ABSTRACT
BACKGROUND: Observational studies suggest index clinical manifestation of venous thromboembolism (VTE) predicts recurrence type. Data regarding the association between index manifestation and recurrence rates are conflicting. OBJECTIVES: To perform a meta-analysis of randomized controlled trials (RCTs) to determine the type and frequency of recurrent VTE (rVTE) in persons after an index deep vein thrombosis (DVT) or pulmonary embolism (PE). PATIENTS/METHODS: We searched bibliographic databases for RCTs of acute (early) treatment of rVTE in persons with an index DVT or PE (±DVT), enrolling ≥ 50 subjects anticoagulated ≥ 3-months and reporting types of rVTE. We pooled (random-effects) the proportion of rVTEs that were DVTs, PEs, and fatal PEs, the proportion of recurrent PEs that were fatal, and absolute rVTE rates. RESULTS: In nine RCTs (N = 13 640; 413 rVTEs) evaluating persons with an index PE; 66% (95% CI, 60-72%) of rVTEs were PE and 27% (95% CI, 22-33%) were fatal PE. Among 25 RCTs (N = 17 340; 692 rVTEs) evaluating persons with an index DVT, 36% (95% CI, 29-44%) experienced a recurrent PE and 10% (95% CI, 7-13%) a fatal PE. Recurrent PEs following an index PE had a higher fatality rate than after an index DVT (41%; 95% CI, 33-48% vs. 25%; 95% CI, 18-33%; P = 0.007). The rVTE rate was higher following an index DVT compared with a PE (2.6%; 95% CI, 1.6-3.8% vs. 4.9%; 95% CI, 4.0-6.0%; P = 0.002). CONCLUSIONS: Our meta-analysis suggests most rVTEs will be the same type as the index event. While index DVTs are associated with a higher rVTE rate than index PEs; recurrent PEs are associated with high fatality.
Subject(s)
Pulmonary Embolism , Venous Thromboembolism , Venous Thrombosis , Anticoagulants/therapeutic use , Humans , Predictive Value of Tests , Pulmonary Embolism/diagnosis , Pulmonary Embolism/drug therapy , Pulmonary Embolism/mortality , Randomized Controlled Trials as Topic , Recurrence , Risk Assessment , Risk Factors , Time Factors , Treatment Outcome , Venous Thromboembolism/diagnosis , Venous Thromboembolism/drug therapy , Venous Thromboembolism/mortality , Venous Thrombosis/diagnosis , Venous Thrombosis/drug therapy , Venous Thrombosis/mortalityABSTRACT
OBJECTIVE: To evaluate the urological management of the relationship of the couple with both male and female sexual dysfunction. MATERIALS AND METHODS: Review of the guidelines published on this subject in the Medline database together with our own clinical experience in this field. RESULTS: To optimize therapy the urologist should consider the couple when a patient presents with a sexual symptom otherwise the risk of inappropriate, unsuccessful treatment is high. If a dysfunctional relationship is clearly present, with major conflict between the partners or a marked lack of communication, these negative couples must be seen for sex therapy within a multidisciplinary approach. Even with a positive couple, without major conflict, it is advisory to include the partner in the diagnosis and the treatment, for her attitude as a factor which can influence the sexual motivation of the couple, the means and results of the management. In addition, poor knowledge of a sexual problem concerning the woman, whether this predates the partner's dysfunction or not, can impede the efficacy of pharmaceutical treatment. CONCLUSION: Thus, the couple should be seen as a clinical entity with its own fulfillment, which plays an important role in treatment effectiveness, in compliance. Adapting the management to the real expectations of the patient and the couple is essential. With the possible help of the pharmacological treatments of sexual symptoms, a work on all aspects of the couple's dysfunction should bring a new harmony in sexual and affectionate aspects of the relationship.
Subject(s)
Sexual Dysfunction, Physiological , Sexual Dysfunctions, Psychological , Sexual Partners , Female , Humans , Male , Sexual Dysfunction, Physiological/diagnosis , Sexual Dysfunction, Physiological/etiology , Sexual Dysfunction, Physiological/therapy , Sexual Dysfunctions, Psychological/diagnosis , Sexual Dysfunctions, Psychological/etiology , Sexual Dysfunctions, Psychological/therapy , Urologic Diseases/complicationsABSTRACT
More than two thirds of the patients after radical prostatectomy (RP) have a lasting impairment of the quality of their erection and are may be considered as in failure of erectile rehabilitation. The treatment of penile rehabilitation failures after RP follows the rules and recommendations of the treatment of erectile dysfunction according to its degree of severity and of chess in previous treatments. Psychosexual counselling is often necessary to assess and improve the sexual living of cancer and of consequences of the treatment in the couple.
Subject(s)
Erectile Dysfunction/etiology , Erectile Dysfunction/rehabilitation , Prostatectomy/adverse effects , Erectile Dysfunction/therapy , Humans , Male , Treatment FailureABSTRACT
The reliability of automated systems was assessed by simultaneously using an MS2 and a methodology of data interpretation/mathematical modelling. Two experimental situations were analysed. Bacterial growth both in synthetic and in complex media could be well described by Monod's model and the logistic model. In the two cases, the fit of the models to the data was satisfactory.
Subject(s)
Bacteria/growth & development , Computer Simulation , Models, Biological , KineticsABSTRACT
Special novobiocin elution disks were prepared for testing of staphylococci in the Autobac system. The disk mass has been choosed by principal component analysis. The verification of the results showed the interest of this test for routine identification of the staphylococcal strain isolated in the urinary tract infections.
Subject(s)
Microbial Sensitivity Tests , Novobiocin/pharmacology , Staphylococcus/drug effects , Drug Resistance, Microbial , Staphylococcus/classification , Staphylococcus/isolation & purification , Staphylococcus aureus/drug effectsABSTRACT
Growth kinetics of 2Nitrobacter strains (N.w. and L) coexisting in the same soil are studied in batch and continuous culture. Monod's parameters are estimated numerically from experimental data in the case of the batch experiment, and from steady-state equations in the case of the chemostat. In both cases, the 2 strains show different values for their growth parameters. N.w. may be characterized by its highµ max-Ks values, relative to strain L. But for each strain,µ max is significantly lowered between batch and continuous culture. In this latter case, at N-NO2 (-) concentrations less than 1.5µg·ml(-1), the 2 strains exhibit similar growth rates showing that for concentrations of the limiting substrate prevailing in the soil, they may compete for this substrate.
ABSTRACT
Nineteen patients with systemic scleroderma and five with localized scleroderma were treated with topical dimethyl sulfoxide by painting and immersion techniques. Partial control was obtained by using a very low concentration (5%) on one side when involvement was symmetrical. Duration of treatment ranged from 3 to 15 months. Topical dimethyl sulfoxide did not improve the skin induration, range of motion, or Raynaud's phenomenon in the scleroderma patients. No substantial beneficial effect was noted on the healing of ischemic ulcers, and the continuous application of dimethyl sulfoxide did not prevent new ulceratins from developing. Relief of pain was noted in ten of 16 patients, probably due to the local analgesic effect of dimethyl sulfoxide.
