Work Capacity of the Bladder During Voiding: A Novel Method to Evaluate Bladder Contractile Function and Bladder Outlet Obstruction

Background:

Work in voiding (WIV) of the bladder may be used to evaluate bladder status throughout urination rather than at a single time point. Few studies, however, have assessed WIV owing to the complexity of its calculations. We have developed a method of calculating work capacity of the bladder while voiding and analyzed the associations of bladder work parameters with bladder contractile function and bladder outlet obstruction (BOO).

Methods:

The study retrospectively evaluated 160 men and 23 women, aged >40 years and with a detrusor pressure at maximal flow rate (P_det Q_max) of ≥40 cmH₂O in men, who underwent urodynamic testing. The bladder power integration method was used to calculate WIV; WIV per second (WIV/t) and WIV per liter of urine voided (WIV/v) were also calculated. In men, the relationships between these work capacity parameters and P_det Q_max and Abrams-Griffiths (AG) number were determined using linear-by-linear association tests, and relationships between work capacity parameters and BOO grade were investigated using Spearman''s association test.

Results:

The mean WIV was 1.15 ± 0.78 J and 1.30 ± 0.88 J, mean WIV/t was 22.95 ± 14.45 mW and 23.78 ± 17.02 mW, and mean WIV/v was 5.59 ± 2.32 J/L and 2.83 ± 1.87 J/L in men and women, respectively. In men, WIV/v showed significant positive associations with P_det Q_max (r = 0.845, P = 0.000), AG number (r = 0.814, P = 0.000), and Schafer class (r = 0.726, P = 0.000). Conversely, WIV and WIV/t showed no associations with P_det Q_max or AG number. In patients with BOO (Schafer class > II), WIV/v correlated positively with increasing BOO grade.

Conclusions:

WIV can be calculated from simple urodynamic parameters using the bladder power integration method. WIV/v may be a marker of BOO grade, and the bladder contractile function can be evaluated by WIV and WIV/t.     

支气管镜术对小儿上气道梗阻性疾病的病因诊断价值

目的：探讨支气管镜术对小儿上气道梗阻（UAO）的病因诊断价值。方法对2006年3月至2015年2月因上气道梗阻症状而行支气管镜检查的210例患儿的临床资料进行回顾性分析。结果210例 UAO 患儿中,经支气管镜检查明确病因205例,病因诊断率97.6%。其中先天性 UAO 114例,占54.3%,以喉软化、气管狭窄、会厌或舌根部囊肿最常见,分别占64.0%（73/114）、17.5%（20/114）、14.0%（16/114）,2种以上畸形占17.5%（20/114）。后天性 UAO 96例,占45.7%,以炎症、肿瘤或肉芽增生、异物最常见,分别占54.2%（52/96）、18.7%（18/96）、16.7%（16/96）。呼吸道先天畸形主要见于婴儿及新生儿期,炎症在各个年龄段均常见,肿瘤或肉芽增生主要见于幼儿期,异物主要见于幼儿期及学龄前期。结论支气管镜术对 UAO 的病因能发挥很好的诊断作用。呼吸道先天畸形（喉软化、气管狭窄、囊肿）、炎症、肿瘤或肉芽增生、异物是儿童 UAO 的常见病因,不同年龄组病因组成不同。     

Mesenteric panniculitis of the colon with obstruction of the inferior mesenteric vein

Mesenteric panniculitis is a rare disease characterized by nonspecific inflammation of the fat tissue of the mesentery. We present an extremely rare case of mesenteric panniculitis of the sigmoid colon, complicated by occlusion of the inferior mesenteric vein. A 75-year-old male presented with a one-month history of abdominal distention and abdominal mass without pain. Physical examination revealed a firm mass in the lower abdomen. Barium enema study demonstrated rugged mucosa and a serrated contour in the rectosigmoid colon. Computed tomography showed that the mass arose from the mesentery, which surrounded the mesenteric vessels. The density of the mass was slightly higher than that of fatty tissue. Based on these radiologic findings, the patient was diagnosed as having mesenteric panniculitis of the rectosigmoid colon. Colonoscopy showed narrowing with edematous mucosa in the rectosigmoid colon, whereas marked dilated vessels were noted in the proximal portion of the sigmoid colon. Angiography showed occlusion of the inferior mesenteric vein, with venous flow returningvia a collateral vein. The patient was observed without medication because his condition was satisfactory. His symptoms subsequently disappeared during a period of several weeks. The mass in the lower abdomen gradually diminished in size, disappearing three months later. Computed tomography and barium enema showed improvement of the lesion. The favorable outcome of the present case was probably because of formation of a collateral vein. The present case suggests that aggressive therapy for mesenteric panniculitis should be avoided, because the outcome of this disorder is good, even when there is obstruction of vessels.     

Colonic perforation by a large gallstone: A rare case report

INTRODUCTION

Herein we present the case of an 86-year-old woman with gallstone perforation of the sigmoid colon.

PRESENTATION OF CASE

An 86-year-old woman with known cholelithiasis presented to our office with one week of abdominal pain and nausea. X-rays taken at presentation demonstrated pneumobilia, and CT scan showed a 3.5 cm gallstone in the sigmoid colon. Medical management was unsuccessful in passing the stone, and a colonoscopy on day 4 was unsuccessful in incorporating the stone. Subsequent clinical deterioration prompted a laparotomy, where a perforation was discovered. A Hartmann''s procedure was performed and the patient recovered after a complicated post-operative course.

DISCUSSION

Gallstone ileus is an uncommon, but medically important, cause of bowel obstruction. This presentation is considered a surgical emergency and thus prompt identification and removal is essential. Obstructions tend to occur in either the stomach or along the various segments of the small intestine but have been reported in the colon as well.

CONCLUSION

In cases of gallstones that manage to pass into the large intestine, it is prudent to attempt conservative measures for passage. Failure to do so should raise suspicion of a possible stricture, either benign or malignant, preventing its evacuation. Earlier surgical intervention should be considered in these cases.     

Ileosigmoid knotting—A disastrous double closed loop obstruction

INTRODUCTION

Ileosigmoid knotting (ISK) is a rare entity which needs prompt recognition and immediate surgical intervention to avoid catastrophic complications caused by gangrenous bowel and subsequent peritonitis. Preoperative investigations are only diagnostic of obstruction and CT findings are helpful but are not always available.

PRESENTATION OF CASE

This case report describes a 22 year old male presenting with acute abdomen managed with emergency exploration in view of findings of peritonitis. Intra-operatively an ileal segment was wrapped around the base of sigmoid colon with gangrenous ileal segment suggesting ISK. Resection of gangrenous ileal segment with double barrel ileostomy was done. Patient tolerated procedure well.

DISCUSSION

Patients with ileosigmoid knotting present with frank obstruction and require immediate medical and surgical treatment. This condition rapidly progresses to gangrenous bowel, generalized peritonitis and sepsis with very high mortality.

CONCLUSION

Early diagnosis, prompt fluid resuscitation, preoperative antibiotics and immediate surgical exploration are keys for optimal management of this condition.     

The effect of different nasal irrigation solutions following septoplasty and concha radiofrequency: a prospective randomized study

Introduction

Nasal irrigation solutions are widely used following endonasal surgery. These irrigation solutions remove infective debris and crusts, reducing the probability of synechia formation, and accelerate mucosal healing.

浅谈清热利湿法疗痛风

通过中医古籍考证、文献整理、临床研究等方法浅谈历代医家、现代学者和本课题组关于“清热利湿法”治疗湿热痹阻型痛风的现状,提出“清热利湿法”的具体作用机制有待进一步研究探索。     

Novel device (AirWave) to assess endotracheal tube migration: A pilot study

Introduction

Little is known about endotracheal tube (ETT) migration during routine care among critically ill patients. AirWave is a novel device that uses sonar waves to measure ETT migration and obstructions in real time. The aim of the present study is to assess the accuracy of the AirWave to evaluate ETT migration. In addition, we determined the degree of variation in ETT position and tested whether more pronounced migration occurs in specific clinical scenarios.

Methods

After institutional review board approval, we included mechanically ventilated patients from February 2012 to May 2012. A chest radiography (CXR) was obtained at baseline and 24 hours when clinically indicated. The ETT distance at the lips was recorded at baseline and every 4 hours. The AirWave system continuously recorded ETT position changes from baseline, and luminal obstructions.

Results

A total of 42 patients (age: 61 [SD ± 13] years, men: 52%) were recruited. A total of 19 patients had measurements of ETT migration at 24 hours by the 3 methodologies used in this study. The mean (SD) of the ETT migration at 24 hours was + 0.04 (1.2), -0.42 (0.7) and + 0.34 (1.81) cm when measured by portable CXR, ETT distance at the teeth and AirWave device, respectively. Bland-Altman analysis of tube migration at 24 hours comparing the AirWave with CXR readings showed a bias of 0.1 cm with 95% limit of agreement of − 3.8 and + 4.3 cm. Comparison of tube migration at 24 hours determined by AirWave with ETT distance at the lips revealed a bias of − 0.4 with 95% limit of agreement − 3.7 to + 3 cm, similar to the values observed between CXR and ETT distance at the lips (bias of − 0.3 cm, 95% limit of agreement of − 3.4 to + 2.8 cm). Factors associated with ETT migration at 24 hours were ETT size and initial measurement from ETT tip to carina by portable CXR. AirWave detected in eight patients some degree of ETT obstruction (30% ± 9.6%) that resolved with prompt ETT catheter suction.

Conclusions

The AirWave may provide useful information regarding ETT migration and obstruction in real time.     

Preventing Urethral Obstruction Using the 6-Point Fixation and Weight-Adjusted Spacing Nomogram During Sling Surgery

The aim of the study was to assess the outcome of a 6-point fixation technique and weight-adjusted spacing nomogram for performing sling surgery. Fifty women with stress incontinence underwent implantation of a Gore-tex patch sling. Sling tension was gauged based on the patient’s body weight. Postoperative analysis was performed using cough stress tests, Q-tip tests, pelvic examinations and patient satisfaction questionnaires. Urodynamics were performed for women with persistent incontinence. Mean follow-up was 24 months (range 7–28). Mean age was 58 years (range 29–87). Stress incontinence was cured in 47/50 patients (94.0%). De novo urge incontinence occurred in 1/23 (4.3%) patients. Mean time to suprapubic tube removal was 7 days (range 1–21). No patients experienced urinary retention or urethral obstruction. Mean satisfaction score was 9/10 (range 7–10) and all patients said they would undergo surgery again. The combination of a 6-point fixation technique and a weight-adjusted spacing nomogram allows for a successful sling outcome without obstruction.