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| From
the Editor |
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Editorial
A. Abyad (Chief Editor) |
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Original contribution/Clinical Investigation
Diabetes Mellitus
- Knowledge, Management and Complications: Survey
report from Faisalabad-Pakistan
Ijaz Anwer, Ahmad Shahzad, Kashmira Nanji, Farah
Haider, Muhammad Masood Ahmad
Alanine aminotransferase
indicates excess weight and dyslipidemia
Mehmet Rami Helvaci, Orhan Ayyildiz* Mustafa
Cem Algin, Yusuf Aydin, Abdulrazak Abyad, Lesley
Pocock
Comparative Analysis of Antimicrobial Peptides
Gene Expression in Susceptible/Resistant Mice
Macrophages to Leishmania major Infection
Hamid Daneshvar, Iraj Sharifi, Alireza Kyhani,
Amir Tavakoli Kareshk, Arash Asadi
Does
socio-economic status of the patients have effect
on clinical outcomes after coronary artery bypass
grafting surgery?
Forough Razmjooei, Afshin Mansourian, Saeed
Kouhpyma
Comparison of the uterine
artery Doppler indices during pregnancy between
gestational diabetes and diabetes mellitus and
healthy pregnant women
Nazanin Farshchian, Farhad Naleini, Amir Masoud
Jaafarnejhad,
Parisa Bahrami Kamangar
Survey single dose
Gentamicin in treatment of UTI in children with
range of 1 month to 13 years old in Jahrom during
2015
Ehsan Rahmanian, Farideh Mogharab,
Vahid Mogharab
Evaluation of control of
bleeding by electro cauterization of bleeding
points of amplatz sheath tract after percutaneous
nephrolithotomy (PCNL) in Jahrom Peymanieh hospital
during year 2015-2016
Ali Reza Yousefi , Reza Inaloo
Comparison of the three-finger
tracheal palpation technique with triple ID
formula to determine endotracheal tube depth
in children 2-8 years in 2016-2017
Anahid Maleki, Alireza Ebrahim Soltani, Alireza
Takzare, Ebrahim Espahbodi,
Mehrdad Goodarzi , Roya Noori
Effect of Sevoflurane
and Propofol on pulmonary arterial pressure
during cardiac catheterization in children with
congenital heart diseases
Faranak Behnaz, Mahshid Ghasemi , Gholamreza
Mohseni, Azim Zaraki
Population and Community Studies
Prevalence
and risk factors of obesity in children aged
2-12 years in the Abu Dhabi Islands
Eideh Al-Shehhi, Hessa Al-Dhefairi, Kholoud
Abuasi, Noora Al Ali, Mona Al Tunaiji, Ebtihal
Darwish
Study and comparison
of psychological disorders in normal students
and students with multiple sclerosis in Shahrekord
Neda Ardestani-Samani, Mohammad Rabiei, Mohammad
Ghasemi-Pirbalooti, Asghar Bayati, Saeid Heidari-Soureshjani
Comparative
study of self-concept, physical self-concept,
and time perspective between the students with
multiple sclerosis and healthy students in Shahrekord
Neda Ardestani-Samani, Mohammad Rabiei, Mohammad
Ghasemi-Pirbalooti, Asghar Bayati, Saeid Heidari-Soureshjani
Relationship
between Coping Styles and Religious Orientation
with Mental Health in the Students of the Nursing-Midwifery
Faculty of Zabol
Nasim Dastras, Mohsen Heidari Mokarrar, Majid
Dastras, Shirzad Arianmehr
Tuberculosis in Abadan,
Iran (2012-2016): An Epidemiological Study
Ali-Asghar ValiPour, Azimeh Karimyan, Mahmood
Banarimehr, Marzieh Ghassemi, Maryam Robeyhavi,
Rahil Hojjati,
Parvin Gholizadeh
Family Stability and Conflict
of Spiritual Beliefs and Superstitions among
Yazdi People in Iran: A Qualitative Study
Zahra Pourmovahed , Seyed Saied Mazloomy Mahmoodabad
; Hassan Zareei Mahmoodabadi ; Hossein Tavangar
; Seyed Mojtaba Yassini Ardekani ; Ali Akbar
Vaezi
A comparative
study of the self-actualization in psychology
and Islam
Simin Afrasibi, Zakieh Fattahi
The effectiveness
of cognitive - behavioral therapy in reducing
the post-traumatic stress symptoms in male students
survivors of earthquake in the central district
of Varzeghan
Sakineh Salamat, Dr.Ahad Ahangar, Robab Farajzadeh
Reviews
Effects and mechanisms
of medicinal plants on stress hormone (cortisol):
A systematic review
Kamal Solati, Saeid Heidari-Soureshjani, Lesley
Pocock
Comparing Traditional
and medical treatments for constipation : A
Review Article
Mohammad Yaqub Rajput
A review of anti-measles
and anti-rubella antibodies in 15- 25 year old
women in Jahrom City in 2011
Ehsan Rahmania , Farideh Mogharab, Vahid Mogharab
Review of percutaneous
nephrolithotomy in children below 12 years old
in Jahrom hospital, during 2010-2014
Ali Reza Yousefi , Reza Inaloo
Physical and
mental health in Islam
Bahador Mehraki, Abdollah Gholami
International Health Affairs
The Challenges of Implementation
of Professional Ethics Standards in Clinical Care
from the viewpoint of Nursing Students and Nurses
Saeedeh Elhami, Kambiz Saberi, Maryam Ban, Sajedeh
Mousaviasl, Nasim Hatefi Moadab, Marzieh Ghassemi
Cognitive Determinants
of Physical Activity Intention among Iranian Nurses:
An Application of Integrative Model of Behavior
Prediction
Arsalan Ghaderi, Firoozeh Mostafavi, Behzad Mahaki,
Abdorrahim Afkhamzadeh,
Yadolah Zarezadeh , Erfan Sadeghi
Effect of resilience-based
intervention on occupational stress among nurses
Hossein Jafarizadeh, Ebrahim Zhiyani, Nader
Aghakhani, Vahid Alinejad, Yaser Moradi
Education and Training
Calculation of Salaries
and Benefits of Faculty Members in the Ministry
of Health and Medical Education of Iran
Abdolreza Gilavand
The effect of education
on self-care behaviors of gastrointestinal side
effects on patients undergoing chemotherapy
Shokoh Varaei, Ehsan Abadi Pishe, Shadan Pedram
Razie, Lila Nezam Abadi Farahani
Creating and
Validating the Faith Inventory for Students
at Islamic Azad University of Ahvaz
Solmaz Choheili, Reza Pasha, Gholam Hossein
Maktabi, Ehsan Moheb
Creating
and Validating the Adjustment Inventory for
the Students of Islamic Azad University of Ahvaz
Homa Choheili, Reza Pasha, Gholam Hossein Maktabi,
Ehsan Moheb
Evaluating
the Quality of Educational Services from the
Viewpoints of Radiology Students of Ahvaz Jundishapur
University of Medical Sciences
Abdolreza Gilavand, Jafar Fatahiasl
An Investigation
of Psychosocial aspect of Iranian Nursing Students'
Clinical Setting
Mahsa Boozaripour , Zanyar Karimi, Sima Zohari
Anbohi, Amir Almasi-Hashiani, Fariba Borhani
Clinical Research and Methods
Comparison of the
Antibacterial Effects of Chlorhexidine Mouth
washes with Jaftex Mouth wash on Some Common
Oral Microorganisms (An in Vitro Study)
Ebrahim Babadi, Zahra Bamzadeh, Fatemeh Babadi
Study of the effect
of plasma jet on Fusarium isolates with ability
to produce DON toxins
Elham Galin Abbasian, Mansour Bayat, Arash chaichi
Nosrati, Seyed Jamal Hashemi, Mahmood Ghoranneviss
The comparison of
anti-inflammatory effect in two methods of topical
dexamethasone injection and topical application
of ginger alcoholic extract after removing mandibular
wisdom teeth
Sahar Zandi, Seyyed Muhammadreza Alavi, Kamran
Mirzaie, Ramin Seyedian, Narges Aria, Saman
Jokar
The effect of curcumin
on growth and adherence of major microorganisms
causing tooth decay
Leila Helalat, Ahmad Zarejavid, Alireza Ekrami,
Mohammd Hosein Haghighizadeh, Mehdi Shiri Nasab
|
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Chief
Editor -
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Abyad
MD, MPH, MBA, AGSF, AFCHSE
.........................................................
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|
|
|
| November 2017
- Volume 15, Issue 9 |
|
|
Evaluation of control
of bleeding by electro cauterization of bleeding
points of amplatz-sheath tract after percutaneous
nephrolithotomy (PCNL) in Jahrom Peymanieh hospital
during year 2015-2016
Ali Reza Yousefi
Reza Inaloo
Department of Urology, Jahrom University of
Medical Sciences, Jahrom, Iran
Corresponding author:
Reza Inaloo,
Department of Urology,
Jahrom University of medical sciences,
Jahrom, Iran
Tel: +989173130056
Email: rezainaloo@yahoo.com
|
Abstract
Introduction: Complications
frequently related to percutaneous renal
surgery include renal hemorrhage, perforation
of the collecting system, urinary tract
infection, and injury to adjacent organs.
Renal hemorrhage is the most common and
worrisome complication after PCNL. In
an effort to reduce postoperative hemorrhage
after completion of percutaneous renal
surgery, we cauterized the bleeding points
over the access tract.
Material &
Methods: This cross sectional study
was carried out on the 85 patients who
underwent PCNL between March 2015 and
March 2016 in Jahrom Peymanie hospital
using census sampling method. Electro
cauterization of bleeding points after
operation was performed for the participants.
Patient’s data was collected with
a research made questionnaire including
clinical and diagnosis characteristics.
Data was recorded by Statistics Software
(SPSS, Edition14) using chi-square test
and Student’s t-test.
Results:
From 85 patients 58 patients (68.2%) were
male and 27 patients (31.8%) were female.
The patients age ranged from 20 to 82
years old. The stone size range was from
10 to 35mm. 15 patients had stones located
in upper pole, 20 patients had stones
located in pelvis and midpole of the kidney,
13 patients had stones located in the
lower pole and 37 patients had multiple
staghorn stone. The mean hemoglobin (Hb)
concentration before operation was 14±0.5
mg/dL while it was 14±0.2 mg/dL
after operation. There was no statistically
significant correlation between hemoglobin
level before and after operation (P>0.05).
Conclusion:
Electro cauterization of bleeding points
with an electrode probe after percutaneous
surgery decreased morbidity. It is an
effective and safe procedure and should
be considered an option in percutaneous
renal surgery.
Key words: bleeding,
electro cauterization, percutaneous nephrolithotomy
|
Nephrolithiasis is a common clinical disorder
affecting up to 5% of the general population
in the USA (l). The prevalence of renal stone
disease has been rising in both sexes, being
estimated that about 5% of American women and
l2% of men will develop a kidney stone at some
time in their life (2). Nevertheless, in certain
areas of the world, as in the Middle East, the
lifetime risk appears to be even higher (3).
There has been heightened awareness of renal
stone disease in children as well (4). Recurrence
rates of 50% after l0 years and 75% after 20
years have been reported (5, 6). Clinical manifestations
are characterized by lumbar pain of sudden onset
(the location of pain depends on the location
of stone in the urinary tract) that may be accompanied
by nausea and vomiting, gross or microscopic
hematuria Diagnosis of renal stone in the acute
setting is beyond the scope of the present update
but in brief, is represented by urinalysis and
imaging. Urinalysis often reveals hematuria
but the latter is absent in approximately 9%
of cases (7). Crystal Luria is occasional and
the presence of leucocyturia may suggest associated
urinary tract infection. Unenhanced helical
computed tomography (CT) scan, the most sensitive
and specific radiographic test (8, 9), is becoming
the diagnostic procedure of choice to confirm
the presence of kidney stone and especially
of ureteral stones (10). However, high doses
of radiation and elevated costs must be considered
(11). Since renal ultrasound (US) provides information
about obstruction (12) but may miss ureteral
stones, the association of US with conventional
abdominal X-ray may help (13). Renal colic must
be differentiated from musculoskeletal pain,
herpes zoster, pyelonephritis, appendicitis,
diverticulitis, acute cholecystitis, gynecologic
disease, ureteral stricture or obstruction due
to blood clot, polycystic kidney disease. Stone
formation usually results from an imbalance
between factors that promote urinary crystallization,
and those that inhibit crystal formation and
growth (14). The main determinants of calcium
oxalate (CaOx) super saturation are oxalate
and calcium concentration, while the latter
associated to urinary pH determines calcium
phosphate super saturation. Urinary pH itself
is the main determinant of uric acid super saturation
(l4).
Sampling & data collection & statistical
analysis:
In a cross sectional study we reviewed the old
charts of all patients in whom cauterization
of bleeding points of access tract was performed
after percutaneous nephrolithotomy (PCNL). We
prepared a questionnaire including questions
about age, sex, size and location of stone,
mean hemoglobin level before and after operation,
hemoglobin drop after operation, stone free
rate, operating time, length of postoperative
hospital stay, postoperative urinary tract infection
rate, and blood transfusion rate, presence of
per renal hematoma or urinoma. Per renal hematoma
or urinoma was detected by KUB sonography the
day after PCNL. Stone free patient was defined
as those who had no stone or stone smaller than
4mm one week after PCNL. All patients who underwent
PCNL between March 2015 and March 2016 in Jahrom
Peymanie hospital and who had Electro cauterization
of bleeding points after operation was performed
participated in this study using census sampling
method. Finally 85 patients were elected to
participate in this study. Data was recorded
by SPSS program using chi-square test and Student’s
t-test. The most important difculty in this
study especially in data collection is that
sometimes the charts of the patients were not
complete and we needed to call them.
Operation method:
All the patients underwent regional spinal anesthesia.
Renal access was obtained under Fluoroscope
guidance with an 18-guage needle and a 0.038
J-tip guide wire after retrograde placement
of a SF or 6F ureteral occlusion balloon catheter
cystoscopically. The access tract was dilated
with metal coaxial dilators to allow for the
passage of a 30F-working sheath. The pneumatic
lithotripter was used for lithotripsy. After
completion of stone extraction, a 6F double-J
catheter was inserted in ante grade fashion
after withdrawal of the occlusion balloon catheter.
The bleeding points were cauterized with an
elongated electrode probe connected to the hand
piece of a conventional electric cauterizing
device. The probe touched the bleeding points
gently and cauterized them for a few seconds,
as one would in transurethral surgery.
The bleeding points were usually located just
beneath the collecting system torn by manipulation
of instruments and beneath the urothelium where
the access tract entered the collecting system.
Most bleeding ceased after cauterization but
some did not. To avoid adjacent organ or renal
pedicle injury, we never cauterized the bleeding
point for too long or too deep, especially for
those located over the renal pelvis or ureter.
Totally
85
patients
who
underwent
PCNL
and
Electro
cauterization
of
bleeding
points
after
their
operation
participated
in
this
study.
From
85
patients,
58
patients
(68.2%)
were
male
and
27
patients
(31.8%)
were
female.
The
patients
age
ranged
from
20
to
82
years
old.
The
stone
size
ranged
from
10
to
35mm.
All
the
patients
underwent
regional
(spinal
or
epidural)
anesthesia
for
the
operation.
From
85
patients;
l5
patients
(17.6%)
had
stones
located
in
upper
pole,
20
patients
(23.5%)
had
stones
located
in
pelvis
of
the
kidney,
l3
patients
(15.2%)
had
stones
located
in
lower
pole
and
37
patients
(43.5%)
had
multiple
staghorn
stone.
The
mean
hemoglobin
(Hb)
concentration
before
operation
was
14±0.5
mg/dL
while
it
was
14±
0.2
mg/dL
after
operation.
There
was
no
statistically
signicant
correlation
between
hemoglobin
level
before
and
after
operation
(P>0.05).
Figure
1:
Percentage
of
patients
with
renal
stone
in
each
sex
Figure
2:
Stone
location
Figure
3:
Mean
hemoglobin
level
before
and
after
PCNL
Percutaneous
renal
surgery
is
a
common
urologic
procedure.
It
has
been
widely
used
for
the
removal
of
renal
and
upper
ureteral
stones
and
also
for
the
treatment
of
pelvi-ureteral
stricture
and
management
of
tumor
of
the
upper
urinary
tract.
Improvements
in
instrumentation
and
technology
in
recent
years
have
decreased
the
complication
rate
of
percutaneous
renal
surgery
dramatically.
However,
complications
do
occur.
Renal
hemorrhage
after
percutaneous
renal
surgery
is
one
of
the
most
common
complications.
Bleeding
may
occur
during
any
point
of
theprocedure.
Venous
bleeding
is
the
most
common
type
and
can
be
controlled
by
clamping
the
nephrostomy
tube.
Excessive
bleeding
during
percutaneous
renal
surgery
may
result
from
renal
vessel
injury,
such
as
to
a
segmental
branch.
For
excessive
bleeding
during
percutaneous
renal
surgery,
in
addition
to
nephrostomy
tube
clamping,
several
techniques
can
be
used
to
minimize
bleeding
Intravenous
administration
of
mannitol
with
hydration
leads
to
forced
diuresis,
dilation
of
renal
tubules,
swelling
of
the
renal
capsule,
and
increased
intra
renal
pressure,
which
may
enhance
the
effect
of
tamponed.
Application
of
the
Kaye
tamponade
balloon
catheter
is
an
alternative
to
minimize
postoperative
hemorrhage,
and
the
device
can
be
placed
and
inated
to
control
bleeding
in
the
access
tract
(4).
Angiography
and
embolization
is
required
in
persistent
and
active
bleeding,
in
addition
to
the
above-mentioned
conservative
treatment.
Despite
these
efforts,
percutaneous
renal
surgery
still
has
a
greater
transfusion
rate
than
other
common
urologic
procedures.
Because
of
the
potential
risks
associated
with
blood
transfusion,
including
transfusion
reactions
and
transmission
of
the
human
immunodeciency
virus,
hepatitis,
and
other
infectious
diseases,
it
is
important
to
develop
a
procedure
to
minimize
renal
hemorrhage
after
percutaneous
renal
surgery.
Serial
reports
about
tubeless
percutaneous
renal
surgery
for
selected
patients
have
recently
been
published.
After
draining
with
a
double-J
catheter
or
externalized
ureteral
catheter
on
removal
of
the
nephroscope
with
a
Working
sheath
and
completion
of
the
percutaneous
renal
procedure,
the
guidewire
over
the
nephrostomy
site
was
still
in
place.
The
guidewire
was
removed,
and
the
wound
was
closed
if
no
bleeding
was
evident
at
the
nephrostomy
site.
The
advantages
of
tubeless
percutaneous
renal
surgery
include
earlier
discharge,
lower
analgesic
requirement,
faster
recovery
to
resume
normal
activities,
and
greater
cost
benets.
In
literature
and
Medline
there
is
only
one
article
performed
by
Yeong-Chin
J
Ou
et
al
in
Chiayi
Christian
Hospital,
Chiayi,
Taiwan
(1).
In
their
study
Electro
cauterization
of
bleeding
points
with
an
elongated
electrode
probe
was
performed
in
249
patients.
The
age,
height,
weight,
preoperative
hemoglobin
level,
stone
burden,
operating
time,
stone
free
rate,
length
of
postoperative
hospital
stay,
postoperative
urinary
tract
infection
rate,
and
blood
transfusion
rate
were
recorded
by
retrospective
chart
review.
There
was
no
statistically
signicant
differences
in
age,
height,
weight,
stone
burden,
operating
time,
stone
free
rate,
or
length
of
postoperative
hospital
stay
found
between
patients
with
or
without
Electro
cauterization.
No
increase
occurred
in
the
postoperative
urinary
tract
infection
rate
in
patients
who
received
Electro
cauterization,
and
these
patients
had
a
statistically
signicant
decrease
in
the
transfusion
rate.
No
nephrostomy
tube
was
inserted
at
the
completion
of
surgery
in
84
(33.7%)
of
the
249
operations
in
which
Electro
cauterization
was
performed.
They
nally
concluded
that
Electro
cauterization
of
the
bleeding
points
at
the
end
of
percutaneous
renal
surgery
decreases
the
blood
transfusion
rate
without
causing
an
increase
in
morbidity.
This
procedure
is
safe
and
effective
and
may
make
more
patients
suitable
for
tubeless
modification
(1).
Encouraged
by
the
positive
results,
many
institutions
have
expanded
the
use
of
tubeless
modication
for
percutaneous
renal
surgery.
After
cauterization
of
the
bleeding
points
in
percutaneous
renal
surgery,
84
(33.7%)
of
249
PCNLs
were
performed
with
a
tubeless
modication
without
any
sequelae.
In
2002,
Limb
and
Bellman
(12)
reported
that
of
398
patients
undergoing
percutaneous
renal
surgery,
112
(28.1%,
86
undergoing
PCNL
and
undergoing
ante
grade
endopyelotomy)
underwent
a
tubeless
modication.
The
stone
burden
of
their
patients
who
underwent
tubeless
PCNL
was
330-279
mm2.
In
our
study,
after
cauterization
of
bleeding
points,
the
percentage
of
patients
undergoing
tubeless
modication
was
greater
(33.7%
versus
28.1%),
even
though
the
stone
burden
was
large
in
our
patients.
Electro
cauterization
of
bleeding
points
with
an
elongated
electrode
probe
after
percutaneous
surgery
decreased
the
transfusion
rate
without
causing
any
increase
in
surgical
morbidity.
The
procedure
also
made
more
patients
undergoing
percutaneous
renal
surgery
suitable
for
a
tubeless
modication.
It
is
an
effective
and
safe
procedure
and
should
be
considered
an
option
in
percutaneous
renal
surgery.
1.
Jou
YC,
Cheng
MC,
Sheen
JH,
Lin
CT,
Chen
PC.
Cauterization
of
access
tract
for
nephrostomy
tube-free
percutaneous
nephrolithotomy.
J
Endourol.
2004
Aug;18(6):547-9.
2.
Stamatelou
KK,
Francis
ME,
Jones
CA,
Nyberg
LM,
Curhan
GC.
Time
trends
in
reported
prevalence
of
kidney
stones
in
the
United
States:
1976-1994.
Kidney
Int
2003;63(5):1817-23.
3.
Moe
OW.
Kidney
stones:
Pathophysiology
and
medical
management.
Lancet
2006;367:333-44.
4.
Pak
CYC,
Resnick
MI,
Preminger
GM.
Ethnic
and
geographic
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