Minimally Invasive Treatments for Benign Prostatic Hyperplasia: Systematic Review and Network Meta-Analysis

PurposeTo review and to compare indirectly the outcomes of minimally invasive therapies for the treatment of lower urinary tract symptoms secondary to benign prostatic hyperplasia.Materials and MethodsA literature search via Medline and Cochrane Central databases was completed for randomized control studies published between January 2000 to April 2020 for the following therapies: Rezum, Urolift, Aquablation, and prostatic artery embolization (PAE). Data on the following variables were included: International prostate symptom score (IPSS), maximum urinary flow rate, quality of life, and postvoid residual (PVR). Standard mean differences between treatments were compared through a meta-analysis using transurethral resection of the prostate (TURP) to assess differences in treatment effect.ResultsThere was no significant difference in outcomes between therapies for IPSS at the 3, 6, and 12-month follow ups. Although outcomes for Rezum were only available out to 3 months, there were no consistently significant differences in outcomes when comparing Aquablation versus PAE versus Rezum. TURP PVR was significantly better than Urolift at 3, 6, and 12 months. No significant differences in minor or major adverse events were noted.ConclusionAlthough significant differences in outcomes were limited, Aquablation and PAE were the most durable at 12 months. PAE has been well studied on multiple randomized control trials with minimal adverse events while Aquablation has limited high quality data and has been associated with bleeding-related complications.     

Family Caregivers' Subjective Caregiving Burden,Quality of Life,and Depressive Symptoms Are Associated With Terminally Ill Cancer Patients' Distinct Patterns of Conjoint Symptom Distress and Functional Impairment in Their Last Six Months of Life

Context

Family caregivers constitute a critical component of the end-of-life care system with considerable cost to themselves. However, the joint association of terminally ill cancer patients' symptom distress and functional impairment with caregivers' subjective caregiving burden, quality of life (QOL), and depressive symptoms remains unknown.

有精神病性症状躁狂发作的临床特征研究

目的探讨有精神病性症状的躁狂发作的临床特征。方法使用自编的一般情况问卷及有精神病性症状的躁狂发作的精神症状调查问卷,共收集135例"有精神病性症状的躁狂发作"患者,并根据患者的精神病性症状是否与心境相协调进一步分成两组(非典型组59例和典型组76例),比较两组间临床资料的异同。结果在有精神病性症状的躁狂发作中,伴有与心境不协调的精神病性症状的非典型躁狂发作占43.7%、伴有与心境协调的精神病性症状的典型躁狂发作占56.3%,非典型躁狂发作在起病形式、病程特点、病前社会功能、病前性格、首发症状及近期疗效与典型躁狂发作相比有显著性差异(P<0.05),典型组在起病形式上以急性起病者居多,病程多表现为间歇性病程,病前社会功能良好,性格以外向者居多,多以情感症状为首发症状及近期疗效相对较好。结论伴有与心境协调的精神病性症状的典型躁狂发作和伴有与心境不协调的精神病性症状的非典型躁狂发作在临床上均极为常见,非典型躁狂发作为躁狂发作的一个特殊的亚型,我们应对其加强认识。     

Uhthoff's symptom in multiple sclerosis

A case report is presented in which a patient's initial complaint is of blurred vision after exercise (Uhthoffs symptom). Visual acuity and colour vision were found to be reduced after exercise. Additional neurological signs included homonymous scotomata and delayed visual evoked and somatosensory responses. Magnetic resonance imaging demonstrated multiple abnormal lesions in the brain. The significance of this symptom and its relationship to multiple sclerosis are discussed.     

急性肠系膜静脉血栓形成16例临床分析

目的　分析急性肠系膜静脉血栓形成 (ASMVT)的临床特征和诊断方法。方法　对北京友谊医院 1985年 10月至 2 0 0 2年 10月确诊的 16例ASMVT的临床资料进行分析 ,并结合文献 ,总结ASMVT的临床特征和诊断方法。结果 16例ASMVT患者 ,年龄 19～ 6 4岁 (平均 4 5 9岁 )。主要症状有腹痛 ( 16 / 16 )、腹胀 ( 16 / 16 )、呕吐 ( 10 / 16 )、发热 ( 8/ 16 ) ,主要体征有腹部膨隆 ( 16 / 16 )、腹膜刺激征( 16 / 16 )。误诊率 75 % ( 12 / 16 ) ,死亡率 4 4 % ( 7/ 16 )。结论　ASMVT的临床表现有一定的特征 ,早期彩色超声检查、诊断性腹腔穿刺、结合CT或肠系膜上动脉造影异常发现可对ASMVT做出正确的诊断 ,早期手术可以降低死亡率     

Panic Anxiety after Abrupt Discontinuation of Mianserin

Abstract: We observed a case of withdrawal after abrupt discontinuation of mianserin. A 41-year-old woman was treated according to a diagnosis of depression, which was her 6th episode. Mianserin 30 mg/day, etizolam 1 mg/day and flunitrazepam 1 mg/day were administered. When the patient discontinued taking the drugs by herself because of subsiding of these symptoms, severe panic anxiety appeared. This panic anxiety was not relieved by taking etizolam and flunitrazepam again, but subsided rapidly by the re-administration of mianserin 30 mg/day, and because of that the depressive symptom also disappeared.
From these experiences panic anxiety seemed to be a withdrawal symptom, and involvement of the noradrenergic system in panic anxiety as well as serotonergic system was suggested.     

Well-being (quality of life) in connection with hypertensive treatment

Quality of life is often considered to equate how the medical treatment is subjectively perceived by the patient, but ought to include the total impact of the disease/treatment on the patient's emotional, physical, and social well-being. Recently, a proposal for a generally applicable definition of quality of life in health care was put forward. This definition includes general well-being, health, and welfare (external factors), as three fundamental components, and the definition is based on both objective and subjective judgments. General well-being is exclusively and expression of the individual's subjective experience and is based on his or her own qualitative evaluation of well-being in relation to condition, treatments, and experiences. Health is according to the proposed definition, judged both objectively (signs) and subjectively (symptoms). Apart from health and well-being, there is also reason to include objectively registrable factors at the welfare level (external factors) such as the consumption of medicines, number of days in hospital, length of sick leave, need of in-home care, etc. This review is an attempt to elucidate the effects of antihypertensive pharmacotherapy on the patient's general well-being. The topic will be discussed from several points of views (e.g., aims of antihypertensive treatment, occurrence of symptoms in the population, compliance with prescribed treatment, symptom inventories, the concept of quality of life.