Although ipilimumab has been shown to improve survival in patients with metastatic melanoma and cause regression of metastatic renal cell carcinoma, the associated immune-related toxicities are of concern.The resultan...Although ipilimumab has been shown to improve survival in patients with metastatic melanoma and cause regression of metastatic renal cell carcinoma, the associated immune-related toxicities are of concern.The resultant T cell activation by this monoclonal antibody causes an increased immune response, which has been associated with many immune-regulated adverse effects.One of the most concerning effects is the development of colitis.Upwards to 8% of patients have been reported to develop colitis, with 5% being severe(Grades 3-4).While initial treatment of such adverse effects is generally comprised of supportive and symptomatic treatment, more severe cases warrant the use of high dose steroids.Furthermore, use of anti-TNF agents is usually reserved for those cases that prove to be refractory to steroids.We describe a systematic case review of seven patients who developed gastrointestinal symptoms following initiation of ipilimumab immunotherapy, and present the steps in their evaluation, treatment and outcomes at our institution.展开更多
Objective:This study aimed to evaluate the feasibility of the fluoroscopy-free single-use flexible ureteroscopy procedure in the treatment of kidney stones with abnormal renal anatomy compared to normal renal anatomy....Objective:This study aimed to evaluate the feasibility of the fluoroscopy-free single-use flexible ureteroscopy procedure in the treatment of kidney stones with abnormal renal anatomy compared to normal renal anatomy.Methods:Forty patients with abnormal (Group A) and 80 patients with normal (Group B) renal anatomy who had 10–20 mm renal stones were included. They were treated with LithoVue single-use flexible ureteroscopy (Boston Scientific, Marlborough, MA, USA) after ureteric dilatation by two different size semi-rigid ureteroscopes. This technique was chosen as the aim was to exclude any ureteric pathology (e.g., stone or stricture), confirm the placement of a safe guidewire, avoid balloon dilatation of the ureter, and achieve safe insertion of a 12 Fr, 35/45 cm ureteric access sheath with optical and tactile sign and without fluoroscopy image for guidance.Results:The mean ages were 43 years and 45 years in Group A and Group B, respectively. The mean stone burden was 14.62 (standard deviation: 5.35) mm^(3) and 14.79 (standard deviation: 4.58) mm^(3) in Group A and Group B, respectively. There is no significant difference between both groups according to the mean operative time, hospital stay, or stone-free rate. The stone-free rate was about 93% in both groups when the stone size was between 10 mm and 15 mm, and less than 54% when the stone size was more than 15 mm to 20 mm. In the majority of cases (80.0% in Group A and 92.5% in Group B), we completed the procedure without fluoroscopy. The perioperative complication rates were comparable in the two groups.Conclusion:Fluoroscopy-free single-use flexible ureteroscopy, when performed by expert urologists, is a feasible treatment for pre-stented patients with kidney calculi of ≤15 mm with abnormal renal anatomy.展开更多
This paper presents a robust kinematic model that describes northern Red Sea and Gulf of Suez rifting and the development of marginal extensional half-graben sub-basins (ESB). A combination of Landsat Enhanced Themati...This paper presents a robust kinematic model that describes northern Red Sea and Gulf of Suez rifting and the development of marginal extensional half-graben sub-basins (ESB). A combination of Landsat Enhanced Thematic Mapper Plus (ETM+) and structural data was used to provide model constraints on the development of rift segments and ESB in the active rift zones. Structural analysis shows rotation and change in strike of rift-bounding faults. The model describes the northern Red Sea region as a poly-phase rift system initiated by late Oligocene (30 - 24 Ma) orthogonal rifting and the development of marginal ESB (now inland ESB), followed by oblique rifting and flank uplift during the early Miocene (24 - 18 Ma). The oblique rifting fragmented the rift depression into segments separated by oblique-slip accommodation within reactivated Pan-African (ca. 600 Ma) fracture zones, resulting in the development of antithetic faults and an en-echelon distribution of inland ESB. The current phase of rifting was instigated by the development of the Dead Sea Transform in response to increased northeasterly extension during the middle Miocene (ca. 18 Ma). The model explains the widening of the Red Sea rift during the last phase more than the Gulf of Suez rift by developing more antithetic faults and formation of offshore ESB, and deepening the rift depression.展开更多
基金Supported by Med Star Georgetown University Hospital,Washington,DC,United States
文摘Although ipilimumab has been shown to improve survival in patients with metastatic melanoma and cause regression of metastatic renal cell carcinoma, the associated immune-related toxicities are of concern.The resultant T cell activation by this monoclonal antibody causes an increased immune response, which has been associated with many immune-regulated adverse effects.One of the most concerning effects is the development of colitis.Upwards to 8% of patients have been reported to develop colitis, with 5% being severe(Grades 3-4).While initial treatment of such adverse effects is generally comprised of supportive and symptomatic treatment, more severe cases warrant the use of high dose steroids.Furthermore, use of anti-TNF agents is usually reserved for those cases that prove to be refractory to steroids.We describe a systematic case review of seven patients who developed gastrointestinal symptoms following initiation of ipilimumab immunotherapy, and present the steps in their evaluation, treatment and outcomes at our institution.
文摘Objective:This study aimed to evaluate the feasibility of the fluoroscopy-free single-use flexible ureteroscopy procedure in the treatment of kidney stones with abnormal renal anatomy compared to normal renal anatomy.Methods:Forty patients with abnormal (Group A) and 80 patients with normal (Group B) renal anatomy who had 10–20 mm renal stones were included. They were treated with LithoVue single-use flexible ureteroscopy (Boston Scientific, Marlborough, MA, USA) after ureteric dilatation by two different size semi-rigid ureteroscopes. This technique was chosen as the aim was to exclude any ureteric pathology (e.g., stone or stricture), confirm the placement of a safe guidewire, avoid balloon dilatation of the ureter, and achieve safe insertion of a 12 Fr, 35/45 cm ureteric access sheath with optical and tactile sign and without fluoroscopy image for guidance.Results:The mean ages were 43 years and 45 years in Group A and Group B, respectively. The mean stone burden was 14.62 (standard deviation: 5.35) mm^(3) and 14.79 (standard deviation: 4.58) mm^(3) in Group A and Group B, respectively. There is no significant difference between both groups according to the mean operative time, hospital stay, or stone-free rate. The stone-free rate was about 93% in both groups when the stone size was between 10 mm and 15 mm, and less than 54% when the stone size was more than 15 mm to 20 mm. In the majority of cases (80.0% in Group A and 92.5% in Group B), we completed the procedure without fluoroscopy. The perioperative complication rates were comparable in the two groups.Conclusion:Fluoroscopy-free single-use flexible ureteroscopy, when performed by expert urologists, is a feasible treatment for pre-stented patients with kidney calculi of ≤15 mm with abnormal renal anatomy.
文摘This paper presents a robust kinematic model that describes northern Red Sea and Gulf of Suez rifting and the development of marginal extensional half-graben sub-basins (ESB). A combination of Landsat Enhanced Thematic Mapper Plus (ETM+) and structural data was used to provide model constraints on the development of rift segments and ESB in the active rift zones. Structural analysis shows rotation and change in strike of rift-bounding faults. The model describes the northern Red Sea region as a poly-phase rift system initiated by late Oligocene (30 - 24 Ma) orthogonal rifting and the development of marginal ESB (now inland ESB), followed by oblique rifting and flank uplift during the early Miocene (24 - 18 Ma). The oblique rifting fragmented the rift depression into segments separated by oblique-slip accommodation within reactivated Pan-African (ca. 600 Ma) fracture zones, resulting in the development of antithetic faults and an en-echelon distribution of inland ESB. The current phase of rifting was instigated by the development of the Dead Sea Transform in response to increased northeasterly extension during the middle Miocene (ca. 18 Ma). The model explains the widening of the Red Sea rift during the last phase more than the Gulf of Suez rift by developing more antithetic faults and formation of offshore ESB, and deepening the rift depression.
