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1.
Bol. méd. postgrado ; 36(2): 43-47, dic.2020. tab, graf
Artigo em Espanhol | LILACS, LIVECS | ID: biblio-1117899

RESUMO

La uroflujometría es un estudio no invasivo del tracto urinario inferior que entrega información objetiva del flujo urinario y es ampliamente recomendado por las guías europeas en el estudio de pacientes con sintomatología urinaria baja. Se realizó un estudio descriptivo transversal cuyo propósito fue describir el uso de la uroflujometría en el estudio de síntomas del tracto urinario bajo en pacientes masculinos que acudieron a la consulta de Servicio de Urología del Hospital Central Universitario Dr. Antonio María Pineda de la ciudad de Barquisimeto, estado Lara durante el lapso 2018- 2019. La muestra estuvo conformada por 150 pacientes. Los resultados indican que el 62% de la muestra corresponde a pacientes entre 60 y 70 años de edad de los cuales 52% manifestaron síntomas urinarios leves. La uroflujometría evidenció que 56% de los pacientes tienen un flujo máximo entre 10 y 20 ml/seg lo cual sugiere una probable obstrucción al flujo de salida; 78% de los pacientes presentan un flujo promedio entre 0 a 10 ml/seg. El 53% de los pacientes mostró un volumen de vaciado < 300 ml y 49% un tiempo de flujo máximo entre 30 y 50 segundos. En conclusión, la uroflujometría es un examen simple y rápido que proporciona información útil sobre la salud de las vías urinarias inferiores(AU)


Uroflowmetry is a non-invasive study of the lower urinary tract that provides objective information on urinary flow and is widely recommended by European guidelines for the study of patients with lower urinary tract symptoms. We performed a cross-sectional descriptive study to describe the use of uroflowmetry for the study of lower urinary tract symptoms in males who attended the Servicio de Urología of the Hospital Central Universitario Dr. Antonio María Pineda (Barquisimeto, Lara state) during the 2018- 2019 period. The sample was made up of 150 males. The results show that 62% of the sample included males between 60 and 70 years old and 52% complained of mild urinary symptoms. Uroflowmetry results showed that 56% of patients had a maximum flow between 10 and 20 ml/sec suggestive of urinary tract obstruction; 78% had an average flow between 0 and 10 ml/sec while 53% had a micturition volume < 300 ml and 49% had a maximum flow time between 30 and 50 seconds. Uroflowmetry is a simple and fast test which provides useful information about the health of lower urinary tract(AU)


Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Idoso , Obstrução Uretral , Sistema Urinário , Prostatismo/diagnóstico por imagem , Tratamento Conservador/métodos , Micção , Doenças Urológicas , Ultrassonografia
2.
Medicine (Baltimore) ; 99(46): e23223, 2020 Nov 13.
Artigo em Inglês | MEDLINE | ID: mdl-33181705

RESUMO

INTRODUCTION: Low back pain (LBP) is high prevalent and it is the leading cause of years lived with disability in both developed and developing countries. The sacroiliac joint (SIJ) is a common reason that caused LBP. At present, the treatment of chronic LBP attributed to SIJ is mainly conservative treatment and surgical treatment. However, there are still controversies between the 2 treating methods, and there is no recognized standard of treatment or surgical indications. Recent publications indicated that minimally invasive sacroiliac joint arthrodesis was safe and more effective improving pain, disability, and quality of life compared with conservative management in 2 years follow-up, which re-raise the focus of sacroiliac joints fusion. This paper will systematically review the available evidence, comparing the effectiveness of sacroiliac joint fusion and conservative therapy for the treatment of gait retraining for patients suffered from LBP attributed to the sacroiliac joint. METHOD AND ANALYSIS: A systematic review and meta-analysis of relevant studies in Pubmed, Embase, SCOPUS, and Cochrane Library will be synthesized. Inclusion criteria will be studies evaluating clinical outcomes (i.e., changes to pain and/or function) comparing sacroiliac joint fusion and conservative therapy in populations sacroiliac join related LBP; studies with less than 10 participants in total will be excluded. The primary outcomes measured will be pain score, Oswestry Disability Index (ODI), and adverse events during treatment. Review Manager (Revman; Version 5.3) software will be used for data synthesis, sensitivity analysis, meta-regression, subgroup analysis, and risk of bias assessment. A funnel plot will be developed to evaluate reporting bias and Begg and Egger tests will be used to assess funnel plot symmetries. We will use the Grading of Recommendations Assessment, Development and Evaluation system to assess the quality of evidence. ETHICS AND DISSEMINATION: Our aim is to publish this systematic review and meta-analysis in a peer-reviewed journal. Our findings will provide information comparing the efficacy and safety comparing sacroiliac joint fusion and non-surgical treatment for patients with LBP attributed to the sacroiliac joint. This review will not require ethical approval as there are no issues about participant privacy.


Assuntos
Tratamento Conservador/normas , Dor Lombar/terapia , Articulação Sacroilíaca/anormalidades , Fusão Vertebral/normas , Protocolos Clínicos , Humanos , Dor Lombar/fisiopatologia , Metanálise como Assunto , Articulação Sacroilíaca/diagnóstico por imagem , Fusão Vertebral/métodos , Revisões Sistemáticas como Assunto
3.
Acta Chir Orthop Traumatol Cech ; 87(5): 340-345, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33146602

RESUMO

PURPOSE OF THE STUDY Subacromial impingement is one of the most common reasons for shoulder pain. The surgical management of this condition has recently become the focus of criticism because of the rising number of surgical procedures and the lack of superiority of surgical over conservative treatment. In this prospective comparative study, we compared standardised conservative care with surgical treatment and placed special emphasis on the patients' ability to work. MATERIAL AND METHODS A total of 106 patients (25 women, 81 men; mean age: 45.4 12.3 years) were included in this prospective comparative clinical study. Patients in the non-operative arm (n = 42) received standardised physiotherapy. Patients in the surgical arm (n = 38) underwent arthroscopic subacromial decompression. All patients were followed up at 3, 6 and 12 months. Shoulder function (Constant score), pain (Numerical Rating Scale), and the duration of inability to work were assessed. RESULTS Shoulder function and pain improved significantly with both kinds of treatment. At no time of follow up we detected significant differences between the two treatment options. An analysis of the patients' ability to work showed that conservative treatment was superior to surgical treatment at 3-month follow-up (0.3 versus 5.0 weeks; p < 0.001) and between 4 and 6-month after intervention (0.2 versus 1.6 weeks; p = 0.032). DISCUSSION In the study presented here, significant improvements in function (Constant score) and pain (NRS) were achieved in both the non-operative and the surgical arm. There were no significant differences between the two groups at any time point. These results are similar to those reported by other authors in recent studies. Unlike other research work, however, our study demonstrated a major difference in the development and duration of inability to work. CONCLUSIONS Conservative and surgical treatment of subacromial impingement syndrome led to similar outcomes for shoulder pain and function at 3, 6 and 12 months after intervention. However, patients who were managed conservatively returned to work significantly earlier than patients who underwent surgery. Key words: subacromial impingement, shoulder, constant score, pain, ability to work.


Assuntos
Síndrome de Colisão do Ombro , Artroscopia , Tratamento Conservador , Descompressão Cirúrgica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Síndrome de Colisão do Ombro/cirurgia , Dor de Ombro/etiologia , Dor de Ombro/terapia , Resultado do Tratamento
4.
J Stroke Cerebrovasc Dis ; 29(11): 105224, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33066904

RESUMO

A 66-year-old man presented with a 6-day history of progressive posterior cervical pain that included lower back pain and fever. Neurological examinations revealed neck stiffness. Computed tomography demonstrated convexity subarachnoid hemorrhage. A spinal T2-weighted image revealed a hypointense signal lesion with contrast enhancement of the intradural extramedullary space at Th12-L1. Digital subtraction angiography showed a fusiform aneurysm with a 10 mm diameter in the artery of Adamkiewicz. We diagnosed the patient's condition as a ruptured aneurysm of the artery of Adamkiewicz. By day 41 the aneurysm had disappeared following conservative treatment. Aneurysms arising from the artery of Adamkiewicz are extremely rare and can cause both convexity and spinal subarachnoid hemorrhages. Clinicians should therefore look for spinal lesions if patients with convexity subarachnoid hemorrhage of an unknown origin have lower back pain as their initial symptom.


Assuntos
Aneurisma Roto/complicações , Coluna Vertebral/irrigação sanguínea , Hemorragia Subaracnóidea/etiologia , Idoso , Aneurisma Roto/diagnóstico por imagem , Aneurisma Roto/terapia , Tratamento Conservador , Humanos , Dor Lombar/etiologia , Masculino , Hemorragia Subaracnóidea/diagnóstico por imagem , Hemorragia Subaracnóidea/terapia , Resultado do Tratamento
5.
Medicine (Baltimore) ; 99(43): e22901, 2020 Oct 23.
Artigo em Inglês | MEDLINE | ID: mdl-33120841

RESUMO

INTRODUCTION: Chemotherapeutic agents of direct cell damage play a role in initiating thrombotic microangiopathy (TMA), however still being underdiagnosed. Decitabine (DAC) is a pyrimidine analogue of the nucleoside cytidine, which can lead to injury to endothelium. Biopsy-proven DAC-induced kidney injury is rare. PATIENT CONCERNS: A 47-year-old Chinese man with membranous nephropathy presented recurrent edema and acute kidney injury after a 3-day course of low dose DAC infusion because of cyclophosphamide-relating thrombocytopenia. DIAGNOSIS: Laboratory data revealed nephrotic syndrome, hematuria, renal glycosuria and hypokalemia with hyperchloridemia. Renal pathological findings revealed TMA with secondary glomerular crescents formation (28%), partial foot process effacement and acute tubular necrosis. A diagnosis of DAC-induced renal TMA was considered. INTERVENTIONS: As DAC had been timely discontinued before admission, the patient only received supportive treatment. OUTCOMES: The patient achieved rapid remission of acute kidney injury after DAC withdrawal, and his serum creatinine further decreased to normal level after 6 months. CONCLUSION: Careful monitoring of renal function especially serum creatinine should be emphasized during DAC treatment.


Assuntos
Antimetabólitos Antineoplásicos/efeitos adversos , Decitabina/efeitos adversos , Glomérulos Renais/patologia , Rim/patologia , Microangiopatias Trombóticas/induzido quimicamente , Lesão Renal Aguda/etiologia , Tratamento Conservador , Ciclofosfamida/efeitos adversos , Glomerulonefrite Membranosa/patologia , Humanos , Imunossupressores/efeitos adversos , Rim/irrigação sanguínea , Masculino , Pessoa de Meia-Idade , Síndrome Nefrótica/diagnóstico , Síndrome Nefrótica/etiologia , Trombocitopenia/induzido quimicamente , Suspensão de Tratamento
6.
Medicine (Baltimore) ; 99(43): e22934, 2020 Oct 23.
Artigo em Inglês | MEDLINE | ID: mdl-33120850

RESUMO

INDUCTION: Liver transplantation (LT) is the only final therapy for patients with acute liver failure (ALF) that cannot be controlled by conservative treatment. Acute pancreatitis (AP) is a recognized complication of ALF. The pathogenesis of AP in ALF patients has not yet been elucidated. The appearance of AP complicates the patients condition and causes a significantly increased risk of mortality. PATIENT CONCERNS: We report 2 fatal cases who were both admitted with yellowing of skin and sclera with general weakness lasting for 2 weeks. DIAGNOSIS: After admission, the laboratory examination of case 1 showed liver dysfunction with serum levels of total bilirubin (TB) 270 µmol/l, alanine aminotransferase (ALT) 106 U/l. Abdominal computed tomography (CT) showed pelvic and peritoneal cavity fluids, occupation of left lateral lobe of liver and unclear margin of pancreas. The clinical laboratory findings of case 2 revealed TB 351.1 µmol/l, ALT 252 U/l, blood lactic acid 18 mmol/l, ammonia 209 µmol/l. And abdominal CT showed pancreatic exudation. They were both diagnosed with acute liver failure, hepatic encephalopathy and AP which was confirmed during the operation. INTERVENTIONS: They were both received a routine orthotopic LT. OUTCOMES: After the surgery, their liver functions recovered well, and they received conventional conservative treatment for pancreatitis. However, the treatment was not adequately effective, and the infection was too serious and both died of multiple organ failure despite emergency rescue efforts on day 21 and day 19 after LT. CONCLUSION: AP is a serious complication that can contribute to prohibitive morbidity and mortality in LT patients. For this reason, the vulnerable state of the pancreas and the scoring system must be defined to help clinicians decide whether a patient is suitable for liver transplantation, and the clinical experience in the treatment of pancreatitis after LT needs to be summarized as an optimal treatment guideline to facilitate better treatment.


Assuntos
Falência Hepática Aguda/etiologia , Falência Hepática Aguda/terapia , Transplante de Fígado/mortalidade , Pancreatite/complicações , Idoso , Alanina Transaminase/sangue , Bilirrubina/sangue , Tratamento Conservador/métodos , Evolução Fatal , Encefalopatia Hepática/diagnóstico , Humanos , Período Intraoperatório , Masculino , Pessoa de Meia-Idade , Pancreatite/diagnóstico , Pancreatite/terapia , Prognóstico , Tomógrafos Computadorizados
7.
Can J Surg ; 63(5): E431-E434, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33009897

RESUMO

SUMMARY: Hepato-pancreato-biliary (HPB) injuries can be extremely challenging to manage. This scoping review (8438 citations) offers a number of recommendations. If diagnosis and therapy are rapid, patients with major hepatic injuries who present in physiologic extremis have high survival rates despite prolonged hospital stays. Nonoperative management of major liver injuries, as diagnosed using computed tomography, is typically successful. Adjuncts (e.g., angioembolization, laparoscopic washouts, biliary stents) are essential in managing high-grade injuries. Injury to the extrahepatic biliary tree is rare. Cholecystectomy is indicated for all gallbladder trauma. Full-thickness common bile duct injuries require a hepaticojejunostomy, although damage control remains closed suction drainage. Injuries to the pancreatic head often involve concurrent trauma to regional vasculature. Damage control necessitates drainage after stopping hemorrhage. Injury to the left pancreas commonly requires a distal pancreatectomy. Outcomes for high-grade pancreatic and liver injuries are improved by involving an HPB team. Complications are multidisciplinary and should be managed without delay.


Assuntos
Traumatismos Abdominais/terapia , Sistema Biliar/lesões , Fígado/lesões , Pâncreas/lesões , Traumatismos Abdominais/complicações , Traumatismos Abdominais/diagnóstico , Traumatismos Abdominais/mortalidade , Sistema Biliar/diagnóstico por imagem , Tratamento Conservador/efeitos adversos , Tratamento Conservador/métodos , Tratamento Conservador/normas , Tratamento Conservador/estatística & dados numéricos , Humanos , Fígado/diagnóstico por imagem , Pâncreas/diagnóstico por imagem , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Guias de Prática Clínica como Assunto , Índice de Gravidade de Doença , Procedimentos Cirúrgicos Operatórios/efeitos adversos , Procedimentos Cirúrgicos Operatórios/métodos , Procedimentos Cirúrgicos Operatórios/normas , Procedimentos Cirúrgicos Operatórios/estatística & dados numéricos , Fatores de Tempo , Tempo para o Tratamento/normas , Tomografia Computadorizada por Raios X , Resultado do Tratamento
8.
BMC Infect Dis ; 20(1): 801, 2020 Oct 29.
Artigo em Inglês | MEDLINE | ID: mdl-33121447

RESUMO

BACKGROUND: According to the 2006 American Society for Colposcopy and Cervical Pathology guidelines, positive CIN2 p16 in women over the age of 25 should be managed with excisional treatment. However, excisional treatment is associated with physical, psychological and obstetric morbidity and can have a negative impact on sexual function. In our study we sought to identify a clear management strategy, addressing the impact of routine use of p16 immunohistochemistry in this population and identify appropriate criteria for patient selection with the aim of reducing over-treatment. METHOD: We studied the medical records of 130 patients who had undergone laser therapy for CIN2. Each patient underwent colposcopy, biopsy and HPV test and were tested for p16 protein,. Patients were divided based on HPV infection into: single infections, multiple infections. All patients underwent ZTA laser therapy with follow-up (2-year follow-up). STATISTICAL ANALYSIS: Contingency tables were created to evaluate the correlation between single, multiple and CIN2+ infections. Values with p < 0.05 were considered statistically significant. RESULTS: Single infections had a histological regression of 61.8% (21/34) and a histological persistence rate of 35.3% (12/34), which was greater than the multiple infection rate. The common characteristic that the women with persistence and progression had was the dimension of the lesion and the genotype 16. Ten cases of histological persistence and the only case of progression had one lesion greater than three quarters of the cervix. CONCLUSIONS: With the progress of our understanding of the natural history of infection from human papillomavirus and the increasing use of colposcopy, thanks to the addition of HPV genotyping and the technique of immunohistochemistry, conservative management of these lesions is now possible.


Assuntos
Neoplasia Intraepitelial Cervical/complicações , Neoplasia Intraepitelial Cervical/terapia , Tratamento Conservador/métodos , Inibidor p16 de Quinase Dependente de Ciclina/metabolismo , Papillomaviridae/genética , Infecções por Papillomavirus/complicações , Neoplasias do Colo do Útero/complicações , Neoplasias do Colo do Útero/terapia , Adulto , Neoplasia Intraepitelial Cervical/virologia , Colposcopia , Inibidor p16 de Quinase Dependente de Ciclina/imunologia , Progressão da Doença , Feminino , Seguimentos , Genótipo , Humanos , Imuno-Histoquímica , Terapia a Laser , Infecções por Papillomavirus/virologia , Estudos Retrospectivos , Resultado do Tratamento , Neoplasias do Colo do Útero/virologia
9.
Medicine (Baltimore) ; 99(44): e22896, 2020 Oct 30.
Artigo em Inglês | MEDLINE | ID: mdl-33126342

RESUMO

Many patients with chronic pancreatitis (CP) undergo a step-up approach with interventional procedures as first-line treatment and resection reserved for later stages. The aim of this study was to identify predictive factors for a significant clinical improvement (SCI) after surgical treatment.All patients operated for CP between September 2012 and June 2017 at our center was retrospectively reviewed. A prospective patient survey was conducted to measure patients postoperative outcome. The primary endpoint SCI was defined as stable health status, positive weight development and complete pain relief without routine pain medication. Additionally, risk factors for relaparotomy were analyzed.A total of 89 patients with a median follow-up of 38 months were included. In most cases, a duodenum-preserving pancreatic head resection (n = 48) or pancreatoduodenectomy (n = 28) was performed. SCI was achieved in 65.3% (n = 47) of the patients after the final medium follow-up of 15.0 months (IQR: 7.0-35.0 months), respectively. Patients with a longer mean delay (7.7 vs 4 years) between diagnosis and surgical resection were less likely to achieve SCI (P = .02; OR .88; 95%CI .80-98). An endocrine insufficiency was a negative prognostic factor for SCI (P = .01; OR .15; 95%CI .04-68). In total, 96.2% of the patients had a complete or major postoperative relief with a mean pain intensity reduction from 8.1 to 1.9 on the visual analogue scale.The results support that surgical resection for CP should be considered at early stages. Resection can effectively reduce postoperative pain intensity and improve long-term success.


Assuntos
Pancreatectomia , Pancreatite Crônica , Complicações Pós-Operatórias , Tempo para o Tratamento/estatística & dados numéricos , Manutenção do Peso Corporal , Tratamento Conservador/métodos , Insuficiência Pancreática Exócrina/epidemiologia , Insuficiência Pancreática Exócrina/etiologia , Feminino , Alemanha/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor/métodos , Pancreatectomia/efeitos adversos , Pancreatectomia/métodos , Pancreatite Crônica/enzimologia , Pancreatite Crônica/epidemiologia , Pancreatite Crônica/fisiopatologia , Pancreatite Crônica/terapia , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/cirurgia , Prognóstico , Reoperação/métodos , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento
10.
Medicine (Baltimore) ; 99(42): e22800, 2020 Oct 16.
Artigo em Inglês | MEDLINE | ID: mdl-33080753

RESUMO

BACKGROUND: At present, the treatment of base fractures of the fifth metatarsal, especially the area I fractures, is still a controversial topic. The objective of our work was to assess the radiological and clinical outcomes of displaced avulsion fractures of the fifth metatarsal base after treated with conservative treatment or intramedullary screw. METHODS: All of the fifth metatarsal fractures patients underwent surgery by the senior authors in our hospital from January 2017 to December 2019 were reviewed. Institutional Review Board in the Subsidiary Hospital of Guizhou Medical University approved this study. Patients with the following conditions can be included:Patients with the following conditions will be excluded: follow-up less than 6 months; open fracture; pathological fracture; osteoporotic fracture; patients have the history of ankle or foot surgery. Radiographs were taken at 1, 3, 6 and 12 months in outpatient follow-up. The following outcomes were assessed in the follow-up: functional outcomes, the score of patient satisfaction, as well as the motion range, and complications. All the statistical analyses were implemented via applying the software of SPSS Version 12 (SPSS Inc, Chicago, IL). RESULTS: We hypothesized that there was no remarkable difference between two groups in the outcomes after operation. TRIAL REGISTRATION: This study protocol was registered in Research Registry (researchregistry6024).


Assuntos
Tratamento Conservador , Fixação Interna de Fraturas , Fratura Avulsão/terapia , Ossos do Metatarso/lesões , Moldes Cirúrgicos , Fratura Avulsão/diagnóstico por imagem , Humanos , Imobilização , Ossos do Metatarso/diagnóstico por imagem , Ossos do Metatarso/cirurgia , Medidas de Resultados Relatados pelo Paciente , Projetos de Pesquisa , Estudos Retrospectivos , Escala Visual Analógica
11.
Am Surg ; 86(9): 1178-1184, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32935996

RESUMO

BACKGROUND: Nonoperative management of adhesive small bowel obstruction (ASBO) results in resolution for the majority of patients. Previous studies have demonstrated that outcomes for patients with ASBO are improved when patients are admitted to a surgical service, but the effect of general surgery resident coverage is unclear. This study measures quality outcomes for patients with ASBO after the establishment of a new general surgery residency program. METHODS: An institutional review board-approved retrospective chart review of admissions for ASBO was conducted following the implementation of a protocol for ASBO nested within a newly developed resident-run emergency general surgery (EGS) service. Patients successfully treated without operative intervention were analyzed. RESULTS: During the study period, 612 patients were admitted for ASBO. After initiation of the residency, 74% of ASBO were admitted to a surgical service compared with 35% prior to residency (P < .01). Length of stay was reduced by 0.77 days (P = .016), average direct total cost per patient was reduced by 24% (P = .002), and 30-day readmissions were reduced by 35.7% (P = .046). There was no significant difference in mortality (1.4% vs 1.0%). DISCUSSION: Admission to a resident-run surgical service was associated with statistically significant improvement in outcomes for patients with ASBO. These data corroborate prior studies demonstrating the positive impact of residency programs on patient outcomes and provide additional evidence that general surgery residency programs improve outcomes for patients with surgical disease.


Assuntos
Tratamento Conservador/métodos , Educação de Pós-Graduação em Medicina/métodos , Cirurgia Geral/educação , Internato e Residência/métodos , Obstrução Intestinal/terapia , Tempo de Internação/tendências , Readmissão do Paciente/tendências , Idoso , Feminino , Humanos , Intestino Delgado , Masculino , Estudos Retrospectivos
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