Cutaneous continent urinary diversion: History, patient selection and preparation

1997 ◽  
Vol 64 (2) ◽  
pp. 236-242
Author(s):  
S. Leoni ◽  
S. Spatafora ◽  
R. Arnaudi
Keyword(s):  
Urinary Diversion ◽  
Patient Selection ◽  
High Rate ◽  
Routine Practice ◽  
Bowel Diseases ◽  
Patient Preparation ◽  
Koch Pouch ◽  
Stable Part ◽  
Lavage Solution

– History. The first supravesical urinary diversion was carried out in 1908. The results of a large number of cutaneous tubularised continent pouches were published in the fifties. The poor results urged urologists to try to improve the continence mechanisms, but it was not until the eighties that these urinary diversions became a stable part of their armamentarium, thanks to the popularisation of the Koch pouch incorporating the principles of detubularisation, reconfiguration and disruption of the peristaltic integrity. After that there was an explosion of interest in continent pouches and new techniques. Nowadays the Indiana, Koch and Mainz pouches and those associated with the Benchekroun valve and the Mitrofanoff principle are the most popular. Patient selection. Nowadays heterotopic continent urinary diversions are performed after a total cystectomy when the urethra is impracticable. The primary goal of cutaneous pouches is to improve the quality of life; a reasonable life expectancy is therefore the first criterion. Patients must be capable of performing self catheterisation and their motivation and intellective compliance must be considered when suggesting these operations. Dementia, renal failure, bowel diseases, malabsorption and previous intestinal demolition are absolute contraindications. Relative contraindications are radiotherapy and cardio-respiratory diseases. Unlike other authors, we believe that a dry continent stoma is the best choice for obese patients. Patient preparation. The ideal patient preparation should be effective, fast, cheap and not create stress or weakness. Dehydration has to be avoided. The mechanical intestinal wash-out could be done either by total irrigation of the bowel with saline solution or by polyethylene glycol electrolyte lavage solution. Antibiotic prophylaxis against aerobic and anaerobic germs reduces the complication rate of intestinal surgery and has to be recommended. Major urological surgery has a high rate of thromboembolism. It is routine practice for us treat with sub-cutaneous calcium heparine in order to reduce post-operative deep venous thrombosis and fatal pulmonary embolisms.

Does Infliximab Short Infusion have a Beneficial Impact on the Quality of Life in Patients with Inflammatory Bowel Diseases? A Single Centre Prospective Evaluation

2015 ◽  
Vol 24 (2) ◽  
pp. 165-170 ◽  
Author(s):  
Mariabeatrice Principi ◽  
Giuseppe Losurdo ◽  
Rosa Federica La Fortezza ◽  
Pasquale Lopolito ◽  
Rosa Lovero ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Inflammatory Bowel Diseases ◽  
Adverse Reactions ◽  
Severe Disease ◽  
Sexual Life ◽  
Necrosis Factor Alpha ◽  
Short Infusion ◽  
Bowel Diseases ◽  
Inflammatory Bowel

Background & Aims: Infliximab (IFX) is an anti-tumor necrosis factor alpha agent used in inflammatory bowel diseases (IBD) therapy. Usually, it is administered over a 2-hour intravenous infusion. However, shortening the infusion duration to 1 hour has proved to be feasible and safe. In the present study we evaluated whether shortening the IFX infusion could affect the patients' quality of life (QoL) compared to the standard protocol.Methods: Subjects affected by IBD receiving IFX were prospectively recruited. The main criterion to shorten the infusion was the absence of IFX-related adverse reactions during the previous three 2-h infusions. For each patient, demographic, clinical and anthropometric data were collected. A questionnaire investigating their overall/job/social/sexual QoL was administered. Ordinal regression was performed with odds ratios (OR) for significant independent variables.Results: Eighty-one patients were included (46 with ulcerative colitis - UC, 35 with Crohn's disease - CD). Sixteen received the 2-h infusion due to previous adverse reactions, and the remaining 65 underwent the 1-h schedule. Shortening the infusion to 1 hour determined a better QoL (OR=0.626). However, the QoL was negatively influenced by age (OR=1.023), female sex (OR=2.04) and severe disease activity (OR=7.242). One-hour IFX infusion induced a better outcome on work (OR=0.588) and social (OR=0.643) QoL. Long-standing disease was correlated with a slightly better sexual QoL (OR=0.93). Conversely, older age (OR=1.046), severe clinical score (OR=15.579), use of other immunomodulators (OR=3.693) and perianal CD (OR=3.265) were related to an unsatisfactory sexual life. The total number of infusions (OR=0.891), proctitis (OR=0.062) or pancolitis (OR=0.1) minimized the perception of infusion-related side effects.Conclusion: The 1-h short infusion improves overall, social and job QoL, so that, when indicated, it should be recommended.

scholarly journals International Perspectives on Management of Inflammatory Bowel Disease: Opinion Differences and Similarities Between Patients and Physicians From the IBD GAPPS Survey

2021 ◽  
Author(s):  
David T Rubin ◽  
Charles Sninsky ◽  
Britta Siegmund ◽  
Miquel Sans ◽  
Ailsa Hart ◽  
...  
Keyword(s):  
Unmet Need ◽  
Patient Survey ◽  
Complex Disorders ◽  
International Perspectives ◽  
Bowel Diseases ◽  
Life Impact ◽  
Current Therapies ◽  
Inflammatory Bowel ◽  
Patient Advocacy Groups

Abstract Background Inflammatory bowel diseases (IBD), including Crohn disease (CD) and ulcerative colitis (UC), are complex disorders with multiple comorbidities. We conducted international patient and physician surveys to evaluate current experiences and perceptions of patients with CD or UC and physicians who treat IBD. Methods The IBD Global Assessment of Patient and Physician Unmet Need Surveys comprised a patient survey and a physician survey, fielded in North America and Europe between August 16, 2019, and November 10, 2019. Adults with CD or UC (targeted 1:1 ratio) were recruited from physicians, patient advocacy groups, and recruitment panels; physicians were recruited by recruitment agencies and panels. Results In total, 2398 patients with IBD (1368 CD, 1030 UC) and 654 physicians completed surveys. Anxiety and depression were the most common comorbidities among patients with IBD. Patients and physicians were generally aligned on treatment goals and patient-physician communication. Patients with IBD reported high quality-of-life impact by rectal urgency and need to use the toilet, which were rated as lower-impact by physicians. Patients defined remission based on symptoms; physicians defined remission based primarily on clinical tests. Patients expected current treatments to control their disease for a longer duration than did physicians. Patients expressed more concern about corticosteroid use compared with physicians; many physicians reported prescribing corticosteroids for more than 4 months per year in some patients. Conclusions Patients could benefit from education about disease remission and expectations for current therapies. High corticosteroid use is concerning to patients, and physicians should minimize the use of corticosteroids for extended periods of time.

scholarly journals Antioxidant Therapy in Inflammatory Bowel Diseases

Antioxidants ◽  
2021 ◽  
Vol 10 (3) ◽  
pp. 412
Author(s):  
Katarzyna Dziąbowska-Grabias ◽  
Małgorzata Sztanke ◽  
Przemysław Zając ◽  
Michał Celejewski ◽  
Katarzyna Kurek ◽  
...  
Keyword(s):  
Inflammatory Bowel Diseases ◽  
Nitrosative Stress ◽  
Treatment Options ◽  
Chemical Compounds ◽  
Continuous Increase ◽  
Public Health Burden ◽  
Bowel Diseases ◽  
Significant Public Health ◽  
Inflammatory Bowel

Inflammatory bowel diseases (IBD) are a group of chronic, incurable diseases of the digestive tract, the etiology of which remains unclear to this day. IBD result in significant repercussions on the quality of patients’ life. There is a continuous increase in the incidence and prevalence of IBD worldwide, and it is becoming a significant public health burden. Pharmaceuticals commonly used in IBD management, for example, mesalamine, sulfasalazine, corticosteroids, and others, expose patients to diverse, potentially detrimental side effects and frequently do not provide sufficient disease control. The chronic inflammation underlies the etiology of IBD and closely associates with oxidative/nitrosative stress and a vast generation of reactive oxygen/nitrogen species. Relative to this, several substances with antioxidant and anti-inflammatory properties are now intensively researched as possible adjunctive or independent treatment options in IBD. Representatives of several different groups, including natural and chemical compounds will be characterized in this dissertation.

scholarly journals Cannabis and Canabidinoids on the Inflammatory Bowel Diseases: Going Beyond Misuse

2020 ◽  
Vol 21 (8) ◽  
pp. 2940
Author(s):  
Antonelly Cassio Alves de Carvalho ◽  
Gabriela Achete de Souza ◽  
Samylla Vaz de Marqui ◽  
Élen Landgraf Guiguer ◽  
Adriano Cressoni Araújo ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Inflammatory Bowel Diseases ◽  
Literature Search ◽  
Cannabis Sativa ◽  
Antioxidant Properties ◽  
Number Of Patients ◽  
Bowel Diseases ◽  
Inflammatory Bowel ◽  
Anti Inflammatory

Inflammatory bowel diseases (IBD) are characterized by a chronic and recurrent gastrointestinal condition, including mainly ulcerative colitis (UC) and Crohn’s disease (CD). Cannabis sativa (CS) is widely used for medicinal, recreational, and religious purposes. The most studied compound of CS is tetrahydrocannabinol (THC) and cannabidiol (CBD). Besides many relevant therapeutic roles such as anti-inflammatory and antioxidant properties, there is still much controversy about the consumption of this plant since the misuse can lead to serious health problems. Because of these reasons, the aim of this review is to investigate the effects of CS on the treatment of UC and CD. The literature search was performed in PubMed/Medline, PMC, EMBASE, and Cochrane databases. The use of CS leads to the improvement of UC and CD scores and quality of life. The medical use of CS is on the rise. Although the literature shows relevant antioxidant and anti-inflammatory effects that could improve UC and CD scores, it is still not possible to establish a treatment criterion since the studies have no standardization regarding the variety and part of the plant that is used, route of administration and doses. Therefore, we suggest caution in the use of CS in the therapeutic approach of IBD until clinical trials with standardization and a relevant number of patients are performed.

scholarly journals Design of Short, High-Rate DVB-S2-Like Semi-Regular LDPC Codes

2008 ◽  
Vol 2008 ◽  
pp. 1-4
Author(s):  
Luca Barletta ◽  
Arnaldo Spalvieri
Keyword(s):  
Coded Modulation ◽  
High Rate ◽  
Parity Check ◽  
Code Length ◽  
Carrier Recovery ◽  
Low Density Parity Check ◽  
Novel Approach ◽  
Parity Check Codes ◽  
Moderate Length

This work focuses on high-rate () moderate-length () low-density parity-check codes. High-rate codes allow to maintain good quality of the preliminary decisions that are used in carrier recovery, while a moderate code length allows to keep the latency low. The interleaver of the LDPC matrix that we consider is inspired to the DVB-S2 standard one. A novel approach for avoiding short cycles is analyzed. A modified BP decoding algorithm is applied in order to deal with longer cycles. Simulations and results for the AWGN channel are presented, both for BPSK signalling and for coded modulation based on the partition .

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