Retrieval Of Fragments Research Articles

Physical therapy in the management of stone fragments: progress, status, and needs.

With an increased risk of symptomatic events, the complications related to residual fragments are complex and intractable. The management of stone fragments is a challenge to urologists. This review focused on the progress, status, and needs of the newly developed physical therapies to remove fragments and improve the stone-free rate. Physical therapies, including mechanical percussion, diuresis, and inversion therapy, ultrasonic propulsion technology, glue-clot technology, and magnetization technology, will facilitate progress in endoscopic stone fragment retrieval.

MP75-12 PROSPECTIVE EVALUATION OF STONE FREE RATES BY COMPUTED TOMOGRAPHY AFTER AGGRESSIVE URETEROSCOPY

You have accessJournal of UrologyStone Disease: Surgical Therapy VII1 Apr 2017MP75-12 PROSPECTIVE EVALUATION OF STONE FREE RATES BY COMPUTED TOMOGRAPHY AFTER AGGRESSIVE URETEROSCOPY Noah Canvasser, Aaron Lay, Elysha Kolitz, Jodi Antonelli, and Margaret Pearle Noah CanvasserNoah Canvasser More articles by this author , Aaron LayAaron Lay More articles by this author , Elysha KolitzElysha Kolitz More articles by this author , Jodi AntonelliJodi Antonelli More articles by this author , and Margaret PearleMargaret Pearle More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.2160AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Previous retrospective and prospective studies have shown surprisingly low stone free rates (SFR) (approximately 50%) after ureteroscopy (URS) using stringent computed tomography (CT) criteria, although the aggressiveness of fragment extraction was not always quantified. Our goal was to determine SFR by CT after URS and aggressive fragment retrieval, quantified by the number of ureteroscope passes through a ureteral access sheath (UAS). METHODS We prospectively evaluated patients undergoing URS with laser lithotripsy at our institution from December 2015 to October 2016. UAS were used in all patients except those with distal ureteral stones. Every attempt was made to extract all stone fragments, regardless of size, after fragmentation. Patient demographics, stone number, size, and location, and the number of passes of the ureteroscope were recorded. SFR was determined using non-contrast CT scan approximately 8 weeks after the procedure. Stone free (SF) cohort was compared to the residual fragment (RF) cohort using the student′s T-test and the chi-squared test, and binary logistic regression identified factors associated with stone free status. Statistical significance was set at p < 0.05. RESULTS In total, 104 patients (141 renal units) underwent URS, with 67 patients (84 renal units) completing radiographic follow up to date. Mean number of stones was 3.3 and mean aggregate stone size was 13mm. Our overall SFR was 55%, with a mean number of ureteroscope passes of 44 (range 1 - 164). On univariate comparison between the SF and RF cohorts, SF patients had fewer numbers of stones (2.4 vs. 4.3, p=0.001), smaller aggregate stone size (11 vs. 15mm, p=0.02), and a smaller proportion of renal or renal and ureteral stones (54% and 15% vs. 66% and 26%, respectively, p=0.003). There were no significant differences in OR time, UAS size, or the number of ureteroscope passes (41 vs. 48, p=0.4) between groups. Binary logistic regression revealed no significant factors predictive of SF status. CONCLUSIONS SFRs by CT after URS are disappointingly low even with aggressive manual fragment retrieval. Larger sample size is likely to identify select cohorts of patients that benefit most from URS. © 2017FiguresReferencesRelatedDetailsCited bySorensen M (2019) Editorial CommentaryUrology Practice, VOL. 6, NO. 5, (298-298), Online publication date: 1-Sep-2019. Volume 197Issue 4SApril 2017Page: e1007-e1008 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Noah Canvasser More articles by this author Aaron Lay More articles by this author Elysha Kolitz More articles by this author Jodi Antonelli More articles by this author Margaret Pearle More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

PD21-12 ECIRS (ENDOSCOPIC COMBINED INTRARENAL SURGERY) IN THE GALDAKAO-MODIFIED SUPINE VALDIVIA POSITION

You have accessJournal of UrologyStone Disease: Surgical Therapy II1 Apr 2017PD21-12 ECIRS (ENDOSCOPIC COMBINED INTRARENAL SURGERY) IN THE GALDAKAO-MODIFIED SUPINE VALDIVIA POSITION Cesare Marco Scoffone and Cecilia Cracco Cesare Marco ScoffoneCesare Marco Scoffone More articles by this author and Cecilia CraccoCecilia Cracco More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.1050AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES ECIRS (Endoscopic Combined IntraRenal Surgery) in the Galdakao-modified supine Valdivia position is an evolution of the traditional prone percutaneous nephrolithotomy (PNL) for the treatment of large/complex urolithiasis, combining an antegrade rigid and flexible approach with retrograde flexible ureteroscopy. The aim of the present work is to report our 12-years experience, highlighting ECIRS safety and efficacy. METHODS We performed 310 consecutive ECIRS (11/2010-11/20169 standardized step-by-step pre-, intra- and post-operatively. The semirigid 6.5F Wolf ureteroscope and the flexible Storz FlexX2/C ureteroscopes were used for retrograde access. Percutaneous access was gained under ultrasound-assisted biplanar fluoroscopy guidance +/- Endovision contribution (24 Ch in 65% of the cases, 30 Ch in 31%, smaller accesses in 4%), using in 78% one-step balloon dilation. RESULTS Mean age of the 310 patients (210 males, 100 females) was 55 years +/- 20 s.d. (range 19 months-82 years). The ASA score was 1-3, mean BMI 30 kg/m2 +/- 5 s.d., 10% urinary malformations, 7% skeletal deformities, 74% symptomatic for UTI/colics. Urolithiasis (206 left, 104 right renal stones, 15% bilateral, all compositions) had a mean stone size 51 mm +/- 22 s.d. (range 13-72 mm). Stones were single in 55%, multiple/staghorn in 45% of cases, with 24% coexistent ureteral stones. Mean operative time was 88 minutes +/- 35 s.d., including patient positioning. Preliminary semirigid ureteroscopy was performed in 81% of cases, additional flexible ureteroscopy in 53%. Endovision aid to fluoroscopy/ultrasound renal access (90% inferior calyx, 94% single access) was possible in 39% of cases. Retrograde ureteroscopy (ureteral stone treatment, in situ lithotripsy, stone fragments retrieval in calyces parallel to the access tract,…) had an active role in 54% of cases. The stone-free rate was 89.8%, 94.3% after an early second percutaneous look during the same hospital stay. The overall complication rate was 7.4% (1.6% of cases Clavien 3 and never more, no ureteral lesions). Mean fluoroscopy time of the 'really-endoscopic' cases was 3.3 minutes +/- 1.2 s.d., versus 5.5 +/- 3 s.d. of the other ECIRS. CONCLUSIONS ECIRS represents a comprehensive approach to PNL, personalizing stone management and tailoring all intraoperative choices on the patient. Retrograde flexible ureteroscopy, after preliminary evaluation of the dynamic anatomy of collecting system and stones, actively contributes to safety and efficacy of ECIRS, optimizing stone-free rates and reducing complications and radiation exposure. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e440-e441 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Cesare Marco Scoffone More articles by this author Cecilia Cracco More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Comparative study of cell block versus centrifuged smear examination from aspirates of cystic lesions

Background: Cystic fluids encountered during routine FNA poses a diagnostic challenge to cytopathologists due to its low cell yield with high dispersal of cells on conventional centrifuged smears (CS). Cell Block (CB) technique enables retrieval of small tissue fragments from fluids, thereby providing scope for better morphology and material for ancillary techniques which help in improving the diagnosis. Aim : To compare the efficacy of CB versus CS, in cyto-diagnosis of cystic lesions. Methods : This observational study was conducted on a total of 50 fluid samples aspirated from cystic lesions during routine FNA and fluids aspirated peri-operatively from cystic ovarian lesions. Divided into two equal parts, one part was processed for CS and CB by Fixed Sediment Method and relevant immunohistochemistry was performed. CSs were categorized as positive for malignancy, benign diagnosis, Inadequate for opinion and suspicious for malignancy. CBs were categorized as; no material, Non-contributory (CS+, CB-), confirms the smear diagnosis and establishes a specific diagnosis. The comparison between CS and CB was analysed by Chi- square test & kappa test. Results: Out of the 50 cases, 35(70%) were given a benign diagnosis, 10 (20%) were positive for malignancy, 2(4%) were suspicious and 3(6%) were inadequate for opinion on CS. In CB out of 50 cases, 29 of them confirmed/established a diagnosis and 21 cases were non diagnostic / non-contributory. CB gave an improved diagnosis in 2 out of 10 (20% ) malignant cases and 2 out of 35 (5.7%) benign cases.( p value = 0.00054, Kappa value =0.34) Conclusions: CBs complemented CS, more so in malignant lesions by preserved architecture. Aspirates from multiple sites of the cystic lesions (with/without radiological assistance) pooled as one specimen yielded better material for CBs and ancillary techniques like histochemistry and IHC. DOI: 10.21276/APALM.1249

In Vitro Evaluation of Three Methods for the Retrieval of Fractured Screw Fragments from Dental Implants.

To compare the effectiveness of different methods of fractured screw fragment retrieval from dental implants, comparing a conventional method (use of an exploration probe and ultrasonic tips) with two mechanical retrieval kits. One hundred thirty-five screws in implant internal connections were fractured to test fragment retrieval comparing three methods: conventional method with the use of an explorer probe and ultrasonic tips (group CE), extraction with a mechanical kit with a guide cylinder (group MK1), and extraction with a mechanical kit without a guide cylinder (group MK2). Extraction success and retrieval times for each method, as well as success and retrieval times in relation to fracture depth-coronal, middle, or apical-were analyzed by means of chi-square, Fisher exact, Kruskal-Wallis, and Mann-Whitney tests (P < .05). The integrity of implant internal threads was also analyzed. The extraction success rates for groups MK2, CE, and MK1 were 93.3%, 73.3%, and 20%, respectively. The mean ± SD extraction times were 2 minutes, 56 seconds ± 2 minutes, 9 seconds; 3 minutes, 15 seconds ± 1 minute, 48 seconds; and 13 minutes, 34 seconds ± 7 minutes, 25 seconds for groups MK2, CE, and MK1, respectively. Statistically significant differences were found in the number of fractured screws extracted and in the retrieval time. No significant differences were found for retrieval time or extraction success in relation to the depth of the fracture. The mechanical kit without the guide cylinder achieved the best results with respect to the number of screw fragments retrieved, retrieval time, and preservation of implant internal threads.

ヘパリン生食水の flush で断裂し,バスケット鉗子で摘出した Broviac カテーテル塞栓の1例

ヘパリン生食水の flush で断裂し,バスケット鉗子で摘出した Broviac カテーテル塞栓の1例

Percutaneous retrieval of a fractured portacath fragment in two patients undergoing long-term chemotherapy

Percutaneous retrieval of a fractured portacath fragment in two patients undergoing long-term chemotherapy

Novel Biocompatible Adhesive for Intrarenal Embedding and Endoscopic Removal of Small Residual Fragments after Minimally Invasive Stone Treatment in an Ex Vivo Porcine Kidney Model: Initial Evaluation of a Prototype

Residual fragments related to endoscopic intracorporeal lithotripsy are a challenging problem. The impact of residual fragments remains a subject of discussion and growing evidence highlights that they have a central role in recurrent stone formation. Therefore, we developed a novel bioadhesive system for intrarenal embedding and retrieval of residual fragments after endoscopic lithotripsy in an exvivo porcine kidney model. In a standardized setting 30 human stone fragments 1mm or less were inserted in the lower pole of an exvivo porcine kidney model. We assessed the extraction efficacy of flexible ureteroscopy using the bioadhesive system in 15 preparations and a conventional retrieval basket in 15. Outcomes were compared regarding the endoscopic and macroscopic stone-free rate, and overall time of retrieval. Embedding and retrieving the residual fragment-bioadhesive complex were feasible in all trial runs. We observed no adverse effects such as adhesions between the adhesive and the renal collecting system or the instruments used. The stone-free rate was 100% and 60% in the bioadhesive and conventional retrieval groups, respectively (p = 0.017). Mean retrieval time was significantly shorter at 10 minutes 33 seconds vs 36 minutes 56 seconds in the bioadhesive group vs the conventional group (p = 0.001). This novel method involving adhesive based complete removal of residual fragments from the collecting system has proved to be feasible. Our evaluation in a porcine kidney model revealed that this technology performed well. Further tests, including inpatient studies, are required to thoroughly evaluate the benefit and potential drawbacks of bioadhesive based extraction of residual fragments after intracorporeal lithotripsy.

PD19-01 COMPARISON OF A NOVEL COMBINED HOLMIUM LASER AND SUCTION DEVICE, LITHASSIST, TO AN ULTRASONIC LITHOTRIPTER FOR PERCUTANEOUS NEPHROLITHOTOMY- A RANDOMIZED CONTROLLED MULTICENTER CLINICAL TRIAL

You have accessJournal of UrologySurgical Technology & Simulation: Instrumentation & Technology II1 Apr 2016PD19-01 COMPARISON OF A NOVEL COMBINED HOLMIUM LASER AND SUCTION DEVICE, LITHASSIST, TO AN ULTRASONIC LITHOTRIPTER FOR PERCUTANEOUS NEPHROLITHOTOMY- A RANDOMIZED CONTROLLED MULTICENTER CLINICAL TRIAL Necole M Streeper, Zhamshid Okhunov, Jaime Landman, John R Bell, Sara L Best, and Stephen Y Nakada Necole M StreeperNecole M Streeper More articles by this author , Zhamshid OkhunovZhamshid Okhunov More articles by this author , Jaime LandmanJaime Landman More articles by this author , John R BellJohn R Bell More articles by this author , Sara L BestSara L Best More articles by this author , and Stephen Y NakadaStephen Y Nakada More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.1400AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The objective of this study is to compare the efficiency of stone fragmentation and removal of the LithAssist (Cook Medical, Bloomington, IN, USA), a disposable combination holmium laser and suction handheld device, to an ultrasonic lithotripter in patients undergoing percutaneous nephrolithotomy (PNL) for renal stones. METHODS With IRB approval, we performed a randomized controlled multicenter clinical trial to compare the LithAssist to an ultrasonic lithotripter. Patients undergoing a PNL with non-staghorn renal stones were eligible for the study. The primary outcomes were the time to stone clearance and stone clearance rate. In addition, stone burden, S.T.O.N.E nephrolithometry score, post-operative complications, stone-free rates, need for additional modalities, device malfunction, and surgeon comfort with the device were measured. RESULTS A total of 27 PNLs were performed with 14 patients randomized to the LithAssist device (9 female: 5 male, age 60.5±15.1) and 13 patients randomized to an ultrasonic lithotripter (8 female: 5 male, age 59.5±9.7). There was no significant difference between the two devices for stone size (LithAssist 830.8 mm2 vs Ultrasonic 1209.6 mm2), S.T.O.N.E nephrolithometry score (LithAssist 8.5 vs Ultrasonic 9.2), time to stone clearance (LithAssist 57.6 min vs Ultrasonic 43.9 min) or overall operative time (LithAssist 164.6 min vs Ultrasonic 147.5 min). There was a trend for higher stone clearance rate with the ultrasonic lithotripter compared to the LithAssist device, 107.1 mm2/min vs 27.9 mm2/min respectively, p=0.1. Post-operative complications, stone-free rates, need for additional modalities, and device malfunction were similar in both treatment groups. There were two cases that required switching from the LithAssist to the ultrasonic lithotripter. Surgeon comfort with the device was higher for the ultrasonic lithotripter (p<0.001). CONCLUSIONS Preliminary results suggest no significant difference between the LithAssist and ultrasonic lithotripter, however there was a trend for higher stone clearance rate with the ultrasonic lithotripter. Specifically the LithAssist device had poor suctioning secondary to the small caliber of the probe and required more retrieval of stone fragments. Surgeon comfort was significantly higher with the ultrasonic lithotripter. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e445 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Necole M Streeper More articles by this author Zhamshid Okhunov More articles by this author Jaime Landman More articles by this author John R Bell More articles by this author Sara L Best More articles by this author Stephen Y Nakada More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Minimally invasive versus conventional large-bore percutaneous nephrolithotomy in the treatment of large-sized renal calculi: Surgeon’s preference?

Objective: The aim of this study was to compare the efficacy and safety of minimally invasive percutaneous nephrolithotomy (MIP) and conventional percutaneous nephrolithotomy (PCNL) in the treatment of patients with large renal stone burden. MIP has proven its efficacy and safety in the management of small renal calculi. However, conventional PCNL is still considered the standard method for treatment of large renal stones in the upper urinary tract. Materials and methods: A search of two longitudinal databases in two tertiary referral centres for complex stone disease identified 133 consecutive patients who were treated by either MIP or PCNL for renal stones 20 mm or larger between January 2009 and August 2012. Clinical data and outcome measures of the two methods were compared by Student’s t test, chi-squared test or Fisher’s exact test. A p value less than 0.05 was considered statistically significant. Results: Operative time was significantly shorter and hospital stay was significantly longer in conventional PCNL compared to MIP (p = 0.002 and < 0.001, respectively). There were no significant differences in primary stone-free rate or complication rate between the two methods. Only higher graded complications (above Clavien grade II) were significantly more common in conventional PCNL (p = 0.02). Conclusion: MIP is equally effective as conventional PCNL in the treatment of large renal calculi. Both methods have a similar complication rate. The shorter operative time in PCNL may be based on the larger diameter and quicker retrieval of large fragments; the longer mean hospital stay may be caused by the handling of the nephrostomy tube. The current data suggest that the choice of the method mainly depends on the surgeon’s preference.

Use of Computer-Assisted Navigation in the Retrieval of Accidentally Displaced Third Molars

The purpose of this study was to describe the application of computer-assisted navigation for the retrieval of accidentally displaced mandibular third molars. All patients identified as having an accidentally displaced mandibular third molar or root fragment and presented to the authors' department from April 2013 through June 2015 were included in this prospective study. Retrieval of the displaced molar was performed in these patients under the guidance of computer-assisted navigation, in which a registered forceps was used to clamp and retrieve the molar. Postoperative complications were assessed for all patients. Twelve patients were included in this case series. Using computer-assisted navigation, the operation proceeded successfully in all patients. These patients displayed uneventful healing without postoperative complications. Computer-assisted navigation is a safe, straightforward, and minimally invasive treatment method that can be applied for the retrieval of accidentally displaced third molars. It is recommended as an intraoperative tool for the retrieval of teeth or tooth fragments displaced into areas that are difficult to access.

A Novel Two-Step Technique for Retrieving Fractured Peripherally Inserted Central Catheter Segments Migrating into the Heart or the Pulmonary Artery.

Objective. To report the experience of a percutaneous technique for retrieving fractured peripherally inserted central catheter (PICC) segments migrating into the heart or the pulmonary artery. Method. From April 2013 to July 2015, we performed percutaneous retrieval of fractured PICC segments migrating into the heart or the pulmonary artery in five cancer patients who had undergone chemotherapy via PICC. The fractures were diagnosed with chest plain radiography. The patients included three cases of breast cancer, one case of rectal cancer, and one case of lower limb Ewing's tumor. The fractures were retained in the vessels of the patients for 1 to 3 days. All the fractures were retrieved by using a novel two-step technique in the digital subtraction angiography (DSA) suite. This two-step technique involves inserting a pigtail catheter to the heart or the pulmonary artery to grasp the fractured catheter fragment and bring it to the lower segment of the inferior vena cava, followed by grasping and removing the catheter fragment with a retrieval loop system of the vena cava filter retrieval set. Result. The fractured PICC segments were removed successfully in all five patients via unilateral (four patients) or bilateral (one patient) femoral vein access. No complications occurred during the interventional procedure. Conclusion. Percutaneous retrieval can be a safe, convenient, and minimally invasive method for the removal of fractured PICC segments. The technique reported in this paper will be applicable for the retrieval of fractured PICC segments and other catheter fragments migrating into the heart or the pulmonary artery.

New technology in ureteroscopy and percutaneous nephrolithotomy.

New developments of retrograde intrarenal and percutaneous endoscopic surgery for nephrolithiasis have significantly enhanced the indications of endourology compared to extracorporeal shock wave lithotripsy. We want to review the most significant new technologies New technology to access the renal collecting system includes marker-based tracking with iPAD, laser-guided puncture on (Uro)Dyna-CT, electromagnetic tracking (only experimental), and optical tracking for ultrasound-guided puncture. Miniaturization percutaneous nephrolithotomy has been further extended and classified to Midi-PCNL (20-22F/L), Mini-PCNL (16-18F/M), Ultra/Super-mini-PCNL (12-14F/S), and Micro-PCNL (8-10F/XS). Knowledge of Ho:YAG-laser lithotripsy including power settings for fragmentation (depending on stone composition), dusting (0.5J/20Hz), and popcorn-effect/laser-burst (1J/30Hz) becomes mandatory. Also hydrodynamic mechanisms for retrieval of fragments (active/passive washout, purging, vacuum-cleaner-effect) have gained importance. Improvements of FURS focus on digital-HD-video-technology with post-processing software (NBI/SPIES) providing better resolution and increased optical field, further miniaturization of endoscopes to fit in smaller access sheath (12/14F), additional tip-less Nitinol baskets and graspers, and introduction of a robotic device (Avicenna Roboflex) to improve ergonomics of the procedure. Based on recent technical developments, percutaneous nephrolithotomy and particularly flexible ureteroscopy will further gain preference in management of urolithiasis compared to ESWL. Endourology may offer a higher rate of primary success with minimal side-effects which could weigh out the slightly higher degree of invasiveness.

Broken guidewire – A tale of three cases

Guidewire fracture is a rare complication of percutaneous coronary intervention. Retained guide wire fragments in the coronary tree can cause thrombosis, embolic phenomena, dissection, perforation, and vessel occlusion. The management of this complication is still debated and it involves conservative management of leaving wire alone, percutaneous retrieval of fractured fragment, use of second stent to crush the wire, or open heart surgery. Here, I am reporting three cases of broken guidewire and they have been managed in three different ways.

Amplitude spectrum distance: measuring the global shape divergence of protein fragments.

BackgroundIn structural bioinformatics, there is an increasing interest in identifying and understanding the evolution of local protein structures regarded as key structural or functional protein building blocks. A central need is then to compare these, possibly short, fragments by measuring efficiently and accurately their (dis)similarity. Progress towards this goal has given rise to scores enabling to assess the strong similarity of fragments. Yet, there is still a lack of more progressive scores, with meaningful intermediate values, for the comparison, retrieval or clustering of distantly related fragments.ResultsWe introduce here the Amplitude Spectrum Distance (ASD), a novel way of comparing protein fragments based on the discrete Fourier transform of their C α distance matrix. Defined as the distance between their amplitude spectra, ASD can be computed efficiently and provides a parameter-free measure of the global shape dissimilarity of two fragments. ASD inherits from nice theoretical properties, making it tolerant to shifts, insertions, deletions, circular permutations or sequence reversals while satisfying the triangle inequality. The practical interest of ASD with respect to RMSD, RMSDd, BC and TM scores is illustrated through zinc finger retrieval experiments and concrete structure examples. The benefits of ASD are also illustrated by two additional clustering experiments: domain linkers fragments and complementarity-determining regions of antibodies.ConclusionsTaking advantage of the Fourier transform to compare fragments at a global shape level, ASD is an objective and progressive measure taking into account the whole fragments. Its practical computation time and its properties make ASD particularly relevant for applications requiring meaningful measures on distantly related protein fragments, such as similar fragments retrieval asking for high recalls as shown in the experiments, or for any application taking also advantage of triangle inequality, such as fragments clustering.ASD program and source code are freely available at: http://www.irisa.fr/dyliss/public/ASD/.Electronic supplementary materialThe online version of this article (doi:10.1186/s12859-015-0693-y) contains supplementary material, which is available to authorized users.

Use of a Minimally Invasive Retractor System for Retrieval of Intracranial Fragments in Wartime Trauma

Wartime penetrating brain injury can result in deep-seated parenchymal and intraventicular shrapnel, bullets, and bone. Large fragments pose a risk of secondary injury from migration, infection, and metal toxicity. It has been recommended that aggressive removal of fragments be avoided. The goal of this study is to report our technique of minimally invasive removal of select deep-seated fragments using a tubular retractor system. A retrospective review of our database of service members presenting with penetrating traumatic brain injuries incurred during Operations Iraqi Freedom and Enduring Freedom and treated at the Walter Reed Army Medical Center and the National Naval Medical Center was performed. Six individuals were identified in which the Vycor ViewSite retractor system (Vycor Medical, Boca Raton, Florida, USA) was used to remove a ventricular or deep intraparenchymal fragment. All patients were male and ranged in age from 21 to 29 years. Fragment location included the foramen of Monro; the atrium of the right lateral ventricle; parasagittally within the right occipital lobe; the occipital horn of the right lateral ventricle; the deep white matter of the dominant temporal lobe; and within the posterior right temporal lobe deep to the junction of the transverse and sigmoid dural venous sinuses. Fragments included in-driven bone, shrapnel from improvised explosive devices, and bullets. In all cases the fragment was successfully removed. No patient had worsening of their neurologic condition following surgery. Deep parenchymal and intraventricular fragments can be safely removed using a tubular retractor system.

MAKSİLLER İKİNCİ PREMOLAR DİŞİN APİKAL ÜÇLÜSÜNDE KIRILAN RESİPROC EĞENİN MASSERANN KİT İLE ÇIKARTILMASI: OLGU SUNUMU

Blockage of root canals with a seperated file is a common and critic complication in endodontics. Various methods and devices were developed to retrieve seperated fragments. Solution and procedures should be made according to endodontic treatment principles. 32-year-old male patient applied to Ondokuz Mayis University Faculty of Dentistry Department of Endodontics with complaint of pain associated with maxillary right second premolar. Root canal treatment was initiated according to diagnosis based on clinical and radiological examinations. During root canal preparation Reciproc R40 file was seperated. This case report presents retrieval of broken fragment by combined utilization of Masserann Kit and ultrasonic tips and completion of root canal treatment and permanent restoration

What is the stone-free rate following flexible ureteroscopy for kidney stones?

Flexible ureteroscopy (URS) is increasingly being used as the first-line treatment for patients with renal stones. Despite this increase in use, substantial variations exist in the reported stone-free rates (SFR) following flexible URS. These variations are a result of inconsistencies in the definition of 'stone-free', which reflect variations in the type of imaging used to assess the presence of stones postoperatively and the timing of the assessment. Other possible factors such as the importance of residual fragments following stone surgery, and the size and position of the stones might also account for variations in stone-free rates. In order to obtain an accurate estimate of the SFR, especially within subgroups defined by stone characteristics and exact technique, we compare reported SFRs from studies that use imaging other than CT for follow-up and those that use only CT. We also review the evidence on the importance of active retrieval of fragments during flexible URS and whether this technique improves the outcomes of patients with kidney stones.

Retrieval of root fragment in maxillary sinus via anterolateral wall of the sinus to preserve alveolar bone.

The objective of this study was to present a functional surgery for retrieval of displaced root fragments from the maxillary sinus while preserving the alveolar bone. Twenty-one patients with associated root fragments displaced into the maxillary sinus after tooth extraction were collected and reviewed retrospectively. All patients included in the study were subjected to surgical removal of the displaced root by the use of piezosurgery. In case the root fragment was barely detectable, endoscopy would be helpful. Eleven roots were removed via small windows and 10 roots via large windows. Endoscopy was used in 2 patients. Granulomatous tissues were found around 6 root fragments, and cyst formation was found in 1 patient. Only 1 patient had sinusitis temporarily. No patients developed complications such as facial paresthesia, facial asymmetry, or infection. The functional surgery for the retrieval of a displaced root from the maxillary sinus is recommended owing to quick recovery, preservation of alveolar bone, and minimal complications.

SUCCESS FOR REMOVING OR BYPASSING INSTRUMENTS FRACTURED BEYOND THE ROOT CANAL CURVE – 45 CLINICAL CASES

SUMMARY: The aim of the study is to compare success rates for ultrasonic removal or bypassing endodontic instruments, fractured below the curve of root canals. Methods: 45 clinical cases – 30 MB and 5 ML root canals of mandibular molars, as well as 8 MB, 2 DB root canals of maxillary molars were selected from the authors’ private practice. 18 of the fragments are stainless steel files, 6 are rotary Ni-Ti files and 21 – lentulos. Fragments, to which visual access could be achieved by safe straightening of the root canal (26) were treated ultrasonically under dental microscope (OPMI Pico, Carl Zeiss) with magnification 10x and 16x. Bypass is chosen for fragments (19) without visibility. Results: Ultrasonic group: 22 of 26 fragments (84,61%) were totally removed, and full working length was consequently reached in 69,23% of the cases (18 fragments). Four fragments (15,38%) separated additionally from the vibrations and could not be totally ultrasonically removed. Bypass group: only 7 of 19 fragments (36,84%) could be successfully bypassed. Conclusions: Ultrasonic technique for broken instruments removal is significantly more successful than bypassing. Straight visible access to the fragment under dental microscope is crucial for successful fragments retrieval.