A nefrolitotripsia percutânea (NP) é uma das principais formas de tratamento de cálculos renais volumosos. O acesso percutâneo lateral é feito com o paciente em decúbito dorsal horizontal. O estudo objetivou avaliar os resultados de acesso lateral, em posição modificada, no tratamento percutâneo de cálculos renais e também o mesmo associado ao ureteroscópico, em caso de cálculos renais e ureterais concomitantes. Estudou-se 88 pacientes e os resultados foram considerados bem sucedidos em 69,32%. As complicações mais comuns foram febre e sangramento. Concluímos que a NP com acesso lateral apresenta sucesso no tratamento da litíase oferecendo vantagens no posicionamento para realização de procedimento associado à ureteroscopia / Percutaneous nephrolithotripsy (PN) is one of the main alternatives for the treatment of large renal stones. The present study aimed to evoluate the results of the lateral percutaneous approach, in a modified position, for the treatment of kidney stones. We also evaluated the association of the percutaneous with the uretroscopic treatment in patients with concomitant kidney and ureteral stones. A total of 88 patients selected, 69,32% of patients were considered complete success. The most common complication was the development fever and bleeding. In conclusion the PN using the lateral approach is a safe procedure with a high success rate in the treatment of kidney stones and is a advantageous, for patient positioning especially for the performance of ureteroscopic procedures

With the high development of society and economy, the rising level of national education, and the awareness of consumer rights in Taiwan, consumers¡¦ demands for medical and health care is increasing. The role of consumers has transformed to actively select and require medical and health care. The implementation of the National Health Insurance leads to the role change of the medical provider from a price maker to a price receiver, which benefits hospitals with mass product and cost control. Therefore, price-drive medical consumers become quality¡Vdriven ones, which benefits hospitals with good faculty, facilities and service. Nowadays, the hospital business environment is becoming more and more competitive. It is vital not only for hospital substantial business to create customer value of service and quality but also for hospital competitiveness to satisfy customer needs. The business strategy of hospitals is to greatly strengthen internal management and actively seek for the interaction with the external environment to keep survival and growth. Besides, hospitals apply CRM in order to attract new customers, retain old customers and to increase the profits of the customer contribution. Because of the limit of cost and budget tight policy, large hospitals are increasing their scale and the limited resource /number of customers. In this case, it is necessary for hospital¡¦s business strategy to focus on both quality and cost effectiveness. Hospitals build the tight relationship with customers so that they are willing to be diagnosed. Thus, Customer Relationship Management is the core competitive advantage for hospitals. Nevertheless, hospitals are less willing to purchase extracorporeal shock wave lithotripsy machines for the sake of the tight finance budget. As far as medical device suppliers are concerned, they have to adopt BOT approach in order to maintain business growth. Regarding the medical service and cooperation model for renal calculus patients, we discover that it is the equipment suppliers that are responsible for CRM rather than hospitals establishment. The retention number and returning frequency is the key to the revenues of the equipment suppliers, which means the relationship between hospitals and suppliers are unbroken. Our research indicates that the business model of extracorporeal shock wave lithotripsy machine can apply the concept of CRM. The medical equipment business and medical organization develop the model of the patient service with the base; CRM, the core value: customers and the hospital vision. We construct the ¡§four wins¡¨ model for the hospital, the patient, the Health Insurance Bureau and the business with the decision-making strategy, customer service and IT application.

A Hamiltonian model for the radial and translational dynamics of clusters of coupled bubbles in an incompressible liquid developed by Ilinskii, Hamilton, and Zabolotskaya [J. Acoust. Soc. Am. 121, 786-795 (2007)] is extended to included the effects of compressibility in the host liquid. The bubbles are assumed to remain spherical and translation is allowed. The two principal effects of liquid compressibility are time delay in bubble interaction due to the finite sound speed and radiation damping due to energy lost to acoustic radiation. The incorporation of time delays produces a system of delay differential equations of motion instead of the system of ordinary differential equations in models of bubble interaction in an incompressible medium. The form of the Hamiltonian equations of motion is significantly different from the commonly used models based on Rayleigh-Plesset equations for coupled bubble dynamics, and it provides certain advantages in numerical integration of the time-delayed equations of motion. Corrections for radiation damping in clusters of interacting bubbles are developed in the form of a time-delayed expression for bubble self-action following the method of Ilinskii and Zabolotskaya [J. Acoust. Soc. Am. 92, 2837-2841 (1992)]. A set of approximate series expansions of this delayed expression is calculated to first order in the ratio of bubble radius to the characteristic wavelength of acoustic radiation from the bubble, and to varying orders in the ratio of bubble radius to characteristic bubble separation distance. Stability of the delay differential equations of motion is analyzed with four successive levels of approximation for the effects of radiation damping and time delay. The stability is analyzed with and without the effects of viscous and thermal damping. The effect of time delay and radiation damping on the pressure radiated by small systems of bubbles is considered. An approximate method to account for the delays in bubble interaction in a weakly compressible liquid is presented. This method converts the system of delay differential equations into an approximate system of ordinary differential equations, which may simplify numerical integration. Several sets of model equations incorporating propagation time delay in bubble interactions are solved numerically with existing algorithms specialized for delay differential equations. Numerical simulations of the dynamics of single bubbles, pairs of bubbles, and clusters of bubbles are used to compare the different levels of approximation for compressibility effects for low- and high-amplitude radial motion in systems of bubbles under free response and pulsed excitation by an external pressure source. / text

Diss. (sammanfattning) Stockholm : Karol. inst., 2002. / Härtill 4 uppsatser.

A nefrolitotripsia percutânea (NP) é uma das principais formas de tratamento de cálculos renais volumosos. O acesso percutâneo lateral é feito com o paciente em decúbito dorsal horizontal. O estudo objetivou avaliar os resultados de acesso lateral, em posição modificada, no tratamento percutâneo de cálculos renais e também o mesmo associado ao ureteroscópico, em caso de cálculos renais e ureterais concomitantes. Estudou-se 88 pacientes e os resultados foram considerados bem sucedidos em 69,32%. As complicações mais comuns foram febre e sangramento. Concluímos que a NP com acesso lateral apresenta sucesso no tratamento da litíase oferecendo vantagens no posicionamento para realização de procedimento associado à ureteroscopia / Percutaneous nephrolithotripsy (PN) is one of the main alternatives for the treatment of large renal stones. The present study aimed to evoluate the results of the lateral percutaneous approach, in a modified position, for the treatment of kidney stones. We also evaluated the association of the percutaneous with the uretroscopic treatment in patients with concomitant kidney and ureteral stones. A total of 88 patients selected, 69,32% of patients were considered complete success. The most common complication was the development fever and bleeding. In conclusion the PN using the lateral approach is a safe procedure with a high success rate in the treatment of kidney stones and is a advantageous, for patient positioning especially for the performance of ureteroscopic procedures

The purpose of this study is to summarize the results of percutaneous nephrolithotomy (PCNL) for renal stones following failed extracorporeal shockwave lithotripsy (SWL), and to investigate the effect of previous SWL on the performances and morbidities of subsequent PCNL. Sixty-two patients with a history of failed SWL who underwent PCNL on the same kidney (group 1) were compared to 273 patients who had received PCNL as first treatment choice (group 2). Patient demographics, stone characteristics, operative findings, and complications were documented and compared. Groups 1 and 2 had similar patient demographics and stone characteristics. Mean time to establish access was comparable in both groups (10.5 ± 4.2 vs. 9.6 ± 4.5 min, p = 0.894). Time required to remove stones and total operative time were longer in group 1 (71.5 ± 10.3 vs. 62.3 ± 8.6 min, p = 0.011 and 95.8 ± 12.0 vs. 80.6 ± 13.2 min., p = 0.018, respectively). Group 1 had lower clearance rate compared to group 2 (83.9 vs. 93.4 %, p = 0.021), while postoperative complications were similar in both groups. Scattered stone fragments buried within the tissues made the procedure more difficult for stone fragmenting and extracting, which lead to longer operative time and inferior stone free rate. However, the PCNL procedure was safe and effective in patients with failed SWL. The risk of complications was similar and clearance rate was encouraging.

The purpose of this study is to summarize the results of percutaneous nephrolithotomy (PCNL) for renal stones following failed extracorporeal shockwave lithotripsy (SWL), and to investigate the effect of previous SWL on the performances and morbidities of subsequent PCNL. Sixty-two patients with a history of failed SWL who underwent PCNL on the same kidney (group 1) were compared to 273 patients who had received PCNL as first treatment choice (group 2). Patient demographics, stone characteristics, operative findings, and complications were documented and compared. Groups 1 and 2 had similar patient demographics and stone characteristics. Mean time to establish access was comparable in both groups (10.5 ± 4.2 vs. 9.6 ± 4.5 min, p = 0.894). Time required to remove stones and total operative time were longer in group 1 (71.5 ± 10.3 vs. 62.3 ± 8.6 min, p = 0.011 and 95.8 ± 12.0 vs. 80.6 ± 13.2 min., p = 0.018, respectively). Group 1 had lower clearance rate compared to group 2 (83.9 vs. 93.4 %, p = 0.021), while postoperative complications were similar in both groups. Scattered stone fragments buried within the tissues made the procedure more difficult for stone fragmenting and extracting, which lead to longer operative time and inferior stone free rate. However, the PCNL procedure was safe and effective in patients with failed SWL. The risk of complications was similar and clearance rate was encouraging.

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

O uso de LECO na população pediátrica ocorreu de forma lenta devido à baixa casuística e a incerteza dos efeitos das ondas de choque sobre os rins em desenvolvimento, eficiência, complicações e efeitos sobre órgãos adjacentes. No presente estudo, foram avaliadas 138 crianças, com idades entre 1 e 12 anos, portadoras de litíase do trato urinário tratadas com LECO, para avaliar a eficiência e complicações precoces do procedimento. A taxa de sucesso dos cálculos com menos de 11mm foi significantemente maior que nos cálculos maiores. Não foi observada diferença estatisticamente significante quando relacionamos a taxa de sucesso com idade, intensidade da onda e localização do cálculo / The use of Extracorporeal Shock Wave Lithotripsy (ESWL) in children has evolved rather slowly due to the small number of cases and the uncertainty about the effects of shock waves on the immature kidneys, its efficacy, complications and effects on the surrounding organs. In the present study, 138 children aged 1 to 12 years treated for urinary tract lithiasis by ESWL were evaluated in order to assess the efficacy and early complications of the procedure. The success rate for calculi smaller than 11mm was significantly higher than for larger calculi. When the success rate was correlated with age, intensity of the shock wave and location of the calculi no significant statistical difference was observed

O uso de LECO na população pediátrica ocorreu de forma lenta devido à baixa casuística e a incerteza dos efeitos das ondas de choque sobre os rins em desenvolvimento, eficiência, complicações e efeitos sobre órgãos adjacentes. No presente estudo, foram avaliadas 138 crianças, com idades entre 1 e 12 anos, portadoras de litíase do trato urinário tratadas com LECO, para avaliar a eficiência e complicações precoces do procedimento. A taxa de sucesso dos cálculos com menos de 11mm foi significantemente maior que nos cálculos maiores. Não foi observada diferença estatisticamente significante quando relacionamos a taxa de sucesso com idade, intensidade da onda e localização do cálculo / The use of Extracorporeal Shock Wave Lithotripsy (ESWL) in children has evolved rather slowly due to the small number of cases and the uncertainty about the effects of shock waves on the immature kidneys, its efficacy, complications and effects on the surrounding organs. In the present study, 138 children aged 1 to 12 years treated for urinary tract lithiasis by ESWL were evaluated in order to assess the efficacy and early complications of the procedure. The success rate for calculi smaller than 11mm was significantly higher than for larger calculi. When the success rate was correlated with age, intensity of the shock wave and location of the calculi no significant statistical difference was observed