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1.
Urol Clin North Am ; 46(4): 527-539, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31582027

RESUMO

"Surgical (re)construction of a vagina (vaginoplasty) is performed in biological women with congenital or postablative vaginal absence and in transgender women. Penile inversion vaginoplasty is the gold surgical standard for genital Gender Affirmation Surgery in transgender women. In absence of sufficient penoscrotal skin, due to penoscrotal hypoplasia, circumcision, penile trauma with loss of penile skin quantity and/or quality, or when primary vaginoplasty has failed, intestinal vaginoplasty can be performed. This article provides an update on surgical indications of intestinal vaginoplasty, operative technique, perioperative care, and short- and long-term postoperative issues. A review of recent literature is performed."


Assuntos
Laparoscopia/métodos , Complicações Pós-Operatórias/epidemiologia , Cirurgia de Readequação Sexual/efeitos adversos , Cirurgia de Readequação Sexual/métodos , Transexualismo , Vagina/cirurgia , Feminino , Humanos , Laparoscopia/efeitos adversos , Masculino , Seleção de Pacientes , Pênis/cirurgia , Assistência Perioperatória
2.
Urol Clin North Am ; 46(4): 567-580, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31582030

RESUMO

Single-stage phalloplasty may be accomplished by having both the microsurgical and the reconstructive urology team operate simultaneously. Phalloplasty with pars pendulans urethroplasty is completed by the microsurgeons, and pars fixa urethroplasty, vaginectomy, scrotoplasty, and perineal reconstruction are performed by the reconstructive urologist. Some surgeons prefer separating phalloplasty from the urologic portions of the procedure. The single-staged approach is favored in patients whose ultimate goal is to have an aesthetic, sensate, and functional phallus and scrotum. Complications remain high but are predictably lower in higher-volume centers. Reconstructive urologists manage the urethral complications that develop.


Assuntos
Cirurgia de Readequação Sexual/métodos , Transexualismo , Feminino , Genitália Feminina/cirurgia , Humanos , Masculino , Seleção de Pacientes , Complicações Pós-Operatórias/epidemiologia , Cirurgia de Readequação Sexual/efeitos adversos , Uretra/cirurgia
3.
Urol Clin North Am ; 46(4): 581-590, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31582031

RESUMO

The treatment of gender dysphoria related to genitourinary anatomy can be effectively treated with phalloplasty. A phalloplasty may include some or all of the following: penile shaft, glans, shaft urethra, perineal urethra, scrotoplasty, vaginectomy, testicular implants, and erectile devices. The literature does not currently support a gold standard for how best to stage these procedures. This article reviews current techniques for phalloplasty staging and proposes that a staged urethral reconstruction is a reliable technique that allows for potential complications to be managed individually, while minimizing the severity of complications and their impact on the outcome of the final reconstruction.


Assuntos
Disforia de Gênero/cirurgia , Genitália Feminina/cirurgia , Cirurgia de Readequação Sexual/métodos , Transexualismo , Feminino , Humanos , Masculino , Seleção de Pacientes , Prótese de Pênis , Complicações Pós-Operatórias/epidemiologia , Cirurgia de Readequação Sexual/efeitos adversos , Uretra/cirurgia
4.
Urol Clin North Am ; 46(4): 591-603, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31582032

RESUMO

Significant developments have enabled the transformation of phalloplasty to a functional organ. Differences exist in the surgical placement of a prosthesis when within a phallus, such as the lack of corpora, pubic fixation requirement, distal sock placement, and the consideration of a vascular pedicle. Increased complications compared with nonphalloplasty cohorts remain one of the biggest challenges, including rates of infection, erosion, mechanical malfunction, and malposition. Nonetheless, the placement of penile prosthesis within a phalloplasty enables trans men to achieve a once near-impossible goal of penetrative sexual intercourse without an external device.


Assuntos
Genitália Feminina/cirurgia , Implante Peniano/efeitos adversos , Prótese de Pênis , Cirurgia de Readequação Sexual/instrumentação , Transexualismo , Feminino , Humanos , Masculino , Seleção de Pacientes , Complicações Pós-Operatórias/epidemiologia , Cirurgia de Readequação Sexual/efeitos adversos , Uretra/cirurgia
5.
Semin Vasc Surg ; 32(1-2): 73-80, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31540660

RESUMO

The use of autologous femoral veins for in situ reconstruction of the aortoiliac segment is an effective technique to treat native aorta or prosthetic graft infections. The indications, technical details, and outcomes of this procedure are detailed. Graft infection involving the aortic segment, while rare, remains one of the most challenging vascular surgery conditions to treat. The original technique of "neo-aortoiliac surgery" with in situ autologous vein grafts has evolved over the past 25 years and remains a worthwhile alternative for the treatment of aortic graft infections, with lower mortality rates compared with other extra-anatomic or in situ surgical options. Acceptance of this surgical option is due to low graft re-infection rates, rare graft disruption, and low long-term aneurysmal degeneration. Excision of the femoral veins is associated with acceptable rates of lower limb edema. The use of an autologous femoral vein graft can be considered the standard of care in selected patients for the management of aortic graft infections. Optimal management of patients with aortic graft infections requires consideration of all potential therapeutic options because no single modality can be used, and individualizing treatment according to the clinical condition will yield the best patient outcomes.


Assuntos
Aneurisma Infectado/cirurgia , Aorta/cirurgia , Aneurisma Aórtico/cirurgia , Implante de Prótese Vascular/efeitos adversos , Prótese Vascular/efeitos adversos , Veia Femoral/transplante , Infecções Relacionadas à Prótese/cirurgia , Procedimentos Cirúrgicos Reconstrutivos , Aneurisma Infectado/diagnóstico por imagem , Aneurisma Infectado/microbiologia , Aorta/diagnóstico por imagem , Aorta/microbiologia , Aneurisma Aórtico/diagnóstico por imagem , Aneurisma Aórtico/microbiologia , Implante de Prótese Vascular/instrumentação , Tomada de Decisão Clínica , Remoção de Dispositivo , Humanos , Seleção de Pacientes , Infecções Relacionadas à Prótese/diagnóstico por imagem , Infecções Relacionadas à Prótese/microbiologia , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Reoperação , Fatores de Risco , Resultado do Tratamento
6.
Cancer Radiother ; 23(6-7): 503-509, 2019 Oct.
Artigo em Francês | MEDLINE | ID: mdl-31471253

RESUMO

There are many treatment options for localized prostate cancers, including active surveillance, brachytherapy, external beam radiotherapy, and radical prostatectomy. Quality of life remains a primary objective in the absence of superiority of one strategy over another in terms of specific survival with similar long-term biochemical control rates. Despite a significant decrease in digestive and urinary toxicities thanks to IMRT and IGRT, external radiotherapy remains a treatment that lasts approximately 2 months or 1.5 months, when combined with a brachytherapy boost. Given the specific radiosensitivity of this tumor, several randomized studies have shown that a hypofractionated scheme is not inferior in terms of biochemical control and toxicities, allowing to divide the number of fractions by a factor 2 to 8. Given that SBRT becomes a validated therapeutic option for a selected population of patients with localized prostate cancer, extreme hypofractionation is becoming a strong challenger of conventional external radiotherapy or brachytherapy.


Assuntos
Neoplasias da Próstata/patologia , Neoplasias da Próstata/radioterapia , Hipofracionamento da Dose de Radiação , Braquiterapia , Ensaios Clínicos Fase III como Assunto , Estudos de Equivalência como Asunto , Humanos , Irradiação Linfática/métodos , Masculino , Seleção de Pacientes , Cuidados Pós-Operatórios , Qualidade de Vida , Hipofracionamento da Dose de Radiação/normas , Tolerância a Radiação , Radioterapia Guiada por Imagem , Radioterapia de Intensidade Modulada , Ensaios Clínicos Controlados Aleatórios como Assunto
7.
J Nurs Adm ; 49(10): 473-479, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31490796

RESUMO

OBJECTIVE: To describe strategies to recruit and support members from hard-to-reach groups on research-focused Patient and Family Advisory Councils (PFACs). BACKGROUND: Ensuring diverse representation of members of research PFACs is challenging, and few studies have given attention to addressing this problem. METHODS: A qualitative study was conducted using 8 focus groups and 19 interviews with 80 PFAC members and leaders, hospital leaders, and researchers. RESULTS: Recruitment recommendations were: 1) utilizing existing networks; 2) going out to the community; 3) accessing outpatient clinics; and 4) using social media. Strategies to support inclusion were: 1) culturally appropriate communication methods; 2) building a sense of community between PFAC members; 3) equalizing roles between community members/leaders; 4) having a diverse PFAC leadership team; and 5) setting transparent expectations for PFAC membership. CONCLUSION: Increasing the diversity of research PFACs is a priority, and it is important to determine how best to engage groups that have been traditionally underrepresented.


Assuntos
Comitês Consultivos/organização & administração , Pesquisa em Enfermagem/organização & administração , Seleção de Pacientes , Adulto , California , Cuidadores , Família , Feminino , Grupos Focais , Humanos , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa , Projetos de Pesquisa
8.
Khirurgiia (Mosk) ; (8. Vyp. 2): 16-23, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31502589

RESUMO

One of the main problems in the treatment of peritoneal carcinomatosis (PC) in colorectal cancer (CRC) is the adequate selection of patients for cytoreductive surgery (CS) and hyperthermic intraperitoneal chemotherapy (HIPEC). AIM: To determine the predictive factors of overall (OS) and disease-free survival (DFS) in CRC patients with PC after CS with HIPEC. MATERIAL AND METHODS: From 2010 to 2018 years 102 patients with CRC and PC were included in the study. The cytoreduction was complete (CC0, according to Sugabaker scale) in 96 (94.2%) cases. The age median of patients was 65 years. There were 63 (62%) women. In 81 (79%) patients, the PC was synchronous. The median level of CEA was 8.5 ng/ml. The median peritoneal carcinomatous index (PCI) was 3 (1-23). RESULTS: The median of follow-up was 18 (11; 33) months. The median of DFS and OS were 13 (9;31) and 32 (17; n/d) months, respectively. Multifactorial Cox-regression analysis showed the localization of the primary tumor in the right colon (OR=1.66; 95% CI 1.1-2.5; p=0.013) and the level of the PCI (OR = 1.08; 95% CI 1.024-1.15; p=0.008) were independent negative factors of OS. CONCLUSION: The CS and HIPEC in patients with CRC with PC allowes to achieve five-year survival in a part of patients, especially with low PCI. Identifying adverse prognostic factors preoperatively can help in selecting patients for CS in the future.


Assuntos
Neoplasias Colorretais/patologia , Neoplasias Peritoneais/mortalidade , Neoplasias Peritoneais/terapia , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Terapia Combinada , Procedimentos Cirúrgicos de Citorredução , Feminino , Humanos , Hipertermia Induzida , Masculino , Seleção de Pacientes , Neoplasias Peritoneais/secundário , Prognóstico , Análise de Sobrevida
9.
Stud Health Technol Inform ; 267: 262-269, 2019 Sep 03.
Artigo em Inglês | MEDLINE | ID: mdl-31483281

RESUMO

Antimycotics are substances to treat fungal infections, a frequent cause of death on intensive care units. It is of great importance to administer such drugs only to patients who actually need them, since the unnecessary application leads to the selection of multiresistent fungi, making future therapy more difficult, and represents a significant financial burden for the health care system. Within the scope of a prospective study, which analyses the premature discontinuation of the administration of unnecessary antifungal drugs, two software platforms for recruitment support were implemented and compared at the University Hospital Erlangen. Besides technical aspects, such as the necessary development time and query runtimes, their usability and user friendliness for the clinical users were compared. We found that the practical identification of patient cohorts is possible both with a full featured business intelligence application and with a low effort approach based on language constructs of the Arden Syntax. Furthermore, this pilot evaluation led to important insights related to the clinical documentation context and data quality issues. A comprehensive analysis of the clinical environment and documentation context is essential for the final decision on the tool to be used.


Assuntos
Unidades de Terapia Intensiva , Seleção de Pacientes , Software , Eletrônica , Humanos , Estudos Prospectivos
16.
Methodist Debakey Cardiovasc J ; 15(2): 105-110, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31384373

RESUMO

Patients with a functionally univentricular heart who have had an atriopulmonary Fontan are at risk for atrial dilatation, atrial arrhythmias, and progressive circulatory failure. Between 1994 and 2018, we performed 149 Fontan conversions with arrhythmia surgery and epicardial pacemaker placement at Ann & Robert H. Lurie Children's Hospital of Chicago. This operation converts the atriopulmonary Fontan to an extracardiac Fontan that improves hemodynamics and controls the atrial arrhythmias. Operative mortality during that time was 2%, and freedom from death or heart transplant at 10 years is 84%. For properly selected patients, Fontan conversion improves both survival and quality of life. Patients with an atriopulmonary Fontan constitute an eroding population, as they face many comorbidities and have a decreased life expectancy without treatment; therefore, all patients with an atriopulmonary Fontan should be evaluated for this procedure.


Assuntos
Arritmias Cardíacas/cirurgia , Cardiomegalia/cirurgia , Técnica de Fontan , Cardiopatias Congênitas/cirurgia , Adolescente , Adulto , Arritmias Cardíacas/etiologia , Arritmias Cardíacas/mortalidade , Arritmias Cardíacas/fisiopatologia , Cardiomegalia/etiologia , Cardiomegalia/mortalidade , Cardiomegalia/fisiopatologia , Criança , Pré-Escolar , Tomada de Decisão Clínica , Feminino , Técnica de Fontan/efeitos adversos , Técnica de Fontan/mortalidade , Cardiopatias Congênitas/complicações , Cardiopatias Congênitas/mortalidade , Cardiopatias Congênitas/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Seleção de Pacientes , Intervalo Livre de Progressão , Reoperação , Medição de Risco , Fatores de Risco , Fatores de Tempo , Adulto Jovem
17.
Methodist Debakey Cardiovasc J ; 15(2): 111-121, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31384374

RESUMO

Anomalous aortic origin of a coronary artery (AAOCA) is the second leading cause of sudden cardiac death in young athletes. The pathophysiology leading to sudden cardiac death, the specific risks associated with the different varieties of AAOCA, and the effects of different management strategies on the risk of sudden cardiac death are all unknown. This article describes the current knowledge of AAOCA, a proposed nomenclature for the different anatomic subtypes, the different modalities used to diagnose and characterize the disease, the available management strategies, and an algorithm used by the authors to diagnose and manage these patients.


Assuntos
Técnicas de Imagem Cardíaca , Anomalias dos Vasos Coronários/diagnóstico por imagem , Anomalias dos Vasos Coronários/terapia , Morte Súbita Cardíaca/prevenção & controle , Algoritmos , Tomada de Decisão Clínica , Anomalias dos Vasos Coronários/complicações , Anomalias dos Vasos Coronários/fisiopatologia , Morte Súbita Cardíaca/etiologia , Técnicas de Apoio para a Decisão , Humanos , Seleção de Pacientes , Valor Preditivo dos Testes , Prognóstico , Medição de Risco , Fatores de Risco
18.
Methodist Debakey Cardiovasc J ; 15(2): 145-148, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31384378

RESUMO

Steady advances in the diagnosis and management of congenital heart disease over the last few decades has resulted in a growing population of adults with congenital heart disease (ACHD). Consequently, there has been a parallel increase in the number of ACHD patients plagued with end-stage heart failure. Even so, the transplantation rate for these patients has remained low, at about 3% of all adult heart transplants. This review discusses the scope of transplantation for ACHD, including indications and contraindications, specific challenges and nuances, and post-transplant outcomes.


Assuntos
Cardiopatias Congênitas/cirurgia , Insuficiência Cardíaca/cirurgia , Transplante de Coração , Adulto , Fatores Etários , Tomada de Decisão Clínica , Progressão da Doença , Cardiopatias Congênitas/complicações , Cardiopatias Congênitas/mortalidade , Cardiopatias Congênitas/fisiopatologia , Insuficiência Cardíaca/etiologia , Insuficiência Cardíaca/mortalidade , Insuficiência Cardíaca/fisiopatologia , Transplante de Coração/efeitos adversos , Transplante de Coração/mortalidade , Humanos , Seleção de Pacientes , Medição de Risco , Fatores de Risco , Resultado do Tratamento , Listas de Espera
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