RESUMEN
OBJECTIVE: This study was designed to assess the outcome of clam ileocystoplasty (CI) based on patients' subjective perception and objectively validated scoring systems. Quality-of-life parameters were also examined as aspects of outcome. MATERIAL AND METHODS: Between 1989 and 1994, 27 patients (15 male and 12 female) underwent CI. The median age was 41 years (13-75 years). CI was performed after failed pharmacological treatment. The mean length of follow-up for this patient cohort was 18 months (range: 1-4 years). RESULTS: Overall cure rate was objectively assessed at 61%. Seventy-two percent of patients described a subjective improvement of symptoms, and a small number of patients (12.5%) were subjectively worse following the operation. Quality of life was improved in 75% of patients, with 12.5% showing no improvement and 12.5% being worse. Fifty-six percent of patients noted a minor degree of voiding dysfunction, whereas 25% noted moderate and 19% noted severe voiding dysfunction. CONCLUSIONS: CI offered improvement with satisfaction in the group of patients studied, however not all patients achieved a satisfactory outcome. The patients who were worse following the procedure were all young females with detrusor instability. Careful patient selection and pre-operative counselling may reduce the failure rate. Outcome analysis based on standardised questionnaires allows patients and surgeons to make informed decisions with realistic expectations.
Asunto(s)
Íleon/cirugía , Complicaciones Posoperatorias , Calidad de Vida , Vejiga Urinaria/cirugía , Trastornos Urinarios/etiología , Adolescente , Adulto , Anciano , Femenino , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Encuestas y CuestionariosRESUMEN
Two hundred and fifty patients with 290 stones presenting to the Department of Urology were treated with the Candela MDL 2000 Laser Lithotripter. Overall stone clearance rate was 95%. The more proximal the calculus the lower the success rate. Ninety eight percent of stones in the lower ureter, 95% of mid ureteric and 91% of upper ureteric stones were cleared. The major complication was perforation which occurred in 6% of cases. This procedure is a safe and effective treatment for ureteric calculi and is associated with a low complication rate and a high clearance rate. Laser lithotripsy is the optimum ureteroscopic method of treating ureteric calculi and is complimentary to extra corporeal shock wave lithotripsy.
Asunto(s)
Litotripsia por Láser , Cálculos Ureterales/terapia , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Humanos , Litotripsia por Láser/efectos adversos , Litotripsia por Láser/métodos , Persona de Mediana Edad , Sepsis/etiología , Stents , Resultado del Tratamiento , Uréter/lesionesRESUMEN
In a retrospective analysis of 202 renal transplant procedures in the years 1989-1992 we identified an excess of grafts lost from primary renovascular thrombosis in patients receiving continuous ambulatory peritoneal dialysis (CAPD) compared to haemodialysis (HD) patients (9 CAPD versus 0 HD, Chi-squared = 9.63; P < 0.01). All graft losses from thrombosis occurred within 16 days of surgery. Possible predisposing causes were identified in three patients. Donor age was greater in CAPD patients losing their kidneys from thrombosis compared to the overall CAPD group [mean (SD) years, 43.0(12.9) versus 29.1(15.8); P = 0.01] whereas no significant difference in haematocrit, platelet count, antibody status, cyclosporin use, peroperative hypotension, primary diagnosis, smoking, or diabetes mellitus was found. Data from the EDTA registry for 1990-91 show that graft loss from primary renovascular thrombosis in UK-treated patients was reported in 7.1% of CAPD recipients compared with 1.8% in haemodialysis. We suggest that CAPD patients are at greater risk of graft loss from renovascular thrombosis than HD patients and may require more intensive fluid and anticoagulant treatment in the perioperative period.
Asunto(s)
Trasplante de Riñón/efectos adversos , Diálisis Peritoneal Ambulatoria Continua/efectos adversos , Trombosis/etiología , Adolescente , Adulto , Femenino , Rechazo de Injerto/etiología , Humanos , Fallo Renal Crónico/cirugía , Fallo Renal Crónico/terapia , Masculino , Persona de Mediana Edad , Arteria Renal , Diálisis Renal/efectos adversos , Venas Renales , Estudios Retrospectivos , Factores de RiesgoRESUMEN
Treatment of urinary incontinence with the artificial urinary sphincter has been available in centres such as London and Liverpool for a number of years. This service is now available in the department of urology of the Belfast City Hospital. Twelve patients have had successful implantation of an artificial urinary sphincter for urinary incontinence, and ten are now fully continent. One patient with Wegener's granulomatosis developed active disease in his urethra which has precluded activation of the device. One patient has had the device removed because of erosion into the urethra.
Asunto(s)
Incontinencia Urinaria/cirugía , Esfínter Urinario Artificial , Adulto , Anciano , Diseño de Equipo , Falla de Equipo , Estudios de Seguimiento , Humanos , Persona de Mediana Edad , Resultado del Tratamiento , Incontinencia Urinaria/diagnóstico , Incontinencia Urinaria/fisiopatología , UrodinámicaRESUMEN
Seven patients with complete rupture of the membranous urethra secondary to trauma were treated by internal optical urethrotomy (OU). All underwent initial suprapubic catheter drainage. The diagnosis of complete urethral rupture was confirmed by ascending and descending urethrograms and subsequent urethroscopy. OU was performed 3 weeks to 8 years following injury. Although all patients required further OUs for recurrent strictures, all can pass urine satisfactorily. Two patients have slight stress incontinence. This technique is a viable alternative to more conventional procedures for this condition.
Asunto(s)
Complicaciones Posoperatorias/cirugía , Uretra/cirugía , Estrechez Uretral/cirugía , Adulto , Niño , Humanos , Masculino , Persona de Mediana Edad , Rotura , Uretra/lesiones , Estrechez Uretral/etiologíaRESUMEN
A case-control study of 598 patients with colorectal cancer (296 men, 302 women) admitted from January 1974 to October 1983 was undertaken. Patients were matched for age and sex, with controls admitted for unrelated conditions. All information was obtained from the hospital records. In men, there was no evidence of an increased risk of colonic cancer after cholecystectomy relative to men without cholecystectomy. There was some evidence of an increased risk in women (relative risk = 1.7; 95 percent confidence interval, 1.0 to 3.1) and this was highest when the tumor was in the right colon (P less than 0.005). This study confirms previous observations that cholecystectomy leads to an increased risk of right-sided colonic tumors in women but not in men. The apparent difference between the sexes may be explained by the low rate of cholecystectomy in the men examined.
Asunto(s)
Colecistectomía/efectos adversos , Neoplasias del Colon/etiología , Neoplasias del Recto/etiología , Ensayos Clínicos como Asunto , Femenino , Humanos , Irlanda , Masculino , RiesgoRESUMEN
A 23-year-old man presented with prolonged postprandial epigastric pain and an epigastric bruit with systolic and diastolic components, the intensity of which decreased with inspiration as demonstrated by abdominal phonography. Arteriography demonstrated significant narrowing of the origin of the celiac artery. At operation, the origin of the celiac artery was found to be constricted by fibers of the median arcuate ligament of the diaphragm, and this ligament was divided. Intraoperative flow measurements demonstrated an increase in blood flow through the main branches of the celiac axis, after division of the ligament. Four years following successful surgery, the patient has continued to be in good health without symptoms, and the bruit has remained absent. Further abdominal arteriography has demonstrated the normality of the celiac artery. We believe this to be a well-proven case of the "celiac artery compression syndrome."
Asunto(s)
Arteria Celíaca/patología , Adulto , Velocidad del Flujo Sanguíneo , Arteria Celíaca/diagnóstico por imagen , Arteria Celíaca/fisiología , Enfermedad Crónica , Constricción Patológica/diagnóstico por imagen , Constricción Patológica/terapia , Diafragma , Humanos , Ligamentos/cirugía , Masculino , Dolor/etiología , Radiografía , SíndromeRESUMEN
A case of closed abdominal trauma causing complete transection of the supraduodenal common bile duct and gastric stasis in an 8-year-old boy is described. Surgical management involved re-establishment of biliary-enteric continuity and later gastric drainage to overcome gastric stasis. It is postulated that this child had sustained a traumatic vagotomy resulting in failure of gastric emptying. The literature does not report this complication of blunt abdominal injury.
Asunto(s)
Traumatismos Abdominales/complicaciones , Conducto Colédoco/lesiones , Estómago/lesiones , Heridas no Penetrantes/complicaciones , Niño , Vaciamiento Gástrico , Motilidad Gastrointestinal , Humanos , Masculino , Estómago/fisiopatologíaRESUMEN
We have assessed the value of the BICAP electrocoagulation probe in reducing the incidence of further bleeding in patients with upper gastrointestinal haemorrhage. One hundred and twenty-nine patients were studied in a prospective randomized controlled trial. There were 85 male and 44 female patients, age range 16-92 years. Forty-five patients had stigmata of recent haemorrhage (visible vessel or spot) and were randomized during endoscopy to 24 control and 21 treatment patients. Seven control patients rebled compared with nine treated patients (Fisher's exact probability test P = 0.44). The transfusion requirements of control patients (3.9 +/- 3.2 units) was not different from that of treated patients (5.7 +/- 3.7 units): Mann Whitney U test, P = 0.06. In the treatment group there was no difference in the operation rate. Also, the number of probe applications between patients with further bleeding and those with no further bleeding was similar (11.6 +/- 5.5 and 11.0 +/- 5.75 respectively). Access with the probe was considered inadequate in 50 per cent of lesions, but this did not correlate with the incidence of rebleeding. Stigmata of recent haemorrhage were significant in predicting rebleeding (P = 0.0019 Fisher's exact probability test). Overall mortality rate of 3.2 per cent was low and was not influenced by electrocoagulation or presence of stigmata of recent haemorrhage. We have not shown that BICAP bipolar electrocoagulation reduces the incidence of rebleeding in upper gastrointestinal haemorrhage.