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1.
Sherif Dabash Gautham Prabhakar Eric Potter Ahmed M. Thabet Amr Abdelgawad Stephen Heinrich 《Journal of Clinical Orthopaedics and Trauma》2018
Introduction
Premature growth arrest can pose a challenge to the orthopedic surgeon. Various options for treating physeal arrest exist.Methods
Systematic searches were conducted on PubMed/Medline, ScienceDirect, OVID, and Cochrane Library. Secondary searching was performed, where certain articles from reference lists of the selected studies were reviewed that were not found in the primary search.Results
This review article discusses the different methods of management for premature growth arrest.Conclusions
The use of mesenchymal stem cells provides a promising alternative treatment modality. 相似文献2.
Objective
To improve neurologists’ awareness of spine gout by showing a rare case of tophaceous gout in thoracic spine and a summary of vertebral gout in order.Material and methods
We reported a case of a 36-year-old male with a 2-year-history of hyperuricemia. Neurological examination suggested that the strength of his lower limbs decreased. Bilateral Babinski's sign and ankle clonus were positive. He had no bladder or bowel dysfunction. Computed tomography of the thoracic spine showed occupied lesions at the T9, T10 levels which led to the spinal stenosis. Magnetic resonance imaging of the thoracic spine revealed epidural disease at T9, T10 levels. A resection of the occupying lesion in the thoracic spinal canal was performed, tophaceous gout was diagnosed by the pathological examination. We also provide a brief review of literature on 30 cases of spine tophaceous gout.Result
Spinal tophaceous gout is rare, gout can involved in any spine level, but the probability of occurrence of thoracic spine is the least. Most patients had a history of hyperuricemia or peripheral tophus, the most common symptoms are back pain, when the pain stone compression spinal cord or nerve root, there will be the corresponding neurological symptoms or signs.Conclusions
The spinal gout should be considered when a patient has chronic or acute back pain and/or neurological symptoms, with mass on sides of the vertebras on MRI, especially when the patient has a history of hyperuricemia, the pathology examination can confirm the diagnosis. 相似文献3.
Introduction
Epidermoid cyst is a benign tumour frequently observed throughout the body. It can grow in size and may get infected over a period of time.Observation
We are reporting a case of precoccygeal epidermoid cyst in a six year old female child which was managed successfully.Conclusion
Precoccygeal epidermoid cyst in female children has not been reported in the English literature so far. Hence, we are reporting this case. 相似文献4.
Context
Pelvic organ prolapse is a common condition affecting at least a half of adult women. Most women are asymptomatic, but a significant proportion of women choose to have an operation.Objective
The aim of this paper is to review the various surgical procedures for the correction of pelvic organ prolapse.Evidence acquisition
Guidelines from professional organizations, meta-analysis, reviews, and high-quality studies were referred to collect the evidence for the various surgical techniques.Evidence synthesis
Management of pelvic organ prolapse is considered under anterior vaginal wall prolapse, apical prolapse, and posterior vaginal wall prolapse to help the reader organize the information to counsel women in a systematic way.Conclusions
Surgical management of prolapse can be challenging, and various factors affect the procedure of choice and the outcomes. Providing information, careful counseling, and informed choice are crucial to deliver patient expectations. All these factors should be considered when deciding on the surgical procedure. 相似文献5.
6.
Rita Faria Marta O. Soares Eldon Spackman Hashim U. Ahmed Louise C. Brown Richard Kaplan Mark Emberton Mark J. Sculpher 《European urology》2018,73(1):23-30
Background
The current recommendation of using transrectal ultrasound-guided biopsy (TRUSB) to diagnose prostate cancer misses clinically significant (CS) cancers. More sensitive biopsies (eg, template prostate mapping biopsy [TPMB]) are too resource intensive for routine use, and there is little evidence on multiparametric magnetic resonance imaging (MPMRI).Objective
To identify the most effective and cost-effective way of using these tests to detect CS prostate cancer.Design, setting, and participants
Cost-effectiveness modelling of health outcomes and costs of men referred to secondary care with a suspicion of prostate cancer prior to any biopsy in the UK National Health Service using information from the diagnostic Prostate MR Imaging Study (PROMIS).Intervention
Combinations of MPMRI, TRUSB, and TPMB, using different definitions and diagnostic cut-offs for CS cancer.Outcome measurements and statistical analysis
Strategies that detect the most CS cancers given testing costs, and incremental cost-effectiveness ratios (ICERs) in quality-adjusted life years (QALYs) given long-term costs.Results and limitations
The use of MPMRI first and then up to two MRI-targeted TRUSBs detects more CS cancers per pound spent than a strategy using TRUSB first (sensitivity = 0.95 [95% confidence interval {CI} 0.92–0.98] vs 0.91 [95% CI 0.86–0.94]) and is cost effective (ICER = £7,076 [€8350/QALY gained]). The limitations stem from the evidence base in the accuracy of MRI-targeted biopsy and the long-term outcomes of men with CS prostate cancer.Conclusions
An MPMRI-first strategy is effective and cost effective for the diagnosis of CS prostate cancer. These findings are sensitive to the test costs, sensitivity of MRI-targeted TRUSB, and long-term outcomes of men with cancer, which warrant more empirical research. This analysis can inform the development of clinical guidelines.Patient summary
We found that, under certain assumptions, the use of multiparametric magnetic resonance imaging first and then up to two transrectal ultrasound-guided biopsy is better than the current clinical standard and is good value for money. 相似文献7.
Introduction
Strangulation of the genitalia by a metallic device is a rare occurrence. However, such cases present a challenge to any healthcare professional because of the difficulty associated with removing the device.Observation
Herein, we present the case of a patient with genital strangulation that was resolved quickly using a bolt cutter.Conclusion
Bolt cutters are useful for quickly removing metallic strangulation devices, even those made of thick metal. 相似文献8.
Boris Gershman Daniel M. Moreira R. Houston Thompson Stephen A. Boorjian Christine M. Lohse Brian A. Costello John C. Cheville Bradley C. Leibovich 《European urology》2018,73(3):469-475
Background
There are little data regarding the morbidity of lymph node dissection (LND) for renal cell carcinoma (RCC) to assess its risk–benefit ratio.Objective
To evaluate the association of LND with 30-d complications among patients undergoing radical nephrectomy (RN) for RCC.Design, setting, and participants
A total of 2066 patients underwent RN for M0 or M1 RCC between 1990 and 2010, of whom 774 (37%) underwent LND.Intervention
RN with or without LND.Outcome measurements and statistical analysis
Associations of LND with 30-d complications were examined using logistic regression with several propensity score techniques. Extended LND, defined as removal of ≥13 lymph nodes, was examined in a sensitivity analysis.Results and limitations
A total of 184 (9%) patients were pN1 and 302 (15%) were M1. Thirty-day complications occurred in 194 (9%) patients, including Clavien grade ≥3 complications in 81 (4%) patients. Clinicopathologic features were well balanced after propensity score adjustment. In the overall cohort, LND was not statistically significantly associated with Clavien grade ≥3 complications, although there was an approximately 40% increased risk of any Clavien grade complication that did not reach statistical significance. Likewise, LND was not significantly associated with any Clavien grade or Clavien grade ≥3 complications when separately evaluated among M0 or M1 patients. Extended LND was not significantly associated with any Clavien grade or Clavien grade ≥3 complications. LND was not associated with length of stay or estimated blood loss. Limitations include a retrospective design.Conclusions
LND is not significantly associated with an increased risk of Clavien grade ≥3 complications, although it may be associated with a modestly increased risk of minor complications. In the absence of increased morbidity, LND may be justified in a predominantly staging role in the management of RCC.Patient summary
Lymph node dissection for renal cell carcinoma is not associated with increased rates of major complications. 相似文献9.
Introduction
Pelvi uretric junction obstruction (PUJO) is the most common cause of hydronephrosis in the neonatal period and is also the commonest cause of a palpable abdominal mass in a child. Giant hydronephrosis (GH) in a neonate is rare.Observation
We are reporting a unique case of neonatal giant hydronephrosis which was managed successfully.Conclusion
Establishing the correct diagnosis of GH is necessary to plan appropriate surgical intervention. 相似文献10.
Introduction
Emphysematous pyelonephritis is a life threatening infection of the kidney and peri-renal tissues. We present an interesting and rare presentation of this condition which is the first such case to be reported in literature.Observation
A 52-year-old diabetic presented with a right groin swelling. On evaluation and imaging he had right emphysematous pyelonephritis with a peri-renal collection tracking down till the scrotum, mimicking a groin swelling. Management involved broad spectrum antibiotics and aggressive drainage and debridement.Conclusion
Emphysematous pyelonephritis is a rare but important differential diagnosis for a groin swelling where early diagnosis and aggressive management is necessary. 相似文献11.
12.
Background
Endoscopic septostomy is the treatment of choice for monolateral obstruction of the foramen of Monro. Common causes of this condition include: neoplasms, hemorrages, infections, congenital atresia, idiopathic occlusion.Method
All the steps for performing a safe endoscopic pellucidotomy are presented. A brief discussion about the most common technical variations and their rationale is added.Conclusion
Endoscopic pellucidotomy is a safe and effective treatment when a thorough understanding of anatomy is achieved. 相似文献13.
Background
Reconstruction of extensive penoscrotal defects is a surgical challenge. Resurfacing defects in highly complex three-dimensional structures and restoring their function are an essential part of the reconstruction of penoscrotal regions.Objective
We describe a technique using internal pudendal artery perforator (IPAP) pedicled propeller flaps created from the gluteal fold. This could be a reliable surgical option that maintains a natural looking scrotal pouch with minimal donor site morbidity and optimal sexual activity.Design, setting, and participants
We retrospectively reviewed data for 10 consecutive patients who had undergone penoscrotal reconstruction using IPAP pedicled propeller flaps between January 2011 and March 2015.Surgical procedure
The IPAP was identified using a hand-held Doppler ultrasound device. This was the pivot around which the flap was internally rotated more than 90° in a tension-free manner. The long axis of the flap was centred on the gluteal fold to provide a better-orientated donor site scar.Measurements
Complications and patient satisfaction with respect to size, colour match, scar appearance, and sexual activity were evaluated.Results and limitations
Anatomic and aesthetic penoscrotal reconstruction was performed without any major complications in the follow-up period (mean, 19.7 mo). The mean width of the IPAP pedicled propeller flaps was 6.7 cm, and the mean length was 11.7 cm. Partial distal flap necrosis occurred in only one case, and healed spontaneously. All of the patients were satisfied with the cosmetic and functional results.Conclusions
On the basis of reliable perforators, donor site morbidity, flap thickness, and a better orientated scar, our technique using IPAP pedicled propeller flaps created from the gluteal fold could be a reasonable surgical option for extensive penoscrotal reconstruction.Patient summary
The creation of pedicled propeller flaps using an internal pudendal artery perforator could be a reliable surgical option for reconstruction of extensive penoscrotal defects. The approach yields functional and aesthetically acceptable surgical results. 相似文献14.
Introduction
Late recurrence of renal cell carcinoma is rare and mostly of clear cell histology. The objective of our study was to report our case of late recurrence of papillary RCC.Observation
Seventy year old female patient was presented to our department, more than 7 years post radical nephrectomy for moderate risk RCC. The presentation was persistent localized abdominal pain and proved by immunohistochemistry to be a metastatic papillary RCC.Conclusion
Any symptomatic patient, with history of previous radical nephrectomy, should have recurrent cancer considered in his differential diagnosis. 相似文献15.
Giulio Nicita Donata Villari Simone Caroassai Grisanti Michele Marzocco Vincenzo Li Marzi Alberto Martini 《European urology》2017,71(1):133-138
Background
Rectourethral fistulas (RUFs) represent an uncommon complication of pelvic surgery, especially radical prostatectomy. To date there is no standardised treatment for managing RUFs. This represents a challenge for surgeons, mainly because of the potential recurrence risk.Objective
To describe our minimally invasive transanal repair (MITAR) of RUFs and to assess its safety and outcomes.Design, setting, and participants
We retrospectively evaluated 12 patients who underwent MITAR of RUF at our centre from October 2008 to December 2014. Exclusion criteria were a fistula diameter greater than 1.5 cm, sepsis, and/or faecaluria.Surgical procedure
After fistula identification through cystoscopy and 5F-catheter positioning within the fistula, MITAR is performed using laparoscopic instruments introduced through Parks’ anal retractor. The fibrotic margins of the fistula are carefully dissected by a lozenge incision of the rectal wall, parallel to the rectal axis. Under the healthy flap of the rectal wall the urothelium is located and the fistulous tract is sutured with interrupted stitches. After a leakage test of the bladder, the rectal wall is sutured with interrupted stitches. Electrocoagulation is never used during this procedure.Measurements
Fistula closure, postoperative complications, and recurrence.Results and limitations
Median follow-up was 21 (range, 12–74) mo. Median operative time was 58 (range, 50–70) min. Median hospital stay was 1.5 (range, 1–4) d. Early surgical complications occurred in one patient (8.3%). Recurrence did not occur in any of the cases. Limitations included retrospective analysis, small case load, and lack of experience with radiation-induced fustulas.Conclusions
MITAR is a safe, effective, and reproducible procedure. Its advantages are low morbidity and quick recovery, and no need for a colostomy.Patient summary
We studied the treatment of rectourethral fistulas. Our technique, transanally performed using laparoscopic instruments, was found to be safe, feasible, and effective, with limited risk of complications. 相似文献16.
Marcello Zappia Daniela Berritto Francesco Oliva Nicola Maffulli 《Foot and Ankle Surgery》2018,24(4):342-346
Background
Percutaneous Achilles tendon repair has been developed to minimise soft tissue complications following treatment of tendon ruptures. However, there are concerns because of the risk of sural nerve injury. Few studies have investigated the relationship between the Achilles tendon, the sural nerve and its several anatomical course variants.Methods
We studied 7 cadaveric limbs (7 Achilles tendons) in which a percutaneous repair of the Achilles tendon was performed. On each tendon, high resolution real time ultrasonography examination was performed by an experienced musculoskeletal radiologist before and after the procedure, with the surgeons blind to the results of the scan both before and after surgery.Results
In two instances, high resolution real time ultrasonography examination revealed nerve entrapment at the level of most proximal lateral suture.Conclusions
Since the sural nerve can be easily visualised using high-frequency high resolution real time ultrasonography, intraoperative ultrasound can be of assistance during percutaneous repair of Achilles tendon rupture.Clinical relevance
The sural nerve can be readily visualised by high-frequency high resolution real time ultrasonography probes. It could be beneficial to use high resolution real time ultrasonography intraoperatively or perioperatively to minimise the risks of sural nerve injury when undertaking percutaneous repair of Achilles tendon tears. 相似文献17.
Introduction
Adjacent level spondylodiscitis (ALS) after primary surgery for thoracic spondylodiscitis is a very rare condition.Case report
We report the case of a 76-year-old man with this pathology. A first posterior minimally invasive approach combined with anterior approach to the thoracic spine was safely performed for thoracic spondylodiscitis. More than a year later, exploration of recurrent symptoms with 18FDG PET scan helped to diagnose ALS. Further surgery was performed. At 3-year follow-up examination showed no recurrence of the infection.Discussion
ALS should be suspected during recurrent symptoms after spinal fusion surgery. Evaluation should be based on the results of 18FDG PET scan and surgery.Conclusion
Bacterial and histopathological analyses combined with an increase of spine fixation and adapted antimicrobial therapy are a safe management for ALS. 相似文献18.
I. Ziouziou M.A. Touzani T. Karmouni K. El Khader A. Koutani A.I. Attya Andaloussi 《The African Journal of Urology》2018,24(2):104-107
Introduction
The Bladder Cancer Index (BCI) is a validated questionnaire for health-related quality of life in patients with bladder cancer (BC).Objective
To translate the original BCI into an Arabic validated version.Subjects and methods
For translation and validation, we proceeded in 5 steps: (1) Authorization of translation by the authors of the original BCI. (2) Translation from English to Arabic. (3) Submission of the translated version into Arabic to a committee of readers. (4) Backward translation to ensure there was no discrepancy between the two versions during the reverse translation. (5) Qualitative linguistic validation of the document obtained from seven patients having BC.Results
Translation was authorized in February 2015. The reading committee that evaluated the clarity of the text admitted the version with minor revisions. The questionnaire was finally tested on seven patients with bladder tumor treated in the department of urology B at Ibn Sina Teaching Hospital. They all responded to the questionnaire without understanding nor filling difficulty. Therefore, no major changes were made following this qualitative assessment.Conclusion
This Arabic version of BCI questionnaire will enable researchers from Arab countries to use a measurement tool validated and recognized internationally to assess QOL in patients with BC. 相似文献19.
Introduction
Bladder paragangliomas (BP) are rare tumors, with clinical manifestations ranging from hypertension to hematuria to being asymptomatic. Histologically, they can mimic urothelial carcinomas. Around 200 cases of paragangliomas arising in the urinary bladder have been described in the world literature.Observation
We report 2 new cases of BPs presenting with subtle clinical symptoms like increased urinary frequency. On routine cystoscopic examination of the bladder, bladder tumors were detected.Conclusion
We would like to stress on the histomorphology and immunohistochemistry findings of this rare condition and its diagnosis on transurethral resection specimens. 相似文献20.