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Article
Blood pressure changes following extracorporeal shock wave lithotripsy in Kirkuk province
تغير ضغط الدم بعد تفتيت الحصى من موجة الصدمة خارج الجسم في محافظة كركوك

Authors: Omeed O. Darweesh --- Muhammad A. Alshawni --- Kamaran Y. Muhammadamin
Journal: Zanco Journal of Medical Sciences مجلة زانكو للعلوم الطبية ISSN: 19955588/19955596 Year: 2012 Volume: 16 Issue: 3 Pages: 256-261
Publisher: Hawler Medical Univeristy جامعة هولير الطبية

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Abstract

Background and objectives: : Hypertension has been reported as a possible sequela of extracorporeal shock wave lithotripsy. The aim was to determine, in a clinical trial, the ef-fect of extracorporeal shock wave lithotripsy (ESWL) on blood pressureMethods: This study included 216 patients, aged (12-65) years, with asymptomatic renal stones that underwent ESWL in lithotripter unit/ Azadi teaching hospital –Kirkuk Province. Blood pressure was recorded randomly using a standardized protocol. Patients undergoing ESWL received a mean (±SD) of 3608.8 (±475.9) shocks over a mean (6.81) of sessions on one lithotripter. Patients were then followed-up by assessing their blood pressure. Data were analyzed on an intention to treatment basis.Results: At randomization (13.42) % of the study group were hypertensive. Of (320) pa-tients referred to the study, (258) were recruited based on the inclusion and exclusion crite-ria. A total of (216) patients (83 % of patients included) completed follow up, (137) (63.42%) were male and (79) (36.57%) were female. The mean follow-up period was (15.03) months. In the present study there was no association between mean diastolic and systolic blood pressure before and after ESWL.Conclusion: : In the present study there was no evidence that ESWL causes changes in BP. More randomized control trials are needed to demonstrate the relationship between ESWL and hypertension.

Keywords

ESWL --- Hypertension --- Clinical trial


Article
Effect of Shock Wave Frequency on Treatment Outcomes in Patients with Renal Stone Treated by Extracorporeal Shock Wave Lithotripsy

Authors: Samir Ali Muter --- Ziad Hammad Abd --- Hasan Ali Rasheed --- Noorulhuda Mukhlif Najm Al-Ani
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2015 Volume: 14 Issue: 2 Pages: 197-202
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:BACKGROUND: since the introduction of ESWL in treatment of renal stones, it remained the first option for most renal and ureteric stones, with a success rate ranging from 60% to 90%. Multiple variables can affect treatment outcome, including those related to the machine, dose administered, and factors related to the patient; the exact role of most of these factors is still under study.OBJECTIVE: We investigated the effect of shock wave frequency on treatment outcomes in terms of success and complication rates.PATIENTS AND METHOD: 139 patients with radio-opaque renal stones, presented to the Urology consultancy clinic during the period June 2010 through January 2012 and decided to undergo ESWL treatment were randomized into three groups, the first group (46 patients) received shock waves at a frequency of 120 waves per minute, the second (47 patients) at 90 w/m, and the third group (46 patients) at 60 w/m. Patients were followed for treatment outcome and appearance of complications at 1 week, 3 weeks, and 6 weeks. Stone free status or insignificant asymptomatic residual gravels of 5mm or less are considered as success. Durations of hematuria and analgesic requirement were the main complications looked for during follow up, while subcapsular and retroperitoneal hematomas were looked.RESULTS: All patients received 3500-4000 shock waves per session at 17-18 KV energy. Success rate was significantly higher in the second and third groups, while the durations of hematuria and analgesic requirement were significantly shorter in groups 2 and 3. There was no significant difference between groups 2 and 3 in all outcome and complication parameters; however, the duration of treatment was significantly longer in groups 2 and 3.CONCLUSION: ESWL efficacy in fragmenting renal stones is significantly improved by decreasing frequency from the standard 120 sw/min to slower rates (90 and 60 sw/min), with significantly decreased analgesic requirement and hematuria durations. There were no significant differences between the 60 and 90 sw/min frequencies. Taking in account the longer treatment duration for the 60 sw/min frequency; the 90 sw/min frequency would be optimal in terms of stone disintegration, complications, and duration of treatment.


Article
Safety and efficacy of ESWL lithotripsy as a primary modality of treatment for upper ureteric stones: A 5-year experience

Journal: Muthanna Medical Journal مجلة المثنى الطبية ISSN: 2226146x Year: 2016 Volume: 3 Issue: 2 Pages: 86-93
Publisher: Al-Muthanna University جامعة المثنى

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Abstract

Urinary stone disease is a major health care problem due to its high prevalence and incidence. The aim of the study is to evaluate the safety and efficacy of ESWL lithotripsy as a primary modality of treatment for upper ureteric stones. From October 2011 to October 2016, 400 patients (300 male and 100 female) with upper ureteral stones were admitted to Al-Diwaniya teaching hospital, urology unit and enrolled in this study, their age range from 18 to 65 years with a mean age of 40 ± 3 years. All patients were evaluated by history, physical examination, laboratory investigation (including urinalysis, full blood count, coagulation profile and renal function tests). The stone size, location, opacity and degree of obstruction were assessed by preoperative radiographic imaging studies, including KUB, ultrasound and computerized tomography (CT scan). The overall stone-free rate at three months was 95% (380/400). Clearance after first sitting was 70% (280/400), after second sitting was 20% (80/400) and after third sitting was 5% (20/400). Clearance of stone in patients with stone size ≤ 1 cm was 97% (388/400), and in patients with stone size > 1cm was 5% (340/400). Five per cent (20) of cases did not have successful outcome. In conclusion, the results of our study show that ESWL as a primary modality for upper ureteric stones treatment has an overall success rate of 95%. Success rate drops with increasing size of stone, duration of stone in ureter, and no anesthesia is required.


Article
The Effect of Tamsulosin and Combination of Terpenes (Rowatinex) on the Clearance of Renal Stone Gravels After Single Session of Extracorporeal Shock Wave Lithotripsy (ESWL)

Author: Waleed Nassar Jaffal وليد نصار جفال
Journal: Al- Anbar Medical Journal مجلة الأنبار الطبية ISSN: PISSN: 27066207 / EISSN: 26643154 Year: 2012 Volume: 10 Issue: 2 Pages: 26-33
Publisher: University of Anbar جامعة الانبار

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Abstract

Background: Extracorporeal shock wave lithotripsy (ESWL) is currently considered one of the main lines of treatments for urolithiasis. The effectiveness of pharmacologic therapies in facilitating stones expulsion after ESWL has been reported.Objectives: To evaluate the effect of Tamsulosin and terpenes combination (Rowatinex) on the clearance of stone gravels after extracorporeal shock wave lithotripsy (ESWL) of renal stone.Methods: From May 2010 to June 2011 (84) patients with single radio opaque renal stone presented to urologic consultation department at Al-Ramadi teaching hospital/Iraq were included in this prospective, case-control study. All patients were examined by ultrasonography, and intravenous urography. Their age ranged from 19 to 62 years. All patients underwent ESWL and randomly divided into three groups, group A, of 28 patients, received conservative medical therapy alone and served as the control group, group B, of 28 patients, received tamsulosin 0.4 mg once daily in addition to conservative medical treatment and group C, of 28 patients, received Rowatinex capsules, 1 capsule before food 3 times daily in addition to conservative medical therapy. All patients were followed up by clinical examination, urine analysis, ulrasonography and abdominal radiograph (KUB) at 4 and 8 weeks and the number of patients with clinical success was recorded. Clinical success defined as stone-free status or clinically insignificant stone. Results: The age of patients ranged from 19 to 60 years in group A (mean 35.7±6), 20-62 years in group B (mean 36.6±13.25) and 20-61 years in group C (mean 36.2±13.02), there was no significant statistical difference between the age, gender and site and size of renal stones among the three groups (p value > 0.05). The percentage of patients with clinical success after ESWL at 4 weeks was 23% in group A, 44% in group B and 40% in group C and increased to 46%, 80% and 76% in group A, B and C respectively at 8 weeks. The clinical success was statistically more significant in group B and C compared to group A at both 4 and 8 weeks ( p value < 0.05). There was no statistically significant difference in the clinical success between group B and C (p value > 0.05). Although the incidence of drugs side effects in group B and C occurred more than in group A, but no significant side-effect was detected so as to require exclusion of a patient from the study and medical intervention was not performed in any of the patients because of side-effects.Conclusion: The use of medical expulsion in this study by tamsulosin or terpenes combination (Rowatinex) was well tolerated and it demonstrated that it is clinically meaningful and statistically it has significant improvement in the clearance of stone fragments after ESWL of renal stone. The effect on tamsulosin and terpenes combination (Rowatinex) is comparable.


Article
Extracorporeal Shockwave Lithotripsy Vs Urerteroscopy in The Treatment of Upper Ureteric Stones

Author: Salam Abd Elameer Yahya
Journal: Medical Journal of Babylon مجلة بابل الطبية ISSN: 1812156X 23126760 Year: 2016 Volume: 13 Issue: 4 Pages: 755 -761
Publisher: Babylon University جامعة بابل

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Abstract

There are two main options for the intervention which are usually used for the treatment of calculi in the upper ureters and these are: extra corporeal shock wave lithotripsy (ESWL) and the lithotripsy by ureteroscope.Till now,there is controversy regarding which method is the most optimum in the treatment of calculi in the upper ureters.In this study we try to compare both modalities of treatment and which option consider the first-line treatment for upper ureteric calculi.From Jan. 2013 to Jan. 2014,one handered patients (54 males and 46 females) with single, unilateral upper ureteric stone size from (6-18 mm) treated in Al hilla teaching hospital are included in this randomized prospective study.The choice certain method for treatment was based on the clinical state of the patients and patients’ choice.Fifty (31 males and 19 females) patients are treated by ESWL, while the other fifty (23 males and 27 females) patients treated by ureteroscopy.Patients treated with ESWL achieved a 80% overall SFR with a 30 % auxiliary procedure rate. While Complications occur in 8% of cases who are treated by ESWL. Regarding group of patients treated with URS had a 92% SFR with an additional procedure rate of 28% While Complications occur in 18% of patients treated with ureteroscopy. (For ESWL group, the need of auxiliary procedures and complication rate are more common where stone size <1cm.Where as in ureteroscope group, the need of auxiliary procedures are higher for those with stone size>1cm. but the complication rate is still higher in patients with stone size <1cm.So in the urological centers in which both modalities of treatment are present, ESWL is the preferable option for treatment of patients with single upper stone in the upper ureterof ≤1 cm while ureteroscopy used for patients had stones of >1 cm.


Article
Early Detection of Bacteremia and Bacteriuria after Extracorporeal Shock Wave Lithotripsy By C-Reactive Protein Measurements

Author: Ehab Jasim Mohammad
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2017 Volume: 16 Issue: 1 Pages: 41-46
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT :BACKGROUND:Extracorporeal shock wave lithotripsy (ESWL) has long been accepted as the least invasive and reliable method in the treatment of urolithiasis. The success rates have been very high in renal and upper ureteral stones . OBJECTIVE:Is early detection of bacteriuria and bacteriemia after extracorporeal shock wave lithotripsy (ESWL) of calcium and infection stones by measurement of plasma C-reactive protein (CRP) levels.METHODS: A total of 150 patients who had infection stones (n 54) and calcium stones (n 96) were included in the study. All patients had sterile urine before ESWL. The mean age was 41.6+_ 4.85 and male/female ratio was 2.12. Blood cultures were obtained within 1 hour post-ESWL period. Urine cultures were obtained 3 times just after and on the first and seventh day of ESWL. RESULTS: Post-ESWL evaluations showed 6 positive blood cultures with 4(5.32%) patients in infection stone and 2 (2.66%) patient in calcium stone groups, whereas urine cultures revealed 12 (16%) positive results in infection stones and 8(10..66%) in calcium stones. The patients who had positive cultures also had elevated plasma CRP levels when compared to the levels in patients with negative cultures (p 0.000). CONCLUSION: Bacteriuria and bacteriemia after ESWL have been well-identified entities and may be responsible from some of the post-ESWL complications. CRP can be useful for early detection of such complications.


Article
NUMERICAL CALCULATION FOR EQUIVALENT SINGLE WHEEL LOAD (ESWL)
الحساب العددي لحمل العجلة المكافئة المنفردة

Author: Abdulhaq Hadi عبد الحق هادي عبد علي
Journal: Al-Qadisiyah Journal for Engineering Sciences مجلة القادسية للعلوم الهندسية ISSN: 19984456 Year: 2009 Volume: 2 Issue: 2 Pages: 149-163
Publisher: Al-Qadisiyah University جامعة القادسية

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Abstract

The flexible pavement layers attach at every hours during the day to hundred thousand from several traffic loading according to number of axles, number of wheel for each axles (Dual and Triple …,etc) and tire pressure. These different types of above variable generate stresses, strains and defilations in the pavement layers (with overlap stresses and deflection) caused to fatigue of pavement to reduced pavement life. In order to design exchange these loads to Equivalent Single Wheel Load (ESWL). Little programs are available to solve this problem as an exact solution. In this work using 3D finite element model make by SAP 2000 program based on the equal maximum vertical interface deflection for equal contact area concept. The results are compared with the analytical solution obtained from Kenlayer Computer program.

تتعرض الخرسانة الإسفلتية يوميا" بل في كل ساعة خلال اليوم إلى مئات الآلاف من الأحمال المرورية المختلفة الأنواع من حيث عدد المحاور أو عدد الإطارات ضمن المحور الواحد وكذلك مختلف قيم ضغط الإطار.هذه الأنواع المختلفة أعلاه تولد اجهادات وتشوهات وهبوط في طبقات التبليط الإسفلتي وحدوث تتداخل في هذه الاجهادات تسبب تعب او كلال التبليط وبالتالي تقليل العمر الخدمي له ولغرض التصميم الإنشائي للتبليط يتم التعويض عن هذه الأحمال المختلفة بحمل عجلة واحدة مكافئة.في هذا البحث تم بناء نموذج رياضي ثلاثي الأبعاد بطريقة العناصر المحددة وباستخدام برنامجSAP 2000 لغرض دراسة توزيع الاجهادات والتشوهات والهبوط الناتج بطبقات التبليط الإسفلتي المختلفة ومقارنتها بالطرق التحليلية التقليدية وباستخدام Kenlayer Computer Program


Article
PREDICTORS OF SUCCESSFUL URINARY STONE TREATMENT BY EXTRACORPOREAL SHOCKWAVE LITHOTRIPSY

Author: Uday H. Mohammad عدي هاني محمد
Journal: IRAQI JOURNAL OF MEDICAL SCIENCES المجلة العراقية للعلوم الطبية ISSN: P16816579,E22244719 Year: 2013 Volume: 11 Issue: 3 Pages: 243-249
Publisher: Al-Nahrain University جامعة النهرين

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Abstract

Background:In spite of the recent advances in the endoscopic treatment of urinary stones, extracorporeal shock wave lithotripsy (ESWL) is still the treatment of choice for most renal and upper ureteric stones; however the outcome depends on multiple factors.Objective:To investigate the effects of stone density, as measured by Hounsfield Units (HU) by non-contrasted computerized tomography (CT), stone size and stone location on ESWL treatment outcome of urinary calculi.Methods:A prospective study that included 65 patients. Data collection and patient evaluation were performed in Al-Salam Teaching Hospital in Mosul, in the period from March 2012 to December 2012. Patients were submitted to clinical, biochemical and radiological assessments followed by ESWL treatment. Statistical analyses using chi-square, analysis of variance (ANOVA), correlation, regression were performed for statistical significance between ESWL treatment, stone fragmentation and stone density, size and location in the renal pelvicalyseal system.Results:ESWL success rate was high (92%) for low density stones (< 500 HU). ESWL treatment outcome and stone size were inversely related. CT stone densities of 700 HU or less were almost always successfully treated by ESWL. CT stone density and stone size combined account for nearly 74% of the variation in the number of shock waves required to attain fragmentation. Stones located in lower calyceal area had less success rates.Conclusion:Stone density measurement is helpful to predict the success of ESWL for urinary stones, stones with higher density, large size and lower location may better be managed by percutaneous nephrolithotomy or endoscopic procedures.Key words:CT stone density, ESWL, none contrasted CT scan (NCCT).


Article
Efficacy and Safety of Ultrasound Guided Extracorporeal Shock Wave Lithotripsy (SONO ESWL) In Patients with Radiopaque Renal Stone

Author: Wadhah Abbas Al-Marzooq
Journal: Medical Journal of Babylon مجلة بابل الطبية ISSN: 1812156X 23126760 Year: 2017 Volume: 14 Issue: 2 Pages: 361 -367
Publisher: Babylon University جامعة بابل

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Abstract

To assess the advantages and disadvantages of using ultrasound to guide ESWL in patients with radiopaque renal stone. This study included 80 patients with radiopaque renal stone who visited the ESWL unit in urology department at Hillah teaching hospital. Thirty-eight of those patients underwent US guided ESWL while in the other 42 patients the procedure done under fluoroscopy control. The results, complications and operative time were compared between both groups.Both groups were comparable regarding stone size, site and body mass index. Operative time was significantly longer in group 2, there was no significant difference regarding passage of gravels, stone free rate, postoperative hematuria and loin pain between both groups. Therefore, we conclude that even in patients with radiopaque stones, ultrasound can be used to guide ESWL as effectively as fluoroscopy, without any risk of radiation.


Article
8.PRE AND POST EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY (ESWL) URINE CULTURE AS A GUIDE FOR ANTIBIOTICS MANAGEMENT

Authors: Laith A. Al-Anbary --- Ahmed A. Khaleel --- Jabbar S. Hassan
Journal: IRAQI JOURNAL OF MEDICAL SCIENCES المجلة العراقية للعلوم الطبية ISSN: P16816579,E22244719 Year: 2018 Volume: 16 Issue: 3 Pages: 289-297
Publisher: Al-Nahrain University جامعة النهرين

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Background:The lifetime prevalence of kidney stone disease is estimated at 1-15%. The positive urine cultures can be obtained not only from Struvite stones, but also from calcium oxalate stones and also high levels of endotoxins are found both in infection stones (Struvite and carbonate apatite stones), and in non-infection stones. High concentrations of endotoxins (lipopolysaccharides) are thought to be released in the systemic circulation during stone treatment, inducing a systemic inflammatory response (SIRS) and this leads to urosepsis. Pre-Extracorporeal shock wave lithotripsy (ESWL) prophylactic antibiotics have an important role in reducing post-SWL infections, however, previous studies reported conflicting results. The issue of administering prophylactic antibiotics remains controversial in patients with sterile urine undergoing ESWL.Objective: To evaluate possible risk factors for post ESWL bacteriuria and consequently to identify patients with higher danger for urinary tract infection (UTI) or sepsis.Methods:Urine samples from 50 patients underwent ESWL, were collected by clean catch mid-stream urine collection method in sterile containers. Those patients were attending and admitting to Al-Imamein Al-Kadhimein Medical City during the period from October 2016 to January 2017. All patients had a urine culture performed before and after shock wave lithotripsy. Statistical analysis was performed with Epi-Info 7 and Excel programs. Statistical significance was evaluated using the Fisher's exact test with p <0.05 considered statistically significant.Results: A total of 50 patients who underwent ESWL during; the 2- months study period was enrolled in the study. Thirty-three 33 (66%) out of 50 were men and 17 (34%) out of 50 were women. 10 (20%) of patients had hypertension and 5 (10%) had diabetes mellitus. Fifty urine samples were collected from patients enrolled in this were cultivated on blood and MacConkey agar Pre-and post-ESWL Regarding Pre-ESWL results revealed 14 (28%) were urine culture positive while 23 cases were post-SWL urine culture positive. Conclusion: Antibiotic prophylaxis is not justified without defined risk factors such as positive urine culture before ESWL, an external bladder catheter or nephrostomy tube and a history of infectious stones or recurrent urinary tract infection.Keywords: Extracorporeal shock wave lithotripsy (ESWL), urine culture, renal stone and antibioticsCitation: Al-Anbary LA, Khaleel AA, Hassan JS. Pre and post extracorporeal shock wave lithotripsy (ESWL) urine culture as a guide for antibiotics management. Iraqi JMS. 2018; 16(3): 289-297. doi: 10.22578/IJMS.16.3.8

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