scholarly journals Congenital midureteral stenosis in children: a 13-year retrospective study based on data from a large pediatric medical center

BMC Urology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Zhaoyi Meng ◽  
Defu Lin ◽  
Guannan Wang ◽  
Yanchao Qu ◽  
Ning Sun
Keyword(s):  
Urinary Tract Obstruction ◽  
Medical Center ◽  
Intravenous Urography ◽  
Good Prognosis ◽  
Retrograde Pyelography ◽  
Ureteral Stenosis ◽  
Anastomotic Strictures ◽  
First Choice ◽  
Stenotic Segment

Abstract Background Midureteral stenosis is very rare in children and can cause congenital hydronephrosis. We report our experience treating children with congenital midureteral stenosis at our center, focusing on the differences in preoperative diagnosis and treatment compared with other congenital obstructive uropathies. Methods We retrospectively reviewed the medical records of 26 children diagnosed with congenital midureteral stenosis at our center between January 2007 and December 2020, such as preoperative examination methods, intraoperative conditions, and postoperative follow-up results. Results Of the 1625 children treated surgically for ureteral narrowing, only 26 (1.6%) were diagnosed with midureteral stenosis, including 15 infants and 11 children. Eighteen (69.2%) were boys, 13 (50%) were affected on the left side, and 23 (88.5%) had isolated ureteral stenosis. Overall, 13 (50%) of the children presented with prenatal hydronephrosis, and 13 (50%) presented with abdominal pain or a mass. All the children had undergone urinary ultrasound and intravenous urography preoperatively; the diagnostic rate of ultrasound was 92.3%. Only 7 (26.9%) children had undergone pyelography. All the children had undergone surgery. The ureteral stenotic segment was less than 1 cm long in 25 (96.2)% of the children. The mean follow-up duration was 22 months (range: 6–50 months). One child developed anastomotic strictures. Urinary tract obstruction was relieved in the other children without long-term complications. Conclusions Congenital midureteral stenosis is rare, accounting for 1.6% of all ureteral obstructions, and its diagnosis is crucial. Urinary ultrasound has a high diagnostic rate and should be the first choice for midureteral stenosis. Retrograde pyelography can be used when the diagnosis is difficult, but routine retrograde pyelography is not recommended. Congenital ureteral stenosis has a relatively short lesion range, largely within 1 cm. The treatment is mainly resection of the stenotic segment and end-to-end ureteral anastomosis, with a good prognosis.

scholarly journals Congenital Midureteral Stenosis in Children: A 13-year Retrospective Study based on Data from a Large Pediatric Medical Center

2021 ◽  
Author(s):  
Zhaoyi Meng ◽  
Defu Lin ◽  
Guannan Wang ◽  
Yanchao Qu ◽  
Ning Sun
Keyword(s):  
Urinary Tract Obstruction ◽  
Medical Center ◽  
Intravenous Urography ◽  
Good Prognosis ◽  
Retrograde Pyelography ◽  
Ureteral Stenosis ◽  
Anastomotic Strictures ◽  
First Choice ◽  
Stenotic Segment

Abstract Background: Midureteral stenosis is very rare in children and can cause congenital hydronephrosis. We report our experience treating children with congenital midureteral stenosis at our center, focusing on the differences in preoperative diagnosis and treatment compared with other congenital obstructive uropathies.Methods: We retrospectively reviewed the medical records of 26 children diagnosed with congenital midureteral stenosis at our center between January 2007 and December 2020, including preoperative examination methods, intraoperative conditions, and postoperative follow-up results.Results: Of the 1625 children treated surgically for ureteral narrowing, only 26 (1.6%) were diagnosed with midureteral stenosis, including 15 infants and 11 children; 68% were boys; 48% were affected on the left side; and 88% had isolated ureteral stenosis. In all, 50% of the children presented with prenatal hydronephrosis, and 50% presented with abdominal pain or a mass. All children underwent urinary ultrasound and intravenous urography (IVU) preoperatively; the diagnostic rate of ultrasound was 92.3%. Only 7 (26.9%) children underwent pyelography. All children underwent surgery. The ureteral stenotic segment was less than 1 cm long in 96% of the children. The mean follow-up duration was 22 months (range: 6-50 months). One child developed anastomotic strictures. Urinary tract obstruction was relieved in the other children without long-term complications.Conclusions: Congenital midureteral stenosis is rare, accounting for 1.6% of all ureteral obstructions, and its diagnosis is very important. Urinary ultrasound has a high diagnostic rate and should be the first choice for midureteral stenosis. Retrograde pyelography can be used when diagnosis is difficult, but routine retrograde pyelography is not recommended. Congenital ureteral stenosis has a relatively short lesion range, largely within 1 cm. The treatment is mainly resection of the stenotic segment and end-to-end ureteral anastomosis, with a good prognosis.

Nonsurgical Endodontik Retreatment of Maxillary First Premolar

DENTA ◽  
2017 ◽  
Vol 11 (1) ◽  
pp. 88
Author(s):  
Yongki Hadinata W ◽  
Karlina Samadi
Keyword(s):  
Root Canal ◽  
Radiographic Examination ◽  
Periapical Lesion ◽  
First Choice ◽  
Periapical Abscess ◽  
Dental Hospital ◽  
Conservative Dentistry ◽  
Previously Treated ◽  
Endodontic Retreatment

<p><strong><em>Background :</em></strong><em> There are some factors can cause endodontic failure such as inadequate in cleaning or shaping step, non hermetic obturation, or poor restoration, which can cause bacteria multiply. <strong>Purpose :</strong> To report the management of endodontic failure with nonsurgical treatment. <strong>Case :</strong> 46-year-old woman came to Airlangga Dental Hospital Conservative Dentistry Department to treat her upper right tooth which show symptomatic pain in the last 2 weeks. The tooth has been treated and crowned with porcelain fused to metal about 10 years ago. Clinical examination show the presence of fistula on premolar buccal gingiva, react to percussion.  Radiographic examination show not hermetic obturation in one root canal and radiolucency in the periapical area. The diagnosis for maxillary first premolar is previously treated tooth with chronic periapical abscess.. <strong>Treatment :</strong> Crown and post was removed from the tooth, and endodontic retreatment was done. Follow up 6 months after the retreatment show no reaction to percussion, and radiographic examination show no enlargement periapical lesion. <strong>Conclusion :</strong> Nonsurgical endodontic retreatment always become the first choice to resolve endodontic failure for previously treated tooth.</em></p><p><strong><em>Keywords :</em></strong><em> endodontic failure, maxillary first premolar, nonsurgical endodontic retreatment</em></p><p><strong><em>Correspondence:</em></strong><em> Yongki Hadinata W., drg. PPDGS Ilmu Konservasi Gigi Fakultas Kedokteran Gigi Universitas Airlangga, Surabaya. Jl. Mayjen. Prof. Dr. Moestopo No. 47, Surabaya.</em></p>

scholarly journals P-Cresyl Sulfate Is a Valuable Predictor of Clinical Outcomes in Pre-ESRD Patients

2014 ◽  
Vol 2014 ◽  
pp. 1-7 ◽  
Author(s):  
Cheng-Jui Lin ◽  
Chi-Feng Pan ◽  
Chih-Kuang Chuang ◽  
Fang-Ju Sun ◽  
Duen-Jen Wang ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Cardiovascular Event ◽  
Cox Regression ◽  
Medical Center ◽  
Serum Biochemistry ◽  
Cox Regression Analysis ◽  
Kaplan Meier ◽  
Valuable Marker ◽  
Valuable Predictor

Background/Aims. Previous studies have reported p-cresyl sulfate (PCS) was related to endothelial dysfunction and adverse clinical effect. We investigate the adverse effects of PCS on clinical outcomes in a chronic kidney disease (CKD) cohort study.Methods. 72 predialysis patients were enrolled from a single medical center. Serum biochemistry data and PCS were measured. The clinical outcomes including cardiovascular event, all-cause mortality, and dialysis event were recorded during a 3-year follow-up.Results. After adjusting other independent variables, multivariate Cox regression analysis showed age (HR: 1.12,P=0.01), cardiovascular disease history (HR: 6.28,P=0.02), and PCS (HR: 1.12,P=0.02) were independently associated with cardiovascular event; age (HR: 0.91,P<0.01), serum albumin (HR: 0.03,P<0.01), and PCS level (HR: 1.17,P<0.01) reached significant correlation with dialysis event. Kaplan-Meier analysis revealed that patients with higher serum p-cresyl sulfate (>6 mg/L) were significantly associated with cardiovascular and dialysis event (log rankP=0.03, log rankP<0.01, resp.).Conclusion. Our study shows serum PCS could be a valuable marker in predicting cardiovascular event and renal function progression in CKD patients without dialysis.

scholarly journals Appendiceal Neuroendocrine Tumours - Experience of One Service

2021 ◽  
Author(s):  
Vítor Devezas ◽  
Laura Elisabete Barbosa
Keyword(s):  
Retrospective Study ◽  
Acute Appendicitis ◽  
Neuroendocrine Tumours ◽  
Adult Population ◽  
Right Hemicolectomy ◽  
Good Prognosis ◽  
Alive Today

AbstractTumours of the appendix are rare and tend to be diagnosed incidentally, in cases of acute appendicitis. For some authors, appendiceal neuroendocrine tumours (ANETs) are the most frequent neoplasm of the appendix, observed in 0.3% to 0.9% of cases acute appendicitis. The present is a unicentric retrospective study conducted between January 2005 and March 2017. Out of a total of 3,007 surgeries for appendiceal pathologies performed in the adult population at the hospital where the present study was conducted, there were 70 (2.33%) malignant cases, 20 (28.6%) of which were ANETs. The patients had a median age of 44 years (range: 18 to 85 years), and were predominantly women (there were 1.9 times more women than men). In 16 cases (80%), a simple appendicectomy was performed (1 patient was submitted to a right hemicolectomy later). The cases of ANETs had a good prognosis in our series: 85% of the patients are either alive today or were alive after 5 years of follow-up. Despite the fact that ANETs are described as the most frequent tumor of the appendix, this was not confirmed in our series, in which they only represented 28.6% of the cases; adenocarcinoma was the most frequent tumor (65.7%) among our sample.

scholarly journals Immediate Post-Extraction Short Implant Placement with Immediate Loading and without Extraction of an Impacted Maxillary Canine: Two Case Reports

Materials ◽  
2021 ◽  
Vol 14 (11) ◽  
pp. 2757
Author(s):  
José Antonio Moreno-Rodríguez ◽  
Julia Guerrero-Gironés ◽  
Francisco Javier Rodríguez-Lozano ◽  
Miguel Ramón Pecci-Lloret
Keyword(s):  
Dental Implant ◽  
Alveolar Bone ◽  
Case Reports ◽  
Young Patients ◽  
Aesthetic Result ◽  
First Choice ◽  
Surgical Extraction ◽  
Impacted Canine ◽  
Short Implant

For the treatment of impacted maxillary canines, traction associated with a complete orthodontic treatment is the first choice in young patients. However, in adults, this treatment has a worse prognosis. The surgical extraction of the impacted tooth can result in a series of complications and a compromised alveolar bone integrity, which may lead to the requirement of a bone regeneration/grafting procedure to replace the canine with a dental implant. These case reports aimed to describe an alternative treatment procedure to the surgical extraction of impacted maxillary canines in adults. Following clinical and computerized tomography-scan (CT-Scan) examination, the possibility of maintaining the impacted canine in its position and replacing the temporary canine present in its place with a dental implant was planned. A short dental implant with an immediate provisional crown was placed, without contacting the impacted canine. At 3 months follow-up, a definitive metal-ceramic restoration was placed. Follow-up visits were performed periodically. The implant site showed a physiological soft tissue color and firmness, no marginal bone loss, no infection or inflammation, and an adequate aesthetic result in all follow-up visits. These results suggest that the treatment carried out is a valid option to rehabilitate with an osseointegrated short implant area where a canine is included, as long as there is a sufficient amount of the remaining bone.

scholarly journals Cohort profile of Acutelines: a large data/biobank of acute and emergency medicine

BMJ Open ◽  
2021 ◽  
Vol 11 (7) ◽  
pp. e047349
Author(s):  
Ewoud ter Avest ◽  
Barbara C van Munster ◽  
Raymond J van Wijk ◽  
Sanne Tent ◽  
Sanne Ter Horst ◽  
...  
Keyword(s):  
Acute Care ◽  
De Novo ◽  
Medical Center ◽  
Large Data ◽  
Future Research ◽  
Imaging Data ◽  
Novel Studies ◽  
Long Term Follow Up ◽  
Registration Number

PurposeResearch in acute care faces many challenges, including enrolment challenges, legal limitations in data sharing, limited funding and lack of singular ownership of the domain of acute care. To overcome these challenges, the Center of Acute Care of the University Medical Center Groningen in the Netherlands, has established a de novo data, image and biobank named ‘Acutelines’.ParticipantsClinical data, imaging data and biomaterials (ie, blood, urine, faeces, hair) are collected from patients presenting to the emergency department (ED) with a broad range of acute disease presentations. A deferred consent procedure (by proxy) is in place to allow collecting data and biomaterials prior to obtaining written consent. The digital infrastructure used ensures automated capturing of all bed-side monitoring data (ie, vital parameters, electrophysiological waveforms) and securely importing data from other sources, such as the electronic health records of the hospital, ambulance and general practitioner, municipal registration and pharmacy. Data are collected from all included participants during the first 72 hours of their hospitalisation, while follow-up data are collected at 3 months, 1 year, 2 years and 5 years after their ED visit.Findings to dateEnrolment of the first participant occurred on 1 September 2020. During the first month, 653 participants were screened for eligibility, of which 180 were approached as potential participants. In total, 151 (84%) provided consent for participation of which 89 participants fulfilled criteria for collection of biomaterials.Future plansThe main aim of Acutelines is to facilitate research in acute medicine by providing the framework for novel studies and issuing data, images and biomaterials for future research. The protocol will be extended by connecting with central registries to obtain long-term follow-up data, for which we already request permission from the participant.Trial registration numberNCT04615065.

scholarly journals Postnatal management of children with antenatal hydronephrosis

2020 ◽  
Vol 26 (1) ◽  
Author(s):  
Mohammed S. ElSheemy
Keyword(s):  
Renal Function ◽  
Urinary Tract Obstruction ◽  
Cost Effective ◽  
Voiding Cystourethrography ◽  
Main Body ◽  
Antenatal Hydronephrosis ◽  
Postnatal Management ◽  
Effective Manner ◽  
Lower Urinary Tract Obstruction

Abstract Background Postnatal management of infants with antenatal hydronephrosis (ANH) is still one of the most controversial issues. The majority of infants with ANH are asymptomatic with only few children who develop renal insufficiency. Thus, the biggest challenge for pediatric urologists is to distinguish children who will require further investigations and possible intervention prior to the development of symptoms, complications or renal damage in a cost effective manner without exposing them to the hazards of unnecessary investigations. Main body In this review article, literature on ANH were reviewed to present the current suggestions, recommendations, guidelines and their rational for postnatal management of ANH. It is agreed that a large portion of infants with ANH will improve; thus, the protocol of management is based mainly on observation and follow-up by ultrasound to detect either resolution, stabilization or worsening of hydronephrosis. The first 2 years of life are critical for this follow-up as the final picture is mostly reached during that period. Advanced imaging using voiding cystourethrography or renal scintigraphy are required for children at risk. Then, surgical intervention is selected only for a subgroup of these infants who showed worsening of hydronephrosis or renal function. Conclusions The protocol of management is based mainly on observation and follow-up by US to detect either resolution, stabilization or worsening of hydronephrosis. Postnatal evaluation should be performed for any neonate with a history ANH at any stage during pregnancy even if it was resolved during third trimester. Exclusion of UTI should be performed by urinalysis for all cases followed by urine culture if indicated. Serum creatinine should be performed especially in patients with bilateral ANH. US is the initial standard diagnostic imaging technique. Other imaging modalities like VCUG and nuclear renal scans may be required according to the results of the US evaluation. The most important items in decision making are the presence of bilateral or unilateral hydronephrosis, presence or absence of hydroureter, presence of lower urinary tract obstruction and degree of hydronephrosis on the initial postnatal US. Then an intervention is selected only for a subgroup of these patients who showed deterioration in renal function or degree of hydronephrosis or were complicated by UTIs. All these recommendations are based on the available literature. However, management of ANH is still a controversial issue due to lack of high evidence-based recommendations. Randomised controlled studies are still needed to provide a high level evidence for different aspects of management.

scholarly journals OP0159 EFFICACY OF COMPREHENSIVE TECHNOLOGY-ASSISTED HOME-BASED EXERCISE IN ANKYLOSING SPONDYLITIS: A RANDOMIZED, CONTROLLED TRIAL

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 100.3-100
Author(s):  
Y. Wang ◽  
X. Liu ◽  
Y. Shi ◽  
X. Ji ◽  
W. Wang ◽  
...  
Keyword(s):  
Exercise Intervention ◽  
Medical Center ◽  
Controlled Trial ◽  
Intervention Group ◽  
Exercise Program ◽  
Group Differences ◽  
Control Group ◽  
Home Based ◽  
The Mean

Background:Clinical practice guidelines recommend that exercise is an essential component in the self-management of Ankylosing Spondylitis (AS). Attending supervised interventions requiring periodic medical center visits can be burdensome and patients may decline participation, whereas, effective home-based exercise interventions that do not need regular medical center visits are likely to be more accessible and acceptable for patients with AS. Recently, increasing evidences have been accumulated that the wearable devices could facilitate patients with inflammatory arthritis by giving exercise instructions and improving self-efficacy. Therefore, patients with AS may benefit from an effective technology-assisted home-based exercise intervention.Objectives:To investigate the efficacy of a comprehensive technology-assisted home-based exercise intervention on disease activity in patients with AS.Methods:This study was a 16-week assessor-blinded, randomized, waiting-list controlled trial (ChiCTR1900024244). Patients with AS were randomly allocated to the home-based exercise intervention group and the waiting-list control group. A 16-week comprehensive exercise program consisting of a moderate intensity (64%-76% HRmax) aerobic training for 30min on 5 days/week and a functional training for 60min on 3 days/week was given to patients in the intervention group immediately after randomization, with 1.5h training sessions for two consecutive days by a study physical therapist at baseline and Week 8. The aerobic exercise intensity was controlled by a Mio FUSE Wristband with a smartphone application. The functional training consisted of the posture training, range of motion exercises, strength training, stability training and stretching exercises. Patients in control group received standard care during the 16-week follow-up and started to receive the exercise program at Week 16. The primary outcome was ASDAS at Week 16. The secondary outcomes were BASDAI, BASFI, BASMI, ASAS HI, peak oxygen uptake, body composition and muscle endurance tests. The mean difference between groups in change from baseline was analyzed with the analysis of covariance.Results:A total of 54 patients with AS were enrolled (26 in intervention group and 28 in control group) and 46 (85.2%) patients completed the 16-week follow-up. The mean difference of ASDAS between groups in change from baseline to 16-week follow-up was −0.2 (95% CI, −0.4 to 0.003, P = 0.032), and the mean change from baseline was -0.4 (95% CI, -0.5 to -0.2) in the intervention group vs -0.1 (95% CI, -0.3 to 0.01) in the control group, respectively. Significant between-group differences were found between groups for BASDAI (−0.5 [95% CI, −0.9 to −0.2], P = 0.004), BASMI (−0.7 [95% CI, −1.1 to −0.4], P <0.001), BASFI (−0.3 [95% CI, −0.6 to 0.01], P=0.035), peak oxygen uptake (2.7 [95% CI, 0.02 to 5.3] ml/kg/min, P=0.048) and extensor endurance test (17.8 [95% CI, 0.5 to 35.2]s, P=0.044) at Week 16. Between-group differences were detected in ASAS HI (−0.9 [95% CI, −1.7 to −0.1], P=0.030), body fat percentage (−1.0 [95% CI, −2.0 to −0.01] %, P=0.048) and visceral adipose tissue (−4.9 [95% CI, −8.5 to −1.4] cm2, P=0.008) at Week 8, but not at Week 16. No significant between-group differences were detected in the total lean mass, time up and go test and the flexor endurance test during the follow-up.Conclusion:Comprehensive technology-assisted home-based exercise has been shown to have beneficial effects on disease activity, physical function, spinal mobility, aerobic capacity, and body composition as well as in improving fatigue and morning stiffness of patients with AS.References:[1]van der Heijde D, Ramiro S, Landewé R, et al. Ann Rheum Dis 2017;76:978–991.Disclosure of Interests:None declared

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