Thesis (doctoral)--Freie Universität Berlin, 1981.

No description available.

Thesis (Ph. D.)--University of Wisconsin--Madison, 1940. / Typescript. Includes abstract and vita. eContent provider-neutral record in process. Description based on print version record. Bibliography: leaves 32-33.

A urolitíase ocorre com relativa freqüência dentre as afecções que acometem o trato urinário inferior de cães e gatos. Urólitos são agregados de material cristalino e matriz que se forma em um ou mais locais no trato urinário quando a urina torna-se supersaturada com substâncias cristalogênicas. A constituição dos urólitos pode ser decorrente de deposição de um único tipo mineral ou de minerais diferentes que se depositam em camadas (laminações) ou simplesmente agregam-se à pedra. Dependendo do tipo mineral e sua distribuição no urólito, este pode ser classificado em simples (apenas uma camada com predomínio - >70% - de um único tipo mineral), misto (também apenas uma camada identificável, porém sem predomínio de um único mineral) ou composto (presença de mais de uma camada de composição mineral diferente). Atualmente existem dois métodos de análise da composição mineral de cálculo: análise qualitativa e quantitativa, porém apenas a quantitativa permite a determinação do percentual das diferentes composições minerais, além de ser um método mais sensível e específico. Este estudo teve como objetivo analisar os casos de urolitíase canina que tiveram seus cálculos analisados quantitativamente, atendidos no Hospital Veterinário da Faculdade de Medicina Veterinária e Zootecnia da Universidade de São Paulo (FMVZ-USP). Foram analisados 161 urólitos provenientes de 156 cães (5 animais apresentaram recidiva), durante o período de fevereiro de 1999 a janeiro de 2007. Todas as análises foram realizadas no Minnesota Urolith Center, baseada nos métodos de microscopia de luz polarizada, espectroscopia infravermelha e espectroscopia por raios-X com dispersão de energia. Apenas 30,2% (106) dos urólitos eram simples, 1,9% (3) mistos e 67,9% (47) eram compostos. Apesar desse predomínio de urólitos compostos, a avaliação individual desses revelou que 64 de 106 urólitos compostos continham em todas as suas camadas, predomínio (>70%) de um mesmo tipo mineral: 26 continham estruvita, 35 oxalato de cálcio (mono ou dihidratado) e três de urato (urato ácido de sódio e urato ácido de amônio). Tais urólitos, apesar de classificados como compostos poderiam ser manejados como urólitos simples. Por outro lado, 30 urólitos compostos tinham a região interna minerais passíveis de dissolução, mas que seria impedida por uma camada mineral externa não passível de dissolução. O inverso ocorreu em 3 amostras (apenas a camada mais externa seria passível de dissolução) e outras duas amostras apresentaram deposição sequencial de minerais passíveis de dissolução, porém, que exigiriam protocolos distintos. Assim, o conhecimento da composição de todas as camadas (núcleo, pedra, parede e superfície) que compõe o urólito é essencial para o entendimento da formação do cálculo e conseqüentemente para a indicação do tratamento adequado, assim como para a prevenção de recidivas. / Urolithiasis is a relatively common urinary tract disorder of dogs and cats. Whenever urine becomes oversaturate with cristallogenic substances, uroliths may be formed from crystalline material and protein matrix. Uroliths may be composed from only one kind or from different types of minerals, which can be deposited in layers or aggregate forming a stone. They can be classified according to their mineral type and distribution in: simple (only one layer and more than 70% of a single mineral), mixed (one identifiable layer, without predominance of a mineral type) or coumpound (more than one layer of different mineral types). Currently, there are two methods of urolith analyses: quantitative and qualitative analysis. However, only quantitative analysis allows determination of the mineral composition with accuracy, and it is a more sensitive and specific test. One hundred and sixty one canine uroliths were obtained from the Hospital of the School of Veterinary Medicine and Zootechny of University of São Paulo (FMVZ-USP) and were submitted to Minnesota Uroliths Center for quantitative analysis from February 1999 to January 2007. All uroliths were analyzed using polarizing light microscopy, infrared spectroscopy and energy dispersive X-ray spectroscopy. One hundred and six (30,2%) were simple uroliths, 3 (1,9%) mixed, and 47 (67,9%) were compound. Despite the predominance of compound uroliths, individual urolithevaluation revealed that 64 of 106 compound uroliths had a predominant mineral type (>70%) in all layers: 26 were struvite, 35 calcium oxalate (mono or dihydrate) and 3 were urate (sodium acid urate and ammonium acid urate). These uroliths, despite being classified as compound uroliths, could be assumed as simple uroliths. However, 30 compound uroliths had dissoluble inner layers, but the outer layer would prevent them from being dissovable. Three samples had the opposite (outer layer could be dissoluted, but inner layer could not) and 2 other samples had required two different protocols for medical dissolution. Knowledge the composition of all layers (nidus, stone, shell and surface crystals) is essential to understand the urolith etiology and a key factor to successful therapy and prevent recurrence.

Conclusion This series of investigations demonstrated how we can apply our knowledge to improve the treatment outcome of ESWL. Based on clinical information, such as age, suitable candidates for ESWL can be identified, and hence better application of ESWL can be achieved. With an understanding of the benefits and limitations of imaging (NCCT and intravenous urography), treatment success can be predicted, and better treatment plans for patients can be formulated. A policy of more liberal use of analgesia during ESWL can also help to improve the treatment outcomes of patients. Finally, with the use of different assessment methods, the true impact of various new technologies or treatment protocols can be assessed, and the results can lead to better understanding of ESWL and also improvement in the treatment outcomes. / Materials and Methods In a retrospective review of treatment information of 2192 patients, the effect of age on stone-free rates after ESWL was assessed. Next, in a prospective study, the role of stone parameter, measured using non-contrast computerized tomography (NCCT), in predicting the treatment outcomes of upper ureteric stones was examined. The general applicability of caliceal pelvic height (CPH) in determining the treatment outcomes for lower caliceal stones for three different lithotriptors was assessed in the third study. In another retrospective comparative study, the effect on treatment outcomes of additional usage of intravenous analgesic during ESWL, as compared to oral analgesic premedication alone, was analyzed. Finally, the feasibility of the use of two statistical methods, logistic regression and matched-pair analysis, in comparing the treatment results of different lithotriptors was investigated. / Objectives Despite the initial success of extracorporeal shock wave lithotripsy (ESWL), the performance of the contemporary machines has never been as good as that of the first-generation machine. Therefore, a series of studies was conducted to advance the current knowledge of ESWL and investigate possible ways to further optimize the treatment outcomes. / Results We found that the stone-free rate after ESWL for older patients with renal stones, but not for those with ureteric stones, was significantly lower than that of younger patients. Stone parameters measured using NCCT, namely, mean stone density, stone volume, and skin-to-stone distance, were significant predictive factors for successful ESWL for upper ureteric stones. However, caliceal pelvic height, measured by intravenous urography, was a significant predictor of treatment outcomes of lower caliceal stones for only the Piezolith 2300 lithotriptor, and not the other two types of lithotriptors. The additional usage of intravenous analgesic improved the effectiveness quotient and hence treatment outcomes of ESWL. Finally, both logistic regression and matched-pair analysis were found to be feasible approaches for the comparison of the performance of different lithotriptors. / Chi-Fai Ng. / Source: Dissertation Abstracts International, Volume: 73-02, Section: B, page: . / Thesis (M.D.)--Chinese University of Hong Kong, 2010. / Includes bibliographical references (leaves 224-243). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [201-] System requirements: Adobe Acrobat Reader. Available via World Wide Web.

The main purpose of this research was to investigate new medical applications of femtosecond laser ablation. A near-infrared femtosecond laser was tested and proved to be able to overcome the existing limitations and outperform the conventional long-pulse lasers in the areas of human urinary calculus (kidney stone) lithotripsy and skin treatment. The two primary objectives of my research are: 1) to investigate the feasibility of using femtosecond pulsed laser radiation to ablate urinary calculus of various compositions. The laser-calculus interaction mechanism was characterized using pump probe imaging and fast flash imaging. A novel fiber delivery system was developed to transmit and focus high energy femtosecond pulses for urinary calculus lithotripsy. The successful demonstration of the femtosecond laser lithotripsy provided a promising treatment method better than the existing long-pulse laser lithotripsy in a few different aspects, including less collateral damage to surrounding tissue, small-size debris and more controlled experimental condition. 2) to investigate the depth limitation of femtosecond subsurface ablation in scattering skin sample and develop a prototype tissue optical clearing device to enhance femtosecond beam penetration for deeper subsurface cavitation production in the skin. The successful demonstration of the device has potential benefits to new femtosecond-based therapies for reshaping or removing subcutaneous tissues. / text

A urolitíase ocorre com relativa freqüência dentre as afecções que acometem o trato urinário inferior de cães e gatos. Urólitos são agregados de material cristalino e matriz que se forma em um ou mais locais no trato urinário quando a urina torna-se supersaturada com substâncias cristalogênicas. A constituição dos urólitos pode ser decorrente de deposição de um único tipo mineral ou de minerais diferentes que se depositam em camadas (laminações) ou simplesmente agregam-se à pedra. Dependendo do tipo mineral e sua distribuição no urólito, este pode ser classificado em simples (apenas uma camada com predomínio - >70% - de um único tipo mineral), misto (também apenas uma camada identificável, porém sem predomínio de um único mineral) ou composto (presença de mais de uma camada de composição mineral diferente). Atualmente existem dois métodos de análise da composição mineral de cálculo: análise qualitativa e quantitativa, porém apenas a quantitativa permite a determinação do percentual das diferentes composições minerais, além de ser um método mais sensível e específico. Este estudo teve como objetivo analisar os casos de urolitíase canina que tiveram seus cálculos analisados quantitativamente, atendidos no Hospital Veterinário da Faculdade de Medicina Veterinária e Zootecnia da Universidade de São Paulo (FMVZ-USP). Foram analisados 161 urólitos provenientes de 156 cães (5 animais apresentaram recidiva), durante o período de fevereiro de 1999 a janeiro de 2007. Todas as análises foram realizadas no Minnesota Urolith Center, baseada nos métodos de microscopia de luz polarizada, espectroscopia infravermelha e espectroscopia por raios-X com dispersão de energia. Apenas 30,2% (106) dos urólitos eram simples, 1,9% (3) mistos e 67,9% (47) eram compostos. Apesar desse predomínio de urólitos compostos, a avaliação individual desses revelou que 64 de 106 urólitos compostos continham em todas as suas camadas, predomínio (>70%) de um mesmo tipo mineral: 26 continham estruvita, 35 oxalato de cálcio (mono ou dihidratado) e três de urato (urato ácido de sódio e urato ácido de amônio). Tais urólitos, apesar de classificados como compostos poderiam ser manejados como urólitos simples. Por outro lado, 30 urólitos compostos tinham a região interna minerais passíveis de dissolução, mas que seria impedida por uma camada mineral externa não passível de dissolução. O inverso ocorreu em 3 amostras (apenas a camada mais externa seria passível de dissolução) e outras duas amostras apresentaram deposição sequencial de minerais passíveis de dissolução, porém, que exigiriam protocolos distintos. Assim, o conhecimento da composição de todas as camadas (núcleo, pedra, parede e superfície) que compõe o urólito é essencial para o entendimento da formação do cálculo e conseqüentemente para a indicação do tratamento adequado, assim como para a prevenção de recidivas. / Urolithiasis is a relatively common urinary tract disorder of dogs and cats. Whenever urine becomes oversaturate with cristallogenic substances, uroliths may be formed from crystalline material and protein matrix. Uroliths may be composed from only one kind or from different types of minerals, which can be deposited in layers or aggregate forming a stone. They can be classified according to their mineral type and distribution in: simple (only one layer and more than 70% of a single mineral), mixed (one identifiable layer, without predominance of a mineral type) or coumpound (more than one layer of different mineral types). Currently, there are two methods of urolith analyses: quantitative and qualitative analysis. However, only quantitative analysis allows determination of the mineral composition with accuracy, and it is a more sensitive and specific test. One hundred and sixty one canine uroliths were obtained from the Hospital of the School of Veterinary Medicine and Zootechny of University of São Paulo (FMVZ-USP) and were submitted to Minnesota Uroliths Center for quantitative analysis from February 1999 to January 2007. All uroliths were analyzed using polarizing light microscopy, infrared spectroscopy and energy dispersive X-ray spectroscopy. One hundred and six (30,2%) were simple uroliths, 3 (1,9%) mixed, and 47 (67,9%) were compound. Despite the predominance of compound uroliths, individual urolithevaluation revealed that 64 of 106 compound uroliths had a predominant mineral type (>70%) in all layers: 26 were struvite, 35 calcium oxalate (mono or dihydrate) and 3 were urate (sodium acid urate and ammonium acid urate). These uroliths, despite being classified as compound uroliths, could be assumed as simple uroliths. However, 30 compound uroliths had dissoluble inner layers, but the outer layer would prevent them from being dissovable. Three samples had the opposite (outer layer could be dissoluted, but inner layer could not) and 2 other samples had required two different protocols for medical dissolution. Knowledge the composition of all layers (nidus, stone, shell and surface crystals) is essential to understand the urolith etiology and a key factor to successful therapy and prevent recurrence.

Orientadores: Carlos Arturo Levi D'Ancona, Edson Antunes / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-25T22:31:02Z (GMT). No. of bitstreams: 1 Miyaoka_Ricardo_D.pdf: 38810158 bytes, checksum: a73083863b9c18c44630b11b53472286 (MD5) Previous issue date: 2014 / Resumo: Introdução: A terapia medicamentosa expulsiva no tratamento da calculose ureteral visa abreviar o tempo para eliminação espontânea do cálculo e evitar a necessidade de uma intervenção cirúrgica. As terapêuticas atuais baseiam-se essencialmente em bloqueadores de canais de cálcio e bloqueadores alfa-adrenérgicos, mas têm eficácia questionável, conforme demonstram estudos clínicos mais recentes e com alto nível de evidência. Assim, faz-se necessária a investigação persistente de novos agentes para este fim. Objetivos: Descrever modelo padronizado de contratilidade ureteral in vitro com segmentos isolados de ureter humano a fim de avaliar o relaxamento provocado pelo estimulador da guanilato ciclase solúvel BAY 41-2272; avaliar o envolvimento da via do NO-GMPc-PDE5 e dos canais de potássio e urotélio neste processo; avaliar a expressão das enzimas guanilato ciclase solúvel (GCs), óxido nítrico sintase (NOS) e fosfodiesterase tipo 5 (PDE5) no ureter por meio de imunohistoquímica. Materiais e Métodos: Segmentos de ureter distal de 17 doadores falecidos de múltiplos órgãos de ambos sexos (24 ¿ 65 anos de idade, média 40 ± 3.2 anos; homens 2:1 mulheres) foram utilizados. A contratilidade ureteral foi avaliada em banho de solução de Krebs e o tecido pré-contraído com KCl 80nM . Os valores de potência foram determinados como o log negativo da concentração molar para induzir 50% do relaxamento máximo nos espécimes pré-contraídos com KCl. O teste não-pareado T de Student foi usado para as comparações. Resultados: O BAY 41-2272 produziu relaxamento em ureter isolado em tecidos pré-contraídos com KCl (80 mM) com valores de potência (pEC50) e relaxamento máximo (Emax) de 5,82 ± 0,12 (n=8) e 84 ± 5%, respectivamente. A adição do inibidor da sintase de óxido nítrico (L-NAME, 100 ?M, n=6) ou da guanilato ciclase solúvel (ODQ, 10 ?M, n=6) reduziu em, 21 e 44% (P<0,05) a Emax, respectivamente, sem alteração dos valores de pEC50. A pré-incubação do inibidor da PDE5, sildenafil (100 nM) potencializou (pEC50: 6,39 ± 0,10, n=8, P<0,05) o relaxamento induzido pelo BAY 41-2272 em comparação à curva controle. A adição dos bloqueadores inespecíficos de canais de potássio (glibenclamida) ou ATP-dependentes (tetraetilamônio ¿ TEA) e a ausência de urotélio não interferiram nos parâmetro farmacológicos do BAY 41-2272. A imunorreatividade mostrou a presença da eNOS no endotélio de estruturas vasculares do ureter e nNOS no urotélio, estruturas nervosas e, fracamente, na musculatura lisa. A GCs é expressa tanto no urotélio como na musculatura lisa. A PDE5 é expressa, exclusivamente, na musculatura lisa. Conclusão: O BAY 41-2272 provoca relaxamento em segmentos ureterais humanos pré-contraídos com KCl em modelo in vitro de forma concentração-dependente, essencialmente pela ativação da guanilato ciclase presente no músculo liso, e não no urotélio, apesar de um mecanismo GMPc-independente poder estar envolvido. Esta nova classe farmacológica pode ter papel no tratamento clínico de cálculos ureterais obstrutivos / Abstract: Introduction: Medical expulsive therapy in the treatment of ureteral calculi aims to reduce the timeframe for spontaneous stone expulsion avoiding an unwanted surgical intervention. Current clinical therapy is essentially based upon the use of calcium channel blockers and alpha-adrenergic antagonists which have been recently shown to offer questionable efficacy according to well-designed recent clinical trials with a high level of evidence. As such, it is necessary to continue the pursuit for new agents that could abbreviate the time for ureteral stone expulsion. Objectives: To report on a standardized ureteral contractility in vitro model with isolated human ureter segments in order to characterize the relaxation induced by soluble guanylate cyclase stimulator BAY 41-2272; to assess the involvement of NO-cGMP-PDE5 pathway and potassium channels in ureteral relaxation; to assess the immunohystochemical expression of endothelial (eNOS) and neuronal NO synthase (nNOS), soluble guanylate cyclase (sGC) and type 5 phosphodiesterase (IPDE5) in human ureter. Materials and Methods: Distal ureteral segments harvested from 17 multiple organs deceased donors (age 24-65; mean 40 ± 3.2; men/women ratio 2:1) were used. Ureteral contractility was assessed with segments immersed into Kreb¿s solution after being pre contracted with 80mM KCl. BAY 41-2272 induced ureteral relaxation in KCl pre contracted isolated segments with pEC50 and Emax of 5,82 ± 0,12 (n=8) and 84 ± 5%, respectively. Addition of a NOS inhibitor (L-NAME, 100 ?M, n=6) or soluble guanylate cyclase (ODQ, 10 ?M, n=6) led to a reduction of 21% and 44% in Emax values (P<0,05), respectively. pEC50 values remained unaltered. PDE5 inhibitor sildenafil (100 n M) enhanced (pEC50: 6,39 ± 0,10, n=8, P<0,05) the relaxing effect provoked by BAY 41-2272 compared with control curve. Neither unspecific potassium channel blockers glibenclamide nor ATP-dependent potassium channel blocker tetraethylammonium (TEA) nor ureteral urothelium removal influenced the relaxation response by BAY 41-2272. Immunochemistry markers showed eNOS expression in ureteral vascular endothelium, nNOS in urothelium, nerve structures and with less intensity in smooth muscle. Soluble guanylate cyclase was present in urothelium and smooth muscle; and PDE5 was only expressed in ureteral smooth muscle. Conclusions: BAY 41-2272 relaxes human isolated ureter segments in a concentration-dependent manner, mainly by activating the sGC enzyme in smooth muscle cells rather than in the urothelium, although a cyclic guanosine monophosphate-independent mechanism may exist. This pharmacological class may have a role in treating ureteral obstructive calculi / Doutorado / Fisiopatologia Cirúrgica / Doutor em Ciências da Cirurgia

Introdução: A eficácia da litotripsia extracorpórea por ondas de choque (LECO) no tratamento de cálculos em cálice inferior do rim ainda é motivo de controvérsia. Variáveis que possam impactar nos resultados da LECO ainda não estão bem estabelecidos. Objetivo: Avaliar quais variáveis impactam na fragmentação e eliminação de cálculos em cálice inferior do rim após LECO. Material e Métodos: Avaliamos prospectivamente pacientes submetidos à LECO para tratamento de cálculos de cálice inferior de 5 a 20 mm. O índice de massa corpórea (IMC) e a circunferência abdominal foram medidos em cada caso. Um único radiologista, cego aos resultados da LECO, mensurou o tamanho, área e densidade dos cálculos, assim com a distância pele-cálculo, o comprimento, largura e altura infundibular, e o ângulo pielo-calicinal baseado na tomografia computadorizada (TC) realizada antes do procedimento. As taxas de fragmentação, sucesso (cálculos residuais <= 4 mm em pacientes assintomáticos) e eliminação completa foram avaliadas após uma única sessão de LECO, em uma segunda TC, realizada 12 semanas após o procedimento. Análises uni e multivariada foram realizadas. O nível de significância foi estabelecido em p<0,05. Resultados: Cem pacientes foram incluídos no estudo. A idade e IMC médios foram de 47,1 ± 12,5 anos e 28,0 ± 4,7 Kg/m2. O tamanho médio dos cálculos foi de 9,1 ± 3,0 mm. As taxas globais de fragmentação, sucesso e eliminação completa foram de 76%, 54% e 37%, respectivamente. Após a regressão logística múltipla, o IMC (p=0,004) e a densidade (p=0,005) do cálculo impactaram significativamente na fragmentação. O tamanho (p=0,039) e a densidade (p=0,012) do cálculo impactaram significativamente na taxa de sucesso, enquanto o tamanho do cálculo (p=0,029), sua densidade (p=0,046) e o comprimento infundibular (p=0,015) impactaram significativamente na taxa de eliminação completa. As maiores taxas de fragmentação, sucesso e eliminação completa foram encontradas em pacientes com IMC <= 30 Kg/m2, cálculo <=10 mm e <= 900 UH, e comprimento infundibular <= 25 mm. A coexistência das variáveis significantes de mau prognóstico proporcionou uma taxa de eliminação completa <20%. As taxas de doentes livres de cálculos foram menores em pacientes com medidas anatômicas desfavoráveis em relação àqueles com medidas favoráveis, embora a diferença tenha sido significante apenas para o comprimento infundibular (14% vs. 43%, p=0,02). Conclusão: Pacientes com IMC > 30 kg/m2 apresentam uma menor taxa de fragmentação dos cálculos. Tamanho (> 10 mm) e densidade (>900 UH) do cálculo, assim com o comprimento infundibular (>25 mm) influenciam negativamente nos resultados da LECO / Introduction: The efficiency of shock wave lithotripsy (SWL) for treatment of lower pole stone is still controversial. Variables that could impact on SWL outcomes are not well established. Objective: To evaluate which variables impact fragmentation and clearance of lower pole calculi after SWL. Material and Methods: We prospectively evaluated patients undergoing SWL for solitary lower pole kidney stones ranging from 5-20mm. Patient\'s body mass index (BMI) and abdominal waist circumference were recorded. One radiologist, blinded to SWL outcomes, measured stone size, area and density, stone-skin distance, infundibular length, width and height, and infundibulopelvic angle based on baseline noncontrast computed tomography (NCCT). Fragmentation, success (residual fragments <= 4mm in asymptomatic patients) and stone-free rates were evaluated after one single SWL by NCCT 12 weeks post-operatively. Univariate and multivariate analysis were performed. Significance level was set at p < 0.05. Results: One hundred patients were enrolled in this study. Mean age and BMI were 47.1 ± 12.5 years and 28.0 ± 4.7 Kg/m2. Mean stone size was 9.1 ± 3.0 mm. Overall fragmentation, success, and stone-free rates were 76%, 54%, and 37%, respectively. After multiple logistic regression, BMI (p=0.004) and stone density (p=0.005) impacted significantly on fragmentation. Stone size (p=0.039) and stone density (p=0.012) impacted significantly on success rate, whereas stone size (p=0.029), stone density (p=0.046), and infundibular length (p=0.015) impacted significantly on stone-free rate. The higher fragmentation, success and stone-free rates were found for patients with BMI <= 30 Kg/m2, stone <=10 mm and <=900 HU, and infundibular length <= 25 mm. The coexistence of unfavorable variables led to a stone-free rate <20%. Stone-free rates were lower for patients with unfavorable anatomic features compared to those with favorable measurements, although the difference was only significant for infundibular length (14% vs. 43%, p=0.02). Conclusion: Patients with BMI >30 Kg/m2 have a lower stone fragmentation rate. Stone size ( > 10 mm) and stone density (>900 UH), as well as infundibular length ( > 25 mm) impact negatively on SWL outcomes

by Lo, Kin Yin Anthony. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2011. / Includes bibliographical references (leaves 168-195). / Abstracts in English and Chinese. / Abstract --- p.i / Declaration --- p.V / Publications and Conference Presentations --- p.vi / Scholarships and Awards --- p.vii / Acknowledgements --- p.viii / Table of contents --- p.X / Abbreviations --- p.xiv / List of Figures --- p.xvi / List of Tables --- p.xvii / Chapter 1. --- General Introduction --- p.1 / Chapter 2. --- Literature Review --- p.7 / Chapter 2.1 --- Introduction of nephrolithasis and surgical management --- p.9 / Chapter 2.1.1 --- Epidemology and physiochemistry --- p.9 / Chapter 2.1.2 --- Surgical management of nephrolithasis parallel with stone factors --- p.15 / Chapter 2.2 --- Extracorpoeral Shock Wave Lithotripsy in present study --- p.17 / Chapter 2.2.1 --- The 4th generation - Sonolith Vision electroconductive lithotripter --- p.18 / Chapter 2.2.2 --- The role of shock wave delivery rate in treatment outcome and its prediction --- p.23 / Chapter 2.2.3 --- Patient-controlled analgesia during Shock Wave Lithotripsy treatment and its pain management --- p.29 / Chapter 2.2.4 --- Shock wave induced renal injury & the use of urinary biomarker --- p.35 / Chapter 3. --- Materials and Methods --- p.62 / Chapter 3.1 --- Study Design --- p.63 / Chapter 3.2 --- Patient Selection --- p.64 / Chapter 3.3 --- Treatment Protocol --- p.63 / Chapter 3.4 --- Sample size calculation --- p.68 / Chapter 3.5 --- Statistical analysis --- p.68 / Chapter 4. --- The effect of shock wave delivery rate on treatment outcome and its prediction --- p.69 / Chapter 4.1 --- Introduction --- p.70 / Chapter 4.2 --- Materials and Methods --- p.72 / Chapter 4.2.1 --- ESWL treatment protocol --- p.72 / Chapter 4.2.2 --- Outcome Assessment --- p.73 / Chapter 4.2.3 --- Mathematical model development --- p.75 / Chapter 4.2.4 --- Statistical analysis --- p.76 / Chapter 4.3 --- Results --- p.77 / Chapter 4.3.1 --- Baseline characteristics and treatment modalities --- p.78 / Chapter 4.3.2 --- ESWL treatment outcome --- p.79 / Chapter 4.3.3 --- Mathematical model --- p.81 / Chapter 4.4 --- Discussion --- p.82 / Chapter 4.4.1 --- Overall treatment outcome improved by the use of slower rate --- p.82 / Chapter 4.4.2 --- When should we use fast/slow rate? --- p.86 / Chapter 4.4.3 --- Mathematical model to predict ESWL outcome --- p.88 / Chapter 4.5 --- Conclusion --- p.91 / Chapter 5. --- The role of shock wave delivery rate and patient-controlled analgesia in pain --- p.101 / Chapter 5.1 --- Introduction --- p.102 / Chapter 5.2 --- Materials and Methods --- p.104 / Chapter 5.2.1 --- ESWL treatment protocol and PCA settings --- p.104 / Chapter 5.2.2 --- Outcome Assessment --- p.105 / Chapter 5.2.3 --- Statistical analysis --- p.107 / Chapter 5.3 --- Results --- p.108 / Chapter 5.3.1 --- Baseline characteristics and treatment modalities --- p.108 / Chapter 5.3.2 --- Pain experience and satisfaction with PCA at different shock wave delivery rates --- p.108 / Chapter 5.3.3 --- Correlation between rate pain --- p.110 / Chapter 5.3.4 --- Vital signs --- p.110 / Chapter 5.4 --- Discussion --- p.111 / Chapter 5.4.1 --- Adverse complication was mild with PCA using alfentanil --- p.111 / Chapter 5.4.2 --- Less pain experience with 60 SWs/min --- p.112 / Chapter 5.4.3 --- Why PCA usage was the same in both groups? --- p.112 / Chapter 5.4.4 --- No correlation with treatment outcome --- p.114 / Chapter 5.5 --- Conclusion --- p.115 / Chapter 6. --- "The relations among rate of shock wave delivery, induced renal injury and acute complications" --- p.128 / Chapter 6.1 --- Introduction --- p.129 / Chapter 6.2 --- Materials and Methods --- p.130 / Chapter 6.2.1 --- ESWL treatment protocol --- p.130 / Chapter 6.2.2 --- Outcome Assessment --- p.131 / Chapter 6.2.3 --- Statistical analysis --- p.136 / Chapter 6.3 --- Results --- p.137 / Chapter 6.3.1 --- Baseline characteristics and treatment modalities --- p.137 / Chapter 6.3.2 --- Quality control of creatinine and NAG --- p.137 / Chapter 6.3.3 --- Standard curves ofIL-18 and NGAL --- p.137 / Chapter 6.3.4 --- Higher levels of urinary NAG and IL-18 in 60 SWs/min group --- p.138 / Chapter 6.3.5 --- Similar levels of urinary NGAL in both groups --- p.138 / Chapter 6.3.6 --- Unplanned hospital visits were similar in both groups --- p.139 / Chapter 6.4 --- Discussion --- p.140 / Chapter 6.4.1 --- More tubular damages caused by slower rate --- p.140 / Chapter 6.4.2 --- Escalated inflammatory activities in 60 SWs/min --- p.141 / Chapter 6.4.3 --- Vascular damage and ischemic insults were the same in both groups? --- p.142 / Chapter 6.4.4 --- Post-operative complications are similar in both groups --- p.142 / Chapter 6.4.5 --- 60 SWs/min vs. 120 SWs/min - What makes the difference in renal injury? --- p.143 / Chapter 6.5 --- Conclusion --- p.145 / Chapter 7. --- Discussion --- p.154 / Chapter 7.1 --- General discussion --- p.155 / Chapter 8. --- Conclusion --- p.158 / Chapter 8.1 --- General conclusion --- p.159 / Appendix --- p.160 / Appendix I --- p.161 / Appendix II --- p.163 / References --- p.167