AME medical journal最新文献_第9页

High-pressure continuous suction drainage for thoracic empyema with pulmonary fistula 高压持续吸引引流术治疗胸脓肿合并肺瘘

AME medical journal Pub Date : 2021-02-11 DOI: 10.21037/AMJ-20-151

T. Uchida, Yugo Tanaka, S. Tauchi, Y. Maniwa

{"title":"High-pressure continuous suction drainage for thoracic empyema with pulmonary fistula","authors":"T. Uchida, Yugo Tanaka, S. Tauchi, Y. Maniwa","doi":"10.21037/AMJ-20-151","DOIUrl":"https://doi.org/10.21037/AMJ-20-151","url":null,"abstract":"Background: The treatment of thoracic empyema with pulmonary fistula (PF) is challenging and involves administration of antibiotics and efficient drainage of pus. Open window thoracostomy (OWT) is typically offered for these cases, but it has several disadvantages, notably postoperative pain that is associated with rib resection. We described six consecutive cases of thoracic empyema with PF that were successfully treated with high-pressure continuous suction drainage (HCSD) instead of conventional OWT. Methods: Between January 2015 and December 2018, six consecutive patients (mean age of 65.0 years) with thoracic empyema and PF underwent HCSD treatment. Suction was initially set at −20 cmH 2 O and was increased incrementally up to −50 cmH 2 O with careful attention to any potential changes in the patients’ circulatory and respiratory dynamics. Results: All six patients were successfully treated with HCSD alone, and there were no related complications. The mean duration of air leakage was 57.2 days (range, 22–100 days). The drainage tubes were removed after a mean period of 60.2 days (range, 27–105 days). All patients were discharged from the hospital without later readmission. Conclusions: HCSD treatment was safe, minimally invasive, and effective for patients with thoracic empyema with PF and may be considered as an alternative treatment to OWT. 6","PeriodicalId":72157,"journal":{"name":"AME medical journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46855746","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Clinical management of radiation cystitis: a narrative review 放射性膀胱炎的临床治疗：叙述性综述

AME medical journal Pub Date : 2021-02-04 DOI: 10.21037/AMJ-20-169

D. Abramowitz, J. Warner

{"title":"Clinical management of radiation cystitis: a narrative review","authors":"D. Abramowitz, J. Warner","doi":"10.21037/AMJ-20-169","DOIUrl":"https://doi.org/10.21037/AMJ-20-169","url":null,"abstract":"Radiation therapy for various pelvic cancers has led to secondary complications becoming increasingly commonplace. Radiation cystitis is an undesired side effect with a wide spectrum of severity ranging from mild irritative voiding symptoms to life threatening hemorrhagic cystitis (HC). As such, the management of radiation cystitis too has a wide range of potential treatment options. Hyperbaric oxygen therapy can be utilized in the outpatient setting in the stable patient. For the more symptomatic patient, emptying the bladder of any clots followed by continuous bladder irrigation is first line treatment. If the bleeding persists after this, systemic therapies such as systemic tranexamic acid (TXA) or sodium pentosan polysulfate (Elmiron) are options however these have mixed outcomes in the literature. Intravesical treatments of aminocaproic acid (Amicar), aluminum or formalin can be trialed to abate bleeding, however each come with their own side effect profiles. In the case of refractory bleeding to these conservative measures, or in the unstable patient, vascular embolization can be utilized. Urinary diversion with or without cystectomy is a definitive treatment however these surgeries are generally more complicated due to the radiation history. Herein, we review in detail the relevant literature of available medical and surgical techniques for treatment as well as offer our own experience in managing this challenging disease process.","PeriodicalId":72157,"journal":{"name":"AME medical journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47802482","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 1

Pulmonary tuberculosis with venous thromboembolism as an unusual presentation of occult pancreatic cancer: a case report 肺结核伴静脉血栓栓塞是隐匿性胰腺癌的一种不寻常表现:1例报告

AME medical journal Pub Date : 2021-01-04 DOI: 10.21037/AMJ-20-114

Y. Tan, Shaifulamir Shuib, A. Othman, Yusri M Yusof

{"title":"Pulmonary tuberculosis with venous thromboembolism as an unusual presentation of occult pancreatic cancer: a case report","authors":"Y. Tan, Shaifulamir Shuib, A. Othman, Yusri M Yusof","doi":"10.21037/AMJ-20-114","DOIUrl":"https://doi.org/10.21037/AMJ-20-114","url":null,"abstract":"Pancreatic cancer is usually diagnosed at a relatively advanced stage due to the heterogeneous and nonspecific clinical presentation. Thus, it poses a significant diagnostic challenge as the disease is usually clinically silent at the early stage. Typically, by the time of diagnosis, pancreatic cancer is associated with an extremely poor survival rate. The clinical features depend on the size and location of the tumour as well as its metastases. The suspicion of pancreatic cancer thus noted in retrospect and hence suggesting a missed opportunity for early detection. To our best knowledge, there have been no reported cases of pulmonary tuberculosis (PTB) with venous thromboembolism as the initial presentation of pancreatic cancer. The exact pathogenesis regarding venous thromboembolism with tuberculosis in pancreatic cancer is still unknown and debatable. Herein, we report an interesting case of smear positive PTB with venous thromboembolism leading to the elusive diagnosis of advanced pancreatic cancer. We discuss on possible novel hypotheses for the mechanism of venous thromboembolism in pancreatic cancer as well as association between tuberculosis and pancreatic cancer. His condition deteriorated even on standard treatment for PTB and thromboembolism that prompt further investigation for malignancy. He missed the golden period for treatment for the pancreatic cancer and subsequently succumbed to the illness. Early investigation for malignancy may be appropriate for tuberculosis patients who develop venous thromboembolism especially those clinically deterioration on standard treatment.","PeriodicalId":72157,"journal":{"name":"AME medical journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48895646","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Comparison between RECIST 1.1, Choi and PERCIST 1.0 criteria to evaluate response to SBRT of liver metastasis RECIST 1.1、Choi和PERIST 1.0标准评估肝转移SBRT反应的比较

AME medical journal Pub Date : 2021-01-01 DOI: 10.21037/amj-21-17

M. A. Krauel, X. Chen-Zhao, M. N. Baez, O. H. Requejo, U. L. D. L. Guardia, C. Rodríguez

{"title":"Comparison between RECIST 1.1, Choi and PERCIST 1.0 criteria to evaluate response to SBRT of liver metastasis","authors":"M. A. Krauel, X. Chen-Zhao, M. N. Baez, O. H. Requejo, U. L. D. L. Guardia, C. Rodríguez","doi":"10.21037/amj-21-17","DOIUrl":"https://doi.org/10.21037/amj-21-17","url":null,"abstract":"Background: Currently there are no guidelines for follow-up and assessment of response in tumors undergoing liver stereotactic body radiation therapy (SBRT). We analyzed imaging characteristics of liver metastasis treaded by SBRT and compared the accuracy of different imaging criteria (RECIST 1.1, Choi and PERCIST 1.0) to assess treatment response. Methods: Eighty-eight liver metastasis treated with SBRT at our institution, University Hospital HM Sanchinarro, were analyzed. We retrospectively reviewed images of all CT and PET-CT studies performed to these patients at baseline and every three months after SBRT treatment during the first year. Lesion size (cm) and attenuation coefficient values (HU, Hounsfield Units) were measured. 18F-FDG uptake value was collected if PET-CT was made. Surrounding liver tissue attenuation coefficient values and eventual dilation of the biliary ducts were also analyzed. Results: In our retrospective, observational study statistical analysis shown significant differences in the assessment of response of liver metastasis treated with SBRT using different criteria in the four reviews (P<0.001). PERCIST criteria were the most sensitive to assess response. Regarding “non-metabolic” criteria, Choi criteria showed better results in the assessment of response to SBRT than RECIST 1.1. Attenuation coefficient values of perilesional parenchyma did not vary significantly along the first year except in the first quarter (P<0.016), and we did not find dilation of the bile duct after SBRT with greater frequency than in other cases. Conclusions: PERCIST were the most suitable criteria to assess response to SBRT of liver metastasis in our series. Among the rest, Choi were more appropriate than RECIST 1.1.","PeriodicalId":72157,"journal":{"name":"AME medical journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42242895","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Contemporary review on the management of oral anticoagulation and anti-platelet therapies in patients undergoing percutaneous coronary intervention with concurrent atrial fibrillation 经皮冠状动脉介入治疗并发房颤患者口服抗凝和抗血小板治疗的管理现状综述

AME medical journal Pub Date : 2021-01-01 DOI: 10.21037/amj-21-9

Ramone L. Boyd, Natalie Tasseff, Bo Xu

{"title":"Contemporary review on the management of oral anticoagulation and anti-platelet therapies in patients undergoing percutaneous coronary intervention with concurrent atrial fibrillation","authors":"Ramone L. Boyd, Natalie Tasseff, Bo Xu","doi":"10.21037/amj-21-9","DOIUrl":"https://doi.org/10.21037/amj-21-9","url":null,"abstract":"Management of coronary artery disease (CAD) with percutaneous coronary intervention (PCI) in the setting of atrial fibrillation (AF) presents clinicians with the challenge of balancing thrombosis risk with bleeding risk. Major societies including American College of Cardiology (ACC)/American Heart Association (AHA), Heart Rhythm Society (HRS) and European Society of Cardiology (ESC) guideline recommendations include the necessity to use antiplatelet therapy and anticoagulation for the prevention of thromboembolism in patients who undergo intervention with PCI who have concurrent AF. Dual antiplatelet therapy (DAPT) is the standard of care for patients post PCI, and anticoagulation with vitamin K antagonists (VKA) or direct acting oral anticoagulants (DOAC) is the standard of care, with DOACS being recommended by ACC/AHA and ESC as preferred, for patients with AF and elevated ischemic stroke risk. Here, we review the contemporary major society guideline recommendations applicable for the use of triple therapy with dual anti-platelet agents and oral anticoagulant, in patients undergoing PCI who have concurrent AF. We also review and summarize the relevant historical primary literature related to the approval of antiplatelet and anticoagulant therapy in PCI and AF respectively. Using a case description as a basis to illustrate this difficult clinical scenario, we review the contemporary literature, and present proposed management algorithms.","PeriodicalId":72157,"journal":{"name":"AME medical journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45961922","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Recalcitrant posterior urethral stenoses: a narrative review of refractory bladder neck contractures and vesicourethral anastomotic stenoses after treatment for localized prostate cancer 顽固性后尿道狭窄:局限性前列腺癌治疗后顽固性膀胱颈挛缩和膀胱尿道吻合口狭窄的叙述回顾

AME medical journal Pub Date : 2021-01-01 DOI: 10.21037/AMJ-20-191

Ruth Blum, S. Brandes

{"title":"Recalcitrant posterior urethral stenoses: a narrative review of refractory bladder neck contractures and vesicourethral anastomotic stenoses after treatment for localized prostate cancer","authors":"Ruth Blum, S. Brandes","doi":"10.21037/AMJ-20-191","DOIUrl":"https://doi.org/10.21037/AMJ-20-191","url":null,"abstract":"Posterior urethral stenoses, more specifically, bladder neck contracture (BNC) and vesicourethral anastomotic stenosis (VUAS), are a troublesome and dreaded complication after treatment for localized prostate cancer. Patients can develop bothersome and recurrent lower urinary tract symptoms (LUTS) and other urinary complications that diminish their quality of life. The diagnosis and management of these patients can be cumbersome and overwhelming to physicians as many require multiple interventions. We reviewed the current literature to better define the incidence of BNC/VUAS after different treatment modalities for localized prostate cancer and to determine the best management strategies. In general, the incidence is higher in radiated patients and takes significantly longer to present, compared to those that are treated with surgery alone. The risk is highest in patients who undergo salvage prostatectomy with an incidence of up to forty percent. A graded approach should be taken to management, as repeated attempts of minimally invasive methods are relatively successful. More aggressive treatment, either endoscopic or surgical, can result in severe de novo stress urinary incontinence (SUI) and require staged placement of an artificial urinary sphincter (AUS) and requires an educated and motivated patient. Robotic assisted laparoscopic (RAL) techniques are increasing in popularity and show promising results with lower rates of incontinence. Urinary diversion should also be considered in the treatment algorithm for these patients as it is sometimes the best option. However, larger, less heterogeneous studies are needed.","PeriodicalId":72157,"journal":{"name":"AME medical journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43618118","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 1

Robotic surgery in urology: a narrative review from the beginning to the single-site 泌尿外科机器人手术:从开始到单部位的叙述性回顾

AME medical journal Pub Date : 2021-01-01 DOI: 10.21037/amj-20-166

D. Marchi, G. Mantica, A. Tafuri, G. Giusti, F. Gaboardi

{"title":"Robotic surgery in urology: a narrative review from the beginning to the single-site","authors":"D. Marchi, G. Mantica, A. Tafuri, G. Giusti, F. Gaboardi","doi":"10.21037/amj-20-166","DOIUrl":"https://doi.org/10.21037/amj-20-166","url":null,"abstract":": Robotic surgery is a minimally invasive technique that is becoming increasingly popular in surgery and especially in urology. More and more major urological interventions, such as radical prostatectomy and partial nephrectomies, are evolving into laparoscopic and robotic minimally invasive techniques. Robotic surgery itself is constantly evolving in order to improve its performance and minimally invasiveness. A non-systematic literature review was performed using the PubMed/Medline electronic search engine using the following terms: “robotic surgery” or “development of robotic surgery” or “single site surgery” or “single port surgery”. Although it is a very recent technology, some preliminary experiences have been presented in the literature that document the feasibility of some major urological interventions, including radical prostatectomies, radical cystectomy, partial nephrectomy and ureterocystoneostomy. Long-term oncological and functional outcomes are not yet available and require more follow-up. Anyway, the single-port robotic system has proved feasible and safe, although in small cases series. Re-evaluating the development of robotic surgery, with each innovation, it aroused great enthusiasm, leading to a great diffusion of the method before having randomized clinical trials that confirmed the effective improvement of the technique compared to the gold standard. The urological community should not miss the second chance to be able to evaluate an emerging technique based on comparative clinical studies. 6","PeriodicalId":72157,"journal":{"name":"AME medical journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46031552","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 3

Narrative review of 3D imaging for preoperative planning in urology 三维影像在泌尿外科术前规划中的应用综述

AME medical journal Pub Date : 2021-01-01 DOI: 10.21037/AMJ-20-175

F. Gallo, A. Caviglia, M. Beverini, A. Merwe, H. Deventer, M. Schenone, C. Terrone, G. Mantica

引用次数: 1

Saturated phosphatidylcholine as dietary additive for colonic mucus: an open label prospective clinical observation trial 饱和磷脂酰胆碱作为结肠粘液膳食添加剂的开放性前瞻性临床观察试验

AME medical journal Pub Date : 2021-01-01 DOI: 10.21037/amj-21-25

W. Stremmel, G. Fricker, R. Weiskirchen

引用次数: 1

Narrative review on applications of fluorescence-guided surgery in adult and paediatric urology 荧光引导手术在成人和儿童泌尿外科的应用综述

AME medical journal Pub Date : 2021-01-01 DOI: 10.21037/amj-20-194

I. Paraboschi, Federica Farneti, L. Jannello, G. Manzoni, A. Berrettini, G. Mantica

{"title":"Narrative review on applications of fluorescence-guided surgery in adult and paediatric urology","authors":"I. Paraboschi, Federica Farneti, L. Jannello, G. Manzoni, A. Berrettini, G. Mantica","doi":"10.21037/amj-20-194","DOIUrl":"https://doi.org/10.21037/amj-20-194","url":null,"abstract":"More recently, there has been a substantial increase in the use of fluorophores to guide open and laparoscopic procedures with the ultimate aim to optimize both oncological and functional outcomes and to reduce operative time and blood loss. Fluorescent dyes are currently adopted to allow safer and more accurate dissections during both oncological and reconstructive procedures thanks to their ability of highlighting tumour margins and tissue vascularization. Urology is one of the fields in which fluorescenceguided surgery (FGS) has proved to be most useful. In particular, it has assumed a pivotal role in the surgical treatment of oncological patients affected by kidney, bladder, prostate and penis cancers and in the management of paediatric urological conditions. This review aims to provide an update on the use of FGS in adult and paediatric urology, drawing attention to its most recent and interesting applications in this very innovative field of research. Although FGS has been only recently introduced in the clinical scenario, it can be already considered a powerful tool to improve oncological, anatomical and functional outcomes in both adult and paediatric urology. An increased identification of lymph nodes (LNs), a more accurate visualization of tumour margins and a better definition of blood supply and lymphatic drainage have proved to be greatly beneficial for patients undergoing urological procedures, whether they are adults or children. Longitudinal studies with larger sample sizes are still needed to draw firm conclusions and to confirm its benefits in","PeriodicalId":72157,"journal":{"name":"AME medical journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44347358","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 5