We evaluate the effects of a calcium antagonist(nifedipine) and a xanthine oxidase inhibitor (allopurinol), drugs having a protective effect against shock wave induced renal dysfunction, on acute changes of renal function after piezoelectric ESWL. A total of 40 patients with renal stones undergoing piezoelectric ESWL with LT02 lithotriptor was randomly assigned to 4 groups. Group 1 received no medication and the others received nifedipine(group 2), allopurinol(group 3), and nifedipine plus allopurinol(group 4), respectively. NAG, LDH, 7-GTP, D2M, and microalbumin were measured in the 24-hour urine before and after ESWL. Baseline levels of these parameters were not statistically different between the control group and the others. After ESWL, NAG and microalbumin were significantly increased in group l(p<0.01). In groups 2 and 4, all of the parameters after ESWL were not significantly different from the Values before ESWL. Although the level of NAG after ESWL was significantly higher(p<0.01) than that of the pre-ESWL in group 3, the change of NAG was milder in group 3 comparing to group 1. The range of increase of NAG in groups 2 and 4 were significantly low(<0.01) compared to group 1, and the range of increase of microalbumin in groups 2, 3, 4 were significantly low compared to group l(group 2, 4; p<0.01, group 3; p<0.05). Our results indicate that nifedipine and/or allopurinol can prevent or decrease acute changes of renal function after ESWL using LT02 piezoelectric lithotriptor and especially nifedipine seems to be more efficient than allopurinol.
Allopurinol* ; Calcium ; Humans ; Lithotripsy* ; Nifedipine* ; Shock* ; Urinary Calculi ; Xanthine Oxidase

We evaluate the effects of a calcium antagonist(nifedipine) and a xanthine oxidase inhibitor (allopurinol), drugs having a protective effect against shock wave induced renal dysfunction, on acute changes of renal function after piezoelectric ESWL. A total of 40 patients with renal stones undergoing piezoelectric ESWL with LT02 lithotriptor was randomly assigned to 4 groups. Group 1 received no medication and the others received nifedipine(group 2), allopurinol(group 3), and nifedipine plus allopurinol(group 4), respectively. NAG, LDH, 7-GTP, D2M, and microalbumin were measured in the 24-hour urine before and after ESWL. Baseline levels of these parameters were not statistically different between the control group and the others. After ESWL, NAG and microalbumin were significantly increased in group l(p<0.01). In groups 2 and 4, all of the parameters after ESWL were not significantly different from the Values before ESWL. Although the level of NAG after ESWL was significantly higher(p<0.01) than that of the pre-ESWL in group 3, the change of NAG was milder in group 3 comparing to group 1. The range of increase of NAG in groups 2 and 4 were significantly low(<0.01) compared to group 1, and the range of increase of microalbumin in groups 2, 3, 4 were significantly low compared to group l(group 2, 4; p<0.01, group 3; p<0.05). Our results indicate that nifedipine and/or allopurinol can prevent or decrease acute changes of renal function after ESWL using LT02 piezoelectric lithotriptor and especially nifedipine seems to be more efficient than allopurinol.
Allopurinol* ; Calcium ; Humans ; Lithotripsy* ; Nifedipine* ; Shock* ; Urinary Calculi ; Xanthine Oxidase

During a 9-year period 43 children and adolescents 2 to 18 years old underwent 140 extracorporeal shock wave lithotripsy (ESWL) treatments for 48 calculi. The second generation piezoelectric lithotriptor (LT01) was used in 28 cases (65%) while the remaining cases were treated with the third generation piezoelectric lithotriptor (LT02). LT02 lithotriptor differs from an earlier model LT01 in 2 important respects; a stone localization system consisting of ultrasound and fluoroscopy, and more energy per shock wave. The LT01 necessitated caudal anesthesia in 14 cases (50%) while the LT02 necessitated caudal anesthesia in 2 cases (13%) and intravenous anesthesia in 2 cases (13%). Two upper ureteral stones without ureteral dilatation and 1 mid ureteral stone, which were difficult to detect with ultrasound, could be localized by combined ultrasound and fluoroscopy on LT02. The success rate by LT01 and LT02 ESWL was 92.9% and 100%, respectively. The mean session of LT01 and LT02 ESWL was 3.6+/-.4.09 and 2.6+/-2.47, respectively, and the total storage of LT02 ESWL (93+/-97.8) was much less(p<0.05) than that of LT01 ESWL (363+/-380.3). There were no statistical differences in regard to success and the use of stents, stone size or location between the 2 lithotriptors. Six patients required adjuvant procedures, and ESWL complications were not required admission or surgical management. Therefore, LT02 piezoelectric lithotripsy, in comparison with LT01, is more efficient to localize stones and can lessen total storage by reducing treatment sessions in children and adolescents.
Adolescent* ; Anesthesia, Caudal ; Anesthesia, Intravenous ; Calculi ; Child* ; Dilatation ; Fluoroscopy ; Humans ; Lithotripsy* ; Shock ; Stents ; Ultrasonography ; Ureter ; Urinary Calculi

Background: Hemophilia requires a lifetime care for bleeding control and complications. Although patients diagnosed with hemophilia receive factor replacement, they also experience a variety of medical problems as they age. Elective surgery can be performed through appropriate factor replacement during and after surgery. However, for patients with inhibitors, this remains a problem to be overcome. Methods: Patients treated for congenital bleeding disorders between 2008 and 2021 were enrolled in this study. The patients were classified according to the type, severity, and presence of inhibitors. The patients underwent planned coagulation factor replacement depending on the type of surgery. Results: A total of 232 patients treated for congenital bleeding disorders were enrolled. Among them hemophilia A was most prevalent, followed by hemophilia B.In total, 78 of the patients underwent surgery, including 31 major and 55 minor surgeries. Orthopedic surgery was the most common surgery, and patients with inhibitors had significantly more postoperative hospitalization days. Nine patients were incidentally diagnosed. Twelve patients with hemophilia with inhibitors underwent surgery, and 6 of them experienced post-operative complications. Conclusion Proper surgical planning and monitoring with a multidisciplinary team will be required for appropriate perioperative management of patients with hemophilia, especially in patients with inhibitor and elderly hemophilia patients.