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ABSTRACT: To evaluate an alternative approach to tubeless surgery that allows a second percutaneous procedure using the same nephrostomy tract. Twenty patients underwent percutaneous nephrolithotomy from September 2012 to May 2013 at our institution. Inclusion criteria were: absence of urinary infection, single puncture and operative time less than 2h. Following the procedure the initially placed ureteral catheter was exteriorized through the working sheath by tying a non-absorbable suture to its end. On postoperative day 1 all patients were studied with non-enhanced CT or X-ray film. If the patient was rendered stone free, the stent was removed along with the urethro-vesical catheter. If a residual stone was present, we recovered the ureteral catheter and used the same nephrostomy tract for a second endoscopic procedure. Patients were assessed for pain, postoperative complications, length of stay, stone free rate, hematocrit and creatinine variations. Thirteen patients met the inclusion criteria. No major complications related to the stent placement and its exteriorization were seen. Two patients required a second percutaneous procedure successfully achieved recovering the ureteral catheter through the nephrostomy tract. We present a safe and simple modification of tubeless percutaneous nephrolithotomy, with its well-known clinical benefits but maintaining a safe path for an eventual second look procedure if necessary.Actas urologicas españolas 11/2013;
Article: Hibernoma pélvico giganteCirugía Española 11/2013; 91(9):e53. DOI:10.1016/j.ciresp.2013.06.006
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ABSTRACT: To evaluate seasonal distribution, mortality, serotype frequencies, antimicrobial susceptibility, and different severity scores among patients with BPP. Patients were identified by laboratory data and restricted to adulthood. Standard methods were used for serotyping and antimicrobial susceptibility. Risk factors were analyzed by univariate and multivariate methods. Severity scores (APACHE II, CURB-65 and CAP PIRO) were compared using ROC curves. Sixty events of community-acquired BPP occurred between 2005 and 2010. A seasonal pattern was detected. Mean age was 72.1 years old (81.4% ≥60 years). All had a predisposing factor. Previous influenza (3.3%) or pneumococcal immunization (1.7%) was infrequent. Admission to critical units was required by 51.7%. Twenty-two serotypes were identified among 59 strains. Only one strain had intermediate resistance to penicillin (1.7%). In-hospital mortality reached 33.3%. Multivariate analysis identified a CAP PIRO score>3 (OR 29.7; IC95 4.7-187), age ≥65 years (OR 42.1; IC95 2.2-796), and a platelet count<100,000/μL (OR 10.9; IC95 1.2-96) as significant independent factors associated with death. ROC curve analysis did not reveal statistical differences between the three severity scores to predict death (AUC 0.77-0.90). The prognostic yield for all of them was limited (Positive Likelihood Ratio: 1.5-3.8). BPP had a high case-fatality rate in this group of adult patients with no association to resistant isolates, and a low immunization record. Three independent factors were related to death and the prognostic yield of different severity scores was low.The Brazilian journal of infectious diseases: an official publication of the Brazilian Society of Infectious Diseases 10/2013; 18(2). DOI:10.1016/j.bjid.2013.06.001
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