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901.
Background
Deciding on strategy for patients with minor lower urinary tract symptoms (LUTS), elevated prostate-specific antigen (PSA) levels, unsuspicious digital rectal examination (DRE) and/or transrectal ultrasound (TRUS), and multiple negative extended prostate biopsies is complex.Objectives
To define the role and clinical significance of transurethral resection of the prostate (TURP) in these patients.Design, settings, and participants
Thirty-three patients with elevated PSA; minor LUTS, as assessed by the International Prostate Symptoms Score (IPSS); no suspicion for prostate cancer on DRE and/or TRUS; and negative extended prostate biopsies were prospectively enrolled in a cohort study at a tertiary care institution.Intervention
After full urodynamic investigation showing all patients to be bladder outlet obstructed, TURP was performed.Measurements
Resected tissue was histologically examined for presence of prostate cancer. Within 6 mo after TURP, patients were clinically reevaluated by means of IPSS and PSA level.Results and limitations
Preoperatively, mean PSA and IPSS values were 8.2 ng/ml and 6.8, respectively. Mean detrusor pressure at maximum flow was 80.3 cm H2O. Histological examination after TURP revealed benign prostate hyperplasia in 81.8% (subgroup 1) and aggressive prostate cancer in 6.1% of patients (subgroup 2). In 12.1% of patients, only a few chips of nonaggressive prostate cancer (T1a) were detected. In patients without signs of aggressive prostate cancer (93.9% = 12.1% + 81.8%, subgroup 3), mean postoperative PSA and IPSS values were 0.6 ng/ml and 2.4, respectively, while these values were 0.6 ng/ml and 2.5 ng/ml in subgroup 1 (p < 0.0001). This study is limited in sample size, requiring more research to confirm these results.Conclusions
This prospective study shows that, in patients with minor LUTS and no suspicion for prostate cancer, bladder outlet obstruction can result in elevated PSA levels. These patients will benefit from TURP regarding symptomatology and supernormalisation of PSA levels. Moreover, albeit in few cases, histological examination will reveal aggressive prostate cancer. 相似文献902.
INTRODUCTION: Benign prostatic hyperplasia (BPH) is associated with bothersome lower urinary tract symptoms (LUTS) and reduced patient quality of life (QoL). Phosphodiesterase (type) 5 (PDE5) inhibitors such as vardenafil are commonly used for the treatment of erectile dysfunction (ED), but have also been shown to improve the symptoms of BPH. This randomised, double-blind, placebo-controlled study investigated the effects of vardenafil on LUTS and QoL in men with BPH/LUTS, with or without concomitant ED. METHODS: Men aged 45-64 yr with BPH/LUTS and an International Prostate Symptom Score (IPSS) > or =12 were randomised to receive either 10mg vardenafil or placebo twice daily. LUTS were assessed with the use of two primary efficacy parameters, IPSS score and maximum urinary flow rate (Qmax), as well as postvoid residual (PVR) urine volume; ED was measured with the use of the erectile function (EF) domain score of the International Index of Erectile Function (IIEF-EF); and QoL was assessed with the Urolifetrade mark QoL-9 questionnaire. RESULTS: After 8 wk of treatment, there was a significant improvement in the IPSS total score in the vardenafil group compared with placebo (-5.9 and -3.6, respectively; p=0.0013). Nominally significant improvements in irritative and obstructive IPSS subscores (p=0.0017 and p=0.0081, respectively), EF (p=0.0001), and Urolife QoL-9 (p<0.0001) were also associated with vardenafil treatment. Qmax and PVR urine volume did not change significantly with treatment, although baseline values were already considered close to normal. Vardenafil was generally well tolerated, with most adverse events considered mild or moderate in severity. CONCLUSIONS: Vardenafil treatment significantly improved LUTS, EF, and QoL in men with BPH/LUTS. Vardenafil may be considered a promising treatment option for men with symptoms secondary to BPH. 相似文献
903.
The fundamental goal of skull base surgery is tumor removal with preservation of neurological function. Injury to the lower
cranial nerves (LCN; CN 9–12) profoundly affects a patient’s quality of life. Although intraoperative cranial nerve monitoring
(IOM) is widely practiced for other cranial nerves, literature addressing the LCN is scant. We examined the utility of IOM
of the LCN in a large patient series. One hundred twelve patients underwent 123 skull base operations with IOM between January
1994 to December 1999. The vagus nerve (n = 37), spinal accessory nerve (n = 118), and the hypoglossal nerve (n = 83) were monitored intraoperatively. Electromyography (EMG) and compound muscle action potentials (CMAP) were recorded
from the relevant muscles after electrical stimulation. This data was evaluated retrospectively. Patients who underwent IOM
tended to have larger tumors with more intricate involvement of the lower cranial nerves. Worsening of preoperative lower
cranial nerve function was seen in the monitored and unmonitored groups. With the use of IOM in the high risk group, LCN injury
was reduced to a rate equivalent to that of the lower risk group (p > 0.05). The immediate feedback obtained with IOM may prevent injury to the LCN due to surgical manipulation. It can also
help identify the course of a nerve in patients with severely distorted anatomy. These factors may facilitate gross total
tumor resection with cranial nerve preservation. The incidence of high false positive and negative CMAP and the variability
in CMAP amplitude and threshold can vary depending on individual and technical factors. 相似文献
904.
Traumatic vascular injuries involving the extremity are rare and penetrating trauma accounts for the majority of such injuries. The remaining arterial injuries are as a result of either blunt or iatrogenic injuries. The rapid detection, localisation and characterisation of vascular injuries in patients who have a traumatic extremity injury is essential for the effective management and treatment of such injuries. This review will discuss the expanding role of multi-detector computed tomography angiography in diagnosing vascular injuries and its implications on conventional diagnostic angiography. The roles of other non-invasive imaging modalities are reviewed. The presentation and types of vascular injuries in blunt and penetrating injuries are discussed. While surgery remains the gold standard in the management of vascular extremity injuries it has significant morbidity rates. Endovascular techniques are increasingly being used for the treatment of vascular traumatic injuries and various techniques including balloon occlusion, embolisation and stent/stent graft placement are discussed. 相似文献
905.
Background Lower eyelid ectropion is conventionally reconstructed with a local flap or full-thickness skin graft. However, scar contracture
and recurrence of ectropion often occur. This article describes an effective surgical technique for lower eyelid ectropion
repair using a bipedicle orbicularis oculi muscle or myocutaneous flap from the upper eyelid.
Methods This study prospectively analyzed collected data on the bipedicle orbicularis oculi muscle or myocutaneous flap from the upper
eyelid in reconstruction of lower eyelid ectropion between 1995 and 2004. The flap was used in 12 eyelid procedures for the
correction of lower eyelid ectropion, in 10 cases with traumatic ectropion, and in 1 case with bilateral congenital ectropion.
In these cases, a strip of orbicularis oculi muscle or a myocutaneous flap from the upper eyelid with two pedicles attached
in the medial and lateral canthus was advanced to the lower eyelid to suspend the eyelid and repair the skin defect.
Results No problem of flap viability was encountered in any of the patients, and all healed well. Deformities were corrected, and
evaluation showed satisfactory function and appearance during 0.5 to 6 years (average, 2 years) of follow-up evaluation. Eyelid
malposition and bulkiness of the lower eyelid occurred in the early stages, but disappeared gradually about 3 months after
the operation. There was no flap contraction, recurrent deformity, or significant donor site morbidity in the follow-up period.
The incision scars were almost invisible.
Conclusions The application of bipedicle orbicularis oculi muscle or a myocutaneous flap from the upper eyelid in reconstruction of lower
eyelid ectropion is effective and reduces postoperative morbidity. 相似文献
906.
907.
《Disability and rehabilitation》2013,35(4):148-153
Patients with chronic ataxia resulting from traumatic central nervous system (CNS) damage frequently attain a gait pattern dependent upon upper extremity weight-bearing (UEWB). Traditional attempts to train these patients may perpetuate UEWB dependency, by not allowing optimal facilitation of balance and associated movement control required for independent ambulation. In the present study an ambulation retraining approach designed to facilitate coordination and balance while minimizing UEWB was used. This approach can allow the patient to train outside of the clinic; only about 5% of the actual therapy hours involved a therapist. 相似文献
908.
ObjectiveTo review the evidence for tamsulosin as medical expulsive therapy in enhancing the effectiveness of distal ureteral stone clearance rate.MethodsWe searched Pubmed/Medline, Embase, CBM and the Cochrane Library up to October 2011. All randomized controlled trials in which tamsulosin was evaluated with distal ureterolithiasis were eligible for the analysis. Outcome measure assessed was stone clearance rate. Two authors independently assessed study quality and extracted data. All data were analyzed using RevMan 5.1.ResultsThirteen studies involving 1067 participants met the inclusion criteria. Study duration ranged from 7 to 42 d. The pooled analysis showed an improvement of 41% in stone clearance rate of tamsulosin as medical expulsive therapy for distal ureteral calculi (RR=1.41, 95% CI=1.18 to 1.70). According to stone size (6 mmRR=1.52, 1.75, 1.05, 95% CI=1.30 to 1.77, 1.25 to 2.45, 0.95 to 1.16, respectively). Adverse effects of tamsulosin, mainly retrograde ejaculation, dizziness and hypotension, were reported in 7 included trials.ConclusionTreatment with tamsulosin appears to be a safe and effective medical expulsion therapy for distal ureterolithiasis. To make a definite clinical recommendation to use tamsulosin as medical expulsive treatment for distal ureteral calculi, high quality multicentric, randomized, double blinded, controlled trials are necessary to prove its efficacy. 相似文献
909.
The author reports a case of orbital Sarcoidosis in a 70-year-old female that initially presented as diffuse swelling of the lower eyelid. The patient complained of painless swelling of the left lower lid without palpable mass, and a computerized tomography (CT) scan of the orbit was unremarkable. A serum angiotensin converting enzyme level was elevated, and hilar lymphadenopathy was noted on the chest CT. The patient underwent surgical debulking for histologic confirmation, which led to a final diagnosis of sarcoidosis involving the orbital fat. Unexplained chronic eyelid swelling without a mass should be considered a possible ophthalmic manifestation of orbital sarcoidosis. 相似文献
910.