1,721,697 research outputs found
Management of urolithiasis in renal transplantation
No full textObjective: To report our experience with extracorporeal shock wave treatment for upper urinary tract stones in transplanted kidneys. Patients and Methods: A total of eight patients underwent extracorporeal shock wave lithotripsy (SWL) in prone position under analgosedation with the Dornier MPL 9000 lithotripter or the Storz Modulith SLX lithotripter employing ultrasound targeting. The stones had overall diameter ranging 7-12 mm and were located in the renal calices in 5 cases and in the ureter in 3 cases. Five stones were radiopaque and 3 radiolucent. Results: Stone fragmentation was obtained in 87% of the patients and 75% became stone free within 90 days. Serum creatinine values and creatinine clearances remained stable within 30 days post-operatively in all the treated patients. Conclusions: SWL in transplanted kidney is feasible and simple to perform when the patient is treated in prone position with ultrasound targeting and without any complication or deterioration of renal function. Results similar to those achievable in native kidneys can be obtained also in graft kidneys with limited endourological antero-retrograde ancillary manouvres
Management of symptomatic BPH in Italy : Who is treated and how?
No full textOBJECTIVE: To investigate the management of symptomatic benign prostatic hyperplasia (BPH) in Italy.
METHODS: Information on diagnosis, medical and surgical treatment was obtained from two different questionnaires independently mailed to urological centers in Italy. Data on drug treatments were obtained from a national database. General practitioner (GP) clinical practice patterns were obtained from a panel discussion between general practitioners and urologists.
RESULTS: First line medical treatment is currently undertaken by GPs more often and to a smaller extent by urologists to whom patients can self-refer. Primary care diagnostic algorithm consists of patient's interview, physical rectal examination and urinalysis. The main reason for referral of a BPH patient to the urologist by GPs appears to be an unsatisfactory outcome of first line medical therapy. Examination of the suprapubic area plus rectal examination is always performed by urologists during physical examination while evaluation of motor and sensory function is carried out in 28% of patients only. Voiding diary and I-PSS score are currently used by 17 and 65% of urologists, respectively. Urinalysis, plasma creatinine and prostate specific antigen (PSA) are used in 100, 94 and 89% of cases, respectively. Ninety-four percent of urologists use uroflowmetry with evaluation of post voiding residual by ultrasound. Pressure-flow studies are used in selected cases by 89% of urologists. Ultrasound imaging of the kidney, bladder and prostate transrectal ultrasound (TRUS) is reported as current practice in 79, 71 and 53% of questionnaires, respectively. Over six million medical consultations with prescriptions for BPH were carried out in 1998 accounting for 190, 600,000 drug treatment days. Prescriptions for 5alpha-reductase inhibitors accounted for 71,400,000 days of treatment, alpha-blockers for 104,000,000 and plant extracts for 15,300,000 days. In 24 to 28% of cases more than one drug was prescribed. Indications for invasive treatment rely on symptoms (98%), presence of BPH complications (90%), flowmetry (65%), residual urine (50%), prostate volume (40%) and urodynamics (20%). About 10% of patients consulting the outpatient clinics were allocated to watchful waiting, 50% received pharmacological treatment and 40% invasive treatment. Analysis of invasive treatment options resulted in 62% of patients receiving transurethral resection of the prostate (TURP), 29% open prostatectomy and the remaining 9% received various forms of minimally invasive treatments. Patients were most commonly followed up for 3 months with 62% of patients followed up at one year post-operatively and then yearly.
CONCLUSIONS: Our survey suggests that the current clinical practice of primary and secondary care physicians is in line with the recommendations of the IVth International Consultation on BPH. However, Italian urologists seem to use less frequently symptom scores and voiding diaries than recommended. It seems that open surgery is more frequently used in Italy than in other European countries. Minimally invasive treatments remain a very small portion of interventions for the management of BPH in Italy. Fifty-five percent of patient days of treatment are alpha-blockers, 37% is finasteride. The share of alpha-blockers has dramatically grown with the introduction of the first prostate-selective agent, tamsulosin
D. Sabbatucci. Lo stato come conquista culturale ; E. Montanari. Roma. Momenti di una presa di coscienza culturale
No full textTurcan Robert. D. Sabbatucci. Lo stato come conquista culturale ; E. Montanari. Roma. Momenti di una presa di coscienza culturale. In: Revue de l'histoire des religions, tome 194, n°2, 1978. pp. 196-199
D. Sabbatucci. Lo stato come conquista culturale ; E. Montanari. Roma. Momenti di una presa di coscienza culturale
No full textTurcan Robert. D. Sabbatucci. Lo stato come conquista culturale ; E. Montanari. Roma. Momenti di una presa di coscienza culturale. In: Revue de l'histoire des religions, tome 194, n°2, 1978. pp. 196-199
Percutaneous nephrolithotomy in patients with spinal deformities
No full textBACKGROUND AND PURPOSE: To assess the feasibility and efficacy of percutaneous nephrolithotomy (PCNL) in patients with spinal deformities.
PATIENTS AND METHODS: Between 1999 and 2008, eight patients (nine renal units) with spinal deformities underwent 10 PCNLs. Mean stone burden was 372 mm(2) (160-840 mm(2)). Preoperative investigation of the respiratory function, evaluation of anatomy by intravenous pyelography or CT spiral scan, and preoperative planning of the percutaneous access by ultrasonography (US) were performed in all patients. Patients were either in a prone (n = 5) or supine (n = 5) position during PCNL. US-guided fluoroscopic adjusted percutaneous puncture of the desired calix was performed in all the patients.
RESULTS: There was a 40% complication rate related to the number of procedures, with 20% of patients needing blood transfusion and 10% experiencing major complications. Complete stone clearance per kidney after one PCNL was 55.5% (5/9 PCNLs), increasing to 66.6% (6/9 PCNLs) after a second PCNL. Four of nine (44.4%) renal units needed additional procedures after one PCNL (shockwave lithotripsy [SWL], retrograde intrarenal surgery [RIRS], combined simultaneous PCNL and RIRS). At the 3-month follow-up, the overall stone-free rate was 88.8% (eight renal units).
CONCLUSION: PCNL in patients with spinal deformities is challenging. Accurate preoperative evaluation of the anatomy and respiratory function and a precise preoperative planning are mandatory. US-guided puncture of the collecting system permits avoiding visceral injury. Supine PCNL offers advantages in terms of patient comfort, protection of cardiorespiratory function, and the ability to perform a simultaneous combined ureteroscopic approach, although the prone position, if feasible with the patient's body habitus, may offer a wider space for percutaneous access. Combination therapy with either SWL or RIRS after PCNL improves stone-free rate
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
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