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1.
Med Clin North Am ; 104(2): 263-278, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32035568

RESUMEN

Individuals with spinal cord injuries or disorders (SCI/D), whether of traumatic or nontraumatic cause, require multidisciplinary management by their care team to achieve optimal health outcomes. SCI/D is relatively rare in the general population and primary care providers (PCPs) may not have extensive experience managing people with these disorders. Spinal cord injuries, impair the body's autonomic and biomechanical performance by interrupting the communications to and from major bodily systems. This article provides a framework to help PCPs understand how these changes impact their patient's physiologic function and subsequent risks for health complications with guidance for initial treatment approaches.


Asunto(s)
Manejo de Atención al Paciente/métodos , Traumatismos de la Médula Espinal , Enfermedad Crónica , Humanos , Grupo de Atención al Paciente/organización & administración , Traumatismos de la Médula Espinal/fisiopatología , Traumatismos de la Médula Espinal/terapia
2.
Medicine (Baltimore) ; 99(5): e18885, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-32000392

RESUMEN

BACKGROUND: The difference between topping-off technique and posterior lumbar interbody fusion (PLIF) in postoperative outcomes is still controversial. The aim of this study is to compare all available data on outcomes of topping-off technique and PLIF in the treatment of chronic low back pain. METHODS: Articles in PubMed, EMBASE and Cochrane were reviewed. Parameters included radiographical adjacent segment disease (RASD), clinical adjacent segment disease, range of motion (ROM), global lumbar lordosis (GLL), visual analog scale (VAS), visual analog scale of back, (VAS-B) and visual analog scale leg (VAS-L), Oswestry disability index, Japanese Orthopaedic Association (JOA) score, duration of surgery, estimated blood loss (EBL), reoperation rates, complication rates. RESULTS: Rates of proximal RASD (P = .001) and CASD (P = .03), postoperative VAS-B (P = .0001) were significantly lower in topping-off group than that in PLIF group. There was no significant difference in distal RASD (P = .07), postoperative GLL (P = .71), postoperative upper intervertebral ROM (P = .19), postoperative VAS-L (P = .08), DOI (P = .30), postoperative JOA (P = .18), EBL (P = .21) and duration of surgery (P = .49), reoperation rate (P = .16), complication rates (P = .31) between topping-off group and PLIF. CONCLUSIONS: Topping-off can effectively prevent the adjacent segment disease from progressing after lumbar internal fixation, which is be more effective in proximal segments. Topping-off technique was more effective in improving subjective feelings of patents rather than objective motor functions. However, no significant difference between topping-off technique and PLIF can be found in the rates of complications.


Asunto(s)
Dolor de la Región Lumbar/cirugía , Vértebras Lumbares/cirugía , Fusión Vertebral , Enfermedad Crónica , Humanos
3.
Adv Exp Med Biol ; 1191: 237-261, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32002933

RESUMEN

Anxiety disorders are debilitating psychological disorders characterized by a wide range of cognitive and somatic symptoms. Anxiety sufferers have a higher lifetime prevalence of various medical problems. Chronic medical conditions furthermore increase the likelihood of psychiatric disorders and overall dysfunction. Lifetime rates of cardiovascular, respiratory, gastrointestinal, and other medical problems are disproportionately high in anxiety and panic/fear sufferers. The heightened comorbidity is not surprising as many symptoms of anxiety and panic/fear mimic symptoms of medical conditions. Panic disorder specifically is strongly linked to medical conditions due to its salient somatic symptoms, such as dyspnea, dizziness, numbness, chest pain, and heart palpitations, all of which can signal danger and deterioration for chronic disease sufferers. This chapter identifies shared correlates of medical illness and anxiety disorders and evidence for misinterpretation of symptoms as medically relevant and offers an analysis of implications for treatment of both types of conditions. We will concentrate on medical conditions with high associations for anxiety and panic by aspects of symptomatology, specifically neurological disorders (fibromyalgia, epilepsy, cerebral palsy), diabetes, gastrointestinal illness (irritable bowel syndrome, gastroesophageal reflux disease), and cardiovascular and respiratory illnesses (asthma).


Asunto(s)
Trastornos de Ansiedad/epidemiología , Trastornos de Ansiedad/terapia , Trastornos de Ansiedad/complicaciones , Trastornos de Ansiedad/psicología , Enfermedad Crónica , Comorbilidad , Humanos , Trastorno de Pánico/complicaciones , Trastorno de Pánico/epidemiología , Trastorno de Pánico/psicología , Trastorno de Pánico/terapia
6.
Anticancer Res ; 40(1): 1-7, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31892548

RESUMEN

BACKGROUND/AIM: The treatment of colorectal liver metastases is challenging and requires multidisciplinary strategies. Unfortunately, only 25% of patients with colorectal liver metastases are eligible for liver resection. Due to the variety of therapeutic approaches, this percentage has increased; however, at the same time, the definition of resectability has become complex. The aim of this review was to provide an overview of current surgical therapies for colorectal liver metastases. MATERIALS AND METHODS: Relevant studies published before June 2019 were identified using PubMed. A comprehensive review of the current literature regarding the impact of and innovations in the therapy of colorectal liver metastases was carried out. RESULTS: The major advances in the resectability of colorectal liver metastases were effective chemotherapy regimens and preoperative liver volume modulation techniques. In addition, health professionals face rapid technical developments in interventional local therapies, minimally invasive surgery, robot-assisted surgery and even liver transplantation. CONCLUSION: Currently, liver metastases from colorectal cancer are considered a chronic disease. In cases of advanced colorectal liver metastases, the definition of resectability and the indications for surgical treatment should be exclusively determined by experienced hepatobiliary surgeons.


Asunto(s)
Neoplasias Colorrectales/patología , Neoplasias Hepáticas/secundario , Neoplasias Hepáticas/terapia , Enfermedad Crónica , Neoplasias Colorrectales/epidemiología , Terapia Combinada , Manejo de la Enfermedad , Humanos , Incidencia , Neoplasias Hepáticas/diagnóstico , Neoplasias Hepáticas/epidemiología , Resultado del Tratamiento
7.
Anticancer Res ; 40(1): 97-100, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31892557

RESUMEN

BACKGROUND/AIM: Chronic expanding hematoma is defined as a hematoma that gradually expands over 1 month or longer, is without neoplastic features on histological sections, and does not occur in the setting of coagulopathy. The pathogenetic mechanism behind its development is unknown, nor is anything known about its genetic features. CASE REPORT: A 49-year-old man noted a tender lump close to the right femoral trochanter. Examination of a core needle biopsy showed a fibrous capsule with fibrinoid material on one side. The patient underwent surgery with removal of a cystic, encapsulated structure with central bleeding and proliferating vessels in the fibrous capsule. The reactive fibroblasts were without any sign of atypia. Genetic analyses were performed on this chronic expanding hematoma. RESULTS: G-Banding analysis of short-term cultured cells from the chronic expanding hematoma yielded a karyotype with a single clonal chromosome abnormality: 46,XY,t(11;19)(q13;q13)[8]/46,XY[10]. RNA sequencing and examination of the sequencing data using five different programs did not identify fusion genes related to the translocation. CONCLUSION: The acquired translocation t(11;19)(q13;q13) suggested that chronic expanding hematoma is a neoplastic lesion. Since the translocation did not lead to any fusion genes, one can speculate that it causes deregulation of gene expression.


Asunto(s)
Cromosomas Humanos Par 11 , Cromosomas Humanos Par 19 , Estudios de Asociación Genética , Predisposición Genética a la Enfermedad , Hematoma/diagnóstico , Hematoma/genética , Translocación Genética , Biopsia , Bandeo Cromosómico , Enfermedad Crónica , Progresión de la Enfermedad , Humanos , Cariotipificación , Masculino , Persona de Mediana Edad
8.
Zhonghua Yu Fang Yi Xue Za Zhi ; 54(1): 6-7, 2020 Jan 06.
Artículo en Chino | MEDLINE | ID: mdl-31914561

RESUMEN

This article illustrates that health management, as one of the tools of health service, plays an important role in the control and treatment of chronic diseases as well as the history of health management development in China. It was pointed out that currently the concept of health management is not well established in China and the practice of health management in the Chinese market is quite in a mess. Therefore, there is an urgent need for the standardization of health management practice. The China Health Management Association released an organizational standard entitled "Standard for Chronic Disease Health Management" in November, 2019. It is comprehensive, science-based, easy to use and fit into the Chinese situation and it is expected that it will facilitate the development of health management in China.


Asunto(s)
Prestación de Atención de Salud/organización & administración , China , Enfermedad Crónica/prevención & control , Prestación de Atención de Salud/normas , Humanos , Estándares de Referencia
9.
Zhonghua Yu Fang Yi Xue Za Zhi ; 54(1): 39-41, 2020 Jan 06.
Artículo en Chino | MEDLINE | ID: mdl-31914567

RESUMEN

This standard specifies the terms and definitions, processes, components, information systems and information summary, analysis and utilization of health management of major chronic and non-communicable diseases (chronic diseases). It is suitable for medical and health service institutions, health examination institutions and health management-related enterprises to carry out health management services for individuals with major chronic diseases such as cardiovascular diseases, diabetes, cancer, chronic respiratory diseases and so on.


Asunto(s)
Enfermedad Crónica/prevención & control , Prestación de Atención de Salud/organización & administración , Humanos
10.
Internist (Berl) ; 61(1): 5-12, 2020 Jan.
Artículo en Alemán | MEDLINE | ID: mdl-31912164

RESUMEN

Cough is one of the most frequent causes for consultation in primary care. The diagnostic characteristics in primary care with a broad spectrum of causes and unspecific symptoms are presented using the example of acute and chronic cough. The understanding of the formation of the cough stimulus and the induction by inflammatory, mechanical and chemical triggers as well as the significance of the stimulus threshold of the cough receptor facilitate the comprehension of the various possible causes of cough. The necessary diagnostic procedures are based on the exclusion of warning symptoms that necessitate emergency inpatient treatment, on the duration of symptoms and the spectrum of causes to be expected from them. Ambiguities often remain even with careful basic diagnostics. Watchful waiting and active surveillance can initially be the most sensible approach but should not be misconstrued as carelessness. It necessitates follow-up controls and increased attention especially in patients with a high-risk constellation (e.g. multimorbidity, immune suppression, heart failure) in order to be able to quickly react to the development of treatable aspects or even dangerous courses of disease.


Asunto(s)
Tos/diagnóstico , Servicio de Urgencia en Hospital , Atención Primaria de Salud , Enfermedad Aguda , Enfermedad Crónica , Humanos , Derivación y Consulta , Espera Vigilante
13.
Zhonghua Wei Chang Wai Ke Za Zhi ; 23(1): 44-50, 2020 Jan 25.
Artículo en Chino | MEDLINE | ID: mdl-31958930

RESUMEN

Objective: To summarize the experience of diagnosis and treatment of superior mesenteric artery compression syndrome (SMACS) secondary to chronic constipation according to the concept of Lee's triad syndrome. Methods: The concept of Lee's triad syndrome: (1) clinical symptoms: triad of constipation, malnutrition, upper gastrointestinal obstruction (vomiting, difficulty in eating); (2) anatomical manifestations: with triple anatomy anomaly of transverse colon sagging, elevated spleen flexure, and mesentery arterial compression; (3) treatment: with triple treatment of enteral nutrition support, chest-knee posture and fecal microbiota transplantation. A descriptive cohort study was performed. According to Lee's triad syndrome criteria, clinical data of 78 patients with superior mesenteric artery compression syndrome secondary to chronic constipation in the Tenth People's Hospital of Tongji University and General Hospital of Eastern Theater Command from June 2004 to November 2018 were prospectively collected, including basic information, symptoms and signs, imaging findings, nutritional indicators, gastrointestinal quality of life index (GIQLI) and Wexner defecation score. The above parameters based on Lee's triad syndrome criteria were followed up and recorded at 1, 3, 6, 12 months after comprehensive treatment. Results: All the patients had Lee's triple symptoms of constipation, malnutrition, upper gastrointestinal obstruction (vomiting, eating difficulties), and triple anatomy anomaly of transverse colon sagging, elevated spleen curvature, and mesentery arterial compression before treatment. After triple treatment of enteral nutrition support, chest-knee posture, and fecal microbiota transplantation, 69 (88.5%) patients had a significant improvement of symptoms, and 9 patients had no significant improvement of symptoms and then eventually received surgery. The 69 cases without operation received follow-up for 12 months. All the patients eventually returned to normal eating, and upper gastrointestinal angiography and superior mesenteric artery imaging showed duodenal compression disappeared. After 1 month, the constipation-related indexes were improved. After 12 months, the number of autonomous defecation per week increased from 1.0±0.8 to 5.0±1.6 (P<0.001). The GIQLI score increased from 52.7±8.5 to 93.2±7.5 (P<0.001), and the Wexner score decreased from 19.1±2.5 to 6.2±2.1 (P<0.001). After 1 month, nutritional indexes were improved gradually. After 12 months, the BMI increased from (17.9±1.8) kg/m(2) to (21.0±1.3) kg/m(2), total protein increased from (65.2±5.7) g/L to (68.3±4.2) g/L, albumin increased from (32.1±5.1) g/L to (40.4±3.0) g/L, prealbumin increased from (163.2±53.7) mg/L to (259.1±45.6) mg/L, fibrinogen increased from (1.9±0.5) g/L to (2.4±0.5) g/L, whose differences were statistically significant (all P<0.001). Upper gastrointestinal angiography and superior mesenteric artery imaging showed duodenal compression were relieved. The angle between superior mesenteric artery and abdominal aorta increased from (17.4±3.8)° to (37.8±5.8)° (t=-22.26, P<0.001). Conclusion: When patients with SMACS secondary to chronic constipation have Lee's triple symptoms and triple anatomy anomaly, the triple combination treatment of enteral nutrition support, chest-knee posture and fecal microbiota transplantation should be applied.


Asunto(s)
Estreñimiento/complicaciones , Síndrome de la Arteria Mesentérica Superior/diagnóstico , Síndrome de la Arteria Mesentérica Superior/terapia , Enfermedad Crónica , Estudios de Cohortes , Nutrición Enteral , Trasplante de Microbiota Fecal , Humanos , Posición de Rodillas al Pecho , Arteria Mesentérica Superior/diagnóstico por imagen , Calidad de Vida , Síndrome de la Arteria Mesentérica Superior/diagnóstico por imagen , Síndrome de la Arteria Mesentérica Superior/etiología , Síndrome , Resultado del Tratamiento
14.
Lancet ; 395(10220): 294-303, 2020 01 25.
Artículo en Inglés | MEDLINE | ID: mdl-31982075

RESUMEN

BACKGROUND: In chronic central serous chorioretinopathy (CSCR), fluid accumulates in the subretinal space. CSCR is a common visually disabling condition that develops in individuals up to 60 years of age, and there is no definitive treatment. Previous research suggests the mineralocorticoid receptor antagonist, eplerenone, is effective for treating CSCR; however, this drug is not licensed for the treatment of patients with CSCR. We aimed to evaluate whether eplerenone was superior to placebo in terms of improving visual acuity in patients with chronic CSCR. METHODS: This randomised, double-blind, parallel-group, multicentre placebo-controlled trial was done at 22 hospitals in the UK. Participants were eligible if they were aged 18-60 years and had had treatment-naive CSCR for 4 months or more. Patients were randomly assigned (1:1) to either the eplerenone or the placebo group by a trial statistician through a password-protected system online. Allocation was stratified by best-corrected visual acuity (BCVA) and hospital. Patients were given either oral eplerenone (25 mg/day for 1 week, increasing to 50 mg/day for up to 12 months) plus usual care or placebo plus usual care for up to 12 months. All participants, care teams, outcome assessors, pharmacists, and members of the trial management group were masked to the treatment allocation. The primary outcome was BCVA, measured as letters read, at 12 months. All outcomes apart from safety were analysed on a modified intention-to-treat basis (participants who withdrew consent without contributing a post-randomisation BCVA measurement were excluded from the primary analysis population and from most secondary analysis populations). The trial is registered with ISRCTN, ISRCTN92746680, and is completed. FINDINGS: Between Jan 11, 2017, and Feb 22, 2018, we enrolled and randomly assigned 114 patients to receive either eplerenone (n=57) or placebo (n=57). Three participants in the placebo group withdrew consent without contributing a post-randomisation BCVA measurement and were excluded from the primary outcome analysis population. All patients from the eplerenone group and 54 patients from the placebo group were included in the primary outcome. Modelled mean BCVA at 12 months was 79·5 letters (SD 4·5) in the placebo group and 80·4 letters (4·6) in the eplerenone group, with an adjusted estimated mean difference of 1·73 letters (95% CI -1·12 to 4·57; p=0·24) at 12 months. Hyperkalaemia occurred in eight (14%) patients in each group. No serious adverse events were reported in the eplerenone group and three unrelated serious adverse events were reported in the placebo group (myocardial infarction [anticipated], diverticulitis [unanticipated], and metabolic surgery [unanticipated]). INTERPRETATION: Eplerenone was not superior to placebo for improving BCVA in people with chronic CSCR after 12 months of treatment. Ophthalmologists who currently prescribe eplerenone for CSCR should discontinue this practice. FUNDING: Efficacy and Mechanism Evaluation Programme, and National Institute for Health Research and Social Care.


Asunto(s)
Coriorretinopatía Serosa Central/tratamiento farmacológico , Eplerenona/uso terapéutico , Antagonistas de Receptores de Mineralocorticoides/uso terapéutico , Adulto , Coriorretinopatía Serosa Central/fisiopatología , Enfermedad Crónica , Método Doble Ciego , Eplerenona/efectos adversos , Femenino , Estudios de Seguimiento , Humanos , Masculino , Cumplimiento de la Medicación/estadística & datos numéricos , Persona de Mediana Edad , Antagonistas de Receptores de Mineralocorticoides/efectos adversos , Resultado del Tratamiento , Agudeza Visual/efectos de los fármacos , Adulto Joven
15.
N Engl J Med ; 382(2): 152-162, 2020 01 09.
Artículo en Inglés | MEDLINE | ID: mdl-31914242

RESUMEN

BACKGROUND: There is widespread interest in programs aiming to reduce spending and improve health care quality among "superutilizers," patients with very high use of health care services. The "hotspotting" program created by the Camden Coalition of Healthcare Providers (hereafter, the Coalition) has received national attention as a promising superutilizer intervention and has been expanded to cities around the country. In the months after hospital discharge, a team of nurses, social workers, and community health workers visits enrolled patients to coordinate outpatient care and link them with social services. METHODS: We randomly assigned 800 hospitalized patients with medically and socially complex conditions, all with at least one additional hospitalization in the preceding 6 months, to the Coalition's care-transition program or to usual care. The primary outcome was hospital readmission within 180 days after discharge. RESULTS: The 180-day readmission rate was 62.3% in the intervention group and 61.7% in the control group. The adjusted between-group difference was not significant (0.82 percentage points; 95% confidence interval, -5.97 to 7.61). In contrast, a comparison of the intervention-group admissions during the 6 months before and after enrollment misleadingly suggested a 38-percentage-point decline in admissions related to the intervention because the comparison did not account for the similar decline in the control group. CONCLUSIONS: In this randomized, controlled trial involving patients with very high use of health care services, readmission rates were not lower among patients randomly assigned to the Coalition's program than among those who received usual care. (Funded by the National Institute on Aging and others; ClinicalTrials.gov number, NCT02090426; American Economic Association registry number, AEARCTR-0000329.).


Asunto(s)
Enfermedad Crónica/terapia , Hospitalización/estadística & datos numéricos , Manejo de Atención al Paciente/métodos , Readmisión del Paciente/estadística & datos numéricos , Adulto , Anciano , Atención Ambulatoria/estadística & datos numéricos , Costos de la Atención en Salud , Visita Domiciliaria , Humanos , Modelos Lineales , Persona de Mediana Edad , New Jersey , Manejo de Atención al Paciente/organización & administración , Resumen del Alta del Paciente , Estudios Prospectivos , Factores Socioeconómicos , Estados Unidos
16.
J Nerv Ment Dis ; 208(2): 118-126, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31985560

RESUMEN

This study investigated the seroprevalence of Toxoplasma gondii in a cohort of 101 Italian inpatients affected by mood or schizophrenia-spectrum disorders and compared clinical features between seronegative and seropositive subjects. Patients diagnosed according to DSM-5 criteria underwent clinical assessments and blood collection to test parasite-specific IgG/IgM serum levels. Twenty-eight patients (27.7%) had IgG anti-T. gondii, and none had IgM antibodies. We found higher prevalence rate in patients aged 40 years or older, as compared with younger. No significant association was detected between T. gondii and a specific diagnostic category; however, bipolar disorder (BD)-II showed the highest positivity rate (40.9%). The seropositive status was significantly associated with a lower presence of psychotic symptoms, higher number of total episodes of predominant excitatory polarity, longer illness duration, and lower severity of current episode, particularly anxiety, depressive, and withdrawal/retardation symptoms. These preliminary results seem to point out an association between chronic toxoplasmosis and a specific subtype of BD.


Asunto(s)
Trastorno Bipolar/diagnóstico , Esquizofrenia/diagnóstico , Psicología del Esquizofrénico , Toxoplasmosis/diagnóstico , Toxoplasmosis/psicología , Adulto , Anciano , Trastorno Bipolar/epidemiología , Trastorno Bipolar/psicología , Enfermedad Crónica , Estudios de Cohortes , Comorbilidad , Correlación de Datos , Femenino , Humanos , Italia , Masculino , Persona de Mediana Edad , Esquizofrenia/epidemiología , Estudios Seroepidemiológicos , Toxoplasmosis/epidemiología , Adulto Joven
18.
Eur J Histochem ; 64(1)2020 Jan 23.
Artículo en Inglés | MEDLINE | ID: mdl-31988531

RESUMEN

Chronic rhinosinusitis with nasal polyps (CRSwNP) is a persistent sinonasal mucosa inflammatory disease with still unclear pathophysiologic mechanisms that imply events of tissue repair and structural remodelling. Several cascades seem to have a considerable role in the onset and progression of mucosa hyperproliferation in nasal polyps including transforming growth factor ß/Small mother against decapentaplegic (TGFß/Smads), mitogenactivated protein kinases (MAPKs), advanced glycosylation end-products (AGEs) together with epithelial-tomesenchymal transition (EMT). Since many inflammatory mediators are reported to play important roles in the development of nasal polyps (NP) disease, this study aimed to analyse the correlation between the AGEs/receptor of advanced glycosylation end-products (RAGE)/extracellular signal-regulated kinase (ERK) signalling pathway and the main markers of EMT to better understand the influence that they exert on the remodelling of nasal mucous membranes in patients affected by CRSwNP vs normal controls. A total of 30 patients were enrolled in this study. Immunohistochemical analysis, using AGE, RAGE, p-ERK, MMP-3, TGF-ß1, Smad2/3, Collagen I-III, α-SMA, E-cadherin, IL-6 and Vimentin antibodies, was performed. AGE, RAGE, ERK, p-ERK and MMP3 were also evaluated using western blot analysis. We observed an overexpression of the AGE/RAGE/p-ERK and the main mesenchymal markers of EMT (Vimentin and IL-6) in CRSwNP vs controls whereas the TGF-ß/Smad3 pathway did not show any significant differences between the two groups of patients. These observations suggest a complex network of processes in the pathogenesis of NP, and the AGE/RAGE/ERK pathway and EMT might work together in promoting tissue remodelling in the formation of CRSwNP.


Asunto(s)
Transición Epitelial-Mesenquimal/fisiología , Sistema de Señalización de MAP Quinasas/fisiología , Pólipos Nasales/etiología , Sinusitis/etiología , Adulto , Enfermedad Crónica , Quinasas MAP Reguladas por Señal Extracelular/metabolismo , Femenino , Productos Finales de Glicación Avanzada/metabolismo , Humanos , Inmunohistoquímica , Interleucina-6/metabolismo , Masculino , Mucosa Nasal/patología , Pólipos Nasales/patología , Pólipos Nasales/fisiopatología , Receptor para Productos Finales de Glicación Avanzada/metabolismo , Sinusitis/patología , Sinusitis/fisiopatología , Vimentina/metabolismo
19.
Medicine (Baltimore) ; 99(1): e18615, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31895816

RESUMEN

Chronic urinary retention (CUR) is defined as a non-painful bladder that remains palpable or percussible after the patient has passed urine. Acupuncture may decrease PVR and improve bladder function in patients with neurogenic CUR. The aim of this study was to preliminarily observe the effectiveness of electroacupuncture (EA) for patients with CUR caused by a lower motor neuron lesion and to provide some therapeutic data for further study.This study was a pilot study of 30 patients with CUR caused by a lower motor neuron lesion. Patients were treated with EA for 12 weeks with 36 sessions of EA.Responders were defined as participants with a decline in postvoid residual urine (PVR) volume after spontaneous urination of ≥50% from baseline. The proportion of responders, change in PVR volume from baseline after spontaneous urination, and the proportion of patients with severe difficulty with urination, who required assistance with bladder emptying and with stool retention, were measured at weeks 4, 8, and 12.Thirty patients were included in this study, and 23 completed 12 weeks of treatment. The proportion of responders at weeks 4, 8, and 12 was 6.67%, 28%, and 43.48%, respectively. Decrease in PVR volume, compared with baseline, was significant at all asessment timepoints. The proportion of patients with severe difficulty with urination, who required assistance with bladder emptying and with stool retention, decreased after treatment.EA is a potential treatment for improving bladder function in patients with CUR caused by a lower motor neuron lesion.


Asunto(s)
Electroacupuntura/estadística & datos numéricos , Enfermedad de la Neurona Motora/complicaciones , Retención Urinaria/terapia , Adulto , Anciano , Enfermedad Crónica , Femenino , Humanos , Masculino , Persona de Mediana Edad , Enfermedad de la Neurona Motora/sangre , Proyectos Piloto , Retención Urinaria/etiología
20.
Medicine (Baltimore) ; 99(2): e18652, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31914050

RESUMEN

RATIONALE: Choroidal detachment is a major postoperative complication of trabeculectomy. Postoperative choroidal detachment occurs with low intraocular pressure (IOP), and is naturally resolved by elevation of IOP. We report a case of chronic chorioretinal detachment (CRD) in the eye with uveitic glaucoma after trabeculectomy which persisted with normal IOP resistant for medication and required surgery. PATIENT CONCERNS: A 63-year-old man was referred to our department with uncontrolled uveitic glaucoma in his right eye. At first presentation, IOP was 62 mm Hg in the right eye with opened angle, and active ocular inflammation was presented by moderate cell infiltration to the anterior chamber. DIAGNOSIS: Uveitic glaucoma. INTERVENTIONS: Trabeculectomy with mitomycin-C combined with phacoemulsification were performed without any surgical trouble. Postoperative inflammation in the anterior segment was mild, and IOP decreased to the middle-teen. OUTCOMES: At 19 days after surgery, the depth of the anterior chamber changed to shallow and CRD occurred in the inferior quadrant area. This complication could not be resolved by additional systemic corticosteroid medication and scleral fenestration. Although IOP was maintained in middle-teen range, suture fixation of the sclera flap and additional scleral fenestration were necessary to resolve CRD at 191 days after primary surgery. LESSONS: In uveitic eye with uncontrolled ocular hypertension, severe CRD after trabeculectomy is able to occur even with normal IOP, which requires surgical procedure in addition to the medical treatment.


Asunto(s)
/etiología , Glaucoma/cirugía , Trabeculectomía/efectos adversos , Antibióticos Antineoplásicos/uso terapéutico , Enfermedad Crónica , Humanos , Presión Intraocular , Masculino , Persona de Mediana Edad , Mitomicina/uso terapéutico , Hipotensión Ocular/etiología , Facoemulsificación/métodos , Trabeculectomía/métodos
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