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Background and Purpose: Percutaneous nephrolithotomy (PCNL) traditionally necessitates the placement of a nephrostomy tube at the conclusion of the surgical procedure. Although tubeless PCNL has become more popular, patients with complex problems still need traditional nephrostomy tube drainage. The goal of this study was to investigate whether patient body mass index (BMI) impacted inadvertent nephrostomy tube dislodgement. Furthermore, we hoped to determine whether nephrostomy tube type impacted tube dislodgement rates., Methods: A retrospective review between 2005 and 2012 of 475 consecutive PCNL cases was undertaken. Patients were categorized based on the type of nephrostomy tube placed. BMI was examined as a continuous variable. The primary outcome of nephrostomy tube dislodgment was determined based on imaging obtained at the time of PCNL and postoperative hospitalization. Logistic regression analysis was then used to adjust for nephrostomy tube type and BMI., Results: Overall, 24 (5.5%) total patients experienced nephrostomy tube dislodgment postoperatively. The mean BMI for patients experiencing nephrostomy tube dislodgment was 39.7 vs 30.9 for those without tube dislodgment (P<0.0001; 95% confidence interval [CI] 4.6 to 12.9). Using logistic regression and adjusting for the use tube type, BMI was an independent predictor of tube dislodgement (P<0.001). For each unit of increase in BMI, the likelihood of tube dislodgment increased by 6% (1.06). After adjusting for BMI, however, nephrostomy tube type was not found to be an independent predictor of nephrostomy tube dislodgment., Conclusions: Nephrostomy tube type did not influence nephrostomy tube dislodgment rates. As a patient's BMI increased, the likelihood of tube dislodgment increased in a directly proportionate fashion. This is possibly because of the nephrostomy tube being fixed directly to the mobile skin associated with their fat pannus. Although the nephrostomy tube type itself did not affect tube dislodgment rates, a redesigned nephrostomy tube or fixation device should take into account the above findings related to obese patients to reduce the likelihood of nephrostomy tube dislodgment.

As a first step toward building a smart home behavioral monitoring system capable of classifying a wide variety of human behavior, a wireless sensor network (WSN) system is presented for RSSI localization. The low-cost, non-intrusive system uses a smart watch worn by the user to broadcast data to the WSN, where the strength of the radio signal is evaluated at each WSN node to localize the user. A method is presented that uses simultaneous localization and mapping (SLAM) for system calibration, providing automated fingerprinting associating the radio signal strength patterns to the user's location within the living space. To improve the accuracy of localization, a novel refinement technique is introduced that takes into account typical movement patterns of people within their homes. Experimental results demonstrate that the system is capable of providing accurate localization results in a typical living space.

Background: Understanding the role that urologic disease plays within central Haiti could lead to the development of sustainable and regionally appropriate urologic care. We aim to document the prevalence of urologic surgical disease presenting for treatment in central Haiti., Methods: The present study is based on a retrospective review of surgical case logs at five Partners in Health and Zanmi Lasante hospitals in central Haiti. Data were collected from June 30, 2009, through July 29, 2010, and included patient demographics, disease processes, interventions required, surgeon name, and surgeon training (urologic trained versus non-urologic trained)., Results: Urologic surgical disease comprised 498/5,539 (9.0 %) of all surgical cases in central Haiti from July 2009-July 2010. A total of 492 diagnoses and 498 urologic procedures on 469 patients were recorded. Most common diagnoses included hydrocele (33.3 %), phimosis (23.0 %), benign prostatic hyperplasia (10.8 %), and cryptorchidism (7.3 %). Hydrocelectomy was the most commonly performed procedure (160/498, 32.1 %), followed by circumcision (117/498, 23.4 %) and open prostatectomy (38/498, 7.6 %). Surgeon training (urologic versus non-urologic) was determined for 360/498 (72.3 %) of surgical cases. Urologic trained surgeons performed 55/360 (15.3 %) of all surgical procedures. Among patients who underwent prostatectomy, urology surgeons performed 14/31 (45.2 %) of open prostatectomies, and non-urology surgeons performed 17/31 (54.8 %). Urologists performed all transurethral resections of the prostate (9 vs. 0; p = 0.0051)., Conclusions: Urologic surgical diseases comprise a substantial source of morbidity for patients in central Haiti. Understanding the scale and scope of urologic disease is important in developing health systems to adequately address the regional burden of surgical disease in limited-resource settings.

Introduction: Fine needle aspiration cytology (FNAC) for salivary gland tumours requires expertise in interpretation. When a diagnosis is not clear (despite a cellular aspirate), published work is lacking on the value of repeating the test., Methods: A retrospective study of 135 patients who had FNAC followed by definitive excision for a suspected salivary gland tumour. Accuracy was compared among those requiring repeat FNAC on one more occasion because of a non-diagnostic initial cytology report., Results: 33 patients (24% of study group) had repeat FNAC. A definite cytological diagnosis was subsequently made in 27/33 patients (82%). The sensitivity (84%) and specificity (93%) of repeat FNAC in distinguishing benign from malignant tumours was similar to initial FNAC (70% and 95%, respectively)., Conclusions: Repeat FNAC may provide a cytological diagnosis in cases where the initial diagnosis is not clear, although cytology should be used in conjunction with other investigations of salivary tumours, including image-guided biopsy examination where appropriate. Ideally salivary gland FNAC should be interpreted by a specialist pathologist., (Copyright 2009 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.)

Annual water storage in a 5.3 ha, polyethylene-lined, off-stream irrigation reservoir in northern Alabama, USA, resulted in marked improvement in water quality. Results of three-year monitoring from June 1999 to May 2002 indicate that the relatively static conditions of the reservoir enhanced settling of suspended particles by 85% (from 14.4 to 2.1 mg TSS/L) that cleared the water and increased sunlight penetration. The organic and inorganic particles that settled to the bottom removed up to 88% of the nutrients and other chemical substances from the water. Nutrients remaining in the water column were rapidly assimilated by phytoplankton algae. With the basin sealed at the bottom and no runoff input there was limited opportunity for nutrients or other substances to enter the reservoir in quantities that would adversely affect water quality. Consequently, reservoir water was found to be of high quality and suitable as a raw water supply. Non-traditional, off-stream storage reservoirs such as described in this paper may be uniquely suited for agricultural irrigation and public water supply in regions such as southeastern US that experience relatively frequent drought conditions but have relatively abundant long-term annual rainfall.

Penile and/or genital involvement may be an early manifestation of AIDS-related Kaposi sarcoma. Diagnosis may be suggested by history, and epidemiologic and sociologic data. Precise diagnosis can be documented by the urologist by early recognition and biopsy of genital lesions. Early awareness and treatment may control this potentially virulent disease.

The radiographic appearance of the hydronephrotic upper urinary tract due to congenital ureteropelvic junction obstruction may not return to normal even though the obstruction is relieved by surgical repair. We present a case of ureteropelvic junction obstruction in which the success of the repair was demonstrated dramatically only by diuretic radionuclide urography.