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Hig. Supracostal Percutaneous Nephrolithotomy Access: Assessing.Safety in Access above the Eleventh Rib after Performing.Preoperative Planning.with Computed Tomog.aphy

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Open Journal of Urolog. 2015年第4期5卷 25-33页

作者： Joel E. Abbott Anthony D. DiMatteo Elise Fazio samuel g. deem Ali K. Sobh Albert DePolo Julio g. Davalos St John Providence Health Michigan State University Warren USA Charleston Area Medical Center West Virginia School of Osteopathic Medicine Charleston USA Chesapeake Urolog. Associates University of Maryland Glen Burnie USA

Objective: To determine if supracostal renal access above the 11th rib during.percutaneous nephrolithotomy (PCNL) is a safe option in carefully selected patients determined by preoperative computed tomog.aphy (CT) imag.ng. Patients and Methods: We retrospectively isolated 142 patients who underwent access above the eleventh rib during.PCNL, which we term “hig. supracostal renal access.” We then compared these patients to 113 individuals who underwent access below the twelfth rib. Renal access was achieved by the operative surg.on with fluoroscopic g.idance in conjunction with pre-operative computed tomog.aphy (CT) scan. Outcomes were compared. Results: Overall surg.cal outcomes were equivalent when comparing.hig. supracostal versus subcostal access sites. As expected due to proximity, pleural complications occurred in 4% of the hig. supracostal g.oup (n = 6) compared with 0% of the control (subcostal) g.oup (p = 0.035). Of these six complications, three were manag.d conservatively with observation and two required cardio-thoracic intervention with video-assisted thoracoscopic pleural repair (1%). In the remaining.case, the patient was preoperatively consented for placement of a thoracostomy tube, which was placed during.the procedure, due to the difficult location of her upper pole stone and closely adjacent low-lying.pleura, and the planned transpleural approach. Hospital stay was not sig.ificantly pro-long.d between the hig. supracostal access and subcostal access g.oups, with an averag. leng.h of stay of 2.2 ± 2.1 days and 2.0 ± 1.9 days (p = 0.59) respectively. Conclusions: Careful, systematic preoperative planning.based on CT and fluoroscopic imag.ng.allows for a confident understanding.of a “safety zone” in placement and dilatation of renal access points during.PCNL. We have shown that planned upper pole renal access above the 11th rib is achievable with acceptable morbidity and excellent success rates.

关键词： Percutaneous Nephrolithotomy Calculi Endoscopic Surg.cal Procedure

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Prostate cancer screening. A primary care survey

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Health 2010年第10期2卷 1179-1183页

作者： samuel deem Brian DeFade Josh Lohri James P. Tierney Asmita Modak Mary Emmett 不详

Prostate cancer is the most common intrinsic cancer in men and the 2nd most common cause of cancer related death in men over fifty years of ag.. The benefit of early screening.for prostate cancer is yet to be proven. Multiple org.nizations currently offer recommendations reg.rding.prostate cancer screening. Prostate Specific Antig.n (PSA) testing.was introduced into widespread use in the late 80’s and its role in screening.is debatable. We surveyed by mail every primary care physician in West Virg.nia who has a state license. Results from 438 respondents indicated that the American Cancer Society (ACS) g.idelines were most commonly used and that PSA testing.does seem to be a g.od screening.test. We present the results and discuss the different points of view reg.rding.prostate cancer screening.

关键词： Prostate Cancer Screening PSA g.idelines Survey

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Contemporary manag.ment of upper tract urothelial cell carcinoma

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World Journal of Clinical Urolog. 2017年第1期6卷 1-9页

作者： Kellen Choi Ryan McCafferty samuel deem Department of Urolog. Charleston Area Medical Center Department of Anesthesiolog. Pg.-1 Larkin Community Hospital

Upper tract urothelial cell carcinoma(UTUCC),formerly known as transitional cell carcinoma of the upper urinary tract,is a rare oncolog.c disease in Western *** its disease process and its manag.ment are not as well defined as other urolog.c cancers. We are reviewing.the current evidence based literature available to develop a plan for the treatment of UTUCC. A Pub Med search was completed using.the key words "upper tract urothelial cell carcinoma","epidemiolog.","risk factor","treatment" and "prog.osis". Six hundred fifty two articles were found. We narrowed our search to articles published between January 2004 and June 2016 for a more contemporary review of the topic. Four hundred seventy articles were then available for review. Further detailed search was performed for relevance on the topic and hundred one articles were selected for the review. Many risk factors have been found to be associated with the development of UTUCC,including.tobacco use. Patients are often asymptomatic and may only present with microscopic or g.oss hematuria. Tumor g.ade and stag. are pivotal in determining.the treatment options for UTUCC. Advancements in endoscopic techniques have aided in the diag.osis,g.ading.and treatment of this disease. Treatment options include topical therapy,with combinations of methotrexate,vinblastine,doxorubicin and cisplatin or g.mcitibine or cisplatin,endoscopic resection,seg.ental ureterectomy and ureteral implantation,and nephroureterectomy,including.bladder cuff. Treatment recommendations depend on tumor g.ade and stag.,renal function,tumor location and the patient's prog.osis. There are currently no tissue or blood-based biomarkers available to accurately monitor the disease. Further studies of g.ne expression and biomarkers may hopefully improve the manag.ment of this disease. Althoug. rare in many countries,UTUCC is becoming.more prevalent due to exposure to carcinog.nic herbal remedies and other identifiable risk factors. Numerous treatme

关键词： Urothelial cell carcinoma Diag.osis Upper tract Epidemiolog. Risk factors Treatment Prog.osis

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治疗中等体积肾结石：ESWL、PCNL孰优孰劣？

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现代泌尿外科杂志 2011年第5期16卷 476-476页

作者： samuel deem BRIAN DEFADE ASMITA MODAK 李翔（摘译）贺大林（审校）

目的新型碎石机更注重保护肾脏免收损失，但其碎石效率确受到质疑，随着技术的日益成熟，PCNL已被AUA指南推荐用于治疗包括鹿角状结石在内的复杂肾结石。临床中最常见的肾结石体积介于1～2cm之间。本研究目的在于探讨对于中等体积的肾... 详细信息

目的新型碎石机更注重保护肾脏免收损失，但其碎石效率确受到质疑，随着技术的日益成熟，PCNL已被AUA指南推荐用于治疗包括鹿角状结石在内的复杂肾结石。临床中最常见的肾结石体积介于1～2cm之间。本研究目的在于探讨对于中等体积的肾结石采用ESWL或PCNL治疗方法孰优孰劣。

关键词：复杂肾结石 PCNL 治疗方法 ESWL 体积鹿角状结石碎石效率碎石机

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