Does bladder wall thickness decrease when obstruction is resolved?

Introduction and hypothesis

The aim of the current study was to determine if sonographic bladder wall thickness diminishes after symptomatic obstruction is resolved in female patients after stress incontinence surgery.

Methods

Between December 2008 and December 2010, 62 female patients with symptomatic bladder outlet obstruction, as defined by Blaivas, who had undergone prior surgery for urinary stress incontinence were included in the study. The patients’ history was taken and symptoms were noted. Patients underwent gynaecological examination, and multichannel urodynamic assessment was performed. Vaginal sonographic assessment of the bladder wall thickness (BWT) was performed before and after urethrolysis.

Results

62 patients were included in this study, 55 of whom had undergone suburethral sling insertion and seven had Burch colposuspension. Postoperatively, BWT decreased significantly from 9.1?mm?±?2.1 to 7.6?mm?±?2.2 (p?p?Conclusions If obstruction is resolved, bladder wall thickness decreases. Preoperatively elevated residual urine may increase the risk of persistent obstruction after urethrolysis.     

Intima–media thickness measurements in children with cardiovascular risk factors

Measuring intima–media thickness (IMT) is now a standard diagnostic procedure in assessing cardiovascular risk and hypertensive target-organ damage (TOD) in adults. There is also an increasing number of pediatric publications evaluating IMT in children from high-risk groups, such as those with arterial hypertension, diabetes, chronic kidney disease, obesity, dyslipidemia, and homocystinurias. It has been shown that carotid IMT is strongly related with other markers of TOD in children with arterial hypertension and with metabolic cardiovascular risk factors. In children with coarctation of the aorta, carotid IMT correlated both with blood pressure and even with mild residual aortic gradient. On the other hand, studies in children with high cardiovascular risk have shown that normalization of blood pressure and metabolic abnormalities led to regression of arterial changes and decrease of IMT. Although not yet accepted as standard pediatric procedure, IMT measurement is emerging as a promising method of assessing TOD and cardiovascular risk and monitoring treatment efficacy. From a practical point of view, clinical utility of IMT measurements seems to be similar to use of echocardiography in assessing left ventricular mass. However, IMT measurements in children and adolescents should be standardized to avoid bias caused by the use of different measurement methods.     

Partial thickness wound: Does mechanism of injury influence healing?

Wound healing is a complex multistep process which is temporally and spatially controlled. In partial thickness wounds, regeneration is possible from the stem cells in the edges of the wound and from the remnants of the epidermal appendages (such as hair follicles and sebaceous glands). This study examines whether the mechanism of injury influences healing of wounds of similar depth. Burn and excisional wounds were created on the back of Hampshire pigs and harvested at 7, 14, 28, 44, 57 and 70 days after injury and processed for histology and immunohistochemistry. Quantitative analysis of re-epithelialisation, inflammatory response and thickness of the scar and semi-quantitative analyses of the architecture of the resultant scar were performed and subjected to statistical analysis. Results demonstrated a higher number of neutrophils, macrophages and lymphocytes present in the burn on day 7 compared to the excisional wounds. The inflammatory profile of burn wounds was higher than that of excisional wounds for the first month after injury albeit less marked than on day 7 after injury. Re-epithelialisation was markedly advanced in excisional wounds compared to burn wounds at day 7 after injury, corresponding to the higher number of hair follicles in the underlying dermis of excisional wounds at this time point. The thickness of the neo-epidermis increased with time and at day 70 after wounding, the neo-epidermis of the burn was significantly thicker than the neo-epidermis of the excisional scar. Interestingly, following partial thickness excision of skin, there was neo-dermal reformation albeit with an altered architecture, lacking the normal basket-weave pattern of collagen. The thickness of the dermis of partial thickness excisional scar was greater than that of the adjacent unwounded skin. The neo-dermis of the burn scar was even thicker, with the collagen arranged more compactly and disorganised compared to excisional scar and normal skin. This study provides evidence that the mechanism of injury does influence wound healing and the resultant scarring.     

Is cartilage thickness different in young subjects with and without patellofemoral pain?

OBJECTIVE: To determine the differences in load-bearing patellofemoral joint cartilage thickness between genders. To determine the differences in load-bearing cartilage thickness between pain-free controls and individuals with patellofemoral pain. METHODS: The articular cartilage thickness of the patella and anterior femur was estimated from magnetic resonance images in 16 young, pain-free control subjects (eight males, eight females) and 34 young individuals with patellofemoral pain (12 males, 22 females). The average age of all subjects was 28+/-4 years. The cartilage surfaces were divided into regions approximating the location of patellofemoral joint contact during knee flexion. The mean and peak cartilage thicknesses of each region were computed and compared using a repeated-measures Analysis of Variance. RESULTS: On average, males had 22% and 23% thicker cartilage than females in the patella (P < 0.01) and femur (P < 0.05), respectively. Male control subjects had 18% greater peak patellar cartilage thickness than males with patellofemoral pain (P < 0.05); however, we did not detect differences in patellar cartilage thickness between female control subjects and females with patellofemoral pain (P = 0.45). We detected no significant differences in femoral cartilage thickness between the control and pain groups. CONCLUSIONS: Thin cartilage at the patella may be one mechanism of patellofemoral pain in male subjects, but is unlikely to be a dominant factor in the development of pain in the female population.     

Can sonographic peritoneal thickness be used to follow pediatric patients on peritoneal dialysis?

Background

Peritoneal dialysis (PD) is an effective and successful therapy for end-stage renal disease (ESRD). However, PD does not have a life-long effectiveness, and peritoneal membrane failure is commonly observed in long-term PD patients. We hypothesized that ultrasonography could be used to follow these patients.

Methods

We recruited two patient groups (age range 3–18 years), of whom 20 had ESRD with ongoing PD for ≥24 months (study group) and 20 were pre-dialysis non-ESRD patients (control group). None of the patients had peritonitis during the preceding 3 months, and none had a history of abdominal surgery or malignancy. We measured the sonographic thickness of the parietal peritoneum and obtained Doppler indices of the superior mesenteric artery (SMA) by trans-abdominal ultrasonography.

Results

Peritoneal thickness as determined by sonography was significantly greater in the PD group than in the controls. The correlation between duration of PD and thickness of the peritoneal membrane was linear and statistically significant. We categorized all 20 patients as either rapid transporters or slow transporters for both creatinine and glucose. The peritoneal membranes of patients who were rapid transporters for both creatinine and glucose were significantly thicker than those of the slow transporters. No statistical difference was found between the Doppler indices of the SMA between the groups.

Conclusion

Thickness of the parietal peritoneum as determined by sonography is associated with PD duration and transport characteristics. We conclude that ultrasonography is a non-invasive and practical method which can be useful for following PD patients.     

Determinants of the intima–media thickness in children and adolescents with chronic kidney disease

The aim of the study was to evaluate changes in the arterial wall in children with chronic kidney disease (CKD). We studied 60 patients: 32 with stages 2–4 CKD [chronic renal failure (CRF)], 28 with stage 5 CKD [end-stage renal disease (ESRD)], and 43 controls (C). The evaluated parameters included intima–media thickness (IMT) of the carotid arteries, bone mineral density (BMD), serum lipid levels, and parameters of the calcium–phosphorus metabolism. Patients were divided into two groups: group 1 with normal arteries, and group 2 with arterial changes. The highest serum fetuin A level was found in group 1 compared with groups 2 and C. A negative correlation between IMT and fetuin A level was found. In patients with ESRD, a positive correlation of IMT with phosphorus level and age and a negative correlation with cyclase-activating parathyroid hormone and cyclase inhibiting parathyroid hormone (CAP/CIP) ratio was observed. Multiple linear regression showed that lower fetuin-A and alkaline phosphatase (AP) levels and higher lumbar spine BMD independently predicted higher IMT. Arterial wall changes in children with CKD were related to lower fetuin A and AP level and higher BMD. Low CAP/CIP and high phosphorus level may also be significant factors for arterial changes in patients with ESRD.     

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转化医学的理念已在临床广泛推广,数字医学也在近几年取得快速发展。国内数字医学领域优秀团队的成功元素为:创新的攻关理念、明确的攻关目标、多元的攻关团队、坚韧的攻关精神、精诚团结的攻关核心领导。在此基础上,分析在数字医学的不同阶段,临床医生如何认识自己的角色和任务,树立转化医学理念,从而更好地发挥主观能动性,实现数字医学在临床的跨越发展。     

The thickness of the anterior compartment does not indicate compartment syndrome in acutely traumatised legs?

Background

The study was conducted to achieve early detection of increased compartment pressure by comparing the changes between the thickness and pressure within the musculofascial compartments after lower leg injury.

Methods

We included cases of a lower-leg fracture between January and December 2007. Bilateral lower leg compartment pressure and thickness were measured before the surgery and post-anaesthesia, and the surgery was performed within 12 h after the initial trauma. The intracompartment pressure (ICP) was measured with a Wick catheter pressure monitor. The thickness (width) of the anterior compartment of lower leg was measured using ultrasound.

Results

All data were measured within 4–6 h of the injury. The average thickness in injured legs versus uninjured was 30 mm (15–46 mm) versus 20.4 mm (13–30 mm), P < 0.001. The average intracompartment pressure (ICP) in injured leg versus uninjured was 45.3 mmHg (26–80 mmHg) versus 17.5 mmHg (15–20 mmHg), P < 0.001. The thickness and ICP were significantly increased for injured lower legs compared to the uninjured legs, but the increase in ICP did not show a significant relationship with the change in thickness of the injured lower leg.

Conclusion

In this study, the results of ICP and thickness changes of injury lower leg compared with uninjured leg revealed no statistically significant correlation. Some injuries showed a high ICP with only mild changes in thickness, while some showed a high ICP with significant changes. Although ultrasound has many advantages for the evaluation of soft tissue changes after trauma, this study revealed that thickness changes are not a predicable parameter for determining pressure on the acute fracture of lower leg.     

Can subfoveal choroidal thickness replace subjective tests in patients using tadalafil to treat erectile dysfunction?

We aimed to determine the effect on choroidal thickness of daily 5 mg tadalafil use in patients with erectile dysfunction (ED) and to evaluate agreement between short form of International Index of Erectile Function (IIEF 1–5, 15) scores and choroidal thickness during follow-up. Enhanced depth imaging spectral domain–optical coherence tomography (EDI-OCT) was used to measure full choroidal thickness in the subfoveal area, choroidal thickness (CT) and small-choroidal-vessel-layer (SCVL) thickness. Thirty of the 45 patients included complete their follow-ups and exhibited medication continuity. Patients were divided into two groups, five (16.7%) with ED at any level at third-month follow-up, and 25 (83.3%) with no ED, and subgroup analysis was then performed. Median changes in SCVL thickness at first- and sixth-month follow-ups were 20.5 µm versus 9.0 μm (p = .001) and 23.5 µm versus 12.5 µm (p = .005) in patients without and with ED respectively. The SCVL thickness increased by 20 μm compared with the baseline level, indicating an improvement in the patient's complaints of erectile dysfunction. The level of increase in SCVL thickness can be a useful and objective guide to clinicians if they cannot be present when the IIEF questionnaire is administered.     

Does the thickness of the vertebral subchondral bone reflect the composition of the intervertebral disc?

Degeneration of the intervertebral disc, seen radiologically as loss of disc height, is often associated with apparent remodelling in the adjacent vertebral body. In contrast, maintenance or apparent increase in disc height is a common finding in osteoporosis, suggesting the properties of the intervertebral disc may be dependent on those of the vertebral body or vice versa. We have investigated this relationship by measuring the radiological thickness of the subchondral bone and comparing it to the chemical composition of the adjacent disc. Sagittal slabs were sampled from lumbar spines obtained at autopsy and X-rayed microfocally. The thickness of the subchondral bone was measured and correlated with the composition of the adjacent intervertebral disc. Eighty-three cadaveric endplates were studied from individuals aged 17–85 years. There was regional variation in thickness of the subchondral bone, being greater adjacent to the annulus than the nucleus, and the endplates cranial to the disc were thicker than those caudal. There was a positive correlation between the thickness of the subchondral bone and the proteoglycan content of the adjacent disc, particularly in the region of the nucleus. A weaker correlation was seen here between water content and thickness, whilst there was no significant correlation at the annulus or between the bone thickness and collagen content. The positive relationship between the radiographic thickness of vertebral subchondral bone and the proteoglycan content of the adjacent disc seen in human cadaveric material could be due to the bone responding to a greater hydrostatic pressure being exerted by discs with higher proteoglycan content than by those with less proteoglycan present. It is suggested that while this is true in normal specimens, the relationship becomes altered in disease states, possibly because of changes to the nutritional pathway of the disc, with resultant endplate-bone remodelling affecting the flow of solutes to and from the intervertebral disc.     

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施维锦教授 (上海第二医科大学附属仁济医院 ) :近几年来 ,胆总管切开置管引流术后拔Ｔ管引起胆漏腹膜炎时有发生 ,文献上亦屡见报道 ,这是以往极少见的。今天组织一次病例讨论 ,希同道们发表高见。李可为主治医师 (上海第二医科大学附属仁济医院 ) :首先介绍病例。病人女性 ,68岁。右上腹阵发性痛 1周 ,寒战、发热 5天伴恶心、呕吐及黄疸来诊。体检 :神清 ,体温3 8 3℃ ,脉率 10 8/ｍｉｎ ,呼吸 2 4/ｍｉｎ ,巩膜及全身皮肤黄染。右上腹压痛 ,轻度肌卫 ,右肋缘下触及肿大胆囊 ,肝脾未及。血ＷＢＣ 16× 10 9/Ｌ ,中性 86%。肝功能ＳＧＰＴ …     

街头T恤

夏天是一个追捧T恤设计的季节，这股风气先由时装杂志所带动，然后在时尚一族的积极响应下，一跃成为流行殿堂里和牛仔服抢夺风头的宠儿。     

Paediatric partial‐thickness scald burns – is Biobrane the best treatment available?

The article critically analyses the role of Biobrane, one of the widely used modern biosynthetic dressings, in paediatric partial-thickness scald burns. Most of the studies, available in the literature, confirmed that Biobrane has significantly reduced the hospital stay, wound healing time and requirements of pain medications. However, very few studies with long-term follow up are available. Further randomised controlled trials are required to challenge the supremacy of Biobrane in paediatric partial-thickness burns.