Hemendra Shah

Impact of Case Volumes on the Outcomes of Percutaneous Nephrolithotomy

BACKGROUND Previous studies have demonstrated relationships between case volumes and outcomes in surgery. Little is known about the impact of case volumes on the outcomes of percutaneous nephrolithotomy (PCNL). OBJECTIVE To investigate the influence of case volumes on the efficacy and safety outcomes of PCNL. DESIGN, SETTING, AND PARTICIPANTS From November 2007 to December 2009, prospective data were collected by the Clinical Research Office of the Endourological Society from consecutive patients over a 1-yr period in 96 centers globally. Data of 3933 patients in the Global PCNL study database were included in this study. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Patients were divided into low- and high-volume groups based on the median annual case volume of their respective treatment center. Preoperative characteristics and outcomes were compared between the two groups. Case volume was treated as a continuous variable. The relationship between case volume and stone-free (SF) rate, complication rate, and duration of hospital stay was explored using multivariate regression analysis. RESULTS AND LIMITATIONS SF rates were higher in high-volume centers (82.5% vs 75.1%; p value <0.001). Complication rates were lower in high-volume centers (15.9% vs 21.7%; p value 0.002), whereas the mean (standard deviation [SD]) duration of stay was shorter in high-volume centers (3.4 [2.6] vs 4.9 [3.7] d; p value <0.001). SF rate increased with case volume, whereas complication rate and duration of stay diminished with increasing case volumes after adjusting for stone burden, urine culture status, American Society of Anesthesiologists score, and the presence of staghorn stones. The highest SF rates were observed in centers with >120 cases per year. CONCLUSIONS Centers that perform high numbers of PCNLs per year achieve better results. Both the efficacy and safety outcomes of PCNL improve with the number of surgeries performed in a given center per year.

CT Findings in Abdominal Actinomycosis

The diagnosis of abdominal actinomycosis is difficult because of its relative infrequency and imitation of other diseases. We present four cases in which these difficulties in diagnosis were experienced and show the utility of CT in suggesting this disease. Aspiration, biopsy, and proper culture technique, in conjunction with typical CT findings of transfascial and multiple organ involvement, led to the proper diagnosis in all cases.

Hemorrhagic Adrenal Metastases: CT Findings

Adrenal hemorrhage secondary to metastases is uncommon. We have encountered four such cases that presented as large adrenal masses. In all cases the CT findings were of an inhomogeneous mixed-density adrenal mass with extensive perirenal changes suggestive of perirenal hemorrhage or mass. When such a lesion is seen, hemorrhagic adrenal metastases should be considered. Fluid may be of high density, suggestive of hemorrhage. However, as the adrenal is in the perinephric space, hemorrhage from any cause (trauma, metastases, or anticoagulant) in the adrenal gland will gravitate into the perinephric space.

MR and CT appearance of iliopsoas bursal distention secondary to diseased hips

Occasionally hip joint disease may extend into surrounding structures, including the retroperitoneum, via the iliopsoas bursa. The enlargement of this bursa may present as an inguinal or pelvic mass that may affect other surrounding structures and can result in a multitude of clinical presentations. The two cases presented herein of iliopsoas bursa distention secondary to hip disease demonstrate the excellent specificity of CT and magnetic resonance in differentiating this clinical entity from other causes of groin masses.

Solitary splenic abscess: a new complication of splenic salvage treated by percutaneous drainage.

A patient sustained a gunshot injury to the spleen. The spleen was left intact in an attempt to maintain normal immune function in the patient. The patient developed a splenic abscess as a result of the injury, a complication of splenic salvage that we have not found reported before. The abscess was treated successfully via CT-guided percutaneous drainage.

Intermittent torsion of accessory hepatic lobe: An unusual cause of recurrent right upper quadrant pain

An accessory lobe of the liver is a rare congenital anomaly that can undergo torsion and present as an acute surgical emergency. It is rarely diagnosed preoperatively. We report the preoperative utility of CT scan and MRI in the diagnosis and surgical planning of a case of intermittent accessory hepatic lobe torsion.

Bremsstrahlung imaging after 32P treatment for residual suprasellar cyst.

A patient with residual suprasellar cystic neoplasm was treated by direct instillation of the 32P colloid. The incidental bremsstrahlung images on a conventional gamma camera helped to localize the pharmaceutical within and outside of the lesion. Advantages of bremsstrahlung imaging and the dosimetry results of phantom studies carried out are described.

CT of emphysematous gastritis

Emphysematous gastritis is a serious, often fatal condition. It is the result of destruction of the mucosal membrane with subsequent bacterial invasion of the stomach. We have encountered two cases at CT. Recognition is important since early intervention may be lifesaving.

Gorham's syndrome. Correlative imaging using nuclear medicine, plain film, and 3-D CT.

The authors present a case of Gorhams syndrome involving the mandible in a 52-year-old man demonstrated by multiple imaging modalities. Gorhams Syndrome (diseappearing bone disease, massive osteolysis) is a rare idiopathic disorder of bone characterized radiographically by progressive bony resorption. The process is usually monostotic in the initial phase with involvement of adjacent bones by direct spread across joint spaces. The clinical course is unpredictable with spontaneous arrest of the osteolysis being common

Urolithiasis: evaluation, dietary factors, and medical management: an update of the 2014 SIU-ICUD international consultation on stone disease

PurposeThe aim of this review was to provide current best evidence for evaluation, dietary, and medical management of patients with urolithiasis.MethodsLiterature addressing evaluation, dietary, and medical management of urolithiasis was searched. Papers were analyzed and rated according to level of evidence (LOE), whereupon a synthesis of the evidence was made. Grade of recommendation (GOR) was judged from individual clinical experience and knowledge of the evidence according to the Oxford Centre for Evidence-based Medicine.ResultsIt is obvious that different stone diseases influence the life of stone-forming individuals very differently, and that evaluation and medical management should be personalized according to risk of recurrence, severity of stone disease, presence of associated medical conditions, and patient’s motivation. With regard to evaluation, dietary and medical management of patients with urolithiasis evidence from the literature suggest that selective metabolic evaluation may lead to rational dietary and medical management. Statements based on LOE and GOR are provided to guide clinical practice.ConclusionThe provided evidence for evaluation of patients with urolithiasis aims at defining patients at high risk for recurrent/complicated stone disease. Based on this approach, evidence-based dietary and medical management regimes are suggested.