Peritoneal dialysis (PD) surgery include PD catheter insertion and removal. Both procedures require the use of anesthesia. The end-stage renal disease (ESRD) patients usually have severe ...comorbidities. The general anesthesia, because of its negative systemic effect, should be omitted in this vulnerable group of the patients. Transversus abdominis plane (TAP) block as a newer method of regional anesthesia is a technique without systemic effect and recently started to be used in ESRD patients for PD catheter placement and/or removal. Here we report a patient in whom we for the first time simultaneously removed and implanted a PD catheter by using a bilateral transversus abdominis plane block.
The patient was an 80-year-old man who was admitted for removal of malfunctioned PD catheter. Since the patient opted for staying on PD simultaneous implantation of catheter was planned. Because of his age and significant comorbidities, general anesthesia was avoided and bilateral TAP block become our option. In the same anesthesia, using bilateral TAP block, the old PD catheter was removed and a new one was implanted. Until now the patient is on regular PD without any complications.
The TAP block could be used as a primary anesthetic technique in ESRD patients for PD surgery even for synchronous removal and implantation of PD catheter.
Computerized tomography (CT) is the most accurate method for evaluating pelvic calcifications, which are of utmost importance for planning kidney transplantation (KT). The aim of our study was to ...evaluate the incidence and distribution of iliac artery calcifications and correlate the novel pelvic calcification score (PCS) with cardiovascular risk factors and graft and overall survival in KT patients.
We retrospectively included 118 KT patients operated at our institution with pretransplant pelvic CT. Calcification morphology, circumference and length of both common and external iliac arteries were independently scored by two uroradiologists. PCS was calculated as the total score sum of all three calcification features in all vessels. PCS correlation with graft and patient survival was performed.
Calcification in at least one vascular segment was found in 79% of patients. PCS was significantly higher in male patients (
= 0.006), patients over 55 years (
< 0.001), and patients on haemodialysis (
= 0.016). Patients with a PCS >3 had significantly shorter graft and overall survival rates (
= 0.041 and
= 0.039, respectively).
The extent of iliac artery calcification in KT recipients quantified by PCS on pretransplant CT correlates with graft and overall patient survival. A PCS over three was associated with worse clinical outcomes and could become a possible prognostic factor.
Our novel PCS is a robust method for quantifying iliac artery calcification burden. Since higher a PCS correlates with worse patient and graft survival, PCS has the potential to become a prognostic factor in kidney transplant patients.
Kidney transplantation is the most efficient method of renal replacement therapy. When this method is performed, native urinary bladder is the preferred urinary reservoir. However, in some patients ...with an anatomically and functionally abnormal lower urinary tract, the urinary bladder cannot be used for transplantation. In these patients, urinary diversion should be performed before kidney transplantation. We present a case of a 32-year-old male patient with orthotopic kidney transplantation performed using a colon pouch (Mainz-pouch III). He was born with severe anomalies including sacral agenesis, anorectal atresia, and hypospadias, which were corrected during childhood. Neurogenic bladder with severe vesicoureteral reflux led to end-stage renal disease. This dysfunctional bladder was unsuitable for kidney transplantation, and a staged approach for future transplantation was chosen. The first step was the creation of urinary diversion. Due to a short appendix, we created a continent, colon pouch (Mainz pouch III). Two years later, orthotopic kidney transplantation was performed using a right cadaveric kidney. The renal vessels were anastomosed to the aorta and inferior vena cava and the pyelon to the native ureter. Four years after transplantation, the patient has stable renal function without any complications. This is the first documented case of using Mainz-pouch III as a reliable option for kidney transplantation in selected patients.
Prostate cancer is one of the most important men's health issues in developed countries. For patients with prostate cancer a preoperative staging of the disease must be made. Involvement of lymph ...nodes could be assessed using imaging methods (CT or/and MRI), however, newer methods also exist (PET/CT, PSMA PET/CT). For some patients during radical prostatectomy a pelvic lymphadenectomy is recommended. Pelvic lymphadenectomy is indicated in intermediate- and high-risk group patients and with increased probability of lymph node invasion. The most used prediction tools for preoperative assessment of lymph nodes are Briganti and MSKCC nomograms and Partin tables. Pelvic lymphadenectomy can include different lymph nodes group, but extended lymphadenectomy is the recommended procedure. In 1-20% of patients, the lymph node invasion is present. Pelvic lymphadenectomy is primarily a diagnostic and staging method, and in minority of patients with positive lymph nodes it can be a curative method, too. In other patients with positive lymph nodes adjuvant therapy (radiotherapy and androgen deprivation therapy) can be beneficial.
Cilj: Radom smo željeli prikazati pacijenta s izrazito smanjenim kapacitetom i complianceom mokraćnog mjehura i posljedično značajno narušenom kvalitetom života, koji je uspješno liječen ...autoaugmentacijom mokraćnoga mjehura. Prikaz slučaja: Pacijent u dobi od 36 godina javio se na urološki pregled zbog izrazitih smetnji mokrenja koje su trajale posljednje tri godine. Prevladavajuće smetnje bile su frekvencija, nikturija, urgencija i urgentna inkontinencija. Zbog opisanih smetnji pacijent se psihički promijenio, a zbog čestih i bolnih nagona na mokrenje nije mogao obavljati obaveze iz privatnog i poslovnog života. Nakon opsežne laboratorijske, mikrobiološke i slikovne obrade te nakon neuspješnog konzervativnog liječenja pacijentu je predloženo kirurško liječenje. Učinjena je autoaugmentacija mokraćnog mjehura. Poslijeoperacijski tijek bio je uredan. Pri otpustu iz bolnice frekvencija mokrenja bila je četiri do pet puta dnevno, nikturija jedan do dva puta, a prosječni volumen izmokrenog urina oko 400 ml. Rasprava i zaključak: U pažljivo probranih pacijenata autoaugmentacija mokraćnog mjehura može značajno poboljšati kvalitetu života pacijenata s izrazito smanjenim kapacitetom i complianceom mokraćnog mjehura. Ovaj kirurški zahvat najčešće prolazi bez težih komplikacija, a kako ne zahtijeva uporabu crijevnih segmenata, u slučaju neuspjeha moguće je naknadno pristupiti enterocistoplastici, ortotopnoj ili supravezikalnoj derivaciji mokraćnog mjehura.
Potkovičasti bubreg najčešća je fuzijska anomalija bubrega. Darivatelji koji imaju potkovičasti bubreg smatraju se suboptimalnima zbog čestih vaskularnih i uroloških anomalija. Prikazat ćemo ...transplantaciju potkovičastog bubrega mladoga kadaveričnog darivatelja. Nakon učinjene eksplantacije en bloc bubreg je uz adekvatno prepariranje krvnih žila i uretera razdvojen na dva dijela. Oba dijela potkovičastog bubrega uspješno su transplantirana u dva različita bolesnika u terminalnom stadiju kronične bubrežne insuficijencije. Poslijeoperacijski tijek bio je uredan i oba bolesnika 18 mjeseci nakon transplantacije imaju normalnu bubrežnu funkciju. Transplantacija potkovičastog bubrega zbog anatomskih je razloga zahtjevnija, ali s obzirom na to da su njezini rezultati podjednaki onima u standardnoj transplantacijskoj populaciji, trebalo bi potaknuti transplantacijske kirurge da iskoriste
bubrege s ovom anomalijom.
Cilj: Prikazati učestalost i raspodjelu kalcificiranosti ilijačnih arterija u pacijenata u kojih je učinjena transplantacija bubrega u našem transplantacijskom centru. Ispitanici i metode: ...Retrospektivnim istraživanjem bili su obuhvaćeni pacijenti u Kliničkom bolničkom centru Rijeka u kojih je između 1. siječnja 2015. godine i 31. prosinca 2018. godine učinjena transplantacija bubrega. Procjena kalcificiranosti ilijačnih arterija učinjena je uz pomoć kompjutorizirane tomografije (CT). Rezultati: U promatranom razdoblju u našem transplantacijskom centru učinjeno je 115 transplantacija bubrega, a 92 (80 %) pacijenata imalo je prijeoperacijski CT. Prosječna dob pacijenata bila je 60,3 godina, a 26 % pacijenata je imalo šećernu bolest kao osnovnu bolest. Arterijske kalcifikacije pronađene su u 72 (78 %) pacijenata. Kalcifikacije su najčešće pronađene na desnoj zajedničkoj ilijačnoj arteriji (63 pacijenata – 68,5 %), a najrjeđe na lijevoj vanjskoj ilijačnoj arteriji (23 pacijenta – 25 %). Zaključak: Većina naših pacijenata ima prisutne kalcifikacije na ilijačnim arterijama. Prijeoperacijsko utvrđivanje njihove raspodjele i proširenosti ima važnu ulogu prilikom planiranja transplantacije bubrega.
Aim. To evaluate the incidence and distribution of calcifications of iliac arteries in patients with kidney transplantation in our transplant center. Patients and Methods. We retrospectively analyzed patients with kidney transplantation operated at University Hospital Rijeka from January 1st 2015 to December 31st 2018. The assessment of iliac arteries calcifications was made using computed tomography. Results. In observed period 115 kidney transplantations were performed in our transplant center and 92 (80%) of patients had preoperative CT scan. The average age was 60,3 years and 26% of patients had diabetes mellitus as principal disease. Arterial calcifications were found in 72 (78%) patients. The calcifications were most common in the right common iliac artery (63 pts – 68,5%) and rarest in left external iliac artery (23 pts - 25%) Conclusion. Most of our patients have calcifications of iliac arteris. Preoperative assessment of their distribution and extent had a very important role in the planning of kidney transplantation.
Urodinamika i njezina klinička primjena Trošelj, Marin; Rubinić, Nino; Vukelić, Ivan ...
Medicina fluminensis,
09/2017, Letnik:
53, Številka:
3
Journal Article
Recenzirano
Odprti dostop
Urodinamika je metoda kojom se procjenjuje funkcija mokraćnoga sustava, najčešće njegovog donjeg dijela. Donji dio urinarnog sustava je funkcionalna cjelina koja se sastoji od mokraćnoga mjehura, ...sfinkterskoga mehanizma i mokraćne cijevi. Osnovna funkcija mu je punjenje i pražnjenje mjehura uz kontinenciju. Urodinamikom se mogu adekvatno evaluirati sve te funkcije. Urodinamika je indicirana kao nadopuna standardnim pretragama. Najčešće korištene metode su mikciometrija, cistometrija i profilometrija uretre. Mikciometrijom se određuje protok urina u jedinici vremena tijekom akta mikcije. Cistometrijom mjerimo
tlakove u mjehuru tijekom njegova punjenja i pražnjenja. Profilometrijom uretre određujemo tlakove u uretri, a dobiveni podaci govore nam o kontinenciji ispitanika. U preglednom radu prikazat ćemo osnove urodinamskog ispitivanja s kliničkim primjerima.
Cilj: Prikazati učestalost uroloških komplikacija nakon transplantacije bubrega u našem transplantacijskom centru. Ispitanici i metode: Retrospektivnim istraživanjem bili su obuhvaćeni svi pacijenti ...u Kliničkom bolničkom centru Rijeka u kojih je između 30. siječnja 1971. godine i 31. prosinca 2018. godine učinjena transplantacija bubrega. Rezultati: U promatranom razdoblju u našem transplantacijskom centru učinjeno je 1160 transplantacija bubrega. Urološke komplikacije imala su ukupno 154 pacijenta (13,3 %). Najčešće komplikacije su bile stenoza uretera u 52 pacijenta (4,5 %), urinarna fistula u 50 pacijenata (4,3 %), retencija urina u 23 pacijenta (1,9 %) te urolitijaza u 8 pacijenata (0,7 %). U većine pacijenata je provedeno kirurško liječenje. U posljednje vrijeme značajno se povećalo rješavanje uroloških komplikacija korištenjem minimalno-invazivnih metoda. U dvoje pacijenata (0,17 %) je zbog uroloških komplikacija došlo do gubitka grafta, a u troje pacijenata (0,25 %) su one dovele do smrtnog ishoda. Zaključak: Urološke komplikacije u našoj transplantacijskoj populaciji nisu česte. U pacijenata u kojih je potrebno kirurško liječenje endourološke metode predstavljaju danas inicijalnu metodu liječenja.
Aim: To evaluate the incidence of urological complications after kidney transplantation in our transplant center. Patients and Methods: We retrospectively analyzed all patients with kidney transplantation operated in University Hospital Rijeka from January 30st 1971 to December 31st 2018. Results: In the observed period 1160 kidney transplantations were performed in our transplant center. Urological complications were noticed in the 154 patients (13.3%). The most frequent complications were ureteral stenosis in 52 patients (4.5%), urinary fistula in 50 patients (4.3%), urinary retention in 23 patients (1.9%) and urolithiasis in the 8 patients (0.7%). The majority of the patients underwent surgical treatment. Recently, minimally invasive surgery was the method of choice for treatment of urological complications. In two patients (0,17%) urological complications caused graft loss and in the three patients (0,25%) this complications lead to death. Conclusion: Urological complications are not frequent in our transplant population. In the group of patients that required surgical treatment endourology methods are currently the initial treatment modality.
Testosterone replacement therapy is becoming more and more popular in men as “anti-aging medicine”. Testosterone has beneficial effects on body mass and muscle gain, and much research has examined ...testosterone in palliative cancer therapy for oncology patients. In addition to direct effects on weight gain, testosterone improves mood and self-confidence, strength, libido, muscle mass, bone density, and cognitive functions and reduces the risk of cardiovascular disease. Lower testosterone levels are found in 65 % of male patients with progressive tumors compared to only 6 % of men in the general population. We hypothesize that perioperative substitution testosterone therapy (PSTT) together with a balanced diet, may be more effective than balanced diet alone in the overall treatment outcome of patients with head and neck squamous cell carcinomas. Therefore, PSTT in combination with a balanced diet should be considered as an additional tool for head and neck carcinoma treatment.
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•Lower testosterone levels often occur as a result of advanced tumors.•Decreased testosterone levels have been linked to muscle mass and strength loss.•Testosterone therapy should be considered as additional tool for cancer treatment.
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