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Objectives: To evaluate the utilization of hematopathology resources within our enterprise on axillary lymph node core biopsy (AxLNCB) specimens, particularly those obtained in the context of breast cancer screening., Methods: The utilization of hematopathology resources was determined for all AxLNCB specimens over a 30-month period from across our enterprise, and chart review was performed for select patient demographics and radiographic features. The AxLNCB cases with benign histology were reviewed for subtyping of histologic patterns., Results: Of the total 594 AxLNCB specimens, 61.6% were benign and 38.6% malignant. Of malignant cases, only 9.3% contained any hematologic malignancy, yet 94% of all cases received tissue triage for lymphoma, and 81% were reviewed at least in part by a hematopathologist. Six clinical parameters were found to independently predict risk of hematologic malignancy: male sex (P = .041), bilateral lymphadenopathy (P = .004), diffuse cortical thickening (P = .005), lack of breast cancer (P = .001), older age (P < .001), and history of hematologic malignancy (P < .001)., Conclusions: Our enterprise overused hematopathology resources in the evaluation of AxLNCB performed in the study period. Our process could improve from the application of a simple tool generated from this cohort to predict percent risk of the specimen containing hematologic malignancy using patient characteristics easily found via routine chart review., (© The Author(s) 2024. Published by Oxford University Press on behalf of American Society for Clinical Pathology. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Objective: To examine sex in human vascular surgery research by quantifying the inclusion and analysis of sex-based data in high-impact vascular surgery journals., Methods: A bibliographic review of original articles published in the European Journal of Vascular and Endovascular Surgery, Journal of Vascular Surgery, JVS: Venous and Lymphatic Disorders, Journal of Endovascular Therapy, and Annals of Vascular Surgery from January 1, 2018, to December 31, 2020, and from January 1, 2023, to December 31, 2023, was conducted. Abstracted data included sex-based data analysis, inclusion of sex as a variable in multivariable analysis, inclusion of sex as an independent variable, and a discussion of sex-based results., Results: Of the 3762 articles that included human, animal, or cell subjects, 249 (6.6%) did not state sex. Of those 249 articles, 183 included human subjects, 55 included animal subjects, and 11 used cell lines as the subjects. These were removed from analysis as well as the remaining 68 articles with animal subjects. In addition, 23 researched a sex-specific pathology and were removed from analysis. Of the remaining 3422 articles included in our study, 42.3% analyzed sex, 46.9% included sex in multivariable analysis, 4.8% included sex as an independent variable, and 26.6% included a discussion of sex. There were no significant differences in all four sex variables between 2018, 2019, and 2020. Between 2018-2020 and 2023, there were significant increases in all four sex variables. Multicenter studies had significantly higher rates of independent analysis of sex over single-center studies (7.4% vs 3.3%, P < .001). There was no significant difference in independent analysis of sex between U.S.-based and non-U.S.-based studies. Only 191 articles (5.6%) had 90% or greater matching of men and women in their study., Conclusions: Equitable inclusion and analysis of sex is rare in vascular surgery research. Less than 5% of articles included an independent analysis of data by sex, and few studies included males and females equally. Clinical research is the basis for evidence-based medicine; therefore, it is important to strive for equitable inclusion, analysis, and reporting of data to foster generalizability of clinical research to men and women., Competing Interests: Disclosures None., (Published by Elsevier Inc.)

Introduction: Visual inspection with acetic acid (VIA) is a primary alternative to reduce cervical cancer (CaCu) incidence and mortality. The study aimed to determine the proportion of women aged 30-49 years who used VIA in the last two years and the factors associated with the use of the test in the primary care setting., Methods: Cross-sectional, multicenter study. Seven hundred and six women aged 30 to 49 years participated, users of primary health care centers in a region of Peru. The dependent variable was the use of the VIA test in the last two years and the independent variables were sociodemographic, socio-health, information and attitudinal factors., Results: The proportion of women who used the VIA test was 30.6%. The following factors were associated with greater use of the test: urban area of residence, having received a recommendation for VIA, feeling worried about acquiring CaCu, having heard about CaCu and the human papilloma virus. Also, considering having a greater or equal probability of developing CaCu compared to women of the same age, and with lower use of the test, coming from the highlands and considering it risky to undergo VIA., Conclusion: The VIA screening program for CaCu would not be achieving the desired impact. There is a need to strengthen strategies and interventions in primary care to improve screening behaviors and rates.

The mechanical properties of the extracellular matrix dictate tissue behaviour. In epithelial tissues, laminin is a very abundant extracellular matrix component and a key supporting element. Here we show that laminin hinders the mechanoresponses of breast epithelial cells by shielding the nucleus from mechanical deformation. Coating substrates with laminin-111-unlike fibronectin or collagen I-impairs cell response to substrate rigidity and YAP nuclear localization. Blocking the laminin-specific integrin β4 increases nuclear YAP ratios in a rigidity-dependent manner without affecting the cell forces or focal adhesions. By combining mechanical perturbations and mathematical modelling, we show that β4 integrins establish a mechanical linkage between the substrate and keratin cytoskeleton, which stiffens the network and shields the nucleus from actomyosin-mediated mechanical deformation. In turn, this affects the nuclear YAP mechanoresponses, chromatin methylation and cell invasion in three dimensions. Our results demonstrate a mechanism by which tissues can regulate their sensitivity to mechanical signals., (© 2023. The Author(s).)

Introduction: Preventive screening for cervical cancer is the best available strategy to reduce the incidence and mortality from this neoplasm. However, the low proportion of women who undergo routine screening is a pending concern for healthcare systems worldwide., Objective: To estimate the prevalence and factors associated with preventive cervical cancer screening in a Peruvian region., Methods: Cross-sectional, multicenter study. It enrolled 1146 women users of healthcare centers in a Peruvian sanitary region. The dependent variable was the performance of cervical cancer preventive screening with Papanicolaou or visual inspection with acetic acid in the last two years. The independent variables were sociodemographic and socio-sanitary factors, knowledge about cervical cancer and human papillomavirus, attitudes and information towards screening tests. To evaluate the association between the variables, crude and adjusted prevalence ratios were calculated with generalized linear models of Poisson., Results: The overall prevalence of preventive screening was 50.5%. This was associated with being tested, having a higher education level and urban area of residence, using contraceptive methods, having health insurance, being recommended by healthcare personnel to be screened, and being concerned about developing cervical cancer. It was also associated with responding that this cancer is preventable, being aware of cervical cancer or human papillomavirus, and believing it can cause cervical cancer. In contrast, considering preventive screening risky was associated with not having the test., Conclusions: The proportion of women with preventive cervical cancer screening is low. In addition, certain associated modifiable factors were identified, which could improve preventive screening behaviors and rates., Competing Interests: This work is licensed under a Creative Commons Attribution 4.0 International License., (This work is licensed under a Creative Commons Attribution 4.0 International License.)

Background: Residential segregation is an important factor that negatively impacts cancer disparities, yet studies yield mixed results and complicate clear recommendations for policy change and public health intervention. In this study, we examined the relationship between local and Metropolitan Statistical Area (MSA) measures of Black isolation (segregation) and survival among older non-Hispanic (NH) Black women with breast cancer (BC) in the United States. We hypothesized that the influence of local isolation on mortality varies based on MSA isolation-specifically, that high local isolation may be protective in the context of highly segregated MSAs, as ethnic density may offer opportunities for social support and buffer racialized groups from the harmful influences of racism., Methods: Local and MSA measures of isolation were linked by Census Tract (CT) with a SEER-Medicare cohort of 5,231 NH Black women aged 66-90 years with an initial diagnosis of stage I-IV BC in 2007-2013 with follow-up through 2018. Proportional and cause-specific hazards models and estimated marginal means were used to examine the relationship between local and MSA isolation and all-cause and BC-specific mortality, accounting for covariates (age, comorbidities, tumor stage, and hormone receptor status)., Findings: Of 2,599 NH Black women who died, 40.0% died from BC. Women experienced increased risk for all-cause mortality when living in either high local (HR = 1.20; CI = 1.08-1.33; p < 0.001) or high MSA isolation (HR = 1.40; CI = 1.17-1.67; p < 0.001). A similar trend existed for BC-specific mortality. Pairwise comparisons for all-cause mortality models showed that high local isolation was hazardous in less isolated MSAs but was not significant in more isolated MSAs., Interpretation: Both local and MSA isolation are independently associated with poorer overall and BC-specific survival for older NH Black women. However, the impact of local isolation on survival appears to depend on the metropolitan area's level of segregation. Specifically, in highly segregated MSAs, living in an area with high local isolation is not significantly associated with poorer survival. While the reasons for this are not ascertained in this study, it is possible that the protective qualities of ethnic density (e.g., social support and buffering from experiences of racism) may have a greater role in more segregated MSAs, serving as a counterpart to the hazardous qualities of local isolation. More research is needed to fully understand these complex relationships., Funding: National Cancer Institute., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Background: Breast cancer (BC) is the most common cancer among US women, and institutional racism is a critical cause of health disparities. We investigated impacts of historical redlining on BC treatment receipt and survival in the United States., Methods: Home Owners' Loan Corporation (HOLC) boundaries were used to measure historical redlining. Eligible women in the 2010-2017 Surveillance, Epidemiology, and End Results-Medicare BC cohort were assigned a HOLC grade. The independent variable was a dichotomized HOLC grade: A and B (nonredlined) and C and D (redlined). Outcomes of receipt of various cancer treatments, all-cause mortality (ACM), and BC-specific mortality (BCSM) were analyzed using logistic or Cox models. Indirect effects by comorbidity were examined., Results: Among 18 119 women, 65.7% resided in historically redlined areas (HRAs), and 32.6% were deceased at a median follow-up of 58 months. A larger proportion of deceased women resided in HRAs (34.5% vs 30.0%). Of all deceased women, 41.6% died of BC; a larger proportion resided in HRAs (43.4% vs 37.8%). Historical redlining is a statistically significant predictor of poorer survival after BC diagnosis (hazard ratio = 1.09, 95% confidence interval [CI] = 1.03 to 1.15 for ACM, and hazard ratio = 1.26, 95% CI = 1.13 to 1.41 for BCSM). Indirect effects via comorbidity were identified. Historical redlining was associated with a lower likelihood of receiving surgery (odds ratio = 0.74, 95% CI = 0.66 to 0.83, and a higher likelihood of receiving palliative care odds ratio = 1.41, 95% CI = 1.04 to 1.91)., Conclusion: Historical redlining is associated with differential treatment receipt and poorer survival for ACM and BCSM. Relevant stakeholders should consider historical contexts when designing and implementing equity-focused interventions to reduce BC disparities. Clinicians should advocate for healthier neighborhoods while providing care., (© The Author(s) 2023. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Background: Elevated hydrogen sulfide (H 2 S) contributes to vasodilatation and hypotension in septic shock, and traditional therapies do not target this pathophysiologic mechanism. High-dose IV hydroxocobalamin scavenges and prevents H 2 S formation, which may restore vascular tone and may accentuate recovery. No experimental human studies have tested high-dose IV hydroxocobalamin in adults with septic shock., Research Question: In adults with septic shock, is comparing high-dose IV hydroxocobalamin with placebo feasible?, Study Design and Methods: We conducted a phase 2 single-center, double-blind, allocation-concealed, placebo-controlled, parallel-group pilot randomized controlled trial comparing high-dose IV hydroxocobalamin with placebo in critically ill adults with septic shock. Patients meeting Sepsis 3 criteria were randomized 1:1 to receive a single 5-g dose of high-dose IV hydroxocobalamin or equivalent volume 0.9% saline solution as placebo. The primary outcome was study feasibility (enrollment rate, clinical and laboratory compliance rate, and contamination rate). Secondary outcomes included between-group differences in plasma H 2 S concentrations and vasopressor dose before and after infusion., Results: Twenty patients were enrolled over 19 months, establishing an enrollment rate of 1.05 patients per month. Protocol adherence rates were 100% with zero contamination. In the high-dose IV hydroxocobalamin group, compared to placebo, there was a greater reduction in vasopressor dose between randomization and postinfusion (-36% vs 4%, P < .001) and randomization and 3-h postinfusion (-28% vs 10%, P = .019). In the high-dose IV hydroxocobalamin group, the plasma H 2 S level was reduced over 45 mins by -0.80 ± 1.73 μM, as compared with -0.21 ± 0.64 μM in the placebo group (P = .3)., Interpretation: This pilot trial established favorable feasibility metrics. Consistent with the proposed mechanism of benefit, high-dose IV hydroxocobalamin compared with placebo was associated with reduced vasopressor dose and H 2 S levels at all time points and without serious adverse events. These data provide the first proof of concept for feasibility of delivering high-dose IV hydroxocobalamin in septic shock., Trial Registry: ClinicalTrials.gov; No.: NCT03783091; URL: www., Clinicaltrials: gov., (Copyright © 2022 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.)

Aim: This study examined the feasibility of integrating actigraphy devices into orthopaedic surgical settings to assess the concurrent validity between objective actigraphy data and PROMIS measures. Additionally, the association between changes in actigraphy data and longitudinal changes in PROMIS measures was examined., Methods: Data were collected from 17 participants using actigraphy devices the week prior to and after orthopaedic surgery from 02/2019 to 03/2020. Participants completed PROMIS measures (Physical Function, Sleep Disturbance, Pain Interference) preoperatively and up to 6 months postoperatively. Nonparametric correlations (r s ) assessed for concurrent validity. Linear mixed-effects models examined the association between changes in actigraphy data and PROMIS measures., Results: Prolonged wake after sleep onset was associated with increased sleep disturbances (r s  = 0.49; p = 0.045) and pain interference (r s  = 0.51; p = 0.04). Changes in pain interference were correlated with increased awakenings (r s  = 0.54; p = 0.03). Increased wake after sleep onset was associated with worsening sleep disturbance (β = 0.12; p = 0.01) and pain interference scores over the postoperative period (β = 0.12; p = 0.02)., Conclusions: This study is among the first to examine changes in objective actigraphy data and longitudinal PROMIS measures following orthopaedic surgery and illustrates the feasibility of incorporating actigraphy into surgical settings to evaluate postoperative recovery., (© 2022 John Wiley & Sons Australia, Ltd. This article has been contributed to by U.S. Government employees and their work is in the public domain in the USA.)

Lack of oxygen (hypoxia and anoxia) is detrimental to cell function and survival and underlies many disease conditions. Hence, metazoans have evolved mechanisms to adapt to low oxygen. One such mechanism, metabolic suppression, decreases the cellular demand for oxygen by downregulating ATP-demanding processes. However, the molecular mechanisms underlying this adaptation are poorly understood. Here, we report on the role of ndrg1a in hypoxia adaptation of the anoxia-tolerant zebrafish embryo. ndrg1a is expressed in the kidney and ionocytes, cell types that use large amounts of ATP to maintain ion homeostasis. ndrg1a mutants are viable and develop normally when raised under normal oxygen. However, their survival and kidney function is reduced relative to WT embryos following exposure to prolonged anoxia. We further demonstrate that Ndrg1a binds to the energy-demanding sodium-potassium ATPase (NKA) pump under anoxia and is required for its degradation, which may preserve ATP in the kidney and ionocytes and contribute to energy homeostasis. Lastly, we show that sodium azide treatment, which increases lactate levels under normoxia, is sufficient to trigger NKA degradation in an Ndrg1a-dependent manner. These findings support a model whereby Ndrg1a is essential for hypoxia adaptation and functions downstream of lactate signaling to induce NKA degradation, a process known to conserve cellular energy., Competing Interests: JP, AG, PK, LK, PC, AO, NT, SV, BC, PD, YL, RB No competing interests declared, (© 2022, Park et al.)

Objective: To determine the association between post-traumatic stress disorder (PTSD) symptoms and health-related quality of life (HRQoL) of post-COVID-19 patients in primary care., Design: Cross-sectional, multicenter, random probability sampling study., Location: Primary care centers in Ica-Peru., Participants: Six hundred and thirty-six patients with previous diagnosis of COVID-19., Main Measures: The variable PTSD symptoms was measured with the COVID-19-PTSD questionnaire and HRQOL with the EuroQol scale (EQ-5D). Sociodemographic and health factors including post-COVID-19 syndrome were analyzed. A descriptive analysis was performed and crude and adjusted prevalence ratios (PR) were calculated using generalized linear models of the Poisson family to search for associations between variables., Results: Of the participants, 21.4% presented symptoms of PTSD; 33.6% symptoms of dysphoric and anxious arousal; 22.3% intrusion, avoidance and negative affect; 22.6% anhedonia; and 23.6% externalizing behavior. 50.3% revealed at least one component of HRQoL affected; 35.5% problems linked to anxiety/depression; 34.9% pain/discomfort; 11% daily activity; 10.7% mobility and 6.6% self-care. The presence of PTSD symptoms was associated with the HRQoL affected (PR=2.46: 95% CI: 2.19-2.78). Also, certain sociodemographic and health variables were associated with PTSD symptoms and affected HRQoL., Conclusions: PTSD symptoms, increase the probability of affecting the patient's HRQoL post COVID-19. There are potentially modifiable sociodemographic and health variables that could decrease PTSD symptoms and improve HRQoL., (Copyright © 2022 The Authors. Publicado por Elsevier España, S.L.U. All rights reserved.)

In order to know the level of satisfaction of users from outpatient clinics in four public hospitals in the Ica region after the implementation of the "Zero Queues" plan, 1,067 users were surveyed by using an instrument that inquired about general characteristics, service qualification, and overall satisfaction. A global satisfaction level "very satisfied/satisfied" of 72.5% was found in the Support Hospital of Nazca; 70.6% in Hospital Santa María del Socorro of Ica; 72.1% in the Regional Hospital of Ica, and 73.7% in Hospital San Juan de Dios of Pisco. It is concluded that the implementation of the "Zero Queues" plan improved overall satisfaction, courteous treatment, compliance with health care hours, and the clarity and information provided above the expected standard.

Introduction and Objective: Despite guidelines, routine 24-hour urine testing is completed in <10% of high-risk, recurrent stone formers. Using surrogates for metabolic testing, such as key patient characteristics, could obviate the cost and burden of this test while providing information needed for proper stone prevention counseling., Methods: We performed a retrospective study of 392 consecutive patients from 2007 to 2014 with ≥2 lifetime stone episodes, >70% calcium oxalate by mineral analysis, and ≥1 24-hour urine collection. We compared mean 24-hour urine values by age in decades. We used logistic regression and receiver operating characteristic (ROC) curve analysis to assess the predictive ability of age, gender, body mass index (BMI), and comorbidities to detect abnormal 24-hour urine parameters., Results: The mean age of the cohort was 51 ± 16 years. Older age was associated with greater urinary oxalate (p-trend <0.001), lower urinary uric acid (UA) (p-trend = 0.007), and lower urinary pH (p-trend <0.001). A nonlinear association was noted between age and urinary calcium or citrate (calcium peaked at 40-49 years, p = 0.03; citrate nadired at 18-29 years, p = 0.001). ROC analysis of age, gender, and BMI to predict 24-hour urine abnormalities performed the best for hyperuricosuria (area under the curve [AUC] 0.816), hyperoxaluria (AUC 0.737), and hypocitraturia (AUC 0.740). Including diabetes mellitus or hypertension did not improve AUC significantly., Conclusions: In our recurrent calcium oxalate cohort, age significantly impacted urinary calcium, oxalate, citrate, and pH. Along with gender and BMI, age can be used to predict key 24-hour urine stone risk results. These data lay the foundation for a risk prediction tool, which could be a surrogate for 24-hour urine results in recurrent stone formers, who are unwilling or unable to complete metabolic testing. Further validation of these findings is needed in other stone populations.

Background: The proposed revision to the Accreditation Council for Graduate Medical Education (ACGME) Common Program Requirements includes participation in real or simulated patient safety activities, such as root cause analysis (RCA).1 Because exposure to RCA may occur with low frequency, a mock RCA was developed and piloted for feasibility with Hematology/Oncology fellows., Objective: To improve trainee knowledge of the goals and application of RCA in patient safety and quality improvement through a simulated experience., Methods: A mock RCA was implemented with Hematology/Oncology fellows over two subsequent years. In small groups, they reviewed a case involving an adverse event and identified sources of harm. Additional details, in the form of provider interviews, were available upon request. Trainees identified the root cause(s) and proposed measurable changes. Teams presented proposals to peers and a panel representing hospital leadership. Feedback was provided. Trainees completed evaluations and were surveyed regarding their perceptions., Results: Thirteen of 15 fellows completed the survey. Twelve of 13 (92%) fellows felt the mock RCA improved their comfort level for participation in a real RCA. Ten of 13 fellows (77%) reported increased awareness and likelihood of reporting near misses and/or adverse events following participation. More thorough patient care documentation following the session was reported by 8 of 13 (62%)., Conclusion: A pilot trial of a mock RCA with Hematology/Oncology fellows had high trainee satisfaction. Post-session surveys and informal interviews suggest trainees have reduced anxiety when faced with participation in a real RCA and have more interest in the process after participation., Competing Interests: Competing interests: None declared.

Purpose: We investigated the association between sleep disordered breathing and erectile dysfunction in older men., Materials and Methods: We performed a cross-sectional analysis of community dwelling men age 67 years or older enrolled in the Osteoporotic Fractures in Men Sleep Study. Participants underwent overnight polysomnography (2003 to 2005) and completed sexual health questionnaires (2005 to 2006). We defined sleep disordered breathing using the apnea-hypopnea index or nocturnal hypoxemia. Erectile dysfunction was defined using the MMAS (Massachusetts Male Aging Study) scale and, in sexually active men, the International Index of Erectile Function. We used logistic regression to examine the association between sleep disordered breathing and erectile dysfunction., Results: Mean participant age was 76±5 years. Of the 2,676 men completing the MMAS, 70% had moderate to complete erectile dysfunction. Among 1,099 sexually active men completing the IIEF-5 (5-item International Index of Erectile Function), 26% had moderate to severe erectile dysfunction. A higher apnea-hypopnea index was associated with greater odds of MMAS defined moderate to complete erectile dysfunction after adjusting for age and study site (OR 1.39, 95% CI 1.00-1.92 for severe sleep disordered breathing vs none, p trend=0.008), but not after further adjustment for body mass index, socioeconomic status and comorbidities (OR 1.05, 95% CI 0.75-1.49, p trend=0.452). Greater nocturnal hypoxemia was associated with increased odds of MMAS defined moderate to complete erectile dysfunction (unadjusted OR 1.36, 95% Cl 1.04-1.80 vs none) but this was attenuated after adjustment for age and study site (OR 1.24, 95% CI 0.92-1.66). Sleep disordered breathing was not associated with erectile dysfunction by 5-item International Index of Erectile Function., Conclusions: In this cross-sectional analysis in older men sleep disordered breathing was associated with higher odds of erectile dysfunction in unadjusted analyses that was largely explained by higher body mass index and increased comorbidity among men with sleep disordered breathing. Prospective studies accounting for obesity and multimorbidity would further clarify the association of sleep disordered breathing and erectile dysfunction., (Copyright © 2017 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.)

Objectives: To evaluate in an in vitro study the irrigation and drainage capabilities of a variety of available catheters. Three-way Foley catheters are used when irrigation of the bladder is anticipated to prevent or manage blood clots in the bladder., Methods: Six operators applied maximal one-handed pressure irrigation with a catheter-tip syringe through the irrigation and drainage ports of the Bardex and Dover three-way catheters (16F to 26F). Maximal manual irrigation flow was recorded using a flowmeter. Continuous gravity irrigation and drainage flows were measured by suspending a 2-L irrigation bag 80 cm above the catheters and fastening an artificial bladder to the drainage tip of each Foley catheter with the catheter balloon inflated to 30 mL., Results: The Bardex 22F and 24F catheters had superior manual irrigation using the irrigation port (maximal urinary flow rate 8.9 +/- 1.3 mL/s and 9.5 +/- 1.5 mL/s, respectively, P < 0.000001) compared with the Dover 22F and 24F catheters. The Bardex and Dover 22F catheters (maximal urinary flow rate 29.0 +/- 1.9 mL/s and 29.3 +/- 1.9 mL/s, respectively, P = 0.66) and 24F catheters (maximal urinary flow rate 30.5 +/- 2.0 mL/s and 30.6 +/- 1.2 mL/s, respectively, P = 0.83) performed equally in manual irrigation using the drainage port. The Bardex 22F (average flow rate 1.6 +/- 0.1 mL/s, P < 0.00001) and 24F (average flow rate 1.7 +/- 0.0 mL/s, P < 0.000001) catheters exhibited better continuous irrigation and flow than the Dover 22F and 24F catheters., Conclusions: Three-way catheters are placed in situations in which efficient bladder irrigation is essential for patient safety. The Bardex 22F to 26F catheters optimized continuous bladder irrigation of the catheters tested.

We present a rare case of a laparoscopic ureterectomy for the treatment of unusual chronic pain from a large retained stone in a ureteral stump. The history of long-term co morbidities from retained ureteral stumps is reviewed, as well as a discussion on the possible etiology of the pain for this particular patient. An argument for the change of the standard of care for the management of ureters in relation to nephrectomies is also made in regard to adult patients with a history of stone disease.

Flank pain, irritative urinary symptoms, and hematuria are traditional symptoms of urolithiasis. We report a case of urolithiasis in a neobladder in a patient with a chief complaint of medial thigh pain.

Purpose: Traditionally, percutaneous stone extraction has relied on the use of 2-prong and 3-prong graspers, which are prone to causing trauma to the urothelium. We evaluate the efficiency of stone removal with a novel tipless stone basket designed specifically for percutaneous procedures., Materials and Methods: A 3, 5 and 8 mm human calculus were placed in the calix of a percutaneous renal model. A 26Fr Storz nephroscope (27093B, Storz Medical AG, Kreuzlingen, Switzerland) was inserted through a 30Fr Amplatz sheath into the model with camera input from a Storz telecam SL-NTSC feeding to a 20-inch Sony Triniton monitor (Sony Corp of America, New York, New York). Operators were randomized to start stone extraction with a Storz 3-prong grasper (27090RB) or a Cook 12Fr Perc-NCircle (38 cm) (Cook Urological, Inc., Indianapolis, Indiana). Subsequent testing alternated between the 2 devices until 10 extraction attempts were conducted with each device. Time to extraction of all 3 calculi and number of inadvertent withdrawals of the sheath were recorded. Three experienced operators tested each device., Results: Stone extraction times were shorter with the Cook Perc-NCircle than the 3-prong grasper for all operators. Mean time for stone extraction was 25.3 +/- 11.2 seconds for the Perc-NCircle compared to 35.1 +/- 18.5 seconds for the 3-prong grasper (p = 0.016). Loss of access by inadvertent removal of the Amplatz sheath occurred in 53% of the attempts with the 3-prong grasper compared to 7% of attempts with the Perc-NCircle., Conclusions: The Cook Perc-NCircle facilitates a more expeditious approach to percutaneous stone removal with less risk of sheath withdrawal.

Purpose of Review: The management of calyceal diverticulum has evolved from an open surgical approach to a minimally invasive approach. Currently, the percutaneous, ureteroscopic and laparoscopic techniques are recommended by individual investigators. Recent studies have helped establish patient selection criteria for each of the above procedures. This review will discuss technique and results and suggest a treatment algorithm for the patient with a symptomatic calyceal diverticulum., Recent Findings: Excellent long-term success has been reported with all three minimally invasive modalities. Percutaneous ablation of the calyceal diverticulum is the most established minimally invasive technique for this disorder. A direct puncture into the calyceal diverticulum is recommended. Limitations exist primarily for an anteriorly located diverticulum. In this situation, if the diverticulum is in a superior anterior calyx, a ureteroscopic approach is recommended while if the diverticulum is in a middle or lower pole calyx, a laparoscopic approach is recommended., Summary: This review suggests that experience and expertise in percutaneous, ureteroscopic and laparoscopic techniques provide the urologist with the best opportunity to individualize treatment approach based on location and size of the diverticulum. A treatment algorithm based on these parameters may be helpful in patient counseling and decision-making.

The controversial issue of physicians' unions has been revived in the past few years by the economic juggernaut of managed care. The uproar of legal and ethical dilemmas surrounding the creation of physician unions centers around self-employed physicians, their formal employment relationship to HMOs under the National Labor Relations Act, and the ramifications of exempting physicians from current antitrust laws. Will physician collective bargaining increase competition and equalize the power between physicians and HMOs so that the quality of patient care improves? This report discusses relevant laws and the history of physicians' unionization, reviews contemporary thought and present policies on physician unionization, and comments on alternatives and new policies that could be created in order to resolve this dilemma.