RESUMO
End-stage renal disease affects millions of people worldwide, and the only definitive solutions are renal transplants that are not widely available. Temporary solutions are renal replacement therapies such as peritoneal dialysis, hemodialysis and hemodiafiltration. These therapies as they are applied today are just partial measures and have many drawbacks and complications such as high mortality rates and high costs due to the use of supplemental drugs and emergency room visits. Many enhancements to the therapies have been published, but they are not applied consistently in real world practice. Our work presents the results from the systematic application of several techniques to provide individualized therapies that can minimize the drawbacks and improve patient outcomes. This approach is based on the use of exercise, analysis of cardiovascular parameters, such as heart-rate variability, body composition and dry weight measurements through the use of bioimpedance and real-time monitoring of energy expenditure and nutrition intradialytically in order to provide individualized and dynamically variable therapies. Results show that patients can lead long, productive lives while maintaining a quality of life equivalent to that of a renal transplant.
Assuntos
Hemodiafiltração , Falência Renal Crônica , Monitorização Fisiológica , Metabolismo Energético , Humanos , Monitorização Fisiológica/instrumentação , Esforço Físico , Qualidade de Vida , Diálise Renal , Resultado do TratamentoAssuntos
Hemorroidas/terapia , Soluções Esclerosantes/uso terapêutico , Humanos , Métodos , SeringasRESUMO
Se hace una precisión en las definiciones relacionadas con el trabajo, la enfermedad y el ocio. Se estimula la dosificación del trabajo y el ejercicio del ocio, con una llamada final a emplear el tiempo en otras actividades distintas al trabajo. Todo su contenido manejado con un humor serio y profundo.
Assuntos
Humanos , Doença , Aposentadoria , TrabalhoRESUMO
BACKGROUND: Anorectal fistula is a common problem that affects quality of life. Main objective of therapy has been to eradicate the fistula tract while preserving fecal continence. Latest good results for anal fistula treatment have been an anal fistula plug. This study was undertaken to determine if these results could be reproduced in Puerto Rico. METHOD: From January 2003 to January 2008, two experienced colorectal surgeons performed this new operation in 23 consecutive patients. A multivariable analysis was undertaken including age, sex, location of the fistula, previous surgeries, Seton placement before the insertion of the plug, continence pre and post operation, as well as close follow up. No patient with inflammatory bowel disease was included. RESULTS: We had a good result or healing of the fistula in 14 of 23 patients for a success rate of 60%. We had a subgroup of patients who did slightly better and had a healing rate of 66% compared to the 60% of the whole group. It appears to be a trend in favor of the Seton group but is not statically significant. We had 9 failures of 23 patients or 39%. Suppuration was noticed in three patients and all three had failures of the plug with recurrences. CONCLUSIONS: This new operation is another alternative to add to our armamentarium but we need to search for an operation that decreases the incidence of recurrences we had in our study while maintaining function of the sphincters.
Assuntos
Humanos , Masculino , Feminino , Fístula Retal/terapia , Desenho de Equipamento , Porto Rico , Estudos RetrospectivosRESUMO
Se presentan los resultados del uso combinado del abordaje sagital anterior transanorectal(ASATAR)con injerto libre de mucosa bucal para los casos de estenosis uretral que presentan una separación amplia de los cabos uretrales.Esta técnica ha sido utilizada en tres pacientes con antecedente de trauma uretral,los cuales en su totalidad ya habían sido intervenidos quirúrgicamente con anterioridad usando otros métodos quirúrgicos sin éxito.La edad de los pacientes era de tres,cinco y siete años.En los tres pacientes se presentó estenosis uretral postoperatoria,uno de los cuales tuvo que ser reintervenido utilizando la misma técnica,los otros dos pacientes están en programa de dilatación uretral,preservando un flujo miccional adecuado.La continencia urinaria está preservada en el 100 por ciento de los pacientes.El ASATAR es una alternativa eficaz,que ofrece una exposición en primer plano de los elementos pélvico,facilitando la reconstrucción uretral con un margen de seguridad muy satisfactorio