Strictures and fistulas of the anterior urethra

1997 ◽  
Vol 64 (4) ◽  
pp. 400-404
Author(s):  
S. Ranno ◽  
R. Leonardi ◽  
G. Stracuzzi ◽  
G. Minaldi ◽  
P. Miria
Keyword(s):  
Gold Standard ◽  
Surgical Reconstruction ◽  
Reconstruction Technique ◽  
Free Graft ◽  
Spongy Tissue ◽  
Anterior Portion ◽  
The Past ◽  
Urethral Strictures ◽  
Free Grafts ◽  
Urethral Surgery

– The first documents of urethral surgery for urethral strictures date back to the 4th century BC. In the past, endoscopic surgery was the best solution for most urologists. Nowadays, literature shows that the approach to urethral strictures depends on the degree of involvement of the spongy body. The choice of surgical reconstruction technique depends on the anatomical differences in the anterior portion of the urethra, which is divided anatomically into navicular, penile and bulbar. The gold standard for urethroplasty of the navicular urethra is the free graft which can take root due to the presence of glandular tissue. Techniques using a preputial pedunculated graft are good for penile urethra, while a free graft of preputial origin, that has first been perforated and then tubularised, is suggested for very long strictures (> 5 cm). Epidermal or mucosal free grafts can be used for bulbous urethral strictures, due to the presence of thick spongy tissue. The urethra should be completely substituted with a neo-urethra formed by preputial pedunculated and tubularised graft only for wide strictures with associated fibrosis of the spongy portion. Recurrent strictures can be treated twice with surgery.

Sending out Biased Signals: an Appropriate Proposition for Pain?

2019 ◽  
Vol 32 (2) ◽  
pp. 108-110 ◽  
Author(s):  
E. Besserer-Offroy ◽  
P. Sarret
Keyword(s):  
Side Effects ◽  
Acute Pain ◽  
Gold Standard ◽  
Pain Treatment ◽  
Opioid Analgesics ◽  
Mu Opioid Receptor ◽  
Clinical Development ◽  
Mu Opioid ◽  
Development Stages ◽  
The Past

In the past few years, several biased ligands acting at the mu-opioid receptor were reported in the literature. These agonists are aimed at reducing pain while having fewer side effects than morphine, the gold standard of opioid analgesics. In this mini-review, we describe and discuss the recent advances in mu-biased ligands actually in preclinical and clinical development stages, including the latest U.S. Food and Drug Administration review of oliceridine, a biased mu-agonist for moderate to severe acute pain treatment developed by the company Trevena.

Real Bills, The Gold Standard, and Central Bank Policy

1976 ◽  
Vol 50 (4) ◽  
pp. 503-513 ◽  
Author(s):  
Robert Craig West
Keyword(s):  
Central Bank ◽  
Discount Rate ◽  
Real World ◽  
Federal Reserve ◽  
Economic Activity ◽  
Gold Standard ◽  
Government Regulation ◽  
International Exchange ◽  
The Real ◽  
The Past

Students of the origins and accomplishments of government regulation of economic activity have open suspected that the laws on which regulation is based were addressed to problems and conditions of the past that no longer prevailed, or — what is worse — assumptions about the “real world” that are highly unrealistic. This is Professor West's main conclusion about the Federal Reserve Act of 1913, especially as regards its discount rate and international exchange policies.

ROOT END FILLING MATERIALS – A REVIEW

2021 ◽  
pp. 5-9
Author(s):  
Bynagari Chandra Shekar ◽  
Veerendra Uppin ◽  
Madhu Pujar
Keyword(s):  
Root Canal ◽  
Gold Standard ◽  
The Past ◽  
Filling Materials ◽  
Restorative Materials ◽  
The Creation ◽  
Almost All

The aim of a root end lling is to prevent irritants from the root canal from leaking into the periapical region and to improve the apical seal created by nonsurgical endodontic care. Various restorative materials that have been used for coronal restorations have been tried and tested as root end lling materials, as well as the creation of restorative materials designed specically for root end lling. In the past, amalgam was the preferred material for root end lling. MTA, a recently established material that meets almost all of the criteria for an ideal root end lling material, has become the gold standard against which newer materials are measured. This article examines traditional endodontic root end materials and provides an overview of recent advancements in root end lling

Surgical Reconstruction of Membranous Urethral Strictures Due to Radiation

2019 ◽  
pp. 285-302
Author(s):  
Connor G. Policastro ◽  
Javier C. Angulo ◽  
Reynaldo Gomez ◽  
Dmitriy Nikolavsky
Keyword(s):  
Surgical Reconstruction ◽  
Urethral Strictures

scholarly journals The Clinical Concept of Fibromyalgia as a Changing Paradigm in the Past 20 Years

2012 ◽  
Vol 2012 ◽  
pp. 1-8 ◽  
Author(s):  
Mary-Ann Fitzcharles ◽  
Muhammad B. Yunus
Keyword(s):  
Gold Standard ◽  
Standard Treatment ◽  
Good Health ◽  
Pain Processing ◽  
Predictors Of Outcome ◽  
Rational Treatment ◽  
The Past ◽  
Active Patient ◽  
Pharmacologic Treatments ◽  
Clinical Concept

Fibromyalgia (FMS) is a valid clinical condition that affects 2%–4% of the population with a pivot symptom of widespread body pain. The cause and cure of FMS are as yet unknown. The concept of FMS has evolved over the past two decades to incorporate symptoms beyond pain as contributing to the global spectrum of suffering. FMS is now recognized to be grounded in the neurological domain with evidence of dysregulation of pain processing. Appreciation of the neurophysiologic mechanisms operative in FMS has contributed to rational treatment recommendations, although a “gold standard treatment” does not currently exist. Ideal treatments for FMS patients should be individualized with emphasis on active patient participation, good health practices, and multimodal intervention, incorporating nonpharmacologic and pharmacologic treatments. Predictors of outcome, which is favourable in over 50% of patients, are unknown, but those with better outcome do more physical activity and use fewer medications.

scholarly journals Outcome of urethral strictures treated by endoscopic urethrotomy and urethroplasty

2014 ◽  
Vol 8 (1-2) ◽  
pp. 16 ◽  
Author(s):  
Javier Tinaut-Ranera ◽  
Miguel Angel Arrabal-Polo ◽  
Sergio Merino-Salas ◽  
Mercedes Nogueras-Ocaña ◽  
Victor Lopez-Leon ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Urethral Stricture ◽  
Previous Treatment ◽  
Urinary Flow ◽  
The Past ◽  
Urethral Strictures ◽  
High Surgical Risk ◽  
Endoscopic Urethrotomy ◽  
Male Patients ◽  
Maximum Urinary Flow

Introduction: We analyze the outcomes of patients with urethral stricture who underwent surgical treatment within the past 5 years.Methods: This is a retrospective study of male patients who underwent surgery for urethral stricture at our service from January 2008 to June 2012. We analyzed the comorbidities, type, length and location of the stricture and the surgical treatment outcome after endoscopic urethrotomy, urethroplasty or both.Results: In total, 45 patients with a mean age of 53.7 ± 16.7 years underwent surgical treatment for urethral stricture. Six months after surgery, 46.7% of the patients had a maximum urinary flow greater than 15 mL/s, whereas 87.3% of the patients exhibited no stricture by urethrography after the treatment. The success rate in the patients undergoing urethrotomy was 47.8% versus 86.4% in those undergoing urethroplasty (p = 0.01). Twenty percent of the patients in whom the initial urethrotomy had failed subsequently underwent urethroplasty, thereby increasing the treatment success.Conclusion: In most cases, the treatment of choice for urethral stricture should be urethroplasty. Previous treatment with urethrotomy does not appear to produce adverse effects that affect the outcome of a urethroplasty if urethrotomy failed, so urethrotomy may be indicated in patients with short strictures or in patients at high surgical risk.

Anesthesia for Lung Transplantation

2019 ◽  
pp. 322-329
Author(s):  
J. Devin Roberts
Keyword(s):  
Lung Transplantation ◽  
Transesophageal Echocardiography ◽  
Gold Standard ◽  
Anesthetic Management ◽  
Survival Rates ◽  
Anesthesia Care ◽  
Lung Isolation ◽  
The Past ◽  
Lung Transplants ◽  
End Stage

Since the first human procedure in 1963, lung transplantation has become the gold standard treatment of a variety of end-stage lung diseases. With over 4000 lung transplants performed in 2015 and steadily improving survival rates over the past three decades, anesthetic management of patients undergoing lung transplant can significantly contribute to patient outcomes. Anesthesia care for lung transplantation can be both complex and clinically challenging. Anesthesiologists taking part in these procedures need to have specific skills regarding thoracic and cardiac anesthesia. There are both technical and physiological challenges, such as achieving adequate lung isolation and oxygenation, interpretation and use of transesophageal echocardiography, and the management of respiratory and myocardial impairments. This chapter provides an overview of these perioperative anesthetic management considerations utilizing a problem-based format.

scholarly journals Methodological and physical biases in global to subcontinental borehole temperature reconstructions: an assessment from a pseudo-proxy perspective

2020 ◽  
Vol 16 (2) ◽  
pp. 453-474
Author(s):  
Camilo Melo-Aguilar ◽  
J. Fidel González-Rouco ◽  
Elena García-Bustamante ◽  
Norman Steinert ◽  
Johann H. Jungclaus ◽  
...  
Keyword(s):  
Surface Temperature ◽  
20Th Century ◽  
Temperature Increase ◽  
Spatial Scales ◽  
Ground Surface ◽  
Reconstruction Technique ◽  
Last Millennium ◽  
Lulc Changes ◽  
The Past ◽  
Borehole Temperature

Abstract. Borehole-based reconstruction is a well-established technique to recover information of the past climate variability based on two main hypotheses: (1) past ground surface temperature (GST) histories can be recovered from borehole temperature profiles (BTPs); (2) the past GST evolution is coupled to surface air temperature (SAT) changes, and thus, past SAT changes can be recovered from BTPs. Compared to some of the last millennium (LM) proxy-based reconstructions, previous studies based on the borehole technique indicate a larger temperature increase during the last few centuries. The nature of these differences has fostered the assessment of this reconstruction technique in search of potential causes of bias. Here, we expand previous works to explore potential methodological and physical biases using pseudo-proxy experiments with the Community Earth System Model Last Millennium Ensemble (CESM-LME). A heat-conduction forward model driven by simulated surface temperature is used to generate synthetic BTPs that are then inverted using singular value decomposition. This procedure is applied to the set of simulations that incorporates all of the LM external forcing factors as well as those that consider the concentration of the green house gases (GHGs) and the land use land cover (LULC) changes forcings separately. The results indicate that methodological issues may impact the representation of the simulated GST at different spatial scales, with the temporal logging of the BTPs as the main sampling issue that may lead to an underestimation of the simulated GST 20th-century trends. Our analysis also shows that in the surrogate reality of the CESM-LME the GST does not fully capture the SAT warming during the industrial period, and thus, there may be a further underestimation of the past SAT changes due to physical processes. Globally, this effect is mainly influenced by the GHG forcing, whereas regionally, LULC changes and other forcings factors also contribute. These findings suggest that despite the larger temperature increase suggested by the borehole estimations during the last few centuries of the LM relative to some other proxy reconstructions, both the methodological and physical biases would result in a underestimation of the 20th-century warming.

scholarly journals The euro and the recent European crisis vis-à-vis the gold standard and the great depression: institutionalities, specificities and interfaces

2017 ◽  
Vol 37 (1) ◽  
pp. 147-166 ◽  
Author(s):  
GIULIANO CONTENTO DE OLIVEIRA ◽  
PAULO JOSÉ WHITAKER WOLF
Keyword(s):  
Great Depression ◽  
Gold Standard ◽  
Institutional Arrangements ◽  
European Countries ◽  
Lender Of Last Resort ◽  
Central European ◽  
The Past ◽  
The Great Depression ◽  
European Crisis ◽  
Harmful Effects

ABSTRACT The paper aims to establish interfaces between the Great Depression of the 1930s under the Gold Standard and the recent European Crisis under the Euro. It is argued that, despite their specificities, both crises revealed the potentially harmful effects, in economic and social terms, of institutional arrangements that considerably reduce the autonomy of monetary, fiscal and exchange rate policies of participating countries, without being accompanied by increased cooperation between them, which should be led by a global (in the case of the Great Depression) or regional (in the case of the European Crisis) hegemonic power, which is not only capable of, but is also willing to act as a buyer and lender of last resort, especially in circumstances characterized by increased uncertainty, the deterioration of the general state of expectations and increased liquidity preference. In fact, central European countries in the past and peripheral European countries nowadays were effectively pushed toward deflationary adjustments in which a reduction of prices and wages was accompanied by a reduction of output and employment levels. Thus, in the absence of the possibility of restoring the autonomy of economic policy, the overcome of the crisis necessarily requires, both before - under the Gold Standard - and nowadays - under the Euro -, joint actions aimed to assure that the responsibility for the adjustment will be equally distributed among all the economies, in order to avoid that some of them benefit at the expense of the others in this process.

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