BACKGROUND:Renal stones in anomalous kidneys pose surgical challenges due to altered anatomy. Miniaturized percutaneous nephrolithotomy (mini-PCNL) reduces morbidity, but concerns remain about stone-free rates (SFRs) and infection. Suction-assisted mini-PCNL (SM-PCNL) enhances fragment removal and controls intrarenal pressure, but its role in anomalous kidneys is unclear. OBJECTIVE:To evaluate perioperative outcomes of SM-PCNL in anomalous kidneys in a multicenter, real-world study and assess variations based on positioning, lithotripsy modality, and renal anomalies. METHODOLOGY:This prospective study across 15 centers (January-December 2024) included 287 adults undergoing SM-PCNL for renal stones in anomalous kidneys. Patients with normal anatomy, non-suction PCNL, or incomplete data were excluded. SFR was assessed via a 30-day non-contrast CT: 100% stone-free (Grade A), residual fragments ≤4 mm (Grade B), or >4 mm/multiple (Grade C, requiring reintervention). RESULTS:Malrotation (65.5%) was the most common anomaly, followed by duplex systems (25.1%), horseshoe kidneys (8.4%), and ectopic kidneys (1.0%). Median stone size was 1.7 cm. Supine positioning was used in 54.4%. Lithotripsy was performed with holmium laser (50.9%), thulium fiber laser (11.1%), or pneumatic lithotripsy (26.1%). Intraoperative clearance was 95.4%. At 30 days, 93.4% achieved Grade A, 5.6% Grade B, and 1.0% required reintervention. Complications were low; 0.7% had sepsis requiring intensive care unit admission. No transfusions or pleural injuries occurred. CONCLUSION:SM-PCNL using 18F suction sheaths with laser in a single stage achieved 93.4% complete SFR with negligible complications and minimal reintervention.
This review synthesizes current literature on the epidemiology, mechanistic links, and clinical consequences of the COPD-CKD association. In addition to evaluating established risk factors such as age and tobacco smoking, we discuss emerging insights into the roles of novel biomarkers and epigenetic modifications in bridging the lung-kidney axis. The review further examines how the presence of CKD influences clinical management in COPD patients, including impacts on drug dosing, electrolyte balance, acid-base homeostasis, and outcomes during acute exacerbations, and conversely, how COPD can adversely affect renal function. Recognizing that the dual burden of COPD and CKD may worsen patient prognosis by increasing the risk for cardiovascular events, hospitalizations, and mortality, we advocate for early detection, routine screening using both creatinine and cystatin C measurements, and a multidisciplinary approach to care. Finally, we outline future research directions aimed at standardizing screening protocols, refining risk stratification, and developing targeted therapies that address shared pathogenic pathways.
The treatment landscape for Chronic Lymphocytic Leukemia has rapidly evolved from chemoimmunotherapy to highly effective targeted agents. Despite superior efficacy and safety profiles of these novel agents, challenges persist, particularly due to limited head-to-head trials and regional differences in drug availability and molecular testing. This multiregional expert consensus, developed by 13 hematology experts from Latin America, the Middle East and Africa, Asia-Pacific, and Russia using an adapted Delphi approach, provides evidence-informed recommendations for first-line treatment and sequencing tailored to patient risk and real-world resource constraints. The panel agreed on 16 key statements, emphasizing that targeted therapies are preferred for nearly all newly diagnosed patients. Molecular testing for del(17p), TP53 mutation, and IGHV status is recommended for prognosis and treatment planning. High-risk patients (del(17p) and/or TP53 mutation) should preferably receive continuous therapy with second-generation BTK inhibitors (acalabrutinib or zanubrutinib), which are generally preferred over ibrutinib due to safety advantages. Low-risk patients (IGHV-mutated, without del(17p)/TP53) are best suited for time-limited, venetoclax-based regimens. Upon relapse, switching therapeutic classes is recommended: venetoclax after continuous BTKi therapy, and BTKi after fixed-duration venetoclax. Overall, the consensus underscores the importance of individualized, shared decision-making that accounts for molecular risk, comorbidities, and patient preferences, while highlighting global disparities in access to modern CLL therapies.
Introduction: Suppurative thyroiditis represents infrequent pathology, which comprises less than 1% of thyroid diseases, since thyroid gland is well-protected by its capsule. Case Report: The 57-year-old female was urgently hospitalized with pain and tenderness of the left side of the neck. Ultrasonography revealed pronounced swelling of the neck soft tissues and non-homogenous mass 2 cm below the skin surface with the size of 13.0 x 10.0 x 12.0 cm, which was spreading behind the sternum. Contrast-enhanced CT of the neck demonstrated thyroid gland’s left lobe lesion with the size of 13.4 x 10.2 x 12.0 cm with a thin capsule, which merely contained fluid component with sings of calcification and accumulated contrast at the periphery, tracheal compression by 50% and massive locoregional lymphadenopathy. Abscess of the thyroid gland’s left lobe cyst was suspected. Considering the patient's stable condition, it had been decided to perform ultrasound-guided drainage of the formation under local anesthesia. Consequently, the patient underwent radical left hemithyroidectomy in a planned manner. Specimen histological picture met criteria of papillary thyroid cancer, infiltrative follicular variant, pT3aN0M0 with signs of lymphovascular invasion. Conclusions: Thyroid cancer as any neoplasia can be promoted by chronic inflammation or produce signaling factors inducing inflammatory process. As in this case, a male patient was treated for thyroid abscess, but eventually he was diagnosed with papillary thyroid cancer. Since a risk of having cancer increases with age, older patients should be monitored more closely for the presence of malignancy.
