[First successful clinical application of tissue engineered blood vessel]

With this tissue engineering (TE) technique, the peripheral pulmonary artery was successfully reconstructed, using the patient's own venous cells in a 4-year-old girl, 2 years after Fontan procedure. A 4-year-old girl was given a diagnosis of single right ventricle, double-outlet right ventricle and pulmonary atresia. She underwent left modified Blalock-Taussig shunt at a month old, pulmonary artery angioplasty at a year and 3 months old, and bidirectional cavopulmonary shunt at 2 years and a month old. She underwent again pulmonary artery angioplasty and Fontan operation at 3 years and 3 months. An angiographical examination 7 months after the operation revealed total occlusion of the right intermediate pulmonary artery. TE technique using autologous cells was indicated. The application of this procedure was approved by the ethical committee in Tokyo Women's Medical University. The patient's parents were thoroughly informed and signed a consent form. Approximately 2 cm of the peripheral vein was explanted under sterile conditions. The tissue was minced, placed in tissue culture dishes and cultured at 37 degrees C, 100% humidity and a 5% CO2 atmosphere for almost a month. The number of cells substantially increased to reach 12 millions for almost a month. The culture medium was changed every 3 days. The polymer tube that served as a scaffold for cells was composed of the copolymer of PCL-PLA (50:50) with reinforcement by woven PGA. The polymer conduit, 10 mm in diameter, 20 mm in length and 1 mm in thickness, was designated to biodegradate within 8 weeks. The number of seeded cells was approximately a million/cm2. The graft transplantation was performed 10 days after seeding cells. The occlusive right intermediate pulmonary artery was reconstructed with the TE vessel graft under extracorporeal circulation with a pump-oxygenator. The patient followed a satisfactory postoperative course. The postoperative angiography demonstrated that the graft was not constricted and dilated but that it preserved good patency. Long-term follow-up are necessary. We plan to continue to use the TE technique using autologous cells in the low pressure system like venous or pulmonary circulation. Because our results even in early experimental phase were valuable and promising, we believe that the TE approach may play an important role in the near future as an another alternative, together with transplantation and artificial organ, especially in the field of cardiovascular surgery that mostly needs replants.

[A modified Fontan operation in the presence of a supracardiac total anomalous pulmonary venous connection]

We report a case of 2-year-old girl with asplenia syndrome who successfully underwent modified Fontan procedure and concomitant repair of supracardiac total anomalous pulmonary venous connection (TAPVC). The preoperative diagnosis included a common atrioventricular canal (type C), a double outlet right ventricle, a common atrium, common atrioventricular valve regurgitation, pulmonary stenosis, and a bilateral superior vena cava (SVC). Cardiac catheterization revealed a Qp/Qs of 1.3, mean PA pressure of 16 mmHg and an Rp of 1.3. The TAPVC drained to left SVC (LSVC) at a position proximal to the hemiazygos vein with an ostium of 5 mm in diameter. The LSVC was divided distal to its connection to the common pulmonary vein (CPV). The TAPVC ostium was cut back into the CPV, then it was anastmosed with posterior aspect of the atrial wall in an effort to provide a wide anastomosis. The postoperative course was uneventful and the patient was discharged from hospital on the 35th postoperative day.

Spontaneous rupture of the pancreaticoduodenal artery possibly related to prior occlusion of the common hepatic artery: report of a case

We report herein a case of spontaneous rupture of the pancreaticoduodenal artery (PDA) associated with obstruction of the common hepatic artery. A 68-year-old man was admitted to our hospital following the sudden onset of severe upper abdominal pain. Computed tomography revealed a large mass formation in the peritoneal cavity. Hemorrhagic shock rapidly developed during the initial evaluation, necessitating an exploratory laparotomy to be performed in the emergency room. This revealed a large hematoma in the retroperitoneal space, and a ruptured PDA was sutured. Postoperative angiography showed obstruction of the common hepatic artery and also suggested that the source of the bleeding was the PDA. Thus, a diagnosis of spontaneous rupture of a PDA aneurysm associated with occlusion of the common hepatic artery was made. Following this case report, we discuss the development of true aneurysms of the PDA and the treatment of ruptured true PDA aneurysms resulting in shock.

Effects of interleukin-4 on proteoglycan accumulation in human gingival fibroblasts

In inflammatory gingival diseases, cytokines have been demonstrated to play critical roles by coordinating the stimulation of immunological and connective tissue cells. The activities of these cells, degrading and remodeling extracellular matrices, constitute the major pathological and repair processes. Thus, elucidating cellular and molecular events occurring in inflamed connective tissues is crucial for the understanding and treatment of inflammation. In order to test a hypothesis that proinflammatory cytokines affect metabolism of major extracellular matrix molecules, we studied metabolism of proteoglycans (PGs) by human gingival fibroblasts (HGF) under the influence of interleukin-4 (IL-4) as a model of gingivitis. HGF in cell culture were metabolically radiolabeled using [3H]glucosamine and [35S]sulfate in the presence or absence of IL-4, and the labeled PGs were analyzed by chromatographic techniques. The incorporation of 35S into PGs increased with IL-4 both in media and cell layer. At 100 ng/ml of IL-4, the increment of 35S incorporation over control culture was 16-39% (p<0.001) in media and 12-35% (p=0.01) in cell layer. The 35S-labeled macromolecules were PGs containing heparan sulfate (HS) and chondroitin sulfate (CS) chains. From the molecular weight and glycosaminoglycan composition analyses, versican and perlecan-type and biglycan and decorin-type were very likely to be the major PG constituents both in media and cell layer. IL-4 stimulated synthesis of versican and perlecan-type more potently than biglycan and decorin-type. With IL-4 treatment, the ratio of CSPG/HSPG decreased in media and increased in cell layer. This ratio suggested that syndecan family HSPGs were also present in HGF. In conclusion, IL-4 stimulated accumulation of CS/HSPGs in human gingival fibroblasts.

Extending Fitts' law to a three-dimensional pointing task

An attempt was made to extend Fitts' law to a three-dimensional movement (pointing) task to enhance its predictive performance in this domain. An experiment was conducted in which 10 subjects performed three-dimensional pointing movements under the manipulation of target size, distance to target and direction to target. As expected, the duration of these three-dimensional movements was rather variable and affected markedly by direction to target. As a result, the variance in the movement times produced was not satisfactorily explained by the conventional Fitts' model. The conventional model was extended by incorporating a directional parameter into the model. The extended model was shown to better fit the data than the conventional Fitts' model, both in terms of r(2) and the standard error of the residual between the measured movement time and the value predicted by model fit.

Shoulder joint movement of the non-throwing arm during baseball pitch--comparison between skilled and unskilled pitchers

The shoulder of a non-throwing arm during a baseball pitch must be in a constant position while the shoulder of the throwing arm moves in a nearly circular path around it. However, it has not been investigated whether a skilled pitch requires less shoulder-joint movement. It was hypothesized that pitchers with less shoulder movement of the non-throwing arm can be considered to have higher skill and to attain higher initial ball velocity. Nine baseball pitchers were used as subjects. The coach classified them into a skilled and an unskilled group. The pitching motions were recorded using two high-speed cameras. The time series of three-dimensional landmark coordinates of the shoulder joint of the non-throwing arm during the baseball pitch were calculated using the direct linear transformation method. The shoulder-joint movement (SJM) index, which expresses the movement (displacement) of the shoulder joint of the non-throwing arm quantitatively, was proposed to compare the SJM at different skill levels and investigate the relationship between SJM and initial ball velocity. The SJM of the skilled pitchers was smaller than that of the unskilled pitchers, and the smaller value of the SJM led to faster initial ball velocity. The data suggest that the less SJM of the non-throwing arm is required to attain a skilled pitch and higher initial ball velocity.

[A case of bronchiolitis obliterans: auscultation leading to accurate diagnosis]

This is a case of a 31-year-old man with a history of common cold. He had been suffering from productive cough and dyspnea on exertion. Squawks were heard through auscultation, and hyperinflation was also observed in his chest radiograph. Bronchiolitis was first suspected as a result of HRCT and TBLB. He was then treated with CAM for six months, but his symptoms showed little improvement. So we evaluated his squawks objectively by phonopneumograph, performed video assisted thoracoscopic surgery and diagnosed his illness as constrictive bronchiolitis. Based on the examinations, PSL therapy was applied to his case, which contributed improving his condition remarkably. The significance of this case is that proper auscultation led to the accurate diagnosis.

Non-neoplastic glandular structures in a benign peripheral nerve sheath tumor

It is a recognized fact that glandular structures sometimes occur in peripheral nerve sheath tumors (PNST). Reports indicate that epithelial potential could be expressed in malignant PNST, while the glands in most benign PNST could be trapped skin adnexa. We present a case of spindle cell tumor with glandular structures. The patient was a 55-year-old man who had a subcutaneous tumor excised. The spindle cell tumor had histological characteristics of neurofibroma. The glandular structures had a pattern of immunohistochemical staining that was similar to that of the secretory coils and excretory ducts of normal eccrine glands. Therefore, the glands were thought to be naturally existing eccrine glands. The glands were completely enclosed within the tumor and not connected to one another; a cluster formation was not observed. The upper portion of tumor included some glands of skin adnexa. The spindle cell tumor may have originated from the nerves distributed around the skin adnexa, and grown to the subcutaneous tissue. The glands may have been left behind rather than have been trapped in the tumor.

Portal vein thrombosis associated with antiphospholipid syndrome

Portal vein thrombosis is a rare occurrence, and often an underlying hypercoagulable state can be found. Recently, there has been growing interest and recognition of the antiphospholipid syndrome in association with acquired hypercoagulable state. This syndrome consists of the association of lupus anticoagulant or antiphospholipid antibodies with arterial or venous thrombosis, thrombocytopenia, and spontaneous abortion. We report a case of portal vein thrombosis associated with the antiphospholipid syndrome. In our patient, chronic liver disease, hepatobiliary infection, abdominal malignancies, myeloproliferative disorders, and inherited coagulation disorders were excluded. This case report suggests that serum antiphospholipid antibodies should be investigated in patients with portal vein thrombosis of unexplained etiology.

[Comparisons of factors affecting voiding disorders between patients with benign prostate hyperplasia and volunteers]

PURPOSE

The prostate size and motivation to visit clinics were investigated in patients with prostate hyperplasia.

OBJECTS AND METHODS

One hundred ninety-five patients who had urinary symptoms and visited our outpatient clinic between September 1994 and October 1999 and 268 age-matched volunteers in Mitaka City who underwent a medical examination of the prostate in June 1997 were compared. International Prostate Symptom Score (IPSS), Quality Of Life Score (QOL score), residual urine volume, prostate volume and urinary flow rate were measured.

RESULTS

The prostate volume of the volunteers was 20-25 cm3 irrespective of the age. The prostate size of the outpatients was larger than that of the volunteers for every age group. IPSS and QOL score were significantly higher in the outpatients than in the volunteers. Diurnal urinary frequency and sense of residual urine contributed to the discrimination index of the two groups more significantly than the other scores. There was a significant correlation between prostate volume and residual urine volume. The score of weak urinary steam was inversely and significantly correlated with peak urinary flow rate.

CONCLUSIONS

There was no age-related enlargement of the prostate gland. The prostate gland was significantly larger in the patients than in the volunteers even in those in their fifties. Urinary frequency and sense of residual urine are important factors for men to seek and receive medical care.

[A tube retractor for cardiac surgery]

A retractor exclusively used to retract the tubes in cardiac surgery which needs cardiopulmonary bypass was developed. The half-cylinder-shaped end, the lightly curved handle and the flat and triangular grip enable easy and effective grasp of the tubes. This new instrument facilitates operative procedures by effectively retracting the tubes which persistently obstruct the operative field, in such a case of placement of a retrograde cardioplegia tube via the right atrium.

[The significance of early detection for prostate cancer in mass screening]

PURPOSE

In Mitaka city, mass screening for prostate cancer was conducted for 3 years from 1995 to 1997. Clinical stages were compared between patients found by screening and those diagnosed at our clinic during the same time. The significance of serum-free prostate specific antigen (PSA) in mass screening for prostate cancer was examined.

MATERIAL AND METHODS

A prospective clinical trial was conducted on men aged 50 years or older. The primary examination consisted of taking the international prostate symptom score, quality of life score, PSA (Tandem-R) and digital rectal examination (DRE). If PSA was greater than 4.0 ng./ml and/or if DRE suggested cancer, transrectal ultrasound-guided sextant prostate biopsies were indicated.

RESULTS

Of the men screened, 23.2% (320/1375) had serum PSA greater than 4.0 ng./ml. and/or suspicious findings on DRE. Biopsy was performed in 199 of 320 (62.1%). Cancer was detected in 21 (1.5%, 21/1375). Prostate cancer was found in one case among 154 males (0.65%, 1/154) who were screened twice or more. The cancer stage found by screening was significantly earlier than that diagnosed at the outpatient clinic (Wilcoxon's rank-sum test: p = 0.0047). Receiver operating characteristics analysis showed that the optimal free PSA-to-PSA ratio was 12%. Positive predictive value increased from 18% to 50% when free PSA-to-PSA ratio was combined with PSA.

CONCLUSION

1. Cancer detection rate was 1.5% in the mass screening in Mitaka City. 2. Cancer stage found by screening was significantly earlier than that diagnosed at the outpatient clinic. 3. Free PSA determination might eliminate unnecessary biopsies in men with PSA above 4.0 ng./ml with minimal loss of cancer detection.

A novel monoclonal antibody K1 recognises early neurones in the rat cortex

The aim of this study was to produce monoclonal antibodies specific for neurones that are generated earliest in the rat neocortex. One of the established clones, K1, showed a strong immunoreactivity in the marginal zone at the 19th day of gestation (E19). The immunoreactivity of K1 initially appeared in the primordial plexiform layer at E15, in the subplate at E16, and in the marginal zone by E17. It became undetectable in the first postnatal week. The immunoreactivity was not detected in the neocortex of adults or elderly. Western blotting analysis revealed reactive bands at positions corresponding to proteins of 290 and 280 kDa for the neocortical membrane fractions prepared from E16 to E21 embryos. In these stages, smears of bands were also found at positions corresponding to higher molecular weights. A single band of protein of 280 kDa was detected for the soluble fractions prepared from the embryos at E19 and E21. These reactivities were susceptible to protease, but not to enzymatic or chemical destruction of carbohydrate residues. Electron microscopic analysis showed that the K1 immunoreactivity was detected primarily on the cellular membranes of neurites. In the marginal zone at E19, the K1 immunoreactivity was localised where neurites make contact with other neurites or somata. A portion of these contact points had typical features of synapses. In the cortical plate of the same stage, arrays of tiny K1-immunoreactive puncta were observed on a subset of radial processes. These results suggest that monoclonal antibody K1 is a marker recognising neurites of subplate neurones that extend radially and make neuronal contacts in the marginal zone.

[Objective evaluation of treatment for sleep apnea syndrome]

CPAP treatments for sleep apnea syndrome (SAS) are being established; however, there is no established evaluation method to scale the long-lasting effectiveness of the treatment. The only available method is to judge the results from each patient's subjective symptoms. We therefore tested a self-contained microcomputer with an acceleration sensor (Lifecorder) in an attempt to evaluate the effectiveness of treatments objectively. Fifteen patients with OSAS were the subjects. We keep the records of Lifecorders that were worn by the subjects a month before and a month after nasal CPAP treatment. We also assessed their daily physical activity levels; the number of steps taken, calories consumed, intensity of each activity along with improvement in their subjective symptoms. The number of steps taken in a day increased as did the calories consumed after treatment in 9 subjects. Moderate and intensive activities also increased among those 9 subjects. Our results indicate that evaluation with a Lifecorder, which is simple and inexpensive, can provide objective indicators to assess the effectiveness of treatments in patients' daily activities.

[A case of familial juvenile gouty nephropathy associated with a right renal tumor]

We present a case of familial juvenile gouty nephropathy which was associated with a right renal tumor that was found incidentally. The patient was a 27-year-old woman who initially presented with acute gouty arthritis at the age of twenty years. Her mother and her sister had been attacked with acute gouty arthritis in their early twenties. Progressive deterioration in the renal function was noted in the three family members who had experienced gouty attack. Her mother was maintained on hemodialysis. As image diagnoses could not rule out malignancy in her right renal tumor, in situ non-ischemic enucleation of the right renal tumor using a microwave tissue coagulator(Microtaze) and a renal biopsy were performed. The pathological diagnosis of the renal tumor was tubulopapillary adenoma, and the renal biopsy showed minimal change in the glomeruli and tubules. The post-operative course was uneventful. The serum creatinine and creatinine clearance before and three months after the operation were 2.4 mg/dl and 2.6 mg/dl, 36.7 ml/min and 32.5 ml/min, respectively. The renal biopsy findings that glomerular and tubular changes were minimal and there was no tissue precipitation of uric acid or sodium urate, and the fact that her renal function decreased progressively despite the treatment of hyperuricemia suggested strongly that renal function might have deteriorated due to unknown factors other than hyperuricemia.

[Two siblings with adult-type metachromatic leukodystrophy: correlation between clinical symptoms and neuroimaging]

We reported two siblings with adult-type metachromatic leukodystrophy (MLD). Patient 1 was a 19-year-old male, and patient 2 was a 20-year-old female. Their initial symptoms were similar. They developed abnormal behavior and personality changes, poor concentration, and inappropriate smiling. In patient 1, his condition deteriorated and he developed incontinence. His attention span and verbal expression severely decreased. He had an inability to engage in meaningful conversation. The siblings were diagnosed as having MLD by marked reduced leukocyte arylsulfatase A activity. T2-weighted MRI of these two cases showed a high intensity area in the cerebral white matter. The high intensity areas of the cerebral white matter gradually spread over one year. However, SPECT of these cases showed only a few abnormal findings in the initial stage. Using SPECT, a reduction of regional cerebral blood flow (rCBF) spreading to the cerebral cortex was seen over one year after it was seen using MRI. The discrepancy between MRI and SPECT findings in the initial stage was characteristic. MLD is an important disease that involves white matter dementia. The discrepancy between MRI and SPECT is helpful to diagnose white matter dementia.

Age-related changes of cornu ammonis 1 pyramidal neurons in gerbil transient ischemia

This study reports that postischemic apoptotic cell death of the hippocampal cornu ammonis (CA) 1 neurons is delayed in aged gerbils. Age-related changes in the process of CA1 neuronal death following transient ischemia was studied. Two groups of Mongolian gerbils were used in this study, which compared adult (4-month-old) and aged (24-month-old) animals by hematoxylin-eosin stain, in situ nick-end labeling (TUNEL method) and electron microscopy. In the process of neuronal death, neuronal loss of the aged group was histologically less severe than that of the adult group. TUNEL-positive cells were found on days 3-5 after ischemia in the adult group, while they were still found on day 7 in the aged group. The apoptotic process of the aged group was delayed compared to the adult group. Furthermore, lipofuscin was ultrastructurally observed inside the apoptotic body 5 days after ischemia in CA1 pyramidal neurons of the aged group. It is likely that colocalization of lysosomal enzyme cathepsin D with lipofuscin might be associated with the age-related alteration of lysosomal system in the neurons. Altogether these data suggest that age-related lysosomal changes might affect the apoptotic cascade process in postischemic CA1 neurons.

Mating in Bacillus thuringiensis can induce plasmid integrative prophage J7W-1

Bacillus thuringiensis serovar israelensis, a bacterium which possesses plasmid transfer ability after mating, has been lysogenized by plasmid integrative phage J7W-1. The induction of phage in this J7W-1 lysogen was observed after mating with phage-insensitive strains, such as B. thuringiensis serovar thuringiensis, B. cereus and B. subtilis, as well as the phage-sensitive strain serovar israelensis. The phage induction was not observed after mating with B. thuringiensis strains AF101, serovar dendrolimus and serovar indiana. Because these strains are naturally associated with J7W-1 or its related phage, the data strongly suggest a constitutive expression of the repressor encoded by the prophage in these strains. However, the phage induction was observed in B. thuringiensis serovar aizawai, although it contained the J7W-1 DNA homologous region(s).

[Sphincter-preserving surgery for lower rectal cancer aimed at improving postoperative bowel function]

Much attention has been focused on sphincter-preserving surgery for patients with lower rectal cancer, leading to renewed interest in the outcome of postoperative bowel function. Some patients who undergo sphincter-preserving surgery experience bowel dysfunction, such as frequent stools, severe constipation, soiling, and incontinence. These symptoms were thought to be correlate with lower resting pressure, lower rectal compliance, sensory disturbance of the anal canal, spasm, and delayed transit in the colon above the anastomosis. To improve postoperative bowel function, reconstruction with the colonic J-pouch has been performed, which results in a satisfactory functional outcome. About 80% of patients with a J-pouch were able to tolerate over 10 minutes after feeling the desire to defecate. An anorectal manometric study showed no abnormal spastic movement of the neorectum and a transit study showed that the J-pouch group was superior to the straight group with respect to the smoothness of movement of radiopaque markers from the cecum to anal ring, although a small number of markers were retained in the colonic J-pouch. Patients who received a colonic J-pouch had fewer defecation problems in daily life. Further study is need to improve postoperative bowel movement in patients who undergo sphincter-preserving surgery.

Temperature influences induction of a J7W-1-related phage in Bacillus thuringiensis serovar indiana

Induction of a plasmid-integrative J7W-1-related phage in Bacillus thuringiensis serovar indiana by ethidium bromide was influenced by the temperature at which the host cells were cultured. Under optimal growth conditions, the maximum titer of the phage produced by the serovar indiana reached 1.2 x 10(6) PFU/ml at 37 degrees C while at 27 degrees C it was lower by an order of magnitude (1.3 x 10(5) PFU/ml). The temperature-sensitive period was estimated to occur early during the phage induction. However, the temperature effect observed with the serovar indiana did not occur with the serovar israelensis. In the latter case, the phage induction was the same at 37 degrees C or 27 degrees C. Thus we assume that the temperaturesensitive phage induction observed with the serovar indiana as host was not a phenomenon caused by the phage genome but rather by product(s) encoded by certain host gene(s).

Selectivity for the shape, size, and orientation of objects for grasping in neurons of monkey parietal area AIP

In this study, we mainly investigated the visual selectivity of hand-manipulation-related neurons in the anterior intraparietal area (area AIP) while the animal was grasping or fixating on three-dimensional (3D) objects of different geometric shapes, sizes, and orientations. We studied the activity of 132 task-related neurons during the hand-manipulation tasks in the light and in the dark, as well as during object fixation. Seventy-seven percent (101/132) of the hand-manipulation-related neurons were visually responsive, showing either lesser activity during manipulation in the dark than during that in the light (visual-motor neurons) or no activation in the dark (visual-dominant neurons). Of these visually responsive neurons, more than half (n = 66) responded during the object-fixation task (object-type). Among these, 55 were tested for their shape selectivity during the object-fixation task, and many (n = 25) were highly selective, preferring one particular shape of the six different shapes presented (ring, cube, cylinder, cone, sphere, and square plate). For 28 moderately selective object-type neurons, we performed multidimensional scaling (MDS) to examine how the neurons encode the similarity of objects. The results suggest that some moderately selective neurons responded preferentially to common geometric features shared by similar objects (flat, round, elongated, etc.). Moderately selective nonobject-type visually responsive neurons, which did not respond during object fixation, were found by MDS to be more closely related to the handgrip than to the object shape. We found a similar selectivity for handgrip in motor-dominant neurons that did not show any visual response. With regard to the size of the objects, 16 of 26 object-type neurons tested were selective for both size and shape, whereas 9 object-type neurons were selective for shape but not for size. Seven of 12 nonobject-type and all (8/8) of the motor-dominant neurons examined were selective for size, and almost all of them were also selective for objects. Many hand-manipulation-related neurons that preferred the plate and/or ring were selective for the orientation of the objects (17/20). These results suggest that the visual responses of object-type neurons represent the shape, size, and/or orientation of 3D objects, whereas those of the nonobject-type neurons probably represent the shape of the handgrip, grip size, or hand-orientation. The activity of motor-dominant neurons was also, in part, likely to represent these parameters of hand movement. This suggests that the dorsal visual pathway is concerned with the aspect of form, orientation, and/or size perception that is relevant for the visual control of movements.

Comparative study of pulsed dye laser and pneumatic lithotripters for transurethral ureterolithotripsy

BACKGROUND

Clinical effectiveness and safety of the Swiss Lithoclast (Lithoclast) and the Candela MDL-2000 (MDL) in the treatment of lower ureteral stone were examined retrospectively.

METHODS

Eighty-six stones from 66 patients and 26 stones from 20 patients were treated by Lithoclast and MDL, respectively.

RESULTS

The stone-free rate on 3-month follow-up was 97% and 95% for the Lithoclast and MDL, respectively (no significant difference). The operation time was significantly shorter for the Lithoclast than for the MDL (90.2+/-50.2 vs 120.4+/-55.1 min; P<0.05). Postoperative analgesics were required significantly less frequently in Lithoclast (10/66 vs 11/20; P<0.01). Postoperative hospital stay was significantly shorter for Lithoclast (8.7+/-5.1 vs 12.1+/-4.2 days; P<0.01).

CONCLUSIONS

Swiss Lithoclast is an effective and less invasive modality for endoscopic treatment of lower ureteral stones.