ABSTRACT
Quality of life (QoL) was analyzed in 73 patients with severe multiple trauma (PTS > or = 40 patients) between 1 and 13 years after injury. QoL was assessed by the Aachen Longtime Outcome Score (ALOS), the Spitzer Index (SI) and individual self-assessment. The patients were asked about further social, financial, psychological and physical items. According to the ALOS, 81% of the patients showed moderate, 14% severe and 5% no disability. In 66% of the patients a favorable Spitzerindex (8-10 points) was found. Only 14% had poor SI scores (0-4 points). Also, two out of three patients regarded the current state of their health as "good" or "very good". Predominantly, handicaps resulted from permanent physical disability, in particular the lower extremities, whereas psychosocial and financial problems were reported infrequently. Besides injuries to the head or extremities, low QoL correlated with severity of injury and increasing age. Within the first 4 post-traumatic years SI and ALOS, as well as individual self-assessment, improved with time after injury. The rate of patients who returned to work (69%) was similar to other multiple trauma series, including series with less severe injuries. The reasonable long-term outcome even after severe multiple trauma seems to justify the enormous staff and economic expense required to manage these patients. Further improvement in QoL may be achieved by professional psychological support and early fracture treatment.
Subject(s)
Disabled Persons/psychology , Multiple Trauma/rehabilitation , Quality of Life , Adaptation, Psychological , Adolescent , Adult , Aged , Cost of Illness , Female , Follow-Up Studies , Humans , Male , Middle Aged , Multiple Trauma/psychology , Personality Inventory , Sick Role , Treatment OutcomeABSTRACT
The TULIP (transurethral ultrasound-guided laser-induced prostatectomy) system combines a real-time ultrasound transducer and a Nd:YAG laser delivery system with a 1.064 microns wavelength within a 22 F urethral probe. The goal is to produce a coagulation necrosis of the prostatic parenchyma, with a subsequent elimination of tissue in the urine. 29 patients have been included in this study, and 13 have a minimal one year follow-up. No complication occurred. 2 patients underwent a transurethral resection of the prostate secondary to the TULIP treatment. All patients complained of irritative urinary symptoms (frequency, burning on urination...) in the days or weeks following the treatment, and suprapubic catheterization tube had to be left in place for a mean duration of 13.8 days. Inclusion/exclusion criteria and evaluation modalities have been the same as in the American national study published elsewhere. At one year, our success rate for at least one criteria has been 84.6%, but only 2 (15%) out of 13 patients have been successful both in symptom score and flow rate.
Subject(s)
Laser Therapy/instrumentation , Prostatectomy/methods , Prostatic Hyperplasia/surgery , Ultrasonography/instrumentation , Aged , Aged, 80 and over , Evaluation Studies as Topic , Follow-Up Studies , Humans , Laser Therapy/methods , Male , Middle Aged , Time Factors , Ultrasonography/methodsABSTRACT
The TULIP (Transurethral Ultrasound-guided Laser-Induced Prostatectomy) system combines a real-time ultrasound transducer and a Nd:YAG laser delivery system with a 1.064 micron wavelength within a 22 F urethral probe. The goal is to produce a coagulation necrosis of the prostatic parenchyma, with a subsequent elimination of tissue in the urine. 29 patients have been included in this study, and 13 have a minimal one year follow-up. No complication occurred. 2 patients underwent a transurethral resection of the prostate secondary to the TULIP treatment. All patients complained of irritative urinary symptoms (frequency, burning on urination...) in the days or weeks following the treatment, and suprapubic catheterization tube had to be left in place for a mean duration of 13.8 days. Inclusion/exclusion criteria and evaluation modalities have been the same as in the American national study published elsewhere. At one year, our success rate for at least one criteria has been 84.6%, but only 2 (15%) out of 13 patients have been successful both in symptom score and flow rate.
Subject(s)
Laser Therapy/methods , Prostatectomy/methods , Prostatic Hyperplasia/surgery , Follow-Up Studies , Humans , Male , Organ Size , Postoperative Complications , Prostatic Hyperplasia/diagnostic imaging , Prostatic Hyperplasia/physiopathology , Ultrasonography , UrodynamicsABSTRACT
A case of complete ureteral transection complicating percutaneous nucleotomy for disk herniation is reported. The ureteral lesion was contralateral to the percutaneous approach and was treated by intubated ureteroureterostomy, since complete section precluded endourological management.
Subject(s)
Intervertebral Disc Displacement/surgery , Intraoperative Complications/therapy , Lumbar Vertebrae , Ureter/injuries , Female , Humans , Middle Aged , Surgical Procedures, Operative/methodsABSTRACT
Over the last 11 years we have treated 47 patients with infiltrating bladder carcinomas with the neodymium:YAG laser alone or in combination with TUR. After a mean observation period of 3 1/2 years (19-133 months) 39 patients (83%) were still alive. Only two of them showed tumor dissemination. Thirteen patients (27.7%) had no recurrent disease after laser therapy. Mostly heterotopic recurrences with no tumor progression were found in 23 patients (48.9%). Six patients (12.8%) developed recurrences with progression, including two cases with pelvic lymph node metastases. Five patients (10.6%) died of their tumor disease and three of myocardial infarction, having shown no signs of tumor recurrence at the last follow-up examination.
