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21.
OBJECTIVE: To compare an ileocaecal orthotopic bladder, (which has been the standard procedure in Egypt for >30 years) with the ileal neobladder, as there is no ideal continent orthotopic bladder replacement for patients after cystectomy for bladder cancer. PATIENTS AND METHODS: Between June 1999 and December 2001, 60 patients with invasive bladder cancer were randomized into two groups. Group A comprised 29 patients who had radical cystectomy and reconstruction with an ileal neobladder (median age 50 years, 27 men and two women) and group B included 31 who had an ileocaecal bladder substitution after radical cystectomy (median age 51 years, 28 men and three women). RESULTS: The complication rate after surgery in group A was 17%, with two deaths, one from acute myocardial infarction and the other from haematemesis. In group B, the complication rate was 13%, with two deaths, one from a massive pulmonary embolism and the other from liver cell failure. Daytime continence was achieved in 93% of patients in group A and 90% in group B. The mean (sd) postvoid residual urine volume was larger in group A than group B, at 90 (72) vs 12 (20) mL. Acidosis and hyponatraemia were evident in the patients in group A but in none in group B (P < 0.05). The pelvicalyceal systems were preserved in 85% of patients in group A and 93% in group B during the 2-year follow-up. The mean (sd) renal cortical thickness was less in group A than in group B, at 1.8 (0.5) and 1.9 (0.2) cm, respectively. Although the cystometric capacity was greater and the basal pressure less in group A than B, these were not reflected in the degree of diurnal and nocturnal continence or back pressure on the renal units. CONCLUSION: Continence in both pouches was similar but the renal units were preserved better in the ileocaecal than in the ileal neobladder. Residual urine volume was greater in the ileal neobladder, with its potential complications of infection and stone formation, and acidosis was more evident. 相似文献
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Tarek Alsaied Lynn A. Sleeper Marco Masci Sunil J. Ghelani Nina Azcue Tal Geva Andrew J. Powell Rahul H. Rathod 《Journal of cardiovascular magnetic resonance》2018,20(1):85
Background
Maldistribution of pulmonary artery blood flow (MPBF) is a potential complication in patients who have undergone single ventricle palliation culminating in the Fontan procedure. Cardiovascular magnetic resonance (CMR) is the best modality that can evaluate MPBF in this population. The purpose of this study is to identify the prevalence and associations of MPBF and to determine the impact of MPBF on exercise capacity after the Fontan operation.Methods
This retrospective single-center study included all patients after Fontan operation who had maximal cardiopulmonary exercise test (CPET) and CMR with flow measurements of the branch pulmonary arteries. MPBF was defined as >?20% difference in branch pulmonary artery flow. Exercise capacity was measured as percent of predicted oxygen consumption at peak exercise (% predicted VO2). Linear and logistic regression models were used to determine univariate and multivariable predictors of exercise capacity and correlates of MPBF, respectively.Results
A total of 147 patients who had CMR between 1999 and 2017 were included (median age at CMR 21.8?years [interquartile range (IQR) 16.5–30.6]) and the median time between CMR and CPET was 2.8?months [IQR 0–13.8]. Fifty-three patients (36%) had MPBF (95% CI 29–45%). The mean % predicted VO2 was 63?±?16%. Patients with MPBF had lower mean % predicted VO2 compared to patients without MPBF (60?±?14% versus 65?±?16%, p?=?0.04). On multivariable analysis, a lower % predicted VO2 was independently associated with longer time since Fontan, higher ventricular mass-to-volume ratio, and MPBF. On multivariable analysis, only compression of the branch pulmonary arteries by the ascending aorta or aortic root was associated with MPBF (OR 6.5, 95% CI 5.6–7.4, p?<?0.001).Conclusion
In patients after the Fontan operation, MPBF is common and is independently associated with lower exercise capacity. MPBF was most likely to be caused by pulmonary artery compression by the aortic root or the ascending aorta. This study identifies MPBF as an important risk factor and as a potential target for therapeutic interventions in this fragile patient population.25.
Mohamed Tarek M. Youssef Menna Allah M. Bakry Azza A. El-Keiy Mai M. 《Metabolic brain disease》2021,36(2):255-264
Metabolic Brain Disease - The foremost neurodegenerative disease is Alzheimer’s (AD), which is characterized as a gradual decrease in memory, cognitive function, and also personal changes... 相似文献
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The hepatitis C virus (HCV) is a common blood-borne illness that affects up to 2% of the world’s population and almost 4 million
Americans. Cognitive impairment, or difficulty with thinking, has become a well-established symptom in persons with end stage
liver disease. It was previously assumed that cognitive impairment was a consequence of cirrhosis-associated hepatic encephalopathy.
Recent evidence, however, suggests that approximately one-third of people with chronic HCV experience cognitive impairment
even in the absence of cirrhosis and that its occurrence is unrelated to other indices of liver function, such as laboratory
values, viral load, and genotype. In the present review, evidence outlining the presence of cognitive deficits associated
with HCV, possible etiological factors, effects of antiviral therapy, and co-infection with human immunodeficiency virus (HIV)
is presented. Implications of these findings and directions for future work are discussed. 相似文献
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Burel R. Goodin Tarek Kronfli Christopher D. King Toni L. Glover Kimberly Sibille Roger B. Fillingim 《Journal of behavioral medicine》2013,36(2):165-174
Greater dispositional optimism has been related to less severe pain; however, whether optimism is associated with endogenous pain modulation has not yet been examined. The beneficial effects of dispositional optimism often vary according to cultural dynamics. Thus, assessing optimism–pain relationships across different ethnic groups is warranted. This study sought to examine the association between optimism and conditioned pain modulation (CPM), and test whether this association differs according to ethnicity. Optimism and CPM were assessed in a sample of healthy, ethnically diverse young adults. CPM was determined by comparing pressure pain thresholds obtained before and during exposure to a cold pressor task. All participants completed a validated measure of dispositional optimism. Greater reported optimism was significantly associated with enhanced CPM, and the strength of this association did not vary according to individuals’ ethnic background. These findings suggest that an optimistic disposition may potentiate endogenous pain inhibition. 相似文献
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Veldtman Gruschen Possner Mathias Mohty Dania Issa Ziyad Alsaleh Monerah AlMarzoog AlJuhara Thaar Emmanual Shisamma Salam Yezan AlHabdan Mohammed Saleh Alsaied Tarek Rathod Rahul H. Siblini Ghassan Vriz Olga 《The international journal of cardiovascular imaging》2021,37(9):2651-2660
The International Journal of Cardiovascular Imaging - Abnormal atrial mechanics in biventricular circulations have been associated with elevated left heart filling pressures. Similar associations... 相似文献