ABSTRACT
PURPOSE: We determined the incidence of voiding symptoms, urodynamic etiology and satisfaction with therapy in a large cohort of men with prostatism during a 12-year period. MATERIALS AND METHODS: We retrospectively analyzed the records of 2,845 consecutive men who underwent urodynamic evaluation between January 1982 and December 1994. Patients were divided into groups 1 and 2 according to the years of study (between 1982 and 1988, and between 1989 and 1994, respectively). Parameters of evaluation included prevalence and distribution of voiding symptoms, urodynamic etiology of symptoms and satisfaction with therapy (medical or surgical). RESULTS: There was 843 evaluable patients 50 to 94 years old (mean age 63.2) Group 2 patients were younger, and had a 22% higher prevalence of nocturia and a 12% higher prevalence of daytime frequency. The prevalence of all other symptoms was the same in both groups. On urodynamics 523 patients (62%) had demonstrable evidence of bladder outlet obstruction of whom 345 (66%) had concomitant detrusor instability. Of the 843 patients 647 (77%) had detrusor instability, which was the sole diagnosis in 199 (24%). We noted low pressure/low flow in 137 patients (16%) and impaired detrusor contractility in 152 (17%), including 57 (7%) in whom the latter condition was the only diagnosis. Urodynamic findings remained the same during the entire 12-year period. Global satisfaction and symptomatic improvement were better with surgical than medical therapy, although the degree of satisfaction was independent of the urodynamic etiology of symptoms. CONCLUSIONS: Symptomatic men with prostatism are presenting with a greater prevalence of significant nocturia and daytime frequency than in the past with no change in urodynamic findings. In addition, patient level of satisfaction remains greater with surgical than medical therapy regardless of the urodynamic presence of bladder outlet obstruction.
Subject(s)
Patient Satisfaction , Prostatic Hyperplasia/physiopathology , Prostatic Hyperplasia/therapy , Urodynamics , Aged , Aged, 80 and over , Diagnosis, Differential , Humans , Male , Middle Aged , Prostatic Hyperplasia/diagnosis , Retrospective Studies , Urinary Bladder Neck Obstruction/etiology , Urination Disorders/etiologyABSTRACT
A preoperative program was initiated by the nursing staff of an orthopaedic unit to prepare patients and their families by providing information about every aspect of hospitalization for total joint replacement in order to decrease length of stay (LOS) and improve patient satisfaction. This included steps to minimize complications, teaching exercises that would increase post operative function, and quality discharge planning. The program is coordinated by the Patient Care Managers (PCM) and is offered to 4 patients twice weekly. The sample consisted of 463 patients admitted for total hip and knee replacement. The average LOS during the 33-month period was 8.0 days for those patients who received the preoperative program and 8.7 days for those patients who did not. Several outliers that had extended hospitalizations were equally distributed in both groups. By providing education preoperatively, we have not only reduced costs, but we have also provided our patients with timely information and quality care.
Subject(s)
Joint Prosthesis , Nursing Assessment , Patient Education as Topic/methods , Preoperative Care/methods , Humans , Length of Stay , Patient Satisfaction , Program Development , Program EvaluationABSTRACT
Hemangiopericytoma (HPC) is an uncommon tumor which was first described in 1942. There are no unique radiological or clinical identifiers that can reliably aid in preoperative diagnosis. Surgery is the only reliable therapy as both chemotherapy and radiotherapy have proven ineffective in several series. The outcome is difficult to predict; the only reliable predictor is the presence or absence of metastasis. We report on a 63-year-old female with a large left renal HPC.
Subject(s)
Hemangiopericytoma , Kidney Neoplasms , Female , Hemangiopericytoma/diagnosis , Hemangiopericytoma/pathology , Hemangiopericytoma/therapy , Humans , Kidney Neoplasms/diagnosis , Kidney Neoplasms/pathology , Kidney Neoplasms/therapy , Middle AgedABSTRACT
The concept of automatic threshold tracking is the most recent adaptation of artificial cardiac pacemakers to physiologic needs. Earlier pacemaker innovations were primarily in the area of timing of impulse delivery, whereas more recent changes have focused on alteration of the amplitude and duration of the pacemaker stimulus. Matching of this stimulus to the cardiac excitation threshold is important because a stimulus greater than necessary is wasteful of battery energy and may produce arrhythmias, whereas a stimulus of less than threshold intensity fails to pace the heart. Because of the wide range of clinically encountered threshold levels it is impossible to design a fixed output pacer that is efficient and safe for all patients at all times. The threshold tracking pacemaker searches for and finds the threshold level, and adjusts its stimulus to just above this level. The device ensures an adequate safety margin of stimulation, but reduces the stimulus level to the lowest safe level possible. It is fully automatic, adjusts immediately to any threshold changes and is not dependent on manual alteration.
