Rolled Vaginal Wall Flap for the Treatment of Stress Urinary Incontinence

Objectives: Anterior vaginal wall slings (AVWS) have been used for decades in the treatment of female stress urinary incontinence (SUI). The main drawback of using the vaginal wall as a sling is its tendency to weaken and stretch over the course of years. The use of synthetic tapes for the treatment of SUI is effective but costly. For patients who cannot afford synthetic tapes; we describe the preliminary results of a modified AVWS technique for the treatment of SUI types II and III. Patients and Methods: In this series; a modification of the AVWS was applied in 35 female patients with SUI. A fortified and rolled flap is used to provide compression and support of the urethra. The vaginal mucosal surface of the flap is cauterized and two diagonal sutures are placed across it. The flap is then rolled on itself with a running 2/0 vicryl suture. Two sutures attached to both ends are passed retropubically to the anterior abdominal wall and tied over the rectus sheath. Results: All 35 female patients had type II/III SUI. After a median follow up of 43 months; 91of the patients were dry or used 0-1 pad per day. Only one patient suffered from transient retention for one week post-operatively. Conclusion: This is a simple method to reinforce vaginal wall flaps. It could offer a durable and effective option for the treatment of SUI in patients who can not afford synthetic tapes. Long-term follow up is required to evaluate the durability of the procedure

Tension-Free Vaginal Tape Versus Transobturator Tape for Treatment of Female Stress Urinary Incontinence

The transobturator tape (TOT) is based on a similar principle as the tension-free vaginal tape (TVT); but introduced through the obturator foramen. The aim of this study was to compare these slings as surgical procedures for the treatment of stress urinary incontinence (SUI) in women. Patients and Methods This is a retrospective case-control study including female patients with SUI; either due to urethral hypermobility or intrinsic sphincter deficiency. Thirty patients were treated with TVT (group 1) and 30 were treated with TOT (group 2). The parameters studied were: pre-operative clinical data; operative data and surgical outcome. Results The post-operative complications in group 1 consisted of bladder perforation in one patient (3.3); urinary retention in 3 (10) and de novo urgency in 3 (10). The post-operative complications in group 2 consisted of vaginal xposure in 2 patients (6.7); de novo urgency in 2 (6.7) and transient urinary retention in one (3.3). In the TVT group; objective cure was achieved in 27/30 patients (90); while 3 patients (10) reported subjective cure; failure was not encountered. In the TOT group; objective cure was achieved in 24/30 patients (80) and subjective cure in 4 patients (13.3); and it failed in 2 patients (6.7). Conclusion TVT and TOT are effective procedures for the treatment of female SUI; with comparable results regarding operative time; hospital stay and the risk of complications

Comparison of pre and post surgical caudal block in reducing stress responses in children

Surgical stress stimulates the release of catecholamine and cortisol. Both of which have anti-insulin action resulting in an increase of plasma glucose concentration. The most common regional block in pediatric age group is caudal epidural analgesia. The aim of this study was to compare the stress response following pre and post surgical caudal block. After approval by our local ethics committee and written parental consent 70 children between two and seven years of age scheduled for elective lower abdominal procedures were enrolled in this study. Anesthesia was induced with fentanyl 1micro g/kg, midazolam 0.03mg/kg, propofol 3mg/kg, LMA was inserted, maintenance was with halothane 1-1.5%, N2O 3 lit/min, O2 3 lit/min. Halothane concentration was decreased to 0.6% in children who received pre surgical caudal block [20 minutes after block]. Children in group-A received pre surgical caudal block with 0.25% bupivacain 1ml/kg, those in group B received post surgical caudal block with same dosage and concentration. Demographic data were similar. Plasma glucose concentration were decreased during the course of this study in Group A, [P = 0.045]. However, in Group B the plasma glucose level increase 15 min after beginning of surgery [P = 0.001]. The hemodynamic changes with in group A was less than group B [P < 0.05]. In children, pre but not post surgical caudal block attenuates the stress response associated with lower abdominal surgery

Lidando com o estresse: o cotidiano do enfermeiro ao assistir uma criança com câncer em uma unidade intensiva pediátrica

O presente trabalho sob a forma de anteprojeto, abordando a temática do estresse, tem por objetivos: identificar e analisar o estresse físico, psicológico e emocional provocado pelo impacto do cenário oncológico nos enfermeiros intensivistas pediátricos, para que possam ser elaboradas estratégias que venham a minimizar os efeitos dos fatores estressores nos referidos profissionais. Para tanto, utilizaremos os referenciais teóricos sobre estresse, as condições de trabalho e estresse, a patologia câncer e seu impacto e o cuidar da criança com câncer. Utilizaremos, quanto aos fins, a metodologia descritiva com abordagem quantitativa. Os sujeitos da pesquisa serão os enfermeiros atuantes no Centro de Terapia Intensiva (CTI) pediátrico do Hospital do Câncer I (HCI) - Instituto Nacional de Câncer (INCA), que irão responder a dois questionários, que abordarão dados de caracterização pessoal e as características evidenciáveis do estresse. A realização desta pesquisa tem o intuito de contribuir para uma melhoria na qualidade de vida e trabalho desses enfermeiros, e, conseqüentemente, melhoria na qualidade da assistência prestada.

Study effect of relaxation technique on anxiety and stress in elders with hypertension

Anxiety and stress are among the most important problems of modern life. These problems, particularly in elders who their adaptation to the problems is low, result in serious complications in health. This study was performed to assess the effects of progressive muscle relaxation [PMR] technique on anexiety and stress in the hepertensive elders. This quasi-experimental study was conducted in Kahrizak charity foundation in Tehran, in 2005. In this study, 55 elderly men and women who resided in the centre and suffered from hypertension, were randomly divided into two groups; experimental [27] and control [28]. PMR technique was administrated to the individuals of experimental group for 6 weeks [3 times a week, for 20 minutes]. Subsequently, using depression anxiety stress [DAS] questionair, the level of anxiety and stress was measured in the two groups at the beginning, in the third week and at the end of the study. The data was analyzed, using Manvitni, Wilkakson and ANOVA tests. Using PMR, mean of anxiety and stress in the individuals of experimental group was 38.8 +/- 4.02, before intervention and decreased to 3434.3 +/- 3.7, at the third min. and to 33 +/- 5.17, at the end of intervention [p<0.01]. In the control group, the means were 38.6+4.14, before intervention, 37.5+6.07 at the third week and 39.5 +/- 4.16 at the end of intervention. These differences were statistically significant [p<0.05]. Also, in the individuals of experimental group, there was a significant decrease in SBP, DBP, HR, RR [p<0.01], whereas in the control group, these parameters, except RR were increased [p<0.01]. Our results showed that using non therapeutic techniques such as PMR may control both stress and anxiety and their complications such as hypertension in elders. This would result in healthy and prolonged life in this age group like others

Protective effect of quercetin [QRT], a bioflavonoid on stress-induced gastric ulcers in rats

Peptic ulcer is one of the most common diseases which represent a serious medical problem due to its frequency, high economic cost and frequent adverse reactions associated with drugs used in its management. In this work, an attempt was undertaken to investigate the protective effect of quercetin [QRT], the most abundant natural bioflavonoid which is widely distributed in edible plants and has a powerful antioxidant effect on stress-induced gastric ulcers in rats. In this experimental model the pathogenesis of the lesions has been related to the production of reactive oxygen species. The rats were randomly classified into 4 equal groups, [10 animals each] as follows: [1] Control group, [2] Pylorically ligated group in which animals were subjected to pyloric ligation only, [3] Cold restraint stress [CRS] group in which rats were subjected to pyloric ligation, allowed to recover, and then restrained by immobilizaiton and placed in a refrigerator at 4°C for 3 hours, and [4] Quercetin [QRT] treated group that received 50 mg/kg QRT intraperitonealy 1 hour before pyloric ligation and induction of gastric mucosal ulceration by cold restraint stress. Three hours later, all rats were decapitated, their stomachs were removed and the gastric content of groups 2, 3 and 4 were collected. Then, gastric juice parameters [volume, total acidity, total acid output, total pepsin concentration as well as glycoprotein contents] were studied. Also, the effect of QRT on stress induced gastric ulcer parameters [ulcer incidence; ulcer score; ulcer index and preventive index] were investigated in groups 1, 3 and 4. On the other hand, prior to decapitation, blood samples were collected from all animals for measurement of superoxide dismutase [SOD] activity in red blood cell [RBC] lysates as an index of the antioxidant state. The results obtained in the present study clearly demonstrate that intraperitioneal administration of QRT led to a markedly significant reduction in the occurrence of gastric ulceration in all treated rats as evidenced by the reduction of the mean ulcer score and ulcer index with a preventive index of 73.5%. Pretreatment with QRT was also associated with a significant decrease in the total acid and pepsin concentrations as well as a highly significant increase of glycoprotein contents compared with cold restraint group. Furthermore, the administration of QRT significantly increased SOD level as compared to cold restraint group. It is concluded that QRT has a protective effective role against stress-induced gastric ulcer in rats and the relevance of these results was discussed

Endoscopic macroplastiqueTM injection for the treatment of female stress incontinence. Role and efficacy

Objectives To evaluate the role; safety and efficacy of endoscopic MacroplastiqueTM implants in the management of female stress incontinence. Material and Methods Between 1995 and 1999; transurethral submucosal injection of MacroplastiqueTM was performed in 68 women (mean age 58 years; range 32 - 85 years) for the treatment of genuine stress incontinence. Fourteen patients had undergone previous surgery for incontinence that had failed to correct the problem. Under general or regional anaesthesia; the Macroplastique was injected sub-mucosally 1 cm distal to the bladder neck at 3; 6 and 9 o' clock positions. In 26 cases the 12 o' clock position was chosen to ensure a good occlusion of the bladder neck. The mean volume of Macroplastique injected was 3 ml. Results At a mean follow-up of 19 months; 24 patients (35.3) were dry; 18 patients (26.5) were improved and 26 patients (38.2) were still wet. Complications were all minor. Conclusion Transurethral submucosal injection of MacroplastiqueTM should be used in women with mild to moderate stress incontinence who have failed to respond to physiotherapy. Being a minimally invasive day case procedure with low morbidity which can be repeated if necessary and has a satisfactory success rate; we believe Macroplastique implantation could be a good alternative line of treatment for stress incontinence

Actividad gastrointestinal del extracto acuoso bruto de Quassia amara (Simarubaceae) / The gastrointestinal activity of crude aqueous extract of Quassia amara (Simarubaceae)

En este estudio se ha investigado el efecto del extracto acuoso bruto de Q. amara a nivel gastroitestinal utilizando varios modelos experimentales en animales. Los resultados muestran que este extracto a dosis de 500 y 1000 mg/Kg produce un aumento del tránsito gastrointestinal y que es capaz de inhibir las lesiones inducidas por la indometacina, el alcohol y el estres. Los animales tratados con dosis de 1000mg/Kg mostraron disminución de la acidez de los contenidos estomacales y de la actividad péptica y un incremento en la cantidad del moco protector de la mucosa

Musicoterapia. Una modalidad terpéutica para el estrés laboral / Music therapy. A therapeutic modality for occupational stress

Se realiza una breve exposición acerca de la relación entre estrés y enfermedad. Se analiza la importancia del medio laboral como generador de situaciones de estrés y la importancia de los factores mediadores de la respuesta del hombre ante tales situaciones. Se destaca la función del trabajo como elemento para la realización del ser humano y la necesidad de dortar al trabajador de los recursos apropiados para enfrentar el estrés. Se plantea el objetivo esencial de los servicos médicos brindados al trabajador de la Industria Básica concebidos de manera integral y que incluyen la evaluación y tratamiento psicológicos. Un recurso terapéutico escogido por el Profilactorio Nacional Obrero del Ministerio de la Industria Básica lo constituye la musicoterapia. Se definen los principios, indicaciones y nuestra experiencia en la aplicación de esta técnica aplicada a los obreros atendidos en nuestro centro

Effects of acupuncture on behavioral, cardiovascular and hormonal responses in restraint-stressed Wistar rats

Stress is a well-known entity and may be defined as a threat to the homeostasis of a being. In the present study, we evaluated the effects of acupuncture on the physiological responses induced by retraint stress. Acupunture is an ancient therapeutic technique which is used in the treatment and prevention of diseases. Its proposed mechanisms of action are based on the principle of homeostasis. Adult male Wistar EPM-1 rats were divided into four groups: group I (N=12), unrestrained rats with cannulas previously implanted into their femoral arteries for blood pressure and heart rate measurements; group II (N=12), rats that were also cannulated and were submitted to 60-min immobilization; group III (N=12), same as group II but with acupuncture needles implanted at points SP6, S36, REN17, P6 and DU20 during the immobilization period; group IV (N=14), same as group III but with needles implanted at points not related to acupuncture (non-acupoints). During the 60-min immobilization period animals were assessed for stress-related behaviors, heart rate, blood pressure and plasma corticosterone, noradrenaline and adrenaline levels. Group III animals showed a significant reduction (60 percent on average, P<0.02) in restraint-induced behaviors when compared to groups II and IV. Data from cardiovascular and hormonal assessments indicated no differences between group III and group II and IV animals, but tended to be lower (50 percent reduction on average) in group I animals. We hypothesize that acupuncture at points SP6, S36, REN17, P6 and DU20 has an anxiolytic effect on restraint-induced stress that is not due to a sedative action.

Nutrición en el enfermo quirúrgico pediátrico / Nutrition in the surgical pediatric patient

El éxito del tratamiento nutricional de los pacientes pediátricos quirúrgicos depende del adecuado conocimiento de la respuesta metabólica de estrés a la cirugía, la capacidad de evaluar el nivel de estrés, el compromiso nutricional existente y la tolerancia al ayuno. Sobre estas bases es posible modular el aumento del gasto energético en reposo y el hipercatabolismo asociados con las enfermedades quirúrgicas y el procedimiento operatorio, proveyendo aportes nutricionales acordes a las demandas metabólicas de cada momento, mediante enterales y parenterales de apoyo nutricional. De este modo se puede disminuir el catabolismo proteico, estimular el anabolismo y así promover adecuadas respuestas de cicatrización, inmunidad y crecimiento

SAMADHI TANK : A floatcell for enhancement of learning and management of stress and some painful conditions

The main objective of the present investigation was to study the Samadhi tank; a technologically and controlled relaxation environment and its effects on the African blacks within the tropics. Other objectives were to investigate the effects of flotation in the Samadhi tank on the human of cardiovascular and cardiorespiratory systems; the body temperature; intellectual learning; relief of tension and the therapeutic response of some patients having hypertension and other painful conditions