ABSTRACT
INTRODUCTION: Our goal was to determine the rate of complications, early revision and removal after full ambulatory implantation of bulbar AUS in men; secondly, to describe satisfaction and short-term continence rate. MATERIAL AND METHODS: Between April 2018 and April 2019, 28 consecutive patients underwent AUS implantation in a newly organised ambulatory setting. A prospective database of all included patients was established with comprehensive data collected on medical history, aetiology and severity of SUI, surgical procedures, postoperative complications and patient satisfaction. RESULTS: Twenty-eight patients were included (30 consecutive procedures: 22 primary AUS placement, 6 complete revisions, 2 partial revisions), with a mean follow up of 223±220.5 days. Fourteen patients had prior radiotherapy. Readmission rate was 6.7% in the first 30 days after surgery. Both revision and removal rates were 6.7%. Complications were reported in 26.7% of procedures, mainly Clavien-Dindo I. Patient satisfaction of ambulatory surgery organisation and experience was high (87/5% satisfied or very satisfied). Full continence & social continence were achieved for, respectively, 55.6% and 88.9% of procedures. CONCLUSION: Ambulatory placement of AUS is safe and can be performed successfully. Larger patient cohorts and randomised trials are crucial to improve knowledge on non-indications for full ambulatory AUS implantation in men.
Subject(s)
Urinary Incontinence, Stress , Urinary Sphincter, Artificial , Humans , Male , Urinary Sphincter, Artificial/adverse effects , Treatment Outcome , Prosthesis Implantation/methods , Feasibility Studies , Urinary Incontinence, Stress/surgery , Retrospective StudiesABSTRACT
This study examined whether the distribution of biochemical, physiological, and metabolic risk factors for non-communicable diseases (NCDs) among children and youth in urban India vary by socioeconomic status (SES). Data were derived from a cross-sectional survey of students enrolled in the 2nd and 11th grades in 19 randomly selected schools in Delhi (Nâ¯=â¯1329) in 2014-15. Mixed-effect regression models were used to determine the prevalence of risk factors for NCDs among private (higher SES) and government (lower SES) school students. After adjusting for age, gender, and grade we found the percentage of overweight (13.16% vs. 3.1%, p valueâ¯<â¯0.01) and obese (8.7% vs. 0.3%, p valueâ¯<â¯0.01) students was significantly higher among private relative to government school students. Similarly, significantly higher percentage of private school students had higher waist circumference values (7.72% vs. 0.58%, p valueâ¯<â¯0.01) than government school students. Furthermore, similar trend was observed across schools in the distribution of other NCD risk factors: raised blood pressure, raised total cholesterol, and low-density lipoprotein. Surprisingly, despite a higher prevalence of all risk factors, significantly higher percentage of private school students had adequate/ideal levels of high-density lipoprotein. Overall, the risk profile of private school students suggests they are more vulnerable to future NCDs.
ABSTRACT
Mutations in codons 12/13 of K-ras exon 2 are associated with reduced benefit from anti-epidermal growth factor receptor antibody treatment for metastatic colorectal cancer (CRC). Here, we evaluated the frequency of K-ras mutations and their relationship with clinicopathological features and treatment outcomes in Saudi Arabian patients with CRC. The genetic status of K-ras was determined in 300 patients diagnosed with CRC. Clinical information was collected retrospectively. K-ras was wild-type in 58% and mutated in 42% of the tumors. Most mutations were at codon 12 (89%) and were associated with metastasis [odds ratio (OR) = 1.38 (95%CI = 1.14-1.67] and occurrence of >40 µg/L carcinoembryonic antigen (CEA) [OR = 1.33 (1.1-1.74)] during diagnosis. Patients in stages I-III of the disease with wild-type K-ras tumors had a median relapse free survival (RFS) of 29 months in contrast to 22 months for those with the mutated K-ras tumor (P = 0.0357). In multivariate analysis, only the stage of the disease significantly predicted RFS (P = 0.001). Patients in stage IV of CRC with the wild-type K-ras tumor did not reach the median overall survival (OS), whereas patients with the mutated K-ras tumor survived for 23.5 months (P = 0.044). CEA level >40 µg/L (P = 0.004) and status of K-ras (P = 0.044) were independent predictors of OS. This is the largest study investigating K-ras mutations in patients with CRC in the Middle East. Mutations were associated with advanced stage of CRC, higher serum CEA, shorter RFS and OS.
Subject(s)
Arabs/genetics , Colorectal Neoplasms/genetics , Colorectal Neoplasms/pathology , Mutation , Proto-Oncogene Proteins p21(ras)/genetics , Adult , Aged , Aged, 80 and over , Exons , Female , Humans , Male , Middle Aged , Mutation Rate , Prognosis , Retrospective Studies , Saudi Arabia , Survival Analysis , Young AdultABSTRACT
PURPOSE: Evaluate how the spherical glass mega fillers (SGMFs) can positively interfere with light diffusion when incorporated in a composite restoration. MATERIALS AND METHODS: 30 samples (Ss) were performed, applying 2 composite layers of 3 mm each: 6 were made with composite only; 6 with a layer of SGMFs of O1.5mm within the first layer of composite; 6 with 2 overlapping layers of SGMFs of O1.5mm; 6 with a layer of SGMFs of O2mm; 6 with 2 overlapping layers of SGMFs of O2mm. The curing time was set at 40s for the first layer, and 120s for the second layer, transilluminated through the first layer. Digital pictures were taken, in standardized settings, during the transillumination, and the light intensity was measured with a digital image analysis software. RESULTS: From a lateral view the Ss with a single layer of SGMFs of O1.5mm and O2mm, the relative increments of light intensity, were of 24.37% and 33.33% respectively. Concerning the Ss made with 2 layers of SGMFs, the relative increments were of 67.99% and 66.4% respectively. In front view has emerged a relative increase rate of light intensity of 53.66% and 79.58%, in the Ss with a single layer of SGMFs of O1.5mm and of O2mm respectively. Furthermore, in the Ss with two layers of SGMFs of O1.5mm and O2mm the relative increments were of 267.53 and 319.63% respectively. CONCLUSION: The SGMFs are reliable in facilitating light diffusion within the light-curing composite resins.
ABSTRACT
We describe the re-siting of ventriculoperitoneal shunts to the gallbladder in two children. The first child had a rare case of hydrocephalus associated with plasminogen deficiency. She had had multiple VP shunt revisions due to non-absorption of CSF from the peritoneum. The second had craniopharyngioma-related hydrocephalus with once again a non-absorbing peritoneum. We report no surgical complications in the revisions for both the cases, and there has been a subsequent follow-up of 46 and 28 months, respectively, without incident. A review of the relevant literature describing the use and the performance of ventriculocholecystic shunts in comparison with other ventricular shunts is considered.
Subject(s)
Cerebrospinal Fluid Shunts/methods , Cholecystostomy/methods , Hydrocephalus/surgery , Child, Preschool , Female , Humans , Hydrocephalus/etiology , Infant , Reoperation/methods , Treatment Outcome , Ventriculoperitoneal Shunt/adverse effects , Ventriculoperitoneal Shunt/methods , Ventriculostomy/methodsSubject(s)
Arnold-Chiari Malformation/therapy , Hepatitis C/therapy , Syringomyelia/therapy , Arnold-Chiari Malformation/complications , Arnold-Chiari Malformation/pathology , Aspartate Aminotransferases/blood , Brain/pathology , Decompression, Surgical , Female , Headache/etiology , Hepatitis C/complications , Hepatitis C/pathology , Humans , Liver Function Tests , Magnetic Resonance Imaging , Middle Aged , Neurosurgical Procedures , Spine/pathology , Syringomyelia/complications , Syringomyelia/pathologyABSTRACT
We present feasibility, toxicity and efficacy results of an intensified six-cycle ChlVPP/ABVVP regimen in advanced Hodgkin lymphoma (HL). From February 2004 to August 2007, 82 consecutive eligible patients were enrolled. According to the Hasenclever index, 64 patients (78%) were considered at low risk, 15 (18%) at intermediate and 3 (4%) at high risk. The most relevant toxicity was haematological: grade 3-4 neutropenia occurred in 32% of patients, grade 3-4 anaemia in 26% of patients. Severe infections and febrile neutropenia were observed in 8% of patients. With a median follow-up of 35 months (range 12-55), the three-year freedom from treatment failure (FFTF) and overall survival (OS) were 75% (95% CI 65%-86%) and 94% (95% CI 87%-99%), respectively. The intensified ChlVPP/ABVVP regimen in advanced HL is effective, does not seem to differ from standard regimens in terms of FFTF and OS and showed a favourable toxicity profile.
ABSTRACT
We present a case of two separate closed parietal meningoceles without communication to the CNS and not in the midline. This is the first such case reported in the literature.
Subject(s)
Ectodermal Dysplasia/diagnosis , Encephalocele/diagnosis , Meningocele/diagnosis , Diagnosis, Differential , Encephalocele/surgery , Female , Humans , Infant, Newborn , Magnetic Resonance Imaging , Meningocele/surgery , Occipital Bone/diagnostic imaging , RadiographyABSTRACT
Vein of Galen malformations are rare vascular abnormalities, which develop during gestation and usually present in the neonatal period or early childhood. Symptoms are due to high output cardiac failure, hydrocephalus, seizures or haemorrhage. We report a case where a patient remained symptom free until presentation following a haemorrhage at the age of 47 years.
Subject(s)
Intracranial Aneurysm/diagnosis , Vein of Galen Malformations/diagnosis , Calcinosis/diagnosis , Calcinosis/therapy , Embolization, Therapeutic/methods , Humans , Intracranial Aneurysm/therapy , Magnetic Resonance Angiography , Male , Middle Aged , Treatment Outcome , Vein of Galen Malformations/therapy , Ventriculoperitoneal Shunt/methodsSubject(s)
Heart Failure/complications , Pulmonary Edema/diagnosis , Adult , Humans , Male , Pulmonary Edema/etiologySubject(s)
Aortic Valve Insufficiency/pathology , Aortic Valve/pathology , Heart Valve Prosthesis Implantation , Heart Valve Prosthesis , Adult , Aortic Valve/diagnostic imaging , Aortic Valve/surgery , Aortic Valve Insufficiency/diagnostic imaging , Aortic Valve Insufficiency/surgery , Bioprosthesis , Dyspnea/diagnostic imaging , Dyspnea/pathology , Humans , Hypertrophy, Left Ventricular/diagnostic imaging , Male , UltrasonographyABSTRACT
We report a case of hepatocellular carcinoma superimposed on chronic hepatitis C virus (HCV) hepatitis in which final diagnosis of hepatocellular carcinoma was delayed because there was no consensus on hypervascularity with two diagnostic methods at the time of presentation. A 3 cm lesion was initially observed as hypovascular at multidetector-row computed tomography. Conversely, two months later the lesion appeared hypervascular at contrast-ultrasonography and gadolinium-enhanced dynamic magnetic resonance, and hyperintense after superparamagnetic iron oxide-enhanced T2W studies. Only in the late follow-up it was definitively confirmed as hypervascular in the arterial phase of multidetector-row computed tomography. This case clearly highlights some pitfalls in the European Association for the study of the liver guidelines for hepatocellular carcinoma management, which were readdressed in the last American Association for the Study of Liver Diseases (AASLD) and in the forthcoming international proposals, leading to more pragmatic suggestions for clinical practice.
Subject(s)
Carcinoma, Hepatocellular/diagnostic imaging , Hepatitis C, Chronic/complications , Liver Neoplasms/diagnostic imaging , Magnetic Resonance Imaging/methods , Adult , Biopsy, Fine-Needle , Carcinoma, Hepatocellular/complications , Carcinoma, Hepatocellular/pathology , Female , Hepatitis C, Chronic/diagnostic imaging , Hepatitis C, Chronic/pathology , Humans , Liver Neoplasms/complications , Liver Neoplasms/pathology , Practice Guidelines as Topic , UltrasonographySubject(s)
Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Peripheral Nervous System Diseases/diagnosis , Peripheral Nervous System Diseases/drug therapy , Waldenstrom Macroglobulinemia/complications , Antibodies, Monoclonal/administration & dosage , Antibodies, Monoclonal, Murine-Derived , Cladribine/administration & dosage , Humans , Male , Middle Aged , Rituximab , Waldenstrom Macroglobulinemia/drug therapySubject(s)
Antibodies, Monoclonal/pharmacology , Chlorambucil/pharmacology , Lymphoma, Non-Hodgkin/drug therapy , T-Lymphocyte Subsets/drug effects , Antibodies, Monoclonal/therapeutic use , Antibodies, Monoclonal, Murine-Derived , Antineoplastic Agents/therapeutic use , CD4-Positive T-Lymphocytes , CD8-Positive T-Lymphocytes , Chlorambucil/therapeutic use , Humans , Killer Cells, Natural , Lymphocyte Count , Lymphoma, Non-Hodgkin/immunology , RituximabABSTRACT
A case of growing skull fracture associated with unrecognized extradural haematoma is presented together with the relevant radiology. The pathophysiology of growing skull fracture is reviewed in light of this previously unreported case.
Subject(s)
Skull Fractures/pathology , Cerebral Hemorrhage/complications , Cerebral Hemorrhage/pathology , Cerebral Hemorrhage/surgery , Child, Preschool , Hematoma/complications , Hematoma/pathology , Hematoma/surgery , Humans , Magnetic Resonance Imaging , Male , Skull Fractures/etiology , Skull Fractures/surgery , Tomography, X-Ray Computed , Treatment OutcomeABSTRACT
Penetrating injuries involving the spinal cord are not common. The incidence is, however, much higher in armed conflict. In a civilian population, gunshot wounds and stabbings account for the majority of such injuries. A pencil causing penetrating injury involving the spinal cord is very rare. We present the case of a young boy who accidentally suffered a penetrating injury involving the spinal cord from a pencil in his coat pocket.
Subject(s)
Foreign Bodies/surgery , Lumbar Vertebrae/injuries , Spinal Canal/injuries , Spinal Cord Compression/surgery , Spinal Cord Injuries/surgery , Spinal Injuries/surgery , Thoracic Vertebrae/injuries , Thoracic Wall/injuries , Wounds, Penetrating/surgery , Child , Debridement , Foreign Bodies/diagnosis , Humans , Laminectomy , Lumbar Vertebrae/pathology , Magnetic Resonance Imaging , Male , Neurologic Examination , Paraplegia/diagnosis , Paraplegia/surgery , Postoperative Complications/etiology , Postoperative Complications/rehabilitation , Spinal Canal/pathology , Spinal Cord/pathology , Spinal Cord Compression/diagnosis , Spinal Cord Injuries/diagnosis , Spinal Injuries/diagnosis , Spinal Nerve Roots/injuries , Spinal Nerve Roots/pathology , Spinal Nerve Roots/surgery , Wounds, Penetrating/diagnosisABSTRACT
A 68 year old woman presented with right ventricular myocardial infarction complicated by refractory hypoxaemia. She was found to have a significant right to left shunt at the atrial level through a previously undiagnosed ostium secundum atrial septal defect. Percutaneous closure of the atrial septal defect with an Amplatzer septal occluder resulted in prompt improvement in her oxygenation and clinical state. Such closure should be considered for patients with right ventricular infarction and refractory hypoxaemia caused by a right to left interatrial shunt.
Subject(s)
Heart Septal Defects, Atrial/complications , Hypoxia/etiology , Myocardial Infarction/complications , Prostheses and Implants , Aged , Echocardiography, Transesophageal , Female , Heart Septal Defects, Atrial/diagnostic imaging , Heart Septal Defects, Atrial/therapy , HumansABSTRACT
Previous evidence for the presence of chicken anemia virus (CAV) in the gonads of immune specific-pathogen-free chickens raised the question whether this occurs also in commercial breeders. The presence of CAV was investigated by nested PCR in the gonads and spleens of hens from two 55- and 59-week-old, CAV-vaccinated (flocks 2 and 3), and two 48- and 31-week-old non-vaccinated broiler breeder flocks (flocks 1 and 4). In addition, lymphoid tissues of 20-day-old embryos from these hens were also investigated for the presence of CAV. CAV was detected in the gonads and of 5/6 and 11/22 of the vaccinated hens and in some hens also in the spleen alone. Embryos from 7/8 and 5/18 of these hens were positive. In the non-vaccinated flocks, CAV was detected in the gonads of 11/34 and 10/10 hens in flocks 1 and 4, respectively. In addition, 11 birds in flock 1 had positive spleens. CAV DNA was detected in 3/11 and 2/10 of their embryos. CAV-positive gonads and embryos were detected in samples from hens with moderate as well as high VN antibody titers. Vaccinated chickens positive for CAV in the gonads and in their embryos had VN titers ranging from >1:512 to <1:2048. In non-vaccinated chickens, the VN titers of CAV positive chickens ranged from 1:128 to 1:4096. These results demonstrate that CAV genome can remain present in the gonads of hens in commercial broiler breeder flocks even in the presence of high neutralizing antibody titers that have been associated with protection against CAV vertical transmission. It also suggests that transmission to the progeny may occur irrespectively of the level of the humoral immune response in the hens.
Subject(s)
Chick Embryo/virology , Chicken anemia virus/isolation & purification , Chickens , Circoviridae Infections/veterinary , Gonads/virology , Infectious Disease Transmission, Vertical/veterinary , Poultry Diseases/virology , Animals , Antibodies, Viral/blood , Chicken anemia virus/genetics , Circoviridae Infections/transmission , Circoviridae Infections/virology , DNA, Viral/chemistry , DNA, Viral/genetics , Enzyme-Linked Immunosorbent Assay/veterinary , Female , Male , Neutralization Tests/veterinary , Polymerase Chain Reaction/veterinary , Poultry Diseases/transmission , Spleen/virologyABSTRACT
Rheumatoid disease is a systemic disorder affecting multiple organs. It is known to affect the nervous system in a variety of ways, but its presentation with spinal cord compression by a rheumatoid nodule is rare. We report two cases presenting with cord compression by a rheumatoid nodule who underwent surgical decompression with good recovery.