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1.
Global Health ; 16(1): 8, 2020 01 14.
Artigo em Inglês | MEDLINE | ID: mdl-31937338

RESUMO

BACKGROUND: In the Mekong Delta region of Vietnam, high quantities of products containing antimicrobial are used as prophylactic and curative treatments in small-scale chicken flocks. A large number of these contain antimicrobial active ingredients (AAIs) considered of 'critical importance' for human medicine according to the World Health Organization (WHO). However, little is known about the retail prices of these products and variables associated with the expense on antimicrobials at farm level. Therefore, the aims of the study were: (1) to investigate the retail price of antimicrobials with regards to WHO importance criteria; and (2) to quantify the antimicrobial expense incurred in raising chicken flocks. We investigated 102 randomly-selected small-scale farms raising meat chickens (100-2000 per flock cycle) in two districts in Dong Thap (Mekong Delta) over 203 flock production cycles raised in these farms. Farmers were asked to record the retail prices and amounts of antimicrobial used. RESULTS: A total of 214 different antimicrobial-containing products were identified. These contained 37 different AAIs belonging to 13 classes. Over half (60.3%) products contained 1 highest priority, critically important AAI, and 38.8% 1 high priority, critically important AAI. The average (farm-adjusted) retail price of a daily dose administered to a 1 kg bird across products was 0.40 cents of 1 US$ (₵) (SE ± 0.05). The most expensive products were those that included at least one high priority, critically important AAI, as well as those purchased in one of the two study districts. Farmers spent on average of ₵3.91 (SE ± 0.01) on antimicrobials per bird over the production cycle. The expense on antimicrobials in weeks with disease and low mortality was greater than on weeks with disease and high mortality, suggesting that antimicrobial use had a beneficial impact on disease outcomes (χ2 = 3.8; p = 0.052). Farmers generally used more expensive antimicrobials on older flocks. CONCLUSIONS AND RECOMMENDATION: The retail prices of antimicrobial products used in chicken production in Mekong Delta small-scale chicken farms are very low, and not related to their relevance for human medicine. Farmers, however, demonstrated a degree of sensitivity to prices of antimicrobial products. Therefore, revising pricing policies of antimicrobial products remains a potential option to curb the use of antimicrobials of critical importance in animal production.


Assuntos
Anti-Infecciosos/economia , Galinhas , Comércio/estatística & dados numéricos , Fazendas , Animais , Anti-Infecciosos/uso terapêutico , Humanos , Inquéritos e Questionários , Vietnã
2.
J Craniofac Surg ; 30(8): 2479-2482, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31689730

RESUMO

OBJECTIVES: To retrospectively assess malocclusions, skeletal relationships and the functional needs of orthognathic patients treated in a University teaching hospital. SUBJECTS AND METHODS: This study used clinical records of 100 consecutive patients [51 female, 49 males, mean (SD) age =21.5 (2.71) years] who had orthognathic surgery in a Shahid Beheshti University of Medical Sciences affiliated hospital (9/2014-7/2017). Malocclusion type (incisor classification), sagittal skeletal pattern (ANB angle), index of orthognathic functional treatment need (IOFTN) score, and osteotomy type were recorded. RESULTS: Overall, 66%, 31%, and 3% had Class III, II, and Class I malocclusions, respectively. Similarly, 68% and 32% had Class III and II sagittal skeletal relationships, respectively. Overall, 95% of patients scored IOFTN 4 or 5. The most prevalent IOFTN score were 4.3 (37%), 5.3 (16%), 5.4 (16%), and 4.2 (10%). There were no gender differences (P >0.05) for the distribution of malocclusions, sagittal skeletal relationships, different IOFTN scores, or when IOFTN scores were re-grouped (5, 4, and ≤3). When IOFTN scores were re-grouped (5, 4, and ≤3), they were equally distributed among patients with Class II or III skeletal relationships (P >0.05), but when the authors looked at different malocclusions, there were significant differences in IOFTN score distribution (P = 0.006). The use of genioplasty (4%) or distraction osteogenesis (2%) was limited. Single jaw surgery of either maxilla or mandible was used in 15% and 22% of patients, respectively. About 63% had undergone double-jaw surgery. CONCLUSION: Retrospective assessment using IOFTN identified 95% of patients as having great and very great functional needs, but prospective studies using IOFTN is needed to assess the need for orthognathic surgery. Class III malocclusions and Class III sagittal skeletal relationships were more common in this sample.


Assuntos
Má Oclusão/cirurgia , Adulto , Feminino , Humanos , Masculino , Mandíbula/cirurgia , Maxila/cirurgia , Procedimentos Ortopédicos , Estudos Retrospectivos , Adulto Jovem
3.
Urologe A ; 58(11): 1304-1312, 2019 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-31506761

RESUMO

The increase of medical knowledge and technical innovations together with the demographic change represent a challenge for the new conception of guidelines and clinical studies. The present S2k guidelines, which are exclusively concerned with kidney and ureteral stones, should support the treatment of urolithiasis in hospitals and private practices and provide information on urolithiasis for patients. Increasing interdisciplinary collaboration in stone treatment is also demonstrated in the number of professional and working groups participating in the update of the new guidelines. The present S2k guidelines emerged from a consensus process and demonstrate the current recommendations in step with actual practice. They provide decision-making guidance for diagnostics, treatment and metaphylactic measures based on expert opinions and available published fundamental evidence from the literature.


Assuntos
Litotripsia/normas , Guias de Prática Clínica como Assunto , Ureteroscopia/normas , Urolitíase/cirurgia , Procedimentos Cirúrgicos Urológicos/normas , Urologia/normas , Tratamento por Ondas de Choque Extracorpóreas , Humanos , Cálculos Renais , Nefrolitotomia Percutânea , Resultado do Tratamento , Cálculos Ureterais , Urolitíase/diagnóstico , Urolitíase/prevenção & controle , Procedimentos Cirúrgicos Urológicos/instrumentação
4.
Carbohydr Polym ; 223: 115107, 2019 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-31426987

RESUMO

The effect was studied of adding both KCl and CaCl2 on gelation of solutions of ι-carrageenan, κ-carrageenan and mixtures of both types. The gel temperature (Tg) of ι-car was found to be determined by the CaCl2 concentration and Tg of κ-car by the KCl concentration. At a given salt concentration, ι-car was stiffest with pure CaCl2, but κ-car gels and mixed carrageenan gels were stiffer when both KCl and CaCl2 were present. Gelation of κ-car increased the turbidity of mixed carrageenan gels in the presence of KCl or CaCl2, but when both salts were present it led to a drop of the turbidity. In mixed salt, K+ induces formation of a homogeneous κ-car network that causes the mixed network to become more homogeneous. Rheological and structural properties of carrageenan gels can be tuned for a given polymer and salt concentration by adding both KCl and CaCl2 to κ-car/ι-car mixtures.

5.
World J Urol ; 37(7): 1369-1375, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30288598

RESUMO

PURPOSE: Aquablation of the prostate using the AquaBeam™ system promises equivalent functional outcomes, reduced learning curve, and improved sexual function compared to transurethral prostate resection as shown in prospective randomized trials. This prospective cohort study aims to evaluate if published results can be transferred into the clinical routine in a non-selected patient collective. METHODS: This study includes all patients treated between September 2017 and June 2018 with Aquablation of the prostate. Patients have been evaluated prospectively for the perioperative course and early follow-up. Besides voiding parameter and symptom score, TRUS-volume change, ejaculatory function, and adverse events have been recorded. RESULTS: 118 consecutive patients have been treated in the given time. Aquablation could be carried out successfully in all patients. IPSS, QoL, Qmax, and PVR improved significantly after the procedure and continued to improve during 3-month follow-up. Mean OR time was 20 min, TRUS volume decreased by 65%, and 73% of the patients retained antegrade ejaculation. Thirteen adverse events (> Clavien-Dindo I) occurred in 10 patients. CONCLUSION: The surgical ablation of the prostate using Aquablation achieved significant and immediate improvement of functional voiding parameters Qmax and PVR as well as symptomatic improvement of IPSS and QoL. Aquablation seems to be safe and effective with a low perioperative complication profile even in a non-selected group of patients.


Assuntos
Técnicas de Ablação/métodos , Hiperplasia Prostática/cirurgia , Ressecção Transuretral da Próstata/métodos , Obstrução Uretral/cirurgia , Água , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Hiperplasia Prostática/complicações , Disfunções Sexuais Fisiológicas/epidemiologia , Resultado do Tratamento , Obstrução Uretral/etiologia
6.
World J Urol ; 37(9): 1927-1931, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30515596

RESUMO

OBJECTIVE: To compare open simple prostatectomy, endoscopic enucleation and laparoscopic, robot-assisted enucleation of high-volume prostate in terms of operation time, blood loss, transfusion and complication rates and early continence rates. MATERIAL AND METHODS: Patients with BPH treated endoscopically (ThuVEP, Hamburg and Hannover) or robotically (Mainz) were evaluated prospectively for prostate size, free flow and validated questionnaires (IPSS, QoL). 35 patients were matched to patients after open prostatectomy (Mainz) for age, prostate size, IPSS and QoL scores. Operation time was noted from the first cut to the last suture; blood loss was estimated by the drop of haemoglobin preoperatively and one day after surgery. Transfusion rates were documented. Early continence was estimated by pad use over the first 24 h after catheter removal. Statistical analysis was performed with SPSS 22.0. RESULTS: No significant differences in prostate size, age and preoperative questionnaires were found (p > 0.3). Postoperative flow and the results of the questionnaires were significantly improved (all p < 0.05), without difference between the approaches (p > 0.8). Endoscopic surgery showed superiority in operation time (both p < 0.05); blood loss and transfusion rates were significantly lower compared to open surgery (both p < 0.01) and lower than in robotic surgery without reaching significance (p = 0.18, p = 0.36). Similar results were seen in early continence rates. CONCLUSION: Due to our results, endoscopic surgery should be considered as first-line therapy unless there are comorbidities like diverticula and/or bladder calculi that can be easily treated simultaneously by robotic surgery. Against the background of these findings, indications favouring open surgery are getting sparse.


Assuntos
Endoscopia , Prostatectomia/métodos , Hiperplasia Prostática/cirurgia , Procedimentos Cirúrgicos Robóticos , Idoso , Humanos , Masculino , Análise por Pareamento , Estudos Retrospectivos
7.
Urologe A ; 57(9): 1075-1090, 2018 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-30030596

RESUMO

The monopoly of robotic surgical devices of the last 15 years will end in 2019 when key patents of Intuitive Surgical expire. Thus, we can expect an interesting competitive situation in the coming years. Based on personal experience with robot-assisted surgery since 2001, we conducted a search of the current literature together with a search of relevant patents in this field. Finally, we visited the websites of manufacturers of existing and future robotic surgical devices with possible applications in urology. Such devices have to prove that they meet the high-quality standard of the current Da Vinci series (SI, X, XI). For this purpose, we propose to classify the main features of the different devices, such as type of console (closed/open), arrangement of robotic arms (single/multiple carts/attached to operating room table), type of three-dimensional videosystem (by mirror/ocular/using polarizing glasses) or degrees of freedom (DOF) of end effectors (5 vs. 7 DOF). In the meantime, there are also robotic systems used in endourology: Avicenna Roboflex® and the AquaBeam® system for robot-assisted aquablation therapy of the prostate. While Roboflex® improves the ergonomics of flexible ureteroscopy-similar to the Da Vinci robot, AquaBeam® may for the first time eliminate the surgeon, who might only be needed to manage severe postoperative bleeding.


Assuntos
Laparoscopia , Procedimentos Cirúrgicos Robóticos/métodos , Procedimentos Cirúrgicos Robóticos/tendências , Ureteroscopia/métodos , Procedimentos Cirúrgicos Urológicos/tendências , Urologia/tendências , Endoscopia , Ergonomia , Humanos , Laparoscopia/tendências , Masculino , Cirurgia Vídeoassistida/tendências
8.
Phys Med Biol ; 63(6): 065013, 2018 03 21.
Artigo em Inglês | MEDLINE | ID: mdl-29469054

RESUMO

In lung cancer, quantification by positron emission tomography/computed tomography (PET/CT) imaging presents challenges due to respiratory movement. Our primary aim was to study the impact of motion compensation implied by retrospectively gated (4D)-PET/CT on the variability of PET quantitative parameters. Its significance was evaluated by comparison with the variability due to (i) the voxel size in image reconstruction and (ii) the voxel size in image post-resampling. The method employed for feature extraction was chosen based on the analysis of (i) the effect of discretization of the standardized uptake value (SUV) on complementarity between texture features (TF) and conventional indices, (ii) the impact of the segmentation method on the variability of image features, and (iii) the variability of image features across the time-frame of 4D-PET. Thirty-one PET-features were involved. Three SUV discretization methods were applied: a constant width (SUV resolution) of the resampling bin (method RW), a constant number of bins (method RN) and RN on the image obtained after histogram equalization (method EqRN). The segmentation approaches evaluated were 40[Formula: see text] of SUVmax and the contrast oriented algorithm (COA). Parameters derived from 4D-PET images were compared with values derived from the PET image obtained for (i) the static protocol used in our clinical routine (3D) and (ii) the 3D image post-resampled to the voxel size of the 4D image and PET image derived after modifying the reconstruction of the 3D image to comprise the voxel size of the 4D image. Results showed that TF complementarity with conventional indices was sensitive to the SUV discretization method. In the comparison of COA and 40[Formula: see text] contours, despite the values not being interchangeable, all image features showed strong linear correlations (r > 0.91, [Formula: see text]). Across the time-frames of 4D-PET, all image features followed a normal distribution in most patients. For our patient cohort, the compensation of tumor motion did not have a significant impact on the quantitative PET parameters. The variability of PET parameters due to voxel size in image reconstruction was more significant than variability due to voxel size in image post-resampling. In conclusion, most of the parameters (apart from the contrast of neighborhood matrix) were robust to the motion compensation implied by 4D-PET/CT. The impact on parameter variability due to the voxel size in image reconstruction and in image post-resampling could not be assumed to be equivalent.


Assuntos
Tomografia Computadorizada Quadridimensional/métodos , Processamento de Imagem Assistida por Computador/métodos , Neoplasias Pulmonares/radioterapia , Movimento , Tomografia por Emissão de Pósitrons/métodos , Técnicas de Imagem de Sincronização Respiratória/métodos , Idoso , Idoso de 80 Anos ou mais , Algoritmos , Feminino , Humanos , Neoplasias Pulmonares/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Razão Sinal-Ruído
9.
Ann Maxillofac Surg ; 7(1): 73-77, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28713739

RESUMO

BACKGROUND: Information regarding the prevalence of surgical osteotomies used for the correction of dentofacial deformities in Iran is lacking. MATERIALS AND METHODS: This retrospective cross-sectional study assessed the distribution of orthognathic surgeries performed (2011-2015) at major University hospital in Iran. Records of 103 orthognathic surgery patients were assessed (58 female, 45 males, aged = 23.47 [6.44] years). RESULTS: Class III malocclusion (incisor classification, 45.6%) and Class II skeletal pattern (based on ANB angle, 51.5%) were the most prevalent type. Overall, 4.8%, 51.5%, and 43.7% of subjects had Class I, II, and III sagittal skeletal patterns, respectively. The most prevalent (66%) osteotomy was the bimaxillary osteotomy. The frequencies of reported and corrected asymmetries in the lower third of the face (35%) were similar among patients with different malocclusions (χ2 = 4.134, P = 0.127) or sagittal skeletal patterns (χ2 = 2.133, P = 0.344), as well as between Class II and III malocclusions (P = 0.125) or sagittal skeletal patterns (P = 0.149). CONCLUSION: Compared to Class II subjects, Class III (malocclusions or sagittal skeletal patterns) subjects had more bimaxillary osteotomies, indicating the higher prevalence of skeletal discrepancies affecting both jaws in Class III subjects.

10.
Biomacromolecules ; 17(11): 3800-3807, 2016 11 14.
Artigo em Inglês | MEDLINE | ID: mdl-27712058

RESUMO

Heat-induced aggregation and gelation of aqueous solutions of whey protein isolate (WPI) in the presence of sodium caseinate (SC) and CaCl2 was studied at pH 6.6. The effect of adding SC (0-100 g/L) on the structure of the aggregates and the gels was investigated by light scattering and confocal laser scanning microscopy at different CaCl2 concentration ([CaCl2] = 0-30 mM). The gelation process was studied by oscillatory shear rheology. At the whey protein concentrations studied here (34 and 60 g/L), no gels were formed in the absence of CaCl2 and SC. However, WPI solutions gelled above a critical CaCl2 concentration that increased with increasing SC concentration. In the absence of CaCl2, WPI gels were formed only above a critical SC concentration. The critical SC concentration needed to induce WPI gelation decreased weakly when CaCl2 was added. In an intermediate range of CaCl2 concentrations, gels were formed both at low and high SC concentrations, but not at intermediate SC concentrations. Finally, at high CaCl2 concentrations gels were formed at all SC concentrations. The gelation rate and the gel structure of the gels formed at low and high casein concentrations were very different. The effect of SC on the thermal gelation of WPI was interpreted by competition for Ca2+, a chaperon effect, and microphase separation.


Assuntos
Cálcio/química , Reologia , Proteínas do Soro do Leite/química , Caseínas/química , Caseínas/farmacologia , Géis/química , Temperatura Alta , Concentração de Íons de Hidrogênio , Soluções/química , Proteínas do Soro do Leite/antagonistas & inibidores
11.
Urologe A ; 55(10): 1297-1301, 2016 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-27596847

RESUMO

The treatment of urolithiasis is still one of the most frequent tasks in the daily urological practice. Driven by the technological developments, patient demands and also personal experiences of urologists, many interventional treatment options have been established. To identify the most suitable treatment option, it is of utmost importance to consider not only stone size and localization but also the individual situation of the patient and the published evidence, which despite all efforts often lags behind the technical and clinical reality.


Assuntos
Litotripsia/normas , Nefrostomia Percutânea/normas , Assistência Centrada no Paciente/normas , Guias de Prática Clínica como Assunto , Ureteroscopia/normas , Urolitíase/terapia , Terapia Combinada/normas , Medicina Baseada em Evidências/normas , Humanos , Radiologia/normas , Resultado do Tratamento , Urolitíase/diagnóstico , Urologia/normas
12.
Urologe A ; 55(7): 904-22, 2016 Jul.
Artigo em Alemão | MEDLINE | ID: mdl-27325405

RESUMO

Every tenth German citizen will suffer from at least one urinary calculus during the lifetime. The diagnostics, treatment and follow-up treatment of urolithiasis are, therefore, part of the daily routine practice for all urologists in hospitals and private practices as well as in many other disciplines, such as general practitioners, internists, nephrologists and pediatricians. Although the diagnostics and therapy have experienced substantial alterations over the last 10 years, the possibilities of metabolic diagnostics and secondary prevention for patients at risk are, unfortunately and unjustly, in many places very poorly represented. The present S2k guidelines, which for the first time were established in an interdisciplinary consensus process, represent the current practical recommendations and, whenever possible, use tables and algorithms in order to facilitate easy reference in the routine daily work. Last but not least, this greatly simplifies the measures for metaphylaxis.


Assuntos
Litotripsia/normas , Guias de Prática Clínica como Assunto , Ureteroscopia/normas , Urolitíase/diagnóstico , Urolitíase/terapia , Urologia/normas , Técnicas de Diagnóstico Urológico/normas , Medicina Baseada em Evidências , Alemanha , Humanos , Resultado do Tratamento , Ultrassonografia/normas
13.
Implant Dent ; 25(3): 367-72, 2016 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-27213529

RESUMO

PURPOSE: To retrospectively evaluate alveolar dimensions of healthy maxillary first molars (MFMs), which have implications for (immediate) implant placement and endodontic therapy. MATERIALS AND METHODS: Cone-beam computed tomographic records of 95 patients (150 MFMs) were used [32 men and 63 men, aged 37.2 (14.9) years]. The vertical distance from sinus floor (SF) and MFM apexes (mesio-buccal [MB] and disto-buccal [DB]) and also distance between root apexes (spreading of the roots, MB to palatal and DB to palatal, representing bone width) were measured. RESULT: The mean (SD) thickness of buccal and palatal bony walls (2 mm from crest) was 1.58 (0.6) mm and 1.34 (0.54) mm, respectively. The mesio-distal and bucco-lingual socket sizes at crest were 7.3 (0.84) mm and 10.5 (0.90) mm, respectively. The mean distance from SF to MFM furcation was 6.51 (2.94) mm. The mean distance (95% confidence interval) between SF and MB, DB, and palatal apexes was -0.36 mm (-0.91 to 0.19), 0.32 mm (-0.27 to 0.9), and -2.2 mm (-2.7 to -1.7), retrospectively. Significant differences were found for root apex distances to SF for MB versus palatal roots and DB roots versus palatal roots, but not for MB versus DB roots (P > 0.05). CONCLUSION: The present findings on MFM dento-alveolar morphology, in particular high intrusion of palatal roots into SF, can be used as a clinical risk management tool for immediate implant placement and endodontic therapy.


Assuntos
Processo Alveolar/diagnóstico por imagem , Tomografia Computadorizada de Feixe Cônico , Carga Imediata em Implante Dentário/métodos , Dente Molar/diagnóstico por imagem , Adulto , Processo Alveolar/anatomia & histologia , Feminino , Humanos , Masculino , Maxila/anatomia & histologia , Maxila/diagnóstico por imagem , Dente Molar/anatomia & histologia
14.
Urologe A ; 55(2): 184-94, 2016 Feb.
Artigo em Alemão | MEDLINE | ID: mdl-26518303

RESUMO

This report summarizes the relevant aspects of the S2e guideline of the German Urologists for the conservative and pharmacological treatment of lower urinary tract symptoms due to benign prostatic hyperplasia. Recommendations are given regarding watchful waiting, behavioral therapy, phytotherapy and pharmacological mono- and combination therapy. The influence of the different therapeutic options on bladder outlet obstruction (BOO) is described in detail.


Assuntos
Terapia Comportamental/normas , Guias de Prática Clínica como Assunto , Hiperplasia Prostática/terapia , Obstrução do Colo da Bexiga Urinária/terapia , Conduta Expectante/normas , Inibidores de 5-alfa Redutase/uso terapêutico , Antagonistas Adrenérgicos alfa/uso terapêutico , Medicina Baseada em Evidências , Alemanha , Humanos , Masculino , Fitoterapia/normas , Hiperplasia Prostática/complicações , Hiperplasia Prostática/diagnóstico , Resultado do Tratamento , Obstrução do Colo da Bexiga Urinária/diagnóstico , Obstrução do Colo da Bexiga Urinária/etiologia , Urologia/normas
15.
Urologe A ; 55(2): 195-207, 2016 Feb.
Artigo em Alemão | MEDLINE | ID: mdl-26518304

RESUMO

This report summarizes the relevant aspects of the S2e guideline of the German Urologists for the instrumental treatment of the lower urinary tract symptoms due to benign prostatic hyperplasia. Recommendations are given regarding open and transurethral procedures (TUR-P, bipolar TUR-P, TUI-P, HE-TUMT, TUNA, and the different Laser techniques). Recommendations are also given concerning intraprostatic stents and injection therapies. The influence of the different therapeutic options on bladder outlet obstruction (BOO) is described in detail.


Assuntos
Guias de Prática Clínica como Assunto , Prostatectomia/normas , Hiperplasia Prostática/terapia , Stents , Obstrução do Colo da Bexiga Urinária/prevenção & controle , Medicina Baseada em Evidências , Alemanha , Humanos , Masculino , Prostatectomia/métodos , Hiperplasia Prostática/complicações , Hiperplasia Prostática/diagnóstico , Resultado do Tratamento , Obstrução do Colo da Bexiga Urinária/diagnóstico , Obstrução do Colo da Bexiga Urinária/etiologia , Urologia/normas
16.
Aktuelle Urol ; 46(5): 391-4, 2015 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-26378390

RESUMO

The prevalence of kidney stones is increasing worldwide. Asymptomatic non-obstructing kidney stones are increasingly detected as an incidental finding on radiologic imaging, which has been performed more frequently over the last decades. Beside the current interventional treatment modalities such as extracorporeal shockwave lithotripsy (ESWL), ureterorenoscopy (URS) and percutaneous nephrolithotomy (PNL), active surveillance of asymptomatic kidney stones has been a focus of discussion lately, not only for attending physicians, but even more so for patients. The current German and European guidelines recommend active surveillance for patients with asymptomatic kidney stones if no interventional therapy is mandatory because of pain or medical factors. Herein we review the current literature on risks and benefits of active surveillance of asymptomatic non-obstructing kidney stones.


Assuntos
Cálculos Renais/terapia , Litotripsia , Nefrostomia Percutânea , Ureteroscopia , Conduta Expectante , Estudos Transversais , Humanos , Achados Incidentais , Cálculos Renais/diagnóstico , Cálculos Renais/epidemiologia
18.
Langmuir ; 31(12): 3605-11, 2015 Mar 31.
Artigo em Inglês | MEDLINE | ID: mdl-25743065

RESUMO

The structure and stability of water-in-water emulsions was investigated in the presence of spherical, pH-sensitive microgels. The emulsions were formed by mixing aqueous solutions of dextran and PEO. The microgels consisted of cross-linked, synthetic polymers with a radius that steeply increased from 60 to 220 nm with increasing pH within a narrow range around 7.0. At all pH values between 5.0 and 7.5, the microgels were preferentially situated at the interface, but only in a narrow range between pH 7.0 and 7.5, the emulsions were stable for at least 1 week. The droplet size was visualized with confocal laser scanning microscopy and was found to be smallest in the stable pH range. Emulsions could be stabilized or destabilized by small changes of the pH. Addition of small amounts of salt led to a shift of the pH range where the emulsions were stable. The effects of varying the microgel concentration and the polymer composition were investigated.

19.
World J Urol ; 33(4): 517-24, 2015 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-25300823

RESUMO

INTRODUCTION: To evaluate the current role of thulium vapoenucleation of the prostate (ThuVEP) for the treatment of benign prostatic obstruction (BPO). METHODS: A Medline search for randomized trials, case series, and comparative studies being published since the initial description of the ThuVEP procedure (2009-2014) was performed to assess the safety, the perioperative morbidity, the efficacy, and the durability of the technique. RESULTS: A total of 14 peer-reviewed original articles, seven case series [level of evidence (LOE) 4] and seven comparative studies (LOE 3b), have been identified. ThuVEP has been shown to be a size-independent, safe, efficacious, and durable procedure for the treatment of BPO in large, prospective, and retrospective series (LOE 4/3b). The feasibility and safety of the ThuVEP procedure has also been confirmed in patients at high cardiopulmonary risk on oral anticoagulants (LOE 4). It has also been demonstrated that the erectile function is not impaired by the ThuVEP procedure (LOE 4). However, published ThuVEP series are from very few centers of excellence not exceeding a LOE of 3b. Randomized controlled trials comparing ThuVEP with standard procedures for the treatment of BPO, namely transurethral resection of the prostate, open prostatectomy, or holmium laser enucleation of the prostate, have not been published so far. CONCLUSIONS: ThuVEP appears to be a size-independent, safe, efficacious, and durable procedure for the treatment of BPO (LOE 4/3b). Multicentric PRT are however needed to define the current role of ThuVEP in the armamentarium of minimally invasive transurethral surgery of the prostate.


Assuntos
Lasers de Estado Sólido/uso terapêutico , Sintomas do Trato Urinário Inferior/cirurgia , Prostatectomia/métodos , Hiperplasia Prostática/cirurgia , Túlio , Obstrução do Colo da Bexiga Urinária/cirurgia , Humanos , Terapia a Laser/métodos , Sintomas do Trato Urinário Inferior/etiologia , Masculino , Hiperplasia Prostática/complicações , Resultado do Tratamento , Obstrução do Colo da Bexiga Urinária/etiologia
20.
J Phys Condens Matter ; 26(46): 464102, 2014 Nov 19.
Artigo em Inglês | MEDLINE | ID: mdl-25347117

RESUMO

The morphology of aggregates formed by heating the globular protein ß-lactoglobulin (ß-lg) changes with the addition of a small amount of CaCl2, from small strands to larger spherical aggregates (microgels). We investigated the effect of this morphological transition on the structure of mixtures of ß-lg aggregates with the polysaccharide κ-carrageenan (κ-car), using confocal laser scanning microscopy and dynamic light scattering. The change in the morphology of the ß-lg aggregates strongly reduced the κ-car concentration at which the system phase separated. As a consequence a dramatic change in the structure of the mixtures occurred over a narrow range of the CaCl2 concentration. Phase separation leads to the formation of micron-sized protein rich domains that have a tendency to stick together in large flocs. There is a big difference between the protein concentrations in the two phases, but the κ-car concentration is only weakly lower in the protein rich phase. A comparison is made between mixtures prepared at room temperature, after separately heating ß-lg, and heated mixtures of native ß-lg and κ-car. The micro-phase separated structure of the two systems is similar, but the aggregates disperse upon dilution in the former case, while they are covalently bound within the domains in the latter case. Other, more subtle, differences were also observed. The results explain the very high sensitivity of the structure of ß-lg/κ-car mixtures to calcium ions.


Assuntos
Carragenina/química , Lactoglobulinas/química , Transição de Fase , Agregados Proteicos , Temperatura Alta , Concentração de Íons de Hidrogênio , Microscopia Confocal
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