scholarly journals Does Endourological Intervention a Suitable Treatment Options in Management of Iatrogenic Thermal Ureteral Injury?

2021 ◽  
Author(s):  
Oguz Ozden Cebeci ◽  
Tayyar Alp Özkan
Keyword(s):  
Thermal Injury ◽  
Treatment Options ◽  
Treatment Success ◽  
Surgical Techniques ◽  
Ureteral Injury ◽  
Gynecologic Surgery ◽  
Success Rates ◽  
Key Words Ureter ◽  
Urological Intervention ◽  
Iatrogenic Ureteral Injury

Introduction This study aimed to evaluate the etiological factors and their effects on long-term clinical outcomes in patients with iatrogenic ureteral injury (IUI). Material and Method Twenty-seven patients who underwent surgery because of IUI were evaluated between January 2011 and April 2018. Patients were classified according to the time of diagnosis and the need for reoperation after the urologic intervention. The IUI cases detected during gynecological surgery were called ‘perioperative’ IUI, and those diagnosed late as ‘postoperative’ (delayed) IUI. The IUI type was categorized as ‘cold transection’ due to surgical dissection or ligation and ‘thermal injury’ if it depended on any energy-based surgical device. Results Postoperative diagnosed cases consisted of exclusively after laparoscopic surgery (p=.025). Patients with thermal injury to the ureter were mostly diagnosed postoperatively (p= .021). Patients who underwent endourological intervention, 31.25% (N = 5/16) were diagnosed during gynecologic surgery, and 68.75% (n = 11/16) were diagnosed postoperatively. For open reconstructive surgery, these rates were observed to be 72.72% (n = 8/11) and 27.28% (n = 3/11), respectively (p=.034). IUI was due to thermal injury in all patients who developed complications after the urological intervention (p = .046), and the first urological intervention was endoscopic double loop stenting (p = .005). One of these patients was diagnosed in the perioperative period and seven in the postoperatively (p = .016). Conclusion Treatment success rates are low in patients who underwent endourological intervention after thermal IUI. Therefore, surgical techniques in which the traumatic ureter segment is excised should be preferred to avoid complications. Key Words Ureter, Iatrogenic, Thermal Injury, Iatrogenic Ureteral Injury, Endourological Intervention.

scholarly journals Surgical approaches for treatment of ureteropelvic junction obstruction – a systematic review and network meta-analysis

BMC Urology ◽  
2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Annemarie Uhlig ◽  
Johannes Uhlig ◽  
Lutz Trojan ◽  
Marc Hinterthaner ◽  
Alexander von Hammerstein-Equord ◽  
...  
Keyword(s):  
Ureteropelvic Junction Obstruction ◽  
Treatment Options ◽  
Operating Time ◽  
Surgical Techniques ◽  
Ureteropelvic Junction ◽  
Surgical Approaches ◽  
Transfusion Rate ◽  
Complication Rates ◽  
Success Rates ◽  
Urinary Leakage

Abstract Background Multiple surgical treatment options are available for the treatment of ureteropelvic junction obstruction (UPJO). The aim of this study is to compare the most frequently used technics in a comprehensive network approach. Methods A systematic literature search of the EMBASE, MEDLINE and COCHRANE libraries was conducted in January 2018. Publications were included that evaluated at least two of the following surgical techniques: open pyeloplasty (OP), endopyelotomy (EP), laparoscopic (LP) and robot assisted pyeloplasty (RP). Main outcomes were operative success, complications, urinary leakage, re-operation, transfusion rate, operating time, and length of stay. Network meta-analyses with random effects models simultaneously assessed effectiveness of all surgical techniques. Results A total of 26 studies including 3143 patients were analyzed. Compared with RP, EP and LP showed lower operative success rates (EP: OR = 0.09, 95%CI:0.05–0.19; p < 0.001; LP: OR = 0.51, 95%CI:0.31–0.84; p = 0.008). Compared with OP, LP and RP had lower risk for complications (LP: OR = 0.62; 95%CI:0.41–0.95; p = 0.027; RP: OR = 0.41; 95%CI:0.22–0.79; p = 0.007). Compared with RP, no significant differences were detected for urinary leakage or re-operation, transfusion rates. Compared with EP, RP yielded longer operating time (mean = 102.87 min, 95%CI:41.79 min–163.95 min, p = < 0.001). Further significant differences in operating times were detected when comparing LP to EP (mean = 115.13 min, 95%CI:65.63 min–164.63 min, p = < 0.001) and OP to EP (mean = 91.96 min, 95%CI:32.33 min–151.58 min, p = 0.003). Conclusions Multiple surgical techniques are available for treatment of UPJO. RP has the highest rates of operative success and as well as LP lower complication rates than OP. Although surgical outcomes are worse for EP, its operating time is shorter than OP, RP, and LP. Surgeons should consider these findings when selecting the optimal treatment method for individual patients.

scholarly journals Omics and Artificial Intelligence to Improve In Vitro Fertilization (IVF) Success: A Proposed Protocol

Diagnostics ◽  
2021 ◽  
Vol 11 (5) ◽  
pp. 743
Author(s):  
Charalampos Siristatidis ◽  
Sofoklis Stavros ◽  
Andrew Drakeley ◽  
Stefano Bettocchi ◽  
Abraham Pouliakis ◽  
...  
Keyword(s):  
Artificial Intelligence ◽  
In Vitro Fertilization ◽  
Treatment Options ◽  
Treatment Success ◽  
Multiple Gestation ◽  
Success Rates ◽  
Neural Network Models ◽  
Vitro Fertilization ◽  
Infertile Couples

The prediction of in vitro fertilization (IVF) outcome is an imperative achievement in assisted reproduction, substantially aiding infertile couples, health systems and communities. To date, the assessment of infertile couples depends on medical/reproductive history, biochemical indications and investigations of the reproductive tract, along with data obtained from previous IVF cycles, if any. Our project aims to develop a novel tool, integrating omics and artificial intelligence, to propose optimal treatment options and enhance treatment success rates. For this purpose, we will proceed with the following: (1) recording subfertile couples’ lifestyle and demographic parameters and previous IVF cycle characteristics; (2) measurement and evaluation of metabolomics, transcriptomics and biomarkers, and deep machine learning assessment of the oocyte, sperm and embryo; (3) creation of artificial neural network models to increase objectivity and accuracy in comparison to traditional techniques for the improvement of the success rates of IVF cycles following an IVF failure. Therefore, “omics” data are a valuable parameter for embryo selection optimization and promoting personalized IVF treatment. “Omics” combined with predictive models will substantially promote health management individualization; contribute to the successful treatment of infertile couples, particularly those with unexplained infertility or repeated implantation failures; and reduce multiple gestation rates.

scholarly journals Immunomodulatory agents combat multidrug-resistant tuberculosis by improving antimicrobial immunity

2021 ◽  
Author(s):  
Jagadeeswara Rao Muvva ◽  
Sultan Ahmed ◽  
Rokeya Sultana Rekha ◽  
Sadaf Kalsum ◽  
Ramona Groenheit ◽  
...  
Keyword(s):  
Treatment Options ◽  
Treatment Success ◽  
Treatment Strategies ◽  
Multidrug Resistant ◽  
Success Rates ◽  
Immunomodulatory Agents ◽  
Human Macrophages ◽  
Resistant Tuberculosis ◽  
Multidrug Resistant Tuberculosis ◽  
Mdr Tb

Abstract Background Multidrug-resistant tuberculosis (MDR-TB) has low treatment success rates and new treatment strategies are needed. We explored if treatment with vitamin D (vitD) and phenylbutyrate (PBA) could improve conventional chemotherapy by enhancing immune-mediated eradication of Mycobacterium tuberculosis. Methods A clinically relevant model was used consisting of human macrophages infected with M. tuberculosis-isolates (n=15) with different antibiotic-resistance profiles. The antimicrobial effect of vitD+PBA, was tested together with rifampicin or isoniazid. Methods included colony-forming units (intracellular bacterial growth), mRNA expression analyses (LL-37, β-defensin, nitric oxide synthase, and dual oxidase-2), RNA interference (LL-37-silencing in primary macrophages), western blot and confocal microscopy (LL-37 and LC3 protein expression). Results VitD+PBA inhibited growth of clinical MDR-TB strains in human macrophages and strengthened intracellular growth inhibition of rifampicin and isoniazid via induction of the antimicrobial peptide LL-37 and LC3-dependent autophagy. Gene-silencing of LL-37 expression enhanced MDR-TB growth in vitD+PBA-treated macrophages. The combination of vitD+PBA and isoniazid were equally effective to reduce intracellular MDR-TB growth as compared to a &gt;125-fold higher dose of isoniazid alone, suggesting potent additive effects of vitD+PBA with isoniazid. Conclusions Immunomodulatory agents that trigger multiple immune pathways can strengthen standard MDR-TB treatment and contribute to next-generation individualized treatment options for difficult-to-treat pulmonary TB patients.

scholarly journals Iatrogenic ureteral trauma: A 16-year single tertiary centre experience

2015 ◽  
Vol 143 (3-4) ◽  
pp. 162-168 ◽  
Author(s):  
Dragoslav Basic ◽  
Ivan Ignjatovic ◽  
Milan Potic
Keyword(s):  
Treatment Success ◽  
Diagnostic Procedures ◽  
Ureteral Injury ◽  
Excretory Urography ◽  
Abdominal Ultrasonography ◽  
Tertiary Centre ◽  
Ureteral Injuries ◽  
Therapeutic Procedures ◽  
Retrograde Ureteropyelography ◽  
Iatrogenic Ureteral Injury

Introduction. Iatrogenic ureteral injuries can occur during various abdominopelvic and retroperitoneal surgical procedures including gynecological, urological, colorectal and vascular. Objective. The aim of our study was to examine the incidence and types of iatrogenic ureteral injuries occurred over the period of 16 years, as well as to evaluate the values of applied diagnostic and therapeutic procedures. Methods. A retrospective analysis of clinical data (medical records and operative reports) of 55 patients (11 male and 44 female; mean age 54.5 years) with verified iatrogenic ureteral injury from 1998 to 2014, was performed. Results. Iatrogenic ureteral injuries occurred during gynecological procedures in 55%, urological in 25%, colorectal in 15% and vascular in 5% of cases. Mechanisms of injury were incomplete transection (n=23), complete transection (n=1), ligation (n=7), partial perforation (mucosal abrasion) (n=13) and total perforation (n=1). The most frequent diagnostic procedures for postoperative identification of ureteral injuries were abdominal ultrasonography, excretory urography, antegrade pyeloureterography and retrograde ureteropyelography. Early therapeutic procedures were applied in 35 (64%), while delayed in 20 cases (36%). Early (<30 days) or late (>30 days) postoperative complications were verified in 14 cases (25%). Conclusion. Among different surgeries that may lead to the development of iatrogenic ureteral injury, gynecological procedures represent the most common cause. Rapid diagnosis enables immediate ureteral repair and is associated with low morbidity rates, representing a major factor contributing to the treatment success and ultimately preserving the renal function.

scholarly journals Therapeutic drug monitoring of oral targeted antineoplastic drugs

2020 ◽  
Author(s):  
Anna Mueller-Schoell ◽  
Stefanie L. Groenland ◽  
Oliver Scherf-Clavel ◽  
Madelé van Dyk ◽  
Wilhelm Huisinga ◽  
...  
Keyword(s):  
Therapeutic Drug Monitoring ◽  
Drug Monitoring ◽  
Treatment Options ◽  
Treatment Success ◽  
Therapeutic Window ◽  
Current Evidence ◽  
Therapeutic Drug ◽  
Success Rates ◽  
Drug Dosing ◽  
Drug Concentrations

Abstract Purpose This review provides an overview of the current challenges in oral targeted antineoplastic drug (OAD) dosing and outlines the unexploited value of therapeutic drug monitoring (TDM). Factors influencing the pharmacokinetic exposure in OAD therapy are depicted together with an overview of different TDM approaches. Finally, current evidence for TDM for all approved OADs is reviewed. Methods A comprehensive literature search (covering literature published until April 2020), including primary and secondary scientific literature on pharmacokinetics and dose individualisation strategies for OADs, together with US FDA Clinical Pharmacology and Biopharmaceutics Reviews and the Committee for Medicinal Products for Human Use European Public Assessment Reports was conducted. Results OADs are highly potent drugs, which have substantially changed treatment options for cancer patients. Nevertheless, high pharmacokinetic variability and low treatment adherence are risk factors for treatment failure. TDM is a powerful tool to individualise drug dosing, ensure drug concentrations within the therapeutic window and increase treatment success rates. After reviewing the literature for 71 approved OADs, we show that exposure-response and/or exposure-toxicity relationships have been established for the majority. Moreover, TDM has been proven to be feasible for individualised dosing of abiraterone, everolimus, imatinib, pazopanib, sunitinib and tamoxifen in prospective studies. There is a lack of experience in how to best implement TDM as part of clinical routine in OAD cancer therapy. Conclusion Sub-therapeutic concentrations and severe adverse events are current challenges in OAD treatment, which can both be addressed by the application of TDM-guided dosing, ensuring concentrations within the therapeutic window.

scholarly journals One-year outcomes of microhook trabeculotomy versus suture trabeculotomy ab interno

2021 ◽  
Author(s):  
Hiroshi Yokoyama ◽  
Masashi Takata ◽  
Fumi Gomi
Keyword(s):  
Survival Analysis ◽  
Clinical Success ◽  
Treatment Success ◽  
Medication Use ◽  
Glaucoma Surgery ◽  
Success Rates ◽  
Kaplan Meier ◽  
One Year ◽  
Ab Interno

Abstract Purpose To compare clinical success rates and reductions in intraocular pressure (IOP) and IOP-lowering medication use following suture trabeculotomy ab interno (S group) or microhook trabeculotomy (μ group). Methods This retrospective review collected data from S (n = 104, 122 eyes) and μ (n = 42, 47 eyes) groups who underwent treatment between June 1, 2016, and October 31, 2019, and had 12-month follow-up data including IOP, glaucoma medications, complications, and additional IOP-lowering procedures. The Kaplan–Meier survival analysis was used to evaluate treatment success rates defined as normal IOP (> 5 to ≤ 18 mm Hg), ≥ 20% reduction of IOP from baseline at two consecutive visits, and no further glaucoma surgery. Results Schlemm’s canal opening was longer in the S group than in the μ group (P < 0.0001). The Kaplan–Meier survival analysis of all eyes showed cumulative clinical success rates in S and µ groups were 71.1% and 61.7% (P = 0.230). The Kaplan–Meier survival analysis of eyes with preoperative IOP ≥ 21 mmHg showed cumulative clinical success rates in S and μ groups were 80.4% and 60.0% (P = 0.0192). There were no significant differences in postoperative IOP at 1, 3, and 6 months (S group, 14.9 ± 5.6, 14.6 ± 4.5, 14.6 ± 3.9 mmHg; μ group, 15.8 ± 5.9, 15.2 ± 4.4, 14.7 ± 3.7 mmHg; P = 0.364, 0.443, 0.823), but postoperative IOP was significantly lower in the S group at 12 months (S group, 14.1 ± 3.1 mmHg; μ group, 15.6 ± 4.1 mmHg; P = 0.0361). There were no significant differences in postoperative numbers of glaucoma medications at 1, 3, 6, and 12 months (S group, 1.8 ± 1.6, 1.8 ± 1.5, 2.0 ± 1.6, 1.8 ± 1.5; μ group, 2.0 ± 1.6, 2.0 ± 1.6, 2.1 ± 1.6, 2.2 ± 1.7; P = 0.699, 0.420, 0.737, 0.198). Conclusion S and µ group eyes achieved IOP reduction, but μ group eyes had lower clinical success rates among patients with high preoperative IOP at 12 months.

scholarly journals Outcomes of Endodontic Therapy Comparing Conventional Sodium Hypochlorite Irrigation with Passive Ultrasonic Irrigation Using Sodium Hypochlorite and Ethylenediaminetetraacetate. A Retrospective Analysis

2016 ◽  
Vol 10 (1) ◽  
pp. 375-381 ◽  
Author(s):  
Moritz Hertel ◽  
Katja Sommer ◽  
Eckehard Kostka ◽  
Sandra Maria Imiolczyk ◽  
Husam Ballout ◽  
...  
Keyword(s):  
Sodium Hypochlorite ◽  
Clinical Symptoms ◽  
Treatment Success ◽  
Success Rates ◽  
Chi Square ◽  
Passive Ultrasonic Irrigation ◽  
Ultrasonic Irrigation ◽  
Endodontic Irrigation ◽  
Group 2

The aim of the present study was to investigate the clinical outcomes of two different standardized endodontic irrigation protocols. It was assumed that the additional use of ethylenediaminetetraacetate (EDTA) and passive ultrasonic irrigation (PUI) would result in an increased rate of absence of symptoms and remission based on the periapical index (PAI) compared to passive irrigation using only sodium hypochlorite (NaOCl). Data and radiographs from 199 teeth retrieved from the institutional endodontic database were analyzed retrospectively. In 106 teeth irrigation was performed using only NaOCl (protocol 1). Ninety-three teeth were irrigated using NaOCl and EDTA (protocol 2). Chlorhexidine (CHX) was additionally used in revision treatments in both groups. All irrigants in group 2 were activated by PUI. Mean follow-up periods were: protocol 1 = 9.2 ± 4.4 and protocol 2 = 6.6 ± 2.5 months (p < 0.0001 (chi-square test). The frequencies of the PAImasterpoint and PAIfollow-up scores did not differ significantly between teeth, which received either protocol 1 or 2 (p = 0.555 and 0.138). Statistical analysis revealed no significant association between treatment success (absence of clinical symptoms and PAIfollow-up = I or PAImasterpoint > PAIfollow-up > I) and the applied protocol (success rates: protocol 1 = 72.6% vs. protocol 2 = 82.8%; p = 0.203). Furthermore, the frequency of extractions did not differ significantly between the two protocols (p = 0.102). No association was found between follow-up time and treatment success (p = 0.888). The hypothesis was not confirmed. Even though the obtained success rate was higher after supplementing the irrigation protocol with EDTA and PUI, no significance was recorded. Hence, protocol 2 was not superior to protocol 1 regarding therapy success, at least within the limited follow-up period. It may be cautiously concluded that sufficient mechanical debridement combined with passive NaOCl irrigation results in comparably high success rates compared to EDTA and PUI.

scholarly journals CURRENT PHARMACOLOGICAL STATUS OF CARDIOPROTECTIVE PLANTS AGAINST ISOPROTERENOL INDUCED MYOCARDIAL INFARCTION

2018 ◽  
Vol 11 (4) ◽  
pp. 17
Author(s):  
Syeda Nishat Fathima ◽  
Vasudeva Murthy S
Keyword(s):  
Myocardial Infarction ◽  
Lifestyle Modification ◽  
Treatment Options ◽  
Surgical Techniques ◽  
Cardiac Biomarkers ◽  
Therapeutic Interventions ◽  
Current Status ◽  
Plant Parts ◽  
Heart Muscle Cells ◽  
Modern Era

 Objective: Cardiovascular diseases are the major cause of morbidity and mortality in the modern era. Myocardial infarction is a condition where there is a significant decrease or block in the blood (oxygen) supply to the part of heart, leading to degeneration of a portion of the myocardium which triggers a cascade of cellular, inflammatory and biochemical events, leading eventually to the irreversible death (necrosis) of heart muscle cells. Various therapeutic interventions, including lifestyle modification, pharmacological treatment options, and surgical techniques are available. The present review focus on the plants that have been evaluated for cardioprotective activity against isoproterenol-induced myocardial infarction.Method: The current status of Cardioprotective plants was obtained from a literature search of electronic databases such as Google Scholar, Pubmed and Scopus up to 2017 for publications on medicinal plants used against isoproterenol-induced myocardial infarction. Isoproterenol, Isoprenaline, myocardial infarction, cardioprotective were used as keywords for the searching.Result: A total of 117 different plant parts and their extracts have till now been published to possess cardioprotection against isoproterenol-induced myocardial infarction. Isoproterenol a beta-adrenergic receptors agonist causes severe stress in myocardium resulting in the infarct-like lesion and produced cardiotoxic effects by elevating the levels of cardiac biomarkers and causing changes in ECG. Plant-based medicines with their antioxidant, antiapoptotic, antihyperlipidemic, platelet antiaggregatory, anti-lipid peroxidation property provide substantial evidence for the management of Ischemia.Conclusion: This review, therefore, provides a useful resource to enable a thorough assessment of the profile of plants that have cardioprotective activity against isoproterenol-induced myocardial infarction.

scholarly journals Fundamentals of the Currently Available Single Port Abdominal Laparoscopic Gynecologic Systems and Utility in Minor Gynecologic Surgery

2021 ◽  
Author(s):  
M. Luann Racher ◽  
Ann Marie Mercier
Keyword(s):  
Single Incision ◽  
Surgical Techniques ◽  
Gynecologic Surgery ◽  
Single Incision Laparoscopic Surgery ◽  
Single Incision Laparoscopy ◽  
Surgical Access ◽  
Single Incision Surgery ◽  
Added Benefit ◽  
Multiport Laparoscopy

Single incision laparoscopic surgery encompasses a plethora of techniques and styles. Single incision laparoscopy has demonstrated outcomes comparable to traditional multiport laparoscopy with the added benefit of improved cosmesis. This book chapter will review single incision surgery for minor gynecologic surgery, including adnexal surgical procedures and myomectomy. The chapter reviews available data in regard to outcomes in single incision laparoscopy. It also discusses the commercially available single incision surgical access systems, laparoscopes, and accessory instruments. Surgical techniques beneficial in single incision laparosocpy, including uterine manipulation, are also reviewed.

scholarly journals Glans Resurfacing in Carcinoma in situ of the Penis: A Case Report

2020 ◽  
pp. 1-5
Author(s):  
Raquel Catarino ◽  
André Cardoso ◽  
Carlos Ferreira ◽  
Diogo Pereira ◽  
Tiago Correia ◽  
...  
Keyword(s):  
Case Report ◽  
Carcinoma In Situ ◽  
Penile Cancer ◽  
Treatment Options ◽  
Surgical Techniques ◽  
Disease Recurrence ◽  
Premalignant Lesions ◽  
Surgical Approaches ◽  
Aesthetic Result

Aims: Penile cancer is an uncommon malignancy in Western countries. There are known premalignant lesions that can progress to invasive penile cancer, namely carcinoma in situ (CIS) of the glans. Treatment options for this disease include topical chemotherapy and laser ablation, but the published literature demonstrates limited efficacy for these approaches. Surgical techniques with penile-preserving approaches are performed with the goal of removing the entire tumor and preserving as much of penis as possible. There are no large, randomized studies comparing treatment options for these lesions, and reports concerning the surgical approaches are scarce. Presentation of Case: In this study, we present a case report of a patient with CIS of the glans penis surgically treated with glans resurfacing. Discussion and Conclusions: There were no complications during follow-up, and after 20 months, the patient has no evidence of disease recurrence, has preserved urinary and erectile functions and is currently satisfied with the cosmetic appearance. CIS treatment with glans resurfacing allows the maintenance penile length and function with a good aesthetic result without compromising oncologic control. This approach also allows an accurate staging of the disease and assessment of the treatment efficacy.

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