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Anal fissure is one of the most common and painful proctological pathologies affecting mainly young individuals. The physiopathology in the development of a chronic anal fissure seems to be a combination of internal anal sphincter hypertonia and poor vascularization at the posterior midline. Treatment of acute fissures is conservative with supportive therapy, leading to healing in the majority of the patients. Open or closed lateral internal sphincterotomy is the treatment of choice for chronic anal fissures. In low pressure chronic fissures, sphincterotomy should be avoided and a V-Y island advancement flap may be an alternative procedure. Sphincterotomy can induce anal incontinence, a feared complication of this technique. Recent interest has developed in chemical sphincterotomy with local botulin toxin injections or glyceryl trinitrate application. Long-term follow-up is needed to evaluate these new therapeutic options. 相似文献
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Purpose Before the advent of general anesthesia, taxis (hernia reduction) was the treatment of choice of incarcerated hernia but,
over the years, its use subsided in favor of urgent herniorrhaphy. The role of taxis for incarcerated hernias in a growing
geriatric population must be reexamined.
Methods We attempted taxis in 101 adult patients diagnosed with anterior abdominal wall incarcerated hernia. Following successful
taxis, patients were hospitalized for a 24-h period of observation to obviate any complications of taxis. Upon their discharge,
the patients were advised to follow with an elective hernia repair. Unsuccessful attempts at taxis were followed by emergency
surgery. The gender of the patient, type of hernia, time lapse since incarceration, and signs of intestinal occlusion were
recorded and mortality and morbidity rates were calculated.
Results Taxis was successful in 60.3% of cases. No taxis-related complication was observed, even though the mean delay in presentation
since incarceration was 12 h. Mortality and morbidity within the taxis group were null.
Conclusion Taxis is a feasible and safe maneuver pending an eventual surgical treatment. By offering better conditions at a later repair,
the mortality and morbidity may be considerably lowered. Further studies are needed in order to elucidate various aspects
of this two-stage treatment of incarcerated hernia. 相似文献
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Qi Li Hidetaka Hara Zhongqiang Zhang Michael E. Breimer David K. C. Cooper 《Xenotransplantation》2018,25(3)
An important question in xenotransplantation is whether an allotransplant can safely be carried out in a patient who has become sensitized to a pig xenograft. To answer this question, we have searched the literature. We primarily limited our review to the clinically relevant pig‐to‐non‐human primate (NHP) model and found five studies that explored this topic. No NHP that had received a pig graft developed antibodies to alloantigens, and in vitro studies indicated no increased humoral and/or cellular alloreactivity. We carried out a small in vitro study ourselves that confirmed this conclusion. There have been three experiments in which patients undergoing dialysis were exposed to wild‐type pig kidneys and three clinical studies related to bridging a patient in hepatic failure to liver allotransplantation. Despite the development of anti‐pig antibodies, all subsequent organ (kidney or liver) allografts were successful (except possibly in one case). In addition, pig fetal islets were transplanted into patients with kidney allografts; there was no increase in panel‐reactive alloantibodies and the kidney grafts continued to function satisfactorily. In conclusion, the limited data suggest that, after sensitization to pig antigens, there is no evidence of antibody‐mediated or accelerated cellular rejection of a subsequent allograft. 相似文献
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McGreevy JM 《Surgery》2006,139(2):274-5; discussion 274
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《European urology》2014,65(4):839-842
BackgroundAntimicrobial resistance is a major health problem, caused primarily by overuse of antibiotics in clinical situations in which they are not necessary. Practice guidelines recommend that antibiotics be given before outpatient cystoscopy to prevent symptomatic urinary tract infection (UTI).ObjectiveTo determine the frequency of febrile UTI after outpatient flexible cystoscopy in antibiotic-naive bladder tumor patients.Design, setting, and participantsA total of 2010 consecutive outpatients with bladder tumors were entered into a prospective registry study. All patients underwent cystoscopy after they submitted a voided urine sample for culture. Significant bacteriuria was defined as >104 colony-forming units per milliliter with a single organism. Patients were stratified for known risk factors for UTI.InterventionPatients underwent flexible cystoscopy and received no antibiotics immediately before or after cystoscopy. They were followed for 30 d for onset of febrile UTI.Outcome measurements and statistical analysisThe end point was incidence of febrile UTI within 30 d of cystoscopy. Febrile UTI was defined as temperature >38 °C and dysuria, or having received antibiotics from an outside physician for urinary symptoms.Results and limitationsOf the 2010 patient cystoscopies, 489 (24%) had asymptomatic bacteriuria, and 1521 (76%) had sterile urine. Thirty-nine patients (1.9%) developed febrile UTI ≤30 d after cystoscopy—4.5% in colonized patients and 1.1% in uninfected patients (p = 0.02). All UTIs resolved in ≤12–24 h with oral antibiotics. None of the patients was admitted for bacterial sepsis. Limitations of the study are that it is a single-surgeon experience in one institution, and results may not apply to other patient populations.ConclusionsAntibacterial therapy before outpatient flexible cystoscopy does not appear necessary in bladder tumor patients who have no clinical signs or symptoms of acute UTI, including asymptomatic bacteriuria. Antibiotic stewardship is the responsibility of all urologists. 相似文献
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Bianchi-Demicheli F Ortigue S De Ziegler D Damsa C Sekoranja L 《International journal of impotence research》2005,17(4):381-382
Even with the help of modern pharmacology, treatment of erectile dysfunction often remains complex, and requires taking into account the social, psychological, and behavioral dimensions of the disorder. This brief report presents a case study highlighting this complexity. 相似文献
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Necole M. Streeper 《Current urology reports》2018,19(5):29