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1.

Introduction and hypothesis

The study examined how often detrusor overactivity (DO) causes leakage during a stress test in women with mixed urinary incontinence (MUI) and whether there are differences between those who do and those who do not have DO during the stress test.

Methods

A retrospective study was performed in 100 women who had an ambulatory urodynamic recording done where bladder, urethral, and vaginal pressures, and leakage were recorded. The stress test consisted of 20 jumping jacks and three forceful coughs.

Results

All the women leaked during the stress test: five due to simultaneous stress test and DO, 87 due to the stress test only, and eight during the stress test as well as due to DO before or after the stress test.

Conclusions

During the stress test, 5 % of women with MUI leaked due to the coughs and jumps and simultaneous DO. Women in whom DO was detected had significantly higher Urgency Incontinence Index and leakage during the 24-h pad test.  相似文献   

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PURPOSE: Acute urinary retention is relatively rare in otherwise healthy men. The condition may be attributable to a combination of obstruction and detrusor hypocontractility. We determined whether acute or chronic urinary retention is accompanied by characteristic ultrastructural features in bladder detrusor smooth muscle cells and whether any of these ultrastructural features may be useful for classifying these conditions. MATERIALS AND METHODS: Bladder biopsies of 15 men, including 13 in acute and 2 in chronic urinary retention, and 6 controls were examined by transmission electron microscopy. They were semiquantitatively and morphometrically analyzed for degenerative changes, cellular hypertrophy, variations in intercellular distances, abnormal cell junctions and configurations, and intracellular changes. RESULTS: No significant ultrastructural features were noted in the detrusor muscle of patients in acute urinary retention compared with controls. CONCLUSIONS: We cannot confirm the reports of others that characteristic ultrastructural features in smooth muscle cells accompany bladder outlet obstruction and detrusor hypocontractility.  相似文献   

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BACKGROUND: This cross-sectional study was conducted to determine whether a spot urine protein/creatinine ratio (UPr/UCr) provides accurate quantitation of 24-hr urinary protein excretion (24-hr Prot) in out-patients with primary glomerulonephritis (GN) and different renal function levels. METHODS: Patients were classified into three groups according to creatinine (Cr) clearance (ml/min) and into five categories according to morning UPr/UCr. Correlation between 24-hr Prot and UPr/UCr was calculated according to the three renal function levels. The Bland and Altman method was used to assess agreement between 24-hr Prot and UPr/UCr. Agreement limits were obtained calculating the mean difference between 24-hr Prot and morning UPr/UCr +/- 2SD. Sensitivity and specificity were determined for different renal function levels and UPr/UCr cut-off values. RESULTS: High correlation coefficients (r=0.91, 0.95 and 0.98) were observed in patients with normal, reduced and severely reduced renal function. Differences and variability between 24-hr Prot and UPr/UCr tended to increase with higher proteinuria levels, and this trend was observed for the three renal function levels. The best UPr/UCrcut-off values to detect abnormal or nephrotic proteinuria were, respectively, 0.3 and 2.6. CONCLUSIONS: Correlation and agreement between UPr/UCr and 24-hr Prot was good for all renal function levels, but demonstrated more marked differences as urinary protein excretion increased. Morning UPr/UCr had good sensitivity and specificity for the diagnosis of 24-hr Prot, even in patients with reduced renal function.  相似文献   

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Is the bladder a reliable witness for predicting detrusor overactivity?   总被引:4,自引:0,他引:4  
Hashim H  Abrams P 《The Journal of urology》2006,175(1):191-4; discussion 194-5
PURPOSE: We determined how well the symptoms of OAB syndrome correlate with urodynamic DO using International Continence Society definitions. MATERIALS AND METHODS: The study included adult males and females 18 years or older who attended a tertiary referral center for urodynamics from February 2002 to February 2004. Patients were selected based on OAB syndrome symptoms (urgency, urgency urinary incontinence and frequency). The percent of patients who had symptoms alone or in combination and DO was calculated. RESULTS: There was a better correlation in results between OAB symptoms and the urodynamic diagnosis of DO in men than in women. Of men 69% and 44% of women with urgency (OAB dry) had DO, while 90% of men and 58% of women with urgency and urgency urinary incontinence (OAB wet) had DO. Stress urinary incontinence seems to have accounted for the decreased rates in women since 87% of women with urgency urinary incontinence also had the symptom of stress urinary incontinence. The ICS definition does not specify what constitutes abnormal voiding frequency. Analysis of results showed that increasing voiding frequency did not have any effect on increasing the accuracy of diagnosis of DO except in women with 10 or more daytime micturition episodes. CONCLUSIONS: The bladder is a better and more reliable witness in men than in women with a greater correlation between OAB symptoms and urodynamic DO, more so in the OAB wet than in OAB dry patients.  相似文献   

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INTRODUCTION AND OBJECTIVES: Factors like cold, flushing solutions, ischemia and reperfusion may alter the microscopic appearance of transitional cells leading to falsely positive results of urinary cytology in patients after kidney transplantation. After seeing 1 patient presenting with two consecutive highly suspicious cytology specimens 3 days after transplantation and no sign of urothelial tumor at retrograde urography, we analyzed the cytological picture of transitional cells in post-transplant patients. MATERIAL AND METHODS: We investigated 31 urine specimens of 11 patients undergoing kidney transplantation preoperatively (if possible) and on days 1, 3 and 9 postoperatively. Microscopic cytology was performed by using Papanicolaou's criteria: 0 - no cytology possible (no cells), I+II - negative cytology, III - doubtful, IV - suspicious for tumor, V - tumor cells. All microscopic examinations were performed by one experienced senior pathologist. RESULTS: Mean patient age was 55.8 (+/- 17.5) years, mean residual diuresis 856 (+/- 636) ml, mean cold ischemia time 13.6 (+/- 6.4) h, mean creatinine level on day 1: 582 microM/l, day 3: 533 microM/l and day 9: 259 microM/l. None of the urinary cytology results were suspicious for malignant transformation (Papanicolaou I+II). No patient presented signs of urothelial malignancy after a mean follow-up of 3 months. CONCLUSION: Although microscopic urinary cytology may be falsely positive in 1-12% of non-transplanted patients due to urothelia atypia, inflammation or radiation/chemotherapy, the present study suggests that conventional microscopic cytology examinations in post-transplant patients are not heavily altered and do not lead to an increased false-positive rate.  相似文献   

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Introduction and hypothesis  

A dipstick test is recommended to screen for urinary tract infection in patients with overactive bladder (OAB). It was the aim of this study to test if a dipstick test is sufficient to identify patients with urinary tract infection attending a urological private practice because of OAB.  相似文献   

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Alexander Becker  Guy Lin 《Injury》2010,41(5):479-483

Introduction

Highly sensitive and accurate for the detection of injuries requiring intervention in haemodynamically unstable patients, FAST may underestimate intra-abdominal injuries in stable patients with blunt abdominal trauma. Diminished accuracy of ultrasound has been reported in different cohorts of multiple injured patients. We hypothesised that multiple injured patients with a high Injury Severity Score (ISS) will have a decreased accuracy of FAST for the assessment of blunt abdominal trauma.

Methods

Data from the trauma registry of a Level 1 trauma centre were retrospectively reviewed. All haemodynamically stable blunt trauma patients who underwent both FAST and CT scan of abdomen from January 1, 2000 to January 1, 2005 were included in the cohort. All patients were divided into three groups according to their ISS: Group 1 included patients with an ISS from 1 to 14, Group 2 included patients with an ISS from 16 to 24, and Group 3 consisted of patients with ISS ≥ 25.

Results

3181 patients with blunt abdominal trauma included into the study were divided into the three groups according to the ISS. The mean ISS was 7.9 ± 3.97, 19.6 ± 2.48 and 41.3 ± 11.95 in Groups 1, 2 and 3, respectively. The accuracy of ultrasound was 90.6% in the group of patients with the highest ISS (≥25) compared with 97.5 and 97.1 for Groups 1 and 2 (p < 0.001). Similarly, ultrasound had a significantly lower sensitivity, specificity, PPV and NPV for patients in Group 3 compared with the first two groups (p < 0.001). There was a significantly lower sensitivity in Group 2 compared with Group 1 (p < 0.001), but no differences in specificity, accuracy, PPV or NPV were demonstrated.

Conclusion

Patients with high ISS are at increased risk of having ultrasound-occult injuries and have a lower accuracy of their ultrasound examination than patients with low and moderate ISS.  相似文献   

14.
Is endothelial function impaired in erectile dysfunction patients?   总被引:2,自引:0,他引:2  
Erectile dysfunction (ED) and vascular disease are thought to be linked at the level of the endothelium. Endothelial dysfunction, resulting in the inability of the smooth muscle cells lining the arterioles to relax, prevents vasodilatation. Likewise, penile erection depends on the relaxation of smooth muscle in the corpus cavernosum and the wall of small arteries. The aim was to assess the systemic vascular function in patients with ED. In all, 32 ED patients diagnosed with Doppler Ultrasound and the International Index of Erectile Function-5-item questionnaire and 25 healthy men as a control group enrolled to the study. They all underwent the tests including serum glucose and lipid levels. Echocardiography and exercise stress test was performed routinely. Baseline demographics (body mass index, heart rate and blood pressures), fasting glucose and lipid levels were not significantly different between ED and control groups. Endothelial-dependent brachial artery flow-mediated vasodilatation and brachial artery response to 0.4 mg nitroglycerine (NTG) were measured. Participants were negative on exercise stress test, and echocardiographic parameters including ejection fraction were similar. Endothelial-dependent brachial artery percent diameter change with flow-mediated dilatation (6.01+/-2.9 vs 12.3+/-3.5) and brachial artery response to NTG (12.8+/-4.2 vs 17.8+/-5.2) were significantly different between groups (P<0.001). We found that endothelial function was impaired in ED patients with no apparent cardiovascular disease and diabetes mellitus. This impaired function might be explained by the abnormality in systemic nitric oxide-cyclic guanosine monophosphate vasodilator system and suggest that ED and vascular disease may be linked at the level of the endothelium.  相似文献   

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BACKGROUND: In spite of many reports focusing on prognostic factors after hepatectomy in patients with colorectal liver metastases, few studies have investigated pathological factors, eg, fibrous pseudocapsulation, growth pattern at the tumor margin, and proliferation activity of cancer cells, other than histological type and surgical margin. The aim of the present study was to investigate whether absence of pseudocapsulation, infiltrative growth pattern of metastases, and higher proliferation of cancer cells shown by Ki-67 immunohistochemical reactivity were associated with poorer survival after hepatectomy among patients with colorectal liver metastases. METHODS: Between 1988 and 1998, 221 patients underwent hepatic resection of colorectal metastases with curative intent in our institution. Pathology analyses were focused on pseudocapsulation of liver metastases, growth pattern at the tumor edge, and Ki-67 labelling index (Ki-67 LI) of cancer cell nuclei. Univariate analyses of survival and of disease-free survival were performed for several clinicopathological factors, and multivariate analyses of survival and disease-free survival were also performed. RESULTS: The univariate survival analyses showed that pseudocapsulation, growth pattern, and Ki-67 LI were significant prognostic factors, besides synchronous versus metachronous occurrence of metastases, carcinoembryonic antigen level before hepatectomy, and number of metastases. A multivariate analysis showed that Ki-67 labeling index was the most reliable prognostic factor of survival. In addition, Ki-67 LI and microscopic growth pattern were multivariately predictive factors of disease-free survival. CONCLUSIONS: This large single-institution study showed that investigation of cancer cell proliferation and pathologic characteristics of the tumor margin are major prognostic factors.  相似文献   

16.
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether an early invasive approach (involving early coronary angiography followed by revascularisation if suitable) is superior to a conservative approach (with revascularisation only in patients with failed medical therapy) in patients with acute coronary syndrome. Altogether 282 papers were found using the reported search, of which seven presented the best evidence to answer the clinical question. The author, journal, date and country of publication, patient group studied, study type, relevant outcomes, results, and study weaknesses of these papers are tabulated. We conclude that in patients diagnosed with acute coronary syndrome, an early invasive approach is clearly superior to a conservative approach.  相似文献   

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Study designClinical measurement.IntroductionThe University of New Brunswick (UNB) Test of Prosthetic Function was developed for children. No studies have examined its use with adults.Purpose of the studyOur purposes were to utilize the UNB with adults to examine test–retest, inter-rater reliability and examine validity.MethodsThe UNB was administered to 51 subjects. Forty-five completed it twice within 1 week. Internal consistency was examined. Test–retest reliability and inter-rater reliability were estimated. ANOVAs compared scores by prosthetic use. Correlations between UNB scales, 2 dexterity tests (the Modified Box and Block Test, the modified Jebsen–Taylor Hand Function Test), and the self-reported Upper Extremity Functional Scale (UEFS) were examined.ResultsAlphas were 0.74–0.75 and 0.69–9.79 for spontaneity and skill respectively. ICCs for test–retest reliability and inter-rater reliability were 0.73, 0.76 for spontaneity and 0.76 and 0.79 for skill. There were no differences in scores by prosthetic experience. UNB correlations with dexterity measures were moderate, and correlations with UEFS were weak for spontaneity and non-significant for skill.ConclusionsUNB scales had acceptable reliability and preliminary evidence of validity for adults.Level of evidenceIIb.  相似文献   

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