scholarly journals Comparative analysis of Bricker versus Wallace ureteroenteric anastomosis and identification of predictors for postoperative ureteroenteric stricture

2021 ◽  
Author(s):  
U Krafft ◽  
O Mahmoud ◽  
J Hess ◽  
J.P Radtke ◽  
A Panic ◽  
...  
Keyword(s):  
Renal Function ◽  
Urinary Diversion ◽  
Surgical Care ◽  
University Hospital ◽  
Stricture Formation ◽  
Significant Difference ◽  
The Individual ◽  
The University ◽  
Anastomotic Techniques

Abstract Purpose Ureteroenteric anastomosis after cystectomy is usually performed using the Bricker or Wallace technique. Deterioration of renal function is the most common long-term complication of urinary diversion (UD). To improve surgical care and optimize long-term renal function, we compared the Bricker and Wallace anastomotic techniques and identified risk factors for ureteroenteric strictures (UES) in patients after cystectomy. Material and methods Retrospective, monocentric analysis of 135 patients who underwent cystectomy with urinary diversion at the University Hospital Essen between January 2015 and June 2019. Pre- and postoperative renal function, relevant comorbidities, prior chemo- or radiotherapy, pathological findings, urinary diversion, postoperative complications, and ureteroenteric strictures (UES) were analyzed. Results Of all 135 patients, 69 (51.1%) underwent Bricker anastomosis and 66 (48.9%) Wallace anastomosis. Bricker and Wallace groups included 134 and 132 renal units, respectively. At a median follow-up of 14 (6–58) months, 21 (15.5%) patients and 30 (11.27%) renal units developed UES. We observed 22 (16.6%) affected renal units in Wallace versus 8 (5.9%) in Bricker group (p < 0.001). A bilateral stricture was most common in Wallace group (69.2%) (p < 0.001). Previous chemotherapy and 90-day Clavien-Dindo grade ≥ III complications were independently associated with stricture formation, respectively (OR 9.74, 95% CI 2–46.2, p = 0.004; OR 4.01, 95% CI 1.36–11.82, p = 0.013). Conclusion The results of this study show no significant difference in ureteroenteric anastomotic techniques with respect to UES development regarding individual patients but suggest a higher risk of bilateral UES formation in patients undergoing Wallace anastomosis. This is reflected in the increased UES rate under consideration of the individual renal units.

scholarly journals Incidence, characteristics and prognosis of different cardiac etiologies underlying cardiac syncope

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
P Lopez Ayala ◽  
D Flores ◽  
T Zimmermann ◽  
J Du Fay De Lavallaz ◽  
T Nestelberger ◽  
...  
Keyword(s):  
Cardiac Disease ◽  
Vasovagal Syncope ◽  
University Hospital ◽  
Funding Source ◽  
Cardiac Syncope ◽  
Significant Difference ◽  
Structural Disease ◽  
The University ◽  
Long Term Mortality

Abstract Background Cardiac syncope has been shown to carry the highest hazard for all-cause death compared to other causes of syncope including vasovagal and orthostatic syncope. However, little is known about the incidence, characteristics and prognosis of different cardiac etiologies underlying cardiac syncope. Purpose To evaluate the incidence, characteristics and prognosis of different cardiac etiologies underlying cardiac syncope. Methods We enrolled patients presenting to the emergency department (ED) with syncope in a large prospective international multicentre study. The cause of syncope (cardiac vs non-cardiac) including the detailed cardiac aetiology (if cardiac) was centrally adjudicated by two independent cardiologists based on detailed in-hospital as well as outpatient cardiac work-up during 360 days following presentation. Cardiac syncope was classified into four groups: bradyarrhythmia, tachyarrhythmia, structural disease and other (cardiopulmonary and great vessels), as recommended in the ESC Syncope Guidelines. All-cause death during 2-years follow-up was the primary outcome. Results Among 2025 patients presenting with syncope to the ED, cardiac syncope was the final adjudicated diagnoses in 318 (15.7%) patients. The incidence rate of all-cause death among cardiac syncope patients was 103 cases per 1000 person-years. Bradyarrhythmia was the most frequent primary cause of cardiac syncope (n=146, 45.9%) followed by tachyarrhythmia (n=75, 23.6%), structural disease (n=64, 20.1%) and other cardiac (n=26, 8.2%). Patients were 37% female with a median age of 77 years (IQR 67–83) showing no statistically significant difference between subgroups. Clinical characteristics differed significantly among the four subgroups. E.g. syncope occurred during exercise in 12 patients (8.2%) with bradyarrhythmia, 10 patients (13.3%) with tachyarrhythmia, 16 patients (25%) with structural disease, and 5 patients (19%) with other cardiac (p&lt;0.01). Likely of most importance, long-term mortality differed significantly among the four different cardiac subgroups. The multivariable-adjusted hazard ratios (HR) among patients with bradyarrhythmia, tachyarrhythmia, structural disease and other cardiac as compared to patients with vasovagal syncope, the HR were 1.3 (95% CI 0.7–2.5), 4.6 (95% CI 2.3–9.1), 3.1 (95% CI 1.5–6.4) and 5.9 (95% CI 2.3–15.2), respectively (Figure 1). Conclusions Bradyarrhythmia, tachyarrhythmia, and structural cardiac disease are the dominant causes of cardiac syncope. Interestingly, with the appropriate therapy initiated long-term mortality of bradyarrhythmia is comparable to that of vasovagal syncope, while long-term mortality of tachyarrhythmia and structural cardiac disease were substantially increased 3 to 5 fold. Figure 1. Kaplan-Meier curve Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): The Swiss National Science Foundation, the Swiss Heart Foundation, the Stiftung für kardiovaskuläre Forschung Basel, the University of Basel and the University Hospital Basel.

P0840RENAL FUNCTION AND RISK FACTORS IN LIVER TRANSPLANT PATIENTS

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Gun Woo Kang ◽  
Seoung Gyu Kim ◽  
In Hee Lee ◽  
Ki Sung Ahn
Keyword(s):  
Risk Factors ◽  
Renal Function ◽  
Renal Dysfunction ◽  
Univariate Analysis ◽  
Surgical Techniques ◽  
University Hospital ◽  
Post Transplantation ◽  
Term Survival ◽  
Significant Difference

Abstract Background and Aims Advanced surgical techniques and medical managements play major roles in improving patient survival after liver transplantation (LT). At the same time, identifying the causes and risk factors for long-term survival after LT are also important. Renal dysfunction following malignancy and infection is known as an important cause of mortality after LT. Various causes such as pre/post transplantation factors are known to affect renal function. The purpose of this study is to investigate the changes of renal function in patients undergoing LT and to identify factors that can predict long-term renal dysfunction. Method A retrospective study was performed on 113 patients aged 15 years or older who had undergone LT at Daegu Catholic University Hospital form January 2012 to December 2013. 97 patients survived and were followed up. Changes of renal function after LT were identified using serum creatinine every year up to 4 years. And all patients were divided into groups with increased creatinine (70 patients) and non-increased creatinine (27 patients) at 4 years after LT. pre-transplantation factors were blood urea nitrogen (BUN), creatinine, protein, albumin, hemoglobin, total bilirubin, international normalized ratio. Subsequent BUN and creatinine were compared by independent t test. Statistical analysis was performed with IBM SPSS Statistics for Window, Version 19.0. Results 58 were male (59.7%) and the mean age was 49.5 years old. 83 patients (85.6%) received liver transplantations from living donors. There were no significant differences in the donor types and recipient’s sex between the two groups with the increased and non-increased creatinine at 4 years after LT. However, the age of recipients was a significant difference between the two groups (51.3 and 45.4 years old) (p=0.018). Annual mean creatinine levels from pre-transplantation to 4 years after LT were 0.88 ± 0.39 (before transplant), 1.19 ± 0.54 (1 year after LT), 1.07 ± 0.44 (2 years), 1.12 ± 0.68 (3 years), and 1.19 ± 0.99 (4 years). Renal function decreased in 1 year after LT and improved in 2 years, then decreased again. In univariate analysis, the increased creatinine group was older than the non-increased group, and BUN and creatinine at 1 year after LT were significant differences in the two groups (p = 0.018, p = 0.031, p = 0.013). Multivariate analysis identified the creatinine at 1 year was an independent risk factor for long-term renal function after LT (OR 14.31, 95% CI: 1.5-133.3, p = 0.019). Conclusion This study explored that renal function was continuously decreased after LT and renal function at 1 year after LT had a significant effect on long-term renal function. Therefore, management of renal function during one year after LT is important for long-term renal function and may reduce mortality.

scholarly journals The Long-Term Effect of Preterm Birth on Renal Function: A Meta-Analysis

2021 ◽  
Vol 18 (6) ◽  
pp. 2951
Author(s):  
Ju Sun Heo ◽  
Jiwon M. Lee
Keyword(s):  
Renal Function ◽  
Preterm Birth ◽  
Glomerular Filtration ◽  
Renal Plasma Flow ◽  
Meta Analysis ◽  
Full Term ◽  
Significant Difference ◽  
Preterm Group ◽  
Preterm Born

The preterm-born adult population is ever increasing following improved survival rates of premature births. We conducted a meta-analysis to investigate long-term effects of preterm birth on renal function in preterm-born survivors. We searched PubMed and EMBASE to identify studies that compared renal function in preterm-born survivors and full-term-born controls, published until 2 February 2019. A random effects model with standardized mean difference (SMD) was used for meta-analyses. Heterogeneity of the studies was evaluated using Higgin’s I2 statistics. Risk of bias was assessed using the Newcastle–Ottawa quality assessment scale. Of a total of 24,388 articles screened, 27 articles were finally included. Compared to full-term-born controls, glomerular filtration rate and effective renal plasma flow were significantly decreased in preterm survivors (SMD −0.54, 95% confidence interval (CI), −0.85 to −0.22, p = 0.0008; SMD −0.39, 95% CI, −0.74 to −0.04, p = 0.03, respectively). Length and volume of the kidneys were significantly decreased in the preterm group compared to the full-term controls (SMD −0.73, 95% CI, −1.04 to −0.41, p < 0.001; SMD −0.82, 95% CI, −1.05 to −0.60, p < 0.001, respectively). However, serum levels of blood urea nitrogen, creatinine, and cystatin C showed no significant difference. The urine microalbumin to creatinine ratio was significantly increased in the preterm group. Both systolic and diastolic blood pressures were also significantly elevated in the preterm group, although the plasma renin level did not differ. This meta-analysis demonstrates that preterm-born survivors may be subject to decreased glomerular filtration, increased albuminuria, decreased kidney size and volume, and hypertension even though their laboratory results may not yet deteriorate.

scholarly journals Comparing the first and second waves of COVID-19 in a tertiary university hospital in Barcelona

F1000Research ◽  
2021 ◽  
Vol 10 ◽  
pp. 1197
Author(s):  
Yolima Cossio ◽  
Marta-Beatriz Aller ◽  
Maria José Abadias ◽  
Jose-Manuel Domínguez ◽  
Maria-Soledad Romea ◽  
...  
Keyword(s):  
Tertiary Hospital ◽  
Healthcare Systems ◽  
University Hospital ◽  
Emergency Rooms ◽  
Daily Number ◽  
Patient Demographics ◽  
Significant Difference ◽  
The University ◽  
Hospital Wards ◽  
Second Wave

Background: Hospitals have constituted the limiting resource of the healthcare systems for the management of the COVID-19 pandemic. As the pandemic progressed, knowledge of the disease improved, and healthcare systems were expected to be more adapted to provide a more efficient response. The objective of this research was to compare the flow of COVID-19 patients in emergency rooms and hospital wards, between the pandemic's first and second waves at the University Hospital of Vall d’Hebron (Barcelona, Spain), and to compare the profiles, severity and mortality of COVID-19 patients between the two waves. Methods: A retrospective observational analysis of COVID-19 patients attending the hospital from February 24 to April 26, 2020 (first wave) and from July 24, 2020, to May 18, 2021 (second wave) was carried out. We analysed the data of the electronic medical records on patient demographics, comorbidity, severity, and mortality. Results: The daily number of COVID-19 patients entering the emergency rooms (ER) dropped by 65% during the second wave compared to the first wave. During the second wave, patients entering the ER were significantly younger (61 against 63 years old p<0.001) and less severely affected (39% against 48% with a triage level of resuscitation or emergency; p<0.001). ER mortality declined during the second wave (1% against 2%; p<0.000). The daily number of hospitalised COVID-19 patients dropped by 75% during the second wave. Those hospitalised during the second wave were more severely affected (20% against 10%; p<0.001) and were referred to the intensive care unit (ICU) more frequently (21% against 15%; p<0.001). Inpatient mortality showed no significant difference between the two waves. Conclusions: Changes in the flow, severity and mortality of COVID-19 patients entering this tertiary hospital during the two waves may reflect a better adaptation of the health care system and the improvement of knowledge on the disease.

scholarly journals Science of the Vatican Observatory since 2000

2020 ◽  
Vol 7 (2) ◽  
pp. 282-298
Author(s):  
Guy Consolmagno, S.J.
Keyword(s):  
Scientific Work ◽  
Advanced Technology ◽  
Research Programs ◽  
Research Areas ◽  
Stellar Astronomy ◽  
University Of Arizona ◽  
To Come ◽  
The Individual ◽  
The University

Five research areas have been the focus of the scientific work of the Specola Vaticana (Vatican Observatory) over the past twenty years: planetary sciences, stellar astronomy, extragalactic astronomy, cosmology, and the development of the Vatican Advanced Technology Telescope (vatt). The choice of research program is left to the individual astronomers, all of whom work closely with lay collaborators around the world. Notable, especially in connection with the vatt, is the close coordination of the Specola with the Steward Observatory of the University of Arizona. One unique strength of the Specola is its independence from short-term funding requirements. As a result of its stable funding, Specola astronomers can engage in long-term research programs such as surveys of meteorite properties, exoplanets, stellar clusters, and galaxy clusters, which may take ten or more years to come to fruition. In this way the Specola complements the large research programs of contemporary astronomy.

Single Centre Experience in Patients with Primary Hyperparathyroidism: Sporadic, Lithium-associated and in Multiple Endocrine Neoplasia

2019 ◽  
Vol 128 (10) ◽  
pp. 693-698
Author(s):  
Sabine Dillenberger ◽  
Detlef K. Bartsch ◽  
Elisabeth Maurer ◽  
Peter Herbert Kann
Keyword(s):  
Primary Hyperparathyroidism ◽  
Multiple Endocrine Neoplasia ◽  
University Hospital ◽  
Primary Surgery ◽  
Endocrine Neoplasia ◽  
Single Centre Experience ◽  
Significant Difference ◽  
History Of ◽  
The University

Abstract Purpose It is assumed that primary hyperparathyroidism (pHPT) in Multiple Endocrine Neoplasia (MEN) and lithium-associated pHPT (LIHPT) are associated with multiple gland disease (MGD), persistence and recurrence. The studies purpose was to determine frequencies, clinical presentation and outcome of sporadic pHPT (spHPT), LIHPT and pHPT in MEN. Additional main outcome measures were the rates of MGD and persistence/recurrence. Methods Retrospective analysis of medical records of 682 patients with pHPT who had attended the University Hospital of Marburg between 01–01–2004 and 30–06–2013. All patients were sent a questionnaire asking about their history of lithium medication. Results Out of 682 patients, 557 underwent primary surgery (532 spHPT, 5 LIHPT, 20 MEN), 38 redo-surgery (31 spHPT, 7 MEN), 55 were in follow-up due to previous surgery (16 spHPT, 1 LIHPT, 38 MEN) and 37 were not operated (33 spHPT, 1 LIHPT, 3 MEN). Primary surgeries were successful in 97.4%, revealed singular adenomas in 92.4%, double adenomas in 2.9% and MGD in 3.4% of the cases. Rates of MGD in MEN1 (82.35%) were significantly higher than in spHPT (3.8%), while there was no significant difference between LIHPT (20%) and spHPT. Rates of persistence/recurrence did not significantly differ due to type of surgery (bilateral/unilateral) or type of HPT (spHPT/LIHPT/MEN). Conclusions History of lithium medication is rare among pHPT patients. While MGD is common in MEN1, rates of MGD, persistence or recurrence in LIHPT were not significantly higher than in spHPT.

scholarly journals The Role of a “Treat-to-Target” Approach in the Long-Term Renal Outcomes of Patients with Gout

2019 ◽  
Vol 8 (7) ◽  
pp. 1067
Author(s):  
Woo-Joong Kim ◽  
Jung Soo Song ◽  
Sang Tae Choi
Keyword(s):  
Renal Function ◽  
Kidney Disease ◽  
Chronic Kidney Disease Stage ◽  
Multivariable Analysis ◽  
Serum Urate ◽  
Disease Stage ◽  
Treat To Target ◽  
Renal Outcomes ◽  
Significant Difference

Background: Although gout is accompanied by the substantial burden of kidney disease, there are limited data to assess renal function as a therapeutic target. This study evaluated the importance of implementing a “treat-to-target” approach in relation to renal outcomes. Methods: Patients with gout who underwent continuous urate-lowering therapy (ULT) for at least 12 months were included. The effect of ULT on renal function was investigated by means of a sequential comparison of the estimated glomerular filtration rate (eGFR). Results: Improvement in renal function was only demonstrated in subjects in whom the serum urate target of <6 mg/dL was achieved (76.40 ± 18.81 mL/min/1.73 m2 vs. 80.30 ± 20.41 mL/min/1.73 m2, p < 0.001). A significant difference in the mean change in eGFR with respect to serum urate target achievement was shown in individuals with chronic kidney disease stage 3 (−0.35 ± 3.87 mL/min/1.73 m2 vs. 5.33 ± 11.64 mL/min/1.73 m2, p = 0.019). Multivariable analysis predicted that patients ≥65 years old had a decreased likelihood of improvement (OR 0.31, 95% CI 0.13–0.75, p = 0.009). Conclusions: The “treat-to-target” approach in the long-term management of gout is associated with better renal outcomes, with a greater impact on those with impaired renal function.

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