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991.
Objectives: Detrusor myectomy is a recognized method of bladder augmentation for treating refractory detrusor overactivity. Herein we report the long‐term outcomes of this procedure at the University Hospital of Wales in Cardiff, UK. Methods: Detrusor myectomy was carried out in 33 patients (7 males, 26 females) with urodynamically proven detrusor overactivity between 1995 and 2002. The mean patient age was 33 years (range 5–62). A total of 18 patients had idiopathic detrusor overactivity, whereas 15 had neurogenic detrusor overactivity. Results: A total of 24 patients had a detrusor myectomy alone, whereas eight patients had a detrusor myectomy with implantation of artificial urinary sphincter. One patient had detrusor myectomy with transuretero‐ureterostomy. The mean follow up was 148 months (range 108–192). A total of 10 of the 18 patients with idiopathic detrusor overactivity (55.5%) and six of the 15 patients with neurogenic detrusor overactivity (40%) showed marked improvement in symptoms. Detrusor overactivity was completely abolished in 11 patients and significantly reduced in five. Postoperatively, mean cystometric capacity improved from 290 to 458 mL, whereas mean maximum amplitude of detrusor contraction was reduced from 44 cm/H2O to 20 cm/H2O. An overall success rate of 48.5% (16/33 patients) was achieved. Intermittent self catheterization was needed to achieve bladder emptying in 12 of the 16 (75%) patients. Of the remaining 17 patients who did not improve, six had CLAM enterocystoplasty carried out and two await the operation. An ileal conduit diversion and suprapubic catheter insertion was carried out in one patient each, whereas seven patients declined any further intervention. Conclusions: Detrusor myectomy offers a reasonable long‐term success rate to patients undergoing surgical treatment for refractory detrusor overactivity. 相似文献
992.
Shih AW Weir MA Clemens KK Yao Z Gomes T Mamdani MM Juurlink DN Hird A Hodsman A Parikh CR Wald R Cadarette SM Garg AX 《Kidney international》2012,82(8):903-908
Intravenous bisphosphonates can cause acute kidney injury; however, this risk was not found with oral bisphosphonates in randomized clinical trials with restrictive eligibility criteria. In order to provide complementary safety data, we studied the risk of acute kidney injury in a population-based cohort of 122,727 patients aged 66 years and older discharged from hospital following a new fragility fracture and no history of bisphosphonate use in the prior year. Bisphosphonate treatment was identified within 120 days after discharge and event rates were measured from 90 days of therapy initiation. The primary outcome was hospitalization with acute kidney injury with secondary outcomes of new nephrology consultation and, in a subset of patients with laboratory values, acute kidney injury was defined as an increase in serum creatinine. We identified 18,286 bisphosphonate users and 104,441 non-users with a mean age of 81 years. Of 5772 patients with laboratory values, 40% had chronic kidney disease (eGFR <60?ml/min per 1.73?m(2)). Overall, there was no statistically significant difference in the risk of acute kidney injury among bisphosphonate users compared to non-users (adjusted odds ratio 1.03), and no significant differences in other outcomes or in subgroups of patients with baseline chronic kidney disease. Thus, in this older population-based cohort, oral bisphosphonate use was not associated with acute kidney injury. 相似文献
993.
Background
Obstructed abdominal wall hernias have been reported to be the leading cause of mechanical intestinal obstruction (MIO) among adults in developing countries. In the developed countries, postoperative adhesions are the commonest cause. With the worldwide improvements in health services and education, especially in developing countries, we aimed to determine the effects of these improvements on the patterns and outcomes of management of MIO in Jordan 相似文献994.
Hussain ZM Fitting S Watanabe H Usynin I Yakovleva T Knapp PE Scheff SW Hauser KF Bakalkin G 《Journal of neurotrauma》2012,29(9):1785-1793
Traumatic brain injury (TBI) induces a cascade of primary and secondary events resulting in impairment of neuronal networks that eventually determines clinical outcome. The dynorphins, endogenous opioid peptides, have been implicated in secondary injury and neurodegeneration in rodent and human brain. To gain insight into the role of dynorphins in the brain's response to trauma, we analyzed short-term (1-day) and long-term (7-day) changes in dynorphin A (Dyn A) levels in the frontal cortex, hippocampus, and striatum, induced by unilateral left-side or right-side cortical TBI in mice. The effects of TBI were significantly different from those of sham surgery (Sham), while the sham surgery also produced noticeable effects. Both sham and TBI induced short-term changes and long-term changes in all three regions. Two types of responses were generally observed. In the hippocampus, Dyn A levels were predominantly altered ipsilateral to the injury. In the striatum and frontal cortex, injury to the right (R) hemisphere affected Dyn A levels to a greater extent than that seen in the left (L) hemisphere. The R-TBI but not L-TBI produced Dyn A changes in the striatum and frontal cortex at 7 days after injury. Effects of the R-side injury were similar in the two hemispheres. In naive animals, Dyn A was symmetrically distributed between the two hemispheres. Thus, trauma may reveal a lateralization in the mechanism mediating the response of Dyn A-expressing neuronal networks in the brain. These networks may differentially mediate effects of left and right brain injury on lateralized brain functions. 相似文献
995.
Goldsmith ZG Astroza GM Wang AJ Simmons WN Iqbal MW Lipkin ME Preminger GM Ferrandino MN 《Journal of endourology / Endourological Society》2012,26(10):1340-1345
Abstract Background and Purpose: Flexible working angles and fine optical visualization are major requisite factors in performing laparoendoscopic single-site (LESS) urologic procedures. Multiple mechanical design approaches have been used to develop deflectable laparoscopes for LESS procedures. We compared the optical characteristics of three such devices using a bench top approach to simulate LESS in straight and deflected positions. Materials and Methods: A 10-mm fixed-rod rotating lens device (Storz EndoCameleon) and two 5-mm articulating devices (Olympus EndoEye and Stryker IdealEye) were compared using standard industry testing protocols for image resolution (United States Air Force-1951 test target), distortion (multifrequency grid distortion target), and color reproducibility (Gretag Macbeth color checker). Results: The 10-mm fixed-rod rotating lens system demonstrated the highest image resolution (5.04 line pairs/mm), but also the highest distortion (22.8%). Among the 5-mm flexible articulating laparoscopes, resolution was superior with the Olympus EndoEye (4.00 line pairs/mm) compared with the Stryker IdealEye (3.17 line pairs/mm). Distortion (7.0%) and color reproduction (1.18) were superior with the IdealEye vs the EndoEye (18.8 %, 1.27). Laparoscope deflection resulted in attenuation of resolution by 11% with both articulating models, but not with the fixed rod system. Conclusions: Definition of these optical characteristics may inform further development and selection of laparoscopic systems optimized for LESS surgery. A narrow but flexible camera can be crucial in the limited working space available during these procedures. Further investigation is warranted to determine if these objective findings translate into improved surgeon performance. 相似文献
996.
997.
MK Rafiq M Bradburn AR Proctor C Billings S Bianchi CJ McDermott PJ Shaw 《Amyotrophic lateral sclerosis》2012,13(6):528-532
Amyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative condition, respiratory failure being the commonest cause of death. Quality of life and survival can be improved by supporting respiratory function with non-invasive ventilation. Transcutaneous carbon dioxide monitoring is a non-invasive method of measuring arterial carbon dioxide levels enabling simple and efficient screening for respiratory failure. The aim of this study was to validate the accuracy of carbon dioxide level recorded transcutaneously with a TOSCA 500 monitor. It is a prospective, observational study of 40 consecutive patients with ALS, recruited from a specialist ALS clinic. The partial pressure of carbon dioxide (PCO(2)) in each patient was determined by both transcutaneous monitoring and by an arterialized ear lobe capillary blood sample. The carbon dioxide (CO(2)) levels obtained with these two methods were compared by Bland-Altman analysis. The results showed that the mean difference between arterialized and transcutaneous readings was - 0.083 kPa (SD 0.318). The Bland-Altman limits of agreement ranged from 0.553 to - 0.719 kPa. The difference was 0.5 kPa in 90% of the recordings. Four of the 40 measurements had a difference of >?0.5 kPa, with a maximum recorded difference of 0.95 kPa. In conclusion, non-invasive carbon dioxide monitoring using a TOSCA monitor is a useful clinical tool in neurology practice. Users should be aware of the possibility of occasional inaccurate readings. A clinically unexpected or incompatible reading should be verified with a blood gas analysis, especially when a decision to provide ventilatory support is required. 相似文献
998.
ABSTRACT: Sigmoid volvulus is a rare surgical complication occurring in pregnancy and puerperium. Only 84 cases of sigmoid volvulus in pregnancy have been reported in the English literature so far. We have reviewed the available literature on this subject and present another case recently managed at our institution. The available literature suggests that over the years, there has been an improvement in the maternal and fetal outcome for this critical condition, but delay in presentation and a further delay in diagnosis remain a challenge for the treating physicians. Our patient was a 30-week pregnant lady, who presented late with 6?days history of abdominal pain, distension and absolute constipation. She had evidence of multi-organ dysfunction at presentation due to complicated sigmoid volvulus. She was resuscitated and surgical exploration revealed gangrenous large bowel. Bowel resection with diverting ileostomy was performed, but she succumbed to the septic shock due to late presentation. Acute surgical pathology may be overlooked in pregnant patients due to reluctance in radiological workup and a high index of suspicion is essential for enhanced outcome. There is a need to increase the awareness amongst the obstetricians and general practitioners. Early diagnosis and referral and timely surgical intervention could significantly improve the outcome of this surgical and obstetric catastrophe. 相似文献
999.
Shereen Shoma Muhammad Kamruzzaman Andrew N. Ginn Jonathan R. Iredell Sally R. Partridge 《Diagnostic microbiology and infectious disease》2014
blaNDM genes, encoding metallo-β-lactamases providing resistance to carbapenems, have been reported in many locations since the initial report in 2008, including in several Enterobacteriaceae isolates in Australia/New Zealand. Here, we compare 4 additional carbapenem-resistant Klebsiella pneumoniae carrying blaNDM-1 isolated in Australia. Two are sequence type ST147, previously associated with blaNDM in Australia and elsewhere. They carry blaNDM-1 and different 16S rRNA methylase genes (armA or rmtC) on different conjugative plasmids, in 1 case with an IncFIIY replicon. One isolate belongs to the globally important ST11 but did not transfer a plasmid to Escherichia coli. The fourth isolate belongs to the novel ST1068 and transferred blaNDM-1, armA, and an IncA/C plasmid. Amplification and sequencing of ompK porin genes suggest that, unlike the case for other carbapenemase genes, ompK36 defects may not be required for NDM to cause clinically relevant levels of carbapenem resistance. 相似文献
1000.
Aurora Merovci Carolina Solis-Herrera Giuseppe Daniele Roy Eldor Teresa Vanessa Fiorentino Devjit Tripathy Juan Xiong Zandra Perez Luke Norton Muhammad A. Abdul-Ghani Ralph A. DeFronzo 《The Journal of clinical investigation》2014,124(2):509-514
Chronic hyperglycemia impairs insulin action, resulting in glucotoxicity, which can be ameliorated in animal models by inducing glucosuria with renal glucose transport inhibitors. Here, we examined whether reduction of plasma glucose with a sodium-glucose cotransporter 2 (SGLT2) inhibitor could improve insulin-mediated tissue glucose disposal in patients with type 2 diabetes. Eighteen diabetic men were randomized to receive either dapagliflozin (n = 12) or placebo (n = 6) for 2 weeks. We measured insulin-mediated whole body glucose uptake and endogenous glucose production (EGP) at baseline and 2 weeks after treatment using the euglycemic hyperinsulinemic clamp technique. Dapagliflozin treatment induced glucosuria and markedly lowered fasting plasma glucose. Insulin-mediated tissue glucose disposal increased by approximately 18% after 2 weeks of dapagliflozin treatment, while placebo-treated subjects had no change in insulin sensitivity. Surprisingly, following dapagliflozin treatment, EGP increased substantially and was accompanied by an increase in fasting plasma glucagon concentration. Together, our data indicate that reduction of plasma glucose with an agent that works specifically on the kidney to induce glucosuria improves muscle insulin sensitivity. However, glucosuria induction following SGLT2 inhibition is associated with a paradoxical increase in EGP. These results provide support for the glucotoxicity hypothesis, which suggests that chronic hyperglycemia impairs insulin action in individuals with type 2 diabetes. 相似文献