Multi-aspect analysis of ureteral access sheath usage in retrograde intrarenal surgery: A RIRSearch group study

Objective:To evaluate the effect of ureteral access sheath(UAS)use and calibration change on stone-free rate and complications of retrograde intrarenal surgery(RIRS).Methods:Data from 568 patients undergoing RIRS for kidney or upper ureteral stones were retrospectively included.Firstly,patients were compared after 1:1 propensity score matching,according to UAS usage during RIRS(UAS used[+]87 and UAS non-used[−]87 patients).Then all UAS+patients(n=481)were subdivided according to UAS calibration:9.5-11.5 Fr,10-12 Fr,11-13 Fr,and 13-15 Fr.Primary outcomes of the study were the success and complications of RIRS.Results:Stone-free rate of UAS+patients(86.2%)was significantly higher than UAS−patients(70.1%)after propensity score matching(p=0.01).Stone-free rate increased with higher caliber UAS(9.5-11.5 Fr:66.7%;10-12 Fr:87.0%;11-13 Fr:90.6%;13-15 Fr:100%;p<0.001).Postoperative complications of UAS+patients(11.5%)were significantly lower than UAS−patients(27.6%)(p=0.01).Complications(8.7%)with 9.5-11.5 Fr UAS was lower than thicker UAS(17.2%)but was not statistically significant(p=0.09).UAS usage was an independent factor predicting stone-free status or peri-and post-operative complications(odds ratio[OR]3.654,95%confidence interval[CI]1.314-10.162;OR 4.443,95%CI 1.350-14.552;OR 4.107,95%CI 1.366-12.344,respectively).Conclusion:Use of UAS in RIRS may increase stone-free rates,which also increase with higher caliber UAS.UAS usage may reduce complications;however,complications seemingly increase with higher UAS calibration.

Effect of bariatric surgery on humoral control of metabolic derangements in obese patients with type 2 diabetes mellitus: How it works

Obesity and diabetes is a co-pandemic and amajor health concern that is expanding. It has many psychosocial and economic consequences due to morbidity and mortality of this disease combination. The pathophysiology of obesity and related diabetes is complex and multifactorial. One arm of this disease process is the genetic susceptibility. Other arm is dependent on the intricate neuro-humoral factors that converge in the central nerve system. Gut hormones and the adipose tissue derived factors plays an important role in this delicate network. Bariatric surgery provides the only durable option for treatment of obesity and furthermore it provides a remission in the concomitant diseases that accompany obesity. This review provides a brief insight to all these mechanisms and tries to deduce the possible reasons of remission of type 2 diabetes after bariatric surgery.

Ultrasound Guided Erector Spinae Block with Costotransverse Ligament Puncture Is More Effective than Erector Spinae Block Alone;Eight Cases for Oncologic Breast Surgery;A Brief Technical Report

Objectives: Due to the complex breast innervation, postoperative analgesia after breast surgery is a challenge for the anesthesiologists. The erector spinae plane block (ESP) is a newly defined promising technique for this purpose. Since the description by Forero, ultrasound-guided erector spinae block (ESP) has performed for several surgeries for postoperative analgesia. Many regional methods pectoral nerve block (PECs), serratus plane block (SPB), were described in the literature for maintaining postoperative analgesia. Among all these regional anesthesia techniques, paravertebral block (PVB) is the most studied and found to be a valid regional technique for this purpose. Due to its anatomic proximity to the pleura and central neuraxial system, it’s also one of the most challenging techniques. Materials and Methods: Patients aged between 37 and 47 years, American Society of Anesthesiologists physical status I-II and scheduled for elective unilateral modified radical mastectomy (MRM) surgery without axillary lymph node dissection were enrolled to this case series. In this report, we describe a novel combination of ESP and simplified PVB block and its successful application in 8 cases of oncologic breast surgery. In our clinic, ESP block is performed for all oncological breast cases. Eight cases of MRM without axillary dissection were randomly selected by the same anesthesiologist (AS). 15 mL 0.25% bupivacaine was administered between the erector spinae muscles and the transverse process at the level of the 4th thoracal vertebra with the caudo-cranial approach. Additionally, the needle tip was directed to T4 superior costotransverse ligament, and the ligament was perforated at the top point where it attaches to the T4 transverse process. Results: The ESP block is used for a local anesthetic depot, as a safe and straightforward technique and costotransverse ligament puncture facilitates diffusion and ensures local anesthetic passage to the paravertebral area for thoracic postsurgical analgesia. Using lower doses, comparing this combination with all studies with ESP, it appears that there are a better Numeric Pain Rating Scale (NPRS) scores in the first postoperative hours. NPRS scores at the 12th and 24th hours appear to be similar to those performed in ESP without costotransverse ligament puncture. Conclusion: We submit the first description of a novel combination of ESP block and simplified paravertebral block (PVB) and its successful application in 8 cases of oncologic breast surgery.

Ultrasound-Guided Erector Spinae Plane Block for Lumbar Spinal Stenosis Surgery

Background: In this retrospective observational study, we evaluated patients who underwent elective lumbar stenosis surgery between February 1, 2019, and April 1, 2019. Patients who underwent surgery for lumbar spinal stenosis under general anesthesia alone were compared with those who underwent general anesthesia combined with erector spinae plane block. Aims: We aimed to retrospectively evaluate whether erector spinae plane block reduced opioid consumption following surgery for spinal stenosis. Study Design: A retrospective observational study. Methods: We collected data on the pain scores, time for the first requirement for patient-controlled analgesia with tramadol, the cumulative patient-controlled analgesia dose, requirement for rescue analgesia, time to first stand up postoperatively and the incidence of postoperative nausea and vomiting. Results: Sixty patients were included in the study. The numerical rating scale’s pain scores were significantly lower in the erector spinae plane group at 1, 2, 4, 6, 12 and 24 hours than in the general anesthesia group. The cumulative dose of patient-controlled analgesia with tramadol was higher in the general anesthesia group than in the ESP group [212.0 (6.6) mg, vs. 107.3 (36.9 mg), (p <0.001)]. The time to first stand up after surgery was significantly longer in the general anesthesia group (p = 0.011). Conclusion: ESP block appear to be an effective method to relieve pain after lumbar surgery.

Disease that should be remembered: Sacrococcygeal pilonidal sinus disease and short history

Pilonidal sinus disease has led to heated debates since it was first described in the medical literature. Although a consensus has been built on its etiology and pathogenesis, the same course has not progressed for treatment modality. This review is a short article about the process of pilonidal sinus disease from past to present. Some important points were mentioned between the years 1833, which is accepted as the milestone for the awareness of the disease, in which it was first reported until the year of 1880, in which it was given its name. Although its name has been the same for about two centuries, some other names such as "Jeep Disease" have also been used depending on the population affected by the disease. At present, it is indisputable that the disease is acquired. Large series were presented about the treatment in the last two decades. Some surgical methods were even named after the ones who first described them and they have many supporters. However, since the treatment modalities have some advantages and disadvantages and they do not have marked superiority over others, debates still continue. We hope that pilonidal sinus disease will not lose its significance and be underrated in parallel with the developments in technology and specialization in medicine.

Novel Membranes Regenerated from Blends of Cellulose/Gluten Using Ethylenediamine/Potassium Thiocyanate Solvent System

Current industrial methods for dissolution of cellulose in making regenerated cellulose products are relatively expensive,toxic and dangerous and have environmental problems coming with the hazard chemical wastes.To solve these problems,a novel ethylenediamine and potassium thiocyanate(ED/KSCN)solvent system was developed,that is economical,ecofriendly,and highly efficient.The ED/KSCN solvent system was proven to be a suitable solvent for fabricating cellulose(blended with other polymers)membranes.In this study,gluten was used to develop nonporous membranes with cellulose.The method of casting these membranes provided better ones than the former researchers’techniques.These composite membranes’physical and mechanical properties were studied by analysis of morphology,viscosity,crystallinity,thermal behaviors,tensile properties and water absorption of membranes.Results showed that membranes are nonporous,uniform,strong,flexible,ecofriendly and renewable.Mechanical and physical properties were influenced by the ratio of cellulose/gluten.By blending 40% gluten,the tensile strength of cellulose membrane dropped to 15.89 MPa from 35.11 MPa.However,its elongation at break increased from 35.3% to 57.02% accordingly.

The Death of the Security Goddess Securitas: Brave New World

The term“security”comes from the word“Securitas”.Securitas was the Goddess of security and stability,in the Roman Empire.In modern times,security is often described as the absence of threat and fear.However,this conceptualization has perils of which Aldous Huxley’s novel Brave New World can be accepted as the most extreme example.In such a world there is no need for the security goddess Securitas anymore.Everything is automated from birth to death.There is no fear and nothing to be afraid of,but the price that is paid,is becoming robotic in a totalitarian society.That is why a new conceptualization and a new definition of security can help prevent and overcome this totalitarian problem.By analyzing the main themes of the BNW novel without going into the details of the events and characters;the main purpose of this paper is to examine the issue of security and its nature and to offer a new definition of security.Firstly,a very short plot of the novel will be given.Secondly,the themes and ideas of the BNW will be discussed in terms of why it is a dystopia rather than a utopia.Thirdly,BNW will be evaluated in juxtaposition with the concept of security.Finally,an alternative definition of the concept of security will be offered in order to enhance its meaning and also to be able to prevent the coming of a possible future like BNW.

Corpus callosum in schizophrenia with deficit and non-deficit syndrome:a statistical shape analysis

Background The corpus callosum(CC)is the most targeted region in the cerebrum that integrates cognitive data between homologous areas in the right and left hemispheres.Aims Our study used statistical analysis to determine whether there was a correlation between shape changes in the CC in patients with schizophrenia(SZ)(deficit syndrome(DS)and non-deficit syndrome(NDS))and healthy control(HC)subjects.Methods This study consisted of 27 HC subjects and 50 schizophrenic patients(20 with DS and 30 with NDS).3 patients with DS and 4 patients with NDS were excluded.Three-dimensional,sagittal,T1-spoiled,gradient-echo imaging was used.Standard anatomical landmarks were selected and marked on each image using specific software.results As to comparing the Procrustes mean shapes of the CC,statistically significant differences were observed between HC and SZ(DS+NDS)(p=0.017,James’s Fj=73.732),HC and DS(p<0.001,James’s Fj=140.843),HC and NDS(p=0.006,James’s Fj=89.178)and also DS and NDS(p<0.001,James’s Fj=152.967).Shape variability in the form of CC was 0.131,0.085,0.082 and 0.086 in the HC,SZ(DS+NDS),DS and NDS groups,respectively.Conclusions This study reveals callosal shape variations in patients with SZ and their DS and NDS subgroups that take into account the CC’s topographic distribution.