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Posterior urethral valves represent the most common post-vesical obstructive malformation. They affect the male gender and appear as intraluminal folds located immediately proximal to the verumontanum. One of the most credited pathogenetic theories considers them an anomalous insertion of mesonephric duct into the cloaca or an incomplete involution of plicae colliculi. At present, the diagnosis of posterior urethral valves is prenatal and the pattern is characterized by detrusor hypertrophy and more or less marked hydroureteronephrosis. Urinary tract disorders that accompany posterior urethral valves include moderate hydroureteronephrosis to severe functional impairment of the entire urinary tract with consequent renal failure. Treatment of posterior urethral valves consists in their resection. At present, with miniaturized endoscopes, valve fulguration is feasible also in newborn infants. In low-weight patients or in case of poor general condition, temporary external urinary bypass (e.g. cystostomy) is feasible. PMID:12696266
Manzoni, Carlo; Valentini, Anna Lia
Posterior urethral polyp with type I posterior urethral valves: a rare association in a neonate.
Urethral polyp is a rare cause of bladder outlet obstruction, voiding dysfunction, and hematuria in the pediatric age group. Urethral polyps are rarely associated with other congenital urinary tract anomalies. In this study, we report a case of solitary posterior urethral polyp with type I posterior urethral valve in a 7-day-old neonate presented with urinary retention and deranged renal function. The polyp was diagnosed on cystoscopy. Transurethral resection of the polyp with posterior urethral valve fulguration was performed. Pathologic assessment revealed a fibroepithelial lesion, which was consistent with congenital posterior urethral polyp. PMID:24767515
Kesan, Krushnakumar V; Gupta, Rahul Kumar; Kothari, Paras; Gupta, Abhaya; Mudkhedkar, Kedar; Kamble, Ravikiran; Dikshit, K Vishesh
Post-traumatic female urethral reconstruction.
Post-traumatic urethral damage resulting in urethrovaginal fistulas or strictures, though rare, should be suspected in patients who have unexpected urinary incontinence or lower urinary tract symptoms after pelvic surgery, pelvic fracture, a long-term indwelling urethral catheter, or pelvic radiation. Careful physical examination and cystourethroscopy are critical to diagnose and assess the extent of the fistula. A concomitant vesicovaginal or ureterovaginal fistula should also be ruled out. The two main indications for reconstruction are sphincteric incontinence and urethral obstruction. Surgical correction intends to create a continent urethra that permits volitional, painless, and unobstructed passage of urine. An autologous pubovaginal sling, with or without a Martius flap at time of reconstruction, should be considered. The three approaches to urethral reconstruction are anterior bladder flaps, posterior bladder flaps, and vaginal wall flaps. We believe vaginal flaps are usually the best option. Options for vaginal repair of fistula include primary closure, peninsula flaps, bilateral labial pedicle flaps, and labial island flaps. Outcomes are optimized by using exacting surgical principles during repair and careful postoperative management by an experienced reconstructive surgeon. PMID:18702924
Blaivas, Jerry G; Purohit, Rajveer S
Posterior urethral valve: delayed presentation in adolescence.
Posterior urethral valves (PUV) are now commonly suspected on antenatal ultrasound, but can present with a broad spectrum of severity postnatally. Rarely, the diagnosis is missed until adolescence or adulthood when the patient usually presents with lower urinary tract symptoms. We describe an even rarer case of PUV in a late adolescent who first presented with preserved renal function and urinary incontinence. We review the literature on presentation, natural history and outcomes of both early and late presenting PUV cases. PMID:23094222
Mahadik, Punit; Vaddi, Surya Prakash; Godala, Chandra-Mohan; Sambar, Venkatkrishna; Kulkarni, Sushanth; Gundala, Ramesh
Posterior Urethral Valve: Delayed Presentation in Adolescence
Posterior urethral valves (PUV) are now commonly suspected on antenatal ultrasound, but can present with a broad spectrum of severity postnatally. Rarely, the diagnosis is missed until adolescence or adulthood when the patient usually presents with lower urinary tract symptoms. We describe an even rarer case of PUV in a late adolescent who first presented with preserved renal function and urinary incontinence. We review the literature on presentation, natural history and outcomes of both early and late presenting PUV cases.
Vaddi, Surya Prakash; Godala, Chandra-Mohan; Sambar, Venkatkrishna; Kulkarni, Sushanth; Gundala, Ramesh
Posterior urethral valves: long-term outcome.
Posterior urethral valves represent the most common cause of bladder outlet obstruction in infancy that impairs renal and bladder function. Long-term outcome of patients with previous PUV is evaluated. Patients over 18�years of age, treated from 1982 to 1995 before the age of 3�years were considered. Previous surgery, renal function, bladder activity, urinary incontinence, and fertility/sexual activity were evaluated. Clinical interview, creatinine clearance, uroflowmetry with ultrasound post-void urine residue, and self-administered questionnaire were recorded. Out of 45 identified records, 24 patients (53.3%) accepted to be enrolled (age 18-34�years, mean 23�years). The mean follow-up was 19.5�years (16-30�years). Out of the 21 excluded patients, 20 did not reply to the clinical interview and 1 died at age of 6�years. All the 24 patients had early endoscopic section of PUV; nine also received transient ureterocutaneostomy or vesicostomy. Ureteroneocystostomy was performed in five patients and ureterocystoplasty with unilateral nephrectomy in two. At follow-up chronic renal failure was detected in 13 patients (54.1%) and 9 (37.5%) had arterial hypertension. End-stage renal disease developed in five patients (20.8%): three had successful renal transplantation and two were in dialysis. Lower urinary tract symptoms were present in seven patients (29.1%). No significant fertility deficit and sexual dysfunction were observed in 23 patients, while 1 patient was azoospermic. No paternity was reported so far. Long-term outcome of patients with previously treated PUV is mandatory. Kidney, bladder, and sexual functions should be monitored till adulthood to verify any modified behaviour. PMID:21748651
Caione, Paolo; Nappo, Simona Gerocarni
Posterior Urethral Valves; A single Center Experience
Objective Posterior urethral valves (PUV) are the most common cause of bladder outlet obstruction in infancy that impair renal and bladder function. This study was planned to evaluate and record the various clinical presentations and management, complications, and surgical management and long-term outcome of PUV. Methods In a retrospective study, 98 patients who have been treated for PUV are evaluated in Mofid Children's Hospital from January 2007 to December 2012. Detailed history taken and paraclinical examinations were performed in each patient and diagnosis was confirmed by voiding-cysto-urethrography (VCUG). PUV had been ablated in 62 patients by electric hook, and diversion was performed in 42 (42.85%) cases. Data were analyzed by SPSS software version18. Findings Totally 98 patients with mean age at diagnosis 62 (�13) days were included in this study. Fifty seven cases had been catheterized within one to 6 days of life (mean age one day), PUV was ablated in 62 patients by electric hook, and diversion was performed in 42 cases. The most common symptom in our group was dribbling poor stream 51% and urinary tract infection (UTI) 40.8%. There was vesico-ureteral-reflux (VUR) in 61.2%, and hydronephrosis in 82.6%. Most common associated anomaly was kidney anomalies (multicystic kidney disease and renal agenesis/dysplasia) in 8 (8.2%) patients. Twenty patients had prenatal diagnosis of PUV. Complication occurred in three (3.1%) patients. Mortality occurred in 5 (5.1%) patients. Mean follow-up period was 3.4�1.2 years (1.5 months to 5 years). Conclusion Urinary drainage by feeding tube in early days of infancy, followed by valve ablation is the best treatment in PUV, and urinary diversion improves the outcome. VCUG is still the gold-standard imaging modality for documenting PUVs. The factors like renal dysplasia and UTI have their role in final outcome.
Mirshemirani, Alireza; Khaleghnejad, Ahmad; Rouzrokh, Mohsen; Sadeghi, Afsaneh; Mohajerzadeh, Leila; Sharifian, Mustafa
Bilateral epididymitis in a child with undiagnosed posterior urethral valves.
Posterior urethral valves are most commonly detected in the early neonatal period, the diagnosis often antenatally suspected from ultrasound findings. Nevertheless, some cases might go undetected and become manifest later in life with lower urinary tract symptoms. We describe the unusual case of a 5-year-old boy with a 2-month history of bladder distension, urinary dribbling, and epididymitis. Cystourethrography revealed posterior urethral valves with reflux into the seminal vesicles, vas deferens, and epididymis, bilaterally. A review of the published data is provided in the context of this unusual presentation pattern. PMID:23477755
Kwong, Justin; Lorenzo, Armando J; DeMaria, Jorge; Braga, Luis H P
Congenital posterior urethral obstruction: the historical perspective
The currently accepted interpretation of urethral anatomy and pathology in boys is based on studies from the first half of this century, most notably from Hugh Hampton Young and his colleagues. The studies that led to Young's conclusions and the developments in the management allow for reinterpretation, particularly with the advent of prenatal diagnosis and video-endoscopic recording technology.
P. A. Dewan
Augmentation Cystoplasty in Boys with Posterior Urethral Valves
The role of augmentation cystoplasty in the neuropathic and exstrophy bladder has been well documented. However, its place and the timing of such surgery in the �valve bladder� are not well established. We report our experience with augmentation cystoplasty in 20 boys with previously treated posterior urethral valves. Urodynamic studies confirmed poorly compliant, unstable bladders with low functional capacities, which
A. M. Kajbafzadeh; F. M. J. Quinn; P. G. Duffy; P. G. Ransley
Complications of Primary Realignment of Posterior Urethral Disruption After Pelvic Trauma
Background: There are two fundamental selections for the management of traumatic posterior urethral injury, delayed repair or early primary realignment. Objectives: The aim of this study was to assess the complications of primary realignment of posterior urethral disruption. Patients and Methods: This retrospective descriptive cross-sectional study was done at the Shohada-ye Ashayer University Hospital in Khorramabad. All male patients admitted to the hospital with posterior urethral disruption and had undergone primary realignment of the urinary tract between 2003 and 2010 were included. Primary realignment of the urinary tract was done up to 24 hours after injury. The patients underwent open cystostomy and then a nelaton catheter was inserted from the bladder neck to the distal urethra anterogradely. Upon voiding from the catheter, another nelaton catheter was fixed to it and was pulled into the bladder. The catheter was removed if the urethra was intact in the retrograde urethrography after three weeks. The patients were followed for six months. The data were presented as mean and percentage. Results: A total of 24 patients were evaluated while seven, eleven, four, and two patients were aged under 20, 20 to 39, 40 to 59, and over 60 years old, respectively. Thirteen patients (54.16%) had urinary tract stenosis after the primary realignment. Erectile dysfunction was reported in three of them. Urinary incontinence did not occur in patients without stenosis. Conclusions: Early primary realignment of posterior urethral disruption had significant complications. In this study we did not have a control group, thus we could not compare the complications of delayed repair and early primary realignment of the posterior urethra. We recommend further case-control studies with larger sample size.
Haidari, Mohammad; Azargoon, Alireza; Mahmoudvand, Hormoz; Almasi, Vahid; Pournia, Yadollah; Shams Khorramabadi, Manouchehr
Posterior Urethral Valves: Renal Failure and Prenatal Treatment
Posterior urethral valves occur in 1?:?5000 live births. Despite the high prevalence, the few children that survive do poorly, with over 50% progressing to ESRD in 10 years. The gold standard for post-natal diagnosis is voiding cystourethrography, while pre-natal diagnosis is dependent on routine screening ultrasonography. Despite the ability to identify features of bladder outlet obstruction early in fetal development, there is no consensus on how to incorporate early detection into current screening protocols. There has yet to be a marker that allows prediction of obstruction in the absence of or prior to radiographic evidence of obstruction. With our current screening strategy, the majority of interventions are performed well after irreversible damage has occurred. Improved mortality and long term morbidity from posterior urethral valves and congenital bladder outlet obstruction will likely remain unchanged until it is possible to intervene prior to the onset of irreversible renal damage. New biologic markers and improved instrumentation will allow for more effective diagnosis and intervention at earlier stages of fetal development.
Casella, Daniel P.; Tomaszewski, Jeffrey J.; Ost, Michael C.
A child with Beckwith-Wiedemann syndrome and posterior urethral valves.
Beckwith-Wiedemann syndrome is a somatic overgrowth syndrome characterized by a variable incidence of congenital anomalies, including hemihypertrophy, omphalocele, macroglossia and renal malformations. We report a child with Beckwith-Wiedemann syndrome and posterior urethral valves. Urethral valve resection was successfully performed under general anesthesia after voiding cystourethrography. This is the first report of Beckwith-Wiedemann syndrome associated with posterior urethral valves. PMID:15844777
Buyukcelik, M; Satar, N; Dursun, H; Bayazit, Y; Bayazit, A K; Soran, M; Noyan, A; Anarat, A
[Traumatic macular hole and posterior vitreous].
We studied retrospectively the clinical features of 18 eyes of 18 patients with traumatic macular hole. The macular hole was elliptical with irregular edges in 17 eyes (94%) and its size ranged from 1/5 to 1/2 of the disc diameter. Posterior vitreous detachment was found in 3 eyes (17%); the vitreous was detached from the macula in only one of these 3 eyes. Commotio retinae, vitreous hemorrhage, hyphema, or choroidal rupture was also found in several eyes. These findings suggest that traumatic macular hole develops usually in the absence of posterior vitreous detachment and its pathogenesis is independent of the occurrence of posterior vitreous detachment. We speculate that blunt trauma-induced deformity of the eyeball or impact on the posterior pole provides a mechanical cause for the macular rupture. PMID:7484503
Yanagiya, N; Akiba, J; Takahashi, M; Kakehashi, A; Kado, M; Yoshida, A
Renal transplantation in children with posterior urethral valves.
The objective of this study was to analyze whether renal transplantation (RT) in children with posterior urethral valves (PUV) constitutes a special group with respect to groups with different etiologies of end-stage renal disease (ESRD). Between 1979 and 2004, 22 RT were performed in 19 children with PUV. The median age at RT was 10 years (range: 1.3-17). Immunosuppression was provided by triple therapy and polyclonal/monoclonal antibodies. This group was compared with the two control groups: (1) glomerulopathy (n=62) and (2) pyelonephritis/dysplasia (n=42) without lower urinary tract disease, transplanted in the same period. Ten graft losses occurred in 22 transplants: thrombosis (2), acute rejection (3), chronic graft nephropathy (2), and death of patients (3) with a functioning graft in the 1st postoperative month. We did not find significant differences versus the control group in renal function or probability of graft or patient survival at 1, 5, and 10 years. We observed a greater risk of urological complication in patients with PUV. RT with PUV constitutes a special group due to the compulsory young age and the need for careful and complex medicosurgical management; nevertheless, the results achieved were similar to those obtained in our general RT population. PMID:16491414
Mendizabal, Santiago; Zamora, Isabel; Serrano, Agustin; Sanahuja, Maria Jose; Roman, Ezena; Dominguez, Carlos; Ortega, Pedro; Garc�a Ibarra, Fernando
Etiopathogenesis and management of bladder dysfunction in patients with posterior urethral valves
Posterior urethral valves are the commonest cause of urethral obstruction in a male child. It has significant effects on the development of upper urinary tracts and in the evolution of urinary bladder function. The effect on the kidneys and the urinary bladder persists even after the successful management of the obstructing valves. A detailed evaluation of the associated bladder dysfunction will help in planning management protocols that will improve the long-term outcome of these patients.
Thomas, Joseph
Traumatic enucleation for posterior uveal melanoma.
Two features of eyes enucleated for posterior uveal melanoma that may serve as indicators for traumatic enucleation and relate to dissemination of tumor cells at the time of enucleation are myelin artifact of the optic nerve head and acute hemorrhage within the tumor. Myelin artifact occurs when crushed optic nerve tissue is squeezed into the eye at the time of enucleation. Intralesional hemorrhage may occur during surgery and may be correlated with fluctuations in intraocular pressure. We reviewed 519 cases of posterior uveal melanoma treated by enucleation between 1950 and 1970. Without knowledge of the follow-up data, we examined histologic sections for myelin artifact, intralesional hemorrhage, subretinal hemorrhage, Callender cell type, size of tumor, necrosis, and scleral or orbital invasion. Neither myelin artifact nor intralesional hemorrhage were independent prognostic risk factors. These findings do not support or refute the hypothesis that excessive trauma during enucleation results in a worse prognosis. PMID:2240138
Specht, C S; McLean, I W; Biscoe, B W
[Clinical practice guideline. Traumatic urethral stenosis in males].
The incidence of urethral stenosis in Mexico had not been documented. At the Centro M�dico Nacional La Raza, during the year 2010, 629 patients with urethral stenosis were attended as outpatient consultation: 85 % with previous urethral stenosis and 15 % with urethral treatment complication. Urethral stenosis is a chronic illness, with multiple etiological origins and the handling is controversial. It has a great negative impact for the patients and the recurrence reaches 85 %. The treatment consisted of an invasive approach (urethral dilations, endoscopy procedure) and open surgery (urethroplasty). The World Health Organization and World Alliance take the world challenge about the urinary tract infections associated with the attention of patients, focused on urethral stenosis. The objective of the following clinical guide is to offer to the health professional a clinical tool for making decisions in the handling of the hardship or masculine urethral stenosis, based on the best available evidence, carrying out in systematized form with bibliographical research using validated terms of the MeSH: urethral structures, in the databases Trip database, PubMed, Guideline Clearinghouse, Cochrane Library and Ovid. PMID:24021082
Serrano-Brambila, Eduardo Alonso; Moreno-Alc�zar, Oth�n Martino; Neri-P�ez, Edgar; S�nchez-Mart�nez, Luis Carlos; Hern�ndez-Ord��ez, Octavio Francisco; Morales-Morales, Arturo; Basavilvazo-Rodr�guez, M Antonia; Torres-Arreola, Laura del Pilar; Valenzuela-Flores, Adriana Abigail; Hern�ndez-Valencia, Marcelino
PurposeObstructive uropathies, including posterior urethral valves (PUVs) and kidney hypodysplasia, are the most frequent cause of renal failure in children. The role of renin-angiotensin system genes in renal and urinary tract development has been observed in experimental models. The aim of this study was to investigate the distribution of angiotensin converting enzyme (ACE), angiotensinogen (AGT) and angiotensin receptor type 1
Prenatal resolution of megacystis possibly caused by spontaneous rupture of posterior urethral valves.
We report herein a case of resolution of severe megacystis, possibly caused by spontaneous rupture of posterior urethral valves during follow-up on a prenatal ultrasound. A 32-year-old woman presented at gestational week 15 for evaluation of fetal bladder enlargement. Prenatal ultrasonography revealed megacystis and posterior urethral dilatation. The longitudinal diameter of the bladder was 25 mm. Megacystis spontaneously resolved at gestational week 16. No association with urinary ascites was observed, and amniotic fluid volume remained normal throughout gestation. A boy was delivered vaginally at week 37. Apgar scores were 8 at 1 minute and 9 at 5 minutes. The neonate voided smoothly. Ultrasonography revealed a thickened bladder wall and normal kidneys and upper urinary tracts. Voiding cystourethrography showed dilatation of the posterior urethra but confirmed normal bladder capacity with smooth voiding and no vesicoureteral reflux. On day 57, remnant valves were incised. Postoperatively, filling cystometry showed a compliant bladder with no involuntary phasic contraction. At 7 months follow-up, the infant was asymptomatic, and ultrasonography showed some improvement of bladder wall thickness. Resolution of megacystis in utero appears to have resulted from spontaneous rupture of the posterior urethral valves. To the best of our knowledge, no similar cases have been previously reported. PMID:19040955
Matsui, Futoshi; Shimada, Kenji; Matsumoto, Fumi; Obara, Takashi
... syphilis, human papilloma virus (HPV), which causes venereal warts, and HIV Urethritis caused by injury or chemical ... lead to infertility. Antibiotic treatment of chlamydia will cure this disease and can prevent complications. If untreated, ...
[Possibilities for the operative treatment of traumatic posterior shoulder dislocation].
Traumatic posterior locked shoulder dislocation is very rare. The dislocation is often combined with fractures of the humeral head or reversed Hill-Sachs deformities. This case report shows two different possibilities for treatment. PMID:18305918
Irlenbusch, L; Pyschik, M; Hein, W; Brehme, K
Purpose:Posterior urethral valves are the most common cause of congenital obstructive uropathy leading to renal failure in childhood. We investigate the influence of bladder dysfunction on renal function impairment.
Bladder augmentation and continent urinary diversion in boys with posterior urethral valves
Posterior urethral valve (PUV) is a condition that leads to characteristic changes in the bladder and upper urinary tract. Dysfunction of the bladder such as a hyperreflective, hypertonic, and small capacity bladder as well as sphincter incompetence and/or myogenic failure should be adequately treated. Poor compliance/small bladder could be treated with anticholinergics, but bladder augmentation will probably be indicated. Although bladder reconstruction with gastrointestinal segments can be associated with multiple complications, including metabolic disorders, calculus formation, mucus production, enteric fistulas, and malignancy formation, enterocystoplasty is still the gold standard. In contrast to a neuropathic or exstrophic bladder, augmentation of the valve bladder allows spontaneous voiding without significant residual urine in the majority of cases, but some require CIC (clean intermittent cathterization). Augmentation cystoplasty is also an efficient approach in those children who will require kidney transplantation in the future.
[Urethral stent to treat a refractory traumatic urethra stricture in a male hunting dog].
In a 1.5-year-old male hunting dog, a urethral defect distal to the pelvic flexure and the resulting urethral fistula were treated with a mucosal graft and a transurethral catheter. Six months postoperatively a stricture of the urethra occurred. Following balloon dilatation, urination was normal. One month after dilatation, urethral narrowing relapsed and was treated using a combination of balloon dilatation and urethral stent implantation. Ten months following stent implantation the dog continued to show normal urination, although a deformation of the proximal part of the stent was diagnosed radiographically. During the 1-year follow-up no additional complications were observed. In the future, urethral stents may replace surgical resection of the narrowed urethral region and re-anastomosis of the urethra. PMID:24920145
Vogt, S; Schneider, M; Peppler, C; G�nther, C; Kramer, M
Reconstruction and management of posterior urethral and straddle injuries of the urethra.
Urethral stricture disease, once associated mainly with gonococcal urethritis, is now most frequently a consequence of trauma, such as a fall-astride injury or a pelvic fracture. This article discusses issues and approaches related to the treatment of strictures associated with perineal straddle trauma and pelvic fracture urethral distraction defects. The authors emphasize that endoscopic procedures seldom cure these strictures and in-dwelling stents are seldom useful in treatment. Primary anastomotic techniques are associated with success rates in the high 90% range and appear to be remarkably durable in most cases. In contrast, tubed reconstruction of the urethra is inevitably associated with diminished success rates and with problems of durability. PMID:16488284
Jordan, Gerald H; Virasoro, Ram�n; Eltahawy, Ehab A
[Post-traumatic arteriovenious fistula of the posterior fossa (author's transl)].
The authors report a case of post-traumatic arterioveinous fistula of the dura-mater associated with an extradural hematoma of the posterior fossa. The traumatic nature of the lesion is confirmed by the presence of an occipital fracture facing the fistule responsable for the extradural hematoma. The authors have found on similar case citied in the literature (11). PMID:752817
Petrov, V; Stevenaert, A; Collignon, J
Post-traumatic overload or acute syndrome of the os trigonum: a possible cause of posterior ankle impingement
The purpose of this paper is to discuss the post-traumatic overload syndrome of the os trigonum as a possible cause of posterior ankle impingement and hindfoot pain. We have reviewed 19 athletes who were referred to our foot unit between 1995 and 2001 because of posterior ankle pain, and in whom a post-traumatic overload syndrome of os trigonum was diagnosed.
E. Mouhsine; X. Crevoisier; P. F. Leyvraz; A. Akiki; M. Dutoit; R. Garofalo
Posterior Surgery Alone in the Treatment of Post-traumatic Kyphosis by Posterior Column Osteotomy, Spondylodesis, Instrumentation, and Vertebroplasty
Study Design Retrospective study. Purpose To determine if posterior surgery alone can satisfactorily treat post-traumatic kyphosis (PTK). Overview of Literature One of the worst complications of vertebral fractures is PTK. The type of surgery and approach to treat a symptomatic and refractory PTK is a challenging issue in spinal surgery, and yet, there is no specific treatment algorithm. Methods From August 2003 to September 2010, we collected 26 cases (male to female ratio, 2.25; mean age, 31.9�9.7 years and follow-up period of 42.4�8.1 months) with PTK treated by posterior column osteotomy, spondylodesis, instrumentation and cement vertebroplasty in one stage posterior surgery. PTK angle, Oswestry Disability Index (ODI), visual analogue scale (VAS), and subjective satisfaction from surgery were used to determine the results. We used a student t test for analyzing the data before and after surgery. Results In our patients, T11 and L1 had the highest incidence of vertebral fractures. The results indicated that in PTK, ODI, and VAS were significantly improved this surgery. Solid fusion occurred in 96.2% of patients with 3.2��2.1� loss of correction. A total of 84.6% of patients have satisfaction level of excellent and good. Conclusions Posterior surgery alone with posterior column osteotomy, vertebroplasty, posterior spinal fusion and instrumentation can effectively treat symptomatic PTK.
Hasankhani, Ebrahim Ghayem; Ebrahimzadeh, Mohamed Hosein; Kachooei, Amir Reza; Heidari, Hosein
Judo-related traumatic posterior sternoclavicular joint dislocation in a child.
: Judo is a combat sport with high risk of injury. We present a rare case of traumatic left posterior sternoclavicular (SC) joint dislocation, inflicted to a 12-year-old boy during a judo contest. An extensive literature review did not reveal any case of posterior SC joint dislocation in judo. The patient was treated with closed reduction under general anesthesia. At 2-year follow-up, his left upper extremity had full range of motion, and he did not complain of any residual symptoms. He decided to discontinue judo training; however, he participates in other physically demanding sports. Although not often encountered, posterior SC joint dislocation is a challenging and critical medical problem that can be fatal if not promptly diagnosed and treated on time and should be considered in the differential diagnosis of trauma-related anterior chest pain. PMID:24172655
Galanis, Nikiforos; Anastasiadis, Prodromos; Grigoropoulou, Foteini; Kirkos, John; Kapetanos, George
Traumatic Posterior L4-L5 Fracture Dislocation of the Lumbar Spine: A Case Report
Study Design?Case report. Objective?The diagnosis and surgical management of a patient with traumatic bilateral posterior dislocation of L4�L5 is presented with a thorough review of the existing literature. Summary of Background Data?Traumatic dislocation of L4�L5 has been reported in the English literature in only five cases; of these, only two were retrolisthesis. Methods?A 20-year-old patient was involved in a high-energy vehicular accident and presented with back pain and inability to ambulate. Neurological assessment showed motor strength grade 2/5 in the proximal lower-extremity muscle groups (L1�L3 myotomes) and 0/5 strength distally (L4�S1 myotomes); in addition, incontinence of sphincters was found. X-rays and computed tomography (CT) scan revealed a three-column ligamentous injury with posterior fracture-dislocation of the L4 vertebral body with complete posterior displacement of L4 to L5 vertebral body. The patient underwent posterior approach with reduction, transpedicular fixation, and posterolateral fusion with autologous bone graft. Results?At 1-year follow-up, the patient had recovered muscular strength in proximal lower-extremities muscle groups, sphincter function had fully recovered, and he was able to ambulate with crutches. There was no recovery of distal extremity sensorimotor function. Plain radiograph and CT scan showed good alignment and progressive maturation of his fusion procedure. Conclusion?Traumatic retrolisthesis of L4�L5 is a high-energy unstable fracture; reduction of the dislocation is challenging because of the heavy forces acting in the lower lumbar spine. Instrumented fusion restores alignment and maintains segmental stability.
Zarate-Kalfopulos, Baron; Romero-Vargas, Samuel; Alcantara-Canseco, Cesar; Rosales-Olivarez, Luis Miguel; Alpizar-Aguirre, Armando; Reyes-Sanchez, Alejandro
Posterior Dislocation of Long Head of Biceps Tendon following Traumatic Anterior Shoulder Dislocation: Imaging and Intra-operative Findings
A case of posterior dislocation of the long head of biceps tendon, a rare occurrence following traumatic anterior glenohumeral dislocation, along with complete rotator cuff rupture and large haemarthrosis is presented with imaging and intra-operative findings. The interposed tendon prevented complete reduction. Appearances at MRI were diagnostic and directed the surgical approach.
McArthur, Claire; Welsh, Findlay; Campbell, Colin
Posterior urethral valves: Persistent renin angiotensin system activation after valve ablation and role of pre-emptive therapy with angiotensin converting enzyme-inhibitors on renal recovery
Aim: To study renin angiotensin system (RAS) activity after posterior urethral valve ablation and the role of early induction of angiotensin converting enzyme-inhibitors (ACE-I) on the outcome of renal function. Materials and Methods: Thirty four children underwent valve ablation in which therapy with ACE-I was started 40.5 � 4.1 (range 32-47 months) formed the study group. Post-ACE-I data were collected after mean duration of 18.2 � 4.0 (12-28 months). Plasma renin activity (PRA), urinary micro albumin, glomerular filtration rate (GFR), and serum creatinine, before and after therapy were monitored. Results: Therapy with ACE-I resulted in a fall in micro albuminuria by 45.7% and 42.0% in patients without and with vesico ureteral reflux, respectively, and improvement in split renal function by 6.6% and 5.9% GFR respectively. A similar response was noted in patients without and with renal scars. Conclusion: The decline in renal function after valve ablation is accompanied by activation of RAS reflected in a gradual rise in PRA. Therapy with ACE-I stabilizes and then improves renal function, thereby, retarding the pace of renal damage.
Bajpai, Minu; Chaturvedi, Pradeep K.; Bal, Chandra S.; Sharma, Meher C.; Kalaivani, Mani
Computed tomography (CT) is the accepted frontline imaging modality for blunt abdominopelvic trauma. However, urethral injuries are traditionally diagnosed with retrograde urethrography. The CT appearances of urethral injuries and the signs associated with posterior urethral injuries are not well described in the literature. CT scans of patients with pelvic fractures and urethrographically proved posterior urethral injuries were evaluated. CT scans of patients with similar pelvic fractures who did not have urethral injuries were also evaluated. The CT findings of elevation of the prostatic apex, extravasation of urinary tract contrast material above the urogenital diaphragm (UGD), and extravasation of urinary tract contrast material below the UGD were specific for type I, II, and III urethral injuries, respectively. If extraperitoneal bladder rupture is present along with periurethral extravasation of contrast material, the possibility of type IV and IVA urethral injuries should be considered. In addition, the CT findings of distortion or obscuration of the UGD fat plane, hematoma of the ischiocavernosus muscle, distortion or obscuration of the prostatic contour, distortion or obscuration of the bulbocavernosus muscle, and hematoma of the obturator internus muscle were more common in patients with pelvic fractures and associated urethral injuries than in patients with uncomplicated pelvic fractures. PMID:12853670
Ali, Muhammad; Safriel, Yair; Sclafani, Salvatore J A; Schulze, Robert
Glanular diphallus with urethral stricture.
An unusual case of a 5-year-old boy with duplication of the glans, a rare variety of diphallia, is reported. The two glandes were arranged one above the other, the dorsal glans had only a blind pit while the ventral glans had a patent urethra with glanular hypospadias. The child also had right renal agenesis and a posterior urethral stricture. PMID:11793071
Gavali, J S; Deshpande, A V; Sanghani, H H; Hirugade, S T; Talpallikar, M C; Borwankar, S S
Role of striated and smooth muscle components in the urethral pressure profile in traumatic neurogenic bladders: a neuropharmacological and urodynamic study. Preliminary report.
Urodynamic investigations with urethral pressure profile, and vesical, intrarectal and anal pressure recordings were performed in 37 patients with spinal cord lesions. The recordings were done before and after phentolamine injections and/or pudendal nerve blocks to evaluate the respective contribution of sympathetic and somatic innervation to the maximum urethral closure pressure in the mid and distal portions of the membranous urethra. A pressure gradient was demonstrated in the membranous urethra with higher values in the distal than in the mid portion. These results emphasize that the interrupted withdrawal technique is superior to the continuous technique in patients with upper motor neuron bladders. Mid urethral striated and smooth muscle components were shown to represent approximately 60 and 30 per cent of the maximum urethral closure pressure, respectively. In the distal urethra striated and smooth components are more abundant than in the mid portion and contribute in equal proportion to the maximum urethral closure pressure. No substantial role was found for the vascular bed in the maximum urethral closure pressure. The greatest pressure decrease in the mid and distal urethra of patients with lower motor neuron bladders was believed to be an effect of denervation supersensitivity. The results of pudendal blocks showed sphincter dyssynergia to be mediated through pudendal nerves via spinal reflex arcs. Phentolamine effects on bladder activity suggest that blockade of alpha-adrenergic receptors inhibits primarily the transmission in vesical and/or pelvic parasympathetic ganglia and acts secondarily through direct depression of the vesical smooth muscle. Our neuropharmacological results raise strong doubts as to the existence of a sympathetic innervation of the striated urethral muscle in humans. PMID:6126598
Rossier, A B; Fam, B A; Lee, I Y; Sarkarati, M; Evans, D A
Traumatic Posterior Fossa SubduralHemorrhage Associated with an ArachnoidCyst in a Pediatric Patient
Background: Acute subdural hematoma associated with subarachnoid hemorrhage of the posterior fossa following closed head trauma is a relatively rare entity with a high mortality rate. Most authors recommend immediate surgical intervention for acute subdural hematoma. To the best of our knowledge, concurrent acute subdural hematoma and subarachnoid hemorrhage with an arachnoid cyst at the infratentorial compartment have not been
Osman Kizilkili�; Sait Albayram; Bengi Gurses; Taner Tanriverdi; Civan Islak; Naci Kocer
The efficacy and hemodynamic response to Dexmedetomidine as a hypotensive agent in posterior fixation surgery following traumatic spine injury
Aim: This study was designed to evaluate the efficacy of dexmedetomidine (DEX) as a hypotensive agent in comparison to nitroglycerin (NTG) in posterior fixation surgery for traumatic spine injury. Materials and Methods: Forty patients ASA I or II aged 18-65 years scheduled for posterior fixation surgery were randomly assigned to receive either DEX 1 ?g/kg over 10 min before induction of anesthesia followed by 0.2-0.7 ?g/kg/h infusion during maintenance in DEX group or NTG 3-5 ?g/kg/min infusion after induction of anesthesia in NTG group to maintain mean arterial blood pressure (MAP) between 65 and 70 mmHg. The two groups were compared for achievement of target MAP, intraoperative blood loss, and reversibility of hypotensive state. Student's t-test was used for continuous variables and chi-square test for categorical variables. P-value < 0.05 was considered significant. Results: Patients in DEX group achieved the target MAP with better heart rate (HR) control, as compared to NTG group during the period of observation. The blood loss was significantly lesser in the DEX group (422.11 � 149.34 ml) than the NTG group (564.51 � 160.88 ml), P = 0.01. The time to hypotension reversal in NTG group (5.63 � 1.93 min) was lesser compared to DEX group (9.15 � 2.16 min), P = 0.65. Conclusion: DEX is an effective and safe agent in achieving controlled hypotension in adults undergoing posterior fixation spine surgery.
Jamaliya, Ramila H; Chinnachamy, Rajesh; Maliwad, Jyotsna; Deshmukh, Varun P; Shah, Bharat J; Chadha, Indu A
Traumatic posterior atlantoaxial dislocation without related fractures of C1-C2.
Posterior dislocation without any associated fracture of odontoid is exceedingly rare and only 11 cases have been reported so far. A 32 year old male presented with pain, stiffness in neck, difficulty in breathing, associated lacerations on face and deformity of mandible and inability to open mouth. His plain radiographs, CT scan, MRI demonstrated a posterior dislocation of the atlas with respect of axis and a flake of bone from odontoid process on CT scan. He was successfully managed by closed reduction, C1C2 lateral mars pedicular screw stabilization and inter facetal fusion with synthetic bone graft substitute. At 10 months followup he had lost only 30� cervical rotation. The case is reported in view of rarity and to discuss the treatment rationale. PMID:24379471
Kambali, Maruti; Anand, Hs Vijay; Priyamargavi, H; Varma, Ram Bhupal
Congenital giant male anterior urethral diverticulum with calculi.
Urethral diverticulum is a sac-like outpouching of urethral mucosa. It may be anterior or posterior according to anatomical locations. It is less common in men than in women. It can be congenital or acquired. Anterior urethral diverticula are usually congenital as compared to majority of posterior diverticula which are acquired. The most common aetiologies of male acquired diverticula are stricture, abscess, trauma or post-hypospadias repair. We report a case of congenital giant anterior urethral diverticulum with a calculus which has been managed successfully with surgical excision and repair in two layers. PMID:24567184
Kamal, Mir Reza; Jindal, Tarun; Sinha, Rajan Kumar; Karmakar, Dilip
[Sudden blindness following operative care of a multiply traumatized patient: posterior ischemic optic neuropathy].
A 32-year-old man had fallen from an 8-m high scaffolding and had suffered multiple traumatic injuries, such as compression fractures of the thoracic vertebrae (TV) 5-7 without incarceration of the spinal canal plus a distal femoral fracture. During surgery on the day of the accident, spondylodesis and dorsal stabilization of TV 4-7 using an internal fixator were carried out and the distal femoral fracture was stabilized with a dynamic condylar screw (DCS). On the day following the accident, the malposition of a pedicle screw located at the height of TV 4 and the borderline malposition of a pedicle screw of TV 7 were corrected. Between the day of the accident and day 8 after, the patient developed impaired vision and in the further course amaurosis associated with fixed pupils. No organopathy could be noticed which could have explained the sudden vision loss. A study of the literature was done, using the keywords "blindness" and "spine surgery." Only very few cases describing a connection of spine surgery and postoperative vision loss could be found. This article aims to elaborate on the few connections worked out in these investigations. PMID:16874480
Schmoz, S; Wawro, W; Weng, S; Stuttmann, R; Hofmann, G O
Glanular diphallus with urethral stricture
An unusual case of a 5-year-old boy with duplication of the glans, a rare variety of diphallia, is reported. The two glandes\\u000a were arranged one above the other, the dorsal glans had only a blind pit while the ventral glans had a patent urethra with\\u000a glanular hypospadias. The child also had right renal agenesis and a posterior urethral stricture.
J. S. Gavali; A. V. Deshpande; H. H. Sanghani; S. T. Hirugade; M. C. Talpallikar; S. S. Borwankar
Primary urethral calculus is rarely seen and is usually encountered in men with urethral stricture or diverticulum. We present a case of giant urethral calculus secondary to a urethral stricture in a man. The patient was treated with calculus extraction with end to end urethroplasty.
Kotkar, Kunal; Thakkar, Ravi; Songra, MC
A Case of Post-radiotherapy Urethral Stricture with Spontaneous Bladder Rupture, Mimicking Obstructive Uropathy due to Cancer Metastasis
Non-traumatic, spontaneous urinary bladder rupture is a rare complication of urethral stricture. Furthermore, its symptoms are often nonspecific, and misdiagnosis is common. The authors experienced a case of urethral stricture with spontaneous bladder rupture and bilateral hydronephrosis, mimicking obstructive uropathy attributed to cancer metastasis. A 55-year-old woman was admitted with abdominal pain and distension, oliguria, and an elevated serum creatinine level. She had undergone radical hysterectomy for uterine cervical cancer and received post-operative concurrent chemoradiation therapy 13 years previously. Non-contrast enhanced computed tomography showed massive ascites and bilateral hydronephrosis. The initial diagnosis was acute kidney injury due to obstructive uropathy caused by malignant disease. After improvement of her renal function by bilateral percutaneous nephrostomy catheterization, contrast-enhanced computed tomography and a cytologic examination of ascites showed no evidence of malignancy. However, during retrograde pyelography, a severe urethral stricture was found, and subsequent cystography showed leakage of contrast into the peritoneal cavity and cystoscopy revealed a defect of the posterior bladder wall. After urethral dilatation and primary closure of the bladder wall, acute kidney injury and ascites were resolved.
Shin, Jun Young; Yoon, Sang Min; Choi, Hyuck Jae; Lee, Si Nae; Kim, Hai Bong; Joo, Woo Chul; Song, Joon Ho; Kim, Moon-Jae
Traumatic C4-C5 unilateral facet dislocation with posterior disc herniation above a prior anterior fusion.
We report the case of a unilateral cervical facet dislocation above the level of a prior non-instrumented cervical discectomy and fusion, resulting in incomplete neurologic injury. Pre-reduction imaging demonstrated a large posterior disk extrusion. This finding altered our management approach from closed reduction to urgent anterior cervical discectomy, open anterior reduction, and fusion. The patient had excellent neurologic recovery and outcome at 12 months postoperative follow-up. PMID:22837997
Raizman, Noah M; Yu, Warren D; Jenkins, Matthew V; Wallace, Matthew T; O'Brien, Joseph R
... options for urethral stricture disease are varied and selection depends upon the length, location and degree of ... in Public (Paruresis) Prostate Cancer Prostate Cancer: Causes, Natural History, & Diagnosis Prostate Cancer: Chemotherapy Prostate Cancer: Cryoablation ...
Ipsilaterality of Motor Innervation of Canine Urethral Sphincter
The functional activity of the sphincter muscle of the urethra is known to be controlled largely by the hypogastric and pudendal nerves. It remains unknown, however, whether innervation of the muscle by these peripheral nerves is ipsi- or bilateral. In an attempt to answer this question urethral closure pressure was determined simultaneously in the anterior, posterior, right and left portions
Takashi Morita; Norihisa Kizu; Shun Kondo; Shinobu Dohkita; Seigi Tsuchida
INDICATIONS Urethral catheterization may be performed for diagnostic or therapeutic purposes. Therapeutically, catheters may be placed to decompress the bladder in patients with acute or chronic urinary retention as a result of conditions such as infravesicular obstruction of the urinary tract or neurogenic bladder. Catheterization and subse- quent irrigation may be required in patients with gross hematuria to remove blood
Todd W. Thomsen; Gary S. Setnik
KTP-532 laser ablation of urethral strictures
NASA Astrophysics Data System (ADS)
In 1988, the KTP-532 laser was used to ablate a series of benign urethral strictures. Rather than using a single incision, as in urethrotomy, strictures were treated with a 360$DEG contact photoradiation. Thirty-one males, average age 53.2 years, received 37 treatments. Six patients underwent a second laser treatment. Stricture etiology was commonly iatrogenic (32%), traumatic (16%), and post-gonococcal (10%). Stricture location included mainly bulbar (49%), membranous (20%), and penile (12%) areas. The surgical technique consisted of a circumferential ablation followed by foley catheter placement (mean 10 days). Follow-up on 29 of 31 patients ranged from 1 to 16 months (mean 9.7) Complete success occurred in 17 patients (59%) who had no further symptoms or instrumentation. Partial success was seen in 6 patients (20.5%) with symptoms but no stricture recurrence. Six patients (20.5%) failed therapy requiring additional surgery or regular dilatations. No complications were encountered. Although longer assessment is required, KTP-532 laser ablation of urethral strictures appears efficacious.
Malloy, Terrence P.
Management of urethral strictures
Controlled clinical trials are unusual in surgery, rare in urology, and almost non?existent as far as the management of urethral stricture is concerned. What data there are come largely from so called �expert opinion� and the quality of this is variable. None the less, the number of so called experts, past and present, is comparatively small and in broad principle their views more or less coincide. Although this review is therefore inevitably biased, it is unlikely that expert opinion will take issue with most of the general points raised here.
Mundy, A R
Gram stain of urethral discharge
Urethral discharge Gram stain ... microscope slide. A series of stains called a gram stain is applied to the specimen. The stained ... culture ) should be performed in addition to the gram stain. More sophisticated diagnostic tests (such as PCR ...
Management of Traumatic Brain Injury
In the past years several recommendations have been published concerning the diagnostic work-up and treatment of patients with traumatic brain injury (TBI). They show that with regard to the surgical management of acute epidural hematomas, acute subdural hematomas, traumatic parenchymal lesions, posterior fossa mass lesions, as well as depressed skull fractures there is a lack of controlled studies, which would
Hans-Georg Imhof; Philipp M. Lenzlinger
Intra-Urethral Valve with Integral Spring.
National Technical Information Service (NTIS)
The invention relates to prosthetic urethral valves for controlling urinary continence. More particularly, the invention relates to a prosthetic urethral valve having an integral spring member which may be installed totally within a patient's urethra with...
S. Leighton
Magnetic resonance imaging of solid urethral and peri-urethral lesions.
Solid urethral and peri-urethral lesions are rare and encompass benign and malignant aetiologies. A diagnosis without imaging is often challenging secondary to non-specific clinical symptoms and overlapping findings at the time of physical examination. Magnetic resonance (MR) imaging may be helpful in confirming a diagnosis while providing anatomical detail and delineating disease extent. This article reviews the normal MR anatomy of the male and female urethra, the MR appearance of solid primary and secondary urethral lesions, and the MR appearance of solid urethral lesion mimics. Teaching points � MRI is an important imaging technique in the evaluation of the spectrum of solid urethral lesions.� With excellent soft tissue resolution, MR is accurate in staging primary urethral carcinoma.� Disruption of the zonal anatomy of the female urethral wall indicates peri-urethral extension.� Be aware of benign urethral lesions, particularly those that may mimic solid urethral masses. PMID:23686749
Del Gaizo, Andrew; Silva, Alvin C; Lam-Himlin, Dora M; Allen, Brian C; Leyendecker, John; Kawashima, Akira
Inlay buccal mucosal graft for reoperative posterior urethroplasty.
Posterior urethral distraction injury following major pelvic trauma is a surgical challenge. Although rarely seen, cases of failure after formal urethral reconstruction are even more problematic. We adapted the concept of augmented free buccal mucosal grafts, which have been successful in anterior urethroplasty, for repairing the posterior urethra in these rare cases with the aim of reducing the likelihood of penile chordee postoperatively. During 2007-2009, four patients were candidates for the proposed procedure because they had received formal transperineal urethral reconstruction but were unable to urinate through the urethra. The urethra was approached transperineally and opened in the midline, rather than divided. Buccal mucosal grafts of an appropriate size were placed in the created urethral groove from 4- to 8 o'clock in the lithotomy view. After the procedure, the urethral catheter was kept for 3 weeks. All patients voided through the urethra after the procedure. The maximal postoperative urinary flow rates were between 12-15�ml/seconds in all cases for a follow-up period of 18-30 months. The recurrence rate was 50% (2/4). Recurrent strictures were minor, and they showed a web-like stricture ring near the suture line. Restricture within 6 months of surgery responded well to endoscopic internal urethrotomy plus dilatations. In conclusion, without further compromising urethral length, reoperative posterior urethroplasty with the inlay grafting technique can be considered in selective cases. PMID:22453071
Tang, Shou-Hung; Kao, Chien-Chang; Wu, Seng-Tang; Meng, En; Cha, Tai-Lung
Evaluation and Treatment of Urethral Stricture Disease
Any process causing trauma to the urethral tissue or underlying corpus spongiosum can lead to urethral stricture disease.\\u000a The traditional treatment algorithm for urethral strictures, also known as the reconstructive ladder, begins with minimally invasive interventions, including urethral dilation and endoscopic urethrotomy. Inevitably, endoscopic\\u000a incision and dilation fails, resulting in stricture recurrence. After the expenditure of valuable time and resources,
Leo R. Doumanian
Buccal mucosal grafts for urethral reconstruction
Objectives: Patients requiring urethral reconstruction but who have a paucity of usable genital tissue present a considerable technical challenge. Herein we report the experience of three centers in the use of buccal mucosa for urethral replacement.Methods: From 1991 to 1996, 22 urethral reconstructions were completed using a graft of buccal mucosa. Eighteen of 22 patients had previously failed hypospadias repairs,
A. A. Caldamone; L. E. Edstrom; M. A. Koyle; R. Rabinowitz; W. C. Hulbert
[Chronic traumatic cerebellar hematoma].
Traumatic hematomas of the posterior cranial fossa are a rarity. The paper is concerned with clinical cases of chronic intracerebellar hematoma characterized by general cerebral and cerebellar symptoms. Early diagnosis and surgical intervention made it possible to attain a favourable outcome in the immediate postoperative period. PMID:2171260
Okladnikov, G I; Nesterenko, L Kh; Kurov, O M
Urethral squamous cell papilloma: Case report and literature review
Lesions around the urethral meatus in women are common. The differential diagnosis for these lesions is extensive and includes urethral caruncle, urethral prolapse, urethral diverticulum, periurethral gland abscesses and, of most concern, urethral carcinoma. Non-invasive squamous lesions of the urethra are rare and their clinical significance is uncertain. We present a case of a urethral squamous papilloma at the urethral meatus in a premenopausal woman causing significant symptoms.
Gustafson, Paul; Fenster, Howard N.; So, Alan I.
Urethritis due to Chlamydia trachomatis.
Ninety-five men suffering from gonococcal urethritis were treated and observed. Forty-nine developed postgonococcal non-specific urethritis (PGU). Seventeen men were demonstrated to be free from PGU after careful observation; these formed a control group. Chlamydia trachomatis was isolated from urethral material from 26 (53%) of the PGU group but from none of the controls. This difference was highly significant (P less than 0-001). It confirms that C. tachomatis is a pathogen in the urethra. The presence of specific IgM antibody to C. trachomatis in serum from some men developing PGU, from whom that organism was isolated, suggests that the infection was recent in those cases. Ureaplasma urealyticum (T strain mycoplasma) was isolated from urethral material taken from 22 (45%) of the 49 men in the PGU group, and from 12 (71%) of the 17 in the control group. Mycoplasma hominis was isolated from 10 (20%) of the 49 men in the PGU group, and from four (24%) of the 17 men in the control group. Thus, no evidence was obtained that mycoplasmas (U. urealyticum, M. hominis) are patogenic in the urethra. PMID:871894
Vaughan-Jackson, J D; Dunlop, E M; Darougar, S; Treharne, J D; Taylor-Robinson, D
Traumatic amputations usually result directly from factory, farm, or power tool accidents or from motor vehicle accidents. Natural disasters, war, and terrorist attacks can also cause traumatic amputations.
On Demand Urethral Dilatation Versus Intermittent Urethral Dilatation: Results and Complications in Women With Urethral Stricture
Background: The treatment of urethral stricture in female patients is through dilatation of the urethra by tubes of increasing diameter. There are two main methods: intermittent dilatation and on demand dilatation. Objectives: The main aim of this study was to compare the results of these two methods, and to determine the best one. Patients and Methods: In this clinical trial study, we reviewed the documents of women diagnosed with urethral stricture, who came to the Baqiyatallah Clinic from 2007 and 2012. According to the method of dilatation, the patients were divided into two groups: intermittent dilatation and on demand dilatation. Patients� data were then collected and analyzed. Results: Eighty-six patients were enrolled in the study. The mean age of the participants was 48.13 years (between 44 and 79 years). The mean urinary residual and maximum urinary flow speed changes, before and after on demand dilatation, were higher than in the intermittent method. Conclusions: For treating urethral stricture, on demand urethral dilatation is more effective than intermittent dilatation.
Heidari, Fatemeh; Abbaszadeh, Shahin; Ghadian, Alireza; Tehrani Kia, Farahnaz
Urethral lymphocyte isolation in non-gonococcal urethritis.
AIMS: A pilot feasibility study to investigate the local immune response in patients with non-gonococcal urethritis (NGU). METHODS: Urethral lymphocytes were extracted from first void urine (FVU) of patients with non-gonococcal urethritis and gonorrhoea using magnetic beads coated with antibody against either the pan-T cell marker CD2 or to CD4. The CD2+ and CD4+ lymphocyte content of FVU were compared between chlamydia-positive and chlamydia-negative and between first and subsequent attacks of NGU. RESULTS: Median CD2+ lymphocyte content of FVU was significantly higher in cases of gonorrhoea and chlamydia-positive urethritis than in chlamydia-negative NGU. Median CD2+ lymphocyte content of FVU in chlamydia-negative NGU was 15.6 x 10(4), (n = 14 range 3.2-111) which was significantly lower than in chlamydia positive NGU (35.2 x 10(4), n = 18, range 7.4-390 p = 0.037) and gonorrhoea (67.7 x 10(4), n = 8 range 13-501, p = 0.019). Comparing the first with subsequent attacks of NGU, CD2+ cell numbers were greater in those presenting with their first episode of chlamydia-negative NGU (21.8 x 10(4), range 5.6-111) compared with those who had experienced NGU before (12.3 x 10(4), range 3.2-20.4, p = 0.033), but not in those presenting with chlamydia-positive NGU. There was no difference in CD4+ cells between any of the groups. CONCLUSION: The lower total lymphocyte content of subsequent attacks of chlamydia-negative NGU compared with the first attack chlamydia-positive and negative NGU suggests that a different aetiology may be operating in some of these patients. Sufficient lymphocytes can be isolated from the urethra in patients with NGU for studies of lymphocyte subsets to be carried out.
Shahmanesh, M; Pandit, P G; Round, R
Imaging of tibialis posterior dysfunction.
Tibialis posterior dysfunction is a complex progressive condition caused primarily by injury to the tibialis posterior tendon, leading to acquired pes planus. The tibialis posterior is the most frequent ankle tendon to be injured, and the disorder commonly occurs in late middle-aged females. Degenerative, inflammatory, functional and post-traumatic aetiologies have all been proposed. Failure of the tibialis posterior tendon causes excessive load stress on the spring ligament and sinus tarsi ligaments. A wide spectrum of bony and soft-tissue abnormalities may be seen on plain radiographs, ultrasound and MRI, including malalignment, anatomical variants, and enthesopathic and tendinopathic changes. Knowledge of the anatomical and biomechanical considerations in tibialis posterior dysfunction allows the radiologist to diagnose injury to key structures and provide prognostic information that may assist with management options to prevent further flat foot deformity. PMID:18591197
Kong, A; Van Der Vliet, A
[Urethral diverticulum with stone complicating epispadias repair].
Diverticula of the male urethra are rare clinical entities. Congenital and acquired have similar modes of presentation. No case of urethral diverticulum, containing stone, complicating epispadias repair have been reported. We report the case of 8-year-old boy with an urethral diverticulum, containing stone, complicating epispadias repair. Diverticulectomy with removal of the stone by urethroplasty was performed. Through this observation and review of the literature, authors describe pathological and management finding of urethral diverticula. PMID:20142059
Margi, M; Benhaddou, H; Ammor, A; Abdelhak, M; Oulahyane, R; Benhmamouch, M N
Male Urethral Diverticulum Having Multiple Stones
Congenital diverticulum of male urethra is an uncommon entity. Neglected management complicates the process in the form of calculi formation and recurrent urinary infection. A 10-year-old boy presented with urinary voiding disturbances and development of a painless hard lump at the penoscrotal junction. Imaging demonstrated presence of anterior urethral diverticulum with contained calculi in it. Open urethral diverticulectomy, extraction of multiple calculi, and primary urethral reconstruction over a Foley catheter was carried out. Early diagnosis and individualized surgical management of congenital male urethral diverticulum is the key to a successful outcome.
Mohanty, D; Garg, PK; Jain, BK; Bhatt, S
Graft surgery in extensive urethral stricture disease.
Surgical treatment of long urethral stricture disease remains one of the most challenging problems in urology. In recent years there has been continuous discussion with regard to the etiology, location, length, and management of extensive urethral stricture disease. Various tissues such as genital and extragenital skin, buccal mucosa, lingual mucosa, small intestinal submucosa, and bladder mucosa have been proposed for urethral reconstruction. The most frequent questions pertain to the optimal technique for urethroplasty and the optimal graft for substitution urethroplasty, as judged by both patient satisfaction and outcome success. We review the recent literature with respect to any new information on graft urethroplasty for extensive urethral stricture. PMID:24935160
Djordjevic, Miroslav L
[Urethral valves. Fate of the bladder and upper urinary tract].
Posterior urethral valve is a condition that leads to characteristic changes in the bladder and upper tracts. The bladder develops hypertrophic changes including muscular hypertrophy, dilatation of the prostatic urethra (keyhole appearance), and progressive hydroureteronephrosis. The voiding cystourethrogram confirms the diagnosis and documents vesicoureteral reflux and accompanying bladder changes. The follow-up of the serum creatinine level is a parameter for renal recovery. In our opinion, primary endoscopic ablation of the valves followed by a wait-and-see attitude is the most efficacious management of posterior urethral valves. The development of the bladder function is controlled by ultrasound and voiding cystourethrogram. Urodynamics provide a formal and objective means of assessing bladder function, but should be carefully applied in infants. Valve ablation in a neonate with significant reflux and a markedly trabeculated bladder can remodel itself remarkably within the 1st year of life. The persistence of hydronephrosis, bladder wall thickening and trabeculation, and persistent elevation of serum creatinine can all be harbingers that a degree of bladder outlet obstruction persists and one needs to rule out a persistent anatomic obstruction. At what point a functional obstruction occurs and which management is reasonable are still issues of debate and require the vigilance of a pediatric urologist to sort out. Dysfunctions of the bladder such as hyperreflexia, hypertonic, small capacity bladder, sphincter incompetence and/or myogenic failure should be adequately treated. PMID:15085265
Carr, M C; Snyder, H M
Urethritis in women attending an STD clinic
Of an unselected group of 159 women attending a sexually transmitted diseases (STD) clinic 20% (32) had symptoms of urethritis. A positive correlation existed between the finding of more than 10 polymorphonuclear leucocytes (PMNL) per high-power field in the Gram-stained urethral smear and the presence of Neisseria gonorrhoeae, Chlamydia trachomatis, and Trichomonas vaginalis. Conversely, these organisms were rarely isolated if
J E Wallin; S E Thompson; A Zaidi; K H Wong
Reactive arthritis associated with Mycoplasma genitalium urethritis.
Mycoplasma genitalium is an important cause of sexually transmitted infections that is gaining recognition and is an independent cause of acute and chronic nongonococcal urethritis in men. M. genitalium has been implicated as a possible causative factor in reactive arthritis. We report a case of reactive arthritis complicating M. genitalium urethritis in an HLA-B27-positive patient. PMID:24034901
Chrisment, D; Machelart, I; Wirth, G; Lazaro, E; Greib, C; Pellegrin, J-L; B�b�ar, C; Peuchant, O
Urethral pressure measurement--problems and clinical value.
Urethral pressure measurements are in use to assess urethral closure and voiding function. The lack of general agreement on an explicit definition of urethral pressure and standardisation of the methodology for measurement has limited the clinical utility of urethral pressure measurements. PMID:11409615
Lose, G
Multiple Urethral Stones Causing Penile Gangrene
Penile urethral stones are a rare occurrence resulting from a number of causes including migration of stones within the urinary tract, urethral strictures, meatal stenosis, and obstructing tumours such as adenomatous metaplasia of the uroepithelium, hypospadias, urethral diverticulum, and very rarely primary fossa navicularis calculi. We report the case of a 54-year-old male presenting with penile gangrene and sepsis resulting from impaction of multiple stones within the penile urethra. This paper summarises the topic and discusses the pathophysiology of this unusual condition.
Ramdass, Michael J.
Fracture of the penis with urethral rupture.
We report a rare case of penile fracture with incomplete urethral rupture in a 25 years old male who sustained the injury during sexual intercourse. He presented with a tense haematoma on the ventral aspect of the penile shaft, associated with urethral bleeding. Per urethral catheterization was possible though it was painful. Exploration and repair of the penile fracture and urethra were performed within 16 hrs. The patient made an uneventful recovery with good erectile and voiding function. This case illustrates the value of early surgical repair of the fracture in order to prevent complications. The true incidence of penile fracture is not known even in the Western countries because it is under reported or hidden for social embracement and even it is reported to physicians it remains undiagnosed or mismanaged. Very rarely it is associated with urethral rupture. PMID:18285737
Roy, Mk; Matin, Ma; Alam, Mm; Suruzzaman, M; Rahman, Mm
Polypoidal Intestinal Metaplasia and Dysplasia of the External Urethral Meatus
Urethral mucosa with intestinal metaplasia and dysplasia is a rare occurrence. To date only a single case has been reported in a male with long-standing urethral stricture. We present a 33-year-old female with polypoid intestinal metaplasia and dysplasia of the external urethral meatus in the absence of an inciting factor. Intestinal metaplasia of the urethral mucosa may undergo dysplasia, emphasizing the necessity of a high degree of clinical suspicion and vigilant pathological examination of these lesions.
Mathew, Mary; Nayal, Bhavna; Rao, Lakshmi; Narayanan Unni, Raghunath; Thomas, Joseph
Urethral erosion of a tension-free vaginal tape
BackgroundUrethral dilation has been recommended to treat voiding dysfunction that may occur after placement of tension-free vaginal tape (TVT) for the treatment of stress urinary incontinence. We report on a case of urethral erosion by the tape secondary to repetitive urethral dilations after surgery.
Brett J. Vassallo; Steven D. Kleeman; Jeffrey Segal; Mickey M. Karram
\\u000a The objective of this chapter is to review the various etiologies and management of traumatic blepharoptosis. Iatrogenic causes\\u000a constitute the most common category of factors in traumatic ptosis. This includes ptosis postintraocular surgery and posteyelid\\u000a and adnexal procedures. Contact lens wear, various systemic interventions, and birth trauma are other iatrogenic causes reported\\u000a in the literature in association with upper lid
Nariman S. Boyle; Eli L. Chang
Pathologic Outcomes following Urethral Diverticulectomy in Women
Purpose. Although most urethral diverticula in women are benign, there is a subset of patients who develop malignant changes. Limited studies report the pathologic findings associated with this relatively rare entity. We describe the clinicopathologic findings of women who underwent urethral diverticulectomy. Methods. A consecutive series of 29 women who underwent surgical resection of a urethral diverticulum were identified between 1992 and 2013. Clinical and radiographic data was collected by retrospective review of patient medical records. All pathological slides were rereviewed by a single urologic pathologist. Results. Of the 14 women with clinical data, 9 (64%) presented with urgency, 7 (50%) with urinary frequency, 3 (21%) with urinary incontinence, and 3 (21%) with dysuria. Mean diverticular size was 2.3 (�1.4) cm. Although one patient (3%) had invasive adenocarcinoma on final pathology, the remaining 28 cases (97%) demonstrated benign features. The most common findings were inflammation (55%) and nephrogenic adenoma (21%). Conclusions. Although most urethral diverticula in women are benign, there is a subset of patients who develop malignancy in association with the diverticulum. In this series, 97% of cases had a benign histology. These findings are important when counseling patients regarding treatment options.
Laudano, Melissa A.; Jamzadeh, Asha E.; Lee, Richard K.; Robinson, Brian D.; Tyagi, Renuka; Kaplan, Steven A.; Te, Alexis E.
Rhinosporidiosis presenting as an urethral polyp.
Rhinosporidiosis is an inflammatory disease caused by Rhinosporidium seeberi, a protoctistan mesomycetozoa, member of a group of novel aquatic parasites, characterized by hyperplastic polypoid lesions of the nasal cavity and rarely other mucous membranes. We report an unusual presentation of rhinosporidiosis as an urethral polyp, which is only the second case of rhinosporidiosis reported from Pakistan. PMID:18541092
Azad, Najamul Sahar; Ahmad, Zubairali; Kayani, Naila
Pathologic Outcomes following Urethral Diverticulectomy in Women.
Purpose. Although most urethral diverticula in women are benign, there is a subset of patients who develop malignant changes. Limited studies report the pathologic findings associated with this relatively rare entity. We describe the clinicopathologic findings of women who underwent urethral diverticulectomy. Methods. A consecutive series of 29 women who underwent surgical resection of a urethral diverticulum were identified between 1992 and 2013. Clinical and radiographic data was collected by retrospective review of patient medical records. All pathological slides were rereviewed by a single urologic pathologist. Results. Of the 14 women with clinical data, 9 (64%) presented with urgency, 7 (50%) with urinary frequency, 3 (21%) with urinary incontinence, and 3 (21%) with dysuria. Mean diverticular size was 2.3 (�1.4) cm. Although one patient (3%) had invasive adenocarcinoma on final pathology, the remaining 28 cases (97%) demonstrated benign features. The most common findings were inflammation (55%) and nephrogenic adenoma (21%). Conclusions. Although most urethral diverticula in women are benign, there is a subset of patients who develop malignancy in association with the diverticulum. In this series, 97% of cases had a benign histology. These findings are important when counseling patients regarding treatment options. PMID:24860605
Laudano, Melissa A; Jamzadeh, Asha E; Dunphy, Claire; Lee, Richard K; Robinson, Brian D; Tyagi, Renuka; Kaplan, Steven A; Te, Alexis E; Chughtai, Bilal
Traumatic rectourethral fistula repair: A potential application of porcine small intestinal submucosa
Rectourethral fistula is an uncommon but devastating condition. Traumatic rectourethral fistula is still uncommon and repair of traumatic rectourethral fistula involves a complex procedure. Most of the urologists would prefer to repair the fistula through perineal route especially when urethral reconstruction is also required. The repaired ends of the fistula are separated with various interposition flaps and grafts in order to prevent recurrence. Gracilis interposition muscle flap is commonly used. We describe the first case of traumatic rectourethral fistula repair in a 45-year-old man using interposition of a porcine small intestinal submucosal (Biodesign� (Surgisis�) graft.
Rajaian, Shanmugasundaram; Rajadoss, Muthukrishna Pandian; Nayak, Sukriya; Kekre, Nitin S.
Pars plana vitrectomy with posterior iris claw implantation for posteriorly dislocated nucleus and intraocular lens
We evaluated the safety and efficacy of pars plana vitrectomy (PPV) with primary posterior iris claw intraocular lens (IOL) implantation in cases of posterior dislocation of nucleus and IOL without capsular support. This was a retrospective interventional case series. Fifteen eyes underwent PPV with primary posterior iris claw IOL implantation performed by a single vitreoretinal surgeon. The main outcome measures were changes in best corrected visual acuity and anterior and posterior segment complications. A total of 15 eyes were included in this study. Eight had nucleus drop, three had IOL drop during cataract surgery and four had traumatic posterior dislocation of lens. The final postoperative best corrected visual acuity was 20/60 or better in 11 patients. This procedure is a viable option in achieving good functional visual acuity in eyes without capsular support.
Patil, Kishor B; Meleth, Padmanabhan; Prabhu, Shanker M
Acquired Male Urethral Diverticula: Presentation, Diagnosis and Management
Purpose We describe the etiology, presentation, treatment and outcomes of men diagnosed with an acquired urethral diverticulum. Materials and Methods We retrospectively analyzed the records of men with an acquired urethral diverticulum in an 11-year period (2000 to 2011) at a tertiary care reconstructive practice. Patient demographics, history, presentation, anatomical details such as diverticulum size and location, management and outcomes were recorded. Technical success was defined as unobstructed urination without urinary tract infection. Results A total of 22 men with an acquired urethral diverticulum were included in analysis. Median age at presentation was 48.5 years (range 18 to 86). Most commonly, patients presented with recurrent urinary tract infection, urinary dribbling, incontinence or a weak urinary stream. Of the 22 men 12 (54.5%) underwent urethral diverticulectomy and urethroplasty, 3 (13.5%) underwent ileal conduit urinary diversion and 7 (32%) were treated nonoperatively. Select cases were managed conservatively when the urethral diverticulum was confirmed in a nonobstructed urethra, it was small or asymptomatic and it could be manually emptied after voiding. At a mean followup of 2.3 years there was a 91% urethral diverticulum recurrence-free rate. Conclusions Acquired male urethral diverticula are rare but should be considered when there is recurrent urinary tract infection, obstructive voiding symptoms, a history of hypospadias, urethral stricture or trauma, or prolonged urethral catheterization. Treatment options may include surgical excision of the urethral diverticulum or urinary diversion. Some patients may be adequately treated nonoperatively with post-void manual decompression.
Cinman, Nadya M.; McAninch, Jack W.; Glass, Allison S.; Zaid, Uwais B.; Breyer, Benjamin N.
Posterior plica perforation: rare complication of adenotonsillectomy.
Tonsillectomy is one of the most common operations performed by otolaryngologists. Some extraordinary complications of this surgery are massive bleeding, taste perception disorders due to glossopharyngeal nerve damage, hematoma of the mouth floor, jugular vein thrombosis, Grisel syndrome, cervical osteomyelitis, nasopharyngeal stenosis, pulmonary edema, infection, and lingual artery pseudoaneurysm. In this clinical report, an 8-year-old girl presented with a posterior plica perforation after adenotonsillectomy performed 1 week previously and this complication has led to velopharyngeal insufficiency. This rare complication may result from traumatic damage or excessive cauterization of the posterior plica. PMID:25006950
Yildirim, Yavuz Selim; Senturk, Erol; Ozturan, Orhan
Posterior segment manifestations of ocular trauma.
Nonpenetrating or blunt ocular trauma, orbital trauma and systemic trauma may cause a variety of posterior segment abnormalities. Blunt ocular trauma may cause damage to the retina (commotio retinae), retinal pigment epithelium (retinal pigment epithelial edema), choroid (choroidal rupture) and optic nerve (optic nerve evulsion) alone or in combination. Traumatic macular holes and retinal detachment or dialysis may also occur after blunt ocular trauma. Trauma to the orbital tissues adjacent to the globe can cause concussive forces with damage to multiple structures within the eye (chorioretinitis sclopetaria). Systemic trauma may result in diffuse retinopathy (Purtscher's retinopathy, shaken baby syndrome) or localized retinal abnormalities (whiplash retinopathy, fat embolism syndrome). Alterations in intravascular (Valsalva retinopathy) or intracranial pressure (Terson's syndrome) due to a variety of causes may result in preretinal or vitreous hemorrhage and associated visual loss. The purpose of this report is to review each of these entities of traumatic posterior segment abnormalities. PMID:2191381
Williams, D F; Mieler, W F; Williams, G A
Histomorphology of the urethral process of the goat (Capra hircus).
The urethral process of the goat was an extension of the pars spongiosa of the male urethra. The erectile (cavernous) tissue of the urethral process was a continuation of the corpus spongiosum penis. The epithelium lining the urethra was stratified transitional. Two compact fibrocartilaginous strands were embedded in the erectile tissue, which were absent towards the tip of the urethral process. Smooth muscle was absent in the tunica mucosa-submucosa of the urethral process. The tunica mucosa-submucosa was richly supplied with blood vessels and nerves and it may be assumed that the urethral process is a sensory structure. Large cavernous sinuses, within the erectile tissue, were lined by endothelial cells. There was a circular fibroelastic layer enclosing the entire corpus spongiosum penis to withstand expansion of the erectile tissue during erection and copulation. The surface epithelium lining the urethral process was stratified squamous. A few connective tissue papillae were observed evaginating into the surface epithelium. PMID:941673
Ghoshal, N G; Bal, H S
Isolated anterior urethral recurrence of prostatic adenocarcinoma
Isolated anterior urethral metastases from prostate cancer are rare. The pathogenesis of this form of loco-regional recurrence may be related to spread by instrumentation-induced implantation and could potentially then be associated with a better prognosis than metastatic disease secondary to a more malignant phenotype. We report a case of a 68-year-old man with high-risk prostate cancer, diagnosed at transurethral resection of prostate, who was originally treated with combination external beam radiotherapy and hormonal therapy. He re-presented 4 years after his original diagnosis with recurrent gross hematuria and cystourethroscopic biopsies of anterior urethral polyps revealing isolated recurrent prostatic adenocarcinoma. We present our this case and review the literature.
Beiko, Darren; Zaza, Khaled; Power, Kevin V.; Siemens, D. Robert; Boag, Alexander H.
Isolated anterior urethral recurrence of prostatic adenocarcinoma.
Isolated anterior urethral metastases from prostate cancer are rare. The pathogenesis of this form of loco-regional recurrence may be related to spread by instrumentation-induced implantation and could potentially then be associated with a better prognosis than metastatic disease secondary to a more malignant phenotype. We report a case of a 68-year-old man with high-risk prostate cancer, diagnosed at transurethral resection of prostate, who was originally treated with combination external beam radiotherapy and hormonal therapy. He re-presented 4 years after his original diagnosis with recurrent gross hematuria and cystourethroscopic biopsies of anterior urethral polyps revealing isolated recurrent prostatic adenocarcinoma. We present our this case and review the literature. PMID:24940466
Beiko, Darren; Zaza, Khaled; Power, Kevin V; Siemens, D Robert; Boag, Alexander H
Sexually transmitted diseases syndromic approach: urethral discharge.
Urethral discharge (UD) in men is one of the most identifiable sexually transmitted infections (STI)-associated syndromes. UD performs very well, giving the possibility of an accurate diagnosis, a treatment at first encounter, a rapid cure with effective drugs, a modification of the risk behavior. Furthermore the patient is informed about the infectious nature of STDs, the transmission through sexual intercourse, the increased risks of infertility and other complications and, finally, the importance of completing treatment, even after improvement. Applying the syndromic approach to UD has resulted in effective case management of urethritis, as shown in different studies. Thus, there are numerous reasons why treatment of gonorrhea should include a regimen with complete in vivo activity against both N. gonorrhoeae and C. trachomatis. PMID:23007213
Di Carlo, A
Risk factors for renal insufficiency in children with urethral valves.
Posterior urethral valves (PUV) associated with renal dysplasia are one of the most common causes of end stage kidney disease (ESKD) in childhood. In order to identify risk factors for the progression of this condition to early renal failure, we have retrospectively analyzed the clinical course, renal function, and first postnatal renal ultrasound in a sample of 42 young male patients with PUV, who were followed at a single center. Twelve (28.6%) were diagnosed with ESKD at a median age of 11.3 years. Our comparison of PUV patients without decreased estimated glomerular filtration rate (eGFR) (group A; K/DOQI CKD stage 0-1) with PUV patients showing a decreased eGFR (group B; K/DOQI CKD stage 2-5) revealed the following significant risk factors for loss of eGFR: renal volume <3rd percentile (P < 0.001), elevated echogenicity (P = 0.001), pathologic corticomedullary differentiation (P < 0.001), >3 febrile urinary tract infections (P = 0.012), and decreased eGFR at 1 year of age (P < 0.001). Receiver operating characteristic curve analysis in the cohort confirms that patients showing a renal volume >88.2 ml/m(2) body surface area (BSA) are not at risk to develop K/DOQI CKD stage 5 (sensitivity 75%, specificity 77.3%, positive/negative predictive value 37.5/94.4%). Ultrasound promises to be a valuable tool for identifying endangered patients. PMID:22009479
Pohl, Michael; Mentzel, Hans-Joachim; Vogt, Susanna; Walther, Mario; R�nnefarth, Gabriele; John, Ulrike
Female urethral syndrome. A female prostatitis?
The cause of the female urethral syndrome has previously been obscure, as it has been associated by definition with a lack of objective findings but a plethora of subjective complaints of retropubic pressure, dyspareunia, urinary frequency, and dysuria. There is now strong evidence that the microscopic paraurethral glands connected to the distal third of the urethra in the prevaginal space are homologous to the prostate. They stain histologically for prostate-specific antigen and, like the prostate, are subject to both infection and cancer. The most important aspect of recognizing this microscopic "female prostate" as an anatomic feature is that its infections may completely explain many cases of the urethral syndrome. Further, the diagnosis is not elusive if trained clinicians palpate for localized and objective paraurethral tenderness through the anterior vagina wall to one or both sides of the urethra. Treatment parallel to that for male prostatitis is usually rewarded by the elimination of symptoms and the objective finding of the loss of tenderness of the paraurethral glands. As with prostatitis, the localized problem often recurs. It is time to alert primary care physicians to this disorder and to eliminate the widespread practice of treating affected women with either invasive urethral dilation or tranquilizers. Images Figure 1. Figure 3.
Gittes, R F; Nakamura, R M
Dorsolateral onlay urethroplasty for pan anterior urethral stricture by a unilateral urethral mobilisation approach.
The preferred management of urethral strictures involving long segments of anterior urethra is dorsal onlay buccal mucosa augmentation urethroplasty. This requires circumferential mobilisation of the urethra, which might cause ischaemia of the urethra in addition to chordee. The authors managed a pan anterior urethral stricture, applying a dorsolateral free graft by unilateral urethral mobilisation through a perineal approach. This is a recently described surgical technique which preserves the lateral vascular supply on one side thereby minimising ischaemia. Since circumferential mobilisation of urethra is not carried out in this technique, there are no chances of developing a chordee. Entire procedure is carried out by a perineal incision and no incision is made on the penis except for meatotomy. The pendulous urethra is accessed by penile eversion through the perineal wound. Obviating penile incisions minimises chances of wound infection and fistula formation. PMID:22689855
Chaudhary, Ranjit; Jain, Nidhi; Singh, Kulwant; Bisoniya, Hari Singh; Chaudhary, Rahul; Biswas, Rakesh
Dorsolateral onlay urethroplasty for pan anterior urethral stricture by a unilateral urethral mobilisation approach
The preferred management of urethral strictures involving long segments of anterior urethra is dorsal onlay buccal mucosa augmentation urethroplasty. This requires circumferential mobilisation of the urethra, which might cause ischaemia of the urethra in addition to chordee. The authors managed a pan anterior urethral stricture, applying a dorsolateral free graft by unilateral urethral mobilisation through a perineal approach. This is a recently described surgical technique which preserves the lateral vascular supply on one side thereby minimising ischaemia. Since circumferential mobilisation of urethra is not carried out in this technique, there are no chances of developing a chordee. Entire procedure is carried out by a perineal incision and no incision is made on the penis except for meatotomy. The pendulous urethra is accessed by penile eversion through the perineal wound. Obviating penile incisions minimises chances of wound infection and fistula formation.
Chaudhary, Ranjit; Jain, Nidhi; Singh, Kulwant; Bisoniya, Hari Singh; Chaudhary, Rahul; Biswas, Rakesh
Vascularisation of Urethral Repairs with the Gracilis Muscle Flap
Background The ability to achieve a long-term, stricture-free urethral repair is one of the ongoing challenges of reconstructive urologic surgery. A successful initial repair is critical, as repeat procedures are difficult, owing to distortion, scarring, and short urethral stumps. Methods We describe a technique in which the gracilis muscle flap is laid on or wrapped around the urethral repair site to provide a well-vascularised soft tissue reinforcement for urethral repair. This technique promotes vascular induction, whereby a new blood supply is introduced to the repair site to improve the outcome of urethral repair or anastomotic urethroplasty. The surface contact between the muscle flap and the repair site is enhanced by the use of fibrin glue to improve adherence and promote inosculation and healing. We employed this technique in 4 patients with different urethral defects. Results After a follow-up period of 32 to 108 months, all of the urethral repairs were successful without complications. Conclusions Our results suggest that the use of a gracilis muscle flap to vascularise urethral repairs can improve the outcome of challenging urethral repairs.
Kua, Ee Hsiang Jonah; Leo, Kah Woon; Ong, Yee Siang; Cheng, Christopher
Clinical and Functional Anatomy of the Urethral Sphincter
Continence and micturition involve urethral closure. Especially, insufficient strength of the pelvic floor muscles including the urethral sphincter muscles causes urinary incontinence (UI). Thus, it is most important to understand the main mechanism causing UI and the relationship of UI with the urethral sphincter. Functionally and anatomically, the urethral sphincter is made up of the internal and the external sphincter. We highlight the basic and clinical anatomy of the internal and the external sphincter and their clinical meaning. Understanding these relationships may provide a novel view in identifying the main mechanism causing UI and surgical techniques for UI.
Ahn, Hyo Kwang; Huh, Youngbuhm
Posterior Urethra Rupture: Contrast-Enhanced Computed Tomography Scan and Urethrocystography Demonstrations
In the follow-up study of patients with pelvic fractures, rupture of the posterior urethra is registered in 3�25% of cases (Koraitim et al., 1996). The diagnostic gold standard for the assessment of hemodynamically stable trauma patients is contrast-enhanced CT scan, especially helical CT. Nevertheless, simultaneous suprapubic cystography and ascending urethrograms (the so-called up-and-downogram) are the investigation of choice in assessing the site, severity, and length of urethral injuries. (Carlin and Resnick, 1995) This paper discusses the evaluation and diagnosis of urethral injury in multiple-trauma patient.
Marks, Wojciech; Dawid, S.; Lasek, J.; Witkowski, Z.; Golabek-Dropiewska, K.; Stasiak, M.
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Penile shaft sinus: A sequalae of circumcision in urethral duplication
Urethral duplication (UD) is rare congenital anomalies with varied presentation. Careful clinical evaluation of children by specialist would enhance diagnosis, adequate management and reduce occurrence of complication. We present a 12-year-old boy with chronic post circumcision ventral penile sinus that was successfully managed for urethral duplication.
Abdur-Rahman, Lukman O.; A, AbdulRasheed; O, Nasir John; Agboola; Adeniran, James O.
Obstructed or Malpositioned Urethral Catheter Induced Acute Kidney Injury
Unanticipated renal failure may be induced by an obstructed urethral catheter that was a component of complex management or difficult insertion. Two patients with new-onset uremia due to obstructed urethral catheters evinced rapid return of renal function when their blocked catheters were replaced.
Patel, Ankita; Friedman, Eli A.
Urethral bulking agents: techniques and outcomes.
Stress urinary incontinence is a common health problem affecting women and interfering with their quality of life. The use of bulking agents for urethral augmentation seems to be a beneficial way of restoring continence in these patients while avoiding the risk of surgical intervention. Many agents are available for injection, but the ideal choice should be durable, nonmigratory, and hypoallergenic, while evoking healing with minimal scarring. We reviewed the literature to provide an update on the best techniques of bulking agent injection, to describe the different available injectable agents, and to give their outcome and possible complications. PMID:19709488
Kotb, Ahmed F; Campeau, Lysanne; Corcos, Jacques
Long-Term Outcome of Primary Endoscopic Realignment for Bulbous Urethral Injuries: Risk Factors of Urethral Stricture
Purpose Although endoscopic realignment has been accepted as a standard treatment for urethral injuries, the long-term follow-up data on this procedure are not sufficient. We report the long-term outcome of primary endoscopic realignment in bulbous urethral injuries. Methods Patients with bulbous urethral injuries were treated by primary endoscopic realignment between 1991 and 2005. The operative procedure included suprapubic cystostomy and transurethral catheterization using a guide wire, within 72 hours of injury. The study population included 51 patients with a minimum follow-up duration of 5 years. Results The most common causes of the injuries were straddle injury from falling down (74.5%), and pelvic bone fracture (7.8%). Gross hematuria was the most common complaint (92.2%). Twenty-three patients (45.1%) had complete urethral injuries. The mean time to operation after the injury was 38.8�43.2 hours. The mean operation time and mean indwelling time of a urethral Foley catheter were 55.5�37.6 minutes and 22.0�11.9 days, respectively. Twenty out of 51 patients (39.2%) were diagnosed with urethral stricture in 89.1�36.6 months after surgery. A multivariate analysis revealed that young age and operation time were independent risk factors for strictures as a complication of urethral realignment (hazard ratio [HR], 6.554, P=0.032; HR, 6.206, P=0.035). Conclusions Urethral stricture commonly developed as a postoperative complication of primary endoscopic urethral realignment for bulbous urethral injury, especially in young age and long operation time.
Lee, Jea Whan; Park, Seung Chol; Rim, Joung Sik
Stricture disease: radiology of urethral stents.
Self-expanding metal stents are emerging as an effective alternative treatment in the management of urethral obstruction. The radiologic studies of 33 men with anterior urethral strictures (subprostatic, n = 11; bulbar, n = 22) that had recurred despite repeated optical urethrotomy and dilation were reported. In all patients, the stricture was successfully treated with stent insertion. Urethrography performed 1 month later in 19 patients showed an irregular intrastent lumen of varying degrees due to a hyperplastic urothelial reaction confirmed at endoscopy the same day. Available follow-up urethrograms in seven patients at 3 months showed that the hyperplasia was settling, and by 6 months, the intrastent lumen was smooth and of good caliber. Urethrography revealed postoperative structures in 14 patients. Strictures seen at 1 month (n = 6) were due to initial stent misplacement and were treated with the insertion of a second stent. Strictures seen 3 months after insertion (n = 4) occurred within the stent lumen and were considered to be significant at endoscopy in only one patient. Strictures that developed 6-12 months after stent insertion (n = 4) were not within the stent and were considered to represent genuine new strictures. PMID:2068309
Donald, J J; Rickards, D; Milroy, E J
During a 5-year period, we treated 14 cases of traumatic asphyxia. There were 12 male and 2 female patients ranging in age from 2 to 32 years. Most suffered crushing injuries at work or were run over by motor vehicles. Mild to severe cervicofacial cyanosis and petechiae developed in all patients. A fear response was reported by 12 of the patients. Subconjunctival hemorrhage was also found in 12 patients. Nine patients had tachypnea and 7 complained of dyspnea. Most of the patients suffered some associated injuries including 8 head injuries, 7 pulmonary contusions, and 6 cases of blunt abdominal trauma. Less-associated injuries were rib fractures, brachial and radial nerve injuries, hemothorax, and pneumothorax. The hospital stay ranged from 4 to 28 days (mean, 14 days) and follow-up from 10 to 60 months (mean, 32 months). Treatment for traumatic asphyxia included measurement of arterial blood gases, oxygen supplementation, and intubation with mechanical ventilation. The patients' recovery conditions were relative to the severity of injury and the associated injuries. PMID:1985583
Lee, M C; Wong, S S; Chu, J J; Chang, J P; Lin, P J; Shieh, M J; Chang, C H
Sacral Neuromodulation Effects on Periurethral Sensation and Urethral Sphincter Activity
Aims To characterize the effect of sacral neuromodulation (SNM) on urethral neuromuscular function. Methods Following IRB approval, women with refractory overactive bladder (OAB) underwent standardized urethral testing prior to and after stage 1 SNM implantation. Periurethral sensation was measured using current perception thresholds (CPT). Striated urethral sphincter activity was quantified using concentric needle electromyography (CNE) and Multi-Motor Unit Action Potential (MUP) analysis software. Nonparametric analyses were used to characterize pre/post changes with intervention. Baseline CPT and CNE findings were compared between SNM responders and non-responders. Results 27 women were enrolled in this pilot study with a mean age of 61�13 years. Twenty of 26 women (76.9%) responded to SNM and went to stage 2 permanent implantation. Four (14.8%) withdrew after stage 1 implantation; 3 of the 4 withdrawals had not had therapeutic responses to SNM. CPT and CNE parameters did not significantly differ from baseline 2 weeks after SNM. Pre-SNM urethral sensation was not significantly different between responders and non-responders. However, responders had larger amplitude, longer duration and more turns and phases at baseline approaching significance, reflecting more successful urethral reinnervation, than non-responders. Conclusions SNM does not alter urethral neuromuscular function two weeks post Stage 1implantation. Women with more successful urethral reinnervation may be more responsive to SNM.
Gleason, Jonathan L; Kenton, Kimberly; Greer, W. Jerod; Ramm, Olga; Szychowski, Jeff M.; Wilson, Tracey; Richter, Holly E.
Poor Quality of Life in Patients with Urethral Stricture Treated with Intermittent Self-Dilation
Purpose We assessed patient perceptions of regular intermittent self-dilation in men with urethral stricture. Materials and Methods We constructed and distributed a visual analog questionnaire to evaluate intermittent self-dilation via catheterization by men referred for urethral stricture management at a total of 4 institutions. Items assessed included patient duration, frequency, difficulty and pain associated with intermittent self-dilation as well as interference of intermittent self-dilation with daily activity. The primary outcome was patient perceived quality of life. Multivariate analysis was performed to assess factors that affected this outcome. Results Included in the study were 85 patients with a median age of 68 years, a median of 3.0 years on intermittent self-dilation and a median frequency of 1 dilation per day. On a 1 to 10 scale the median intermittent self-dilation difficulty was 5.0 � 2.7, the median pain score was 3.0 � 2.7 and median interference with daily life was 2.0 � 1.3. Overall quality of life in patients with stricture was poor (median score 7.0 � 2.6 with poor quality of life defined as 7 or greater). On univariate analysis younger age (p <0.01), interference (p = 0.03), pain (p <0.01) and difficulty performing intermittent self-dilation (p = 0.03) correlated with poor quality of life in a statistically significant manner. On multivariate analysis only difficulty catheterizing (p <0.01) and younger age (p = 0.05) were statistically significant predictors. Patients with stricture involving the posterior urethra had a statistically significant increase in difficulty and decrease in quality of life (each p = 0.04). Conclusions Most patients with urethral stricture who are on intermittent selfdilation rate difficulty and pain as moderate, and inconvenience as low but report poor quality of life.
Lubahn, Jessica D.; Zhao, Lee C.; Scott, J. Francis; Hudak, Steven J.; Chee, Justin; Terlecki, Ryan; Breyer, Benjamin; Morey, Allen F.
The stone formation in the Memotherm urethral stent implantation area: Is it a rare complication?
Recurrent urethral stricture is one of the biggest problems in urology. Urethral stents as an alternative treatment has been used since 1985. The stone formation in the Memotherm (Angiomed) urethral stent implantation area is a rare complication. We report the case of a 67-year-old man who had a stone in the Memotherm urethral stent implantation area 6 years after his urethral stent surgery.
Karakose, Ayhan; Atesci, Yusuf Ziya; Aydogdu, Ozgu
Air bag associated posterior segment ocular trauma.
Airbags indeed reduce the risk of injury and death in motor vehicle accidents, however, ocular injury induced by airbag deployment has been reported. From 1999 to 2001, medical records were retrospectively reviewed for patients with severe ocular injury related to airbag inflation at Taipei Veterans General Hospital. The ocular presentation, clinical course, management and visual outcome were recorded and studied in detail. Three cases of ocular posterior segment injury associated with airbag inflation were identified. Mean age was 37.3 years old (range 34-39 years). None of the patients was wearing a seat belt. All patients had periocular contusion, corneal edema, and hyphema. Vitreous hemorrhage was found in 3 cases, and there were 2 cases with severe macular injury, including traumatic maculopathy and hypotony maculopathy. Retinal detachment developed in 1 case. One patient presented with traumatic macular hole 6 weeks after injury. The initial visual acuity was hand motion only in all patients, the final visual outcomes recovered to 6/20, 1/60 and 2/60, respectively. The airbag-associated posterior segment ocular trauma was induced by impact with fully deployed airbag. Severe ocular posterior segment trauma with devastating visual sequelae might occur in drivers and passengers who have not fastened their seat belt. PMID:15553805
Yang, Chang-Sue; Chou, Tzu-Fang; Liu, Jorn-Hon; Hsu, Wen-Ming
Urethral reconstruction with autologous vein graft: an experimental study.
There is no universally accepted material for urethral reconstruction. This study presents the results of segmental urethral replacement with a free graft of jugular vein in rabbits. Histological examination showed ingrowth of normal transitional epithelium into the venous endothelium. Retrograde urethrograms revealed an excellent result up to 300 days. Fistulas and infection occurred in 4/44 rabbits; these settled spontaneously. No structures or papillary hypertrophy were noted. Segmental urethral reconstruction with autologous vein graft is a simple technique with few complications and appears suitable for use in clinical cases. PMID:7551530
Kahveci, R; Kahveci, Z; Sirmali, S; Ozcan, M
Penile fracture with bilateral corporeal rupture without urethral involvement
Concomitant urethral injury is rare in penile fracture. We report the case of a 34-year-old male who presented to the emergency department 12 hours after a blunt self-injury of the penis. Physical examination revealed a swollen, ecchymotic, and deviated circumcised penis without blood at the meatus. The fracture line extending along the bilateral corpora without urethral involvement was seen intraoperatively. The fracture side was repaired primarily. The patient healed and recovered without complication. To our knowledge, this is the second reported case of bilateral corporeal rupture without urethral involvement.
Yonguc, Tarik; Bozkurt, Ibrahim Halil; Ors, Bumin; Kozacioglu, Zafer; Arslan, Burak; Yonguc, Nilufer Goksin
Reconstruction for the distal urethral end incorrectly anastomosed to the proximal false passage in the treatment of urethral stricture
Patient: Male, 24 Final Diagnosis: Urethral stricture Symptoms: � Medication: � Clinical Procedure: � Specialty: Urology Objective: Unusual or unexpected effect of treatment Background: The most dependable management of anterior urethral stricture is the complete excision of the area of fibrosis, with a primary reanastomosis of the normal ends of the anterior urethra. Case Report: A 24-year-old man had urethral stricture in the penoscrotal junction caused by catheterization approximately 3 years ago. After the resection of the urethral stricture segment and the end-to-end anastomosis were performed, in addition to stricture, urethrocutaneous fistula formation as another complication in the penoscrotal junction was confirmed. The direct vision internal urethrotomy did not improve all the above symptoms. The retrograde urethrogram and voiding cysto-urethrogram showed complete obliteration in the penile urethra, urethrocutaneous fistula, and proximal urethral bifurcation singularity. Intraoperatively, we found that the distal urethral end had been anastomosed to the proximal false passage in the initial surgery and the proximal urethra was located in the dorsal side of the false passage. Then, tubularized preputial flap urethroplasty was performed. The patient was followed up for 10 months. His peak urinary flow was 18.3 milliliter per second. Conclusions: We would remind urologists that urethral end intraoperatively anastomosed to the false passage is a rare, serious, avoidable, and elementary medical error. Urethroplasty is one of the curative choices for treatment of this unexpected condition.
Li, Zhao-Lun; Fu, De-Lai; Chong, Tie; Li, He-Cheng
Clinical characteristics of traumatic macular holes.
The clinical characteristics of 20 eyes of 20 consecutive patients with traumatic macular hole were studied retrospectively. The macular holes were elliptical with irregular edges in 19 eyes (95%) and ranged in size from 0.2 to 0.5 DD (disc diameter). Posterior vitreous detachment (PVD) was found in only 3 eyes (15%); the vitreous was detached from the macula in only one of these 3. Other conditions found in the 20 patients included commotio retinae, vitreous hemorrhage, hyphema, and choroidal rupture. These findings strongly suggest that most traumatic macular holes develop in the absence of PVD and that the pathogenesis is independent of the occurrence of PVD. We believe that the macular rupture (hole) is caused mechanically by the force of the impact on the posterior pole and the ocular deformity which result from blunt trauma. PMID:9130060
Yanagiya, N; Akiba, J; Takahashi, M; Shimizu, A; Kakehashi, A; Kado, M; Hikichi, T; Yoshida, A
Management of traumatic sternoclavicular joint injuries.
Traumatic sternoclavicular joint injuries account for <3% of all traumatic joint injuries. Proper recognition and treatment are vital because these injuries may be life threatening. Injuries are classified according to patient age, severity, and, in the setting of dislocation, the direction of the medial clavicle. Anterior injuries are far more common than posterior injuries. Posterior dislocation may be associated with complications such as dyspnea, dysphagia, cyanosis, and swelling of the ipsilateral extremity as well as paresthesia associated with compression of the trachea, esophagus, or great vessels. These life-threatening complications may present at the time of injury but can develop later, as well. Radiography has been largely supplanted by CT for evaluation of this injury, although an oblique view developed by Wirth and Rockwood is useful in evaluating isolated sternoclavicular injury. MRI is useful in differentiating physeal injury from sternoclavicular dislocation in patients aged<23 years. PMID:21205762
Groh, Gordon I; Wirth, Michael A
Posterior knee pain is a common patient complaint. There are broad differential diagnoses of posterior knee pain ranging from common causes such as injury to the musculotendinous structures to less common causes such as osteochondroma. A precise understanding of knee anatomy, the physical examination, and of the differential diagnosis is needed to accurately evaluate and treat posterior knee pain. This article provides a review of the anatomy and important aspects of the history and physical examination when evaluating posterior knee pain. It concludes by discussing the causes and management of posterior knee pain.
Perret, D.
[Traumatic recurrence of idiopathic spinal cord herniation].
Idiopathic spinal cord herniation is a rare cause of thoracic myelopathy and its recurrence is even more infrequent. Cord herniation is through an anterior dural defect in thoracic spine with unknown causes. Symptomatic cases must be surgically treated to reduce the hernia and seal the defect to prevent recurrences. We report a patient presenting a Brown-S�quard syndrome secondary to a D5 spinal cord herniation treated successfully and its posterior traumatic recurrence. PMID:23453309
Lorente-Mu�oz, As�s; Cort�s-Franco, Severiano; Moles-Herbera, Jes�s; Casado-Pellejero, Juan; Rivero-Celada, David; Alberdi-Vi�as, Juan
Management of advanced primary urethral carcinomas.
Primary urethral carcinoma (PUC) is a rare malignancy accounting for <1% of genitourinary cancers, with a predilection for men and African-Americans. The sites and histology of urethral carcinoma vary by gender and anatomical location. Squamous cell carcinoma is most common among both genders but adenocarcinomas are noted in 15-35% of cases among women. Obstructive or irritative symptoms and haematuria are common modes of presentation. Clinical evaluation includes cystourethroscopy with biopsy and examination under anaesthesia. Magnetic resonance imaging provides a highly effective method to image the primary tumour while def?ning the potential involvement of surrounding structures. Most tumours are localised, with regional metastases to nodal sites seen in up to 30% of cases in both genders, while distant metastases at presentation are rare (0-6%), but occur in up to 40% of cases with recurrent disease. Among men, the two most important prognostic factors are disease location and stage. Low-stage tumours (T1-2) and tumours involving the fossa navicularis or the penile urethra have a better prognosis than higher stage tumours (>T2 or N+) and lesions involving the bulbomembranous urethra. In women, in addition to stage and location, the size of the tumour has also prognostic implications. While surgery and radiation therapy (RT) are of benefit in early stage disease, advanced stage PUC requires multimodal treatment strategies to optimise local control and survival. These include induction chemotherapy followed by surgery or RT and concurrent chemoradiation with or without surgery. The latter strategy has been used successfully to treat other human papillomavirus-related cancers of the vagina, cervix and anus and may be of value in achieving organ preservation. Given the rarity of PUC, prospective multi-institutional studies are needed to better define the optimal treatment approach for this disease entity. PMID:24447439
Dayyani, Farshid; Hoffman, Karen; Eifel, Patricia; Guo, Charles; Vikram, Raghu; Pagliaro, Lance C; Pettaway, Curtis
Benign (Not Cancerous) Urethral Lesions in Children -- Girls
... sign of this problem is a thin, reddish membrane protruding from one portion of the urethral opening. ... wounding. Examples are scars, abscesses, tumors and ulcers. membrane: A thin sheet or layer of tissue that ...
Proposed new method for nonoperative treatment of urethral stones.
Urethral calculi is a common clinical problem in the Middle and Far East. Different endoscopic and operative techniques have been used in the treatment of impacted urethral stones. We report a noninvasive procedure to treat this condition. Intraurethral instillation of 2% lidocaine jelly was followed by spontaneous expulsion of the stone in 14 of 18 patients. The indications and limitations of the method are outlined. PMID:1942337
el-Sherif, A E; el-Hafi, R
Detection of Chlamydia trachomatis in urine from men with urethritis
The performance of a commercial EIA (Chlamydiazyme) for detection ofChlamydia trachomatis in urine specimens was compared with that of culture of urethral samples from men with urethritis. The incidence of chlamydial infection on the basis of culture results was 34 % (56\\/167). The sensitivity, specificity, positive and negative predictive values for the EIA were 55 % (31\\/56), 98 % (109\\/111),
M. B�ckman; A. K. M. Rud�n; O. Ringertz; E. G. Sandstr�m
Ureaplasma urealyticum causing persistent urethritis in a patient with hypogammaglobulinaemia
Ureaplasma urealyticum organisms (ureaplasmas) were isolated in large numbers (up to 10(8) colour changing units (ccu)\\/ml) over a period of four years from the urethra of a man with hypogammaglobulinaemia and non-gonococcal urethritis. Elimination of Mycoplasma hominis by antibiotic treatment early in the course of the urethritis did not diminish the severity of his condition, which indicated that this mycoplasma
D Taylor-Robinson; P M Furr; A D Webster
Treatment of Overactive Bladder Syndrome with Urethral Calibration in Women
Our objective was to determine whether urethral calibration with Walther's urethral sounds may be an effective treatment for overactive bladder syndrome. The diagnosis of overactive bladder syndrome is a clinical one based on the presence of urgency, with or without urge incontinence, and is usually accompanied by frequency and nocturia in the absence of obvious pathologic or metabolic disease. These symptoms exert a profound effect on the quality of life. Pharmacologic treatment is generally used to relieve symptoms, however anticholinergic medications may be associated with several undesirable side effects. There are case reports of symptom relief following a relatively quick and simple office procedure known as urethral dilation. It is hypothesized that this may be an effective treatment for the symptoms of overactive bladder. Women with clinical symptoms of overactive bladder were evaluated. Eighty-eight women were randomized to either urethral calibration (Treatment), or placebo (Control) treatment. Women's clinical outcomes at two and eight weeks were assessed and compared between the two treatment arms. Eight weeks after treatment, 31.1% (n=14) of women who underwent urethral calibration were responsive to the treatment versus 9.3% (n=4) of the Control group. Also, 51.1% (n=23) of women within the Treatment group showed at least a partial response versus 20.9% (n=9) of the Control group. Our conclusion is that Urethral calibration significantly improves the symptoms of overactive bladder when compared to placebo and may be an effective alternative treatment method.
Sato, Renee L; Matsuura, Grace HK; Wei, David C; Chen, John J
Dorsal onlay vaginal graft urethroplasty for female urethral stricture
Introduction: Female urethral stricture is an underdiagnosed and overlooked cause of female bladder outlet obstruction. The possible etiologies may be infection, prior dilation, difficult catheterization with subsequent fibrosis, urethral surgery, trauma, or idiopathic. We present our technique and results of dorsal onlay full thickness vaginal graft urethroplasty for female urethral stricture. Materials and Methods: A retrospective review was performed on 16 female patients with mid-urethral stricture who underwent dorsal onlay vaginal graft urethroplasty from January 2007 to June 2011. Of these, 13 patients had previously undergone multiple Hegar dilatations, three had previous internal urethrotomies. The preoperative work up included detailed voiding history, local examination, uroflowmetry, calibration, and micturating cystourethrogram. Results: All patients had mid-urethral stricture. Mean age was 47.5 years. Mean Qmax improved from 6.2 to 27.6 ml/s. Mean residual volume decreased from 160 to 20 ml. Mean duration of follow-up was 24.5 months (6 months to 3 years). Only one patient required self-calibration for 6 months after which her stricture stabilized. None of the patient was incontinent. Conclusion: Dorsal vaginal onlay graft urethroplasty could be considered as an effective way to treat female urethral stricture.
Singh, Manmeet; Kapoor, Rakesh; Kapoor, Deepa; Kapoor, Rohit; Srivastav, Alok; Chipde, Saurabh
Urethral Sparing Histotripsy of the Prostate in a Canine Model
Objective To evaluate the feasibility and healing response to urethral sparing prostate histotripsy a canine model of benign prostatic hypertrophy. Methods Histotripsy was performed on 10 canines using a 750 kHz piezoelectric ultrasound transducer targeting the prostatic parenchyma while avoiding the urethra. Periprocedure prostatic urethral integrity was evaluated with serial cystourethroscopy. Evolution of histotripsy treatment effect and subjects� response to urethral sparing was evaluated with serial ultrasound and laboratory evaluation, respectively. Subjects were euthanized acutely or chronically and findings were confirmed histologically. Results Bilateral treatment was possible in 8/10 subjects while unilateral treatment was performed in 2/10. Failure to spare the urethra was observed in 2/18 treatments; one acutely and one chronically despite normal cystourethroscopy for the first week. Modest prostatic volume reduction was seen in subjects survived to 8 weeks post-histotripsy. Laboratory studies revealed transient perioperative increases in mean white-blood cell count, C-reactive protein, and lactate dehydrogenase. On histology, 80% of successful urethral sparing treatment cavities were completely epithelialized, containing simple fluid with minimal cellular debris at 8 weeks despite no communication with the urethra. Conclusions Urethral sparing histotripsy of the prostate is feasible and well tolerated in a canine model, resulting in modest volume reduction and prompt resorption of homogenized tissue debris. Human studies to evaluate the clinical utility and symptomatic response of urethral sparing are needed.
Schade, George R.; Hall, Timothy L.; Roberts, William W.
A Balloon-Tipped Catheter for Measuring Urethral Pressures
Background: Better methods are needed for recording urethral function for complex urologic problems involving the bladder, urethra, and pelvic floor. Objective: To evaluate a balloon catheter for recording urethral pressure and function using bench-top testing and evaluation in an animal model. Methods: Balloon pressure�recording methods included slightly inflating the balloon with water and placing the pressure transducer on the distal end of the catheter. For bench-top testing, manual procedures and a silastic tube with a restriction were used. In 3 anesthetized dogs, pressure recorded from the skeletal urethral sphincter was induced with electrical stimulation of the sphincter. Anal sphincter pressure was also recorded. Results: Bench-top testing showed good pressure recordings, including a confined peak at the tube restriction. Animal tests showed urethral pressure records with rapid responses when electrical stimulation was applied. Peak pressure at the urethral skeletal sphincter was 55.7 � 15 cmH2O, which was significantly higher than the peak pressure recorded 2 cm distally in the proximal urethra (3.3 � 2.3 cmH2O). Peak anal pressures were smaller and unchanged for the 2 stimulations. Conclusions: Balloon-pressure recordings showed rapid responses that were adequate for the tests conducted. In the animal model, high-pressure contractions specific to the skeletal urethral sphincter were shown. Balloon-tipped catheters warrant further investigation and may have applications for the evaluation of detrusor-sphincter dyssynergia after spinal cord injury or for stress urinary incontinence.
Walter, James S; Wheeler, John S; Wang, Xiaoli; Wurster, Robert D
A misleading urethral smear with polymorphonuclear leucocytes and intracellular diplococci; case report of urethritis caused by Neisseria meningitidis.
The primary pathogens found in men with urethritis are Chlamydia trachomatis and Neisseria gonorrhoeae. Rapid diagnosis of N. gonorrhoeae infection can be made based on a Gram- or methylene blue-stained urethral smear. We describe a case of a man with purulent penile discharge, in which microscopic examination led to the presumptive diagnosis of gonorrhoea. A nucleic acid amplification test was negative for N. gonorrhoeae but positive for C. trachomatis. Culture showed Gram-negative diplococci which were identified as Neisseria meningitidis. N. meningitidis can be sporadically pathogenic in the genito-urinary tract and mimicks gonococcal urethritis, and appears identical by microscopy. When a gonococcal urethritis is suspected based on clinical signs and microscopic examination, but investigatory tests cannot confirm the diagnosis, a N. meningitidis infection should be considered. PMID:24000224
Genders, R E; Spitaels, D; Jansen, C L; van den Akker, Th W; Quint, K D
Posterior fossa hemorrhages in the newborn.
Of 700 neonates examined by computed tomography (CT) in a 4 years period, 17 were found to have a posterior fossa hemorrhage. Eleven were born at term, and six were premature. Delivery was traumatic in 12 babies. The hematoma was in the subdural space in nine and within the cerebellum in eight. The CT diagnosis of extravasated blood in the posterior fossa is easy both in full-term neonates and prematures. The localization of the hematoma, however, may be difficult. While in the full-term neonates differentiation between subdural and intracerebellar location is relatively easy, in the premature the cerebellar hematoma frequently has a crescentic shape that resembles a subdural collection. Four patients with a subdural hematoma and four with a cerebellar hematoma were operated on. The general prognosis is poor: seven patients died; of the survivors, only three are normal at follow-up. PMID:7240500
Scotti, G; Flodmark, O; Harwood-Nash, D C; Humphries, R P
Traumatic abdominal wall hernia
INTRODUCTION Traumatic abdominal wall hernia (TAWH) is a rare entity. Most cases occur in children, following an injury from the bicycle handle bar. In adults, it usually results from road traffic accidents (RTA). We present one of the largest reported cases of TAWH following RTA managed by delayed mesh repair. PRESENTATION OF CASE A 35�yr old obese male with RTA was diagnosed with TAWH with 19�cm�נ15�cm defect in left flank. As there were no intra abdominal injuries and overlying skin was abraded, he was planned for elective repair after 6 months. On exploration a defect of 30�cm�נ45�cm was found extending from midline anteriorly to 8�cm short of midline posteriorly in transverse axis and costal margin to iliac crest in craniocaudal axis. After restoration of bowel into abdominal cavity, primary closure or even approximation of muscular defect was not possible thus a mesh closure using 60�cm�נ60�cm prolene mesh in subcutaneous plane was done. After 4 months follow up, patient is healthy and has no recurrence. DISCUSSION Emergent surgical management of TAWH is usually favoured due to high incidence of associated intra abdominal injuries. Delayed repair may be undertaken in selected cases. CONCLUSION TAWH, although rare, should be suspected in cases of RTA with abdominal wall swellings. With time, the hernia defect may enlarge and muscles may undergo atrophy making delayed repair difficult.
Yadav, Siddharth; Jain, Sunil K.; Arora, Jainendra K.; Sharma, Piyush; Sharma, Abhinav; Bhagwan, Jai; Goyal, Kaushal; Sahoo, Bhabani S.
... Frequently Asked Questions Glossary Contact Us mild Traumatic Brain Injury Click Here to Start VIDEO STORIES What ... most common deployment injuries is a mild Traumatic Brain Injury (TBI). A mild TBI is an injury ...
Urethral caruncle: Case report of a rare acute urinary retension cause
A urethral caruncle is a benign vascular tumour usually originating from the rear lip of the external urethral mea and often observed in postmenopausal women. Urethral caruncle is not included within the list of bladder overdistension causes in women. We present urethral caruncle as a rare cause of acute urinary obstruction in a 41-year-old woman. The case was evaluated with physical examination and the bladder was evacuated with a 12-Fr urethral catheter. A pressure flow study was performed. The caruncle was excised under spinal anesthesia. There were no complications. The urethral catheter was withdrawn on the sixth day and she was discharged with local estrogen.
Coban, Soner; B?y?k, Ismail
Endoscopic removal of a proximal urethral stent using a holmium laser: Case report and literature review
Urethral stents were initially developed for the management of urethral strictures and obstructive voiding disorders in select patients. Urethral stent complications are common and may require stent explantation, which is often quite challenging. We present our experience with endoscopic removal of an encrusted UroLume proximal urethral stent in a 72-year-old male using a holmium laser. The literature on various management options and outcomes for urethral stent removal is reviewed. Endoscopic removal of proximal urethral stents is feasible and safe and should be considered as the primary treatment option in patients requiring stent extraction.
Botelho, Francisco; Thomas, Anil A.; Miocinovic, Ranko; Angermeier, Kenneth W.
Traumatic Wound Dehiscence following Corneal Transplantation
Purpose To investigate the incidence, mechanisms, characteristics, and visual outcomes of traumatic wound dehiscence following keratoplasty. Methods Medical records of 32 consecutive patients with traumatic globe rupture following keratoplasty who had been treated at our center from 2001 to 2009 were retrospectively reviewed. Results The study population consisted of 32 eyes of 32 patients including 25 men and 7 women with history of corneal transplantation who had sustained eye trauma leading to globe rupture. Mean patient age was 38.1 (range, 8 to 87) years and median interval between keratoplasty and the traumatic event was 9 months (range, 30 days to 20 years). Associated anterior segment findings included iris prolapse in 71.9%, lens extrusion in 34.4%, and hyphema in 40.6% of eyes. Posterior segment complications included vitreous prolapse (56%), vitreous hemorrhage (28%) and retinal detachment (18%). Eyes which had undergone deep anterior lamellar keratoplasty (DALK; 5 cases, 15.6%) tended to have less severe presentation and better final visual acuity. There was no correlation between the time interval from keratoplasty to the traumatic event, and final visual outcomes. Conclusion The host-graft interface demonstrates decreased stability long after surgery and the visual prognosis of traumatic wound dehiscence is poor in many cases. An intact Descemet�s membrane in DALK may mitigate the severity of ocular injuries, but even in these cases, the visual outcome of globe rupture is not good and prevention of ocular trauma should be emphasized to all patients undergoing any kind of keratoplasty.
Jafarinasab, Mohammad-Reza; Feizi, Sepehr; Esfandiari, Hamed; Kheiri, Bahareh; Feizi, Mohadesse
Posterior form sympathetic ophthalmia.
Two cases of posterior form sympathetic ophthalmia are presented. The histologic abnormalities in one of them are described. Based on findings in these two cases and other descriptions of posterior form sympathetic ophthalmia in the literature, the authors conclude that except for absence of anterior uveal tract involvement, there is no histopathologic difference between posterior form sympathetic ophthalmia and classical sympathetic ophthalmia. Although there is disagreement in the literature, the authors also conclude that the therapy and prognosis of posterior form sympathetic ophthalmia does not differ from that of classical sympathetic ophthalmia. Images FIGURE 1 FIGURE 2 FIGURE 3 A FIGURE 3 B FIGURE 4 A FIGURE 4 B
McPherson, S D; Dalton, H T
Because of their tendency to progressively enlarge with compression of adjacent structures, as well as the small chance of malignancy, most intrathoracic goiters should be excised surgically. Most anterior substernal goiters and some ipsilateral posterior mediastinal goiters can be removed safely through a cervical incision. Large posterior mediastinal goiters, contralateral retrotracheal or retroesophageal posterior mediastinal goiters, and isolated mediastinal goiters with no significant cervical connection are best removed through a combined cervical and thoracic approach. The Lahey Clinic experience with three patients with posterior mediastinal goiter is described. PMID:3409742
Shahian, D M; Rossi, R L
Posterior thoracic osteotomies.
Spinal osteotomies are used to treat partially flexible and fixed deformities. Fixed thoracic spinal deformities have been traditionally treated with anterior release and posterior correction with fusion. In recent decades, it has been shown that posterior-only osteotomies might be sufficient to achieve proper deformity correction with lower complication rates than with combined anterior and posterior procedures. Different types of osteotomies have been described to treat spinal deformities through a single posterior approach. These include posterior column osteotomies such as the Smith-Petersen osteotomy and the Ponte osteotomy, and three-column osteotomies such as the pedicle subtraction osteotomy, the posterior vertebral column resection and the posterior vertebral column decancellation. In general, three-column osteotomies are most commonly performed in the lumbar spine, where the vast majority of reports have focused on. They can also be performed in the thoracic spine in the setting of rigid thoracic deformity. A progressive increase in complications has been reported with more aggressive osteotomies. The aim of this article was to describe the most common posterior spinal osteotomies used to treat adult thoracic spinal deformities, with special emphasis on the technical aspects, complications and outcomes, based on current publications and European Spine Study Group (ESSG) data. PMID:24781506
Pellis�, Ferran; Vila-Casademunt, Alba
SUMMARY The increasing demand of esthetics and the progressive advances in restorative dentistry leads the utilization of restoration of the posterior teeth by esthetic restorative materials. The major problem that the clinicians face when restoring posterior teeth by resin composites is the polimerization contraction and the subsequent formation of microleakage. The studies of reducing these polimerization contraction involves both the
Serdar ARIKAN
Most mediastinal goiters are retrosternally situated in the anterior mediastinal compartment. Posterior mediastinal goiters, either retrotracheal or retroesophageal, are rare. We herein describe a case involving a retrotracheal goiter in the right posterior mediastinum, which was excised using a combined cervico-partial sternotomy and right thoracotomy approach. PMID:15353470
Chong, Chee-Fui; Cheah, Wei-Keat; Sin, Fai-Lam; Wong, Poo-Sing
Determination of urethral catheter surface lubricity.
Device for in-vitro measurement of static and kinetic friction coefficient of catheter surface was developed. Tribometer was designed and constructed to work with exchangeable counter-faces (polymers, tissue) and various types of tubes, in wet conditions in order to mimic in-vivo process. Thus seven commercially available urethral catheters, made from vinyl polymers, natural latex with silicone coating, all-silicone or hydrogel coated, and one made from polyvinylchloride with polyurethane/polyvinylpyrrolidone hydrogel coating obtained in our laboratory, were tested against three various counter faces: polymethacrylate (organic glass), inner part of porcine aorta and porcine bladder mucosa. Additionally, the hydrophility/hydrophobity of tested catheters was stated via water wetting contact angle measurement. Super-hydrophilic biomaterials revealed low friction on tissue and hydrophobic counter-face; slightly hydrophobic showed higher friction in both cases, while more hydrophobic manifested low friction on tissue but high on hydrophobic polymer. The smoothest friction characteristic was achieved in all cases on tissue counter-faces. The measured values of the static coefficient of friction of catheters on bladder mucosa counter-face were as follows: the highest (0.15) for vinyl and siliconised latex catheters and 3 folds lower (0.05) for all-silicone ones. Hydrogel coated catheters exhibited the lowest static and kinetic friction factors. PMID:18071872
Kazmierska, Katarzyna; Szwast, Maciej; Ciach, Tomasz
Anterior Urethral Valve and Diverticulum in a Neonate with Febrile Urinary Tract Infection
Anterior urethral valve is a rare congenital anomaly that can cause obstructive uropathy. Herein, we report a case of an anterior urethral valve that led to the development of febrile urinary tract infection in a neonate.
Song, Jin Hyun; Lee, Min Ho; Lee, Ji Hye; Lee, Chang Ho; Jeon, Youn Soo; Lee, Nam Kyu
Increased Frequency of Detection of Ureaplasma urealyticum and Mycoplasma genitalium in AIDS Patients without Urethral Symptoms
The roles of Mycoplasma genitalium and Ureaplasma urealyticum in nongonococcal urethritis are not yet well established. The aim of this study was to determine the presence of these microorganisms in the urethral tracts of 187 human immunodeficiency virus type 1 (HIV-1)-infected male patients with no clinical signs of urethritis. The results indicate that the prevalence of M. genitalium and U.
Where Do Patients Go for Treatment of Urethritis?
Background: Urethritis is characterized by urethral inflammation, and it can result from both infectious and noninfectious conditions. Physicians and other health care providers play a critical role in preventing and treating urethritis. Objectives: The aim of this study was to describe and identify predictors of health care seeking behavior among men with urethritis. Patients and Methods: In total, 98 male patients aged between 16 to 52 years-of-age (mean 30.9 � 8.0 years), who attended our clinic with symptoms of urethritis, were included in the study. We conducted face-to-face interviews with the patients using a 9-item survey questionnaire. Patients were divided into three groups according to their level of education as follows: group I (n = 44), elementary school; group II (n = 38), high school; and group III (n = 16), university. Results: Among the 98 patients evaluated, the source of treatment was physicians in 44 patients (44.9%), drugstores in 38 cases (38.77%), and friends in 16 patients (16.32%). There was a statistically significant difference found between the groups according to the source of treatment (P < 0.001). The most common factors associated with seeking care from other sources, rather than physicians, were economic reasons in 19 patients (35.18%), confidentiality concerns in 24 (44.4%), and ease of access in 11 patients (20.37%). Conclusions: A substantial proportion of patients with urethritis sought help from other sources, rather than physicians. The results of our study show that the patients with higher levels of education were more likely to seek help from health care services. It is important to promote the public�s knowledge through informative studies and educational materials in order to encourage patients to seek rapid and effective treatment from proper sources.
Hoscan, Mustafa Burak; Tunckiran, Ahmet; Oksay, Taylan; Ozorak, Alper; Ozkardes, Hakan
The quality of hospital records of urethral catheterisation.
BACKGROUND: This prospective and retrospective study carried out over a period of one month (50 patients) looked at the quality of hospital records of urethral catheterisation with reference to the hospital protocol. The patients were catheterised on general surgical wards as well as in theatre. RESULTS: The quality of hospital records of this procedure was poor and a number of complications noted. CONCLUSIONS: Good documentation of urethral catheterisation would result in a better quality of audit and, therefore, identify potential ways of minimising complications. We recommend this by regular audit of hospital records, re-inforcement of protocols and informed consent of this procedure, with particular reference to theatre.
Conybeare, A.; Pathak, S.; Imam, I.
Anaphylaxis to an urethral lubricant: chlorhexidine as the "hidden" allergen.
We report on a severe allergic reaction during urethral catheterisation, initially erroneously attributed to natural rubber latex (NRL). However, the negative investigations for latex, the uneventful further applications of NRL, the positive skin test and basophil activation test for chlorhexidine strongly support diagnosis of chlorhexidine anaphylaxis. This case illustrates that it is not widely appreciated that "innocent" products such as urethral lubricants may elicit serious life-threatening reactions. Careful inspection of the medical records is once again re-emphasised to be mandatory in order to avert subsequent anaphylaxis. PMID:15819380
Ebo, D G; Bridts, C H; Stevens, W J
Development of an artificial urethral valve using SMA actuators
NASA Astrophysics Data System (ADS)
The development of an artificial urethral valve for the treatment of urinary incontinence which occurs frequently in the aged is described. The prototype urethral valve is assembled in hand-drum form with four thin shape memory alloy (SMA) (nickel - titanium alloy) plates of 0.3 mm thickness. The shape memory effect in two directions is used to replace the urinary canal sphincter muscles and to control the canal opening and closing functions. The characteristic of the SMA is to assume the shape of a circular arc at normal temperatures and a flat shape at higher temperatures. Experiments have been conducted using a canine bladder and urinary canal.
Chonan, S.; Jiang, Z. W.; Tani, J.; Orikasa, S.; Tanahashi, Y.; Takagi, T.; Tanaka, M.; Tanikawa, J.
Suction posterior capsulorhexis.
A technique for creating a posterior capsulorhexis during phacoemulsification is presented. It can be used in cases with posterior capsule tears or opacities. The free edge of the capsule is grasped with suction using a 2 mL syringe and a 27 gauge Rycroft cannula introduced via the paracentesis. The edge is then manipulated to produce a continuous curvilinear opening in the posterior capsule. The combination of a closed eye plus the use of a viscoelastic agent in the anterior chamber and capsular bag minimizes the possibility of vitreous prolapse during the maneuver. Occlusion of the cannula tip by the posterior capsule reduces the risk of vitreous aspiration. In-the-bag intraocular lens implantation is readily achieved. PMID:10476499
Hugkulstone, C E
Dislocation of the Posterior Tibial Tendon: A Literature Review and Presentation of Two Cases
Dislocation of the posterior tibial tendon has rarely been reported in the English literature. The most common mechanism is a traumatic injury. We present two patients with a traumatic dislocation. One patient was delayed in presentation to the treating physician by seven months. The second patient presented within one week. Both underwent surgical stabilization with repair of the torn retinaculum and deepening of the groove posterior to the medial malleolus. They have both returned to their pre-injury level of activity without any recurrence of dislocation.
Goucher, Nicholas R; Coughlin, Michael J; Kristensen, Ronald M
Quantitative Evaluation of Electrodes for External Urethral Sphincter Electromyography during Bladder-to-Urethral Guarding Reflex
Purpose Accuracy in the recording of external urethral sphincter (EUS) electromyography (EMG) is an important goal in the quantitative evaluation of urethral function. This study aim was to quantitatively compare electrode recordings taken during tonic activity and leak point pressure (LPP) testing. Methods Several electrodes, including the surface electrode (SE), concentric electrode (CE), and wire electrode (WE), were placed on the EUS singly and simultaneously in six female Sprague-Dawley rats under urethane anesthesia. The bladder was filled via a retropubic catheter while LPP testing and EUS EMG recording were done. Quantitative baseline correction of the EUS EMG signal was performed to reduce baseline variation. Amplitude and frequency of one-second samples of the EUS EMG signal were measured before LPP (tonic activity) and during peak LPP activity. Results The SE, CE, and WE signals demonstrated tonic activity before LPP and an increase in activity during LPP, suggesting that the electrodes accurately recorded EUS activity during tonic activity and during the bladder-to-EUS guarding reflex, regardless of the size or location of detection areas. SE recordings required significantly less baseline correction than both CE and WE recordings. The activity in CE-recorded EMG was significantly higher than that of the SE and WE both in single and simultaneous recordings. Conclusions These electrodes may be suitable for testing EUS EMG activity. The SE signal had significantly less baseline variation and the CE detected local activity more sensitively than the other electrodes, which may provide insight into choosing an appropriate electrode for EUS EMG recording.
Steward, James E.; Clemons, Jessica D.; Zaszczurynski, Paul J.; Butler, Robert S.; Damaser, Margot S.; Jiang, Hai-Hong
Increased frequency of detection of Ureaplasma urealyticum and Mycoplasma genitalium in AIDS patients without urethral symptoms.
The roles of Mycoplasma genitalium and Ureaplasma urealyticum in nongonococcal urethritis are not yet well established. The aim of this study was to determine the presence of these microorganisms in the urethral tracts of 187 human immunodeficiency virus type 1 (HIV-1)-infected male patients with no clinical signs of urethritis. The results indicate that the prevalence of M. genitalium and U. urealyticum was higher in AIDS patients than in asymptomatic, HIV-1-infected patients and in healthy individuals. The high rate of mycoplasmas and ureaplasmas detected in AIDS patients, in the absence of urethritis, argues against major roles in causing disease at the urethral mucosal level for these microorganisms. PMID:10325375
Martinelli, F; Garrafa, E; Turano, A; Caruso, A
Traumatic hip dislocation in children.
The aim of this study was to evaluate the outcomes of reduction in the treatment of traumatic posterior hip dislocation in children. Data of 22 pediatric patients (22 hips) with traumatic hip dislocation from January 1995 to December 2007 were analyzed. The clinical evaluation focused on symptoms, physical findings, and range of motion. Radiographs identified the type of hip dislocation. The hip dislocation classification was based on Thompson and Epstein. The reduction procedure was performed according to three variants: variant 1, closed reduction; variant 2, release of the adductor longus, lengthening of the psoas tendon, and insertion of a Kirschner wire through the femoral head into the acetabulum; and variant 3, removal of the soft-tissue interposition of the hip. After reduction, radiography was used to determine whether the hip is concentric and to check whether any other injuries might have been caused after manipulation. There were six females (27.3%) and 16 males (72.7%) in this study. All had type I posterior dislocation of the hip. The ages of the patients at diagnosis ranged from 3 years, 2 months to 9 years, 10 months. The reduction procedure was performed according to variant 1 in 16, variant 2 in five, and variant 3 in one. We attained excellent results in eight hips (36.4%), good results in seven hips (31.8%), fair results in four hips (18.2%), and poor results in three hips (13.6%). There was avascular necrosis in three hips (13.6%), coxa magna in two hips (9.1%), deficient limb of 2 cm in two hips (9.1%), and a limp in two hips (9.1%). The hip scores were 82.4 points on average (range 62-100). Children with traumatic hip dislocation should undergo reduction as soon as possible. If the interval from injury to reduction exceeds 3 weeks, we suggest that the surgeon release the adductor longus, lengthen the psoas tendon, and insert a Kirschner wire. This simple and safe surgical procedure results in marked improvement in hip function and prevents complications later. PMID:22751480
Hung, Nguyen Ngoc
[The surgical results in traumatic cataract].
The retrospective analysis of the postoperative course in 204 traumatic cataracts (140 isolated, simple cataracts and 64 aggravated ones) showed an apparent functional improvement in the simple cases (preoperative and postoperative visual acuity 0.0139 and 0.8520, respectively); the incidence of postoperative detachment of retina was of 4.9%, that of postoperative endophthalmitis that of cystoid macular edema of 3.2%; complications more commonly occurred in aggravated traumatic cataracts and partially accounted for the poorer functional results. During the investigated interval (1988-1992) a rapid shift to extracapsular cataract extraction and posterior chamber lens implants was made. The crystalline grafts preserved binocular vision in 92% of the cases and contact lens in 50% of the cases. Lens implant remains a matchless solution for the visual rehabilitation of the patients with aphakia. PMID:7654673
Chiseli??, D; Vancea, P P; Filimon, O; Br?ni?teanu, D; Bredetean, M; Poiata, I
Urethral pseudodiverticulum secondary to penile fracture and complete urethra dissection
A 22-year-old man reported cracking sound and acute pain during sexual intercourse followed by rapid penile detumescence and ecchymosis. He experienced more pain because he could not urinate and had a palpably full bladder. Moreover, his urethra was bleeding. Physical examination revealed swollen, ecchymotic and deviated penis and penis ultrasonography showed an injury of the tunica albuginea and Buck�s fascia with an expanding hematoma. Suprapubic catheter was positioned. Surgical exploration revealed a tear of tunica albuginea of both corpora cavernosa and complete urethral dissection. End-to-end urethral anastomosis and suture of corpora cavernosa lesion were performed. Vescical catheter was mantained for 6 days and suprapubic catheter for 3 months to allow a complete urethral healing. A pseudodiverticulum was found at anastomosis level on the urethrocistography 1 month after surgery. It disappeared by allowing micturition via the suprapubic catheter. The patient presented regular urinary flow and physiological erections 30 days later. In our experience, prompt surgical repair preserved erectile function and keeping the suprapubic catheter protected the urethra; this was the correct management for repairing the urethral lesion.
Di Pierro, Giovanni B.; Iannotta, Luca; Innocenzi, Michele; Caterina, Gulia; Grande, Pietro; Cristini, Cristiano; Gentile, Vincenzo
Urethral Sphincter EMG as Event Detector for Neurogenic Detrusor Overactivity
The aim of this study was to investigate the feasibility of using external urethral sphincter electromyogram (EMG) (EUSEMG) to detect the onset of detrusor contractions in patients with both neurogenic detrusor overactivity (NDO) and detrusor sphincter dyssynergia (DSD). Detrusor pressure (Pdet) and EUSEMG was recorded in 23 neurogenic patients during slow artificial bladder filling. The time delay between the onset
John Hansen; Albert Borau; Alfred Rodr�guez; Joan Vidal; T. Sinkjaer; N. J. M. Rijkhoff
Urethral function after cystectomy: a canine in vivo experiment
To study the function of the pelvic floor and the isolated urethra after removal of the bladder, 5 male and 5 female mongrel dogs were used in an acute in vivo experiment. Urethral pressure changes secondary to unilateral stimulation of the pelvic and pudendal nerves were recorded. After baseline data of the intact system were documented, the following procedures were
Wilhelm A. Hiibner; Flavio Trigo-Rocha; Eugen G. Plas; Emil A. Tanagho
Outcome of urethral strictures treated by endoscopic urethrotomy and urethroplasty
Introduction: We analyze the outcomes of patients with urethral stricture who underwent surgical treatment within the past 5 years. Methods: This is a retrospective study of male patients who underwent surgery for urethral stricture at our service from January 2008 to June 2012. We analyzed the comorbidities, type, length and location of the stricture and the surgical treatment outcome after endoscopic urethrotomy, urethroplasty or both. Results: In total, 45 patients with a mean age of 53.7 � 16.7 years underwent surgical treatment for urethral stricture. Six months after surgery, 46.7% of the patients had a maximum urinary flow greater than 15 mL/s, whereas 87.3% of the patients exhibited no stricture by urethrography after the treatment. The success rate in the patients undergoing urethrotomy was 47.8% versus 86.4% in those undergoing urethroplasty (p = 0.01). Twenty percent of the patients in whom the initial urethrotomy had failed subsequently underwent urethroplasty, thereby increasing the treatment success. Conclusion: In most cases, the treatment of choice for urethral stricture should be urethroplasty. Previous treatment with urethrotomy does not appear to produce adverse effects that affect the outcome of a urethroplasty if urethrotomy failed, so urethrotomy may be indicated in patients with short strictures or in patients at high surgical risk.
Tinaut-Ranera, Javier; Arrabal-Polo, Miguel Angel; Merino-Salas, Sergio; Nogueras-Ocana, Mercedes; Lopez-Leon, Victor Manuel; Palao-Yago, Francisco; Arrabal-Martin, Miguel; Lahoz-Garcia, Clara; Alaminos, Miguel; Zuluaga-Gomez, Armando
Posterior nutcracker syndrome.
Renal vein compression syndromes are rare causes of hematuria and can be divided into anterior and posterior nutcracker syndrome. When the left renal vein is compressed between the aorta and the superior mesenteric artery it causes anterior nutcracker syndrome. The posterior nutcracker syndrome is very rare and is considered when the left renal vein is compressed between the aorta and vertebral column. Symptoms of nutcracker syndromes may include intermittent left flank pain associated with hematuria, proteinuria, and sometimes with symptoms of pelvic congestion. Diagnosis is often difficult and plan for treatment is always challenging and requires careful evaluation of the patient's history and workup findings. We present a rare case report of a posterior nutcracker syndrome diagnosed in a young lady with long-standing symptoms that required surgical intervention. PMID:21890560
Skeik, Nedaa; Gloviczki, Peter; Macedo, Thanila A
NSDL National Science Digital Library
Very concise description of what constitutes a traumatic brain injury and the cost to society in hospitalizations, injuries and deaths resulting from traumatic brain injury. It also looks very concisely at new understandings of the nature of TBIs and the research being done to find better treatments.
Dr. Leslie Nader (MSMR)
Association of Mycoplasma genitalium with acute non-gonococcal urethritis in Russian men: a comparison with gonococcal and chlamydial urethritis.
Urethral specimens from 172 men who attended sexually transmitted disease clinics in the Moscow Oblast were examined for Neisseria gonorrhoeae, Chlamydia trachomatis and Mycoplasma genitalium by nucleic acid amplification tests. N. gonorrhoeae was detected in the urethra of 41 (24%) of the 172 men and C. trachomatis in 57 (33%). The latter occurred in 15 (36%) of the 41 men who were infected by N. gonorrhoeae and in 42 (32%) of 131 uninfected by gonococci. Of the 42 men uninfected by gonococci but chlamydia infected, 39 (93%) had symptoms and/or signs of urethritis. M. genitalium was detected in 45 (26%) of the 172 men, in nine (22%) of the 41 men infected with N. gonorrhoeae and in 12 (21%) infected with C. trachomatis. M. genitalium was detected alone in 25 (28%) of the 89 men uninfected by either gonococci or C. trachomatis. Of these 25 men, 24 (96%) had urethral symptoms and signs of inflammation, a proportion significantly more than experienced by the 64 men uninfected by any of the microorganisms. Of the 31 men who apparently had no symptoms or signs of urethritis, only three (10%) were infected by M. genitalium. The data provide evidence for the pathogenicity and frequent occurrence of M. genitalium in men in Moscow and presumably elsewhere in Russia. PMID:19304966
Taylor-Robinson, D; Renton, A; Jensen, J S; Ison, C A; Filatova, E; Dmitriev, G; Akovbian, V
Posterior Cruciate Ligament Injuries
... but is still able to help keep the knee joint stable. Grade 2 Sprains. A Grade 2 Sprain stretches the ligament to ... the ligament. Grade 3 Sprains. This type of sprain is most commonly ... and the knee joint is unstable. Posterior cruciate ligament tears tend ...
Posterior Cranial Fossa Meningiomas*
This study evaluated the outcomes, complications, and recurrence rates of posterior cranial fossa meningiomas. We retrospectively reviewed our surgical experience with 64 posterior cranial fossa meningiomas. Mean age was 56 years with a female preponderance (67.2%). Headache was the most common symptom. Retrosigmoid approach was the commonest surgical procedure (23.4%). The incidence of cranial nerve related complications was 28%. Postoperatively facial nerve weakness was observed in 11%. The incidence of cerebrospinal fluid leak was 4.6%. Gross total resection was achieved in 37 patients (58%). Sixteen patients (25%) with residual tumors underwent Gamma knife radiosurgery. Recurrence or tumor progression was observed in 12 patients (18.7%). Operative mortality was 3.1%. At their last follow-up, 93% of the cases achieved Glasgow Outcome Scale scores 4 or 5. Total excision is the ideal goal which can be achieved with meningiomas located in certain location, such as lateral convexity, but for other posterior fossa meningiomas the close proximity of critical structures is a major obstacle in achieving this goal. In practicality, a balance between good functional outcome and extent of resection is important for posterior cranial fossa meningiomas in proximity to critical structures.
Javalkar, Vijayakumar; Banerjee, Anirban Deep; Nanda, Anil
Approximate Posterior Distributions
This paper proposes the use of approximate posterior distributions resulting from operational prior distributions chosen with regard to the realized likelihood function. L.J. Savage's �precise measurement� is generalized for approximation in terms of an arbitrary operational prior density, including mixed-type prior distributions with positive probabilities on singular subsets. A new approximation is also given relating such distributions to absolutely continuous
James M. Dickey
We present a method to compute the conditional distribution of a statistical shape model given partial data. The result is a "posterior shape model", which is again a statistical shape model of the same form as the original model. This allows its direct use in the variety of algorithms that include prior knowledge about the variability of a class of shapes with a statistical shape model. Posterior shape models then provide a statistically sound yet easy method to integrate partial data into these algorithms. Usually, shape models represent a complete organ, for instance in our experiments the femur bone, modeled by a multivariate normal distribution. But because in many application certain parts of the shape are known a priori, it is of great interest to model the posterior distribution of the whole shape given the known parts. These could be isolated landmark points or larger portions of the shape, like the healthy part of a pathological or damaged organ. However, because for most shape models the dimensionality of the data is much higher than the number of examples, the normal distribution is singular, and the conditional distribution not readily available. In this paper, we present two main contributions: First, we show how the posterior model can be efficiently computed as a statistical shape model in standard form and used in any shape model algorithm. We complement this paper with a freely available implementation of our algorithms. Second, we show that most common approaches put forth in the literature to overcome this are equivalent to probabilistic principal component analysis (PPCA), and Gaussian Process regression. To illustrate the use of posterior shape models, we apply them on two problems from medical image analysis: model-based image segmentation incorporating prior knowledge from landmarks, and the prediction of anatomically correct knee shapes for trochlear dysplasia patients, which constitutes a novel medical application. Our experiments confirm that the use of conditional shape models for image segmentation improves the overall segmentation accuracy and robustness. PMID:23837968
Albrecht, Thomas; L�thi, Marcel; Gerig, Thomas; Vetter, Thomas
Posterior microphthalmos pigmentary retinopathy syndrome.
Posterior Microphthalmos Pigmentary Retinopathy Syndrome (PMPRS). Posterior microphthalmos (PM) is a relatively infrequent type of microphthalmos where posterior segment is predominantly affected with normal anterior segment measurements. Herein, we report two siblings with posterior microphthalmos retinopathy syndrome with postulated autosomal recessive mode of inheritance. A 13-year-old child had PM and retinitis pigmentosa (RP) and his 7-year-old sister had PM, RP, and foveoschisis. The genetics of this syndrome and variable phenotype is discussed. Importance of being aware of posterior microphthalmos and its posterior segment associations is highlighted. PMID:21416382
Pehere, Niranjan; Jalali, Subhadra; Deshmukh, Himanshu; Kannabiran, Chitra
Primary anastomosis of the traumatically amputated penis.
Penile amputation is an uncommon condition for which immediate surgical replantation is warranted. This work aimed to represent intervention and management for an amputated penis by replantation and reconstruction. A 23-year-old man presented with traumatic penile amputation for 2 h where the penile proximal part was 1 cm far from the pubis. Replantation included end-to-end anastomosis of the urethral mucosa over a catheter, approximation of the corpus cavernosum and tunica albuginea, anastomosis of the deep dorsal vein, dorsal nerve, both dorsal arteries and superficial dorsal vein. At day 5 post-operatively, the replanted penis had preserved capillary filling. The catheter was removed at day 11, where the patient urinated smoothly. The preliminary cosmetic appearance was satisfactory with frequent morning erection, reported night emission twice within the first month post-operatively. Sensation was preserved in the distal anastomosed stump. It is concluded that meticulous microsurgical technique decreases the possibility of skin loss and increases the chance of erectile function. PMID:19601940
Salem, H K; Mostafa, T
Urethral Erosion and Perineal Cellulitis after Midurethral Sling Procedure
Midurethral tension-free sling procedure has become one of the most popular techniques for the treatment of stress urinary incontinence. As the time elapsed, however, complications associated with a synthetic tape have been reported to occur. Recently, we experienced a rare case of urethral erosion with perineal cellulitis at anterior wall of vagina after midurethral sling procedure. So our experience was presented with a review of literature.
Kim, Jong Min; Bae, Jang Ho; Song, Phil Hyun; Shin, Esther
Forensic implications in self-insertion of urethral foreign bodies
A 54-year-old Caucasian male presented to our emergency department because he had self inserted a transparent plastic and flexible tube into the urethral meatus, during erotic games. A plain pelvic x-ray film and an abdominal ultrasound were executed to determine the size, shape, orientation and location of the foreign body, and any eventually associated visceral injuries or complications. As results,
R. Boscolo-Berto; M. Iafrate; G. Viel
Urethral erosion of tension-free vaginal tape
Tension-free vaginal tape (TVT) is gaining popularity as a treatment of choice for women with stress urinary incontinence. It is a minimally invasive procedure with reported short operative and postoperative hospitalization times and low complication rates. We describe urethral erosion of a TVT sling material in a 55-year-old woman who presented with immediate postoperative urinary retention. The sling material was
Shahar Madjar; Marie-Blanche Tchetgen; Amy Van Antwerp; Joseph Abdelmalak; Raymond R Rackley
Nitinol urethral stents: long-term results in dogs
No information has been available to date on the long-term behavior of nitinol (nickel-titanium alloy) urethral stents. In the present study, prostheses of this type were implanted in 18 German shepherd dogs in order to evaluate the reaction of the mucosa, muscles and periurethral tissue. Follow-up examinations performed after 1 week, and 1, 3, 6, 12 and 18 months included
D. Latal; J. Mraz; P. Zerhau; M. Susani; M. Marberger
Relationship of Ureaplasma urealyticum Biovar 2 to Nongonococcal Urethritis
. ��The aim of this study was to determine the frequency of Ureaplasma urealyticum biovars 1 and 2 among 340 men with or without nongonococcal urethritis (NGU) attending a venereal disease clinic in Sweden.\\u000a NGU was defined by the presence of at least four polymorphonuclear leukocytes per microscopic field (�1,000 magnification)\\u000a on a smear in which Neisseria gonorrhoeae could not
K. Povlsen; E. Bj�rnelius; P. Lidbrink; I. Lind
Epidemiology, Etiology, Histology, Classification, and Economic Impact of Urethral Stricture Disease
\\u000a Urethral stricture is a common urologic problem, with the highest prevalence in underdeveloped countries. Urethral strictures\\u000a have a significant economic impact and burden. Economics and resource availability can influence stricture treatment. Detailed\\u000a here-in is the epidemiology of anterior urethral strictures as to demographics, incidence, and signs and symptoms. Histology\\u000a and pathology are addressed; in particular, the fibrotic process of spongiofibrosis
Steven B. Brandes
Spinal osteotomies to treat post-traumatic thoracolumbar deformity.
Fractures of the thoracolumbar junction can lead to regional kyphosis, this being a significant cause of pain and disability for the patients. After a traumatic fracture of the thoracolumbar spine, early or late regional kyphosis can be observed. This post-traumatic deformity can, however, be corrected with appropriate surgical methods. Posterior tricolumnar osteotomies are some of the most powerful methods of correction and are particularly indicated when sagittal and coronal deformities have to be simultaneously corrected or when anterior surgery is not possible. Anterior corpectomy and lengthening with posterior instrumentation are, however, an alternative technique to restore the anterior column support and to correct the regional kyphotic deformity and an option for appropriate sagittal balance restoration and control of symptoms. Proper surgical technique, evaluation of the bone quality and identification of eventual extension of the deformity to the thoracic spine are key aspects in prevention of failures. PMID:24770652
Cecchinato, R; Berjano, P; Damilano, M; Lamartina, C
Diseases of the vitreous, fundus and optic nerve are described and illustrated according to their ophthalmological appearance. Vitreal alterations are commonly of developmental, degenerative, age related, traumatic or inflammatory origin and of minor clinical relevance. In contrast, those affecting the fundus, may be accompanied by visual deficits or blindness. Fundic lesions of inflammatory (multifocal or peripapillary chorioretinitis, haemorrhage, retinal detachment) and traumatic origin have to be differentiated from congenital (congenital stationary night blindness, colobomatous defects, retinal dysplasia), degenerative (cystic retinal degeneration), metabolic (equine motor neuron disease), neoplastic and age related alterations (senile retinopathy). Inflammation (acute neurochorioretinitis) and ischaemia (ischaemic neuro-chorioretinopathy) involving the optic nerve will lead to blindness. The optic disc can be aplastic/hypoplastic or excavated due to coloboma or glaucoma, affected by ligation of the carotid and palatine arteries. Optic disc masses may arise due to inflammation, severe systemic haemorrhage, neoplasia or trauma. Lesions of the retrobulbar optic nerve can be caused by Borna virus infection, fungal granuloma, toxic insult, halicephalobiasis, trauma, severe blood loss and infection of the sphenopalatine sinus. PMID:20939170
Nell, B; Walde, I
Posterior fossa arachnoid cysts.
Arachnoid cysts of the posterior fossa are rare lesions that are considered to be mostly congenital in origin. In this article, we retrospectively review 12 patients who underwent surgical treatment for their symptomatic posterior fossa arachnoid cysts. The most common presenting symptoms were gait disturbances and headache. The diagnosis was established on computed tomography or magnetic resonance imaging. Surgery consisted of cyst wall excision with fenestration in nine cases and shunting procedures in three cases. In all cases except one who-died, the postsurgical follow-up neuroradiological investigations showed that the cysts had decreased in size, the cerebellum had re-expanded, and if there was preoperative hydrocephalus, the ventricular size was decreased. The follow-up period ranged from 1 to 11 years. All surviving cases are free of symptoms and no arachnoid cysts recurred. The classification, pathophysiology, differential diagnosis and surgical treatment of infratentorial arachnoid cysts are discussed and the relevant literature is reviewed. PMID:10492679
Erdin�ler, P; Kaynar, M Y; Bozkus, H; Ciplak, N
Diagnosis and therapy of the female urethral diverticula.
The various diagnostic and therapeutic modalities currently in use for urethral diverticula are reviewed. Various radiographic techniques have been reported, but only voiding cystourethrography (VCUG) and positive-pressure urethrography (PPU) are currently utilized. Urethroscopy is another suitable technique for diagnosis. Various sonographic techniques have been proposed, but their sensitivity is improved only by the transvaginal approach and magnetic resonance imaging (MRI). Various treatment methods have been proposed. The standard operative approach is surgical, through the vagina. The techniques currently in use to treat urethral diverticula are the Spence procedure, the typical urethral diverticulectomy, and the Tancer partial ablation technique. A full history, and physical examination is the first step in screening. When the diagnosis is suspected ultrasound and radiological imaging is necessary. Sonography is the first non-invasive examination to be performed. In negative cases it is imperative to perform a PPU or MRI. Symptomatic and very large diverticula must be treated in the easiest way possible. The best treatment, except for complicated and infected diverticula, is excision. PMID:11294533
Fortunato, P; Schettini, M; Gallucci, M
Syndromic management of urethral discharge in Ghanaian pharmacies
Objectives: To evaluate the training of pharmacists in Accra, Ghana, in the syndromic management of STIs. Methods: We randomly selected 50 pharmacy outlets that had received the training (intervention) and 50 outlets that had not received the training (no intervention). Simulated clients described the symptoms of urethral discharge to the first pharmacy staff encountered and completed a standardised questionnaire after each encounter. Results: Correct drug provision for urethral discharge improved with the educational intervention but remained relatively low (no intervention 18%; intervention 39%; p <0.05). More encouraging, treatment for gonorrhoea was usually correct without the intervention (64%) and improved further in the intervention outlets (76%). The treatment for chlamydia was less often appropriate but also improved (31% and 41%). Condom promotion was poor, with almost no outlets offering condoms. Conclusions: The current training led to improvements in the treatment of urethral discharge. Future training needs to be improved, especially with regard to condom promotion. Moreover, since less than one third of simulated clients were seen by pharmacists, the training should be expanded to other pharmacy staff. With enhanced training of all pharmacy staff, the role of pharmacy outlets in STI management and prevention in Ghana and elsewhere can be optimised. Key Words: pharmacists; sexually transmitted infections; syndromic management
Adu-Sarkodie, Y; Steiner, M; Attafuah, J; Tweedy, K
Feasibility of a computerized male urethral catheterization simulator.
Catheterization of the male urethra might cause harm and discomfort for the patient. Computer-based simulator training might improve the skills of students as well as professional nurses. This study aims to study the feasibility of a new portable computer-based male urethral catheterization simulator, Urecath (Melerit Urecath Vision). The simulator consists of three software modules: teaching (explains the different procedures in the catheterization), learning (game settings with practice and self-assessments tests), and simulator module that is connected to a box with a model of a penis where syringes and the urinary catheter can be inserted. Registered nurses (n=23), nurse assistants (n=14), nurse students (n=12), and a nurse assistant student (n=1) participated in a simulation session and answered 30 questions about the feasibility of the simulator. The participants appreciated the different modules, particularly the teaching and learning modules. The simulator module was appreciated for its cross-sectional views and feedback but was found to lack a tactile component; there was too little and no varying resistance when inserting the catheter. The participants perceived the present prototype of Urecath as a valuable education tool. The male urethral catheterization simulator prototype Urecath has advantages in its present shape but to be an alternative to existing training options for practicing male urethral catheterization, it should be complemented with a tactile mode and degrees of difficulty. PMID:19443272
J�ud, Anna; Sandholm, Anders; Alseby, Lola; Petersson, G�ran; Nilsson, Gunilla
Acute injuries of the Achilles tendon are common among athletes and non-athletes alike. Injuries of other posterior calf muscles are far less common but should be considered in the differential, to ensure proper diagnosis and treatment of patients with calf injuries. This article focuses on these calf injuries, including injuries of the gastrocnemius, plantaris, soleus, and flexor hallucis longus, which may occasionally be mistaken for Achilles tendon disorders. PMID:19857847
Campbell, John T
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Traumatic lumbar hernia: can't afford to miss.
We describe the radiological and surgical correlation of an uncommon case of a traumatic lumbar hernia in a 22-year-old man presenting to the emergency department following a motor vehicle accident. Computed tomography (CT) of the abdomen revealed a right-sided traumatic inferior lumbar hernia containing a small amount of fat through the posterior lateral internal oblique muscle with hematoma in the subcutaneous fat and adjacent abdominal wall musculature, which was repaired surgically via primary closure on emergent basis. The purpose of this article is to emphasize the importance of diagnosing traumatic lumbar hernia on CT and need for urgent repair to avoid potential complications of bowel incarceration and strangulation. PMID:24424984
Saboo, Sachin S; Khurana, Bharti; Desai, Naman; Juan, Yu-Hsiang; Landman, Wendy; Sodickson, Aaron; Gates, Jonathan
The posterior Monteggia lesion.
Thirteen posterior Monteggia fracture-dislocations in adults were treated surgically at the Massachusetts General Hospital from 1980 to 1988. A characteristic lesion was observed, consisting of a proximal ulna fracture with a triangular or quandrangular fracture at or near the level of the coronoid, a posterior or posterolateral radiocapitellar dislocation, and, in 10 cases, a radial head fracture. Nine patients were women and four were men, with an average age of 56 years. Following reduction of the radiocapitellar dislocation, the ulnar fractures were treated with plates in each case. Seven fractured radial heads were excised, one replaced with a silicone prosthesis, and three treated by open reduction and internal fixation. The 11 surviving patients were observed using the performance index of Broberg and Morrey at an average follow-up time of 38.4 months. The conditions of three were rated excellent, three good, four fair, and one poor. Incomplete reduction of the ulnar fracture with residual posterior radiocapitellar subluxation was observed in four cases, all leading to loss of forearm supination. We believe this lesion to be more common than previously reported. Recognition of its specific anatomic features is essential to achieve a functional outcome. PMID:1761999
Jupiter, J B; Leibovic, S J; Ribbans, W; Wilk, R M
Acute urinary retention in women due to urethral calculi: A rare case.
We present a case of a 51-year-old woman with acute urinary retention caused by a urethral calculus. Urethral calculi in women are extremely rare and are usually formed in association with underlying genitourinary pathology. In this case, however, no pathology was detected via thorough urological evaluation. We discuss the pathogenesis, clinical presentation and treatment of urethral calculi. To our knowledge, this is the second reported case of a primary urethral calculus in a female with an anatomically normal urinary tract and the first in a middle-aged Caucasian female. PMID:24554984
Turo, Rafal; Smolski, Michal; Kujawa, Magda; Brown, Stephen C W; Brough, Richard; Collins, Gerald N
Female urethral diverticulum presenting with acute urinary retention: Reporting the largest diverticulum with review of literature
Female urethral diverticulum is a rare entity with diverse spectrum of clinical manifestations. It is a very rare cause of bladder outlet obstruction and should be considered as a differential diagnosis in females presenting with acute urinary retention associated with a vaginal mass. Strong clinical suspicion combined with thorough physical examination and focused radiological investigations are vital for its diagnosis. Herein we report a case of giant urethral diverticulum presenting with acute urinary retention in a young female. It was managed by excision and urethral closure, and is the largest urethral diverticulum reported till date in the literature.
Pradhan, Manas Ranjan; Ranjan, Priyadarshi; Kapoor, Rakesh
Acute urinary retention in women due to urethral calculi: A rare case
We present a case of a 51-year-old woman with acute urinary retention caused by a urethral calculus. Urethral calculi in women are extremely rare and are usually formed in association with underlying genitourinary pathology. In this case, however, no pathology was detected via thorough urological evaluation. We discuss the pathogenesis, clinical presentation and treatment of urethral calculi. To our knowledge, this is the second reported case of a primary urethral calculus in a female with an anatomically normal urinary tract and the first in a middle-aged Caucasian female.
Turo, Rafal; Smolski, Michal; Kujawa, Magda; Brown, Stephen C.W.; Brough, Richard; Collins, Gerald N.
Uncontrolled epistaxis secondary to traumatic pseudoaneurysm of the maxillary artery.
We describe a rare case of traumatic pseudoaneurysm of the maxillary artery following a fall. The patient presented with epistaxis that could not be controlled with anterior and posterior nasal packing. She was urgently taken to the angiography suite for evaluation and ultimately underwent embolization of a left maxillary artery pseudoaneurysm with 500-700?micron Contour PVA followed by coiling with two 3?mm Tornado coils. Bleeding subsided after embolization, and the patient suffered no neurologic sequelae. PMID:22937363
Adil, Eelam; Setabutr, Dhave; Carr, Michele M
Acute traumatic cervical cord injury in patients with os odontoideum.
We retrospectively reviewed acute cervical cord injury after minor trauma in 10 patients with os odontoideum. Their clinical history, neurological symptoms, radiological investigations, follow-up period, American Spinal Injury Association impairment classification and motor score were reviewed. Before their traumatic injury, three patients were asymptomatic and seven reported myelopathic symptoms, including four patients with neck pain, two patients with unsteadiness and one patient with dizziness. Falls were the most common cause of injury (n=6), followed by minor motor vehicle accidents (n=3) and assault (n=1). MRI and dynamic cervical lateral radiographs showed that all patients had atlantoaxial instability and cord compression. Most patients had spinal cord thinning and hyperintensity on T2-weighted MRI. Spinal cord compression was posterior (n=5), or both anterior and posterior (n=5). All patients underwent posterior rigid screw fixation and fusion, including atlantoaxial fusion (n=8) and occipitocervical fusion (n=2). We conclude that patients with asymptomatic or myelopathic atlantoaxial instability secondary to os odontoideum are at risk for acute spinal cord injury after minor traumatic injury. Fixation and fusion should be undertaken as prophylactic treatment for patients at risk of developing myelopathy and to avoid the neurological deterioration associated with acute traumatic cervical cord injury. PMID:20655229
Zhang, Zhengfeng; Zhou, Yue; Wang, Jian; Chu, Tongwei; Li, Changqing; Ren, Xianjun; Wang, Weidong
Traumatic Alterations in Consciousness: Traumatic Brain Injury
Mild traumatic brain injury (mTBI) refers to the clinical condition of transient alteration of consciousness as a result of traumatic injury to the brain. The priority of emergency care is to identify and facilitate the treatment of rare but potentially life threatening intra-cranial injuries associated with mTBI through the judicious application of appropriate imaging studies and neurosurgical consultation. Although post-mTBI symptoms quickly and completely resolve in the vast majority of cases, a significant number of patients will complain of lasting problems that may cause significant disability. Simple and early interventions such as patient education and appropriate referral can reduce the likelihood of chronic symptoms. Although definitive evidence is lacking, mTBI is likely to be related to significant long-term sequelae such as Alzheimer's disease and other neurodegenerative processes.
Blyth, Brian J.; Bazarian, Jeffrey J.
Traumatic Brain Injury and Dystonia
Traumatic brain injury (TBI) occurs when a sudden trauma damages to the brain. TBI can occur when the head suddenly ... between dystonia and TBI is urgently needed. Traumatic Brain Injury & Dystonia Diagnosis & Treatment � TBI may involve physical, cognitive, ...
The Traumatic Brain Injury National Data Center (TBINDC) at Kessler Medical Rehabilitation Research and Education Center is the coordinating center for the research and dissemination efforts of the Traumatic Brain Injury Model Systems (TBIMS) program funded by the National Instit...
Posterior cortical atrophy (PCA) is a neurodegenerative syndrome that is characterized by a progressive decline in visuospatial, visuoperceptual, literacy and praxic skills. The progressive neurodegeneration affecting parietal, occipital and occipito-temporal cortices which underlies PCA is attributable to Alzheimer's disease (AD) in the majority of patients. However, alternative underlying aetiologies including Dementia with Lewy Bodies (DLB), corticobasal degeneration (CBD) and prion disease have also been identified, and not all PCA patients have atrophy on clinical imaging. This heterogeneity has led to diagnostic and terminological inconsistencies, caused difficulty comparing studies from different centres, and limited the generalizability of clinical trials and investigations of factors driving phenotypic variability. Significant challenges remain in identifying the factors associated with both the selective vulnerability of posterior cortical regions and the young age of onset seen in PCA. Greater awareness of the syndrome and agreement over the correspondence between syndrome-and disease-level classifications are required in order to improve diagnostic accuracy, research study design and clinical management.
Crutch, Sebastian J; Lehmann, Manja; Schott, Jonathan M; Rabinovici, Gil D; Rossor, Martin N; Fox, Nick C
Etiology of urethral discharge in West Africa: the role of Mycoplasma genitalium and Trichomonas vaginalis.
OBJECTIVE: To determine the etiological role of pathogens other than Neisseria gonorrhoeae and Chlamydia trachomatis in urethral discharge in West African men. METHODS: Urethral swabs were obtained from 659 male patients presenting with urethral discharge in 72 primary health care facilities in seven West African countries, and in 339 controls presenting for complaints unrelated to the genitourinary tract. Polymerase chain reaction analysis was used to detect the presence of N. gonorrhoeae, C. trachomatis, Trichomonas vaginalis, Mycoplasma genitalium, and Ureaplasma urealyticum. FINDINGS: N. gonorrhoeae, T. vaginalis, C. trachomatis, and M. genitalium--but not U. urealyticum--were found more frequently in men with urethral discharge than in asymptomatic controls, being present in 61.9%, 13.8%, 13.4% and 10.0%, respectively, of cases of urethral discharge. Multiple infections were common. Among patients with gonococcal infection, T. vaginalis was as frequent a coinfection as C. trachomatis. M. genitalium, T. vaginalis, and C. trachomatis caused a similar clinical syndrome to that associated with gonococcal infection, but with a less severe urethral discharge. CONCLUSIONS: M. genitalium and T. vaginalis are important etiological agents of urethral discharge in West Africa. The frequent occurrence of multiple infections with any combination of four pathogens strongly supports the syndromic approach. The optimal use of metronidazole in flowcharts for the syndromic management of urethral discharge needs to be explored in therapeutic trials.
Pepin, J.; Sobela, F.; Deslandes, S.; Alary, M.; Wegner, K.; Khonde, N.; Kintin, F.; Kamuragiye, A.; Sylla, M.; Zerbo, P. J.; Baganizi, E.; Kone, A.; Kane, F.; Masse, B.; Viens, P.; Frost, E.
Extended Posterior Circumferential Approach to Thoracic and Thoracolumbar Spine
\\u000a Abstract\\u000a \\u000a \\u000a Objective\\u000a ��Posterior spinal surgical approach to achieve a retropleural\\/ retroperitoneal corpectomy with circumferential spinal cord\\u000a decompression following subtotal vertebrectomy, posterior instrumentation and interbody spacer placement under compression\\u000a as well as kyphosis correction with spinal column shortening.\\u000a \\u000a \\u000a \\u000a \\u000a Indications\\u000a ��Infective, traumatic or neoplastic lesions of the vertebral body that lead to vertebral body destruction, instability and\\u000a neurologic deficit.\\u000a \\u000a Need for immediate
Gabriel D. Sundararaj; Krishnan Venkatesh; Parasa Narendra Babu; Rohit Amritanand
Treatment of Low-Grade Bulbar Transitional Cell Carcinoma with Urethral Instillation of Mitomycin C
A 63-year old man was referred to us after three rapid recurrences of low-grade urethral papillary transitional cell carcinoma of the bulbar urethra, after repeated primary excision. Cystoscopy confirmed 3-4 low-grade urethral transitional cell carcinomas, which were subsequently fulgurated. After urethral healing, a solution of Mitomycin C (40 mg/80 cc) was instilled into the urethra for fifteen minutes and held in place with a penile clamp. Urethral instillations were repeated weekly for six weeks. The patient is currently disease-free more than one year and three months posttreatment. This case highlights the successful treatment of urethral carcinoma with topical chemotherapy, which is usually reserved for the bladder, using a slight modification of standard technique.
Melonakos, Emmanuel J.; Santucci, Richard A.
Squamous cell carcinoma on top of urethral stricture: case report and review of the literature
Introduction: Urethral stricture is a common urological condition, resulting from trauma or venereal infections. The aim of our study was to report a rare case of squamous cell carcinoma of the penis and pseudoepitheliomatous hyperplasia (PEH) of scrotal skin, on top of repeatedly managed urethral stricture which was of unknown aetiology. Methods: A Medline search of publications studying the association of urethral stricture with penile cancer was done. Results: Two case reports were identified that described two occurrences, which were separated by a few months. Conclusion: Repeated management of urethral stricture with visual urethrotomy or urethral dilation may result in a chronic inflammatory status, predisposing to PEH and squamous cell carcinoma of the genital organs.
Kotb, Ahmed Fouad; Attia, Doaa; Ismail, Asmaa Mohamed; Elabbady, Ahmed
Use of a urine enzyme immunoassay as a diagnostic tool for Chlamydia trachomatis urethritis in men.
We collected first-voided urine specimens from 659 males attending a sexually transmitted disease clinic and performed both enzyme immunoassay (EIA) for detection of chlamydial antigen and leukocyte esterase testing on these urine samples. The overall prevalence of chlamydial urethritis in the study population as determined by culture of urethral swabs was 11%. However, 46% of all men in the study had no symptoms of urethritis. Compared with urethral cultures for chlamydiae, the urine EIA had a sensitivity of 42% and a specificity of 99%. The sensitivity of the EIA strongly correlated with the amount of antigen present in culture as assessed by numbers of inclusion-forming units. The sensitivity of the leukocyte esterase test compared with that of chlamydia culture was 88%. We conclude that in this population of men, which included many patients without symptoms of urethritis, the urine EIA was a relatively insensitive means of screening for chlamydial infection.
Schwebke, J R; Clark, A M; Pettinger, M B; Nsubga, P; Stamm, W E
Three Distinct Urethral Fistulae 35 Years After Pelvic Radiation
Introduction: While the development of fistulae is a well-known complication of radiotherapy, such fistulae can often be challenging to manage. Case Presentation: We describe the case of a 37 year old male who developed in succession a urethrocutaneous fistula to the thigh, a rectourethral fistula and a peritoneo-urethral fistula 35 years after radiotherapy for pediatric pelvic rhabdomyosarcoma. These complications were managed successfully after multiple surgical procedures. Discussion: We subsequently discuss the different approaches currently employed for the management of radiation induced urinary fistulas and describe the rationale behind our approach towards their surgical management.
Sharma, Arindam; Kurtz, Michael P.; Eswara, Jairam R.
Scanning electron microscopical examination of gonococcal urethral exudate.
The relationship of gonococci and phagocytes in gonococcal urethral exudate was examined using a scanning electron microscope. Several stages in the phagocytic process were evident. These included pseudopodias, microvilli, and simple attachment of gonococci to phagocytic surfaces. Epithelial cells, also a part of the exudate, were examined in this study. Parallels are drawn between this and other phagocytic systems. The technique provides excellent preservation of phagocyte-bacterial interrelationships and offers a means of investigating the nature of the resistance of Neisseria gonorrhoeae to phagocytosis. Images
Klein, R D; Roth, I L; McCullough, H S
[Traumatic and occupational deafness].
The frequency of accidental, traumatic hearing loss is increasing due to a sometimes violently noisy environment and to the development of sports as leisure activities. The diagnosis is based on knowledge of the circumstances of the trauma and on otoscopic examination. Total audiometry localises the damage. Occupational hearing loss forms a special subset of traumatic deafness. This trauma is usually due to intense noise occurring at the work-place. It is of insidious onset, irreversibly progressive and without treatment once under way; Prevention is based on knowledge of the deleterious effects of noise and on the individual factors of the subject at risk. PMID:10737087
Poncet, J L; Kossowski, M; Verdaille, P
One-stage dorsal inlay oral mucosa graft urethroplasty for anterior urethral stricture
Background Anterior urethral stricture remains a great challenge. We reported our clinical technique and results by using inlay dorsal buccal mucosal graft urethroplasty for repair of anterior urethral stricture. Methods From January 2005 to July 2008, 87 male patients (range from 9 to 72�years old) with anterior urethral stricture have been treated by one-stage dorsal inlay oral mucosal graft (OMG) urethroplasty. All patients gave written informed consent for their participation. All patients showed that urethral plate had been either scarred or removed previously. In our surgery, the urethra was dissected dorsally and scar of the urethral plate was removed. The remnant urethral plate was split at midline and a buccal mucosa patch was inserted between the two parts. Neourethra was tubularized and covered with dartos flap. The pre-operative assessments included clinical data, urine analysis, uroflowmetry, retrograde and voiding cystogram, urethral ultrasonography and endoscopy. Postoperatively, the flow rate and void residual volume were analyzed by uroflowmetry and sonography. Any further instrumentation to assist voiding was considered as failure. Results After 12 to 48�months (mean: 25.8�months), 78 patients (89.66%) have shown good results by the one-stage urethroplasty. However, 9 patients (10.3%) required further treatment due to recurrence, while 6 patients (6.9%) had fistula. Conclusions This one-stage dorsal inlay approach using dorsal oral mucosal grafts is a reliable method to create a substitute urethral plate for tubularization. This approach represents a safe option for anterior urethral stricture patients especially with grossly scarred urethral plate.
Early Experience With a Thermo-Expandable Stent (Memokath) for the Management of Recurrent Urethral Stricture
Purpose To report our early experience with thermo-expandable urethral stents (Memokath) for the management of recurrent urethral stricture and to assess the efficacy of urethral stents. Materials and Methods Between March 2012 and February 2013, 13 patients with recurrent urethral stricture after several attempts with direct visual internal urethrotomy (DVIU) or failed urethroplasty underwent DVIU with thermally expandable, nickel-titanium alloy urethral stent (Memokath) insertion. Follow-up study time points were at 1, 3, 6, 9, and 12 months after stent insertion. Follow-up evaluation included uroflowmetry, retrograde urethrogram, plain radiography, and urinalysis. Results The mean patient age was 47.7 years (range, 18 to 74 years). The mean urethral stricture length was 5.54 cm (range, 1 to 12 cm). There were six patients with bulbar, four patients with proximal penile, one patient with distal penile, and two patients with whole penile urethral strictures, respectively. The overall success rate was 69% (9/13) and the mean postoperative peak flow rate was 17.7 mL/s (range, 6 to 28 mL/s). Major complications occurred in four patients including one patient (7.7%) with urethrocutaneous fistula induced by the stent and three patients with urethral hyperplasia. The mean follow-up duration was 8.4 months. Conclusions Our initial clinical experience indicates that thermo-expandable stents can be another temporary management option for recurrent urethral stricture patients who are unfit for or refuse urethroplasty. Distal or whole penile urethral stricture can be factors predicting poor results.
Jung, Hyun Su; Kim, Joon Woo; Lee, Jun Nyung; Kim, Hyun Tae; Yoo, Eun Sang
Novel posterior fixation keratoprosthesis
NASA Astrophysics Data System (ADS)
The keratoprosthesis is the last solution for corneally blind patients that cannot benefit from corneal transplants. Keratoprostheses that have been designed to be affixed anteriorly usually necessitate multi-step surgical procedures and are continuously subjected to the extrusion forces generated by the positive intraocular pressure; therefore, clinical results in patients prove inconsistent. We proposed a novel keratoprosthesis concept that utilizes posterior corneal fixation which `a priori' minimizes the risk of aqueous leakage and expulsion. This prosthesis is implanted in a single procedure thereby reducing the number of surgical complications normally associated with anterior fixation devices. In addition, its novel design makes this keratoprosthesis implantable in phakic eyes. With an average follow-up of 13 months (range 3 to 25 months), our results on 21 cases are encouraging. Half of the keratoprostheses were implanted in severe burn cases, with the remainder in cases of pseudo- pemphigus. Good visual results and cosmetic appearance were obtained in 14 of 21 eyes.
Lacombe, Emmanuel
Rapid, on-site diagnosis of chlamydial urethritis in men by detection of antigens in urethral swabs and urine.
First-void urine (FVU) sediments of 240 men were tested for Chlamydia trachomatis antigens by two enzyme immunoassays, TestPack Chlamydia (15 min) and Chlamydiazyme (3.5 h), and the results were compared with urethral swab culture results. The sensitivity and specificity on FVU sediment for TestPack Chlamydia were 76.2% (32 of 42 specimens) and 95.5% (189 of 198 specimens) versus 81.0% (34 of 42 specimens) and 96.5% (191 of 198 specimens) for Chlamydiazyme, respectively. Rapid, on-site detection of chlamydial antigen in male FVU would shorten the infectious period by hastening diagnosis and treatment. PMID:2007651
Sellors, J; Mahony, J; Jang, D; Pickard, L; Castriciano, S; Landis, S; Stewart, I; Seidelman, W; Cunningham, I; Chernesky, M
Rapid, on-site diagnosis of chlamydial urethritis in men by detection of antigens in urethral swabs and urine.
First-void urine (FVU) sediments of 240 men were tested for Chlamydia trachomatis antigens by two enzyme immunoassays, TestPack Chlamydia (15 min) and Chlamydiazyme (3.5 h), and the results were compared with urethral swab culture results. The sensitivity and specificity on FVU sediment for TestPack Chlamydia were 76.2% (32 of 42 specimens) and 95.5% (189 of 198 specimens) versus 81.0% (34 of 42 specimens) and 96.5% (191 of 198 specimens) for Chlamydiazyme, respectively. Rapid, on-site detection of chlamydial antigen in male FVU would shorten the infectious period by hastening diagnosis and treatment.
Sellors, J; Mahony, J; Jang, D; Pickard, L; Castriciano, S; Landis, S; Stewart, I; Seidelman, W; Cunningham, I; Chernesky, M
Treatment of urethral strictures with the KTP 532 laser
NASA Astrophysics Data System (ADS)
The objective of this study was to evaluate and compare the safety and efficacy of the KTP 532 laser to direct vision internal urethrotomy (DVIU) in the management of urethral strictures. A total of 32 patients were randomized prospectively in this study, 14 DVIU and 18 KTP 532 laser. Patients were evaluated postoperatively with flowmetry and in the case of recurrence with cystourethrography at 3, 12, 24 weeks. With the KTP 532 laser complete symptomatic and urodynamic success was achieved in 15 (83%) patients at 12 and 24 weeks. Success rate was lower in the DVIU group with 9 (64%) patients at 12 weeks and 8 (57%) patients at 24 weeks. With the KTP mean preoperative peak-flow was improved from 6 cc/s to 20 cc/s at 3, 12 and 24 weeks. With DVIU mean preoperative peak-flow was improved from 5.5 cc/s to 20 cc/s at 3 weeks followed by a steady decrease to 13 cc/s at 12 weeks and to 12 cc/s 24 weeks. No complications were observed in either group of patients. Our results confirm that stricture vaporization with the KTP 532 laser is a safe and efficient procedure. It thus represents a valuable alternative in the endoscopic treatment of urethral strictures.
Schmidlin, Franz R.; Oswald, Michael; Iselin, Christoph E.; Jichlinski, Patrice; Delacretaz, Guy P.; Leisinger, Hans-Jurg; Graber, Peter
Traumatic sacral spondylolisthesis
Purpose of study: Increased fracture rates among osteoporotic patients in proximity to instrumentation and prosthetic joint replacements is well documented in the literature. The authors have recently described burst fractures of the caudal end-instrumented lumbar vertebrae in adult patients treated with an instrumented fusion for scoliosis. The purpose of this study was to describe traumatic sacral spondylolisthesis (TSS), which is
Thomas Dwyer; Michael O'Brien; Christopher Dewald; Daniel Gelb; Laura Flawn; Thomas Lowe
Approximately 250 per 100,000 of the population sustain traumatic brain injury (TBI) annually (Cassidy et al., 2004), making it the most commonly occurring neurological condition. Of these 102 per 100,000 are hospitalised (Chesnut, Carney, Maynard, Patterson, Mann, & Helfand, 1998). Because of advances in trauma care these individuals are surviving injuries that would previously have been fatal (Klimczak, Donovick, &
Janet M. Leathem; Muriel Christianson
Transition after Traumatic Loss
ERIC Educational Resources Information Center
Children experience grief when they suffer the loss of a close relationship. When that loss also traumatizes children, they experience additional emotional reactions. It is important that adults educate themselves and others who deal with children about typical, healthy grief reactions. Following a non-violent loss, the initial reactions of�
Kuban, Caelan
Post-traumatic amnesia and the nature of post-traumatic stress disorder after mild traumatic brain injury
The prevalence and nature of post-traumatic stress disorder (PTSD) following mild traumatic brain injury (MTBI) is controversial because of the apparent paradox of suffering PTSD with impaired memory for the traumatic event. In this study, 1167 survivors of traumatic injury (MTBI: 459, No TBI: 708) were assessed for PTSD symptoms and post-traumatic amnesia during hospitalization, and were subsequently assessed for
[The urethral protractor. A new instrument for facilitating the anastomosis between urethra and bladder in radical prostatectomy and urethro-intestinal anastomoses following cystectomy].
The urethral protractor is a new device that helps push the urethral stump upwards together with the urogenital diaphragma. It facilitates suturing the anastomosis in radical prostatectomy and the intestino-urethral anastomosis after cystectomy. With the help of the urethral protractor, the urethral stump can be directed into various positions in order to simplify the localization and control of bleeding close to the urethra. By tilting the urethral protractor to one side, damage to the neurovascular bundles can be avoided when suturing. The urethral protractor consists of a rigid, reusable, suture guide made of stainless steel and a special, disposable balloon catheter. PMID:2382324
Fr�hlich, G; W�rdehoff, A
Outcome of traumatic hip dislocation in children.
We reviewed 13 patients without an underlying syndrome with traumatic hip dislocation between 3 and 10 years of age (mean 4.8 years) at the time of injury. The final reviews were between 1 and 11 years (mean 6 years). All children had posterior dislocation, except one, who had an anterior dislocation. Time taken from trauma to reduction was less than 6 h in three patients, 6 h to 1 day in two patients, 1 day to 3 weeks in seven patients, and 4 weeks in one. All of them underwent closed reduction, except two, who required open reduction through a posterior approach. All patients had excellent hip function and radiographic result on the basis of Garret classification, except for one with limping at 4 years after trauma. The patients treated with hip spica after reduction (10 patients) did not have recurrent dislocation whereas two out of three patients who were treated without postreduction hip spica developed recurrent dislocation. One out of 13 patients without an underlying syndrome and a 6-year-old patient with Down syndrome with neglected hip dislocation and radiological avascular necrosis at presentation recovered with congruent hip following a complete and maintained reduction. This case series suggested that closed reduction was possible for cases of neglected hip dislocation for up to 3 weeks. Open reduction through the posterior approach was safe in neglected irreducible posterior hip dislocation. Those hips that underwent complete reduction and were maintained reduced with hip spica had an excellent functional outcome even in the presence of avascular necrosis. This is a level IV study. PMID:23838854
Sulaiman, Abdul R; Munajat, Ismail; Mohd, Fazliq E
Posterior cerebral epilepsy: special considerations
Surgical treatment for epileptic seizures emanating from the posterior cerebral cortex (occipital, parietal, posterior temporal areas) is less common than for seizures from the anterior temporal and frontal regions. The diagnosis entails integrating the combination of clinical, electrographical, neuropsychological, and imaging studies. Extremely important is the knowledge of the pathways of possible suprasylvian spread anteriorly toward the central sulcus of
Jack D. Grabow
Unsatisfactory performance of the leukocyte esterase test of first voided urine for rapid diagnosis of urethritis.
BACKGROUND AND OBJECTIVES--The objective of this study was to determine the performance characteristics of a dipstick test for leukocyte esterase (LE), (Chemstrip 2LN, Boehringer Mannheim) in predicting the presence of urethritis and urethral pathogens in men presenting to a busy sexually transmitted disease clinic and to street outreach facilities. METHODS--Urethral swabs for polymorphonuclear (pmn) cell count, gonorrhoea culture and chlamydia enzyme immunoassay (EIA) as well as 15 ml of first voided urine (FVU) were collected from 737 symptomatic and 726 asymptomatic men. Gonorrhoea cultures and pmn counts were processed according to standard methods. Either Abbott Chlamydiazyme EIA (confirmed) or Syva Microtrak EIA (confirmed) test was employed to detect C trachomatis. The LE test was immediately dipped in FVU, read after 60-120 seconds by the clinician and considered positive if trace, 1+ or 2+. RESULTS--Microscopic evidence of urethritis (> or = = 4 pmn cells per 1000 x field) was found on urethral smear of 782 (53.5%) patients. Chlamydia, gonorrhoea or both were present in 104 (7.1%) patients. Performance characteristics of the LE test were as follows: (table below) CONCLUSION--The LE test did not have adequate sensitivity to be considered a reliable rapid diagnostic test for urethritis or urethral pathogens, particularly in the asymptomatic portion of this STD clinic population.
Patrick, D M; Rekart, M L; Knowles, L
Posterior reversible encephalopathy syndrome.
Posterior reversible encephalopathy syndrome (PRES) is a recently proposed cliniconeuroradiologic entity with several well-known causes, such as hypertensive encephalopathy, eclampsia, and the use of cytotoxic and immunosuppressive drugs, as well as some causes more recently described. PRES is characterized by neuroimaging findings of reversible vasogenic subcortical edema without infarction. The pathogenesis is incompletely understood. Two opposing hypotheses are commonly cited, but the issue is controversial: (1) the current more popular theory suggests that severe hypertension exceeds the limits of autoregulation, leading to breakthrough brain edema; (2) the earlier original theory suggests that hypertension leads to cerebral autoregulatory vasoconstriction, ischemia, and subsequent brain edema. The clinical syndrome of PRES typically involves headache, encephalopathy, visual symptoms, and seizures. The clinical presentation is often nonspecific, and therefore the diagnosis of PRES has come to increasingly rely on magnetic resonance imaging (MRI) abnormalities consistent with PRES with documented recovery clinically and on repeated neuroimaging. The diagnosis has important therapeutic and prognostic implications because the reversibility of the clinical and radiologic abnormalities is contingent on the prompt control of blood pressure and/or discontinuing the offending drug. PMID:24365441
Lamy, C; Oppenheim, C; Mas, J L
Posterior atlantoaxial dislocation complicating odontoid fracture without neurologic deficit: a case report and review of the literature.
Traumatic posterior atlantoaxial dislocation associated with odontoid fracture is extremely rare, with only eight cases reported thus far in the English literature. This report concerns a 47-year-old female who presented with considerable pain and stiffness in the neck without a neurologic deficit after injury due to a fall. Radiographs, computed tomography, and magnetic resonance imaging demonstrated a posterior dislocation of the atlas with respect to the axis with an odontoid fracture. No cord compression or intramedullary cord signal abnormalities were detected at the level of the atlantoaxial dislocation. A pedicle screw fixation/fusion was performed via a posterior approach following successful closed reduction. PMID:24469150
Meng, Hao; Gao, Yuan; Li, Mo; Luo, Zhuojing; Du, Junjie
Use of an Aortic Stent Graft Extension for the Treatment of Urethral Stricture in a Dog
ABSTRACT A 2-year-old male mixed dog was referred to us for further evaluation and treatment of a 4-week-history of oliguria and abdominal distension after a surgical repair of urethral injury. To relieve the urethral stricture, we placed a self-expanding aortic stent graft extension with a partial coverage with an expanded polytetrafluoroethylene (ePTFE). After the placement of the stent, the dog presented with a normal urinary voiding, despite the presence of urinary incontinence. The current case indicates that the ePTFE-covered, self-expanding ASGE is an effective intervention for the treatment of severe urethral stricture in the dog.
BAE, Jae Hyun; KWON, Yong Hwan; JUNG, Ye Chan; JUNG, Ji Mo; LEE, Hae Beom; LEE, Ki Chang; KIM, Nam Soo; KIM, Min-Su
Lateral dislocation and incarceration of the posterior tibial tendon through the distal tibiofibular syndesmosis.
A case of acute, traumatic, lateral dislocation of the posterior tibial tendon is presented as a unique pattern of posterior tibial tendon dislocation. Several attempts at both closed and open reduction were required to relocate the tendon and reduce the fracture-dislocation. This case is being presented to demonstrate the use of cross-sectional imaging to both recognize the initial bony injury and to identify tendon anatomy and pathology that may not be seen in the operating room with limited visualization. PMID:24671259
Trividi, Mitesh; Brown, Elliott; Lese, Andrea; Katz, Lee D
Classification of posterior vitreous detachment
Diagnosing a posterior vitreous detachment (PVD) is important for predicting the prognosis and determining the indication for vitreoretinal surgery in many vitreoretinal diseases. This article presents both classifications of a PVD by slit-lamp biomicroscopy and of a shallow PVD by optical coherence tomography (OCT). By biomicroscopy, the vitreous condition is determined based on the presence or absence of a PVD. The PVD then is classified as either a complete posterior vitreous detachment (C-PVD) or a partial posterior vitreous detachment (P-PVD). A C-PVD is further divided into a C-PVD with collapse and a C-PVD without collapse, while a P-PVD is divided into a P-PVD with shrinkage of the posterior hyaloid membrane (P-PVD with shrinkage) and a P-PVD without shrinkage of the posterior hyaloid membrane (P-PVD without shrinkage). A P-PVD without shrinkage has a subtype characterized by vitreous gel attachment through the premacular hole in a posterior hyaloid membrane to the macula (P-PVD without shrinkage [M]). By OCT, a shallow PVD is classified as the absence of a shallow PVD or as a shallow PVD. A shallow PVD is then subclassified as a shallow PVD without shrinkage of the posterior vitreous cortex, a shallow PVD with shrinkage of the posterior vitreous cortex, and a peripheral shallow PVD. A shallow PVD without shrinkage of the posterior vitreous cortex has two subtypes: an age-related shallow PVD and a perifoveal PVD associated with a macular hole.
Kakehashi, Akihiro; Takezawa, Mikiko; Akiba, Jun
Traumatic insemination in terrestrial arthropods.
Traumatic insemination is a bizarre form of mating practiced by some invertebrates in which males use hypodermic genitalia to penetrate their partner's body wall during copulation, frequently bypassing the female genital tract and ejaculating into their blood system. The requirements for traumatic insemination to evolve are stringent, yet surprisingly it has arisen multiple times within invertebrates. In terrestrial arthropods traumatic insemination is most prevalent in the true bug infraorder Cimicomorpha, where it has evolved independently at least three times. Traumatic insemination is thought to occur in the Strepsiptera and has recently been recorded in fruit fly and spider lineages. We review the putative selective pressures that may have led to the evolution of traumatic insemination across these lineages, as well as the pressures that continue to drive divergence in male and female reproductive morphology and behavior. Traumatic insemination mechanisms and attributes are compared across independent lineages. PMID:24160423
Tatarnic, Nikolai J; Cassis, Gerasimos; Siva-Jothy, Michael T
Primary posterior mediastinum hydatid cyst.
Primary posterior mediastinal hydatid cyst is a serious health problem for the Mediterranean countries. We diagnosed a case of a 46-year-old female with a primary posterior mediastinum hydatid cyst on CT and MRI. It was provisionally identified as either a hydatid cyst or bronchogenic cyst or neuroenteric cyst. CT guided aspiration with 18 gauge needle confirmed as hydatid sand. This is very rare in this population but it should be kept in mind when one is looking at any cyst in the posterior mediastinum. PMID:24709247
Ahmed, Mughis Uddin; Eid, Ahmed Fathi; Al-Hawashim, Nadia; Sheikh, Mohammed Younus; Yiannakou, Nearchos
Posterior sampling with improved efficiency
The Markov Chain Monte Carlo (MCMC) technique provides a means to generate a random sequence of model realizations that sample the posterior probability distribution of a Bayesian analysis. That sequence may be used to make inferences about the model uncertainties that derive from measurement uncertainties. This paper presents an approach to improving the efficiency of the Metropolis approach to MCMC by incorporating an approximation to the covariance matrix of the posterior distribution. The covariance matrix is approximated using the update formula from the BFGS quasi-Newton optimization algorithm. Examples are given for uncorrelated and correlated multidimensional Gaussian posterior distributions.
Hanson, K.M.; Cunningham, G.S.
Changing a urethral or suprapubic catheter: the patient's perspective.
Understanding the patient's perspective in any area of health care is now recognised as being crucial to good practice, but little is known about patients' views on living with an indwelling urinary catheter. In this study, 36 people living with either a urethral or suprapubic catheter across the UK were interviewed. After thematic analysis, the authors interpreted what they learned. Many issues were raised, including the need to know who was responsible for changing the catheter, the importance of continuity of care, 24-hour access to services, and good hygiene. Patients valued nurses with training and experience, with plenty of time, who took care and who listened to what mattered to the patient. The patient's perspective is important at all levels, not only when designing and planning an integrated continence service, but also in delivering services in the community. PMID:24335792
Chapple, Alison; Prinjha, Suman; Mangnall, Joanne
Female urethral malignant melanoma with vesical invasion: a case report.
We report a 75-year-old female with a primary urethral malignant melanoma. Amass protruding from inside the urethra was detected on physical examination. Abdominopelvic magnetic resonance imaging revealed a mass extending from the urethra with dimensions of 4x2 cm, and periurethral heterogenous fatty planes consistent with infiltration. The histopathologic examination was consistent with HMB45(+) malignant melanoma. We performed cystourethrectomy and bilateral inguinal and pelvic lymphadenectomy in one session. The pathology report revealed primary malignant melanoma of the urethra invading the inferior bladder wall. The patient received no adjuvant therapy because of cardiopulmonary morbidities and the presence of multiple pulmonary metastases. The patient eventually died 13 months after surgery. PMID:20123598
Akbas, Alpaslan; Akman, Tolga; Erdem, Mehmet Remzi; Antar, Baran; Kilicarslan, Isin; Onol, Sinasi Yavuz
Laser deposition of TiO2 for urethral catheter
NASA Astrophysics Data System (ADS)
Catheters and medicals tubes are widely used to introduce pharmaceuticals and nutrients into arteries and veins, and to drain fluids or urine from urethra or the digestive organs. It is well known that illuminated TiO2 photocatalysts can decompose most noxious or toxic organic compounds. We studied the properties of titanium dioxide layers created by pulsed laser deposition from pure titanium and titanium dioxide targets with the goal to develop urethral catheter using TiO2 coated plastic tube. To reach crystalline structure at low substrate temperatures the radio-frequency discharge between the target and the substrate was implemented. The crystalline structure of layers was determined by X-ray diffraction and Fourier Transform Infrared Spectroscopy. Morphology was studied by atomic force microscopy (AFM). Using RF discharge, mixture of anatase and rutile was found at substrate temperature of 90�C (which was reached only by RF discharge).
Jel�nek, Miroslav; Remsa, Jan; Zezulov�, Mark�ta
\\u000a Traumatic brain injury (TBI) is a serious public health problem, often referred to as a silent epidemic due to lack of public\\u000a awareness [1]. TBI is still the leading cause of mortality and morbidity in the world for individuals under the age of 45\\u000a [2]. In the United States alone, based on population data from 1995 to 2001, 1.4 million
Terri Morris
Transscleral suture fixation of posterior chamber intraocular lenses in children under 3 years
� Background: Children who have undergone lentectomy for congenital or traumatic cataract do not have adequate capsular support\\u000a for secondary posterior chamber intraocular lens (PC-IOL) implantation and thus will become severely amblyopic if contact\\u000a lens intolerance occurs. In order to prevent amblyopia we fixed PC-IOLs by transscleral sutures in three children younger\\u000a than 3 years. Clinical outcome, visual acuity and
Hans Mittelviefhaus; Karin Mittelviefhaus; J�rgen Gerling
[Traumatic fracture of the thoracic spine T1-T10].
We describe the incidence, causes, management and prognosis of traumatic fractures of the thoracic spine from T1 to T10 in surgical cases of traumatic fractures of spine during the period from June 1994 to June 2003 studied retrospectively. The type of fracture was determined according to the Gertzbein classification, and the degree of stability using the Denis classification. The neurological picture at admission and 30 days after surgery was evaluated using the ASIA/IMSOP classification. Surgery was performed in patients with complete spinal cord injury (n=7) for the purpose of stabilization using the posterior approach. In cases without spinal cord injury or incomplete injury (n=12), the surgical procedure was performed aiming to decompress the nerve tissue, to correct the alignment of the spine and to stabilize the spine. PMID:15608977
Falavigna, Asdrubal; Righesso Neto, Orlando; Ferraz, Fernando Antonio Patriani; Boniatti, M�rcio Manozzo
Primary clear cell adenocarcinoma of a urethral diverticulum treated with multidisciplinary robotic anterior pelvic exenteration.
Primary urethral carcinoma is extremely rare and is marked by a variety of clinical symptoms. Primary carcinoma of a urethral diverticulum is still rarer and clear cell adenocarcinoma of the urethra is particularly uncommon (Swartz et al., 2006). Such infrequency has led to inadequate management guidance in the literature for a disease that is often late in presentation and carries substantial morbidity and mortality. This treatable but grave disease deserves definitive curative treatment. We present the first published instance in which it was treated with robotic anterior exenteration. In our case, a 47-year-old female was referred to the urology service for investigation of recurring urinary tract infections. During the workup, the patient was found to have an advanced clear cell urethral adenocarcinoma originating in a urethral diverticulum. We discuss the natural history of this condition, its consequences, and the first instance of its treatment using robotic anterior pelvic exenteration. PMID:24454400
Scantling, Dane; Ross, Curtis; Jaffe, Jamison
Bladder muscle biopsy and urethral sphincter EMG in patients with bladder dysfunction after pelvic surgery.
Eleven patients who suffered persistent bladder dysfunction after pelvic surgery have been investigated by needle urethral sphincter electromyography (EMG) and bladder muscle biopsy, and the results compared with those obtained in a series of controls. Individual motor units recorded from the urethral sphincter in patients who had undergone pelvic surgery were strikingly abnormal, suggesting the presence of reinnervation, and the density of detrusor innervation was significantly reduced. However, since reduction in the density of detrusor innervation may occur in circumstances other than peripheral nerve injury, we conclude that urethral sphincter EMG provides the most effective means of assessing damage to vesico-urethral innervation as a result of previous pelvic surgery. Images Figure 5.
Kirby, R S; Fowler, C J; Gilpin, S A; Gosling, J A; Milroy, E J; Turner-Warwick, R T
Remote discovery of an asymptomatic bowel perforation by a mid-urethral sling.
Bowel perforation is a rare complication of mid-urethral sling procedures and is usually reported shortly after the surgery. We report a remotely discovered asymptomatic bowel injury found at the time of subsequent surgery. The patient with a history of several prior pelvic surgeries underwent an uneventful retropubic mid-urethral sling placement. Five years later, during an abdominal sacrocolpopexy procedure, mesh from the mid-urethral sling was found perforating the wall of the cecum and fixating it to the right pelvic sidewall. Cecal wedge resection was performed to excise the sling mesh. Asymptomatic bowel perforation by mid-urethral sling mesh has not been previously reported. Pelvic and abdominal surgeons should be aware of the possibility of finding this injury in patients with prior sling surgeries. PMID:22052439
Elliott, Jason E; Maslow, Ken D
Quantitative Relationship of Ureaplasma Urealyticum to the Clinical Course of Nongonococcal Urethritis in the Human Male.
National Technical Information Service (NTIS)
The pathogenic role of Ureaplasma urealyticum (T Mycoplasma)in nongonococcal urethritis (NGU) was examined by a quantitative cultural method. Selected male patients with primary or recurrent U. urealyticum-associated NGU were treated with reduced regimens...
M. C. Shepard
Reappraisal of intergender differences in the urethral striated sphincter explains why a completely circular arrangement is difficult in females: a histological study using human fetuses
To investigate why the development of a completely circular striated sphincter is so rare, we examined histological sections of 11 female and 11 male mid-term human fetuses. In male fetuses, the striated muscle initially extended in the frontal, rather than in the horizontal plane. However, a knee-like portion was absent in the female fetal urethra because, on the inferior side of the vaginal end, a wide groove for the future vestibule opened inferiorly. Accordingly, it was difficult for the developing striated muscle to surround the groove, even though there was not a great difference in width or thickness between the female vestibule and the male urethra. The development of a completely circular striated sphincter seems to be impossible in females because of interruption of the frontal plane by the groove-like vestibule. However, we cannot rule out the possibility that before descent of the vagina, the urethral striated muscle extends posteriorly.
Takenaka, Atsushi; Rodriguez-Vazquez, Jose Francisco; Murakami, Gen; Matsubara, Akio
The ectopic posterior pituitary gland.
An ectopic posterior pituitary gland is a rare condition and may present with an empty pituitary fossa, hypoplasia or absence of the infundibular stalk and resultant short stature due to growth hormone deficiency. The location of the ectopic lobe can vary, but it is most commonly situated along the median eminence in the floor of the third ventricle. We report a case of an ectopic posterior pituitary gland, describe the causes and discuss the diagnostic imaging features. PMID:24209704
Mahomed, Nasreen; Motshudi, Thapelo
Urethral reconstruction using autologous and everted vein graft: an experimental study
Urethral reconstruction is one of the problematic issues in pediatric surgery. To evaluate the efficacy of vein graft for\\u000a urethral reconstruction in rabbits, about 3�cm of distal urethra was excised under microscopic magnification. In groups A,\\u000a B, and D, the urethra was replaced with the internal jugular vein. In group B, before performing anastomosis, vein grafts\\u000a were everted. In group
H. R. Foroutan; A. Khalili; B. Geramizadeh; A. R. Rasekhi; N. Tanideh
[Questionnaire survey on medical care for male urethritis in community clinics in Shiga prefecture].
Six regional medical associations in Shiga prefecture agreed to cooperate in an investigation of medical care for male gonococcal and chlamydial urethritis. In June 2011, we sent a questionnaire to 372 medical offices in Shiga prefecture, and analyzed replies of respondents. Ten urologists and 175 non-urologists responded to the survey (response rate 49.7%). Among 185 physicians, 52 (10 urologists and 42 nonurologists) have treated male patients with gonococcal and chlamydial urethritis. More than 20% (42/175) of non-urological clinics are involved in the medical management. At initial diagnosis for sexually transmitted male urethritis, all urologists select the nucleic acid amplification method (100%), whereas many non-urologists do not (35%). For the treatment of chlamydial urethritis, non-urologists select levofloxacin (LVFX, 52.8%) rather than azithromycin (AZM, 22.0%), whereas urologists use AZM (78.0%) mostly but do not use LVFX (0%) (p = 0.023). For the treatment of gonococcal urethritis, non-urologists prefer oral new quinolones (53.1%) compared to urologists (25.0%) (p = 0. 74). For cure judgment of gonoccocal and chlamydial urethritis, many non-urologists rely on the improvement of subjective symptoms (50 and 47%), but urologists do not (10 and 0%) (p = 0.022 and 0.026, respectively). As for recognition of the clinical guideline for sexually transmitted disease, most urologists (90%) know it, but few non-urologists (13%) do (p < 0.001). We found that non-urological clinics make a great contribution to the medical treatment for male gonococcal and chlamydial urethritis in Shiga prefecture. It is important to standardize the medical care for sexually transmitted male urethritis by familiarizing non-urological practitioners with the clinical guideline. PMID:24594766
Yamashita, Hiroto; Araki, Isao; Kageyama, Susumu; Baba, Masato; Nakano, Etsuji; Okada, Yusaku
Does pelvic organ prolapse quantification exam predict urethral mobility in stages 0 and I prolapse?
Objective: To determine if women with anterior support stages 0 or I by pelvic organ prolapse quantification (POP-Q) system require Q-tip testing to assess urethral mobility. Methods: A prospective study of 134 women presenting for urogynecologic evaluation were examined and assigned stages of anterior wall support according to the POP-Q system. A Q-tip test was performed and urethral hypermobility was
Karen Noblett; Christopher S. Driskill
Posterior femoral cutaneous nerve conduction.
The posterior femoral cutaneous nerve is a sensory nerve comprised of fibers originating from the anterior and posterior divisions of the first three sacral segments. It exists the pelvis distal to the piriformis muscle and proceeds distally, superficial to and between the medial and lateral hamstring musculature. The nerve's major cutaneous distribution is the posterior aspect of the thigh and a variable area of the posterior calf. An electrophysiologic technique to assess the peripheral axons of the posterior femoral cutaneous nerve is described. A recording electrode is placed 6cm proximal to the midpopliteal fossa and the nerve is stimulated supramaximally 12cm proximally on a line between the active electrode and the ischial tuberosity. A ground electrode is placed just proximal to the active recording electrode. The lower extremities of 40 individuals with a mean age of 34 years (20 to 78 years) were examined. The mean peak latency of the response is 2.8 (2.3 to 3.4) msec +/- 0.2msec with a mean amplitude of 6.5 (4.1 to 12.0) microV +/- 1.5 microV. This technique may facilitate the proximal evaluation of lower extremity peripheral neuropathies, lesions of the posterior femoral cutaneous nerve, or the assessment of the peripheral nervous system in persons with lower extremity amputations. PMID:2241545
Dumitru, D; Nelson, M R
Symptomatic urethritis is more prevalent in men infected with Mycoplasma genitalium than with Chlamydia trachomatis
Objectives: To study the prevalence, symptoms, and signs of Mycoplasma genitalium and Chlamydia trachomatis infections in men attending a Swedish STD clinic and to study the criteria for urethritis. Methods: A cross sectional study among STD clinic attendees in �rebro, Sweden. Attendees were examined for microscopic urethritis and first void urine (FVU) was tested for M genitalium and C trachomatis. Results: The prevalence of M genitalium and C trachomatis was 7% (34/512) and 12% (61/512), respectively. Dual infection was diagnosed in four men. In both infections 90% of the patients had signs of microscopic urethritis. M genitalium positive men had symptomatic urethritis significantly more often than those infected with C trachomatis (73% v 40%, RR 1.8; 95% CI 1.2 to 2.7). 63% of female partners of men infected with M genitalium were infected with M genitalium compared with chlamydial infection in 67% of female partners of men infected with C trachomatis. Non-chlamydial non-gonococcal urethritis without evidence of M genitalium infection was diagnosed in 180 men (35%). Symptoms and/or visible discharge were reported in 49% in this group. Conclusions: M genitalium is a common infection associated with symptomatic urethritis and with a high prevalence of infected sexual partners supporting its role as a sexually transmitted infection.
Falk, L; Fredlund, H; Jensen, J
Management of the stricture of fossa navicularis and pendulous urethral strictures
Objective: Management of distal anterior urethral stricture is a common problem faced by practicing urologists. Literature on urethral stricture mainly pertains to bulbar urethral stricture and pelvic fracture urethral distraction defect. The present article aims to review the management of the strictures of fossa navicularis and pendulous urethra. Materials and Methods: The literature in English language was searched from the National Library of Medicine database, using the appropriate key words for the period 1985-2010. Out of 475 articles, 115 were selected for the review based on their relevance to the topic. Results: Etiology of stricture is shifting from infective to inflammatory and iatrogenic causes. Stricture of fossa navicularis is most often caused by lichen sclerosus et atrophicus and instrumentation. Direct visual internal urethrotomy is limited to selected cases in the management of pendulous urethral stricture. With experience and identification of various prognostic factors, conservative management by dilatation and internal urethrotomy is being replaced by various reconstructive procedures, using skin flaps and grafts with high success rates. Single-stage urethroplasty is preferred over the 2-stage procedure as the latter disfigures the penis and poses sexual problems temporarily. Conclusions: Flaps or grafts are useful for single-stage reconstruction of fossa navicularis and pendulous urethral strictures. The buccal and lingual mucosa serves as a preferred resource material for providing the inner lining of the urethra. Off-the-shelf materials, such as acellular collagen matrix, are promising.
Singh, Shrawan K.; Agrawal, Santosh K.; Mavuduru, Ravimohan S.
Early responding to traumatic events.
How to respond optimally following traumatic events remains a Holy Grail. A number of early interventions lack evidence of effect. Practical, pragmatic support provided in an empathic manner is likely to be an appropriate initial response and complement the high levels of resilience shown by individuals exposed to traumatic events. PMID:24785764
Bisson, Jonathan I
Hypopituitarism after traumatic brain injury
Traumatic brain injury (TBI) is one of the main causes of death and disability in young adults, with consequences ranging from physical disabilities to long-term cognitive, behavioural, psychological and social defects. Post-traumatic hypopituitarism (PTHP) was recognized more than 80 years ago, but it was thought to be a rare occurrence. Recently, clinical evidence has demonstrated that TBI may frequently cause
Marta Bondanelli; Maria Rosaria Ambrosio; Maria Chiara Zatelli; Laura De Marinis
Outpatient management of traumatic microhyphemas.
Traumatic microhyphema is an entity encountered in emergency rooms and general ophthalmology practices. The management of traumatic microhyphema has not been well defined in the literature. We discuss the effectiveness of our treatment regimen and the incidence of rebleed in patients with microhyphema. PMID:2244716
Wilson, T W; Nelson, L B; Jeffers, J B; Manley, D R
We present a case of traumatic proptosis in a competitive football player. This entity can occur with a significant decrease in vision, but in this case it did not. Some other causes of this condition are also discussed. A review of some traumatic conditions that may cause proptosis is provided as well.
Should we consider alternatives to combined cervical and urethral swabs for detection of Chlamydia trachomatis in females?
Background The optimum approach for detecting Chlamydia trachomatis (CT) is considered to be combined cervical and urethral testing. Objective To assess the contribution of female urethral swabs in CT diagnosis and to examine alternatives. Method Urethral and endocervical samples for CT were performed on 757 sexually active female patients, >16 years, attending the genitourinary medicine clinic at Macclesfield District General Hospital from October 2005 to November 2006. Swabs were collected and transported to the laboratory in separate AC2 sample collection tubes and were tested by AC2 assay. Results Of the 757 patients tested simultaneously by both endocervical and urethral swab, a total of 90 had CT identified by either method giving a positivity rate of 11.9%. Results for urethral and endocervical swabs were concordant in 77 patients (85.6%). Eighty two infections (91.1%) would have been diagnosed by swabbing the cervix only but an additional 8 (8.9%) were picked up by urethral swab. Urethral symptoms had been mentioned by 1 of these 8 women. Conclusion 8.9% infected women were positive only on urethral swab. One of these would have been picked up owing to presenting symptoms, hence reducing the extra yield to 7.8% and leaving only 7 positives on 757 urethral swabs with a detection rate of 1% of all urethral swabs. Considering the low yield and the discomfort of urethral swabbing, an additional urethral swab appears unwarranted on grounds of both cost and patient care. As a small number of cases were detected at the urethra but not the cervix, it may be worthwhile investigating the performance of AC2 when placing an endocervical swab in first catch urine. An effective and simpler approach may be a switch to testing vaginal swabs by AC2.
Mahto, M; Mallinson, H
Detailed urethral dosimetry in the evaluation of prostate brachytherapy-related urinary morbidity
Purpose: To evaluate the relationship between urinary morbidity after prostate brachytherapy and urethral doses calculated at the base, midprostate, apex, and urogenital diaphragm. Methods and Materials: From February 1998 through July 2002, 186 consecutive patients without a prior history of a transurethral resection underwent monotherapeutic brachytherapy (no supplemental external beam radiation therapy or androgen deprivation therapy) with urethral-sparing techniques (average urethral dose 100%-140% minimum peripheral dose) for clinical T1c-T2b (2002 AJCC) prostate cancer. The median follow-up was 45.5 months. Urinary morbidity was defined by time to International Prostate Symptom Score (IPSS) resolution, maximum increase in IPSS, catheter dependency, and the need for postimplant surgical intervention. An alpha blocker was initiated approximately 2 weeks before implantation and continued at least until the IPSS returned to baseline. Evaluated parameters included overall urethral dose (average and maximum), doses to the base, midprostate, apex, and urogenital diaphragm, patient age, clinical T stage, preimplant IPSS, ultrasound volume, isotope, and D90 and V100/150/200. Results: Of the 186 patients, 176 (94.6%) had the urinary catheter permanently removed on the day of implantation with only 1 patient requiring a urinary catheter >5 days. No patient had a urethral stricture and only 2 patients (1.1%) required a postbrachytherapy transurethral resection of the prostate (TURP). For the entire cohort, IPSS on average peaked 2 weeks after implantation with a mean and median time to IPSS resolution of 14 and 3 weeks, respectively. For the entire cohort, only isotope predicted for IPSS resolution, while neither overall average prostatic urethra nor segmental urethral dose predicted for IPSS resolution. The maximum postimplant IPSS increase was best predicted by preimplant IPSS and the maximum apical urethral dose. Conclusions: With the routine use of prophylactic alpha blockers and strict adherence to urethral-sparing techniques, detailed urethral dosimetry did not substantially improve the ability to predict urinary morbidity. Neither the average dose to the prostatic urethra nor urethral doses stratified into base, midprostate, apex, or urogenital diaphragm segments predicted for IPSS normalization. Radiation doses of 100%-140% minimum peripheral dose are well tolerated by all segments of the prostatic urethra with resultant tumorcidal doses to foci of periurethral cancer.
Allen, Zachariah A. [Schiffler Cancer Center, Wheeling, WV (United States); Merrick, Gregory S. [Schiffler Cancer Center, Wheeling, WV (United States) and Wheeling Jesuit University, Wheeling, WV (United States)]. E-mail: email@example.com; Butler, Wayne M. [Schiffler Cancer Center, Wheeling, WV (United States); Wheeling Jesuit University, Wheeling, WV (United States); Wallner, Kent E. [Puget Sound Healthcare Corporation, Group Health Cooperative, and University of Washington, Seattle, WA (United States); Kurko, Brian [Schiffler Cancer Center, Wheeling, WV (United States); Anderson, Richard L. [Schiffler Cancer Center, Wheeling, WV (United States); Murray, Brian C. [Schiffler Cancer Center, Wheeling, WV (United States); Galbreath, Robert W. [Schiffler Cancer Center, Wheeling, WV (United States); Wheeling Jesuit University, Wheeling, WV (United States); Ohio University Eastern, St. Clairsville, OH (United States)
Traumatic neurogenic shock is a rare but serious complication of spinal cord injury. It associates bradycardia and hypotension caused by a medullary trauma. It is life-threatening for the patient and it aggravates the neurological deficit. Strict immobilization and a quick assessment of the gravity of cord injury are necessary as soon as prehospital care has begun. Initial treatment requires vasopressors associated with fluid resuscitation. Steroids are not recommended. Early decompression is recommended for incomplete deficit seen in the first 6 hours. We relate the case of secondary spinal shock to a luxation C6/C7 treated in prehospital care. PMID:23566590
Maurin, O; de R�gloix, S; Caball�, D; Arvis, A-M; Perrochon, J-C; Tourtier, J-P
Traumatic lumbar visceral herniation in a young woman?
INTRODUCTION Lumbar herniation is uncommon, with traumatic etiology being rare. Traumatic lumbar hernias are usually caused by seatbelt injury in motor vehicle accidents. It is exceedingly uncommon to see lumbar hernias in an unrestrained passenger of a motor vehicle accident. PRESENTATION OF CASE We present a case of a traumatic inferior lumbar hernia in a young woman who was an unrestrained driver of a vehicle involved in a high-speed collision, with multiple rollover and ejection. CT scans of the abdomen and pelvis suggested soft tissue injury involving muscles in the left lower posterior flank with traumatic herniation of the colon and small bowel. Emergent midline abdominal laparotomy confirmed herniation in the left lower quadrant. After abdominal closure, in the prone position, an extensive laceration over the left flank also confirmed herniation. Due to its dirty nature, the wound was irrigated, lavaged and covered with wound vacuum-assisted closure placement. The decision was made in favor of delayed elective hernia repair. DISCUSSION Lumbar hernias are usually caused by sudden force to the abdomen, leading to increased intra-abdominal pressure. This pressure combined with areas of weakness in the superior and/or inferior triangle lead to herniation. Uncommonly, the contents of lumbar hernias can strangulate or incarcerate leading to bowel obstruction. This can often be prevented by detection with CT and laparotomy. CONCLUSION Lumbar herniation of traumatic etiology is rare. Early detection with CT and/or exploratory laparotomy is important to avoid increases in size of the defect and bowel strangulation and incarceration.
Woolbert, Ashley; Calasanz, Emily R.; Nazim, Muhammad
Posterior crossbite - treatment and stability
Posterior crossbite is defined as an inadequate transversal relationship of maxillary and mandibular teeth. Even when eliminating the etiologic factors, this malocclusion does not have a spontaneous correction, and should be treated with maxillary expansion as early as possible. This treatment aims at providing a better tooth/skeletal relationship, thereby improving masticatory function, and establishing a symmetrical condyle/fossa relationship. Should posterior crossbite not be treated early, it may result in skeletal changes, demanding a more complex approach. Additionally, an overcorrection expansion protocol should be applied in order to improve the treatment stability. Although the literature has reported a high rate of relapse after maxillary expansion, the goal of this study was to demonstrate excellent stability of the posterior crossbite correction 21 years post treatment.
de ALMEIDA, Renato Rodrigues; de ALMEIDA, Marcio Rodrigues; OLTRAMARI-NAVARRO, Paula Vanessa Pedron; CONTI, Ana Claudia de Castro Ferreira; NAVARRO, Ricardo de Lima; MARQUES, Henry Victor Alves
Endoscopic Assessment and Prediction of Prostate Urethral Disintegration After Histotripsy Treatment in a Canine Model*
Abstract Background and Purpose Histotripsy is a nonthermal focused ultrasound technology that uses acoustic cavitation to homogenize tissue. Previous research has demonstrated that the prostatic urethra is more resistant to histotripsy effects than prostate parenchyma, a finding that may complicate the creation of transurethral resection of the prostate-like treatment cavities. The purpose of this study was to characterize the endoscopic appearance of the prostatic urethra during and after histotripsy treatment and to identify features that are predictive of urethral disintegration. Materials and Methods Thirty-five histotripsy treatments were delivered in a transverse plane traversing the prostatic urethra in 17 canine subjects (1�3/prostate ?1?cm apart). Real-time endoscopy was performed in the first four subjects to characterize development of acute urethral treatment effect (UTE). Serial postprocedure endoscopy was performed in all subjects to assess subsequent evolution of UTE. Results Endoscopy during histotripsy was feasible with observation of intraurethral cavitation, allowing characterization of the real-time progression of UTE from normal to frank urethral disintegration. While acute urethral fragmentation occurred in 3/35 (8.6%) treatments, frank urethral disintegration developed in 24/35 (68.5%) within 14 days of treatment. Treating until the appearance of hemostatic pale gray shaggy urothelium was the best predictor of achieving urethral fragmentation within 14 days of treatment with positive and negative predictive values of 0.91 and 0.89, respectively. Conclusion Endoscopic assessment of the urethra may be a useful adjunct to prostatic histotripsy to help guide therapy to ensure urethral disintegration, allowing drainage of the homogenized adenoma and effective tissue debulking.
Schade, George R.; Styn, Nicholas R.; Hall, Timothy L.
Visibility of the urethral meatus and risk of urinary tract infections in uncircumcised boys
Background: Uncircumcised boys are at higher risk for urinary tract infections than circumcised boys. Whether this risk varies with the visibility of the urethral meatus is not known. Our aim was to determine whether there is a hierarchy of risk among uncircumcised boys whose urethral meatuses are visible to differing degrees. Methods: We conducted a prospective cross-sectional study in one pediatric emergency department. We screened 440 circumcised and uncircumcised boys. Of these, 393 boys who were not toilet trained and for whom the treating physician had requested a catheter urine culture were included in our analysis. At the time of catheter insertion, a nurse characterized the visibility of the urethral meatus (phimosis) using a 3-point scale (completely visible, partially visible or nonvisible). Our primary outcome was urinary tract infection, and our primary exposure variable was the degree of phimosis: completely visible versus partially or nonvisible urethral meatus. Results: Cultures grew from urine samples from 30.0% of uncircumcised boys with a completely visible meatus, and from 23.8% of those with a partially or nonvisible meatus (p = 0.4). The unadjusted odds ratio (OR) for culture growth was 0.73 (95% confidence interval [CI] 0.35�1.52), and the adjusted OR was 0.41 (95% CI 0.17�0.95). Of the boys who were circumcised, 4.8% had urinary tract infections, which was significantly lower than the rate among uncircumcised boys with a completely visible urethral meatus (unadjusted OR 0.12 [95% CI 0.04�0.39], adjusted OR 0.07 [95% CI 0.02�0.26]). Interpretation: We did not see variation in the risk of urinary tract infection with the visibility of the urethral meatus among uncircumcised boys. Compared with circumcised boys, we saw a higher risk of urinary tract infection in uncircumcised boys, irrespective of urethral visibility.
Dubrovsky, Alexander Sasha; Foster, Bethany J.; Jednak, Roman; Mok, Elise; McGillivray, David
Isolated posterior cruciate ligament injury.
The patient was a 19-year-old male cadet at a military academy who was evaluated by a physical therapist in a direct-access capacity for a chief complaint of right knee pain and giving way after falling onto his right knee while snow sledding at a high rate of speed 2 weeks earlier. Knee radiographs were ordered by the physical therapist, which demonstrated a large suprapatellar joint effusion. Due to concern for a posterior cruciate ligament injury and to assess for concomitant injury, magnetic resonance imaging was ordered, which revealed disruption of the posterior cruciate ligament without injury to surrounding tissues. PMID:24256175
Glenesk, Kathleen; Fogarty, Brian T; Westrick, Richard B
Autonomic dysreflexia-induced reversible posterior leukoencephalopathy syndrome in patients with spinal cord injury: Two case reports
Background/objectives To report two cases of reversible posterior leukoencephalopathy syndrome (RPLS) in patients with traumatic cervical spinal cord injury. Design Case report. Setting Rehabilitation Inpatient Unit, Pusan National University Hospital, Yangsan-si, Korea. Results Two men with spastic tetraplegia developed autonomic dysreflexia. Use of antihypertensive medication and Foley catheter insertion prevented further episodes of acute arterial hypertension and development of new symptoms. Conclusion RPLS can occur in the setting of autonomic dysreflexia in patients with traumatic cervical cord injury. The prompt recognition of this syndrome is of importance to prevent further morbidity and mortality in patients with spinal cord injury.
Joa, Kyung-Lim; Shin, Yong-Il; Suh, Huy; Kim, Soo-Yeon; Chang, Jae Hyeok; Ko, Hyun-Yoon
The Surgical Management of Traumatic C6-C7 Spondyloptosis
A case of traumatic spondyloptosis of the cervical spine at the C6-C7 level is reported. The patient was treated succesfully with a anterior-posterior combined approach and decompression. The patient had good neurological outcome after surgery. A-51-year-old female patient was transported to our hospital's emergency department after a vehicle accident. The patient was quadriparetic (Asia D, MRC power 4/5) with severe neck pain. Plain radiographs, computerize tomography and spinal magnetic resonance imaging (MRI) showed C6-7 spondyloptosis and C5, C6 posterior element fractures. Gardner-Wells skeleton traction was applied. Spinal alignment was reachived by traction and dislocation was decreased to a grade 1 spondylolisthesis. Then the patient was firstly operated by anterior approach. Anterior stabilization and fusion was firstly achieved. Seven days after first operation the patient was operated by a posterior approach. The posterior stabilization and fusion was achieved. Postoperative lateral X-rays and three-dimensional computed tomography showed the physiological realignment and the correct screw placements. The patient's quadriparesis was improved significantly. Subaxial cervical spondyloptosis is a relatively rare clinical entity. In this report we present a summary of the clinical presentation, the surgical technique and outcome of this rarely seen spinal disorder.
Keskin, Fatih; Kalkan, Erdal
Mid-urethral slings in female incontinence: Current status
The advent of the mid-urethral sling (MUS) 15 years ago has drastically changed the surgical management of stress urinary incontinence (SUI). Both retropubic and transobturator MUS can be placed in the ambulatory setting with excellent results. The tension-free vaginal tape (TVT) sling has the most robust and long-term data, but more recent literature suggests that the transobturator tape sling may offer comparable efficacy in appropriately selected patients. Single incision sling (SIS) is the newest addition to the MUS group and was developed in an attempt to minimize morbidity and create an anti-incontinence procedure that could be performed in the office. The efficacy of SIS remains unknown as the current literature regarding SIS lacks long-term results and comparative trials. The suprapubic arc sling appears to have equally effective outcomes in at least the short-term when compared with TVT. Although evolution of the SIS has led to a less invasive procedure with decreased post-op pain and reduced recovery time, durability of efficacy could be the endpoint we are sacrificing. Until longer-term data and more quality comparison trials are available, tailoring one's choice of MUS to the individual patient and her unique clinical parameters remains the best option.
Krlin, Ryan M.; Murphy, Alana M.; Ingber, Michael S.; Vasavada, Sandip P.
[Effect of urethral stenoses on the urinary tract].
Intrauterine operations were carried out in fetal sheep varying from 50-122 days of gestation. Silk, catgut and polyglycolicacid sutures were used to produce varying degrees of stenosis. The urachus was ligated with a silk suture in all cases. Urachal ligation alone produces no ill effects on the upper urinary tract. The addition of urethral stenosis results in dilatation of the upper tract depending on the degree of infravesical obstruction. Partial ligation of the urethra produces a pyelocalyectasis which may disappear later. More severe degrees of obstruction are followed by hydronephrosis, hydroureter and megacystis. Dilatation begins in the region of the renal pelvis and proceeds in the antegrade manner towards the bladder. Histologically the parenchyma was reduced in thickness and showed dilated tubules. In the ureter and the bladder muscular hypertrophy was noticed. Depending on the time of the experiment, there was an increase of connective tissue within the ureter and bladder. In cases of extreme obstruction the ureter showed muscular atrophy. No infection, ureteral reflux, bladder diverticulosis, extravesicalisation of the ureter or narrowing of the ureter by hypertrophied musculature was seen. These experiments may throw some light on the pathogenesis of the megaureter syndrome occurring in childhood. PMID:7250874
Osterhage, H R
Mid-urethral slings in female incontinence: Current status.
The advent of the mid-urethral sling (MUS) 15 years ago has drastically changed the surgical management of stress urinary incontinence (SUI). Both retropubic and transobturator MUS can be placed in the ambulatory setting with excellent results. The tension-free vaginal tape (TVT) sling has the most robust and long-term data, but more recent literature suggests that the transobturator tape sling may offer comparable efficacy in appropriately selected patients. Single incision sling (SIS) is the newest addition to the MUS group and was developed in an attempt to minimize morbidity and create an anti-incontinence procedure that could be performed in the office. The efficacy of SIS remains unknown as the current literature regarding SIS lacks long-term results and comparative trials. The suprapubic arc sling appears to have equally effective outcomes in at least the short-term when compared with TVT. Although evolution of the SIS has led to a less invasive procedure with decreased post-op pain and reduced recovery time, durability of efficacy could be the endpoint we are sacrificing. Until longer-term data and more quality comparison trials are available, tailoring one's choice of MUS to the individual patient and her unique clinical parameters remains the best option. PMID:22022053
Krlin, Ryan M; Murphy, Alana M; Ingber, Michael S; Vasavada, Sandip P
Premedication with midazolam for urethral catheterization of febrile infants.
Febrile infants undergoing urethral catheterization (UC) are often not treated for pain and distress. The aim was to evaluate the effectiveness of midazolam premedication. We compared a convenience sample of infants who underwent UC with midazolam with those who did not receive midazolam. Outcome measures were Visual Analog Scale assessment, duration of cry, and emergency department length of stay. Thirty-two study participants and 18 controls were prospectively enrolled. Midazolam premedication showed a 53% decrease in the mean Visual Analog Scale score when parents assessed distress (33.6 vs. 71.7, P<0.0001) and a 48% decrease when nurses assessed distress (28.7 vs. 55.5, P<0.0002); the median cry duration was significantly shorter (0 vs. 240 s). Serious adverse events were not observed during sedation and at 48 h after discharge. Study participants had longer emergency department length of stay compared with the controls (191.5 vs. 139 min, P<0.017). In this cohort, midazolam significantly reduced the distress associated with UC without causing serious adverse events. PMID:24323046
Weiser, Giora; Cohen, Dana; Krauss, Baruch; Galbraith, Roger; Shavit, Itai
Traumatic internal carotid artery dissection.
Traumatic internal carotid artery dissection is a serious condition that may cause ischemic stroke in young patients. It has been under-diagnosed in the past. We present three cases of traumatic internal carotid artery dissection. The clinical manifestations include hemicrania, hemiparesis, partial Horner's syndrome and cranial nerve palsy. Diagnosis is with carotid color Doppler ultrasound, CT angiography of the neck and conventional angiography. The outcome may be poor with hemiparesis, persistent vegetative state and death. We review the literature and discuss the clinical presentation, diagnosis, grading and treatment choices for traumatic internal carotid artery dissection and stroke. PMID:16410213
Yang, Shun-Tai; Huang, Yin-Cheng; Chuang, Chi-Cheng; Hsu, Peng-Wei
Urethral Pain Among Prostate Cancer Survivors 1 to 14 Years After Radiation Therapy
Purpose: To investigate how treatment-related and non-treatment-related factors impact urethral pain among long-term prostate cancer survivors. Methods and Materials: Men treated for prostate cancer with radiation therapy at the Sahlgrenska University Hospital in Goeteborg, Sweden from 1993 to 2006 were approached with a study-specific postal questionnaire addressing symptoms after treatment, including urethral burning pain during urination (n=985). The men had received primary or salvage external-beam radiation therapy (EBRT) or EBRT in combination with brachytherapy (BT). Prescribed doses were commonly 70 Gy in 2.0-Gy fractions for primary and salvage EBRT and 50 Gy plus 2 Multiplication-Sign 10.0 Gy for EBRT + BT. Prostatic urethral doses were assessed from treatment records. We also recruited 350 non-pelvic-irradiated, population-based controls matched for age and residency to provide symptom background rates. Results: Of the treated men, 16% (137 of 863) reported urethral pain, compared with 11% (27 of 242) of the controls. The median time to follow-up was 5.2 years (range, 1.1-14.3 years). Prostatic urethral doses were similar to prescription doses for EBRT and 100% to 115% for BT. Fractionation-corrected dose and time to follow-up affected the occurrence of the symptom. For a follow-up {>=}3 years, 19% of men (52 of 268) within the 70-Gy EBRT + BT group reported pain, compared with 10% of men (23 of 222) treated with 70 Gy primary EBRT (prevalence ratio 1.9; 95% confidence interval 1.2-3.0). Of the men treated with salvage EBRT, 10% (20 of 197) reported urethral pain. Conclusions: Survivors treated with EBRT + BT had a higher risk for urethral pain compared with those treated with EBRT. The symptom prevalence decreased with longer time to follow-up. We found a relationship between fractionation-corrected urethral dose and pain. Among long-term prostate cancer survivors, the occurrence of pain was not increased above the background rate for prostatic urethral doses up to 70 Gy{sub 3}.
Pettersson, Niclas, E-mail: firstname.lastname@example.com [Department of Physics and Biomedical Engineering, Sahlgrenska University Hospital, Goeteborg (Sweden)] [Department of Physics and Biomedical Engineering, Sahlgrenska University Hospital, Goeteborg (Sweden); Olsson, Caroline [Division of Clinical Cancer Epidemiology, Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Goeteborg (Sweden)] [Division of Clinical Cancer Epidemiology, Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Goeteborg (Sweden); Tucker, Susan L. [Department of Bioinformatics and Computational Biology, University of Texas MD Anderson Cancer Center, Houston, Texas (United States)] [Department of Bioinformatics and Computational Biology, University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Alsadius, David; Wilderaeng, Ulrica [Division of Clinical Cancer Epidemiology, Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Goeteborg (Sweden)] [Division of Clinical Cancer Epidemiology, Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Goeteborg (Sweden); Johansson, Karl-Axel [Department of Physics and Biomedical Engineering, Sahlgrenska University Hospital, Goeteborg (Sweden)] [Department of Physics and Biomedical Engineering, Sahlgrenska University Hospital, Goeteborg (Sweden); Steineck, Gunnar [Division of Clinical Cancer Epidemiology, Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Goeteborg (Sweden)] [Division of Clinical Cancer Epidemiology, Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Goeteborg (Sweden)
[Experimental evaluation of the Sysmex UF-1000i for ruling out non-gonococcal urethritis].
Acute nongonococcal urethritis (NGU) is one of the commonest sexually transmitted infections affecting men and women. The diagnosis of NGU has traditionally required microscopic evidence of urethritis. However, a significant proportion of patients with urethral symptoms do not have microscopic evidence of urethritis. The purpose of the present study was to evaluate the analytical performance of the UF1000i, a recently introduced fluorescence flow cytometer intended for urinalysis purposes which provides new analytical features that seem particularly suitable for microbiological diagnostics, for ruling out NGU or predicting the presence of infection. The Sysmex UF1000i is a flow cytometry analyzer capable of quantifying a lot of particles, including bacteria (BACT) and white blood cells (WBCs). To evaluate the analytical performance of the UF1000i as a method for ruling out NGU, we examined 200 urethral smear samples, collected in a new liquid transport medium (Copan), and compared the UF1000i results with standard culture/molecular and microscopic Gram stain results. With instrument cut-off values of 200 BACT x 10^6/L and 500 WBCs x 10^6/L, we obtained a sensitivity of 84%, a specificity of 82%, and a high negative predictive value (96%). Culture/molecular detection of pathogens remains the gold standard technique for the diagnosis of NGU. However, the Sysmex UF1000i is capable of improving the efficiency of NGU presumptive diagnosis, providing results in a few minutes, with a high negative predictive value and high values of sensitivity. PMID:22992559
Grosso, Shamanta; Bruschetta, Graziano; Camporese, Alessandro
PCR for Diagnosis of Male Trichomonas vaginalis Infection with Chronic Prostatitis and Urethritis
The aim of this study was to assess the usefulness of PCR for diagnosis of Trichomonas vaginalis infection among male patients with chronic recurrent prostatitis and urethritis. Between June 2001 and December 2003, a total of 33 patients visited the Department of Urology, Hanyang University Guri Hospital and were examined for T. vaginalis infection by PCR and culture in TYM medium. For the PCR, we used primers based on a repetitive sequence cloned from T. vaginalis (TV-E650). Voided bladder urine (VB1 and VB3) was sampled from 33 men with symptoms of lower urinary tract infection (urethral charge, residual urine sensation, and frequency). Culture failed to detect any T. vaginalis infection whereas PCR identified 7 cases of trichomoniasis (21.2%). Five of the 7 cases had been diagnosed with prostatitis and 2 with urethritis. PCR for the 5 prostatitis cases yielded a positive 330 bp band from bothVB1 and VB3, whereas positive results were only obtained from VB1 for the 2 urethritis patients. We showed that the PCR method could detect T. vaginalis when there was only 1 T. vaginalis cell per PCR mixture. Our results strongly support the usefulness of PCR on urine samples for detecting T. vaginalis in chronic prostatitis and urethritis patients.
Lee, Jong Jin; Moon, Hong Sang; Lee, Tchun Yong; Hwang, Hwan Sik; Ahn, Myoung-Hee
[Posterior ceramic bonded partial restorations].
Posterior ceramic bonded partial restorations are conservative and esthetic approaches for compromised teeth. Overlays constitute a less invasive alternative for tooth tissues than crown preparations. With inlays and onlays they are also indicated in case of full arch or quadrant rehabilitations including several teeth. This article screens indications and realization of this type of restorations. PMID:17432532
Mainjot, Am�lie; Vanheusden, Alain
Stereolithography for Posterior Fossa Cranioplasty
Posterior fossa cranioplasty has been suggested for improvement of neurological symptoms following craniectomy. However, there is no particular recommendation in the literature about techniques for prosthesis manufacture and implantation. We report our experience using rapid prototyping technology and stereolithography for pre-surgical implant design and production of cranioplasties. ImagesFigure 1Figure 2Figure 3Figure 4Figure 5
Agner, Celso; Dujovny, Manuel; Evenhouse, Raymond; Charbel, Fady T.; Sadler, Lewis
Posterior Tibial Tendon Dysfunction (PTTD)
The official consumer website of: Visit ACFAS.org | About ACFAS | Informaci�n en Espa�ol ... tendon serves as one of the major supporting structures of the foot, helping it to function while walking. Posterior tibial tendon dysfunction (PTTD) is a condition caused ...
Children's Understanding of Posterior Probability
ERIC Educational Resources Information Center
Do young children have a basic intuition of posterior probability? Do they update their decisions and judgments in the light of new evidence? We hypothesized that they can do so extensionally, by considering and counting the various ways in which an event may or may not occur. The results reported in this paper showed that from the age of five,�
Girotto, Vittorio; Gonzalez, Michael
Bilateral caudal superficial epigastric skin flap and perineal urethrostomy for wound reconstruction secondary to traumatic urethral rupture in a cat.
Use of a bilateral caudal superficial epigastric skin flap and perineal urethrostomy for reconstruction of a wound which occurred secondary to rupture of the distal urethra and extravasation of urine is reported. A 10-month-old male neutered Domestic Shorthaired cat was presented with a history of trauma, signs of pain of the hind quarters and anuria. Progression of the clinical signs, including anuria, lethargy, anorexia, and azotemia, prompted referral and investigation 108 hours following the initial injury. Retrograde urethrography indicated a rupture of the distal pelvic urethra with extravasation of urine subcutaneously. Development of extensive skin necrosis of the perineum and rump progressed leaving a large wound defect which was managed with wound debridement and dressing. The wound was closed using staged caudal superficial epigastric skin flaps and perineal urethrostomy as part of the reconstruction. PMID:21225089
Clarke, B S; Findji, L
Nucleus caudalis lesioning: Case report of chronic traumatic headache relief
Background: The nucleus caudalis dorsal root entry zone (DREZ) surgery is used to treat intractable central craniofacial pain. This is the first journal publication of DREZ lesioning used for the long-term relief of an intractable chronic traumatic headache. Case Description: A 40-year-old female experienced new-onset bi-temporal headaches following a traumatic head injury. Despite medical treatment, her pain was severe on over 20 days per month, 3 years after the injury. The patient underwent trigeminal nucleus caudalis DREZ lesioning. Bilateral single-row lesions were made at 1-mm interval between the level of the obex and the C2 dorsal nerve roots, using angled radiofrequency electrodes, brought to 80�C for 15 seconds each, along a path 1 to 1.2 mm posterior to the accessory nerve rootlets. The headache improved, but gradually returned. Five years later, her headaches were severe on over 24 days per month. The DREZ surgery was then repeated. Her headaches improved and the relief has continued for 5 additional years. She has remained functional, with no limitation in instrumental activities of daily living. Conclusions: The nucleus caudalis DREZ surgery brought long-term relief to a patient suffering from chronic traumatic headache.
Sandwell, Stephen E.; El-Naggar, Amr O.
Post traumatic spinal arachnoid cysts
Summary Based on the study of 10 cases of post traumatic spinal arachnoid cysts (SAC), acute and chronic clinical variants are individualized. A physiopathological hypothesis is advanced to explain their mechanism of formation.
F. Lesoin; M. Rousseau; C. E. Thomas; M. Jomin
Post-Traumatic Stress Disorder
... United States population will have PTSD at some point in their lives and about 5.2 million adults have PTSD during a given year. Traumatic events that may trigger PTSD include violent personal assaults, natural or human- ...
Detection of Chlamydia trachomatis in urethral and urine samples from symptomatic and asymptomatic male patients by the polymerase chain reaction
To evaluate the commercially available polymerase chain reaction (PCR) assay Amplicor (Roche Molecular Systems, USA) for diagnosis ofChlamydia trachomatis infection, urethral and urine swabs from a total of 344 male patients were tested and the results compared with those obtained by the nonisotopic hybridization assay Pace 2 (Gen Probe, USA) for urethral samples and by the enzyme immunoassay EIA MicroTrak
A. Stary; B. Choueiri; I. H�rting-M�ller; P. Halisch; L. Teodorowicz
[Indirect traumatic diaphragmatic rupture].
Between 1969 and 1988 51 polytraumatized patients were treated for rupture of the diaphragm due to blunt trauma. In 39 cases the lesion was in the left hemidiaphragm, in 11 cases on the right side and in one case on both sides. Clinical investigation and posterior-anterior chest X-ray were the most important diagnostic procedures. A high percentage of ruptures was only detected intraoperatively during acute laparotomy/thoracotomy. Early or delayed surgery had no influence on the survival of patients. The prognosis depends on the severity of associated injuries, which are the main causes of death in these patients. PMID:1858376
Holzberger, P; K�nigsrainer, A; Tauscher, T; M�ller, L; Th�ni, H
Posterior ischemic optic neuropathy in the setting of posterior reversible encephalopathy syndrome and hypertensive emergency.
We present the magnetic resonance imaging findings of posterior ischemic optic neuropathy in a patient with posterior reversible encephalopathy syndrome secondary to hypertensive emergency. PMID:24647142
Joos, Zachary P; Adesina, Ore-Ofe O; Katz, Bradley J
Urethral diverticulum: a new complication associated with tension-free vaginal tape.
A case of a urethral diverticulum following the insertion of a tension-free vaginal tape (TVT) is presented. The patient was a woman with stress urinary incontinence who underwent surgery to correct intrinsic sphincter deficiency. Three cases of urethral diverticula have been published thus far as complications of TVT insertions, but this is the first complication associated with intrinsic sphincter deficiency. The high pressures in the proximal urethra that result from positioning the TVT in the middle urethra, especially when obstruction co-exists with an open bladder neck, can be a predisposing factor for this complication. The possibility of a urethral diverticulum when postvoid incontinence occurs after the insertion of a TVT should be carefully evaluated. PMID:19077415
Athanasopoulos, A; McGuire, E J
[Can bladder catheterization in pediatrics cause complications? The case of a urethral dysuria cystograph].
A urethral dysuria cystograph (CUMS (Cistografia Ureteral Miccional Seriada)) is the first diagnostic procedure, by means of x-rays, to evaluate bladder-urethral reflux. It consists of a bladder catheter to administer a radiopaque contrast dye through the ureter. To use the aforementioned technique without any asepsis measures and without knowledge about it can lead to possible complications. By means of a retrospective study using a sample of 181 patients, the authors have evaluated the incidence of possible complications and/or subsequent discomfort due to a urethral dysuria cystograph (CUMS). As final results, by means of an after test telephone call, the authors observed that 96.7% of the children who underwent this technique did not manifest any type of complication nor urinary discomfort. PMID:20014629
Alc�zar Garc�a, A; Daviu Llorens, E; Daza Laguna, A; Dur�n Feliubadalo, C; Pons Torrents, X
Urethral sphincter EMG as event detector for Neurogenic detrusor overactivity.
The aim of this study was to investigate the feasibility of using external urethral sphincter electromyogram (EMG) (EUSEMG) to detect the onset of detrusor contractions in patients with both neurogenic detrusor overactivity (NDO) and detrusor sphincter dyssynergia (DSD). Detrusor pressure (Pdet) and EUSEMG was recorded in 23 neurogenic patients during slow artificial bladder filling. The time delay between the onset of a detrusor contraction and the onset of EUSEMG activity was calculated together with the detrusor pressure increase related to this delay. Of 23 patients enrolled, 12 patients showed both NDO and DSD. Of these 12 patients, 10 had a strong correlation between detrusor pressure and EUSEMG. One patient in this group was excluded due to a storage pressure above 30 cm H2O. Two detection methods were applied on the remaining 9 patients. Method 1 was a root mean square (RMS)-integrator with simple thresholding. This approach had a good sensitivity but also a poor specificity (many false-positive detections). Detection method 2 included a kurtosis-based scaling function, which was multiplied to a similar RMS-integrator as used in method 1. Onset detection occurred before Pdet exceeded 18 cm H2O with both methods. However, method 1 resulted in 14.1 +/- 12.8 false-positive detections during one bladder filling. Pdet at onset detection was on average 1.0 +/- 1.1 cmH2 0 higher with detection method 2 but the number of false-positives was reduced by 95.8%. This paper demonstrates the feasibility of using EUSEMG to estimate the onset of a detrusor contraction in selected patients. PMID:17605352
Hansen, John; Borau, Albert; Rodr�guez, Alfred; Vidal, Joan; Sinkjaer, Thomas; Rijkhoff, Nico J M
Coincidence of HPV11-Positive Urethral Condyloma Acuminatum and HPV-Negative Multiple Bladder Papillomas in a Female
Human papillomaviruses (HPVs) are associated with proliferative lesions in a variety of human epithelial types. A 38-year-old female presented with a diagnosis of urethral condyloma acuminatum. She underwent transurethral resection of the urethral condyloma. At that time, multiple (five) bladder tumors were simultaneously found and also removed by transurethral resection. Four of the bladder tumors were diagnosed as squamous papilloma, and the other was urothelial inverted papilloma. Postoperative course was uneventful. Genomic DNA was extracted from 10??m thick sections of each bladder tumor as well as urethral condyloma. Then, 16 types of HPV DNA sequences were assessed with the PapiPlex method using genomic DNA samples extracted from each bladder tumor as well as urethral condyloma. HPV-11 was detected in DNA extracted from the urethral condyloma, while no HPV DNA sequences were positive in any of the genomic DNA samples extracted from the bladder tumors.
Nakazaki, Natsuko; Zaitsu, Masayoshi; Mikami, Koji; Yui, Shunsuke; Kanatani, Ayumi; Nakatani, Takushi; Ito, Akiko; Takeshima, Yuta; Tonooka, Akiko; Oka, Hideaki; Miki, Tomoko; Takeuchi, Takumi
Use of intraocular lenses in children with traumatic cataract in south India
AIMS�To assess the long term results of intraocular lens (IOL) implantation for traumatic cataract in young children in a developing country.?METHODS�Prospective hospital based study of 52�children (age 2-10 years) undergoing unilateral cataract extraction and IOL insertion for traumatic cataract performed by a single surgeon in south India. Children were reviewed regularly and followed up initially for 3�years.?RESULTS�There were no serious operative complications. Clinically significant posterior capsule opacification was almost universal (92%) and YAG capsulotomy or membranectomy was performed on 48�eyes. Some degree of pupil capture affected 35% of eyes and was complete in 6%. Visual acuity was 6/12 or better in 67% of eyes at the last follow up examination.?CONCLUSION�The visual acuity results 3�years after implantation of posterior chamber IOLs in older children with traumatic cataracts in south India were encouraging. In developing countries where follow up is unreliable it is essential to plan to clear the axial part of the posterior capsule either at the time of surgery or soon afterwards.?? Keywords: intraocular lens; children; cataract; India
Eckstein, M.; Vijayalakshmi, P; Killedar, M.; Gilbert, C.; Foster, A.
Anterior Urethrectomy for Primary Carcinoma of the Female Urethra Mimicking a Urethral Caruncle
Here we report a case of primary carcinoma of the female urethra. A 52-year-old woman presented with a palpable urethral mass associated with intermittent pain that she first experienced a few months prior. Clinical examination showed a urethral mass that appeared to be a caruncle; therefore, simple carunclectomy was performed. However, on histological examination, the mass was revealed to be a squamous cell carcinoma; therefore, anterior urethrectomy was performed. During a 4-year follow-up period, the patient has been well with no dysuria, dyspareunia, or incontinence.
Shim, Ji Sung; Oh, Mi Mi; Lee, Jeong Gu
Location of bladder and urethral sphincter motoneurons in the male guinea pig (Cavia porcellus).
Although the guinea pig is used widely in experimental medical research, including in studies on micturition control, the spinal origin of preganglionic parasympathetic bladder and somatic external urethral sphincter motoneurons is not known. In the male guinea pig using wheat germ agglutinin-conjugated horseradish peroxidase and dextran Alexa Fluor 488/568 tracers, preganglionic parasympathetic bladder motoneurons were observed in the ventrolateral part of the intermediolateral cell group of the first sacral segment. The external urethral sphincter motoneurons were found to be located in the ventral horn of the first sacral segment, in a cell group corresponding with the nucleus of Onuf in cat and human. PMID:15147780
Kuipers, Rutger; Izhar, Zofiet; Gerrits, Peter O; Miner, Wesley; Holstege, Gert
[Methods of endoluminal treatment of urethral stenosis up to the end of the 19th Century].
Ever since Hippocrates, physicians have managed patients that suffered from urethral stricture. To that end, genius and imagination put to the service of scientific knowledge, have produced numerous apparatus, instruments and methods of a varied nature, with the aim of allowing urine passage through the strictured urethra. Illustrious names such as Andr�s Laguna or Francisco D�az, and other not so well known. Spanish and foreigners, are mentioned in this paper in an intent to contribute a brief view on the evolution of the methods used to treat urethral stricture up to the end of the 19th Century. PMID:9542186
Lozano Ortega, J L
The value of urine specimens in screening for male urethritis and its microbial aetiologies in Tanzania.
OBJECTIVE--To evaluate the first void urine (FVU) specimen in screening for urethritis and its microbial aetiologies in a male African population in which urinary schistosomiasis is also prevalent. PATIENTS AND METHODS--Two hundred and forty eight males aged 15-54 years provided FVU specimens: 55 patients from a clinic for sexually transmitted diseases (STD), 151 patients from a medical outpatient clinic and 42 villagers from an area of high endemicity for S haematobium. Specimens were tested for leucocyte esterase (LE) using a dipstick (Nephur-Test+Leuco, Boehringer-Mannheim France SA). Ova of S haematobium were sought in terminal urine samples from all subjects. For all STD patients, and all medical outpatients with a positive LE test, urine and urethral swabs were tested for Chlamydia trachomatis antigen, and urethral swabs were tested for Neisseria gonorrhoeae by gram stain and isolation. RESULTS--The prevalence of LE positivity was 38/41 in STD patients with urethral signs or symptoms (93%), 5/14 among other STD patients (36%), 21/151 among medical outpatients (15%) and 13/42 among villagers (31%). As a screening test for urethral infection (detection of gonorrhoea or chlamydia and/or > or = 5 polymorphs per high power field on gram stain) the LE test had a sensitivity of 94% and a specificity of 53% among STD patients. Of 24 STD patients with gonococcal or chlamydial infection, 23 had a positive LE test (96%). Among general medical outpatients, 12 of 22 with a positive LE test had either conventionally defined urethritis or gonococcal or chlamydial infection, giving a positive predictive value of 55% for the LE test in this group. Of 18 subjects in all groups with urinary schistosomiasis nine had a positive LE test (50%), although three of these also had gonorrhoea. Chlamydial antigen was detected in the FVU specimen of all six subjects in whom it was detected in a urethral swab, and in an additional three subjects in the outpatient group. CONCLUSIONS--The FVU, which is an easily collected and non-invasive specimen, can provide valuable information on the prevalence of urethritis and on its microbial aetiology among the general male population in African countries.
Mayaud, P; Changalucha, J; Grosskurth, H; Ka-Gina, G; Rugemalila, J; Nduba, J; Newell, J; Hayes, R; Mabey, D
Urethral Cytokine and Immune Responses in Chlamydia trachomatis-Infected Males
Penile urethral swabs collected from PCR-confirmed Chlamydia trachomatis-infected, C. trachomatis-uninfected, and non-C. trachomatis-infected, nongonococcal urethritis-infected males were analyzed for cytokine, total immunoglobulin (Ig), and specific antibody levels by enzyme-linked immunosorbent assay. Differential cellular components of the swab transport medium were also enumerated for the same groups. Although low, the levels of C. trachomatis-specific IgA and IgG antibodies and interleukin 8 cytokine were significantly higher in C. trachomatis-infected individuals. There were no significant differences in the levels of seven additional cytokines evaluated.
Pate, Mitchell S.; Hedges, Spencer R.; Sibley, Don A.; Russell, Michael W.; Hook, Edward W.; Mestecky, Jiri
Coexistence of urethritis with genital ulcer disease in South Africa: influence on provision of syndromic management
Objective: To assess whether syndromic management of genital ulcer disease was sound, if based on the premise that men with genital ulcers rarely have a concomitant urethral infection. Methods: Specimens were taken in 1998 from 186 mine workers in Carletonville, South Africa, who were seen consecutively with genital ulcers. The specimens comprised a swab from the ulcer, a urethral swab for a Gram stained smear, and 10�15 ml of a first catch urine sample. The latter was tested by ligase chain reaction assays for Neisseria gonorrhoeae and Chlamydia trachomatis specific DNA sequences and by a polymerase chain reaction (PCR) assay for Mycoplasma genitalium. Ulcer inducing micro-organisms were detected either by a multiplex PCR assay, or in the case of lymphogranuloma venereum (LGV) serologically, and human immunodeficiency virus (HIV) infection was detected by an enzyme linked immunosorbent assay (ELISA) test. Results: Most (54%) of the ulcers were chancroidal, 18% were herpetic (HSV type 2), 6.5% primary syphilitic, and 3.2% due to LGV. More than one micro-organism was detected in 9.1% of the ulcers and less than 10% were undiagnosed. Microscopic examination of the urethral smears showed that 99 (53%) of the men had urethritis, of whom 45 (45%) were infected with N gonorrhoeae. Of the 54 men (55%) who had non-gonococcal urethritis (NGU), 11 (19.6%) harboured C trachomatis or M genitalium. Almost two thirds (64.5%) of the men had HIV infection, but this did not seem to have influenced the aetiology of the ulcers. Nor was a particular ulcer associated with one type of urethritis more than the other. Neither C trachomatis nor M genitalium was associated significantly with non-gonococcal urethritis (NGU) in either HIV positive or HIV negative men. Conclusion: The combination of antibiotics used for the management of genital ulcer disease in men in this South African mining population needs to be widened to encompass frequently occurring concomitant gonococcal urethritis and NGU infections. This means treatment with long acting penicillin, combined with ciprofloxacin and azithromycin or erythromycin. A similar situation may exist in other geographical locations with a need to provide appropriate antimicrobial combinations depending on the patterns of infection detected.
Ballard, R; Fehler, H; Htun, Y; Radebe, F; Jensen, J; Taylor-Robinson, D
Fournier's Gangrene in a Heterosexual Man: A Complication of Neisseria meningitidis Urethritis
A 55-year-old heterosexual male presented to the emergency department with a symptomatology consistent with urethritis and Fournier's gangrene. Urethral swab and operative tissue cultures were positive for coagulase-negative Staphylococcus and an intracellular Gram-negative diplococcus. The latter was initially thought to be Neisseria gonorrhea; however, DNA sequencing technique confirmed it to be Neisseria meningitidis. The patient required three separate surgical debridements to control widespread necrotizing infection. Following documentation of sterile wound healing with appropriate antibiotics, four reconstructive surgeries were necessary to manage the resultant wound defects. To our knowledge, Neisseria meningitidis as a causative organism in Fournier's gangrene has not been reported in the literature.
Porshinsky, Brian S.; Patel, Abhishek P.; McClung, Christopher D.
Isolated posterior cruciate ligament injuries in athletes
The literature is divided as to the necessity of an intact posterior cruciate ligament for functional stability. Pre sented here is a prospective study of isolated posterior cruciate injuries seen in the acute stage in 13 patients, 6 males and 7 females. The diagnosis of posterior cruciate ligament tear was made clinically and con firmed by arthroscopy. The average age
P. J. Fowler; S. S. Messieh
Posterior Fossa Dermoid Cysts Causing Cerebellar Abscesses
Dermoid cysts are uncommon tumors, and posterior fossa dermoid cysts may rarely cause abscess formation or formation of daughter abscesses within the cerebellum. At present, there are only 16 cases with posterior fossa dermoid cysts causing cerebellar abscesses reported in the literature. Two cases, 22 and 14 months old, with posterior fossa dermoid cysts and dermal sinus causing multiple cerebellar
Feyza Karag�z G�zey; N. Serdar Bas; Altay Sencer; Erhan Emel; M. Kemal Hamamcioglu; Nezih �zkan; Kemal Hepgul; Abdurrahman Aycan
Traumatic unilateral vasomotor rhinitis.
Vasomotor rhinitis (VMR) is a commonly encountered entity that may be difficult to diagnose. The classic symptoms are clear rhinorrhea and nasal congestion, commonly brought on by exercise, stress, heat, cold, and environmental irritants. The diagnosis is one of exclusion, and management usually involves avoidance of inciting agents and treatment with an anticholinergic nasal spray. We describe a case of VMR in a 22-year-old woman who presented with symptoms of clear, left-sided rhinorrhea and epiphora that had begun shortly after a motor vehicle accident approximately 1.5 years earlier, but which she had not reported at that time. The patient's left carotid canal had been fractured and the surrounding sympathetic plexus injured in the accident, resulting in an overactive parasympathetic system. Both exercise and heat exacerbated her symptoms. Allergy was excluded by negative allergy testing, and the patient did not respond to fluticasone nasal spray. Given the mechanism of injury, the unilaterality of symptoms, and the patient's lack of response to nasal steroids, it was thought that the VMR was due to the earlier traumatic injury, which had resulted in imbalance of the autonomic neural input. A trial of ipratropium was given to directly treat the parasympathetic overactivity. This treatment resulted in immediate improvement in both the nasal and lacrimal secretions. PMID:23288805
Harlor, Evan J; Greene, J Scott; Considine, Catherine
Ocular contusion may result in numerous types of retinal breaks, including horseshoe tears, operculated holes, large irregular retinal breaks, macular holes, and, most often, retinal dialyses. Supranasal dialyses have a high correlation with trauma and may require months before symptoms appear. Large irregular breaks occur only following trauma and may be found in the area of contusion. Horseshoe-shaped tears and operculated holes may occur at areas of vitreoretinal attachment. Macular holes may also occur from trauma, either from detachment of vitreous or as a sequela of retinal edema. Careful examination of the posterior pole and retinal periphery is necessary when there is a history of trauma or findings indicative of a past episode of trauma. Binocular assessment of the retina is a prerequisite to conducting an appropriate examination. PMID:8268698
Dolan, B J
An unusual case of traumatic petechiae.
We report a rare cause of traumatic petechiae without the full blown symptoms and signs of traumatic asphyxia. There were no complications encountered and there was spontaneous resolution. PMID:15789793
Haji, A; Imana, M A
Concussion and Mild Traumatic Brain Injury
... page: About CDC.gov . Injury Prevention & Control : Traumatic Brain Injury CDC's Injury Center Share Compartir Concussion and Mild ... Concussion? A concussion is a type of traumatic brain injury (TBI) caused by a bump, blow, or jolt ...
Traumatic Brain Injury (TBI): Moderate or Severe
... skull and enters the brain Defense and Veterans Brain Injury Center Traumatic Brain Injury (TBI) Moderate or Severe FA M ILIE S PA ... therapy sessions. Photo Credit: www.gettyimages.com Traumatic Brain Injury (TBI) Moderate or Severe
ERs See Spike in Traumatic Brain Injuries
Traumatic Brain Injury Common Among Homeless Men
Tibial avulsion fracture of the posterior root of the medial meniscus in a skeletally-immature child - a case report.
It has been theorized that a traumatic tibial avulsion fracture of the posterior root of the medial meniscus (MM) is the cause of the so-called meniscus ossicle (MO). We report the delayed appearance of a tibial avulsion fracture of the posterior root of the MM after a valgus, twisting injury in a 12-year-old boy with open physes. Magnetic resonance imaging (MRI) scans performed 3 days after the injury did not demonstrate a definitive tibial avulsion fracture of the posterior root of the MM; whereas, a repeat MRI for 3 months post-injury did. Medial extrusion of the MM was also noted on the 3 month MRI. Arthroscopic reattachment of the avulsed posterior root of the MM using a trans-physeal nonabsorbable suture tied over a proximal tibia staple was performed. Follow-up MRI at 6 months postoperatively demonstrated healing of the tibial avulsion fracture of the posterior root of the MM in an anatomic position. The patient had a complete resolution of symptoms and there was no angular deformity or limb-length discrepancy at 2 years postoperatively. To our knowledge, this is the first report describing a tibial avulsion fracture of the posterior root of the MM in a skeletally-immature patient successfully treated by a trans-physeal arthroscopic suture. This case also illustrates the development of the MO of the posterior root of the MM. PMID:20199863
Matava, Matthew J; Kim, Young-Mo
Approaches to a posterior polar cataract
Posterior polar cataracts present special challenges to the cataract surgeon. These are often associated with weakness/dehiscence of the posterior capsule and thus have a higher rate of intraoperative posterior capsule rupture. The surgeon needs to adhere to special surgical strategies to minimize the risk of a posterior capsule rupture. These include, adhering to the principles of closed chamber technique, avoiding hydrodissection � instead performing �inside-out� hydrodelineation and using modest to low phaco parameters and reducing these stepwise. This article provides important pearls on how to approach a posterior polar cataract.
Vasavada, Abhay R.; Vasavada, Viraj A.; Raj, Shetal M.
Urethral metastasis from a sigmoid colon carcinoma: a quite rare case report and review of the literature
Background Urethral metastatic adenocarcinoma is extremely rare. Moreover, only 9 previous cases with metastases from colorectal cancer have been reported to date, and not much information on urethral metastases from colorectum is available so far. Case presentation We report our experience in the diagnosis and the management of the case with urethral metastasis from a sigmoid colon cancer. A 68-year-old man, who underwent laparoscopic sigmoidectomy for sigmoid colon carcinoma four years ago, presented gross hematuria with pain. Urethroscopy identified a papillo-nodular tumor 7�mm in diameter in the bulbar urethra. CT-scan imaging revealed the small mass of bulbous portion of urethra and solitary lung metastasis. Histological examination of the tumor obtained by transurethral resection showed moderately differentiated adenocarcinoma, which was diagnosed as a metastasis of a sigmoid colon carcinoma pathologically by morphological examination. Immunohistochemical analysis of the urethral tumor revealed the positive for cytokertin 20 and CDX2, whereas negative for cytokertin 7. These features were consistent with metastatic adenocarcinoma of the sigmoid colon cancer. As the management of this case with urethral and lung metastasis, 6-cycle of chemotherapy with fluorouracil with leucovorin plus oxaliplatin was administered to the patient, and these metastases were disappeared with no recurrence of disease for 34�months. Conclusion Urethral metastasis from colorectal cancer is a very rare occurrence. However, in the presence of urinary symptoms, the possibility of the urethral metastasis should be considered.
A novel radiographic technique to asses grafts in the female -pelvis: a comparison of the Inside-Out and the Outside-In trans-obturator mid urethral sling positioning
The three-dimensional configuration of mid-urethral sling tapes is difficult to demonstrate in traditional anatomical dissections or imaging studies. The aim of this study was to test the utility of a novel technique using mesh tapes to assess spatial differences between the in-out and out-in transobturator mid-urethral slings. Two independent surgeons performed their usual transobturator mid-urethral sling placement on 10 fresh thawed cadavers, alternating sides in the consecutive cadavers. Tantalum wires threaded through the polypropylene-tapes rendered them radio-opaque. Following placement, CT scans were obtained to generate 3-D and MIPS images for analysis. Results showed that the mean angle formed by the in-out sling measured 122� (95%CI: 107�-136�); versus 144� (95%CI: 131�-151�) for the out-in sling (p?=?0.02). The paired differences between the tapes� inner angles were significantly different; with a mean difference of 20� (median 19.0�), (p?=?0.008). There was no significant correlation between either approach and BMI or angle of the pubic arch. The images revealed that the tapes lie as a band posterior/dorsal to the urethra rather than inferior. In conclusion: marking mesh with �Tantalum wire, in combination with 3-D and MIPS CT-scan reconstruction images, provided a unique method to visualize the entire sling trajectory. The clinical implications of the more horizontal positioning after the out-in approach remain to be determined.
Hinoul, P.; Elzevier, H.W.; Kirkemo, A.; Patel, B.G.; Flynn, B.J.; Walters, M.D.
A novel radiographic technique to asses grafts in the female -pelvis: a comparison of the Inside-Out and the Outside-In trans-obturator mid urethral sling positioning.
The three-dimensional configuration of mid-urethral sling tapes is difficult to demonstrate in traditional anatomical dissections or imaging studies. The aim of this study was to test the utility of a novel technique using mesh tapes to assess spatial differences between the in-out and out-in transobturator mid-urethral slings. Two independent surgeons performed their usual transobturator mid-urethral sling placement on 10 fresh thawed cadavers, alternating sides in the consecutive cadavers. Tantalum wires threaded through the polypropylene-tapes rendered them radio-opaque. Following placement, CT scans were obtained to generate 3-D and MIPS images for analysis. Results showed that the mean angle formed by the in-out sling measured 122� (95%CI: 107�-136�); versus 144� (95%CI: 131�-151�) for the out-in sling (p?=?0.02). The paired differences between the tapes' inner angles were significantly different; with a mean difference of 20� (median 19.0�), (p?=?0.008). There was no significant correlation between either approach and BMI or angle of the pubic arch. The images revealed that the tapes lie as a band posterior/dorsal to the urethra rather than inferior. In conclusion: marking mesh with -Tantalum wire, in combination with 3-D and MIPS CT-scan reconstruction images, provided a unique method to visualize the entire sling trajectory. The clinical implications of the more horizontal positioning after the out-in approach remain to be determined. PMID:24753952
Hinoul, P; Elzevier, H W; Kirkemo, A; Patel, B G; Flynn, B J; Walters, M D
5Fluorouracil in the treatment of penile and urethral condylomata acuminata
5-Fluorouracil (5-FU) cream was compared with podophyllin 25 percent in alcohol for treating genital and urethral condylomata acuminata. The cure rate after four weeks was found to be 6 of 18 patients treated with 5-FU and 10 of 19 treated with podophyllin. By changing the treatment for those not cured, warts regressed after four weeks in four more patients in
J Wallin
Dorsal Onlay versus Ventral Onlay Urethroplasty for Anterior Urethral Stricture: A Meta-Analysis
Background: Ventral and dorsal sides of urethra were chosen to place grafts in free graft onlay urethroplasty. As the advantages and disadvantages of these two sites are still unclear, we systemically analyzed clinical articles reported in the literature. Materials and Methods: The literature till October 2007 regarding the use of ventral\\/dorsal graft urethroplasty in anterior urethral strictures was searched using
Kunjie Wang; Xunzhong Miao; Li Wang; Hong Li
Urethral sphincter EMG-controlled dorsal penile\\/clitoral nerve stimulation to treat neurogenic detrusor overactivity
The goal of this study was to investigate whether real-time external urethral sphincter (EUS) EMG-controlled dorsal genital nerve (DGN) stimulation can suppress undesired detrusor bladder contractions in patients with both neurogenic detrusor overactivity (NDO) and detrusor sphincter dyssynergia (DSD). Detrusor pressure (Pdet) and EUS EMG were recorded in 12 neurogenic patients who underwent two filling cystometries. The first one was
E. Opisso; A. Borau; N. J. M. Rijkhoff
A case of urethral reconstruction using a superficial circumflex iliac artery.
A radial forearm free flap has been conventionally used for urethral reconstruction. However, aesthetic and functional complications occur frequently at the donor site. The use of a superficial circumflex iliac artery perforator (SCIP) flap can resolve these disadvantages. Here, we report our case with a review of literature. A 69-year-old man visited our hospital with multiple contusions of the abdomen and genital amputation. After necrotic tissue debridement, the length of the residual corpus carvernosum was 1.5 cm and that of the corpus spongiosum and urethra was 1 cm. For the reconstruction of the penis, a SCIP flap and anterolateral thigh free flap was performed. The primary closure was performed at the donor site. Three weeks postoperatively, the patient had a urethral foley catheter removed. The neourethra was functioning well without stricture. Four months postoperatively, the patient had no complications such as urethral stricture. A good recovery was also achieved with no aesthetic deficits at the donor site. SCIP flap is appropriate for urethral reconstruction. Because of its proximity to the recipient sites, it makes surgical preparation easier and the primary closure at the donor site available. It is also advantageous in that its location is almost unnoticeable. PMID:22783536
Yoo, Kun-Woon; Shin, Hyun-Woo; Lee, Hye Kyung
Y-type urethral duplication in children: Management strategy at our center
Aims: Report of seven children with Y-type urethral duplication (YUD). Materials and Methods: (A) Four staged operations were performed in patients having extensive perineal dissection (for rectourinary fistula separation and anterior mobilization of ventral urethra (VU)), tension rectocutaneous anastomosis, and children who were not toilet trained). These stages are (1) diversion sigmoid colostomy with anterior mobilization of VU as perineal urethrostomy via anterior sagittal approach; (2) Orthotopic urethral (OU) reconstruction; (3) anastomosis of OU and perineal urethra; (4) colostomy closure with management of complications. (B) The patients having VU onto the perineum underwent single stage urethral reconstruction. Results: The VU was urethrorectal/urethroanal in five and urethroperineal in two. Low anorectal malformation and upper urinary tract anomalies were present in 57.1% (4/7) and 14.7% (1/7) patients, respectively. Buccal mucosa free graft, transverse inner preputial flap, and perineal skin were tubularized for OU reconstruction. Mean age at 1st , 2nd , 3rd , and 4th surgery was 5 � 0.78, 28 � 0.78, 36 � 0.78, 49 � 0.78 months respectively. Three patients needed surgery for complications (urethrocutaneous fistula in two and urethral diverticulum in one) in a mean 3.12 � 0.34 years of follow-up. Final uroflowmetry and fecal continence were good in all patients. Conclusions: The YUD is a difficult entity to manage. Although, staged procedure appears to be time consuming, but good and promising results can be achieved by staging the procedure.
Singh, Sunita; Rawat, Jiledar
Enigma of urethral pain syndrome: Why are there so many ascribed etiologies and therapeutic approaches?
Urethral pain syndrome has had several sobriquets, which have led to much confusion over the existence of this pathological condition and the useful options in the care of the afflicted patient. Our aim was to explore the proposed etiologies of this syndrome, and to provide a critical analysis of each proposed etiology and present a balanced argument on the plausibility of the proposed etiology and therapeutic approaches. We carried out an English language electronic search in the following databases: Medline, Embase, Amed, Cinahl, Pubmed, Cochrane Library, Trip Database and SUMSearch using the following search terms: urethral syndrome, urethral diseases, urethra, urologic diseases etiology/etiology, presentation, treatment, outcome, therapeutics and treatment from 1951 to 2011. In excess of 200 articles were recovered. With the clearly defined objectives of analyzing the proposed etiologies and therapeutic regimes, two author(s) (HP and IO) perused the abstracts of all the recovered articles, selecting those that addressed the etiologies and therapeutic approaches to treating the urethral pain syndrome. The number of articles was reduced to 25. The full text of all 25 articles were retrieved and reviewed. Through the present article, we hope to elucidate the most probable etiology of this condition whilst simultaneously, advance a logical explanation for the apparent success in the treatment of this condition using a range of different therapeutic modalities. We have carried out a narrative review, which we hope will reduce some of the confusion around this clinical entity by combining the known facts about the disease. PMID:24447292
Phillip, Harris; Okewole, Idris; Chilaka, Victor
Comparison of cervical, urethral, and urine specimens for the detection of Chlamydia trachomatis in women.
Cervical, urethral, and first void urine (FVU) specimens from 937 women were tested for Chlamydia trachomatis by culture or EIA to determine the most sensitive combination of tests and specimens. For cervical and urethral specimens the prevalence of infection by culture or confirmed EIA was 7.2% (67/937) at either site, 6.8% (64/937) at the cervix, and 4.3% (40/937) at the urethra. Of 67 specimens, 37 (55.2%) yielded a positive test from both the cervical and urethral swabs. Three (4.5%) of the 67 infections were only at the urethra and none were only in FVU. Only 37.3% (25/67) of all positive women had a positive FVU. The most sensitive combination was cervical swab culture and EIA, which detected 95.5% (64/67) of the infections, a substantial increase over culture only (76.1%) or EIA of the cervical swab (79.1%). The testing of urethral and FVU specimens apparently offers only minimal advantage over testing of cervical specimens only for chlamydia. PMID:2056207
Sellors, J W; Mahony, J B; Jang, D; Pickard, L; Goldsmith, C H; Gafni, A; Chernesky, M A
Urethral pressure profile during the spinal shock stage in man: a preliminary report.
The functional state of the proximal urethra in the spinal shock stage in man is not fully understood. We studied patients with spinal cord injuries during spinal shock and found that the urethral pressure profile had a normal configuration, the peak profile pressure increased with bladder filling and phentolamine (10 mg. intravenously) reduced the peak pressure, with empty and full bladders. PMID:318708
Awad, S A; Bryniak, S R; Downie, J W; Twiddy, D A
Treatment of stress urinary incontinence: recent developments in the role of urethral injection.
Stress urinary incontinence is prevalent in adult women and has a considerable impact on quality of life. However, it often remains undiagnosed and therefore untreated. Non-invasive treatment is likely to be offered in mild cases and may entail physiotherapy, minimally invasive devices or pharmacotherapy. Surgical intervention is widely considered as the only effective option for more severe cases. These strategies are not suitable for all patients, and urethral injection represents an alternative, minimally invasive procedure. The choice of the bulking agent is the key to the success of this treatment: the most extensively studied are silicone, polytetrafluoroethylene and bovine collagen. However, doubts regarding the safety and efficacy of these materials has led to the development of carbon-coated zirconium beads, calcium hydroxylapatite and dextranomer/hyaluronic acid (Dx/HA) copolymer. Of these, the most clinical experience has been gained with Dx/HA copolymer. Until 2 years ago, urethral injection could only be administered endoscopically. The recent development of devices for 'blind' injection has increased the speed and convenience of urethral injection, removing the need for surgical facilities. Although few data are yet available, it is conceivable that urethral injection administered 'blind' may in future be considered as an option for all patients failing non-invasive treatment. PMID:12599014
van Kerrebroeck, Philip; ter Meulen, Flip; Farrelly, Elisabeth; Larsson, Gregor; Edwall, Lena; Fianu-Jonasson, Aino
Cystoscopic-guided balloon dilation of a urethral stricture in a female dog
A 9-year-old, spayed female, Labrador retriever was referred for evaluation of dysuria. Cystoscopic examination revealed a urethral stricture in the proximal urethra that was dilated by use of an angioplasty balloon (Gruntzig angioplasty balloon) under cystoscopic guidance. Following the procedure, the dysuria resolved.
Wood, Michael W.; Vaden, Shelly; Cerda-Gonzalez, Sofia; Keene, Bruce
Morphological Plasticity in Efferent Pathways to of the Rat Following Urethral Obstruction the Urinary Bladder
Partial urethral ligation in female Wistar rats produces changes in the neural control of the lower urinary tract in- cluding bladder hyperactivity and facilitation of a spinal mic- turition reflex pathway. To gain insight into the mechanisms underlying these changes, axonal tracing studies were con- ducted to examine the postganglionic efferent limb of the micturition reflex pathway which originates in
William D. Steers; Jonathan Ciambotti; Susan Erdman; William C. de Groat
Patient-perceived outcomes in the treatment of stress urinary incontinence: focus on urethral injection therapy.
Intervention for stress urinary incontinence (SUI) is generally focused on minimizing urinary leakage. However, the overall impact of SUI therapy on patients' quality of life is, arguably, more important than leakage outcomes. We performed a literature search to investigate the effect of urethral injection therapy on quality of life. Significant quality-of-life improvements have been observed with a number of injectable agents, while there is a distinct lack of correlation between subjective and objective outcomes. Two studies comparing urethral injection therapy with surgical intervention found superior objective efficacy with surgery, but no significant differences in quality-of-life improvements. Personal goals of patients undergoing urethral injection are yet to be explored, but there may be willingness to trade a lower success rate in favor of a more minor treatment procedure. In conclusion, quality-of-life improvements after urethral injection appear significant and comparable to those obtained with surgery. Further study of patients' own perceptions, pre- and posttreatment, would be valuable. PMID:16847584
Chapple, Christopher R; Brubaker, Linda; Haab, Fran�ois; van Kerrebroeck, Philip; Robinson, Dudley
A severe complication of mid-urethral tapes solved by laparoscopic tape removal and ureterocutaneostomy
Mid-urethral tapes are largely used to manage stress urinary incontinence (SUI). In certain cases, however, this procedure results in bothersome complications that lead to complete resection. We present the case of an 85-year-old woman who presented with ongoing suprapubic pain, hematuria, vaginal bleeding and recurrent urinary tract infections. The patient had undergone a tension-free vaginal tape (TVT) procedure in 1999 and a transobturator tape (TOT) placement in 2003 for SUI. Investigations revealed a urethral stone, erosion of both TOT and TVT and an urethra-vaginal fistula. Under local anesthesia the urethral stone was removed endoscopically and the TOT removed via a vaginal approach. Due to her comorbidity, she underwent a laparoscopic intraperitoneal removal of the TVT and a definitive ureterocutaneostomy to relieve her pain, inflammation and incontinence. This is the first ever presented case of erosion of mid-urethral tapes and incontinence treated with a laparoscopic resection of the tape and ureterocutaneostomy as definitive urinary diversion.
Schatz, Tobias; Hruby, Stephan; Colleselli, Daniela; Janetschek, Gunter; Lusuardi, Lukas
Urethral erosion of tension-free vaginal tape presenting as recurrent stress urinary incontinence
The suburethral sling with tension-free vaginal tape (TVT) has become a popular treatment for stress urinary incontinence. Erosion of the mesh into the urethra is rare, usually presenting with hematuria, pain, voiding dysfunction or urge incontinence. A patient with stress incontinence was treated with a TVT suburethral sling. One month later, symptoms of recurrent stress incontinence developed. Cystourethroscopy revealed urethral
Clifford Y. Wai; Shanna D. Atnip; Kristin N. Williams; Joseph I. Schaffer
PurposeWe optimized the axonal blocking effect of high frequency, biphasic stimulation on neurally evoked contractions of the external urethral sphincter (EUS) and further investigated the repeatability of the blocking effect during relatively long periods to evaluate any acute nerve damage.
CHANGFENG TAI; JAMES R. ROPPOLO; WILLIAM C. de GROAT
Origins and courses of the nervous branches to the male urethral sphincter
The striated sphincter of the male urethra, the so-called rhabdosphincter, contributes significantly to urethral closure pressure. It is generally agreed that the somatic nerve fibers from the pudendal nerve innervate the rhabdosphincter, and the autonomic nerve fibers innervate the smooth muscle of the urethra. Although it is difficult to clearly identify the rhabdosphincter macroscopically, we minutely investigated the nerve branches
K. Akita; H. Sakamoto; T. Sato
Purpose:High frequency electrical stimulation (1 to 10 kHz) of the pudendal nerve was evaluated as a method to block the external urethral sphincter contractions and increases in intraurethral pressure induced by electrical stimulation of pudendal nerve efferent axons.
CHANGFENG TAI; JAMES R. ROPPOLO; WILLIAM C. de GROAT
Unusual Urethral Metastasis from Colon Carcinoma Presenting with Difficult Urination and Hematuria
Urethral metastases originating from the colon are extremely rare. We report a case of a 67-year-old man who presented with difficult urination and hematuria. Diagnostic cystoscopy showed an abnormal, exophytic lesion in his proximal penile urethra a bulbar urethra. His pathology was diagnosed as adenocarcinoma consistent with colon metastasis.
Karakose, Ayhan; Aydogdu, Ozgu; Atesci, Yusuf Z.
A Case of Urethral Reconstruction Using a Superficial Circumflex Iliac Artery
A radial forearm free flap has been conventionally used for urethral reconstruction. However, aesthetic and functional complications occur frequently at the donor site. The use of a superficial circumflex iliac artery perforator (SCIP) flap can resolve these disadvantages. Here, we report our case with a review of literature. A 69-year-old man visited our hospital with multiple contusions of the abdomen and genital amputation. After necrotic tissue debridement, the length of the residual corpus carvernosum was 1.5 cm and that of the corpus spongiosum and urethra was 1 cm. For the reconstruction of the penis, a SCIP flap and anterolateral thigh free flap was performed. The primary closure was performed at the donor site. Three weeks postoperatively, the patient had a urethral foley catheter removed. The neourethra was functioning well without stricture. Four months postoperatively, the patient had no complications such as urethral stricture. A good recovery was also achieved with no aesthetic deficits at the donor site. SCIP flap is appropriate for urethral reconstruction. Because of its proximity to the recipient sites, it makes surgical preparation easier and the primary closure at the donor site available. It is also advantageous in that its location is almost unnoticeable.
Yoo, Kun-Woon; Lee, Hye Kyung
Congenital anterior urethral diverticulum in an adolescent boy with obstructive urinary symptoms
A case of anterior urethral diverticulum in a 12�years old boy who presented with obstructive urinary symptoms is described.\\u000a The diagnosis was made on retrograde urethrography. Open diverticulectomy and urethroplasty was done with complete excision\\u000a of obstructing anterior valve. The clinical presentation, diagnosis, and management of this rare condition is discussed.
Muhammad Rafique
Nongonococcal urethritis: New views through the prism of modern molecular microbiology
The rapidly advancing technology of modern molecular microbiology has greatly improved our understanding of the epidemiology\\u000a of sexually transmitted infections and the etiology and pathogenesis of the diseases they cause. It is now clear that Mycoplasma genitalium accounts for a significant proportion of nonchlamydial nongonococcal urethritis (NGU) cases. DNA sequencing of Ureaplasma spp has revealed a new species, Ureaplasma parvum.
David H. Martin
Spontaneous closure of traumatic macular hole
PURPOSE : To report eight cases of spontaneous closure of traumatic macular hole.DESIGN : Consecutive observational case series.PATIENTS AND METHODS : In a consecutive series of 18 eyes of 18 patients with traumatic macular hole, eight patients achieved spontaneous closure of traumatic macular hole. Clinical records of the eight eyes of eight patients were reviewed, together with the results of
Takehiro Yamashita; Akinori Uemara; Eisuke Uchino; Norihito Doi; Norio Ohba
Traumatic Loss in Children and Adolescents
Although different types of childhood trauma have many common characteristics and mental health outcomes, traumatic loss in children and adolescents has a number of distinctive features. Most importantly, youth who experience a traumatic loss may develop childhood traumatic grief (CTG), which is the encroachment of trauma symptoms on the grieving process and prevents the child from negotiating the typical steps
Anthony P. Mannarino; Judith A. Cohen
Isolated posterior cruciate ligament calcification
The authors present a case of calcified posterior cruciate ligament (PCL). A 61-year-old female presented in our department reporting 12 months history of knee pain that was getting worse during the night. The patient was under medication for epileptic seizure, osteoporosis and hyperthyroidism. X-rays demonstrated calcification of the PCL. CT and MRI excluded any other intra-articular and extra-articular pathology. Arthroscopic debridement of the calcium deposits was performed and the symptoms resolved immediately, while the postoperative x-rays were normal. Histological examination confirmed the calcium nature of the lesion. Two years postoperatively the patient remains asymptomatic.
Koukoulias, Nikolaos E; Papastergiou, Stergios G
Severe hypotension following urethral catheterization during general anesthesia in a patient with bladder cancer -A case report-
The process of micturition is related to activation of the cardiovascular autonomic nervous system. Hypotension with bradycardia often occurs during or immediately after micturition. We experienced a case of sudden severe hypotension and bradycardia following urethral catheterization in a patient who underwent an urethral dilatation and transurethral resection of bladder tumor while under general anesthesia. The patient was treated with inotropics and intravenous fluids, and he recovered without any complications. The characteristics of this case are similar to the physiologic changes that occur in micturition syncope. Therefore, it is presumed that the autonomic reflex that was triggered by the urethral catheterization caused the hypotension and bradycardia.
Son, Hee Won; Lee, Ok-Kyung; Park, Soon Eun; Cho, Young Woo
Chlamydia trachomatis antigen can be detected in the urine sample of men with non-gonococcal urethritis.
We tested the first portion of voided urine (FVU) and urethral swab from 80 patients with non-gonococcal urethritis (NGU) using a novel enzyme-amplified immunoassay (IDEIA) for the detection of Chlamydia trachomatis antigen. Urine specimens were positive in all patients with positive urethral swabs (positive coincidence ratio, 100%) and in 6 of 54 patients with negative swabs (negative coincidence ratio, 88.9%). Our data suggest that FVU is suitable for the detection of Chlamydia trachomatis antigen using the IDEIA test in patients with NGU. PMID:1926657
Tanaka, M; Matsumoto, T; Kumazawa, J; Nakayama, H; Miyazaki, Y
Is there a need for smooth muscle cell transplantation in urethral reconstruction?
Background: Hypospadias and urethral strictures are conditions requiring additional tissue for reconstruction. Due to a limited source of tissue, autologous skin and oral mucosa are frequently used. However, long-term follow-up studies demonstrated significant complications and diminished quality of life. Recently, a variety of tubular biodegradable biomaterials have been used. Cell seeding seems to be important to improve the host acceptance and neovascularization. Objective: To compare in vivo performance of smooth muscle cell (SMC)-seeded and unseeded tubular collagen-based scaffolds in a rabbit urethral reconstruction model. Materials and Methods: Sixteen New Zealand rabbits underwent an open-bladder biopsy for SMC harvesting. The SMCs were cultured for 3 weeks and labeled with ethynyldeoxyuridine (EdU). A 1-cm-length tubular collagen-based 0.5?wt% scaffold was seeded and cultured with SMCs and implantation in a rabbit model. Eight rabbits received SMC-seeded scaffolds for a 1-cm-length circumferential urethral repair, situated 1.5?cm from the meatus. After 1 and 3 months, four rabbits underwent a urethrography and were sacrificed. The penises underwent hematoxylin and eosin, immunohistochemistry, and EdU fluorescence staining. In the control group eight rabbits received acellular scaffolds. Results: The SMC-seeded group presented one stricture at 1 month and one fistula at 3 months. Three strictures were present in the unseeded group at 1 month and one at 3 months. In the seeded group, more SMC expression and neovascularization was observed, and less mononuclear and giant cells could be found. All scaffolds showed luminal urothelial cell revetment. The detection of EdU-labeled SMCs revealed SMC transplantation survival. Conclusion: SMC-seeded tubular collagen scaffolds improved urethral regeneration in this rabbit model. Such constructs may be valuable for repair of severe urethral diseases. PMID:24329538
Arenas da Silva, Luis Fernando; Micol, Lionel; Tiemessen, Dorien; van Kuppevelt, Toin H; Frey, Peter; Oosterwijk, Egbert; Geutjes, Paul; Feitz, Wout F
[Traumatic tricuspid regurgitation: case report].
Traumatic tricuspid regurgitation is a rare disease owing to penetrating or nonpenetrating thoracic trauma. In the last 40 years, since motorism is increasing, this disease can be seen more frequently. In most cases, rupture of chordae tendinae on the tricuspid valve, damage of the front papillary muscle and rupture of the tricuspid valve leaflets. On an acute stage, the damage of the valve can remain undiagnosed. Later on, the patient might have no symptoms; however, symtoms of right heart failure indicating an operation appear. This case-study is concerned with a patient with traumatic tricuspid regurgitation. PMID:17091607
Bizo?, J; Br�t, R
Anterior dislocation of a sulcus fixated posterior chamber intraocular lens in a high myope
A 31-year-old man with high axial myopia and strabismus fixus convergens underwent bilateral refractive lens exchange followed by a squint surgery (bilateral superior partial Jensen?s procedure and medial rectus recession). After one year he presented with traumatic anterior dislocation of the sulcus fixated posterior chamber polymethyl methacrylate lens. The lens was dialed back into the ciliary sulcus without any complications. This case highlights the importance of implanting an intraocular lens (IOL) in-the-bag. If the IOL needs to be implanted in the sulcus, a larger diameter of the IOL with larger optic size and overall length is desirable, especially in highly myopic eyes.
Asnani, Priyadarshi; Kothari, Kulin
Outcomes of C1 and C2 posterior screw fixation for upper cervical spine fusion.
To achieve stable fixation of the upper cervical spine in posterior fusions, the occiput is often included. With the newer techniques, excluding fixation to the occiput will retain the occiput-cervical motion, while still allowing a stable fixation. Harms's technique has been adapted at our institution and its effectiveness for indications such as C2 complex fractures and tumors using C1 or C2 as endpoints of a posterior fixation are reviewed. Fourteen cases were identified, consisting of one os odontoideum; four acute fractures and four non-unions of the odontoid; three tumors and two complex fractures of C2 vertebral body, and one C2-C3 post-traumatic instability. One misplaced screw without clinical consequences was the only complication recorded. Screw loosening or migration was not observed at follow-up, showing a stable fixation. PMID:19387696
De Iure, F; Donthineni, R; Boriani, S
Outcomes of C1 and C2 posterior screw fixation for upper cervical spine fusion
To achieve stable fixation of the upper cervical spine in posterior fusions, the occiput is often included. With the newer techniques, excluding fixation to the occiput will retain the occiput�cervical motion, while still allowing a stable fixation. Harms�s technique has been adapted at our institution and its effectiveness for indications such as C2 complex fractures and tumors using C1 or C2 as endpoints of a posterior fixation are reviewed. Fourteen cases were identified, consisting of one os odontoideum; four acute fractures and four non-unions of the odontoid; three tumors and two complex fractures of C2 vertebral body, and one C2�C3 post-traumatic instability. One misplaced screw without clinical consequences was the only complication recorded. Screw loosening or migration was not observed at follow-up, showing a stable fixation.
Donthineni, R.; Boriani, S.
Hypertrophic olivary degeneration with gadolinium enhancement after posterior fossa surgery in a child with medulloblastoma.
Hypertrophic olivary degeneration (HOD) is a rare transsynaptic form of degeneration occurring secondary to the disruption of the dentato-rubro-olivary pathway ("Guillain-Mollaret triangle"). HOD can be caused by ischemic, hemorrhagic, traumatic, or neoplastic lesions, and it can also occur following posterior fossa surgery. MRI characteristics of HOD include T2 signal increase and hypertrophy. To date, blood�brain barrier disruption has not been reported in HOD. Here, we present the first case of HOD with temporary gadolinium enhancement in a 10-year-old child 7 months after resection of a posterior fossa medulloblastoma. The recognition of gadolinium enhancement as a radiological feature of HOD may help to distinguish between this benign secondary condition and tumor recurrence. PMID:24122017
Nowak, Johannes; Alkonyi, Balint; Rutkowski, Stefan; Homola, Gy�rgy A; Warmuth-Metz, Monika
Traumatic Brain Injury Inpatient Rehabilitation
ERIC Educational Resources Information Center
Traumatic brain injuries (TBI) can cause multiple medical and functional problems. As the brain is involved in regulating nearly every bodily function, a TBI can affect any part of the body and aspect of cognitive, behavioral, and physical functioning. However, TBI affects each individual differently. Optimal management requires understanding the�
Im, Brian; Schrer, Marcia J.; Gaeta, Raphael; Elias, Eileen
Evaluation after Traumatic Brain Injury
ERIC Educational Resources Information Center
It is important to determine if a traumatic brain injury (TBI) has occurred when an individual is assessed in a hospital emergency room after a car accident, fall, or other injury that affects the head. This determination influences decisions about treatment. It is essential to screen for the injury, because the sooner they begin appropriate�
Trudel, Tina M.; Halper, James; Pines, Hayley; Cancro, Lorraine
Biomechanics of traumatic brain injury
A biomechanical model for traumatic brain injury and soft tissue damage is presented. A variational constitutive model for soft biological tissues is utilized to reproduce axonal damage and cavitation injury through inelastic deformation. The material response is split into elastoplastic and viscoelastic components, including rate effects, shear and porous plasticity, and finite viscoelasticity. Mechanical damage of brain tissue is classified
Tamer El Sayed; Alejandro Mota; Fernando Fraternali; Michael Ortiz
Management of traumatic aortic rupture.
A traumatic thoracic aortic injury is a severe and life-threatening clinical entity. Although largely fatal; if untreated, these injuries are amenable to surgical repair if appropriately diagnosed. Therefore, early triage of this condition is critically important. Unfortunately, aortic injuries rarely occur in isolation, and there has been no good cutoff value to help select the appropriate surgical strategy. Algorithms for the both diagnosis and treatment of traumatic thoracic aortic injury have undergone changes in recent years. There have been several case reports, retrospective series and registry data describing the treatment of patients with traumatic thoracic aortic rupture using endovascular treatment. Endovascular treatment is a less-invasive management option for polytraumatized patients. Because it is less invasive, without the need for thoracotomy or the use of heparin, endovascular repair can be performed even in acutely injured patients, without the risk of destabilizing pulmonary, head or abdominal traumatic lesions. Long-term follow-up especially in young patients is necessary after endovascular treatment. PMID:23338596
Watanabe, Ken-ichi; Fukuda, Ikuo; Asari, Yasushi
The National Traumatic Occupational Fatalities (NTOF) surveillance system is a death certificate-based census of occupational injury deaths. Death certificates are obtained from the 50 States, New York City, and the District of Columbia for decedent's ages 16 years or older with ...
Reconsidering Post-Traumatic Stress
ERIC Educational Resources Information Center
This article serves to challenge the prevailing wisdom that suggests that most trauma is followed by post-traumatic stress disorder (PTSD), and is best treated with critical incident stress debriefing (CISD). Instead, recent evidence suggests that many individuals exposed to stress do not experience stress responses. Even those who do, however,�
Berman, Dene S.; Davis-Berman, Jennifer
Porcine small intestinal submucosa augmentation urethroplasty and balloon dilatation of a urethral stricture secondary to inadvertent prostatectomy in a dog.
A 10-month-old, male German shepherd dog experienced inadvertent prostatectomy during cryptorchidectomy. Cystourethral anastomosis was performed 1 day later. The dog developed stranguria and incontinence. A proximal urethral stricture was diagnosed with a contrast urethrogram 5 weeks later. Urethral augmentation with an onlay graft of porcine small intestinal submucosa was performed. Urinary diversion was accomplished with a urethral catheter followed by a cystostomy tube. The stricture recurred over the next 6 weeks. Three urethral balloon dilatations were performed 3 days apart, with the third attempt resulting in expansion of the stricture. Twenty-two months postdilatation, the dog intermittently urinated with a steady stream and had mild to moderate urinary incontinence. PMID:20810558
Powers, Michelle Y; Campbell, Bonnie G; Weisse, Chick
A case of clear cell adenocarcinoma arising from the urethral diverticulum: Utility of urinary cytology and immunohistochemistry
Carcinomas rarely arise from the urethral diverticulum. In this report, we present a case of clear cell adenocarcinoma arising from the urethral diverticulum. A 42-year-old woman complained of bloody discharge and lower back pain. Imaging studies showed a tumor involving the region surrounding the urethra and cystourethroscopy showed papillary and villous tumors in the urethral diverticula. Cytology of the urine sediment showed papillary or spherical clusters of atypical cells, some of which had clear abundant cytoplasm and formed mirror ball-like clusters, suggesting adenocarcinoma. Although histological diagnosis was indeterminate by biopsy and transurethral resection (TUR) because of absence of stromal invasion, surgically resected specimen via cysturethrectomy revealed that the tumor was clear cell carcinoma. Urinary cytological findings and immunohistochemical analysis for CD15, Ki-67, and p53 might be useful for accurate diagnosis of clear cell adenocarcinoma that arises from the urethral diverticulum when sufficient materials are not available by biopsy and TUR.
Nakatsuka, Shin-ichi; Taguchi, Isao; Nagatomo, Tadasuke; Yamane, Michiaki; Sugio, Kenji; Yoshino, Ryuichi; Oku, Kazuko; Nagano, Teruaki; Kimura, Hayato; Nakajo, Kazuya; Kawabata, Gaku
A case of clear cell adenocarcinoma arising from the urethral diverticulum: Utility of urinary cytology and immunohistochemistry.
Carcinomas rarely arise from the urethral diverticulum. In this report, we present a case of clear cell adenocarcinoma arising from the urethral diverticulum. A 42-year-old woman complained of bloody discharge and lower back pain. Imaging studies showed a tumor involving the region surrounding the urethra and cystourethroscopy showed papillary and villous tumors in the urethral diverticula. Cytology of the urine sediment showed papillary or spherical clusters of atypical cells, some of which had clear abundant cytoplasm and formed mirror ball-like clusters, suggesting adenocarcinoma. Although histological diagnosis was indeterminate by biopsy and transurethral resection (TUR) because of absence of stromal invasion, surgically resected specimen via cysturethrectomy revealed that the tumor was clear cell carcinoma. Urinary cytological findings and immunohistochemical analysis for CD15, Ki-67, and p53 might be useful for accurate diagnosis of clear cell adenocarcinoma that arises from the urethral diverticulum when sufficient materials are not available by biopsy and TUR. PMID:22615710
Nakatsuka, Shin-Ichi; Taguchi, Isao; Nagatomo, Tadasuke; Yamane, Michiaki; Sugio, Kenji; Yoshino, Ryuichi; Oku, Kazuko; Nagano, Teruaki; Kimura, Hayato; Nakajo, Kazuya; Kawabata, Gaku
Posterior Estimates and Transforms for Speech Recognition
\\u000a This paper describes ANN based posterior estimates and their application to speech recognition. We replaced the standard back-propagation\\u000a with the L-BFGS quasi-Newton method. We have focused only on posterior based feature vector extraction. Our goal was a feature\\u000a vector dimension reduction. Thus we designed three posterior transforms to space with dimensionality 1 or 2. The designed\\u000a transforms were tested on
Jan Zelinka; Lubos Sm�dl; Jan Trmal; Ludek M�ller
Cell-Seeded Tubularized Scaffolds for Reconstruction of Long Urethral Defects: A Preclinical Study
Background The treatment options for patients requiring repair of a long segment of the urethra are limited by the availability of autologous tissues. We previously reported that acellular collagen-based tubularized constructs seeded with cells are able to repair small urethral defects in a rabbit model. Objective We explored the feasibility of engineering clinically relevant long urethras for surgical reconstruction in a canine preclinical model. Design, setting, and participants Autologous bladder epithelial and smooth muscle cells from 15 male dogs were grown and seeded onto preconfigured collagen-based tubular matrices (6 cm in length). The perineal urethral segment was removed in 21 male dogs. Urethroplasties were performed with tubularized collagen scaffolds seeded with cells in 15 animals. Tubularized constructs without cells were implanted in six animals. Serial urethrography and three-dimensional computed tomography (CT) scans were performed pre- and postoperatively at 1, 3, 6, and 12 mo. The animals were euthanized at their predetermined time points (three animals at 1 mo, and four at 3, 6, and 12 mo) for analyses. Outcome measurements and statistical analysis Statistical analysis of CT imaging and histology was not needed. Results and limitations CT urethrograms showed wide-caliber urethras without strictures in animals implanted with cell-seeded matrices. The urethral segments replaced with acellular scaffolds collapsed. Gross examination of the urethral implants seeded with cells showed normal-appearing tissue without evidence of fibrosis. Histologically, an epithelial cell layer surrounded by muscle fiber bundles was observed on the cell-seeded constructs, and cellular organization increased over time. The epithelial and smooth muscle phenotypes were confirmed using antibodies to pancytokeratins AE1/AE3 and smooth muscle�specific desmin. Formation of an epithelial cell layer occurred in the unseeded constructs, but few muscle fibers formed. Conclusions Cell-seeded tubularized collagen scaffolds can be used to repair long urethral defects, whereas scaffolds without cells lead to poor tissue development and strictures. This study demonstrates that long tissue-engineered tubularized urethral segments may be used for urethroplasty in patients.
Orabi, Hazem; AbouShwareb, Tamer; Zhang, Yuanyuan; Yoo, James J.; Atala, Anthony
Transurethral Implantation of Macroplastique� for the Treatment of Female Stress Urinary Incontinence Secondary to Urethral Sphincter Deficiency
Objective: To assess the results of transurethral implantation of Macroplastique� in women with stress incontinence secondary to urethral sphincter deficiency using subjective and objective outcome measures.Methods: A total of 60 women with genuine stress incontinence secondary to intrinsic urethral sphincter deficiency were treated with transurethral implantation of Macroplastique. The patients had undergone a mean of 1.9 (range 0�7) previous episodes
S. C. Radley; C. R. Chapple; I. C. Mitsogiannis; K. S. Glass
Prune belly syndrome with urethral hypoplasia and vesico-cutaneous fistula: A case report and review of literature
Association between Prune belly syndrome (PBS) and urethral hypoplasia is an unusual condition. It is usually fatal unless there is a communication between the fetal bladder and the amniotic sac. We report a case of PBS with urethral hypoplasia and congenital vesico-cutaneous fistula in a male neonate. Patient underwent cutaneous vesicostomy and was discharged for close follow up of his renal function and for future reconstruction.
Sarhan, Osama M.; Al-Ghanbar, Mustafa S.; Nakshabandi, Ziad M.
Giant urethral diverticulum -- repair augmented with bovine pericardium collagen matrix graft and tension-free vaginal tape.
A 44-year-old nulliparous woman was diagnosed with a giant urethral diverticulum. Surgical excision of the diverticulum was done. The urethral defect was closed with 2-0 vicryl sutures. A piece of bovine pericardium collagen matrix graft was placed over the fascial repair. A tension-free vaginal tape (TVT) sling was then placed over the graft. Concomitant anti-incontinence procedure can be combined with diverticulum repair. PMID:22315853
Gunasekaran, Karthik; Davila, G W; Ghoniem, G M
The Use of Small Intestinal Submucosa as an off-the-shelf Urethral Sling Material for Pediatric Urinary Incontinence
PurposeUse of autologous rectus fascia for urethral slings in the pediatric population has produced reliable and predictable results. However, the potential morbidity and complications associated with harvesting the autologous rectus fascia have driven efforts to find a reliable off-the-shelf material for urethral slings. Small intestinal submucosa is a collagen based material that has been shown to promote tissue specific regeneration
James R. Colvert; Bradley P. Kropp; Earl Y. Cheng; John C. Pope; John W. Brock; Mark C. Adams; Paul Austin; Peter D. Furness; Martin A. Koyle
Prune belly syndrome with urethral hypoplasia and vesico-cutaneous fistula: A case report and review of literature.
Association between Prune belly syndrome (PBS) and urethral hypoplasia is an unusual condition. It is usually fatal unless there is a communication between the fetal bladder and the amniotic sac. We report a case of PBS with urethral hypoplasia and congenital vesico-cutaneous fistula in a male neonate. Patient underwent cutaneous vesicostomy and was discharged for close follow up of his renal function and for future reconstruction. PMID:24311916
Sarhan, Osama M; Al-Ghanbar, Mustafa S; Nakshabandi, Ziad M
Posterior spinal osteosynthesis for cervical fracture/dislocation using a flexible multistrand cable system: technical note.
Cervical instability secondary to fracture/dislocation or traumatic subluxation involving the posterior elements may be treated by a variety of fusion techniques. The rigidity of the stainless steel wires used in posterior cervical fusions often leads to difficulty with insertion, adequate tension, and conformation of the graft construct. This report describes a technique of posterior cervical fusion employing a wire system using flexible stainless steel cables. The wire consists of a flexible, 49-strand, stainless steel cable connected on one end to a short, malleable, blunt leader with the opposite end connected to a small islet. The cable may be used in occipitocervical, atlantoaxial, facet-to-spinous process, and interspinous fusion techniques. The cable loop is secured by using a tension/crimper device that sets the desired tension in the cable. In addition to superior biomechanical strength, the flexibility of the cable allows greater ease of insertion and tension adjustment. In terms of direct operative instrumentation in posterior cervical arthrodesis, involving both the upper and lower cervical spine, the cable system appears to be a safe and efficient alternative to monofilament wires. PMID:1758614
Huhn, S L; Wolf, A L; Ecklund, J
Epidemiology of traumatic hip dislocation in patients treated in Cear?, Brazil
OBJECTIVE: To describe the epidemiological profile of patients with traumatic hip dislocation treated in our Institute from November/2012 to July/2013. METHODS: A descriptive cross-sectional study based on interviews and involving 43 patients who suffered traumatic hip dislocation was conducted. RESULTS: The mean age of patients was 34.4 years old and 90.7% were male. Regarding the mechanism of injury, 95% involved traffic accidents. The posterior dislocation of the hip was the most common injury (93%). Associated lesions were observed in 74.4% of patients, hip fractures being the most frequent. The time span between accident and dislocation reduction was less than 6 hours in 37.2% of patients, between 6 and 12 hours in 32.5% and over 12 hours in 30.3%, ranging from 1 hour to 15 days. A fraction of 90.7% of patients was submitted to closed reduction. CONCLUSION: Traumatic hip dislocation affected mostly young adults, victims of traffic accidents. The posterior dislocation of the hip was the most frequent injury and closed reduction was performed in 90.7% of patients. The time span between accident and dislocation reduction was less than 12 hours in most patients. Level of Evidence III, Study of Nonconsecutive Patients.
Lima, Luciana Cascao; do Nascimento, Robson Alves; de Almeida, Victor Monte Tenorio; Facanha, Fernando Antonio Mendes
Operatively treated traumatic versus non-traumatic rotator cuff ruptures: A registry study
Backround Operative treatment of traumatic rotator cuff ruptures, i.e. ruptures with a predisposing traumatic event, is reported to yield superior results compared to operative treatment of non-traumatic, degenerative ruptures. Aim The purpose of this study was to evaluate the difference of outcome, peroperative findings, and demographics after operative treatment of traumatic versus non-traumatic rotator cuff rupture. Methods A total of 306 consecutive shoulders with an operated rotator cuff rupture (124 traumatic and 182 non-traumatic) were followed up. Constant and Murley score, size of the rupture, and age of the patients were used as an outcome measure. Results A total of 112 traumatic and 167 non-traumatic rotator cuff rupture shoulders were available for 1-year follow-up (91%). Mean Constant and Murley score was preoperatively lower in the traumatic group (46 versus 52, P = 0.01). At 3 months postoperatively, Constant and Murley scores were 61 and 60 (P = 0.72) and at 1 year 73 and 77 (P = 0.03), respectively. Altogether 91% of the patients in the traumatic and 93% in the non-traumatic group were satisfied with the final outcome (P = 0.45). In 94% of traumatic and 95% of a non-traumatic cases the rupture involved the supraspinatus tendon. In the traumatic group the rupture was larger and involved more frequently the whole supraspinatus insertion area (41% versus 17%, P < 0.0001). Mean age of patients was 58 and 57 years, respectively. Conclusion Operative treatment of both traumatic and non-traumatic rotator cuff ruptures gives essentially good results. In our cohort, patients' recollection of predisposing trauma reflects the size of the rotator cuff rupture, but does not reflect the age of the patients.
Joukainen, Antti; Itala, Ari; Aarimaa, Ville
Management of traumatic hemorrhagic retinal detachment with pars plana vitrectomy.
Traumatic hemorrhagic retinal detachment may prevent successful visual rehabilitation of eyes with severe posterior segment injury. We managed 19 consecutive cases of traumatic hemorrhagic retinal detachment with pars plana vitrectomy, scleral buckling, and fluid-gas exchange, with or without internal drainage of subretinal hemorrhage. We based our approach on the amount of subretinal hemorrhage present and the location of associated retinal breaks. Internal drainage of subretinal hemorrhage was performed in 16 eyes to allow adequate retinopexy to hemorrhagically elevated retinal breaks (9 eyes), to remove massive subretinal hemorrhage (4 eyes), and to allow intraoperative reattachment when the retina exhibited bullous retinal detachment (3 eyes). Overall, with a minimum of 6 months of follow-up, anatomic reattachment was achieved in 13 (68%) of 19 eyes, and functional success (visual acuity 5/200 or better) was achieved in 6 (32%) of 19 eyes. Anatomic failure resulted from proliferative vitreoretinopathy (4 eyes) and globe atrophy (2 eyes). Drainage of subretinal blood appeared to be beneficial for hemorrhagically elevated retinal tears to allow adequate retinopexy and may help to accomplish long-term anatomic attachment in eyes with massive subretinal hemorrhage or bullous retinal detachment. PMID:2205184
Han, D P; Mieler, W F; Schwartz, D M; Abrams, G W
Anterior urethral valves without diverticulae: a report of two cases and a review of the literature.
Two unusual cases of anterior urethral valves (AUV) without diverticulae are presented. The first case is a male child born with prenatal diagnosis of bilateral hydronephrosis. On cystoscopy, iris-like diaphragm valves were encountered about 3?mm distal to the skeletal sphincter. In the second case, an 18-month-old male child was investigated for recurrent febrile urinary tract infections and obstructed urinary symptoms. Cystoscopy confirmed the presence of slit-like valves 5?mm distal to the skeletal sphincter. Fulguration of the AUVs was performed in both cases. It may be worthwhile to review all cases of anterior urethral obstruction collectively and re-categorize them appropriately to include the unusual AUVs without diverticulum in that classification. PMID:24118555
Singh, Dig Vijay; Taneja, Rajesh
A case report of urethral prolapse in a 38 year old female with 46XY karyotype.
A 38-year old female presented with the acute onset of a vulval mass associated with pain and vaginal bleeding. She is female phenotype but has 46XY karyotype and Complete Androgen Insensitivity Syndrome (CAIS). At 15 years old she had a laparotomy and bilateral orchidectomy. Following admission, an examination under anaesthesia and cystoscopy was performed. A diagnosis of strangulated complete urethral prolapse was made. The lesion was excised with diathermy and the meatal skin was reanastomosed to the urethra. At follow-up, the urethra was well healed. The patient now attends Menopause Clinic for oestrogen-replacement therapy. We hope this case raises awareness of the possibility of urethral prolapse in younger women who are oestrogen deficient. It provides further incentive for compliance with hormone replacement therapy for patients with CAIS following gonadectomy, or other women with premature menopause. PMID:25017598
Watson, Helena; Stasiowska, Ewa
A Giant Dumbbell Shaped Vesico-Prostatic Urethral Calculus: A Case Report and Review of Literature
Calculi in the urethra are an uncommon entity. Giant calculi in prostatic urethra are extremely rare. The decision about treatment strategy of calculi depends upon the size, shape, and position of the calculus and the status of the urethra. If the stone is large and immovable, it may be extracted via the perineal or the suprapubic approach. In most of the previous reported cases, giant calculi were extracted via the transvesical approach and external urethrotomy. A 38-year-old male patient presented with complaints of lower urinary tract symptoms. Further investigations showed a giant urethral calculus secondary to stricture of bulbo-membranous part of the urethra. Surgical removal of calculus was done via transvesical approach. Two calculi were found and extracted. One was a huge dumbbell calculus and the other was a smaller round calculus. This case was reported because of the rare size and the dumbbell nature of the stone. Giant urethral calculi are better managed by open surgery.
Prabhuswamy, Vinod Kumar; Tiwari, Rahul; Krishnamoorthy, Ramakrishnan
Posterior approaches in the management of cervical spondylosis and ossification of the posterior longitudinal ligament
BACKGROUNDIf the cervical lordotic curvature has been well preserved, spondylostenosis or ossification of the posterior longitudinal ligament, with or without instability, may be approached posteriorly in selected older patients (over 65 years of age). Posterior surgical alternatives include the laminectomy with or without fusion, or laminoplasty. However, in younger patients or in geriatric patients with predominantly anterior disease with kyphosis,
Nancy Epstein
Posterior acceleration as a mechanism of blunt traumatic injury of the aorta
Rupture of the thoracic aorta is a leading cause of rapid fatality in automobile crashes, but the exact mechanisms of this injury remain unidentified. One commonly postulated mechanism is a differential motion of the aortic arch relative to the heart and its neighboring vessels caused by high-magnitude acceleration of the thorax. This paper investigates acceleration as an aortic injury mechanism
Jason Forman; Stephen Stacey; Jay Evans; Richard Kent
Efficient search using posterior phone probability estimates
We present a novel, efficient search strategy for large vocabulary continuous speech recognition (LVCSR). The search algorithm, based on stack decoding, uses posterior phone probability estimates to substantially increase its efficiency with minimal effect on accuracy. In particular, the search space is dramatically reduced by phone deactivation pruning where phones with a small local posterior probability are deactivated. This approach
Steve Renals; Mike Hochberg
Cerebral Palsy Spasticity. Selective Posterior Rhizotomy
We have performed selective posterior rhizotomies on 60 children with cerebral palsy. The procedure involves lumbar laminectomy with stimulation of the rootlets (fascicles) of the second lumbar to the first sacral posterior roots bilaterally; those rootlets associated with an abnormal motor response, as evidenced by sustained or diffused muscular contraction, are divided leaving intact rootlets associated with a brief localized
Warwick J. Peacock; Leila J. Arens; Barbara Berman
Do men become infertile after having sexually transmitted urethritis? An epidemiologic examination
Objective: To critically assess the possibility that gonorrhea or chlamydia causes male infertility.Design: Comprehensive literature review structured to evaluate the epidemiologic tenets for causality, including biologic plausibility, strength of association, dose response, consistency, temporality, and treatment effect.Result(s): It is biologically plausible that gonorrhea and\\/or chlamydia could cause male infertility. There is clinical and pathologic evidence linking these pathogens to urethritis,
Roberta B. Ness; Nina Markovic; Catherine L. Carlson; Michael T. Coughlin
The assessment of bladder and urethral function in spinal cord injury patients
Summary��The correlation between the anatomic site of spinal cord injury and real-time conditions of bladder and urethral function\\u000a was assessed in order to provide a reasonable basis for the clinical treatment of neurogenic bladder. A total of 134 patients\\u000a with spinal cord injuries (105 males, 29 females; averaged 34.1 years old) were involved in this retrospective analysis, including\\u000a urodynamic evaluation,
Zhong Chen; Shuangquan Sun; Rongjin Deng; Dan Cai; Xiaoyi Yuan; Guanghui Du; Weimin Yang; Zhangqun Ye
Pressure�flow study as an evaluating method of neurogenic urethral relaxation failure
Voiding difficulty is a common feature in neurological diseases, which can be attributed to dysfunction of the urethral sphincter and the detrusor. Electromyography (EMG)�cystometry can reveal the presence of detrusor�external sphincter dyssynergia (DESD), however, internal sphincter function on voiding is not easily evaluated. Pressure�flow study is widely used to diagnose benign outlet obstruction due to prostatic hypertrophy. We applied pressure�flow
Ryuji Sakakibara; Clare J Fowler; Takamichi Hattori; Iqbal F Hussain; Michael J Swinn; Tomoyuki Uchiyama; Tomonori Yamanishi
Relationship between the effects of alfuzosin on rat urethral and blood pressures and its tissue concentrations
This study was undertaken in order to establish the ?1-antagonist effects of alfuzosin on phenylephrine-induced increases in urethral and arterial blood pressures at 1 and 6 hours post dosing (10mgkg, p.o.). At each time, plasma and prostatic concentrations of alfuzosin were measured and correlations between tissue concentrations and pharmacological effects were calculated. At one and six hours post dosing, alfuzosin
D. J. Martin; P. Lluel; T. Pouyet; C. Rauch-Desanti; I. Angel
A unique complication of urethral catheterization: pubic hair associated with struvite bladder calculi.
Bladder stones account for 5% of all urinary stone disease and can develop on a foreign body, such as a misplaced suture, eroded surgical mesh, or ureteral stent. In this case study, the authors present a patient with bladder stones associated with pubic hairs introduced during a monthly indwelling Foley catheter change. Clinicians have an important role in instructing patients on the use of proper technique and hygiene practices during urethral catheterization to minimize the potential for urinary complications. PMID:24354112
Perz, Sarah; Ellimoottil, Chandy; Rao, Manoj; Bresler, Larissa
Severe cerebral vasospasm after traumatic brain injury.
Severe traumatic brain injury is associated with both acute and delayed neuro- logical injury. Cerebral vasospasm is commonly associated with delayed neurological decline in aneurysmal subarachnoid hemorrhage patients. However, the role played by vasospasm in traumatic brain injury is less clear. Vasospasm occurs earlier, for a shorter duration, and often without significant neurological consequence among traumatic brain injury patients. Detection and management strategies for vasospasm in aneurysmal subarachnoid hemorrhage are not easily transferrable to traumatic brain injury patients. We present a patient with a severe traumatic brain injury who had dramatic improvement following emergent decompressive hemicraniectomy. Two weeks after initial presentation he suffered a precipitous decline despite intensive surveillance. This case illustrates the distinct challenges of diagnosing cerebral vasospasm in the setting of severe traumatic brain injury. [Full text available at http://rimed.org/rimedicaljournal-2014-07.asp, free with no login]. PMID:24983022
Fehnel, Corey R; Wendell, Linda C; Potter, N Stevenson; Klinge, Petra; Thompson, Bradford B
Effects of Concomitant Surgeries during Mid-Urethral Slings (MUS) on Post-operative Complications, Voiding Dysfunction, Continence Outcomes, and Urodynamic Variables
Objectives To determine whether concomitant surgeries affected outcomes in a randomized trial comparing retropubic (RMUS) versus transobturator midurethral slings (TOMUS). Methods Subjects (n=597) were stratified into 4 groups based on type of concomitant surgeries: Group I had anterior/apical with or without posterior repairs (n=79, 13%), Group II had posterior repairs or perineorrhaphy only (n=38, 6%), Group III had non-prolapse procedures (n=34, 6%) and Group IV had no concomitant surgeries (n=446, 75%). Complication rates, voiding dysfunction, objective and subjective surgical failure rates and changes in urodynamic (UDS) values (post-op minus pre-op) were assessed and compared in these 4 groups. Results There were no differences in complications, voiding dysfunction and subjective failure outcomes between these 4 groups. Group I had lower odds ratio (OR) of objective surgical failure compared to Group IV (OR 0.38, 95% CI 0.18�0.81, p=0.05). The OR of failure of all undergoing concomitant surgeries (Groups I�III) was lower than Group IV (OR 0.57, 95% CI 0.35�0.95, p=0.03). The change in Pdet@Qmax (from pressure-flow) was significantly higher in Group III versus IV (p=0.01). The change in Qmax (from uroflowmetry) was significantly less in Group I and II versus Group IV (p=0.046 and 0.04, respectively). Conclusions Concomitant surgeries did not increase complications. Subjects who underwent certain concomitant surgeries had lower failure rates than those undergoing slings only. These data support safety and efficacy of performing concomitant surgery at the time of mid-urethral slings.
Chai, Toby C.; Kenton, Kimberly; Xu, Yan; Sirls, Larry; Zyczynski, Halina; Wilson, Tracey S.; Rahn, David D.; Whitcomb, Emily L.; Hsu, Yvonne; Gormley, Elizabeth A.
Using transurethral Ho:YAG-laser resection to treat urethral stricture and bladder neck contracture
NASA Astrophysics Data System (ADS)
Objective: Ho:YAG laser had been used to treat the common diseases of urinary system such as bladder cancer and benign prostatic hyperplasia in our hospital. This study is to assess the efficacy and safety of transurethral Ho:YAG-laser resection to treat the urethral stricture and bladder neck contracture. Methods: From May 1997 to August 2004, 26 cases of urethral stricture and 33 cases of bladder neck contracture were treated by transurethral Ho:YAG-laser resection. These patients were followed up at regular intervals after operation. The uroflow rate of these patients was detected before and one-month after operation. The blood loss and the energy consumption of holmium-laser during the operation as well as the complications and curative effect after operation were observed. Results: The therapeutic effects were considered successful, with less bleeding and no severe complications. The Qmax of one month postoperation increased obviously than that of preoperation. Of the 59 cases, restenosis appeared in 11 cases (19%) with the symptoms of dysuria and weak urinary stream in 3-24 months respectively. Conclusions: The Ho:YAG-laser demonstrated good effect to treat the obstructive diseases of lower urinary tract such as urethral stricture and bladder neck contracture. It was safe, minimal invasive and easy to operate.
Bo, Juanjie; Dai, Shengguo; Huang, Xuyuan; Zhu, Jing; Zhang, Huiguo; Shi, Hongmin
Aerocyst urethral catheter insertion compared to expansion sponges application in external dacryocystorhinostomy
AIM To evaluate the clinical effect and complications of two different filling materials (aerocyst urethral catheter and expansion sponges) applying in external dacryocystorhinostomy (EXT-DCR) and compare their advantages and disadvantages. METHODS A retrospective study was made in the period from April, 1 2000 to April, 1 2005. Totally 180 patients (240 eyes) underwent the EX-DCR using different filling materials and divided into three groups randomly: negative control groups (group 1), expansion sponges group (group 2) and aerocyst urethral catheter group (group 3). The gender, etiology, clinical findings, surgical technique, filling materials, the condition of ocular surface and complications were analyzed. Filling materials were removed during day 7. Postoperative success was determined by lacrimal patency to irrigation, a positive dye test, hemorrhage and errhysis conditions after extubation and subjective resolution of epiphora and liquor puris. RESULTS During a mean follow-up of 5.14�1.69 years, the success rate were 73.7% (group 1), 86.5% (group 2), 98.7% (group 3) in three groups. There was significant statistical difference among three groups in the surgical success rate and the operative complications (including hemorrhage, errhysis, periorbital ecchymosis after extubation)(P<0.05). CONCLUSION EXT-DCR with aerocyst urethral cathete intraoperatively have higher success rate, fewer operative complications and a high patient satisfaction ,and can be used to simplify and speed up traditional EXT-DCR.
Shao, Yi; Yu, Yao; Pei, Chong-Gang; Zhou, Qiong; Dong, Wen-Jia; Qu, Yangluowa; Yang, Lu; Gao, Gui-Ping
The prevalence of urethral infections amongst asymptomatic young men in Hat Yai, southern Thailand.
The aim of this study was to survey sexual behaviour and estimate the prevalence of urethral infections amongst male vocational college students. A cross-sectional survey was performed among 479 young men attending 2 vocational colleges in Hat Yai, southern Thailand. Polymerase chain reaction (PCR) tests of first-void urine (FVU) samples were used to detect infection with Chlamydia trachomatis, Neisseria gonorrhoeae, Ureaplasma urealyticum, Mycoplasma genitalium and Mycoplasma hominis. Girlfriends were the usual sexual partners for 89% of men with only 11% regularly patronizing sex workers. Condom usage was low. The prevalence of any urethral infection was 15.9% with: C. trachomatis 4%, N. gonorrhoeae 0.2%, U. urealyticum 10.9%, M. genitalium 2.3% and M. hominis 1.3%. Infection with more than one organism was found in 2% of men. While the prevalence of infection with chlamydia or gonorrhoea was relatively low, the prevalence of 'any urethral infection' was moderately high and suggests that unprotected sexual intercourse is commonly occurring. As girlfriends were the most usual sexual partners, they must be at significant risk of pelvic infection. There is a need for programmes targeting this group of people. PMID:10872914
Chandeying, V; Skov, S; Duramad, P; Makepeace, B; Ward, M; Khunigij, P
Urethral lift for benign prostatic hyperplasia: a comprehensive review of the literature.
Current treatments for benign prostatic hyperplasia (BPH) include watchful waiting, medical therapy, and interventional procedures. The post-surgical complication profile and the early discontinuation of medical therapy are significant drawbacks of the established approach and stimulate the search for less-invasive approaches. Our aim is to provide a comprehensive review all available literature on prostatic urethral lift (PUL), presenting an overview of safety, indications, surgical technique and results of the procedure, and to evaluate the potential role it could play in the treatment of BPH. A comprehensive search was conduct on PubMed and Scopus database to identify original articles in English dealing with PUL without any limit to publication date. Keywords used were prostatic urethral lift, urethral lifting, Urolift, benign prostatic hyperplasia and minimally invasive therapy. The PUL seems to offer a better IPSS improvement when compared to medical therapy, but the result is inferior when compared to surgical therapy. Published studies report an absence of degradation of erectile or ejaculatory function after treatment, which appears a noteworthy benefit of PUL. Additional advantages of the PUL are a better complication profile in comparison to other surgical therapies and the use of a local anesthesia, sometimes without postoperative catheterization. The PUL, a novel, minimally invasive treatment option for men affected by BPH, presents a promising potential although it is clear that PUL is not a substitute for traditional ablative surgical approach, as this procedure requires a scrupulous selection of the patient. PMID:23794125
Larcher, Alessandro; Broglia, Luigi; Lughezzani, Giovanni; Mistretta, Francesco; Abrate, Alberto; Lista, Giuliana; Fossati, Nicola; Sangalli, Mattia; Kuefner, Dana; Cestari, Andrea; Buffi, Nicolomaria; Lazzeri, Massimo; Guazzoni, Giorgio; Montorsi, Francesco
Urethral compensatory mechanisms to maintain urinary continence after pudendal nerve injury in female rats
Introduction and hypothesis To investigate the urethral compensatory mechanisms to maintain urinary continence after pudendal nerve injury. Methods In naive, acute pudendal nerve transection (PNT) and 4 weeks after PNT (PNT-4w) female rats, leak point pressures (LPPs) during bladder compression were measured before and after the application of hexamethonium (C6), propranolol and N?nitro-L-arginine methyl ester (L-NAME), or terazosin and atropine. Responses to carbachol and phenylephrine of proximal and middle urethral muscle strips from naive and PNT-4w rats were also examined. Results LPPs were significantly decreased in PNT rats but not in PNT-4w rats. LPPs in PNT rats were significantly increased by C6 or L-NAME while LPPs in PNT-4w rats were significantly decreased by C6, or terazosin and atropine. Excitatory responses to carbachol and phenylephrine in the proximal urethral muscle were significantly larger in PNT-4w rats. Conclusions These results suggest that ?1-adrenoceptor and muscarinic receptor-mediated contractility is upregulated in the proximal urethra 4 weeks after PNT.
Furuta, Akira; Suzuki, Yasuyuki; Asano, Koji; de Groat, William C.; Egawa, Shin; Yoshimura, Naoki
Ruptured urinary bladder attributable to urethral compression by a haematoma after vertebral fracture in a bull
Background In male cattle, rupture of the urinary bladder is usually associated with urethral obstruction by uroliths. Less common causes include urethral compression or stricture. This case report describes the findings in a young Limousion breeding bull with rupture of the urinary bladder because of urethral compression by a haematoma after coccygeal fracture. Case presentation The bull had been introduced into a 40-head Red-Holstein herd one week before being injured. One week after introduction to the herd, the bull had an acute onset of anorexia and he was referred to the clinic. There was marked abdominal distension, reduced skin turgor and enophthalmus. The serum concentration of urea and creatinine was increased. Ultrasonographic examination revealed severe ascites and abdominocentesis yielded clear yellow fluid with high urea and creatinine concentrations, which supported a diagnosis of uroperitoneum. The bull was euthanatized because of a poor prognosis. Postmortem examination revealed a comminuted fracture of the first two coccygeal vertebrae associated with a massive haematoma that obstructed entire pelvic cavity. The haematoma compressed the urethra thereby preventing outflow of urine, which resulted in a 5-cm tear ventrally at the neck of the bladder. It was assumed that the newly-introduced bull had sustained the vertebral fractures when he was mounted by a cow. Conclusions The present case study serves to expand the differential diagnosis of urinary bladder rupture. Therefore, in addition to obstructive urolithiasis, compression and stricture of the urethra might be considered in male cattle with uroperitoneum.
Use of buccal mucosa grafts for urethral reconstruction in children: a retrospective cohort study
Background The use of buccal mucosa grafts (BMG) for urethral reconstruction has increased in popularity over the last several decades. Our aim was to describe our institutional experience with and outcomes after BMG urethroplasty. Methods We conducted a retrospective cohort study of boys undergoing BMG urethral reconstruction. Preoperative and perioperative characteristics and postoperative outcomes were evaluated. Results Twenty-nine patients (median age 8.2�years) underwent BMG urethroplasty from 1995�2012. Of the 10 patients undergoing 1-stage repairs, 6 had tubularized grafts, the last of which was performed in 2000 due to an unacceptably high revision rate (100%). A 2-stage approach was elected for 19 patients (median follow-up 21.3�months). Complications including stricture, fistula, or chordee were seen in 60% of patients completing both stages and 32% required ?1 revision. However, 71% of 2-stage patients were free of significant problems at last follow-up. Conclusions We found BMG to be a reasonable option for use in complex pediatric urethral reconstruction. Tubularized grafts had poor results, and we no longer use them. We favor a 2-stage approach for all patients except those with �simple� non-hypospadiac strictures. Although revision procedures were not uncommon, the majority of patients were ultimately free of long-term problems.
Tegress(TM) Urethral Implant Phase III Clinical Experience and Product Uniqueness
Advances in materials technology, coupled with a heightened understanding of wound healing and tissue-materials interactions in the lower urinary tract, have led to the development of a variety of new urethral bulking agents that are expected to be available in the near future. Experience with such bulking agents continues to grow and study results are disseminated as more clinical trials are initiated and completed. The intention of this report is to review the characteristics and initial clinical results for one of these new agents: Tegress� Urethral Implant (C. R. Bard, Inc., Murray Hill, NJ). This material, with unique phase-change properties upon exposure to body temperature fluids, offers ease of injection and requires less volume for clinical effect than bovine collagen. Additionally, Tegress Urethral Implant performance in clinical trials has suggested improved durability and correspondingly higher continence and improvement rates versus bovine collagen. As these materials evolve, an understanding of preferential implant techniques is being gained also. Delivery method and implant site may prove to substantially alter the biologic activity of these compounds. As outlined in this review, experience with Tegress Implant resulted in changes in delivery technique that translated into improved materials and tissue interaction.
Dmochowski, Roger R
45 CFR 1308.16 - Eligibility criteria: Traumatic brain injury.
Code of Federal Regulations, 2010 CFR
... false Eligibility criteria: Traumatic brain injury. 1308.16 Section 1308.16...1308.16 Eligibility criteria: Traumatic brain injury. A child is classified as having traumatic brain injury whose brain injuries are...
45 CFR 1308.16 - Eligibility criteria: Traumatic brain injury.
Code of Federal Regulations, 2010 CFR
... false Eligibility criteria: Traumatic brain injury. 1308.16 Section 1308.16...1308.16 Eligibility criteria: Traumatic brain injury. A child is classified as having traumatic brain injury whose brain injuries are...
Posterior Instrumentation for Occipitocervical Fusion
Since 1995, 29 consecutive patients with craniocervical spine instability due to several pathologies were managed with posterior occipitocervical instrumentation and fusion. Laminectomy was additionally performed in nineteen patients. The patients were divided in two groups: Group A which included patients managed with screw-rod instrumentation, and Group B which included patients managed with hook-and-screw-rod instrumentation. The patients were evaluated clinically and radiographically using the following parameters: spine anatomy and reconstruction, sagittal profile, neurologic status, functional level, pain relief, complications and status of arthrodesis. The follow-up was performed immediately postoperatively and at 2, 6, 12 months after surgery, and thereafter once a year. Fusion was achieved in all but one patient. One case of infection was the only surgery related complication. Neurological improvement and considerable pain relief occurred in the majority of patients postoperatively. There were neither intraoperative complications nor surgery related deaths. However, the overall death rate was 37.5% in group A, and 7.7% in group B. There were no instrument related failures. The reduction level was acceptable and was maintained until the latest follow-up in all of the patients. No statistical difference between the outcomes of screw-rod and hook-and-screw-rod instrumentation was detected. Laminectomy did not influence the outcome in either group. Screw-rod and hook-and-screw-rod occipitocervical fusion instrumentations are both considered as safe and effective methods of treatment of craniocervical instability.
Sapkas, George; Papadakis, Stamatios A; Segkos, Dimitrios; Kateros, Konstantinos; Tsakotos, George; Katonis, Pavlos
Posterior repair and sexual function
OBJECTIVE The purpose of this study was to determine the effect of posterior repair (PR) on sexual function in patients who have undergone incontinence and/or pelvic reconstructive surgery. STUDY DESIGN A cohort study of women who underwent incontinence and/or prolapse surgery was performed. Participants completed the pelvic organ prolapse urinary incontinence sexual questionnaire (PISQ) before and after the operation. PISQ scores were compared between women who underwent PR and women who did not. RESULTS Of 73 study participants, 30 women underwent PR; 43 women did not (no PR). Although there was no difference in dyspareunia between groups pre-op, dyspareunia prevalence post-op was significantly lower in the no PR group. Preoperative PISQ scores were similar between groups. After the operation, both groups significantly improved their PISQ scores, without a difference between groups. CONCLUSION Although the incidence of dyspareunia differed between PR and no PR groups, overall improvement in sexual function was reflected in improved total PISQ scores that occurred irrespective of PR performance.
Komesu, Yuko M.; Rogers, Rebecca G.; Kammerer-Doak, Dorothy N.; Barber, Matthew D.; Olsen, Ambre L.
Traumatic grief and traumatic stress in survivors 12 years after the genocide in Rwanda.
The relationship between exposure to traumatic events and traumatic grief and the role of mediating and moderating variables [peritraumatic distress, post traumatic stress disorder (PTSD) symptoms and symptoms of depression] were studied in survivors of the genocide of Batutsi in Rwanda in 1994. One hundred and two survivors (70 women, mean age 45 � 7.53 years) participated in this retrospective study. All of them had lost a member of their family. The severity of traumatic exposure (Comprehensive Trauma Inventory), peritraumatic distress (Peritraumatic Distress Inventory), current PTSD symptoms (PTSD Checklist), depressive symptoms (Beck Depression Inventory) and traumatic grief symptoms (Inventory of Traumatic Grief) was evaluated. A hierarchical multiple regression analysis was then conducted to examine the relative contribution of each variable to the symptoms of traumatic grief. The severity of traumatic exposure was related to traumatic grief symptoms (B=0.06, R=0.6, R(2)?=0.36 and �=0.6, t=7.54, p=0.00). The Baron and Kenny procedure (1986) (including three separate regressions), along with the Sobel test, was used to test mediation effects. Peritraumatic distress and PTSD symptoms may be mediating variables between traumatic exposure and traumatic grief. Traumatic grief is a complex but assessable entity, where previous distress and suffering result from both psychological trauma and the loss of a loved one. PMID:22282057
Mutabaruka, Jean; S�journ�, Nathal�ne; Bui, Eric; Birmes, Philippe; Chabrol, Henri
HIV infection associated post-traumatic stress disorder and post-traumatic growth � A systematic review
The phenomenon of post-traumatic stress has been well documented in the literature as a lasting mental health condition associated with exposure to traumatic life events. The diagnosis and experience of human immunodeficiency virus (HIV) disease may be such a trauma. On the other hand, the phenomenon of post-traumatic growth (PTG) has been described, whereby people show positive mental health growth
Lorraine Sherr; Navneet Nagra; Grace Kulubya; Jose Catalan; Claudine Clucas; Richard Harding
Depression following traumatic brain injury
Objective: Review the existing literature on the incidence, neurobiological and psychosocial correlates, and methods of assessment and treatment of depression following traumatic brain injury (TBI).Data Sources: Computerized database searches of the English-language literature from Index Medicus, Psychological Abstracts, Excerpta Medica, and Cumulative Index of Nursing and Allied Health Literature.Study Selection: Given the relatively small number of publications specifically related to
Mitchell Rosenthal; Bruce K. Christensen; Thomas P. Ross
Management of Traumatic Brain Injury
Opinion statement��Traumatic brain injury (TBI) is a complex disease process that requires constant attention as one manages the associated body\\u000a systems. Even though an �isolated� brain injury may be the cause for admission to the hospital, the injured brain cannot be\\u000a thought of in isolation from the remainder of the body. All body systems, from cardiac to pulmonary, need to
Andrew Losiniecki; Lori Shutter
Models of Traumatic Cerebellar Injury
Traumatic brain injury (TBI) is a major cause of morbidity and mortality worldwide. Studies of human TBI demonstrate that\\u000a the cerebellum is sometimes affected even when the initial mechanical insult is directed to the cerebral cortex. Some of the\\u000a components of TBI, including ataxia, postural instability, tremor, impairments in balance and fine motor skills, and even\\u000a cognitive deficits, may be
Matthew B. Potts; Hita Adwanikar; Linda J. Noble-Haeusslein
Endocannabinoids and Traumatic Brain Injury
In response to traumatic brain injury, there is local and transient accumulation of 2-AG at the site of injury, peaking at\\u000a 4�h and sustained up to at least 24�h. Neuroprotection exerted by exogenous 2-AG suggests that the formation of 2-AG may serve\\u000a as a molecular regulator of pathophysiological events, attenuating the brain damage. Inhibition of this protective effect\\u000a by SR-141716A,
R. Mechoulam; E. Shohami
Statins in traumatic brain injury
Summary��Traumatic brain injury (TBI) is a common cause of long-term neurological morbidity, with devastating personal and societal\\u000a consequences. At present, no pharmacological intervention clearly improves outcomes, and therefore a compelling unmet clinical\\u000a need remains. 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors, or �statins,� offer a potential novel therapeutic\\u000a strategy for TBI. Statins are well tolerated, easy to administer, and have a long
Elissa F. Wible; Daniel T. Laskowitz
Infections in severely traumatized children.
To study the incidence and types of infection among severely traumatized children, we reviewed the medical charts of 212 children, hospitalized following traumatic injury, who received antibiotics at sometime during their hospitalization. Infection occurred in 19%. Eleven children had trauma-related infections, whereas 29 (71% of those infected) had 36 nosocomial infections. Tracheitis, sepsis, and urinary tract infections were the most common nosocomial infections and were diagnosed in the second week (10 +/- 3 days) following injury. Nosocomial infections were more likely to develop in children who were more severely injured and who had a greater number of invasive procedures. Severe head injury (cerebral edema or subarachnoid hemorrhage) was more common in those with nosocomial infection (P < .0002, odds ratio 6.8, 95% confidence interval 2.2 to 21.3). Those without these injuries were much less likely to develop nosocomial infections (specificity 97% and negative predictive value 86%). Finally, the development of any nosocomial infection prolonged the hospitalization by a mean of 16 +/- 6 days when comparing children with the same degree of traumatic injury. Prevention of nosocomial infection in children with severe trauma will significantly reduce length of hospitalization. PMID:1479496
Bell, L M; Baker, M D; Beatty, D; Taylor, L
Traumatic injuries in revue dancers.
Revue productions are a combination of dancing and singing, musical and spoken sequences, and acrobatics, performed with or without a story line, and characterized by a versatility of dance styles and a high number of performances (over 250 in a 10-month season). The aim of this quantitative single cohort study is to evaluate work-related traumatic injuries in this dance genre. Data were obtained from work accident reports of the German Social Accident Insurance Institution for the public sector in Berlin (UKB) involving 440 revue dancers (183 males and 257 females). Analysis was conducted with Excel 2007 and PASW Statistics 18. One out of three female dancers and one out of two male dancers sustained an acute injury in the course of a theatrical season (0.22 injuries per 1,000 hours). The incidence rate was 0.44 for males and 0.31 for females, with the lower extremity as the most commonly injured body region, followed by the spine. Of all occupational accidents, 75.1% happened on stage, with 69% during performances. The dance partner and dance floor were the most common exogenous factors resulting in a traumatic injury. Of all traumatic injuries, 81.7% occurred in the first 3 hours after starting work. Gender specific differences could be observed. Due to the limited availability of comparable studies of other forms of professional dance, in this study revue dance is largely considered as an independent genre. PMID:24568800
Wanke, Eileen M; Arendt, Michael; Mill, Helmgard; Koch, Franziska; Wanke, Alice; Groneberg, David A
Quantitative EEG analysis in post-traumatic anosmia.
Many objective and quantitative methods have been developed to create a procedure or a device to prove, describe and quantify olfactory deficit and anosmia, especially after a head trauma. Electrophysiological testing throughout olfactoelectroencephalography (olfactoEEG) is based on brain activity desynchronisation, and on the subsequent disappearance of alpha activity on the posterior regions after an olfactory stimulus. Yet traditional evaluation of EEG can be difficult, because of little or hardly detectable alpha activity on the posterior regions ('alpha rare'). The aim of this study was to evaluate the Olfactory Stop Reaction (OSR) by means of frequency band power calculation and subsequent topographical mapping in patients with post-traumatic anosmia, who presented 'alpha rare' EEG. Twenty-five consecutive patients, affected by anosmia caused by head trauma, were submitted to an EEG recording with olfactory stimulation. After signal processing and analysis, an Olfactory Stop Reaction was detected in 17 out of 25 patients; moreover, in these patients we detected a significant decrease in alpha band power in the occipital regions and an increase in theta band power on midline frontal and central regions after olfactory stimulation. In the remaining eight patients, no significant variation in band power was observed. In conclusion, an objective evaluation of the olfactory function with this method of automatic EEG signal analysis allows the limits given by psychophysical methods and traditional EEG to be overcome and attempts to fulfil the requirements for standardization of olfactory function evalution. PMID:17113930
Bonanni, E; Borghetti, D; Fabbrini, M; Maestri, M; Cignoni, F; Sartucci, F; Murri, L
Traumatic basal subarachnoid hemorrhage suspected to have been caused by contrecoup cerebellar contusions: a case report.
Traumatic cerebellar hemorrhagic contusions are infrequent, and the pathogenic mechanism involves a coup injury that is associated with motor vehicle accidents in most cases. Traumatic basal subarachnoid hemorrhage (TBSAH) is commonly reported after blunt trauma to the neck or unrestricted movement of the head, and the source of the hemorrhage is most frequently identified in the vertebrobasilar arteries. A 55-year-old woman who was addicted to alcohol was found dead in her bed. She had a bruise on the left side of her posterior parietal region, and autopsy revealed massive subarachnoid hemorrhage at the base of the brain; the hematoma was strongly attached to the right lower surface of the cerebellar hemisphere. No ruptured cerebral aneurysms, arteriovenous malformations or vertebrobasilar artery leakage were detected. Hemorrhagic cerebellar contusions were regarded as the source of the TBSAH. This is the first report of TBSAH suspected to have been caused by contrecoup cerebellar contusions. PMID:24411402
Sato, Takako; Tsuboi, Kento; Nomura, Masakatsu; Iwata, Misa; Abe, Shuntaro; Tamura, Akiyoshi; Tsuchihashi, Hitoshi; Nishio, Hajime; Suzuki, Koichi
Posterior labral injury in contact athletes.
Nine athletes (seven football offensive linemen, one defensive lineman, and one lacrosse player) were found at arthroscopy to have posterior labral detachment from the glenoid. In our series, this lesion is specific to contact athletes who engage their opponents with arms in front of the body. All patients had pain with bench pressing and while participating in their sport, diminishing their ability to play effectively. Conservative measures were ineffective in relieving their symptoms. Examination under anesthesia revealed symmetric glenohumeral translation bilaterally, without evidence of posterior instability. Treatment consisted of glenoid rim abradement and posterior labral repair with a bioabsorbable tack. All patients returned to complete at least one full season of contact sports and weightlifting without pain (minimum follow-up, > or = 2 years). Although many injuries leading to subluxation of the glenohumeral joint occur when an unanticipated force is applied, contact athletes ready their shoulder muscles in anticipation of impact with opponents. This leads to a compressive force at the glenohumeral joint. We hypothesize that, in combination with a posteriorly directed force at impact, the resultant vector is a shearing force to the posterior labrum and articular surface. Repeated exposure leads to posterior labral detachment without capsular injury. Posterior labral reattachment provides consistently good results, allowing the athlete to return to competition. PMID:9850774
Mair, S D; Zarzour, R H; Speer, K P
Mobile-bearing total knee arthroplasty: a full traumatic rotation of 180�.
From February 2008 to September 2012 we implanted 204 mobile-bearing knee prostheses in 192 patients. All the prostheses were cemented (both femoral and tibial components), and the patella was not replaced. Only one early complication of the implants (1/204 = 0.004%) occurred after a traumatic event as a full 180� rotation of the mobile-bearing polyethylene insert. A 78-year-old woman presented with swelling and severe pain at her right knee. This traumatic event was the only case among our mobile-bearing insert patients. ?The failed polyethylene inserts were retrieved and studied using a scanning electron microscope (SEM, ZEISS EVO 50 EP, Cambridge, UK) operating at 20 kV. ?Scratching and pitting were found on the UHMWPE insert perpendicular to the machining tracks for the concave surface. SEM micrographs of the insert showed burnishing on the concave surfaces and longitudinal scratches were clearly detectable and well-marked on the analyzed surfaces. ?A traumatic, fully rotating, polyethylene insert is rare and our case is the first report describing a traumatic event with a complete 180 degree rotation mobile-bearing in a total knee prosthesis. ?In the literature few reports discuss clinical outcomes after total knee arthroplasty in patients with Parkinson's disease and they cite mixed results. However, some authors suggest that posterior-stabilized and cruciate-retaining TKA should work well while others prefer cruciate-retaining, condylar constrained kinetics, or hinged devices. Although we did not implant a posterior-stabilized mobile-bearing total knee prosthesis or a constrained prosthesis, we obtained good clinical and radiological results at the 2-year followup. PMID:23653296
Sudanese, Alessandra; Castiello, Emanuela; Affatato, Saverio
Sickle cell disease and posterior reversible leukoencephalopathy.
Sickle cell disease can present with neurological manifestations. One such presentation is with posterior reversible leukoencephalopathy also known as reversible posterior leukoencephalopathy. The condition is classically described as reversible over time; it commonly presents with oedematous changes involving the white matter of the occipital and parietal regions. Only a few patients with the association between sickle cell disease and posterior reversible leukoencephalopathy have been described in the adult literature. We present two patients from our institutions to emphasise the association between the two conditions and summarise the published cases in the literature. PMID:24656986
Geevasinga, Nimeshan; Cole, Catherine; Herkes, Geoffrey K; Barnett, Yael; Lin, Jamie; Needham, Merrilee
Posterior compartment prolapse: a urogynecology perspective.
Posterior compartment prolapse is often caused by a defect in the rectovaginal septum, also known as Denonvillier's fascia. Patients with symptomatic posterior compartment prolapse can present with bulge symptoms as well as defecatory dysfunction, including constipation, tenesmus, splinting, and fecal incontinence. The diagnosis can successfully be made on clinical examination. Treatment of posterior prolapse includes pessaries and surgery. Both traditional colporrhaphy and site-specific defect repair have excellent success rates. Complications from surgery can include sexual dysfunction, de novo dyspareunia, and defecatory dysfunction. Compared with native tissue repair, biological and synthetic grafting has not improved overall anatomic and subjective outcomes. PMID:22877719
Richardson, Monica L; Elliot, Christopher S; Sokol, Eric R
A Posterior Petrous Meningioma with Recurrent Vertigo
Meningioma's account for around 15% of all primary brain tumors with some 10% of meningiomas arising in the posterior fossa. In rare cases, a meningioma can form around the endolymphatic sac. When formed in the posterior fossa, meningioma tumors can produce vague, non-specific vertiginous symptoms. Research has observed that a subset of these lesions could produce symptoms indistinguishable from those of Meniere's disease. Therefore, we described the clinical features of a case of posterior petrous meningioma with recurrent vertigo as well as the substantial resolution of symptoms after tumor removal via transmastoid approach.
Choi, Seong Jun; Lee, Jong Bin; Bae, Joon-Ho; Yoon, Jung-Hee; Lee, Ho-Jin; Kim, Chan-Ho; Park, Keehyun
Traumatic Brain Injury: A Challenge for Educators
ERIC Educational Resources Information Center
In this article, the authors provide information designed to enhance the knowledge and understanding of school personnel about traumatic brain injury (TBI). The authors specifically define TBI and enumerate common characteristics associated with traumatic brain injury, discuss briefly the growth and type of services provided, and offer some�
Bullock, Lyndal M.; Gable, Robert A.; Mohr, J. Darrell
Masculinity and Post-Traumatic Spirituality
Building on narrative empirical research and counselling with male victims of (sexual) violence, this paper explores post-traumatic spirituality. There is some convincing research to date that shows that traumatization is not always detrimental to spirituality but may even enhance the person's spiritual engagement and growth. Although many more factors are involved, one interesting aspect is the influence of gender in
R. Ruard Ganzevoort
The Effects of Traumatic and Abusive Relationships
ERIC Educational Resources Information Center
The present study aimed to understand what constitutes a traumatic relationship experience for adults in abusive intimate relationships and what effects, losses, and coping strategies were the most salient for these participants. A total of 101 individuals (42 males, 59 females) who reported experiencing an abusive or traumatic relationship�
Orzeck, Tricia L.; Rokach, Ami; Chin, Jacqueline
Traumatic rupture of the right subclavian artery
The case report of a patient who sustained a traumatic rupture of the right subclavian artery in a motor vehicle accident is presented. The preoperative diagnosis, surgical approach, postoperative management, and indications for angiography in traumatic lesions of the thoracic aorta and great vessels are discussed. The relevant literature is reviewed. Images
Girdwood, Robert W.; Holden, Michael P.; Ionescu, Marian I.
Post-traumatic symptoms in abused children
A variety of symptoms have been described as sequelae of physical and sexual abuse in childhood. This review suggests that some of these symptoms can be understood as developmentally mediated manifestations of post-traumatic disorders. Like traumatized combat or concentration camp survivors, severely abused children develop anxiety, compulsive repetitions, sleep disturbances and depression, ego constriction, and disturbed expressions of anger. The
Jean Goodwin
Post-Traumatic Stress Disorder and Violence.
ERIC Educational Resources Information Center
This paper is a clinical discussion of post-traumatic stress disorder and violence, particularly as it applies to the Vietnam Post-Traumatic Stress Syndrome. In the first section, the syndrome is described as the sudden onset of explosive rage and unprovoked violence with little or no warning, accompanied by a drastic change in personality. It is�
French, Laurence
Secondary Traumatic Stress in Substance Abuse Treatment
ERIC Educational Resources Information Center
The terms secondary traumatic stress (STS), vicarious traumatization (VT), and compassion fatigue (CF) have all been used, sometimes interchangeably, to refer to the observation that those who provide clinical services to trauma survivors may themselves experience considerable emotional disruption, becoming indirect victims of the trauma.�
Bride, Brian E.; Walls, Erin
Traumatic Bonding: Clinical Implications in Incest.
ERIC Educational Resources Information Center
"Traumatic bonding" is defined as "the evolution of emotional dependency between...a child and an adult [in] a relationship characterized by periodic sexual abuse." Maintains that the concept holds promise for explaining confusing dynamics of incest. Demonstrates ways in which traumatic bonding can be applied to cases of incest and discusses�
deYoung, Mary; Lowry, Judith A.
Thorough decompression of the posterior cervical foramen.
Regardless of the approach to the cervical spine, it is clear that surgical outcome is directly related to surgical technique. Posterior decompressions must be thorough and complete because laminoforaminotomies provide an excellent means of decompressing foraminal pathology. One of the distinct advantages of posterior laminoforaminotomy is that it offers direct visualization, exposure, and decompression of the nerve root without performing a fusion. A posterior laminoforaminotomy is the preferred approach for patients with a soft lateral disk herniation, for those at increased risk for nonunion, or those for whom an anterior procedure would not be optimal. To perform a thorough decompression and prevent iatrogenic instability and neurologic deficits, however, surgeons must be familiar with the anatomy of the foramen as well as the compressive pathology. Several issues must be addressed before performing a posterior laminoforaminotomy, namely, the absence of instability and junctional kyphosis, and the proper identification of the offending pathology. PMID:17472315
Lehman, Ronald A; Riew, K Daniel
The Posterior Cervical Lymph Node in Toxoplasmosis
Posterior cervical node enlargement is characteristic of clinical toxoplasmosis in adults. Lymph node biopsies from 37 patients, who were tested for toxoplasmosis by serologic and isolation studies, were examined. A characteristic pattern of sinus histiocytosis was seen in 17 of 18 posterior cervical nodes and in only 1 of 4 lymph nodes from other sites from patients with toxoplasmosis. The characteristic pattern was not seen in posterior cervical nodes or in lymph nodes from other sites from patients with other diseases. Lymphoma obscured the characteristic changes of toxoplasmosis in the posterior cervical nodes and other nodes of 5 patients with these coexisting diseases. Organisms were seen in tissue sections in only 2 instances. T gondii was isolated from mice in 14 of 17 attempts using nodes from patients with toxoplasmosis, but from none of 8 attempts using nodes from patients with other diseases. ImagesFig 3Fig 4Fig 1Fig 2
Gray, George F.; Kimball, Anne C.; Kean, B. H.
Posterior Hip Pain in an Athletic Population
Context: Posterior hip pain is a relatively uncommon but increasingly recognized complaint in the orthopaedic community. Patient complaints and presentations are often vague or nonspecific, making diagnosis and subsequent treatment decisions difficult. The purposes of this article are to review the anatomy and pathophysiology related to posterior hip pain in the athletic patient population. Evidence Acquisition: Data were collected through a thorough review of the literature via a MEDLINE search of all relevant articles between 1980 and 2010. Results: Many patients who complain of posterior hip pain actually have pain referred from another part of the body�notably, the lumbar spine or sacroiliac joint. Treatment options for posterior hip pain are typically nonoperative; however, surgery is warranted in some cases. Conclusions: Recent advancements in the understanding of hip anatomy, pathophysiology, and treatment options have enabled physicians to better diagnosis athletic hip injuries and select patients for appropriate treatment.
Frank, Rachel M.; Slabaugh, Mark A.; Grumet, Robert C.; Virkus, Walter W.; Bush-Joseph, Charles A.; Nho, Shane J.
Imaging features of posterior limbus vertebrae.
Posterior limbus vertebra (PLV) is the retropulsion of the vertebral ring apophysis resulting from disc herniation through posterior ring physis. Large PLV can cause spinal stenosis, and small PLV can be mistaken as intraspinal disc herniation. Although the clinical presentations were similar, the surgery was quite different. We had experienced preoperative misdiagnosed cases and the surgery could not be finished. Therefore we analyzed the imaging features of PLV in 34 patients in order to prompt appropriate preoperative diagnosis and surgical planning. PMID:23154012
Huang, Pei-Yu; Yeh, Lee-Ren; Tzeng, Wen-Sheng; Tsai, Meng-Yuan; Shih, Tiffany Ting-Fang; Pan, Huay-Ben; Chen, Clement Kuen-Huang
Posterior fossa subdural hematoma mimicking intracerebellar hemorrhage.
Subdural hematomas of the posterior fossa are very rare and most cases are related to head injury. The influence of anticoagulation in cases of spontaneous development is well known. Although diagnosis is easily achieved by CT sean, atypical forms may lead to the wrong diagnosis of cerebellar hematoma. We present a case of a posterior fossa acute subdural hematoma occurring in an anticoagulated patient who was preoperatively misdiagnosed as an intracerebellar hemorrhage. PMID:14710308
Miranda, P; Alday, R; Lagares, A; P�rez, A; Lobato, R D
Evaluation and Management of Posterior Shoulder Instability
Context: Posterior shoulder instability is a commonly misdiagnosed disorder in many competitive athletes. Type of Study: Clinical review. Evidence Acquisition: Relevant studies on posterior shoulder instability from 1950 to 2010 in PubMed and Cochrane databases were reviewed. Results: A total of 107 studies were reviewed. Conclusion: Patients who have undergone at least 6 months of physical therapy and still experience instability symptoms should be considered for surgical stabilization directed at their underlying pathology.
Tannenbaum, Eric; Sekiya, Jon K.
Posterior Reversible Encephalopathy Syndrome Due to Hyponatremia
Posterior reversible encephalopathy syndrome (PRES) is characterized by variable associations of seizure activity, consciousness impairment, headaches, visual abnormalities, nausea/vomiting, and focal neurological signs. The PRES may occur in diverse situations. The findings on neuroimaging in PRES are often symmetric and predominate edema in the white matter of the brain areas perfused by the posterior brain circulation, which is reversible when the underlying cause is treated. We report the case of PRES in normotensive patient with hyponatremia.
Jeon, Ji-Su; Park, Sung-Pa; Seo, Jong-Geun
Neuroimaging in Traumatic Brain Imaging
Summary: Traumatic brain injury (TBI) is a common and potentially devastating clinical problem. Because prompt proper management of TBI sequelae can significantly alter the clinical course especially within 48 h of the injury, neuroimaging techniques have become an important part of the diagnostic work up of such patients. In the acute setting, these imaging studies can determine the presence and extent of injury and guide surgical planning and minimally invasive interventions. Neuroimaging also can be important in the chronic therapy of TBI, identifying chronic sequelae, determining prognosis, and guiding rehabilitation.
Lee, Bruce; Newberg, Andrew
Post-traumatic diaphragmatic hernia.
Post- traumatic diaphragmatic hernia is not an uncommon sequel. But lack of awareness of this condition may delay in diagnosis and result in life-threatening complications. CT scan is regarded as the investigative tool of choice but some prefer Barium studies in delayed cases of diaphragmatic hernia. Chest X- ray and Ultrasonography of the chest and abdomen may also help in arriving at a diagnosis. An awareness of the condition assisted by the radiological investigations will lead to an early diagnosis and treatment which ultimately helps in managing the patients with diaphragmatic hernias better. PMID:23904727
Hajong, R; Baruah, A
Early traumatic events in psychopaths.
The relationship between diverse early traumatic events and psychopathy was studied in 194 male inmates. Criminal history transcripts were revised, and clinical interviews were conducted to determine the level of psychopathy using the Psychopathy Checklist-Revised (PCL-R) Form, and the Early Trauma Inventory was applied to assess the incidence of abuse before 18 years of age. Psychopathic inmates presented a higher victimization level and were more exposed to certain types of intended abuse than sociopathic inmates, while the sum of events and emotional abuse were associated with the PCL-R score. Our studies support the influence of early adverse events in the development of psychopathic offenders. PMID:23550705
Borja, Karina; Ostrosky, Feggy
Correlation between Urethrovesical Anatomy and Urethral Closure Function in Female Stress Urinary Incontinence before and after Operation: Urethrocystographic and Urethrocystometric Evaluation
32 patients with stress urinary incontinence were investigated by bead chain urethrocystography (UCG) and simultaneous urethrocystometry (UGM) before and after operation. 12 patients were incontinent postoperatively. Two important determinants of the operative success emerged. Firstly, an operation-induced decrease in the urethral inclination angle or urethral mobility of at least 40 % was associated with a success rate of 81 %,
Erkki Kujansuu; Antti Kauppila; Seppo L�hde
Posterior horn instability of the medial meniscus a sign of posterior meniscotibial ligament insufficiency
Purpose��In longstanding chronic anterior cruciate ligament (ACL) insufficiency, we identified an abnormal movement of the posterior\\u000a medial meniscal horn, likely due to insufficiency of the posteromedial meniscotibial ligament. Passing from extension to flexion\\u000a or vice versa, the medial posterior horn slides below the posterior rim of the tibia exposing the tibial plateau. Fixation\\u000a with suture anchors of the meniscotibial ligament
P. P. Mariani
Correction of congenital hydronephrosis in utero. I. The model: fetal urethral obstruction produces hydronephrosis and pulmonary hypoplasia in fetal lambs.
In an attempt to simulate congenital hydronephrosis secondary to urethral obstruction, we evaluated the consequences of obstructing the urethra in fetal lambs by several techniques. When the urethra was ligated before 108 days gestation, the bladder decompressed through the urachus and the upper-urinary tract developed normally. Ligation of both the urethra and urachus produced gross bilateral hydronephrosis, hydroureter, and megacystis, as well as severe pulmonary hypoplasia, and was associated with a high perinatal mortality. Intermittent urethral obstruction produced with a balloon constrictor or by diverting urine externally and pressure-limited obstruction produced with a Pudenz valve both proved unsatisfactory for producing congenital hydronephrosis. Finally, ligation of the urachus and progressive gradual obstruction of the urethra with an ameroid constrictor produced hydronephrosis and pulmonary hypoplasia. This model simulates urethral obstruction in the human fetus and produces a clinical and pathologic picture similar to that seen in infants born with congenital hydronephrosis. PMID:6875771
Harrison, M R; Ross, N; Noall, R; de Lorimier, A A
The Spectrum of Disease in Chronic Traumatic Encephalopathy
ERIC Educational Resources Information Center
Chronic traumatic encephalopathy is a progressive tauopathy that occurs as a consequence of repetitive mild traumatic brain injury. We analysed post-mortem brains obtained from a cohort of 85 subjects with histories of repetitive mild traumatic brain injury and found evidence of chronic traumatic encephalopathy in 68 subjects: all males, ranging�
McKee, Ann C.; Stein, Thor D.; Nowinski, Christopher J.; Stern, Robert A.; Daneshvar, Daniel H.; Alvarez, Victor E.; Lee, Hyo-Soon; Hall, Garth; Wojtowicz, Sydney M.; Baugh, Christine M.; Riley, David O.; Kubilus, Caroline A.; Cormier, Kerry A.; Jacobs, Matthew A.; Martin, Brett R.; Abraham, Carmela R.; Ikezu, Tsuneya; Reichard, Robert Ross; Wolozin, Benjamin L.; Budson, Andrew E.; Goldstein, Lee E.; Kowall, Neil W.; Cantu, Robert C.
Standard Treatment Regimens for Nongonococcal Urethritis Have Similar but Declining Cure Rates: A Randomized Controlled Trial
Background.?Azithromycin or doxycycline is recommended for nongonococcal urethritis (NGU); recent evidence suggests their efficacy has declined. We compared azithromycin and doxycycline in men with NGU, hypothesizing that azithromycin was more effective than doxycycline. Methods.?From January 2007 to July 2011, English-speaking males ?16 years, attending a sexually transmitted diseases clinic in Seattle, Washington, with NGU (visible urethral discharge or ?5 polymorphonuclear leukocytes per high-power field [PMNs/HPF]) were eligible for this double-blind, parallel-group superiority trial. Participants received active azithromycin (1 g) + placebo doxycycline or active doxycycline (100 mg twice daily for 7 days) + placebo azithromycin. Urine was tested for Chlamydia trachomatis (CT), Mycoplasma genitalium (MG), Ureaplasma urealyticum biovar 2 (UU-2), and Trichomonas vaginalis (TV) using nucleic acid amplification tests. Clinical cure (<5 PMNs/HPF with or without urethral symptoms and absence of discharge) and microbiologic cure (negative tests for CT, MG, and/or UU-2) were determined after 3 weeks. Results.?Of 606 men, 304 were randomized to azithromycin and 302 to doxycycline; CT, MG, TV, and UU-2 were detected in 24%, 13%, 2%, and 23%, respectively. In modified intent-to-treat analyses, 172 of 216 (80%; 95% confidence interval [CI], 74%�85%) receiving azithromycin and 157 of 206 (76%; 95% CI, 70%�82%) receiving doxycycline experienced clinical cure (P = .40). In pathogen-specific analyses, clinical cure did not differ by arm, nor did microbiologic cure differ for CT (86% vs 90%, P = .56), MG (40% vs 30%, P = .41), or UU-2 (75% vs 70%, P = .50). No unexpected adverse events occurred. Conclusions.?Clinical and microbiologic cure rates for NGU were somewhat low and there was no significant difference between azithromycin and doxycycline. Mycoplasma genitalium treatment failure was extremely common. Clinical Trials Registration.?NCT00358462.
Manhart, Lisa E.; Gillespie, Catherine W.; Lowens, M. Sylvan; Khosropour, Christine M.; Colombara, Danny V.; Golden, Matthew R.; Hakhu, Navneet R.; Thomas, Katherine K.; Hughes, James P.; Jensen, Nicole L.; Totten, Patricia A.
Mycoplasma genitalium: a common cause of persistent urethritis among men treated with doxycycline
Background/objective Persistent or recurrent non?gonococcal urethritis (NGU) is commonly observed in men attending sexually transmitted diseases clinics. The aim of this study was to determine the importance of Mycoplasma genitalium in this condition and to monitor the effect of treatment with macrolides. Methods 78 male patients with persistent or recurrent symptomatic non?chlamydial NGU after treatment with doxycycline 200?mg day 1 and 100?mg for the following 8?days were enrolled. The patients had a first void urine specimen examined for the presence of M genitalium DNA by an inhibitor controlled PCR. Treatment with azithromycin and/or erythromycin and/or repeat doxycycline was prescribed at the doctor's discretion to the M genitalium positive men. Microbiological cure rate was determined at a 3?week follow up visit. Results M genitalium was detected in 32 (41%) men and those infected had more often a high grade urethritis (>10 PMNLs/hpf) than those negative for M genitalium (p?=?0.01). 22 men had been treated with azithromycin, 19 of whom received 1.5?g over 5?days and three received 1?g as a single dose. All 20 who came back after treatment were M genitalium negative. Only two of five erythromycin treated controlled cases were M genitalium negative after treatment compared to all six given azithromycin at inclusion (p?=?0.12). Six of nine female partners were M genitalium positive; they were treated with 1.5?g azithromycin given over 5?days, and the four tested were M genitalium negative after treatment. Conclusions M genitalium is a common cause of persistent or recurrent urethritis among men treated with doxycycline and erythromycin appears to be less efficient than azithromycin in eradicating the infection.
Wikstrom, A; Jensen, J S
Serological typing of Ureaplasma urealyticum isolates from urethritis patients by an agar growth inhibition method.
An agar growth inhibition method for serotyping Ureaplasma urealyticum is described, and the results of applying this method to serotyping 338 strains of the organism are presented. The serotyped strains consisted of cloned isolates from male patients with primary and recurrent nongonococcal urethritis (NGU), isolates from symptomatic patients with other genitourinary tract infections and disorders, and isolates from asymptomatic carriers of U. urealyticum in the genitourinary tract (controls). Among 122 male patients with NGU, serotype 4 was associated most frequently (52%) with this disease at Camp Lejeune, N.C. Seventeen percent of the isolates were type 2. The remaining isolates consisted of types 1, 3, 6, and 8 and accounted for 6 to 9% each of the serotypes isolated from the NGU group. Types 5 and 7 were not isolated. Among 91 symptomatic patients with other genitourinary tract infections and disorders, U. urealyticum type 4 also was associated most frequently (37%) with these disorders. The remaining isolates, represented by types 1, 2, 3, 6, 7, and 8, accounted for 9 to 15% each of the types isolated from this group. Type 5 was not isolated. Among 125 symptomfree carriers of U. urealyticum in the genitourinary tract, type 8 was recovered most frequently (30%), whereas type 4 was isolated next most frequently (24%). The remaining isolates consisted of types 1, 2, 3, 5, and 6 and accounted for 2 to 15% each in this asymptomatic control group. Type 7 was not isolated. Of the present eight serotypes of U. urealyticum studied in this investigation, type 4 was associated most frequently with disease (NGU) and certain other disorders of the genitourinary tract at Camp Lejeune. A previously unknown association of U. urealyticum with frequently abacteriuric, unexplained pyuria (with or without urethral pruritus and dysuria) is reported, suggesting the existence of asymptomatic Ureaplasma urethritis. PMID:730828
Shepard, M C; Lunceford, C D
The Evolution of Surgical Treatment for Female Stress Urinary Incontinence: Era of Mid-Urethral Slings
Based on the integral theory, tension-free placement of a mid-urethral sling (MUS) for female stress urinary incontinence (SUI) has gained substantial popularity owing to the ease of the procedure and its effectiveness. Published series with long-term follow-up show continence rates after the MUS procedure ranging from 70% to 80%. Complication rates after MUS procedures are usually low. This review aimed to describe the historical change and the current use of the MUS. We discuss the efficacy and complications of various MUS procedures and the current strategies for managing failed slings.
Lee, Young-Suk; Lee, Ha Na
Pressure-flow study as an evaluating method of neurogenic urethral relaxation failure.
Voiding difficulty is a common feature in neurological diseases, which can be attributed to dysfunction of the urethral sphincter and the detrusor. Electromyography (EMG)-cystometry can reveal the presence of detrusor-external sphincter dyssynergia (DESD), however, internal sphincter function on voiding is not easily evaluated. Pressure-flow study is widely used to diagnose benign outlet obstruction due to prostatic hypertrophy. We applied pressure-flow study in neurological patients in order to evaluate neurogenic urethral relaxation failure. We recruited 71 patients with neurological diseases. All were men under 60 years, with mean age of 44 years, ranging from 18 to 59 years. None had abnormal finding of digital examination or ultrasound echography of the prostate. Standard cystometry showed detrusor hyperreflexia in 33 patients and residual urine was noted in 36. DESD was noted in seven of 43 patients. Pressure-flow relation curve and a detrusor pressure (P(det)) at the point of maximum flow rate (Q(max)) (i.e., P(det)Q(max)) were obtained by urodynamic computers. The Abram-Griffiths (AG) number (P(det)Q(max)-2Q(max)), showing outlet obstruction particularly over 40, was also obtained. The points of P(det)Q(max) of the patients fell into three categories of the AG nomogram, showing obstruction in 19.7%, equivocal in 52.1% and unobstructed in 28.2%. Patients with DESD had AG number over 40 more commonly (57.1%) than those without DESD (8.4%) (p<0.05). The mean AG number was 46.4 in patients with DESD, which was larger than 17.1 in patients without DESD (p<0.01). Patients with detrusor hyperreflexia had AG number over 40 more commonly (42.4%) than those with normal cystometric curve (0%) (p<0.01). The mean AG number was 30.6 in patients with detrusor hyperreflexia, which was larger than 13.6 in patients with normal cystometric curve (p<0.01). The results showed that 19.7% of patients with neurological diseases had obstructive pattern (high pressure voiding), evidence of urethral relaxation failure with relatively preserved detrusor contraction. DESD is a factor contributing to the urethral relaxation failure of the patients. The results also indicated a relationship between detrusor hyperreflexia and obstructed pattern, probably reflecting co-occurrence of detrusor hyperreflexia with DESD or detrusor-internal sphincter dyssynergia. PMID:10742544
Sakakibara, R; Fowler, C J; Hattori, T; Hussain, I F; Swinn, M J; Uchiyama, T; Yamanishi, T
Penile fracture with bilateral corporeal rupture and complete urethral disruption: case report and literature review.
Penile fracture is a rare injury most commonly sustained during sexual intercourse. We report the case of a 35-year-old man who presented with bilateral rupture of the corpora cavernosa and complete disruption of the urethra. A review of the literature on penile fracture is also presented. Urgent surgical exploration was performed and the injuries repaired primarily. In follow-up, the patient reported satisfactory erectile function. This case highlights the importance of early surgical repair and evaluation for concomitant urethral injuries in cases of penile fracture. PMID:21470546
Hoag, Nathan A; Hennessey, Kiara; So, Alan
Penile fracture with bilateral corporeal rupture and complete urethral disruption: case report and literature review
Penile fracture is a rare injury most commonly sustained during sexual intercourse. We report the case of a 35-year-old man who presented with bilateral rupture of the corpora cavernosa and complete disruption of the urethra. A review of the literature on penile fracture is also presented. Urgent surgical exploration was performed and the injuries repaired primarily. In follow-up, the patient reported satisfactory erectile function. This case highlights the importance of early surgical repair and evaluation for concomitant urethral injuries in cases of penile fracture.
Hoag, Nathan A.; Hennessey, Kiara; So, Alan
A case of penile fracture at the crura of the penis without urethral involvement: Rare entity
Penile fracture is a rare injury, most commonly sustained during sexual intercourse. We report the case of a 29-year-old man who presented with bilateral rupture of the crura of the cavernosa without urethral injury. This is the first case in the literature to present with this unique finding. Urgent surgical exploration was performed and the injuries repaired primarily. At follow-up, the patient reported satisfactory erectile function. This case highlights the importance of early diagnosis with unusual presentation and early surgical repair for better outcome.
Srinivas, B. V.; Vasan, S. S.; Mohammed, Sajid
A case of penile fracture at the crura of the penis without urethral involvement: Rare entity.
Penile fracture is a rare injury, most commonly sustained during sexual intercourse. We report the case of a 29-year-old man who presented with bilateral rupture of the crura of the cavernosa without urethral injury. This is the first case in the literature to present with this unique finding. Urgent surgical exploration was performed and the injuries repaired primarily. At follow-up, the patient reported satisfactory erectile function. This case highlights the importance of early diagnosis with unusual presentation and early surgical repair for better outcome. PMID:23204666
Srinivas, B V; Vasan, S S; Mohammed, Sajid
Urethral plug--a new secondary male sex characteristic in rat and other rodents.
The plug is an eosinophilic mass, partly homogenous and partly porous, filling the proximal urethra in rats and occasionally extending into the bladder. Its average weight in 131 adult rats was 0.063 g. These plugs are normally present in the urethra of adult male rats, and this seems to be the case for all laboratory Muridae and Cavidae. The absence of a plug in an adult male may be a sign of abnormality associated with failing health. There is an interesting similarity between the amino acid composition of the content of seminal vesicles, that of the urethral plug, and that of the copulatory vaginal plug in female rodents. PMID:7078062
Kunst�r, I; K�pper, W; Weisser, H; Naumann, S; Messow, C
Glans reconstruction with the use of an inverted urethral flap after distal penile amputation for carcinoma.
Restoration of adequate cosmesis and preservation of sexual and urinary function are the main goals of penile reconstructive surgery following amputation for carcinoma. Split thickness skin grafts and oral mucosa grafts have been widely used for the creation of a pseudoglans with excellent cosmetic and functional results. The main drawbacks associated with the use of grafts are donor site morbidity, the lack of engorgement of the pseudoglans and the risk of poor graft take, which may lead to contracture and poor cosmetic results. In the present series the long term cosmetic and functional outcomes of glans reconstruction with an inverted distal urethral flap are described. PMID:23695401
Sansalone, Salvatore; Garaffa, Giulio; Vespasiani, Giuseppe; Zucchi, Alessandro; Kuehhas, Franklin Emmanuel; Herwig, Ralf; Silvani, Mauro; Pecoraro, Stefano; Loreto, Carla; Leonardi, Rosario
Multi-disciplinary update on pelvic fracture associated bladder and urethral injuries.
Pelvic ring fractures often result in severely injured patients with multiple organ injuries. The most common associated injuries are intraabdominal or urogenital, and urogenital injuries are the most common associated injuries in those with severe pelvic fractures. Prompt and effective diagnosis and management of these injuries is essential to successful outcomes, but this is potentially complicated by poor communication and coordination among the many specialists involved. To address this, we present a multi-disciplinary review of pelvic fracture-associated bladder and urethral injuries that is specifically geared towards orthopaedic, urology, and trauma surgeons caring for these patients. PMID:22592152
Figler, Bradley D; Figler, Brad; Hoffler, C Edward; Reisman, William; Carney, K Jeff; Moore, Thomas; Feliciano, David; Master, Viraj
[Usefulness of urethral endoprosthesis in the management of urinary retention after brachytherapy for localized prostate cancer].
Brachytherapy is a possible treatment for localized low risk prostate cancer. Although this option is minimally invasive, some side effects may occur. Acute retention of urine (ARU) has been observed in 5% to 22% of cases and can be prevented in most cases by alpha-blocker treatment. Several alternatives have been reported in the literature for the management of ARU following brachytherapy: prolonged suprapubic catheterization, transurethral resection of the prostate and also intermittent self-catheterization. The authors report an original endoscopic approach, using urethral endoprosthesis, with a satisfactory voiding status. PMID:24560204
Kerkeni, W; Chahwan, C; Lenormand, C; Dubray, B; Benyoucef, A; Pfister, C
Non-traumatic colorectal perforations.
Over a 6 year period, between January 1992 and December 1997, 30 patients with non-traumatic colorectal perforations undergoing laparotomy were reviewed. The aim of this study was to evaluate predictions on the prognosis using the Mannheim Peritonitis Index (MPI) and to evaluate the risk of this complication. The mean age of the patients was 56.4 years (range 16-88 years). The male:female ratio was 19:11. All patients showed signs of peritonitis and underwent emergency operations. In 50% (15) of the patients, tumor was the cause. According to the MPI scoring, there were 18 patients with an MPI score of 26 or less and 12 patients with an MPI score of 27 or more. For patients with a score less than 27 the mortality rate was zero (0/18) and for score greater than 26, 66.6% (8/12). Overall mortality was 26.6% (8/30). Of 15 patients with perforated colorectal cancers, four patients died (26.6%). The mortality rate for benign perforations was 26.6% (4/15) also. In conclusion, colorectal cancers are the most common cause of the non-traumatic colorectal perforations. Patients with an MPI score greater than 26 represent the highest risk group. PMID:10408288
Yilmazlar, T; Toker, S; Zorluo?lu, A
Imaging of traumatic adrenal injury.
Traumatic adrenal injury is a relatively rare event, reported in 0.15 to 4 % of blunt abdominal trauma cases. The location of the adrenal glands, protected deeply within the retroperitoneum, accounts for the rarity of adrenal trauma. These injuries are unilateral in 75 to 90 % of cases and most commonly afflict the right adrenal gland. While no specific clinical symptoms or signs point directly to adrenal injury, and isolated adrenal injury is rare, the presence of adrenal injury can be an indicator of severe trauma. In fact, mortality rates in series of adrenal injuries range from 7 to 32 %. The most common associated injuries affect the liver, ribs, kidney, or spleen. Three theories of adrenal injury from blunt trauma have been proposed: (1) acute rise in intra-adrenal venous pressure due to compression of the IVC during impact, (2) crushing between the spine and surrounding organs, and (3) deceleration forces shearing the small adrenal arterioles. The most common imaging features include a 2-3-cm oval hematoma, irregular hemorrhage obliterating the adrenal gland, periadrenal hemorrhage or fat stranding, and uniform adrenal swelling with increased attenuation. The differential diagnosis of adrenal abnormalities on trauma CT includes adenoma, carcinoma, myelolipoma, metastases, pheochromocytoma, and tuberculosis. Preexisting adrenal disorders can predispose the adrenal to injury with minor trauma. Most adrenal traumatic injuries are managed conservatively. PMID:22895661
To'o, Katherine J; Duddalwar, Vinay A
[Pathogenesis of traumatic proliferative vitreoretinopathy].
Proliferative vitreoretinopathy is the main cause of loss of vision following posterior penetrating eye injury. Clinically, it can range from macular epiretinal membrane to total retinal detachment and phthisis bulbi. To gain more knowledge of its pathogenesis, the author performed morphologic studies using a primate model and also studied the distribution of fibronectin in 13 enucleated patient eyes using immunofluorescent histochemical techniques. Results indicate this disease process represents an overstimulated response to retinal injury. Posterior vitreous detachment at the level of internal limiting membrane appears to be a predisposing factor. During the active phase of the disease process, there is selective increase of fibronectin in the choroid. This increase is not merely due to the passive leakage of plasma caused by the injury, but the choroid itself produces cellular fibronectin. Fibronectin is known to enhance wound healing and may be an important factor in the pathogenesis of proliferative vitreoretinopathy. PMID:1299605
Xu, H
Assessing Traumatic Event Exposure: Comparing the Traumatic Life Events Questionnaire to the Structured Clinical Interview for "DSM-IV"
ERIC Educational Resources Information Center
Post-traumatic stress disorder (PTSD) diagnosis requires first identifying a traumatic event, but very few studies have evaluated methods of potential traumatic event assessment and their impact on PTSD diagnosis. The authors compared a behaviorally specific comprehensive multiple-item traumatic event measure with a single-item measure to�
Peirce, Jessica M.; Burke, Christopher K.; Stoller, Kenneth B.; Neufeld, Karin J.; Brooner, Robert K.
[Legal aspects of traumatic cerebrovascular lesions].
The paper opens with an account of what may be entailed in traumatic damage to cerebral vessels and cervical vessels, and its pathomechanism. There follows an account of two cases involving traumatic cerebral infarction and the resulting problems for the expert witness. Ascertainment of the relationship between external trauma and cerebral infarction depends on the nature and degree of the traumatic violence (precise trauma anamnesis), the reaction of the organism thereto, and the seriousness of previous complaints (arteriosclerosis, causes of cerebral embolism). PMID:2762427
Dachsel, R; Kittel, J
Late Manifestations of Traumatic Lesions of the Anterior Skull Base
The authors review their experience in detecting occult traumatic dural lesions. In a retrospective study covering the period from January 1, 1984 to December 31, 1996, 23 patients were evaluated for occult traumatic dural lesions. Clinical presentation, diagnostic work-up, and management of the dural lesions were analyzed. The clinical presentations of the previously undetected dural lesions of the anterior skull base were meningitis in eight cases, cerebrospinal fluid (CSF) rhinorrhea in eight cases, both meningitis and CSF rhinorrhea in five cases, and a pulsating swelling in the region of the right upper eyelid in one case. In another case a fracture of the posterior frontal wall was detected incidentally on the preoperative CT scan performed prior to surgery for chronic sinusitis. One patient had a CSF fistula of the lateral skull base in addition to the frontobasal fistula. The interval between trauma and diagnosis varied from 1 to 48 years. Dural lesions were localized by high-resolution CT, fluorescein nasal endoscopy, CT cisternography, and MRI. Intraoperative exposure of the dural lesions and duraplasty were possible in all cases. During the first attempt successful repair of the dural lesions was accomplished in 22 (95.7%) of the 23 patiants. Two interventions were necessary to close a CSF leak of the cribriform plate. Modern clinical and radiologic diagnostic methods should be employed to search for an occult dural lesion in patients with recurrent meningitis, meningitis caused by upper airway pathogens, or CSF rhinorrhea. The patient will remain at risk of potentially fatal meningitis until the lesion is appropriately repaired by duraplasty.
Schick, B.; Weber, R.; Kahle, G.; Draf, W.; Lackmann, G.M.
Traumatic hemipelvectomy in children: report on 2 survivors with urological involvement.
Traumatic hemipelvectomy through the sacroiliac joint is a devastating injury, mainly because of motor vehicle accidents. Recent improvements in prehospital trauma care have increased the chances of survival for victims. Besides amputation of the lower limb, associated complications usually involve digestive and urological systems. We report on 2 pediatric patients from 2 different European countries. PATIENT 1: A 9-year-old boy suffered uprooting of his left lower limb, laceration of the rectum and anal sphincter, as well as an injury to distal urethra with partial loss of cavernous bodies. Initial management included a colostomy and an essay of contention by means of a polypropylene prosthesis that had to be removed in the following months. After several attempts at urethral reconstruction, he underwent a Mitrofanoff derivation. PATIENT 2: An 18-month-old girl lost her left lower limb and suffered severe lacerations of bladder and rectum. Among other measures, management included a colostomy, a skin graft, and 2 attempts at reconstruction of her bladder neck, including a modified Casale procedure (cecum and ileocecal appendix were in a high position that made a Mitrofanoff derivation impossible) and a Malone procedure. To the authors' knowledge, she would be the youngest reported survivor of this kind of injury. PMID:21034958
Calonge, Wenceslao M; Alova, Ilona; Ramos, Manuel R; Mart�nez, Leopoldo; Lortat-Jacob, St�phan; Ochoa de Castro, Antonio; Lottmann, Henri
Bladder dysfunction changes from underactive to overactive after experimental traumatic brain injury
Although bladder dysfunction is common after traumatic brain injury (TBI), few studies have investigated resultant bladder changes and the detailed relationship between TBI and bladder dysfunction. The goal of this study was to characterize the effects of TBI on bladder function in an animal model. Fluid-percussion injury was used to create an animal model with moderate TBI. Female Sprague-Dawley rats underwent TBI, sham TBI or were not manipulated (na�ve). All rats underwent filling cystometry while bladder pressure and external urethral sphincter electromyograms were simultaneously recorded 1 day, 1 week, 2 weeks, and 1 month after injury. One day after injury, 70% of the animals in the TBI group and 29% of the animals in the sham TBI group showed no bursting activity during urination. Compared to na�ve rats, bladder function was mainly altered 1 day and 1 week after sham TBI, suggesting the craniotomy procedure affected bladder function mostly in a temporary manner. Compared to either na�ve or sham TBI, bladder weight was significantly increased 1 month after TBI and collagen in the bladder wall was increased. Bladder function in the TBI group went from atonic 1 day post-TBI to overactive 1 month post-TBI, suggesting that TBI significantly affected bladder function.
Jiang, Hai-Hong; Kokiko-Cochran, Olga N.; Li, Kevin; Balog, Brian; Lin, Ching-Yi; Damaser, Margot S.; Lin, Vernon; Cheng, Julian Yaoan; Lee, Yu-Shang
Arthroscopic management of shoulder instabilities: anterior, posterior, and multidirectional.
Arthroscopy is considered a relatively new technique for the surgical repair of an unstable shoulder. Shoulder arthroscopy has grown in popularity and is considered the gold standard for treating carefully selected patients. Despite its increasing popularity, the procedure has a significant learning curve and has resulted in early higher recurrence rates when compared with patients treated with open techniques. With the addition of newer instrumentation, the refinement of techniques, and additional capsular plication and tensioning, outcomes for patients treated with shoulder arthroscopy should continue to improve. A major distinguishing feature in selecting appropriate candidates for shoulder arthroscopy is whether there have been significant bone changes resulting from dislocation recurrence. Recurrent anterior dislocation may create an anterior glenoid rim fracture, erosion loss from multiple recurrences, and an impression defect on the posterior aspect of the humeral head. The loss of contact area between the "ball and cup" may compromise the results of techniques that restore the anatomic restraints of soft tissues. Early intervention is becoming recognized as an important factor in patient selection for arthroscopic treatment. Imaging studies after traumatic injuries include radiographs, CT scans, possible articular contrast studies, and MRIs. These studies can identify and quantify rim fractures and the remaining articular contact in patients with recurrent subluxations, allowing for earlier appropriate intervention. Patients with significant bone loss may be best treated with an open procedure that allows grafting of the deficiency. Arthroscopic techniques to repair fractures or graft deficiencies continue to evolve. Rim fractures can be anatomically repaired with a suture anchor technique when recognized early. Rim erosion from chronic recurrent dislocations may require a combination of soft-tissue reattachment and coracoid grafting. Humeral head defects may require either soft-tissue or bone grafting to avoid engagement with the anterior edge of the glenoid. These techniques require arthroscopic skill and experience and are currently being performed as open procedures. In the future, it is likely that arthroscopy will be involved in the entire spectrum of treatment for shoulder instability. PMID:20415377
Abrams, Jeffrey S; Bradley, James P; Angelo, Richard L; Burks, Robert
The Urethral Rhabdosphincter, Levator Ani Muscle, and Perineal Membrane: A Review
Detailed knowledge of the anatomy of the rhabdosphincter and adjacent tissues is mandatory during urologic surgery to ensure reliable oncologic and functional outcomes. To characterize the levator ani (LA) function for the urethral sphincter, we described connective tissue morphology between the LA and urethral rhabdosphincter. The interface tissue between the LA and rhabdosphincter area in males contained abundant irregularly arrayed elastic fibers and smooth muscles. The male rhabdosphincter was positioned alongside the LA to divide the elevation force and not in-series along the axis of LA contraction. The male perineal membrane was thin but solid and extends along the inferior margin or bottom of the rhabdosphincter area. In contrast, the female rhabdosphincter, including the compressor urethrae and urethrovaginal sphincter muscles, was embedded in the elastic fiber mesh that is continuous with the thick, multilaminar perineal membrane. The inferomedial edge of the female LA was attached to the upper surface of the perineal membrane and not directly attached to the rhabdosphincter. We presented new diagrams showing the gender differences in topographical anatomy of the LA and rhabdosphincter.
Hinata, Nobuyuki; Murakami, Gen
Recreational urethral sounding is associated with high risk sexual behaviour and sexually transmitted infections
OBJECTIVE To determine whether men who perform recreational sounding are at increased risk of engaging in unsafe sexual behaviours, developing sexually transmitted infections (STIs) and lower urinary tract symptoms (LUTS). SUBJECTS AND METHODS In a cross-sectional, international, internet-based survey of the sexual practices of >2000 men who have sex with men, subjects were asked if they had engaged in urethral sounding for sexual gratification. We compared ethnodemographic and health-related variables between the sounding and non-sounding populations. The International Prostate Symptom Score and a modified validated version of the International Index of Erectile Function were used to quantify LUTS and erectile dysfunction (ED) in both populations. RESULTS There were 2122 respondents with complete data, 228 (10.7%) of whom had engaged in recreational sounding. Men who had engaged in sounding were more likely to report certain high risk sexual behaviours (e.g. multiple sexual partners and sex with partners who were not well known) and had increased odds of reporting STIs. Men who had engaged in sounding had a slight but statistically significant increase in LUTS but no significant difference in prevalence of ED. CONCLUSIONS Urethral sounding is a sexual practice that is associated with higher risk sexual behaviour and carries the potential for morbidity. Research on means for risk reduction for men who choose to engage in recreational sounding requires further study.
Breyer, Benjamin N.; Shindel, Alan W.
Neural control of the female urethral and anal rhabdosphincters and pelvic floor muscles
The urethral rhabdosphincter and pelvic floor muscles are important in maintenance of urinary continence and in preventing descent of pelvic organs [i.e., pelvic organ prolapse (POP)]. Despite its clinical importance and complexity, a comprehensive review of neural control of the rhabdosphincter and pelvic floor muscles is lacking. The present review places historical and recent basic science findings on neural control into the context of functional anatomy of the pelvic muscles and their coordination with visceral function and correlates basic science findings with clinical findings when possible. This review briefly describes the striated muscles of the pelvis and then provides details on the peripheral innervation and, in particular, the contributions of the pudendal and levator ani nerves to the function of the various pelvic muscles. The locations and unique phenotypic characteristics of rhabdosphincter motor neurons located in Onuf's nucleus, and levator ani motor neurons located diffusely in the sacral ventral horn, are provided along with the locations and phenotypes of primary afferent neurons that convey sensory information from these muscles. Spinal and supraspinal pathways mediating excitatory and inhibitory inputs to the motor neurons are described; the relative contributions of the nerves to urethral function and their involvement in POP and incontinence are discussed. Finally, a detailed summary of the neurochemical anatomy of Onuf's nucleus and the pharmacological control of the rhabdosphincter are provided.
de Groat, William C.
Bladder and urethral recordings in acute and chronic spinal cord injury patients.
Three groups of patients with upper motor neuron lesions were studied. A first group consisted of 19 patients with complete lesions and 3 patients with incomplete lesions. All had an unbalanced bladder function which required surgical interventions. A second group consisted of 9 patients with chronic complete lesions who achieved balanced bladder function spontaneously. A third group consisted of 11 patients in the acute stage of injury. Polygraph recordings of pressure within the bladder, urethra, rectum and external anal sphincter were carried out with the help of video-tape monitoring and radiographic image intensification. Special catheter ballons with radiopaque markings were employed for pressure measurements. The behavior of the external urethral sphincter during spinal shock and the sequence of return of sacral somatic and visceral motor reflexes during recovery from spinal shock were investigated. It was shown that in spinal shock, the majority of patients retained sacral segment somatomotor reflex activity, in the absence of visceromotor activity, and that resistance values at the external urethral sphincter remained high. The highest resistance recorded in the membranous urethra was found to be located at the distal external sphincter, just before the bulb of the urethra. PMID:1265929
Rossier, A B; Ott, R
A rare complication: misdirection of an indwelling urethral catheter into the ureter.
We report 3 patients with the rare complication of an indwelling urethral catheter misdirected into the ureter. This is the largest series to date. Patients were referred to us for a variety of reasons following exchange of their chronic indwelling urinary catheters. CT in all cases demonstrated the urinary catheters residing in the left ureter. The ages of the patients were 37, 67 and 81 years old. All patients suffered from neurogenic bladder. Two patients were female, one was male, and 2 of the 3 had a sensory disorder inhibiting their pain response. The catheters were replaced with open-end Foley catheters. Extensive follow-up CT scans were obtained in one case, demonstrating improvement of hydronephrosis and no evidence of ureteral stenosis. Cystoscopy in this patient demonstrated normally positioned and functioning ureteral orifices. Although the placement of an indwelling urethral catheter is a comparatively safe procedure, one must keep in mind that this complication can occur, particularly in female patients with neurogenic bladder. CT without contrast is a noninvasive, definitive diagnostic tool. PMID:24553489
Ishikawa, Tsutomu; Araki, Motoo; Hirata, Takeshi; Watanabe, Masami; Ebara, Shin; Watanabe, Toyohiko; Nasu, Yasutomo; Kumon, Hiromi
Tubularized Penile-Flap Urethroplasty Using a Fasciocutaneous Random Pedicled Flap for Recurrent Anterior Urethral Stricture
This report describes the use of a tubularized random flap for the curative treatment of recurrent anterior urethral stricture. Under the condition of pendulous lithotomy and suprapubic cystostomy, the urethral stricture was removed via a midline ventral penile incision followed by elevation of the flap and insertion of an 18-Fr catheter. Subcutaneous buried interrupted sutures were used to reapproximate the waterproof tubularized neourethra and to coapt with the neourethra and each stump of the urethra, first proximally and then distally. The defect of the penile shaft was covered by advancement of the surrounding scrotal flap. The indwelling catheter was maintained for 21 days. A 9 month postoperative cystoscopy showed no flap necrosis, no mechanical stricture, and no hair growth on the lumen of the neourethra. The patient showed no voiding discomfort 6 months after the operation. The advantages of this procedure are the lack of need for microsurgery, shortening of admission, the use of only spinal anesthesia (no general anesthesia), and a relatively short operative time. The tubularized unilateral penile fasciocutaneous flap should be considered an option for initial flap urethroplasty as a curative technique.
Lee, Byung Kwon
Tubularized penile-flap urethroplasty using a fasciocutaneous random pedicled flap for recurrent anterior urethral stricture.
This report describes the use of a tubularized random flap for the curative treatment of recurrent anterior urethral stricture. Under the condition of pendulous lithotomy and suprapubic cystostomy, the urethral stricture was removed via a midline ventral penile incision followed by elevation of the flap and insertion of an 18-Fr catheter. Subcutaneous buried interrupted sutures were used to reapproximate the waterproof tubularized neourethra and to coapt with the neourethra and each stump of the urethra, first proximally and then distally. The defect of the penile shaft was covered by advancement of the surrounding scrotal flap. The indwelling catheter was maintained for 21 days. A 9 month postoperative cystoscopy showed no flap necrosis, no mechanical stricture, and no hair growth on the lumen of the neourethra. The patient showed no voiding discomfort 6 months after the operation. The advantages of this procedure are the lack of need for microsurgery, shortening of admission, the use of only spinal anesthesia (no general anesthesia), and a relatively short operative time. The tubularized unilateral penile fasciocutaneous flap should be considered an option for initial flap urethroplasty as a curative technique. PMID:22783537
Lee, Yong Jig; Lee, Byung Kwon
Improved automated brachytherapy seed localization in trans-urethral ultrasound data
NASA Astrophysics Data System (ADS)
The utility of Trans-urethral ultrasound(TUUS) for permanent prostate brachytherapy is dependent on the quality of the data acquired. Previous work on Trans-urethral ultrasound suggested that TUUS acquires higher quality images than Trans-rectal ultrasound. Manual segmentation of TUUS data limits the utility of TUUS intra-operative, however, automated segmentation methods can be used to reduce the processing time. This research describes a segmentation paradigm which incorporates a priori information about the implanted seeds in order to provide a reasonable segmentation. The segmentation framework incorporates information about the size, shape, and orientation of the seeds. The paradigm integrates this information using fuzzy inference rules. The results show that the automated method is at least 4 times faster than manual segmentation. The sensitivity and specificity of the method were 76% and 93%, respectively. The decrease sensitivity is acceptable because it is the specificity which is more critical in determining if adequate dose has been delivered. Future work with this method will increase accuracy by incorporating additional information about the seeds.
Holmes, David R., III; Robb, Richard A.
Bitter triggers acetylcholine release from polymodal urethral chemosensory cells and bladder reflexes.
Chemosensory cells in the mucosal surface of the respiratory tract ("brush cells") use the canonical taste transduction cascade to detect potentially hazardous content and trigger local protective and aversive respiratory reflexes on stimulation. So far, the urogenital tract has been considered to lack this cell type. Here we report the presence of a previously unidentified cholinergic, polymodal chemosensory cell in the mammalian urethra, the potential portal of entry for bacteria and harmful substances into the urogenital system, but not in further centrally located parts of the urinary tract, such as the bladder, ureter, and renal pelvis. Urethral brush cells express bitter and umami taste receptors and downstream components of the taste transduction cascade; respond to stimulation with bitter (denatonium), umami (monosodium glutamate), and uropathogenic Escherichia coli; and release acetylcholine to communicate with other cells. They are approached by sensory nerve fibers expressing nicotinic acetylcholine receptors, and intraurethral application of denatonium reflexively increases activity of the bladder detrusor muscle in anesthetized rats. We propose a concept of urinary bladder control involving a previously unidentified cholinergic chemosensory cell monitoring the chemical composition of the urethral luminal microenvironment for potential hazardous content. PMID:24843119
Deckmann, Klaus; Filipski, Katharina; Krasteva-Christ, Gabriela; Fronius, Martin; Althaus, Mike; Rafiq, Amir; Papadakis, Tamara; Renno, Liane; Jurastow, Innokentij; Wessels, Lars; Wolff, Miriam; Sch�tz, Burkhard; Weihe, Eberhard; Chubanov, Vladimir; Gudermann, Thomas; Klein, Jochen; Bschleipfer, Thomas; Kummer, Wolfgang
Management of Posterior Fossa Dissecting Aneurysms
Summary Treatment and prognosis of 14 patients of posterior fossa arterial dissections (AD) and dissecting aneurysms (DA) in one institution was reviewed. Internal trapping of aneurysm was performed for six patients presenting with SAH (three Vertebral, one posterior cerebral, one posterior inferior cerebellar, one anterior inferior cerebellar DA). The patency of the parent arteries was preserved in four DA patients with SAH (two Vertebral, two Basilar DA), 1 incidental vertebral DA, and one DA patient with brainstem infarction using stents and coils (four patients) or coils only (two patient). Proximal occlusion of parent artery was performed in a vertebral DA with SAH. One patient with a superior cerebellar DA presented with a midbrain infarct developed SAH with spontaneous occlusion of the aneurysm two weeks later. Of the 14 cases, ten were angiographically stable or cured during a follow up period of four to 70 months. one spontaneously resolved and two recurred. There was one death.
Winston Chong, W. K.
Detailed Ophthalmologic Evaluation of Posterior Microphthalmos
We performed various ophthalmic investigations in order to confirm the diagnosis and document the various features of posterior microphthalmos in a 21-year-old male. Ophthalmic examination revealed low vision with high hyperopia, papillomacular folds, midperipheral pigmentary changes and crowded optic discs. The optic discs were small and crowded with increased nerve fiber layer thickness. Fundus fluorescein angiography showed reduced diameter of a capillary free zone. Anterior segment (AS) optical coherence tomography demonstrated near normal anterior chamber depths, but markedly diminished anterior chamber angles. In spite of the increased corneal thickness and steep corneas, lens thickness and endothelial cell counts were normal. Sclerochoroidal thickening and foreshortening of the globes were detected with B-scan ultrasonography. Electroretinographic findings and visual field tests were similar to those in pigmentary retinopathy. Posterior microphthalmos is a complex eye disorder, which affects predominantly the posterior segment but also involves the AS of the eye.
Alkin, Zeynep; Ozkaya, Abdullah; Karakucuk, Yalcin; Demirok, Ahmet
Detailed ophthalmologic evaluation of posterior microphthalmos.
We performed various ophthalmic investigations in order to confirm the diagnosis and document the various features of posterior microphthalmos in a 21-year-old male. Ophthalmic examination revealed low vision with high hyperopia, papillomacular folds, midperipheral pigmentary changes and crowded optic discs. The optic discs were small and crowded with increased nerve fiber layer thickness. Fundus fluorescein angiography showed reduced diameter of a capillary free zone. Anterior segment (AS) optical coherence tomography demonstrated near normal anterior chamber depths, but markedly diminished anterior chamber angles. In spite of the increased corneal thickness and steep corneas, lens thickness and endothelial cell counts were normal. Sclerochoroidal thickening and foreshortening of the globes were detected with B-scan ultrasonography. Electroretinographic findings and visual field tests were similar to those in pigmentary retinopathy. Posterior microphthalmos is a complex eye disorder, which affects predominantly the posterior segment but also involves the AS of the eye. PMID:24791113
Alkin, Zeynep; Ozkaya, Abdullah; Karakucuk, Yalcin; Demirok, Ahmet
Surgical approaches to posterior third ventricular tumors.
A variety of surgical approaches to the posterior third ventricle and pineal region exist. The choice of approach is influenced by the exact location of the lesion, its expected pathologic findings, and the comfort level of the operating surgeon with the approach that is being considered. For most pineal region masses that are situated in the midline below the deep venous system, we favor the supracerebellar-infratentorial approach in the sitting position. For pineal region lesions that displace the deep venous system inferiorly or have significant lateral extension, we prefer the occipital-transtentorial approach in the three-quarter prone or sitting position. For lesions that are truly in the posterior third ventricle without extension posterior to the splenium, we prefer the interhemispheric-transcallosal approach in the lateral position. PMID:15024799
Lozier, Alan P; Bruce, Jeffrey N
Transtentorial approach to the posterior temporomedial structures.
The supracerebellar transtentorial (SCTT) approach, a modification of the infratentorial supracerebellar approach, facilitates simple and minimally invasive access to posterior temporomedial structures without requiring retraction of the temporal or occipital lobe. The SCTT approach was used in 16 patients over a 3-year period. Eleven patients harbored tumors confined to, or located mainly within, the posterior hippocampal formation, three patients harbored aneurysms (one ruptured posterior cerebral artery [PCA] aneurysm at the P2-P3 junction, one ruptured giant PCA [P2] aneurysm, and one giant basilar artery-superior cerebellar artery aneurysm), one patient had juvenile-type moyamoya disease, and one patient suffered from medically intractable epilepsy. In these patients, the SC PMID:11565884
Ziyal, I M; Ozgen, T
Multiclass posterior probability support vector machines.
Tao, et al have recently proposed the posterior probability support vector machine (PPSVM) which uses soft labels derived from estimated posterior probabilities to be more robust to noise and outliers. Tao, et al's model uses a window-based density estimator to calculate the posterior probabilities and is a binary classifier. We propose a neighbor-based density estimator and also extend the model to the multiclass case. Our bias-variance analysis shows that the decrease in error b