Symptomatic lymphocele after kidney transplantation: a single-center experience.

INTRODUCTION: In a retrospective study, we evaluated the frequency, clinical presentation, and management of lymphocele in kidney transplant recipients operated on in a single center. MATERIALS AND METHODS: Between September 1984 and June 2005, we had 2147 kidney transplantations from living donors. During the follow-up period, ultrasonography was performed in symptomatic patients and those with elevated serum creatinine level postoperatively. Other radiological procedures were done in complicated cases. Patients with lymphocele were treated by percutaneous drainage with or without injection of sclerotizing agent (povidone iodine). If recurrence occurred, surgical intraperitoneal drainage was performed. In cases with multiloculated collection or inappropriate access for percutaneous drainage, the primary approach was surgical intraperitoneal drainage. RESULTS: Symptomatic lymphocele collection was seen in 17 kidney recipients of our series (0.8; 95 confidence interval, 0.4 to 1.2). It presented with elevation of serum creatinine concentrations (47.1), pain and abdominopelvic swelling (29.4), and lower extremity edema (23.5). Percutaneous drainage was used for the treatment of lymphocele in 11 patients, but recurrence occurred in 7 (63.6). These cases were treated with open surgical drainage. In 6 patients, the primary approach was surgical intraperitoneal drainage, because of multiloculated collection or inappropriate access for percutaneous drainage. All of the patients were treated successfully and no graft loss occurred during the follow-up period. CONCLUSION: Symptomatic lymphocele is an uncommon complication after kidney transplantation. Surgical intraperitoneal drainage is the most effective approach for the management of symptomatic lymphocele

Emergent versus delayed lithotripsy for obstructing ureteral stones: a cumulative analysis of comparative studies

Objective To analyze the current evidence on the use of ureteroscopy (URS) and extracorporeal shock wave lithotripsy (ESWL) for the management of obstructing ureteral stones in emergent setting. Methods A systematic literature review was performed up to June 2016 using Pubmed and Ovid databases to identify pertinent studies. The PRISMA criteria were followed for article selection. Separate searches were done using a combinations of several search terms: "laser lithotripsy", "ureteroscopy", "extracorporeal shock wave lithotripsy", "ESWL", "rapid", "immediate", "early", "delayed", "late", "ureteral stones", "kidney stones", "renal stones". Only titles related to emergent/rapid/immediate/early (as viably defined in each study) versus delayed/late treatment of ureteral stones with either URS and/or ESWL were considered for screening. Demographics and operative outcomes were compared between emergent and delayed lithotripsy. RevMan review manager software was used to perform data analysis. Results Four studies comparing emergent (n = 526) versus delayed (n = 987) URS and six studies comparing emergent (n = 356) versus delayed (n = 355) SWL were included in the analysis. Emergent URS did not show any significant difference in terms of stone-free rate (91.2 versus 90.9%; OR 1.04; CI 0.71, 1.52; p = 0.84), complication rate (8.7% for emergent versus 11.5% for delayed; OR 0.94; CI 0.65, 1.36; p = 0.74) and need for auxiliary procedures (OR 0.85; CI 0.42, 1.7; p = 0.85) when compared to delayed URS. Emergent ESWL was associated with a higher likelihood of stone free status (OR 2.2; CI 1.55, 3.17; p < 0.001) and a lower likelihood of need for auxiliary maneuvers (OR 0.49; CI 0.33, 0.72; p < 0.001) than the delayed procedure. No differences in complication rates were noticed between the emergent and delayed ESWL (p = 0.37). Conclusions Emergent lithotripsy, either ureteroscopic or extracorporeal, can be offered as an effective and safe treatment for patients with symptomatic ureteral stone. If amenable to ESWL, based on stone and patient characteristics, an emergent approach should be strongly considered. Ureteroscopy in the emergent setting is mostly reserved for distally located stones. The implementation of these therapeutic approaches is likely to be dictated by their availability.info:eu-repo/semantics/publishedVersio

Impact of sex on response to neoadjuvant chemotherapy in patients with bladder cancer

© 2020 Elsevier Ltd. All rights reserved. This manuscript is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International Licence http://creativecommons.org/licenses/by-nc-nd/4.0/.Objective: To assess the effect of patient's sex on response to neoadjuvant chemotherapy (NAC) in patients with clinically nonmetastatic muscle-invasive bladder cancer (MIBC). Methods: Complete pathologic response, defined as ypT0N0 at radical cystectomy, and downstaging were evaluated using sex-adjusted univariable and multivariable logistic regression modeling. We used interaction terms to account for age of menopause and smoking status. The association of sex with overall survival and cancer-specific survival was evaluated using Cox regression analyses. Results: A total of 1,031 patients were included in the analysis, 227 (22%) of whom were female. Female patients had a higher rate of extravesical disease extension (P = 0.01). After the administration of NAC, ypT stage was equally distributed between sexes (P = 0.39). On multivariable logistic regression analyses, there was no difference between the sexes or age of menopause with regards to ypT0N0 rates or downstaging (all P > 0.5). On Cox regression analyses, sex was associated with neither overall survival (hazard ratio 1.04, 95% confidence interval 0.75–1.45, P = 0.81) nor cancer-specific survival (hazard ratio 1.06, 95% confidence interval 0.71–1.58, P = 0.77). Conclusion: Our study generates the hypothesis that NAC equalizes the preoperative disparity in pathologic stage between males and females suggesting a possible differential response between sexes. This might be the explanation underlying the comparable survival outcomes between sexes despite females presenting with more advanced tumor stage.Peer reviewedFinal Accepted Versio

Aplicación del método lógico de tildación de palabras simples y compuestas para mejorar el aprendizaje de la ortografía acentual en los estudiantes del tercer grado de educación secundaria de la I.E. “San Luis de la Paz” Nº 88388, Nuevo Chimbote 2010

TesisEl presente informe de investigación titulado: “Aplicación del método lógico de tildación de palabras simples y compuestas para mejorar el aprendizaje de la ortografía acentual en los estudiantes del tercer grado de educación secundaria de la I. E. “San Luis de la Paz” Nº 88388, Nuevo Chimbote 20i0”, se realizó en la Escuela Académico Profesional de Educación Secundaria de la Universidad Nacional del Santa. El problema que se abordó fue el de ortografía acentual y derivó en la siguiente formulación: ¿En qué medida la aplicación del método lógico de tildación de palabras simples y compuestas mejora el aprendizaje de la ortografía acentual en los estudiantes del tercer grado de educación secundaria de la I. E. “San Luis de la Paz” Nº 88388, Nuevo Chimbote 20i0? Como hipótesis se consideró: La aplicación del método lógico de tildación de palabras simples y compuestas mejora en un nivel significativo el aprendizaje de la ortografía acentual en los estudiantes del tercer grado de educación secundaria de la I. E. “San Luis de la Paz” Nº 88388, Nuevo Chimbote 20i0, y se determinó, para el objetivo general: Demostrar que la aplicación del método lógico de tildación de palabras simples y compuestas mejora en un nivel significativo el aprendizaje de la ortografía acentual en los estudiantes del tercer grado de educación secundaria de la I. E. “San Luis de la Paz” Nº 88388, Nuevo Chimbote 20i0. La población muestral estuvo conformada por las secciones designadas de manera intencional 3ºA y 3ºC con 24 estudiantes cada una: la primera (A) grupo experimental y la segunda (C) grupo control. Con el grupo experimental se desarrollaron diversas sesiones educativas, utilizando la estrategia metodológica constituida en la variable experimental; mientras que con el grupo control se trabajaron los mismos contenidos, pero basándose en la utilización de las estrategias metodológicas tradicionales. En el análisis de datos se utilizó la media, la moda, la mediana, la desviación estándar, el coeficiente de variación y la prueba T- Student, acompañados de sus respectivos cuadros. Una vez analizados los datos se comprobó la hipótesis de la investigación: la aplicación del método lógico de tildación de palabras simples y compuestas mejora en un nivel significativo el aprendizaje de la ortografía acentual en los estudiantes, tras alcanzar, en su totalidad, i00%, el nivel excelente (i7-20). Además, la prueba T- Student validó la hipótesis alternativa e importancia del método, al obtener una probabilidad de significancia (p = 0,002) menor que el nivel ( = 0,05)

Effects of supercritical carbon dioxide processing on optical crystallinity and in vitro release of progesterone and Gelucire 44/14 solid and semi-solid dispersions

The aim of this study was to determine the effect of supercritical carbon dioxide (SC-CO2) on the crystallinity and drug release of Gelucire 44/14-based endogenous progesterone (PGN) dispersion systems. The light scattering from PGN crystals incorporated in Gelucire 44/14 was imaged using optical microscopy. In vitro dissolution was used to determine the release kinetics of PGN, Gelucire 44/14, incorporated by a supercritical fluid (SCF) method. Release profiles were evaluated according to zero-order, first-order, Higuchi, Krosmeyer-Peppas, and dual first-order models. The dual first-order release model illustrated two distinct release rates: an initial rapid release followed by a slow diffusion of PGN from the dispersion systems. The dual first-order release model adds a new tool to the elucidation of release mechanisms from lipid and micelle-forming-based dispersion systems, where parallel processes contribute to drug release

Evaluation of progesterone permeability from supercritical fluid processed dispersion systems

The aim of this study was to investigate the permeability of unique dispersion systems prepared by supercritical fluid (SCF) processing, to deliver bioidentical progesterone (PGN) across mouse skin. Semisolid dispersions of PGN were made up of either polyethylene glycol (PEG) 400/4000, Gelucire 44/14, d-a-tocopheryl PEG 1000 succinate (TPGS), tanscutol P or myritol 318. SCF dispersion systems were compared with various control formulations; a market cream, aqueous suspension, and three conventionally prepared dispersions comelted, cosolvent and physically mixed systems. The permeability coefficient in the absence or presence of a permeation enhancer was evaluated using ex vivo mouse skin. The permeation study results for the TPGS/myritol/transcutol P dispersion system prepared using supercritical carbon dioxide (SC-CO 2) had a two-fold improvement in transdermal permeation over 24 h compared to the control formulation, 245.7 and 126 μgcm-2, respectively (p valu

Predicting emergency interventions in patients with acute ureteral colic using acute renal colic scoring system in a Pakistani cohort

Objective: To evaluate the acute renal colic score (ARC) in predicting the need of emergency intervention (EI) in patients with ureteric colic secondary to a ureteral stone.Patient and methods: In an emergency room (ER) of a university hospital, we conducted a prospective cohort study over a period of 6 months. ARC score was calculated using four parameters, i.e., serum creatinine, total white cell count (TLC), stone length and level. Primary outcome measure was EI, which was defined as the need of endourological intervention within 48 h of presentation. ARC was calculated for each patient against the two possible outcomes, i.e., EI vs. no EI. The need of intervention was based on patient-related clinical factors and the decision of the attending urologist.Results: The study included 132 patients. EI was performed in 85 patients (64.4%). URS was the most common intervention performed in 81 (95.3%) patients, followed by the a insertion of a double J stent in two (2.4%) patients for forniceal rupture and high TLC count and percutaneous nephrostomy in two (2.4%) patients for raised creatinine and TLC. All four variables in ARC score including serum creatinine (p \u3c 0.001), TLC (p \u3c 0.001), stone size (p \u3c 0.001) and stone level (p \u3c 0.001) were found to be significantly associated with need for EI. Using ROC the sensitivity and specificity of the score was 92.9% and 87.5%, respectively, with AUC of 0.93.Conclusions: ARC score is highly sensitive and specific in determining the need of EI in patients with uncomplicated ureteric colic within 48 h of initial presentation