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Clinical Practice Pearls
P R O B E
• V o l . L I I I • N o . 3 • A p r – J u n 2 0 1 4
T ch Byte
Retrograde Endoscopic Lithotripsy Using the
Innovative Nanosecond Electropulse Method
Gudkov A, et al
Springerplus
. 2013;2:538.
The purpose of this clinical study was to assess the safety
and efficiency of a novel lithotripsy method for endoscopic
treatment of urinary stones throughout the urinary tract via
semi-rigid and flexible endoscopes. This method was based
on the transfer of nanosecond high voltage electric pulses to
the stones through flexible probes of various sizes.
The study involved 879 patients aged 19 to 88 with renal,
ureter, and bladder calculi. All treatments were performed
retrograde transurethrally. A variety of probes were used
for stone fragmentation at different locations. Auxiliary
treatments and adverse events were recorded as per protocol.
Statistical analysis was conducted using SPSS software.
Nanosecond electropulse lithotripsy (NEPL) was found to
be technically feasible for all patients with stones located in
the kidney, ureteropelvic junction, ureter, and bladder. It
requires only a few dozen pulses to disintegrate stones while
causing only minor stone migration. The overall stone-free
rate in the study was 96%. The average time required
for executing the entire procedure was 45 ± 28 min. The
overwhelming majority of intraoperative complications
occurred due to endoscopic manipulation when using a
rigid ureterorenoscope and not due to lithotripsy impact.
NEPL is a new, efficient, and safe method for urinary stone
disintegration that can be used throughout the urinary tract
using rigid and flexible endoscopes. The main advantages
of relatively low-cost NEPL are fast stone fragmentation
requiring only a few dozen pulses to disintegrate stones,
tissue safety, and availability of highly flexible probes
for treating stones in the lower pole through a flexible
ureterorenoscope.
Rapid Multiplex PCR Assay to
Identify Respiratory Viral Pathogens: Moving
Forward Diagnosing the Common Cold
Layman CP, et al
Hawaii J Med Public Health
. 2013;72(9 Suppl 4):24–26.
The majority of upper respiratory tract infections (URTIs)
are viral in etiology, but definitive diagnosis can prove
difficult due to frequently overlapping clinical presentations
of viral and bacterial infections, and the variable sensitivity,
and lengthy turn-around time of viral culture.
A new automated nested multiplex PCR technology, the
FilmArray® system was tested to determine the feasibility
of replacing the standard viral culture with a rapid turn-
around system. A feasibility study was conducted using a
single-blinded comparison study, comparing PCR results
with archived viral culture results from a convenience
sample of cryopreserved archived nasopharyngeal swabs
from acutely ill emergency department patients who
presented with complaints of URTI symptoms. A total
of 61 archived samples were processed. Viral culture had
previously identified 31 positive specimens from these
samples.
The automated nested multiplex PCR detected 38 positive
samples. In total, PCR was 94.5% concordant with the
previously positive viral culture results. However, PCR
was only 63.4% concordant with the negative viral culture
results, owing to PCR detection of 11 additional viral
pathogens not recovered on viral culture. The average time
to process a sample was 75 min.
The study indicates that automated nested multiplex
PCR is a feasible alternative to viral culture in an acute
clinical setting.
