ABSTRACT
OBJECTIVE: To assess the outcomes of holmium laser enucleation of the prostate (HoLEP) at the extremes of the size spectrum, comparing whether the results are consistent for very large and small prostates. METHODS: A retrospective review of 402 patient charts was conducted to compare the outcomes of HoLEP in patients with prostate size ≤40 g (group 1), 41-200 g (group 2), and >200 g (group 3). Various preoperative, perioperative, and postoperative variables were collected. RESULTS: HoLEP showed comparable voiding outcomes among all 3 groups, although patients with small prostates had a higher International Prostate Symptom Score during follow-up (P = .022). We noted a higher rate of perioperative blood transfusion in patients with very large prostates (P = .019) and a higher rate of transient acute urinary retention (AUR) in group 1 when compared to group 3 (P = .048). Patients with smaller prostates had a higher rate of bladder neck stenosis and urethral strictures, but the differences were not found to be statistically significant. The incidence of other complications, length of hospital stay, and catheterization duration did not differ significantly among the groups. CONCLUSION: HoLEP has consistent and safe outcomes across a wide range of prostate sizes. Although, the risk of blood transfusion is higher in patients with very large prostates and the risk of transient AUR is greater in patients with small glands, the overall efficacy and safety of HoLEP are not significantly influenced by prostate size.
Subject(s)
Laser Therapy , Lasers, Solid-State , Prostatic Hyperplasia , Transurethral Resection of Prostate , Male , Humans , Prostate/surgery , Prostatic Hyperplasia/complications , Prostatic Hyperplasia/surgery , Prostatic Hyperplasia/diagnosis , Lasers, Solid-State/therapeutic use , Holmium , Treatment Outcome , Transurethral Resection of Prostate/methods , Laser Therapy/adverse effects , Laser Therapy/methods , Retrospective StudiesABSTRACT
Patient blood management (PBM) strategies aim to maintain hemoglobin concentration, optimize hemostasis, and minimize blood loss to improve patient outcomes. Because postpartum hemorrhage (PPH) is a leading cause of maternal mortality and blood product utilization, PBM principles can be applied in its therapeutic approach. First, pre-operative identification of risk factors for PPH and identification of peri-delivery anemia should be conducted. Iron supplementation should be used to optimize hemoglobin concentration before delivery; it can also be used to treat anemia in the postpartum period after severe PPH. Both acute normovolemic hemodilution and intraoperative cell salvage can be effective techniques to reduce allogeneic blood transfusion during or after surgical procedures. Furthermore, these strategies appear to be safe when used in the pregnant population.
Subject(s)
Anemia , Postpartum Hemorrhage , Pregnancy , Female , Humans , Postpartum Hemorrhage/diagnosis , Postpartum Hemorrhage/therapy , Blood Transfusion/methods , Anemia/diagnosis , Anemia/therapy , Hemoglobins , Postpartum Period , Blood Loss, Surgical/prevention & controlABSTRACT
PURPOSE OF REVIEW: Limited English proficiency (LEP) impacts patient access to safe and comprehensive care during the antepartum, intrapartum, and postpartum periods. In this review, we explore disparities in care delivery and outcomes that LEP women experience, and discuss the importance of providing language concordant care and using interpretation services appropriately. RECENT FINDINGS: The number of individuals with LEP is steadily increasing in the United States. Pregnant women with LEP suffer disparities in obstetric care and are at risk for postpartum depression, breastfeeding difficulties, and substandard newborn care after neonatal ICU discharge because of insufficient education. Addressing these issues requires the implementation of language concordant care and education, along with the utilization of medically trained interpreters. Although further evidence is needed, the authors support these interventions to improve patient satisfaction, decrease medical errors, and curtail misdiagnoses. SUMMARY: The pregnant woman with limited English proficiency is at risk of receiving suboptimal care and experiencing negative outcomes during the antepartum, intrapartum, and postpartum periods. The use of medically trained interpreters and the provision of language concordant care, through workforce diversification and the creation of forms and educational materials in diverse languages, can improve patient safety, outcomes, and quality of care.
Subject(s)
Labor, Obstetric , Limited English Proficiency , Communication Barriers , Female , Humans , Infant, Newborn , Pregnancy , United StatesABSTRACT
Following the occurrence of a fire at a tire landfill in the surrounding area of Madrid City (Spain), polycyclic aromatic hydrocarbons (PAHs) and trace elements present in soils were analyzed to assess the impact of the fire. The capacity of the soils' clay mineral fraction to reflect this air pollution incident was studied. Fourteen soil samples were collected at different distances under the smoke plume, and they were subjected to high-performance liquid chromatography-photodiode array detection, inductively coupled plasma mass spectrometry and X-ray diffraction analyses. Clay minerals content showed a strong correlation with the pollutants potentially released in the tire fire, acenaphthene, pyrene, benzo(a)pyrene and benzo(a)fluoranthene. Trace metals Zn and Se were related to the proximity of the tire fire without any relationship with clay minerals content. This work suggests the use of natural clay minerals as potential PAHs geo-indicators in response to air pollution, complementary to current air and biological analyses.
Subject(s)
Clay/chemistry , Environmental Monitoring/methods , Fires , Minerals/chemistry , Soil Pollutants/analysis , Accidents , Polycyclic Aromatic Hydrocarbons/analysis , Spain , Trace Elements/analysis , Waste Disposal FacilitiesABSTRACT
OBJECTIVE: Respiratory muscle weakness is a functional repercussion of chronic lung disease (CLD). The objective of this study was to assess the effects of home-based respiratory muscle training (RMT) in children and adolescents with CLD or neuromuscular disease (NMD). METHODS: This was a quasi-experimental study involving children and adolescents with CLD or NMD. Before and after 6 months of home-based RMT, we measured respiratory muscle strength (MIP and MEP), PEF, and peak cough flow (PCF). We made statistical comparisons between the pre-RMT and post-RMT values, as well as evaluating the correlation between the duration and effect of RMT. RESULTS: The study included 29 patients, with a mean age of 12 years (range, 5-17 years), of whom 18 (62.1%) were male. The CLD group comprised 11 patients (37.9%), and the NMD group comprised 18 (62.1%). The mean duration of the RMT was 60 weeks (range, 46-90 weeks) in the CLD group and 39 weeks (range, 24-89 weeks) in the NMD group. In comparison with the pre-RMT values, the post-RMT values for MIP and MEP were significantly higher in both groups, whereas those for PEF and PCF were significantly higher only in the NMD group. We found no correlation between the duration and the effect of RMT. CONCLUSIONS: Home-based RMT appears to be an effective strategy for increasing respiratory muscle strength in children and adolescents with CLD or NMD, although it increased the ability to cough effectively only in those with NMD. .
OBJETIVO: A fraqueza muscular respiratória é uma repercussão funcional da doença pulmonar crônica (DPC). O objetivo deste estudo foi avaliar os efeitos do treinamento muscular respiratório (TMR) domiciliar em crianças e adolescentes com DPC ou doença neuromuscular (DNM). MÉTODOS: Estudo quasi-experimental com crianças e adolescentes com DPC ou DNM. Foram medidos a força muscular respiratória (PEmáx e PImáx) e o pico de fluxo da tosse (PFT) antes e depois de 6 meses de TMR domiciliar. Foram realizadas comparações estatísticas entre valores pré- e pós-TMR e foram avaliadas as correlações entre a duração e o efeito do TMR. RESULTADOS: Foram incluídos no estudo 29 pacientes, com média de idade de 12 anos (variação, 5-17 anos), dos quais 18 (62,1%) eram meninos. O grupo DPC consistiu em 11 pacientes (37,9%) e o grupo DNM, em 18 (62,1%). A média da duração do TMR foi de 60 semanas (variação, 46-90 semanas) no grupo DPC e de 39 semanas (variação, 24-89 semanas) no grupo DNM. Em comparação com os valores pré-TMR, os valores pós-TMR para PImáx e PEmáx foram significativamente maiores nos dois grupos, enquanto aqueles para PFE e PFT foram significativamente maiores apenas no grupo DNM. Não houve correlações entre a duração e o efeito do TMR. CONCLUSÕES: O TMR domiciliar parece ser uma estratégia eficaz para o aumento da força muscular respiratória em crianças e adolescentes com DPC ou DNM, embora aumente efetivamente a capacidade de tosse somente naqueles com DNM. .
Subject(s)
Adolescent , Child , Child, Preschool , Female , Humans , Male , Breathing Exercises , Lung Diseases/physiopathology , Muscle Strength/physiology , Neuromuscular Diseases/physiopathology , Respiratory Muscles/physiology , Airway Resistance/physiology , Chronic Disease , Muscle Stretching Exercises , Muscle Contraction/physiology , Respiratory Function TestsABSTRACT
OBJECTIVE: Respiratory muscle weakness is a functional repercussion of chronic lung disease (CLD). The objective of this study was to assess the effects of home-based respiratory muscle training (RMT) in children and adolescents with CLD or neuromuscular disease (NMD). METHODS: This was a quasi-experimental study involving children and adolescents with CLD or NMD. Before and after 6 months of home-based RMT, we measured respiratory muscle strength (MIP and MEP), PEF, and peak cough flow (PCF). We made statistical comparisons between the pre-RMT and post-RMT values, as well as evaluating the correlation between the duration and effect of RMT. RESULTS: The study included 29 patients, with a mean age of 12 years (range, 5-17 years), of whom 18 (62.1%) were male. The CLD group comprised 11 patients (37.9%), and the NMD group comprised 18 (62.1%). The mean duration of the RMT was 60 weeks (range, 46-90 weeks) in the CLD group and 39 weeks (range, 24-89 weeks) in the NMD group. In comparison with the pre-RMT values, the post-RMT values for MIP and MEP were significantly higher in both groups, whereas those for PEF and PCF were significantly higher only in the NMD group. We found no correlation between the duration and the effect of RMT. CONCLUSIONS: Home-based RMT appears to be an effective strategy for increasing respiratory muscle strength in children and adolescents with CLD or NMD, although it increased the ability to cough effectively only in those with NMD.
OBJETIVO: A fraqueza muscular respiratória é uma repercussão funcional da doença pulmonar crônica (DPC). O objetivo deste estudo foi avaliar os efeitos do treinamento muscular respiratório (TMR) domiciliar em crianças e adolescentes com DPC ou doença neuromuscular (DNM). MÉTODOS: Estudo quasi-experimental com crianças e adolescentes com DPC ou DNM. Foram medidos a força muscular respiratória (PEmáx e PImáx) e o pico de fluxo da tosse (PFT) antes e depois de 6 meses de TMR domiciliar. Foram realizadas comparações estatísticas entre valores pré- e pós-TMR e foram avaliadas as correlações entre a duração e o efeito do TMR. RESULTADOS: Foram incluídos no estudo 29 pacientes, com média de idade de 12 anos (variação, 5-17 anos), dos quais 18 (62,1%) eram meninos. O grupo DPC consistiu em 11 pacientes (37,9%) e o grupo DNM, em 18 (62,1%). A média da duração do TMR foi de 60 semanas (variação, 46-90 semanas) no grupo DPC e de 39 semanas (variação, 24-89 semanas) no grupo DNM. Em comparação com os valores pré-TMR, os valores pós-TMR para PImáx e PEmáx foram significativamente maiores nos dois grupos, enquanto aqueles para PFE e PFT foram significativamente maiores apenas no grupo DNM. Não houve correlações entre a duração e o efeito do TMR. CONCLUSÕES: O TMR domiciliar parece ser uma estratégia eficaz para o aumento da força muscular respiratória em crianças e adolescentes com DPC ou DNM, embora aumente efetivamente a capacidade de tosse somente naqueles com DNM.
Subject(s)
Breathing Exercises , Lung Diseases/physiopathology , Muscle Strength/physiology , Neuromuscular Diseases/physiopathology , Respiratory Muscles/physiology , Adolescent , Airway Resistance/physiology , Child , Child, Preschool , Chronic Disease , Female , Humans , Male , Muscle Contraction/physiology , Muscle Stretching Exercises , Respiratory Function TestsABSTRACT
Se brindaron elementos de la evolución en Cuba de los estudios de disolución, biodisponibilidad y bioequivalencia de respaldo para nuevos productos farmacéuticos. Se describió el entorno farmacéutico, clínico y sanitario del país que ha propiciado un empleo y fabricación de productos genéricos y la creación de adecuadas condiciones para la investigación y desarrollo de los medicamentos. Fueron relacionados los antecedentes de los estudios de equivalencia terapéutica en productos nacionales referidos a estudios in vitro e in vivo. Se citó la reglamentación básica vigente para establecer la intercambiabilidad terapéutica de los medicamentos en la práctica clínica, que fija las pautas de estos estudios en su condición de ensayos más empleados para demostrarla y se brindaron ejemplos de formulaciones investigadas. Fueron caracterizados los parámetros y condiciones generales bajo las cuales se han realizado estudios de bioequivalencia recientes en una de las instituciones especializadas del país. Se concluyó sobre el satisfactorio nivel alcanzado(AU)
Subject(s)
Drugs, Generic/standards , Drug Industry/standards , Quality of Homeopathic Remedies , International Nonproprietary Names for Pharmaceutical Substances , Therapeutic EquivalencyABSTRACT
Se brindaron elementos de la evolución en Cuba de los estudios de disolución, biodisponibilidad y bioequivalencia de respaldo para nuevos productos farmacéuticos. Se describió el entorno farmacéutico, clínico y sanitario del país que ha propiciado un empleo y fabricación de productos genéricos y la creación de adecuadas condiciones para la investigación y desarrollo de los medicamentos. Fueron relacionados los antecedentes de los estudios de equivalencia terapéutica en productos nacionales referidos a estudios in vitro e in vivo. Se citó la reglamentación básica vigente para establecer la intercambiabilidad terapéutica de los medicamentos en la práctica clínica, que fija las pautas de estos estudios en su condición de ensayos más empleados para demostrarla y se brindaron ejemplos de formulaciones investigadas. Fueron caracterizados los parámetros y condiciones generales bajo las cuales se han realizado estudios de bioequivalencia recientes en una de las instituciones especializadas del país. Se concluyó sobre el satisfactorio nivel alcanzado
Subject(s)
International Nonproprietary Names for Pharmaceutical Substances , Drug Industry/standards , Drugs, Generic/standards , Quality of Homeopathic Remedies , Therapeutic EquivalencyABSTRACT
Hydatidosis is and endemic disease in the south of Chile, especially in Region IX where remain rates of high prevalence. Cholangiohydatidosis is and infrequent complication of liver hydatidosis. The objetive of this paper is to describe clinical features of a series of patients with cholangiohydatidosis. Series of cases of cholangiohydatidosis treated consecutively and the corresponding follow-up is reported. Clinical, laboratory and images characteristics are described. Descriptive statistic was used and its incidence was calculated. In the studied period, 13 patients with cholangiohydatidosis were recruited, 9 men (69,2 percent) and 4 women (30,7 percent). Observed laboratory abnormalities were an increment of leukocytes in 8 patients (61,5 percent) and hepatic cholestasis with hepatocyte signs of cytolysis in 11 patients (84,6 percent). Choledocus diameter average measured by ultrasonography was 24,7 mm. All the patients had at least one liver cyst whose diameter average was of 12,1 cm. At surgery, evidence of biliary communications was detected in all patients and choledocoduodenal anastomoses in one case (7,7 percent). With a mean follow-up of 38,7 months morbility was 23 percent and mortality 7,7 percent. Accumulated incidence of this entity was of 0,07 cases in 5 years. Cholangiohydatidosis is an uncommon complication of liver hydatidosis that presents considerable morbidity and mortality rates
Subject(s)
Humans , Male , Female , Cholangitis , Cholestasis , Echinococcosis, Hepatic/complications , Cholangitis , Choledochostomy , Cholestasis , Clinical Evolution , Cystectomy , Residence Characteristics , Follow-Up StudiesABSTRACT
Objetivo: La interleuquina 2 (IL-2) es un potente estimulador de la respuesta inmune que provoca regresión tumoral en pacientes oncológicos. Sin embargo, como contrapartida, la IL-2 puede inducir sensibilización a los medios de contraste yodados (MCI), fenómeno descrito con poca frecuencia en la bibliografía. En este trabajo describimos el incremento de reacciones adversas a los MCI en nuestros pacientes tratados con IL-2 y planteamos actitudes de manejo específicas ante esta situación.Material y método: Se realizó un análisis retrospectivo de 712 pacientes oncológicos (168 tratados con IL-2 y un grupo control de 544 sin este tratamiento) estudiados mediante tomografía computarizada (TC) con contraste intravenoso (administración de 80-160 ml de MCI no iónico a través de un inyector). Ningún paciente presentaba antecedentes alérgicos al inicio del tratamiento.Resultados: La incidencia de reacciones adversas a los MCI entre nuestros pacientes tratados con IL-2 fue 7,14 por ciento (de 168 pacientes). Esta cifra difiere significativamente (p < 0,001) de la del grupo control (1,28 por ciento de 544 pacientes). Así los pacientes tratados con IL-2 presentan un riesgo relativo 5,6 veces mayor (IC 95 por ciento; 2,2-13,9) de padecer una reacción adversa con respecto a los no tratados. La mayor parte de estas reacciones adversas en los pacientes tratados con IL-2 fueron leves y evolucionaron favorablemente sin tratamiento en 11 pacientes.Un paciente requirió hidratación intravenosa forzada por hipotensión.Conclusiones: La IL-2 (potente estimulador del sistema inmune) debe considerarse factor de riesgo para el desarrollo de reacciones de hipersensibilidad u otras reacciones adversas a los MCI.El conocimiento de este hecho debe ser tenido en cuenta en las decisiones y en las estrategias de seguimiento del paciente en el Servicio de Radiología (AU)
Subject(s)
Adult , Aged , Female , Male , Middle Aged , Humans , Contrast Media/adverse effects , Iodine Compounds/adverse effects , Iodine Compounds/administration & dosage , Iodine Compounds , Tomography, X-Ray Computed/methods , Interleukin-2/therapeutic use , Interleukin-2/administration & dosage , Interleukin-2/pharmacology , Iodine/adverse effects , Iodine , Drug Hypersensitivity/complications , Drug Hypersensitivity , Neoplasms/complications , Neoplasms , Retrospective Studies , Immunophenotyping , Adjuvants, Immunologic/administration & dosage , Adjuvants, Immunologic/therapeutic use , Adjuvants, Immunologic/adverse effectsABSTRACT
El trasplante hepático construye una alternativa terapéutica de alta eficacia en pacientes con hepatopatías agudas o crónicas irreversibles. Es fundamental efectuar una rigurosa selección de los candidatos; ésta permite evaluar el tipo de enfermedad y su momento evolutivo y, detectar contraindicaciones que disminuyan su eficacia. El objetivo de este trabajo es conocer el número de eventuales candidatos a TH por año en el Hospital Regional de Temuco, sus características clínicas y demográficas. Se efectúa un estudio descriptivo y retrospectivo de los pacientes que ingresaron a los Servicios de Medicina Interna y Cirugía del Hospital Regional de Temuco, para estudio y/o tratamiento de alguna enfermedad hepatobiliar grave e irreversible, aguda o crónica, entre enero de 1993 y diciembre de 1994. Estos individuos fueron considerados como potenciales candidatos a trasplante hepático, y tras la revisión de sus historias clínicas, se efectuá un análisis del diagnóstico etiológico, características clínicas, tiempo de evolución, número de hospitalizaciones, y la evolución en el tiempo, para determinar su real condición de candidatos a trasplante hepático. La indicación y el momento evolutivo adecuado para el trasplante se basó en criterios internacionalmente aceptados. Se intentó conocer el destino y supervivencia de estos individuos, para lo cual se recurrió a las oficinas del Registro Civil e Identificación. De los pacientes inicialmente valorados, se descartaron 36 (58 por ciento), por carecer de indicación precisa de trasplante; por lo tanto, la serie final a estudiar quedó conformada por 26 pacientes, 18 hombres (69 por ciento) y 8 mujeres (31 por ciento), con una edad promedio de 46 años. La etiología que determinó la indicación de trasplante hepático fue: dato hepático hepatocelular (73 por ciento), colestásico (8 por ciento); insuficiencia hepática aguda (15 por ciento); y hepatocarcinoma (4 por ciento). Se constató que al año de seguimiento sólo 7 pacientes (32 por ciento) se encontraban vivos; y a los 2 años, sólo 2 (9 por ciento) persistían vivos
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Liver Diseases/diagnosis , Patient Selection , Liver Transplantation , Clinical Evolution , Graft Survival , Hospitalization , Hospitals, State , Liver Diseases/etiologyABSTRACT
La hidatidosis constituye una zoonosis endémica en la IX Región de Chile.Esto, trae como consecuencia que se produzcan hechos considerados como rarezas dentro de la práctica clínica como la asociación de hidatidosis y embarazo. Se presentan 3 pacientes embarazadas portadoras de hidatidosis abdominal, intervenidas quirúrgicamente en nuestro servicio durante el período abril-diciembre de 1996. El diagnóstico fue confirmado mediante ecotomografía abdominal y determinación de inmunoglobulinas específicas. Se les sometió a cirugía a las 26, 38 y 14 semanas respectivamente. Todas las pacientes presentaban quistes fértiles. La evolución postoperatoria fue satisfactoria. En los dos primeros casos la interrupción del embarazo fue electiva mediante operación cesárea, con recién nacidos de término sin complicaciones. Ambas pacientes recibieron quimioterapia complementaria. El último caso, con una evolución postoperatoria correcta, cursa su embarazo en forma fisiológica. Las placentas sometidas a estudio histopatológico no demostraron evidencias de infestación con equinoccocus granulosus. Se presenta una serie de casos consecutivos de embarazadas con EH tratadas en forma agresiva. Creemos que esta conducta es plenamente justificada, dado los graves riesgos implícitos para el binomio madre-hijo