RESUMO
OBJECTIVES: To review our experience with enterovesical fistulas in order to determine the most accurate diagnostic studies and most effective method of treatment. METHODS: A retrospective record review of 76 patients who were diagnosed and treated for enterovesical fistulas over a 12-year period was performed. Data collection focused on presenting symptoms, urinary disease process, diagnostic studies, and methods of management. RESULTS: Diverticular disease was the primary etiologic factor in the majority of patients (59%), with colonic malignancy, granulomatous bowel disease, and radiation therapy accounting for the majority of the remainder. Cystoscopy (60%) and cystography (44%) were the most sensitive diagnostic studies. There was no statistical difference in the complication rate between groups treated with single or multistage repair. CONCLUSIONS: One-stage repair of enterovesical fistulas can be safely performed when the cause is diverticular or granulomatous bowel disease. Staged repairs may be more judicious in patients with large intervening pelvic abscesses or those in whom advanced malignancy or radiation changes are present.
Assuntos
Fístula Intestinal/diagnóstico , Fístula Intestinal/cirurgia , Fístula da Bexiga Urinária/diagnóstico , Fístula da Bexiga Urinária/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Cistoscopia , Feminino , Seguimentos , Humanos , Fístula Intestinal/etiologia , Intestino Grosso , Intestino Delgado , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/cirurgia , Valor Preditivo dos Testes , Reoperação , Estudos Retrospectivos , Procedimentos Cirúrgicos Operatórios/métodos , Fatores de Tempo , Fístula da Bexiga Urinária/etiologiaAssuntos
Neoplasias da Mama/genética , Proteínas de Transporte/genética , Expressão Gênica , Glicoproteínas de Membrana/genética , Membro 1 da Subfamília B de Cassetes de Ligação de ATP , Antineoplásicos/uso terapêutico , Mama/metabolismo , Neoplasias da Mama/tratamento farmacológico , Feminino , Humanos , RNA Mensageiro/análise , RNA Mensageiro/genéticaRESUMO
We report 2 cases of nephrolithiasis owing to hematin stones. One patient had no apparent explanation for this finding, while the other was receiving warfarin anticoagulation for a prosthetic aortic valve. The chemical nature, etiology and clinical features of hematin calculi are discussed.
Assuntos
Hemina/análise , Cálculos Renais/química , Idoso , Feminino , Humanos , Cálculos Renais/epidemiologia , Pessoa de Meia-Idade , Fatores de Risco , Varfarina/uso terapêuticoRESUMO
OBJECTIVE: To assess the relationship of prostate-specific antigen (PSA) obtained under optimal conditions with the presence or absence of organ-confined prostate cancer following radical prostatectomy. PATIENTS AND METHODS: The medical records of 300 consecutive patients who underwent radical retropubic prostatectomy were retrospectively reviewed. Ninety-three patients were excluded who had a pre-operative PSA level potentially altered by various factors (prostate infection, manipulation or instrumentation). RESULTS: A pre-operative PSA value < 4 ng/mL accurately predicted pathologically confined disease in 42 of 51 patients (82%) which contrasted with extracapsular disease in 74 of 84 patients (88%) who had a PSA value > 10 ng/mL. One of the 53 patients with a PSA > 15 ng/mL had organ-confined disease at surgery. CONCLUSION: These data demonstrate that optimal serum PSA values correlate well with pathological stage.