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Sample records for traumatic posterior urethral

  1. Posterior Urethral Strictures

    PubMed Central

    Gelman, Joel; Wisenbaugh, Eric S.

    2015-01-01

    Pelvic fracture urethral injuries are typically partial and more often complete disruptions of the most proximal bulbar and distal membranous urethra. Emergency management includes suprapubic tube placement. Subsequent primary realignment to place a urethral catheter remains a controversial topic, but what is not controversial is that when there is the development of a stricture (which is usually obliterative with a distraction defect) after suprapubic tube placement or urethral catheter removal, the standard of care is delayed urethral reconstruction with excision and primary anastomosis. This paper reviews the management of patients who suffer pelvic fracture urethral injuries and the techniques of preoperative urethral imaging and subsequent posterior urethroplasty. PMID:26691883

  2. Posterior Urethral Strictures.

    PubMed

    Gelman, Joel; Wisenbaugh, Eric S

    2015-01-01

    Pelvic fracture urethral injuries are typically partial and more often complete disruptions of the most proximal bulbar and distal membranous urethra. Emergency management includes suprapubic tube placement. Subsequent primary realignment to place a urethral catheter remains a controversial topic, but what is not controversial is that when there is the development of a stricture (which is usually obliterative with a distraction defect) after suprapubic tube placement or urethral catheter removal, the standard of care is delayed urethral reconstruction with excision and primary anastomosis. This paper reviews the management of patients who suffer pelvic fracture urethral injuries and the techniques of preoperative urethral imaging and subsequent posterior urethroplasty. PMID:26691883

  3. Traumatic posterior urethral fistula to hip joint following gunshot injury: a case report

    PubMed Central

    2009-01-01

    Introduction Urinary system fistula to the hip joint is a rare complication. We report a case of delayed posterior urethral fistula to the hip joint following penetrating gunshot wound injury. Case presentation A 37-year-old Iranian Balochi male was shot with a firearm in the superior part of his right pelvis. He underwent primary closure on the same day. Ten months later, he developed urinary retention. He underwent retrograde urethrography and antegrade cystography which showed a stricture measuring 5 cm in length. There was also a history of progressive pain in the right hip joint accompanied by low grade fever which started 2 months after the initial injury. Hip X-ray showed evidence of an acetabular cavity and femoral head destruction diagnostic of complicated septic arthritis. The patient subsequently underwent reconstructive surgery for the urethral stricture and urethral fistula via a transperineal approach followed by total hip arthroplasty. Conclusion Hip joint contamination with urine following a urethro-acetabular fistula can lead to severe and disabling complications such as septic arthritis. We recommend that every clinician should keep these fistulas in mind as a complication of penetrating urethral injury and every attempt should be made for their early diagnosis and prompt treatment. PMID:20062771

  4. Fetoscopic transuterine release of posterior urethral valves: a new technique.

    PubMed

    Clifton, Matthew S; Harrison, Michael R; Ball, Robert; Lee, Hanmin

    2008-01-01

    Fetal urinary tract obstruction with oligohydramnios produces pulmonary hypoplasia and renal dysplasia. Decompression of the obstructed urinary tract may restore amniotic fluid and allow lung growth, but transabdominal catheter shunt decompression is often inadequate and does not allow for cycling of the bladder, while open procedures cause significant maternal morbidity. Disruption of the anatomic obstruction, usually posterior urethral valves in a male fetus, would be ideal but has proven technically difficult. Here we describe a new technique of percutaneous fetal cystoscopy and disruption of posterior urethral valves, and the case report of our first application of this technique. We pre-sent a case of a 17-week male fetus with posterior urethral valves which underwent fetal cystoscopy for mechanical disruption of posterior urethral valves. This minimally invasive approach to disruption of posterior urethral valves in a fetus is a novel method for decompressing the urinary tract. The technique offers a minimal degree of maternal morbidity and, if instituted early enough, can restore amniotic fluid volume, avert fatal pulmonary hypoplasia and may preserve renal function. PMID:18033963

  5. Giant urethral diverticulum's caused by traumatic vesicle catheterization in children: a case report

    PubMed Central

    Kkhattala, Khalid; Rami, Mohamed; Elmadi, Aziz; Chater, Lamia; Mahmoudi, Abdelhalim; Bouabadallah, Youssef

    2011-01-01

    Urethral diverticula are saclike dilations of the urethra and are classified as either congenital or acquired. While urethral diverticula are commonly seen in female patients, they are rarely seen in men. The most common etiologies of male acquired diverticula include urethral trauma, stricture, abscess or post-hypospadias repair. We report a case of acquired urethral diverticula caused by a traumatic vesical catheterization in a 6-year old boy and review the literature on the topic. PMID:22187597

  6. SIU/ICUD Consultation on Urethral Strictures: Posterior urethral stenosis after treatment of prostate cancer.

    PubMed

    Herschorn, Sender; Elliott, Sean; Coburn, Michael; Wessells, Hunter; Zinman, Leonard

    2014-03-01

    Posterior urethral stenosis can result from radical prostatectomy in approximately 5%-10% of patients (range 1.4%-29%). Similarly, 4%-9% of men after brachytherapy and 1%-13% after external beam radiotherapy will develop stenosis. The rate will be greater after combination therapy and can exceed 40% after salvage radical prostatectomy. Although postradical prostatectomy stenoses mostly develop within 2 years, postradiotherapy stenoses take longer to appear. Many result in storage and voiding symptoms and can be associated with incontinence. The evaluation consists of a workup similar to that for lower urinary tract symptoms, with additional testing to rule out recurrent or persistent prostate cancer. Treatment is usually initiated with an endoscopic approach commonly involving dilation, visual urethrotomy with or without laser treatment, and, possibly, UroLume stent placement. Open surgical urethroplasty has been reported, as well as urinary diversion for recalcitrant stenosis. A proposed algorithm illustrating a graded approach has been provided. PMID:24361008

  7. Management for the anterior combined with posterior urethral stricture: a 9-year single centre experience

    PubMed Central

    Deng, Tuo; Liao, Banghua; Luo, Deyi; Liu, Bing; Wang, Kunjie; Liu, Jiaming; Jin, Tao

    2015-01-01

    Objective: Therapy for anterior combined with posterior urethral stricture is difficult and controversial. This study aims to introduce a standard process for managing anterior combined with posterior urethral stricture. Patients and methods: 19 patients with anterior combined with posterior urethral stricture were treated following our standard process. Average (range) age was 52 (21-72) years old. In this standard process, anterior urethral stricture should be treated first. Endoscopic surgery is applied for anterior urethra stricture as a priority as long as obliteration does not occur, and operation for posterior urethral stricture can be conducted in the same stage. Otherwise, an open reconstructive urethroplasty for anterior urethral is needed; while in this condition, the unobliterated posterior urethra can also be treated with endoscopic surgery in the same stage; however, if posterior urethra obliteration exists, then open reconstructive urethroplasty for posterior urethral stricture should be applied 2-3 months later. Results: The median (range) follow-up time was 25.8 (3-56) months. All 19 patients were normal in urethrography after 1 month of the surgery. 4 patients (21.1%) recurred urethral stricture during follow-up, and the locations of recurred stricture were bulbomembranous urethra (2 cases), bulbar urethra (1 case) and bladder neck (1 case). 3 of them restored to health through urethral dilation, yet 1 underwent a second operation. 2 patients (10.5%) complaint of dripping urination. No one had painful erection, stress urinary incontinence or other complications. Conclusions: The management for anterior combined with posterior urethral stricture following our standard process is effective and safe. PMID:26064293

  8. Rare copy number variants implicated in posterior urethral valves.

    PubMed

    Boghossian, Nansi S; Sicko, Robert J; Kay, Denise M; Rigler, Shannon L; Caggana, Michele; Tsai, Michael Y; Yeung, Edwina H; Pankratz, Nathan; Cole, Benjamin R; Druschel, Charlotte M; Romitti, Paul A; Browne, Marilyn L; Fan, Ruzong; Liu, Aiyi; Brody, Lawrence C; Mills, James L

    2016-03-01

    The cause of posterior urethral valves (PUV) is unknown, but genetic factors are suspected given their familial occurrence. We examined cases of isolated PUV to identify novel copy number variants (CNVs). We identified 56 cases of isolated PUV from all live-births in New York State (1998-2005). Samples were genotyped using Illumina HumanOmni2.5 microarrays. Autosomal and sex-linked CNVs were identified using PennCNV and cnvPartition software. CNVs were prioritized for follow-up if they were absent from in-house controls, contained ≥10 consecutive probes, were ≥20 Kb in size, had ≤20% overlap with variants detected in other birth defect phenotypes screened in our lab, and were rare in population reference controls. We identified 47 rare candidate PUV-associated CNVs in 32 cases; one case had a 3.9 Mb deletion encompassing BMP7. Mutations in BMP7 have been associated with severe anomalies in the mouse urethra. Other interesting CNVs, each detected in a single PUV case included: a deletion of PIK3R3 and TSPAN1, duplication/triplication in FGF12, duplication of FAT1-a gene essential for normal growth and development, a large deletion (>2 Mb) on chromosome 17q that involves TBX2 and TBX4, and large duplications (>1 Mb) on chromosomes 3q and 6q. Our finding of previously unreported novel CNVs in PUV suggests that genetic factors may play a larger role than previously understood. Our data show a potential role of CNVs in up to 57% of cases examined. Investigation of genes in these CNVs may provide further insights into genetic variants that contribute to PUV. © 2015 Wiley Periodicals, Inc. PMID:26663319

  9. Pediatric Bulbar and Posterior Urethral Injuries: Operative Outcomes and Long-Term Follow-Up.

    PubMed

    Trachta, Jan; Moravek, Jiri; Kriz, Jan; Padr, Radek; Skaba, Richard

    2016-02-01

    Aim The aim of this study was to analyze complications and outcomes of end-to-end urethral anastomosis performed for posttraumatic bulbar strictures or posterior urethral injuries in pediatric patients. Methods The records of 15 boys, age 18 years and below, admitted to our tertiary trauma center with urethral injuries from 1989 to 2014 were reviewed retrospectively. Out of these 15 boys, 7 were excluded (2 for iatrogenic trauma, 2 for minor straddle injuries who were not operated on, 2 for incomplete records, and 1 lost to follow-up) and 8 analyzed patients were operated for bulbar or posterior urethral injury. The mean follow-up after the operation was 4.5 years (range 0.5-10). To obtain up-to-date follow-up information, all the analyzed patients were contacted by a letter and telephone in January 2015 and asked about lower urinary tract or erectile dysfunction (ED) using the International Index of Erectile Function-5 questionnaire. Results Mean age at the time of injury was 12.3 years (range 5-17). Four patients with pelvic fracture had complete posterior urethra disruption, three patients after straddle injury developed obliterating stricture of the bulbar urethra and one patient had torn his bulbar urethra apart by a sharp hook. Except for the immediate exploration of the open perineal wound, all patients were operated via perineal approach 1 to 6 months after initial suprapubic catheter insertion. Five patients needed a cystotomy to identify the proximal urethral stump by a probe, and two patients had partial pubectomy to gain urethral length. Postoperative complications included stricture in anastomosis in six patients (all reoperated, four more than once including attempts of endoscopic internal urethrotomy). Six days after surgery, one patient developed massive external bleeding around a permanent urinary catheter due to a posttraumatic ruptured arterial aneurysm that was later stopped by urgent angiography and coil insertion. After discharge, three patients had transient stress incontinence. All patients had uroflowmetry maximum flow above 20 mL/s on their last follow-up except for two (12 and 15 mL/s). None have any lower urinary tract dysfunction symptoms in adulthood; one suffers from mild ED and two report moderate ED due to penile shortening. Conclusion Delayed end-to-end anastomosis for pediatric urethral injury is a safe operational option. However, high rate of short-term complications and reoperations should be expected. Penile shortening is one of the most severe long-term complications. PMID:26540444

  10. Solitary Crossed Renal Ectopia: Concurrence of Posterior Urethral Valve and Hypospadias

    PubMed Central

    Bagheri, Amin; Khorramirouz, Reza; Keihani, Sorena; Fareghi, Mehdi; Kajbafzadeh, Abdol-Mohammad

    2015-01-01

    Solitary crossed renal ectopia (SCRE) represents an exceedingly rare congenital disorder. Although skeletal and genitourinary abnormalities most commonly accompany this condition, vesicoureteral reflux (VUR) has been described in only a few cases. Here, we present two unique cases of SCRE complicated by high-grade VUR concomitant with posterior urethral valve in one case and hypospadias in the other one. We also provide a brief review of the literature on this subject. PMID:26167315

  11. Segmental urethrectomy and urethrorrhaphy for treatment of fresh and late traumatic urethral lesions.

    PubMed

    Chatelain, C; Jardin, A; Le Guillou, M; Perron, J; Petit, M; Kss, R

    1975-01-01

    For 16 years we have used segmental urethrectomy with end-to-end urethrorrhaphy for treatment of traumatic urethral lesions, in preference to two-stage urethroplasties. The approach has been transperineal, retropubic, and if necessary transpubic. Good results in 41 cases with long-term follow-up allow us to say that this is a good operation. It provides in two thirds of the patients a correct and stable urethral stream, complete bladder emptying, and does not affect urinary control or sexual function if this was normal following the injury. PMID:1233178

  12. Use of Silodosin to Visualize the Posterior Urethra in Pelvic Floor Urethral Distraction Defect Patients

    PubMed Central

    Ranjan, Nikhil; Singh, Rana Pratap; Ahmed, Ahsan; Kumar, Vijoy; Singh, Mahendra

    2015-01-01

    Background: Retrograde urethrogram and voiding cystourethrogram are used to define length and location of urethral stricture prior to surgery. We used a single dose of silodosin prior to VCUG to relax the bladder neck and achieve visualization of posterior urethra. Objectives: To evaluate the efficacy of silodosin in visualization of posterior urethra during VCUG, and to compare the findings with a control group. Patients and Methods: Patients were divided into two groups A and B containing 20 and 15 patients, respectively. Patients in group A were given a single dose of silodosin prior to radiological studies. Results: In group A 19 out of 20 patients were able to achieve satisfactory bladder neck opening while in group B 10 out of 15 patients were able to achieve bladder neck opening. Conclusions: Silodosin use prior to VCUG confers a statistically significant increase in bladder neck opening and visualization of posterior urethra. PMID:26543831

  13. Spontaneous Rupture of Kidney Due to Posterior Urethral ValveDiagnostic Difficulties

    PubMed Central

    Kili?-Pstrusi?ska, Katarzyna; Pukaj?o-Marczyk, Agnieszka; Patkowski, Dariusz; Zalewska-Dorobisz, Urszula; Zwoli?ska, Danuta

    2013-01-01

    Background Spontaneous kidney rupture could develop in the course of posterior urethral valve (PUV), the most common cause of outflow urinary tract obstruction in male infants. However, urinary extravasation is a rare complication among this group of children. Case Presentation Our case report presents diagnostic difficulties connected with spontaneous kidney rupture due to PUV in a 6 week-old infant. Due to not equivocal images, thundery course of disease and rapid deterioration in the infant's condition, the patient required an urgent laparatomy. Conclusion This case showed that the investigation of renal abnormalities during early neonatal period, is very important specifically in PUV that can lead to kidney rupture. PMID:23795264

  14. Unsuccessful outcomes after posterior urethroplasty

    PubMed Central

    Engel, Oliver; Fisch, Margit

    2015-01-01

    Posterior urethroplasty is the most common strategy for the treatment of post-traumatic urethral injuries. Especially in younger patients, post-traumatic injuries are a common reason for urethral strictures caused by road traffic accidents, with pelvic fracture or direct trauma to the perineum. In many cases early endoscopic realignment is the first attempt to restore the junction between proximal and distal urethra, but in some cases primary realignment is not possible or not enough to treat the urethral injury. In these cases suprapubic cystostomy alone and delayed repair by stricture excision and posterior urethroplasty is an alternative procedure to minimise the risk of stricture recurrence. PMID:26019980

  15. [Urethral stent to treat a refractory traumatic urethra stricture in a male hunting dog].

    PubMed

    Vogt, S; Schneider, M; Peppler, C; Günther, C; Kramer, M

    2014-01-01

    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

  16. Pelvic-fracture urethral injury in children

    PubMed Central

    Hagedorn, Judith C.; Voelzke, Bryan B.

    2015-01-01

    Objective To review paediatric posterior urethral injuries and the current potential management options; because urethral injury due to pelvic fracture in children is rare and has a low incidence, the management of this type of trauma and its complications remains controversial. Methods We reviewed previous reports identified by searching the PubMed Medline electronic database for clinically relevant articles published in the past 25years. The search was limited to the keywords pediatric, pelvic fracture, urethral injury, stricture, trauma and reconstruction. Results Most paediatric urethral injuries are a result of pelvic fractures after high-impact blunt trauma. After the diagnosis, immediate bladder drainage via a suprapubic cystotomy, or urethral realignment, are the initial management options, except for a possible immediate primary repair in girls. The common complications of pelvic fracture-associated urethral injury include urethral stricture formation, incontinence and erectile dysfunction. Excellent results can be achieved with delayed urethroplasty for pelvic fracture-associated urethral injuries. Conclusion Traumatic injury to the paediatric urethra is rare and calls for an immediate diagnosis and management. These devastating injuries have a high complication rate and therefore a close follow-up is warranted to assure adequate delayed repair by a reconstructive urologist. PMID:26019977

  17. Study of prognostic significance of antenatal ultrasonography and renin angiotensin system activation in predicting disease severity in posterior urethral valves

    PubMed Central

    Bhadoo, Divya; Bajpai, M.; Abid, Ali; Sukanya, Gayan; Agarwala, Sandeep; Srinivas, M.; Deka, Deepika; Agarwal, Nutan; Agarwal, Ramesh; Kumar, Rakesh

    2015-01-01

    Aims: Study on prognostic significance of antenatal ultrasonography and renin angiotensin system activation in predicting disease severity in posterior urethral valves. Materials and Methods: Antenatally diagnosed hydronephrosis patients were included. Postnatally, they were divided into two groups, posterior urethral valve (PUV) and non-PUV. The studied parameters were: Gestational age at detection, surgical intervention, ultrasound findings, cord blood and follow up plasma renin activity (PRA) values, vesico-ureteric reflux (VUR), renal scars, and glomerular filtration rate (GFR). Results: A total of 25 patients were included, 10 PUV and 15 non-PUV. All infants with PUV underwent primary valve incision. GFR was less than 60 ml/min/1.73 m2 body surface area in 4 patients at last follow-up. Keyhole sign, oligoamnios, absent bladder cycling, and cortical cysts were not consistent findings on antenatal ultrasound in PUV. Cord blood PRA was significantly higher (P < 0.0001) in PUV compared to non-PUV patients. Gestational age at detection of hydronephrosis, cortical cysts, bladder wall thickness, and amniotic fluid index were not significantly correlated with GFR while PRA could differentiate between poor and better prognosis cases with PUV. Conclusions: Ultrasound was neither uniformly useful in diagnosing PUV antenatally, nor differentiating it from cases with non-PUV hydronephrosis. In congenital hydronephrosis, cord blood PRA was significantly higher in cases with PUV compared to non-PUV cases and fell significantly after valve ablation. Cord blood PRA could distinguish between poor and better prognosis cases with PUV. PMID:25829668

  18. One step arthroscopically assisted Latarjet and posterior bone-block, for recurrent posterior instability and anterior traumatic dislocation

    PubMed Central

    DAmbrosi, Riccardo; Perfetti, Carlo; Garavaglia, Guido; Taverna, Ettore

    2015-01-01

    This case presents the challenges of the surgical management for a patient with a history of recurrent posterior shoulder instability and subsequently traumatic anterior dislocation. The patient was already on the waiting list for an arthroscopic posterior stabilization with anchors, when a car accident caused an additional anterior shoulder dislocation. This traumatic anterior dislocation created a bone loss with a glenoid fracture and aggravated the preexisting posterior instability. In order to address both problems, we decided to perform an arthroscopically assisted Latarjet procedure for anterior instability and to stabilize with a bone graft for posterior instability. To our best knowledge, this type of surgical procedure has so far never been reported in the literature. The purpose of this report is to present the surgical technique and to outline the decision making process. PMID:26288539

  19. A review of urodynamic evaluation in children and its role in the management of boys with posterior urethral valves

    PubMed Central

    Desai, Divyesh Y.

    2007-01-01

    Posterior urethral valves are the commonest cause of lower urinary tract outflow obstruction in male infants with an estimated incidence of 1:5000 male infants and 1:25,000 live births. Despite treatment with fulguration of the obstructing valves, bladder function is abnormal in up to 70% of older children and adolescents. Bladder dysfunction causes morbidity e.g. urinary incontinence and has been implicated in the late deterioration of renal function in this population. A poor understanding and inappropriate management of bladder dysfunction can result in unnecessary morbidity, which can handicap a child for life. Any method that measures function or dysfunction of the lower urinary tract constitutes a urodynamics investigation. Broadly, the investigations can be classified into simple or noninvasive urodynamics and invasive urodynamics. The objective of urodynamics assessments in children is to reproduce the patient's complaints or symptoms. Video urodynamics can provide additional information that may contribute to a further understanding of the problem under investigation. Urodynamics provides a useful tool to test the efficacy of treatment as well as determine any refinements necessary to improve the outcome of such treatment. PMID:19718301

  20. Posterior Urethral Valves in Children: Pattern of Presentation and Outcome of Initial Treatment in Ile-Ife, Nigeria

    PubMed Central

    Talabi, Ademola Olusegun; Sowande, Oludayo Adedapo; Etonyeaku, Amarachukwu Chiduziem; Salako, Abdulkadir A; Adejuyigbe, Olusanya

    2015-01-01

    Background: The management of posterior urethral valves (PUV) and its sequelae is still a challenge to most pediatric surgeons in our environment due to late presentation and inadequate facilities for long-term evaluation and treatment. Despite initial successful treatment about 40% would develop chronic renal failure. The aim is to describe the presentation, management and outcome of the initial treatment in boys with PUV. Materials and Methods: It is a retrospective analysis of PUV in boys 8 years and below over a 17 years period. Demographic characteristics, clinical features, investigations, and treatment outcome were reviewed. Results: Thirty-seven cases were analyzed. The median age was 5 months (range from birth to 8 years). Three (8.1%) patients had prenatal ultrasound diagnosis. The most common presentation was voiding dysfunction 37 (100%). Part of the preoperative investigation included micturating cystourethrogram (n = 31: 83.8%) and abdomino-pelvic ultrasonography (n = 37:(100%). The mean serum creatinine value of those who presented within the first 30 days of life and those who presented afterwards were 325 (251) mol/L and 141 (100) mol/L respectively, P = 0.003. Surgical interventions included trans-vesical excision of valves (n = 9: 28.1%), valvotomy (n = 10: 31.3%), balloon avulsion (n = 8: 25.0%), vesicostomy (n = 4: 12.5%) and endoscopic valve avulsion (n = 1: 3.1%). Seventeen (56.7%) patients had serum creatinine >70.4 mol/L after 1-month of valve excision. Five (13.5%) patients had postrelief complications and 5 (13.5%) died on admission. Ninety percentage (27/30) of patients had poor prognostic indices. Conclusions: The initial treatment outcome was good but most had poor prognostic factors. PMID:26425072

  1. A Giant Urethral Calculus.

    PubMed

    Sigdel, G; Agarwal, A; Keshaw, B W

    2014-01-01

    Urethral calculi are rare forms of urolithiasis. Majority of the calculi are migratory from urinary bladder or upper urinary tract. Primary urethral calculi usually occur in presence of urethral stricture or diverticulum. In this article we report a case of a giant posterior urethral calculus measuring 7x3x2 cm in a 47 years old male. Patient presented with acute retention of urine which was preceded by burning micturition and dribbling of urine for one week. The calculus was pushed in to the bladder through the cystoscope and was removed by suprapubic cystolithotomy. PMID:26982670

  2. Blocked Urethral Valves

    MedlinePLUS

    ... development, there can be abnormal development of the lungs. The severity of posterior urethral valves can vary widely. Most cases are diagnosed before birth with a screening ultrasound. This condition may be suspected in boys if ...

  3. Posterior Surgery Alone in the Treatment of Post-traumatic Kyphosis by Posterior Column Osteotomy, Spondylodesis, Instrumentation, and Vertebroplasty

    PubMed Central

    Hasankhani, Ebrahim Ghayem; Ebrahimzadeh, Mohamed Hosein; Kachooei, Amir Reza; Heidari, Hosein

    2013-01-01

    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. PMID:24353841

  4. Management of traumatic double-level spondyloptosis of the thoracic spine with posterior spondylectomy: case report.

    PubMed

    Rahimizadeh, Abolfazl; Rahimizadeh, Ava

    2015-12-01

    Traumatic spondyloptosis of the thoracic spine is an uncommon injury. In most cases, spondyloptosis is confined to one vertebral body, whereas double-level spondyloptosis is extremely rare. Most patients who sustain traumatic spondyloptosis immediately become paraplegic, but in some cases neurological function is preserved. If this occurs, it is due to detachment of the pedicles from the corresponding vertebral body, resulting in spontaneous decompression of neural elements. Herein, the authors describe a case of undetected traumatic double-level spondyloptosis in the upper thoracic region in an adult male patient who was neurologically intact for 2 days but later became paraplegic. Initially, management of this pathology seemed a very challenging scenario. However, with review of the reconstructed CT images and reproduction of the injury on a plastic model, a posterior-only approach was chosen as an alternative operative solution for this catastrophic injury. Via this single-stage posterior approach, long-segment pedicle screw/rod instrumentation resulted in successful reduction, restoration of alignment, and stabilization after 1-level posterior spondylectomy. To the best of the authors' knowledge, this is the first example reported in the literature of double-level spondyloptosis of the thoracic and the lumbar spine. This report describes the rationale, mechanism, and technical details afforded for reduction and stabilization of this rare injury. PMID:26296192

  5. Judo-related traumatic posterior sternoclavicular joint dislocation in a child.

    PubMed

    Galanis, Nikiforos; Anastasiadis, Prodromos; Grigoropoulou, Foteini; Kirkos, John; Kapetanos, George

    2014-05-01

    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

  6. The spectrum of pelvic fracture urethral injuries and posterior urethroplasty in an Italian high-volume centre, from 1980 to 2013

    PubMed Central

    Barbagli, Guido; Sansalone, Salvatore; Romano, Giuseppe; Lazzeri, Massimo

    2014-01-01

    Objective To describe the emergency and delayed treatment of patients with pelvic fracture urethral injuries (PFUI) presenting to an Italian high-volume centre. Patients and methods In a retrospective, observational study we evaluated the spectrum of PFUI and posterior urethroplasty in an Italian high-volume centre, from 1980 to 2013. Patients requiring emergency treatment for PFUI and delayed treatment for pelvic fracture urethral defects (PFUD) were included. Patients with incomplete clinical records were excluded from the study. Descriptive statistical methods were applied. Results In all, 159 male patients (median age 35years) were included in the study. A traffic accident was the most frequent (42.8%) cause of PFUI, and accidents at work were reported as the cause of trauma in 34% of patients. Agricultural accidents decreased from 24.4% to 6.2% over the course of the survey. A suprapubic cystostomy was the most frequent (49%) emergency treatment in patients with PFUI. The use of surgical realignment decreased from 31.7% to 6.2%, and endoscopic realignment increased from 9.7% to 35.3%. A bulbo-prostatic anastomosis was the most frequent (62.9%) delayed treatment in patients with PFUD. The use of the Badenoch pull-through decreased from 19.5% to 2.6%, and endoscopic holmium laser urethrotomy increased from 4.9% to 32.7%. Conclusions The spectrum of PFUI and subsequent treatment of PFUD has changed greatly over the last 10years at our centre. These changes involved patient age, aetiology, emergency and delayed treatments, and were found to be related to changes in the economy and lifestyle of the Italian patients. PMID:26019976

  7. TRAUMATIC POSTERIOR DISLOCATION OF THE HIP IN CHILDREN:REPORT ON FIVE CASES

    PubMed Central

    Brandão, Gilberto Francisco; Américo, Luiz Renato Drumond; Soares, Cláudio Beling Gonçalves; Faria, Rodrigo Galinari Costa; Teixeira, Luiz Eduardo Moreira

    2015-01-01

    Objective: To evaluate a series of cases of traumatic posterior dislocations in children, with the treatment and results, and to review issues relating to the epidemiology, clinical and radiographic diagnosis, treatment, complications and prognosis of such cases. Methods: Five patients with traumatic hip dislocation, with a mean age of 4.6 ± 0.9 years and a follow-up period of 19.8 ± 7.0 months, were evaluated retrospectively. The time elapsed between dislocation and reduction, the type of treatment, the associated injuries and the subsequent complications were evaluated. Results: The initial treatment was closed reduction, which was performed on average 5.2 ± 3.6 hours after the initial trauma. All the patients underwent the reduction under anesthesia. The complementary treatment included plaster cast immobilization and traction. No need for additional surgery was observed and there were no long-term side effects. Conclusion: Traumatic dislocation of the hip should be treated quickly by means of closed reduction, with appropriate control over the reduction and rigorous observation in order to diagnose and treat late complications.

  8. Primary urethral tuberculosis masquerading as a urethral caruncle: a diagnostic curiosity!

    PubMed

    Singh, Iqbal; Hemal, A K

    2002-01-01

    Primary urethral tuberculosis associated with a caruncle is an extremely rare entity and ours is the second such case to be reported. A middle-aged woman presented with symptoms of frequency dysuria syndrome for the last 2 years. Local examination and cystoscopy revealed localized parurethral induration, tenderness and a urethral caruncle with chronic obliterative urethritis. Transvaginal ultrasound revealed a solid lesion arising from the posterior urethral wall. Excision of the caruncle and transurethral resection of the paraurethral mass lesion revealed chronic granulomatous inflammation with chronic urethritis and fibrocollagenous tissue. The literature regarding the genesis of urethral caruncle, the underlying conditions, its differential diagnosis and management has been reviewed. PMID:12549649

  9. Delayed Vertebral Artery Dissection after Posterior Cervical Fusion with Traumatic Cervical Instability: A Case Report

    PubMed Central

    Oh, Chang Hyun; Ji, Gyu Yeul; Hyun, Dongkeun; Kim, Eun Young; Park, Hyeonseon; Jang, A Reum

    2015-01-01

    Vascular injury presented immediately after the penetration, but delayed onset of vascular symptom caused by an embolism or vessel dissection after cervical fusion or traumatic event is extremely rare. We present a case of a 56-year-old woman who underwent an operation for cervical fusion for type II Odontoid process fracture. She presented symptoms of seizure with hemiparesis in 6 days after the operation. Multifocal acute infarction due to an embolism from the left VA (V3 segment) dissection was observed without a definite screw breach the transverse foramen. We hereby reported the instructive case report of delayed onset of vertebral artery dissection after posterior cervical fusion with type II odontoid process fracture patient. When a cervical operation performed in the cervical trauma patient, even if no apparent VA injury occurs before and during the operation, the surgeon must take caution not to risk cerebral infarction because of the delayed VA dissection. PMID:26217387

  10. Posterior Dislocation of Long Head of Biceps Tendon following Traumatic Anterior Shoulder Dislocation: Imaging and Intra-operative Findings

    PubMed Central

    McArthur, Claire; Welsh, Findlay; Campbell, Colin

    2013-01-01

    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. PMID:24421954

  11. Bipolar plasma vaporization using plasma-cutting and plasma-loop electrodes versus cold-knife transurethral incision for the treatment of posterior urethral stricture: a prospective, randomized study

    PubMed Central

    Cai, Wansong; Chen, Zhiyuan; Wen, Liping; Jiang, Xiangxin; Liu, Xiuheng

    2016-01-01

    OBJECTIVE: Evaluate the efficiency and safety of bipolar plasma vaporization using plasma-cutting and plasma-loop electrodes for the treatment of posterior urethral stricture. Compare the outcomes following bipolar plasma vaporization with conventional cold-knife urethrotomy. METHODS: A randomized trial was performed to compare patient outcomes from the bipolar and cold-knife groups. All patients were assessed at 6 and 12 months postoperatively via urethrography and uroflowmetry. At the end of the first postoperative year, ureteroscopy was performed to evaluate the efficacy of the procedure. The mean follow-up time was 13.9 months (range: 12 to 21 months). If re-stenosis was not identified by both urethrography and ureteroscopy, the procedure was considered “successful”. RESULTS: Fifty-three male patients with posterior urethral strictures were selected and randomly divided into two groups: bipolar group (n=27) or cold-knife group (n=26). Patients in the bipolar group experienced a shorter operative time compared to the cold-knife group (23.45±7.64 hours vs 33.45±5.45 hours, respectively). The 12-month postoperative Qmax was faster in the bipolar group than in the cold-knife group (15.54±2.78 ml/sec vs 18.25±2.12 ml/sec, respectively). In the bipolar group, the recurrence-free rate was 81.5% at a mean follow-up time of 13.9 months. In the cold-knife group, the recurrence-free rate was 53.8%. CONCLUSIONS: The application of bipolar plasma-cutting and plasma-loop electrodes for the management of urethral stricture disease is a safe and reliable method that minimizes the morbidity of urethral stricture resection. The advantages include a lower recurrence rate and shorter operative time compared to the cold-knife technique. PMID:26872076

  12. Current management of urethral stricture disease

    PubMed Central

    Smith, Thomas G.

    2016-01-01

    Introduction: Broadly defined, urethral strictures are narrowing of the urethral lumen that is surrounded by corpus spongiosum, i.e., urethral meatus through the bulbar urethra. Urethral stenosis is narrowing of the posterior urethra, i.e., membranous urethra through bladder neck/prostate junction, which is not enveloped by corpus spongiosum. The disease has significant quality of life ramifications because many times younger patients are affected by this compared to many other urological diseases. Methods: A review of the scientific literature concerning urethral stricture, stenosis, treatment, and outcomes was performed using Medline and PubMed (U.S. National Library of Medicine and the National Institutes of Health). Abstracts from scientific meetings were included in this review. Results: There is level 3 evidence regarding the etiology and epidemiology of urethral strictures, stenoses, and pelvic fracture urethral injuries. Outcomes data from literature regarding intervention for urethral stricture are largely limited to level 3 evidence and expert opinion. There is a single level 1 study comparing urethral dilation and direct vision internal urethrotomy. Urethroplasty outcomes data are limited to level 3 case series. Conclusions: Progress is being made toward consistent terminology, and nomenclature which will, in turn, help to standardize treatment within the field of urology. Treatment for urethral stricture and stenosis remains inconsistent between reconstructive and nonreconstructive urologists due to varying treatment algorithms and approaches to disease management. Tissue engineering appears to be future for reconstructive urethral surgery with reports demonstrating feasibility in the use of different tissue substitutes and grafts. PMID:26941491

  13. Congenital giant male anterior urethral diverticulum with calculi

    PubMed Central

    Kamal, Mir Reza; Jindal, Tarun; Sinha, Rajan Kumar; Karmakar, Dilip

    2014-01-01

    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

  14. Urethral injury in laparoscopic-assisted abdominoperineal resection

    PubMed Central

    Stitt, Laurel; Flores, Francisco Avila; Dhalla, Sonny S.

    2015-01-01

    We present a 71-year-old man who underwent laparoscopic-assisted abdominoperineal resection for recurrence of rectal cancer, which was complicated by a urethral injury. Traumatic urinary catheter insertion was ruled out as an alternative etiology. This case highlights the importance of recognizing urethral injury as a possible complication of laparoscopic-assisted abdominoperineal resection surgery.

  15. Giant urethral calculus

    PubMed Central

    Kotkar, Kunal; Thakkar, Ravi; Songra, MC

    2011-01-01

    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. PMID:24950400

  16. Imaging of urethral stricture disease

    PubMed Central

    Maciejewski, Conrad

    2015-01-01

    Accurate imaging of urethral strictures is critical for preoperative staging and planning of reconstruction. The current gold standard, retrograde urethrography (RUG), allows for accurate diagnosis, staging, and delineation of urethral strictures, and remains a cornerstone in the management of urethral stricture disease. In complex situations, the RUG can be combined with voiding cystourethrogram (VCUG) in order to better visualize the posterior urethra or complex distraction defects. Direct visualization of the stricture by cystoscopy, either retrograde or antegrade, can provide additional information as to the location and appearance of stricture, as well as precise location on fluoroscopic imaging. Sonourethrography (SU) is a useful adjunct to allow for three-dimensional assessment of stricture length and location, and can be a useful intraoperative assessment tool, however, its use remains limited to a second-line setting. Cross-sectional imaging in the form of computed tomography (CT) or magnetic resonance urethrography can provide additional three-dimensional information of anatomic structures and their relations, and can serve as a useful adjunct in complex clinical scenarios. PMID:26816803

  17. Familial bulbar urethral strictures

    PubMed Central

    Jindal, Tarun; Pal, Partha; Sinha, Rajan Kumar; Karmakar, Dilip

    2014-01-01

    Strictures are commonly encountered in the urological practice. The most common aetiologies are infection, trauma and iatrogenic events. Familial occurrence of urethral stricture is exceptionally rare. We present a case in which bulbar urethral strictures developed in a father and his two sons. PMID:24591388

  18. Anterior urethral stricture review

    PubMed Central

    Stein, Marshall J.

    2013-01-01

    Male anterior urethral stricture disease is a commonly encountered condition that presents to many urologists. According to a National Practice Survey of Board Certified Urologist in the United States most urologists treat on average 6-20 urethral strictures yearly. Many of those same urologists surveyed treat with repeated dilation or internal urethrotomy, despite continual recurrence of the urethral stricture. In point of fact, the urethroplasty despite its high success rate, is underutilized by many practicing urologists. Roughly half of practicing urologist do not perform urethroplasty in the United States. Clearly, the reconstructive ladder for urethral stricture management that was previously described in the literature may no longer apply in the modern era. The following article reviews the etiology, diagnosis, management and comparisons of treatment options for anterior urethral strictures. PMID:26816721

  19. Epidemiology of urethral strictures

    PubMed Central

    Blaschko, Sarah D.; McAninch, Jack W.; Breyer, Benjamin N.

    2014-01-01

    Urethral stricture disease is relatively common and is associated with a significant financial cost and potentially debilitating outcomes. Understanding urethral stricture epidemiology is important to identify risk factors associated with the etiology or progression of the disease. This understanding may lead to better treatments and preventative measures that could ameliorate disease severity, produce better health outcomes, and reduce expenditures. We performed a comprehensive review of urethral stricture disease based on available published case series, identified gaps in knowledge of this disease, and recommend future directions for research.

  20. Controversies in urethral reconstruction.

    PubMed

    Barbagli, G; Sansalone, S; Romano, G; Lazzeri, M

    2011-09-01

    Urethral strictures are a frequent source of lower urinary tract symptoms in men. Open urethroplasty is regarded as the gold-standard treatment for urethral stricture disease. The treatment for urethral strictures is a continually evolving process and there is renewed controversy over the best approach to take in reconstructing the urethra, since the superiority of one approach over another has not yet been clearly defined. Anterior urethroplasty can be treated, with low morbidity, in an outpatient surgical setting, thus decreasing the impact of urethroplasty. In order to improve outcome in adult patients when the penile shaft is involved, reconstructive urethral surgeons have learned to apply the principles of delicate tissue handling, and the development of minimally invasive techniques. Genital or extra-genital skin has been used as a free graft or harvested as a flap for some time, thanks to its location, hairless skin and durability. Since the early 1990s, the use of oral mucosa was introduced in genital reconstructive surgery and has become popular for urethral reconstructions. Urethral reconstructive surgery is changing rapidly and this change has posed problems for surgeons who see the principles that previously defined their profession becoming obsolete or unworkable. New techniques and new engineered material are a part of our future. PMID:21993323

  1. AB061. Trickier and tips for surgical treatment of complex male urethral fistula

    PubMed Central

    Wang, Kunjie; Li, Hong

    2015-01-01

    The male urethral fistula is the common and difficult complication of the surgical treatments of urethral stricture, hypospadias and prostate disease. Surgical reconstruction remains the mainstay in the management. Sometime the surgical therapy of the male urethral fistula is still a challenge. The key point of the treatment of anterior urethral fistula is using Dartos Fascia flap to overlapping it in one-two layer fashion. For posterior urethra, rectourethral fistula is great challenge. But unfortunately, the rectourethral fistula is becoming increasingly common with earlier diagnosis of prostate cancer, which is amenable to treatment with radical prostatectomy. Surgical approaches for definitive repair include the perineal, transanal, and combined abdominoperineal approaches. Perineal approach is good for rectourethral fistula with posterior urethral stricture. Transanal approach, the York-Mason approach, is good choice for small rectourethral fistula without posterior urethral stricture. We also use a new approach with combine perineal approach with transanal approach for some big rectourethral fistula without posterior urethral stricture. Among the numerous methods for closure of rectourinary fistulae, no single procedure has been proved most efficacious. However, it has become clear that a more aggressive surgical approach is necessary when local tissue integrity is dubious.

  2. Urethral diverticula in women.

    PubMed

    Greenwell, Tamsin J; Spilotros, Marco

    2015-12-01

    Female urethral diverticula are rare, benign epithelium-lined outpouchings of the female urethra. Patients can present with a multitude of symptoms, most commonly urinary incontinence, recurrent UTIs and dyspareunia. These presenting symptoms are often confused with other diagnoses leading to delayed diagnosis or misdiagnosis. Diagnosis and preoperative assessment of bladder function is most accurate using a combination of clinical examination, T2-weighted postvoid MRI and videocystometrography. Best treatment is by vaginal excision, a procedure with a very low recurrence rate and high patient acceptability. Excision also results in high cure rates for associated dyspareunia, UTI and voiding dysfunction. Pre-existing urodynamically proven stress urinary incontinence (USUI) resolves in 50% of patients after excision of the diverticulum with Martius labial fat pad interposition without the need for further treatment. Potential adverse effects after surgery are new-onset USUI, urethrovaginal fistula and urethral stricture. The rate of onset of these potential adverse effects is low and related to the preoperative appearance of the diverticulum on an MRI scan and the complexity of the diverticulum. PMID:26458752

  3. [One-step reconstruction of penile urethral strictures. Indications and techniques].

    PubMed

    Alvarez-Vijande, Ricardo

    2014-01-01

    Penile urethra stenoses generally appear as a sequel after acute (sexually transmitted diseases) or chronic urethritis processes, associated with diseases such as lichen sclerosus or as a consequence of traumatism, iatrogeny and forced distention of the urethral lumen. One third of these lesions may be congenital and they usually present in the youngest patients. When there is indication for surgical urethral reconstruction there are multiple surgical techniques and different tissues. The selection of the best technique depends on the availability of different tissue sources, the knowledge of the various technical options, and being familiar or having personal experience with the surgical techniques. This chapter aims to review the various technical options of more frequent use for urethral lumen reconstruction, to offer the greatest number of resources to solve a medical problem of complex solution. PMID:24531670

  4. Peyronies disease after urethral swab, an unusual complication: a case report

    PubMed Central

    Paulis, Gianni; Barletta, Davide

    2015-01-01

    Urethral swabs are still currently used as a diagnostic tool when urethritis or prostatitis are suspected. Urologists are certainly aware that Peyronies disease may occur after traumatic urethral instrumentation (catheterization, urethrocystoscopy, etc), but onset of Peyronies disease after urethral swab for diagnostic purposes has never been reported in the literature. This paper presents the case of a patient who developed Peyronies disease after a clumsy urethral swab insertion. It is an unusual, and to date unreported, complication which we would like to call attention to. In the case of our patient, the swab had been inserted to a greater depth than normally required and strong pressure had also been applied. During the procedure, the patient experienced severe urethral and penile pain, which was followed by urethrorrhagia, and later penile curvature. The patient was treated conservatively with good results, partly because the disease was still in its active stage and not yet stable. In the light of what we report, when ordering a urethral swab, physicians should always recommend that it be performed at testing centers that follow accurate, rigorous standards. Patients should also be informed that the test they are to undergo consists of a swab being inserted into the urethra for a short distance, not more than 23 cm. PMID:26605209

  5. Urethral diverticulum in females.

    PubMed

    Woodhouse, C R; Flynn, J T; Molland, E A; Blandy, J P

    1980-08-01

    Thirteen cases of urethral diverticulum in females are reported. Symptoms were non-specific. Two cases presented with suppuration in previously undiagnosed diverticula. The most important physical sign was palpation of the sac on vaginal examination. Micturating cystourethrography was the most useful investigation. An association with carcinoma makes excision mandatory and in 10 cases this was performed by a vaginal approach. A laterally based flap incision is described which was used in 7 cases without complication. In one case the diverticulum recurred after 5 years and was removed in the same way. Two cases that presented with suppuration were treated by incision and drainage: in one the diverticulum re-formed and the other case was lost to follow-up. The aetiology of the condition is unknown but we believe, on histological evidence, that it is congenital. PMID:6775728

  6. Urethral stricture after transurethral resection.

    PubMed

    Fuhse, J; Knpper, M

    1984-01-01

    After 101 transurethral resections, iatrogenic postoperative urethral strictures have occurred in 10 cases due to pathologic changes in the bladder and bladder neck. Urethral stricture after transurethral resection (TUR) thus has represented the most common postoperative complication. No morbidity increase of urethral strictures after TUR could be demonstrated in one of the analysed groups. Fifty per cent of the incidence rate of strictures was localized in the pars pendulans urethrae. Factors causing the stricture have been demonstrated, and the incidence rate of strictures was reduced when these factors were taken into consideration. Preference is given either to conservative or surgical therapy depending on the localization of the stricture, even though endoscopic methods are used more frequently now in the treatment of stenoses of the urethra. PMID:6724828

  7. [A clinical study on urethral recurrence observed after cystectomy].

    PubMed

    Yasumoto, R; Asakawa, M; Yoshihara, H; Sakamoto, W; Iseki, T; Nakatani, T; Wada, S; Kishimoto, T; Maekawa, M

    1990-10-01

    A clinical study was made on 108 male patients who underwent cystectomy. The posterior urethra and partial anterior urethra were removed in 47 cases, half of the perpendicular urethra was removed in 13 cases and the anterior urethra up to the fossa navicularis was removed in 48 cases. Out of 60 cases without urethrectomy, urethral recurrence was observed in 13 cases (21.7%), while no recurrence was observed in the cases treated with urethrectomy. The average period of time from cystectomy to urethral recurrence was 24.7 months (11-39 months). Urethral cancer of such early stages as pIa and pIb were found in 3 and 6 cases, respectively. Stage pT2 was found in 4 cases. Grade 1 cancer was found in 3 cases, grade 2, in 5 cases, and 3 in 5 cases. The proximal end of the perpendicular urethra was found to be the most frequent site for recurrence with 11 cases exhibiting recurrence at this location and 2 cases at the mid-portion of the perpendicular urethra. Many cases exhibited multiple recurrence of tumor of visually grayish, velvety and non-papillary type which was histologically all transitional cell carcinoma. Bladder tumor with higher grade tended to cause urethral cancer recurrence with higher grade. Bladder tumors at multiple locations from the trigone to the lateral and posterior walls tended to cause recurrence in the urethra (p less than 0.05). Of all the cases, 10 cases underwent urethrectomy and 2 cases penectomy. 12 cases received chemotherapy and 5 cases radiation therapy as postoperative adjuvant treatments.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:2273704

  8. An unusual urethral foreign body?

    PubMed Central

    Naidu, Krishanth; Chung, Amanda; Mulcahy, Maurice

    2013-01-01

    INTRODUCTION Lower urinary tract foreign body insertions have a low incidence. The motives for insertion of a variety of objects are difficult to comprehend. This case warrants discussion given the great management challenge faced by the oddity and infrequency with which a fork is encountered in the penile urethra. PRESENTATION OF CASE A 70-year-old man presents to the Emergency Department with a bleeding urethral meatus following self-insertion of a fork into the urethra to achieve sexual gratification. Multiple retrieval methods were contemplated with success achieved via forceps traction and copious lubrication. DISCUSSION The presentation of urethral foreign bodies can vary widely, as can the type of object inserted. The most prevalent motivation for self-insertion of urethral foreign bodies is autoerotism. Motivations ought to be explored in light of possible underlying psychological or psychiatric conditions. The most appropriate surgical extraction technique can be guided by physical examination and imaging. Endoscopic removal is often successful, depending on the object's physical attributes and morphology. It is important to arrange appropriate follow-up, as late complications can occur such as urethral strictures. CONCLUSION Psychological and surgical arms encompass the management plan. Foreign body retrieval is determined by its physical attributes and morphology with the aim to minimise urothelial trauma and preserve erectile function. Essentially, endourological extraction serves the primary means of retrieval. Cystourethoscopy is important to diagnose urothelial injuries and to ensure complete removal of foreign bodies following extraction. PMID:24055017

  9. On Demand Urethral Dilatation Versus Intermittent Urethral Dilatation: Results and Complications in Women With Urethral Stricture

    PubMed Central

    Heidari, Fatemeh; Abbaszadeh, Shahin; Ghadian, Alireza; Tehrani Kia, Farahnaz

    2014-01-01

    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. PMID:24783171

  10. Evaluation of healing at urethral anastomotic site by pericatheter retrograde urethrogram in patients with urethral stricture

    PubMed Central

    Solanki, Shailesh; Hussain, Shabbir; Sharma, Deepti B.; Solanki, Fanindra S.; Sharma, Dhananjay

    2014-01-01

    Introduction: Stricture urethra has been always a surgical challenge. Different opinions regarding time require healing at anastomotic site after urethroplasty, so various strategies are there regarding time for post-operative catheter removal. In this study, healing was assessed by pericatheter retrograde urethrogram (PUG) before the catheter removal. Materials and Methods: Prospective study was conducted from January 2006 to December 2009. Twenty eight cases of short-segment urethral stricture (<2 cm) who underwent urethroplasty were included and divided into two groups depending upon etiology; post-traumatic group (road traffic accident/straddle type injury) and iatrogenic stricture group (due to prolong catheterization/after cystoscopy/Faulty Foleys balloon placement). Post-operative PUG was done on 14th post-operative day in all patients for healing assessment. Extravasation of dye on PUG was taken as anastomotic leak. If the patient had not showed extravasation, the catheter was removed. Otherwise it was kept further for next one week and again PUG was done for healing assessment. Results: Extravasation of dye was noted in 4 patients (33%) of iatrogenic group and 14 patients (87.5%) of the post-traumatic group on 14th post-operative day PUG. (P ? 0.05). The decision to remove catheter was depended upon PUG finding and it was safe, no complication was developed in any patient. Conclusion: Iatrogenic strictures have better healing than post-traumatic stricture in the post-operative period. PUG is a safe and simple procedure and can guide about safe removal of catheter in the post-operative period. PMID:25371610

  11. Buccal mucosa graft urethroplasty in a case of urethral amyloidosis presenting with long anterior urethral stricture

    PubMed Central

    Kurbatov, Dmitry; Stojanovic, Borko; Dubskiy, Sergey; Lepetukhin, Alex; Djordjevic, Miroslav L.

    2015-01-01

    Urethral amyloidosis is a rare condition, but clinically relevant because it can mimic urothelial carcinoma. We report a case of localized urethral amyloidosis presenting with a long anterior urethral stricture. We used extensive grafts of buccal mucosa for standard augmentation urethroplasty, with a successful outcome at the 2-year follow-up. PMID:26600896

  12. Male urethral diverticulum having multiple stones.

    PubMed

    Mohanty, D; Garg, Pk; Jain, Bk; Bhatt, S

    2014-03-01

    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. PMID:25031909

  13. Bladder neck incompetence at posterior urethroplasty

    PubMed Central

    Koraitim, Mamdouh M.

    2015-01-01

    The finding of an incompetent bladder neck (BN) at the time of posterior urethroplasty will necessarily exacerbate the already difficult situation. In such cases the aim of the treatment is not only to restore urethral continuity by end-to-end urethral anastomosis, but also to restore the function of the BN to maintain urinary continence. Fortunately, the incidence of incompetence of the BN at posterior urethroplasty is uncommon, usually ?4.5%. It seems that pelvic fracture-related BN injuries, in contrast to urethral injuries which result from a shearing force, are due to direct injury by the sharp edge of the fractured and displaced pubic bone. The risk of injuries to the BN is greater in children, in patients with a fracture involving both superior and inferior pubic rami on the same side, and in those managed initially by primary realignment. An incompetent BN is suspected by finding an open rectangular BN on cystography, and a fixedly open BN on suprapubic cystoscopy. An incompetent BN can be treated either subsequent to or concomitant with the urethral repair, according to whether a perineal or a perineo-abdominal urethroplasty is used, respectively. Several options have been reported to treat pelvic fracture-related BN incompetence, including reconstructing the BN, forming a new sphincter by tubularisation of a rectangular flap of the anterior bladder wall, and mechanical occlusion by an artificial sphincter or collagen injection. Reconstruction of the BN by the Young-Dees-Leadbetter?? procedure probably provides the most successful results. PMID:26019982

  14. Urethral and penile war injuries: The experience from civil violence in Iraq

    PubMed Central

    Al-Azzawi, Issam S.; Koraitim, Mamdouh M.

    2014-01-01

    Objective To determine the incidence, mechanism of injury, wounding pattern and surgical management of urethral and penile injuries sustained in civil violence during the Iraq war. Patients and methods In all, 2800 casualties with penetrating trauma to the abdomen and pelvis were received at the Al-Yarmouk Hospital, Baghdad, from January 2004 to June 2008. Of these casualties 504 (18%) had genitourinary trauma, including 45 (8.9%) with urethral and/or penile injuries. Results Of 45 patients, 29 (64%) were civilians and 16 (36%) were Iraqi military personnel. The injury was caused by an improvised explosive device (IED) in 25 (56%) patients and by individual firearms in 20 (44%). Of the patients, 24 had penile injuries, 15 had an injury to the bulbar urethra and six had an injury to the posterior urethra. Anterior urethral injuries were managed by primary repair, while posterior urethral injuries were managed by primary realignment in five patients and by a suprapubic cystostomy alone in one. An associated injury to major blood vessels was the cause of death in eight of nine patients who died soon after surgery (P < 0.001). Conclusion Urethral and penile injuries were caused by IEDs and individual firearms with a similar frequency. Most of the casualties were civilians and a minority were military personnel. Injuries to the anterior urethra can be managed by primary repair, while injuries to the posterior urethra can be managed by primary realignment. An associated trauma to major blood vessels was the leading cause of death in these casualties. PMID:26019940

  15. The mechanism of continence after posterior urethroplasty

    PubMed Central

    Bagga, Herman S.; Angermeier, Kenneth W.

    2015-01-01

    The standard of care after a pelvic fracture urethral injury is a repair via a one-stage anastomotic posterior urethroplasty using a step-wise perineal approach. The initial injury, immediate postoperative management, and surgical repair can all affect urinary continence in these patients. Proximal continence mechanisms, particularly the bladder neck, are particularly important in maintaining urinary continence in these patients. Patients with bladder neck dysfunction should be counselled about the greater risk of urinary incontinence. PMID:26019981

  16. Urethritis

    MedlinePLUS

    ... are at risk for the following: Bladder infection ( cystitis ) Epididymitis Infection in the testicles ( orchitis ) Prostate infection ( ... are at risk for the following: Bladder infection (cystitis) Cervicitis Pelvic inflammatory disease (PID -- an infection of ...

  17. Management of the Recurrent Male Urethral Stricture.

    PubMed

    Zaid, Uwais B; Lavien, Garjae; Peterson, Andrew C

    2016-04-01

    Urethral stricture disease negatively impacts quality of life and leads to significant urologic pathology including lower urinary tract symptoms, recurrent urinary tract infections, and potentially more severe sequelae such as detrusor dysfunction, renal failure, urethral carcinoma, and Fournier's gangrene. Open urethral reconstruction is considered a durable and definitive treatment for urethral stricture with lifetime success rates ranging from 75-100%; however, strictures do recur up to 10years after surgery. Recurrence rates vary by repair type. There also is no agreed-upon modality for recurrence surveillance, but there are many modalities with varying degrees of invasiveness. Recurrent strictures may be managed endoscopically or via open repair. We review stricture recurrence rates, surveillance modalities, risk factors, and management options. PMID:26902627

  18. [Iatrogenic urethral stenosis. Apropos of 100 cases].

    PubMed

    Boujnah, H; Abid, I; Trabelsi, N; Zmerli, S

    1989-03-01

    Iatrogenic causes of stenosis of urethra appear to be increasing in frequency. 100 cases out of a total of 582 patients being of iatrogenic origin. The principal cause is the use of a urethral catheter. Various therapeutic methods are used, preference being given quite clearly to internal urethrotomy. Prevention is of fundamental importance and is based on the less untimely routine use of urethral catheters, particularly after general surgical operations and in intensive care. PMID:2659605

  19. Urethral Diverticulum Masquerading as Anterior Vaginal Wall Cyst: A Diagnostic Dilemma.

    PubMed

    Kaur, Gurpreet; Jain, Sandhya; Sharma, Abha; Suneja, Amita; Guleria, Kiran

    2015-10-01

    Urethral diverticulum (UD) is a condition in which a variably sized outpouching forms, next to the urethra. Because it connects to the urethra, this outpouching repeatedly gets filled with urine during micturition, thus causing symptoms. In females, it presents as a bulge in anterior vagina, mimicking a vaginal wall cyst. Various aetiologies proposed attributing to urethral diverticulum formation is repeated infection of the periurethral gland, childbirth trauma, iatrogenic and urethral instrumentation. Patients of UD present with non specific irritative lower urinary tract symptoms such as increased frequency, urgency and dysuria; symptoms may not correlate with the size of the diverticulum. Recurrent cystitis or urinary tract infection is seen in one-third of patients. Pain, hematuria, post-void dribbling, dyspareunia, urinary retention or incontinence is other symptoms. In some cases, there may be associated urethral calculi or carcinoma. Magnetic resonance imaging (MRI) is highly sensitive and specific for the diagnosis of UD, although non invasive sonography may be the first line investigation. Treatment is by transvaginal diverticulectomy or marsupialization. A 60-year-old P9L6 postmenopausal lady, presented with a tender, hard suburethral anterior vaginal wall mass. Cystourethroscopy revealed a small opening in posterior urethra, with stone visible through it. With the final diagnosis of suburethral diverticulum with retained multiple calculi, excision of the diverticulum and repair of urethra was done vaginally. Correct evaluation and treatment of this condition can lead to avoidance of urinary tract injury. PMID:26557574

  20. Urethral Diverticulum Masquerading as Anterior Vaginal Wall Cyst: A Diagnostic Dilemma

    PubMed Central

    Kaur, Gurpreet; Sharma, Abha; Suneja, Amita; Guleria, Kiran

    2015-01-01

    Urethral diverticulum (UD) is a condition in which a variably sized outpouching forms, next to the urethra. Because it connects to the urethra, this outpouching repeatedly gets filled with urine during micturition, thus causing symptoms. In females, it presents as a bulge in anterior vagina, mimicking a vaginal wall cyst. Various aetiologies proposed attributing to urethral diverticulum formation is repeated infection of the periurethral gland, childbirth trauma, iatrogenic and urethral instrumentation. Patients of UD present with non specific irritative lower urinary tract symptoms such as increased frequency, urgency and dysuria; symptoms may not correlate with the size of the diverticulum. Recurrent cystitis or urinary tract infection is seen in one-third of patients. Pain, hematuria, post-void dribbling, dyspareunia, urinary retention or incontinence is other symptoms. In some cases, there may be associated urethral calculi or carcinoma. Magnetic resonance imaging (MRI) is highly sensitive and specific for the diagnosis of UD, although non invasive sonography may be the first line investigation. Treatment is by transvaginal diverticulectomy or marsupialization. A 60-year-old P9L6 postmenopausal lady, presented with a tender, hard suburethral anterior vaginal wall mass. Cystourethroscopy revealed a small opening in posterior urethra, with stone visible through it. With the final diagnosis of suburethral diverticulum with retained multiple calculi, excision of the diverticulum and repair of urethra was done vaginally. Correct evaluation and treatment of this condition can lead to avoidance of urinary tract injury. PMID:26557574

  1. Male urethral strictures and their management

    PubMed Central

    Hampson, Lindsay A.; McAninch, Jack W.; Breyer, Benjamin N.

    2014-01-01

    Male urethral stricture disease is prevalent and has a substantial impact on quality of life and health-care costs. Management of urethral strictures is complex and depends on the characteristics of the stricture. Data show that there is no difference between urethral dilation and internal urethrotomy in terms of long-term outcomes; success rates range widely from 880%, with long-term success rates of 2030%. For both of these procedures, the risk of recurrence is greater for men with longer strictures, penile urethral strictures, multiple strictures, presence of infection, or history of prior procedures. Analysis has shown that repeated use of urethrotomy is not clinically effective or cost-effective in these patients. Long-term success rates are higher for surgical reconstruction with urethroplasty, with most studies showing success rates of 8590%. Many techniques have been utilized for urethroplasty, depending on the location, length, and character of the stricture. Successful management of urethral strictures requires detailed knowledge of anatomy, pathophysiology, proper patient selection, and reconstructive techniques. PMID:24346008

  2. 21 CFR 876.4590 - Interlocking urethral sound.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Interlocking urethral sound. 876.4590 Section 876...) MEDICAL DEVICES GASTROENTEROLOGY-UROLOGY DEVICES Surgical Devices 876.4590 Interlocking urethral sound. (a) Identification. An interlocking urethral sound is a device that consists of two metal...

  3. 21 CFR 876.4590 - Interlocking urethral sound.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Interlocking urethral sound. 876.4590 Section 876...) MEDICAL DEVICES GASTROENTEROLOGY-UROLOGY DEVICES Surgical Devices 876.4590 Interlocking urethral sound. (a) Identification. An interlocking urethral sound is a device that consists of two metal...

  4. 21 CFR 876.4590 - Interlocking urethral sound.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Interlocking urethral sound. 876.4590 Section 876...) MEDICAL DEVICES GASTROENTEROLOGY-UROLOGY DEVICES Surgical Devices 876.4590 Interlocking urethral sound. (a) Identification. An interlocking urethral sound is a device that consists of two metal...

  5. 21 CFR 876.4590 - Interlocking urethral sound.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Interlocking urethral sound. 876.4590 Section 876...) MEDICAL DEVICES GASTROENTEROLOGY-UROLOGY DEVICES Surgical Devices 876.4590 Interlocking urethral sound. (a) Identification. An interlocking urethral sound is a device that consists of two metal...

  6. 21 CFR 876.4590 - Interlocking urethral sound.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Interlocking urethral sound. 876.4590 Section 876...) MEDICAL DEVICES GASTROENTEROLOGY-UROLOGY DEVICES Surgical Devices 876.4590 Interlocking urethral sound. (a) Identification. An interlocking urethral sound is a device that consists of two metal...

  7. Urethral Stone Disease Leading to Retention After Hair-bearing Neophalloplasty

    PubMed Central

    Viviano, Robert; Morganstern, Bradley A.; O'Toole, Adam

    2014-01-01

    A 35-year-old male patient with a past history of traumatic penile amputation and subsequent penile reconstruction with a radial artery free flap phalloplasty presented to the urology clinic for urinary retention and complaint of a firm penile mass. The patient had been lost to follow-up for 2 years before this presentation. Patient had a suprapubic tube in place from initial surgery, with imaging showing 2 large uroliths encrusted around the end. Urethral stricture was suspected in the patient. On cystoscopy, an additional obstructing urolith was found in penile urethra, appearing to have formed in situ.

  8. Primary Urethral Clear-Cell Adenocarcinoma

    PubMed Central

    Mehra, Rohit; Vats, Pankaj; Kalyana-Sundaram, Shanker; Udager, Aaron M.; Roh, Michael; Alva, Ajjai; Pan, Jincheng; Lonigro, Robert J.; Siddiqui, Javed; Weizer, Alon; Lee, Cheryl; Cao, Xuhong; Wu, Yi-Mi; Robinson, Dan R.; Dhanasekaran, Saravana M.; Chinnaiyan, Arul M.

    2014-01-01

    Primary clear-cell adenocarcinoma of the urethra, a rare tumor that histomorphologically resembles clear-cell carcinoma of the female genital tract, occurs predominantly in women and is associated with a relatively poor prognosis. The histogenesis of this rare urethral neoplasm has not been completely resolved, but it is thought to arise from either mllerian rests or metaplastic urothelium. Herein, we present comprehensive surgical pathological and cytopathological findings from a patient with primary urethral clear-cell adenocarcinoma and describe next-generation sequencing results for this patient's unique tumorthe first such reported characterization of molecular aberrations in urethral clear-cell adenocarcinoma at the transcriptomic and genomic levels. Transcriptome analysis revealed novel gene fusion candidates, including ANKRD28-FNDC3B. Whole-exome analysis demonstrated focal copy number loss at the SMAD4 and ARID2 loci and 38 somatic mutations, including a truncating mutation in ATM and a novel nonsynonymous mutation in ALK. PMID:24389164

  9. Infection-induced urethral defect treated by urethral reconstruction with a radial forearm flap.

    PubMed

    Kanno, Toru; Shibasaki, Noboru; Ito, Masaaki; Tsuji, Yutaka; Taki, Yoji; Takeuchi, Hideo; Mihara, Hiroya; Ikeda, Mika; Yoshimoto, Yuji

    2005-02-01

    Abstract A 47-year-old man was admitted with the chief complaint of a urethral defect. An approximately 17-cm defect of the urethra seemed to have been occurred by the infection of implanted foreign bodies in the penile skin. Reconstruction of the urethra and the ventral skin was performed with a free radial forearm flap. A fistula formed at the proximal anastomosis after the operation, but was controlled conservatively. Urethral stricture at the proximal anastomosis subsequently developed. A urethral stent made of shape memory alloy was placed with the preservation of voiding function. PMID:15733125

  10. Optical urethrotomy under local urethral anaesthesia.

    PubMed

    Greenland, J E; Lynch, T H; Wallace, D M

    1991-04-01

    A series of 46 patients underwent 76 optical urethrotomies under local urethral anaesthesia in the out-patient clinic; in 70% of patients the strictures were controlled by local anaesthetic urethrotomy alone; 61% felt either no pain or mild pain during the procedure; 72% expressed a preference for local anaesthesia should the procedure have to be repeated and 82% were happy with the result of their treatment. Optical urethrotomy under local urethral anaesthesia produces results comparable to those reported by others using general anaesthesia. If large numbers of patients are to be treated, possibly repeatedly, then out-patient urethrotomy may result in more efficient use of resources. PMID:2032078

  11. Innovative approaches for complex penile urethral strictures

    PubMed Central

    Siegel, Jordan; Tausch, Timothy J.; Simhan, Jay

    2014-01-01

    Urethral strictures are a common urologic disease that arises from varied etiologies. These strictures range in severity from simple, short lesions to complex, long defects. Likewise, the management approach varies based on the complexity of the lesion. We reviewed the literature of urethral stricture disease and its management. In particular we have focused on complex strictures of the male penile urethra. Often these cases cannot be managed with traditional reconstructive techniques and require newer approaches. Furthermore tissue engineered graft materials provide a possible tissue source for future reconstructive endeavors. PMID:26816766

  12. Urethral erosion of transobturator male sling.

    PubMed

    Harris, Stephanie E; Guralnick, Michael L; O'Connor, R Corey

    2009-02-01

    The transobturator male sling has been introduced as an alternative to other surgical methods for the treatment of mild to moderate postprostatectomy stress urinary incontinence. We report the first published case of mesh erosion into the urethra observed 5 months after placement. The patient was treated with suprapubic tube urinary diversion, suburethral sling explantation, and buccal mucosal grafting of the urethral defect. PMID:18400275

  13. Management of radiation-induced urethral strictures

    PubMed Central

    Hofer, Matthias D.

    2015-01-01

    Radiation as a treatment option for prostate cancer has been chosen by many patients. One of the side effects encountered are radiation-induced urethral strictures which occur in up to 11% of patients. Radiation damage has often left the irradiated field fibrotic and with poor vascularization which make these strictures a challenging entity to treat. The mainstay of urologic management remains an urethroplasty procedure for which several approaches exist with variable optimal indication. Excision and primary anastomoses are ideal for shorter bulbar strictures that comprise the majority of radiation-induced urethral strictures. One advantage of this technique is that it does not require tissue transfers and success rates of 70-95% have consistently been reported. Substitution urethroplasty using remote graft tissue such as buccal mucosa are indicated if the length of the stricture precludes a tension-free primary anastomosis. Despite the challenge of graft survival in radiation-damaged and poorly vascularized recipient tissue, up to 83% of patients have been treated successfully although the numbers described in the literature are small. The most extensive repairs involve the use of tissue flaps, for example gracilis muscle, which may be required if the involved periurethral tissue is unable to provide sufficient vascular support for a post-operative urethral healing process. In summary, radiation-induced urethral strictures are a challenging entity. Most strictures are amenable to excision and primary anastomosis (EPA) with encouraging success rates but substitution urethroplasty may be indicated when extensive repair is needed. PMID:26816812

  14. Urethral Reconstruction with Tissue-Engineered Human Amniotic Scaffold in Rabbit Urethral Injury Models

    PubMed Central

    Wang, Fuli; Liu, Tao; Yang, Lijun; Zhang, Geng; Liu, Heliang; Yi, Xiaomin; Yang, Xiaojian; Lin, Tzu-yin; Qin, Weijun; Yuan, Jianlin

    2014-01-01

    Background Mitigating urethral injury remains a great challenge for urologists due to lack of ideal biomaterials for urethroplasty. The application of amniotic membrane (AM) over other synthetic materials makes it a better potential source for urethral reconstruction. We separated the basement layer of AM to obtain denuded human amniotic scaffold (dHAS) and then inoculated primary rabbit urethral epithelial cells on the surface of dHAS to determine whether this strategy minimizes potential rejection and maximizes the biocompatibility of human AM. Material/Methods After the successful acquisition of dHAS from AM, cell-seeded dHAS were prepared and characterized. Both cell-seeded dHAS and acellular dHAS were subcutaneously implanted. Immune responses were compared by histological evaluation and CD4+ cell and CD8+ cell infiltrations. Then they were applied as urethroplastic materials in the rabbit models of urethral injury to fully explore the feasibility and efficacy of tissue-engineered dHAS xenografts in urethral substitution application. Results Mild inflammatory infiltration was observed in cell-seeded dHAS grafts, as revealed by fewer accumulations of CD4+ cells and CD8+ cells (or neutrophils or other immune cells). Urethral defects of rabbits in the urethroplastic group with dHAS implantation (n=6) were completely resolved in 1 month, while there were 1 infection and 1 fistula in the control group with acellular dHAS patches (n=6). Histopathological analysis revealed mild immune response in the cell-seeded dHAS group (P<0.05). Conclusions Tissue-engineered dHAS minimizes potential rejection and maximizes the biocompatibility of AM, which makes it a potential ideal xenograft for urethral reconstruction. PMID:25424000

  15. Management of non-gonococcal urethritis.

    PubMed

    Moi, Harald; Blee, Karla; Horner, Patrick J

    2015-01-01

    Non-gonococcal urethritis (NGU), or inflammation of the urethra, is the most common treatable sexually transmitted syndrome in men, with approximately 20-50 % of cases being due to infection with Chlamydia trachomatis and 10-30 % Mycoplasma genitalium. Other causes are Ureaplasma urealyticum, Trichomonas vaginalis, anaerobes, Herpes simplex virus (HSV) and adenovirus. Up to half of the cases are non-specific. Urethritis is characterized by discharge, dysuria and/or urethral discomfort but may be asymptomatic. The diagnosis of urethritis is confirmed by demonstrating an excess of polymorpho-nuclear leucocytes (PMNLs) in a stained smear. An excess of mononuclear leucocytes in the smear indicates a viral etiology. In patients presenting with symptoms of urethritis, the diagnosis should be confirmed by microscopy of a stained smear, ruling out gonorrhea. Nucleid acid amplifications tests (NAAT) for Neisseria gonorrhoeae, C. trachomatis and for M. genitalium. If viral or protozoan aetiology is suspected, NAAT for HSV, adenovirus and T. vaginalis, if available. If marked symptoms and urethritis is confirmed, syndromic treatment should be given at the first appointment without waiting for the laboratory results. Treatment options are doxycycline 100 mg x 2 for one week or azithromycin 1 gram single dose or 1,5 gram distributed in five days. However, azithromycin as first line treatment without test of cure for M. genitalium and subsequent Moxifloxacin treatment of macrolide resistant strains will select and increase the macrolide resistant strains in the population. If positive for M. genitalium, test of cure samples should be collected no earlier than three weeks after start of treatment. If positive in test of cure, moxifloxacin 400 mg 7-14 days is indicated. Current partner(s) should be tested and treated with the same regimen. They should abstain from intercourse until both have completed treatment. Persistent or recurrent NGU must be confirmed with microscopy. Reinfection and compliance must be considered. Evidence for the following recommendations is limited, and is based on clinical experience and guidelines. If doxycycline was given as first therapy, azithromycin five days plus metronidazole 4-500 mg twice daily for 5-7 days should be given. If azithromycin was prescribed as first therapy, doxycycline 100 mg x 2 for one week plus metronidazole, or moxifloxacin 400 mg orally once daily for 7-14 days should be given. PMID:26220178

  16. New frontiers in urethral reconstruction: injectables and alternative grafts

    PubMed Central

    2015-01-01

    Contemporary management of anterior urethral strictures requires both endoscopic as well as complex substitution urethroplasty, depending on the nature of the urethral stricture. Recent clinical and experimental studies have explored the possibility of augmenting traditional endoscopic urethral stricture management with anti-fibrotic injectable medications. Additionally, although buccal mucosa remains the gold standard graft for substitution urethroplasty, alternative grafts are necessary for reconstructing particularly complex urethral strictures in which there is insufficient buccal mucosa or in cases where it may be contraindicated. This review summarizes the data of the most promising injectable adjuncts to endoscopic stricture management and explores the alternative grafts available for reconstructing the most challenging urethral strictures. Further research is needed to define which injectable medications and alternative grafts may be best suited for urethral reconstruction in the future. PMID:26813260

  17. Distributed pressure sensors for a urethral catheter.

    PubMed

    Ahmadi, Mahdi; Rajamani, Rajesh; Timm, Gerald; Sezen, A S

    2015-08-01

    A flexible strip that incorporates multiple pressure sensors and is capable of being fixed to a urethral catheter is developed. The urethral catheter thus instrumented will be useful for measurement of pressure in a human urethra during urodynamic testing in a clinic. This would help diagnose the causes of urinary incontinence in patients. Capacitive pressure sensors are fabricated on a flexible polyimide-copper substrate using surface micromachining processes and alignment/assembly of the top and bottom portions of the sensor strip. The developed sensor strip is experimentally evaluated in an in vitro test rig using a pressure chamber. The sensor strip is shown to have adequate sensitivity and repeatability. While the calibration factors for the sensors on the strip vary from one sensor to another, even the least sensitive sensor has a resolution better than 0.1 psi. PMID:26738054

  18. Giant lithiasis in a female urethral diverticulum.

    PubMed

    Gmez Gallo, Alvaro; Valdevenito Seplveda, Juan Pablo; San Martn Montes, Marcelo

    2007-02-01

    The formation of gallstones in a urethral diverticulum is a rare clinical entity and is usually seen in males. The case of a 50 year old woman is presented, who consults for hard vaginal mass and dispareunia associated with repeated urinary infections, with radiological images and an interesting photoendoscopic vision of the upper dome of the gallstone. The diverticulum was approached via vaginal way and the local extraction was successful. PMID:16632186

  19. [Female urethral stenosis caused by vulvar dystrophy].

    PubMed

    Romero Prez, P; Schiefenbusch Munne, E; Lobato Encinas, J J; Mira Llinares, A

    1990-05-01

    A rare case of chronic obstructive uropathy from urethral stenosis secondary to valvular dystrophy presenting as complete acute urinary retention preceded by progressive dysuria in a 77-year-old patient is described. Patient age and ultrasound evidence of bilateral hydronephrosis led us to suspect obstructive anuria from a neoplasm. The literature is reviewed, highlighting the role of gynecological disorders in the etiopathogenesis of female obstructive uropathy. PMID:2200351

  20. Multiple urethral anomalies: Parameatal urethral cyst, penile curvature, incomplete hypospadiac anterior duplication of the urethra and distal hipospadias

    PubMed Central

    Tuglu, Devrim; Yuvanç, Ercan; Yılmaz, Erdal; Gur, Serhan; Batislam, Ertan

    2015-01-01

    The male genitourinary system is quite complex. There are numerous known anomalies of the male urethra either as isolated cases or in combination with other disorders. An improved understanding of the embryology and anatomy of the normal male urethral development might help explain the causes of the various urethral abnormalities. We contribute to the etiology of congenital anomalies with this multiple urethral anomalies case. PMID:26029298

  1. The Efficacy of Bulbar Urethral Mobilization for Anastomotic Anterior Urethroplasty in a Case With Recurrent Anterior Urethral Stricture

    PubMed Central

    Fukui, Shinji; Aoki, Katsuya; Kaneko, Yoshiteru; Samma, Shoji; Fujimoto, Kiyohide

    2014-01-01

    A 2-month-old boy was diagnosed with febrile urinary tract infection. Voiding cystourethrography showed bulbar and anterior urethral strictures, and endoscopic internal urethrotomy was performed. He developed febrile urinary tract infection again and revealed the recurrence of the anterior urethral stricture. Consequently, endoscopic internal urethrotomy was performed 4 times. Because the anterior urethral stricture had not improved, he was referred to us. Anterior urethroplasty was performed when he was 5 years. After excision of the scarred portions of the urethra, the defect of the urethra was 20 mm. Transperineal bulbar urethral mobilization was performed, and a single-stage end-to-end anterior urethroplasty without tension could be performed simultaneously.

  2. Gonococcal Conjunctivitis Despite Successful Treatment of Male Urethritis Syndrome.

    PubMed

    Peters, Remco P H; Verweij, Stephan P; McIntyre, James A; Schaftenaar, Erik

    2016-02-01

    We report a case of progressive, cephalosporin-susceptible, Neisseria gonorrhoeae conjunctivitis despite successful treatment of male urethritis syndrome. We hypothesize that conjunctival infection progressed due to insufficient penetration of cefixime and azithromycin and point out that extragenital infection and male urethritis may not be cured simultaneously in settings where the syndromic approach is used. PMID:26760182

  3. Female Urethral Diverticulum Containing a Giant Calculus

    PubMed Central

    Dong, ZhiLong; Wang, Hanzhang; Zuo, LinJun; Hou, MingLi

    2015-01-01

    Abstract Urethral diverticula with calculi have a low incidence as reported in the literature. Diverticulum of female urethra is rare, often discovered due to associated complications. We report a case of diverticulum of the female urethra containing giant calculi in a 62-year-old multiparous woman. She consulted with our office due to dysuria and a hard, painful periurethral mass in the anterior vagina wall. The diverticulum was approached surgically by a vaginal route, and local extraction of the calculi and subsequent diverticulectomy successfully treated the condition. Diagnosis of a complicated diverticulum can be easily achieved if one possesses a high degree of clinical symptoms. PMID:25997056

  4. Treatment of gonorrheal urethritis with spectinomycin hydrochloride

    PubMed Central

    Brown, J.; Tabert, O.; Hanna, J. D.; Rentiers, P. L.

    1974-01-01

    One hundred and eighty-seven males with uncomplicated gonorrheal urethritis were treated with spectinomycin hydrochloride in a dosage of 2 g. given intramuscularly. A failure rate of 3.2% was observed and no complications of therapy were encountered. In addition, 310 strains of N. gonorrhoeae were tested for susceptibility to penicillin G and spectinomycin. All strains were sensitive to 20 μg./ml. of spectinomycin and this susceptibility appeared to decrease as penicillin resistance increased. A greater incidence of relative resistance to penicillin G was observed than in similar studies from other Canadian areas. PMID:4272505

  5. Sacral Neuromodulation Effects on Periurethral Sensation and Urethral Sphincter Activity

    PubMed Central

    Gleason, Jonathan L; Kenton, Kimberly; Greer, W. Jerod; Ramm, Olga; Szychowski, Jeff M.; Wilson, Tracey; Richter, Holly E.

    2013-01-01

    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 6113 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. PMID:23168535

  6. Isolated posterior capsular rupture following blunt head trauma

    PubMed Central

    Mansour, Ahmad M; Jaroudi, Mahmoud O; Hamam, Rola N; Maalouf, Fadi C

    2014-01-01

    Closed-globe traumatic cataract is not uncommon in males in the pediatric age group. However, there is a relative paucity of literature on isolated posterior lens capsule rupture associated with closed-globe traumatic cataract. We report a case of a 6-year-old boy who presented with white cataract 1 day after blunt trauma to the forehead associated with posterior capsular rupture that was detected by B-scan ultrasonography preoperatively. No stigmata of trauma outside the posterior capsule could be detected by slit-lamp exam, funduscopy, and optical coherence tomography. Phacoemulsification with posterior chamber intraocular lens implant was performed 24 hours after trauma, with the patient achieving 6/6 visual acuity 1 week and 6 months after surgery. Our case is unique, being the youngest (amblyogenic age) to be reported, with prompt surgical intervention, and with no signs of trauma outside the posterior capsule. PMID:25506201

  7. Traumatic Grief

    MedlinePLUS

    ... Professionals Resources for Parents and Caregivers Resources for Military Children and Families Resources for Educators Resources for ... Culture and Trauma Definitions References Resources Economic Stress Military and Veteran Families and Children Secondary Traumatic Stress ...

  8. Amputation - traumatic

    MedlinePLUS

    ... accidents, or from motor vehicle accidents. Natural disasters, war, and terrorist attacks can also cause traumatic amputations. ... bag and place the bag in an ice water bath. Do NOT directly put the body part ...

  9. Pars plana vitrectomy with posterior iris claw implantation for posteriorly dislocated nucleus and intraocular lens

    PubMed Central

    Patil, Kishor B; Meleth, Padmanabhan; Prabhu, Shanker M

    2011-01-01

    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. PMID:22011497

  10. Evaluating efficacy of various operative procedures done in anterior urethral stricture using urethral stricture score

    PubMed Central

    Mathur, Rajkumar; Patil, Lukesh A.; Khan, Fareed

    2016-01-01

    Context: Scoring systems have been an important tool of clinical decision making in medicine. As scoring systems like Glasgow Coma scale have made a revolutionary change in stratifying the patient, in particular, clinical scenario. Wiegand et al. in 2012 proposed UREThRAL Score a novel method to quantify anterior urethral stricture. Aims: The aim was to validate urethral stricture score (USS) for evaluating the efficacy of operative procedures. Settings and Design: Study was done in a retrospective manner and includes patients operated for anterior urethral stricture by a single surgeon in tertiary care center over the period of 20082014. Subjects and Methods: A total of 57 cases were included in this study who met the inclusion criteria, of these cases 7 underwent excision and primary anastomosis (EPA), 20 underwent preputial flap urethroplasty (PFUP), 22 underwent tunica albuginea urethroplasty (TAU), and rest 8 underwent scrotal flap urethroplasty (SFUP). Procedures were assigned different complexity level, and USS was compared with the particular procedure to see the relation between both. Statistical Analysis Used: Data were analyzed using ANOVA on SPSS software. Results: Mean USS for EPA, PFUP, TAU, and SFUP in our study group was found to be 6.57, 8.95, 9.00, and 10.00, respectively, with an overall USS of 9.03, with a standard deviation of 1.56. USS was significantly associated with complexity. Conclusions: Mean USS increased with increase in surgical complexity indicating that higher USS correlates with more complex surgery. Strongest association between complexity and the individual parameter was found with location and length. PMID:26834400

  11. Post-traumatic spinal deformity.

    PubMed

    Vaccaro, A R; Silber, J S

    2001-12-15

    There are approximately 50,000 fractures to the bony spinal column each year in the United States. The vast majority of unstable spinal injuries are recognized early and managed appropriately. Rarely, the initial treatment may have been inadequate, or in less obvious injuries, less aggressive immobilization techniques may have been chosen. This along with continued exposure to physiologic stresses may lead to a gradual post-traumatic deformity that may further impede the functional as well as emotional status of these often already compromised patients. The management of post-traumatic deformity can be extremely challenging. A post-traumatic kyphotic deformity may occur in the cervical, thoracic, thoracolumbar, or lumbar spine, and once appropriate imaging studies are obtained, careful surgical considerations must be undertaken. Surgical intervention is considered if the kyphotic deformity is progressive over time or there is new onset or progression of a neurologic deficit. Surgical procedures include either a posterior or anterior only approach or any variation of a combined anterior or posterior procedure. In most cases a posterior only fusion is often insufficient for optimal correction and stabilization. Although the majority of patients developing a post-traumatic deformity usually occur after spinal column trauma initially treated nonoperatively, several miscellaneous causes of post-traumatic deformity may occur after surgery. These include nonunion, implant failure, Charcot spine, and technical error. The overall outcome after the surgical management of post-traumatic deformity has been satisfactory with better outcomes in the patients treated earlier as opposed to later. Operative complications include the increased risk of neurologic injury because of the draping of the neural elements over the anterior vertebral elements, any pre-existing spinal cord injury, and possible scarring with cord tethering. Trauma to the spinal cord and column is a devastating injury that may be fraught with many complications including post-traumatic deformity. Certainly, the best treatment is prevention with close follow-up and early intervention when needed. Once present, the treatment of post-traumatic deformity follows basic biomechanical principles consisting of re-establishing the integrity of the compromised spinal columns so that spinal stability can be restored. PMID:11805617

  12. Poor Quality of Life in Patients with Urethral Stricture Treated with Intermittent Self-Dilation

    PubMed Central

    Lubahn, Jessica D.; Zhao, Lee C.; Scott, J. Francis; Hudak, Steven J.; Chee, Justin; Terlecki, Ryan; Breyer, Benjamin; Morey, Allen F.

    2014-01-01

    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. PMID:23820057

  13. Transperineal ultrasonography in stress urinary incontinence: The significance of urethral rotation angles

    PubMed Central

    Al-Saadi, Wasan Ismail

    2015-01-01

    Objective To assess, using transperineal ultrasonography (TPUS), the numerical value of the rotation of the bladder neck [represented by the difference in the anterior (α angle) and posterior urethral angles (β angle)] at rest and straining, in continent women and women with stress urinary incontinence (SUI), to ascertain if there are significant differences in the angles of rotation (Rα and Rβ) between the groups. Patients, subjects and methods In all, 30 women with SUI (SUI group) and 30 continent women (control group) were included. TPUS was performed at rest and straining (Valsalva manoeuver), and the threshold value for the urethral angles (α and β angles) for each group were estimated. The degree of rotation for each angle was calculated and was considered as the angle of rotation. Results Both the α and β angles were significantly different between the groups at rest and straining, and there was a significant difference in the mean increment in the value of each angle. Higher values of increment (higher rotation angles) were reported in the SUI group for both the α and β angles compared with those of the control group [mean (SD) Rα SUI group 19.43 (12.76) vs controls 10.53 (2.98) °; Rβ SUI group 28.30 (12.96) vs controls 16.33 (10.8) °; P < 0.001]. Conclusion Urethral rotation angles may assist in the assessment and diagnosis of patients with SUI, which may in turn reduce the need for more sophisticated urodynamic studies. PMID:26966596

  14. Management of advanced primary urethral carcinomas.

    PubMed

    Dayyani, Farshid; Hoffman, Karen; Eifel, Patricia; Guo, Charles; Vikram, Raghu; Pagliaro, Lance C; Pettaway, Curtis

    2014-07-01

    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 defıning 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

  15. Urethral cavernous hemangioma in a female patient: a rare entity

    PubMed Central

    Bolat, Mustafa Suat; Yüzüncü, Kubilay; Akdeniz, Ekrem; Demirdoven, Ayse Nurten

    2015-01-01

    Genitourinary hemangiomas are rare entities of the urinary system. We reported a female patient who suffered dyspareunia and intermitant hematuria that was proved as urethral cavernous hemangioma. Despite its benign nature, hemangiomas may recur due to incomplet excision.

  16. [Urogenital bleeding revealing urethral prolapse in a prepubertal girl].

    PubMed

    Ballouhey, Q; Abbo, O; Sanson, S; Cochet, T; Galinier, P; Pienkowski, C

    2013-06-01

    Urethral prolapse is a complete eversion of the distal urethral mucosa through the external meatus. It occurs primarily in prepubertal, primarly Black girls. Its pathophysiology has not been clearly identified. We report a case of a 5-year-old girl who came to the Emergency Department with a 1-day history of genital pain and "vaginal bleeding". Early recognition makes differential diagnosis with sexual abuse and staging allows prompt management under general anesthesic like prolapse reduction or surgical excision. PMID:23731697

  17. Anterior corpectomy via the mini-open, extreme lateral, transpsoas approach combined with short-segment posterior fixation for single-level traumatic lumbar burst fractures: analysis of health-related quality of life outcomes and patient satisfaction.

    PubMed

    Theologis, Alexander A; Tabaraee, Ehsan; Toogood, Paul; Kennedy, Abbey; Birk, Harjus; McClellan, R Trigg; Pekmezci, Murat

    2016-01-01

    OBJECT The authors present clinical outcome data and satisfaction of patients who underwent minimally invasive vertebral body corpectomy and cage placement via a mini-open, extreme lateral, transpsoas approach and posterior short-segment instrumentation for lumbar burst fractures. METHODS Patients with unstable lumbar burst fractures who underwent corpectomy and anterior column reconstruction via a mini-open, extreme lateral, transpsoas approach with short-segment posterior fixation were reviewed retrospectively. Demographic information, operative parameters, perioperative radiographic measurements, and complications were analyzed. Patient-reported outcome instruments (Oswestry Disability Index [ODI], 12-Item Short Form Health Survey [SF-12]) and an anterior scar-specific patient satisfaction questionnaire were recorded at the latest follow-up. RESULTS Twelve patients (7 men, 5 women, average age 42 years, range 22-68 years) met the inclusion criteria. Lumbar corpectomies with anterior column support were performed (L-1, n = 8; L-2, n = 2; L-3, n = 2) and supplemented with short-segment posterior instrumentation (4 open, 8 percutaneous). Four patients had preoperative neurological deficits, all of which improved after surgery. No new neurological complications were noted. The anterior incision on average was 6.4 cm (range 5-8 cm) in length, caused mild pain and disability, and was aesthetically acceptable to the large majority of patients. Three patients required chest tube placement for pleural violation, and 1 patient required reoperation for cage subsidence/hardware failure. Average clinical follow-up was 38 months (range 16-68 months), and average radiographic follow-up was 37 months (range 6-68 months). Preoperative lumbar lordosis and focal lordosis were significantly improved/maintained after surgery. Patients were satisfied with their outcomes, had minimal/moderate disability (average ODI score 20, range 0-52), and had good physical (SF-12 physical component score 41.7% 10.4%) and mental health outcomes (SF-12 mental component score 50.2% 11.6%) after surgery. CONCLUSIONS Anterior corpectomy and cage placement via a mini-open, extreme lateral, transpsoas approach supplemented by short-segment posterior instrumentation is a safe, effective alternative to conventional approaches in the treatment of single-level unstable burst fractures and is associated with excellent functional outcomes and patient satisfaction. PMID:26431072

  18. Treatment of Overactive Bladder Syndrome with Urethral Calibration in Women

    PubMed Central

    Sato, Renee L; Matsuura, Grace HK; Wei, David C; Chen, John J

    2013-01-01

    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. PMID:24167769

  19. Dorsal onlay vaginal graft urethroplasty for female urethral stricture

    PubMed Central

    Singh, Manmeet; Kapoor, Rakesh; Kapoor, Deepa; Kapoor, Rohit; Srivastav, Alok; Chipde, Saurabh

    2013-01-01

    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. PMID:23956514

  20. In-vivo laser induced urethral stricture animal model for investigating the potential of LDR-brachytherapy

    NASA Astrophysics Data System (ADS)

    Sroka, Ronald; Lellig, Katja; Bader, Markus; Stief, Christian; Weidlich, Patrick; Wechsel, G.; Assmann, Walter; Becker, R.; Fedorova, O.; Khoder, Wael

    2015-02-01

    Purpose: Treatment of urethral strictures is a major challenge in urology. For investigation of different treatment methods an animal model was developed by reproducible induction of urethral strictures in rabbits to mimic the human clinical situation. By means of this model the potential of endoluminal LDR brachytherapy using β-irradiation as prophylaxis of recurrent urethral strictures investigated. Material and Methods: A circumferential urethral stricture was induced by energy deposition using laser light application (wavelength λ=1470 nm, 10 W, 10 s, applied energy 100 J) in the posterior urethra of anaesthetized New Zealand White male rabbits. The radial light emitting fiber was introduced by means of a children resectoscope (14F). The grade of urethral stricture was evaluated in 18 rabbits using videourethroscopy and urethrography at day 28 after stricture induction. An innovative catheter was developed based on a β-irradiation emitting foil containing 32P, which was wrapped around the application system. Two main groups (each n=18) were separated. The "internal urethrotomy group" received after 28days of stricture induction immediately after surgical urethrotomy of the stricture the radioactive catheter for one week in a randomized, controlled and blinded manner. There were 3 subgroups with 6 animals each receiving 0 Gy, 15 Gy and 30 Gy. In contrast animals from the "De Nuovo group" received directly after the stricture induction (day 0) the radioactive catheter also for the duration of one week divided into the same dose subgroups. In order to determine the radiation tolerance of the urethral mucosa, additional animals without any stricture induction received a radioactive catheter applying a total dose of 30 Gy (n=2) and 15 Gy (n=1). Cystourethrography and endoscopic examination of urethra were performed on all operation days for monitoring treatment progress. Based on these investigation a classification of the stricture size was performed and documented for correlation. At further 28 days after catheter removal the animals were euthanasized and the urethra tissue was harvested. Histological examination of tissue with assessment of radiation damage, fibrotic and inflammatory changes were performed. After deblinding histological finding were correlated with the applied dose. Results: All animals developed a stricture, while 15/18 (83,3%) showed a significant, high grade stricture with more than 90% lumen narrowing. Histopathological examination including evaluation of urethral inflammation, fibrosis and collagen content were investigated in additional 6 rabbits confirming the former findings. No rabbits died prematurely during the study. The experiments showed that the procedure of the application of radioactive catheter was safe without any problems in contamination and protection handling. The combination of internal urethrotomy and LDR-brachytherapy results in a stricture free rate of 66.7% in the 15-Gy group, compared with only 33.3% among animals from the 0- and 30-Gy groups. Furthermore histological classification of inflammation and fibrosis of 0 Gy and 15 Gy showed similar extent. Conclusion: This new method of laser induced urethral stricture was very efficient and showed a high reproducibility, thus being useful for studying stenosis treatments. The experiments showed that application of local β-irradiation by means of radioactive catheters modulated the stenosis development. This kind of LDR-brachytherapy shows potential for prophylaxis of urethral stricture. As this was an animal pilot experiment a clinical dose response study is needed.

  1. Traumatic injury of the bladder and urethra

    MedlinePLUS

    ... urethra; Bruised bladder; Urethral injury; Bladder injury; Pelvic fracture; Urethral disruption ... bladder wall. Less than 1 in 10 pelvic fractures lead to bladder injury. Other causes of bladder ...

  2. Urethroplasty using autologous urethral tissue-embedded acellular porcine bladder submucosa matrix grafts for the management of long-segment urethral stricture in a rabbit model.

    PubMed

    Chun, So Young; Kim, Bum Soo; Kwon, Se Yun; Park, Sung Il; Song, Phil Hyun; Yoo, Eun Sang; Kim, Bup Wan; Kwon, Tae Gyun; Kim, Hyun Tae

    2015-03-01

    We conducted this study to evaluate the combined effect of acellular bladder submucosa matrix (BSM) and autologous urethral tissue for the treatment of long segment urethral stricture in a rabbit model. To prepare the BSM, porcine bladder submucosa was processed, decellularized, configured into a sheet-like shape, and sterilized. Twenty rabbits were randomized to normal control, urethral stricture, urethroplasty using BSM only or BSM/autologous urethral tissue (n=5 per group). Retrograde urethrography was performed at 4, 8, and 12 weeks postoperatively, and the grafted specimens were harvested at week 12 to evaluate urethral reconstruction through histopathologic and immunohistochemical analysis. The mean urethral width of the control, stricture, BSM, and BSM/autologous urethral tissue groups at week 12 was 10.30.80, 3.81.35, 8.80.84, and 9.11.14 mm, respectively. The histopathologic study revealed that the BSM/autologous urethral tissue graft had a normal area of urethral lumen, compact muscular layers, complete epithelialization, and progressive infiltration by vessels in the regenerated urethra. In contrast, the BSM grafts revealed keratinized epithelium, abundant collagenized fibrous connective tissue, and were devoid of bundles of circular smooth muscle. Nontransected ventral onlay-augmented urethroplasty using an acellular BSM scaffold combined with an autologous urethral tissue graft represents a feasible procedure for urethral reconstruction. PMID:25729254

  3. Determination of urethral catheter surface lubricity.

    PubMed

    Kazmierska, Katarzyna; Szwast, Maciej; Ciach, Tomasz

    2008-06-01

    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

  4. Necrotizing Urethritis due to Aerococcus urinae.

    PubMed

    Babaeer, Abdulrahman A; Nader, Claudia; Iacoviello, Vito; Tomera, Kevin

    2015-01-01

    A 49-year-old male presented to the emergency with hematuria and pain in the shaft of the penis for one day. The patient was found to be in a state of shock. The shaft of the penis and the scrotum were swollen and tender. No skin necrosis was observed and no crepitus was palpable. Serum white count (WBC) was 29.5 10(3)/?L. A CT scan showed gas in the corpus spongiosum. Antibiotics were started with IV metronidazole, vancomycin, and piperacillin/tazobactam. Metronidazole was then replaced by clindamycin. Exploration was performed but no necrotic tissue was identified. Cystourethroscopy revealed dusky looking urethra. A suprapubic tube and a urethral catheter were placed in the bladder. WBC trended down to 13.9 10(3)/?L on the fourth postoperative day. Urine culture grew Aerococcus urinae and blood cultures grew Alpha Hemolytic Streptococcus. On the sixth day, the patient was feeling worse and WBC increased. MRI revealed absent blood flow to the corpus spongiosum. Urethroscopy revealed necrosis of the urethra. Urethrectomy was performed via perineal approach. The patient immediately improved. The patient was discharged on the sixth postoperative day to continue ampicillin/sulbactam IV every 6 hours for a total of 4 weeks from the day of urethrectomy. PMID:26171271

  5. Necrotizing Urethritis due to Aerococcus urinae

    PubMed Central

    Babaeer, Abdulrahman A.; Nader, Claudia; Iacoviello, Vito; Tomera, Kevin

    2015-01-01

    A 49-year-old male presented to the emergency with hematuria and pain in the shaft of the penis for one day. The patient was found to be in a state of shock. The shaft of the penis and the scrotum were swollen and tender. No skin necrosis was observed and no crepitus was palpable. Serum white count (WBC) was 29.5 103/?L. A CT scan showed gas in the corpus spongiosum. Antibiotics were started with IV metronidazole, vancomycin, and piperacillin/tazobactam. Metronidazole was then replaced by clindamycin. Exploration was performed but no necrotic tissue was identified. Cystourethroscopy revealed dusky looking urethra. A suprapubic tube and a urethral catheter were placed in the bladder. WBC trended down to 13.9 103/?L on the fourth postoperative day. Urine culture grew Aerococcus urinae and blood cultures grew Alpha Hemolytic Streptococcus. On the sixth day, the patient was feeling worse and WBC increased. MRI revealed absent blood flow to the corpus spongiosum. Urethroscopy revealed necrosis of the urethra. Urethrectomy was performed via perineal approach. The patient immediately improved. The patient was discharged on the sixth postoperative day to continue ampicillin/sulbactam IV every 6 hours for a total of 4 weeks from the day of urethrectomy. PMID:26171271

  6. Transurethral holmium laser vaporization to the urethral tumour through a ureteroscope

    PubMed Central

    Li, Aihua; Fang, Wei; Zuo, Xiaoming; Zhang, Feng; Li, Weiwu; Lu, Honghai; Liu, Sikuan; Wang, Hui; Zhang, Binghui

    2014-01-01

    We present 2 cases of urethral cancers: one is recurrent bladder transitional cell carcinoma accompanied by urethral metastatic carcinoma located on the right side of verumontanum, and the other is primary bladder and metastatic urethral adenocarcinoma. The urethral tumour was treated by transurethral holmium laser vaporization to the urethral tumour through a ureteroscope and the bladder tumour was treated with transurethral resection and degeneration of the bladder tumour (TURD-Bt). After the second or third therapy, patients were free of urethral or bladder tumour recurrence; they also did not experience urethral stricture or urinary incontinence during the 24- to 36-month follow-up. Transurethral holmium laser vaporization and TURD-Bt could be performed to treat non-invasive urethral cancer accompanied with bladder cancer and preserve the urethra and bladder. PMID:25553166

  7. Posterior fossa tumor

    MedlinePLUS

    Posterior fossa tumor is a type of brain tumor located in or near the bottom of the skull. ... The posterior fossa is a small space in the skull, found near the brainstem and cerebellum. The cerebellum is the part ...

  8. Asymptomatic urethral infection in male sexually transmitted disease clinic attendees.

    PubMed

    Yu, J T H T; Tang, W Y M; Lau, K H; Chong, L Y; Lo, K K

    2008-03-01

    The purpose of this study is to determine the prevalence of asymptomatic male patients with urethral infections attending a government sexually transmitted infection clinic in Hong Kong and their microbiological profile. A total of 274 consecutive male patients without any symptoms for urethral infections were recruited. A questionnaire was used to record the symptoms, sexual history and demographics. Further assessment, including urethral smear for Gram stain, gonococcal culture and polymerase chain reaction (PCR) for Chlamydia trachomatis (CT), Mycoplasma genitalium (MG) and Ureaplasma urealyticum (UU) were performed. In 274 asymptomatic patients, 36 patients had non-gonococcal urethritis (NGU) and two patients had positive gonococcal culture. Among the asymptomatic patients with NGU, there were 6 (16.6%), 10 (22.8%) and five (13.9%) patients with positive PCR for CT, UU and MG, respectively. In addition, there were 14 asymptomatic patients with positive PCR for CT but without evidence of NGU. In conclusion, urethral infections were identified in a significant number of asymptomatic male patients and therefore, routine screening for this group is warranted. PMID:18397552

  9. Traumatic hemipelvectomy.

    PubMed

    Klingman, R R; Smith, P; Stromberg, B; Valentine, J; Goebel, M

    1991-08-01

    Traumatic hemipelvectomy is an uncommon and devastating injury with few patients alive when they reach the hospital. There are only 19 reported survivors of this injury. This group includes 17 males and 2 females. All had severe, associated injuries. The mechanism of injury involved motorcycle, automobile, pedestrian/motor vehicle, or heavy machinery accidents. All surviving patients are young (10-34 years of age). Most suffered from a variety of postoperative complications. Two interesting patients with traumatic hemipelvectomy are reported. One involves a new mechanism of injury, the propellor of a motorboat. The management of these 2 patients is explained, the experience of others with similar injuries is reviewed, and the benefit of reconstruction with the gluteus myocutaneous flap is discussed. PMID:1952740

  10. Surgical Outcome of Excision and End-to-End Anastomosis for Bulbar Urethral Stricture

    PubMed Central

    Suh, Jun-Gyo; Choi, Woo Suk; Paick, Jae-Seung

    2013-01-01

    Purpose Although direct-vision internal urethrotomy can be performed for the management of short, bulbar urethral strictures, excision and end-to-end anastomosis remains the best procedure to guarantee a high success rate. We performed a retrospective evaluation of patients who underwent bulbar end-to-end anastomosis to assess the factors affecting surgical outcome. Materials and Methods We reviewed 33 patients with an average age of 55 years who underwent bulbar end-to-end anastomosis. Stricture etiology was blunt perineal trauma (54.6%), iatrogenic (24.2%), idiopathic (12.1%), and infection (9.1%). A total of 21 patients (63.6%) underwent urethrotomy, dilation, or multiple treatments before referral to our center. Clinical outcome was considered a treatment failure when any postoperative instrumentation was needed. Results Mean operation time was 151 minutes (range, 100 to 215 minutes) and mean excised stricture length was 1.5 cm (range, 0.8 to 2.3 cm). At a mean follow-up of 42.6 months (range, 8 to 96 months), 29 patients (87.9%) were symptom-free and required no further procedure. Strictures recurred in 4 patients (12.1%) within 5 months after surgery. Of four recurrences, one patient was managed successfully by urethrotomy, whereas the remaining three did not respond to urethrotomy or dilation and required additional urethroplasty. The recurrence rate was significantly higher in the patients with nontraumatic causes (iatrogenic in three, infection in one patient) than in the patients with traumatic etiology. Conclusions Excision and end-to-end anastomosis for short, bulbar urethral stricture has an acceptable success rate of 87.9%. However, careful consideration is needed to decide on the surgical procedure if the stricture etiology is nontraumatic. PMID:23878686

  11. Mild Traumatic Brain Injury

    MedlinePLUS

    ... Questions Glossary Contact Us Visitor Feedback mild Traumatic Brain Injury mild Traumatic Brain Injury VIDEO STORIES What is TBI? Measuring Severity ... most common deployment injuries is a mild Traumatic Brain Injury (TBI). A mild TBI is an injury ...

  12. Traumatic Brain Injury

    MedlinePLUS

    ... Center PTACs Workspaces Log-in Search for: Traumatic Brain Injury A legacy resource from NICHCY Disability Fact ... in her. Back to top What is Traumatic Brain Injury? A traumatic brain injury (TBI) is an ...

  13. [Urethritis caused by Trichomonas vaginalis in men. Epidemiology].

    PubMed

    Hernanz, J M; Clavo, I; Menendez, B; Jareo, M; Moya, D; Jover, J

    1987-01-01

    The interviews of sexually transmitted diseases (STD) done in the Dispensario "Martnez Anido" of Madrid in the period understood between September of 1984 and September of 1985 are revised. Among all of the 1,370 surveys, the trichomonal urethritis in the male, represents 2.2% of all of the urethritis and 4.6% of the nongonococcal urethritis in the male. Mean age of patients was 35 years, the social-economic level was inferior than those which we observed in others STD, all of the cases were heterosexual and the source of contamination was in 100% a prostitute of a low level. The answer to the treatment with metronidazole of the only doses of 2 gr. was satisfactory in all cases. PMID:3312865

  14. Con: bulbomembranous anastomotic urethroplasty for pelvic fracture urethral injuries

    PubMed Central

    Tausch, Timothy J.

    2015-01-01

    Current literature remains controversial regarding whether to treat patients sustaining pelvic fracture urethral injuries (PFUIs) with primary endoscopic realignment (PER) versus suprapubic tube (SPT) placement alone with elective bulbomembranous anastomotic urethroplasty (BMAU). Success rates for PER following PFUI are wide-ranging, depending on various authors definitions of what defines a successful outcome. At our institution, for SPT/BMAU patients, the mean time to definitive resolution of stenosis was dramatically shorter compared to PER cases. The vast majority of PER patients required multiple endoscopic urethral interventions and/or experienced various other adverse events which were rarely noted among the SPT/BMAU group. While PER does occasionally result in urethral patency without the need for further intervention, the risk of delay in definitive treatment and potential for adverse events has led to a preference for SPT and elective BMAU at our institution. PMID:26816814

  15. Con: bulbomembranous anastomotic urethroplasty for pelvic fracture urethral injuries.

    PubMed

    Tausch, Timothy J; Morey, Allen F

    2015-02-01

    Current literature remains controversial regarding whether to treat patients sustaining pelvic fracture urethral injuries (PFUIs) with primary endoscopic realignment (PER) versus suprapubic tube (SPT) placement alone with elective bulbomembranous anastomotic urethroplasty (BMAU). Success rates for PER following PFUI are wide-ranging, depending on various authors' definitions of what defines a successful outcome. At our institution, for SPT/BMAU patients, the mean time to definitive resolution of stenosis was dramatically shorter compared to PER cases. The vast majority of PER patients required multiple endoscopic urethral interventions and/or experienced various other adverse events which were rarely noted among the SPT/BMAU group. While PER does occasionally result in urethral patency without the need for further intervention, the risk of delay in definitive treatment and potential for adverse events has led to a preference for SPT and elective BMAU at our institution. PMID:26816814

  16. Medication Effects on Periurethral Sensation and Urethral Sphincter Activity

    PubMed Central

    Greer, W. Jerod; Gleason, Jonathan L.; Kenton, Kimberly; Szychowski, Jeff M.; Goode, Patricia S; Richter, Holly E

    2014-01-01

    Aim To characterize urethral neuromuscular function before and 2 weeks after medication therapy. Methods Premenopausal women without lower urinary tract symptoms were randomly allocated to one of six medications for 2 weeks (pseudoephedrine ER 120mg, imipramine 25mg, cyclobenzaprine 10mg, tamsulosin 0.4mg, solifenacin 5mg or placebo). At baseline and after medication, participants underwent testing: quantitative concentric needle EMG (CNE) of the urethral sphincter using automated Multi-Motor Unit Action Potential (MUP) software; current perception threshold (CPT) testing to measure periurethral sensation; and standard urodynamic pressure flow studies (PFS). Nonparametric tests were used to compare pre-post differences. Results 56 women had baseline testing; 48 (85.7%) completed follow-up CNE, and 49 (87.5%) completed follow-up CPT and PFS testing. Demographics showed no significant differences among medication groups with respect to age (mean 34.3 10.1), BMI (mean 31.8 7.5), parity (median 1, range 07), or race (14% Caucasian, 80% African American). PFS parameters were not significantly different within medication groups. No significant pre-post changes in CNE values were noted; however, trends in amplitudes were in a direction consistent with the expected physiologic effect of the medications. With CPT testing, a trend toward increased urethral sensation at the 5 Hz stimulation level, was observed following treatment with pseudoephedrine (0.15 to 0.09 mA at 5Hz; P=0.03). Conclusion In women without LUTS, pseudoephedrine improved urethral sensation, but not urethral neuromuscular function on CNE or pressure flow studies. Imipramine, cyclobenzaprine, tamsulosin, solifenacin, and placebo did not change urethral sensation or neuromuscular function. PMID:25185603

  17. Development of an artificial urethral valve using SMA actuators

    NASA Astrophysics Data System (ADS)

    Chonan, S.; Jiang, Z. W.; Tani, J.; Orikasa, S.; Tanahashi, Y.; Takagi, T.; Tanaka, M.; Tanikawa, J.

    1997-08-01

    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.

  18. Pro: endoscopic realignment for pelvic fracture urethral injuries

    PubMed Central

    Stein, Daniel M.

    2015-01-01

    Patients with pelvic fracture urethral distraction injuries may benefit from early endoscopic realignment. Realignment is associated with a low risk of immediate complications and has a high success rate for achieving catheter placement. Review of over thirty studies assessing for subsequent urethral stenosis, including at least a dozen that directly compare realignment to suprapubic diversion along, conclude that there is a benefit averaging at least 35% in favor of realignment. Furthermore, realignment may result in easier subsequent urethroplasty and possibly shorter stenoses. PMID:26816813

  19. Air bag associated posterior segment ocular trauma.

    PubMed

    Yang, Chang-Sue; Chou, Tzu-Fang; Liu, Jorn-Hon; Hsu, Wen-Ming

    2004-08-01

    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

  20. Impacted calculus within a urethral stent: A rare cause of urinary retention

    PubMed Central

    Rajaian, Shanmugasundaram; Gopalakrishnan, Ganesh; Kumar, Santosh; Kekre, Nitin S.

    2011-01-01

    An elderly male presented to the emergency department with acute urinary retention. He had poor flow of urine associated with serosanguinous discharge per urethra for 3 days duration. Earlier he underwent permanent metallic urethral stenting for post TURP bulbar urethral stricture. Plain X-ray of Pelvis showed an impacted calculus within the urethral stent in bulbar urethra. Urethrolitholapaxy was done with semirigid ureteroscope. Urethral stent was patent and well covered. Subsequently he had an uneventful recovery. We describe a unique case of acute urinary retention due to calculus impaction within a urethral stent. PMID:21716876

  1. Traumatic amputations

    PubMed Central

    Ramasamy, Arul

    2013-01-01

    Traumatic amputations remain one of the most emotionally disturbing wounds of conflict, as demonstrated by their frequent use in films to illustrate the horrors of war. Unfortunately, they remain common injuries, particularly following explosions, and, in addition, many survivors require primary amputation for unsalvageable injuries or to save their life. A third group, late amputations, is being increasingly recognised, often as a result of the sequelae of complex foot injuries. This article will look at the epidemiology of these injuries and their acute management, complications and outcome. PMID:26516502

  2. [Serious pelvic traumatisms in children].

    PubMed

    Allouis, M; Bracq, H; Catier, P; Babut, J M

    1981-01-01

    The rareness of pelvic fractures in children is due to the resilience of bony tissue and to the thickness of the periosteum at this age. Therefore, such fractures are most often seen after violent traumatisms, which explains their frequent association with visceral lesions that determine the gravity and dominate the prognosis. The authors have presented 9 observations of fractures of the pelvis, with or without pelvis dislocation, which were the most often associated with urological lesions either acute (urethral rupture, bladder rupture) neither chronic (hydronephrosis) but sometimes with vasculo-nervous, gynecological or others lesions. The different therapeutic techniques and their indications in the treatment of such fractures are similar to those used in the adult. Excepting those cases of polytraumatisms, where mortality remains elevated, the treatment of such fractures is most often satisfactory in the short term, but requires a thorough and prolonged monitoring in children presenting associated urological and gynecological lesions in order to evaluate with precision the long term prognosis. PMID:7226352

  3. Management of the devastated posterior urethra and bladder neck: refractory incontinence and stenosis

    PubMed Central

    Anderson, Kirk M.; Higuchi, Ty T.

    2015-01-01

    Stricture of the proximal urethra following treatment for prostate cancer occurs in an estimated 1-8% of patients. Following prostatectomy, urethral reconstruction is feasible in many patients. However, in those patients with prior radiation therapy (RT), failed reconstruction, refractory incontinence or multiple comorbidities, reconstruction may not be feasible. The purpose of this article is to review the evaluation and management options for patients who are not candidates for reconstruction of the posterior urethra and require urinary diversion. Patient evaluation should result in the decision whether reconstruction is feasible. In our experience, risk factors for failed reconstruction include prior radiation and multiple failed endoscopic treatments. Pre-operative cystoscopy is an essential part of the evaluations to identify tissue necrosis, dystrophic calcification, or tumor in the urethra, prostate and/or bladder. If urethral reconstruction is not feasible it is imperative to discuss options for urine diversion with the patient. Treatment options include simple catheter diversion, urethral ligation, and both bladder preserving and non-preserving diversion. Surgical management should address both the bladder and the bladder outlet. This can be accomplished from a perineal, abdominal or abdomino-perineal approach. The devastated bladder outlet is a challenging problem to treat. Typically, patients undergo multiple procedures in an attempt to restore urethral continuity and continence. For the small subset who fails reconstruction, urinary diversion provides a definitive, end-stage treatment resulting in improved quality of life. PMID:26816811

  4. Treatment of urethral strictures with balloon dilation: A forgotten tale.

    PubMed

    Stamatiou, Konstantinos; Christopoulos, Georgios; Moschouris, Hippocrates; Zavradinos, Dimitrios; Kiltenis, Michalis; Marinis, Athanasios

    2015-09-01

    Urethral stricture is a common condition that can lead to serious complications such as urinary infections and renal insufficiency secondary to urinary retention. Treatment options include catheterization and dilation, urethroplasty and endoscopic internal urethrotomy as well. Although treatment option depends on the type, length and aetiology of stricture, the choice can be influenced to varying degrees by the simplicity of the method, the preferences of the patient the available accoutrements and the patient health condition. Both urethroplasty and endoscopic internal urethrotomy require anaesthesia and thus are not suitable for many elder and unfit for surgical treatment patients. On the other hand, dilations are easy to perform in every day clinical practice however they have been associated with iatrogenic urethral trauma. In contrast, balloon dilation under vision dilates by radial application of forces against the stricture, avoiding the potentially shearing forces associated with sequential rigid dilation. Since it reduces the possibility of an iatrogenic urethral trauma and the subsequent spongiofibrosis may lead into improved therapeutic outcomes. In this report we describe a technique for the treatment of urethral strictures with balloon dilation in elder and unfit for surgical treatment patients. PMID:26428653

  5. Congenital urethral stenosis in a male miniature piglet

    PubMed Central

    Pouleur-Larrat, Bndicte; Maccolini, Edouard; Carmel, Eric Norman; Hlie, Pierre

    2014-01-01

    A 2-month-old male miniature pig showed progressive abdominal pain, pollakiuria, and stranguria that progressed to complete urinary obstruction. Postmortem examination revealed idiopathic urethral stenosis at the level of the recess, of probable congenital origin. Urinary tract malformations should be included in the differential diagnosis of miniature piglets with urinary disorders. PMID:24891635

  6. A Method for Recording Urethral Pressure Profiles in Female Rats

    PubMed Central

    Xu, Shengfei; Li, Xiaohui; Xu, Lei; Chen, Biao; Tan, Huibing; Du, Guanghui

    2015-01-01

    Aims Urethral pressure profile (UPP) and leak-point pressure (LPP) measurements as well as external urethral sphincter (EUS) electromyography (EMG) and videourodynamic analyses are the primary methods for evaluating urethral function in humans. However, UPP recording in female rats, a widely used animal model, is challenging due to their small body sizes. This study reports a novel method for recording UPP in female rats. Materials and Methods Seventeen anesthetized female rats were studied. LPP data for 14 rats were included. The other 3 rats were excluded because of death or abnormal urogenital organs. UPP curves were recorded using a modified water-perfusion catheter system, with the lateral hole facing the 3-, 6-, 9-, and 12-oclock positions in a randomized sequence. LPP, functional urethral length (FUL) and maximum urethral closure pressure (MUCP) were analyzed. Results The mean LPP was 64.39 20.29 cm H2O. The mean FUL and MUCP values at the 3-, 6-, 9-, and 12-oclock positions were 12.90 1.20, 16.70 1.95, 13.90 2.42, and 11.60 0.97 mm, respectively, and 38.70 11.85, 33.90 11.82, 37.40 11.95, and 71.90 23.01 cm H2O, respectively. The FUL at the 6-oclock position and MUCP at the 12-oclock position were significantly greater than those at the other 3 positions. The FUL and MUCP of repeated UPP recordings were not significantly different than those of the first recordings. Conclusions UPP recording using a modified method based on a water-perfusion catheter system is feasible and replicable in female rats. It produces UPP curves that sensitively and appreciably reflect detailed pressure changes at different points within the urethra and thus provides opportunity to evaluate urethral structures, especially the urethral sphincter, in detail. These results may enhance the utility of female rat models in research of urinary sphincter mechanisms. PMID:26502072

  7. Posterior Tibialis Tendon Dysfunction: Overview of Evaluation and Management.

    PubMed

    Yao, Kaihan; Yang, Timothy Xianyi; Yew, Wei Ping

    2015-06-01

    EDUCATIONAL OBJECTIVES As a result of reading this article, physicians should be able to: 1. Recognize posterior tibialis tendon dysfunction and begin to include it in differential diagnoses. 2. Recall the basic anatomy and pathology of the posterior tibialis tendon. 3. Assess a patient for posterior tibialis tendon dysfunction with the appropriate investigations and stratify the severity of the condition. 4. Develop and formulate a treatment plan for a patient with posterior tibialis tendon dysfunction. The posterior tibialis is a muscle in the deep posterior compartment of the calf that plays several key roles in the ankle and foot. Posterior tibialis tendon dysfunction is a complex but common and debilitating condition. Degenerative, inflammatory, functional, and traumatic etiologies have all been proposed. Despite being the leading cause of acquired flatfoot, it is often not recognized early enough. Knowledge of the anatomical considerations and etiology of posterior tibialis tendon dysfunction, as well as key concepts in its evaluation and management, will allow health care professionals to develop appropriate intervention strategies to prevent further development of flatfoot deformities. PMID:26091214

  8. Ca2+ signalling in urethral interstitial cells of Cajal.

    PubMed

    Sergeant, Gerard P; Hollywood, M A; McHale, N G; Thornbury, K D

    2006-11-01

    Interstitial cells of Cajal (ICC) in the urethra have been proposed as specialized pacemakers that are involved in the generation of urethral tone and therefore the maintenance of urinary continence. Recent studies on freshly dispersed ICC from the urethra of rabbits have demonstrated that pacemaker activity in urethra ICC is characterized by spontaneous transient depolarizations (STDs) under current clamp and spontaneous transient inward currents (STICs) under voltage clamp. When these events were simultaneously recorded with changes in intracellular Ca(2+) (using a Nipkow spinning disk confocal microscope) they were found to be associated with global Ca(2+) oscillations. In this short review we will consider some of these recent findings regarding the contribution of intracellular Ca(2+) stores and Ca(2+) influx to the generation of pacemaker activity in urethral ICC with particular emphasis on the contribution of reverse Na(+)/Ca(2+) exchange (NCX). PMID:16916912

  9. Ca2+ signalling in urethral interstitial cells of Cajal

    PubMed Central

    Sergeant, Gerard P; Hollywood, M A; McHale, N G; Thornbury, K D

    2006-01-01

    Interstitial cells of Cajal (ICC) in the urethra have been proposed as specialized pacemakers that are involved in the generation of urethral tone and therefore the maintenance of urinary continence. Recent studies on freshly dispersed ICC from the urethra of rabbits have demonstrated that pacemaker activity in urethra ICC is characterized by spontaneous transient depolarizations (STDs) under current clamp and spontaneous transient inward currents (STICs) under voltage clamp. When these events were simultaneously recorded with changes in intracellular Ca2+ (using a Nipkow spinning disk confocal microscope) they were found to be associated with global Ca2+ oscillations. In this short review we will consider some of these recent findings regarding the contribution of intracellular Ca2+ stores and Ca2+ influx to the generation of pacemaker activity in urethral ICC with particular emphasis on the contribution of reverse Na+/Ca2+ exchange (NCX). PMID:16916912

  10. Idiopathic female pseudohermaphroditism with urethral duplication and female hypospadias.

    PubMed

    D'Cunha, Aureen Ruby; Kurian, Jujju Jacob; Jacob, Tarun John K

    2016-01-01

    Female hypospadias is a rare anomaly of the female urethra where it opens on the anterior vaginal wall anywhere between the introitus and the fornix. It is often associated with other genitourinary anomalies such as Cloacal malformation, female pseudohermaphroditism, nonneurogenic neurogenic bladder and urethral duplication. Idiopathic female pseudohermaphroditism is extremely rare, and most cases occur secondary to adrenogenital syndrome or maternal androgen exposure. We report a unique case of a 1-year and 4-month-old girl who presented with ambiguous genitalia and renal failure secondary to a non-neurogenic neurogenic bladder. On further evaluation, she was found to have urethral duplication with a hypospadiac female urethra. She initially underwent a vesicostomy and was further planned to undergo an appendicular Mitrofanoff at an older age. The mainstay of treatment in these cases includes relief of bladder outlet obstruction and recovery of renal function by adequate urinary drainage. Clitoral reduction, if cosmetically warranted, may be planned at puberty. PMID:26965407

  11. Posterior lumbar interbody fusion.

    PubMed

    DiPaola, Christian P; Molinari, Robert W

    2008-03-01

    Posterior lumbar interbody fusion (PLIF) and transforaminal lumbar interbody fusion (TLIF) create intervertebral fusion by means of a posterior approach. Both techniques are useful in managing degenerative disk disease, severe instability, spondylolisthesis, deformity, and pseudarthrosis. Successful results have been reported with allograft, various cages (for interbody support), autograft, and recombinant human bone morphogenetic protein-2. Interbody fusion techniques may facilitate reduction and enhance fusion. The rationale for PLIF and TLIF is biomechanically sound. However, clinical outcomes of different anterior and posterior spinal fusion techniques tend to be similar. PLIF has a high complication rate (dural tear, 5.4% to 10%; neurologic injury, 9% to 16%). These findings, coupled with the versatility of TLIF throughout the entire lumbar spine, may make TLIF the ideal choice for an all-posterior interbody fusion. PMID:18316711

  12. Cholinergic urethral brush cells are widespread throughout placental mammals.

    PubMed

    Deckmann, Klaus; Krasteva-Christ, Gabriela; Rafiq, Amir; Herden, Christine; Wichmann, Judy; Knauf, Sascha; Nassenstein, Christina; Grevelding, Christoph G; Dorresteijn, Adriaan; Chubanov, Vladimir; Gudermann, Thomas; Bschleipfer, Thomas; Kummer, Wolfgang

    2015-11-01

    We previously identified a population of cholinergic epithelial cells in murine, human and rat urethrae that exhibits a structural marker of brush cells (villin) and expresses components of the canonical taste transduction signaling cascade (α-gustducin, phospholipase Cβ2 (PLCβ2), transient receptor potential cation channel melanostatin 5 (TRPM5)). These cells serve as sentinels, monitoring the chemical composition of the luminal content for potentially hazardous compounds such as bacteria, and initiate protective reflexes counteracting further ingression. In order to elucidate cross-species conservation of the urethral chemosensory pathway we investigated the occurrence and molecular make-up of urethral brush cells in placental mammals. We screened 11 additional species, at least one in each of the five mammalian taxonomic units primates, carnivora, perissodactyla, artiodactyla and rodentia, for immunohistochemical labeling of the acetylcholine synthesizing enzyme, choline acetyltransferase (ChAT), villin, and taste cascade components (α-gustducin, PLCβ2, TRPM5). Corresponding to findings in previously investigated species, urethral epithelial cells with brush cell shape were immunolabeled in all 11 mammals. In 8 species, immunoreactivities against all marker proteins and ChAT were observed, and double-labeling immunofluorescence confirmed the cholinergic nature of villin-positive and chemosensory (TRPM5-positive) cells. In cat and horse, these cells were not labeled by the ChAT antiserum used in this study, and unspecific reactions of the secondary antiserum precluded conclusions about ChAT-expression in the bovine epithelium. These data indicate that urethral brush cells are widespread throughout the mammalian kingdom and evolved not later than about 64.5millionyears ago. PMID:26044348

  13. Surgical correction of urethral dilatation in an intersex goat.

    PubMed

    Karras, S; Modransky, P; Welker, B

    1992-11-15

    Multiple congenital urethral abnormalities were successfully corrected in a polled goat kid. Anatomic genito-urinary abnormalities identified were paired testes with associated epididymis, ductus deferens, and active endometrial tissue. Blood karyotyping revealed the female state--XX sex chromosomes. This case exemplifies the complex interactions in addition to Y dominant Mendelian genetics that determine reproductive tract development in goats. The resultant intersex state is clinically recognized with greater frequency in polled progeny. PMID:1289340

  14. Sonourethrography in anterior urethral stricture: comparison to radiographic urethrography.

    PubMed

    Arda, K; Basar, M; Deniz, E; Yildiz, S; Akpnar, L; Oler, T

    1995-09-01

    Twenty-three male patients with known or suspected urethral stricture disease were evaluated using sonourethrography and standard retrograde x-ray urethrography for comparative analysis of two techniques. Results were evaluated statistically. These two methods can substitute each other in determining the stricture area length of anterior urethra. Due to advantages, if both of these methods are used combining each other, we believe that they will be much more sensitive. PMID:7581525

  15. Use of overlapping buccal mucosa graft urethroplasty for complex anterior urethral strictures

    PubMed Central

    2015-01-01

    Complex anterior urethral stricture disease typically manifests as a symptomatic, severely narrowed, long stricture (or multiple strictures) in which conventional excision and/or augmentation is not feasible. Overlapping buccal mucosal graft urethroplasty (OBMGU) is an innovative hybrid technique, combining the well-established principles of dorsal and ventral graft augmentation to allow single stage reconstruction of complex anterior urethral strictures. In this review, we discuss the rationale, techniques, and outcomes of OBMGU for complex anterior urethral strictures. PMID:26813234

  16. Urethral recurrence after cystectomy: current preventative measures, diagnosis and management.

    PubMed

    Chan, Yvonne; Fisher, Patrick; Tilki, Derya; Evans, Christopher P

    2016-04-01

    To summarise the current literature on the diagnosis and management of urethral recurrence (UR) after radical cystectomy (RC), as UR after RC is rare but associated with high mortality. With the recently increased use of orthotopic bladder substitution and the questionable benefit of prophylactic urethrectomy, identification of patients at high risk of UR, management of the remnant urethra, and treatment of UR become critical questions. A review of the PubMed database from 1980 to 2014 was performed to identify studies evaluating recurrent urothelial cancer of the urethra after RC. The search terms used included 'urethral recurrence', 'cystectomy' or 'cystoprostatectomy'. Selected studies provided information on the type of urinary diversion performed, the incidence of UR, and the time to UR. Incidence of UR after RC ranges from 1% to 8% with most recurrences occurring within the first 2 years after surgery. Increased risk of UR is associated with involvement of the prostate, tumour multifocality, bladder neck involvement, and cutaneous diversion. The median overall survival after UR ranges from 6 to 54 months and the 5-year disease-specific survival after UR is reported to be between zero and 83%. UR remains a relatively rare event. Current literature suggests that urethral wash cytology may be useful in patients with intermediate- to high-risk of recurrence to enable early detection of non-invasive disease, which may be amenable to conservative therapy before urethrectomy. PMID:26556525

  17. Somatomotor and sensory urethral control of micturition in female rats.

    PubMed

    Cruz, Yolanda; Pasteln, Csar; Balog, Brian M; Zaszczurynski, Paul J; Damaser, Margot S

    2014-12-01

    In rats, axons of external urethral sphincter (EUS) motoneurons travel through the anastomotic branch of the pudendal nerve (ABPD) and anastomotic branch of the lumbosacral trunk (ABLT) and converge in the motor branch of the sacral plexus (MBSP). The aim of the present study was to determine in female rats the contribution of these somatomotor pathways and urethral sensory innervation from the dorsal nerve of the clitoris on urinary continence and voiding. EUS electromyographic (EMG) activity during cystometry, leak point pressure (LPP), and voiding efficiency (VE) were assessed in anesthetized virgin Sprague-Dawley female rats before and after transection of the above nerve branches. Transection of the MBSP eliminated EUS EMG, decreased LPP by 50%, and significantly reduced bladder contraction duration, peak pressure, intercontraction interval, and VE. Transection of the ABPD or ABLT decreased EUS EMG discharge and LPP by 25% but did not affect VE. Transection of the dorsal nerve of the clitoris did not affect LPP but reduced contraction duration, peak pressure, intercontraction interval, and VE. We conclude that somatomotor control of micturition is provided by the MBSP with axons travelling through the ABPD and ABLT. Partial somatomotor urethral denervation induces mild urinary incontinence, whereas partial afferent denervation induces voiding dysfunction. ABPD and ABLT pathways could represent a safeguard ensuring innervation to the EUS in case of upper nerve damage. Detailed knowledge of neuroanatomy and functional innervation of the urethra will enable more accurate animal models of neural development, disease, and dysfunction in the future. PMID:25339694

  18. Understanding Child Traumatic Stress

    MedlinePLUS

    ... Online Research Public Awareness Sustainability Policy Issues Understanding Child Traumatic Stress Page Contents: Responding to Danger When ... a Traumatic Situation is Like for a Young Child Think of what it is like for young ...

  19. Acute urinary retention in women due to urethral calculi: A rare case

    PubMed Central

    Turo, Rafal; Smolski, Michal; Kujawa, Magda; Brown, Stephen C.W.; Brough, Richard; Collins, Gerald N.

    2014-01-01

    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

  20. Recurrent posterior shoulder instability after rifle shooting.

    PubMed

    Cho, Jae-Ho; Chung, Nam-Su; Song, Hyung-Keun; Lee, Doo-Hyung

    2012-11-01

    Rifle shooting produces a sudden counterforce against the body thorough the anterior shoulder, which may produce a traumatic injury in soldiers. Posterior instability of the shoulder can occur in soldiers who practice rifle shooting. To the authors' knowledge, few reports have examined shooting-related injuries in soldiers. This article describes the case of a 27-year-old male soldier who presented with left shoulder pain and instability after rifle training. He developed symptoms, and presented radiographic findings consistent with a posterior Bankart lesion. Intraoperatively, while in the lateral decubitus position, a posterior portal was created 3 cm inferior and 2 cm lateral to the posterolateral corner of acromion for making a proper angle for inserting anchors. A reverse bony Bankart lesion and adjacent cartilage breakdown at the glenoid rim were noted. An arthroscopic capsulolabral repair was performed with 3-mm bioabsorbable anchors to the glenoid rim. No gross reverse Hill-Sachs lesion or hyaline cartilage lesion was noted. Postoperatively, the arm was supported in a sling with an abduction pillow for 5 weeks. Codman's exercises, scapular protraction exercises, and elbow and wrist exercises were started. Physical therapy focused on reestablishing glenohumeral range of motion and rotator cuff and periscapular muscle strength. Six months postoperatively, the patient had normal scapular kinesis and reported no shoulder pain or symptoms of instability associated with a reverse bony Bankart lesion. PMID:23127465

  1. SIU/ICUD Consultation on Urethral Strictures: The management of anterior urethral stricture disease using substitution urethroplasty.

    PubMed

    Chapple, Christopher; Andrich, Daniela; Atala, Anthony; Barbagli, Guido; Cavalcanti, Andr; Kulkarni, Sanjay; Mangera, Altaf; Nakajima, Yosuke

    2014-03-01

    In this systematic review of the literature, a search of the PubMed database was conducted to identify articles dealing with augmentation/substitution urethral reconstruction of the anterior urethral stricture. The evidence was categorized by stricture site, surgical technique, and the type of tissue used. The committee appointed by the International Consultation on Urological Disease reviewed this data and produced a consensus statement relating to the augmentation and substitution of the anterior urethra. In this review article, the background pathophysiology is discussed. Most cases of urethral stricture disease in the anterior urethra are consequent on an ischemic spongiofibrosis. The choice of technique and the surgical approach are discussed along with the potential pros and cons of the use of a graft vs a flap. There is research potential for tissue engineering. The efficacy of the surgical approach to the urethra is reviewed. Whenever possible, a 1-stage approach is preferable from the patient's perspective. In some cases, with complex penile urethral strictures, a 2-stage procedure might be appropriate, and there is an important potential role for the use of a perineal urethrostomy in cases where there is an extensive anterior urethral stricture or where the patient does not wish to undergo complex surgery, or medical contraindications make this hazardous. It is important to have accurate outcome measures for the follow-up of patients, and in this context, a full account needs to be taken of patients' perspectives by the use of appropriate patient-reported outcome measures. The use of symptoms and a flow rate can be misleading. It is well established that with a normally functioning bladder, the flow rate does not diminish until the caliber of the urethra falls below 10F. The most accurate means of following up patients after stricture surgery are by the use of endoscopy or visualization by urethrography. Careful consideration needs to be made of the outcomes reported in the world literature, bearing in mind these aforementioned points. The article concludes with an overview of the key recommendations provided by the committee. PMID:24411214

  2. Segmental Urethral Dosimetry and Urinary Toxicity in Patients With No Urinary Symptoms Before Permanent Prostate Brachytherapy

    SciTech Connect

    Thomas, Carys; Keyes, Mira Liu, Mitchell; Moravan, Veronika

    2008-10-01

    Purpose: To determine whether segmental urethral dosimetry is predictive for the degree of urinary morbidity after prostate brachytherapy in patients with no urinary symptoms before prostate brachytherapy. Methods and Materials: Between May 2000 and November 2005, 1,107 patients underwent iodine-125 monotherapy with urethral sparing techniques. A total of 166 patients fulfilled the selection criteria: baseline (International Prostate Symptom Score) IPSS {<=}5, no androgen deprivation therapy, and prostate ultrasound planning volumes (PUTV) <45 mL. The median follow-up was 44 months. Urinary morbidity was defined by maximum increase in IPSS, time to IPSS resolution, maximum Radiation Therapy Oncology Group (RTOG) score, time to RTOG resolution, and urinary retention. Surrogate deviated urethra was contoured and doses calculated at the base, mid-prostate, apex, and urogenital diaphragm. Univariate and multivariate analysis was used to evaluate urethral and prostate dosimetry, age, PUTV, and number of needles for their association with urinary morbidity. Results: Urethral dose was fairly constant in all urethra segments except prostate base, where the variation in does was large. On multivariate analysis, higher urethral base D50, V100, and larger PUTV were predictive for higher maximum increase in IPSS. Higher urethral base V100 and larger PUTV predicted for prolonged IPSS resolution. Higher urethral base D50 and larger needle number predicted for longer RTOG resolution. Higher urethral base V100 predicted for RTOG {>=}2 toxicity. Conclusions: Radiation dose to the urethral base, larger PUTV, and needle number, predicted for increased urinary toxicity after prostate brachytherapy. Correlation between urinary morbidity and urethral base dosimetry may reflect a large variation in urethral dose observed at the prostate base.

  3. Spontaneous ventral urethral fistula in a young man whose mother had a retained IUD in uterus during the gestation

    PubMed Central

    Wei, Shuyi; Li, Qiang; Li, Senkai; Zhou, Chuande; Li, Fengyong; Zhou, Yu; Ding, Jian; Cao, Yujiao; Zhan, Siya; Xie, Linhai

    2014-01-01

    Urethral fistula is rare and is usually a complication of penile and urethral surgery. A few congenital cases have been reported. To our knowledge, there are only 2 reports about spontaneous ventral urethral fistula in the English literature. We present what we believe is the first case of a patient with spontaneous ventral urethral fistula whose mother had a retained IUD in uterus during the gestation. PMID:24554982

  4. Spontaneous postmenopausal urethral prolapse: a case report and review of literature.

    PubMed

    Yucetas, Ugur; Balaban, Muhsin; Aktas, Alper; Guc, Bulut

    2012-12-01

    Urethral prolapse is a circular protrusion of the distal urethra through the external meatus. It is very rare condition seen mostly in black premenercheal black girl and occasionally in postmenopausal white women. We present a case of spontaneous urethral prolapse in 63-year-old postmenopousal white women with succesful management with estrogen treatment. PMID:23427747

  5. Observations on the microbiology of urethritis in black South African men.

    PubMed

    Taylor-Robinson, D; Jensen, J S; Fehler, G; Radebe, F; Ballard, R C

    2002-05-01

    The occurrence of Neisseria gonorrhoeae, Chlamydia trachomatis and Mycoplasma genitalium was determined by molecular techniques in urine specimens from 182 black South African men who had symptoms and/or overt signs of urethritis. Eighty-six (47.3%) of these men were infected with N. gonorrhoeae. There were 185 men without overt evidence of urethritis, 16 (8.6%) of whom were also infected with N. gonorrhoeae. Of the 96 men who had non-gonococcal urethritis, 14 (14.6%) were infected with C. trachomatis, 16 (16.7%) with M. genitalium and only one with both microorganisms. In comparison, 15 (8.9%) of 169 men without overt urethritis and without N. gonorrhoeae were infected with C. trachomatis and 15 (8.9%) with M. genitalium, proportions that were about half the size of those in the group with overt urethritis. PMID:11972936

  6. A urethropexy technique for surgical treatment of urethral prolapse in the male dog.

    PubMed

    Kirsch, J A; Hauptman, J G; Walshaw, R

    2002-01-01

    Urethral prolapse is an uncommon condition affecting young male dogs, most commonly English bulldogs. Current described techniques for surgical treatment of urethral prolapse involve manual reduction of prolapsed mucosa and placement of a temporary purse-string suture at the penile tip, or resection of the prolapsed tissue and apposition of urethral and penile mucosa. The incidence of recurrence of urethral prolapse following resection of the prolapse is not known. This report describes a technique for surgical treatment of urethral prolapse in the male dog that minimizes surgical and anesthetic time, is simple to perform, requires minimal equipment, is effective, and is not associated with significant complications or recurrence. Three cases are described. PMID:12118692

  7. Squamous cell carcinoma on top of urethral stricture: case report and review of the literature

    PubMed Central

    Kotb, Ahmed Fouad; Attia, Doaa; Ismail, Asmaa Mohamed; Elabbady, Ahmed

    2013-01-01

    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. PMID:23589733

  8. Anteromedian external urethral sphincterotomy: technique, rationale and complications.

    PubMed

    Yalla, S V; Fam, B A; Gabilondo, F B; Jacobs, S; Di Benedetto, M; Rossier, A B; Gittes, R F

    1977-04-01

    Experiences are presented with bilateral (3 and 9 o'clock incisions) and anteromedian (12 o'clock incision) external urethral sphincterotomy in 84 patients with neuropathic vesicourethral dysfunctions. Hemorrhage and loss of reflexogenic erections have been notably absent in 31 patients who underwent anteromedian sphincterotomy. The rationale is discussed for the preference of anteromedian over bilateral sphincterotomy based on postoperative complications. The postoperative, radiologically aided cystosphincterometric and electromyographic studies during micturition indicated the adequacy of the surgical procedures, satisfying the urodynamic criteria, although dyssynergic myolectric activity of the periurethral striated muscle continued to exist. PMID:850324

  9. Three Distinct Urethral Fistulae 35 Years After Pelvic Radiation

    PubMed Central

    Sharma, Arindam; Kurtz, Michael P.; Eswara, Jairam R.

    2014-01-01

    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. PMID:24783170

  10. Diabetes Insipidus after Traumatic Brain Injury.

    PubMed

    Capatina, Cristina; Paluzzi, Alessandro; Mitchell, Rosalid; Karavitaki, Niki

    2015-01-01

    Traumatic brain injury (TBI) is a significant cause of morbidity and mortality in many age groups. Neuroendocrine dysfunction has been recognized as a consequence of TBI and consists of both anterior and posterior pituitary insufficiency; water and electrolyte abnormalities (diabetes insipidus (DI) and the syndrome of inappropriate antidiuretic hormone secretion (SIADH)) are amongst the most challenging sequelae. The acute head trauma can lead (directly or indirectly) to dysfunction of the hypothalamic neurons secreting antidiuretic hormone (ADH) or of the posterior pituitary gland causing post-traumatic DI (PTDI). PTDI is usually diagnosed in the first days after the trauma presenting with hypotonic polyuria. Frequently, the poor general status of most patients prevents adequate fluid intake to compensate the losses and severe dehydration and hypernatremia occur. Management consists of careful monitoring of fluid balance and hormonal replacement. PTDI is associated with high mortality, particularly when presenting very early following the injury. In many surviving patients, the PTDI is transient, lasting a few days to a few weeks and in a minority of cases, it is permanent requiring management similar to that offered to patients with non-traumatic central DI. PMID:26239685

  11. Diabetes Insipidus after Traumatic Brain Injury

    PubMed Central

    Capatina, Cristina; Paluzzi, Alessandro; Mitchell, Rosalid; Karavitaki, Niki

    2015-01-01

    Traumatic brain injury (TBI) is a significant cause of morbidity and mortality in many age groups. Neuroendocrine dysfunction has been recognized as a consequence of TBI and consists of both anterior and posterior pituitary insufficiency; water and electrolyte abnormalities (diabetes insipidus (DI) and the syndrome of inappropriate antidiuretic hormone secretion (SIADH)) are amongst the most challenging sequelae. The acute head trauma can lead (directly or indirectly) to dysfunction of the hypothalamic neurons secreting antidiuretic hormone (ADH) or of the posterior pituitary gland causing post-traumatic DI (PTDI). PTDI is usually diagnosed in the first days after the trauma presenting with hypotonic polyuria. Frequently, the poor general status of most patients prevents adequate fluid intake to compensate the losses and severe dehydration and hypernatremia occur. Management consists of careful monitoring of fluid balance and hormonal replacement. PTDI is associated with high mortality, particularly when presenting very early following the injury. In many surviving patients, the PTDI is transient, lasting a few days to a few weeks and in a minority of cases, it is permanent requiring management similar to that offered to patients with non-traumatic central DI. PMID:26239685

  12. Urethral Dysfunction in Female Mice with Estrogen Receptor ? Deficiency

    PubMed Central

    Chen, Yung-Hsiang; Chen, Chao-Jung; Yeh, Shuyuan; Lin, Yu-Ning; Wu, Yang-Chang; Hsieh, Wen-Tsong; Wu, Bor-Tsang; Ma, Wen-Lung; Chen, Wen-Chi; Chang, Chawnshang; Chen, Huey-Yi

    2014-01-01

    Estrogen has various regulatory functions in the growth, development, and differentiation of the female urogenital system. This study investigated the roles of ER? in stress urinary incontinence (SUI). Wild-type (ER?+/+) and knockout (ER??/?) female mice were generated (aged 68 weeks, n?=?6) and urethral function and protein expression were measured. Leak point pressures (LPP) and maximum urethral closure pressure (MUCP) were assessed in mice under urethane anesthesia. After the measurements, the urethras were removed for proteomic analysis using label-free quantitative proteomics by nano-liquid chromatographymass spectrometry (LC-MS/MS) analysis. The interaction between these proteins was further analysed using MetaCore. Lastly, Western blot was used to confirm the candidate proteins. Compared with the ER?+/+ group, the LPP and MUCP values of the ER??/? group were significantly decreased. Additionally, we identified 85 differentially expressed proteins in the urethra of ER??/? female mice; 57 proteins were up-regulated and 28 were down-regulated. The majority of the ER? knockout-modified proteins were involved in cell-matrix adhesion, metabolism, immune response, signal transduction, nuclear receptor translational regelation, and muscle contraction and development. Western blot confirmed the up-regulation of myosin and collagen in urethra. By contrast, elastin was down-regulated in the ER??/? mice. This study is the first study to estimate protein expression changes in urethras from ER??/? female mice. These changes could be related to the molecular mechanism of ER? in SUI. PMID:25275480

  13. Persistent occiput posterior.

    PubMed

    Barth, William H

    2015-03-01

    Persistent occiput posterior (OP) is associated with increased rates of maternal and newborn morbidity. Its diagnosis by physical examination is challenging but is improved with bedside ultrasonography. Occiput posterior discovered in the active phase or early second stage of labor usually resolves spontaneously. When it does not, prophylactic manual rotation may decrease persistent OP and its associated complications. When delivery is indicated for arrest of descent in the setting of persistent OP, a pragmatic approach is suggested. Suspected fetal macrosomia, a biparietal diameter above the pelvic inlet or a maternal pelvis with android features should prompt cesarean delivery. Nonrotational operative vaginal delivery is appropriate when the maternal pelvis has a narrow anterior segment but ample room posteriorly, like with anthropoid features. When all other conditions are met and the fetal head arrests in an OP position in a patient with gynecoid pelvic features and ample room anteriorly, options include cesarean delivery, nonrotational operative vaginal delivery, and rotational procedures, either manual or with the use of rotational forceps. Recent literature suggests that maternal and fetal outcomes with rotational forceps are better than those reported in older series. Although not without significant challenges, a role remains for teaching and practicing selected rotational forceps operations in contemporary obstetrics. PMID:25730235

  14. Suprapubic Cystostomy for the Management of Urethral Injuries During Penile Prosthesis Implantation

    PubMed Central

    Anele, Uzoma A; Le, Brian V; Burnett, Arthur L

    2014-01-01

    Introduction Urethral injury is an uncommon surgical complication of penile prosthesis (PP) surgery. Conventional dogma requires abortion of the procedure if the adjacent corporal body is involved or delayed implantation to avert device infection associated with urinary extravasation. Besides the setback of the aborted surgery, this management approach also presents the possible difficulty of encountering corporal fibrosis at the time of reoperation. Aim We report an approach using primary urethral repair and temporary suprapubic cystostomy for the management of incidental urethral injuries in a cohort of patients allowing for successful completion of unaborted PP implantation. Materials and Methods We performed a retrospective analysis of all patients receiving PPs from 1990 to 2014 in which incidental urethral injuries were repaired and PP implantation was completed with suprapubic cystostomy (suprapubic tube [SPT] insertion). After allowing for urethral healing and urinary diversion via SPT for 48 weeks, the PP was activated. Main Outcome Measures Successful management was determined by the absence of perioperative complications within 6 months of implantation. Results We identified four cases, all receiving inflatable PPs, managed with temporary suprapubic cystostomy. These patients sustained urethral injuries during corporal dissection (one patient), corporal dilation (one patient), and penile straightening (two patients). All patients were managed safely and successfully. Conclusion Primary urethral repair followed by temporary suprapubic cystostomy offers a surgical approach to complete PP implantation successfully in patients who sustain urethral injury complications, particularly for complex PP surgeries. Anele UA, Le BV, and Burnett AL. Suprapubic cystostomy for the management of urethral injuries during penile prosthesis implantation. PMID:25548649

  15. Simple perineal and elaborated perineal posterior urethroplasty

    PubMed Central

    Webster, George D.; Peterson, Andrew C.

    2015-01-01

    A pelvic fracture urethral distraction defect (PFUDD) can present in varying lengths and degrees of complexity. In recent decades the repair of PFUDD has developed into a reliance on a perineal anastomotic approach for all but the most complex cases, which might still require an abdominal transpubic approach, or rarely a staged skin-inlay procedure. There is now controversy about the extent to which the perineal repair needs to be elaborated in individual patients. As originally described, the elaborated perineal approach comprises four steps that are used sequentially, as required, depending on the magnitude of the urethral defect. These steps are urethral mobilisation, corporal body separation, inferior wedge pubectomy and supra-crural urethral re-routing to the anastomosis. We present a review of the progressive repair, its reported use and outcomes and our recommendations for its continued use. PMID:26019973

  16. A Case of Urethrocutaneous Fistula: A Forgotten Segment of a Broken Urethral Catheter

    PubMed Central

    Hong, Young Kwon; Yu, Young Dong; Kang, Moon Hyung; Lee, Seung Ryeol; Park, Dong Soo; Oh, Jong Jin

    2014-01-01

    A retained urethral catheter is a rare iatrogenic complication of which few cases have been reported in the literature. In this study, we describe a case of a forgotten urethral Foley catheter causing urethracutaneous fistula on scrotum. An 80-year-old man was referred for a small pus-draining cutaneous opening on the lower part of the scrotum. The distal segment of a broken Foley catheter was found, and it was located from urinary bladder to bulbous urethra with its tip penetrating the urethral mucosa. This catheter was removed using flexible cystoscopic forceps, and urethracutaneous fistula was well resolved with conservative therapy.

  17. Posterior Tibial Tendon Transfer.

    PubMed

    Shane, Amber M; Reeves, Christopher L; Cameron, Jordan D; Vazales, Ryan

    2016-01-01

    When performed correctly with the right patient population, a tibialis posterior muscle/tendon transfer is an effective procedure. Many different methods have been established for fixating the tendon, each of which has its' own indications. Passing through the interosseous membrane is the preferred and recommended method and should be used unless this is not possible. Good surgical planning based on patient needs and expectations, along with excellent postoperative care including early range of motion and physical therapy minimizes risk of complications and allows for the optimal outcome to be achieved. PMID:26590722

  18. Posterior tibial tendoscopy.

    PubMed

    Monteagudo, Manuel; Maceira, Ernesto

    2015-03-01

    The posterior tibial tendon (PTT) helps the triceps surae to work more efficiently during ambulation. Disorders of the PTT include tenosynovitis, acute rupture, degenerative tears, dislocation, instability, enthesopathies, and chronic tendinopathy with dysfunction and flat foot deformity. Open surgery of the PTT has been the conventional approach to deal with these disorders. However, tendoscopy has become a useful technique to diagnose and treat PTT disorders. This article focuses on PTT tendoscopy and tries to provide an understanding of the pathomechanics of the tendon, indications for surgery, surgical technique, advantages, complications, and limitations of this procedure. PMID:25726479

  19. Surgical options for posterior tibial plateau fracture

    PubMed Central

    Chen, Hongwei; Wu, Lijun

    2015-01-01

    Objective: To investigate surgical methods and clinical effectiveness of posteromedial and posterolateral approaches for the posterior tibial plateau fracture. Method: 21 cases who received surgery through posterior approaches for the treatment of posterior tibial plateau fractures (PTPFs) were included. Results: 21 cases were subject to follow-up for 12-24 months (an average of 16.2 months). No cases developed incision inflammation, neurovascular injury, internal fixation loosening and breakage. All fractures were healed. No cases developed knee varus and valgus deformity and fracture dislocation. After surgery, Rasmussen score for knee joint functions was 13-30 points (a mean of 24.2). The results were excellent in 12 cases, good in 7 cases and fair in 2 cases. The percentage of excellent and good results was 90.5%. Rasmussen radiology score was 10-18 points (a mean of 15.6 points). The results were excellent in 13 cases, good in 7 cases and fair in 1 cases. The percentage of excellent and good results was 95.2%. 1 case had significant limited range of knee flexion and extension, which was improved after phase II release under arthroscopy combined with function exercise. 2 cases developed traumatic arthritis, which was relieved after intra-articular injection with sodium hyaluronate and oral nonsteroidal anti-inflammatory drug. Conclusion: The posteromedial and posterolateral approaches for PTPF is good for reduction and fixation of PTPF. The approaches have benefits such as clear exposure, convenient placement of internal fixation, less trauma and good clinical outcome. PMID:26885086

  20. Management of urethral injuries in University of Nigeria Teaching Hospital.

    PubMed

    Attah, C A; Mbonu, O; Anikwe, R M

    1982-08-01

    A plea is made for diversion of urine by suprapubic cystostomy as initial treatment in clinically established urethral injury. When early retrograde urethrography is not possible this study should be done between 3 and 6 weeks after injury, when infection or extravasation of urine at the injured site might have cleared. The quality of x-ray at this time is good and helps to determine the definitive treatment of the resultant stricture, if any. Good results were achieved in 32 patients treated along these guidelines. Poor results were achieved in 13 additional patients treated initially with interlocking sounds, even though the nature of the injury could have contributed partly to the bad result. PMID:7109093

  1. Evaluation and management of anterior urethral stricture disease

    PubMed Central

    Mangera, Altaf; Osman, Nadir; Chapple, Christopher

    2016-01-01

    Urethral stricture disease affects many men worldwide. Traditionally, the investigation of choice has been urethrography and the management of choice has been urethrotomy/dilatation. In this review, we discuss the evidence behind the use of ultrasonography in stricture assessment. We also discuss the factors a surgeon should consider when deciding the management options with each individual patient. Not all strictures are identical and surgeons should appreciate the poor long-term results of urethrotomy/dilatation for strictures longer than 2 cm, strictures in the penile urethra, recurrent strictures, and strictures secondary to lichen sclerosus. These patients may benefit from primary urethroplasty if they have many adverse features or secondary urethroplasty after the first recurrence.

  2. Eliminating pulse-induced artifacts in Urethral Pressure data.

    PubMed

    Klunder, Mario; Feuer, Ronny; Amend, Bastian; Kelp, Alexandra; Stenzl, Arnulf; Sievert, Karl-Dietrich; Sawodny, Oliver; Ederer, Michael

    2015-08-01

    Urethral Pressure Profilometry (UPP) is a tool in the diagnosis of urinary incontinence. The pressure profile along the urethra is measured by a special catheter in order to assess the contraction strength of the sphincter muscle. The use of microtip catheters with several pressure sensors and an integrated acceleration sensor enables signal reconstruction of the pressure distribution on the urethra's inside. Experimental data from minipigs exhibit artifact patterns in the pressure data. It is shown that these artifacts are caused by vascular pulsation in the sphincter structure. We therefore investigate different methods exploiting the time-correlation of the artifacts to eliminate pulse-induced artifacts in the pressure data without compromising the actual signal. Evaluation of these methods applied to experimental data conclude this work showing that both an Input-Model and Principal Component Analysis Decorrelation are effective at removing the artifacts. PMID:26736868

  3. Laser deposition of TiO2 for urethral catheter

    NASA Astrophysics Data System (ADS)

    Jelnek, Miroslav; Remsa, Jan; Zezulov, Markta

    2010-10-01

    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 90C (which was reached only by RF discharge).

  4. Traumatic Wound Dehiscence following Corneal Transplantation

    PubMed Central

    Jafarinasab, Mohammad-Reza; Feizi, Sepehr; Esfandiari, Hamed; Kheiri, Bahareh; Feizi, Mohadesse

    2012-01-01

    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 Descemets 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. PMID:23264863

  5. Juvenile allergic urethritis with urethro-ejaculatory reflux presenting as acute intermittent bilateral testicular torsion.

    PubMed

    Patel, Ramnik V; Brimioulle, Marina; Govani, Dhaval; Youssef, Talaat

    2015-01-01

    We report a case of juvenile allergic urethritis secondary to double concentrate orange squash of a famous brand in a 3-year-old boy who developed bilateral urethro-ejaculatory reflux (UER) and severe urethral, perineal and scrotal pain referred to both lower limbs intermittently predominantly during and after micturition-simulating features of bilateral intermittent testicular torsion. Accurate history, urinalysis, ultrasound, colour Doppler and food challenge were helpful in diagnosis. Topical steroids, antihistaminic, analgesic and anti-inflammatory medications together with withdrawal of the allergen produced complete recovery. Allergic urethritis in association with bilateral UER causing secondary seminal vesiculitis and epididymitis is rare. It presented as acute scrotum and responded to innovative treatment. Allergic disease can have a dramatic effect on a child's quality of life. This is the first documented case of allergic urethritis and associated UER presenting as juvenile acute scrotum. Steroids, antihistamines and anti-inflammatory agents together with avoidance of the allergen helped achieve recovery. PMID:26150614

  6. Parameatal Urethral Cyst in a Newborn–A Case Report and Review of the Literature

    PubMed Central

    Spyridakis, Ioannis; Patoulias, Dimitrios; Tsioulas, Paschalis; Patoulias, Ioannis

    2016-01-01

    Parameatal urethral cysts are rare congenital lesions of the penis that are usually <1cm in diameter in the paediatric population and do not create any urinary difficulties. Their natural course is either to resolve or to be surgically excised without any postoperative complications. We report a case of a newborn with a parameatal urethral cyst that produced voiding difficulties and was treated by surgical excision. PMID:26894139

  7. Palliative Surgery for Rare Cases of Anterior Urethral Metastasis in Prostate Cancer

    PubMed Central

    Gmez Gmez, Enrique; Carrasco Aznar, Jose Carlos; Moreno Rodrguez, Maria del Mar; Valero Rosa, Jos; Requena Tapia, Maria Jos

    2014-01-01

    Penis metastasis from prostate cancer is very rare, and its management varies from case to case as there are very few cases reported in the literature. We describe a patient with prostate cancer treated with radiotherapy and androgen deprivation therapy who presented with urethral bleeding as a symptom of anterior urethral metastasis during followup. We propose a way to manage this and review the literature. PMID:25161796

  8. The posterior bone block procedure in posterior shoulder instability: a long-term follow-up study.

    PubMed

    Meuffels, D E; Schuit, H; van Biezen, F C; Reijman, M; Verhaar, J A N

    2010-05-01

    We present the long-term outcome, at a median of 18 years (12.8 to 23.5) of open posterior bone block stabilisation for recurrent posterior instability of the shoulder in a heterogenous group of 11 patients previously reported on in 2001 at a median follow-up of six years. We found that five (45%) would not have chosen the operation again, and that four (36%) had further posterior dislocation. Clinical outcome was significantly worse after 18 years than after six years of follow-up (median Rowe score of 60 versus 90 (p = 0.027)). The median Western Ontario Shoulder Index was 60% (37% to 100%) at 18 years' follow-up, which is a moderate score. At the time of surgery four (36%) had glenohumeral radiological osteoarthritis, which was present in all after 18 years. This study showed poor long-term results of the posterior bone block procedure for posterior instability and a high rate of glenohumeral osteoarthritis although three patients with post-traumatic instability were pleased with the result of their operations. PMID:20436001

  9. Traumatic Glaucoma in Children

    PubMed Central

    Kaur, Savleen; Singh Pandav, Surinder

    2014-01-01

    ABSTRACT Young patients are more prone to ocular trauma but most of the published studies describe complicated cataract as a result of trauma with its treatment modality. As a result, little is known about the different causes, common presenting signs and symptoms, visual outcomes, and most frequent management modalities of traumatic glaucoma in children. This review aims to study the demographical profile, presentation, management and outcome of traumatic glaucoma in children as well as the various factors associated with advanced glaucomatous changes. How to cite this article: Kaur S, Kaushik S, Pandav SS. Traumatic Glaucoma in Children. J Curr Glaucoma Pract 2014; 8(2):58-62.

  10. Trans-vastus Intermedius Transfer of the Pedicled Anterolateral Thigh Flap for Posterior Thigh Reconstruction

    PubMed Central

    Batdorf, Niles J.; Lettieri, Salvatore C.

    2013-01-01

    Summary: Proximal, posterior thigh wounds from oncologic or traumatic defects can be difficult wounds to reconstruct if local flap options have been sacrificed during the trauma or oncologic resection. Free flap options to cover these defects are also difficult because of the lack of convenient recipient vessels in the region. The authors present 2 cases (oncologic and traumatic) wherein a myocutaneous anterolateral thigh (ALT) flap was harvested and tunneled from the anterior muscle compartment to the posterior muscle compartment of the thigh through a medially based transmuscular tunnel, decreasing the required pedicle distance to the wound. This technique of transmuscular tunneling of the ALT flap expands the indications and utility of the ALT flap to cover posterior thigh wounds. PMID:25289275

  11. Novel posterior fixation keratoprosthesis

    NASA Astrophysics Data System (ADS)

    Lacombe, Emmanuel

    1992-08-01

    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.

  12. Tissue Engineering for Human Urethral Reconstruction: Systematic Review of Recent Literature

    PubMed Central

    de Kemp, Vincent; de Graaf, Petra; Fledderus, Joost O.; Ruud Bosch, J. L. H.; de Kort, Laetitia M. O.

    2015-01-01

    Background Techniques to treat urethral stricture and hypospadias are restricted, as substitution of the unhealthy urethra with tissue from other origins (skin, bladder or buccal mucosa) has some limitations. Therefore, alternative sources of tissue for use in urethral reconstructions are considered, such as ex vivo engineered constructs. Purpose To review recent literature on tissue engineering for human urethral reconstruction. Methods A search was made in the PubMed and Embase databases restricted to the last 25 years and the English language. Results A total of 45 articles were selected describing the use of tissue engineering in urethral reconstruction. The results are discussed in four groups: autologous cell cultures, matrices/scaffolds, cell-seeded scaffolds, and clinical results of urethral reconstructions using these materials. Different progenitor cells were used, isolated from either urine or adipose tissue, but slightly better results were obtained with in vitro expansion of urothelial cells from bladder washings, tissue biopsies from the bladder (urothelium) or the oral cavity (buccal mucosa). Compared with a synthetic scaffold, a biological scaffold has the advantage of bioactive extracellular matrix proteins on its surface. When applied clinically, a non-seeded matrix only seems suited for use as an onlay graft. When a tubularized substitution is the aim, a cell-seeded construct seems more beneficial. Conclusions Considerable experience is available with tissue engineering of urethral tissue in vitro, produced with cells of different origin. Clinical and in vivo experiments show promising results. PMID:25689740

  13. Urethral condylomas in men: experience in 123 patients without previous treatment.

    PubMed

    Vives, lvaro; Vazquez, Andrs; Rajmil, Oswaldo; Cosentino, Marco

    2016-01-01

    The most common sexually transmitted infection (STI) is infection by human papillomavirus. There are more than 100 types of human papillomavirus, and over 30 of them involve the genital area. Urethral involvement is uncommon and usually limited to the distal 3?cm of the meatus. There are various treatments for urethral condylomas; as a rule, they are limited by a difficult approach, by recurrences, and by potential complications, the most significant of which is urethral stenosis. The purpose of the treatments is to remove the warts and induce lesion-free periods. Such treatments do not eliminate the infection nor do they prevent continued transmission of the virus. We retrospectively evaluated 123 patients diagnosed and treated for condylomas in the genital area at our Institution between April 2009 and April 2012. The patients' mean age was 28.7 years (range 19-51). Of the 123 patients included, 48 (39%) had a history of previous STIs, most frequently gonococcal urethritis. Three of them had a urethral malformation in the form of hypospadias, and another three reported a previous urologic manipulation (catheterisation). Meatal/urethral condylomas are rare, cryotherapy is simple, easy to apply, and has a very low risk of complications in patients with externally accessible warts. PMID:25712107

  14. White Matter Integrity in Highly Traumatized Adults With and Without Post-Traumatic Stress Disorder

    PubMed Central

    Fani, Negar; King, Tricia Z; Jovanovic, Tanja; Glover, Ebony M; Bradley, Bekh; Choi, KiSueng; Ely, Timothy; Gutman, David A; Ressler, Kerry J

    2012-01-01

    Prior structural imaging studies of post-traumatic stress disorder (PTSD) have observed smaller volumes of the hippocampus and cingulate cortex, yet little is known about the integrity of white matter connections between these structures in PTSD samples. The few published studies using diffusion tensor imaging (DTI) to measure white matter integrity in PTSD have described individuals with focal trauma rather than chronically stressed individuals, which limits generalization of findings to this population; in addition, these studies have lacked traumatized comparison groups without PTSD. The present DTI study examined microstructural integrity of white matter tracts in a sample of highly traumatized African-American women with (n=25) and without (n=26) PTSD using a tract-based spatial statistical approach, with threshold-free cluster enhancement. Our findings indicated that, relative to comparably traumatized controls, decreased integrity (measured by fractional anisotropy) of the posterior cingulum was observed in participants with PTSD (p<0.05). These findings indicate that reduced microarchitectural integrity of the cingulum, a white matter fiber that connects the entorhinal and cingulate cortices, appears to be associated with PTSD symptomatology. The role of this pathway in problems that characterize PTSD, such as inadequate extinction of learned fear, as well as attention and explicit memory functions, are discussed. PMID:22871912

  15. Normal anatomic relationship between urethral sphincter complex and zones of prostrate in young Chinese males on MRI

    PubMed Central

    Wang, Xiangdong; Liu, Tieyan; Zhao, Jing; Sun, Jingyi; Chen, Yuefeng; Sun, Pengyu; Wang, Xuesong; Liu, Sheng

    2015-01-01

    Objective In this research, the normal anatomic relationship between urethral sphincter complex and zones of prostrate in young Chinese males has been studied. Methods: The sagittal, coronal, and axial T2-weighted non-fat suppressed fast spin-echo images of pelvic cavities of 86 Chinese young males were studied. Result: Urethral sphincter complex threaded through the prostate and divided it into 2 parts: transition zone (TZ), periurethral glands internal to the urethral sphincter and peripheral zone (PZ), central zone (CZ), anterior fibromuscular stroma (AFS) zone external to the urethral sphincter. The length of urethral striated sphincter is 12.26-20.94 mm (mean 16.59 mm) at membranous urethra. Conclusions: In this paper, we summarized the normal anatomic relationship between urethral sphincter complex and zones of prostrate in young Chinese males with no urinary control problems. PMID:26629244

  16. A case of a urethral diverticular adenocarcinoma after the fenestration of the anterior vaginal wall for pelvic floor abscess

    PubMed Central

    Watanabe, Ryuta; Sugahara, Takeshi; Hamada, Hitoshi

    2016-01-01

    A 61-year-old woman presented to the gynecology department with complaints of atypical genital bleeding. Magnetic resonance imaging revealed a localized urethral tumor extended to vagina. Histological test of the biopsy tissue of the mass suggested the adenocarcinoma. The patient was performed the fenestration of the anterior vaginal wall 15 years ago. Under the diagnosis of urethral diverticular adenocarcinoma, we performed standard open total cystectomy with lymph node excision and ileal conduit. We could not establish a diagnosis of urethral diverticulum from the histological test; however, we clinically diagnosed as urethral diverticular adenocarcinoma. Because carcinoma arising from urethral diverticula is reported, a close long-term follow-up for the recurrence or generation of malignant tumors by genitourinary examinations or images is necessary, for the patient with urethral diverticula. PMID:26941237

  17. Minimal invasive transcaruncular optic canal decompression for traumatic optic neuropathy.

    PubMed

    Vaitheeswaran, Krishna; Kaur, Preetinder; Garg, Shalini

    2014-12-01

    Traumatic optic neuropathy is a cause of loss of vision associated with head injuries. Treatment options include observation, steroids and decompression of the optic canal. We report a case where the optic canal decompression was performed using a transcaruncular approach under a regional block. The incision was made through the caruncle and the dissection was carried down to the periosteum down to the orbital apex where the optic nerve was seen exiting through the optic canal posterior to the posterior ethmoidal artery. The optic nerve was decompressed with good visualization. Hemostasis and wound closure was achieved using fibrin glue. Postoperatively visual acuity improved with minimal inflammation enabling early rehabilitation. PMID:25208226

  18. Traumatic Brain Injury

    MedlinePLUS

    Traumatic brain injury (TBI) happens when a bump, blow, jolt, or other head injury causes damage to the brain. Every year, millions of people in the U.S. suffer brain injuries. More than half are bad enough that ...

  19. Traumatic Brain Injury (TBI)

    MedlinePLUS

    ... Research Information Clinical Trials Resources and Publications Traumatic Brain Injury (TBI): Condition Information Skip sharing on social ... external force that affects the functioning of the brain. It can be caused by a bump or ...

  20. Traumatic Brain Injury

    MedlinePLUS

    ... time it doesn't involve a loss of consciousness. A person who has a concussion may feel ... a mild traumatic brain injury include: Loss of consciousness Headache Confusion Feeling dizzy or lightheaded Blurry vision ...

  1. Primary traumatic patellar dislocation

    PubMed Central

    2012-01-01

    Acute traumatic patellar dislocation is a common injury in the active and young adult populations. MRI of the knee is recommended in all patients who present with acute patellar dislocation. Numerous operative and non-operative methods have been described to treat the injuries; however, the ideal management of the acute traumatic patellar dislocation in young adults is still in debate. This article is intended to review the studies to the subjects of epidemiology, initial examination and management. PMID:22672660

  2. Spinal osteotomies to treat post-traumatic thoracolumbar deformity.

    PubMed

    Cecchinato, R; Berjano, P; Damilano, M; Lamartina, C

    2014-07-01

    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

  3. Detailed urethral dosimetry in the evaluation of prostate brachytherapy-related urinary morbidity

    SciTech Connect

    Allen, Zachariah A.; Merrick, Gregory S. . E-mail: gmerrick@wheelinghospital.com; Butler, Wayne M.; Wallner, Kent E.; Kurko, Brian; Anderson, Richard L.; Murray, Brian C.; Galbreath, Robert W.

    2005-07-15

    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.

  4. Traumatic Alterations in Consciousness: Traumatic Brain Injury

    PubMed Central

    Blyth, Brian J.; Bazarian, Jeffrey J.

    2010-01-01

    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. PMID:20709244

  5. Reinnervation of Urethral and Anal Sphincters With Femoral Motor Nerve to Pudendal Nerve Transfer

    PubMed Central

    Ruggieri, Michael R.; Braverman, Alan S.; Bernal, Raymond M.; Lamarre, Neil S.; Brown, Justin M.; Barbe, Mary F.

    2012-01-01

    Aims Lower motor neuron damage to sacral roots or nerves can result in incontinence and a flaccid urinary bladder. We showed bladder reinnervation after transfer of coccygeal to sacral ventral roots, and genitofemoral nerves (L1, 2 origin) to pelvic nerves. This study assesses the feasibility of urethral and anal sphincter reinnervation using transfer of motor branches of the femoral nerve (L2–4 origin) to pudendal nerves (S1, 2 origin) that innervate the urethral and anal sphincters in a canine model. Methods Sacral ventral roots were selected by their ability to stimulate bladder, urethral sphincter, and anal sphincter contraction and transected. Bilaterally, branches of the femoral nerve, specifically, nervus saphenous pars muscularis [Evans HE. Miller’s anatomy of the dog. Philadelphia: W.B. Saunders; 1993], were transferred and end-to-end anastomosed to transected pudendal nerve branches in the perineum, then enclosed in unipolar nerve cuff electrodes with leads to implanted RF micro-stimulators. Results Nerve stimulation induced increased anal and urethral sphincter pressures in five of six transferred nerves. Retrograde neurotracing from the bladder, urethral sphincter, and anal sphincter using fluorogold, fast blue, and fluororuby, demonstrated urethral and anal sphincter labeled neurons in L2–4 cord segments (but not S1–3) in nerve transfer canines, consistent with rein-nervation by the transferred femoral nerve motor branches. Controls had labeled neurons only in S1–3 segments. Postmortem DiI and DiO labeling confirmed axonal regrowth across the nerve repair site. Conclusions These results show spinal cord reinnervation of urethral and anal sphincter targets after sacral ventral root transection and femoral nerve transfer (NT) to the denervated pudendal nerve. These surgical procedures may allow patients to regain continence. PMID:21953679

  6. Visibility of the urethral meatus and risk of urinary tract infections in uncircumcised boys

    PubMed Central

    Dubrovsky, Alexander Sasha; Foster, Bethany J.; Jednak, Roman; Mok, Elise; McGillivray, David

    2012-01-01

    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] 0.351.52), and the adjusted OR was 0.41 (95% CI 0.170.95). 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 0.040.39], adjusted OR 0.07 [95% CI 0.020.26]). 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. PMID:22777988

  7. UTI in patients with urethral catheters: an audit tool.

    PubMed

    Penfold, P

    This article presents an audit tool for the evaluation of practice relating to urinary tract infection in hospital patients with indwelling urethral catheters. It has been formulated primarily because urinary tract infection is a known complication of catheterization, and because studies have shown practitioners' knowledge in this area to be poor. Although health professionals have an obligation to ensure their practice is evidence based, this requires substantial time and skills in critical appraisal. The standard presented here is based on evidence from an extensive literature review on how best to minimize urinary tract infection during catheter insertion, meatal hygiene and management of the drainage system. The audit tool offers the potential for improved practice and demonstration of clinical effectiveness through measurable reduction in rates of urinary tract infection. Moreover, it provides an ideal opportunity for nurses to take the lead in clinical audit activity, which is so often medically led. The supplementary information will also provide a useful guide for nurses to undertake and initiate clinical audit activity in the future. PMID:10409959

  8. Use of Martius flap in the complex female urethral surgery

    PubMed Central

    Tupikina, Nataliya; Pushkar, Dmitry

    2014-01-01

    Introduction Objectives were to evaluate safety and patient reported perception of the Martius fibroadipose flap for complex female urethra reconstruction. Material and methods Patients operated with a Martius flap were contacted again via telephone to rate their selfperception on cosmetic appearance, pain or numbness of the flap harvest site. Results 37 women (mean age of 46.8 yrs.) were operated with Martius flaps. Complications were limited to bleeding from the flap bed in 19% (7/37); hematomas 5.4% (2/37); and lymphorrhea from the labial incision in 13.5% (5/37) and labial wound infection in 5.4% of cases (2/37). For selfperception 65% of patients (24/37) were phone interviewed (mean follow up 54.2 months). Only 17% of women (4/24) complained to cosmetic problems. Two patients (8%) complained to a periodical mild pain. And 12.5% (3/24) of the women had decreased sensation or numbness at the labia. Conclusions Martius flap is safe and it is not causing significant complications during female urethral reconstruction. However, an informed consent for decreased sensation and numbness at the flap harvesting area should be obtained. PMID:25140241

  9. Bacterial VaginosisAssociated Bacteria in Men: Association of Leptotrichia/Sneathia spp. With Nongonococcal Urethritis

    PubMed Central

    Manhart, Lisa E.; Khosropour, Christine M.; Liu, Congzhu; Gillespie, Catherine W.; Depner, Kevin; Fiedler, Tina; Marrazzo, Jeanne M.; Fredricks, David N.

    2014-01-01

    Background Approximately 45% of nongonococcal urethritis cases have no identified etiology. Novel bacteria recently associated with bacterial vaginosis (BV) in women may be involved. We evaluated the association of idiopathic nongonococcal urethritis and 5 newly described BV-associated bacteria (BVAB). Methods Heterosexual men 16 years or older attending a sexually transmitted disease clinic in Seattle, Washington, from May 2007 to July 2011 and negative for Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, Mycoplasma genitalium, and Ureaplasma urealyticumbiovar2 were eligible. Cases had urethral discharge or 5 or more polymorphonuclear leukocytes per high-power field in urethral exudates. Controls had no urethral discharge and less than 5 polymorphonuclear leukocytes per high-power field. Urine was tested for Atopobium spp., BVAB-2, BVAB-3, Megasphaera spp., and Leptotrichia/Sneathia spp. using quantitative taxon-directed polymerase chain reaction. Results Cases (n = 157) and controls (n = 102) were of similar age, education, and income, and most were white. Leptotrichia/Sneathia spp. was significantly associated with urethritis (24/157 [15.3%] vs. 6/102 [5.9%], P = 0.03). BVAB-2 was more common in cases than in controls (7/157 [4.5%] vs. 1/102 [1.0%], P = 0.15), and BVAB-3 (n = 2) and Megasphaera spp. (n = 1) were only detected in men with urethritis, but these bacteria were found only in men who also had Leptotrichia/Sneathia spp. Atopobium spp. was not associated with urethritis. The quantity of bacteria did not differ between cases and controls. Among treated cases, doxycycline was more effective than azithromycin for clinical cure of men with Leptotrichia/Sneathia spp. (9/10 vs. 7/12, P = 0.16) and BVAB-2 (3/3 vs. 0/3, P = 0.10). Conclusions Leptotrichia/Sneathia spp. may be urethral pathogens or contribute to a pathogenic microbiota that can also include BVAB-2, BVAB-3, and Megasphaera spp. Doxycycline may be more effective than azithromycin against these newly identified bacteria. PMID:24220356

  10. Urethral Pain Among Prostate Cancer Survivors 1 to 14 Years After Radiation Therapy

    SciTech Connect

    Pettersson, Niclas; Olsson, Caroline; Tucker, Susan L.; Alsadius, David; Wilderaeng, Ulrica; Johansson, Karl-Axel; Steineck, Gunnar

    2013-01-01

    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}.

  11. TRAUMATIC BRAIN INJURY (TBI) DATABASE

    EPA Science Inventory

    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...

  12. Post-traumatic stress disorder

    MedlinePLUS

    ... post traumatic stress disorder (PTSD). Cochrane Database Syst Rev . 2010;(7):CD007316. Roberts NP, Kitchiner NJ, Kenardy ... treat acute traumatic stress symptoms. Cochrane Database Syst Rev . 2010;(3):CD007944.

  13. Posterior sampling with improved efficiency

    SciTech Connect

    Hanson, K.M.; Cunningham, G.S.

    1998-12-01

    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.

  14. Severe Traumatic Injury

    PubMed Central

    Minei, Joseph P.; Schmicker, Robert H.; Kerby, Jeffrey D.; Stiell, Ian G.; Schreiber, Martin A.; Bulger, Eileen; Tisherman, Samuel; Hoyt, David B.; Nichol, Graham

    2014-01-01

    Objectives The public health implications of regional variation in incidence and outcome of severe traumatic injury remain to be analyzed. The objective of this study was to determine whether the incidence and outcome associated with severe traumatic injury differs across geographic regions of North America. Methods A prospective, observational study was conducted of the Resuscitation Outcomes Consortium of all patients in 9 North American sites (6 US and 3 Canadian) sustaining severe traumatic injury from April 1, 2006 to March 31, 2007 followed to hospital discharge. Eligible patients were assessed by organized emergency medical services, and had field-based physiologic criteria including systolic blood pressure ≤90 mm Hg, Glasgow Coma Scale score ≤12, respiratory rate <10 or >29 per minute, advanced airway procedure, or traumatic death in the field. Census data were used to determine rates adjusted for age and sex. The main outcome measures were incidence rate, mortality rate, case fatality rate, and survival to discharge for patients sustaining severe traumatic injury assessed by EMS. Results The total catchment population of 20.5 million yielded 7080 cases of severe traumatic injury. Median age was 36 years and 67% were male. The median incidence of EMS-assessed severe traumatic injury per 100,000 population across sites was 37.4 (interquartile range [IQR] = 24.6 – 69.6); survival ranged from 39.8% to 80.8%, with a median of 64.5% (IQR = 55.5–78.4). About 942 cases were pronounced dead at the scene and 5857 patients were transported to hospital; 4477 (63.2%) were discharged alive. The median incidence of severe trauma due to a blunt mechanism, transported to hospital, was 25.8 (IQR = 13.1–44.3); survival ranged from 52.6% to 87.3%, with a median of 78.0% (IQR = 68.4–83.5). The median incidence of severe penetrating trauma, transported to hospital, was 2.6 (IQR = 1.5–10.4); survival ranged from 37.5% to 84.7%, with a median of 67.5% (IQR = 54.1–75.9). All P values for differences across sites for incidence and survival were <0.001. Conclusions In this study involving 9 geographic regions in North America, there were significant and important regional differences in severe traumatic injury, incidence, and outcome. These differences were sustained for patients with either isolated blunt or penetrating injury mechanisms. PMID:20531005

  15. Orandi flap for penile urethral stricture: Polishing the gold standard

    PubMed Central

    Goel, Apul; Kumar, Manoj; Singh, Manmeet

    2015-01-01

    Introduction: We describe the combined use of the Orandi flap and the scrotal skin advancement flap to reduce complications for pendulous urethral stricture in men >40 years old. Methods: Over the last 40 months, 10 men underwent urethroplasty for pendulous stricture by the modified Orandi urethroplasty. In this, additionally, a midline hairless scrotal skin flap of the size of the ventral skin defect on the pendulous portion was raised based on the dartos fascia. This flap was mobilized so that it reached the pendulous portion without tension and covered the penile defect. The catheter was removed after 4 weeks. Patients were followed every 3 months using uroflowmetry and the American Urological Association (AUA) symptom score. Results: The mean age was 55.5. Of the 10 patients, the etiology was post-catheterization in 5 and idiopathic in the remaining 5. Three men also had stricture extending into the bulbous urethra (repaired using buccal graft). The mean additional time needed for the flap coverage was 36.2 minutes (range: 3045). The median follow-up was 12 months (range: 340). The mean postoperative symptom score was 5.2 and the mean flow rate was 20.1 mL/sec. In 2 men, the meatus got retracted to the distal penile part (probably due to downward traction by scrotal skin). No patient complained of disfigurement. Two men reported recurrence (1 each in bulbous and penile urethra). The limitations are small number of patients and the observational nature of this study. Conclusions: The intermediate-term results show that the modified Orandi urethroplasty is an acceptable treatment option with acceptable cosmetic results. PMID:26085873

  16. Posterior capsulorrhaphy for treatment of recurrent posterior glenohumeral instability.

    PubMed

    Shin, Robert D; Polatsch, Daniel B; Rokito, Andrew S; Zuckerman, Joseph D

    2005-01-01

    The surgical treatment of recurrent posterior shoulder instability via a posterior approach has had a variable degree of success reported in the literature with recurrence rates ranging between 8% and 45%. The purpose of this study was to review the results of posterior capsulorrhaphy in a consecutive series of patients with recurrent posterior instability. Seventeen consecutive patients underwent operative management for posterior glenohumeral instability. The dominant shoulder was involved in ten patients. All patients were male with an average age of 28.1 years (range: 16 to 54 years). Ten patients had sustained a specific injury which precipitated the instability. Six patients reported dislocations requiring formal closed reduction maneuvers; the remainder described episodes of recurrent subluxation with spontaneous reduction. All patients underwent a posterior capsulorrhaphy using an infraspinatus splitting approach. Eight shoulders required repair of a posterior capsulolabral detachment. In addition, one patient required augmentation with a posterior bone block for significant glenoid rim deficiency. Outcome was assessed by personal interview, clinical assessment, and standardized radiographs. At an average follow-up of 3.9 years (range: 1.8 to 10.8 years) patients estimated their overall shoulder function to be 81% of the contralateral unaffected shoulder. The subjective result was excellent for eight patients, good for five patients, fair in two patients, and poor in two patients. One of the poor outcomes was in a patient with glenohumeral degenerative changes at the index procedure which progressed and eventually required a total shoulder arthroplasty. The other poor result was in a patient found to have a full-thickness rotator cuff tear 10.6 years after the index procedure. Two patients (12%) had recurrence of their instability. Both of these patients sustained a significant re-injury which precipitated their symptoms. Five patients complained of occasional night pain at the time of their last follow-up examination. Only one patient (who was re-injured) had to change professions as a result of shoulder symptoms. Posterior capsulorrhaphy for treatment of isolated posterior glenohumeral instability yields satisfactory clinical results. Recurrent instability in this series was associated with a specific re-injury and did not appear to increase with longer follow-up. PMID:16536210

  17. 2015 UK National Guideline on the management of non-gonococcal urethritis.

    PubMed

    Horner, P; Blee, K; O'Mahony, C; Muir, P; Evans, C; Radcliffe, K

    2016-02-01

    We present the updated British Association for Sexual Health and HIV guideline for the management of non-gonococcal urethritis in men. This document includes a review of the current literature on its aetiology, diagnosis and management. In particular it highlights the emerging evidence that azithromycin 1 g may result in the development of antimicrobial resistance in Mycoplasma genitalium and that neither azithromycin 1 g nor doxycycline 100 mg twice daily for seven days achieves a cure rate of >90% for this micro-organism. Evidence-based diagnostic and management strategies for men presenting with symptoms suggestive of urethritis, those confirmed to have non-gonococcal urethritis and those with persistent symptoms following first-line treatment are detailed. PMID:26002319

  18. Photodynamic therapy of urethral condylomata acuminata using topically 5-aminolevulinic acid

    NASA Astrophysics Data System (ADS)

    Wang, Xiuli; Wang, Hongwei; Wang, Haishan; Xu, Shizheng; Liao, Kanghuang; Hillemanns, Peter

    2005-07-01

    Background Electrocoagulation and laser evaporation for urethral condylomata acuminata have high recurrence rates and can be associated with urethral malformations. Objective To investigate the effect of photodynamic therapy (PDT) with topical 5-aminolevulinic acid (ALA) on urethral condylomata acuminata and to examine the histological changes in lesions of condylomata acuminata after ALA-PDT. Methods One hundred and sixty-four urethral condylomata patients were given topical ALA followed by intraurethral PDT through a cylindrical fiber. Among the cases, 16 penile and vulval condylomatous lesions in 11 patients were treated with topical ALA-PDT at same time. After the treatment, biopsy specimens were collected from the 16 penile and vulval lesions. The histological changes were then evaluated by light microscope and electron microscope. Results The complete response rate for urethral condylomata by topical ALA-PDT was 95.12% and the recurrence rate was 5.13% after 6 to 24 months follow-up. Keratinocytes in middle and upper layers of the epidermis with marked vacuolation and some necrocytosis were detected one and three hours after PDT. Necrosis in all layers of the epidermis was noted five hours after PDT by microscopy. In electron microscopy of kerationcytes, distinct ultrastructural abnormalities of mitochondrion, endoplasmic reticulum and membrane damage were observed. Apoptotic bodies were detected three hours after PDT and a large number of the keratinocytes exhibited necrosis five hours after PDT by electron microscope. Conclusions Results suggests that topical ALA-PDT is a simple, effective, relatively safe, less recurrent and comparatively well tolerated treatment for urethral condylomata acuminata. The mechanisms might be that ALA-PDT could trigger apoptotic process and necrosis in the HPV infected keratinocytes. Key words:

  19. Urethral complications after tension-free vaginal tape procedures: A surgical management case series

    PubMed Central

    Sergouniotis, Fotios; Jarlshammar, Björn; Larsson, Per-Göran

    2015-01-01

    AIM: To analyze the clinical features, diagnostic modalities, and the surgical management of urethral complications after tension-free vaginal tape procedures. METHODS: This study encompasses a retrospective review of nine patients presented with urethral complications after midurethral sling procedures. The patients underwent the procedures during a period from 1999 to 2012 in three different regional hospitals in the southwest part of Sweden. The time from sling placement to diagnosis, the risk factors, clinical features, diagnosis, surgical management, and functional outcome are presented. The presenting symptoms were described as either early onset (< 12 mo) or late onset (> 12 mo) according to when they were first reported. RESULTS: Eight cases of urethral erosion and one case of bladder-neck erosion were detected. The mean interval for diagnoses of the erosions ranged from 3 mo to 11 years. The most common presenting symptoms included de novo urgency with or without incontinence (7/9 patients), urinary retention/voiding dysfunction (4/9 patients), urethritis (4/9 patients), relapse of stress-incontinence (3/9 patients), recurrent urinary tract infections (5/9 patients), and hematuria (1/9 patient). In most cases, voiding dysfunction and urethritis occurred early after the operation. The surgical management applied in most cases was transurethral resection of the intraurethral part of the mesh. The removal of the intraurethral mesh resulted in improvement or complete cure of urgency symptoms in 5/7 patients with urgency. Four patients were reoperated with a new stress-incontinence surgery, one with laparoscopic Burch, and three with retropubic tension-free vaginal tape procedures. CONCLUSION: Urethral complications should be suspected in the case of de novo urgency and relapse of stress-incontinence. Transurethral excision of the intraurethral mesh is the recommended treatment. PMID:26167464

  20. Dorsal inlay buccal mucosal graft (Asopa) urethroplasty for anterior urethral stricture

    PubMed Central

    Marshall, Stephen D.; Raup, Valary T.

    2015-01-01

    Asopa described the inlay of a graft into Snodgrasss longitudinal urethral plate incision using a ventral sagittal urethrotomy approach in 2001. He claimed that this technique was easier to perform and led to less tissue ischemia due to no need for mobilization of the urethra. This approach has subsequently been popularized among reconstructive urologists as the dorsal inlay urethroplasty or Asopa technique. Depending on the location of the stricture, either a subcoronal circumferential incision is made for penile strictures, or a midline perineal incision is made for bulbar strictures. Other approaches for penile urethral strictures include the non-circumferential penile incisional approach and a penoscrotal approach. We generally prefer the circumferential degloving approach for penile urethral strictures. The penis is de-gloved and the urethra is split ventrally to exposure the stricture. It is then deepened to include the full thickness of the dorsal urethra. The dorsal surface is made raw and grafts are fixed on the urethral surface. Quilting sutures are placed to further anchor the graft. A Foley catheter is placed and the urethra is retubularized in two layers with special attention to the staggering of suture lines. The skin incision is then closed in layers. We have found that it is best to perform an Asopa urethroplasty when the urethral plate is ?1 cm in width. The key to when to use the dorsal inlay technique all depends on the width of the urethral plate once the urethrotomy is performed, stricture etiology, and stricture location (penile vs. bulb). PMID:26816804

  1. Coexistence of urethritis with genital ulcer disease in South Africa: influence on provision of syndromic management

    PubMed Central

    Ballard, R; Fehler, H; Htun, Y; Radebe, F; Jensen, J; Taylor-Robinson, D

    2002-01-01

    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 1015 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. PMID:12181466

  2. The Use of Flaps and Grafts in the Treatment of Urethral Stricture Disease

    PubMed Central

    Wisenbaugh, Eric S.; Gelman, Joel

    2015-01-01

    The use of various grafts and flaps plays a critical role in the successful surgical management of urethral stricture disease. A thorough comprehension of relevant anatomy and principles of tissue transfer techniques are essential to understanding the appropriate use of grafts or flaps to optimize outcomes. We briefly review these principles and discuss which technique may be best suited for a given anterior urethral stricture, depending on the location and length of the stricture, the presence or absence of an intact corpus spongiosum, and the availability of adequate and healthy penile skin. PMID:26664357

  3. Safety of primary intraocular lens insertion in unilateral childhood traumatic cataract.

    PubMed

    Kumar, S; Panda, A; Badhu, B P; Das, H

    2008-01-01

    This study analyzes the results of cataract surgery with primary intraocular lens implantation in unilateral childhood traumatic cataract following penetrating trauma and its long term follow up. It is a hospital based study of 114 children (age 3-10 years) with unilateral traumatic cataract who underwent extracapsular cataract extraction/ lens aspiration with implantation of posterior chamber intraocular lens (IOL). Primary posterior capsulotomy (PPC) was performed in 57 eyes and the rest 57 were without PPC (NPPC). The patients were followed up at regular intervals for a period of 3 years. Postoperative inflammation and pupillary capture were two frequent complications seen during postoperative period. Development of posterior capsular opacification (PCO) was 1/57, 4/57 at 8th week and 7/30 and 14/39 at 6 months, in PPC and NPPC group, respectively. Best corrected visual acuity (BCVA)>or=6/18 was achieved in 50% of eyes at 8th week post operatively and the same at 3 years with/without membranectomy/capsulotomy was evident in 73.3% of eyes. Meticulous case selection with insertion of "in the bag IOL" and subjecting the traumatized cataractous eyes to primary posterior capsulotomy are factors responsible for optimal outcome in unilateral traumatic cataract in children. PMID:19079390

  4. Transition after Traumatic Loss

    ERIC Educational Resources Information Center

    Kuban, Caelan

    2011-01-01

    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

  5. Delayed post-traumatic saccular aneurysm of PICA in an adolescent.

    PubMed

    Binning, Mandy J; Hauschild, Tricia B; Amini, Amin; MacDonald, Joel D

    2009-12-01

    Delayed traumatic intracranial aneurysms of the posterior circulation caused by nonpenetrating head injury are rare, especially in pediatric patients. The true incidence and natural history of these aneurysms are poorly understood. We report a case of a 15-year-old boy who initially presented with subarachnoid hemorrhage of the posterior fossa without any evidence of associated aneurysm. On a routine computed tomography of the head, however, he was found to have a saccular aneurysm of the proximal posterior inferior cerebellar artery. The patient was treated successfully by microsurgical clipping and PICA/PICA bypass. PMID:19396391

  6. Impaired Pituitary Axes Following Traumatic Brain Injury

    PubMed Central

    Scranton, Robert A.; Baskin, David S.

    2015-01-01

    Pituitary dysfunction following traumatic brain injury (TBI) is significant and rarely considered by clinicians. This topic has received much more attention in the last decade. The incidence of post TBI anterior pituitary dysfunction is around 30% acutely, and declines to around 20% by one year. Growth hormone and gonadotrophic hormones are the most common deficiencies seen after traumatic brain injury, but also the most likely to spontaneously recover. The majority of deficiencies present within the first year, but extreme delayed presentation has been reported. Information on posterior pituitary dysfunction is less reliable ranging from 3%–40% incidence but prospective data suggests a rate around 5%. The mechanism, risk factors, natural history, and long-term effect of treatment are poorly defined in the literature and limited by a lack of standardization. Post TBI pituitary dysfunction is an entity to recognize with significant clinical relevance. Secondary hypoadrenalism, hypothyroidism and central diabetes insipidus should be treated acutely while deficiencies in growth and gonadotrophic hormones should be initially observed. PMID:26239686

  7. Rethinking "posterior" tongue-tie.

    PubMed

    Douglas, Pamela Sylvia

    2013-12-01

    Currently, many clinicians who help with breastfeeding problems are diagnosing "posterior" tongue-tie in infants and performing or referring for frenotomy. In this "Speaking Out" article, I argue that the diagnosis of "posterior" tongue-tie has successfully raised awareness of the importance of impaired tongue function in breastfeeding difficulty. However, the diagnosis of "posterior" tongue-tie also applies a reductionist, medicalized theoretical frame to the complex problem of impaired tongue function, risking unintended outcomes. Impaired tongue function arises out of multiple interacting and co-evolving factors, including the interplay between social behaviors concerning breastfeeding and mother-infant biology. Consideration of theoretical frames is vital if we are to build an evidence base through efficient use of the scarce resources available for clinical breastfeeding research and minimize unintended outcomes. PMID:24143939

  8. Anterior Urethral Stricture Disease Negatively Impacts the Quality of Life of Family Members

    PubMed Central

    Weese, Jonathan R.; Eswara, Jairam R.; Marshall, Stephen D.; Chang, Andrew J.; Vetter, Joel; Brandes, Steven B.

    2016-01-01

    Purpose. To quantify the quality of life (QoL) distress experienced by immediate family members of patients with urethral stricture via a questionnaire given prior to definitive urethroplasty. The emotional, social, and physical effects of urethral stricture disease on the QoL of family members have not been previously described. Materials and Methods. A questionnaire was administered prospectively to an immediate family member of 51 patients undergoing anterior urethroplasty by a single surgeon (SBB). The survey was comprised of twelve questions that addressed the emotional, social, and physical consequences experienced as a result of their loved one. Results. Of the 51 surveyed family members, most were female (92.2%), lived in the same household (86.3%), and slept in the same room as the patient (70.6%). Respondents experienced sleep disturbances (56.9%) and diminished social lives (43.1%). 82.4% felt stressed by the patient's surgical treatment, and 83.9% (26/31) felt that their intimacy was negatively impacted. Conclusions. Urethral stricture disease has a significant impact on the family members of those affected. These effects may last decades and include sleep disturbance, decreased social interactions, emotional stress, and impaired sexual intimacy. Treatment of urethral stricture disease should attempt to mitigate the impact of the disease on family members as well as the patient.

  9. The urethral plug: a new treatment modality for genuine urinary stress incontinence in women.

    PubMed

    Nielsen, K K; Kromann-Andersen, B; Jacobsen, H; Nielsen, E M; Nordling, J; Holm, H H; Larsen, J F

    1990-11-01

    A new modality, the urethral plug, was used to treat 22 women with genuine urinary stress incontinence. The plug is made of thermoplastic elastomer (Kraton G), and consists of a meatal plate, a soft stalk and 1 or 2 spheres along the stalk. The spheres were located according to the result of the urethral pressure profile. The midpoint of the proximal sphere was placed at the bladder neck and the distal sphere was placed just above the maximum urethral pressure point. At voiding the plug was removed and afterwards a new plug was inserted. The plug with 2 spheres was tested in week 1 (period 1) and the plug with only the distal sphere was tested in week 2 (period 2). A total of 22 patients completed period 1. Eight patients did not complete period 2, mostly due to either unchanged incontinence during period 1 or a repeated loss of the plug with 1 sphere. In periods 1 and 2, 73 and 79% of the patients were subjectively and objectively continent or improved. A total of 14 patients completed both periods. Eight patients preferred the plug with 2 spheres, 1 preferred the other plug and 5 had no preference. The side effects were few. This preliminary study shows that the urethral plug seems to be a promising alternative treatment for female genuine urinary stress incontinence. PMID:2231895

  10. A systematic review of animal and clinical studies on the use of scaffolds for urethral repair.

    PubMed

    Qi, Na; Li, Wen-Jiao; Tian, Hong

    2016-02-01

    Replacing urethral tissue with functional scaffolds has been one of the challenging problems in the field of urethra reconstruction or repair over the last several decades. Various scaffold materials have been used in animal studies, but clinical studies on use of scaffolds for urethral repair are scarce. The aim of this study was to review recent animal and clinical studies on the use of different scaffolds for urethral repair, and to evaluate these scaffolds based on the evidence from these studies. PubMed and OVID databases were searched to identify relevant studies, in conjunction with further manual search. Studies that met the inclusion criteria were systematically evaluated. Of 555 identified studies, 38 were included for analysis. It was found that in both animal and clinical studies, scaffolds seeded with cells were used for repair of large segmental defects of the urethra, such as in tubular urethroplasty. When the defect area was small, cell-free scaffolds were more likely to be applied. A lot of pre-clinical and limited clinical evidence showed that natural or artificial materials could be used as scaffolds for urethral repair. Urinary tissue engineering is still in the immature stage, and the safety, efficacy, cost-effectiveness of the scaffolds are needed for further study. PMID:26838750

  11. Cystoscopic-guided balloon dilation of a urethral stricture in a female dog

    PubMed Central

    Wood, Michael W.; Vaden, Shelly; Cerda-Gonzalez, Sofia; Keene, Bruce

    2007-01-01

    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. PMID:17824158

  12. [Female urethral obstruction and bladder neck stenosis - fact or myth - how to proceed].

    PubMed

    Gunnemann, A; Liedl, B; Palma, P C R; Yoshimura, Y; Muctar, S

    2015-09-01

    The female urethra is probably the most neglected organ in women. Female urethral stricture and primary bladder neck obstruction are rare clinical entities. Traditional and new surgical techniques have been described for the treatment of female urethral stricture. However, they are based on limited data. There is no consensus on best management. The techniques of urethroplasty all have a higher mean success rate (80-94%) than urethral dilatation (urethral dilatation, although there is a lack of high-level evidence to recommend one technique over another.Primary bladder neck obstruction (PBNO) is a condition in which the bladder neck fails to open adequately during voiding. This leads to increased striated sphincter activity or obstruction of urinary flow without another anatomic cause being present, for example an obstruction caused by genitourinary prolapse in women. Watchful waiting, pharmacotherapy and surgical intervention are possible treatments. PMID:26378388

  13. Anastomotic Urethroplasty in Female Urethral Stricture Guided by Cystoscopy A Point of Technique

    PubMed Central

    Patil, Sachin; Dalela, Deepansh; Dalela, Divakar; Goel, Apul; Sankhwar, Pushpalata; Sankhwar, Satya N.

    2013-01-01

    Purpose: During anastomotic urethroplasty for stricture urethra with false passage using standard technique, there remains a chance of anastomosis of normal distal urethra to proximal false lumen. Herein, we present a point of technique in which by using antegrade cystoscope, one cannot just identify and dissect normal anatomical proximal urethral lumen, but also perform some of the steps for anastomosis under direct vision. This will avoid making anastomosis to false lumen and thus leading to further complications. Materials and Methods: We report a case of 35-years-female who was presented to us with total mid-urethral stricture with false passage following multiple urethral dilatation attempts. We used antegrade cystoscopy during anastomotic urethroplasty to identify and dissect the proximal end of urethra thereby avoiding anastomosis to false tract. Results: We successfully performed anastomotic urethroplasty avoiding false passage. Post-operative Uroflow showed Q max of 18 ml/sec. Voiding cystourethrogram post-operatively showed anastomosis between normal anatomical lumens. Conclusion: This modification of using antegrade cystoscopy helps to identify proximal urethral end which in turn helps in avoiding anastomosis to false tract and ensures anastomosis between normal lumens. PMID:24741435

  14. Androgen Regulates Mafb Expression Through its 3'UTR During Mouse Urethral Masculinization.

    PubMed

    Matsushita, Shoko; Suzuki, Kentaro; Ogino, Yukiko; Hino, Shinjiro; Sato, Tetsuya; Suyama, Mikita; Matsumoto, Takahiro; Omori, Akiko; Inoue, Satoshi; Yamada, Gen

    2016-02-01

    External genitalia are prominent organs showing hormone-dependent sexual differentiation. Androgen is an essential regulator of masculinization of the genital tubercle, which is the anlage of external genitalia. We have previously shown that v-maf avian musculoaponeurotic fibrosarcoma oncogene homolog B (MAFB) is an androgen-inducible regulator of embryonic urethral masculinization in mice. However, it remains unclear how androgen regulates Mafb expression. The current study suggests that the Mafb 3' untranslated region (UTR) is an essential region for its regulation by androgen. We identified 2 functional androgen response elements (AREs) in Mafb 3'UTR. Androgen receptor is bound to such AREs in 3'UTR during urethral masculinization. In addition to 3'UTR, Mafb 5'UTR also showed androgen responsiveness. Moreover, we also demonstrated that ?-catenin, one of genital tubercle masculinization factors, may be an additional regulator of Mafb expression during urethral masculinization. This study provides insights to elucidate mechanisms of gene regulation through AREs present in Mafb 3'UTR for a better understanding of the processes of urethral masculinization. PMID:26636186

  15. Rotational and Axial Pattern Flaps in a Cat for Wound Reconstruction Secondary to Urethral Rupture.

    PubMed

    Watrous, Gwyneth K; Martin, Dawn M; Plesman, Rhea L; Ringwood, Brendon

    2016-01-01

    A 3 yr old intact male domestic shorthair cat was presented with urine extravasation from urethral rupture. Extensive skin necrosis developed in the perineal region and left hind limb that necessitated delayed primary wound closure with a caudal superficial epigastric axial pattern flap, scrotal and preputial rotational skin flaps, and perineal urethrostomy. PMID:26606210

  16. Segmental and descending control of the external urethral and anal sphincters in the cat.

    PubMed Central

    Mackel, R

    1979-01-01

    1. The present work concerns the contribution of the somatic central nervous system to two viscero-somatic reflexes, micturition and defecation. Descending and segmental actions and properties of the motoneurones innervating the striated external urethral and external anal sphincters were studied with intracellular recording in male cats, under chloralose anaesthesia. 2. Motoneurones innervating the external urethral and external anal sphincters were intermingled and most strongly concentrated in the lateral part of the ventral horn in the S2 segment of the spinal cord. 3. Stimulation of the S1 to S3 ipsilateral dorsal roots or of the homonymous pudendal nerve branches showed that less than half of the sphincter motoneurons receive monosynaptic excitatory connexions from low threshold afferents. 4. The after-hyperpolarization recorded in the external urethral and external anal sphincter motoneurones was relatively short lasting, not long lasting as would have been expected for motoneurones innervating slow-twitch, tonic type muscles. 5. There was no evidence for recurrent inhibition in pudendal motoneurones innervating the external urethral and external anal sphincters. 6. Descending excitation and inhibition to the sphincter motoneurones originated in the nucleus reticularis gigantocellularis of the medullary reticular formation. The descending reticulospinal actions are comparable to those observed in hind limb motoneurones. 7. It is suggested that the segmental reflex connexions play a role in controlling bladder and rectal continence. The descending actions studied also modulate the segmental reflex actions and may provide voluntary control of the sphincter muscles. PMID:512936

  17. Vasopressin-induced mouse urethral contraction is modulated by caveolin-1.

    PubMed

    Zeng, Jianwen; Ekman, Mari; Grossi, Mario; Svensson, Daniel; Nilsson, Bengt-Olof; Jiang, Chonghe; Uvelius, Bengt; Swrd, Karl

    2015-03-01

    Caveolae are 50-100nm large invaginations in the cell membrane that are considered to play roles in receptor signaling. Here we aimed to investigate the expression and distribution of the arginine-vasopressin (AVP) V1a receptor and its functional dependence on caveolin-1 (Cav1) in the mouse urethra. Female Cav1 knockout (KO) and wild type (WT) mice were used, and urethral preparations were micro-dissected for mechanical experiments. Methyl-?-cyclodextrin (m?cd) was used to deplete cholesterol and to disrupt caveolae. Protein expression and localization was determined using immunofluorescence and western blotting and transcript expression was determined by qRT-PCR. We found that Cav1 and AVP V1a receptors were expressed in urethral smooth muscle cells with apparent co-localization at the cell membrane. AVP caused urethral contraction that was inhibited by the V1a receptor antagonist SR49059. Concentration-response curves for AVP were right-shifted and maximal contraction was reduced in Cav1 KO mice and after m?cd treatment. In addition to caveolin-1 we also detected caveolin-2, cavin-1 and cavin-3 in the mouse urethra by western blotting. Caveolin-2, cavin-1 and cavin-3 as well as V1a receptor expression was reduced in KO urethra. We conclude that AVP regulates urethral contractility via the V1a receptor through a Cav1-dependent mechanism involving, in part, altered V1a receptor expression. PMID:25637087

  18. Urethral metastasis from a sigmoid colon carcinoma: a quite rare case report and review of the literature

    PubMed Central

    2014-01-01

    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 7mm 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 34months. 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. PMID:24884559

  19. Microsurgical Posterior Fossa Vestibular Neurectomy

    PubMed Central

    Silverstein, Herbert; Norrell, Horace; Wanamaker, Hayes; Flanzer, John

    1991-01-01

    Between 1925 and 1945, Walter Dandy and Kenneth McKenzie performed more than 700 posterior fossa eighth nerve sections and vestibular neurectomies, treating the intractable vertigo accompanying Meniere's disease. During the past 10 years, using microsurgical techniques and reaching the posterior fossa through the temporal bone, vestibular neurectomy has enjoyed a resurgence of popularity. When hearing is to be preserved, vestibular neurectomy is the surgical treatment of choice, if the patient fails to undergo a remission of the vertigo of Meniere's disease. This report reviews 115 consecutive vestibular neurectomies performed for the treatment of Meniere's disease from 1978 to 1988. In 1978, the retrolabyrinthine vestibular neurectomy (RVN) was introduced, a procedure in which the posterior fossa is entered anterior to the sigmoid sinus and behind the labyrinth. During the last three years, the approach to the posterior fossa has been a small dural opening behind the sigmoid sinus, the combined retrolabyrinthine-retrosigmoid (R-R) approach. There have been no cases of facial paralysis and no serious complications. A high incidence of headache (75%) resulted when the posterior wall of the internal auditory canal was drilled away for better exposure. Transient cerebrospinal fluid (CSF) leaks occurred in 7% of the patients having the RVN, the incidence was 3% when the combined R-R approach was used. In the RVN series, wound infection occurred in 20% of cases until perioperative antibiotics reduced the rate to 3%. The results in curing or improving vertigo have been excellent (94%), and hearing has been preserved to within 20 dB of the preoperative levels in 76%. Until a cure for Meniere's disease is found, microsurgical posterior fossa vestibular neurectomy remains the best treatment. ImagesFigure 1Figure 2Figure 3Figure 4Figure 5Figure 6 PMID:17170816

  20. [Post-traumatic stress].

    PubMed

    Ogłodek, Ewa; Araszkiewicz, Aleksander

    2012-01-01

    As civilization advanced, the number of disasters, including their types and size of the threat to humanity. In addition to natural disasters and wars, there are currently a disaster communication, environmental and technological. Disasters "new generation" include increasingly frequent bombings and terrorist attacks. These events are an impediment to long-lasting and deep impact on the mental functioning of the victims of the event. This represents a potential risk of a variety of psychopathological symptoms, which go beyond the limits of human suffering. ICD-I0 classification includes individuals sickness arising as a consequence of pathological after surviving the disaster, which include: acute stress disorder (ASD), post-traumatic stress disorder (PTSD), post-traumatic stress disorder linked to depression, symptoms anxiety, addictions, dissociative disorders and personality changes and permanent after the disaster. PMID:22400171

  1. Traumatic transconjunctival orbital emphysema.

    PubMed

    Stroh, E M; Finger, P T

    1990-06-01

    Orbital emphysema can be produced by trans-conjunctival migration of air from a high pressure airgun. In an industrial accident an 8 mm conjunctival laceration was produced in the superior fornix which acted as a portal of entry for air into the subconjunctival, subcutaneous, and retrobulbar spaces. Computed tomography revealed no evidence of orbital fracture and showed that traumatic orbital emphysema occurred without a broken orbital bone. PMID:2378847

  2. Management of recurrent anterior urethral strictures following buccal mucosal graft-urethroplasty: A single center experience

    PubMed Central

    Javali, Tarun Dilip; Katti, Amit; Nagaraj, Harohalli K.

    2016-01-01

    Objective: To describe the safety, feasibility and outcome of redo buccal mucosal graft urethroplasty in patients presenting with recurrent anterior urethral stricture following previous failed BMG urethroplasty. Materials and Methods: This was a retrospective chart review of 21 patients with recurrent anterior urethral stricture after buccal mucosal graft urethroplasty, who underwent redo urethroplasty at our institute between January 2008 to January 2014. All patients underwent preoperative evaluation in the form of uroflowmetry, RGU, sonourethrogram and urethroscopy. Among patients with isolated bulbar urethral stricture, who had previously undergone ventral onlay, redo dorsal onlay BMG urethroplasty was done and vice versa (9+8 patients). Three patients, who had previously undergone Kulkarni-Barbagli urethroplasty, underwent dorsal free graft urethroplasty by ventral sagittal urethrotomy approach. One patient who had previously undergone urethroplasty by ASOPA technique underwent 2-stage Bracka repair. Catheter removal was done on 21st postoperative day. Follow-up consisted of uroflow, PVR and AUA-SS. Failure was defined as requirement of any post operative procedure. Results: Idiopathic urethral strictures constituted the predominant etiology. Eleven patients presented with stricture recurrence involving the entire grafted area, while the remaining 10 patients had fibrotic ring like strictures at the proximal/distal graft-urethral anastomotic sites. The success rate of redo surgery was 85.7% at a mean follow-up of 41.8 months (range: 1 yr-6 yrs). Among the 18 patients who required no intervention during the follow-up period, the graft survival was longer compared to their initial time to failure. Conclusion: Redo buccal mucosal graft urethroplasty is safe and feasible with good intermediate term outcomes. PMID:26834398

  3. Surgical Outcome of Urethroplasty Using Penile Circular Fasciocutaneous Flap for Anterior Urethral Stricture

    PubMed Central

    Kim, Kyoung Rok; Suh, Jun-Gyo; Paick, Jae-Seung

    2014-01-01

    Purpose Penile circular fasciocutaneous flap urethroplasty is a useful technique for a long anterior urethral stricture due to the flap's hairless nature and ample length. We investigated the surgical outcomes of urethroplasty for a complex anterior urethral stricture, performed using a penile circular fasciocutaneous flap. Materials and Methods Between 2008 and 2013, we performed a retrospective review of 29 patients who underwent urethroplasty using a penile circular fasciocutaneous flap and had at least 6 months of follow-up. A total of 20 cases utilized only a fasciocutaneous flap, while 9 cases combined a fasciocutaneous flap with other surgery. Success was defined as no requirement of additional urethral instrumentation. Results The overall success rate was 68.9% (20 out of 29 cases) at a median follow-up of 19 months. Furthermore, fasciocutaneous flap urethroplasty rendered the actual stricture-free rate of 79.3%. The location of recurrence was mostly at the junction of the flap. Among 9 surgical failures, 5 cases were treated successfully by using an additional surgical procedure. Fistula repair was needed in 1 case 4 months later. Further, periodic urethral dilation was performed in the remaining 3 cases. The failure rate was significantly higher in patients with suprapubic cystostomy than in patients without suprapubic cystostomy. The most common complication was post-micturition dribbling. Conclusions Penile circular fasciocutaneous flap urethroplasty is a useful method for the reconstruction of a long anterior urethral stricture. A sufficient healthy margin should be acquired for better surgical results due to the fact that most recurrence occurs at the junction of the flap. PMID:25237658

  4. Post-traumatic headaches.

    PubMed

    Riechers, Ronald G; Walker, Mark F; Ruff, Robert L

    2015-01-01

    Chronic pain, especially headache, is an exceedingly common complication of traumatic brain injury (TBI). In fact, paradoxically, the milder the TBI, the more likely one is to develop headaches. The environment of injury and the associated comorbidities can have a significant impact on the frequency and severity of headaches and commonly serve to direct management of the headaches. Trauma likely contributes to the development of headaches via alterations in neuronal signaling, inflammation, and musculoskeletal changes. The clinical picture of the patient with post-traumatic headaches is often that of a mixed headache disorder with features of tension-type headaches as well as migrainous headaches. Treatment of these headaches is thus often guided by the predominant characteristics of the headaches and can include pharmacologic and nonpharmacologic strategies. Pharmacologic therapies include both abortive and prophylactic agents with prophylaxis targeting comorbidities, primarily impaired sleep. Nonpharmacologic interventions for post-traumatic headaches include thermal and physical modalities as well as cognitive behavioral approaches. As with many postconcussive symptoms, headaches can lessen with time but in up to 25% of patients, chronic headaches are long-term residua. PMID:25701908

  5. Traumatic brain injury

    PubMed Central

    Risdall, Jane E.; Menon, David K.

    2011-01-01

    There is an increasing incidence of military traumatic brain injury (TBI), and similar injuries are seen in civilians in war zones or terrorist incidents. Indeed, blast-induced mild TBI has been referred to as the signature injury of the conflicts in Iraq and Afghanistan. Assessment involves schemes that are common in civilcian practice but, in common with civilian TBI, takes little account of information available from modern imaging (particularly diffusion tensor magnetic resonance imaging) and emerging biomarkers. The efficient logistics of clinical care delivery in the field may have a role in optimizing outcome. Clinical care has much in common with civilian TBI, but intracranial pressure monitoring is not always available, and protocols need to be modified to take account of this. In addition, severe early oedema has led to increasing use of decompressive craniectomy, and blast TBI may be associated with a higher incidence of vasospasm and pseudoaneurysm formation. Visual and/or auditory deficits are common, and there is a significant risk of post-traumatic epilepsy. TBI is rarely an isolated finding in this setting, and persistent post-concussive symptoms are commonly associated with post-traumatic stress disorder and chronic pain, a constellation of findings that has been called the polytrauma clinical triad. PMID:21149359

  6. The Microbial Communities in Male First Catch Urine Are Highly Similar to Those in Paired Urethral Swab Specimens

    PubMed Central

    Toh, Evelyn; Diao, Lixia; Gao, Xiang; Fortenberry, J. Dennis; Van Der Pol, Barbara

    2011-01-01

    Urine is the CDC-recommended specimen for STI testing. It was unknown if the bacterial communities (microbiomes) in urine reflected those in the distal male urethra. We compared microbiomes of 32 paired urine and urethral swab specimens obtained from adult men attending an STD clinic, by 16S rRNA PCR and deep pyrosequencing. Microbiomes of urine and swabs were remarkably similar, regardless of STI status of the subjects. Thus, urine can be used to characterize urethral microbiomes when swabs are undesirable, such as in population-based studies of the urethral microbiome or where multiple sampling of participants is required. PMID:21603636

  7. Posterior Tibial Tendon Dysfunction (PTTD)

    MedlinePLUS

    ... ACFAS | Información en Español Advanced Search Home » Foot & Ankle Conditions » Posterior Tibial Tendon Dysfunction (PTTD) Text Size ... the arch, and an inward rolling of the ankle. As the condition progresses, the symptoms will change. ...

  8. Children's Understanding of Posterior Probability

    ERIC Educational Resources Information Center

    Girotto, Vittorio; Gonzalez, Michael

    2008-01-01

    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,

  9. Stereolithography for Posterior Fossa Cranioplasty

    PubMed Central

    Agner, Celso; Dujovny, Manuel; Evenhouse, Raymond; Charbel, Fady T.; Sadler, Lewis

    1998-01-01

    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 PMID:17171056

  10. [Traumatic fracture of the thoracic spine T1-T10].

    PubMed

    Falavigna, Asdrubal; Righesso Neto, Orlando; Ferraz, Fernando Antonio Patriani; Boniatti, Mrcio Manozzo

    2004-12-01

    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

  11. Pelvic fracture-related urethral and bladder injury.

    PubMed

    Durrant, Jordan J; Ramasamy, A; Salmon, M S; Watkin, N; Sargeant, I

    2013-03-01

    Major pelvic ring fracture (PRF) due to blunt trauma results in lower urinary tract injury (LUTI) in up to 10% of cases. Significant comorbidity may result and this is particularly the case for unrecognised injury. The increase in military injuries due to improvised explosive devices in recent conflicts has revealed a complex injury cohort. The incidence of pelvic fracture related LUTI in these casualties is up to three times higher than that seen in civilian patients with pelvic fracture. A complete understanding of LUTI following pelvic fracture is still lacking. Complex fractures of the anterior pelvic arch are associated with LUTI and initial management is largely conservative. In battlefield injuries, the combination of the blast wave, penetrating fragment and bodily displacement results in open pelvic fracture combined with gross perineal and pelvic soft-tissue destruction and traumatic femoral amputations. These are some of the most challenging injuries that any surgical team will manage and life saving measures are the priority. There are established pathways for the management of LUTI following blunt trauma related pelvic fracture. Military injuries are more complex and require a significantly different approach. This paper outlines the developments in the understanding and management of pelvic fracture-related LUTI, focussing primarily on injury mechanisms and early management. Recent military surgical experience is discussed, highlighting the significant differences to civilian practice. PMID:23631324

  12. Ventral inlay buccal mucosal graft urethroplasty: A novel surgical technique for the management of urethral stricture disease

    PubMed Central

    Terlecki, Ryan Patrick

    2015-01-01

    To describe the novel technique of ventral inlay substitution urethroplasty for the management of male anterior urethral stricture disease. A 58-year-old gentleman with multifocal bulbar stricture disease measuring 7 cm in length was treated using a ventral inlay substitution urethroplasty. A dorsal urethrotomy was created, and the ventral urethral plated was incised. The edges of the urethral plate were mobilized without violation of the ventral corpus spongiosum. A buccal mucosa graft was harvested and affixed as a ventral inlay to augment the caliber of the urethra. The dorsal urethrotomy was closed over a foley catheter. No intraoperative or postoperative complications occurred. Postoperative imaging demonstrated a widely patent urethra. After three years of follow-up, the patient continues to do well with no voiding complaints and low postvoid residuals. Ventral inlay substitution urethroplasty appears to be a safe and feasible technique for the management of bulbar urethral strictures. PMID:25685305

  13. Trichomonas vaginalis infection: How significant is it in men presenting with recurrent or persistent symptoms of urethritis?

    PubMed

    Ng, Andrea; Ross, Jonathan Dc

    2016-01-01

    Persistent or recurrent non-gonococcal urethritis has been reported to affect up to 10-20% of men attending sexual health clinics. An audit was undertaken to review the management of persistent or recurrent non-gonococcal urethritis in men presenting at Whittall Street Clinic, Birmingham, UK. Detection of Trichomonas vaginalis infection was with the newly-introduced nucleic acid amplification test. A total of 43 (8%) of 533 men treated for urethritis re-attended within three months with persistent or recurrent symptoms. Chlamydia trachomatis infection was identified in 13/40 (33%), T. vaginalis in 1/27 (4%) and Mycoplasma genitalium in 6/12 (50%). These findings suggest that the prevalence of T. vaginalis infection remains low in our clinic population and may not contribute significantly to persistent or recurrent non-gonococcal urethritis. PMID:25663246

  14. Locked posterior dislocation of the shoulder: A report of three cases.

    PubMed

    Benhamida, M K; Ouertatani, M; Hasayri, I; Benhassine, A; Meherzi, M; Bouhdiba, S; Mestiri, M

    2015-04-01

    Posterior shoulder dislocations account for 4% of all shoulder dislocations. In two-thirds of the cases, the diagnosis is made only once the shoulder is locked, which radically changes the treatment and prognosis. We report three clinical cases of locked posterior shoulder dislocation. Closed reduction was attempted in one case but failed. All patients underwent open reduction and subscapularis transfer according to either Neer's (2 cases) or McLaughlin's technique (1 case). The functional outcome was satisfactory in two cases despite recurrent dislocation on the third day after surgery. The third patient eventually developed post-traumatic shoulder osteoarthritis. The best treatment consists of detecting posterior dislocations immediately when they occur under suggestive circumstances (electrocution, epileptic seizure, severe trauma shoulder). PMID:25765116

  15. Post-Traumatic Stress Disorder

    MedlinePLUS

    Post-traumatic stress disorder (PTSD) is a real illness. You can get PTSD after living through or seeing a traumatic event, such as war, a hurricane, sexual assault, physical abuse, or a bad accident. PTSD makes you feel stressed and afraid after the danger is over. It affects your life and ...

  16. Effects of different alpha-1 adrenoceptor blockers on proximal urethral function using in vivo isovolumetric pressure changes.

    PubMed

    Yamaguchi, Takanori; Nagano, Masashi; Osada, Yukio

    2005-10-01

    The effects of different alpha-1 adrenoceptor blockers on the urethra and the cardiovascular system were evaluated using an in vivo isovolumetric intra-urethral pressure model in New Zealand white rabbits. The urethra of anesthetized male rabbits was cannulated through the bladder and secured at the vesico-urethral junction. The distal side of urethra under the pubic bone was also closed to allow measurement of the intra-urethral pressure. Both the intra-urethral pressure and the femoral arterial pressure were monitored. The effects of five different alpha-1 adrenoceptor blockers on the increases in both the intra-urethral pressure and blood pressure induced by phenylephrine were then examined. The inhibition rate of the alpha-1 adrenoceptor blockers prazosin, bunazosin, terazosin, alfuzosin and tamsulosin on the increase in intra-urethral pressure caused as a result of contraction by phenylephrine was 87.5 +/- 4.5% (mean +/- S.E.), 88.0 +/- 7.2%, 86.2 +/- 6.2%, 81.4 +/- 4.8% and 92.5 +/- 5.0% respectively. The potency ranking of these alpha-1 adrenoceptor blockers was tamsulosin > bunazosin > prazosin > terazosin > alfuzosin. Their inhibition rate of the arterial pressure increase induced by phenylephrine was 81.9 +/- 5.0%, 86.2 +/- 5.9%, 76.0 +/- 6.0%, 63.6 +/- 5.7% and 58.0 +/- 5.2% respectively, with a potency ranking of bunazosin > prazosin > terazosin > alfuzosin > tamsulosin. We therefore conclude that the alpha-1 adrenoceptor blockers bunazosin and prazosin have a more potent action on both the urethra and the vascular system. However, tamsulosin and alfuzosin displayed a marked blockade of the increased urethral pressure induced by phenylephrine, with much less of a blockade of arterial pressure. In the present study, tamsulosin has been shown to be the most sensitive and powerful of the alpha-1 adrenoceptor blockers on urethral smooth muscle. PMID:16428864

  17. Comparison of Antimicrobial Susceptibilities of Pharyngeal, Rectal, and Urethral Neisseria gonorrhoeae Isolates among Men Who Have Sex with Men

    PubMed Central

    Zaidi, Akbar; Asbel, Lenore; Baldwin, Tamara; Gratzer, Beau; Guerry, Sarah; Kerani, Roxanne P.; Pathela, Preeti; Pettus, Kevin; Soge, Olusegun O.; Stirland, Ali; Weinstock, Hillard S.

    2015-01-01

    U.S. surveillance for Neisseria gonorrhoeae antimicrobial susceptibilities is based exclusively on male urethral isolates. These data inform gonorrhea treatment guidelines, including recommendations for the treatment of extragenital infections, but data on the susceptibilities of extragenital isolates are limited. We compared the antimicrobial susceptibilities of pharyngeal, rectal, and urethral gonococcal isolates collected from men who have sex with men (MSM), at five sentinel sites throughout the United States. MICs were determined by the agar dilution method. Generalized linear models were used to compare (i) the proportions of isolates with elevated MICs and (ii) geometric mean MICs according to anatomic site, adjusted for city. In December 2011 to September 2013, totals of 205 pharyngeal, 261 rectal, and 976 urethral isolates were obtained. The proportions of isolates with elevated ceftriaxone MICs (≥0.125 μg/ml) did not differ according to anatomic site (0.5% of pharyngeal isolates, 1.5% of rectal isolates, and 1.7% of urethral isolates, with a city-adjusted odds ratio [aOR] of 0.4 [95% confidence interval {CI}, 0.0 to 3.9] for pharyngeal versus urethral isolates and an aOR of 0.9 [95% CI, 0.2 to 4.2] for rectal versus urethral isolates). The city-adjusted geometric mean ceftriaxone MICs of pharyngeal (0.0153 μg/ml) and rectal (0.0157 μg/ml) isolates did not differ from that of urethral isolates (0.0150 μg/ml) (ratios of geometric mean MICs of 1.02 [95% CI, 0.90 to 1.17] and 1.05 [95% CI, 0.93 to 1.19], respectively). Similar results were observed for other antimicrobials, including cefixime and azithromycin. These findings suggest that, at the population level, gonococcal antimicrobial susceptibility surveillance based on urethral isolates from MSM adequately reflects the susceptibilities of N. gonorrhoeae strains circulating among MSM. PMID:25691638

  18. Differential vulnerabilities of urethral afferents in diabetes and discovery of a novel urethra-to-urethra reflex

    PubMed Central

    Yang, Zhongguang; Dolber, Paul C.

    2010-01-01

    Urethral reflexes are important regulators of micturition, and impairment of urethral afferent neuronal function may disrupt coordinated bladder and urethral activity, thereby contributing to voiding dysfunction in lower urinary tract disorders. Chemical stimulation by intraurethral irritant solution perfusion was used to determine whether urethral afferent neuronal function is altered in diabetes mellitus (DM). Sprague-Dawley rats were studied 10 wk after streptozotocin injection to induce DM or vehicle alone. Escalating doses of capsaicin (0.130 ?M) or acetic acid (0.011%; AA) were perfused intraurethrally while recording isovolumetric bladder activity, urethral perfusion pressure, and electromyography of the external urethral sphincter (EUS-EMG). Some rats were additionally treated with ?-bungarotoxin, hexamethonium, or bilateral transection of the sensory branches of the pudendal nerves (PudSNx). Intraurethral capsaicin inhibited bladder contractions in six out of seven control rats but not in any of six DM rats. Low-frequency oscillations (LFOs) of intraurethral pressure were observed in five out of six control rats with capsaicin-induced bladder inhibition. In contrast, intraurethral AA inhibited bladder contractions and enhanced tonic EUS-EMG activity in six out of six control and five out of six DM rats. LFOs occurred in four out of six control and three of five DM rats with AA-induced bladder inhibition. Chemically induced bladder inhibition and LFOs were not prevented by ?-bungarotoxin but were eliminated by PudSNx and hexamethonium. Finally, LFOs were followed by phasic EUS activity. These findings show that DM affects urethral afferent neurons differentially, compromising those expressing TRPV1 receptors. Urethral smooth muscle LFOs are neurogenically mediated and induce EUS activity, revealing the existence of a hitherto undescribed reflex pathway: a smooth-to-striated muscle urethra-to-urethra reflex. PMID:19864303

  19. FKBP5 Genotype and Structural Integrity of the Posterior Cingulum

    PubMed Central

    Fani, Negar; King, Tricia Z; Reiser, Emily; Binder, Elisabeth B; Jovanovic, Tanja; Bradley, Bekh; Ressler, Kerry J

    2014-01-01

    Alterations in the microarchitecture of the posterior cingulum (PC), a white matter tract proximal to the hippocampus that facilitates communication between the entorhinal and cingulate cortices, have been observed in individuals with psychiatric disorders, such as depression and post-traumatic stress disorder (PTSD). PC decrements may be a heritable source of vulnerability for the development of affective disorders; however, genetic substrates for these white matter abnormalities have not been identified. The FKBP5 gene product modulates glucocorticoid receptor function and has been previously associated with differential hippocampal structure, function, and affect disorder risk. Thus, FKBP5 is an attractive genetic target for investigations of PC integrity. We examined associations between PC integrity, measured through diffusion tensor imaging (DTI) and fractional anisotropy (FA; an index of white matter integrity), and polymorphisms in the FKBP5 SNP rs1360780 in a sample of 82 traumatized female civilians. Findings indicated that, compared with individuals without this allele, individuals who carried two risk' alleles for this FKBP5 SNP (T allele; previously associated with mood and anxiety disorder risk) demonstrated significantly lower FA in the left PC, even after statistically controlling for variance associated with age, trauma exposure, and PTSD symptoms. These data suggest that specific allelic variants for an FKBP5 polymorphism are associated with decrements in the left PC microarchitecture. These white matter abnormalities may be a heritable biological marker that indicates increased vulnerability for the development of psychiatric disorders, such as PTSD. PMID:24253961

  20. [Traumatic neurogenic shock].

    PubMed

    Maurin, O; de Rgloix, S; Caball, D; Arvis, A-M; Perrochon, J-C; Tourtier, J-P

    2013-05-01

    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

  1. [Posterior thoracotomy in ventral decubitus].

    PubMed

    Parshin, V D; Grigir'eva, S P; Parshin, V V; Khetagurov, M A; Dydykin, S S; Laptina, V I

    2013-01-01

    The rigidity of the chest wall, thank to its bone framework, determines the variety of operative access in thoracic surgery, both thoracoscopic and open. The posterior thoracotomy on the bed of the resected rib in ventral decubitus is traditionally but gratuitously rarely used access. The method permits comfortable access to trachea, bifurcation, main bronchi and thoracic esophagus. It can also be used in cases of foregoing thoracothomy. Authors own the experience of 111 cases with the use of posterior thoracotomy in ventral decubitus. The access proved to be preferable for the operations on the membranous part of the trachea and main bronchi, some localizations of thoracic tracheoesophageal fistula. The access suggests fast mobilization of the root of the lung without foregoing pneumolisis, which is important in cases of pleural cavity obliteration after tuberculosis or pleural empyem. PMID:23715388

  2. Pediatric Posterior Sternoclavicular Joint Injuries.

    PubMed

    Chaudhry, Sonia

    2015-08-01

    Posterior sternoclavicular joint injuries are increasingly diagnosed in children and young adults. Most of these injuries are the result of indirect mechanisms, typically lateral compression, with a posterior-to-anterior force applied to the shoulder during sports. Less frequently, these injuries are caused by direct impact on the medial clavicle, which can occur in rollover motor vehicle accidents, or may represent atraumatic instability. In patients younger than 25 years, physeal separation is more common than true dislocation. Theoretically, these patients have increased remodeling potential. Reduction is recommended to prevent and/or manage the compression of mediastinal structures, which can lead to life-threatening injury. Open surgical stabilization is the preferred treatment for acute and chronic retrosternal injuries. A thoracic or trauma surgeon should be available during stabilization in the rare event of potentially life-threatening hemorrhage after reduction. Outcomes have been largely successful, with pain-free, unrestricted range of motion and return to activity. PMID:26116848

  3. Nanotherapy for posterior eye diseases.

    PubMed

    Kaur, Indu Pal; Kakkar, Shilpa

    2014-11-10

    It is assumed that more than 50% of the most enfeebling ocular diseases have their origin in the posterior segment. Furthermore, most of these diseases lead to partial or complete blindness, if left untreated. After cancer, blindness is the second most dreaded disease world over. However, treatment of posterior eye diseases is more challenging than the anterior segment ailments due to a series of anatomical barriers and physiological constraints confronted for delivery to this segment. In this regard, nanostructured drug delivery systems are proposed to defy ocular barriers, target retina, and act as permeation enhancers in addition to providing a controlled release. Since an important step towards developing effective treatment strategies is to understand the course or a route a drug molecule needs to follow to reach the target site, the first part of the present review discusses various pathways available for effective delivery to and clearance from the posterior eye. Promise held by nanocarrier systems, viz. liposomes, nanoparticles, and nanoemulsion, for effective delivery and selective targeting is also discussed with illustrative examples, tables, and flowcharts. However, the applicability of these nanocarrier systems as self-administration ocular drops is still an unrealized dream which is in itself a huge technological challenge. PMID:24862316

  4. [Diffuse post-traumatic calcification of the anterior longitudinal ligamentum of cervical and dorsal spine].

    PubMed

    Manzini, C U; Spina, V; Mascia, M T; Magistro, R; Carpenito, G; Ferri, C

    2004-01-01

    Among the different conditions causing inflammation and calcification/ossification of the soft tissues of the spinal cord, single or recurrent traumatic events are included. Within the international literature, the involvement of the posterior longitudinal ligament, following spinal cord injuries is frequently reported, especially in the elders. The Authors describe here an uncommon calcification/ossification of the anterior longitudinal ligament occurred after a double traumatic event in a young man, followed clinically and radiologically for a long-term period. On the basis of clinical, laboratory and radiological findings, the differential diagnosis with other possible aetiologies, especially DISH (Diffuse idiopathic skeletal hyperostosis) and ankylosing spondylitis, is discussed. PMID:15309220

  5. Traumatic wound microbiome workshop.

    PubMed

    Kirkup, B C; Craft, D W; Palys, T; Black, C; Heitkamp, R; Li, C; Lu, Y; Matlock, N; McQueary, C; Michels, A; Peck, G; Si, Y; Summers, A M; Thompson, M; Zurawski, D V

    2012-10-01

    On May 9-10, 2011, the Walter Reed Army Institute of Research, as the Army Center of Excellence for Infectious Disease, assembled over a dozen leaders in areas related to research into the communities of microorganisms which colonize and infect traumatic wounds. The objectives of the workshop were to obtain guidance for government researchers, to spur research community involvement in the field of traumatic wound research informed by a microbiome perspective, and to spark collaborative efforts serving the Wounded Warriors and similarly wounded civilians. During the discussions, it was made clear that the complexity of these infections will only be met by developing a new art of clinical practice that engages the numerous microbes and their ecology. It requires the support of dedicated laboratories and technologists who advance research methods such as community sequencing, as well as the kinds of data analysis expertise and facilities. These strategies already appear to be bearing fruit in the clinical management of chronic wounds. There are now funding announcements and programs supporting this area of research open to extramural collaborators. PMID:22622764

  6. Chronic traumatic encephalopathy.

    PubMed

    Omalu, Bennet

    2014-01-01

    Chronic traumatic encephalopathy (CTE) is a progressive neurodegenerative syndrome, which is caused by single, episodic, or repetitive blunt force impacts to the head and transfer of acceleration-deceleration forces to the brain. CTE presents clinically as a composite syndrome of mood disorders and behavioral and cognitive impairment, with or without sensorimotor impairment. Symptoms of CTE may begin with persistent symptoms of acute traumatic brain injury (TBI) following a documented episode of brain trauma or after a latent period that may range from days to weeks to months and years, up to 40 years following a documented episode of brain trauma or cessation of repetitive TBI. Posttraumatic encephalopathy is distinct from CTE, can be comorbid with CTE, and is a clinicopathologic syndrome induced by focal and/or diffuse, gross and/or microscopic destruction of brain tissue following brain trauma. The brain of a CTE sufferer may appear grossly unremarkable, but shows microscopic evidence of primary and secondary proteinopathies. The primary proteinopathy of CTE is tauopathy, while secondary proteinopathies may include, but are not limited to, amyloidopathy and TDP proteinopathy. Reported prevalence rates of CTE in cohorts exposed to TBI ranges from 3 to 80% across age groups. PMID:24923391

  7. A case report of urethral prolapse in a 38 year old female with 46XY karyotype.

    PubMed

    Watson, Helena; Stasiowska, Ewa

    2014-06-01

    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

  8. Delayed repair of pelvic fracture urethral injuries: Preoperative decision-making

    PubMed Central

    Osman, Nadir I.; Mangera, Altaf; Inman, Richard D.; Chapple, Christopher R.

    2015-01-01

    Pelvic fracture urethral injuries comprise one of the most challenging reconstructive procedures in urology. The obliterated or stenosed urethra can usually be effectively repaired by an end-to-end anastomosis (bulbomembranous anastomosis). To achieve this, a progression of surgical steps can be used to make a tension-free anastomosis. Before undertaking surgery it is important to comprehensively assess the patient to define their anatomical defects, in particular the site of the stenosis, the length of the distraction injury and the integrity of the bladder neck, and thus guide preoperative decision-making. Contemporary reports suggest that most pelvic fracture urethral distraction defects (PFUDD) can be adequately managed by a perineal approach. Nevertheless it is essential that all surgeons treating these injuries are familiar with the whole spectrum of operative steps that are necessary to repair PFUDD. PMID:26413351

  9. Complicated urethral rupture and scrotal urethrostomy in a Bongo antelope (Tragelaphus eurycerus isaaci).

    PubMed

    Fresno, Laura; Fernández-Morán, Jesús; Fernández-Bellon, Hugo; Andaluz, Anna; García-Arnas, Félix

    2008-09-01

    A 4-yr-old, 300-kg male Bongo antelope presented a fluctuant swelling on the ventral abdomen surrounding the penis, which was confirmed later as compatible with urethral rupture. Initial treatment included broad-spectrum antibiotic and radical surgical debridement. Total prepuce and partial penile amputation with orchidectomy was performed and normal micturition was restored. At a later stage, when the extent of the lesion was controlled, a permanent scrotal urethrostomy was performed. Complete healing by second intention was achieved 2 mo after the last surgery. Although the outcome was very good, considering the extent and severity of the tissue damage, prompt permanent urethrostomy when urethral rupture was first suspected would have prevented deterioration of the condition and prevented the need for extensive surgery. PMID:18817013

  10. Analysis of feline urinary calculi and urethral plugs by infrared spectroscopy and scanning electron microscopy.

    PubMed

    Escolar, E; Bellanato, J

    2003-05-17

    The chemical constituents of 34 feline urinary calculi and five urethral plugs were analysed by infrared spectroscopy. The analysis revealed that 18 (52.9 per cent) of the calculi contained magnesium ammonium phosphate hexahydrate (struvite) as the major component; 10 (29.4 per cent) contained complex ammonium urates (three of them also containing calcium phosphate, mainly on the surface); three were composed of calcium phosphates and three were composed mainly of calcium oxalate mono and dihydrates. The urethral plugs were composed primarily of struvite, but also contained large amounts of organic matter. The examination of 16 selected samples by scanning electron microscopy and electron dispersive x-ray analysis revealed that their crystalline structures were similar to those of canine stones. PMID:12790167

  11. AB165. Urethral injury of penile surgery result in urethrocutaneous fistula (report of 9 cases)

    PubMed Central

    Yang, Huai; Wu, Shijian; Lv, Jun; Chen, Bote

    2014-01-01

    Objective To explore the reason of penile surgery that result in urethral injury. Methods To review the penile surgery (circumcision, penile curvature correction) that result in urethrocutaneous fistula from March 2009 to May 2014. Six cases resulted from circumcision, and three cases resulted from penile curvature correction. Results All patients were lack of corpus spongiosum penis, and the urethra was only covered with ventral skin of penis and tunica mucosa. Urethra was easy to be hurt when separate the ventral skin of penis and tunica mucosa. Conclusions The urethra of urethral injury of penile surgery usually has congenital pathological changes that corpus spongiosum penis does not close well or doesnt close in the development. So before taking the Penile surgery, the corpus spongiosum should be touched to check the development of anterior corpus spongiosum to avoid injuring tunica mucosa when pulling and separating the ventral skin of penis.

  12. Delayed repair of pelvic fracture urethral injuries: Preoperative decision-making.

    PubMed

    Osman, Nadir I; Mangera, Altaf; Inman, Richard D; Chapple, Christopher R

    2015-09-01

    Pelvic fracture urethral injuries comprise one of the most challenging reconstructive procedures in urology. The obliterated or stenosed urethra can usually be effectively repaired by an end-to-end anastomosis (bulbomembranous anastomosis). To achieve this, a progression of surgical steps can be used to make a tension-free anastomosis. Before undertaking surgery it is important to comprehensively assess the patient to define their anatomical defects, in particular the site of the stenosis, the length of the distraction injury and the integrity of the bladder neck, and thus guide preoperative decision-making. Contemporary reports suggest that most pelvic fracture urethral distraction defects (PFUDD) can be adequately managed by a perineal approach. Nevertheless it is essential that all surgeons treating these injuries are familiar with the whole spectrum of operative steps that are necessary to repair PFUDD. PMID:26413351

  13. Urethral Hairballs as a Long-Term Complication of Hypospadias Repair: Two Case Reports

    PubMed Central

    Kampantais, Spyridon; Dimitriadis, Charalampos; Laskaridis, Leonidas; Perdikis, Ioannis; Kirtsis, Petros; Toutziaris, Chrysovalantis

    2012-01-01

    Many times hair-bearing urethral grafts have been used inadvertently in the treatment of hypospadias. This can be accompanied with numerous troublesome long-term complications such as formation of stones, diverticula, and hairballs. We report two cases of men with a history of hypospadias repair being affected by such complications. We also discuss about their management and the effect of thioglycolic acid instillation to stop hair growth in the urethra mucosa in the second case. PMID:22924153

  14. Persistent increase in the incidence of acute male urethritis diagnosed in general practices in France

    PubMed Central

    Massari, Vronique; Dorlans, Yves; Flahault, Antoine

    2006-01-01

    Background At-risk sexual behaviour seems to have increased in Europe, possibly due to the reassuring efficacy of highly active antiretroviral treatments. Aim To follow, from 1990 to 2003, in France, the trends in the incidence of acute male urethritis diagnosed in general practice, a marker of at-risk sexual behaviour. Design of study Electronic disease surveillance. Setting General practices located all over mainland France. Method The GPs of the French Sentinelles network reported, via online computer systems, the acute urethritis cases they diagnosed, and for each case the characteristics of the patients. Results After a striking decrease between 1990 and 1995 from 460 per 100 000 men aged 1564 years (95% confidence interval [CI] = 390 to 520) to 180 (95% CI = 150 to 200), when antiretroviral drugs became available on the French market, the incidence of acute male urethritis stopped decreasing. Between 1996 and 2003, it may have risen again from 190 per 100 000 men (95% CI = 160 to 210) to 325 per 100 000 men (95% CI = 280 to 370) aged 1564 years. The percentage of homosexual/bisexual men among the cases reported was higher than in the general population (10% versus 4%, P<0.001). Homosexual/bisexual patients were younger than heterosexual patients (34 versus 37 years, P = 0.04), more of them had a discharge (88% versus 59%, P<0.001), a history of sexually transmitted disease (65% versus 32%, P<0.001), and at least two sexual partners (74% versus 38%, P<0.001). The most frequent pathogens were Chlamydia trachomatis (25%), Neisseria gonorrhoea (21%), Mycoplasma genitalium (8%), Ureaplasma urealyticum (5%), Trichomonas vaginalis (3%) and other bacteria (32%). Presence of co-infections was observed in 8.3% of patients. Conclusions This increase in the incidence of urethritis, shows that the sexual health of men has worsened in France, and calls for urgent new preventive measures. PMID:16464324

  15. Evaluation of Onlay Island Flap Technique in Shallow Urethral Plate Hypospadiasis

    PubMed Central

    Mohajerzadeh, Leily; Mirshemirani, Alireza; Rouzrokh, Mohsen; Sadeghian, Naser; Khaleghnejad-Tabari, Ahmad; Mahdavi, Alireza; Poorhasan, Sareh

    2016-01-01

    Background: Hypospadias is one of the most common congenital genital anomalies in males that necessitates to be operated early in infancy (when 6 to 9 months old). On the other hand, hypospadias is a challenging field of pediatric urology with multiple reconstruction techniques. A perfect hypospadias repair is supposed to return urethral continuity with sufficient caliber, eradicate phallus curvature, and supply an acceptable appearance with low complications. Objectives: This study aimed to evaluate the outcomes of using onlay island flap technique in the repair of hypospadias with shallow urethral plate. Patients and Methods: In this prospective study within June 2012 to December 2013, we performed onlay island flap procedure to repair hypospadias with shallow urethral plate measuring less than 6 millimeter. This technique was selected for all types of hypospadiasis except subcoronal type. Nesbits dorsal plication procedure was established for chordee. In cases with very small glans, urethroplasty was performed without glansplasty. Results: Twenty three patients with mean age of 30 (range 10 - 60) months underwent onlay island flap repair; all had a shallow urethral plate < 6 mm, 3 had a very small glans, and 18 had chordee. Meatus was located in distal shaft in 5 cases, mid shaft in 8, proximal in 6 and penoscrotal type in 4 patients. Chordee was corrected with Nesbits dorsal plication in 16 cases. Complications were: meatal stenosis in 2 cases and urethrocutaneous fistula in 2 patients, all of which were repaired surgically. Mean follow up time was 13 (3 - 20) months. All cases that had glansplasty have excellent esthetic appearance. Conclusions: This technique offers acceptable results regarding meatal stenosis, urethrocutaneous fistula and esthetic outcome. PMID:26848382

  16. Efficacy of mitomycin C in reducing recurrence of anterior urethral stricture after internal optical urethrotomy

    PubMed Central

    Shahzad, Muhammad; Orakzai, Nasir; Khan, Ihsanullah; Ahmad, Mubashira

    2015-01-01

    Purpose To determine the efficacy of mitomycin C in reducing the recurrence of anterior urethral stricture after internal optical urethrotomy (IOU). Materials and Methods This was a randomized controlled trial conducted in the Department of Urology at the Institute of Kidney Diseases Peshawar from March 2011 to December 2013. A total of 151 patients who completed the study were divided into two groups by the lottery method. Group A (cases) comprised 78 patients in whom mitomycin C 0.1% was injected submucosally in the stricture after conventional IOU. Group B (controls) comprised 73 patients in whom IOU only was performed. Self-clean intermittent catheterization was not offered in either group. All patients were regularly followed up for 18 months. Recurrence was diagnosed by use of retrograde urethrogram in all patients and flexible urethroscopy in selected cases. Data were collected on a structured pro forma sheet and were analyzed by SPSS. Results The mean age of the patients in group A was 37.3110.1 years and that in group B was 40.111.4 years. Recurrence of urethral stricture was recorded in 11 patients (14.1%) in group A and in 27 patients (36.9%) in group B (p=0.002). The mitomycin group also showed a delay in recurrence compared with the control group (p=0.002). Conclusions Recurrence of urethral stricture is high after optical urethrotomy. Mitomycin C was found to be highly effective in preventing the recurrence of urethral stricture after IOU. PMID:26366278

  17. A Case of Embryonal Rhabdomyosarcoma Presenting as a Lobulated Protrusion From the Urethral Meatus at Birth.

    PubMed

    Bethell, George S; Johal, Navroop S; Cuckow, Peter M

    2015-10-01

    This is the first reported case of rhabdomyosarcoma presenting as a mass protruding from the urethral meatus present at birth. A male neonate was transferred to a tertiary pediatric urology center on day 4 of life where the mass was surgically excised. Histology confirmed an embryonal rhabdomyosarcoma and chemotherapy commenced. The patient completed chemotherapy at the age of 8 months. The child is now 3.5 years old and well with no recurrence of disease. PMID:26166669

  18. Prefabricated partial distal urethral in 2-staged repair of proximal hypospadias with severe chordee

    PubMed Central

    Fan, Zhi-Qiang; Sun, Jian-Tao; Huangfu, Xue-Hun; Chen, Guo-Xiao; Hao, Jian-Wei; Liu, Zhong-Hua

    2015-01-01

    Purpose: To describe a new technique for staged hypospadias repair in which the urethral plate is divided and tubularized transverse island flap prefabricated partial distal urethral at the time of the first stage. Materials and methods: Sixteen patients with proximal hypospadias associated with severe chordee were operated on using a new staged technique. At the time of the first stage, the urethral plate was divided and chordee was corrected. Then tubularized transverse island flap was used to prefabricate partial distal urethra. The defective urethra was repaired using the Thiersch-Duplay principle at the second stage. Results: All participants have completed both stages of the operation. The mean follow-up duration was 18.4 months (range from 6 to 72 months). In the first-stage surgery, the modified tabularized transverse preputial island flap was performed on 6 patients, whereas the modified preputial double-faced island flap was performed on the other 10 patients. All of the prefabricated partial distal neourethras had no evidence of stenosis or scarring. The result of the second-stage procedure was a complete penis with integrated urethral. All patients were satisfied with cosmetic and functional results. Neither stricture nor diverticula was observed. A good urinary stream during the urination was attained in 12 (75.0%) patients. Four cases (25.0%) developed urethrocutaneous fistula after the second stage repair. Conclusions: In our preliminary series, this procedure improved functional and cosmetic results. It may be applicable to most cases of proximal hypospadias. Even when complications occur, they are less severe compared to those of the traditional staged approach. PMID:25932188

  19. Transurethral radiotherapy for benign prostatic hypertrophy-related urethral obstruction. Dosimetry, ethics, and preliminary results.

    PubMed

    Koukourakis, M; Zambatis, H; Skarlatos, J; Stamatelatos, I; Georgolopoulou, V; Rebelakos, A; Yannakakis, D

    1994-01-01

    The aim of this study is to present our preliminary experience in treating BPH-related urine retention, resistant to other medical treatment, with transurethral brachytherapy. We also deal with dosimetric analysis so as to eliminate ethical concerns about the exposure of patients not suffering from cancer to a certain level of body irradiation. Patients suffering from BPH-related urethral obstruction were treated with two transurethral applications (three weeks apart) of Cs137 MDR, which delivered a total of 16 Gy, at 0.5 cm from the urethral walls (dose rate 5-7 Gy/h). The application was done under ultrasonographic observation. Dosimetric calculation of the radiation exposure of the human body during transurethral radiotherapy (TURT) was performed for patients suffering from prostate cancer and treated with external beam radiotherapy and a boost dose through transurethral brachytherapy. For this purpose we used TLDs on skin surface and dosimetric analysis of X-ray films. Five patients treated for BPH urethral obstruction presented no sign of acute toxicity. All of them were weaned of their indwelling catheter immediately after the end of the first application. Obstruction did not recur within 12-18 months of follow-up. The dose delivered outside the prostate ranges from 1-7 cG, depending upon location. Proximal rectal and bladder walls received 1-2 Gy, a dose that is far from inducing acute or late toxicity. The estimated risk for carcinogenesis is negligible, and the expected benefit for the quality of life transcends the risks. No ethical concern is justified for testing transurethral radiotherapy for BPH-related urethral obstruction. TURT seems to be effective and provides durable results. Further investigation is required. PMID:7522461

  20. A unique complication of urethral catheterization: pubic hair associated with struvite bladder calculi.

    PubMed

    Perz, Sarah; Ellimoottil, Chandy; Rao, Manoj; Bresler, Larissa

    2013-01-01

    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

  1. The urethral plug II: an alternative treatment in women with genuine urinary stress incontinence.

    PubMed

    Nielsen, K K; Walter, S; Maegaard, E; Kromann-Andersen, B

    1993-10-01

    An improved design of the recently developed urethral plug was evaluated for the treatment of women with genuine urinary stress incontinence. The plug consists of an oval meatal plate, a soft stalk and 1 or 2 spheres along the stalk with fixed distances between the meatal plate and the spheres. Inside the stalk is a removable semi-rigid guide pin to ease insertion. Forty women were randomly allocated to treatment with either the 2-sphere or the 1-sphere plug during period 1 (2 weeks). In period 2 (2 weeks) the patients used the other plug. They then continued with what they judged to be the better plug in period 3 (2 months). Eighteen patients (45%) completed period 3 with the "preference" plug and 17 were subjectively and objectively continent or improved. Fourteen of these women preferred the 2-sphere device. The plugs were equally effective in patients with mild or severe incontinence. To accommodate variations in urethral length and to avoid the loss of plugs, the devices are available in different lengths. Six women developed urinary tract infections and 2 of these had a plug in the bladder. The urethral plug is an effective treatment in a group of women with stress incontinence. Removal by hand is advisable in order to avoid retention of plugs in the bladder. PMID:8261298

  2. Hypothesis That Urethral Bulb (Corpus Spongiosum) Plays an Active Role in Male Urinary Continence

    PubMed Central

    Rehder, Peter; Staudacher, Nina M.; Schachtner, Joerg; Berger, Maria E.; Schillfahrt, Florian; Hauser, Verena; Mueller, Raphael; Skradski, Viktor; Horninger, Wolfgang; Glodny, Bernhard

    2016-01-01

    The proximal urethral bulb in men is enlarged, surrounds the bulbous urethra, and extends dorsally towards the perineum. During intercourse engorgement takes place due to increased blood flow through the corpus spongiosum. Antegrade ejaculation is facilitated by contraction of the bulbospongiosus muscles during climax. Micturition during sexual stimulation is functionally inhibited. Supporting the bulb may indirectly facilitate continence in a certain subset of patients with postprostatectomy incontinence. During physical activity with increased abdominal pressure, reflex contraction of the pelvic floor muscles as well as the bulbospongiosus muscles occurs to support sphincter function and limit urinary incontinence. Operations to the prostate may weaken urinary sphincter function. It is hypothesized that the distal urinary sphincter may be supported indirectly by placing a hammock underneath the urethral bulb. During moments of physical stress the “cushion” of blood within the supported corpus spongiosum helps to increase the zone of coaptation within the sphincteric (membranous) urethra. This may lead to urinary continence in patients treated by a transobturator repositioning sling in patients with postprostatectomy incontinence. This paper describes the possible role of the urethral bulb in male urinary continence, including its function after retroluminal sling placement (AdVance, AdVance XP® Male Sling System, Minnetonka, USA).

  3. Evaluation of Gonodecten for the presumptive diagnosis of gonococcal urethritis in men.

    PubMed Central

    Janda, W M; Jackson, T

    1985-01-01

    Gonodecten (Gd; U.S. Packaging Corp., LaPorte, Ind.) is a commercially available test for the presumptive diagnosis of gonococcal urethritis in men. With this test, urethral discharge is collected on a swab, placed in a plastic tube, and moistened with oxidase reagent. Development of a purple color on the swab within 3 min indicates the presence of gonococci. This system was compared with culture and Gram-stained smear for the diagnosis of gonorrhea. Of 240 specimens tested, 174 were positive with culture, Gram stain, and the Gd test and 48 were negative with all tests. For eight specimens, cultures and smears were positive, but the Gd test was negative. Nine specimens produced positive Gd tests with negative smears and cultures. Only one specimen was positive on culture and with the Gd test and negative on Gram-stained smear. Haemophilus species were isolated from 14 specimens; 5 produced positive Gd test reactions, with gonococci being coisolated from 4. The sensitivity and specificity of the Gd test compared with culture were 95.6 and 84.2%, respectively, whereas the Gram stain was 99.5% sensitive and 100% specific compared with culture. The Gd test may be a useful screening test for the diagnosis of gonorrhea in men with urethral discharge, particularly in settings where a microscope, Gram stain reagents, or technological expertise is not readily available. PMID:2579091

  4. Sexually dimorphic expression of Mafb regulates masculinization of the embryonic urethral formation

    PubMed Central

    Suzuki, Kentaro; Numata, Tomokazu; Suzuki, Hiroko; Raga, Dennis Diana; Ipulan, Lerrie Ann; Yokoyama, Chikako; Matsushita, Shoko; Hamada, Michito; Nakagata, Naomi; Nishinakamura, Ryuichi; Kume, Shoen; Takahashi, Satoru; Yamada, Gen

    2014-01-01

    Masculinization of external genitalia is an essential process in the formation of the male reproductive system. Prominent characteristics of this masculinization are the organ size and the sexual differentiation of the urethra. Although androgen is a pivotal inducer of the masculinization, the regulatory mechanism under the control of androgen is still unknown. Here, we address this longstanding question about how androgen induces masculinization of the embryonic external genitalia through the identification of the v-maf avian musculoaponeurotic fibrosarcoma oncogene homolog B (Mafb) gene. Mafb is expressed prominently in the mesenchyme of male genital tubercle (GT), the anlage of external genitalia. MAFB expression is rarely detected in the mesenchyme of female GTs. However, exposure to exogenous androgen induces its mesenchymal expression in female GTs. Furthermore, MAFB expression is prominently down-regulated in male GTs of androgen receptor (Ar) KO mice, indicating that AR signaling is necessary for its expression. It is revealed that Mafb KO male GTs exhibit defective embryonic urethral formation, giving insight into the common human congenital anomaly hypospadias. However, the size of Mafb KO male GTs is similar with that of wild-type males. Moreover, androgen treatment fails to induce urethral masculinization of the GTs in Mafb KO mice. The current results provide evidence that Mafb is an androgen-inducible, sexually dimorphic regulator of embryonic urethral masculinization. PMID:25362053

  5. Striated muscle and nerve fascicle distribution in the female rat urethral sphincter.

    PubMed

    Kim, Ronald J; Kerns, James M; Liu, Shirley; Nagel, Ted; Zaszczurynski, Paul; Lin, Dan Li; Damaser, Margot S

    2007-02-01

    The anatomical basis for urinary continence depends on a thorough understanding of the tissues in the urethra. The objective of this study was to evaluate the morphology and neuroanatomy of urethral striated muscle, called the rhabdosphincter or external urethral sphincter, in normal female rats. Urethras from 12 female rats were dissected from the bladder, fixed, embedded in paraffin or epon, and sectioned every 1 mm. Striated muscle content was taken as the ratio of the striated muscle area to net urethral area. Nerve fascicles containing myelinated axons near the rhabdosphincter were counted and mapped. Both striated muscle content and number of nerve fascicles peak in the proximal third of the urethra, with a secondary peak at the distal end of the urethra. This secondary peak may correspond to an analog of the combined compressor urethrae/urethrovaginal sphincter located in the distal urethra in human. The rhabdosphincter has a variable distribution along the length of the urethra. In the middle and distal thirds of the urethra, the dorsal striated muscle fibers between the urethra and vagina become more sparse. The majority of nerve fascicles are contained in the lateral quadrants of the urethra, similar to the lateral distribution of somatic nerves in humans. In conclusion, this study demonstrates the normal distribution of the striated musculature and neuroanatomy in the urethra, with similarities to the human. It thus supports and extends the usefulness of the rat as an experimental model for studying urinary incontinence. PMID:17441207

  6. Penile inversion through a penoscrotal incision for the treatment of penile urethral strictures

    PubMed Central

    Tracey, James M; Zhumkhawala, Ali A; Chan, Kevin G.; Lau, Clayton S.

    2016-01-01

    Purpose This article describes a novel technique for the repair of penile urethral strictures and establishes the safety, feasibility, and efficacy of this innovative surgical approach. Materials and Methods Patients with urethral strictures underwent a one-sided anterior dorsal oral mucosal graft urethroplasty through a penoscrotal inversion technique. The clinical outcome was considered a failure when any instrumentation was needed postoperatively, including dilatation. Results Five patients underwent the novel procedure. The patients' mean age was 58 years. The cause of stricture was instrumentation in 2 cases (40%), lichen sclerosis in 1 case (20%), and failed hypospadias repair in 2 cases (40%). The mean stricture length was 3 cm. The overall mean (range) follow-up was 6 months (range, 3–9 months). Of the 5 patients, 4 (80%) had a successful outcome and 1 (20%) had a failed outcome. The failure was successfully treated by use of a meatotomy. Conclusions The penile inversion technique through a penoscrotal incision is a viable option for the management of penile urethral strictures with several advantages to other techniques: namely, no penile skin incision, a single-stage operation, and supine positioning. PMID:26981596

  7. Treatment of Urethral Strictures from Irradiation and Other Nonsurgical Forms of Pelvic Cancer Treatment.

    PubMed

    Khourdaji, Iyad; Parke, Jacob; Chennamsetty, Avinash; Burks, Frank

    2015-01-01

    Radiation therapy (RT), external beam radiation therapy (EBRT), brachytherapy (BT), photon beam therapy (PBT), high intensity focused ultrasound (HIFU), and cryotherapy are noninvasive treatment options for pelvic malignancies and prostate cancer. Though effective in treating cancer, urethral stricture disease is an underrecognized and poorly reported sequela of these treatment modalities. Studies estimate the incidence of stricture from BT to be 1.8%, EBRT 1.7%, combined EBRT and BT 5.2%, and cryotherapy 2.5%. Radiation effects on the genitourinary system can manifest early or months to years after treatment with the onus being on the clinician to investigate and rule-out stricture disease as an underlying etiology for lower urinary tract symptoms. Obliterative endarteritis resulting in ischemia and fibrosis of the irradiated tissue complicates treatment strategies, which include urethral dilation, direct-vision internal urethrotomy (DVIU), urethral stents, and urethroplasty. Failure rates for dilation and DVIU are exceedingly high with several studies indicating that urethroplasty is the most definitive and durable treatment modality for patients with radiation-induced stricture disease. However, a detailed discussion should be offered regarding development or worsening of incontinence after treatment with urethroplasty. Further studies are required to assess the nature and treatment of cryotherapy and HIFU-induced strictures. PMID:26494994

  8. The case against primary endoscopic realignment of pelvic fracture urethral injuries

    PubMed Central

    Tausch, Timothy J.; Morey, Allen F.

    2015-01-01

    Objectives To review previous reports and present our experience on the outcomes after treating pelvic fracture urethral injuries (PFUIs) with primary endoscopic realignment (PER) vs. placing a suprapubic tube (SPT) with elective bulbomembranous anastomotic urethroplasty (BMAU). Methods We reviewed previous reports and identified articles that reported outcomes after PER vs. SPT and elective BMAU for patients who sustained PFUIs. We also present our institutional experience of treating patients who were referred after undergoing either form of treatment. Results The success rates for PER after PFUI are wide-ranging (1186%), with variable definitions for a successful outcome. At our institution, for patients treated by SPT/BMAU, the mean time to a definitive resolution of stenosis was dramatically shorter (6months, range 315) than for those treated with PER (122months, range 4574; P<0.01). The vast majority of patients treated by PER required multiple endoscopic urethral interventions (median 4, range 136;P<0.01) and/or had various other adverse events that were rare among the SPT/BMAU group (14/17, 82%, vs. 2/23, 9%;P<0.05). Conclusion While PER occasionally results in urethral patency with no need for further intervention, the risk of delay in definitive treatment and the potential for adverse events have led to a preference for SPT and elective BMAU at our institution. PMID:26019972

  9. Treatment of Urethral Strictures from Irradiation and Other Nonsurgical Forms of Pelvic Cancer Treatment

    PubMed Central

    Khourdaji, Iyad; Parke, Jacob; Chennamsetty, Avinash; Burks, Frank

    2015-01-01

    Radiation therapy (RT), external beam radiation therapy (EBRT), brachytherapy (BT), photon beam therapy (PBT), high intensity focused ultrasound (HIFU), and cryotherapy are noninvasive treatment options for pelvic malignancies and prostate cancer. Though effective in treating cancer, urethral stricture disease is an underrecognized and poorly reported sequela of these treatment modalities. Studies estimate the incidence of stricture from BT to be 1.8%, EBRT 1.7%, combined EBRT and BT 5.2%, and cryotherapy 2.5%. Radiation effects on the genitourinary system can manifest early or months to years after treatment with the onus being on the clinician to investigate and rule-out stricture disease as an underlying etiology for lower urinary tract symptoms. Obliterative endarteritis resulting in ischemia and fibrosis of the irradiated tissue complicates treatment strategies, which include urethral dilation, direct-vision internal urethrotomy (DVIU), urethral stents, and urethroplasty. Failure rates for dilation and DVIU are exceedingly high with several studies indicating that urethroplasty is the most definitive and durable treatment modality for patients with radiation-induced stricture disease. However, a detailed discussion should be offered regarding development or worsening of incontinence after treatment with urethroplasty. Further studies are required to assess the nature and treatment of cryotherapy and HIFU-induced strictures. PMID:26494994

  10. Hypothesis That Urethral Bulb (Corpus Spongiosum) Plays an Active Role in Male Urinary Continence.

    PubMed

    Rehder, Peter; Staudacher, Nina M; Schachtner, Joerg; Berger, Maria E; Schillfahrt, Florian; Hauser, Verena; Mueller, Raphael; Skradski, Viktor; Horninger, Wolfgang; Glodny, Bernhard

    2016-01-01

    The proximal urethral bulb in men is enlarged, surrounds the bulbous urethra, and extends dorsally towards the perineum. During intercourse engorgement takes place due to increased blood flow through the corpus spongiosum. Antegrade ejaculation is facilitated by contraction of the bulbospongiosus muscles during climax. Micturition during sexual stimulation is functionally inhibited. Supporting the bulb may indirectly facilitate continence in a certain subset of patients with postprostatectomy incontinence. During physical activity with increased abdominal pressure, reflex contraction of the pelvic floor muscles as well as the bulbospongiosus muscles occurs to support sphincter function and limit urinary incontinence. Operations to the prostate may weaken urinary sphincter function. It is hypothesized that the distal urinary sphincter may be supported indirectly by placing a hammock underneath the urethral bulb. During moments of physical stress the "cushion" of blood within the supported corpus spongiosum helps to increase the zone of coaptation within the sphincteric (membranous) urethra. This may lead to urinary continence in patients treated by a transobturator repositioning sling in patients with postprostatectomy incontinence. This paper describes the possible role of the urethral bulb in male urinary continence, including its function after retroluminal sling placement (AdVance, AdVance XP® Male Sling System, Minnetonka, USA). PMID:27022393

  11. Using transurethral Ho:YAG-laser resection to treat urethral stricture and bladder neck contracture

    NASA Astrophysics Data System (ADS)

    Bo, Juanjie; Dai, Shengguo; Huang, Xuyuan; Zhu, Jing; Zhang, Huiguo; Shi, Hongmin

    2005-07-01

    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.

  12. Striving for the perfect surgery in traumatic cataract following penetrating trauma in a tertiary care hospital at eastern Nepal.

    PubMed

    Panda, A; Kumar, S; Das, H; Badhu, B P

    2007-01-01

    This study analyzes the result of traumatic cataract surgery in a tertiary care hospital at eastern Nepal. It is a hospital-based study of 112 patients (age 15-62), who underwent cataract extraction for unilateral traumatic cataracts. The study was carried out to evaluate the surgical outcome of tramatic cataract. Thirty-eight eyes had associated posterior capsular defect. No serious postoperative complications were encountered. Posterior capsular opacification at the end of sixth week was evident only in two eyes. Best corrected visual acuity nof 6/18 or more at the eighth week was achieved in 61 (54%) eyes. Astigmatism of less than 3D was achieved in 82 (73%) eyes. Rational surgical approach in traumatic cataract provides encouraging results. To comment on actual outcome long term follow up is mandatory. PMID:18274567

  13. Mild traumatic brain injury.

    PubMed

    Katz, Douglas I; Cohen, Sara I; Alexander, Michael P

    2015-01-01

    Mild traumatic brain injury (TBI) is common but accurate diagnosis and defining criteria for mild TBI and its clinical consequences have been problematic. Mild TBI causes transient neurophysiologic brain dysfunction, sometimes with structural axonal and neuronal damage. Biomarkers, such as newer imaging technologies and protein markers, are promising indicators of brain injury but are not ready for clinical use. Diagnosis relies on clinical criteria regarding depth and duration of impaired consciousness and amnesia. These criteria are particularly difficult to confirm at the least severe end of the mild TBI continuum, especially when relying on subjective, retrospective accounts. The postconcussive syndrome is a controversial concept because of varying criteria, inconsistent symptom clusters and the evidence that similar symptom profiles occur with other disorders, and even in a proportion of healthy individuals. The clinical consequences of mild TBI can be conceptualized as two multidimensional disorders: (1) a constellation of acute symptoms that might be termed early phase post-traumatic disorder (e.g., headache, dizziness, imbalance, fatigue, sleep disruption, impaired cognition), that typically resolve in days to weeks and are largely related to brain trauma and concomitant injuries; (2) a later set of symptoms, a late phase post-traumatic disorder, evolving out of the early phase in a minority of patients, with a more prolonged (months to years), sometimes worsening set of somatic, emotional, and cognitive symptoms. The later phase disorder is highly influenced by a variety of psychosocial factors and has little specificity for brain injury, although a history of multiple concussions seems to increase the risk of more severe and longer duration symptoms. Effective early phase management may prevent or limit the later phase disorder and should include education about symptoms and expectations for recovery, as well as recommendations for activity modifications. Later phase treatment should be informed by thoughtful differential diagnosis and the multiplicity of premorbid and comorbid conditions that may influence symptoms. Treatment should incorporate a hierarchical, sequential approach to symptom management, prioritizing problems with significant functional impact and effective, available interventions (e.g., headache, depression, anxiety, insomnia, vertigo). PMID:25702214

  14. Sleep and Traumatic Brain Injury.

    PubMed

    Baumann, Christian R

    2016-03-01

    Post-traumatic sleep-wake disturbances are frequent and often chronic complications after traumatic brain injury. The most prevalent sleep-wake disturbances are insomnia, excessive daytime sleepiness, and pleiosomnia, (ie, increased sleep need). These disturbances are probably of multifactorial origin, but direct traumatic damage to key brain structures in sleep-wake regulation is likely to contribute. Diagnosis and treatment consist of standard approaches, but because of misperception of sleep-wake behavior in trauma patients, subjective testing alone may not always suffice. PMID:26972030

  15. Approaches to a posterior polar cataract

    PubMed Central

    Vasavada, Abhay R.; Vasavada, Viraj A.; Raj, Shetal M.

    2011-01-01

    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. PMID:23960968

  16. [Post-traumatic endophthalmitis].

    PubMed

    El Chehab, H; Renard, J-P; Dot, C

    2016-01-01

    Post-traumatic endophthalmitis is a rare but serious complication of open globe injury, representing a major turning point for the patient's visual prognosis. Risk factors for this complication are lens capsule rupture, an intraocular foreign body, type of eye trauma and especially a delay in initial management of the trauma. Although Staphylococcus epidermidis is the most common organism, as in postoperative acute endophthalmitis, other microorganisms are more frequently represented and the multi-microbial involvement is common. The diagnosis can be difficult in the presence of inflammatory signs of trauma. Aside from rapid globe repair, neither preventive nor curative treatment have been well delineated. The class of antibiotics, the dosage, route of administration, as well as surgical treatment by vitrectomy remain topics of discussion. PMID:26563842

  17. Indirect traumatic optic neuropathy.

    PubMed

    Singman, Eric L; Daphalapurkar, Nitin; White, Helen; Nguyen, Thao D; Panghat, Lijo; Chang, Jessica; McCulley, Timothy

    2016-01-01

    Indirect traumatic optic neuropathy (ITON) refers to optic nerve injury resulting from impact remote to the optic nerve. The mechanism of injury is not understood, and there are no confirmed protocols for prevention, mitigation or treatment. Most data concerning this condition comes from case series of civilian patients suffering blunt injury, such as from sports- or motor vehicle-related concussion, rather than military-related ballistic or blast damage. Research in this field will likely require the development of robust databases to identify patients with ITON and follow related outcomes, in addition to both in-vivo animal and virtual human models to study the mechanisms of damage and potential therapies. PMID:26759722

  18. [Traumatic basal subarachnoid hemorrhage].

    PubMed

    Lundgaard, Peter; Leth, Peter Mygind; Gregersen, Markil

    2003-04-28

    Massive subarachnoid hemorrhage may occur on a traumatic basis. The injury is most often sustained by a blow with a clenched fist against the posterolateral part of the cranial basis, but the injury may also occur in relation to an accident. The condition is rare, most often occurring in alcohol intoxicated men. The victim typically collapses immediately and usually dies within a few minutes. The origin of the bleeding may be the vertebral artery on the neck or the intercranial basal brain arteries. In some cases the origin of the bleeding cannot be located. The pathogenetic mechanisms have been a subject of discussion. The damage to the artery may occur in relation to a fracture of the transverse process of the atlas or in relation to subluxations in the cervical vertebral column. The arterial rupture may occur in both normal and abnormal arteries. In many of the cases the trauma may be very slight. This has, of course, important legal implications. PMID:12772392

  19. Huge interparietal posterior fontanel meningohydroencephalocele.

    PubMed

    Rosildo, Jorge Flix Companioni; Dos Santos, Manuel Filipe Dias; de Santa Barbara, Rita de Cassia

    2015-01-01

    Congenital encephalocele is a neural tube defect characterized by a sac-like protrusion of the brain, meninges, and other intracranial structures through the skull, which is caused by an embryonic development abnormality. The most common location is at the occipital bone, and its incidence varies according to different world regions. We report a case of an 1-month and 7-day-old male child with a huge interparietal-posterior fontanel meningohydroencephalocele, a rare occurrence. Physical examination and volumetric computed tomography were diagnostic. The encephalocele was surgically resected. Intradural and extradural approaches were performed; the bone defect was not primarily closed. Two days after surgery, the patient developed hydrocephaly requiring ventriculoperitoneal shunting. The surgical treatment of the meningohydroencephalocele of the interparietal-posterior fontanel may be accompanied by technical challenges and followed by complications due to the presence of large blood vessels under the overlying skin. In these cases, huge sacs herniate through large bone defects including meninges, brain, and blood vessels. The latter present communication with the superior sagittal sinus and ventricular system. A favorable surgical outcome generally follows an accurate strategy taking into account individual features of the lesion. PMID:26484324

  20. Longevity of Posterior Composite Restorations

    PubMed Central

    Opdam, N.J.M.; van de Sande, F.H.; Bronkhorst, E.; Cenci, M.S.; Bottenberg, P.; Pallesen, U.; Gaengler, P.; Lindberg, A.; Huysmans, M.C.D.N.J.M.; van Dijken, J.W.

    2014-01-01

    The aim of this meta-analysis, based on individual participant data from several studies, was to investigate the influence of patient-, materials-, and tooth-related variables on the survival of posterior resin composite restorations. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we conducted a search resulting in 12 longitudinal studies of direct posterior resin composite restorations with at least 5 years follow-up. Original datasets were still available, including placement/failure/censoring of restorations, restored surfaces, materials used, reasons for clinical failure, and caries-risk status. A database including all restorations was constructed, and a multivariate Cox regression method was used to analyze variables of interest [patient (age; gender; caries-risk status), jaw (upper; lower), number of restored surfaces, resin composite and adhesive materials, and use of glass-ionomer cement as base/liner (present or absent)]. The hazard ratios with respective 95% confidence intervals were determined, and annual failure rates were calculated for subgroups. Of all restorations, 2,816 (2,585 Class II and 231 Class I) were included in the analysis, of which 569 failed during the observation period. Main reasons for failure were caries and fracture. The regression analyses showed a significantly higher risk of failure for restorations in high-caries-risk individuals and those with a higher number of restored surfaces. PMID:25048250

  1. Understanding Traumatic Stress in Children

    MedlinePLUS

    ... events produce profound and lasting changes in physiological arousal, emotion, cognition, and memory. Moreover, traumatic events may ... abuse to child welfare authorities. Be aware of state laws and work with your team to determine ...

  2. Post-Traumatic Stress Disorder

    MedlinePLUS

    ... examples of traumatic events are a natural disaster, rape, severe car crash or fighting in a war. ... or victims of war or combat Survivors of rape, domestic violence, physical assault such as a mugging ...

  3. National Child Traumatic Stress Network

    MedlinePLUS

    ... Professionals Resources for Parents and Caregivers Resources for Military Children and Families Resources for Educators Resources for ... Culture and Trauma Definitions References Resources Economic Stress Military and Veteran Families and Children Secondary Traumatic Stress ...

  4. Post-Traumatic Stress Disorder

    MedlinePLUS

    ... trigger PTSD include violent personal assaults, natural or human-caused disasters, accidents, or military combat. For Consumers General Information Post-Traumatic Stress Disorder ( NIMH ) Anxiety Information Stress Information Depression Information ...

  5. Endoscopic-assisted removal of traumatic brain hemorrhage: case report and technical note

    PubMed Central

    Nascimento, Clarissa Nbrega Gambarra; Amorim, Robson Luis; Mandel, Maurcio; do Esprito Santo, Marcelo Prudente; Paiva, Wellingson Silva; Andrade, Almir Ferreira; Teixeira, Manoel Jacobsen

    2015-01-01

    The endoscopic technique has been described as a minimally invasive method for spontaneous hematoma evacuation, as a safe and effective treatment. Nevertheless, to our knowledge, there is no description of a technical report of traumatic intracerebral hematoma removal using the neuroendoscope. A 47-year-old man was admitted sustaining 13 points in Glasgow coma scale with brain computed tomography (CT) scan showing a temporal contusion. Guided by a 3D reconstructed CT, using the program OsiriX, the posterior limit of the hematoma was identified. A burr hole was placed at the posterior temporal region, and we used the neuroendoscope to assist the hematoma evacuation. The postoperative tomography showed adequate hematoma removal. He was discharged from hospital 48 h after surgery. Two weeks later, he was conscious and oriented temporally. This endoscopic-assisted technique can provide safe removal of traumatic hematomas of the temporal lobe. PMID:26537390

  6. Unusual case of traumatic neuroma of the orbit.

    PubMed

    Ulivieri, Simone; Muscas, Giovanni; Miracco, Clelia; Oliveri, Giuseppe; Galluzzi, Paolo; Giorgio, Antonio

    2016-04-01

    Traumatic or amputation neuromas are neoformations developing after damage to a peripheral nerve. They are not proper tumors but rather a reactive process or a frustrated attempt of nerve regeneration. Traumatic neuromas are potentially found in every sensory peripheral nerve and often at the site of past surgical intervention, including orbital surgery. A 29-year-old Northern African migrant presented progressive exophthalmos and progressive loss of acuity in left eye, which had started about 6 months before after a cranio-facial trauma caused by a violent assault. MRI of the orbits showed a massive intra-orbital, intra-conical lesion, clearly compressing and dislocating the optic nerve and extending posteriorly to the orbital apex. Surgery was performed through lateral approach of Kroenlein and led to complete excision of the lesion. Histology revealed fibrotic, adipose and striated muscle tissues, a disordered, non-neoplastic overgrowth of small and large fascicles of nerves, inflammatory infiltrates, and fibrosis with sparse calcifications were diffusely observed in a background of fat, scar and striated muscle tissued. Patient was discharged on the fifth day in good health condition, without deficit of eye motion but without recovery of visual acuity. In conclusion, this case demonstrates that traumatic neuromas may arise in the orbit in patients with minor direct trauma to nerves and without previous surgical treatment. PMID:26891178

  7. Traumatic Fracture of Thin Pedicles Secondary to Extradural Meningeal Cyst

    PubMed Central

    Yanni, Daniel S.; Mammis, Antonios; Thaker, Nikhil G.; Goldstein, Ira M.

    2011-01-01

    Spinal dural meningoceles and diverticula are meningeal cysts that have a myriad of clinical presentations and sequelae, secondary to local mass effect. Our objective is to report a technical case report, illustrating a traumatic spinal injury with multiple pedicle fractures, secondary to atrophic lumbar pedicles as well as the diagnostic workup and surgical management of this problem. Posterior lumbar decompression, resection of the meningeal cyst, ligation of the cyst ostium, instrumentation, and fusion were performed with the assistance of intraoperative isocentric fluoroscopy. The cyst's point of communication was successfully located with intraoperative fluoroscopy and the lesion was successfully excised. We suggest that patients with traumatic spinal injuries, having evidence of pre-existing anomalous bony architecture, undergo advanced imaging studies, to rule out intraspinal pathology. The positive clinical and radiographic results support the removal and closure of the pre-existing meningeal cyst at the time of treatment of traumatic spinal injury. Intraoperative isocentric fluoroscopy is a helpful tool in the operative management of these lesions. PMID:22022654

  8. Inverted Internal Limiting Membrane Flap For Large Traumatic Macular Holes.

    PubMed

    Abou Shousha, Mohsen Ahmed

    2016-01-01

    The aim of the study was to assess the role of inverted internal limiting membrane flap as a treatment option for large traumatic macular holes.This is a prospective noncomparative study in which 12 eyes with large traumatic macular holes (basal diameter of 1300-2800 ?m) since 3 to 6 months were subjected to standard 23-gauge vitrectomy with removal of the posterior hyaloid, brilliant blue G (BBG)-assisted internal limiting membrane peeling in a circular fashion keeping it attached to the edge of the hole to create a flap. At the end of the surgery, air fluid exchange was done with inversion of the internal limiting membrane flap inside the macular hole using the soft tipped cannula and sulfur hexafluoride 20% as tamponade. The main follow-up measures are the best corrected visual acuity and the optical coherence tomography for 6 to 9 months.All the included eyes had a closed hole from the first week postoperative and along the follow-up period (6-9 months). The best corrected visual acuity improved from 20/2000 to 20/200 with a median of 20/400 preoperatively to 20/400 to 20/50 with a median of 20/100 at the end of follow-up period.Inverted internal limiting membrane flap is a good adjuvant to standard vitrectomy in the management of large traumatic macular holes that led to the 100% closure rate and improvement of best corrected visual acuity. PMID:26817894

  9. Magnetic resonance imaging in assessment of stress urinary incontinence in women: Parameters differentiating urethral hypermobility and intrinsic sphincter deficiency

    PubMed Central

    Macura, Katarzyna Jadwiga; Thompson, Richard Eugene; Bluemke, David Alan; Genadry, Rene

    2015-01-01

    AIM: To define the magnetic resonance imaging (MRI) parameters differentiating urethral hypermobility (UH) and intrinsic sphincter deficiency (ISD) in women with stress urinary incontinence (SUI). METHODS: The static and dynamic MR images of 21 patients with SUI were correlated to urodynamic (UD) findings and compared to those of 10 continent controls. For the assessment of the urethra and integrity of the urethral support structures, we applied the high-resolution endocavitary MRI, such as intraurethral MRI, endovaginal or endorectal MRI. For the functional imaging of the urethral support, we performed dynamic MRI with the pelvic phased array coil. We assessed the following MRI parameters in both the patient and the volunteer groups: (1) urethral angle; (2) bladder neck descent; (3) status of the periurethral ligaments, (4) vaginal shape; (5) urethral sphincter integrity, length and muscle thickness at mid urethra; (6) bladder neck funneling; (7) status of the puborectalis muscle; (8) pubo-vaginal distance. UDs parameters were assessed in the patient study group as follows: (1) urethral mobility angle on Q-tip test; (2) Valsalva leak point pressure (VLPP) measured at 250 cc bladder volume; and (3) maximum urethral closure pressure (MUCP). The UH type of SUI was defined with the Q-tip test angle over 30 degrees, and VLPP pressure over 60 cm H2O. The ISD incontinence was defined with MUCP pressure below 20 cm H2O, and VLPP pressure less or equal to 60 cm H2O. We considered the associations between the MRI and clinical data and UDs using a variety of statistical tools to include linear regression, multivariate logistic regression and receiver operating characteristic (ROC) analysis. All statistical analyses were performed using STATA version 9.0 (StataCorp LP, College Station, TX). RESULTS: In the incontinent group, 52% have history of vaginal delivery trauma as compared to none in control group (P < 0.001). There was no difference between the continent volunteers and incontinent patients in body habitus as assessed by the body mass index. Pubovaginal distance and periurethral ligament disruption are significantly associated with incontinence; periurethral ligament symmetricity reduces the odds of incontinence by 87%. Bladder neck funneling and length of the suprapubic urethral sphincter are significantly associated with the type of incontinence on UDs; funneling reduced the odds of pure UH by almost 95%; increasing suprapubic urethral sphincter length at rest is highly associated with UH. Both MRI variables result in a predictive model for UDs diagnosis (area under the ROC = 0.944). CONCLUSION: MRI may play an important role in assessing the contribution of hypermobility and sphincteric dysfunction to the SUI in women when considering treatment options. PMID:26644825

  10. Post-traumatic neurodegeneration and chronic traumatic encephalopathy.

    PubMed

    Daneshvar, Daniel H; Goldstein, Lee E; Kiernan, Patrick T; Stein, Thor D; McKee, Ann C

    2015-05-01

    Traumatic brain injury (TBI) is a leading cause of mortality and morbidity around the world. Concussive and subconcussive forms of closed-head injury due to impact or blast neurotrauma represent the most common types of TBI in civilian and military settings. It is becoming increasingly evident that TBI can lead to persistent, long-term debilitating effects, and in some cases, progressive neurodegeneration and chronic traumatic encephalopathy (CTE). The epidemiological literature suggests that a single moderate-to-severe TBI may be associated with accelerated neurodegeneration and increased risk of Alzheimer's disease, Parkinson's disease, or motor neuron disease. However, the pathologic phenotype of these post-traumatic neurodegenerations is largely unknown and there may be pathobiological differences between post-traumatic disease and the corresponding sporadic disorder. By contrast, the pathology of CTE is increasingly well known and is characterized by a distinctive pattern of progressive brain atrophy and accumulation of hyperphosphorylated tau neurofibrillary and glial tangles, dystrophic neurites, 43 kDa TAR DNA-binding protein (TDP-43) neuronal and glial aggregates, microvasculopathy, myelinated axonopathy, neuroinflammation, and white matter degeneration. Clinically, CTE is associated with behavioral changes, executive dysfunction, memory deficits, and cognitive impairments that begin insidiously and most often progress slowly over decades. Although research on the long-term effects of TBI is advancing quickly, the incidence and prevalence of post-traumatic neurodegeneration and CTE are unknown. Critical knowledge gaps include elucidation of pathogenic mechanisms, identification of genetic risk factors, and clarification of relevant variables-including age at exposure to trauma, history of prior and subsequent head trauma, substance use, gender, stress, and comorbidities-all of which may contribute to risk profiles and the development of post-traumatic neurodegeneration and CTE. This article is part of a Special Issue entitled 'Traumatic Brain Injury'. PMID:25758552

  11. Minimally invasive posterior hamstring harvest.

    PubMed

    Wilson, Trent J; Lubowitz, James H

    2013-01-01

    Autogenous hamstring harvesting for knee ligament reconstruction is a well-established standard. Minimally invasive posterior hamstring harvest is a simple, efficient, reproducible technique for harvest of the semitendinosus or gracilis tendon or both medial hamstring tendons. A 2- to 3-cm longitudinal incision from the popliteal crease proximally, in line with the semitendinosus tendon, is sufficient. The deep fascia is bluntly penetrated, and the tendon or tendons are identified. Adhesions are dissected. Then, an open tendon stripper is used to release the tendon or tendons proximally; a closed, sharp tendon stripper is used to release the tendon or tendons from the pes. Layered, absorbable skin closure is performed, and the skin is covered with a skin sealant, bolster dressing, and plastic adhesive bandage for 2 weeks. PMID:24266003

  12. Prevention of posterior capsular opacification.

    PubMed

    Nibourg, Lisanne M; Gelens, Edith; Kuijer, Roel; Hooymans, Johanna M M; van Kooten, Theo G; Koopmans, Steven A

    2015-07-01

    Posterior capsular opacification (PCO) is a common complication of cataract surgery. The development of PCO is due to a combination of the processes of proliferation, migration, and transdifferentiation of residual lens epithelial cells (LECs) on the lens capsule. In the past decades, various forms of PCO prevention have been examined, including adjustments of techniques and intraocular lens materials, pharmacological treatments, and prevention by interfering with biological processes in LECs. The only method so far that seems effective is the implantation of an intraocular lens with sharp edged optics to mechanically prevent PCO formation. In this review, current knowledge of the prevention of PCO will be described. We illustrate the biological pathways underlying PCO formation and the various approaches to interfere with the biological processes to prevent PCO. In this type of prevention, the use of nanotechnological advances can play a role. PMID:25783492

  13. Minimally Invasive Posterior Hamstring Harvest

    PubMed Central

    Wilson, Trent J.; Lubowitz, James H.

    2013-01-01

    Autogenous hamstring harvesting for knee ligament reconstruction is a well-established standard. Minimally invasive posterior hamstring harvest is a simple, efficient, reproducible technique for harvest of the semitendinosus or gracilis tendon or both medial hamstring tendons. A 2- to 3-cm longitudinal incision from the popliteal crease proximally, in line with the semitendinosus tendon, is sufficient. The deep fascia is bluntly penetrated, and the tendon or tendons are identified. Adhesions are dissected. Then, an open tendon stripper is used to release the tendon or tendons proximally; a closed, sharp tendon stripper is used to release the tendon or tendons from the pes. Layered, absorbable skin closure is performed, and the skin is covered with a skin sealant, bolster dressing, and plastic adhesive bandage for 2 weeks. PMID:24266003

  14. Posterior mediastinal hyperfunctioning insular thyroid carcinoma.

    PubMed

    Bellantone, Rocco; Lombardi, Celestino Pio; Bossola, Maurizio; Fadda, Guido; Salvatori, Massimo; Princi, Pietro

    2005-01-01

    A case is presented of a posterior mediastinal mass arising in a 57-year-old woman with severe compressive cervical symptoms and hyperthyroidism. Computed tomography showed intrathoracic thyroid tissue that displaced the trachea towards the front and the right and invaded the posterior mediastinum. Pathological examination showed features of a poorly differentiated (insular) thyroid carcinoma. To the best of our knowledge, this is the first reported case of a posterior mediastinal insular thyroid carcinoma with thyroid hyperfunction. PMID:16277105

  15. Traumatic central serous chorioretinopathy

    PubMed Central

    Steeples, Laura; Sharma, Vinod; Mercieca, Karl

    2015-01-01

    Central serous chorioretinopathy (CSR) is well described in the literature, with recognized associations such as systemic steroid therapy and stress; the association of blunt trauma with CSR is highly unusual. A 44-year-old male developed CSR rapidly after blunt trauma to his left eye with a significant reduction in visual acuity to hand movements. Serial optical coherence tomography and fundus fluorescein angiography images are presented. The patient was managed conservatively and spontaneous resolution occurred by 2 months with an excellent visual outcome. There was no evidence of an alternative underlying pathology for the presentation and particularly no signs of posterior uveitis. Investigations for an underlying vascular, inflammatory or infectious cause were all negative. The patient had previously had CSR in his other eye, and this may indicate a potential predisposition to developing the condition, triggered by blunt trauma. PMID:26265647

  16. Delayed traumatic intracerebral haemorrhage

    PubMed Central

    Baratham, Gopal; Dennyson, William G.

    1972-01-01

    Twenty-one out of 7,866 head injuries were complicated by the development of delayed intracerebral haematomata. The age distribution of patients with this condition closely resembled that of patients with subdural haematomata and differed sharply from patients with extradural haemorrhage. This finding, combined with the fact that the two conditions often coexisted, suggests the possibility of similar aetiological factors operating in their production. The injury producing the lesion was often minor and the larger haematomata appeared to be associated with longer `asymptomatic' intervals. The neurological deterioration was in most instances clearly the result of an increase in intracranial pressure. When possible, angiography followed by definitive craniotomy was the most satisfactory method of management and multiple burr holes even when combined with needling of the hemisphere yielded unsatisfactory results. The distribution of lesions tended to confirm their traumatic origin. On no occasion was there a vascular abnormality to account for the haemorrhage and, despite the fact that the ages of most patients were in the seventh and eighth decades, the incidence of degenerative vascular disease was small. Contusional injury causes a local failure of the mechanisms that regulate cerebral blood flow. Hypoxia, hypercapnia, and venous congestion produce cerebral hyperaemia which encourages gradual haematoma formation particularly at the sites of injury. This explains not only the situation of the lesions but also the latency between the trauma and their development. PMID:5084138

  17. Traumatic Migraine Versus Concussion

    PubMed Central

    Lords, Quinton; Greene, Jeffery P.

    2014-01-01

    Context: An era of increased awareness of sports concussions may decrease a provider’s ability to diagnose the athlete’s actual condition and may ultimately prolong the restriction of the injured athlete from sports. Trauma-triggered migraine is a source of headaches, especially in athletes with a family history of migraines. Evidence Acquisition: Research articles were primarily obtained through the electronic database PubMed from 1993 to August 2012. Primary research parameters included trauma-induced headaches, trauma-induced migraines, and posttraumatic migraine. The secondary search parameters included concussions, migraine treatments, and traumatic migraine treatments. Study Design: Clinical review with case report. Level of Evidence: Level 5. Results: There are no symptoms that distinguish trauma-triggered migraines from concussions, as headache is the most common complaint for both conditions. There is a paucity of studies that offer treatment guidelines for athletes with recurring headaches after trauma sustained during sporting events. Preventive treatment of migraines has been validated and proven effective. Conclusion: Trauma-triggered migraine should be considered in the differential for recurrent trauma-induced headaches. There is a lack of research evaluating efficacy and side effects of treatment of trauma-triggered migraine, and no information was found directing when an athlete can safely return to play. PMID:25177416

  18. Chronic traumatic encephalopathy.

    PubMed

    Yi, Juneyoung; Padalino, David J; Chin, Lawrence S; Montenegro, Philip; Cantu, Robert C

    2013-01-01

    Sports-related concussion has gained increased prominence, in part due to media coverage of several well-known athletes who have died from consequences of chronic traumatic encephalopathy (CTE). CTE was first described by Martland in 1928 as a syndrome seen in boxers who had experienced significant head trauma from repeated blows. The classic symptoms of impaired cognition, mood, behavior, and motor skills also have been reported in professional football players, and in 2005, the histopathological findings of CTE were first reported in a former National Football League (NFL) player. These finding were similar to Alzheimer's disease in some ways but differed in critical areas such as a predominance of tau protein deposition over amyloid. The pathophysiology is still unknown but involves a history of repeated concussive and subconcussive blows and then a lag period before CTE symptoms become evident. The involvement of excitotoxic amino acids and abnormal microglial activation remain speculative. Early identification and prevention of this disease by reducing repeated blows to the head has become a critical focus of current research. PMID:23314081

  19. Acute traumatic patellar dislocation.

    PubMed

    Duthon, V B

    2015-02-01

    Inaugural traumatic patellar dislocation is most often due to trauma sustained during physical or sports activity. Two-thirds of acute patellar dislocations occur in young active patients (less than 20 years old). Non-contact knee sprain in flexion and valgus is the leading mechanism in patellar dislocation, accounting for as many as 93% of all cases. The strong displacement of the patella tears the medial stabilizing structures, and notably the medial patellofemoral ligament (MPFL), which is almost always injured in acute patellar dislocation, most frequently at its femoral attachment. Lateral patellar glide can be assessed with the knee in extension or 20 flexion. Displacement by more than 50% of the patellar width is considered abnormal and may induce apprehension. Plain X-ray and CT are mandatory to diagnose bony risk factors for patellar dislocation, such as trochlear dysplasia or increased tibial tubercle-trochlear groove distance (TT-TG), and plan correction. MRI gives information on cartilage and capsulo-ligamentous status for treatment planning: free bodies or osteochondral fracture have to be treated surgically. If patellar dislocation occurs in an anatomically normal knee and osteochondral fracture is ruled out on MRI, non-operative treatment is usually recommended. PMID:25592052

  20. Clinical evaluation of a single daily dose of phenylpropanolamine in the treatment of urethral sphincter mechanism incompetence in the bitch

    PubMed Central

    Claeys, Stéphanie; Rustichelli, Frederico; Noël, Stéphanie; Hamaide, Annick

    2011-01-01

    The objective of this retrospective study was to determine the efficacy of a single daily oral dose of phenylpropanolamine (PPA) in the treatment of urethral sphincter mechanism incompetence (USMI) in bitches. Nine bitches diagnosed with USMI were treated with a single daily dose [1.5 mg/kg body weight (BW)] of PPA for at least 1 month. Urethral pressure profiles (UPP) were performed in 7 dogs before treatment and repeated in 4 of them after treatment. Treatment with PPA resulted in long-term continence in 8/9 bitches. One dog did not respond to PPA and was treated surgically later. Recheck UPPs showed a significant increase in maximal urethral closure pressure in the 4 bitches after treatment with PPA compared to before treatment. In conclusion, long-term continence can be achieved in bitches affected with USMI after administration of a single daily dose of PPA (1.5 mg/kg BW). PMID:22043069

  1. Emergent Airway Management of an Uncooperative Child with a Large Retropharyngeal and Posterior Mediastinal Abscess.

    PubMed

    Diep, Jack; Kam, David; Kuenzler, Keith A; Arthur, Jill F

    2016-02-01

    Retropharyngeal abscesses are deep neck space infections that can lead to life-threatening airway emergencies and other catastrophic complications. Retropharyngeal abscesses demand prompt diagnosis and early establishment of a definitive airway when there is airway compromise. This can be difficult in an uncooperative patient. We present the case of a 12-year-old girl with mediastinitis and tracheal compression and anterior displacement from a large retropharyngeal and posterior mediastinal abscess secondary to traumatic esophageal perforation, who received successful awake nasal fiberoptic intubation. Anesthesiologists must be prepared for airway emergencies in uncooperative patients, especially children, but there is controversy concerning the use of sedation. PMID:26599735

  2. [Magnetic urethral closure device. Negative outcome after implantation for the treatment of female urinary incontinence].

    PubMed

    Anding, R; van Ahlen, H; Mller, S C; Latz, S

    2015-07-01

    We report on a negative outcome after implantation of a magnetic urethral closure device, consisting of one part screwed into the pubic bone and one part as a vaginal cone, for the treatment of urinary stress incontinence gradeIII. Continence was never achieved for the patient. The urethra narrowed over time due to erosion and scarring and the patient started intermittent catheterization, because spontaneous micturition was not possible. The magnet was broken, the bladder neck was eroded, several fragments were found in the bladder, and numerous fragments were scattered throughout the small pelvis. Surgery consisted of removing most of the fragments, followed by bladder neck closure and suprapubic diversion. PMID:25989875

  3. Female urethral diverticulum containing a giant calculus: a CARE-compliant case report.

    PubMed

    Dong, ZhiLong; Wang, Hanzhang; Zuo, LinJun; Hou, MingLi

    2015-05-01

    Urethral diverticula with calculi have a low incidence as reported in the literature. Diverticulum of female urethra is rare, often discovered due to associated complications. We report a case of diverticulum of the female urethra containing giant calculi in a 62-year-old multiparous woman. She consulted with our office due to dysuria and a hard, painful periurethral mass in the anterior vagina wall. The diverticulum was approached surgically by a vaginal route, and local extraction of the calculi and subsequent diverticulectomy successfully treated the condition.Diagnosis of a complicated diverticulum can be easily achieved if one possesses a high degree of clinical symptoms. PMID:25997056

  4. Glans reconstruction with the use of an inverted urethral flap after distal penile amputation for carcinoma.

    PubMed

    Sansalone, Salvatore; Garaffa, Giulio; Vespasiani, Giuseppe; Zucchi, Alessandro; Kuehhas, Franklin Emmanuel; Herwig, Ralf; Silvani, Mauro; Pecoraro, Stefano; Loreto, Carla; Leonardi, Rosario

    2013-03-01

    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

  5. [Necrotizing fasciitis and double bowel perforation after retropubic sub-urethral sling].

    PubMed

    Carassou-Maillan, A; Savary, D; Jacquetin, B

    2014-10-01

    A 60-year-old woman without medical history developed after a Tension-free Vaginal Tape (TVT) procedure a necrotizing fasciitis and an abscess. After unadapted initial treatment, surgical procedure revealed 2 bowel perforations caused by the sling. Treatment was achieved by total mesh removal, bowel repair, necrosis excision and vacuum-assisted closure system. This is the first case report about the association of necrotizing fasciitis and double bowel perforations after TVT procedure. Any critical sepsis or with unsatisfactory evolution after retropubic sub-urethral sling has to make look for a digestive wound. PMID:24332737

  6. Post-traumatic stress disorder vs traumatic brain injury

    PubMed Central

    Bryant, Richard

    2011-01-01

    Post-traumatic stress disorder (PTSD) and traumatic brain injury (TBI) often coexist because brain injuries are often sustained in traumatic experiences. This review outlines the significant overlap between PTSD and TBI by commencing with a critical outline of the overlapping symptoms and problems of differential diagnosis. The impact of TBI on PTSD is then described, with increasing evidence suggesting that mild TBI can increase risk for PTSD. Several explanations are offered for this enhanced risk. Recent evidence suggests that impairment secondary to mild TBI is largely attributable to stress reactions after TBI, which challenges the long-held belief that postconcussive symptoms are a function of neurological insult This recent evidence is pointing to new directions for treatment of postconcussive symptoms that acknowledge that treating stress factors following TBI may be the optimal means to manage the effects of many TBIs, PMID:22034252

  7. Post-traumatic stress disorder vs traumatic brain injury.

    PubMed

    Bryant, Richard

    2011-01-01

    Post-traumatic stress disorder (PTSD) and traumatic brain injury (TBI) often coexist because brain injuries are often sustained in traumatic experiences. This review outlines the significant overlap between PTSD and TBI by commencing with a critical outline of the overlapping symptoms and problems of differential diagnosis. The impact of TBI on PTSD is then described, with increasing evidence suggesting that mild TBI can increase risk for PTSD. Several explanations are offered for this enhanced risk. Recent evidence suggests that impairment secondary to mild TBI is largely attributable to stress reactions after TBI, which challenges the long-held belief that postconcussive symptoms are a function of neurological insult This recent evidence is pointing to new directions for treatment of postconcussive symptoms that acknowledge that treating stress factors following TBI may be the optimal means to manage the effects of many TBIs. PMID:22034252

  8. An Important Cause of Pes Planus: The Posterior Tibial Tendon Dysfunction

    PubMed Central

    Erol, Kemal; Karahan, Ali Yavuz; Kerimoğlu, Ülkü; Ordahan, Banu; Tekin, Levent; Şahin, Muhammed; Kaydok, Ercan

    2015-01-01

    Posterior tibial tendon dysfunction (PTTD) is an important cause of acquired pes planus that frequently observed in adults. Factors that play a role in the development of PTTD such as age-related tendon degeneration, inflammatory arthritis, hypertension, diabetes mellitus, obesity, peritendinous injections and more rarely acute traumatic rupture of the tendon. PTT is the primary dynamic stabilizer of medial arch of the foot. Plantar flexion and inversion of the foot occurs with contraction of tibialis posterior tendon, and arch of the foot becomes elaveted while midtarsal joints are locked and midfoot-hindfoot sets as rigid. Thus, during the walk gastrocnemius muscle works more efficiently. If the PTT does not work in the order, other foot ligaments and joint capsule would be increasingly weak and than pes planus occurs. We present a 10-year-old female patient diagnosed as PTTD and conservative treatment with review of the current literature. PMID:25918629

  9. Surgical technique and results of primary repair in recent urethral injuries: a review of 49 consecutive cases.

    PubMed

    Janosz, F; Zieli?ski, J; Szkodny, A; Czopik, J; Piekarski, J

    1975-01-01

    Late results after primary repair in 49 recent urethral injuries of the urethra treated through a perineal approach by sutures of realignment with splinting, and suprapublic and perineal drainage were assessed by measuring urethral flow, urethrography, urine analysis and other examinations. In 15 straddle injuries the results were excellent. Of 34 injuries associated with pelvic fracture 50% had satisfactory results. 12% had marked, but tolerable difficulties in micturition. Important details of operative technique are mentioned. A preference for primary repair in comparison with early cybstostomy and delayed reconstruction of the urethra is confirmed. PMID:1233196

  10. A mild and rare form of Klippel-Trenaunay syndrome presenting with urethral bleeding due to penile hemangioma.

    PubMed

    Tepeler, Abdulkadir; Ye?ilolva, Yavuz; K?l?n, Ali; Aktoz, Tevfik; Onen, Abdurrrahman

    2011-02-01

    Klippel-Trenaunay syndrome (KTS) is characterized by a triad of cutaneous port-wine capillary malformations, hemihypertrophy, and varicose veins. Intermittent gross painless hematuria is usually the first clinical sign. An 8-year-old boy with multiple hemangiomas, including glans penis, and associated with KTS presented with urethral bleeding. Radiologic and endoscopic evaluation revealed neither intra-abdominal nor intravesical hemangioma. Urethral bleeding was thought to be related to glanular hemangioma extending to the anterior penile urethra. Although we were able to manage the case conservatively, many patients require endoscopic or surgical interventions. Radiologic and endoscopic evaluations and careful follow-up is essential for diagnosis and prompt treatment. PMID:20719363

  11. Penile necrosis requiring penectomy complicating recto-urethral fistula post prostate cancer external beam radiation and brachytherapy

    PubMed Central

    Kinahan, John; Pai, Howard; Martens, Mildred; Gray, Jason; Biberdorf, Darren; Mihailovic, Alex; McAuley, Iain

    2014-01-01

    Radiation therapy is a well-recognized treatment for unfavourable risk localized prostate cancer. Radiation induced recto-urethral fistulae are known rare complications particularly from brachytherapy. We report a case of a recto-urethral fistula 7 years post-external beam radiation and I-125 brachytherapy, which was complicated by a severe polymicrobial soft tissue infection. This infection required penectomy and pelvic exenteration with diverting colostomy, Indiana pouch urinary diversion and gracilis myo-cutaneuos flap closure of the perineum. PMID:24454604

  12. Penile necrosis requiring penectomy complicating recto-urethral fistula post prostate cancer external beam radiation and brachytherapy.

    PubMed

    Kinahan, John; Pai, Howard; Martens, Mildred; Gray, Jason; Biberdorf, Darren; Mihailovic, Alex; McAuley, Iain

    2014-01-01

    Radiation therapy is a well-recognized treatment for unfavourable risk localized prostate cancer. Radiation induced recto-urethral fistulae are known rare complications particularly from brachytherapy. We report a case of a recto-urethral fistula 7 years post-external beam radiation and I-125 brachytherapy, which was complicated by a severe polymicrobial soft tissue infection. This infection required penectomy and pelvic exenteration with diverting colostomy, Indiana pouch urinary diversion and gracilis myo-cutaneuos flap closure of the perineum. PMID:24454604

  13. Surgical Reconstruction of the Urinary Sphincter after Traumatic Longitudinal Disruption

    PubMed Central

    Rehder, Peter; Schillfahrt, Florian; Skradski, Viktor

    2014-01-01

    The question is whether the urethral sphincter may be reconstructed after longitudinal injury similar to anal sphincter injuries. Analogue to obstetric, anal sphincter repair, an approximation repair of the sphincter may be feasible. An overlap repair is possible in anal sphincter repair, but because of the little tissue available in the urethral sphincter this is not an option. We describe three cases of urethral sphincter injury of different aetiologies. All resulted in a total longitudinal disruption of the muscular components of the urethral sphincter complex. After making the diagnosis of urethral sphincter injury, a primary approximation repair was done. Follow-up of at least two and up to three years is promising with one male patient being completely continent and the two female patients needing one safety pad per day. Longitudinal disruption of the muscular elements of the sphincteric urethra may be primarily reconstructed with good success using an approximation technique with simple interrupted sutures. PMID:25258694

  14. Consistently inconsistent, the posterior vaginal wall.

    PubMed

    Hale, Douglass S; Fenner, Dee

    2016-03-01

    Posterior vaginal wall prolapse is one of the most common prolapses encountered by gynecological surgeons. What appears to be a straightforward condition to diagnose and treat surgically for physicians has proven to be frustratingly unpredictable with regard to symptom relief for patients. Functional disorders such as dyssynergic defecation and constipation are often attributed to posterior vaginal wall prolapse. Little scientific evidence supports this assumption, emphasizing that structure and function are not synonymous when treating posterior vaginal wall prolapse. Rectoceles, enteroceles, sigmoidoceles, peritoneoceles, rectal and intraanal intussusception, rectal prolapse, and descending perineal syndrome are all conditions that have an impact on the posterior vaginal wall. All too often these different anatomic conditions are treated with the same surgical approach, addressing a posterior vaginal wall bulge with a traditional posterior colporrhaphy. Studies that examine the correlation between stage of posterior wall prolapse and patient symptoms have failed to reliably do so. Surgical outcomes measured by prolapse staging appear successful, yet patient expectations are often not met. As increasing attention is being placed on patient satisfaction outcomes concerning surgical treatments, this fact will need to be addressed. Surgeons will have to clearly communicate what can and what cannot be expected with surgical repair of posterior vaginal wall prolapse. PMID:26348375

  15. Cisternography of the posterior fossa with metrizamide

    SciTech Connect

    Kobayashi, N.; Saito, Y.; Miyashita, T.; Tajika, Y.

    1981-12-01

    Nine patients underwent metrizamide cisternography of the posterior fossa. Excellent opacification of the fourth ventricle resulted when the patient's head was suitably positioned and the contrast material was introduced via a C1-2 puncture. With this technique, a benign aqueductal stenosis can be readily identified and the posterior fossa and fourth ventricle can be studied easily.

  16. Traumatic Childhood Events and Autism Spectrum Disorder

    ERIC Educational Resources Information Center

    Kerns, Connor Morrow; Newschaffer, Craig J.; Berkowitz, Steven J.

    2015-01-01

    Traumatic childhood events are associated with a wide range of negative physical, psychological and adaptive outcomes over the life course and are one of the few identifiable causes of psychiatric illness. Children with autism spectrum disorder (ASD) may be at increased risk for both encountering traumatic events and developing traumatic sequelae;…

  17. Traumatic Childhood Events and Autism Spectrum Disorder

    ERIC Educational Resources Information Center

    Kerns, Connor Morrow; Newschaffer, Craig J.; Berkowitz, Steven J.

    2015-01-01

    Traumatic childhood events are associated with a wide range of negative physical, psychological and adaptive outcomes over the life course and are one of the few identifiable causes of psychiatric illness. Children with autism spectrum disorder (ASD) may be at increased risk for both encountering traumatic events and developing traumatic sequelae;

  18. Traumatic Brain Injury: Finding the Information.

    ERIC Educational Resources Information Center

    Karp, Freddi; Flowers, Susan M.

    1988-01-01

    Presents "stop-action" look at selected research activities and resources related to traumatic brain injury. Includes details on research and training centers currently funded by the National Institute on Disability and Rehabilitation Research to study traumatic brain injury and plans for traumatic brain injury related projects from the

  19. The restoration of traumatized teeth.

    PubMed

    Liddelow, G; Carmichael, G

    2016-03-01

    The restoration of a traumatized tooth may require minimally invasive or more extensive treatment options. The majority of injuries occur in the younger population, so management should consider the long-term outcome, failure and future treatment needs over the course of, often, many decades. The aim should be to provide a tooth-restoration complex that closely mimics the functional and aesthetic qualities of an intact tooth for as long as possible. This narrative review will assess the relevant literature pertinent to restoration of traumatized teeth in order to provide guidance for the practising clinician. PMID:26923452

  20. Adjunctive maneuvers to treat urethral stricture: a review of the world literature

    PubMed Central

    Raheem, Omer A.

    2014-01-01

    The development of urethral stricture (US) or bladder neck contracture is a relatively uncommon but well described condition observed primarily in men. Despite familiarity with US disease, management remains challenging for urologists. Risk factors for the development of USs or bladder neck contracture include primary treatment modality, tobacco smoking, coronary artery disease and poorly controlled diabetes mellitus. Numerous treatment options exist for this condition that vary in procedural complexity, including intermittent self catheterization (CIC), serial urethral dilation, endoscopic techniques and open reconstructive repairs. Repetitive procedures for this condition may carry increased failure rates and morbidities. For the treatment of refractory or recalcitrant bladder neck contracture, newer intralesional anti-proliferative, anti-scar agents have been used in combination with transurethral bladder neck incisions to augment outcome and long-term effect. The primary focus of this systematic review of the published literature is to streamline and summarize various and newer therapeutic modalities available to manage patients with US or bladder neck contracture. PMID:26813349

  1. [The urethral plug--an alternative treatment of women with urinary stress incontinence].

    PubMed

    Nielsen, K K; Walter, S; Maegaard, E; Kromann-Andersen, B

    1995-05-29

    A developed urethral plug was evaluated for the treatment of women with genuine urinary stress incontinence. The plug consists of an oval meatal plate, a soft stalk and one or two spheres along the stalk with fixed distances between the meatal plate and the spheres. Inside the stalk is a removable semi-rigid guide pin to ease insertion. Forty women were randomly allocated to treatment with either the two-sphere or the one-sphere plug during period one (two weeks). In period two (two weeks) the patients used the other plug. They then continued with what they judged to be the better plug in period three (two months). Eighteen patients (45%) completed period three with the "preference" plug and 17 were subjectively and objectively continent or improved. Fourteen of these women preferred the two-sphere device. The plugs were equally effective in patients with mild or severe incontinence. Six women developed urinary tract infections and two of these had a plug in the bladder. The urethral plug is an effective treatment in a group of women with stress incontinence. Removal by hand is advisable in order to avoid retention of plugs in the bladder. PMID:7770983

  2. Pudendal denervation affects the structure and function of the striated, urethral sphincter in female rats.

    PubMed

    Heidkamp, M C; Leong, F C; Brubaker, L; Russell, B

    1998-01-01

    Our aim was to examine the effects of denervation on urethral anatomy and urine voiding pattern. Rats usually void at one end of their cage, which gives a behavioral index of continence. The voiding preference for denervated rats was decreased to 88.8 + 4.7%, n = 32, P < 0.001, compared to improvements with time for unoperated (117 +/- 10%, n = 16) or sham-operated rats (105 +/- 8%, n = 5). The volume of urine or the frequency of voidings between denervated, unoperated or sham-operated rats did not differ significantly. Urethral sections were analyzed immunochemically and quantified morphometrically. Smooth muscle volume remained constant but skeletal muscle volume decreased after denervation, from 43 +/- 2% to 36 +/- 3% (P < 0.05, n = 5). Fiber diameter decreased from 14.3 +/- 1.4 microm to 8.5 +/- 0.7 microm (P < 0.005). We concluded that pudendal nerve transection in female rats causes behavioral alterations in voiding and muscular atrophy of the striated sphincter. PMID:9694137

  3. Bitter triggers acetylcholine release from polymodal urethral chemosensory cells and bladder reflexes

    PubMed Central

    Deckmann, Klaus; Filipski, Katharina; Krasteva-Christ, Gabriela; Fronius, Martin; Althaus, Mike; Rafiq, Amir; Papadakis, Tamara; Renno, Liane; Jurastow, Innokentij; Wessels, Lars; Wolff, Miriam; Schtz, Burkhard; Weihe, Eberhard; Chubanov, Vladimir; Gudermann, Thomas; Klein, Jochen; Bschleipfer, Thomas; Kummer, Wolfgang

    2014-01-01

    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

  4. Postgonococcal urethritis: a double-blind study of doxycycline vs placebo.

    PubMed Central

    Mclean, K A; Evans, B A; Lim, J M; Azadin, B S

    1990-01-01

    The occurrence of postgonococcal urethritis (PGU) was studied in heterosexual men who were randomly assigned to receive either oral doxycycline 100 mg or a placebo capsule twice daily for seven days in addition to routine single dose treatment of urethral gonorrhoea. Of 216 patients suitable for assessment, PGU was diagnosed in 54/104 (51.9%) in the placebo group and 30/112 (26.8%) in the doxycycline group. Symptomatic PGU was uncommon (6.7% in the placebo group, 2.7% in the doxycycline group). Persistence of chlamydial infection at first follow-up was associated with the development of PGU in the placebo group (p less than 0.05). Although PGU developed in 10/12 (83%) patients in whom Mycoplasma hominis was isolated on entry to the study, the association was not statistically significant. The development of PGU was not associated with the isolation of Ureaplasma urealyticum. A significant reduction in the incidence of PGU was achieved by the addition of a course of doxycycline (p less than 0.001), but there remained a considerable proportion of patients in whom the aetiology of PGU was unknown. PMID:2179113

  5. The Urethral Rhabdosphincter, Levator Ani Muscle, and Perineal Membrane: A Review

    PubMed Central

    Hinata, Nobuyuki; Murakami, Gen

    2014-01-01

    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. PMID:24877147

  6. A Giant Dumbbell Shaped Vesico-Prostatic Urethral Calculus: A Case Report and Review of Literature

    PubMed Central

    Prabhuswamy, Vinod Kumar; Tiwari, Rahul; Krishnamoorthy, Ramakrishnan

    2013-01-01

    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. PMID:23762742

  7. Recreational urethral sounding is associated with high risk sexual behaviour and sexually transmitted infections

    PubMed Central

    Breyer, Benjamin N.; Shindel, Alan W.

    2013-01-01

    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. PMID:22221824

  8. Lipomatous nevus and urethral caruncle mistaken for ambiguous genitalia in a female infant.

    PubMed

    Brasileiro, Luciana Ferreira; Dias Pereira, Luis Antonio Violin; Miranda, Mrcio Lopes; de Freitas, Leandro Luiz Lopes; Marques-de-Faria, Antonia Paula; Maciel-Guerra, Andrea Trevas; Guerra-Junior, Gil

    2016-02-01

    We report the case of a 46,XX infant referred at 3 months of age for evaluation of ambiguous genitalia with no palpable gonads. The phallus was replaced by a homogeneous peduncular structure covered by skin, and a second peduncular structure covered by mucosa was located between the labia minora above the urethral meatus and the vaginal opening. There were no associated anomalies, and she had normal growth and neuromotor development. During surgery to remove these structures, a bifid clitoris was detected and cystoscopy and vaginoscopy revealed normal female urethra and vagina. The structure located on the phallic region was a superficial lipomatous nevus, and the other mass was a congenital urethral caruncle with ectopic migration/differentiation of colonic epithelium into ventral and anterior part of the urogenital sinus. Both genital lipomas and congenital caruncles of the female urethra are very rare and their etiology is unknown. There is no previous report of coincidence of these two rare findings in an otherwise healthy girl. PMID:26353166

  9. [Urethral Fistula and Scrotal Abscess Associated with Colovesical Fistula Due to the Sigmoid Colon Cancer].

    PubMed

    Nakazawa, Shigeaki; Uemura, Motohide; Miyagawa, Yasushi; Tsujimura, Akira; Nonomura, Norio

    2015-09-01

    We report here a rare case of urethral fistula and scrotal abscess associated with colovesical fistula due to sigmoid colon cancer. An 84-year-old male was referred to our hospital complaining of macrohematuria, fecaluria, pneumaturia and micturitional pain. Computed tomography (CT) showed colovesical fistula. Other examinations, including colonoscopy and cystoscopy, did not reveal a clear cause for the colovesical fistula. Only an elevated serum level of the tumor marker CA19-9 suggested the possibility of sigmoid colon cancer. Eleven days after hospitalization, bilateral scrotal contents had swollen rapidly to the size of a goose egg. CT suggested urethral fistula with scrotal abscess formation. Drainage of scrotal abscess and colostomy were performed. Intraoperatively, the fistula of the bulbar urethra was revealed. Because increased serum CA19-9 suggested a diagnosis of sigmoid colon cancer, cystectomy and sigmoid colectomy with right nephrectomy were performed. Pathological examination revealed adenocarcinoma of sigmoid colon with bladder invasion. His condition was improved with rehabilitation 6 months after operation. PMID:26497865

  10. Traumatic Childhood Events and Autism Spectrum Disorder.

    PubMed

    Kerns, Connor Morrow; Newschaffer, Craig J; Berkowitz, Steven J

    2015-11-01

    Traumatic childhood events are associated with a wide range of negative physical, psychological and adaptive outcomes over the life course and are one of the few identifiable causes of psychiatric illness. Children with autism spectrum disorder (ASD) may be at increased risk for both encountering traumatic events and developing traumatic sequelae; however, this topic has been understudied. This review considers the rationale for examining traumatic events and related symptomology in individuals with ASD and summarizes the limited research on this topic. A conceptual framework for understanding the interplay of ASD, trauma and traumatic sequelae is proposed and recommendations for future research presented. PMID:25711547

  11. Radiographic assessment of posterior malleolar ankle fractures.

    PubMed

    Gonzalez, Olga; Fleming, Justin J; Meyr, Andrew J

    2015-01-01

    The anatomy of the posterior tibial malleolus plays an important role in the structure and function of the ankle mortise. With specific respect to ankle fractures, the presence, size, and displacement of posterior malleolar fractures (Volkmann's fracture) helps determine which will be amendable to operative fixation. The objective of the present study was to increase the body of knowledge with respect to the ability of foot and ankle reconstructive surgeons to assess posterior malleolar ankle fractures using plain film radiography. Three different variables were investigated on Sawbones() models: (1) differing size of posterior malleolar fractures (10%, 25%, and 50% of the tibial plafond), (2) differing displacement of posterior malleolar fractures (0 and 5 mm of proximal displacement), and (3) 2 different radiographic projections (standard lateral and externally rotated lateral projections). Accurate identification of the posterior malleolar fracture occurred on 86.67% (26 of 30) of standard lateral radiographs and 100% (30 of 30) of externally rotated lateral radiographs. Furthermore, the surgeons described the fracture with greater precision and had greater interclass correlation coefficient values with respect to measurement of sagittal plane displacement (0.977 versus 0.939) and percentage of involvement of the tibial plafond (0.972 versus 0.775) with an externally rotated lateral projection compared with a standard lateral projection. Our results provide evidence that an externally rotated lateral radiographic projection can provide surgeons with some additional information with respect to the presence, size, and displacement of posterior malleolar ankle fractures. PMID:25262838

  12. Congenital basis of posterior fossa anomalies.

    PubMed

    Cotes, Claudia; Bonfante, Eliana; Lazor, Jillian; Jadhav, Siddharth; Caldas, Maria; Swischuk, Leonard; Riascos, Roy

    2015-06-01

    The classification of posterior fossa congenital anomalies has been a controversial topic. Advances in genetics and imaging have allowed a better understanding of the embryologic development of these abnormalities. A new classification schema correlates the embryologic, morphologic, and genetic bases of these anomalies in order to better distinguish and describe them. Although they provide a better understanding of the clinical aspects and genetics of these disorders, it is crucial for the radiologist to be able to diagnose the congenital posterior fossa anomalies based on their morphology, since neuroimaging is usually the initial step when these disorders are suspected. We divide the most common posterior fossa congenital anomalies into two groups: 1) hindbrain malformations, including diseases with cerebellar or vermian agenesis, aplasia or hypoplasia and cystic posterior fossa anomalies; and 2) cranial vault malformations. In addition, we will review the embryologic development of the posterior fossa and, from the perspective of embryonic development, will describe the imaging appearance of congenital posterior fossa anomalies. Knowledge of the developmental bases of these malformations facilitates detection of the morphological changes identified on imaging, allowing accurate differentiation and diagnosis of congenital posterior fossa anomalies. PMID:26246090

  13. Preventing intra-urethral migration of a guidewire during antegrade placement of a JJ stent: a technical modification.

    PubMed

    Bansal, Ankur; Gupta, Piyush; Dalela, Disha; Dalela, Diwakar

    2016-01-01

    A JJ stent is usually inserted in antegrade fashion after percutaneous renal surgery. We describe a new technical modification for antegrade stent insertion that prevents intraoperative intra-urethral migration of the guidewire and saves operative time and cost. PMID:26951444

  14. Clinical Efficacy of a Single Two Gram Dose of Azithromycin Extended Release for Male Patients with Urethritis

    PubMed Central

    Takahashi, Satoshi; Kiyota, Hiroshi; Ito, Shin; Iwasawa, Akihiko; Hiyama, Yoshiki; Uehara, Teruhisa; Ichihara, Koji; Hashimoto, Jiro; Masumori, Naoya; Sunaoshi, Kenichi; Takeda, Koichi; Suzuki, Nobukazu; Hosobe, Takahide; Goto, Hirokazu; Suzuki, Hidenori; Onodera, Shoichi

    2014-01-01

    To clarify the clinical efficacy of a single oral 2 g dose of azithromycin extended-release for heterosexual male patients with urethritis, and the current antimicrobial sensitivity of Neisseria gonorrhoeae to azithromycin, a prospective clinical trial was conducted from 2011–2013. In patients with gonococcal urethritis, the eradication rate was 90.9% (30 of 33). The susceptibility rates of isolated Neisseria gonorrhoeae strains to ceftriaxone, spectinomycin, cefixime and azithromycin were 100%, 100%, 95.3% (41/43) and 37.2% (16/43), respectively. In the patients with nongonococcal urethritis, the eradication rate was 90.0% (45 of 50). The microbiological eradication rates for the pathogens were 90.9% (30/33) for Neisseria gonorrhoeae, 91.5% (43/47) for Chlamydia trachomatis, 71.4% (5/7) for Mycoplasma genitalium, and 100% (13/13) for Ureaplasma urealyticum. The main adverse event was diarrhea and its manifestation rate was 35.2% (32 of 120). The symptom of diarrhea was mostly temporary and resolved spontaneously. The conclusion was that the treatment regimen with a single oral 2 g dose of azithromycin extended-release would be effective for patients with urethritis. However, the antimicrobial susceptibilities of Neisseria gonorrhoeae and Mycoplasma genitalium should be carefully monitored because of possible treatment failure.

  15. Outcomes of Direct Vision Internal Urethrotomy for Bulbar Urethral Strictures: Technique Modification with High Dose Triamcinolone Injection

    PubMed Central

    Modh, Rishi; Cai, Peter Y.; Sheffield, Alyssa; Yeung, Lawrence L.

    2015-01-01

    Objective. To evaluate the recurrence rate of bulbar urethral strictures managed with cold knife direct vision internal urethrotomy and high dose corticosteroid injection. Methods. 28 patients with bulbar urethral strictures underwent direct vision internal urethrotomy with high dose triamcinolone injection into the periurethral tissue and were followed up for recurrence. Results. Our cohort had a mean age of 60 years and average stricture length of 1.85 cm, and 71% underwent multiple previous urethral stricture procedures with an average of 5.7 procedures each. Our technique modification of high dose corticosteroid injection had a recurrence rate of 29% at a mean follow-up of 20 months with a low rate of urinary tract infections. In patients who failed treatment, mean time to stricture recurrence was 7 months. Patients who were successfully treated had significantly better International Prostate Symptom Scores at 6, 9, and 12 months. There was no significant difference in maximum flow velocity on Uroflowmetry at last follow-up but there was significant difference in length of follow-up (p = 0.02). Conclusions. High dose corticosteroid injection at the time of direct vision internal urethrotomy is a safe and effective procedure to delay anatomical and symptomatic recurrence of bulbar urethral strictures, particularly in those who are poor candidates for urethroplasty. PMID:26576148

  16. Prevalence of Trichomonas vaginalis, Mycoplasma genitalium and Ureaplasma urealyticum in men with urethritis attending an urban sexual health clinic.

    PubMed

    Khatib, N; Bradbury, C; Chalker, V; Koh, G C K W; Smit, E; Wilson, S; Watson, J

    2015-05-01

    We conducted a study to determine the prevalence of Trichomonas vaginalis (TV), Mycoplasma genitalium (MG) and Ureaplasma urealyticum (UU) in men with urethritis, attending an urban sexual health clinic, in order to inform screening and treatment policies. Men attending an urban sexual health clinic between June 2011 and January 2012 were evaluated. Urine samples were collected from men with urethritis and tested for Chlamydia trachomatis (CT), Neisseria gonorrhoeae (GC) and TV using transcription-mediated amplification and for MG and UU using polymerase chain reaction. Eighty-three samples were analysed. The prevalence of CT was 33.7% (28/83), GC was 16.8% (14/83), TV was 3.6% (3/83), MG was 12.0% (10/83) and UU was 4.8% (4/83). Fifteen men had recurrent urethritis. Of these, three were found to have had TV, five to have had MG and none to have had UU, at initial presentation. Given the prevalence of MG in this study, there is an urgent need for further larger studies looking at optimal treatment regimens and screening strategies in urethritis. PMID:24925897

  17. Assessment of the aetiological factors of non-specific (non gonococcal) urethritis, taking burning micturition as criteria.

    PubMed

    Kuravi, A

    1999-01-01

    Out of 90 cases of non-specific urethritis investigated, aetiological factors could be found in 58 cases. However, in 45 cases i.e. 50%, the causative factors turned out to be common factors like pyogenic, fungal, and trichomonal infections only. PMID:20921633

  18. Evaluation of holmium laser versus cold knife in optical internal urethrotomy for the management of short segment urethral stricture

    PubMed Central

    Jain, Sudhir Kumar; Kaza, Ram Chandra Murthy; Singh, Bipin Kumar

    2014-01-01

    Objectives: Sachse cold knife is conventionally used for optical internal urethrotomy intended to manage urethral strictures and Ho: YAG laser is an alternative to it. The aim of this study was to evaluate the role of urethral stricture treatment outcomes, efficacy, and complications using cold knife and Ho: YAG (Holmium laser) for optical internal urethrotomy Materials and Methods: In this prospective study included, 90 male patients age >18 years, with diagnosis of urethral stricture admitted for internal optical urethrotomy during April 2010 to March 2012. The patients were randomized into two groups containing 45 patients each using computer generated random number. In group A (Holmium group), internal urethrotomy was done with Holmium laser and in group B (Cold knife group) Sachse cold knife was used. Patients were followed up for 6 months after surgery in Out Patient Department on 15, 30 and 180 post-operative days. At each follow up visit physical examination, and uroflowmetry was performed along with noting complaints, if any. Results: The peak flow rates (PFR) were compared between the two groups on each follow up. At 180 days (6 month interval) the difference between mean of PFR for Holmium and Cold knife group was statistically highly significant (P < 0.001). Complications were seen in 12.22% of cases. Conclusion: Both modalities are effective in providing immediate relief to patients with single and short segment (<2 cm long) urethral strictures but more sustained response was attained with Cold knife urethrotomy. PMID:25371611

  19. Prevention of urethral blockage following semen collection in two species of lemur, Varecia variegata variegata and Lemur catta.

    PubMed

    Chatfield, Jenifer; Penfold, Linda

    2007-06-01

    Lemurs are a diverse group of primates comprised of five families, all of which are found only on Madagascar and the Comoro Islands. Of the 60 known species, 17 are endangered and 5 of these are considered critically endangered. The effects of inbreeding on population health and viability have been well described; though negative inbreeding effects can be ameliorated through the introduction of new genetic material. Introduction of new individuals into a population can be extremely challenging because of the highly social nature of lemurs. Semen collection in lemur species is notoriously challenging, as the ejaculate forms a coagulum. During normal breeding, the coagulum forms a copulatory plug in the female. However, this coagulum can present a life-threatening situation when retained in the urethra abnormally following electroejaculation. This study investigates the use of ascorbic acid in preventing urethral blockage in two lemur species during semen collection, demonstrates successful collection of semen by electroejaculation from two species of lemur during the breeding season, and discusses removal of urethral plugs subsequent to semen collection. Semen was collected successfully from all animals. Urethral plugs formed during each collection and were abnormally retained in 2/11 collections. Both plugs were successfully and immediately removed with the use of retropulsion through a urethral catheter. Although the results of this study are encouraging, more investigation is required to establish whether or not this procedure can be safely performed in the field. PMID:17679512

  20. Prevention of urethral blockage following semen collection in two species of lemur, Varecia variegata variegata and Lemur catta.

    TOXLINE Toxicology Bibliographic Information

    Chatfield J; Penfold L

    2007-06-01

    Lemurs are a diverse group of primates comprised of five families, all of which are found only on Madagascar and the Comoro Islands. Of the 60 known species, 17 are endangered and 5 of these are considered critically endangered. The effects of inbreeding on population health and viability have been well described; though negative inbreeding effects can be ameliorated through the introduction of new genetic material. Introduction of new individuals into a population can be extremely challenging because of the highly social nature of lemurs. Semen collection in lemur species is notoriously challenging, as the ejaculate forms a coagulum. During normal breeding, the coagulum forms a copulatory plug in the female. However, this coagulum can present a life-threatening situation when retained in the urethra abnormally following electroejaculation. This study investigates the use of ascorbic acid in preventing urethral blockage in two lemur species during semen collection, demonstrates successful collection of semen by electroejaculation from two species of lemur during the breeding season, and discusses removal of urethral plugs subsequent to semen collection. Semen was collected successfully from all animals. Urethral plugs formed during each collection and were abnormally retained in 2/11 collections. Both plugs were successfully and immediately removed with the use of retropulsion through a urethral catheter. Although the results of this study are encouraging, more investigation is required to establish whether or not this procedure can be safely performed in the field.

  1. Fundamentals and clinical perspective of urethral sphincter instability as a contributing factor in patients with lower urinary tract dysfunction—ICI‐RS 2014

    PubMed Central

    Anding, Ralf; Rosier, Peter; Birder, Lori; Andersson, Karl Erik; Djurhuus, Jens Christian

    2016-01-01

    Aims Urethral pathophysiology is often neglected in discussions of bladder dysfunction. It has been debated whether “urethral sphincter instability,” referred to based on observed “urethral pressure variations,” is an important aspect of overactive bladder syndrome (OAB). The purpose of this report is to summarize current urethral pathophysiology evidence and outline directions for future research based on a literature review and discussions during the ICI‐RS meeting in Bristol in 2014. Methods Urethral pathophysiology with a focus on urethral pressure variation (UPV) was presented and discussed in a multidisciplinary think tank session at the ICI_R meeting in Bristol 2014. This think tank session was based on collaboration between physicians and basic science researchers. Results Experimental animal studies or studies performed in clinical series (predominantly symptomatic women) provided insights into UPV, but the findings were inconsistent and incomplete. However, UPV is certainly associated with lower urinary tract symptoms (likely OAB), and thus, future research on this topic is relevant. Conclusions Future research based on adequately defined clinical (and urodynamic) parameters with precisely defined patient groups might shed better light on the cause of OAB symptoms. Further fundamental investigation of urethral epithelial–neural interactions via the release of mediators should enhance our knowledge and improve the management of patients with OAB. Neurourol. Urodynam. 35:318–323, 2016. © 2016 The Authors. Neurourology and Urodynamics published by Wiley Periodicals, Inc. PMID:26872575

  2. Understanding Traumatic Stress in Children

    ERIC Educational Resources Information Center

    Bassuk, Ellen L.; Konnath, Kristina; Volk, Katherine T.

    2006-01-01

    The unexpected loss of a loved one, a car accident, or exposure to a violent experience is familiar to many. Everyone reacts to such events, but the responses vary widely, ranging from numbness and withdrawal, to crying, nervousness, and agitation. Because traumatic events are prevalent, cause profound suffering, and may lead to life altering

  3. Reconsidering Post-Traumatic Stress

    ERIC Educational Resources Information Center

    Berman, Dene S.; Davis-Berman, Jennifer

    2005-01-01

    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,…

  4. Evaluation after Traumatic Brain Injury

    ERIC Educational Resources Information Center

    Trudel, Tina M.; Halper, James; Pines, Hayley; Cancro, Lorraine

    2010-01-01

    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

  5. NATIONAL TRAUMATIC OCCUPATIONAL FATALITIES (NTOF)

    EPA Science Inventory

    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 ...

  6. Traumatic Brain Injury Inpatient Rehabilitation

    ERIC Educational Resources Information Center

    Im, Brian; Schrer, Marcia J.; Gaeta, Raphael; Elias, Eileen

    2010-01-01

    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

  7. Outcome of Posterior Tibial Plateau Fixation.

    PubMed

    Jiwanlal, Aneel; Jeray, Kyle James

    2016-01-01

    Isolated posterior tibial plateau fractures are rare injuries that encompass a wide variety of fracture patterns. Based on the variation in fracture pattern, the surgical approach varies, with both anterior and posterior approaches described for surgical fixation. Postoperative protocol also varies among studies. The aim of this article is to summarize the outcomes related to posterior column tibial plateau fractures. The papers reviewed, primarily small retrospective case series, showed functional knee range of motion is preserved, a low incidence of wound complications, and patient outcome scores comparable to other reported lower extremity injury outcome scores. PMID:26509660

  8. Bimanual microphaco for posterior polar cataracts.

    PubMed

    Haripriya, Aravind; Aravind, Srinivasan; Vadi, Kavitha; Natchiar, Govindappa

    2006-06-01

    We describe a technique in which bimanual microphacoemulsification technique through 2, 1.4 mm incisions is performed for posterior polar cataract extraction. The low-infusion and low-vacuum system provides good anterior chamber stability and followability. The irrigation and aspiration handpieces are interchangeable, enabling removal of the lens fragments without hydrodissection or nucleus rotation. Only 1 (12.5%) of the 8 cases presented here was complicated by posterior capsule rupture. This occurred after epinucleus removal without any vitreous disturbance. The bimanual microphacoemulsification technique appears to minimize the risk for complications, allowing posterior polar cataract extraction to be performed more safely. PMID:16814047

  9. [Urethral recurrence of invasive carcinoma following BCG treatment for bladder Ca in situ].

    PubMed

    Ruoppolo, M; Gozo, M; Milesi, R; Spina, R; Fragapane, G

    2010-01-01

    CIS is a flat, high-grade, non-invasive microscopic urothelial carcinoma. It is considered a precursor of invasive bladder cancer. CIS is classified as primary, secondary or concurrent, when occurred as isolated CIS without cuncurrent papillary tumors, or detected during the follow-up of patients with a previous papillary tumor, or finally in the presence of bladder neoplasm. BCG is widely established as the treatment of choice for CIS with a success rate of approximately 70%. BCG reduces the risk of progression of CIS into invasive carcinoma in 30 to 50% of cases. Direct and prolonged contact between the urothelium and BCG is a prerequisite for successful therapy. Discovery of CIS in the prostatic or membranous urethra represents an ominous sign. CIS may be present only in the epithelial lining of the prostatic urethra or in the ducts, or in the worst case it may be found in the prostatic tissue stroma. Urethral involvement by CIS is at high risk of tumor progression and development of metastases due to reduced thickness of lamina propria and absence of muscolaris mucosa. 83 patients, enrolled from 1/1996 to 12/2005 at our urological department with CIS: primary (focal and multifocal) in 25, secondary in 7 and cuncurrent in 51 (associated with T1bG3 cancer in 37 cases), and urethral CIS in 5 and conservatively treated by TUR and intravescical instillations of BCG, 4 developed afterwords only invasive cancer of the urethra in the absence of bladder involvement. In 2 cases cancer arised from the prostatic fossa after TURP, in 1 from membranous urethra and in the last from prostatic ducts. Among the 4 patients, 3 were treated by cystoprostatourethrectomy and Platinum-based chemotherapy, 1 refused surgical treatment. Two patients died for disseminated disease. 1 patient is alive at 60-month's follow-up. In the last patient cancer relapsed at 36-month's follow-up. We conclude that prostatic/urethral involvement during follow-up after successful intravesical treatment with BCG in CIS represents a high risk of developing invasive and incontrolled cancer. A careful watch is recommended in these patients. PMID:21308679

  10. Urethral Trauma

    MedlinePLUS

    ... the Foundation provides. The Council serves to develop, review and oversee the educational materials and programs the ... Cause-Related Marketing Planned Giving Charitable Gift Planning is a powerful ...

  11. Urethral stricture

    MedlinePLUS

    ... be caused by inflammation or scar tissue from surgery, disease, or injury. Rarely, it may be caused by ... Douglas, and Bennett's Principles and Practice of Infectious ... GH. McCammon KA. Surgery of the penis and urethra. In: Wein AJ, ...

  12. Urethral Diverticulum

    MedlinePLUS

    ... Fund Annual Fund Alliances & Partner Organizations Cause-Related Marketing Planned Giving Charitable Gift Planning is a powerful ... CareBlog Make a Difference Planned Giving Cause-Related Marketing Research Quick Links Urologic Conditions Financials & Annual Report ...

  13. Congenital Hairy Polyp of Posterior Tonsillar Pillar

    PubMed Central

    Iqbal, Shahid; Talat, Nabila; Saleem, Muhammad

    2014-01-01

    Congenital hairy polyps are exceedingly rare congenital anomalies. We report a case of congenital hairy polyp arising from posterior tonsillar pillar which was excised with bipolar cautry. PMID:26023478

  14. Posterior cruciate ligament (PCL) injury - aftercare

    MedlinePLUS

    ... bone. The posterior cruciate ligament (PCL) is located inside your knee joint and connects the bones of your upper ... device that can take pictures of the tissues inside your knee. The pictures will show whether these tissues have ...

  15. Posterior Shoulder Instability in Overhead Athletes.

    PubMed

    Chang, Edward S; Greco, Nicholas J; McClincy, Michael P; Bradley, James P

    2016-01-01

    Posterior shoulder instability in overhead athletes presents a unique and difficult challenge. Often, this group has an inherent capsular laxity and/or humeral retroversion to accommodate the range of motion necessary to throw. This adaptation makes the diagnosis of posterior capsulolabral pathology challenging, as the examiner must differentiate between adaptive capsular laxity and pathologic instability. Further complicating matters, the intraoperative surgeon must find the delicate balance of achieving stability while still allowing the necessary range of motion. PMID:26614932

  16. An unusual cause of posterior mediastinal cyst

    PubMed Central

    Dhooria, Sahajal; Muthu, Valliappan; Agarwal, Ritesh

    2015-01-01

    Cystic lesions of the mediastinum may be congenital or acquired. The differential diagnosis depends on their location in the mediastinum. Cysts in the posterior mediastinum are generally developmental cysts and are neurogenic or of foregut origin. We report the case of a 14-year-old boy, who presented with dry cough and progressively increasing breathlessness, and was found to have a cystic lesion in the posterior mediastinum. Fine needle aspiration from the cyst helped make a diagnosis of tuberculosis. PMID:26664169

  17. An unusual cause of posterior mediastinal cyst.

    PubMed

    Dhooria, Sahajal; Muthu, Valliappan; Agarwal, Ritesh

    2015-01-01

    Cystic lesions of the mediastinum may be congenital or acquired. The differential diagnosis depends on their location in the mediastinum. Cysts in the posterior mediastinum are generally developmental cysts and are neurogenic or of foregut origin. We report the case of a 14-year-old boy, who presented with dry cough and progressively increasing breathlessness, and was found to have a cystic lesion in the posterior mediastinum. Fine needle aspiration from the cyst helped make a diagnosis of tuberculosis. PMID:26664169

  18. Advances in posterior cruciate ligament reconstruction.

    PubMed

    Levy, Bruce A; Fanelli, Gregory C; Miller, Mark D; Stuart, Michael J

    2015-01-01

    Current advances in posterior cruciate ligament reconstruction have led to excellent clinical and functional outcomes. It is helpful to review anatomy, cadaver sectioning studies, biomechanical studies, clinical outcome data, and novel surgical techniques for posterior cruciate ligament reconstruction, including all-inside reconstructions. Surgeons also should be aware of current controversies regarding transtibial versus inlay, autograft versus allograft, and single-bundle versus double-bundle reconstructions. PMID:25745937

  19. Mature Teratoma Confined to the Posterior Fossa.

    PubMed

    Daugherty, Christopher; Ngo, Thang; Drehner, Dennis; Maugans, Todd

    2016-01-01

    Mature teratomas located solely in the posterior fossa are rare. We describe a girl who presented with hydrocephalus caused by a posterior fossa tumor that was ultimately diagnosed as a mature teratoma following complete extirpation. Unusual imaging characteristics which produced confusion preoperatively were, however, very consistent with mature teratomas that are encountered in the gonads. Immature elements were universally absent; therefore, extirpation was curative. Hydrocephalus is unlikely to resolve after tumor removal, and cerebrospinal fluid diversion may be required. PMID:26730985

  20. Concomitant anterior and posterior infantile perianal protrusions.

    PubMed

    Leung, Alexander K C

    2010-02-01

    Infantile perianal protrusion is characterized by asymptomatic pyramidal protrusion with a rose-red or purplish red surface along the midline, usually anterior to the anus. The protrusion is usually solitary. Two girls are reported with concomitant anterior and posterior infantile perianal pyramidal protrusions and a history of constipation. The occurrence of concomitant anterior and posterior infantile perianal pyramidal protrusions has not been reported previously. PMID:20191927

  1. Posterior-wall-first microvascular anastomotic technique.

    PubMed

    Harris, G D; Finseth, F; Buncke, H J

    1981-01-01

    A posterior-wall-first anastomotic technique has significant advantages over the traditional method of microvascular anastomosis. Since July, 1979, the posterior-wall-first anastomosis has been used in 17 consecutive replantations involving 31 fingers or parts with a success rate of 97%. In addition 20 composite tissue transplants were carried out using the same technique with a success rate of 95%. The technique is described in detail and the advantages clearly stated. PMID:7006723

  2. The neuropathology of traumatic brain injury.

    PubMed

    Mckee, Ann C; Daneshvar, Daniel H

    2015-01-01

    Traumatic brain injury, a leading cause of mortality and morbidity, is divided into three grades of severity: mild, moderate, and severe, based on the Glasgow Coma Scale, the loss of consciousness, and the development of post-traumatic amnesia. Although mild traumatic brain injury, including concussion and subconcussion, is by far the most common, it is also the most difficult to diagnose and the least well understood. Proper recognition, management, and treatment of acute concussion and mild traumatic brain injury are the fundamentals of an emerging clinical discipline. It is also becoming increasingly clear that some mild traumatic brain injuries have persistent, and sometimes progressive, long-term debilitating effects. Evidence indicates that a single traumatic brain injury can precipitate or accelerate multiple age-related neurodegenerations, increase the risk of developing Alzheimer's disease, Parkinson's disease, and motor neuron disease, and that repetitive mild traumatic brain injuries can provoke the development of a tauopathy, chronic traumatic encephalopathy. Clinically, chronic traumatic encephalopathy is associated with behavioral changes, executive dysfunction, memory loss, and cognitive impairments that begin insidiously and progress slowly over decades. Pathologically, chronic traumatic encephalopathy produces atrophy of the frontal and temporal lobes, thalamus, and hypothalamus, septal abnormalities, and abnormal deposits of hyperphosphorylated tau (?) as neurofibrillary tangles and disordered neurites throughout the brain. The incidence and prevalence of chronic traumatic encephalopathy and the genetic risk factors critical to its development are currently unknown. Chronic traumatic encephalopathy frequently occurs as a sole diagnosis, but may be associated with other neurodegenerative disorders, including Alzheimer's disease, Lewy body disease, and motor neuron disease. Currently, chronic traumatic encephalopathy can be diagnosed only at autopsy; however, promising efforts to develop imaging, spinal fluid, and peripheral blood biomarkers are underway to diagnose and monitor the course of disease in living subjects. PMID:25702209

  3. Suprapubic catheters: a comparison of suprapubic versus urethral catheters in the treatment of acute urinary retention.

    PubMed

    Ichsan, J; Hunt, D R

    1987-01-01

    Sixty patients presenting with acute urinary retention were randomly allocated to treatment with either suprapubic or urethral catheters. An initial specimen of urine was obtained for bacteriological culture and organism count. Subsequently, repeat specimens of urine were obtained at intervals of 2 days until the catheter was removed. The results of these cultures showed that suprapubic catheters caused less urinary tract infection (P less than 0.05). In addition, suprapubic catheters were more comfortable for the patients, easier to manage and more cost-effective. In patients with suprapubic catheters, their ability to void could be assessed prior to removal of the catheter, thus avoiding the need for recatheterization. It was concluded that patients presenting with acute urinary retention should be routinely treated by drainage using suprapubic catheters. PMID:3472510

  4. RADIATION THERAPY OF A PRESUMPTIVE URETHRAL TRANSITIONAL CELL CARCINOMA IN AN EASTERN GRAY SQUIRREL (SCIURUS CAROLINENSIS).

    PubMed

    Childs-Sanford, Sara E; St-Vincent, Rachel; Hiss, Anne

    2015-12-01

    An adult female Eastern gray squirrel (Sciurus carolinensis), with a previous history of primary renal transitional cell carcinoma treated by nephrectomy, was diagnosed with a metastatic urethral transitional cell carcinoma (TCC) utilizing the veterinary bladder tumor antigen test in combination with other noninvasive diagnostic tests. The squirrel was treated with piroxicam and external beam radiation therapy given in 18 treatments over 30 days to achieve a total of 54 gray. Mild to moderate side effects from the pelvic irradiation were self-limiting and easily managed. Resolution of clinical signs was achieved for approximately 6 mo until recurrence of metastasis. This report represents the first published account of both TCC and external beam radiation therapy in an Eastern gray squirrel. PMID:26667551

  5. Staged urethroplasty in the management of complex anterior urethral stricture disease

    PubMed Central

    Mori, Ryan L.

    2015-01-01

    Staged buccal mucosa graft urethroplasty has emerged as a reliable procedure for difficult anterior urethral strictures not amenable to one-stage graft or flap reconstruction. It has primarily been used for strictures and/or fistulae occurring after previous surgery for hypospadias or those related to lichen sclerosus (LS). Success rates in these patient populations have improved when compared to earlier techniques. However, prior studies have demonstrated a number of patients requiring more than two procedures to complete the reconstruction, as well as some who have been content with their voiding pattern after the first operation and therefore elected to forego second stage tubularization. In this setting, we have reviewed the surgical technique and summarized previously published work. There may be an opportunity to complete more of these repairs in two operations using additional oral mucosa at the time of tubularization. PMID:26816806

  6. Urethral foreign body in an adolescent boy: report of two rare cases and review of literature.

    PubMed

    Prasad Ray, Rajendra; Ghosh, Bastab; Pal, Dilip Kumar

    2015-11-01

    The presence of a foreign body in the urethra is uncommon. A wide variety of foreign bodies have been described in urethras, but they are often missed in physical examinations as the patient tries to hide the fact. We report two unusual cases of foreign bodies in the urethra in two adolescent boys suffering from psychiatric disorders. In the first case, a 12-year-old boy presented with introduction of sewing needle into the urethra 3 days back. The patient in that case suffered from a delusional disorder. In the second case, a 19 year old man introduced a metallic screw into his urethra for sexual gratification several times in the preceding 4 years. That patient suffered from schizophrenia. Although psychiatric illness is associated with urethral foreign body, such underlying psychiatric disorders are very rare. PMID:25781517

  7. Trans-urethral ultrasound (TUUS) imaging for visualization and analysis of the prostate and associated tissues

    NASA Astrophysics Data System (ADS)

    Holmes, David R., III; Robb, Richard A.

    2000-04-01

    Accurate assessment of pathological conditions in the prostate is difficult. Screening methods include palpation if the prostate gland, blood chemical testing, and diagnostic imaging. Trans-rectal Ultrasound (TRUS) is commonly used for the assessment of pathological conditions, however, TRUS is severely constrained by the relative distal location of the imaging probe. Trans-urethral Ultrasound (TUUS) may overcome some limitations of TRUS. A TUUS catheter was used to image the prostate, rectum, bladder, ureter, neuro-vascular bundles, arteries, and surrounding tissue. In addition, 360 degrees rotational scans were recorded for reconstruction into 3D volumes. Segmentation was challenging, however, new techniques such as active contour methods show potential. 3D visualizations, including both volume and surface rendering, were provided to clinicians off-line. On-line 3D visualization techniques are currently being developed. Potential applications of TUUS include: prostate cancer diagnosis and staging as well as image guided biopsy and therapy.

  8. Biomechanical study on the bladder neck and urethral positions: simulation of impairment of the pelvic ligaments.

    PubMed

    Brando, Sofia; Parente, Marco; Mascarenhas, Teresa; da Silva, Ana Rita Gomes; Ramos, Isabel; Jorge, Renato Natal

    2015-01-21

    Excessive mobility of the bladder neck and urethra are common features in stress urinary incontinence. We aimed at assessing, through computational modelling, the bladder neck position taking into account progressive impairment of the pelvic ligaments. Magnetic resonance images of a young healthy female were used to build a computational model of the pelvic cavity. Appropriate material properties and constitutive models were defined. The impairment of the ligaments was simulated by mimicking a reduction in their stiffness. For healthy ligaments, valsalva maneuver led to an increase in the ? angle (between the bladder neck-symphysis pubis and the main of the symphysis) from 91.8 (at rest) to 105.7, and 5.7 mm of bladder neck dislocation, which was similar to dynamic imaging of the same woman (? angle from 80 to 103.3, and 5mm of bladder neck movement). For 95% impairment, they enlarged to 124.28 and 12 mm. Impairment to the pubourethral ligaments had higher effect than that of vaginal support (115 vs. 108, and 9.1 vs. 7.3mm). Numerical simulation could predict urethral motion during valsalva maneuver, for both healthy and impaired ligaments. Results were similar to those of continent women and women with stress urinary incontinence published in the literature. Biomechanical analysis of the pubourethral ligaments complements the biomechanical study of the pelvic cavity in urinary incontinence. It may be useful in young women presenting stress urinary incontinence without imaging evidence of urethral and muscle lesions or organ descend during valsalva, and for whom fascial damage are not expected. PMID:25527889

  9. Compliance With Guideline Statements for Urethral Catheterization in an Iranian Teaching Hospital

    PubMed Central

    Taleschian-Tabrizi, Negar; Farhadi, Fereshteh; Madani, Neda; Mokhtarkhani, Mohaddeseh; Kolahdouzan, Kasra; Hajebrahimi, Sakineh

    2015-01-01

    Background: It is believed that healthcare staff play an important role in minimizing complications related to urethral catheterization. The purpose of this study was to determine whether or not healthcare staff complied with the standards for urethral catheterization. Methods: This study was conducted in Imam Reza teaching hospital, Tabriz, Iran, from July to September 2013. A total of 109 catheterized patients were selected randomly from surgical and medical wards and intensive care units (ICUs). A questionnaire was completed by healthcare staff for each patient to assess quality of care provided for catheter insertion, while catheter in situ, draining and changing catheter bags. Items of the questionnaire were obtained from guidelines for the prevention of infection. Data analysis was performed with SPSS 16. Results: The mean age of the patients was 50.54 ± 22.13. Of the 109 patients, 56.88% were admitted to ICUs. The mean duration of catheter use was 15.86 days. Among the 25 patients who had a urinalysis test documented in their hospital records, 11 were positive for urinary tract infection (UTI). The lowest rate of hand-washing was reported before bag drainage (49.52%). The closed drainage catheter system was not available at all. Among the cases who had a daily genital area cleansing, in 27.63% cases, the patients or their family members performed the washing. In 66.35% of cases, multiple-use lubricant gel was applied; single-use gel was not available. The rate of documentation for bag change was 79%. Conclusion: The majority of the guideline statements was adhered to; however, some essential issues, such as hand hygiene were neglected. And some patients were catheterized routinely without proper indication. Limiting catheter use to mandatory situations and encouraging compliance with guidelines are recommended. PMID:26673464

  10. Schematic integration of traumatic events.

    PubMed

    Cason, Dana R; Resick, Patricia A; Weaver, Terri L

    2002-02-01

    Across multiple disciplines of psychology, one commonly used heuristic device, the schema, has often been called upon to illustrate the integration of an event. This paper is a critical examination of the literature on schemas and traumatic events. Three perspectives are identified: process-focused models, content-focused models, and construct-focused models. Process-focused models most clearly elucidate the change mechanisms and provide specific treatment implications in terms of exposure-based interventions. Content-focused models provide clinicians and researchers with hypothesized thematic conflicts that may need to be addressed in treatment. Construct-focused models and methodologies may provide a means by which researchers can represent and quantify the degree of conceptual integration of a traumatic event. The concepts of schema formation, activation, and modification are explored from each perspective. Implications for assessment and clinical interventions are also discussed. PMID:11793577

  11. Sleepwalking and the traumatic experience.

    PubMed

    Calogeras, R C

    1982-01-01

    During the closing months of an analysis, a patient suddenly began to sleepwalk. The exploring of this phenomenon, by means of a pivotal dream which ultimately connected with a severe traumatic experience of early childhood, provided confirming evidence for what had previously come out in the treatment regarding his developmental history and pathologic family milieu. Central to the over-determined meanings connected with the sleepwalking was its role as a special type of motoric dream activity which served the function of mastery of traumatic stimuli on several different levels. The exploration of this mastery function led to its linkage with such other aspects of the sleepwalking as its repetitive-compulsive basis, its similarity to the hypnotic state, and its intraphysic communicative function. The sleepwalking, the clarifying dream at its re-occurrence, and its transference reenactment all converged during the final phase of the analysis and were worked through with favourable resolution for the patient. PMID:7152810

  12. Traumatic andropause after combat injury.

    PubMed

    Jones, Gareth Huw; Kirkman-Brown, Jackson; Sharma, Davendra Murray; Bowley, Douglas

    2015-01-01

    In association with lower extremity amputation, complex genitourinary injuries have emerged as a specific challenge in modern military trauma surgery. Testicular injury or loss has profound implications for the recovering serviceman, in terms of hormone production and future fertility. The initial focus of treatment for patients with traumatic testicular loss is haemostasis, resuscitation and management of concurrent life-threatening injuries. Multiple reoperations are commonly required to control infection in combat wounds; in a review of 300 major lower extremity amputations, 53% of limbs required revisional surgery, with infection the commonest indication. Atypical infections, such as invasive fungal organisms, can also complicate military wounding. We report the case of a severely wounded serviceman with complete traumatic andropause, whose symptomatic temperature swings were initially mistaken for signs of occult sepsis. PMID:26318170

  13. Posterior Predictive Bayesian Phylogenetic Model Selection

    PubMed Central

    Lewis, Paul O.; Xie, Wangang; Chen, Ming-Hui; Fan, Yu; Kuo, Lynn

    2014-01-01

    We present two distinctly different posterior predictive approaches to Bayesian phylogenetic model selection and illustrate these methods using examples from green algal protein-coding cpDNA sequences and flowering plant rDNA sequences. The GelfandGhosh (GG) approach allows dissection of an overall measure of model fit into components due to posterior predictive variance (GGp) and goodness-of-fit (GGg), which distinguishes this method from the posterior predictive P-value approach. The conditional predictive ordinate (CPO) method provides a site-specific measure of model fit useful for exploratory analyses and can be combined over sites yielding the log pseudomarginal likelihood (LPML) which is useful as an overall measure of model fit. CPO provides a useful cross-validation approach that is computationally efficient, requiring only a sample from the posterior distribution (no additional simulation is required). Both GG and CPO add new perspectives to Bayesian phylogenetic model selection based on the predictive abilities of models and complement the perspective provided by the marginal likelihood (including Bayes Factor comparisons) based solely on the fit of competing models to observed data. [Bayesian; conditional predictive ordinate; CPO; L-measure; LPML; model selection; phylogenetics; posterior predictive.] PMID:24193892

  14. A comparison of surgical outcomes of perineal urethrostomy plus penile resection and perineal urethrostomy in twelve calves with perineal or prescrotal urethral dilatation

    PubMed Central

    Marzok, M.A.; El-khodery, S.A.

    2013-01-01

    The clinical diagnosis, ultrasonographic findings, surgical management, outcome, and survival rate of perineal or prescrotal urethral dilatation in 12 male calves are described. All calves were crossbred and intact males. The most noticeable clinical presentations were perineal (n= 10) or prescrotal (n= 2) swellings and micturition problems. The main ultrasonographic findings were oval shaped dilatation of the urethra in all animals with dimensions of 40-75 X 30-62 mm. The calves with perineal urethral dilatation were treated by perineal urethrostomy (n= 4) and partial penile transection including the dilated urethra and urethral fistulation (n= 6). Prescrotal urethral dilatations were treated by penile transection proximal to the dilatation site (n= 2). Cystitis and stricture of the urethra were recorded postoperatively for two of the calves that underwent perineal urethrostomy. Nine animals were slaughtered at normal body weight approximately 6-8 months after the surgical treatment. Three animals were slaughtered after approximately three to four months, two of them having gained insufficient body weight. Our study shows that ultrasonography is a useful tool for the diagnosis of urethral dilatation in bovine calves. Our study also shows that the partial penile transection may be a suitable and satisfactory choice of surgical treatment for correcting the urethral dilatation in bovine calves. PMID:26623322

  15. Quantitative EEG analysis in post-traumatic anosmia.

    PubMed

    Bonanni, E; Borghetti, D; Fabbrini, M; Maestri, M; Cignoni, F; Sartucci, F; Murri, L

    2006-12-11

    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

  16. Arthroscopic Repair of Inferior Labrum From Anterior to Posterior Lesions Associated With Multidirectional Instability of the Shoulder

    PubMed Central

    Burt, David M.

    2014-01-01

    Multidirectional instability (MDI) of the shoulder may arise spontaneously; however, recent evidence suggests that traumatic events may play a role in this syndrome. Variable degrees of injury around the circumference of the glenoid have been reported, ranging from Bankart and Kim lesions to 270 of injury and even 360 of injury. Hyperabduction injury may cause inferior subluxation of the shoulder and result in traumatic isolated injury to the inferior labrum from anterior to posterior. This particular lesion spans approximately 180 of the inferior hemisphere and may lead to symptomatic MDI. In contrast to open or arthroscopic plication procedures for atraumatic MDI without labral injury, the goal in these cases is anatomic arthroscopic repair of the inferior labrum tear without the need for capsular plication, volume reduction, or rotator interval closure. PMID:25685683

  17. Comparison of the Combined Anterior-Posterior Approach versus Posterior-Only Approach in Scoliosis Treatment

    PubMed Central

    Pourfeizi, Hossein Hojjat; Sales, Jafar Ganjpour; Borran, Ghanbar; Alavi, Sahar

    2014-01-01

    Study Design This is descriptive analytical study. Purpose The present study aims at comparing treatment results found between the two groups comprising of patients who underwent posterior spinal fusion using thoracic pedicle screws and the ones who underwent combined anterior-posterior method, respectively. Overview of Literature There was controversy about surgical techniques including anterior, posterior, or a combined anterior-posterior approaches are applied to treat non-congenital scoliosis with surgical indications. Methods Medical records of 50 patients suffering from thoracic non-congenital scoliosis with curves exceeding 70° were reviewed. In this study, 25 patients who underwent posterior spinal fusion using thoracic pedicle screws were compared with 25 patients who underwent combined anterior-posterior method. Results Patients treated through posterior-only and combined approaches were respectively hospitalized for 11.84±5.18 and 26.5±5.2 days (p=0.001). There was a significant difference between these two groups considering intensive care unit admission duration (p=0.001), correction in sagittal view of X-ray (p=0.01), and number of days the patients underwent traction (0.001). Finally, coronal view was corrected without any significant difference (p=0.2). Conclusions According to our findings, it is hypothesized that posterior-only method is associated with some significant advantages and is an advisable method in patients with severe scoliosis over than 70°. PMID:24596599

  18. Traumatic occipitocervical disruption: a new technique for stabilisation. Case report and literature review.

    PubMed

    Anderson, A J; Towns, G M; Chiverton, N

    2006-11-01

    Traumatic atlanto-occipital dislocation in adults is usually fatal and survival without neurological deficit is rare. The surgical management of those who do survive is difficult and controversial. Most authorities recommend posterior occipitoaxial fusion, but this compromises cervical rotation. We describe a case in which a patient with a traumatic atlanto-occipital disruption but no neurological deficit was treated by atlanto-occipital fusion using a new technique consisting of cancellous bone autografting supported by an occipital plate linked by rods to lateral mass screws in the atlas. The technique is described in detail. At one year the neck was stable, radiological fusion had been achieved, and atlantoaxial rotation preserved. The rationale behind this approach is discussed and the relevant literature reviewed. We recommend the technique for injuries of this type. PMID:17075091

  19. Non-traumatic compartment syndrome secondary to deep vein thrombosis and anticoagulation

    PubMed Central

    Newman, Peter Alexander; Deo, Sunny

    2014-01-01

    We describe an unusual case of non-traumatic compartment syndrome in three compartments of the left lower limb in a 57-year-old male inpatient. He had recently been started on anticoagulation therapy for multiple pulmonary emboli and deep vein thrombosis of the left posterior tibial and peroneal veins. Three of the four osteofascial compartments had pressures above 70?mm?Hg, hence four compartment fasciotomies were performed. Postoperatively, intravenous heparin therapy was started resulting in a significant blood loss, but he had no neurovascular deficit. At reoperation, for primary wound closure, his tissues looked healthy. Non-traumatic causes of acute compartment syndrome, including deep venous thrombosis and anticoagulation, are considered. PMID:24443334

  20. Detailed ophthalmologic evaluation of posterior microphthalmos.

    PubMed

    Alkin, Zeynep; Ozkaya, Abdullah; Karakucuk, Yalcin; Demirok, Ahmet

    2014-01-01

    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

  1. Detailed Ophthalmologic Evaluation of Posterior Microphthalmos

    PubMed Central

    Alkin, Zeynep; Ozkaya, Abdullah; Karakucuk, Yalcin; Demirok, Ahmet

    2014-01-01

    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

  2. Staged male urethroplasty transferring megalourethra tissue as free graft dorsal inlay to proximal urethral atresia in VACTERL association.

    PubMed

    Bagrodia, Aditya; Yucel, Selcuk; Baker, Linda A

    2011-12-01

    Megalourethra is a rare spectrum of urologic malformations of penile corporal structures frequently associated with multiple congenital anomalies, such as prune belly syndrome or vertebral, anorectal, cardiac, trachea-esophageal, renal, and limb (VACTERL association) defects. A 6-year-old boy with VACTERL association and proximal urethral atresia with distal fusiform megalourethra underwent staged reconstruction, including appendicovesicostomy, perineal urethrostomy, and first-stage urethroplasty with a dorsal inlay free graft of megalourethra tissue to the proximal urethral atretic region, followed by second-stage urethroplasty. At 2.6 years of follow-up, he was continent, voids per urethra without postvoid residual urine volume, and no longer performs clean intermittent catheterization by way of the appendicovesicostomy. PMID:21601242

  3. Giant anterior urethral diverticulum with a calculus masquerading as left inguinal hernia: A missed diagnosis, a lesson to learn

    PubMed Central

    Kushwaha, Renu; Goel, Prabudh; Kureel, Shiv Narain

    2013-01-01

    Congenital anterior urethral diverticulum is an infrequent but important cause of infravesical obstructive uropathy in children. Clinical spectrum usually includes obstructive or irritative urinary symptoms or penile ballooning during the act of micturition. We share our experience in a case of giant anterior urethral diverticulum with a contained calculus presenting as a huge inguino-scrotal swelling and masquerading as left inguinal hernia. The fluctuation in the size of the swelling related to the act of micturition was mistaken for cough impulse. He was subjected to a left inguinal herniotomy, following which he developed urine leak from the surgery wound and was subsequently referred to our centre for further management. The importance of a detailed history, meticulous physical examination, and diagnostic imaging has been stressed. The surgical approach in such cases has also been highlighted. PMID:24019642

  4. Posterior predictive checking of multiple imputation models.

    PubMed

    Nguyen, Cattram D; Lee, Katherine J; Carlin, John B

    2015-07-01

    Multiple imputation is gaining popularity as a strategy for handling missing data, but there is a scarcity of tools for checking imputation models, a critical step in model fitting. Posterior predictive checking (PPC) has been recommended as an imputation diagnostic. PPC involves simulating "replicated" data from the posterior predictive distribution of the model under scrutiny. Model fit is assessed by examining whether the analysis from the observed data appears typical of results obtained from the replicates produced by the model. A proposed diagnostic measure is the posterior predictive "p-value", an extreme value of which (i.e., a value close to 0 or 1) suggests a misfit between the model and the data. The aim of this study was to evaluate the performance of the posterior predictive p-value as an imputation diagnostic. Using simulation methods, we deliberately misspecified imputation models to determine whether posterior predictive p-values were effective in identifying these problems. When estimating the regression parameter of interest, we found that more extreme p-values were associated with poorer imputation model performance, although the results highlighted that traditional thresholds for classical p-values do not apply in this context. A shortcoming of the PPC method was its reduced ability to detect misspecified models with increasing amounts of missing data. Despite the limitations of posterior predictive p-values, they appear to have a valuable place in the imputer's toolkit. In addition to automated checking using p-values, we recommend imputers perform graphical checks and examine other summaries of the test quantity distribution. PMID:25939490

  5. Intraocular Nematode Affixed to Posterior Lens Capsule.

    PubMed

    Karth, Peter A; Swinney, Christian C; Moshfeghi, Darius M; Yannuzzi, Lawrence A; Pang, Claudine E; Leng, Theodore

    2015-01-01

    The clinical presentation of an intraocular nematode unusually affixed to the posterior lens capsule is described. A 64-year-old female patient presented with a 7-year history of gradually declining vision and enlarging central scotoma, but no inflammation. On follow-up 2 years later, vision had further declined and a non-motile, 8-mm nematode was seen affixed to the posterior lens capsule that remained unchanged through final follow-up. The patient disclosed having resided in Africa as a child. Systemic review revealed no evidence of extraocular involvement. Nematode carcasses may remain preserved in the human eye for extended periods without ongoing inflammation. PMID:26599254

  6. Imaging the posterior mediastinum: a multimodality approach

    PubMed Central

    Occhipinti, Mariaelena; Heidinger, Benedikt H.; Franquet, Elisa; Eisenberg, Ronald L.; Bankier, Alexander A.

    2015-01-01

    The posterior mediastinum contains several structures that can produce a wide variety of pathologic conditions. Descending thoracic aorta, esophagus, azygos and hemiazygos veins, thoracic duct, lymph nodes, adipose tissue, and nerves are all located in this anatomical region and can produce diverse abnormalities. Although chest radiography may detect many of these pathologic conditions, computed tomography and magnetic resonance are the imaging modalities of choice for further defining the relationship of posterior mediastinal lesions to neighboring structures and showing specific imaging features that narrow the differential diagnosis. This review emphasizes modality-related answers to morphologic questions, which provide precise diagnostic information. PMID:25993732

  7. Viability and MR detectability of iron labeled mesenchymal stem cells used for endoscopic injection into the porcine urethral sphincter.

    PubMed

    Will, Susanne; Martirosian, Petros; Eibofner, Frank; Schick, Fritz; Bantleon, Rdiger; Vaegler, Martin; Grzinger, Gerd; Claussen, Claus D; Kramer, Ulrich; Schmehl, Jrg

    2015-08-01

    Direct stem cell therapies for functionally impaired tissue require a sufficient number of cells in the target region and a method for verifying the fate of the cells in the subsequent time course. In vivo MRI of iron labeled mesenchymal stem cells has been suggested to comply with these requirements. The study was conducted to evaluate proliferation, migration, differentiation and adhesion effects as well as the obtained iron load of an iron labeling strategy for mesenchymal stem cells. After injection into the porcine urethral sphincter, the labeled cells were monitored for up to six months using MRI. Mesenchymal stem cells were labeled with ferucarbotran (60/100/200 g/mL) and ferumoxide (200 g/mL) for the analysis of migration and viability. Phantom MR measurements were made to evaluate effects of iron labeling. For short and long term studies, the iron labeled cells were injected into the porcine urethral sphincter and monitored by MRI. High resolution anatomical images of the porcine urethral sphincter were applied for detection of the iron particles with a turbo-spin-echo sequence and a gradient-echo sequence with multiple TE values. The MR images were then compared with histological staining. The analysis of cell function after iron labeling showed no effects on proliferation or differentiation of the cells. Although the adherence increases with higher iron dose, the ability to migrate decreases as a presumed effect of iron labeling. The iron labeled mesenchymal stem cells were detectable in vivo in MRI and histological staining even six months after injection. Labeling with iron particles and subsequent evaluation with highly resolved three dimensional data acquisition allows sensitive tracking of cells injected into the porcine urethral sphincter for several months without substantial biological effects on mesenchymal stem cells. PMID:26147577

  8. Subcutaneous granuloma annulare of the penis associated with a urethral anomaly: case report and review of the literature.

    PubMed

    Fathi, Khaled; Harangi, Ferenc; Kravjak, Andras; Pinter, Andras

    2014-01-01

    Granuloma annulare (GA) is an uncommon benign inflammatory skin condition, most often found on the extremities of young females. The subcutaneous variant of GA involving the penis is very rare. We report a case of subcutaneous GA associated with a urethral anomaly in a 15-year-old boy that persisted for a year. Treatment options are discussed with a review of the current literature. PMID:24889683

  9. Development of a CFD urethral model to study flow-generated vortices under different conditions of prostatic obstruction.

    PubMed

    Pel, Johan J M; van Mastrigt, Ron

    2007-01-01

    A novel, non-invasive method to diagnose bladder outlet obstruction involves the recording of noise with a contact microphone pressed against the perineum (between anus and scrotum). This noise results from flow-generated vortices caused by prostatic obstruction. We developed a computational fluid dynamic (CFD) urethral model including urethral geometry to study the relation between generated noise and the degree of obstruction. This model comprised a bladder, bladder neck, prostate and urethra. Calculations were carried out at four bladder pressures, five degrees of obstruction and three obstruction shapes. For each of the sixty simulations, the velocity and pressure distributions along the urethra were calculated including wall shear stresses to localize flow transition from disturbed to normal. Negative pressures at the obstruction outlet induced recirculation of flow. The location of transition was independent of the applied bladder pressure, but it depended primarily on the degree and secondarily on the shape of the obstruction. Based on the presented results, we hypothesize that the location of the maximum amplitude of perineal noise mainly depends on the degree and shape of the prostatic obstruction. Our future aim is to test our hypothesis in male patients and to extend the presented model to 3D with a viscoelastic urethral wall to calculate the fluid-wall interaction. PMID:17151416

  10. Surgical Repair of Bulbar Urethral Strictures: Advantages of Ventral, Dorsal, and Lateral Approaches and When to Choose Them

    PubMed Central

    Venkatesan, Krishnan; Blakely, Stephen; Nikolavsky, Dmitriy

    2015-01-01

    Objectives. To review the available literature describing the three most common approaches for buccal mucosal graft (BMG) augmentation during reconstruction of bulbar urethral strictures. Due to its excellent histological properties, buccal mucosa graft is now routinely used in urethral reconstruction. The best approach for the placement of such a graft remains controversial. Methods. PubMed search was conducted for available English literature describing outcomes of bulbar urethroplasty augmentation techniques using dorsal, ventral, and lateral approaches. Prospective and retrospective studies as well as meta-analyses and latest systematic reviews were included. Results. Most of the studies reviewed are of retrospective nature and majority described dorsal or ventral approaches. Medium- and long-term outcomes of all three approaches were comparable ranging between 80 and 88%. Conclusion. Various techniques of BMG augmentation urethroplasty have been described for repairs of bulbar urethral strictures. In this review, we describe and compare the three most common competing approaches for bulbar urethroplasty with utilization of BMG. PMID:26576149

  11. The second nationwide surveillance of the antimicrobial susceptibility of Neisseria gonorrhoeae from male urethritis in Japan, 2012-2013.

    PubMed

    Hamasuna, Ryoichi; Yasuda, Mitsuru; Ishikawa, Kiyohito; Uehara, Shinya; Hayami, Hiroshi; Takahashi, Satoshi; Matsumoto, Tetsuro; Yamamoto, Shingo; Minamitani, Shinichi; Watanabe, Akira; Iwata, Satoshi; Kaku, Mitsuo; Kadota, Junichi; Sunakawa, Keisuke; Sato, Junko; Hanaki, Hideaki; Tsukamoto, Taiji; Kiyota, Hiroshi; Egawa, Shin; Tanaka, Kazushi; Arakawa, Soichi; Fujisawa, Masato; Kumon, Hiromi; Kobayashi, Kanao; Matsubara, Akio; Naito, Seiji; Kuroiwa, Kentaro; Hirayama, Hideo; Narita, Harunori; Hosobe, Takahide; Ito, Shin; Ito, Kenji; Kawai, Shuichi; Ito, Masayasu; Chokyu, Hirofumi; Matsumura, Masaru; Yoshioka, Masaru; Uno, Satoshi; Monden, Koichi; Takayama, Kazuo; Kaji, Shinichi; Kawahara, Motoshi; Sumii, Toru; Kadena, Hitoshi; Yamaguchi, Takamasa; Maeda, Shinichi; Nishi, Shohei; Nishimura, Hirofumi; Shirane, Takeshi; Yoh, Mutsumasa; Akiyama, Kikuo; Imai, Toshio; Kano, Motonori

    2015-05-01

    Worldwide, the most important concern in the treatment of sexually transmitted infections is the increase in antimicrobial resistant Neisseria gonorrhoeae strains including resistance to cephalosporins, penicillins, fluoroquinolones or macrolides. To investigate the trends of antimicrobial susceptibility among N. gonorrhoeae strains isolated from male patients with urethritis, a Japanese surveillance committee conducted the second nationwide surveillance study. Urethral discharge was collected from male patients with urethritis at 26 medical facilities from March 2012 to January 2013. Of the 151 specimens, 103 N. gonorrhoeae strains were tested for susceptibility to 20 antimicrobial agents. None of the strains was resistant to ceftriaxone, but the minimum inhibitory concentration (MIC) 90% of ceftriaxone increased to 0.125 ?g/ml, and 11 (10.7%) strains were considered less susceptible with an MIC of 0.125 ?g/ml. There were 11 strains resistant to cefixime, and the MICs of these strains were 0.5 ?g/ml. The distributions of the MICs of fluoroquinolones, such as ciprofloxacin, levofloxacin and tosufloxacin, were bimodal. Sitafloxacin, a fluoroquinolone, showed strong activity against all strains, including strains resistant to other three fluoroquinolones, such as ciprofloxacin, levofloxacin and tosufloxacin. The azithromycin MICs in 2 strains were 1 ?g/ml. PMID:25727286

  12. Post-traumatic Stress Disorder.

    PubMed

    Javidi, H; Yadollahie, M

    2012-01-01

    Unexpected extreme sudden traumatic stressor may cause post-traumatic stress disorder (PTSD). Important traumatic events include war, violent personal assault (e.g., sexual assault, and physical attack), being taken hostage or kidnapped, confinement as a prisoner of war, torture, terrorist attack, severe car accidents, and natural disasters. In childhood age sexual abuse or witnessing serious injuries or unexpected death of a beloved one are among important traumatic events.PTSD can be categorized into two types of acute and chronic PTSD: if symptoms persist for less than three months, it is termed "acute PTSD," otherwise, it is called "chronic PTSD." 60.7% of men and 51.2% of women would experience at least one potentially traumatic event in their lifetime. The lifetime prevalence of PTSD is significantly higher in women than men. Lifetime prevalence of PTSD varies from 0.3% in China to 6.1% in New Zealand. The prevalence of PTSD in crime victims are between 19% and 75%; rates as high as 80% have been reported following rape. The prevalence of PTSD among direct victims of disasters was reported to be 30%-40%; the rate in rescue workers was 10%-20%. The prevalence of PTSD among police, fire, and emergency service workers ranged from 6%-32%. An overall prevalence rate of 4% for the general population, the rate in rescue/recovery occupations ranged from 5% to 32%, with the highest rate reported in search and rescue personnel (25%), firefighters (21%), and workers with no prior training for facing disaster. War is one of the most intense stressors known to man. Armed forces have a higher prevalence of depression, anxiety disorders, alcohol abuse and PTSD. High-risk children who have been abused or experienced natural disasters may have an even higher prevalence of PTSD than adults.Female gender, previous psychiatric problem, intensity and nature of exposure to the traumatic event, and lack of social support are known risk factors for work-related PTSD. Working with severely ill patients, journalists and their families, and audiences who witness serious trauma and war at higher risk of PTSD.The intensity of trauma, pre-trauma demographic variables, neuroticism and temperament traits are the best predictors of the severity of PTSD symptoms. About 84% of those suffering from PTSD may have comorbid conditions including alcohol or drug abuse; feeling shame, despair and hopeless; physical symptoms; employment problems; divorce; and violence which make life harder. PTSD may contribute to the development of many other disorders such as anxiety disorders, major depressive disorder, substance abuse/dependency disorders, alcohol abuse/dependence, conduct disorder, and mania. It causes serious problems, thus its early diagnosis and appropriate treatment are of paramount importance. PMID:23022845

  13. The Effects of Traumatic and Abusive Relationships

    ERIC Educational Resources Information Center

    Orzeck, Tricia L.; Rokach, Ami; Chin, Jacqueline

    2010-01-01

    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

  14. Traumatic hemipelvectomy: case report and literature review.

    PubMed

    Schoderbek, Robert J; Battaglia, Todd C; Dorf, Erik R; Kahler, David M

    2005-06-01

    Traumatic hemipelvectomy is a rare but devastating injury involving complete disruption of the hemipelvis from the pubic symphysis to the sacroiliac joints and often results in death. We present an interesting case of traumatic hemipelvectomy caused by a previously undescribed mechanism of injury in which judicious angiography and aggressive surgical treatment contributed to patient survival. PMID:15843944

  15. Traumatic Bonding: Clinical Implications in Incest.

    ERIC Educational Resources Information Center

    deYoung, Mary; Lowry, Judith A.

    1992-01-01

    "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

  16. Secondary Traumatic Stress in Substance Abuse Treatment

    ERIC Educational Resources Information Center

    Bride, Brian E.; Walls, Erin

    2006-01-01

    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.…

  17. Characteristics of Acute Nongonococcal Urethritis in Men Differ by Sexual Preference

    PubMed Central

    Fairley, Christopher K.; Weerakoon, Ajith; Read, Timothy H.; Fehler, Glenda; Chen, Marcus Y.

    2014-01-01

    Nongonococcal urethritis (NGU) is a common clinical syndrome, but no etiological agent is identified in a significant proportion of cases. Whether the spectrum of pathogens differs between heterosexual men (MSW) and men who have sex with men (MSM) is largely unstudied but of considerable clinical relevance. A retrospective review was done using the electronic medical record database of Melbourne Sexual Health Centre, Australia. Cases were first presentations of symptomatic acute NGU with ?5 polymorphonuclear leukocytes (PMNL)/high-powered field (HPF) on urethral Gram stain between January 2006 and December 2011. First-stream urine was tested for Chlamydia trachomatis and Mycoplasma genitalium by PCR. Demographic, laboratory, and behavioral characteristics of cases were examined by univariate and multivariable analyses. Of 1,295 first presentations of acute NGU, 401 (32%; 95% confidence interval [CI] of 29 to 34%) had C. trachomatis and 134 (11%; 95% CI of 9 to 13%) had M. genitalium detected. MSM with acute NGU were less likely to have C. trachomatis (adjusted odds ratio [AOR] = 0.4; 95% CI of 0.3 to 0.6) or M. genitalium (AOR = 0.5; 95% CI of 0.3 to 0.8) and more likely to have idiopathic NGU (AOR = 2.4; 95% CI of 1.8 to 3.3), to report 100% condom use for anal/vaginal sex (AOR = 3.6; 95% CI of 2.7 to 5.0), or to have engaged in sexual activities other than anal/vaginal sex (AOR = 8.0; 95% CI of 3.6 to 17.8). Even when C. trachomatis or M. genitalium was detected, MSM were more likely than MSW to report consistent condom use (OR = 4.7; 95% CI of 2.6 to 8.3). MSM with acute NGU are less likely to have the established bacterial sexually transmitted infections (STIs) and more likely to report protected anal sex or sexual activity other than anal sex prior to symptom onset than MSW. These data suggest that the etiologic spectrum of pathogens differs between MSM and MSW in acute NGU and that relatively low-risk practices are capable of inducing acute NGU. PMID:24899041

  18. Characteristics of acute nongonococcal urethritis in men differ by sexual preference.

    PubMed

    Rane, Vinita S; Fairley, Christopher K; Weerakoon, Ajith; Read, Timothy H; Fehler, Glenda; Chen, Marcus Y; Bradshaw, Catriona S

    2014-08-01

    Nongonococcal urethritis (NGU) is a common clinical syndrome, but no etiological agent is identified in a significant proportion of cases. Whether the spectrum of pathogens differs between heterosexual men (MSW) and men who have sex with men (MSM) is largely unstudied but of considerable clinical relevance. A retrospective review was done using the electronic medical record database of Melbourne Sexual Health Centre, Australia. Cases were first presentations of symptomatic acute NGU with ? 5 polymorphonuclear leukocytes (PMNL)/high-powered field (HPF) on urethral Gram stain between January 2006 and December 2011. First-stream urine was tested for Chlamydia trachomatis and Mycoplasma genitalium by PCR. Demographic, laboratory, and behavioral characteristics of cases were examined by univariate and multivariable analyses. Of 1,295 first presentations of acute NGU, 401 (32%; 95% confidence interval [CI] of 29 to 34%) had C. trachomatis and 134 (11%; 95% CI of 9 to 13%) had M. genitalium detected. MSM with acute NGU were less likely to have C. trachomatis (adjusted odds ratio [AOR] = 0.4; 95% CI of 0.3 to 0.6) or M. genitalium (AOR = 0.5; 95% CI of 0.3 to 0.8) and more likely to have idiopathic NGU (AOR = 2.4; 95% CI of 1.8 to 3.3), to report 100% condom use for anal/vaginal sex (AOR = 3.6; 95% CI of 2.7 to 5.0), or to have engaged in sexual activities other than anal/vaginal sex (AOR = 8.0; 95% CI of 3.6 to 17.8). Even when C. trachomatis or M. genitalium was detected, MSM were more likely than MSW to report consistent condom use (OR = 4.7; 95% CI of 2.6 to 8.3). MSM with acute NGU are less likely to have the established bacterial sexually transmitted infections (STIs) and more likely to report protected anal sex or sexual activity other than anal sex prior to symptom onset than MSW. These data suggest that the etiologic spectrum of pathogens differs between MSM and MSW in acute NGU and that relatively low-risk practices are capable of inducing acute NGU. PMID:24899041

  19. Theta burst stimulation improves visuo-spatial attention in a patient with traumatic brain injury.

    PubMed

    Bonnì, Sonia; Mastropasqua, Chiara; Bozzali, Marco; Caltagirone, Carlo; Koch, Giacomo

    2013-11-01

    Recent studies showed that non-invasive brain stimulation methods, such as repetitive transcranial magnetic stimulation (rTMS) can improve the symptoms of neglect in stroke patients. Here, we adopted this approach to improve visuo-spatial deficit in a patient with traumatic brain injury (TBI) that showed important symptoms of visuo-spatial neglect. We found that continuous theta burst stimulation (cTBS) applied over the left posterior parietal cortex (PPC) induced a clinical improvement of cognitive disorder associated to a functional changes of fronto-parietal network as assessed by means of TMS and resting state fMRI. PMID:23532550

  20. Traumatic atlanto-occipital dissociation presenting as locked-in syndrome.

    PubMed

    Desai, Rupen; Kinon, Merritt D; Loriaux, Daniel B; Bagley, Carlos A

    2015-12-01

    We present an unusual presentation of unstable atlanto-occipital dissociation as locked-in syndrome. Traumatic atlanto-occipital dissociation is a severe injury that accounts for 15-20% of all fatal cervical spinal injuries. A disruption occurs between the tectorial ligaments connecting the occipital condyle to the superior articulating facets of the atlas, resulting in anterior, longitudinal, or posterior translation, and it may be associated with Type III odontoid fractures. Furthermore, the dissociation may be complete (atlanto-occipital dislocation) or incomplete (atlanto-occipital subluxation), with neurologic findings ranging from normal to complete quadriplegia with respiratory compromise. PMID:26190221

  1. [Post-traumatic stress disorder].

    PubMed

    Ponteva, Matti; Henriksson, Markus; Isoaho, Raimo; Laukkala, Tanja; Mnnikk, Timo; Punamki, Raija-Leena; Wahlbeck, Kristian

    2009-01-01

    Psychosocial support and careful monitoring are recommended for acute stress reaction (ASR) and acute stress disorder (ASD). If symptoms require, short focused cognitive-behavioural psychotherapy can be used for ASD. Medication is rarely necessary, but sleeping pills can be used for a short period. Trauma-focused psychotherapeutic interventions are first-line treatment for post-traumatic stress disorder. SSRI or SNRI antidepressant medication is also effective. There is less evidence on antipsychotic and antiepileptic medication. Psychotherapeutic interventions and medication can be, and often are, combined. Children, the elderly, and military and peacekeeping personnel need interventions that are tailored to their needs. PMID:19839195

  2. Imaging of Traumatic Brain Injury.

    PubMed

    Bodanapally, Uttam K; Sours, Chandler; Zhuo, Jiachen; Shanmuganathan, Kathirkamanathan

    2015-07-01

    Imaging plays an important role in the management of patients with traumatic brain injury (TBI). Computed tomography (CT) is the first-line imaging technique allowing rapid detection of primary structural brain lesions that require surgical intervention. CT also detects various deleterious secondary insults allowing early medical and surgical management. Serial imaging is critical to identifying secondary injuries. MR imaging is indicated in patients with acute TBI when CT fails to explain neurologic findings. However, MR imaging is superior in patients with subacute and chronic TBI and also predicts neurocognitive outcome. PMID:26046506

  3. Sleep in traumatic brain injury.

    PubMed

    Vermaelen, James; Greiffenstein, Patrick; deBoisblanc, Bennett P

    2015-07-01

    More than one-half million patients are hospitalized annually for traumatic brain injury (TBI). One-quarter demonstrate sleep-disordered breathing, up to 50% experience insomnia, and half have hypersomnia. Sleep disturbances after TBI may result from injury to sleep-regulating brain tissue, nonspecific neurohormonal responses to systemic injury, ICU environmental interference, and medication side effects. A diagnosis of sleep disturbances requires a high index of suspicion and appropriate testing. Treatment starts with a focus on making the ICU environment conducive to normal sleep. Treating sleep-disordered breathing likely has outcome benefits in TBI. The use of sleep promoting sedative-hypnotics and anxiolytics should be judicious. PMID:26118920

  4. Endoscopic posterior cricoid split with rib grafting.

    PubMed

    Modi, Vikash K

    2012-01-01

    Bilateral vocal fold immobility (BVFI) can be divided into bilateral vocal fold paralysis and cricoarytenoid joint fixation, which can be accompanied with laryngeal stenosis. In children with BVFI, requiring a tracheostomy, the authors preference, to achieve decannulation, is to perform an endoscopic posterior cricoid split with rib grafting after the age of 1. PMID:22472242

  5. Skull Base Approaches for Posterior Circulation Aneurysms

    PubMed Central

    Bowles, Alfred P.; Kinjo, Toshihiko; Al-Mefty, Ossama

    1995-01-01

    With the emergence of skull base surgery, surgical approaches have been developed and redefined, providing surgeons with accessible avenues to difficult lesions of the cranial base. Although the majority of lesions to which these techniques have been applied have been for tumors, we find that these skull base approaches can equally provide access to difficult vascular lesions, especially complex aneurysms of the posterior circulation. In this report three different skull base approaches were used in four patients for the treatment of posterior circulation aneurysms. A cranio-orbital-zygomatic approach was used for the acute stage of a ruptured basilar tip artery anenrysm and for a giant posterior cerebral artery aneurysm. A petrosal approach was used for a ruptured basilar trunk aneurysm, and the transcondylar approach was used for a vertebral artery aneurysm. Each approach provides a wide field and excellent exposure of vital structures with minimal brain retraction. Neck clipping of the aneurysms was successfully achieved in all cases. We believe that our skull base approaches facilitate the surgical treatment of posterior circulation aneurysms. ImagesFigure 1Figure 2Figure 3Figure 4Figure 5Figure 6Figure 7Figure 8Figure 9Figure 10Figure 11Figure 12p258-b PMID:17170966

  6. BAER suppression during posterior fossa dural opening

    PubMed Central

    Shields, Christopher B.; Shields, Lisa B. E.; Jiang, Yi Dan; Yao, Tom; Zhang, Yi Ping; Sun, David A.

    2015-01-01

    Background: Intraoperative monitoring with brainstem auditory evoked responses (BAER) provides an early warning signal of potential neurological injury and may avert tissue damage to the auditory pathway or brainstem. Unexplained loss of the BAER signal in the operating room may present a dilemma to the neurosurgeon. Methods: This paper documents two patients who displayed a unique mechanism of suppression of the BAER apparent within minutes following dural opening for resection of a posterior fossa meningioma. Results: In two patients with anterior cerebellopontine angle and clival meningiomas, there was a significant deterioration of the BAER soon after durotomy but prior to cerebellar retraction and tumor removal. Intracranial structures in the posterior fossa lying between the tumor and dural opening were shifted posteriorly after durotomy. Conclusion: We hypothesized that the cochlear nerve and vessels entering the acoustic meatus were compressed or stretched when subjected to tissue shift. This movement caused cochlear nerve dysfunction that resulted in BAER suppression. BAER was partially restored after the tumor was decompressed, dura repaired, and bone replaced. BAER was not suppressed following durotomy for removal of a meningioma lying posterior to the cochlear complex. Insight into the mechanisms of durotomy-induced BAER inhibition would allay the neurosurgeon's anxiety during the operation. PMID:25883849

  7. Posterior Probabilities for a Consensus Ordering.

    ERIC Educational Resources Information Center

    Fligner, Michael A.; Verducci, Joseph S.

    1990-01-01

    The concept of consensus ordering is defined, and formulas for exact and approximate posterior probabilities for consensus ordering are developed under the assumption of a generalized Mallows' model with a diffuse conjugate prior. These methods are applied to a data set concerning 98 college students. (SLD)

  8. Congenital orbital teratoma up to posterior fossa

    PubMed Central

    Kharosekar, Hrushikesh U.; Jasmit, S.; Velho, V.; Palande, D. A.

    2014-01-01

    Congenital orbital teratoma is a rare condition which presents as marked proptosis of eyeball in a newborn. It is rapidly progressive with secondary damage to eyeball due to pressure effect. This case presented by us is of interest due to radiological features and rarity of this tumor extending into posterior fossa. PMID:25250083

  9. Management of posterior fossa arteriovenous malformations

    PubMed Central

    Almeida, Joao Paulo; Medina, Roberto; Tamargo, Rafael J.

    2015-01-01

    Background: Posterior fossa arteriovenous malformations (AVMs) are rare vascular lesions, representing 715% of all intracranial AVMs. Although less frequent than supratentorial AVMs, they present higher rupture, morbidity, and mortality rates. Microsurgery, radiosurgery, and endovascular neurosurgery are treatment options for obliteration of those lesions. In this paper, we present a critical review of the literature about the management of posterior fossa AVM. Methods: A MEDLINE-based search of articles published between January 1960 and January 2014 was performed. The search terms: Posterior fossa arteriovenous malformation, microsurgery, radiosurgery, and endovascular were used to identify the articles. Results: Current data supports the role of microsurgery as the gold standard treatment for cerebellar AVMs. Brainstem AVMs are usually managed with radiotherapy and endovascular therapy; microsurgery is considered in cases of pial brainstem AVMs. Conclusions: Succsseful treatment of posterior fossa AVMs depend on an integrated work of neurosurgeons, radiosurgeons, and endovascular neurosurgery. Although the development of radiosurgery and endovascular techniques is remarkable, microsurgery remains as the gold standard treatment for most of those lesions. PMID:25745586

  10. Posterior vaginal wall Gartner's duct cyst

    PubMed Central

    Bala, Ripan; Nagpal, Madhu; Kaur, Manmeet; Kaur, Harmanpreet

    2015-01-01

    Cyst of posterior vaginal wall is very rare. This case relates to a patient who presented with polypoidal mass protruding out from vagina which could have been easily mistaken as uterovaginal prolapse, but appropriate clinical evaluation supported with investigations clinched the diagnosis easily.

  11. A Complication of Posterior Malleolar Fracture Fixation.

    PubMed

    Patel, Ankit; Charles, Loren; Ritchie, James

    2016-01-01

    We present a case of tibial nerve impingement by an anteroposterior screw inserted for stabilization of a posterior malleolar fracture. This specific complication has not previously been described in published studies, although numerous reports have described various forms of peripheral nerve entrapment. We discuss the merits of fixation of these fractures using a posterolateral approach. PMID:25907349

  12. Subspecialization in the human posterior medial cortex

    PubMed Central

    Bzdok, Danilo; Heeger, Adrian; Langner, Robert; Laird, Angela R.; Fox, Peter T.; Palomero-Gallagher, Nicola; Vogt, Brent A.; Zilles, Karl; Eickhoff, Simon B.

    2014-01-01

    The posterior medial cortex (PMC) is particularly poorly understood. Its neural activity changes have been related to highly disparate mental processes. We therefore investigated PMC properties with a data-driven exploratory approach. First, we subdivided the PMC by whole-brain coactivation profiles. Second, functional connectivity of the ensuing PMC regions was compared by task-constrained meta-analytic coactivation mapping (MACM) and task-unconstrained resting-state correlations (RSFC). Third, PMC regions were functionally described by forward/reverse functional inference. A precuneal cluster was mostly connected to the intraparietal sulcus, frontal eye fields, and right temporo-parietal junction; associated with attention and motor tasks. A ventral posterior cingulate cortex (PCC) cluster was mostly connected to the ventromedial prefrontal cortex and middle left inferior parietal cortex (IPC); associated with facial appraisal and language tasks. A dorsal PCC cluster was mostly connected to the dorsomedial prefrontal cortex, anterior/posterior IPC, posterior midcingulate cortex, and left dorsolateral prefrontal cortex; associated with delay discounting. A cluster in the retrosplenial cortex was mostly connected to the anterior thalamus and hippocampus. Furthermore, all PMC clusters were congruently coupled with the default mode network according to task-constrained but not task-unconstrained connectivity. We thus identified distinct regions in the PMC and characterized their neural networks and functional implications. PMID:25462801

  13. Post-traumatic stress disorder in children

    PubMed Central

    KAMINER, DEBRA; SEEDAT, SORAYA; STEIN, DAN J.

    2005-01-01

    In the past ten years, there has been increasing recognition that children who have been exposed to traumatic events can, like traumaexposed adults, develop post-traumatic stress disorder (PTSD). Practitioners therefore need to be able to recognise and treat post-traumatic stress reactions in children. However, the direct application of adult diagnostic criteria for PTSD can result in the misdiagnosis of post-traumatic stress reactions in children, while research has only recently begun to investigate the effectiveness of different treatments for children with PTSD. This article discusses issues regarding the assessment and diagnosis of post-traumatic stress reactions in children at different developmental stages, considers neurobiological, cognitive and other factors that are theorized to increase the risk of PTSD in trauma-exposed children, and evaluates current psychotherapeutic and pharmacotherapeutic treatments for childhood PTSD. The need for more systematic research on the management of PTSD in children is noted. PMID:16633528

  14. A Stable Thoracic Hox Code and Epimorphosis Characterize Posterior Regeneration in Capitella teleta.

    PubMed

    de Jong, Danielle M; Seaver, Elaine C

    2016-01-01

    Regeneration, the ability to replace lost tissues and body parts following traumatic injury, occurs widely throughout the animal tree of life. Regeneration occurs either by remodeling of pre-existing tissues, through addition of new cells by cell division, or a combination of both. We describe a staging system for posterior regeneration in the annelid, Capitella teleta, and use the C. teleta Hox gene code as markers of regional identity for regenerating tissue along the anterior-posterior axis. Following amputation of different posterior regions of the animal, a blastema forms and by two days, proliferating cells are detected by EdU incorporation, demonstrating that epimorphosis occurs during posterior regeneration of C. teleta. Neurites rapidly extend into the blastema, and gradually become organized into discrete nerves before new ganglia appear approximately seven days after amputation. In situ hybridization shows that seven of the ten Hox genes examined are expressed in the blastema, suggesting roles in patterning the newly forming tissue, although neither spatial nor temporal co-linearity was detected. We hypothesized that following amputation, Hox gene expression in pre-existing segments would be re-organized to scale, and the remaining fragment would express the complete suite of Hox genes. Surprisingly, most Hox genes display stable expression patterns in the ganglia of pre-existing tissue following amputation at multiple axial positions, indicating general stability of segmental identity. However, the three Hox genes, CapI-lox4, CapI-lox2 and CapI-Post2, each shift its anterior expression boundary by one segment, and each shift includes a subset of cells in the ganglia. This expression shift depends upon the axial position of the amputation. In C. teleta, thoracic segments exhibit stable positional identity with limited morphallaxis, in contrast with the extensive body remodeling that occurs during regeneration of some other annelids, planarians and acoel flatworms. PMID:26894631

  15. A Stable Thoracic Hox Code and Epimorphosis Characterize Posterior Regeneration in Capitella teleta

    PubMed Central

    de Jong, Danielle M.; Seaver, Elaine C.

    2016-01-01

    Regeneration, the ability to replace lost tissues and body parts following traumatic injury, occurs widely throughout the animal tree of life. Regeneration occurs either by remodeling of pre-existing tissues, through addition of new cells by cell division, or a combination of both. We describe a staging system for posterior regeneration in the annelid, Capitella teleta, and use the C. teleta Hox gene code as markers of regional identity for regenerating tissue along the anterior-posterior axis. Following amputation of different posterior regions of the animal, a blastema forms and by two days, proliferating cells are detected by EdU incorporation, demonstrating that epimorphosis occurs during posterior regeneration of C. teleta. Neurites rapidly extend into the blastema, and gradually become organized into discrete nerves before new ganglia appear approximately seven days after amputation. In situ hybridization shows that seven of the ten Hox genes examined are expressed in the blastema, suggesting roles in patterning the newly forming tissue, although neither spatial nor temporal co-linearity was detected. We hypothesized that following amputation, Hox gene expression in pre-existing segments would be re-organized to scale, and the remaining fragment would express the complete suite of Hox genes. Surprisingly, most Hox genes display stable expression patterns in the ganglia of pre-existing tissue following amputation at multiple axial positions, indicating general stability of segmental identity. However, the three Hox genes, CapI-lox4, CapI-lox2 and CapI-Post2, each shift its anterior expression boundary by one segment, and each shift includes a subset of cells in the ganglia. This expression shift depends upon the axial position of the amputation. In C. teleta, thoracic segments exhibit stable positional identity with limited morphallaxis, in contrast with the extensive body remodeling that occurs during regeneration of some other annelids, planarians and acoel flatworms. PMID:26894631

  16. Acid-base and biochemical stabilization and quality of recovery in male cats with urethral obstruction and anesthetized with propofol or a combination of ketamine and diazepam

    PubMed Central

    Freitas, Gabrielle C.; Monteiro Carvalho Mori da Cunha, Marina G.; Gomes, Kleber; Monteiro Carvalho Mori da Cunha, Joo P.; Togni, Monique; Pippi, Ney L.; Carregaro, Adriano B.

    2012-01-01

    This study compared acid-base and biochemical changes and quality of recovery in male cats with experimentally induced urethral obstruction and anesthetized with either propofol or a combination of ketamine and diazepam for urethral catheterization. Ten male cats with urethral obstruction were enrolled for urethral catheterization and anesthetized with either ketamine-diazepam (KD) or propofol (P). Lactated Ringers solution was administered by intravenous (IV) beginning 15 min before and continuing for 48 h after relief of urethral obstruction. Quality of recovery and time to standing were evaluated. The urethral catheter was maintained to measure urinary output. Hematocrit (Hct), total plasma protein (TPP), albumin, total protein (TP), blood urea nitrogen (BUN), creatinine, pH, bicarbonate (HCO3?), chloride, base excess, anion gap, sodium, potassium, and partial pressure of carbon dioxide in mixed venous blood (pvCO2) were measured before urethral obstruction, at start of fluid therapy (0 h), and at subsequent intervals. The quality of recovery and time to standing were respectively 4 and 75 min in the KD group and 5 and 16 min in the P group. The blood urea nitrogen values were increased at 0, 2, and 8 h in both groups. Serum creatinine increased at 0 and 2 h in cats administered KD and at 0, 2, and 8 h in cats receiving P, although the values were above the reference range in both groups until 8 h. Acidosis occurred for up to 2 h in both groups. Acid-base and biochemical stabilization were similar in cats anesthetized with propofol or with ketamine-diazepam. Cats that received propofol recovered much faster, but the ketamine-diazepam combination was shown to be more advantageous when treating uncooperative cats as it can be administered by intramuscular (IM) injection. PMID:23277699

  17. Traumatic Optic Neuropathy: A Review

    PubMed Central

    Kumaran, Arjunan Muthu; Sundar, Gangadhara; Chye, Lim Thiam

    2014-01-01

    The aim of this article is to evaluate current literature on investigation and management of traumatic optic neuropathy (TON), propose recommendations for diagnosis and management, and explore novel future treatments. TON, though uncommon, causes substantial visual loss. Without clear guidelines, there is much ambiguity regarding its diagnosis and management. Investigation and treatment (conservative, medical, surgical, and combined) vary widely between centers. Electronic databases PubMed, MEDLINE, PROSPERO, CENTRAL, and EMBASE were searched for content that matched “Traumatic optic neuropathy.” Articles with abstracts and full text available, published in the past 10 years, written English and limited to human adults, were selected. All study designs were acceptable except case reports and case series with fewer 10 patients. All abstracts were then evaluated for relevance. References of these studies were evaluated and if also relevant, included. A total of 2,686 articles were retrieved and 43 examined for relevance. Of these, 23 articles were included. TON is a clinical diagnosis. Visual-evoked potential is useful in diagnosis and prognosis. Computed tomography demonstrates canal fractures and concomitant injuries. Magnetic resonance images should be reserved for select and stable patients. Conservative treatment is appropriate in mild TON. Steroids are of questionable benefit and may be harmful. Surgery should be reserved for patients with radiological evidence of compression and individualized. PMID:25709751

  18. Psychotherapeutic Options for Traumatized Children

    PubMed Central

    Cohen, Judith A.; Mannarino, Anthony P.

    2010-01-01

    Purpose of review This review addresses two issues. First, it updates readers on new treatments for traumatized children. Second, it examines the breadth of target problems that current evidence-based treatments for child Posttraumatic Stress Disorder (PTSD) effectively address in the context of current diagnostic uncertainty. Specifically, changes have been proposed to the Diagnostic and Statistical Manual for Mental Disorders Fourth Edition (DSM-IV) diagnostic criteria for PTSD and a proposal has been submitted to add a new developmental trauma disorder to optimally describe the range of outcomes experienced by traumatized children. Recent findings Three recently completed treatment studies are described. A review of five established child trauma treatments for PTSD, Child Parent Psychotherapy, Cognitive Behavioral Interventions for Trauma in Schools, Cognitive Behavioral Therapy for PTSD, Structured Psychotherapy for Adolescents Responding to Chronic Stress and Trauma-Focused Cognitive Behavioral Therapy documents that these treatments effectively resolve problems in multiple domains beyond the current PTSD diagnostic criteria. These domains include affect dysregulation, behavioral dysregulation, cognitive dysregulation, and relational dysregulation. Summary New treatments for children are promising for treating PTSD and some other symptoms. Current evidence-based child trauma treatments address a broad array of trauma-related difficulties. PMID:20814304

  19. The Effect of Asymptomatic Urethral Caruncle on Micturition in Women with Urinary Incontinence

    PubMed Central

    Ozkan, Levend; Tarcan, Tufan

    2010-01-01

    Purpose The aim of this study was to evaluate the effect of asymptomatic urethral caruncle (UC) on micturition in women suffering from urinary incontinence. Materials and Methods A total of 232 patients participated in the study. UC was diagnosed in 50 of 232 patients with urinary incontinence during a physical examination in our clinic. All cases were divided into 2 groups: UC combined with urinary incontinence (group 1) and urinary incontinence only (group 2). Urodynamic evaluations were performed according to the International Continence Society standards. Results Both groups were similar in terms of voiding diary, pad test and residual urine volume. Urodynamic studies revealed no significant difference between group 1 and 2 (infravesical obstruction: 6% vs. 4.4%; overactive detrusor: 44% vs. 42.9% respectively). The rates of severe IPSS (37.8% vs. 20.9%) and severe cystocele (20.9% vs. 13.8%) were numerically higher in group 1 with no statistically significant difference. Conclusions Our results suggest that there is no effect of asymptomatic UC on lower urinary tract symptoms in women with urinary incontinence. Therefore, treating asymptomatic UC is unnecessary in these patients. However, during incontinence surgery, it is the surgeon's decision whether to treat asymptomatic UC. PMID:20428428

  20. Bursting stimulation of proximal urethral afferents improves bladder pressures and voiding

    NASA Astrophysics Data System (ADS)

    Bruns, Tim M.; Bhadra, Narendra; Gustafson, Kenneth J.

    2009-12-01

    Reflex bladder excitation has been evoked via pudendal nerve, pudendal nerve branch and intraurethral stimulation; however, afferent-evoked bladder emptying has been less efficient than direct activation of the bladder via sacral root stimulation. A stimulation method that improves activation of the urethra-bladder excitatory reflex with minimal sphincter recruitment may lead to improved bladder emptying. Fine wire electrodes were placed in the wall of the urethra in five cats. Placement of electrodes near the proximal urethra evoked bladder contractions with minimal sphincter activation. On these electrodes, lower frequency burst-patterned stimuli evoked greater bladder voiding efficiencies (71.2 27.8%) than other stimulus patterns on the same electrodes (50.4 41.5%, p > 0.05) or any stimulus pattern on electrodes that elicited urethral closure (16.5 12.7%, p < 0.05). Fine wire electrodes specifically targeted afferent fibers in the urethra, indicating the feasibility of clinical evaluations using the same method. This work may improve the translation of next generation neuroprostheses for bladder control.

  1. Visual Internal Urethrotomy for Adult Male Urethral Stricture Has Poor Long-Term Results

    PubMed Central

    Al Taweel, Waleed; Seyam, Raouf

    2015-01-01

    Objective. To determine the long-term stricture-free rate after visual internal urethrotomy following initial and follow-up urethrotomies. Methods. The records of all male patients who underwent direct visual internal urethrotomy for urethral stricture disease in our hospital between July 2004 and May 2012 were reviewed. The Kaplan-Meier method was used to analyze stricture-free probability after the first, second, third, fourth, and fifth urethrotomies. Results. A total of 301 patients were included. The overall stricture-free rate at the 36-month follow-up was 8.3% with a median time to recurrence of 10 months (95% CI of 9.5 to 10.5, range: 236). The stricture-free rate after one urethrotomy was 12.1% with a median time to recurrence of eight months (95% CI of 7.18.9). After the second urethrotomy, the stricture-free rate was 7.9% with a median time to recurrence of 10 months (95% CI of 9.3 to 10.6). After the third to fifth procedures, the stricture-free rate was 0%. There was no significant difference in the stricture-free rate between single and multiple procedures. Conclusion. The long-term stricture-free rate of visual internal urethrotomy is modest even after a single procedure. PMID:26494995

  2. The incidence, causes, mechanism, risk factors, classification, and diagnosis of pelvic fracture urethral injury

    PubMed Central

    Alwaal, Amjad; Zaid, Uwais B.; Blaschko, Sarah D.; Harris, Catherine R.; Gaither, Thomas W.; McAninch, Jack W.; Breyer, Benjamin N.

    2014-01-01

    Background Pelvic fracture urethral injury (PFUI) is an uncommon but potentially devastating result of pelvic fracture. It ranges in severity based on the cause and the mechanism of injury. Methods We reviewed previous reports to identify the incidence, causes, mechanisms of injury and risk factors of PFUI. In addition, we reviewed the current classification systems and diagnostic methods that have been described to assess the severity of PFUI, to identify optimal management strategies and evaluate outcomes. Results PFUI occurs more commonly in men, but is more likely to be severe in children. The most common cause is motor vehicle collisions, and the mechanism is typically a ligament rupture at the attachment to the urethra. There is no reliable classification system to differentiate partial and complete PFUI. Retrograde urethrography is the standard imaging method but it has its limitations. Conclusions Despite many reports describing this injury, there is still a need to further clarify the incidence, aetiology and mechanism of injury to better determine optimal management strategies and evaluate outcomes. Consensus in the diagnosis of PFUI is lacking, and outcomes of primary realignment and the role of flexible cystoscopy as a diagnostic method are still to be determined. PMID:26019970

  3. Clinical Trials of a Urethral Dose Measurement System in Brachytherapy Using Scintillation Detectors

    SciTech Connect

    Suchowerska, Natalka; Jackson, Michael; Lambert, Jamil; Yin, Yong Bai; Hruby, George; McKenzie, David R.

    2011-02-01

    Purpose: To report on the clinical feasibility of a novel scintillation detector system with fiberoptic readout that measures the urethral dose during high-dose-rate brachytherapy treatment of the prostate. Methods and Materials: The clinical trial enrolled 24 patients receiving high-dose-rate brachytherapy treatment to the prostate. After the first 14 patients, three improvements were made to the dosimeter system design to improve clinical reliability: a dosimeter self-checking facility; a radiopaque marker to determine the position of the dosimeter, and a more robust optical extension fiber. Results: Improvements to the system design allowed for accurate dose measurements to be made in vivo. A maximum measured dose departure of 9% from the calculated dose was observed after dosimeter design improvements. Conclusions: Departures of the measured from the calculated dose, after improvements to the dosimetry system, arise primarily from small changes in patient anatomy. Therefore, we recommend that patient response be correlated with the measured in vivo dose rather than with the calculated dose.

  4. Arthroscopic Findings After Traumatic Shoulder Instability in Patients Older Than 35 Years

    PubMed Central

    Robinson, Elisabeth C.; Thangamani, Vijay B.; Kuhn, Michael A.; Ross, Glen

    2015-01-01

    Background: Shoulder instability in the older patient traditionally has received less attention in the literature than in the younger patient population. However, when traumatic dislocation does occur, these patients often still have frequent pain, disability, and even continued instability. Purpose: To characterize the pathoanatomy of traumatic anterior shoulder instability in the older patient population and to discuss the correlating symptoms that ultimately led to operative treatment. Study Design: Case series; Level of evidence, 4. Methods: Patients with a history of an initial traumatic anterior shoulder instability event occurring after the age of 35 years who underwent arthroscopic surgical intervention were prospectively enrolled. Exclusion criteria included posterior instability, major fractures of the shoulder girdle, and multidirectional instability. All patients initially underwent a period of nonoperative rehabilitation. Operative treatment was performed if a patient continued to have pain and/or instability. Operative reports and arthroscopic pictures were reviewed for pathoanatomical findings. Results: A total of 27 patients (28 shoulders) met the inclusion criteria and were analyzed in this study (22 men and 5 women; mean age, 55 years; age range, 35-74 years). Surgical intervention was performed for recurrent instability in 7 patients, pain for 8 patients, and pain with instability for 13 patients. Arthroscopic findings demonstrated 18 rotator cuff tears (RCTs) (64.3%) and 18 Bankart lesions (64.3%). Nine patients had both an RCT combined with a Bankart lesion (32.1%). Three humeral avulsion of the glenohumeral ligament (HAGL) lesions (10.7%) and 2 anterior labral periosteal sleeve avulsion (ALPSA) lesions (7.1%) were found. All shoulders demonstrated Hill-Sachs lesions of various size and depth. Conclusion: Traumatic shoulder instability in the older patient may result in a wide array of pathologic findings as well as a diversity of clinical presentations. These findings suggest that the clinical diagnostician should maintain a high index of suspicion for RCT, Bankart lesions, and HAGL lesions in older patients who remain symptomatic after traumatic anterior shoulder instability.

  5. The Spectrum of Disease in Chronic Traumatic Encephalopathy

    ERIC Educational Resources Information Center

    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.

    2013-01-01

    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

  6. The Spectrum of Disease in Chronic Traumatic Encephalopathy

    ERIC Educational Resources Information Center

    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.

    2013-01-01

    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…

  7. Posterior cruciate-retaining versus posterior-stabilized total knee arthroplasty: a meta-analysis.

    PubMed

    Bercik, Michael J; Joshi, Ashish; Parvizi, Javad

    2013-03-01

    The objective of this meta-analysis was to compare outcomes of posterior cruciate-retaining and posterior stabilized prostheses. A computerized literature search was conducted to identify randomized controlled trials comparing the clinical outcomes of cruciate-retaining and posterior-stabilized designs. The table of contents of four major Orthopaedic journals and the references section of two arthroplasty text books were reviewed to identify other relevant studies. Ultimately, 1114 patients (1265 knees) were compared. Statistical analysis revealed a significant difference in flexion and range of motion in favor of posterior-stabilized knees, but no difference in complication rates. The clinical importance of this remains unknown. The decision to use one design versus the other should rest with the surgeon's preference and comfort with a particular design. PMID:23433255

  8. Hypertensive posterior reversible encephalopathy syndrome causing posterior fossa edema and hydrocephalus.

    PubMed

    Grossbach, Andrew J; Abel, Taylor J; Hodis, Brendan; Wassef, Shafik N; Greenlee, Jeremy D W

    2014-02-01

    Posterior reversible encephalopathy syndrome (PRES) is a well characterized entity resulting from the inability of cerebral autoregulation to adequately protect the brain from uncontrolled hypertension. It primarily affects the occipital lobes, but can also involve the structures in the posterior fossa including the brainstem and cerebellum. Treatment usually consists of strict blood pressure control, but more aggressive management may be indicated with acutely worsening neurological status. We present a patient with hypertensive encephalopathy that resulted in hydrocephalus and brainstem compression necessitating surgical decompression requiring ventriculostomy and suboccipital craniectomy. In rare cases, PRES can present with severe brainstem compression requiring emergent posterior fossa decompression. When brainstem signs are present on exam, emergent posterior fossa decompression may be safer than ventriculostomy alone. PMID:24126039

  9. An Unusual Cause of Posterior Elbow Impingement: Detachment of a Hypertrophied Posterior Fat Pad

    PubMed Central

    Hamada, Daisuke; Matsuura, Tetsuya; Sugiura, Kosuke; Higuchi, Tadahiro; Suzue, Naoto; Goto, Tomohiro; Tsutsui, Takahiko; Wada, Keizo; Fukuta, Shoji; Sairyo, Koichi

    2015-01-01

    We report a case of a 47-year-old woman who developed posterior impingement of the elbow due to detachment of a hypertrophied posterior fat pad. She reported acute left elbow pain after leaning back onto a hard object with her hand and subsequently experienced a catching sensation. Comparison with the magnetic resonance images of a normal elbow revealed a hypertrophied posterior fat pad interposed between the olecranon and olecranon fossa in both elbows, with the fat pad in the left elbow located more inferiorly than that in the right elbow. Elbow arthroscopy showed the olecranon fossa covered by the fat pad, a portion of which was detached from the rest of the pad. Debridement of the detached portion was performed until no impingement was evident. Postoperatively, full extension of the elbow did not elicit pain. Clinicians should include this pathology among the differential diagnoses for posterior elbow pain. PMID:26613057

  10. Effect of clenching on biomechanical response of human mandible and temporomandibular joint to traumatic force analyzed by finite element method

    PubMed Central

    Yamamoto, Kazuhiko; Sugiura, Tsutomu; Kawakami, Masayoshi; Kang, Yu B.; Tsutsumi, Sadami; Kirita, Tadaaki

    2013-01-01

    Purpose: The purpose of the present study was to analyze the effect of clenching on the biomechanical response of human mandible and temporomandibular joint (TMJ) to traumatic force by the finite element (FE) method. Material and Methods: FE models of the mandible and the TMJ in resting and clenching positions were prepared. Distribution and magnitude of von Mises stress were analyzed by applying force as a point load in the symphyseal, canine, body and angle regions of the mandible. In addition, strain energy density (SED) at the articular disc and in posterior connective tissue of TMJ was analyzed. Results: In the resting position, von Mises stress was mainly concentrated at the condylar neck and in the retromolar region of the mandible. In the clenching position, the stress at the condylar neck decreased in all loadings. The stress in the retromolar region similary decreased in the symphyseal, canine and body loading, respectively; however, higher stress was observed in the retromolar region on the loading side in the angle loading. High SED was generated at the articular disc and in posterior connective tissues of TMJ in the resting position. The SED in these tissues decreased in all loadings in the clenching position. Conclusions: Clenching generally reduces stress at the condylar neck and in the retromolar region of the mandible, and strain energy at the articular disc and in posterior connective tissue of TMJ by traumatic forces on the mandible; however, clenching induces greater stress in the retromolar region on the loading side by traumatic force to the angle region. Key words:Mandibular, temporomandibular joint, traumatic force, clenching, finite element analysis. PMID:23524422

  11. Posterior Pole Sparing Laser Photocoagulation Combined with Intravitreal Bevacizumab Injection in Posterior Retinopathy of Prematurity

    PubMed Central

    Kim, Rebecca; Kim, Yu Cheol

    2014-01-01

    Purpose. To report the results of the posterior pole sparing laser photocoagulation combined with intravitreal bevacizumab injection (IVB) in retinopathy of prematurity (ROP). Methods. A retrospective chart review of premature babies with ROP, all of whom received laser photocoagulation with IVB. Eleven eyes of 6 infants with advanced zone I ROP underwent laser ablation sparing posterior pole with concurrent IVB. The results were compared with those of full-laser treatment combined with IVB to 8 eyes of 5 infants with advanced ROP without involvement of the posterior pole. Results. The posterior pole sparing laser with IVB was performed with zone I, stage 3+ ROP at the mean postmenstrual age of 36 weeks and 5 days. The plus sign decreased significantly at postoperative day 1, the neovascular proliferation regressed by postoperative week 1, and the normal vascularization started at postoperative day 32 on the average. Two months after treatment, vascularization of the spared avascular area was completed. There was no macular dragging, tractional retinal detachment, foveal destruction by laser scars, or any other adverse event. No significant anatomical differences were identified from those of full-laser ablation combined with IVB. Conclusions. Posterior pole sparing laser with IVB can give favorable results without destruction of posterior pole retina. PMID:25614828

  12. Posterior Wnts Have Distinct Roles in Specification and Patterning of the Planarian Posterior Region

    PubMed Central

    Sureda-Gómez, Miquel; Pascual-Carreras, Eudald; Adell, Teresa

    2015-01-01

    The wnt signaling pathway is an intercellular communication mechanism essential in cell-fate specification, tissue patterning and regional-identity specification. A βcatenin-dependent signal specifies the AP (Anteroposterior) axis of planarians, both during regeneration of new tissues and during normal homeostasis. Accordingly, four wnts (posterior wnts) are expressed in a nested manner in central and posterior regions of planarians. We have analyzed the specific role of each posterior wnt and the possible cooperation between them in specifying and patterning planarian central and posterior regions. We show that each posterior wnt exerts a distinct role during re-specification and maintenance of the central and posterior planarian regions, and that the integration of the different wnt signals (βcatenin dependent and independent) underlies the patterning of the AP axis from the central region to the tip of the tail. Based on these findings and data from the literature, we propose a model for patterning the planarian AP axis. PMID:26556349

  13. Arthroscopic approach to the posterior compartment of the knee using a posterior transseptal portal

    PubMed Central

    Ohishi, Tsuyoshi; Takahashi, Masaaki; Suzuki, Daisuke; Matsuyama, Yukihiro

    2015-01-01

    Arthroscopic surgery of the posterior compartment of the knee is difficult when only two anterior portals are used for access because of the inaccessibility of the back of the knee. Since its introduction, the posterior transseptal portal has been widely employed to access lesions in the posterior compartment. However, special care should be taken to avoid neurovascular injuries around the posteromedial, posterolateral, and transseptal portals. Most importantly, popliteal vessel injury should be avoided when creating and using the transseptal portal during surgery. Purpose of the present study is to describe how to avoid the neurovascular injuries during establishing the posterior three portals and to introduce our safer technique to create the transseptal portal. To date, we have performed arthroscopic surgeries via the transseptal portal in the posterior compartments of 161 knees and have not encountered nerve or vascular injury. In our procedure, the posterior septum is perforated with a 1.5-3.0-mm Kirschner wire that is protected by a sheath inserted from the posterolateral portal and monitored from the posteromedial portal to avoid popliteal vessel injury. PMID:26301179

  14. A Cadaveric Study of Bilateral Configuration of Posterior Bifurcation of Posterior Communicating Artery in Indian Population

    PubMed Central

    Saha, Anubha; Mandal, Shyamash

    2015-01-01

    Introduction: Various studies have been done regarding variations of circle of Willis, but few literatures are available about the detail configurations on Indian population. Posterior communicating artery is the main collateral channel between the vertebrobasilar and carotid system. It may act as a main source of blood flow via posterior cerebral artery if fetal configuration is present. Aim of the study is to see the bilateral configurations to compare the blood supply of both cerebral hemispheres via posterior cerebral artery in human cadavers. Materials and Methods: Fifty six formalin fixed brains were used for study. The specimens were classified into 3 types and 21 subtypes according to the configuration of the vessel of both hemispheres. As hemodynamic balance is dependent on the calibre of the vessel, the diameter of the arteries were also taken into consideration. Pearsons correlation had been done. Result: In present study type I is 57.2%, type II is 37.5% and type III is 5.4%. Incidence of unilateral fetal type posterior cerebral artery is in high percentage (33.9%). Greatest diameter of posterior communicating artery is 3.8mm on right and 3.6mm on left side. Significant correlations also have been found between arterial segments of different types. Conclusion: It is expected that the study will help to enrich the knowledge about the arterial predominance of origin of posterior cerebral artery of both cerebral hemispheres in normal or variant cases and its effect on perfusion images. PMID:25954608

  15. Posterior Wnts Have Distinct Roles in Specification and Patterning of the Planarian Posterior Region.

    PubMed

    Sureda-Gómez, Miquel; Pascual-Carreras, Eudald; Adell, Teresa

    2015-01-01

    The wnt signaling pathway is an intercellular communication mechanism essential in cell-fate specification, tissue patterning and regional-identity specification. A βcatenin-dependent signal specifies the AP (Anteroposterior) axis of planarians, both during regeneration of new tissues and during normal homeostasis. Accordingly, four wnts (posterior wnts) are expressed in a nested manner in central and posterior regions of planarians. We have analyzed the specific role of each posterior wnt and the possible cooperation between them in specifying and patterning planarian central and posterior regions. We show that each posterior wnt exerts a distinct role during re-specification and maintenance of the central and posterior planarian regions, and that the integration of the different wnt signals (βcatenin dependent and independent) underlies the patterning of the AP axis from the central region to the tip of the tail. Based on these findings and data from the literature, we propose a model for patterning the planarian AP axis. PMID:26556349

  16. Arthroscopic Reconstruction of Chronic Isolated Posterior Cruciate Ligament Instability in a Professional Dancer

    PubMed Central

    Aksu, Neslihan; Abay, Burak; Soydan, Ramazan; Ercan, Ertu?rul

    2014-01-01

    Objectives: Chronic isolated injuries of the posterior cruciate ligament (PCL) are very rare in the literature. PCL injuries are often presented undiagnosed because of the weak signs of the injury compared to the anterior cruciate ligament (ACL) injuries. We report the surgical outcome of arthroscopic reconstruction of the chronic isolated PCL rupture with ipsilateral autologous hamstring tendon in a professional Caucasian dancer. Methods: A 21-year-old male professional Caucasian dancer presented severe instability without any pain in his right knee lasting for one year. The patient did not describe any specific traumatic event but his both knees received repeatitive direct pretibial trauma during hyperflexion of the knee while landing to the floor. At the physical examination, posterior sagging of the tibia was observed on the affected side at 90o of knee flexion and step off test and posterior drawer test were positive preoperatively under general anesthesia. The Tegner Lysholm score was evaluated as 59 (poor). A magnetic resonance image (MRI) revealed the isolated total rupture of PCL. The treatment of choice was arthroscopic single bundle reconstruction of PCL with ipsilateral autologous hamstring tendon. A standard arthroscopic exploration of the joint was performed preoperatively and we didn't observe any meniscal, cartilage or ligamentous lesion. Anteromedial and anterolateral portals were made in order to visualize the posterior cortex of the tibia with a 70 degree scope. Intra-operative fluroscopy was used to confirm proper tunnel position. During postoperatively first week, the patient was allowed to mobilize nonweight bearing with the use of two crutches without functional knee brace. Quadriceps musculature and passive range of motion was trained. Results: At the 6 month- follow-up, the patient achieved full symmetric restoration of motion. He had returned to full daily activies. The Tegner Lysholm score was evaluated as 95 (excellent) postoperatively. Functional examination of the right knee reveled 140 of flexion, and full knee extension. No posterior sagging was observed and step off test and posterior drawer test was negative. The complaint of instability was disappeared. At 1-year follow-up, clinical findings were unremarkable, with no sign of re-rupture and he returned to his professional career. Conclusion: Surgical reconstruction technique of the PCL and associated rehabilitation protocols has not yet been fully standardized and much work still has be done optimizing correct treatment of PCL injuries. The arthroscopic reconstruction of chronic isolated PCL instability is a very difficult technique as well as its diagnosis. The reconstruction is very beneficial in the athletes and the patients who are not responding well to the conservative treatment.

  17. Medical interventions for traumatic hyphema

    PubMed Central

    Gharaibeh, Almutez; Savage, Howard I; Scherer, Roberta W; Goldberg, Morton F; Lindsley, Kristina

    2014-01-01

    Background Traumatic hyphema is the entry of blood into the anterior chamber (the space between the cornea and iris) subsequent to a blow or a projectile striking the eye. Hyphema uncommonly causes permanent loss of vision. Associated trauma (e.g. corneal staining, traumatic cataract, angle recession glaucoma, optic atrophy, etc.) may seriously affect vision. Such complications may lead to permanent impairment of vision. Patients with sickle cell trait/disease may be particularly susceptible to increases of elevated intraocular pressure. If rebleeding occurs, the rates and severity of complications increase. Objectives To assess the effectiveness of various medical interventions in the management of traumatic hyphema. Search methods We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (The Cochrane Library 2013, Issue 8), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMED-LINE (January 1946 to August 2013), EMBASE (January 1980 to August 2013), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com), ClinicalTrials.gov (www.clinicaltrials.gov) and the WHO International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 30 August 2013. Selection criteria Two authors independently assessed the titles and abstracts of all reports identified by the electronic and manual searches. In this review, we included randomized and quasi-randomized trials that compared various medical interventions versus other medical interventions or control groups for the treatment of traumatic hyphema following closed globe trauma. We applied no restrictions regarding age, gender, severity of the closed globe trauma, or level of visual acuity at the time of enrolment. Data collection and analysis Two authors independently extracted the data for the primary and secondary outcomes. We entered and analyzed data using Review Manager 5. We performed meta-analyses using a fixed-effect model and reported dichotomous outcomes as odds ratios and continuous outcomes as mean differences. Main results We included 20 randomized and seven quasi-randomized studies with 2643 participants in this review. Interventions included antifibrinolytic agents (oral and systemic aminocaproic acid, tranexamic acid, and aminomethylbenzoic acid), corticosteroids (systemic and topical), cycloplegics, miotics, aspirin, conjugated estrogens, traditional Chinese medicine, monocular versus bilateral patching, elevation of the head, and bed rest. No intervention had a significant effect on visual acuity whether measured at two weeks or less after the trauma or at longer time periods. The number of days for the primary hyphema to resolve appeared to be longer with the use of aminocaproic acid compared with no use, but was not altered by any other intervention. Systemic aminocaproic acid reduced the rate of recurrent hemorrhage (odds ratio (OR) 0.25, 95% confidence interval (CI) 0.11 to 0.57), but a sensitivity analysis omitting studies not using an intention-to-treat (ITT) analysis reduced the strength of the evidence (OR 0.41, 95% CI 0.16 to 1.09). We obtained similar results for topical aminocaproic acid (OR 0.42, 95% CI 0.16 to 1.10). We found tranexamic acid had a significant effect in reducing the rate of secondary hemorrhage (OR 0.25, 95% CI 0.13 to 0.49), as did aminomethylbenzoic acid as reported in one study (OR 0.07, 95% CI 0.01 to 0.32). The evidence to support an associated reduction in the risk of complications from secondary hemorrhage (i.e. corneal blood staining, peripheral anterior synechiae, elevated intraocular pressure, and development of optic atrophy) by antifibrinolytics was limited by the small number of these events. Use of aminocaproic acid was associated with increased nausea, vomiting, and other adverse events compared with placebo. We found no difference in the number of adverse events with the use of systemic versus topical aminocaproic acid or with standard versus lower drug dose. The available evidence on usage of corticosteroids, cycloplegics, or aspirin in traumatic hyphema was limited due to the small numbers of participants and events in the trials. We found no difference in effect between a single versus binocular patch or ambulation versus complete bed rest on the risk of secondary hemorrhage or time to rebleed. Authors’ conclusions Traumatic hyphema in the absence of other intraocular injuries uncommonly leads to permanent loss of vision. Complications resulting from secondary hemorrhage could lead to permanent impairment of vision, especially in patients with sickle cell trait/disease. We found no evidence to show an effect on visual acuity by any of the interventions evaluated in this review. Although evidence was limited, it appears that patients with traumatic hyphema who receive aminocaproic acid or tranexamic acid are less likely to experience secondary hemorrhaging. However, hyphema in patients treated with aminocaproic acid take longer to clear. Other than the possible benefits of antifibrinolytic usage to reduce the rate of secondary hemorrhage, the decision to use corticosteroids, cycloplegics, or nondrug interventions (such as binocular patching, bed rest, or head elevation) should remain individualized because no solid scientific evidence supports a benefit. As these multiple interventions are rarely used in isolation, further research to assess the additive effect of these interventions might be of value. PMID:24302299

  18. Assessing Traumatic Event Exposure: Comparing the Traumatic Life Events Questionnaire to the Structured Clinical Interview for "DSM-IV"

    ERIC Educational Resources Information Center

    Peirce, Jessica M.; Burke, Christopher K.; Stoller, Kenneth B.; Neufeld, Karin J.; Brooner, Robert K.

    2009-01-01

    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

  19. Photodynamic therapy for posterior capsule neovascularization.

    PubMed

    Ayata, Ali; Unal, Melih; Er?anli, Dilaver; Glecek, O?uz; Snmez, Murat

    2007-06-01

    We report a 71-year-old man with posterior capsule opacification with severe neovascularization who was treated with photodynamic therapy and neodymium:YAG capsulotomy. Treatment was performed using a diode laser at 692 nm, a light dose of 50 J/cm(2), and 6 mg/m(2) body surface area verteporfin. The initial visual acuity was hand motions; 6 months after therapy, the visual acuity was stable at 20/200. In 9 months of follow-up, there was no recurrence of neovascularization and the pupil area remained clear; no retreatment was needed. Photodynamic therapy provided safe and effective occlusion of neovascular vessels in the posterior capsule area. PMID:17531717

  20. Autonomic dysreflexia and posterior reversible encephalopathy syndrome.

    PubMed

    Matias, Ana Catarina; Rocha, Joo; Cerqueira, Maria Emlia; Pereira, Joo Manuel

    2013-05-01

    Autonomic dysreflexia is a syndrome of massive imbalanced reflex sympathetic discharge in patients who had a spinal cord injury above the splanchnic sympathetic outflow resulting in a sudden increase in blood pressure. Posterior reversible encephalopathy syndrome (PRES) refers to a clinicoradiologic entity characterized by headache, consciousness impairment, visual disturbances, seizures, and posterior transient changes on neuroimaging (cerebral vasogenic edema). Hypertension is a common cause of PRES. The authors describe two case reports of patients with tetraplegia who developed PRES after an autonomic dysreflexia episode. One of them had recurrence of PRES in a similar clinical context. The authors discuss further aspects of PRES and its recurrence, which seems to be unusual particularly after autonomic dysreflexia. PMID:23117272

  1. Posterior fossa lesions: magnetic resonance imaging

    SciTech Connect

    Lee, B.C.P.; Kneeland, J.B.; Deck, M.D.F.; Cahill, P.T.

    1984-10-01

    Studies of 40 patients with abnormalities of the posterior fossa shown on magnetic resonance (MR) imaging were reviewed and compared with CT scans. Thirteen lesions were demonstrated on MR only. Twenty-four lesions were shown on CT but MR provided more data. Three lesions were better shown on CT than on MR. MR is superior to CT because of the lack of streak artifacts and better contrast discrimination. At least two imaging sequences are required for evaluation of the lesions.

  2. A posterior tibial tendon skipping rope.

    PubMed

    van Sterkenburg, M N; Haverkamp, D; van Dijk, C N; Kerkhoffs, G M M J

    2010-12-01

    This report presents an athletic patient with swelling and progressive pain on the posteromedial side of his right ankle on weight bearing. MRI demonstrated tenosynovitis and suspicion of a length rupture. On posterior tibial tendoscopy, there was no rupture, but medial from the tendon a tissue cord came into view, causing impingement on the tendon at the level of maximum pain. The cord was released and 2 weeks and 1 year after the procedure the patient reported no complaints. PMID:20556356

  3. Material Properties of the Posterior Human Sclera?

    PubMed Central

    Grytz, Rafael; Fazio, Massimo A.; Girard, Michael J.A.; Libertiaux, Vincent; Bruno, Luigi; Gardiner, Stuart; Girkin, Christopher A.; Downs, J. Crawford

    2013-01-01

    To characterize the material properties of posterior and peripapillary sclera from human donors, and to investigate the macro- and micro-scale strains as potential control mechanisms governing mechanical homeostasis. Posterior scleral shells from 9 human donors aged 5790 years were subjected to IOP elevations from 5 to 45 mmHg and the resulting full-field displacements were recorded using laser speckle interferometry. Eye-specific finite element models were generated based on experimentally measured scleral shell surface geometry and thickness. Inverse numerical analyses were performed to identify material parameters for each eye by matching experimental deformation measurements to model predictions using a microstructure-based constitutive formulation that incorporates the crimp response and anisotropic architecture of scleral collagen fibrils. The material property fitting produced models that fit both the overall and local deformation responses of posterior scleral shells very well. The nonlinear stiffening of the sclera with increasing IOP was well reproduced by the uncrimping of scleral collagen fibrils, and a circumferentially-aligned ring of collagen fibrils around the scleral canal was predicted in all eyes. Macroscopic in-plane strains were significantly higher in peripapillary region then in the mid-periphery. In contrast, the meso- and micro-scale strains at the collagen network and collagen fibril level were not significantly different between regions. The elastic response of the posterior human sclera can be characterized by the anisotropic architecture and crimp response of scleral collagen fibrils. The similar collagen fibril strains in the peripapillary and mid-peripheral regions support the notion that the scleral collagen architecture including the circumpapillary ring of collagen fibrils evolved to establish optimal load bearing conditions at the collagen fibril level. PMID:23684352

  4. Posterior cruciate ligament tears in wrestlers.

    PubMed

    Stanish, W D; Rubinovich, M; Armason, T; Lapenskie, G

    1986-12-01

    Two cases of isolated injury to the posterior cruciate ligament of the knee are presented. These injuries both occurred in elite wrestlers, members of the Canadian Pan American Team. The mechanism of injury was identical in both cases--the ligament rupture being a result of forced flexion with combined internal rotation of the tibia on femur. A review of the literature is added with a suggestion for conservative treatment as the initial and perhaps definitive management for this problem. PMID:3815708

  5. Late Manifestations of Traumatic Lesions of the Anterior Skull Base

    PubMed Central

    Schick, B.; Weber, R.; Kahle, G.; Draf, W.; Lackmann, G.M.

    1997-01-01

    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. PMID:17170993

  6. Posterior mini-incision hamstring harvest.

    PubMed

    Prodromos, Chadwick C

    2010-03-01

    Many orthopedists looking for alternatives to autograft bone-patellar-tendon-bone grafts are uncertain of their ability to harvest a hamstring graft of adequate length. They may use an allograft instead for this reason despite recent reports of high failure rates. This article presents step-by-step instructions for a posterior mini-incision hamstring harvest that offers a safe and simple method of reliably harvesting sufficient hamstring for 4 or 6 strand repair, while using tiny incisions for excellent cosmesis and minimal pain. Access from the posterior mini-incision allows easy identification and differentiation of the semitendinosus and gracilis (Gr) tendons, as well as precise placement of the anterior mini-incision for tibial tunnel drilling and fixation. Most importantly sectioning of the intertendinous cross-connections is performed under easy direct vision posteriorly, instead of at a distance from the typical anterior incision under retractors. This prevents the tendons from being cut too short by the tendon stripper and is particularly useful in large patients. In addition to the surgical procedure, details on the required equipment are presented. PMID:20160624

  7. Posterior capsular contracture of the shoulder.

    PubMed

    Bach, H Gregory; Goldberg, Benjamin A

    2006-05-01

    Posterior capsular contracture is a common cause of shoulder pain in which the patient presents with restricted internal rotation and reproduction of pain. Increased anterosuperior translation of the humeral head occurs with forward flexion and can mimic the pain reported with impingement syndrome; however, the patient with impingement syndrome presents with normal range of motion. Initial management of posterior capsular contracture should be nonsurgical, emphasizing range-of-motion stretching with the goal of restoring normal motion. For patients who fail nonsurgical management, arthroscopic posterior capsule release can result in improved motion and pain relief. In the throwing athlete, repetitive forces on the posteroinferior capsule may cause posteroinferior capsular hypertrophy and limited internal rotation. This may be the initial pathologic event in the so-called dead arm syndrome, leading to a superior labrum anteroposterior lesion and, possibly, rotator cuff tear. Management involves regaining internal rotation such that the loss of internal rotation is not greater than the increase in external rotation. In the athlete who fails nonsurgical management, a selective posteroinferior capsulotomy can improve motion, reduce pain, and prevent further shoulder injury. PMID:16675620

  8. Pathology of traumatic brain injury.

    PubMed

    Finnie, John W

    2014-12-01

    Although traumatic brain injury (TBI) is frequently encountered in veterinary practice in companion animals, livestock and horses, inflicted head injury is a common method of euthanasia in domestic livestock, and malicious head trauma can lead to forensic investigation, the pathology of TBI has generally received little attention in the veterinary literature. This review highlights the pathology and pathogenesis of cerebral lesions produced by blunt, non-missile and penetrating, missile head injuries as an aid to the more accurate diagnosis of neurotrauma cases. If more cases of TBI in animals that result in fatality or euthanasia are subjected to rigorous neuropathological examination, this will lead to a better understanding of the nature and development of brain lesions in these species, rather than extrapolating data from human studies. PMID:25178417

  9. Why traumatized borderline patients relapse.

    PubMed

    Appelbaum, A H

    1996-01-01

    To be freed of longstanding painful symptoms or to become capable of functioning effectively has unconscious and sometimes conscious negative connotations for patients severely traumatized by childhood sexual abuse. These include rising expectations felt as coming both from within and without; disappointment that life can never make up for what has happened; loss of a justification for receiving care; fear that getting well invalidates the original trauma. Giving up illness may mean renouncing revenge and denying the seriousness of the childhood misery. To the extent that the torment of flashbacks and nightmares represents a continuation of the only family relationships the patient has known, losing these symptoms can feel as if being left entirely alone. The destructive impact of embittered and paranoid reactions unleashed by the experience of change for the better can be mitigated by the therapist's recognition of, and the focus upon, the negative meanings of progress toward health. PMID:9009374

  10. Suicide and Chronic Traumatic Encephalopathy.

    PubMed

    Iverson, Grant L

    2016-01-01

    For nearly 80 years, suicidality was not considered to be a core clinical feature of chronic traumatic encephalopathy (CTE). In recent years, suicide has been widely cited as being associated with CTE, and now depression has been proposed to be one of three core diagnostic features alongside cognitive impairment and anger control problems. This evolution of the clinical features has been reinforced by thousands of media stories reporting a connection between mental health problems in former athletes and military veterans, repetitive neurotrauma, and CTE. At present, the science underlying the causal assumption between repetitive neurotrauma, depression, suicide, and the neuropathology believed to be unique to CTE is inconclusive. Epidemiological evidence indicates that former National Football League players, for example, are at lower, not greater, risk for suicide than men in the general population. This article aims to discuss the critical issues and literature relating to these possible relationships. PMID:26449269

  11. Concussion in Chronic Traumatic Encephalopathy.

    PubMed

    Stein, Thor D; Alvarez, Victor E; McKee, Ann C

    2015-10-01

    Chronic traumatic encephalopathy (CTE) is a progressive neurodegenerative disease that occurs in association with repetitive mild traumatic brain injury. It is associated with a variety of clinical symptoms in multiple domains, and there is a distinct pattern of pathological changes. The abnormal tau pathology in CTE occurs uniquely in those regions of the brain that are likely most susceptible to stress concentration during trauma. CTE has been associated with a variety of types of repetitive head trauma, most frequently contact sports. In cases published to date, the mean length of exposure to repetitive head trauma was 15.4 years. The clinical symptoms of the disease began after a mean latency of 14.5 years with a mean age of death of 59.3 years. Most subjects had a reported history of concussions with a mean of 20.3. However, 16 % of published CTE subjects did not have a history of concussion suggesting that subconcussive hits are sufficient to lead to the development of CTE. Overall, the number of years of exposure, not the number of concussions, was significantly associated with worse tau pathology in CTE. This suggests that it is the chronic and repetitive nature of head trauma, irrespective of concussive symptoms, that is the most important driver of disease. CTE and exposure to repetitive head trauma is also associated with a variety of other neurodegenerations, including Alzheimer disease. In fact, amyloid ? peptide deposition is altered and accelerated in CTE and is associated with worse disease. Here, we review the current exposure, clinical, and pathological associations of CTE. PMID:26260277

  12. Concussion in Chronic Traumatic Encephalopathy

    PubMed Central

    Stein, Thor D.; Alvarez, Victor E.; McKee, Ann C.

    2015-01-01

    Chronic traumatic encephalopathy (CTE) is a progressive neurodegenerative disease that occurs in association with repetitive mild traumatic brain injury. It is associated with a variety of clinical symptoms in multiple domains, and there is a distinct pattern of pathological changes. The abnormal tau pathology in CTE occurs uniquely in those regions of the brain that are likely most susceptible to stress concentration during trauma. CTE has been associated with a variety of types of repetitive head trauma, most frequently contact sports. In cases published to date, the mean length of exposure to repetitive head trauma was 15.4 years. The clinical symptoms of the disease began after a mean latency of 14.5 years with a mean age of death of 59.3 years. Most subjects had a reported history of concussions with a mean of 20.3. However, 16 % of published CTE subjects did not have a history of concussion suggesting that subconcussive hits are sufficient to lead to the development of CTE. Overall, the number of years of exposure, not the number of concussions, was significantly associated with worse tau pathology in CTE. This suggests that it is the chronic and repetitive nature of head trauma, irrespective of concussive symptoms, that is the most important driver of disease. CTE and exposure to repetitive head trauma is also associated with a variety of other neurodegenerations, including Alzheimer disease. In fact, amyloid β peptide deposition is altered and accelerated in CTE and is associated with worse disease. Here, we review the current exposure, clinical, and pathological associations of CTE. PMID:26260277

  13. Electrocardiographic diagnosis of remote posterior wall myocardial infarction using unipolar posterior lead V9

    SciTech Connect

    Rich, M.W.; Imburgia, M.; King, T.R.; Fischer, K.C.; Kovach, K.L. )

    1989-09-01

    The accuracy of four electrocardiographic criteria for diagnosing remote posterior myocardial infarction was assessed prospectively in 369 patients undergoing exercise treadmill testing with thallium scintigraphy. Criteria included the following: (1) R-wave width greater than or equal to 0.04 s and R-wave greater than or equal to S-wave in V1; (2) R-wave greater than or equal to S-wave in V2; (3) T-wave voltage in V2 minus V6 greater than or equal to 0.38 mV (T-wave index); (4) Q-wave greater than or equal to 0.04 s in left paraspinal lead V9. Twenty-seven patients (7.3 percent) met thallium criteria for posterior myocardial infarction, defined as a persistent perfusion defect in the posterobase of the left ventricle. Sensitivities for the four criteria ranged from 4 to 56 percent, and specificities ranged from 64 to 99 percent. Posterior paraspinal lead V9 provided the best overall predictive accuracy (94 percent), positive predictive value (58 percent), and ability to differentiate patients with and without posterior myocardial infarction of any single criterion (p less than .0001). Combining the T-wave index with lead V9 further enhanced the diagnostic yield: the sensitivity for detecting posterior infarction by at least one of these criteria was 78 percent, and when both criteria were positive, specificity was 98.5 percent. It is concluded that a single, unipolar posterior lead in the V9 position is superior to standard 12-lead electrocardiographic criteria in diagnosing remote posterior myocardial infarction, and that combining V9 with the T-wave index maximizes the diagnostic yield.

  14. Controversies in posterior composite resin restorations.

    PubMed

    Wilson, E G; Mandradjieff, M; Brindock, T

    1990-01-01

    The use of posterior composites is riddled with so many controversies that the puzzled practitioner must step warily among them. This modality is a minefield, where one careless movement can bring disaster. All composite restorations are subject to three big destructive forces--moisture, polymerization shrinkage, and clinical wear--forces that can eventually produce both microleakage and deterioration of the silane coupling agent linking filler particles to resin matrix. Despite the extreme technique sensitivity of posterior composite resins, knowledge of resin technology, sound operative dentistry principles and foresight in case selection can be effective in producing durable cosmetic restorations. Posterior composite resin restorations bonded to enamel and dentin reputedly strengthen teeth in both conventional and adhesive types of preparations provided polymerization shrinkage can be controlled. It is imperative that a knowledge of occlusal contacts be used to influence cavity outline, confining the trauma or occlusal forces away from the tooth-resin interface and helping to minimize occlusal wear. With the increased use of posterior resins, the trend in cavity preparations should break away from the traditional Black preparation toward the adhesive type preparation. If the Black Class II preparation is used, it is suggested that bevels be confined to the facial and lingual margins of the proximal box. Prewedging helps to maintain a conservative Class II preparation. Shade selection must be made prior to rubber dam isolation for greater accuracy and to help prevent postinsertion discoloration. The enamel should be pumiced to present a clean substrate for acid etching. The smear layer should be removed. The type of pulp protection applied before acid etching is dependent on the material used. After etching, the enamel should be washed with a 1 per cent potassium chloride solution. It is a more universally chemically stable solution than additive-laden local water supplies. The potassium chloride solution lowers the electrostatic forces on the enamel that would interfere with the flow of enamel bonding agents. Furthermore, tests have shown that the use of potassium chloride washes increase the strength of the enamel body by 40 per cent. Because of the depth of most posterior cavities, an incremental filling technique must be used to ensure a thorough polymerization of the resin and to forestall a massive polymerization shrinkage. When finished and contoured, the margins of the restoration should be re-etched, washed, and dried and then covered with an application of unfilled resin to discourage microleakage. Traditional operative dentistry technique must become flexible enough to meet the new demands of resin technology.(ABSTRACT TRUNCATED AT 400 WORDS) PMID:2403943

  15. Traumatic Spondylolisthesis of the Axis Vertebra in Adults

    PubMed Central

    Schleicher, Philipp; Scholz, Matti; Pingel, Andreas; Kandziora, Frank

    2015-01-01

    Study Design Narrative review. Objective To elucidate the current concepts in diagnosis and treatment of traumatic spondylolisthesis of the axis. Methods Literature review using PubMed, Google Scholar, and Cochrane databases. Results The traumatic spondylolisthesis of the axis accounts to 5% of all cervical spine injuries and is defined by a bilateral separation of the C2 vertebral body from the neural arch. The precise location of the fracture line may vary widely. For understanding the pathobiomechanics, the involvement of the C2–C3 disk is essential. Although its synonym “hangman's fracture” suggests an extension moment as primary injury mechanism, flexion moments are also proven to cause such fracture morphology. The axial force vector (distraction versus compression) is thought to have a significant effect on the neurologic involvement. The most widely accepted classifications, according to Effendi and modified by Levine, regard the displacement of the C2 vertebral body and possible locking of the facet joints. For decisions on conservative versus surgical therapy, a definitive statement about the stability is essential. The stability is determined by involvement of the C2–C3 disk and longitudinal ligaments, which frequently cannot be assessed by X-ray or computed tomography alone. The assessment of this soft tissue injury therefore requires additional imaging either by magnetic resonance imaging to display the disk and longitudinal ligaments or dynamic fluoroscopy to assess functional behavior of the C2–C3 motion segment. If stability is proven, an immobilization of the cervical spine in a semirigid cervical collar is sufficient. Unstable lesions require surgical stabilization. The standard procedure is an anterior C2–C3 diskectomy and fusion, because of the lower morbidity of the anterior approach and the motion preservation between C1 and C2. In rare cases (irreducible locked facet joints, the necessity of decompression of the vertebral artery, contraindication for anterior approach), a posterior approach is sometimes necessary. Isolated direct screw osteosynthesis is of little value, because it only makes sense in cases with an intact C2–C3 disk, which is usually regarded as stable and therefore might be treated conservatively. Conclusions Overall, the clinical evidence regarding traumatic spondylolisthesis of the axis is very low and mainly based on small case series, expert opinion, laboratory findings, and theoretical considerations. PMID:26225285

  16. Traumatic Spondylolisthesis of the Axis Vertebra in Adults.

    PubMed

    Schleicher, Philipp; Scholz, Matti; Pingel, Andreas; Kandziora, Frank

    2015-08-01

    Study Design Narrative review. Objective To elucidate the current concepts in diagnosis and treatment of traumatic spondylolisthesis of the axis. Methods Literature review using PubMed, Google Scholar, and Cochrane databases. Results The traumatic spondylolisthesis of the axis accounts to 5% of all cervical spine injuries and is defined by a bilateral separation of the C2 vertebral body from the neural arch. The precise location of the fracture line may vary widely. For understanding the pathobiomechanics, the involvement of the C2-C3 disk is essential. Although its synonym "hangman's fracture" suggests an extension moment as primary injury mechanism, flexion moments are also proven to cause such fracture morphology. The axial force vector (distraction versus compression) is thought to have a significant effect on the neurologic involvement. The most widely accepted classifications, according to Effendi and modified by Levine, regard the displacement of the C2 vertebral body and possible locking of the facet joints. For decisions on conservative versus surgical therapy, a definitive statement about the stability is essential. The stability is determined by involvement of the C2-C3 disk and longitudinal ligaments, which frequently cannot be assessed by X-ray or computed tomography alone. The assessment of this soft tissue injury therefore requires additional imaging either by magnetic resonance imaging to display the disk and longitudinal ligaments or dynamic fluoroscopy to assess functional behavior of the C2-C3 motion segment. If stability is proven, an immobilization of the cervical spine in a semirigid cervical collar is sufficient. Unstable lesions require surgical stabilization. The standard procedure is an anterior C2-C3 diskectomy and fusion, because of the lower morbidity of the anterior approach and the motion preservation between C1 and C2. In rare cases (irreducible locked facet joints, the necessity of decompression of the vertebral artery, contraindication for anterior approach), a posterior approach is sometimes necessary. Isolated direct screw osteosynthesis is of little value, because it only makes sense in cases with an intact C2-C3 disk, which is usually regarded as stable and therefore might be treated conservatively. Conclusions Overall, the clinical evidence regarding traumatic spondylolisthesis of the axis is very low and mainly based on small case series, expert opinion, laboratory findings, and theoretical considerations. PMID:26225285

  17. Vitreous occlusion of tube implant in a phakic patient with traumatic glaucoma

    PubMed Central

    Dubey, Suneeta; Pegu, Julie; Agarwal, Manisha; Agrawal, Anugya

    2014-01-01

    Tube implants or glaucoma drainage devices have become an important method of intraocular pressure reduction when treating complex cases of traumatic glaucoma. However, it is not uncommon to have complications associated with tube implants. The optimal treatment of patients who have undergone glaucoma implant surgery complicated by vitreous incarceration is uncertain. If vitreous is present or is able to prolapse into anterior chamber, as in aphakic or pseudophakic patient without an intact posterior capsule, a concurrent anterior vitrectomy is usually performed. In such cases, pars plana vitrectomy has been found to be more effective in several studies. However, there are no set guidelines for management of such a case in a phakic eye and the management can be more challenging especially when there is no obvious deficiency in posterior capsule, zonular dialysis, or loose vitreous gel in the anterior chamber prior to or during tube implantation. We describe a case of 14-year-old phakic patient with traumatic glaucoma without vitreous gel in anterior chamber whose tube implant became occluded by vitreous resulting in increased intra ocular pressure. This is the first documented report of vitreous incarceration in a phakic patient and its successful management. PMID:25378882

  18. The fate of synthetic mid-urethral slings in 2013: A turning point

    PubMed Central

    Barboglio, Paholo G.; Ann Gormley, E.

    2013-01-01

    Introduction Since the introduction of the first retropubic tension-free synthetic sling to treat stress urinary incontinence (SUI), newer approaches, different techniques and new devices have been created. Transobturator and single-incision sling (SIS) techniquespara-were developed with the goal of diminishing the rate of complications andspeeding the recovery phase. Methods For this review we searched Medline for relevant papers, with an emphasis on meta-analysis and randomised controlled trials (RCTs). Specially selected reports were identified to address both index patients (defined as those with genuine SUI and no previous anti-incontinence procedure or other genitourinary sign or symptom that might affect her SUI) and, briefly, non-index patients. Two authors independently reviewed papers for eligibility. Results Level 1 evidence from a Cochrane review and two meta-analyses indicated that subjective outcomes with the mid-urethral sling (MUS) were similar to those from colposuspension. However, the MUS was better than colposuspension when assessing objective outcomes (Level 1). MUS are equally effective as autologous pubovaginal slings (Level1). Two meta-analyses suggest that retropubic MUS (RMUS) might be better than transobturator MUS when assessing objective outcomes. Five more recent RCTs with longer term outcomes showed high success rates and only one reported a significant advantage for the RMUS in women with intrinsic sphincteric deficiency. One meta-analysis addressing the SIS showed inferior outcomes to the MUS (Level 1). New and improved SIS techniques have been used, but long-term outcomes are limited and results are still controversial when compared to the MUS. Conclusion MUS are still the standard to treat the index patient as previously stated by the American and European Associations of Urology. Currently data are lacking to define which sling and what approach works best. Complications are significantly different between sling types and are dependent on technique. PMID:26558068

  19. Urethral sphincter EMG-controlled dorsal penile/clitoral nerve stimulation to treat neurogenic detrusor overactivity

    NASA Astrophysics Data System (ADS)

    Opisso, E.; Borau, A.; Rijkhoff, N. J. M.

    2011-06-01

    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 without stimulation and was intended to confirm the NDO and DSD and to set the EMG detection threshold. The second one was with real-time EMG-controlled stimulation of DGNs. Two detection methods were analyzed to detect bladder contractions. The first method was a Kurtosis-scaled root mean square (RMS) detector and was used on-line. The second was a simple RMS detector and was used off-line. Of 12 patients included, 10 patients showed both NDO and DSD. In nine of these ten patients relevant EMG concomitant to detrusor activity was detected and stimulation could suppress at least one detrusor contraction. The second filling compared to the first one showed an increase of 84% in bladder capacity (p = 0.002) and a decrease of 106% in Pdet (p = 0.002). Nine false-positive detections occurred during the ten fillings with electrical stimulation. The mean increases of both time and Pdet between stimulation and bladder contraction onsets for method 1 were 1.8 s and 4 cmH2O and for method 2 were 0.9 s and 2 cmH2O, respectively. This study shows that EUS EMG can be used in real time to detect the onset of a bladder contraction. In combination with DGN stimulation has been shown to be feasible to suppress undesired bladder contractions and in turn to increase bladder capacity in subjects with both NDO and DSD.

  20. High-dose-rate interstitial brachytherapy for female peri-urethral cancer

    PubMed Central

    Gandhi, Ajeet Kumar; Bhatla, Neerja; Kumar, Sunesh; Rath, Goura Kisor

    2016-01-01

    Purpose Peri-urethral cancer (PUC) in females is a rare malignancy. Surgery is not usually contemplated due to associated morbidity. Radiation therapy (RT) can be employed in the form of interstitial brachytherapy (IBT) alone for early lesions, and external beam radiation therapy (EBRT) with or without IBT for advanced lesions. We report our first experience in the literature to evaluate the role of high-dose-rate (HDR) IBT in female PUC. Material and methods Between 2008 and 2013, 10 female patients with PUC (5 primary and 5 recurrent) were treated with HDR-IBT with or without EBRT at our center. Size of the lesion ranged from 1.5 cm to 5.0 cm. A 2-3 plane free-hand implant was performed using plastic catheters. The prescribed dose of HDR-IBT was 42 Gy in 14 fractions for brachytherapy alone (5 patients), and 18-21 Gy for the boost along with EBRT (5 patients). Patients were followed up regularly for assessment of disease control and toxicity. Results At a median follow up of 25 months, six patients were disease free at their last follow up. Four patients developed recurrence: 2 at inguinal nodes, 1 at local site, and 1 at both local as well as inguinal nodes. Moist desquamation was the commonest acute toxicity observed in all 5 patients treated with IBT alone, which healed within 4 weeks’ time. Overall, grade II delayed complication rate was 30%. Conclusions Though small sample size, the results of our study have shown that HDR-IBT provides good loco-regional control with acceptable toxicity for female PUC. PMID:26985196

  1. Vaginal excision of the sub-urethral sling: analysis of indications, safety and outcome

    PubMed Central

    Fabian, George; Kociszewski, Jacek; Kuszka, Andrzej; Fabian, Margarethe; Grothey, Susane; Zwierzchowska, Aneta; Majkusiak, Wojciech

    2015-01-01

    Introduction Sling techniques are the method of choice in stress urinary incontinence management, despite the high rates of complications leading sometimes to the necessity of re-operation, and the tape transection and resection are of the greatest importance. The study was aimed at analyzing the indications, technique and effects of transvaginal tape excision. Material and methods A retrospective study including 100 patients who underwent surgical removal of the sub-urethral sling in Evangelisches Krankenhaus Hagen-Haspe was conducted. The analyzed measures were: sling type, onset of symptoms, rates of particular complications, safety and outcome of the operative procedure. Results Most complications occurred in the first 2 years after surgery. The most common indications for re-operation were: overactive bladder (OAB) (64%), persistent stress urinary incontinence (SUI) (59%), pain (40%), urinary retention (40%), and erosion (29%). Some of the complications co-existed (i.e. vaginal erosion with postoperative pain, infections with urinary retention). During the procedure 1 bladder was injured and 1 patient had a hematoma. In women with OAB, 24-hour frequency decreased from 13.3 to 8.5 (p < 0.001), the mean voiding volume increased from 131.7 to 216.4 ml (p < 0.001), and nocturia increased from 3.28 to 1.19 (p < 0.001). Intensity of urgency decreased from 8.78 to 0.92 in the 10-point visual score (p < 0.001). Pain and urinary retention resolved in 39 out of 40 patients (p < 0.0001). The rate of SUI increased from 59% to 83% (p < 0.001). Conclusions Sling removal is safe and associated with a minimal rate of complications. Removing the tape causes resolution of most of the complications, but SUI recurs or worsens. PMID:26528340

  2. Use of the Memokath Urethral Stent in the management of ileal conduit stomal stenosis

    PubMed Central

    Pan, Tzong-Yang; Al-Sameraaii, Ahmad

    2015-01-01

    Intoduction Ileal conduit stomal stenosis is a difficult complication to manage. Definitive treatment usually requires refashioning or a reconstruction of the conduit. There remains a need for minimally invasive procedures that can restore function to the stoma while avoiding the risks associated with a significant surgical procedure. This case illustrates a novel approach to the management of this complication. Presentation of case An 84 year old female with muscle-invasive bladder cancer underwent cystectomy with formation of an ileal conduit urinary diversion system. Her recovery was complicated by stomal stenosis leading to recurrent urinary tract infections. The Memokath Stent 045 is a thermo-expandable nickeltitanium stent designed for treatment of urethral strictures. The stent was inserted into the stoma under direct vision without the need for general anaesthesia or intraoperative radiography. The conduit remains patent 12 months after insertion and the metal stent showed no evidence of migration, calcification, oxidation or degradation. Discussion The use of a thermo-expandable nickeltitanium stent is able to provide the patency required to treat ileal conduit stomal stenosis. In this case, insertion of the stent was a simple procedure and no adverse events or degradation of the stent was identified at 12 months after insertion. The need for a significant surgical procedure such as a refashioning or reconstruction was avoided and general anaesthesia was not required to perform the procedure. Conclusion This case report highlights the possibility of using the thermo-expandable Memokath Stent 045 as an alternative to the long-term management of ileal conduit stomal stenosis. PMID:26745318

  3. Long-term recording of external urethral sphincter EMG activity in unanesthetized, unrestrained rats

    PubMed Central

    LaPallo, Brandon K.; Wolpaw, Jonathan R.; Chen, Xiang Yang

    2014-01-01

    The external urethral sphincter muscle (EUS) plays an important role in urinary function and often contributes to urinary dysfunction. EUS study would benefit from methodology for longitudinal recording of electromyographic activity (EMG) in unanesthetized animals, but this muscle is a poor substrate for chronic intramuscular electrodes, and thus the required methodology has not been available. We describe a method for long-term recording of EUS EMG by implantation of fine wires adjacent to the EUS that are secured to the pubic bone. Wires pass subcutaneously to a skull-mounted plug and connect to the recording apparatus by a flexible cable attached to a commutator. A force transducer-mounted cup under a metabolic cage collected urine, allowing recording of EUS EMG and voided urine weight without anesthesia or restraint. Implant durability permitted EUS EMG recording during repeated (up to 3 times weekly) 24-h sessions for more than 8 wk. EMG and voiding properties were stable over weeks 2–8. The degree of EUS phasic activity (bursting) during voiding was highly variable, with an average of 25% of voids not exhibiting bursting. Electrode implantation adjacent to the EUS yielded stable EMG recordings over extended periods and eliminated the confounding effects of anesthesia, physical restraint, and the potential for dislodgment of the chronically implanted intramuscular electrodes. These results show that micturition in unanesthetized, unrestrained rats is usually, but not always, associated with EUS bursting. This methodology is applicable to studying EUS behavior during progression of gradually evolving disease and injury models and in response to therapeutic interventions. PMID:24990895

  4. Post-Traumatic Stress Disorder (PDQ)

    MedlinePLUS

    ... of post-traumatic stress anytime from diagnosis through completion of treatment and possible cancer recurrence , so screening ... the effects of a new treatment and how well it works. If a clinical trial shows that ...

  5. Animal models of external traumatic wound infections

    PubMed Central

    Dai, Tianhong; Kharkwal, Gitika B; Tanaka, Masamitsu; Huang, Ying-Ying; Bil de Arce, Vida J

    2011-01-01

    Background: Despite advances in traumatic wound care and management, infections remain a leading cause of mortality, morbidity and economic disruption in millions of wound patients around the world. Animal models have become standard tools for studying a wide array of external traumatic wound infections and testing new antimicrobial strategies. Results: Animal models of external traumatic wound infections reported by different investigators vary in animal species used, microorganism strains, the number of microorganisms applied, the size of the wounds and for burn infections, the length of time the heated object or liquid is in contact with the skin. Methods: This review covers experimental infections in animal models of surgical wounds, skin abrasions, burns, lacerations, excisional wounds and open fractures. Conclusions: As antibiotic resistance continues to increase, more new antimicrobial approaches are urgently needed. These should be tested using standard protocols for infections in external traumatic wounds in animal models. PMID:21701256

  6. Traumatic injury among females: does gender matter?

    PubMed Central

    2014-01-01

    Background Trauma remains one of the leading causes of morbidity and mortality worldwide. Generally, the incidence of traumatic injuries is disproportionately high in males. However, trauma in females is underreported. Aim To study the epidemiology and outcome of different mechanisms and types of traumatic injuries in women. Methods We conducted a traditional narrative review using PubMed, MEDLINE and EMBASE, searching for English-language publications for gender-specific trauma between January 1993 and January 2013 using key words trauma, gender, female and women. Results Among 1150 retrieved articles, 71 articles were relevant over 20 years. Although it is an important public health problem, traumatic injuries among females remain under-reported. Conclusion There is a need for further research and evaluation of the exact burden of traumatic injuries among females together with the implementation of effective community based preventive programs. PMID:25089153

  7. TRAUMATIC BRAIN INJURY SURVEILLANCE SYSTEM (TBISS)

    EPA Science Inventory

    The National Center for Injury Prevention and Control (NCIPC), Centers for Disease Control and Prevention (CDC) had developed and maintains a surveillance system to understand the magnitude and characteristics of hospitalized and fatal traumatic brain injuries in the United State...

  8. Traumatic brain injury-induced sleep disorders.

    PubMed

    Viola-Saltzman, Mari; Musleh, Camelia

    2016-01-01

    Sleep disturbances are frequently identified following traumatic brain injury, affecting 30%-70% of persons, and often occur after mild head injury. Insomnia, fatigue, and sleepiness are the most frequent sleep complaints after traumatic brain injury. Sleep apnea, narcolepsy, periodic limb movement disorder, and parasomnias may also occur after a head injury. In addition, depression, anxiety, and pain are common brain injury comorbidities with significant influence on sleep quality. Two types of traumatic brain injury that may negatively impact sleep are acceleration/deceleration injuries causing generalized brain damage and contact injuries causing focal brain damage. Polysomnography, multiple sleep latency testing, and/or actigraphy may be utilized to diagnose sleep disorders after a head injury. Depending on the disorder, treatment may include the use of medications, positive airway pressure, and/or behavioral modifications. Unfortunately, the treatment of sleep disorders associated with traumatic brain injury may not improve neuropsychological function or sleepiness. PMID:26929626

  9. Traumatic brain injury-induced sleep disorders

    PubMed Central

    Viola-Saltzman, Mari; Musleh, Camelia

    2016-01-01

    Sleep disturbances are frequently identified following traumatic brain injury, affecting 30%–70% of persons, and often occur after mild head injury. Insomnia, fatigue, and sleepiness are the most frequent sleep complaints after traumatic brain injury. Sleep apnea, narcolepsy, periodic limb movement disorder, and parasomnias may also occur after a head injury. In addition, depression, anxiety, and pain are common brain injury comorbidities with significant influence on sleep quality. Two types of traumatic brain injury that may negatively impact sleep are acceleration/deceleration injuries causing generalized brain damage and contact injuries causing focal brain damage. Polysomnography, multiple sleep latency testing, and/or actigraphy may be utilized to diagnose sleep disorders after a head injury. Depending on the disorder, treatment may include the use of medications, positive airway pressure, and/or behavioral modifications. Unfortunately, the treatment of sleep disorders associated with traumatic brain injury may not improve neuropsychological function or sleepiness. PMID:26929626

  10. Morphological analysis of the urethral muscle of the male pig with relevance to urinary continence and micturition.

    PubMed

    Ragionieri, Luisa; Ravanetti, Francesca; Gazza, Ferdinando; Botti, Maddalena; Ivanovska, Ana; Cacchioli, Antonio

    2016-03-01

    To investigate whether the pig could be considered a suitable model to study lower urinary tract function and dysfunction, the pelvic urethra of 24 slaughtered male pigs were collected, and the associated muscles were macroscopically, histologically and histochemically analyzed. In cross-sections of the urethra, a muscular complex composed of an inner layer of smooth muscle and an outer layer of striated muscle that are not separated by fascial planes was observed. A tunica muscularis, composed of differently oriented smooth muscle bundles, is only evident in the proximal part of the pelvic urethra while, in the remaining part, it contributes to form the prostatic fibromuscular stroma. The striated urethral muscle surrounds the pelvic urethra in a horseshoe-like configuration with a dorsal longitudinal raphe, extending from the bladder neck to the central tendon of perineum. Proximally to the bladder, it is constituted of slow-twitch and fast-twitch myofibers of very small diameter, and embedded in an abundant collagen and elastic fiber net. Moving caudally it is gradually encircled and then completely substituted by larger and compact myofibers, principally presenting circular orientation and fast-twitch histochemical characteristics. So, like in humans, the cranial tract of the muscular system surrounding the pelvic urethra is principally composed of smooth musculature. The striated component cranially may have a role in blocking retrograde ejaculation, while the middle and caudal tracts may facilitate urine and semen flow, and seem especially concerned with the rapid and forceful urethral closure during active continence. Some differences in the morphology and structure between pigs and humans seem due to the different morphology of the 'secondary' sexual organs that develop from the urethral wall and to the different effect of gravity on the mechanics of the urinary system in quadruped and bipedal mammals. PMID:26573248

  11. Traumatic pulmonary pseudocyst due to thoracic trauma.

    PubMed

    Gulbahar, Gultekin; Gundogdu, Ahmet Gokhan; Kaplan, Tevfik; Kocer, Bulent

    2016-01-01

    Traumatic pulmonary pseudocyst is uncommon and usually regresses spontaneously with conservative treatment. In rare cases, surgical intervention may be necessary. A pseudocyst may be treated surgically to prevent potential complications if the patient undergoes a thoracotomy for another reason. We present a patient with hemopneumothorax and traumatic pulmonary pseudocyst after a motor vehicle accident, who was operated on electively due to massive air leak. PMID:26187463

  12. Monte Carlo validation and optimisation of detector packaging for spectroscopic dosimetry for in vivo urethral dosimetry during low dose rate brachytherapy.

    PubMed

    Nourbehesht, L K; Cutajar, D L; Guatelli, S; Rosenfeld, A B

    2015-09-01

    The urethral mini-dosimeter, developed by the Centre for Medical Radiation Physics, University of Wollongong, uses spectroscopic dosimetry to provide real time point dose measurements along the urethra during low dose rate prostate brachytherapy. Spectroscopic dosimetry uses the measured spectrum of the treatment isotope to estimate the dose rate at the point of measurement, however, the silicon mini-detectors employed in the urethral mini-dosimeter require water proof encapsulation which must be capable of providing electromagnetic shielding without greatly increasing the size of the probe. The introduction of non-tissue equivalent materials within the encapsulation can change the spectrum of radiation incident on the detector, which may influence the application of spectroscopic dosimetry within the urethral dosimeter. The Monte Carlo code Geant4 was adopted to study the effect of encapsulation on the operation of the urethral mini-dosimeter, as well as to determine whether an appropriate thickness of aluminium shielding was possible for electromagnetic screening. The depth dose response and angular dependence of the urethral mini-dosimeter with three thicknesses of aluminium shielding (20, 50, 100 m) was compared with the urethral mini-dosimeter without aluminium shielding. The aluminium shielding had the effect of increasing the depth dose response (up to 3% within 30 mm and up to 5% within 50 mm), slightly reduced the azimuth angular dependence and slightly increased the polar angular dependence. The 100 m thick shielding provided the least azimuth angular dependence (2 %) and provided a polar angular dependence of 1.4 % within the angles of -45 to 45. PMID:26239932

  13. Determining injuries from posterior and flank stab wounds using computed tomography tractography.

    PubMed

    Bansal, Vishal; Reid, Chris M; Fortlage, Dale; Lee, Jeanne; Kobayashi, Leslie; Doucet, Jay; Coimbra, Raul

    2014-04-01

    Unlike anterior stab wounds (SW), in which local exploration may direct management, posterior SW can be challenging to evaluate. Traditional triple contrast computed tomography (CT) imaging is cumbersome and technician-dependent. The present study examines the role of CT tractography as a strategy to manage select patients with back and flank SW. Hemodynamically stable patients with back and flank SW were studied. After resuscitation, Betadine- or Visipaque-soaked sterile sponges were inserted into each SW for the estimated depth of the wound. Patients underwent abdominal helical CT scanning, including intravenous contrast, as the sole abdominal imaging study. Images were reviewed by an attending radiologist and trauma surgeon. The tractogram was evaluated to determine SW trajectory and injury to intra- or retroperitoneal organs, vascular structures, the diaphragm, and the urinary tract. Complete patient demographics including operative management and injuries were collected. Forty-one patients underwent CT tractography. In 11 patients, tractography detected violation of the intra- or retroperitoneal cavity leading to operative exploration. Injuries detected included: the spleen (two), colon (one), colonic mesentery (one), kidney (kidney), diaphragm (kidney), pneumothorax (seven), hemothorax (two), iliac artery (one), and traumatic abdominal wall hernia (two). In all patients, none had negative CT findings that failed observation. In this series, CT tractography is a safe and effective imaging strategy to evaluate posterior torso SW. It is unknown whether CT tractography is superior to traditional imaging modalities. Other uses for CT tractography may include determining trajectory from missile wounds and tangential penetrating injuries. PMID:24887674

  14. Minimally Invasive Technique for Repairing CSF Leaks Due to Defects of Posterior Table of Frontal Sinus

    PubMed Central

    Bhavana, Kranti; Kumar, Raj; Keshri, Amit; Aggarwal, Sushil

    2014-01-01

    Objective?Cerebrospinal fluid (CSF) leaks from the frontoethmoid and sphenoid region can be easily dealt with endoscopic approaches, but CSF rhinorrhea due to frontal sinus fractures are difficult to treat solely by the nasal endoscopic approach and may require external repair. The technique described targets defects of the posterior table of the frontal sinus where conventional osteoplastic approach of obliteration is usually done. This technique is minimally invasive and involves repair using an endoscope via a frontal trephine. Methods?We have treated five cases of traumatic CSF rhinorrhea with this technique, and the mean follow-up is 1?year (range: 1014 months). The frontal sinus is opened by making a small stab incision (frontal trephine), and the defect site is localized by visualization via endoscope through the trephine. The repair is then performed with fat, bone graft, and fibrin glue. Results?Closure of the defect was achieved in a single stage in all the patients, and none of them had a recurrence of leak in the 1-year follow-up period. Conclusion?This is a good technique for superiorly and laterally placed posterior table defects of the frontal sinus with minimal morbidity and excellent closure rates. PMID:25072011

  15. Cerebral Blood Flow and Autoregulation after Pediatric Traumatic Brain Injury

    PubMed Central

    Udomphorn, Yuthana; Armstead, William M.; Vavilala, Monica S.

    2008-01-01

    Traumatic brain injury is a global health concern and is the leading cause of traumatic morbidity and mortality in children. Despite a lower overall mortality than in adult traumatic brain injury, the cost to society from the sequelae of pediatric traumatic brain injury is very high. Predictors of poor outcome after traumatic brain injury include altered systemic and cerebral physiology, including altered cerebral hemodynamics. Cerebral autoregulation is often impaired following traumatic brain injury and may adversely impact poor outcome. Although altered cerebrovascular hemodynamics early after traumatic brain injury may contribute to disability in children, there is a paucity of information regarding changes in cerebral blood flow and cerebral autoregulation after pediatric traumatic brain injury. In this article, we discuss normal pediatric cerebral physiology and cerebrovascular pathophysiology following pediatric traumatic brain injury. PMID:18358399

  16. Visual Outcome of Traumatic Cataract at a Tertiary Eye Care Centre in North India: A Prospective Study

    PubMed Central

    Sharma, Ashish Kumar; Srivastava, Jai Prakash; Iqbal, Jawed

    2016-01-01

    Introduction One of the most common presentations of blunt and penetrating ocular trauma is traumatic cataract. It remains a significant cause of visual impairment and physical disability among adults and children. It is associated with various ocular injuries. Aim To evaluate the associated ocular injuries and final outcome of patients with traumatic cataract along with their demographic features and modes of trauma. Materials and Methods A prospective study done in Department of Ophthalmology in M.L.B. Medical college, Jhansi from February 2010 to July 2011. A total of 48 patients diagnosed as a case of traumatic cataract were subjected to a detailed history, systemic and local examination with relevant investigations. Medical or surgical managements were done accordingly. Patients were subsequently followed-up and visual acuity was recorded. Appropriate statistical tests were applied. Results A 54.2% patients sustained penetrating trauma while 45.8% got blunt injury. Out of total, 79% patients were males while 50% were less than 15 years of age. Causative agents were stone, wood items, stick, metal objects etc. Among blunt trauma cases, 64% of the patients had visual acuity <6/60 while among penetrating trauma cases nobody had acuity >6/18. Anterior segment was more involved as compared to posterior segment. A 38.5% patients had corneal opacity among penetrating injury patients. The interval between trauma and surgery was less than one month among 75% of patients. After three months of surgery, 43.7% patients had visual acuity of >6/18. Conclusion This study provides recent data of patients hospitalized after ocular trauma and diagnosed as a case of traumatic cataract. Traumatic cataract occurs mostly in younger males. Surgical intervention is necessary to improve visual outcome. Good visual outcome was obtained in nearly half of the patients. Traumatic cataract patients can have good visual outcome depending upon proper management. PMID:26894101

  17. Anterior and posterior fixation for delayed treatment of posterior atlantoaxial dislocation without fracture.

    PubMed

    Yu, Hai Ming; Malhotra, Karan; Butler, Joseph S; Wu, Shi Qiang

    2015-01-01

    Posterior atlantoaxial dislocation (PAAD) without fracture of the odontoid process is a rare injury. Authors have variously reported closed or open reduction, followed by either anterior or posterior fixation, but there is no consensus on best treatment. We present a particularly unstable case of PAAD. Open reduction through a retropharyngeal approach with odontoidectomy was required for reduction. Anterior fixation with transarticular lag screws was required prior to posterior fixation with pedicle screws. Despite non-compliance with postoperative immobilisation, imaging at 20-month follow-up confirmed solid fusion. The patient is pain-free with a good range of movement of the neck and has returned to a manual job. Our case had a greater degree of instability than was previously reported, which necessitated 360 fixation. This is the first reported case of this treatment strategy, which provided a very stable fixation allowing fusion despite early movement and without causing undue stiffness. PMID:26516249

  18. Endovascular treatment of posterior fossa arteriovenous malformations.

    PubMed

    Robert, T; Blanc, R; Ciccio, G; Gilboa, B; Fahed, R; Boissonnet, H; Redjem, H; Pistocchi, S; Bartolini, B; Piotin, M

    2016-03-01

    Infratentorial arteriovenous malformations (AVM) are rare, representing only 7-15% of cerebral AVM. The concentration of eloquent neurological structures and the high rate of bleeding presentation of AVM in this location complicate the management of such lesions. New therapeutic options, especially in endovascular therapy, have fundamentally modified the treatment strategy and also the outcome of posterior fossa AVM. Between 1999 and 2013, baseline, clinical and angiographic data of cerebral AVM were prospectively collected. We analyzed data from patients treated for a posterior fossa AVM, focusing on risk factors for bleeding, and clinical and angiographic outcomes. Sixty-nine patients (mean age 34years, male to female ratio 2:1) were consecutively treated for an infratentorial AVM. Fifty-seven presented with hemorrhage, six with focal neurologic deficits, and the remaining six patients were diagnosed incidentally. The Spetzler-Martin grade was <3 in 39 (56.5%) patients. Associated aneurysms were noted in 43.5% of patients. All patients were treated using endovascular procedures, associated with microsurgical resection in nine patients and with stereotactic radiosurgery in six. Mean follow-up was 28.5months, with angiographic exclusion of the AVM in 72.5% of patients; 21.7% of patients presented a modified Rankin Score ?3 at follow-up. Endovascular embolization seems to be a secure approach for posterior fossa AVM although a large number of sessions are necessary to achieve complete obliteration. Multi-disciplinary discussion and management is crucial to obtain the best cure rate without increasing procedural risks. PMID:26549679

  19. Spontaneous vertebral artery dissection: Posterior circulation stroke.

    PubMed

    Deshmukh, Manoj; Wadhwa, Anju; Rajdeo, Ravi

    2015-01-01

    Spontaneous vertebral artery dissection (VAD) is relatively rare but an important cause of posterior circulation stroke. A 46-year-male complaining of sudden onset headache, neck pain with right-sided neuro deficit in the form of hemiparesis was evaluated by contrast magnetic resonance imaging and dual-energy computed tomography (CT) and brain neck angiography which revealed a short segment extracranial left-sided VAD, associated with acute infarct in the left occipital region. The patient was managed conservatively and followed up for 6 months. Follow-up CT angiography after a period of 6 months revealed the near complete resolution of the arterial dissection in left vertebral artery. PMID:26692700

  20. A Short History of Posterior Dynamic Stabilization

    PubMed Central

    Gomleksiz, Cengiz; Sasani, Mehdi; Oktenoglu, Tunc; Ozer, Ali Fahir

    2012-01-01

    Interspinous spacers were developed to treat local deformities such as degenerative spondylolisthesis. To treat patients with chronic instability, posterior pedicle fixation and rod-based dynamic stabilization systems were developed as alternatives to fusion surgeries. Dynamic stabilization is the future of spinal surgery, and in the near future, we will be able to see the development of new devices and surgical techniques to stabilize the spine. It is important to follow the development of these technologies and to gain experience using them. In this paper, we review the literature and discuss the dynamic systems, both past and present, used in the market to treat lumbar degeneration. PMID:23326674

  1. Standardized bonding protocol posterior porcelain restorations.

    PubMed

    Schoenbaum, Todd R

    2011-06-01

    Strict adherence to a carefully designed protocol for the cementation of posterior porcelain restorations allows for a reliable and minimally invasive procedure. Though such a thorough protocol for porcelain cementation may initially seem time consuming or over-engineered, it is quickly learned and can be applied in nearly all situations. As with many practices in dentistry, the cementation is but the final step in the creation of a beautiful, minimally invasive, and durable restoration that lies at the end of a long line of procedures. All these procedures must also be completed at equivalent levels of excellence to ensure a successful result (Figures 10 to 12). PMID:21761632

  2. Complications when augmenting the posterior maxilla.

    PubMed

    Fugazzotto, Paul; Melnick, Philip R; Al-Sabbagh, Mohanad

    2015-01-01

    The maxillary posterior edentulous region presents a challenge when planning for restoring missing teeth with a dental implant. The available bone in such cases is often not dense and not adequate for the placement of a properly sized implant because of maxillary sinus pneumatization and alveolar bone loss. Maxillary sinus lift is a predictable procedure to provide adequate bone height for the purpose of implant placement. However, complications are encountered during or after the execution of the sinus lift procedure. In this article, the prevention and management of maxillary sinus complications are discussed. PMID:25434561

  3. Posterior shoulder instability in the contact athlete.

    PubMed

    Tannenbaum, Eric P; Sekiya, Jon K

    2013-10-01

    Historically, posterior shoulder instability has been a challenging problem for contact athletes and orthopedic surgeons alike. A complete understanding of the normal shoulder anatomy and biomechanics and the pathoanatomy responsible for the instability is necessary for a successful clinical outcome. In addition, the surgeon must be familiar with the diagnostic imaging and physical examination maneuvers required for the correct diagnosis without missing any other concurrent abnormalities. This understanding will allow orthopedists to plan and execute the appropriate management, whether this may involve conservative or surgical intervention. The goal should always be to correct the abnormality and have the patient return to play with full strength and no recurrent instability. PMID:24079434

  4. The role of the posterior cingulate cortex in cognition and disease

    PubMed Central

    Sharp, David J.

    2014-01-01

    The posterior cingulate cortex is a highly connected and metabolically active brain region. Recent studies suggest it has an important cognitive role, although there is no consensus about what this is. The region is typically discussed as having a unitary function because of a common pattern of relative deactivation observed during attentionally demanding tasks. One influential hypothesis is that the posterior cingulate cortex has a central role in supporting internally-directed cognition. It is a key node in the default mode network and shows increased activity when individuals retrieve autobiographical memories or plan for the future, as well as during unconstrained ‘rest’ when activity in the brain is ‘free-wheeling’. However, other evidence suggests that the region is highly heterogeneous and may play a direct role in regulating the focus of attention. In addition, its activity varies with arousal state and its interactions with other brain networks may be important for conscious awareness. Understanding posterior cingulate cortex function is likely to be of clinical importance. It is well protected against ischaemic stroke, and so there is relatively little neuropsychological data about the consequences of focal lesions. However, in other conditions abnormalities in the region are clearly linked to disease. For example, amyloid deposition and reduced metabolism is seen early in Alzheimer’s disease. Functional neuroimaging studies show abnormalities in a range of neurological and psychiatric disorders including Alzheimer’s disease, schizophrenia, autism, depression and attention deficit hyperactivity disorder, as well as ageing. Our own work has consistently shown abnormal posterior cingulate cortex function following traumatic brain injury, which predicts attentional impairments. Here we review the anatomy and physiology of the region and how it is affected in a range of clinical conditions, before discussing its proposed functions. We synthesize key findings into a novel model of the region’s function (the ‘Arousal, Balance and Breadth of Attention’ model). Dorsal and ventral subcomponents are functionally separated and differences in regional activity are explained by considering: (i) arousal state; (ii) whether attention is focused internally or externally; and (iii) the breadth of attentional focus. The predictions of the model can be tested within the framework of complex dynamic systems theory, and we propose that the dorsal posterior cingulate cortex influences attentional focus by ‘tuning’ whole-brain metastability and so adjusts how stable brain network activity is over time. PMID:23869106

  5. Diagnostic imaging of posterior fossa anomalies in the fetus and neonate: part 2, Posterior fossa disorders.

    PubMed

    Chapman, Teresa; Mahalingam, Sowmya; Ishak, Gisele E; Nixon, Jason N; Siebert, Joseph; Dighe, Manjiri K

    2015-01-01

    This second portion of a two-part review illustrates examples of posterior fossa disorders detectable on prenatal ultrasound and MRI, with postnatal or pathology correlation where available. These disorders are discussed in the context of an anatomic classification scheme described in Part 1 of this posterior fossa anomaly review. Assessment of the size and formation of the cerebellar hemispheres and vermis is critical. Diagnoses discussed here include arachnoid cyst, Blake's pouch cyst, Dandy-Walker malformation, vermian agenesis, Joubert syndrome, rhombencephalosynapsis, Chiari II malformation, ischemia, and tumors. PMID:25457569

  6. Classroom Strategies for Teaching Veterans with Post-Traumatic Stress Disorder and Traumatic Brain Injury

    ERIC Educational Resources Information Center

    Sinski, Jennifer Blevins

    2012-01-01

    Postsecondary institutions currently face the largest influx of veteran students since World War II. As the number of veteran students who may experience learning problems caused by Post-Traumatic Stress Disorder and/or Traumatic Brain Injury continues to rise, the need for instructional strategies that address their needs increases. Educators may…

  7. Stress and Traumatic Stress: How Do Past Events Influence Current Traumatic Stress among Mothers Experiencing Homelessness?

    ERIC Educational Resources Information Center

    Williams, Julie K.; Hall, James A.

    2009-01-01

    The purpose of this research was to evaluate the relationship between past traumatic events and the level of current traumatic stress among mothers experiencing homelessness. The data for this study were gathered from 75 homeless mothers between May 2006 and October 2006 using a cross-sectional survey design with purposive sampling. All mothers

  8. Gender Differences in Traumatic Events and Rates of Post-Traumatic Stress Disorder among Homeless Youth

    ERIC Educational Resources Information Center

    Gwadz, Marya Viorst; Nish, David; Leonard, Noelle R.; Strauss, Shiela M.

    2007-01-01

    In the present report we describe patterns of traumatic events and Post-traumatic Stress Disorder (PTSD), both partial and full, among homeless youth and those at risk for homelessness, with an emphasis on gender differences. Participants were 85 homeless and at-risk youth (49% female) recruited from a drop-in center in New York City in 2000.…

  9. What do Youth Report as a Traumatic Event? Toward a Developmentally Informed Classification of Traumatic Stressors

    PubMed Central

    Taylor, Leslie K.; Weems, Carl F.

    2009-01-01

    The aim of this study was to explore youth reports of traumatic events by 1) identifying the types of events that children and adolescents report as traumatic in their lives, 2) investigating the association between self reported traumatic events and self and parent reported emotional problems and 3) by examining developmental differences in the types and severity of the events reported as traumatic. Information regarding traumas and symptoms was collected from a sample of youth aged 617 using The Child PTSD Checklist. A coding system was developed for classifying the events reported. Findings suggest that youth reported a wide variety of experiences as traumatic that could be reliably coded and classified, and that youth reporting traumatic events and symptoms consistent with PTSD evidence higher levels of emotional, and behavioral problems (via parent and child report) than youth not reporting traumatic events. Youth aged 1317 tended to report traumas that were rated by independent coders as more severe than youth aged 612. While the types of events reported did not differ in PTSD symptoms and other emotional, and behavioral problems there were differences in objective ratings of physical severity and psychological intensity. Implications of the findings are discussed in terms of the creation of developmentally informed classification of traumatic stressors. PMID:20414479

  10. Stress and Traumatic Stress: How Do Past Events Influence Current Traumatic Stress among Mothers Experiencing Homelessness?

    ERIC Educational Resources Information Center

    Williams, Julie K.; Hall, James A.

    2009-01-01

    The purpose of this research was to evaluate the relationship between past traumatic events and the level of current traumatic stress among mothers experiencing homelessness. The data for this study were gathered from 75 homeless mothers between May 2006 and October 2006 using a cross-sectional survey design with purposive sampling. All mothers…

  11. Gender Differences in Traumatic Events and Rates of Post-Traumatic Stress Disorder among Homeless Youth

    ERIC Educational Resources Information Center

    Gwadz, Marya Viorst; Nish, David; Leonard, Noelle R.; Strauss, Shiela M.

    2007-01-01

    In the present report we describe patterns of traumatic events and Post-traumatic Stress Disorder (PTSD), both partial and full, among homeless youth and those at risk for homelessness, with an emphasis on gender differences. Participants were 85 homeless and at-risk youth (49% female) recruited from a drop-in center in New York City in 2000.

  12. Partial posterior hyaloidectomy for macular disorders

    PubMed Central

    Kim, J H; Kang, S W; Kim, Y T; Kim, S J; Chung, S E

    2013-01-01

    Purpose To evaluate the effect of partial posterior hyaloidectomy (PPH) in preventing iatrogenic retinal breaks related to the induction of a posterior vitreous detachment (IPVD) Methods Fifty-nine patients who necessitated IPVD for an epiretinal membrane or macular hole were included in this prospective, interventional case series. Extensive removal of vitreous gel, close to the retina, was conducted before IPVD under 23?G (gauge)-vitrectomy system. The PPH involved the limited extent of IPVD and limited removal of the outermost vitreous cortex to an area slightly beyond the margin of the temporal major vascular arcade. The incidence of retinal breaks related to the surgery was compared with 57 eyes that had undergone conventional 23-G total vitrectomy accompanied by extensive IPVD using ?2-test. Results Patients were followed-up for a mean of 14.3 months (630 months) after the surgery. The incidence of peripheral retinal breaks after the PPH was 3.4% (2/59 eyes), which was significantly lower than that in the eyes that underwent conventional 23?G vitrectomy (15.8%, 9/57 eyes, P=0.023) for the same disorders that required an IPVD. No patient complained of postoperative floaters, postoperatively. Conclusions PPH would be an efficient procedure to prevent iatrogenic peripheral retinal breaks related to an IPVD. PMID:23743531

  13. The posterior staphyloma of pathologic myopia.

    PubMed Central

    Curtin, B J

    1977-01-01

    A total of 250 myopic patients with posterior staphyloma affecting one or both eyes received a complete ocular examination including binocular indirect ophthalmoscopy, refraction, and axial length measurement. Ten types of staphyloma were noted; five primary and five compound. The primary staphyloma involved the posterior pole (Type I), macular area (Type II), peripapillary area (Type III), the fundus nasal to the disc (Type IV) and the area below the disc (Type V). Compound staphylomas consisted of combined primary staphylomas or distinctive and complex variations of a primary staphyloma, usually Type I. This type also was found to have the greatest prevalence of all ten types. Patients in this group had a 19% incidence of legal blindness with 34.5% of staphylomatous eyes having a vision of 20/200 or less. A remarkably wide range of refractions and axial lengths were found for each staphyloma type. These results indicate the importance of the staphyloma in the diagnosis and prognosis of pathologic myopia. It also offers an improved basis for genetic studies of this disease. PMID:613534

  14. Experimental models for posterior capsule opacification research.

    PubMed

    Wormstone, Ian Michael; Eldred, Julie Ann

    2016-01-01

    Millions of people worldwide are blinded due to cataract formation. At present the only means of treating a cataract is through surgical intervention. A modern cataract operation involves the creation of an opening in the anterior lens capsule to allow access to the fibre cells, which are then removed. This leaves in place a capsular bag that comprises the remaining anterior capsule and the entire posterior capsule. In most cases, an intraocular lens is implanted into the capsular bag during surgery. This procedure initially generates good visual restoration, but unfortunately, residual lens epithelial cells undergo a wound-healing response invoked by surgery, which in time commonly results in a secondary loss of vision. This condition is known as posterior capsule opacification (PCO) and exhibits classical features of fibrosis, including hyperproliferation, migration, matrix deposition, matrix contraction and transdifferentiation into myofibroblasts. These changes alone can cause visual deterioration, but in a significant number of cases, fibre differentiation is also observed, which gives rise to Soemmering's ring and Elschnig's pearl formation. Elucidating the regulatory factors that govern these events is fundamental in the drive to develop future strategies to prevent or delay visual deterioration resulting from PCO. A range of experimental platforms are available for the study of PCO that range from invivo animal models to invitro human cell and tissue culture models. In the current review, we will highlight some of the experimental models used in PCO research and provide examples of key findings that have resulted from these approaches. PMID:25939555

  15. Retained self-inserted foreign body into the urethra associated with sequela urethral stenosis: a case report

    PubMed Central

    2014-01-01

    Introduction Self-insertion of foreign bodies into the urethra represents a heterogeneous group of cases concerning a wide variety of objects and involving multiple procedures and surgical techniques. Case presentation We report a case of self-insertion of an electric cable into the urethra by a 36-year-old Caucasian man for erotic reasons. The patient, who has an ambiguous history of self-inflicted penile strangulation in childhood and self-insertion of foreign bodies into the urethra in recent years but no psychiatric history, presented to the emergency department to remove the object introduced one week previously. He was - strangely - asymptomatic and presented neither dysuria nor urinary incontinence or hematuria. A physical examination revealed a penile scar corresponding to the strangulation and a palpable hard, thin mass in the perineal urethra. The biologic findings were normal. Plain film of the urinary tract showed a hollow tubular object, whose size and shape corresponded to those of the urethra. Rigid cystoscopy was performed, which revealed urethral stricture at the projection of the scar. Laborious urethrotomy was performed before reaching the 25cm long cable, which was found in the urethra and removed with difficulty due to stenosis. Conclusions We encountered a particular case combining a self-introduced foreign body in the urethra and the sequelae of such manipulations, which is urethral stricture. We succeeded in treating both by endoscopy, which is not always possible in this situation. PMID:24997473

  16. Quality and in vitro fertilizing ability of cryopreserved cat spermatozoa obtained by urethral catheterization after medetomidine administration.

    PubMed

    Zambelli, D; Prati, F; Cunto, M; Iacono, E; Merlo, B

    2008-03-01

    Quality and in vitro fertilizing ability of frozen-thawed cat semen collected by urethral catheterization (CT) or electroejaculation (EE) after medetomidine administration were compared. Sperm collection was performed by an urinary tomcat catheter and, 4 days apart, by electroejaculation from each of eight tomcats. Results showed that semen collected by CT was characterized by lower volume (10.5+/-5.3 microL, P<0.05), higher sperm concentration (1868.4+/-999.8 x 10(6)/mL, P<0.05) and lower pH (7.0+/-0.4, P<0.05) than that collected by EE (67.1+/-25.9 microL, 542.9+/-577.9 x 10(6)/mL, and 7.9+/-0.4, respectively). Spermatozoa characteristics after thawing at 0, 3 and 6h did not differ between the two methods of collection. Also cleavage rate and embryo production from oocytes fertilized with frozen-thawed spermatozoa collected by CT or EE showed no significant differences (P>0.05). In conclusion, the results obtained in the present study indicate that good quality freezable semen can be collected from cats by urethral catheterization after medetomidine administration. This new method of semen collection appears very useful in practice and, compared with the electroejaculation protocol, permits to obtain semen samples characterized by a higher concentration of spermatozoa, lower total volume and lower pH. PMID:18082880

  17. Traumatic Migration of the Bryan Cervical Disc Arthroplasty.

    PubMed

    Wagner, Scott C; Kang, Daniel G; Helgeson, Melvin D

    2016-02-01

    Study Design?Case study. Objective?To describe a case of dislodgment and migration of the Bryan Cervical Disc (Medtronic Sofamor Danek, Memphis, Tennessee, United States) arthroplasty more than 6 months after implantation secondary to low-energy trauma. Methods?The inpatient, outpatient, and radiographic medical records of a patient with traumatic migration of the Bryan Cervical Disc arthroplasty were reviewed. The authors have no relevant disclosures to report. Results?A 36-year-old man with chronic left upper extremity radiculopathy underwent uncomplicated Bryan Cervical Disc arthroplasty at C5-C6, with complete resolution of his symptoms. Approximately 6 months after his index procedure, he sustained low-energy trauma to the posterior cervical spine, after being struck by a book falling from a shelf. The injury forced his neck into flexion, and though he did not have recurrence of his radiculopathy symptoms, radiographs demonstrated anterior migration of the arthroplasty device. He underwent revision to anterior cervical diskectomy and fusion. Conclusions?Although extremely rare, it is imperative that surgeons consider the potential for failure of osseous integration in patients undergoing cervical disk arthroplasty, even beyond 3 to 6 months postoperatively. This concern is especially relevant to press-fit or milled devices like the Bryan Cervical Disc arthroplasty, which lack direct fixation into adjacent vertebral bodies. We are considering modification of our postoperative protocol to improve protection of the device after implantation, even beyond 3 months postoperatively. PMID:26835211

  18. Traumatic Migration of the Bryan Cervical Disc Arthroplasty

    PubMed Central

    Wagner, Scott C.; Kang, Daniel G.; Helgeson, Melvin D.

    2015-01-01

    Study Design?Case study. Objective?To describe a case of dislodgment and migration of the Bryan Cervical Disc (Medtronic Sofamor Danek, Memphis, Tennessee, United States) arthroplasty more than 6 months after implantation secondary to low-energy trauma. Methods?The inpatient, outpatient, and radiographic medical records of a patient with traumatic migration of the Bryan Cervical Disc arthroplasty were reviewed. The authors have no relevant disclosures to report. Results?A 36-year-old man with chronic left upper extremity radiculopathy underwent uncomplicated Bryan Cervical Disc arthroplasty at C5C6, with complete resolution of his symptoms. Approximately 6 months after his index procedure, he sustained low-energy trauma to the posterior cervical spine, after being struck by a book falling from a shelf. The injury forced his neck into flexion, and though he did not have recurrence of his radiculopathy symptoms, radiographs demonstrated anterior migration of the arthroplasty device. He underwent revision to anterior cervical diskectomy and fusion. Conclusions?Although extremely rare, it is imperative that surgeons consider the potential for failure of osseous integration in patients undergoing cervical disk arthroplasty, even beyond 3 to 6 months postoperatively. This concern is especially relevant to press-fit or milled devices like the Bryan Cervical Disc arthroplasty, which lack direct fixation into adjacent vertebral bodies. We are considering modification of our postoperative protocol to improve protection of the device after implantation, even beyond 3 months postoperatively. PMID:26835211

  19. Post-traumatic stress disorder: a right temporal lobe syndrome?

    NASA Astrophysics Data System (ADS)

    Engdahl, B.; Leuthold, A. C.; Tan, H.-R. M.; Lewis, S. M.; Winskowski, A. M.; Dikel, T. N.; Georgopoulos, A. P.

    2010-12-01

    In a recent paper (Georgopoulos et al 2010 J. Neural Eng. 7 016011) we reported on the power of the magnetoencephalography (MEG)-based synchronous neural interactions (SNI) test to differentiate post-traumatic stress disorder (PTSD) subjects from healthy control subjects and to classify them with a high degree of accuracy. Here we show that the main differences in cortical communication circuitry between these two groups lie in the miscommunication of temporal and parietal and/or parieto-occipital right hemispheric areas with other brain areas. This lateralized temporal-posterior pattern of miscommunication was very similar but was attenuated in patients with PTSD in remission. These findings are consistent with observations (Penfield 1958 Proc. Natl Acad. Sci. USA 44 51-66, Penfield and Perot 1963 Brain 86 595-696, Gloor 1990 Brain 113 1673-94, Banceaud et al 1994 Brain 117 71-90, Fried 1997 J. Neuropsychiatry Clin. Neurosci. 9 420-8) that electrical stimulation of the temporal cortex in awake human subjects, mostly in the right hemisphere, can elicit the re-enactment and re-living of past experiences. Based on these facts, we attribute our findings to the re-experiencing component of PTSD and hypothesize that it reflects an involuntarily persistent activation of interacting neural networks involved in experiential consolidation.

  20. Traumatic optic neuropathy: facial CT findings affecting visual acuity.

    PubMed

    Reddy, Ramachandra P; Bodanapally, Uttam K; Shanmuganathan, Kathirkamanathan; Van der Byl, Giulia; Dreizin, David; Katzman, Lee; Shin, Robert Kang

    2015-08-01

    The purpose of this study was to determine the relationship between admission visual acuity (VA) and facial computed tomographic (CT) findings of traumatic optic neuropathy (TON). We retrospectively evaluated CT findings in 44 patients with TON. Mid-facial fractures, extraconal and intraconal hematomas, hematomas along the optic nerve and the posterior globe, optic canal fracture, nerve impingement by optic canal fracture fragment, and extraconal and intraconal emphysema were evaluated. CT variables of patients with and without available VA were compared. VA was converted into logarithm of the minimum angle of resolution (logMAR) to provide a numeric scale for the purpose of statistical analysis. The risk factors related to poor VA on univariate analysis were as follows: intraconal hematoma [median logMAR -4.7 versus -1.15, p?=?0.016] and hematoma along the optic nerve [median -4.7 versus -1.3, p?=?0.029]. Intraconal hematoma was the best predictor of poor VA (coefficient, 1.01; SE, 0.34; and p?=?0.008). Receiver operating characteristic (ROC) curve analysis showed that the presence of intraconal hematoma and hematoma along the optic nerve predicted poor VA (logMAR of -3.7 or lower) with an area under the curve of 0.8 and 0.85, respectively. TON patients at higher risk of severe visual impairment may be identified based on admission facial CT. PMID:25563705