Urothelial leukoplakia: new aspects of etiology and therapy

We describe 3 women in 1 family who had systemic urothelial leukoplakia with no underlying pathological condition of the urinary tract. Irritative clinical symptoms resolved, and the macroscopic and microscopic appearance improved after 6 months of therapy with sodium pentosanpolysulfate. Electron microscopy showed special cells in the basal layer of the cornified squamous epithelium that also have been found in the trigone of women with so-called squamous metaplasia. Their similarity to Merkel's cells of the skin supports the theory that ectodermal cells are misplaced during embryogenesis. Genetic factors and sex hormones seem to influence the development of certain variants of squamous epithelium within the urinary tract.     

Perioperative fever: etiology and treatment

The authors discuss the causes of intraoperative fever and of fever occurring at different periods postoperatively. Salicylates or other antipyretics should be administered to reduce the body temperature as quickly as possible; however, it is still essential to determine and eliminate the cause of the fever.     

Gastrocutaneous fistula: etiology and treatment

Gastrocutaneous fistula is an infrequent but serious surgical complication which has received little attention in the recent literature. The current report analyzes 13 patients with this complication. The fistula most commonly occurs in the fundic portion of the greater curvature of the stomach and is usually a result of unrecognized iatrogenic injury or associated with severe left upper quadrant inflammation and external drainage. Clinical recognition occurs when the patient develops left subphrenic sepsis or drains gastric content. The fistula is best documented by upper gastrointestinal contrast studies and usually responds to wide drainage and supportive treatment in the presence of benign disease. Oral alimentation apparently need not be delayed until complete fistula closure.     

Plantar fasciitis: etiology and treatment

Plantar fasciitis is a common pathological condition of the foot and can often be a challenge for clinicians to successfully treat. The purpose of this article is to present and discuss selected literature on the etiology and clinical outcome of treating plantar fasciitis. Surgical and nonsurgical techniques have been used in the treatment of plantar fasciitis. Nonsurgical management for the treatment of the symptoms and discomfort associated with plantar fasciitis can be classified into 3 broad categories: reducing pain and inflammation, reducing tissue stress to a tolerable level, and restoring muscle strength and flexibility of involved tissues. Each of these treatments has demonstrated some level of effectiveness in alleviating the symptoms of plantar fasciitis. Previous studies have grouped all forms of nonsurgical therapy together. It is, therefore, difficult to determine if one type of treatment is more effective compared with another. Until such research is available, the clinician would be wise to include treatments from all 3 categories.     

Acute and Chronic Epididymitis

Epididymitis is a relatively common clinical condition presenting as acute or chronic forms. Acute epididymitis is the inflammation of epididymitis accompanied by pain and swelling, while chronic epididymitis may present only with pain. Etiological factors may be infectious or noninfectious, for example urinary obstruction, drug induced, or idiopathic. Bacterial ascent through the urogenital tract is the most common etiology in acute epididymitis, with Chlamydia trachomatis being isolated in all adult age groups. Diagnosis is generally based on patient history, symptoms, and clinical findings. Recent data indicate that sexually active patients with acute epididymitis should be screened for sexually-transmitted diseases, regardless of their age. Additional laboratory investigations and imaging may be required for differential diagnosis with other intrascrotal conditions, particularly with testicular torsion. Although no evidence-based recommendations can be given for the antimicrobial treatment of acute epididymitis, >85% of bacterial strains causing acute epididymitis are susceptible to fluoroquinoles and third-generation cephalosporins. Chronic epididymitis has not been investigated as thorough as acute epididymitis; however, the development and use of a symptom index is promising in terms of achieving a widely-accepted standardization of diagnosis and evaluation. A conservative approach may be beneficial; medical treatment employing antibiotics, anti-inflammatory agents, pain medication, and others are also being utilized without any evidence-based data. Spermatic cord block with short-term and long-term acting agents as well as surgical treatment including epididymectomy microdenervation of the spermatic cord are other treatment alternatives in patients with chronic epididymitis.Patient summaryIn this article, we provide an update on the definition, epidemiology, etiology, diagnostics, and therapy in terms of acute and chronic epididymitis.     

Intragastric blood flow in the etiology of duodenal ulcer--new aspects of surgical treatment

In the experiment on dogs and in patients with duodenal ulcer disease, it was established that the regulation of acid production besides the vagal nerves was mediated by the intragastric gastrin transport with the blood flow. A method of preoperative diagnosis of the intensity of intragastric blood flow permitting to define more accurately the indications for the choice of a method for surgical treatment has been developed. Supplementation of the selective proximal vagotomy with circular mucosectomy at the boundary between the antrum and body of a stomach enhances the effectiveness of operation due to reduction of the antral gastrin influence on the acid-producing zones of the stomach.     

Nocturia: etiology, diagnosis, and treatment

Voiding at night, or nocturia, is a common reason for interrupted sleep in the adult population. The condition affects both men and women, with an incidence that increases dramatically with age. Nocturia has a negative impact on quality of life, affecting both morbidity and mortality. Effective diagnosis of the condition is dependent on a clear understanding of its underlying etiology. In general, the causes of nocturia fall into three categories: diurnal polyuria, nocturnal polyuria, and low bladder capacity. In some individuals, however, nocturnal polyuria and low bladder capacity may both contribute to the overall symptomatology of nocturia. Addressing any underlying conditions that contribute to nocturia is the first step in treating the condition. Lifestyle and behavioral changes may provide benefit in some individuals, but for many, the only option is pharmacotherapy. Antimuscarinic agents are first-line therapies for overactive bladder and are often used in the management of nocturia. Pharmacological and physicochemical differences between available antimuscarinic agents, however, translate into different safety and tolerability profiles, which may make some agents more suitable for use in certain populations, including the elderly. Careful selection of the most appropriate antimuscarinic medication is therefore central in optimizing treatment outcomes.     

先天性脊柱侧凸的研究现状

先天性脊柱侧凸(congenital scoliosis,CS)对患者健康的影响大,造成的社会负担繁重。其病因较复杂;临床表现各不相同,缺乏统一的标准;治疗往往与侧凸的进展密切相关,医生的经验十分重要。近年来对CS的研究日益增多,本文从病因、分型及治疗的角度对近年来CS研究取得的进展及一些注意事项做了总结,供大家参考。     

Slipped capital femoral epiphysis: etiology and treatment

Progression of slip is apt to cause complications including osteonecrosis and osteoarthritis. Such complications result in a poor prognosis for the joint. Therefore, to diagnose slipped capital femoral epiphysis (SCFE) while it is still mild is important to avoid complications as well as to prevent further slippage. In Japan, as the number of obese patients increases, obesity seems to be involved in the onset of slip both biomechanically and endocrinologically. We need to take care of obese children as they comprise a reservoir for SCFE patients. For severe slip cases, treatment is difficult owing to significant deformity of the femoral head with or without such complications as osteonecrosis and osteoarthritis. Transtrochanteric anterior rotational osteotomy is a promising option for preventing further slippage as well as to improve the congruity of the joint.Presented at the 76th Annual Meeting of the Japanese Orthopaedic Association, Kanazawa, Japan, May 25, 2003