Ureterovesical anastomotic techniques for kidney transplantation: a systematic review and meta‐analysis

No consensus exists about which ureterovesical anastomosis technique to use for kidney transplantation. The aim of this systematic review was to compare the existing techniques in relation to the risk of urological complications. All studies that compared ureterovesical anastomotic techniques in kidney transplantation were included. Study endpoints were urinary leakage, ureteral stricture, vesicoureteral reflux and hematuria. Subanalyses of stented and nonstented techniques were performed. Two randomized clinical trials and 24 observational studies were included. Meta‐analyses were performed on the Lich‐Gregoir (LG) versus Politano‐Leadbetter (PL) techniques and LG versus U‐stitch (U) techniques. Compared with the PL technique, the LG technique had a significantly lower prevalence of urinary leakage (risk ratio (RR): 0.47, 95% confidence interval (CI): 0.30 to 0.75) and a significantly lower prevalence of hematuria when compared with both PL and U techniques (RR: 0.28, 95% CI: 0.16 to 0.49 and RR: 0.23, 95% CI: 0.11 to 0.50, respectively), regardless of ureteral stenting. There was no difference in the prevalence of ureteral strictures or vesicoureteral reflux between the various techniques. Of the three most frequently used ureterovesical anastomotic techniques, the LG technique results in fewer urological complications than the PL and U techniques.     

心理干预联合药物对吸烟者的戒烟效果评价

目的 评价伐尼克兰在临床实践中对戒烟门诊患者戒烟的有效性.方法 采用前瞻性观察性研究设计,选择符合纳入标准的吸烟者799人,每名患者首诊时进行标准的基线问卷评估,并在第1、第3和第6个月进行随访.由经过培训的医师对每名患者完成面对面的咨询和个体化戒烟干预.接受药物辅助戒烟者定为心理干预联合药物组(n=272),未用药者为单纯心理干预组(n=527).采用意向性分析的统计学方法分析比较两组的7天时点戒烟率、3个月随访时的1个月持续戒烟率和6个月随访时的3个月持续戒烟率.结果 6个月随访时,心理干预联合药物组的7天时点戒烟率显著高于单纯心理干预组(34.6% vs. 23.1%;OR=1.75,95% CI:1.27～2.42;P<0.001),心理干预联合药物组的3个月持续戒烟率也显著高于单纯心理干预组(31.3% vs. 18.2%;OR=2.04,95%CI:1.46～2.86;P<0.001).1和3个月随访时,心理干预联合药物组无论是7天时点戒烟率还是1个月持续戒烟率均高于单纯心理干预组.结论 在真实临床实践的戒烟门诊中,给予戒烟者药物辅助戒烟可有效提高戒烟率.     

Non-specific inflammation of the respiratory tract in a female patient with inflammatory bowel disease and osteoporosis]

A 33-year-old woman presented with a non-specific inflammation of the respiratory passages, which occurred two months after partial colectomy and sigmoidectomy for local stenosis caused by an unclassified inflammatory bowel disease. After other causes of the respiratory symptoms had been ruled out, it was concluded that these were a complication of the bowel disease. Due to the osteoporosis, the patient was given a prolonged treatment with high doses of inhaled corticosteroids instead of systemic corticosteroids. She was treated successfully.     

A case of gallstone-induced small bowel necrosis masquerading as clinical appendicitis

Cholecysto-duodenal fistula and gallstone ileus are well-recognised complications of gallstone disease. However, small bowel necrosis is a rare complication of gallstone disease. We describe a case of gallstone-induced ileal necrosis presenting with symptoms and signs resembling acute appendicitis. A 79-year-old woman presented to the surgical team with central abdominal pain which subsequently shifted to the right iliac fossa. Clinically, the patient had localised perotinism in the right iliac fossa with high inflammatory markers. Abdominal radiography showed no diagnostic features. Initial clinical impression was that of acute appendicitis. Given that this diagnosis was unlikely in a patient of this age, an abdominal CT scan was performed. The CT scan showed evidence of a large gallstone causing small bowel obstruction in the presence of a cholecysto-duodenal fistula. At surgery, she was found to have an area of necrosis with a pin-point perforation at the site of impaction of the gallstone in the proximal ileum. This occurred secondarily to pressure necrosis from the gallstone impacting at a site where the small bowel diameter narrows in transition from jejunum to ileum. A limited small bowel resection was performed with an uncomplicated postoperative course. This case report draws attention to a rare complication of gallstone disease which presents with a clinical picture similar to acute appendicitis. Preoperative investigation for an elderly patient who presents with an acute abdomen should include an abdominal CT scan to diagnose any rare disease processes which otherwise may not be suspected.     

早期血肿周围水肿的部位特征

背景：对血肿周围水肿（PHO）的自然病史和触发因素仍知之甚少。脑淀粉样血管病（脑叶出血的常见原因）具有局灶性抗凝血及血栓溶解的特性，可能会影响PHO。本研究假定脑叶内出血（ICH）患者的早期（24h内）水肿与血肿体积比较深部ICH患者小。方法：对人住急性卒中中心并经CT证实为自发性幕上ICH连续患者的血肿及PHO体积进行测量，计算并比较脑叶ICH与深部ICH患者的水肿与血肿体积比。结果：共对44例ICH患者进行研究：19例患者为深部ICH，中位血肿体积为8．4ml（IQR4．8～20．8），中位PHO体积为8．2ml（IQR2．8～16）；25例患者为脑叶ICHs，中位血肿体积为17．0nd（IQR0．0～33．1），中位水肿体积为10．2ml（IQR3．4～24．2）。脑叶ICH患者较深部ICH患者的年龄大（65．7岁掷57．4岁，P=0．009），但ICH部位与性别或种族无关，尚无证据支持血肿或水肿体积与ICH类型有关（P=0．23，P=0．39）。脑叶ICH与深部ICH患者的中位水肿与血肿比相似（0．67 vs 0．58，P=0．71）。校正年龄、性别和种族后对比较结果无影响。结论：在ICH发病24h内PHO体积与部位无关，深部ICH和脑叶ICH具有相同的减少早期PHO的治疗目标。     

Antitumor activity and clinical pharmacology of sulofenur in ovarian cancer.

BACKGROUND: Sulofenur is a diarylsulfonylurea with demonstrated antitumor activity in patients with advanced epithelial ovarian cancer refractory to standard chemotherapy. The dose-limiting toxic effects observed in phase I clinical trials have been anemia and methemoglobinemia, resulting in cyanosis. PURPOSE: The purposes of this study were to further define the response rate, toxic effects, and pharmacokinetics and pharmacodynamics of sulofenur in patients with advanced ovarian cancer. METHODS: We conducted a phase II trial of sulofenur at a dose of 800 mg/m2 per day in 35 patients with stage III or IV ovarian cancer refractory to standard chemotherapy. Pharmacokinetics and pharmacodynamics were analyzed by comparing sulofenur parent and metabolite plasma levels with methemoglobin levels. RESULTS: Partial responses lasting 6.5-18 weeks occurred in four (15%; 95% confidence interval = 4%-35%) of the 26 patients assessable for response. In addition, 42% (11) of the assessable patients had prolonged stable disease (median, 20 weeks). The first nine patients received sulofenur as a daily oral dose for 14 days, with a 21-day treatment cycle. However, they developed substantial anemia and methemoglobinemia. As a result, the next 26 patients received sulofenur daily for 5 days followed by 2 days of rest for 3 consecutive weeks, with a 28-day treatment cycle (5/2-day schedule). Preclinical models predicted that 2 days of rest would decrease toxicity while maintaining antitumor activity. Patients treated with the 5/2-day schedule had relatively less severe anemia and methemoglobinemia and needed fewer red blood cell transfusions (31% versus 78% of patients), but 31% still required dose reductions because of these toxic effects. The hydroxy and keto metabolites of sulofenur had prolonged plasma half-lives relative to the parent compound, and the difference was statistically significant. In addition, the correlations of metabolite concentrations with methemoglobin levels were higher than the correlation of sulofenur concentrations with methemoglobin levels, and those differences were statistically significant. CONCLUSION: We conclude that sulofenur has modest clinical activity in heavily pretreated patients with ovarian cancer. IMPLICATIONS: The toxic effects of anemia and methemoglobinemia may limit the ultimate clinical utility of diarylsulfonylureas until less toxic derivatives with alternate metabolic pathways can be identified.