of Tf and KAP is deriving from a power equation (KAP = Tf^1.282) with R^2 = 0.85. The suggested Preliminary DRLs (deriving from the third quartiles of the total sample) for Greece are: KAP = 19 Gy cm^2 and Tf = 8 min, while the relation between KAP and Tf is efficiently described by a power equatio

PLA2R-Negative Membranous Nephropathy Presenting as a Prodrome of IgG4-Related Autoimmune Pancreatitis

Membranous nephropathy (MN) with tubulointerstitial nephritis (TIN) is an established manifestation of immunoglobulin G4 (IgG4)-related disease (IgG4-RD). A pathological feature aiming to distinguish between primary and secondary MN is the presence or absence of glomerular staining for phospholipase A2 receptor (PLA2R), respectively. Isolated MN without TIN has been rarely reported in the context of IgG4-RD. This case report describes a patient with a history of MN successfully treated with steroids and cyclophosphamide, who, 3 years later, presented with unexplained exacerbation of diabetes mellitus due to IgG4-related autoimmune pancreatitis. Pancreatitis was treated, and diabetes improved after treatment with steroids. Based on the presence of isolated IgG4 glomerular capillary deposits along with negative staining for PLA2R and the metachronous appearance of autoimmune pancreatitis, MN was retrospectively classified as secondary to IgG4-RD. Isolated IgG4-positive/PLA2R-negative MN without TIN can be a prodrome of IgG4-RD, reminiscent of MN secondary to neoplasms. © 2019 The Author(s). Published by S. Karger AG, Basel

Doxazosin for the management of distal-ureteral stones

Purpose: To evaluate the efficacy of doxazosin in inducing spontaneous passage of stones in the distal ureter and to compare its efficacy according to the size of the stone. Patients and Methods: Seventy-three patients with a mean age of 46.38 +/- 10.17 years who presented with a distal-ureteral stone were divided into four groups according to stone size and drug treatment: <5 mm without doxazosin ( group A; n = 15); 5-10 mm ( group B; n = 16); < 5 mm with doxazosin 4 mg/day for 4 weeks ( group C; n = 20); and 5-10 mm with doxazosin 4 mg/day for 4 weeks ( group D; n=22). Groups A and B served as controls for groups C and D, respectively. Results: Spontaneous stone passage was documented in 9 patients (60%) in group A v 17 (85%) in group C ( P = 0.047) and 7 ( 43.75%) in group B v 16 (72.73%) in group D ( P = 0.036). The average expulsion time was 8.78 +/- 1.09 days in group A v 7.59 +/- 0.80 days in group C ( P = 0.004) and 12.14 +/- 1.35 days in group B v 7.06 +/- 1.29 days in group D ( P < 0.0001). The number of pain episodes in group D patients was significantly lower than in group B ( P = 0.0078). Conclusions: Doxazosin treatment proved to be safe and effective for distal-ureteral stones, as determined by earlier expulsion, decreased colic frequency, and absence of side effects. The efficacy of doxazosin was significantly higher for 5- to 10-mm stones than for smaller ones

Ureteral injuries during gynecologic surgery: Treatment with a minimally invasive approach

Purpose: To report the safety and efficacy of percutaneous nephrostomy and primary antegrade recanalization for treatment of iatrogenic ureteral strictures after gynecologic surgery. Patients and Methods: Ten women had symptoms suggestive of ureteral obstruction during the immediate postoperative period (5 days-1 week after surgery). Under analgesia and conscious sedation, standard percutaneous nephrostomy was performed, and a long 7F sheath was placed in the upper ureter. The obstructions were traversed with the aid of a 0.0035-inch Glidewire and a 5F angled Glide catheter (Terumo, Japan). Subsequently, the areas were dilated with angioplasty balloons to a maximum diameter of 7 mm. Finally, an 8F percutaneous internal/external nephroureteral drainage stent was inserted to secure ureteral patency. Follow-up was carried out by serial nephrostomography until removal of the stent and by renal ultrasonography thereafter. Results: Twelve obstructions with a mean length of 1.4 cm (range 0.4-1.9 cm) were managed. The technical success rate was 100%. No major complications occurred, and normal renal function was restored. The mean follow-up was 12 months. In 60% of the patients, a patent ureter was depicted at 1 week, whereas in four patients, repeat dilation of the obstructed segment was required. The stents were removed after a mean period of 4.8 weeks. Conclusion: Percutaneous nephrostomy and primary antegrade ureteral balloon dilation is safe and efficacious for treating ureteral injury after pelvic surgery and obviates open surgical manipulations

Preliminary diagnostic reference levels for endoscopic retrograde cholangio-pancreatography in Greece

The main objective of this study was to determine the preliminary Diagnostic Reference Levels (DRLs) in terms of Kerma Area Product (KAP) and fluoroscopy time (Tf) during Endoscopic Retrograde Cholangio-Pancreatography (ERCP) procedures. Additionally, an investigation was conducted to explore the statistical relation between KAP and Tf.Data from a set of 200 randomly selected patients treated in 4 large hospitals in Greece (50 patients per hospital) were analyzed in order to obtain preliminary DRLs for KAP and Tf during therapeutic ERCP procedures. Non-parametric statistic tests were performed in order to determine a statistically significant relation between KAP and Tf.The resulting third quartiles for KAP and Tf for hospitals (A, B, C and D) were found as followed: KAPA = 10.7 Gy cm2, TfA = 4.9 min; KAPB = 7.5 Gy cm2, TfB = 5.0 min; KAPC = 19.0 Gy cm2, TfC = 7.3 min; KAPD = 52.4 Gy cm2, TfD = 15.8 min. The third quartiles, calculated for the total 200 cases sample, are: KAP = 18.8 Gy cm2 and Tf = 8.2 min. For 3 out of 4 hospitals and for the total sample, p-values of statistical indices (correlation of KAP and Tf) are less than 0.001, while for the Hospital A p-values are ranging from 0.07 to 0.08. Using curve fitting, we finally determine that the relation of Tf and KAP is deriving from a power equation (KAP = Tf1.282) with R2 = 0.85.The suggested Preliminary DRLs (deriving from the third quartiles of the total sample) for Greece are: KAP = 19 Gy cm2 and Tf = 8 min, while the relation between KAP and Tf is efficiently described by a power equation. © 2016 Associazione Italiana di Fisica Medica