The risk of sepsis after retrograde intrarenal surgery (RIRS) is low, at around 5%. Urosepsis is the most serious and possibly life-threatening complication of RIRS. Risk factors for sepsis after ...RIRS may be related to patients or surgery.
Nowadays, urolithiasis has become a highly prevalent disease. Recent studies indicate that retrograde intrarenal surgery (RIRS) is becoming more popular among surgical treatments due to the preference of patients and providers. This minimally invasive procedure results in high stone-free rates and relatively low morbidity; however, complications resulting from infection can still occur, including acute urinary tract infection, systemic inflammatory response syndrome, and sepsis.
To identify the independent risk factors for sepsis following RIRS, as well as general risk factors that may contribute to this life-threatening complication in the pre- and intraoperative periods.
A literature review was conducted in April 2020 using the Medline, Scopus, and Cochrane databases. We searched the references of included papers.
We screened 2306 manuscripts and selected 13 for inclusion. The sepsis rate ranged from 0.5% to 11.1%, and the septic shock rate ranged from 0.3% to 4.6%. All selected studies mentioned risks for sepsis and/or infective complications (including sepsis), but only four of them addressed independent risks for urosepsis. These independent risk factors were stone size, high irrigation pressure, prolonged stent dwelling time (>30 d), sepsis as an indication for stent insertion, female gender, positive intraoperative bladder urine culture, longer surgical time, and diabetes mellitus.
RIRS is associated with a low sepsis rate, according to the latest evidence. However, given that this is a serious life-threatening complication, knowing its potential risk factors is extremely important.
In this report, we looked at the outcome of sepsis after planned retrograde intrarenal surgery for stone disease in patients with and without comorbidities. This information may be useful for colleagues in their daily practice.
Alzheimer’s disease (AD) depicts dynamic changes in regional brain function from early stages of the disease. Arterial spin labeling- (ASL-) based MRI methods have been applied for detecting regional ...cerebral blood flow (rCBF) perfusion changes in patients with AD and mild cognitive impairment (MCI). Nevertheless, the results obtained from ASL studies in AD and MCI are still controversial, since rCBF maps may show both hypoperfusion or hyperperfusion areas in brain structures involved in different cognitive functions. The goal of this review is to provide the current state of the art regarding the role of ASL for detecting distinctive perfusion patterns in subjects with MCI and/or AD. The ability to obtain this information using a noninvasive and widely available modality such as ASL should greatly enhance the knowledge into the broad range of hemodynamically related changes taking place during the cognitive decline process in AD.
Este artículo presenta los resultados de una investigación sobre la asistencia a mujeres consideradas “víctimas de trata sexual” en la Comunidad de Madrid, España. Caracterizado por un enfoque ...cualitativo de la investigación, incluye entrevistas a 26 trabajadoras y educadoras sociales y análisis de documentos. Apuntamos a la existencia de mecanismos de control corporal y sexual, económico y vital, que producen formas de violencia en parte de las mujeres asistidas y de las trabajadoras. Algo posible gracias al nexo existente entre moral conservadora y los enfoques neoliberales en la asistencia a las víctimas de trata sexual. Urge reflexionar críticamente sobre estas prácticas para una asistencia que respete la voluntad de las personas implicadas y evite reproducir los mecanismos de control y violencia que trata de combatir.
The article discusses the findings of a research on the assistance of women identified as “sex trafficking victims” in the Autonomous Community of Madrid in Spain. The study includes qualitative interviews with social workers and educators, as well as the analysis of documents. The study points out that there are mechanisms of control of bodies and sexuality, of economic and life options, which, in turn, produce forms of violence on both the women assisted and those who assist them. The coming together of conservative morality and ancient forms of discrimination with the current neoliberal approaches that characterise actions with sex trafficking victims made possible these forms of control and violence. The research suggests the need to critically act upon current practices of assistance to prevent and reduce actions alien to the well-being of the people they address and spreading forms of violence similar to those that counter-trafficking claims to fight against.
O artigo discute os resultados de uma pesquisa sobre a assistência a mulheres identificadas como “vítimas do tráfico sexual” na Comunidade Autónoma de Madrid, na Espanha. O estudo inclui entrevistas qualitativas com assistentes sociais e educadoras, além da análise de documentos. O estudo aponta para a presença de mecanismos de controle dos corpos e da sexualidade, das opções económicas e de vida, que produzem formas de violência tanto sobre as mulheres assistidas quanto sobre aqueles que intervêm na sua assistência. O encontro da moral conservadora e de antigas formas de discriminação com as atuais abordagens neoliberais que caracterizam as intervenções junto das vítimas do tráfico sexual possibilita essas formas de controlo e violência. A pesquisa sugere a necessidade de intervir criticamente nas atuais práticas de assistência para prevenir e reduzir intervenções que não levam em conta o bem-estar da população a que se dirigem e difundem formas de violência semelhantes às que o combate ao tráfico pretende eliminar.
In recent decades, an anti-trafficking legislative and policy framework has been developed in Spain, coupled with the funding of initiatives related to the protection of trafficked persons, ...especially women, largely carried out by faith-based and secular organizations. Using 25 interviews conducted with people employed in programmes targeting trafficked women in the Autonomous Community of Madrid, this article provides deeper exploration of this under-studied subject with a view to gaining a better understanding of the work experiences of professionals involved in these initiatives, with special attention paid to the challenges they face in enacting anti-trafficking activities while avoiding producing violence on assisted persons. The experiences of these professionals highlight that the neoliberal outsourcing of services to non-governmental organizations nevertheless contributes towards making anti-trafficking an apparatus in which violence materializes and reproduces. Significantly, this violence involves not only the people who are being assisted as trafficking victims but also some anti-trafficking professionals.
(1) Objective: To support the efficacy and safety of a range of thulium fiber laser (TFL) pre-set parameters for laser lithotripsy: the efficiency is compared against the Holmium:YAG (Ho:YAG) laser ...in the hands of juniors and experienced urologists using an in vitro ureteral model; the ureteral damage of both lasers is evaluated in an in vivo porcine model. (2) Materials and Methods: Ho:YAG laser technology and TFL technology, with a 200 µm core-diameter laser fibers in an in vitro saline ureteral model were used. Each participant performed 12 laser sessions. Each session included a 3-min lasering of stone phantoms (Begostone) with each laser technology in six different pre-settings retained from the Coloplast TFL Drive user interface pre-settings, for stone dusting: 0.5 J/10 Hz, 0.5 J/20 Hz, 0.7 J/10 Hz, 0.7 J/20 Hz, 1 J/12 Hz and 1 J/20 Hz. Both lasers were also used in three in vivo porcine models, lasering up to 20 W and 12 W in the renal pelvis and the ureter, respectively. Temperature was continuously recorded. After 3 weeks, a second look was done to verify the integrity of the ureters and kidney and an anatomopathological analysis was performed. (3) Results: Regarding laser lithotripsy efficiency, after 3 min of continuous lasering, the overall ablation rate (AR) percentage was 27% greater with the TFL technology (p < 0.0001). The energy per ablated mass J/mg was 24% lower when using the TFL (p < 0.0001). While junior urologists performed worse than seniors in all tests, they performed better when using the TFL than Ho:YAG technology (36% more AR and 36% fewer J/mg). In the in vivo porcine model, no urothelial damage was observed for both laser technologies, neither endoscopically during lasering, three weeks later, nor in the pathological test. (4) Conclusions: By using Coloplast TFL Drive GUI pre-set, TFL lithotripsy efficiency is higher than Ho:YAG laser, even in unexperienced hands. Concerning urothelial damage, both laser technologies with low power present no lesions.
Moses technology was born with the aim of controlling the Moses effect present in every single Ho:YAG laser lithotripsy. The capacity to divide the energy pulse into two sub-pulses gained popularity ...due to the fact that most of the energy would be delivered in the second pulse. However, is this pulse modulation technique really better for endocorporeal laser lithoripsy? A review of the literature was performed and all relevant clinical trials of Moses 1.0 and 2.0, as well as the lab studies of Moses 2.0 carried out up to June 2022 were selected. The search came back with 11 clinical experiences (10 full-text clinical trials and one peer-reviewed abstract) with Moses 1.0 and Moses 2.0, and three laboratory studies (peer-reviewed abstracts) with Moses 2.0 only. The clinical experiences confirmed that the MT (1.0) has a shorter lasing time but lower laser efficacy, because it consumes more J/mm3 when compared with the LP Ho:YAG laser (35 W). This gain in lasing time did not provide enough savings for the medical center. Additionally, in most comparative studies of MT (1.0) vs. the regular mode of the HP Ho:YAG laser, the MT did not have a significant different lasing time, operative time or stone-free rate. Clinical trials with Moses 2.0 are lacking. From what has been published until now, the use of higher frequencies (up to 120 Hz) consumes more total energy and J/mm3 than Moses 1.0 for similar stone-free rates. Given the current evidence that we have, there are no high-quality studies that support the use of HP Ho:YAG lasers with MT over other lasers, such as LP Ho:YAG lasers or TFL lasers.
Seizures in children undergoing stem cell transplantation Turón‐Viñas, Eulalia; López‐Torija, Iván; Coca‐Fernández, Elisabet ...
Pediatric transplantation,
February 2024, 2024-Feb, 2024-02-00, 20240201, Letnik:
28, Številka:
1
Journal Article
Recenzirano
Odprti dostop
Background
Neurological complications (NCs) are of major concern following hematological stem cell transplantation (HSCT), most of which present with seizures.
Procedures
We performed a retrospective ...study (2002–2018) of patients undergoing HSCT in order to analyze the incidence and aetiologies related to seizures.
Results
Of 155 children undergoing HSCT, 27 (17.4%) developed seizures at some point in 2 years of follow‐up. The most frequent etiologies were central nervous system (CNS) infection (n = 10), drug toxicity (n = 8), and vascular disease (n = 5). A statistically significant association was found between seizure and the HSCT type (lower risk for a related identical donor, p = .010), prophylactic or therapeutic mycophenolate use (p = .043 and .046, respectively), steroid use (p = .023), selective CD45RA+ depletion (p = .002), pre‐engraftment syndrome (p = .007), and chronic graft‐versus‐host disease (GVHD) severity (p = .030). Seizures predicted evolution to life‐threatening complications and admission to intensive care (p < .001) and higher mortality (p = .023). A statistically significant association was also found between seizures and sequelae in survivors (p = .029). Children who developed seizures had a higher risk of CNS infection and vascular disease (odds ratio 37.25 95% CI: 7.45–186.05 and 12.95 95% CI 2.24–74.80, respectively).
Conclusions
Neurological complications highly impact survival and outcomes and need to be addressed when facing an HSCT procedure.
(1) Introduction: To evaluate the feasibility of measuring the intrapelvic pressure (IPP) during flexible ureterorenoscopy (f-URS) with a PressureWire and to optimize safety by assessing IPP during ...surgery. (2) Methods: Patients undergoing f-URS for different treatments were recruited. A PressureWire (0.014", St. Jude Medical, Little Canada, MN, USA) was placed into the renal cavities to measure IPP. Gravity irrigation at 40 cmH
O over the patient and a hand-assisted irrigation system were used. Pressures were monitored in real time and recorded for analysis. Fluid balance and postoperative urinary tract infection (UTI) were documented. (3) Results: Twenty patients undergoing f-URS were included with successful IPP monitoring. The median baseline IPP was 13.6 (6.8-47.6) cmH
O. After the placement of the UAS, the median IPP was 17 (8-44.6) cmH
O. With irrigation pressure set at 40 cmH
O without forced irrigation, the median IPP was 34 (19-81.6) cmH
O. Median IPP during laser lithotripsy, with and without the use of on-demand forced irrigation, was 61.2 (27.2-149.5) cmH
O. The maximum pressure peaks recorded during forced irrigation ranged from 54.4 to 236.6 cmH
O. After the surgery, 3 patients (15%) presented UTI; 2 of them had a positive preoperative urine culture, previously treated, and a positive fluid balance observed after the surgery. (4) Conclusion: Based on our experience, continuous monitoring of IPP with a wire is easy to reproduce, effective, and safe. In addition, it allows us to identify and avoid high IPPs, which may affect surgery-related complications.
Introduction
The current pool of organs available for transplantation does not cover requirements, for this reason non-standard risk donors need to be incorporated into the pool. In this way, donors ...with small renal tumour are considered for transplantation after bench tumour excision. The aim of our study was to analyse our experience in using these grafts for transplantation.
Materials and methods
Retrospective analysis from our prospective accrued database of donors with incidental renal mass used for kidney transplantation between January 2007 and August 2018.
Results
Twenty kidney transplantations were performed, thirteen cases received the affected kidney (after tumour removal) and seven the contralateral kidney; from six living and eleven deceased donors. Donor and recipient median age was 58 years (range 22–82) and 56.5 years (range 38–74), respectively. Mean tumour diameter was 12.7 mm (SD 9.5). Tumours resulted in two benign lesions and fifteen renal cell carcinoma. Surgical margins were negative. Two cases presented with bleeding after reperfusion was solved without repercussion. One case presented with immediate vein thrombosis. None of them present delayed graft function. After a 69 month follow-up none of the donors or the recipients presented tumour recurrence.
Conclusions
Kidneys with small incidental tumours seem to be a good option for kidney transplantation in selected patients after bench surgery excision with good functional and oncologic results. More studies and longer follow-up are needed to confirm these results.
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