Late perforation after ventriculoperitoneal (VP) shunting is extremely rare. Colonic perforation is uncommon and represents 0.1%-0.7% of abdominal complications. Colonic perforation can challenge diagnostic and therapeutic decisions, and there are no clear guidelines on the management of this problem. We present a 34-year-old woman who was admitted for a 1-week history of sensation of a foreign body through the anus at the time of bowel movements. She had previously undergone a VP derivation for hydrocephalus secondary to neurocysticercosis. Plain abdominal radiographs demonstrated the shunt within the colonic lumen and through the descendening and sigmoid colon. The shunt was exteriorized in the cervical area and a laparotomy was performed with a primary two-layer colonic close. The patient received antibiotic therapy for 2 weeks with good outcome. Percutaneous and endoscopic approaches have been reported in patients with no abdominal signs. Prompt recognition of this complication is critical to avoid high mortality rates.
IntroductionReusable endoscopes have some limitations regarding their continued use. To sort out these problems, several disposable devices have appeared on the market. Our objective is to show our clinical results with a new digital flexible single-use ureteroscope.Materials and methodsThis study presents a prospective series of patients who underwent endoscopic surgery as treatment for renal stones using the digital disposable endoscope Uscope 3022™. Demographic, procedure and stone information were registered including surgery time, stone-free rate, need of ureteral catheterization and complications, among others. The behavior of the ureteroscope in terms of image quality and problems associated with flexibility and the working channel were also registered.ResultsA total of 71 procedures were included in the analysis. The mean age was 49.9 years old, with 70.4% of male patients. Mean stone size was 11.4 mm (4 to 40 mm). The most frequent stone location was in the lower calyces (28.2%). The stone burden was high (>2 cm) in 8.4% of patients. The mean surgical time was 56.6 minutes (15–180 min). In 94.4% of the cases, a laser was used with dusting parameters. The global stone-free rate (SFR) was 95.2%, but in the subgroups analysis SFR were significantly superior in stones less than 10 mm (97.9%) versus stones between 10 and 20 mm (94.5%) and greater than 20 mm (78.3%) (p <0.01). The postoperative placement of double-J stents was required in 66.2% of patients. Two minor complications were recorded and they were related to the ureteral access sheath used. There were no problems regarding the performance of the ureteroscope.ConclusionsThe clinical data observed in this series does not differ from the results traditionally obtained with other reusable devices. To our knowledge, this series is the first worldwide report evaluating the clinical behavior and results in humans of the Uscope 3022.
155 Background: The prostatic multiparametric MRI (mpMRI) is the combination of anatomical imaging and functional sequences. Nowadays this technique is still being researched due to its positive published results. The objective of this study is to show our experience in the application of the mpMRI in patients, prior to the TRUS-guided biopsy, and the sensitivity and specificity of its measured parameters and their combination. Methods: Prospective cohort. MpMRI was indicated to patients prior to the TRUS-Guided biopsy. Diffusion, PIRADS, DCE and T2 parameters were observed on the MRIs, and the presence of cancer and Gleason score on the biopsy. Logistic regression test was performed with a 95% confidence interval. We assigned different values, depending of the importance of each factor, applying binominal regression. Results: We registered 73 patients with mpMRI prior to the TRUS-Guided Biopsy, and their results. The cancer detection rate was 60.27% (44 patients). The T2 signal had a sensibility of 81.82% and a specificity of 27.59%, ROC curve 0.54 (CI 0.44 – 0.64). The diffusion has a sensibility of 30% and a specificity of 85.19% with a ROC curve of 0.58 (CI 0.48-0.68). The DCE has a sensibility and specificity of 77.78% and 35.29% respectively, ROC curve of 0.57 (CI 0.42-0.71). By combining the T2, diffusion and DCE parameters, having 2 or more altered values, we obtained a sensibility of 84.62% with a 41.18% specificity, curve of 0.68 (CI 0.54-0.81). The sensitivity and specificity with a PIRADS score ≥ 3 was of 68.42 and 36.36% with a ROC curve of 0.56 (CI 0.36-0.76). With a PIRADS ≥ 4 the sensitivity and specificity was 57.89% and 54.55% respectively. The calculated measured score was assigned as 7 points for altered T2, 8 points for altered diffusion and 5 points for altered DCE. With a total value ≥ 12 the sensitivity of the score was 84.62% with a 41.18% sensitivity, ROC curve 0.68 (CI 0.54-0.81). Conclusions: The use of isolated mpMRI parameters have low performance, whereas this is greatly increased when used combined. The assigned weight of each parameter is a factor to consider and review on the existing scores.
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