RESUMEN
OBJECTIVE: To evaluate the effects of bariatric surgery on lower urinary tract symptoms (LUTS) in a prospective cohort study. PATIENTS AND METHODS: Patients undergoing bariatric surgery were recruited into the study. LUTS were assessed using the International Prostate Symptoms Score (IPSS) in men and Bristol Female Lower Urinary Tract Symptoms Score Questionnaire (BFLUTS) in women. Serum glucose, insulin and prostate-specific antigen (PSA) levels were recorded; insulin resistance was quantified using the Homeostasis Model Assessment (HOMA-IR) method. Patients were assessed before surgery, and at 6-8 weeks and 1 year after surgery. Weight loss, change in body mass index (BMI), total symptoms score as well as individual symptoms were tested for statistical significance with correction for multiple testing using Bonferroni method. Linear regression analysis was performed with total symptoms score change at 1 year as the outcome variable and BMI, age, total symptoms score before surgery, HOMA-IR, glucose level before surgery, insulin level before surgery, change in insulin level after surgery, weight loss and BMI loss as predictor variables. RESULTS: In all, 86 patients were recruited and 82% completed at least one follow-up after surgery. There was significant weight loss and reduction of BMI after surgery (P < 0.001). At 6 weeks, there was a significant reduction in overall symptom score (P < 0.001) and this improvement was sustained at 1 year. Linear regression analysis showed that total symptoms score at baseline, HOMA-IR, preoperative insulin level and change in insulin level postoperatively were predictive of the change in total symptoms score while the amount of weight loss was not. CONCLUSIONS: The study confirms the improvement in LUTS after weight loss but there is no correlation between the improvement and the time course or degree of weight loss. Rather there is a suggestion that the improvement in symptoms is linked to improvement in insulin resistance seen as a result of both bariatric surgery and weight loss.
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Cirugía Bariátrica , Síntomas del Sistema Urinario Inferior/fisiopatología , Adulto , Glucemia/metabolismo , Índice de Masa Corporal , Femenino , Humanos , Insulina/sangre , Síntomas del Sistema Urinario Inferior/sangre , Síntomas del Sistema Urinario Inferior/metabolismo , Síntomas del Sistema Urinario Inferior/cirugía , Masculino , Síndrome Metabólico/sangre , Síndrome Metabólico/metabolismo , Persona de Mediana Edad , Estudios Prospectivos , Análisis de Regresión , Resultado del Tratamiento , Pérdida de PesoRESUMEN
BACKGROUND: Gallbladder cancer is a high-mortality cancer with a wide range of incidence worldwide. Some indigenous populations are known to have a higher incidence of gallbladder cancer. Commonly, it is incidentally discovered during routine gallbladder surgery. The primary aim was to determine the incidence and characteristics of gallbladder cancer in a New Zealand population. The secondary aim was to determine if inequalities in gallbladder cancer rates between Maori and non-Maori have decreased. METHODS: A retrospective cohort study utilizing an online database was conducted to identify all patients with gallbladder malignancy treated in the Waitemata District Health Board from 2003 to 2013. The outcomes measured were staging of cancer, histology, ethnicity, incidental finding and survival rates. RESULTS: The age-standardized incidence (ASI) rate of gallbladder carcinoma is 0.60/100 000. The gender-specific ASI rates were 0.21/100 000 (men) and 0.76/100 000 (women). The incidence for Maori was 0.96/100 000 (men) and 1.37/100 000 (women). Gallbladder carcinoma was found incidentally in 0.44% of cholecystectomies, which made up 46.2% of all cases. Right upper quadrant pain was the most common presenting symptom (74.4%). Surgery was the most common treatment modality (66.7%). Mean survival across all patients was 12.24 months. CONCLUSION: Our study found that the ASI of gallbladder carcinoma when compared with the Koea et al. study has decreased for men from New Zealand, but appears to have increased slightly for women from New Zealand. The raw incidence for Maori men and women appears to have decreased, but inequality in gallbladder cancer incidence between Maori and non-Maori remains.
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Adenocarcinoma/epidemiología , Neoplasias de la Vesícula Biliar/epidemiología , Disparidades en el Estado de Salud , Nativos de Hawái y Otras Islas del Pacífico , Adenocarcinoma/diagnóstico , Adenocarcinoma/mortalidad , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Neoplasias de la Vesícula Biliar/diagnóstico , Neoplasias de la Vesícula Biliar/mortalidad , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Nueva Zelanda/epidemiología , Estudios Retrospectivos , Distribución por Sexo , Tasa de SupervivenciaRESUMEN
BACKGROUND: To retrospectively determine key demographic and clinical features of 35 patients with Xanthogranulomatous pyelonephritis (XGP) in a New Zealand setting and to compare it with the existing literature. METHODS: A retrospective review of patients having a confirmed diagnosis of XGP on histopathology examination was performed. Key clinical and demographic features were analysed and compared with the published literature. RESULTS: XGP was diagnosed in 35 patients over a 12-year (2001-2013) period in Auckland Public Hospital. Ninety-one percent of the patients were female. The population had significantly higher numbers of Maori and Pacific Island patients compared with the general population (74%). Staghorn calculi were the most common cause (51.4%) with obstructing ureteric calculi as the next most common (22.9%) cause. Twenty percent of cases were not thought to be XGP prior to nephrectomy (suspicious renal mass). Thirteen (38%) patients suffered serious complications post-operatively (Clavien 3-5). CONCLUSION: XGP is a rare chronic inflammatory condition that appears to be overrepresented by Maori and Pacific islanders in our cohort when compared with the overall patient pool. Surgical treatment is associated with significant morbidity but remains the only definitive option. Obesity and other conditions associated with metabolic syndrome may coexist at the time of presentation and may be contributing factors to the development of XGP and poor outcomes associated with it.
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Pielonefritis Xantogranulomatosa/diagnóstico , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Femenino , Humanos , Masculino , Persona de Mediana Edad , Nativos de Hawái y Otras Islas del Pacífico , Nefrectomía , Nueva Zelanda/epidemiología , Complicaciones Posoperatorias , Pielonefritis Xantogranulomatosa/etnología , Pielonefritis Xantogranulomatosa/etiología , Pielonefritis Xantogranulomatosa/cirugía , Estudios Retrospectivos , Resultado del Tratamiento , Adulto JovenRESUMEN
AIM: NZ needs a surgical workforce with the capacity to meet the increasing health demands of an aging population. This study determined longitudinal patterns of medical student interest in a surgical career and factors influencing that choice. METHOD: We studied medical students entering the Auckland medical programme from 2006-2008 who completed an entry and exit questionnaire on career intentions. Four notional groups were created, depending on the level of interest at entry and at exit. Demographic factors for each category were compared. Analysis of influencing factors was also undertaken. RESULTS: Of 488 students, 310 (64%) completed both an entry and exit questionnaire. Over 50% of students had a strong interest in a surgical career at entry, dropping to 26% at exit. The 'Never Evers' (No interest at entry /No interest at exit) made up 39%,'Divergers' (Strong/No) 35%, 'Die Hards' (Strong/Strong) 18%, and 'Convertibles' (No/Strong) 8%. Less interest in a surgical career was seen among female (P=0.001) and older students (P=0.017). Influencing factors differentiating the 'Die Hards' from the 'Divergers' were work hours and flexibility (less influence among 'Die Hards'), with procedural nature and consultants/mentors (higher). CONCLUSION: There is a significant reduction in interest in a surgical career over the course of the undergraduate programme, especially among female and older students. Yet the level appears sufficient for available training places. Consultant role models are an important career influence. Lack of flexibility in work and training programmes continue to provide challenges in creating a diverse surgical workforce.
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Selección de Profesión , Cirugía General , Estudiantes de Medicina/psicología , Adulto , Factores de Edad , Educación de Pregrado en Medicina , Femenino , Humanos , Intención , Estudios Longitudinales , Masculino , Nueva Zelanda , Factores Sexuales , Estudiantes de Medicina/estadística & datos numéricos , Encuestas y CuestionariosRESUMEN
BACKGROUND: To assess the outcomes of patients undergoing percutaneous renal artery embolization (PRAE) prior to radical nephrectomy. METHODS: We performed retrospective chart review of patients undergoing PRAE in Auckland Public Hospital from January 2004 to December 2011. PRAE was performed under epidural anaesthesia and within 24 h of nephrectomy. We compared our perioperative outcomes with the published literature. RESULTS: Forty-two patients were identified in this series. Patients had predominantly more advanced stage disease with 30 (71%) being T3 or higher (TNM staging). Median operation time was 192 min (range 84-428). 45.2% of patients experienced complications from the surgery. There were no complications associated with PRAE. CONCLUSIONS: PRAE prior to nephrectomy is a safe procedure. There is no convincing evidence in the literature that the benefits outweigh the risks. All published studies are non-randomized and subject to selection bias, so the true role of PRAE has not yet been determined and routine use is probably not justified.
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Carcinoma de Células Renales/terapia , Embolización Terapéutica , Neoplasias Renales/terapia , Nefrectomía , Arteria Renal , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma de Células Renales/mortalidad , Carcinoma de Células Renales/patología , Femenino , Humanos , Neoplasias Renales/mortalidad , Neoplasias Renales/patología , Masculino , Persona de Mediana Edad , Terapia Neoadyuvante , Tempo Operativo , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
Angiostrongylus cantonensis (A. cantonensis) is a nematode parasite found in Southeast Asia, Australia and the Pacific that is the most common cause of eosinophilic meningitis. We report a case of intraparenchymal cerebral haemorrhage associated with A. cantonensis meningitis. This complication has not previously been reported in the literature.
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Angiostrongylus cantonensis/aislamiento & purificación , Hemorragia Cerebral/etiología , Meningitis/complicaciones , Infecciones por Strongylida/diagnóstico , Animales , Hemorragia Cerebral/diagnóstico , Diagnóstico Diferencial , Humanos , Imagen por Resonancia Magnética , Masculino , Meningitis/diagnóstico , Meningitis/parasitología , Micronesia/etnología , Persona de Mediana Edad , Nueva Zelanda/epidemiología , Infecciones por Strongylida/complicaciones , Infecciones por Strongylida/etnología , Tomografía Computarizada por Rayos X , ViajeRESUMEN
Urinary retention is a common acute presentation for men in their later decades. Potential contributing pathologies are numerous. We report an unusual case of acute urinary retention requiring catheterisation secondary to sacral herpes zoster reactivation (S2-4) in an 88-year-old man with minimal preceding obstructive symptoms.