Is Percutaneous Nephrolithotomy the Modality of Choice Versus Extracorporeal Shockwave Lithotripsy for a 20 to 30 mm Single Renal Pelvic Stone with ≤1000 Hounsfield Unit in Adults? A Prospective Randomized Comparative Study

Objectives: To compare the efficacy, complications, and costs of percutaneous nephrolithotomy (PNL) and extracorporeal shock wave lithotripsy (SWL) in the treatment of a 20 to 30 mm single renal pelvic stone with a density ≤1000 HU. Patients and Methods: Eighty patients were prospectively randomized to receive either PNL or SWL during May 2017 to April 2019. The relevant demographic and clinical characteristics were compared. Results: The mean age in the PNL and SWL groups was 43.25 ± 15.16 and 44.18 ± 12.08 years, respectively. The mean stone sizes were 25.2 ± 3.9 and 24.6 ± 2.3 mm, respectively. The stone-free rate (SFR) was significantly different after the primary procedures (92.5% vs 37.5%, respectively; p < 0.04), but it was comparable after 3 months (97.5% vs 90%, respectively; p = 0.723), with a higher rate of auxiliary procedures after SWL (p = 0.017). On multivariate analysis, stone density was the only significant variable for the SFR in the SWL group (p = 0.004). Complications occurred in 27.5% and 22.5% of cases, respectively (p = 0.796). The mean costs of SWL (650.23 ± 424.74 United States Dollars [US$]) were significantly lower than those of PNL (1137.65 ± 224.43 US$; p < 0.0001). Conclusions: The SFRs for PNL and SWL were not significantly different after 3 months in the treatment of a 20 to 30 mm single renal pelvic stone with ≤1000 HU, although PNL provided a significantly higher rate after its primary procedure. SWL was significantly less costly, but it mandated a significantly higher number of auxiliary procedures than PNL.

Effect of alcohol and Cannabis sativa consumption on handwriting

This study reports on the separate effect of Cannabis sativa smoking and of alcohol consumption on handwriting performance in Cannabis users and in alcoholic volunteers, respectively. Handwriting samples were obtained prior to, during, and after 1 hr of Cannabis or alcohol consumption. Handwriting was evaluated for speed, letter forms, size, slant, and alignment. Cannabis sativa smoking exerted greater effect on handwriting than did alcohol drinking. This effect was noted during Cannabis smoking and lasted for 1 hr thereafter. Changes noted in handwriting performance test, which reflect involuntary muscular movement and tremor, suggest a differential CNS depressant action of the compounds used under the experimental trials listed. The results suggest possible forensic application, i.e., the use of handwriting for the purpose of signature comparison obtained under the influence of alcohol or under Cannabis intoxication.