Optimization of extracorporeal shock wave lithotripsy delivery rates achieves excellent outcomes in ureteral stones. Results of a prospective, randomized trial

PURPOSE Management of ureteral stones remains controversial. To determine whether optimizing extracorporeal shock wave lithotripsy (ESWL) delivery rates improves treatment of solitary ureteral stones, we compared outcomes of two SW delivery rates in a prospective, randomized trial. MATERIALS AND METHODS From July 2010 to October 2012, 254 consecutive patients were randomized to undergo ESWL at SW delivery rates of either 60 pulses (n=130) or 90 pulses (n=124) per min. The primary endpoint was stone-free rate at 3-month follow-up. Secondary endpoints included stone disintegration, treatment time, complications, and the rate of secondary treatments. Descriptive statistics were used to compare endpoints between the two groups. Adjusted odds ratios and 95% confidence intervals were calculated to assess predictors of success. RESULTS The stone-free rate at 3 months was significantly higher in patients who underwent ESWL at a SW delivery rate of 90 pulses per min than in those receiving 60 pulses (91% vs. 80%, p=0.01). Patients with proximal and mid-ureter stones, but not those with distal ureter stones, accounted for the observed difference (100% vs. 83%; p=0.005; 96% vs. 73%, p=0.03; and 81% vs. 80%, p=0.9, respectively). Treatment time, complications, and the rate of secondary treatments were comparable between the two groups. In multivariable analysis, SW delivery rate of 90 pulses per min, proximal stone location, stone density, stone size and the absence of an indwelling JJ stent were independent predictors of success. CONCLUSIONS Optimization of ESWL delivery rates can achieve excellent results for ureteral stones.

Is thermochemotherapy with the Synergo system a viable treatment option in patients with recurrent non-muscle-invasive bladder cancer?

OBJECTIVES To prospectively evaluate the outcome of combined microwave-induced bladder wall hyperthermia and intravesical mitomycin C instillation (thermochemotherapy) in patients with recurrent non-muscle-invasive bladder cancer. METHODS Between 2003 and 2009, 21 patients (median age 70 years, range 35-95 years) with recurrent non-muscle-invasive bladder cancer (pTaG1-2 n = 9; pTaG3 n = 3; pT1 n = 9; concurrent pTis n = 8) were prospectively enrolled. Of 21 patients, 15 (71%) had received previous intravesical instillations with bacillus Calmette-Guérin, mitomycin C and/or farmorubicin. Thermochemotherapy using the Synergo system was carried out in 11 of 21 patients (52%) with curative intent, and in 10 of 21 patients (48%) as prophylaxis against recurrence. RESULTS The median number of thermochemotherapy cycles per patient was six (range 1-12). Adverse effects were frequent and severe: urinary urgency/frequency in 11 of 21 patients (52%), pain in eight of 21 patients (38%) and gross hematuria in five of 21 patients (24%). In eight of 21 patients (38%), thermochemotherapy had to be abandoned because of the severity of the adverse effects (pain in 3/8, severe bladder spasms in 2/8, allergic reaction in 2/8, urethral perforation in 1/8). Overall, six of 21 patients (29%) remained free of tumor after a median follow up of 50 months (range 1-120), six of 21 patients (29%) had to undergo cystectomy because of multifocal recurrences or cancer progression and seven of 21 patients (33%) died (2/7 of metastatic disease, 5/7 of non-cancer related causes). CONCLUSIONS Given the high rate of severe side-effects leading to treatment discontinuation, as well as the limited tumor response, thermochemotherapy should be offered only in highly selected cases of recurrent non-muscle-invasive bladder cancer.

Juden auf Wanderschaft

von Joseph Roth

Cenesthopathy in adolescence: An appraisal of diagnostic overlaps along the anxiety–hypochondriasis–psychosis spectrum

Objective To discuss the diagnostic validity of unusual bodily perceptions along the spectrum from age-specific, often transitory and normal, to pathological phenomena in adolescence to hypochondriasis and finally to psychosis. Methods Critical literature review of the cornerstone diagnostic groups along the spectrum embracing anxiety and cenesthopathy in adolescence, hypochondriasis, and cenesthopathy and psychosis, followed by a discussion of the diagnostic overlaps along this spectrum. Results The review highlights significant overlaps between the diagnostic cornerstones. It is apparent that adolescents with unusual bodily perceptions may conceptually qualify for more than one diagnostic group along the spectrum. To determine whether cenesthopathies in adolescence mirror emerging psychosis, a number of issues need to be considered, i.e. age and mode of onset, gender, level of functioning and drug use. The role of overvalued ideas at the border between hypochondriasis and psychosis must be considered. Conclusion As unusual bodily symptoms may in some instances meet formal psychosis risk criteria, a narrow understanding of these symptoms may lead to both inappropriate application of the new DSM-5 attenuated psychosis syndrome and of treatment selection. On the other hand, the possibility of a psychotic dimension of unusual bodily symptoms in adolescents must always be considered as most severe expression of the cenesthopathy spectrum.

Time-dependent and somatically acquired mitochondrial DNA mutagenesis and respiratory chain dysfunction in a scleroderma model of lung fibrosis.

Reactive oxygen species (ROS) have been implemented in the etiology of pulmonary fibrosis (PF) in systemic sclerosis. In the bleomycin model, we evaluated the role of acquired mutations in mitochondrial DNA (mtDNA) and respiratory chain defects as a trigger of ROS formation and fibrogenesis. Adult male Wistar rats received a single intratracheal instillation of bleomycin and their lungs were examined at different time points. Ashcroft scores, collagen and TGFβ1 levels documented a delayed onset of PF by day 14. In contrast, increased malon dialdehyde as a marker of ROS formation was detectable as early as 24 hours after bleomycin instillation and continued to increase. At day 7, lung tissue acquired significant amounts of mtDNA deletions, translating into a significant dysfunction of mtDNA-encoded, but not nucleus-encoded respiratory chain subunits. mtDNA deletions and markers of mtDNA-encoded respiratory chain dysfunction significantly correlated with pulmonary TGFβ1 concentrations and predicted PF in a multivariate model.

The legacy of Israel : essays

by Sir George Adam Smith ... ; planned by ... Israel Abrahams and ed. by Edwyn R. Bevan ... With an introduction by the master of Balliol

(Ozrot Chajim) : Katalog der Michael'schen Bibliothek

hrsg. von den Michael'schen Erben. Nebst einem, vielfache Berichtigungen und Excerpte enthaltenden Register zum Verzeichnis der Handschriften von M. Steinschneider und einem Vorworte von L. Zunz

Joh. Christopheri Wagenseilii Exercitationes varii argumenti

accessit vita et consignatio scriptorum autoris cura Friderici Roth-Scholtzii

Hebraeische Melodien : (nach Eindrücken der Byronschen Gesänge) ; für Viola und Pianoforte ; op. 9

Joseph Joachim. Für Violoncell und Pianoforte bearb. von Philipp Roth

Zu meinem 25-jährigen Amtsjubiläum am 1. Juni 1884 : einige Erfahrungen als 5. Schulchan Aruch

von Armin Roth

Does nest size matter to laying hens?

Laying hens in loose housing systems have access to group-nests which provide space for several hens at a time to lay their eggs. They are thus rather large and the trend in the industry is to further increase the size of these nests. Though practicality is important for the producer, group-nests should also cater to the egg-laying behaviour of hens to promote good welfare. One of the factors playing a role in the attractiveness of a nest is the amount of enclosure: hens prefer more enclosure when having a choice between different nest types. The aim of this study was to investigate if hens prefer smaller group-nests to lay their eggs given that they may seem more enclosed than larger nests. The relative preference of groups of laying hens for two nest sizes – 0.43m2 vs. 0.86m2 – was tested in a free-access choice test. The experiment was conducted in two consecutive trials with 100 hens each. They were housed from 18 to 36 weeks of age in five groups of 20 animals and had access to two commercial group-nests differing in internal size only. We counted eggs daily as a measure of nest preference. At 28 and 36 weeks of age, videos were taken of the pens and inside the nests on one day during the first 5h of lights-on. The nest videos were used to record the number of hens per nest and their behaviour with a 10min scan sampling interval. The pen videos were observed continuously to count the total number of nest visits per nest and to calculate the duration of nest visits of five focal hens per pen. We found a relative preference for the small nest as more eggs, fewer nest visits per egg and longer nest visit durations were recorded for that nest. In addition, more hens – including more sitting hens – were in the small nests during the main egg-laying period, while the number of standing hens did not differ. These observations indicate that even though both nests may have been explored to a similar extent, the hens preferred the small nest for egg-laying.