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1.
Forensic Sci Int ; 302: 109858, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31279508

RESUMO

Fentanyl is a potent synthetic opioid with a variety of possible applications. Transdermal fentanyl patches are regularly prescribed for patients with severe chronic or cancer-related pain. The potential for abuse is well-known and cases associated with illicit fentanyl intake are common. Fentanyl related fatalities due to unintentional misuse are relatively rare. This study focused on those instances and their identification in forensic examinations and adds new cases and consolidates the existing femoral blood concentrations in the event of fatal fentanyl patch misapplications. A total of 35 cases between 2010 and 2018 in which transdermal fentanyl patches were detected during forensic autopsies were identified and reviewed for the frequency of unspecific macroscopic signs of opioid intoxication. Furthermore, a detailed examination is presented for 11 cases in which toxicological results were available. The cause of death was eventually considered to be related to fentanyl patch misuse in 5 of these 11 cases. Co-administered drugs and signs of opioid intoxication, especially pulmonary edema, were frequently found. Lastly, it is advised to include norfentanyl and hair analysis in the interpretation of post-mortem fentanyl concentrations.


Assuntos
Analgésicos Opioides/efeitos adversos , Fentanila/efeitos adversos , Transtornos Relacionados ao Uso de Opioides/complicações , Uso Indevido de Medicamentos sob Prescrição , Adesivo Transdérmico/efeitos adversos , Adolescente , Adulto , Idoso , Analgésicos Opioides/análise , Analgésicos Opioides/envenenamento , Cromatografia Líquida , Feminino , Fentanila/análogos & derivados , Fentanila/análise , Fentanila/envenenamento , Cabelo/química , Humanos , Masculino , Espectrometria de Massas , Edema Pulmonar/patologia , Estudos Retrospectivos , Retenção Urinária/patologia
3.
Acta Medica (Hradec Kralove) ; 62(1): 39-42, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30931896

RESUMO

Spinal epidermoid cysts are benign tumors. Syringomyelia secondary to intramedullary tumors are frequently observed. However, the association between syringomyelia and spinal intradural extramedullary epidermoid cyst in the conus medullaris region is extremely rare. We present the case of a 3-year-old male who was admitted with paraparesis and urinary retention. Magnetic resonance imaging (MRI) of the spine demonstrated intradural extramedullary lesion, compatible with epidermoid cyst, that at the conus medullaris level and a large syringomyelia extending from T4 to L1 vertebrae. Total microsurgical excision of the cyst was performed. No additional drainage was carried out for the syringomyelic cavity. Histopathological examination verified the diagnosis of the epidermoid cyst. Total excision of the cyst and disappearance of the syringomyelia were observed on MRI at 15 days postoperatively. We have clarified the etiology, clinical, histopathological and radiological features, differential diagnosis, and treatment modalities of spinal epidermoid cysts. In addition, we have discussed the possible mechanisms of syringomyelia formation in spinal intradural lesions.


Assuntos
Cisto Epidérmico/cirurgia , Paraparesia/patologia , Doenças da Medula Espinal/cirurgia , Medula Espinal/patologia , Siringomielia/patologia , Retenção Urinária/patologia , Pré-Escolar , Cisto Epidérmico/complicações , Cisto Epidérmico/diagnóstico por imagem , Humanos , Imagem por Ressonância Magnética , Masculino , Paraparesia/diagnóstico por imagem , Paraparesia/etiologia , Medula Espinal/diagnóstico por imagem , Doenças da Medula Espinal/complicações , Doenças da Medula Espinal/patologia , Siringomielia/diagnóstico por imagem , Resultado do Tratamento , Retenção Urinária/diagnóstico por imagem , Retenção Urinária/etiologia
4.
BMJ Case Rep ; 12(3)2019 Mar 08.
Artigo em Inglês | MEDLINE | ID: mdl-30852494

RESUMO

Anterior rectal duplication cyst is rare entity with <50 reported cases to date. It has myriad presentations like bleeding per rectum, constipation, rectal prolapsed and intestinal obstruction due to extrinsic compression of rectum. However, the association of enlarged duplication cyst compressing the bladder neck or ureter, and leading to bladder outlet obstruction or hydroureteronephrosis is extremely rare with only a handful of reported cases. We report a rare case of large anterior rectal duplication cyst in a young girl leading to acute urinary retention with bladder outlet obstruction which was eventually managed by laparoscopic-assisted transabdominal surgical excision of the cyst. The authors believe that such an association has not been previously reported in this age group.


Assuntos
Malformações Anorretais/complicações , Cistos/patologia , Doenças Retais/patologia , Reto/anormalidades , Obstrução do Colo da Bexiga Urinária/patologia , Retenção Urinária/patologia , Criança , Cistos/congênito , Feminino , Humanos , Doenças Retais/congênito , Reto/patologia , Obstrução do Colo da Bexiga Urinária/congênito , Retenção Urinária/congênito
5.
Radiat Oncol ; 13(1): 209, 2018 Oct 24.
Artigo em Inglês | MEDLINE | ID: mdl-30355359

RESUMO

BACKGROUND: To evaluate long-term IPSS score and urinary quality of life after radiotherapy for prostate cancer, in patients with prior history of surgical treatment for benign prostatic hyperplasia (BPH). METHODS: In this retrospective study, we reviewed medical records of patients treated in our department, between 2007 and 2013 with surgery for BPH followed by radiotherapy for localized prostate cancer. Patients were contacted to fill in IPSS questionnaire and they were also asked for urinary quality of life. Predictive factors known to be associated with bad urinary function were also analysed. RESULTS: Fifty-nine patients were included in our study. Median age was 70 years. Median follow-up was 4.6 years. Median radiotherapy dose was 78 Gy (5 × 2 Gy/week). Thirty patients (48.5%) received hormone therapy in combination with RT. Main surgery indications were urinary symptoms (65%) and urinary retention (20%). Five-year biochemical-disease free survival was 75% and 5-year clinical relapse free survival was 84%. At the time of the study, the IPSS after radiotherapy was as follows: 0-7: 77.6%; 8-19:20.7%; 20-35: 1.7%. Urinary quality of life was satisfactory for 74.2% of patients. After multivariate analysis, a high dose of RT and a medical history of hypertension were associated with a poorer quality of urinary life (p = 0.04). CONCLUSION: External radiotherapy remains an appropriate treatment option without a major risk for deterioration in urinary function in patient with antecedent surgery for BPH. High dose of RT and a medical history of hypertension were associated with a poorer quality of urinary life.


Assuntos
Hiperplasia Prostática/complicações , Neoplasias da Próstata/radioterapia , Qualidade de Vida , Radioterapia de Intensidade Modulada/efeitos adversos , Ressecção Transuretral da Próstata/efeitos adversos , Retenção Urinária/patologia , Doenças Urológicas/patologia , Idoso , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/etiologia , Recidiva Local de Neoplasia/patologia , Hiperplasia Prostática/cirurgia , Neoplasias da Próstata/patologia , Dosagem Radioterapêutica , Estudos Retrospectivos , Resultado do Tratamento , Retenção Urinária/etiologia , Micção , Doenças Urológicas/etiologia
6.
Low Urin Tract Symptoms ; 10(2): 186-189, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-28643427

RESUMO

OBJECTIVES: Our aim was to examine correlation between Post-void residual urine (PVR) after uroflowmetry and random PVR. METHODS: Male patients reporting to the Urology outpatient clinic with LUTS were selected. Patients' age, prostate volume, bladder capacity, voided volume, maximum flow rate, average flow rate, random PVR and PVR after uroflowmetry were recorded. We evaluated the correlations between these parameters. Also we assessed if there was a difference between random PVR and PVR after uroflowmetry. We divided PVR after uroflowmetry and random PVR into three groups: Group 1: 0-50 mL, Group 2: 51-100 mL and Group 3: >100 mL. Also we divided the patients into two groups according to bladder capacity as Group 1: ≤400 mL and Group 2: >400 mL. We compared these groups to determine whether a significant difference. RESULTS: Seventy-seven patients applying to the urology outpatient clinic were assessed between 2013 and 2014. PVR after uroflowmetry was significantly higher than random PVR (P < 0.001). When we divided PVR after uroflowmetry and random PVR into three groups there was a significant difference between the groups (P = 0.02). When we divided the patients into two groups according to bladder capacity as Group 1: ≤400 mL and Group 2: >400 mL, PVR after uroflowmetry was different, but random PVR was similar (P < 0.001, P = 0.72). CONCLUSIONS: PVR after uroflowmetry seems to be incorrectly high in patients whose bladder capacity is above 400 mL.


Assuntos
Obstrução do Colo da Bexiga Urinária/fisiopatologia , Bexiga Urinaria Neurogênica/fisiopatologia , Retenção Urinária/fisiopatologia , Idoso , Humanos , Sintomas do Trato Urinário Inferior/patologia , Sintomas do Trato Urinário Inferior/fisiopatologia , Masculino , Tamanho do Órgão/fisiologia , Próstata/patologia , Hiperplasia Prostática/patologia , Hiperplasia Prostática/fisiopatologia , Obstrução do Colo da Bexiga Urinária/patologia , Bexiga Urinaria Neurogênica/patologia , Retenção Urinária/patologia , Micção/fisiologia
8.
Clin. transl. oncol. (Print) ; 18(3): 317-321, mar. 2016. tab
Artigo em Inglês | IBECS | ID: ibc-148716

RESUMO

Purpose To analyze clinical-dosimetric predictors of genitourinary (GU) toxicity in a cohort of prostate cancer (PC) patients treated with moderate hypofractionation and simultaneous integrated boost (SIB) using volumetric modulated arc therapy (VMAT) technique. Materials and methods 60 patients were selected. Patients were stratified into low (43 %), intermediate (30 %) and high-risk (27 %) groups. Low-risk patients received 73.5 Gy to PTV1; intermediate-risk received 73.5 Gy to PTV1 and 60 Gy to PTV2; high-risk received 73.5 Gy to PTV1, 60 Gy to PTV2, and 54 Gy to PTV3. All patients were treated in 30 fractions. Androgen deprivation therapy (ADT) was prescribed upfront in intermediate and high-risk categories. Toxicity was scored according to Common Terminology Criteria for Adverse Events v4.0 scoring system. Results Median follow-up was 30 months (range 16–36 months). GU acute toxicity was recorded as followS: G0 = 16/60 (27 %), G1 = 18/60 (30 %); G2 = 26/ 60 (43 %). GU late toxicity was recorded as follows: G0 = 20/60 (34 %); G1 = 29/60 (48 %); G2 = 11/56 (18 %). The risk of acute G2 GU toxicity was three times higher for prostate volume C80 cc. In 60 % of the patients with a prostate volume C80 cc, the first 3 weeks are at particular risk for toxicity onset. In the late setting, no statistical significance was found between GU toxicity and prostate gland dimension. Conclusion Prostate volume C80 cc resulted a predictive factor of acute G2 GU toxicity, in moderate hypofractionation and volumetric modulated arc radiation therapy for definitive PC (AU)


No disponible


Assuntos
Humanos , Masculino , Feminino , Neoplasias da Próstata/patologia , Terapêutica/métodos , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/metabolismo , Anormalidades Urogenitais/genética , Tomografia Computadorizada por Raios X/métodos , Linfonodos/patologia , Retenção Urinária/patologia , Espectroscopia de Ressonância Magnética , Estudos Retrospectivos , Neoplasias da Próstata/tratamento farmacológico , Terapêutica/instrumentação , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/complicações , Anormalidades Urogenitais/patologia , Estudos Prospectivos , Tomografia Computadorizada por Raios X/instrumentação , Linfonodos/anormalidades , Retenção Urinária/diagnóstico , Espectroscopia de Ressonância Magnética/métodos
9.
World Neurosurg ; 89: 208-14, 2016 May.
Artigo em Inglês | MEDLINE | ID: mdl-26855312

RESUMO

OBJECTIVE: The Adamkiewicz artery (AKA) supplies pudendal nerve roots and conus medullaris. The aim of this study was to elucidate if there is any relationship between neurodegenerative changes of the Onuf nucleus (ON)-pudendal nerve ganglia complex secondary to vasospasm of the AKA after spinal subarachnoid hemorrhage (SAH). METHODS: This study was conducted on 22 rabbits, which were randomly divided into 3 groups: control (n = 5), sham (n = 5), and spinal SAH (n = 12). Experimental spinal SAH was induced at the L2 level. After 2 weeks, the ON-pudendal nerve ganglia complex and AKA were examined histopathologically. Bladder volume values were estimated, and results were analyzed statistically. RESULTS: Two animals died within the first week of experiment. Histopathologically, severe vasospasm of the AKA and neuronal degeneration and neuronal apoptosis were observed in the ON-pudendal nerve ganglia complex in 5 animals of the SAH group. The mean volume of the imaginary AKA, mean bladder volumes, and degenerated neuron densities of ON and pudendal nerve ganglia were estimated. We found that vasospasm of the AKA led to numerous neuron degenerations in ON and pudendal ganglia and consequently urinary retention (P < 0.005). CONCLUSIONS: ON-pudendal nerve ganglia complex degeneration secondary to vasospasm of the AKA may be a cause of urinary retention after spinal SAH.


Assuntos
Células do Corno Anterior/fisiologia , Gânglios Espinais/fisiopatologia , Nervo Pudendo/fisiopatologia , Hemorragia Subaracnóidea/fisiopatologia , Retenção Urinária/fisiopatologia , Animais , Células do Corno Anterior/patologia , Apoptose/fisiologia , Artérias/patologia , Artérias/fisiopatologia , Modelos Animais de Doenças , Gânglios Espinais/patologia , Vértebras Lombares , Masculino , Degeneração Neural/etiologia , Degeneração Neural/patologia , Degeneração Neural/fisiopatologia , Tamanho do Órgão , Nervo Pudendo/irrigação sanguínea , Nervo Pudendo/patologia , Coelhos , Distribuição Aleatória , Sacro , Hemorragia Subaracnóidea/complicações , Hemorragia Subaracnóidea/patologia , Bexiga Urinária/patologia , Bexiga Urinária/fisiopatologia , Retenção Urinária/etiologia , Retenção Urinária/patologia
10.
Conf Proc IEEE Eng Med Biol Soc ; 2016: 4121-4124, 2016 08.
Artigo em Inglês | MEDLINE | ID: mdl-28269189

RESUMO

Residual bladder volume measurement is a very important marker for patients with urinary retention problems. To be able to monitor patients with these conditions at the bedside by nurses or in an out patient setting by general physicians, hand held ultrasound devices will be extremely useful. However to increase the usage of these devices by non traditional users, automated tools that can aid them in the scanning and measurement process will be of great help. In our paper, we have developed a robust segmentation algorithm to automatically measure bladder volume by segmenting bladder contours from sagittal and transverse ultrasound views using a combination of machine learning and active contour algorithms. The algorithm is tested on 50 unseen images and 23 transverse and longitudinal image pairs and the performance is reported.


Assuntos
Algoritmos , Processamento de Imagem Assistida por Computador/métodos , Ultrassonografia/métodos , Bexiga Urinária/diagnóstico por imagem , Retenção Urinária/diagnóstico por imagem , Humanos , Tamanho do Órgão , Reconhecimento Automatizado de Padrão , Bexiga Urinária/patologia , Retenção Urinária/patologia
11.
Ginekol Pol ; 86(1): 77-9, 2015 Jan.
Artigo em Polonês | MEDLINE | ID: mdl-25775880

RESUMO

CASE REPORT: A 48-year-old woman with acute urinary retention due to a big cervical leiomyoma pressing on the urethra was admitted to the Gynecologic Unit. A Foley catheterization was performed and 1500 mL of urine was drained. The gynecologic examination revealed a cervical tumor 10 cm in diameter. Acute urinary retention and intensifying abdominal pain were indications for emergency surgery. The presented case of obstructive urinary retention is a rare finding as the literature offers only single reports on the symptoms of cervical fibroids and the treatment methods. CONCLUSIONS: Cervical leiomyoma is a rare cause of acute urinary retention. The surgical procedure requires considerable experience to avoid intraoperative bleeding and bladder or bowel complications.


Assuntos
Leiomioma/complicações , Leiomioma/cirurgia , Cateterismo Urinário/métodos , Retenção Urinária/etiologia , Retenção Urinária/terapia , Neoplasias Uterinas/complicações , Neoplasias Uterinas/cirurgia , Doença Aguda , Feminino , Humanos , Leiomioma/patologia , Pessoa de Meia-Idade , Resultado do Tratamento , Retenção Urinária/patologia , Urodinâmica , Neoplasias Uterinas/patologia
12.
Br J Neurosurg ; 29(2): 178-80, 2015 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-25646790

RESUMO

In the first prospective comparison of 'scan-negative' (n=11) and 'scan-positive' (n=7) patients with cauda equina syndrome (CES) we found that Hoover's sign of functional leg weakness but not routine clinical features differentiated the two groups (p<0.02). This offers a new direction of study in this area, although magnetic resonance imaging is still required for all patients with possible CES.


Assuntos
Cauda Equina/patologia , Retenção Urinária/patologia , Adulto , Feminino , Seguimentos , Humanos , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Retenção Urinária/diagnóstico
13.
BJU Int ; 115(2): 308-16, 2015 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-24825577

RESUMO

OBJECTIVE: To better risk stratify patients, using baseline characteristics, to help optimise decision-making for men with moderate-to-severe lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH) through a secondary analysis of the Medical Therapy of Prostatic Symptoms (MTOPS) trial. PATIENTS AND METHODS: After review of the literature, we identified potential baseline risk factors for BPH progression. Using bivariate tests in a secondary analysis of MTOPS data, we determined which variables retained prognostic significance. We then used these factors in Cox proportional hazard modelling to: i) more comprehensively risk stratify the study population based on pre-treatment parameters and ii) to determine which risk strata stood to benefit most from medical intervention. RESULTS: In all, 3047 men were followed in MTOPS for a mean of 4.5 years. We found varying risks of progression across quartiles. Baseline BPH Impact Index score, post-void residual urine volume, serum prostate-specific antigen (PSA) level, age, American Urological Association Symptom Index score, and maximum urinary flow rate were found to significantly correlate with overall BPH progression in multivariable analysis. CONCLUSIONS: Using baseline factors permits estimation of individual patient risk for clinical progression and the benefits of medical therapy. A novel clinical decision tool based on these analyses will allow clinicians to weigh patient-specific benefits against possible risks of adverse effects for a given patient.


Assuntos
Inibidores de 5-alfa Redutase/administração & dosagem , Azasteroides/administração & dosagem , Antígeno Prostático Específico/sangue , Hiperplasia Prostática/patologia , Retenção Urinária/patologia , Progressão da Doença , Quimioterapia Combinada , Humanos , Masculino , Valor Preditivo dos Testes , Prognóstico , Hiperplasia Prostática/sangue , Hiperplasia Prostática/terapia , Fatores de Risco , Resultado do Tratamento , Retenção Urinária/terapia
14.
J Neurotrauma ; 31(21): 1800-6, 2014 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-24936867

RESUMO

Spinal cord injury (SCI) affects motor, sensory, and autonomic functions. As current therapies do not adequately alleviate functional deficits, the development of new and more effective approaches is of critical importance. Our earlier investigations indicated that intrathecal administration of a toll-like receptor 9 (TLR9) antagonist, cytidine-phosphate-guanosine oligodeoxynucleotide 2088 (CpG ODN 2088), to mice sustaining a severe, mid-thoracic contusion injury diminished neuropathic pain but did not alter locomotor deficits. These changes were paralleled by a decrease in the pro-inflammatory response at the injury epicenter. Using the same SCI paradigm and treatment regimen, the current studies investigated the effects of the TLR9 antagonist on bladder function. We report that the TLR9 antagonist decreases SCI-elicited urinary retention and ameliorates bladder morphopathology without affecting kidney function. A significant improvement in white matter sparing was also observed, most likely due to alterations in the inflammatory milieu. These findings indicate that the TLR9 antagonist has beneficial effects not only in reducing sensory deficits, but also on bladder dysfunction and tissue preservation. Thus, modulation of innate immune receptor signaling in the spinal cord can impact the effects of SCI.


Assuntos
Oligodesoxirribonucleotídeos/uso terapêutico , Traumatismos da Medula Espinal/complicações , Receptor Toll-Like 9/antagonistas & inibidores , Bexiga Urinária/efeitos dos fármacos , Retenção Urinária/tratamento farmacológico , Substância Branca/efeitos dos fármacos , Animais , Feminino , Camundongos , Oligodesoxirribonucleotídeos/farmacologia , Traumatismos da Medula Espinal/patologia , Traumatismos da Medula Espinal/fisiopatologia , Bexiga Urinária/patologia , Bexiga Urinária/fisiopatologia , Retenção Urinária/etiologia , Retenção Urinária/patologia , Retenção Urinária/fisiopatologia , Substância Branca/patologia , Substância Branca/fisiopatologia
15.
Tierarztl Prax Ausg K Kleintiere Heimtiere ; 42(2): 94-100, 2014 Apr 16.
Artigo em Inglês | MEDLINE | ID: mdl-24737184

RESUMO

OBJECTIVE: Delayed hair re-growth, pruritus and urinary retention are known complications after epidural anaesthesia in dogs. The aim of this study was to prospectively evaluate the effect of epidurally administered drugs on the occurrence of these complications in dogs. MATERIAL AND METHODS: Ninety dogs were included in this study. Eighty client-owned dogs undergoing surgery were randomly assigned to one of three epidural treatment groups: either morphine and bupivacaine (MB), bupivacaine (B), or saline solution 0.9% (S) was administered epidurally to these patients. Ten dogs were only clipped in the lumbosacral area (C). Follow-up started 4 weeks after clipping and was performed every 4-5 weeks in cases of delayed hair re-growth or pruritus. Hair re-growth in the lumbosacral area was observed and compared to hair re-growth in the surgical field and the fentanyl patch area. Cytological analysis and a trichogram were performed if hair re-growth was delayed after 6 months. Time interval to first urination postoperatively was recorded (n = 80). RESULTS: Hair re-growth was delayed in 11 dogs (12.2%; B: n = 7, S: n = 2, MB: n = 1, C: n = 1) with no differences between groups. Pruritus was evident in two dogs (2.2%; MB: n = 1, S: n = 1). After 6 months, hair had started to re-grow in all but one dog (B). After 10 months the coat of this dog had re-grown. Time to first urination did not differ between groups. CONCLUSION AND CLINICAL RELEVANCE: No direct correlation between the particular drugs injected epidurally and delayed hair re-growth, pruritus and urinary retention could be shown. Dog owners should be informed that hair re-growth after epidural anaesthesia could be markedly delayed.


Assuntos
Analgésicos Opioides/efeitos adversos , Anestesia Epidural/veterinária , Doenças do Cão/etiologia , Doenças do Cabelo/veterinária , Retenção Urinária/veterinária , Anestesia Epidural/efeitos adversos , Anestesia Epidural/métodos , Animais , Bupivacaína/efeitos adversos , Doenças do Cão/induzido quimicamente , Doenças do Cão/patologia , Cães , Feminino , Cabelo/crescimento & desenvolvimento , Cabelo/patologia , Doenças do Cabelo/induzido quimicamente , Doenças do Cabelo/patologia , Masculino , Morfina/efeitos adversos , Retenção Urinária/induzido quimicamente , Retenção Urinária/patologia
16.
Urol Int ; 93(1): 122-4, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-23860360

RESUMO

Inflammatory myofibroblastic tumors are commonly seen in young adults and adolescents and commonly present with painless hematuria. We report a case of a 38-year-old woman who presented to us with urinary retention due to a prolapsing tumor mass from the urethra, which was discovered to be an inflammatory myofibroblastic tumor arising from the bladder base and involving the bladder neck. The patient underwent a successful transurethral resection of the tumor and at 6-month follow-up was continent and symptom-free.


Assuntos
Miofibroblastos/patologia , Uretra/cirurgia , Bexiga Urinária/patologia , Retenção Urinária/patologia , Adulto , Feminino , Fibroblastos/patologia , Hematúria/complicações , Humanos , Inflamação , Imagem por Ressonância Magnética , Pelve/patologia , Tomografia Computadorizada por Raios X , Uretra/patologia , Retenção Urinária/terapia
18.
Aktuelle Urol ; 44(6): 462-3, 2013 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-23824929

RESUMO

Henoch-Schönlein purpura (HSP) is the most common form of an immunological systemic vasculitis of childhood. The classic clinical symptoms include purpuric rash, abdominal pain, arthralgias, and haematuria, but the spectrum of HSP may vary to very rare forms. This article reports on an 8-year-old girl with a Henoch-Schönlein purpura (HSP) which resulted in an obstructive bladder mass and subsequent urinary retention. This is the first case reported in the literature, describing such a course.


Assuntos
Púrpura de Schoenlein-Henoch/complicações , Púrpura de Schoenlein-Henoch/diagnóstico , Doenças da Bexiga Urinária/diagnóstico , Doenças da Bexiga Urinária/etiologia , Obstrução do Colo da Bexiga Urinária/diagnóstico , Obstrução do Colo da Bexiga Urinária/etiologia , Retenção Urinária/diagnóstico , Retenção Urinária/etiologia , Biópsia , Criança , Cistite/diagnóstico , Cistite/etiologia , Cistite/patologia , Cistoscopia , Diagnóstico Diferencial , Feminino , Hematúria/diagnóstico , Hematúria/etiologia , Hematúria/patologia , Humanos , Púrpura de Schoenlein-Henoch/patologia , Bexiga Urinária/patologia , Doenças da Bexiga Urinária/patologia , Obstrução do Colo da Bexiga Urinária/patologia , Retenção Urinária/patologia
19.
Mol Cell Biochem ; 381(1-2): 257-65, 2013 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-23740515

RESUMO

Heat shock protein 27 (Hsp27) can regulate actin cytoskeleton dynamics and contractile protein activation. This study investigates whether Hsp27 expression is related to bladder contractile dysfunction after acute urinary retention (AUR). Female rats were randomized either to AUR by urethral ligation or to normal control group. Bladder and smooth muscle strip contraction at time points from 0 h to 7 days after AUR were estimated by cystometric and organ bath studies. Hsp27 expression in bladder tissue at each time point was detected with immunofluorescence, Western blots, and real-time PCR. Expression of the three phosphorylated forms of Hsp27 was detected by Western blots. Smooth muscle ultrastructure was observed by transmission electron microscopy. Data suggest that maximum detrusor pressure and both carbachol-induced and spontaneous detrusor strip contraction amplitude decreased gradually for the duration from 0 to 6 h, and then increased gradually to near-normal values at 24 h. Treatment of muscle strips with the p38MAK inhibitor, SB203580, inhibited carbachol-induced contractions. Smooth muscle ultrastructure damage was the highest at 6 h after AUR, and then lessened gradually during next 7 days, and ultrastructure was close to normal. Expressions of Hsp27 mRNA and protein and the proteins of the three phosphorylated forms were higher at 0 h, decreased to lower levels up to 6 h, and then gradually increased. Therefore, we conclude that rat bladder contractile function after AUR worsens during 0-6 h, and then gradually recovers. The findings of the current study suggest that Hsp27 modulates bladder smooth muscle contraction after AUR, and that phosphorylation of Hsp27 may be an important pathway modulating actin cytoskeleton dynamics in bladder smooth muscle contraction and reconstruction after injury.


Assuntos
Proteínas de Choque Térmico HSP27/metabolismo , Contração Muscular/fisiologia , Músculo Liso/fisiopatologia , Bexiga Urinária/fisiopatologia , Retenção Urinária/metabolismo , Retenção Urinária/fisiopatologia , Animais , Western Blotting , Carbacol/farmacologia , Feminino , Imunofluorescência , Regulação da Expressão Gênica/efeitos dos fármacos , Proteínas de Choque Térmico HSP27/genética , Técnicas In Vitro , Contração Muscular/efeitos dos fármacos , Músculo Liso/efeitos dos fármacos , Músculo Liso/metabolismo , Músculo Liso/ultraestrutura , Fosforilação/efeitos dos fármacos , Pressão , RNA Mensageiro/genética , RNA Mensageiro/metabolismo , Ratos , Ratos Sprague-Dawley , Bexiga Urinária/efeitos dos fármacos , Bexiga Urinária/metabolismo , Bexiga Urinária/ultraestrutura , Retenção Urinária/genética , Retenção Urinária/patologia
20.
Int J Urol ; 20(4): 421-8, 2013 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-22989348

RESUMO

OBJECTIVE: To comprehensively analyze the 5-year outcomes of tamsulosin treatment for patients with benign prostatic hyperplasia. METHODS: Tamsulosin (0.2 mg/day) was given to 112 patients who had International Prostate Symptom Scores ≥8. They were prospectively followed for 5 years with periodic evaluation. If tamsulosin had to be discontinued, the reason was determined. Treatment failure was considered in the case of disease progression (postvoid residual urine volume ≥200 mL, acute urinary retention, febrile urinary tract infection or hydronephrosis as a result of bladder outlet obstruction), conversion to other α1-blockers or need for surgery. An intention-to-treat analysis was carried out. RESULTS: A total of 34 patients (30.4%) continued the same medication for the overall study period, whereas 78 patients (69.6%) discontinued the medication. International Prostate Symptom Scores, Benign Prostatic Hyperplasia Problem Index and Quality of Life Index were significantly improved over the 5-year period. Treatment failure was observed in 21 patients (18.8%). Baseline prostate volume and postvoid residual urine volume were independent factors to predicting treatment failure. A total of 21 patients (18.8%) discontinued tamsulosin because of an improvement of symptoms. They were younger and had lower prostate-specific antigen levels than the remaining 91 patients. Their symptoms were stable even 1 year after termination of therapy. CONCLUSIONS: Long-term efficacy of tamsulosin was observed, although only a small portion of patients continued the treatment. α1-blocker monotherapy might be not appropriate for achieving a good long-term outcome in patients with a large prostate volume and a large amount of postvoid residual urine volume. Persistent improvement of symptoms, even after termination of tamsulosin, was observed in young patients with low prostate-specific antigen levels.


Assuntos
Antagonistas de Receptores Adrenérgicos alfa 1/administração & dosagem , Hiperplasia Prostática/tratamento farmacológico , Hiperplasia Prostática/patologia , Sulfonamidas/administração & dosagem , Antagonistas de Receptores Adrenérgicos alfa 1/efeitos adversos , Idoso , Progressão da Doença , Seguimentos , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Pacientes Desistentes do Tratamento , Valor Preditivo dos Testes , Modelos de Riscos Proporcionais , Estudos Prospectivos , Hiperplasia Prostática/cirurgia , Sulfonamidas/efeitos adversos , Tansulosina , Resultado do Tratamento , Retenção Urinária/tratamento farmacológico , Retenção Urinária/patologia , Retenção Urinária/cirurgia , Transtornos Urinários/tratamento farmacológico , Transtornos Urinários/patologia , Transtornos Urinários/cirurgia
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