scholarly journals Recommendations for a Combined Laparoscopic and Transanal Approach in Treating Deep Endometriosis of the Lower Rectum—The Rouen Technique

2021 ◽  
Vol 11 (5) ◽  
pp. 408
Author(s):  
Şerban Nastasia ◽  
Anca Angela Simionescu ◽  
Jean Jacques Tuech ◽  
Horace Roman
Keyword(s):  
Circular Stapler ◽  
First Line ◽  
Lower Rectum ◽  
Complete Excision ◽  
Deep Endometriosis ◽  
Invasive Approach ◽  
Transanal Approach ◽  
Plasma Energy ◽  
Increased Risk

The complete excision of low rectovaginal deep endometriosis is a demanding surgery associated with an increased risk of intra- and postoperative complications, which can impact the quality of life. Given the choices of optimal surgery procedures available, we would like to emphasize that a minimally invasive approach with plasma medicine and a transanal disc excision could significantly improve surgery for deep endometriosis, avoiding the lateral thermal damage of vascular and parasympathetic fibers of roots S2–S5 in the pelvic plexus. The management of low rectal deep endometriosis is distinct from other gastrointestinal-tract endometriosis nodules. Suggestions and explanations are presented for this minimal approach. These contribute to individualized medical care for deep endometriosis. In brief, a laparoscopic transanal disc excision (LTADE; Rouen technique) was performed through a laparoscopic deep rectal dissection, combined with plasma energy shaving, and followed by a transanal disc excision of the low and mid-rectal deep endometriotic nodules, with the use of a semi-circular stapler. LTADE is indicated as the first-line surgical treatment for low and mid-rectal deep endometriotic nodule excisions, because it can preserve rectal length and innervation. This technique requires a multidisciplinary team with surgical colorectal training.

scholarly journals Hipertensi pada Kehamilan

2019 ◽  
Vol 2 (2) ◽  
pp. 27
Author(s):  
Haidar Alatas
Keyword(s):  
Gestational Hypertension ◽  
Organ Damage ◽  
Antihypertensive Drug Therapy ◽  
Chronic Hypertension ◽  
First Line ◽  
Hypertension In Pregnancy ◽  
Increased Risk ◽  
Hypertensive Disorders In Pregnancy ◽  
In Pregnancy

Hipertensi pada kehamilan sering terjadi (6-10 %) dan meningkatkan risiko morbiditas dan mortalitas pada ibu, janin dan perinatal. Pre-eklampsia/eklampsia dan hipertensi berat pada kehamilan risikonya lebih besar. Hipertensi pada kehamilan dapat digolongkan menjadi pre-eklampsia/ eklampsia, hipertensi kronis pada kehamilan, hipertensi kronis disertai pre-eklampsia, dan hipertensi gestational. Pengobatan hipertensi pada kehamilan dengan menggunakan obat antihipertensi ternyata tidak mengurangi atau meningkatkan risiko kematian ibu, proteinuria, efek samping, operasi caesar, kematian neonatal, kelahiran prematur, atau bayi lahir kecil. Penelitian mengenai obat antihipertensi pada kehamilan masih sedikit. Obat yang direkomendasikan adalah labetalol, nifedipine dan methyldopa sebagai first line terapi. Penatalaksanaan hipertensi pada kehamilan memerlukan pendekatan multidisiplin dari dokter obsetri, internis, nefrologis dan anestesi. Hipertensi pada kehamilan memiliki tingkat kekambuhan yang tinggi pada kehamilan berikutnya. Hypertension complicates 6% to 10% of pregnancies and increases the risk of maternal, fetal and perinatal morbidity and mortality. Preeclampsia / eclampsia and severe hypertension in pregnancy are at greater risk. Four major hypertensive disorders in pregnancy have been described by the American College of Obstetricians and Gynecologists (ACOG): chronic hypertension; preeclampsia-eclampsia; chronic hypertension with superimposed preeclampsia; and gestational hypertension. The current review suggests that antihypertensive drug therapy does not reduce or increase the risk of maternal death, proteinuria, side effects, cesarean section, neonatal and birth death, preterm birth, or small for gestational age infants. The quality of evidence was low. Recommendations for treatment of hypertension in pregnancy are labetalol, nifedipine and methyldopa as first line drugs therapy. Although the obstetrician manages most cases of hypertension during pregnancy, the internist, cardiologist, or nephrologist may be consulted if hypertension precedes conception, if end organ damage is present, or when accelerated hypertension occurs. Women who have had preeclampsia are also at increased risk for hypertension in future pregnancies.

Caring for the Elderly in an Inpatient Setting: Managing Insomnia and Polypharmacy

2009 ◽  
Vol 22 (5) ◽  
pp. 494-506 ◽  
Author(s):  
Jenny Kim ◽  
Toyin S. Tofade ◽  
Howard Peckman ◽  
Toyin S. Tofade
Keyword(s):  
The Elderly ◽  
Inpatient Setting ◽  
First Line ◽  
Medication History ◽  
Increased Risk ◽  
Key Points ◽  
Increased Sensitivity ◽  
Care Costs ◽  
Chronic Comorbidities

Caring for the elderly in an inpatient setting can be difficult because of the lack of literature to provide clinical guidelines addressing issues in this population. Insomnia and polypharmacy are common concerns. This article addresses these concerns by highlighting key points from the available literature. Insomnia may be a problem in the elderly because of their increased sensitivity to changes in environment among other factors. First, obtain a sleep history and a comprehensive medical and medication history to identify the cause. Next, treat the underlying cause with nonpharmacological interventions to restore restful and qualitative sleep. When nonpharmacological interventions are not successful, pharmacological means are indicated. Remember to start low, go slow, and treat for a short duration of time (less than 4 weeks) to avoid withdrawal or rebound insomnia. First-line agents are trazodone, triazolam, temazepam, and lorazepam followed by zaleplon and zolpidem. As people age, it is common for them to have multiple chronic comorbidities, which may result in polypharmacy and an increased risk of adverse events. Clinical practitioners should identify and prevent potential complications of polypharmacy. This should prevent further hospitalizations, decrease health care costs, and ultimately improve the quality of care in the elderly.

scholarly journals Breaking the Tie: How to Start Rehabilitation in Patients With Severe Limiting Intermittent Claudication

2021 ◽  
Author(s):  
Bassem Zarif ◽  
Akram Samir ◽  
Safwat Elnahrawi ◽  
Eman Gamal
Keyword(s):  
Intermittent Claudication ◽  
Cardiovascular Complications ◽  
Exercise Intolerance ◽  
Common Symptom ◽  
First Line ◽  
Physical Effort ◽  
Improve Exercise Tolerance ◽  
Increased Risk ◽  
Artery Disease

Intermittent claudication (IC) is the most common symptom of peripheral artery disease (PAD). IC affects the quality of life and results in marked exercise intolerance and limitation to daily activities with increased risk of cardiovascular complications. Exercise training is the first line of conservative management in PAD. However, patients with IC Patient cannot tolerate exercise because of leg discomfort induced by physical effort. This review will address alternative rehabilitation strategies to reduce exercise limitations and improve exercise tolerance in patients with IC.

Surgery using plasma energy for deep endometriosis: A quality of life assessment

2018 ◽  
Vol 47 (8) ◽  
pp. 359-364 ◽  
Author(s):  
L. Delbos ◽  
P.E. Bouet ◽  
L. Catala ◽  
C. Lefebvre ◽  
C. Teyssedou ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Life Assessment ◽  
Quality Of Life Assessment ◽  
Deep Endometriosis ◽  
Plasma Energy

Which NSAID to choose for treatment of pain syndrome in polymorbid patients?

2021 ◽  
pp. 41-46
Author(s):  
A. P. Pereverzev
Keyword(s):  
Chronic Pain ◽  
Odds Ratio ◽  
Pain Syndrome ◽  
Moderate Pain ◽  
Efficacy And Safety ◽  
First Line ◽  
Increased Risk ◽  
Inflammatory Drugs ◽  
First Line Treatment

A polymorbid patient is a patient with several diseases occurring simultaneously at different stages and phases of their development. Patients with polymorbid pathology have a statistically significant almost 2.5 times higher risk (odds ratio [OR] = 2.41; p = 0.01) of pain syndrome and other diseases (for example, depression, arterial hypertension, etc.), which will contribute to the progression of polymorbidity. Individuals with chronic pain have a significantly increased risk of all causes’ death (hazard ratio [HR] = 1.95; 95 % confidence interval [CI]: 1.26–3.03) and cardiovascular causes (RR = 2.72; 95 % CI: 1.41–5.26) compared to patients without chronic pain. Therefore, in order to improve the prognosis and quality of life of the patient, both acute and chronic pain must be treated with non-pharmacological (exercise therapy, taping, virtual reality, etc.) and pharmacological methods. Non-steroidal anti-inflammatory drugs (NSAIDs) are the first-line treatment for mild to moderate pain. The rational choice of NSAIDs in polymorbid patients can be difficult due to the presence of pathologies that limit their use or conditions that are risk factors of complications of drug therapy. In this article, the author present approaches to choosing the optimal NSAID in polymorbid patients, and justify efficacy and safety of administration of original meloxicam in these individuals (Movalis®, Boehringer Ingelheim International).

ДИАГНОСТИКА ХРОНИЧЕСКИХ ИНДУЦИРОВАННЫХ КРАПИВНИЦ

2019 ◽  
Author(s):  
E.Yu. Borzova
Keyword(s):  
Biological Therapy ◽  
Meta Analysis ◽  
Treatment Algorithm ◽  
The Novel ◽  
First Line ◽  
Systemic Reactions ◽  
Significant Impairment ◽  
Challenge Tests ◽  
First Line Treatment

Хронические индуцированные крапивницы имеют важное социально-экономическое значение вследствие риска развития системных реакций и значительного снижения качества жизни пациентов. Диагностика хронических индуцированных крапивниц основывается на анамнестических данных и проведении провокационных тестов. Современный протокол ведения больных хронической крапивницей включает применение неседативных антигистаминных препаратов. Международные согласительные документы по лечению крапивницы рекомендуют 4-кратное увеличение суточной дозы неседативных антигистаминных препаратов при их неэффективности в стандартных дозах. Данные мета-анализа указывают на эффективность омализумаба при хронических индуцированных крапивницах. В перспективе ожидается расширение арсенала генно-инженерной биологической терапии хронических индуцированных крапивниц.Chronic inducible urticarias are characterized by the risks of systemic reactions and a significant impairment of patients quality of life. The diagnosis of chronic inducible urticarias relies on the patients history and the challenge tests. A treatment algorithm for the management of chronic inducible urticarias includes nonsedating antihistamines as a first-line treatment. The international guidelines for the management of chronic inducible urticarias recommend updosing of nonsedating antihistamines up to four fold if standard doses are not effective. The meta-analysis suggests the efficacy of omalizumab in chronic inducible urticarias. In the prospect, the novel options of biological therapy for chronic inducible urticarias are expected.

Assessment of the Therapeutic Effect of Physiotherapy on Minimizing Imbalances of Geriatric Patients

2020 ◽  
Vol 62 (2) ◽  
pp. 86-91
Author(s):  
Justyna Pawlak ◽  
Małgorzata Dudkiewicz ◽  
Łukasz Kikowski
Keyword(s):  
Quality Of Life ◽  
Therapeutic Effect ◽  
Body Mass ◽  
Geriatric Patients ◽  
The Elderly ◽  
Risk Of Falling ◽  
Increased Risk ◽  
Climbing Stairs ◽  
Tinetti Test

Introduction: The progressing aging process and comorbidities worsen the efficiency of the balance system in the elderly, which leads to a weakening of stability and, as a consequence, to falls and injuries. The first ones lead to: worsening of functioning, reduced mobility, an increased risk of disease and mortality, therefore systematic physical activity and shaping the balance using physiotherapy, which can prevent dangerous falls is very important. Aim: Assessment of the therapeutic effect of physiotherapy on minimizing imbalances in geriatric patients. M aterial and Methods: The study group consisted of 46 people, including 32 women (69.6%) and 14 men (30.4%); average age of respondents – 72.5 years. They were patients of the Department of Rehabilitation of Poddębice Health Center, Ltd. The researchers used a self-made questionnaire, body mass to height index (BMI) and the Tinetti Test. Results: Patients with an elevated BMI (89.1%), as well as those taking more than 4 medication (78.3%), have had more falls over the past year (respectively 91.4% and 81.4%). After the use of comprehensive therapy, none of the patients achieved a worse result than before the physiotherapy while 91.3% of the respondents had an increase in the number of points scored in the Tinetti Test. The percentage of patients at high risk of falling reduced from 67.4% to 37%. There was also a decrease in the fear of walking (in 58.7%), falling (in 57.7%) and climbing stairs (in 47.9%). According to 78.3% of respondents, physiotherapy positively affected their independence and quality of life. Conclusions: The use of comprehensive physiotherapy reduces the fear of walking, climbing stairs and falling, which can be a good predictor of prevention. Both polypragmasia and an elevated body mass index (BMI) increase the risk of falling. Comprehensive physiotherapy of geriatric patients helps to improve balance and gait stereotype. Physiotherapy for the elderly helps improve the quality of life, independence, minimize imbalances, and thus reduce the risk of falls. Balance exercises play an important role in preventing falls.

Lung Function and Quality of Life in Workers with Chemical and Dust Exposure

2018 ◽  
Vol 69 (2) ◽  
pp. 346-349 ◽  
Author(s):  
Marina Ruxandra Otelea ◽  
Oana Cristina Arghir ◽  
Corina Zugravu ◽  
Eugenia Naghi ◽  
Sabina Antoniu ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Occupational Exposure ◽  
Lung Function ◽  
Lung Diseases ◽  
Dust Exposure ◽  
Chronic Lung Diseases ◽  
Respiratory Exposure ◽  
Increased Risk ◽  
Occupational Settings

Regarding the widely distribution of respiratory exposure hazards in occupational settings, workers have an increased risk for chronic lung diseases. For assessing the quality of life and lung function in workers exposed to chemicals and dust, St George�s Respiratory Questionnaire (SGRQ) and spirometry were performed among 40 patients, admitted in Occupational Clinic Department of Colentina Hospital, Bucharest, Romania, during February, 2017. SGRQ showed different predictors for patients according to their occupational exposure and total symptoms score correlated better with decreased spirometric parameters in defining lung function deterioration. Quality of life is earlier affected than lung function deterioration and emphasises the need of more sensitive methods for an earlier identification and better evaluation of respiratory hazards in different workplaces.

The effectiveness of a digital pelvic floor training program in thetreatment of urinary incontinence – a real-world evaluation (Preprint)

2019 ◽  
Author(s):  
Sabine Keim ◽  
Alexandra von Au ◽  
Lina Maria Matthies ◽  
Stephanie Wallwiener ◽  
Sarah Brugger ◽  
...  
Keyword(s):  
Urinary Incontinence ◽  
Pelvic Floor ◽  
University Hospital ◽  
First Line ◽  
First Line Therapy ◽  
A Value ◽  
Pelvic Floor Training ◽  
Significant Impairment ◽  
Pelvic Floor Weakness

BACKGROUND Background: Many women experience urinary incontinence (UI) during andafter pregnancy due to pelvic floor weakness. First-line therapy is conservative treatment, which nowadays can be facilitated by using digitalsolutions. OBJECTIVE The aim ofthe present study was to investigate the efficacy and effectiveness of pelvinain patients with existing UI. METHODS Methods: In the present observational study we analyzed the effectivenessof pelvina, a certified digital pelvic floor training course, in reducing UI symptoms by regularly applying “The Questionnaire for Urinary Incontinence Diagnosis” (QUID) and furthermore examining quality of life (QoL) by conducting the SF-6D. RESULTS Results: In this prospective study, 373 patients with a median age of 36 years (IQR 33 - 47 years) were included. At baseline the patients had a median QUID of 11 (IQR 11 - 15). During the course, incontinence improved significantly to a QUID of 5 (IQR 2 – 11; p<0.001). Additionally, the patients had also shown a significant impairment in their QoL at baseline with a value of 19 (IQR 16 - 22) in SF-6D. After completing the course, the QoL had risen to 24 (IQR 20 - 26). CONCLUSIONS Conclusion: Use of the certified digital pelvic floor course pelvinasignificantly reduces existing UI due to pelvic floor weakness over the timespan of the course. At the same time QoL is significantly improved. CLINICALTRIAL The present study was approved by the ethics committee of the Heidelberg University Hospital (S-392/2019)

Biopsychosocial Patterning of Multimorbidity and Its Consequences

2018 ◽  
pp. 220-236
Author(s):  
Elliot Friedman ◽  
Beth LeBreton ◽  
Lindsay Fuzzell ◽  
Elizabeth Wehrpsann
Keyword(s):  
Quality Of Life ◽  
Older Adults ◽  
Functional Outcomes ◽  
The United States ◽  
Chronic Medical Conditions ◽  
Quality Of Life Research ◽  
Increased Risk ◽  
Over Time

By many estimates the majority of adults over age 65 have two or more chronic medical conditions (multimorbidity) and are consequently at increased risk of adverse functional outcomes. Nonetheless, many older adults with multimorbidity are able to maintain high levels of function and retain good quality of life. Research presented here is designed to understand the influences that help ensure better functional outcomes in these older adults. This chapter presents findings that draw on data from the Midlife in the United States study. The independent and interactive contributions of diverse factors to multimorbidity and changes in multimorbidity over time are reviewed. The degree that multimorbidity increases risk of cognitive impairment and disability is examined. The role of inflammation as a mediator is considered. Multimorbidity is increasingly the norm for older adults, so better understanding of factors contributing to variability in multimorbidity-related outcomes can lead to improved quality of life.

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