Early urinary catheter removal after rectal surgery: systematic review and meta-analysis.

BACKGROUND: Urinary catheters are placed after rectal surgery to prevent urinary retention, but prolonged use may increase the risk of urinary tract infection (UTI). This review evaluated the non-inferiority of early urinary catheter removal compared with late removal for acute urinary retention risk after rectal surgery. METHODS: MEDLINE, Embase and the Cochrane Central Register of Controlled Trials were searched from January 1980 to February 2019. RCTs comparing early versus late catheter removal after rectal surgery were eligible. Primary outcomes were acute urinary retention and UTI; the secondary outcome was length of hospital stay. Early catheter removal was defined as removal up to 2 days after surgery, with late removal after postoperative day 2. The non-inferiority margin from an included trial was used for analysis of change in urinary retention (ΔNI = 15 per cent). Pooled estimates of risk differences (RDs) were derived from random-effects models. Risk of bias was assessed using a modified Cochrane risk-of-bias tool. RESULTS: Four trials were included, consisting of 409 patients. There was insufficient evidence to conclude non-inferiority of early versus late catheter removal for acute urinary retention (RD 9 (90 per cent c.i. -1 to 19) per cent; PNI = 0·31). Early catheter removal was superior for UTI (RD -11 (95 per cent c.i. -17 to -4) per cent; P = 0·001). Results for length of stay were mixed. There were insufficient data to conduct subgroup analyses. CONCLUSION: The existing literature is inconclusive for non-inferiority of early versus late urinary catheter removal for acute urinary retention. Early catheter removal is superior in terms of reducing the risk of UTI.

ANTECEDENTES: Las sondas urinarias se colocan después de la cirugía rectal para prevenir la retención urinaria, pero su uso prolongado puede aumentar el riesgo de infección del tracto urinario. Esta revisión evaluó si la retirada precoz de la sonda urinaria no fue inferior a la retirada tardía del catéter en cuanto al riesgo de retención urinaria aguda tras cirugía rectal. MÉTODOS: Se realizaron búsquedas en las bases de datos MEDLINE, Embase y en el Registro Central Cochrane de Ensayos Controlados desde enero de 1980 hasta febrero de 2019. Se consideraron elegibles los ensayos controlados aleatorizados que comparaban la retirada precoz y tardía de la sonda tras cirugía rectal. Las variables principales fueron la retención urinaria aguda y la infección del tracto urinario. La variable secundaria fue la duración de la estancia hospitalaria. Se consideró retirada precoz cuando ésta ocurrió hasta el segundo día postoperatorio mientras que más allá de ese tiempo se consideró retirada tardía. El margen de no inferioridad de uno de los ensayos incluidos se utilizó para el análisis de la retención urinaria (ΔNI = 15%). Las estimaciones agrupadas de las diferencias de riesgo se derivaron de los modelos de efectos aleatorios. El riesgo de sesgo se evaluó utilizando una herramienta de riesgo de sesgo Cochrane modificada. RESULTADOS: Se incluyeron cuatro ensayos que incluyeron un total de 409 pacientes. No se encontraron evidencias suficientes para concluir la no inferioridad de la retirada precoz del catéter versus la retirada tardía para la retención urinaria aguda (diferencia de riesgo, risk difference, RD 9%, i.c. del 90% -1% a 19%, valor de la P para no inferioridad, P value for non-inferiority, PNI = 0,31). La retirada precoz del catéter fue superior con relación a la infección del tracto urinario (RD -11%, IC del 95%: -17% a -4%, P = 0,001). Los resultados de la duración de la estancia hospitalaria fueron mixtos. No hubo datos suficientes para realizar análisis de subgrupos. CONCLUSIÓN: La literatura existente no es concluyente para determinar la no inferioridad de la retirada precoz de la sonda urinaria versus la retirada tardía con relación a la retención urinaria aguda. La retirada precoz de la sonda es superior y reduce el riesgo de infección del tracto urinario.

Evaluation of topical pharyngeal anesthesia for upper endoscopy including factors associated with patient tolerance.

BACKGROUND: Topical pharyngeal anesthesia is generally used as a pretreatment for upper endoscopy. However its efficacy has not been established. METHODS: A randomized double-blind placebo-controlled study was undertaken. Subjects were 201 patients who underwent upper endoscopy and gave informed consent. Relative risks (RR) of patient discomfort were calculated for pharyngeal anesthesia, anxiety, and other potential confounding factors by using logistic regression analyses. RESULTS: The RR of patient discomfort on intubation was 0.56 for the anesthesia versus the placebo group (95% CI, 0.31-1.01). RR was higher in patients aged 39 or younger than in those 40 or over (RR = 2.22, 95% CI, 1.04-4.74). With subgroup analysis in those examinees less than 40 years old, the RR of patient discomfort was 0.21 for the topical anesthesia (95% CI, 0.04-0.99) versus the placebo group and 4.93 for patients undergoing upper endoscopy for the first time (95% CI, 1.13-21.60). In the first-time patients, the RR was lower in the topical anesthesia than in the placebo group (RR = 0.20; 95% CI, 0.04-0.93); it was higher in patients with a trait-anxiety score higher by 10 points than in those with a lower score (RR = 3.35, 95% CI, 1.01-11.15). With the Bonferroni correction for multiple testing of data, statistical significance is indicated by a CI of 97.5% in the subgroup analyses. CONCLUSIONS: Topical pharyngeal anesthesia appears to be effective in patients less than 40 years old and in those undergoing the procedure for the first time. A high trait-anxiety score could be a predictor of discomfort in first-time examinees.

Oxidative stress during recovery from muscle atrophy.

Single ankle joints of male Wistar rats (15-week-old) were immobilized in the extended position for 7 days and remobilized for 5 days after the immobilization period. Atrophic and contralateral soleus, typical slow red muscles, were collected and their levels of thiobarbituric acid-reactive substance (TBARS) and glutathione were measured. Five-day remobilization did not increase muscle weight significantly. However, there were significant increases in TBARS and oxidized glutathione in the recovering muscle, which strongly suggested that enhanced oxidative stress occurred during the recovery from disuse muscle atrophy. Vitamin E injection accelerated the recovery from atrophy, thus showing that oxidative stress slowed it down.

[A case of diffuse large cell lymphoma treated with combination chemotherapy of CHOP (cyclophosphamide, doxorubicin, vincristine, prednisolone) and BEMP (bleomycin, etoposide, mitoxantrone, procarbazine) with complete remission].

A 73-year-old man with diffuse large cell lymphoma was treated with noncross resistant alternating combination chemotherapy of CHOP and BEMP, consisting of cyclophosphamide (1,000 mg/body, i.v., day 1), doxorubicin (60 mg/body, i.v., day 1), vincristine (2 mg/body, i.v., day 1), prednisolone (100 mg/body, p.o., day 1-5), bleomycin (30 mg/body, i.v., day 22), etoposide (80 mg/body, i.v., day 22-24), mitoxantrone (6 mg/body, i.v., day 22), and procarbazine (100 mg/body, p.o., day 22-26). Following the three courses' administration of CHOP and BEMP, complete remission was obtained with a remission duration of over ten months. Leukocytopenia was a dose-limiting factor. It is concluded that noncross resistant alternating combination chemotherapy of CHOP and BEMP is effective for diffuse large cell lymphoma.

[MQF-FT and MQF-UFT in gallbladder and bile duct cancer].

Four patients with gallbladder cancer and two with bile duct cancer were treated with mitomycin C, carboquone, 5-fluorouracil and OK-432 (MQF-OK therapy) plus tegafur (FT) or UFT. MQF-OK therapy was administered according to our original method. FT and UFT were orally given in a dose of 600-800 mg/body/day and 300-400 mg/body/day, respectively. Three with gallbladder cancer and one with bile duct cancer showed PR. Myelosuppression was observed in all cases, but recovered in two weeks after MQF therapy. We recommend the further trial of MQF-OK therapy plus FT or UFT for gallbladder and bile duct cancer.