RESUMEN
The thoracoabdominal incision was first described in 1946 as an approach to concomitant abdominal, retroperitoneal, and thoracic injuries. In urology, this technique was popularized in 1949 for the resection of large renal tumours. Today, it is reserved for complex cases where optimal exposure of the renal hilum and adrenal and superior pole of the kidney is necessary. We present four consecutive cases in which this approach was taken by a single surgeon at our tertiary surgical centre. The outcomes, postoperative course, and pathology are described. We provide a comprehensive literature review and outline the indications, advantages, and disadvantages of this approach. Objectives. To present a case series outlining the efficacy and safety of the thoracoabdominal incision in complex oncologic procedures in urology. Methods. Four cases utilizing the thoracoabdominal incision, performed by a single surgeon at our tertiary care center, were reviewed. Case history, preoperative imaging, intraoperative experience, postoperative course, final pathology, and complications were examined. A thorough literature review was performed and comparison made with historical cohorts for estimated blood loss, length of stay, and complications encountered versus other common surgical approaches. The indications, advantages, and disadvantages of the thoracoabdominal approach were outlined. Results. All patients had large retroperitoneal masses of varying complexity, requiring maximal surgical exposure. Surgery was straightforward in all cases, without any significant perioperative or postoperative complications. Postoperative pain, length of hospital stay, estimated blood loss, and analgesia requirements were all similar to open and mini-flank approaches in review of historical case series cohorts. Laparoscopic approaches had lower estimated blood loss and length of stay. Conclusions. The thoracoabdominal approach is rarely utilized in urological surgery, due to the perceived morbidity in violating the thoracic cavity. These cases outline the benefit of the thoracoabdominal approach in select cases requiring maximal surgical exposure, and the generally benign postoperative course that appropriately selected patients may hope to endure. Postoperative pain, length of hospital stay, estimated blood loss, and analgesia requirements can be expected to be similar open and mini-flank approaches. As expected, laparoscopic approaches had lower estimated blood loss and length of stay.
RESUMEN
PURPOSE: Standardized bench testing of the new ShockPulse™ intracorporeal lithotripter was performed against three commercially available lithotripsy systems to determine differences and nuances in performance. MATERIALS AND METHODS: The ShockPulse intracorporeal lithotripter was tested against the LUS-2™, CyberWand,™ and EMS LithoClast™ in a standardized bench setting using hard (Ultracal-30) and soft (plaster of Paris) stone phantoms. An in vitro kidney model was used to record the time needed to fragment stone samples into retrievable-sized pieces. The time needed to fully comminute and evacuate stone samples was also recorded. The efficacy of each device at various applied pressures was determined using a hands-free apparatus, which was used to apply 1.0, 1.5, and 2.0 pounds of fixed force. RESULTS: For hard and soft stones, the time needed to create retrievable fragments was similar among all systems (p = 0.585). The ShockPulse was significantly faster than the LUS-2 and LithoClast at fully fragmenting and evacuating stone samples (p = 0.046), while the CyberWand was significantly slower than all three systems at this task (p = 0.001). When fixed forces were applied to a large stone phantom, the ShockPulse and CyberWand were significantly faster than the LUS-2 and LithoClast (p < 0.0001). When groups of smaller stones were tested, the ShockPulse was significantly faster at 1.0 pound (p < 0.001) and 1.5 pounds (p < 0.002) of force. At 2.0 pounds, no differences were observed (p = 0.09). CONCLUSIONS: The ShockPulse is equally as effective and, in some circumstances, more effective than the three commercially available devices against which it was tested in an in vitro setting.
Asunto(s)
Cálculos Renales/terapia , Litotricia/instrumentación , Nefrostomía Percutánea/instrumentación , Humanos , Litotricia/normas , Nefrostomía Percutánea/normas , Tempo Operativo , Fantasmas de Imagen , Estándares de ReferenciaRESUMEN
Over one third of patients with myotonic muscular dystrophy type 1 (DM1) have gastrointestinal complaints. The cause is multifactorial, and treatment options are limited. Twenty DM1 patients with gastrointestinal symptoms were screened over a 2-year period using glucose breath hydrogen testing (GBHT) to evaluate the prevalence of small intestinal bacterial overgrowth (SIBO). Sixty-five percent of patients had a positive GBHT, and diarrhea was the most common presenting symptom. Ciprofloxacin was the most common antibiotic used for treatment, and 70% of patients reported a good response to the initial course of treatment. Although the causes of gastrointestinal symptoms in patients with DM1 are multifactorial, small intestinal bacterial overgrowth is an important diagnostic consideration that is easily diagnosed using glucose breath hydrogen testing and often shows a good response to treatment with common antibiotics.