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The effectiveness of radiation-free RIRS (Retrograde intrarenal surgery) in children and factors affecting success
No full textPediatrik hasta populasyonunda, üriner taşlar için mevcut tedavi seçenekleri arasında ESWL, perkütan nefrolitotomi ve üreteroskopik işlemler yer almaktadır. Literatürde intrarenal taşların üreteroskopik tedavisine ilişkin veriler sınırlıdır. İntrarenal taşların endoskopik tedavi modalitelerinden en önemlisi olan RIRS (Retrograd Intrarenal Surgery), rutin olarak bazı aşamalarında floroskopi kullanılan bir yöntemdir. Çalışmamızda kliniğimizde rutin olarak floroskopi kullanılmadan (radiation- free) uyguladığımız RIRS ile ilgili deneyimlerimizi inceledik. Bu çalışmada incelediğimiz yaş grupları arasında sonuçların farklılık gösterip göstermediğini , kendi sonuçlarımız ile az sayıdaki diğer çalışmaların sonuçları ile arasındaki farkı ve floroskopinin bu yöntemdeki gerekliliğini, operasyon ve taş kırma sürelerini incelediğimiz faktörlerin nasıl etkilediğini , cerrahi başarıyı etkileyen faktörlerin neler olduğunu ve nasıl etkilediklerini değerlendirmeyi amaçladık. Ağustos 2013 ile Ocak 2017 tarihleri arasında kliniğimizde intrarenal taşları için RIRS uyguladığımız 52 pediatrik hastayı (<18yaş) retrospektif olarak inceledik. Yaş ortalaması 7,6 (1-17) olan tüm hasta grubu, okul öncesi yaş grubu (0-5yaş), okul çağı yaş grubu (6-10yaş) ve adolesan yaş grubu olmak üzere üç ayrı gruba ayrıldı. Tüm hasta grubunun yaş ,cinsiyet , taşın bulunduğu taraf ve lokalizasyon, taşın kimyasal yapısı, boyutu, preoperatif uygulanan görüntüleme yöntemi, operasyon ve taş kırma süreleri, preoperatif J stent takımı ve intraoperatif UAS (ureteral access sheat) uygulanması, cerrahi başarı durumu verileri değerlendirildi. Üç grubun bu verilerle ilgili aralarında fark olup olmadığı incelendi. Operasyon ve taş kırma süreleri ve bunları etkileyen faktörler değerlendirildi. Cerrahi başarı 3mm ve üstünde rezidü kalmaması olarak belirlendi. Hastaların taşsızlık oranları işlemden 1 ay sonra çekilen üriner sistem ultrasonu veya spiral opaksız taş tomografisi ile değerlendirildi. Ortalama yaş 7,6 olan toplam 52 hastaya (26 erkek/ 26 kadın) RIRS uygulandı. Ortalama taş boyutu 10,2mm (4-27) idi. Ortalama operasyon süresi 37,3 dk (25-70) iken ortalama taş kırma süresi 25,3 dk (10-45) idi. Cerrahi başarı oranı %73,1 olarak hesaplandı. Hastaların %32,3 üne preoperatif J stent takılırken, %42,3‟üne intraoperatif UAS (ureteral access sheat) uygulandı. Hastaların hiçbirinde herhangi bir komplikasyon tespit edilmedi. Yaş, taş boyutu, taraf, lokalizasyon, preoperatif J stent takılması ve UAS uygulanması faktörlerinin cerrahi başarıya olan etkileri incelenmiş; sadece taş boyutu ile cerrahi başarı arasında anlamlı ilişki bulunmuştur. Operasyon ve taş kırma süresini etkileyen faktörler incelenmiş. Korelasyon analizi ile peoperatif J stent takılmasının, UAS uygulamasının operasyon süresini kısalttığı, taş boyutunun büyüdükçe operasyon süresinin uzadığı görülmüştür. Yine UAS uygulananlarda taş kırma süresinin kısaldığı, taş boyutu artıkça bu sürenin uzadığı görülmüştür. Fleksibıl üreterorenoskopi pediatrik hasta populasyonunda intrarenal taşların tedavisinde güvenli ve etkili bir yöntemdir. Bu yöntemde tecrübenin artmasıyla floroskopi kullanmadan da benzer sonuçlar elde edilebilir. Fleksibıl üreterorenoskopi yüksek taşsızlık oranları ve düşük komplikasyon oranları ile orta boy taşlar için kurumumuzda ilk basamak tedavi olarak yerini almıştır.In the pediatric patient population, available treatment options for urinary stones include ESWL, percutaneous nephrolithotomy and ureteroscopic procedures. Literature on ureteroscopic treatment of intrarenal stones is limited. RIRS (Retrograde Intrarenal Surgery), which is the most important endoscopic treatment modality of intrarenal stones, is a method that routinely uses fluoroscopy in some stages. In our study, we evaluated our experience with RIRS, which we routinely use without fluoroscopy (radiation-free) in our clinic. The aim of this study is to evaluate whether the results differ between age groups we examined, the difference between our own results and the results of a few other studies, the necessity of fluoroscopy in this modality, how the factors we examined affect the duration of operation and lithotripsy, the factors affecting surgical success, and their mode of influence. We retrospectively reviewed 52 pediatric patients (<18 years old) who underwent RIRS for intrarenal stones between August 2013 and January 2017 in our clinic. The entire patient group was divided into three groups: pre-school age group (0-5 year old), school age group (6-10 years old) and adolescent age group and the mean age was 7.6 (1-17). For all patient groups, age, sex, side and localization of the stone, stone chemical structure and size, preoperative imaging method, operation and stone breaking time, preoperative J stent insertion and intraoperative UAS (ureteral access sheat) application, and data on the surgical success were evaluated. The presence of any differences between the three groups regarding these data was analyzed. The duration of operation and lithotripsy and the factors affecting those were evaluated. Surgical success was determined as the absence of residues sized 3mm or higher. The stone-free rates of the patients were evaluated by urinary system ultrasonography or spiral opacity- free stone tomography 1 month after the procedure. A total of 52 patients (26 male / 26 female) with a mean age of 7.6 underwent RIRS. The average stone size was 10.2mm (4-27). The mean duration of operation was 37.3 min (25-70) while the mean duration of lithotripsy was 25.3 min (10-45). Surgical success rate was calculated as 73.1%. Preoperative J stent was applied in 32.3% of patients and intraoperative UAS (ureteral access sheath) was applied to 42.3% of patients. No complications were detected in any of the patients. The effects of age, stone size, side and localization of the stone, preoperative J stent insertion and UAS application factors on surgical success were examined; the only statistically significant correlation was between the stone size and surgical success. Factors affecting duration of operation and lithotripsy were investigated. Correlation analysis showed that insertion of a pre-operated J stent and UAS application shortened the operation time and that the operation time was prolonged as the stone size increased. Again, UAS application shortens the duration of the lithotripsy, and this duration was prolonged as the stone size increased. Flexible ureterorenoscopy is a safe and effective method for the treatment of intrarenal stones in a pediatric patient population. As experience increases in this method, similar results can be obtained without using fluoroscopy. Flexible ureterorenoscopy has taken its place as the first-line treatment for medium stones in our institution, due to its high stone-free and low complication rates
Üroloji Yatakli Servisinde Komplike-Akut Pyelonefrit Tanisi İle Yatan Ve İdrar Kültüründe Üremesi Olan Hastalarin Değerlendirilmesi
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Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Full text linkWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
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