[The dynamic monitoring of gastric residual volume by ultrasound was used to guide the early nutritional treatment of patients with severe mechanical ventilation to gradually achieve the standard].

OBJECTIVE: To explore the application value of dynamic monitoring of gastric residual volume (GRV) in achieving different target energy in severe mechanical ventilation patients. METHODS: A prospective randomized controlled study was conducted. Forty-two patients with mechanical ventilation admitted to the department of critical care medicine of General Hospital of Ningxia Medical University from July to December 2022 were enrolled. According to the random number table method, patients were divided into GRV guided enteral nutrition by traditional gastric juice pumpback method (control group, 22 patients) and GRV guided enteral nutrition by bedside ultrasound (test group, 20 patients). General data were collected from both groups, and clinical indicators such as hypersensitive C-reactive protein (hs-CRP), interleukin-6 (IL-6), neutrophil percentage (Neut%), procalcitonin (PCT), absolute lymphocytes (LYM), prealbumin (PA), and retinol-binding protein (RBP) were dynamically observed. Inflammation, infection, immunity, nutritional indicators, and the incidence of reflux/aspiration, ventilator-associated pneumonia (VAP) were compared between the two groups, and further compared the proportion of patients with respectively to reach the target energy 25%, 50%, and 70% on days 1, 3, and 5 of initiated enteral nutrition. RESULTS: (1) There were no significant differences in gender, age, body mass index (BMI), duration of mechanical ventilation, and acute physiology and chronic health evaluation II (APACHE II), sequential organ failure assessment (SOFA), severe nutritional risk score (NUTRIC) at admission between the two groups, indicating comparability. (2) On day 1 of initiated enteral nutrition, there were no significant differences in infection, inflammation, immunity and nutrition indicators between the two groups. On day 3 of initiated enteral nutrition, the hs-CRP in the test group was lower than that control group, LYM and PA were higher than those control group [hs-CRP (mg/L): 129.60±75.18 vs. 185.20±63.74, LYM: 1.00±0.84 vs. 0.60±0.41, PA (mg/L): 27.30±3.66 vs. 22.30±2.55, all P < 0.05]. On day 5 of initiated enteral nutrition, the hs-CRP, Neut%, PCT in the test group were lower than those control group, LYM and PA were higher than those control group [hs-CRP (mg/L): 101.70±54.32 vs. 148.40±36.35, Neut%: (85.50±7.66)% vs. (92.90±6.01)%, PCT (µg/L): 0.7 (0.3, 2.7) vs. 3.6 (1.2, 7.5), LYM: 1.00±0.68 vs. 0.50±0.38, PA (mg/L): 27.10±4.57 vs. 20.80 ± 3.51, all P < 0.05]. There were no significantly differences in IL-6 and RBP between the two groups at different time points. (3) The proportion of 50% and 70% of achieved target energy in the test group on day 3, day 5 of initiated enteral nutrition were higher than those of the control group (70.0% vs. 36.4%, 70.0% vs. 36.4%, both P < 0.05). (4) The incidence of reflux/aspiration and VAP in the test group on day 5 of initiated enteral nutrition were significantly lower than those control group (incidence of reflux/aspiration: 5.0% vs. 28.6%, incidence of VAP: 10.0% vs. 36.4%, both P < 0.05). CONCLUSIONS: Dynamic monitoring of GRV by bedside ultrasound can accurately improve the proportion of 50% of achieved target energy on day 3 and 75% on day 5 in severe mechanical ventilation patients, improve the patient's inflammation, immune and nutritional status, and can prevent the occurrence of reflux/aspiration and VAP.

A guide to enteral nutrition in intensive care units: 10 expert tips for the daily practice.

The preferential use of the oral/enteral route in critically ill patients over gut rest is uniformly recommended and applied. This article provides practical guidance on enteral nutrition in compliance with recent American and European guidelines. Low-dose enteral nutrition can be safely started within 48 h after admission, even during treatment with small or moderate doses of vasopressor agents. A percutaneous access should be used when enteral nutrition is anticipated for ≥ 4 weeks. Energy delivery should not be calculated to match energy expenditure before day 4-7, and the use of energy-dense formulas can be restricted to cases of inability to tolerate full-volume isocaloric enteral nutrition or to patients who require fluid restriction. Low-dose protein (max 0.8 g/kg/day) can be provided during the early phase of critical illness, while a protein target of > 1.2 g/kg/day could be considered during the rehabilitation phase. The occurrence of refeeding syndrome should be assessed by daily measurement of plasma phosphate, and a phosphate drop of 30% should be managed by reduction of enteral feeding rate and high-dose thiamine. Vomiting and increased gastric residual volume may indicate gastric intolerance, while sudden abdominal pain, distension, gastrointestinal paralysis, or rising abdominal pressure may indicate lower gastrointestinal intolerance.

Effects of Osteopathic Manual Therapy on Hyperinflation in Patients with Chronic Obstructive Pulmonary Disease: A Randomized Cross-Over Study.

Osteopathic manual therapy (OMT) may reduce hyperinflation in patients with chronic obstructive pulmonary disease (COPD) by improving breathing mechanics. The aim of the study was to evaluate the immediate effects of OMT on hyperinflation in stable COPD patients with forced expired volume in 1 s (FEV1) <50% predicted. Nineteen COPD patients of the median age 68 (IQR 63-72) years and the median FEV1 39.8 (IQR 33.4-46.6) % predicted were enrolled into the study. For the first session, patients were randomly assigned to either OMT or sham therapy. During the second session, the two groups of patients were crossed over. Pulmonary function and dyspnea were compared before and after both procedures. Neither pulmonary function nor dyspnea differed significantly before and after OMT or sham procedures. However, 36.7% and 47.4% patients achieved the minimally important difference for residual volume (RV) reduction after both OMT and sham therapy, respectively. Responders to OMT had a greater median (IQR) baseline sense of dyspnea compared to non-responders, assessed on a visual analog scale, of 7.0 (4.5-7.0) vs. 3.0 (0.0-5.0), p = 0.040, respectively. Although OMT did not have an immediate effect on hyperinflation or dyspnea, a subgroup experienced a reduction in RV following OMT and sham therapy. Future studies are needed to identify the characteristics of responders.

Evaluation of bronchoscopic lung volume reduction coil treatment results in patients with severe emphysema.

INTRODUCTION: Bronchoscopic lung volume reduction coil (BLVR-C) implantation is an alternative therapeutic approach that can be applied together with medical treatment for patients with severe emphysema. BLVR-C is both easier and safer in terms of complications than volume reduction surgery. This study aimed to evaluate medium-term outcomes following BLVR-C treatment. METHODS: Forty patients who underwent BLVR-C between September 2013 and March 2014 were reviewed retrospectively. We compared changes between the baseline and 6-month post-procedural results with respect to pulmonary function tests, a 6-min walk test (6MWT), chronic obstructive pulmonary disease (COPD) assessment test (CAT), St. George's Respiratory Questionnaire (SGRQ), and pulmonary artery pressure (PAP) and arterial blood gas analyses. Secondary outcomes included procedure-related and follow-up complications. RESULTS: An average of 9.5 (range: 5-11) coils were placed per lung in an average procedural duration of 20.8 ± 7.0 min (range: 9-45) min. Six months after BLVR-C treatment, significant improvements were observed in patients' pulmonary function tests and quality of life. Changes were observed in the forced exhalation volume in 1 s (+150 mL), residual volume (-14.5%), 6MWT (+48 m), SGRQ (-10.5) and CAT Score (-7.5). Changes in the PAP and partial pressure of carbon dioxide values were not significant, and pneumothorax did not occur. In a 6-month follow-up, 11 cases of COPD exacerbation (41.4%), 7 cases of pneumonia (16.9%) and 1 death (2%) occurred. Treatment in 1 case was postponed because of hypotension and bradycardia during the process. CONCLUSION: BLVR-C treatment appears to be effective over the medium-term and safe for patients with severe emphysema.

An Analytical Comparison of Short-term Effectiveness and Safety Between Thulium:YAG Laser Vaporesection of the Prostate and Bipolar Transurethral Resection of the Prostate in Patients With Benign Prostatic Hyperplasia

PURPOSE: In recent years, laser surgery has been widely used to treat benign prostatic hyperplasia (BPH). A thulium:yttrium-aluminium-garnet (Tm:YAG) laser was recently introduced for BPH surgery. We compared the effectiveness and safety of Tm:YAG laser vaporesection of the prostate (ThuVaRP) with that of bipolar transurethral resection of the prostate (TURP). MATERIALS AND METHODS: From January 2010 to December 2012, 86 patients underwent surgical treatment for symptomatic BPH by a single surgeon. We retrospectively analyzed and compared the medical records of 43 patients who underwent ThuVaRP and 43 patients who underwent bipolar TURP. All patients were assessed by using the International Prostate Symptom Score, transrectal ultrasonography, the serum prostate-specific antigen (PSA) level, uroflowmetry, and postvoid residual volume before and 1 month after surgery. All complications were compared between the two groups. RESULTS: ThuVaRP was superior to TURP in catheterization time (p50 g), operation time was much longer with ThuVaRP. One month after surgery, the decrease in PSA was greater (p=0.045) with ThuVaRP than with TURP, and the increase in maximal urine flow rate was greater (p<0.001) with ThuVaRP than with TURP. The postoperative complication transient urinary incontinence was significantly different between the ThuVaRP group (nine cases, 20.9%) and the TURP group (two cases, 4.7%). Other complications were comparable between groups. CONCLUSIONS: The effectiveness and safety of ThuVaRP and TURP were comparable. ThuVaRP is a promising alternative surgical technique to TURP for BPH.

Treatment of severe advanced emphysema with volume reduction using lung sealant: a case report of 2 patients.

BACKGROUND: Emphysema is a progressive and irreversible disease for which there is no cure to date. The patients experience debilitating shortness of breath with repetitive exacerbations and poor quality of daily life. At present, patients with severe emphysema have limited treatment options. Endoscopic lung-volume reduction with valve implantation or using lung sealant is a treatment option for patients with severe emphysema. By our patients, we detected collateral channels, which allow airflow into the target lobe and prevent atelectasis and significant lung-volume reduction. Thus, we decided to treat the advanced emphysema of our patients with endoscopic volume reduction using lung sealant (AeriSeal). Lung-volume reduction surgery reduces hyperinflation and improves lung function by removal of emphysematous lung tissue. However, lung-volume reduction surgery is also associated with significant short-term morbidity and mortality. Results from recently published Endobronchial Valve for Emphysema Palliation Trail (VENT) and Exhale Airway Stents for Emphysema (EASE) trial showed that treatment was substantially less effective and did not consistently reduce hyperinflation or improve lung function mostly likely due to collateral ventilation present in majority of patients. There is a volume reduction therapy in case of detection of collateral flow; use of a lung sealant is a possible alternative. METHODS: A novel endoscopic tissue sealant (AeriSeal; Aeris Therapeutics, Woburn, MA) is a liquid foam sealant that collapses hyperinflated lung areas destroyed by emphysema. The foam of lung sealant AeriSeal is instilled into the peripheral airways and alveoli where it polymerizes and functions as tissue glue, forming a film of material on the lung surface that seals the target region to cause durable absorption atelectasis. RESULTS: Two patients with advanced emphysema and hyperinflation underwent endoscopic volume reduction with endoscopic tissue sealant (AeriSeal); collateral flow was confirmed by using the Chartis System. Both patients experienced transient fever, malaise, chest discomfort, and shortness of breath for about 3 days after the procedure. Over a period of 8 and 12 weeks, the air within the sealed region was absorbed and the treated area showed atelectasis on computed tomography scan. The follow-up evaluations of those 2 patients showed improved lung function (increased FEV1, and a reduction of TLC and RV) with improved quality of life of both patients. CONCLUSIONS: Correlation and comparisons between changes in primary and secondary outcome measures in the lung function parameters and 6-minute walking test before and after the application of AeriSealant revealed significant reduction of hyperinflation and improvement both in the flow rates and physical capacity of our patients.

Effects of circuit residual volume salvage reinfusion on the postoperative clinical outcome for pediatric patients undergoing cardiac surgery.

This study aimed to evaluate the effects of washed cardiopulmonary (CPB) circuit residual blood reinfusion on the postoperative clinical outcome for pediatric patients undergoing cardiac surgery. A total of 309 consecutive Chinese cardiac patients receiving CPB between October 2010 and April 2011 were prospectively analyzed. For 217 patients, CPB circuit residual blood was reinfused after the cell-saving procedure [cell-salvage group (CS)]. The remaining 92 patients were directly transfused with allogenic red blood cells (RBCs) after their operation [control group (CON)]. Assessment included perioperative transfusion of RBCs, postoperative hematocrit (HCT), chest tube drainage during the first 24 h after the operation, intrahospital mortality, respiratory morbidity, and renal dysfunction. The two groups were well matched in terms of demographics, CPB data, and complexity of surgical procedure. The patients in the CS group had a significantly higher HCT level postoperatively (p = 0.018) and a less allogenic RBCs transfusion (p = 0.000). The two groups did not differ in terms of chest tube drainage during the first 24 h postoperatively, intrahospital mortality, or respiratory morbidity. The incidence of serum creatinine (≥ 2-folds) during the first 72 h after the operation was significantly lower in the CS group (2.3 %) than in the CON group (8.7 %) (p = 0.010). Reinfusion of washed CPB circuit residual blood significantly raised the postoperative HCT level, reduced the allogeneic blood transfusion, decreased the incidence of early postoperative renal dysfunction, and did not increase the chest tube drainage after the operation in pediatric cardiac surgery.

Application of the Modified Clavien Classification System to 120W Greenlight High-Performance System Photoselective Vaporization of the Prostate for Benign Prostatic Hyperplasia: Is It Useful for Less-Invasive Procedures?

PURPOSE: To evaluate the accuracy and applicability of the modified Clavien classification system (CCS) in evaluating complications following photoselective vaporization of the prostate by use of the 120W GreenLight high-performance system (HPS-PVP). MATERIALS AND METHODS: The medical records of 342 men who underwent HPS-PVP were retrospectively analyzed. Patients were older than 40 years and had a prostate volume >30 mL and an International Prostate Symptom Score (IPSS) > or =8. Patients with prostatic malignancy, neurogenic bladder, urethral stricture, large postvoid residual volume (>250 mL), previous prostatic surgery, or urinary tract infection were excluded. All operations were done by a single surgeon, and patients were followed up for uroflowmetry and IPSS postoperatively. All complications were recorded and classified according to the modified CCS, and methods of management were also recorded. RESULTS: The patients' mean age was 71.6+/-7.3 years; mean prostate volume was 50.0+/-17.0 mL, and 95 cases (27.7%) had volumes greater than 70 mL. The mean total IPSS was 21.7+/-7.9 preoperatively and 12.3+/-8.1 at the first month postoperatively. A total of 59 patients (17.3%) experienced postoperative complications until the first month after the surgery. Among them, 49 patients (14.3%) showed grade I complications, 9 patients (2.6%) showed grade II complications, and 1 patient (0.3%) showed a grade IIIb complication. No patients had complications graded higher than IIIb. CONCLUSIONS: Although the modified CCS is a useful tool for communication among clinicians in allowing comparison of surgical outcomes, this classification should be revised to gain higher accuracy and applicability in the evaluation of postoperative complications of HPS-PVP.

Osteopathic manipulative treatment effectiveness in severe chronic obstructive pulmonary disease: a pilot study.

OBJECTIVES: Few and contrastingly data are available about use of osteopathic manipulative treatment (OMT) in patients with chronic obstructive pulmonary disease (COPD). DESIGN: Comparing the effects of the combination of pulmonary rehabilitation and OMT compared with pulmonary rehabilitation (PR) in patients with severely impaired COPD. SETTING: Rehabilitative pulmonary department. INTERVENTIONS: Patients underwent exercise training, OMT, educational support and nutritional and psychological counselling. MAIN OUTCOMES MEASURES: Exercise capacity through 6 min walk test (6MWT--primary outcome) and pulmonary function test (secondary outcomes) were evaluated at the beginning and at the end of the training. Patients were randomly assigned to receive PR+soft manipulation (G1) or OMT+PR (G2) for 5 days/week for 4 weeks. RESULTS: 20 stable COPD patients (5 female--mean age, 63.8±5.1 years; FEV1 26.9±6.3% of predicted) referred for in-patient pulmonary rehabilitation were evaluated. Respect to the baseline, 6 MWT statistically improved in both group. In particular, G2 group gained 72.5±7.5 m (p=0.01) and G1 group 23.7±9.7 m. Between group comparison showed a difference of 48.8 m (95% CI: 17 to 80.6 m, p=0.04). Moreover, in G2 group we showed a decrease in residual volume (RV--from 4.4±1.5 l to 3.9±1.5 l, p=0.05). Between group comparison showed an important difference (-0.44 l; 95% CI: -0.26 to -0.62 l, p=0.001). Furthermore, only in G2 group we showed an increase in FEV1. CONCLUSIONS: This study suggests that OMT+PR may improve exercise capacity and reduce RV in severely impaired COPD patients with respect to PR alone.

Can 80 W KTP Laser Vaporization Effectively Relieve the Obstruction in Benign Prostatic Hyperplasia?: A Nonrandomized Trial

PURPOSE: There is little data evaluating the changes of severity of bladder outlet obstruction after 80 W-potassium-titanyl-phosphate (KTP) photoselective laser vaporization prostatectomy (PVP) by pressure-flow study. We evaluated the efficacy of PVP to relieve the obstruction in benign prostate hyperplasia (BPH) compared with transurethral resection of the prostate (TURP). MATERIALS AND METHODS: This is a prospective, non-randomized single center study. The inclusion criteria were as follows: Men suffering from lower urinary tract symptoms (LUTS) secondary to BPH, age > or =50 years, International Prostatic Symptom Score (IPSS) > or =13, maximum flow rate (Qmax) or =40 was decreased from 64% to 4% in the PVP group and from 86% to 14% in the TURP group. CONCLUSIONS: PVP could reduce the prostate volume effectively and relieve bladder outlet obstruction similar to TURP by the 6-month follow up in men with BPH.

Changes in Surgical Strategy for Patients with Benign Prostatic Hyperplasia: 12-Year Single-Center Experience

PURPOSE: The purpose of this study was to evaluate the annual changes in prostate variables and style of surgical treatment of patients with benign prostatic hyperplasia (BPH) over the past 12 years. MATERIALS AND METHODS: The subjects were 918 patients (January 1999-November 2010) who were treated by either open prostatectomy or transurethral resection of prostate (TURP). Every year, the performance ratio between open prostatectomy and TURP was evaluated. Before surgery, total and transitional zone volumes of the prostate were measured by transrectal ultrasonography (TRUS). After surgery, resection weight and residual volume of the prostate were measured by TRUS. RESULTS: From 2001 through 2010, the performance ratio of TURP increased greatly from 89% to 97%. During 1999 to 2010, the total volume of the prostate increased from 40.0 cc to 55.0 cc in the TURP group and from 74.1 cc to 116.7 cc in the open prostatectomy group. During 1999 to 2010, the mean resection volume of the TURP group increased from 2.3 cc to 20.1 cc. Also, the mean resection volume of the open prostatectomy group increased from 59.3 cc to 114.3 cc. During 1999 to 2003, the resection time of the TURP group decreased from 72.9 minutes to 43.2 minutes. CONCLUSIONS: During 1999 through 2010, the performance ratio between open prostatectomy vs TURP was high for TURP. The total volume and resection volume of the prostate increased annually, and the resection time decreased annually.

Long-Term Follow-Up Results of Photoselective Vaporization of the Prostate with the 120 W Greenlight HPS Laser for Treatment of Benign Prostatic Hyperplasia

PURPOSE: With the use of 12 months of follow-up data, this study was conducted to evaluate the efficacy of photoselective vaporization of the prostate (PVP) with the 120 W Greenlight high performance system (HPS) laser for the treatment of symptomatic benign prostatic hyperplasia. MATERIALS AND METHODS: Data were collected from 104 patients who were diagnosed with benign prostatic hyperplasia and who underwent PVP with the 120 W Greenlight HPS Laser. Postoperative parameters, including International Prostate Symptom Score (IPSS), quality of life (QoL) score, maximum urinary flow rate (Qmax), and postvoid residual volume (PVR), were assessed and compared with preoperative baseline values. RESULTS: The mean age of the patients was 71.1+/-7.7. The baseline mean prostate-specific antigen level was 3.8+/-2.7 ng/ml, the mean prostate size was 43.9+/-20.6 g, the mean preoperative IPSS was 18.4+/-8.5, the mean QoL score was 4.1+/-1.0, the mean Qmax was 9.9+/-5.5 ml/sec, and the mean PVR was 89.6+/-207.1 ml. During surgery, the mean operation time was 21.8+/-11.3 minutes, the mean lasing time was 16.9+/-10.5 minutes, and the mean total applied energy was 170,068+/-63,181 J. At 1 month, significant improvements were observed in total IPSS (11.5+/-6.7, p<0.05), voiding symptom score (6.1+/-5.4, p<0.05), and QoL score (2.2+/-1.5, p<0.05); however, there were no significant improvements in storage symptom score (4.8+/-3.8, p=0.06), Qmax (12.6+/-10.2, p=0.06), and PVR (40.1+/-30.5, p=0.41). However, 3 months after surgery, all postoperative follow-up parameters showed significant improvements, and the 6- and 12-month data showed sustained improvement of postoperative follow-up parameters. CONCLUSIONS: Significant improvements were observed in subjective and objective voiding parameters, which were evident at 3 months after PVP and were sustained throughout a period of 12 months after PVP.

Glossopharyngeal pistoning for lung insufflation in patients with cervical spinal cord injury.

STUDY DESIGN: A prospective cohort study. OBJECTIVES: To evaluate whether patients with cervical spinal cord injury (CSCI) are able to learn the technique of glossopharyngeal pistoning (breathing) for lung insufflation (GI) and if learned, to evaluate the effects of GI on pulmonary function and chest expansion after 8 weeks. SETTING: Karolinska University Hospital, Stockholm, Sweden. METHODS: Twenty-five patients with CSCI (21 men, four women) with a mean age of 46 years (21-70), from the Stockholm area, were used in this study. The participants performed 10 cycles of GI four times a week, for 8 weeks. Pulmonary function tests made before and after the GI training included vital capacity (VC), expiratory reserve volume (ERV), functional residual capacity (FRC; measured with nitrogen washout), residual volume (RV) and total lung capacity (TLC). Chest expansion was measured before and after training. RESULTS: Five of the twenty-five participants had difficulty in performing GI and were excluded in further analysis. Performing a GI maneuvre increased participants' VC on average by 0.88+/-0.5 l. After 8 weeks of training, the participants had significantly increased their VC 0.23 l, (P<0.001), ERV 0.16 l, (P<0.01), FRC 0.86 l, (P<0.001), RV 0.70 l, (P<0.001) and TLC 0.93 l, (P<0.001). Chest expansion increased at the level of the xiphoid process by 1.2 cm (P<0.001) and at the level of the fourth costae by 0.7 cm (P<0.001). CONCLUSIONS: After using GI for a period of 8 weeks, the participants with CSCI who could perform GI were able to improve pulmonary function and chest expansion.

A Short-term Results on Efficacy and Safety of High Power (80W) KTP (Potassium-Titanyl-Phosphate) Laser Vaporization of the Prostate

PURPOSE: Transurethral resection of the prostate (TURP) is the gold standard treatment for symptomatic benign prostate hyperplasia, but significant complications are associated with this procedure. The aim of this study was to compare the standard TURP with the high power (80W) potassium-titanyl-phosphate laser (KTP/532; Greenlights PVTM laser system; Laserscope, San Jose, USA) to elucidate the efficacy and safety of laser treatment. MATERIALS AND METHODS: 47 consecutive men with symptomatic BPH underwent PVP with an 80W KTP laser. All underwent preoperative and postoperative evaluation, including assessments of international prostate symptom score (IPSS), quality of life (QOL), peak urinary flow rate (Qmax), post-void residual volume (PVR), prostate specific antigen (PSA), and ultrasound prostate volume (PV). Secondary outcome parameters included surgical time, anesthesia, and length of catheterization. Follow-up assessment occurred at 3 and 12 months. RESULTS: Mean age was 68+/-1.1 years. Mean operative time was 58+/-15.4 minutes. Mean catheterization times were 12.3+/-1.6 hours. All efficacy parameters were significantly improved compared to those obtained preoperatively. Complications included hematuria lasting 1 and 3 months (4.2%), transient incontinence (4.2%), transient dysuria (10.6%), frequency (21.2%), urgency (12.7%) and retrograde ejaculation (51%). CONCLUSIONS: These results demonstrate that PVP is safe and efficacious for the treatment of symptomatic BPH. Long follow-up will further validate this new modality as the standard for surgical treatment of BPH.

Comparison of Treatment Outcomes between Photoselective Vaporization and Transurethral Resection of the Prostate for Benign Prostatic Hyperplasia / 대한비뇨기과학회지

PURPOSE: We prospectively compared the treatment outcomes of photoselective vaporization of the prostate (PVP) with those of the gold standard transurethral resection of the prostate (TURP). MATERIALS AND METHODS: Between October 2004 and April 2006, a prospective clinical trial was performed with 131 and 41 patients treated by PVP and TURP, respectively. The efficacy of the two procedures were compared in terms of the International Prostate Symptom Score, quality of life score, peak urinary flow rate, postvoid residual volume, complications and perioperative outcomes at 1, 3, 6 and 12 months following treatment. RESULTS: The baseline characteristics of the two groups were similar. The operative times, catheter indwelling times and hospital stays were significantly shorter in the PVP group. All efficacy parameters were significantly improved in both groups compared to those obtained preoperatively. In addition, the degrees of improvement in the efficacy parameters were similar between the two groups within 12 months. With respect to the prostatic volume reduction, the difference between the pre- and post-PVP volumes during the study period was less than that of the TURP group (p<0.001). There were no differences in the overall complications between the two groups, with the exception of more common bleeding reguiring a transfusion and capsule perforation in the TURP group. CONCLUSIONS: PVP provides excellent intraoperative and postoperative safety, and facilitates immediate relief from obstructive voiding symptoms; similarly to TURP, but has the advantages of shorter hospital stays and catheter indwelling times. The short-term treatment outcomes 12 months after PVP and TURP were comparable, with the exception of the prostatic volume reduction.

Effectiveness and Predictive Value of Responsiveness of the Transurethral Microwave Thermotherapy in the Treatment of Benign Prostatic Hyperplasia / 대한비뇨기과학회지

PURPOSE: To evaluate the clinical efficacy and durability of transurethral microwave thermotherapy (TUMT) in the treatment of benign prostatic hyperplasia, the useful clinical factors were retrospectively investigated. MATERIALS AND METHODS: Between September 1997 and July 2003, 113 patients with symptomatic benign prostatic hyperplasia were treated with TUMT (Prostatron with Prostasoft 2.5). 64 patients were followed up at 3, 6 and 12 months after treatment. Treatment outcomes were evaluated by the International Prostate Symptom Score (IPSS), quality of life (QoL) score and by urodynamic investigation. The patients were divided into responders and non-responders on the basis of their response evaluation criteria. RESULTS: The mean IPSS, QoL score, peak flow rate, mean flow rate and post-voiding residual volume were significantly improved after TUMT (p<0.05). The pretreatment QoL score of the responders was significantly lower than that of the non-responders (p<0.05), and peak and average flow rates of the responders were significantly higher than those of the non-responders (p<0.05). Lower prostate-specific antigen (PSA), lower residual volume and higher energy had trends toward a good prognosis (0.05

Characteristics of Inhalational Induction with Sevoflurane in Adults / 대한마취과학회지

BACKGROUND: If an inhalation agent has an odor that causes airway irritation and cardiovascular instability, it is important that inhalation induction is performed rapidly and smoothly. So, we studied characteristics of inhalational induction in healthy adults using high inspired concentrations of sevoflurane. METHODS: Fifty-three patients, 19 to 59 years old, received 6 vol% sevoflurane in 66 vol%N2O/28 vol%O2 by face mask for five minutes until endotracheal intubation. Participants exhaled to residual volume and took vital capacity breaths of the gas mixture, thereafter ventilation was manually assisted. Subsequently we recorded the number of breaths before apnea, time to loss of consciousness, the loss of lid-lash reflex, eyeball deviation, the time until BIS reduced to 45, degree of jaw relaxation, and vital signs. After endotracheal intubation without muscle relaxant, ease of intubation and vital signs were observed. RESULTS: Apnea developed after an average three time vital capacity breaths, time to unconciousness was less than one minute. The mean times to loss of lid-lash reflex was 69.0 +/- 8.2 seconds, to eyeball deviation 85.7 +/- 22.2 seconds, and to pupil convergenece 239.5 +/- 31.4 seconds. There was no case of increased secretion or laryngospasm during mask ventilation. The BIS score was significantly lowered after inhalational induction, and the time to a BIS < 45 was 132.3 +/- 19.7 seconds. Mean blood pressures before and after intubation were 75.0 mmHg, and 104.6 mmHg, and heart rates before and after intubation were 77.0 beats/min and 109.8 beats/min, respectively. CONCLUSIONS: The speed of the induction of anesthesia to loss of lid lash reflex in healthy adults approaches that of intravenous induction techniques. No untoward airway responses were noted using the vital capacity breath technique. Healthy adults were successfully intubated with sevoflurane without muscle relaxant.

Long-term Effect of Visual Laser Ablation of the Prostate: According to Follow-up Period / 대한비뇨기과학회지

PURPOSE: Many techniques have evolved to treat benign prostatic hyperplasia (BPH). These techniques attempt to achieve the clinical benefits of transurethral resection of the prostate, while trying to decrease the morbidity associated with this procedure. Visual laser ablation of the prostate (VLAP) has also been used as an effective treatment modality of BPH. The objective of this paper was to evaluate the long term effect of VLAP for patients with symptomatic BPH. MATERIALS AND METHODS: 85 patients with BPH underwent an initial operation, where a VLAP was performed with a neodymium:YAG laser. 65 patients, 6 months after the operation, and 25, 6 years after the operation, were available for follow-up studies. Voiding outcomes, including peak urinary flow rates, residual urine volumes and American Urological Association (AUA) symptom scores, were measured over time. RESULTS: 6 months after the operation significant improvement was seen in the prostatic size, maximal flow rate and post-void residual volume. However, no significant statistical improvement in these parameters was noticed in the subsequent 6 year follow-up (p>0.05). Comparisons of the mean AUA scores, before the operation, and 6 months (p0.05) after, showed significant differences for the different times. With regard to the quality of life due to the urinary symptoms, 87.7% of patients 6 months, and 72.7% 6 years after the operation felt more than mildly satisfied. CONCLUSIONS: There have been numerous reports on the efficacy of VLAP, which show its many advantages, such as low morbidity, high simplicity and good short-term effect. However, according to this study, the long-term therapeutic effect of VLAP was poor, but its exact role for the treatment of BPH remains to be determined.