1/12. The unexpected outcomes of acupuncture: case reports in support of refocusing research designs.Two distinct positive outcomes are possible with Classical acupuncture; resolution of the "main complaint" for which the patient is seeking treatment and unexpected resolution of health concerns for which the patient is not seeking treatment. Two clinical cases are presented to illustrate this phenomenon clearly. In both cases, the unexpected outcomes follow logically from the central therapeutic imperative of Oriental medicine; treatment of both the patient's root and branch. research designs focused on single health conditions do little to reflect this central clinical reality. To highlight this problem, the two cases presented here are repositioned within the framework of research designs focused on single health conditions. It becomes clear that any eventual "gold standard" of acupuncture-appropriate research designs would reflect the full health care service provided by Classical acupuncture. This, in turn, would ensure that health care policies based on research results would be appropriate to the realities of clinical acupuncture.- - - - - - - - - - ranking = 1keywords = puncture (Clic here for more details about this article) |
2/12. "Pass the ball!" Simultaneous flexible nephroscopy and retrograde intrarenal surgery for large residual upper-pole staghorn stone.Complex staghorn calculi have conventionally been treated with percutaneous nephrolithotomy, extracorporeal lithotripsy, or, occasionally, open surgery. Access to branched calculi is difficult through a single percutaneous track. We tested and make a case for a synchronous bidirectional technique combining the use of flexible instruments through percutaneous and retrograde approaches. We present a case of "pass the ball," which may have a place in tackling large, complex, or branched staghorn calculi without the need for multiple percutaneous punctures, removing larger fragments than is possible through the ureter and avoiding multiple passes through the ureter, saving time and decreasing the possibility of iatrogenic ureteral injury.- - - - - - - - - - ranking = 0.125keywords = puncture (Clic here for more details about this article) |
3/12. Percutaneous nephrolithotomy through an intercostal approach.During a 5-year period percutaneous nephrolithotripsy through an intercostal space was performed in 56 of 231 procedures. Minimal thoracic complications were seen in 3 of 53 patients with 11th intercostal space tracts into a lower, middle, or upper pole calyx. A working sheath and a pyelostomy drainage catheter were used in all these cases. Hydro- and pneumothorax requiring treatment occurred in 2 of 3 patients with a 10th intercostal space approach into an upper pole calyx combined with improper use of the working sheath and/or the pyelostomy catheter. review of the literature also indicates that an intercostal approach appears safe when performed via the 11th intercostal space into a lower or middle pole calyx. Thoracic complications occurred when punctures were made towards an upper pole calyx or above the 11th rib. The complications may be limited by identifying the posterior inferior lung border by fluoroscopy during puncture, and performing it under general anesthesia with controlled breath-holding. The use of a working sheath to seal the pleural opening during the procedure and an efficient pyelostomy drainage catheter to allow free drainage of urine and to tamponade the tract postoperatively are also recommended.- - - - - - - - - - ranking = 0.25keywords = puncture (Clic here for more details about this article) |
4/12. aneurysm of the dilatation balloon catheter: an unusual complication of percutaneous nephrolithotomy.We present herein a previously unreported complication of an aneurysm developing in a balloon dilatation catheter used to dilate a track prior to percutaneous nephrolithotomy. Direct needle puncture of the balloon was required for removal of the catheter.- - - - - - - - - - ranking = 0.125keywords = puncture (Clic here for more details about this article) |
5/12. Percutaneous removal of renal caliceal calculi: an alternative approach.An alternative method is presented for the removal of caliceal calculi refractory to standard techniques. The involved calyx is punctured directly and dilatation performed to the stone without negotiating a wire into the renal pelvis. The stone is then removed under direct vision. This technique has been successfully used in 3 patients without complication.- - - - - - - - - - ranking = 0.125keywords = puncture (Clic here for more details about this article) |
6/12. Anaesthetic experience with percutaneous lithotripsy. A review of potential and actual complications.Percutaneous lithotripsy has evolved over the last several years as a procedure for removing renal calculi via percutaneous puncture of the renal collecting system. This article reviews our initial anaesthetic experience with 48 procedures and identifies both actual and potential complications. The most significant complication identified is instillation of large volumes of irrigation fluid into the retroperitoneal space. Two cases of metabolic acidosis and abdominal distension are presented. One responded to treatment while the other progressed to a fatal disseminated intravascular coagulopathy. Recommendations to prevent this are given.- - - - - - - - - - ranking = 0.125keywords = puncture (Clic here for more details about this article) |
7/12. Colonic perforation during percutaneous nephrolithotomy.Of 250 cases of percutaneous nephrolithotomy perforation of the left colon has been observed in 2 men with mobile kidneys. The clinical signs were rectal hemorrhage with shock in 1 case and passage of gas through the nephrostomy tract in the other case. The perforation was not suspected during the nephrolithotomy. Both patients were treated surgically. In view of the risk of colonic perforation during percutaneous nephrolithotomy, great care should be taken during puncture. This risk is increased in cases with an excessively lateral tract or when the anatomical relationships are modified in subjects with mobile kidneys. Surgical repair is required when the perforation is intraperitoneal or when there is a risk of complications. Simple surveillance is only justified when the perforation is extraperitoneal and when there is no risk of complications.- - - - - - - - - - ranking = 0.125keywords = puncture (Clic here for more details about this article) |
8/12. Percutaneous removal of caliceal and other "inaccessible" stones: results.Percutaneous removal of renal stones (percutaneous nephrolithotomy) is becoming an established procedure, especially for stones lying free in the renal pelvis. However, some renal stones, particularly caliceal stones, are less accessible and, therefore, more difficult by the percutaneous route. We removed percutaneously 95 caliceal or otherwise poorly accessible renal stones from 53 patients with a variety of techniques, including percutaneous puncture above the 12th rib, double or Y percutaneous nephrostomy tracts, rigid and flexible endoscopy, and intrarenal cutting with diathermy. Intravenously assisted local anesthesia was used exclusively in 89 per cent of the patients. Status free of stones was achieved in all but 1 patient who retained 2 small fragments. The average number of sessions was 1.89 and the average hospital stay was 7.9 days. Complications were minor except for 1 patient who required tertiary renal artery embolization for bleeding. Illustrative cases are presented. Virtually all renal stones can be removed percutaneously.- - - - - - - - - - ranking = 0.125keywords = puncture (Clic here for more details about this article) |
9/12. Obstructive migration of renal calculi following cyst aspiration.The authors report 3 cases of ureteral obstruction secondary to puncture of peri-pelvic renal cysts which had been obstructing and dilating the renal pelvis. In each case, non-obstructive calculi passed from the upper collecting system into the ureter or infundibulum within 72 hours of decompression, causing acute renal colic and marked obstruction.- - - - - - - - - - ranking = 0.125keywords = puncture (Clic here for more details about this article) |
10/12. Small renal caliceal calculi as a cause of pain.We report 7 cases of long-standing lumbar or flank pain associated with small renal calculi located peripherally in a calix and no obvious obstruction. After stone removal by percutaneous puncture the patients were relieved of the pain.- - - - - - - - - - ranking = 0.125keywords = puncture (Clic here for more details about this article) |
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