Anomaly and tumor of kidney and urinary tract

2007475 MRI manifestations of renal oncocytoma.JI Jiansong(纪建松) , et al. Dept Radiol, Sir Run RunShaw Hosp, Zhejiang Univ, Hangzhou 310016. Chin JRadiol 2007;41(10):1087 -1089. Objective To analyze the MRI findings of renal on-cocytoma, and to improve the ability for the diagnosis.Methods We retrospectively reviewed MRI findings ofsults Sixcases had a solitary lesion, and 1 of themac-companied with renal clear-cell carcinoma. Tumors ap-peared as round with diameter 1.5 to 3.8 cm,…     

Relationships between serum adiponectin and soluble TNF-α receptors and glucose and lipid oxidation in lean and obese subjects

Insulin resistance might be associated with an impaired ability of insulin to stimulate glucose oxidation and inhibit lipid oxidation. Insulin action is also inversely associated with TNF-α system and positively related to adiponectin. The aim of the present study was to analyze the associations between serum adiponectin, soluble TNF-α receptors concentrations and the whole-body insulin sensitivity, lipid and glucose oxidation, non-oxidative glucose metabolism (NOGM) and metabolic flexibility in lean and obese subjects. We examined 53 subjects: 25 lean (BMI < 25 kg × m⁻²) and 28 with overweight or obesity (BMI > 25 kg × m⁻²) with normal glucose tolerance. Hyperinsulinemic euglycemic clamp and indirect calorimetry were performed. An increase in respiratory exchange ratio in response to insulin was used as a measure of metabolic flexibility. Obese subjects had lower insulin sensitivity, adiponectin and higher sTNFR1 (all P < 0.001) and sTNFR2 (P = 0.001). Insulin sensitivity was positively related to adiponectin (r = 0.49, P < 0.001) and negatively related to sTNFR1 (r = −0.40, P = 0.004) and sTNFR2 (r = −0.52, P < 0.001). Adiponectin was related to the rate of glucose (r = 0.47, P < 0.001) and lipid (r = −0.40, P = 0.003) oxidation during the clamp, NOGM (r = 0.41, P = 0.002) and metabolic flexibility (r = 0.36, P = 0.007). Serum sTNFR1 and sTNFR2 were associated with the rate of glucose (r = −0.45, P = 0.001; r = −0.51, P < 0.001, respectively) and lipid (r = 0.52, P < 0.001; r = 0.46, P = 0.001, respectively) oxidation during hyperinsulinemia, NOGM (r = −0.31, P = 0.02; r = −0.43, P = 0.002, respectively) and metabolic flexibility (r = −0.47 and r = −0.51, respectively, both P < 0.001) in an opposite manner than adiponectin. Our data suggest that soluble TNF-α receptors and adiponectin have multiple effects on glucose and lipid metabolism in obesity.     

Periodontitis and diabetes mellitus—an awareness and perception study among endocrinologists and diabetologists

International Journal of Diabetes in Developing Countries - Periodontitis is a chronic inflammatory disease caused by pathogenic dental plaque which causes microbial dysbiosis leading to...     

Lipids,Lipoproteins, and Metabolites and Risk of Myocardial Infarction and Stroke

Background

Blood lipids are established risk factors for myocardial infarction (MI), but uncertainty persists about the relevance of lipids, lipoprotein particles, and circulating metabolites for MI and stroke subtypes.

Thromboelastography and recombinant factor VIIa—hemophilia and beyond

Thromboelastography (TEG), which records the continuous profiles of whole blood (WB) coagulation, can be used to evaluate the effects of hemostatic agents, such as recombinant factor VII (rFVIIa). Our group has developed a revised TEG model, involving activation with minute amounts of tissue factor and subsequent signal processing, and has used this method to evaluate the effects of rFVIIa both in patients with hemophilia and in those receiving vitamin K antagonist (VKA) thromboprophylaxis. We review the early results of our investigations, which suggest that, in clinical situations where rFVIIa has shown benefit, the changes in the profiles obtained by TEG recording appear to correlate with the clinical outcome.     

Alcohol and Atherosclerosis

Objectives To study the relationship between alcohol and atherosclerosis （AS）. Methods The paper reviewed the mechanism of the alcohol leading to AS from four aspects such as the introduction of alcohol and AS, imbalance of oxidationantioxidation system, oxygen free radical （OFR） and endothelium cell （EC） apoptosis, apoptosis and AS. Results Excessive alcohol could lead to imbalance of oxidation-antioxidation system, and increase OFR, in the meanwhile, OFR could lead to EC apoptosis, which could lead to AS.     

Meetings and Courses

Announcements for this section should be submitted in the correct format at least 3 months before the required date of publication. This list is provided as a service to readers; inclusion does not imply endorsement by the HBPD INT.Section editorShui-Ying LeiEmail: hbpdje@mail.hz.zj.cn     

Meetings and Courses

<正>Announcements for this section should be submitted in the correct format at least 3 months before the required date of publication. This list is provided as a service to readers; inclusion does not imply endorsement by the Hepatobiliary & Pancreatic Diseases International.     

Constipation of anorectal outlet obstruction: pathophysiology, evaluation and management

Constipation is a subjective symptom of various pathological conditions. Incidence of constipation fluctuates from 2 to 30% in the general population. Approximately 50% of constipated patients referred to tertiary care centers have obstructed defecation constipation. Constipation of obstructed defecation may be due to mechanical causes or functional disorders of the anorectal region. Mechanical causes are related to morphological abnormalities of the anorectum (megarectum, rectal prolapse, rectocele, enterocele, neoplasms, stenosis). Functional disorders are associated with neurological disorders and dysfunction of the pelvic floor muscles or anorectal muscles (anismus, descending perineum syndrome, Hirschsprung's disease). However, this type of constipation should be differentiated by colonic slow transit constipation which, if coexists, should be managed to a second time. Assessment of patients with severe constipation includes a good history, physical examination and specialized investigations (colonic transit time, anorectal manometry, rectal balloon expulsion test, defecography, electromyography), which contribute to the diagnosis and the differential diagnosis of the cause of the obstructed defecation. Thereby, constipated patients can be given appropriate treatment for their problem, which may be conservative (bulk agents, high-fiber diet or laxatives), biofeedback training or surgery.     

When fiber is not enough: current thinking on constipation management

Constipation is a common disorder and many patients fail to respond to the simple constipation remedies of increased fiber and fluid intake. When secondary to other conditions, medications, or disease processes, the focus of constipation management is correction of causative factors. However, primary constipation - ie, constipation with no identifiable causative factor - is very common. Patients generally present with one of three patterns: constipation-predominant irritable bowel syndrome, slow transit constipation, or pelvic floor dysfunction resulting in dyssynergic defecation. Baseline evaluation for patients with chronic constipation includes a careful history, focused physical examination, and limited laboratory studies. Patients with dyssynergic defecation usually respond best to biofeedback therapy and pelvic muscle re-education. Constipation-predominant irritable bowel syndrome is best managed with dietary monitoring and modifications, fiber therapy, and education regarding self-monitoring and self-care. Patients with slow transit constipation may benefit from fiber therapy and increased activity, but most also will require laxative therapy. Current guidelines for prescribing laxatives suggest bulk agents as first line and osmotic agents as second line therapy. Stimulant laxatives should generally be reserved for PRN use. Current understanding about the etiology, pathology, and classification of different types of constipation are summarized and a stepwise approach to evaluation and management is presented.     

Pregnancy-related constipation

Constipation is a common complaint in pregnancy. Its symptoms may include infrequent defecation, hard or scybalous stool, or excessive straining. An extensive evaluation is usually unnecessary for women who present with constipation for the first time during pregnancy. Most patients respond to dietary measures or simple laxatives. Few laxatives have been evaluated in clinical trials for use in pregnancy. Evidence supports treatment with fiber supplements and senna. The use of a pharmacologic agent for treatment of constipation during pregnancy must be weighed against possible adverse effects. Most laxatives carry a pregnancy category B or C classification. First-line therapy includes increasing fiber intake through diet or supplements. Osmotic laxatives may be beneficial for some patients. The short-term use of osmotic or stimulant laxatives is generally reserved for patients who fail to respond to dietary changes or bulking agents.     

Simultaneous dynamic proctography and peritoneography for pelvic floor disorders

PURPOSE: We sought to evaluate a new diagnostic technique for the identification of rectal and pelvic floor pathology in patients with obstructed defecation, pelvic fullness/ prolapse, and/or chronic intermittent pelvic floor pain. METHODS: Thirteen symptomatic women with either a nondiagnostic physical examination or nondiagnostic dynamic proctography (DPG) were studied. After placement of intraperitoneal and intrarectal contrast material, resting and straining pelvic x-rays were obtained in all patients, and defecation was videotaped using fluoroscopy. RESULTS: Simultaneous DPG and peritoneography identified clinically suspected and unsuspected enteroceles in 10 of the 13 patients studied. An enterocele or other pelvic floor hernia was ruled out by the technique in three of the women studied. Rectoceles and rectal prolapse that were identified during physical examination were confirmed by DPG with peritoneography. Simultaneous DPG and peritoneography also gave a qualitative assessment of the severity and clinical significance of the identified pelvic floor disorders. Results of simultaneous DPG and peritoneography affected operative treatment planning in 85 percent of patients studied. CONCLUSION: Simultaneous DPG and peritoneography identifies both rectal and pelvic floor pathology and provides a qualitative assessment of pelvic floor pathology severity, which allows for better treatment planning in selected patients with obstructed defecation and pelvic prolapse.Video presentation at the meeting of The American Society of Colon and Rectal Surgeons, Chicago, Illinois, May 2 to 7, 1993.     

Biofeedback therapy for dyssynergic defecation

INTRODUCTION Chronic constipation is a common self-reported bowel symptom that affects 2%-30% of people in Western countries and has considerable impact on health expenses and quality of life[1]. Most patients respond either to fiber- fluid supplementatio…     

Solitary rectal ulcer syndrome in children

SRUS is a rare condition in children, which usually presents with a symptom complex of rectal bleeding, passage of mucus and straining on defecation, tenesmus, perineal and abdominal pain, sensation of incomplete defecation, constipation and rectal prolapse. The underlying etiology of SRUS is not fully understood but it is likely to be secondary to ischemic changes in the rectum associated with paradoxical contraction of pelvic floor and external anal sphincter muscles and rectal prolapse. Conservative measures like high intake of fluids and fibers, laxatives, biofeedback and behavior modification therapy may be beneficial for treatment of constipation. Excision of rectal ulcer and surgery of overt rectal prolapse, however, may be required in refractory cases not responding to conservative treatments. A therapeutic role for botulinum toxin injection into the external anal sphincter for treatment of SRUS associated with constipation and paradoxical contraction of pelvic floor and external anal sphincter muscles in children, may exist.     

Guidelines for diagnosis and treatment of constipation in Mexico. C) Medical and surgical treatment

"Background: There are multiple therapeutic options for the management of constipation, from lifestyle modifications to the use of laxatives and in extreme cases surgery. Objectives and Methods: To establish the clinical guidelines for diagnosis and treatment of chronic constipation in Mexico we conducted a review of the literature regarding medical and surgical treatments for chronic constipation and have made recommendations based on evidence. Results: Low water consumption, physical inactivity and low intake of fiber are conditions associated with chronic constipation, but the evidence to prove these associations is scarce. Bolus forming agents are useful in the management of constipation with normal colonic transit and defecation without dissynergia. Evidence supports the use of lactulose (IB) and polyethylene glycol (IA) as the most safe and effective agents in the long term in adults. The use of stimulant laxatives (docusate, picosulfate, senna) is recommended only for short periods. Tegaserod is an agonist of 5-HT4 receptors and there are many clinical trials supporting its effectiveness in the management of functional constipation (IA). However "their cardiovascular safety has been questioned recently. Biofeedback therapy is the gold standard in the management of constipation associated with pelvic floor dyssynergia. Surgical treatment is reserved for extreme cases of colonic inertia. Conclusions: The treatment of constipation should be based on the underlying pathophysiological mechanisms and the selection of drugs must be made according to the scientific evidence."     

Difficult defecation: difficult problem assessment and management; what really helps?

Difficult defecation is a common and perhaps underrecognized cause of chronic constipation. While the history and a careful digital rectal examination are very useful for diagnosing defecatory disorders, the diagnosis needs to be confirmed by anorectal tests. Anorectal manometry and a rectal balloon expulsion test generally suffice to diagnose defecatory disorders; barium or MR defecography may necessary in selected cases. Colonic transit is normal or slow in patients with defecatory disorders. Pelvic floor retraining by biofeedback therapy is superior to laxatives for managing defecatory disorders.     

Management of obstructed defecation

The management of obstructed defecation syndrome(ODS) is mainly conservative and mainly consists of fiber diet, bulking laxatives, rectal irrigation or hydrocolontherapy, biofeedback, transanal electrostimulation, yoga and psychotherapy. According to our experience, nearly 20% of the patients need surgical treatment. If we consider ODS an "iceberg syndrome", with "emerging rocks", rectocele and rectal internal mucosal prolapse, that may benefit from surgery, at least two out of ten patients also has "underwater rocks" or occult disorders, such as anismus, rectal hyposensation and anxiety/depression, which mostly require conservative treatment. Rectal prolapse excision or obliterative suture, rectoceleand/or enterocele repair, retrograde Malone’s enema and partial myotomy of the puborectalis muscle are effective in selected cases. Laparoscopic ventral sacral colporectopexy may be an effective surgical option. Stapled transanal rectal resection may lead to severe complications. The Transtar procedure seems to be safer, when dealing with recto-rectal intussusception. A multidisciplinary approach to ODS provides the best results.     

Perineal descent and levator ani hernia: a dynamic magnetic resonance imaging study

PURPOSE: Patients with symptomatic pelvic organ prolapse often have multifocal pelvic floor defects that are not always evident of physical examination. In this study, dynamic magnetic resonance imaging of symptomatic patients with pelvic floor prolapse demonstrated unsuspected levator ani hernia. This study was designed to identify any specific symptoms and/or physical findings associated with these hernias.METHODS: Eighty consecutive patients with pelvic organ prolapse, fecal and/or urinary incontinence, or chronic constipation received standardized questionnaires, physical examination, and dynamic magnetic resonance imaging. Fishers exact test was used to compare symptoms and examination findings between patients with or without levator ani hernia.RESULTS: Twelve patients (15 percent) were found to have unilateral (n = 8) or bilateral (n = 4) levator ani hernias on dynamic magnetic resonance imaging. No one specific symptom was directly associated with the presence of a levator ani hernia. Furthermore, levator ani hernias were not found more frequently in patients with previous pelvic floor surgery. Perineal descent on physical examination was associated with the finding of a levator ani hernia in nine patients (P = 0.02). Although not statistically significant, there was a trend toward a lower incidence of levator ani hernia in females using estrogen replacement therapy (P = 0.06).CONCLUSIONS: Patients with symptomatic pelvic organ prolapse and perineal descent on physical examination may have a levator ani hernia. Although the significance of levator ani hernia needs to be determined, the recurrence rate after the surgical management of pelvic organ prolapse remains unacceptably high, and ongoing investigation of all associated abnormalities is warranted.Data were obtained from the Johns Hopkins Pelvic Floor Database. Poster presentation at The American Society of Colon and Rectal Surgery Meeting, Boston, Massachusetts, June 24 to 29, 2000.