First Step Of Treatment Research Articles

Back pain due to spinal metastatic leiomyosarcoma

A 25-year-old female patient presented with severe back pain. Contrast-enhanced thoracic magnetic resonance imaging revealed a large mass lesion at the body of the T11 vertebra and adjacent paravertebral soft tissues including the retroaortic area. The lesion was hypointense on T1-weighted images and hyperintense on T2-weighted images (Fig. 1A–C, E, and F). After intravenous contrast medium administration, the lesion showed diffuse and significant contrast enhancement (Fig. 1D and G). Computed tomography-guided percutaneous core needle biopsy was performed for the definitive diagnosis (Fig. 2, Left). The histopathologic diagnosis of the lesion was reported as metastatic leiomyosarcoma. The patient was given a neoadjuvant chemotherapy as the first step of treatment. The soft tissue component of the lesion demonstrated a marked decrease in size on her control contrast-enhanced thoracic MRI performed at the end of this chemotherapy protocol (Fig. 2, Middle and Right). After this initial treatment, T11 corpectomy operation was performed so as to resect the bony part of the lesion.

Neurosurgical Treatment of Acromegaly.

Surgical removal of as much tumor mass as possible is usually considered the first step of treatment in acromegaly, unless the patients are unfit for surgery or refuse an operation. To date, in almost all cases, minimally invasive, transsphenoidal microscopic or endoscopic approaches are used. Whether a curative approach is feasible or a debulking procedure is planned, can be anticipated on the basis of preoperative magnetic resonance imaging. It mostly depends on localization, size, and the invasive character of the lesion. The surgical results depend on tumor-related factors such as size, extension, the presence or absence of invasion, and the magnitude of IGF-1 and growth hormone oversecretion, respectively. However, even surgeon-related factors such as experience and case load of the centers have been shown to strongly affect surgical results and complication rates. A reoperation can be considered at various stages in the treatment algorithm. There are several new technical gadgets which might aid in the surgical procedure: navigation, the Doppler probe, and variants of intraoperative imaging.

Dairy wastewater utilization: separation of whey proteins in membrane and chromatographic processes

Dairies are obligated to utilize whey after cheese production. From an environmental protection point of view, the high content of lactose and proteins in post-production wastes, like whey, is harmful for the environment. From another point of view, whey is a source of very valuable, active proteins, particularly lactoferrin and serum albumin. Their modulatory potential is exhibited in their pure form and improves after partial, controlled hydrolysis. Unfortunately, the fractionation of this multicomponent medium is not an easy task. The paper describes an integrated process of fractionation of whey proteins. After the first step of treatment based on membrane techniques, the concentrated, most valuable whey proteins were subjected to a few steps of chromatographic separation. The separation properties of the ultrafiltration membranes were unexpected. The typical cut-off boundary was shifted in the direction of components having a lower molecular weight. After laboratory-scale testing, a concept for an industrial-scale process for the isolation of the most valuable whey proteins with purities of nearly 100% was elaborated.

Carpal Tunnel Syndrome in Lactation: A Challenging Issue

Context: Carpal tunnel syndrome (CTS) is a prevalent complaint during pregnancy and lactation. During lactation both environment and hormonal changes can contribute to worsening the symptoms. Some authors believe that CTS in lactation is a separate clinical entity which develops in pregnancy. Therefore, the specific conditions of these patients demand a special assessment of their treatment. Evidence Acquisition: We searched Pubmed, Scopus and Google Scholar regardless of the articles’ publication date. The search was performed using the terms “carpal tunnel syndrome”, “median nerve entrapment” or “median nerve neuropathy” which were independently associated (by using “and” in the builder) with breastfeeding, lactation, nursing, postnatal, postpartum, puerperal, and puerperium. We restricted our search to the articles published in English or Persian. The abstracts of references were carefully reviewed and included, if related to CTS and lactation. Finally, the extracted data about therapeutic options available for mothers during breastfeeding were assigned to different areas such as surgical, medical, etc. Related articles were then discussed under the most appropriate topics. Results: Usually, gradual resolution of the symptoms of CTS occurs after stopping breastfeeding. Reassurance and nursing advice on optimal positions for holding baby and breasts during breastfeeding is the first step of treatment. Intra-carpal steroid injection, diuretics and non-steroidal anti-inflammatory drugs might have some benefits, according to the few observational studies on lactating women with CTS. Splinting as a safe option that does not interfere with breastfeeding with good efficacy is suggested by all authors. Surgical intervention is spared for the patients experiencing severe symptoms for long periods, those with thenar muscles wasting or when conservative treatment fails. Conclusions: Current evidence suggests that in addition to nursing advice regarding positioning during breastfeeding, similar treatment strategy for CTS in general population is suitable for lactating mothers. However, available studies suffer from many shortcomings and have not evaluated all therapeutic options in this field. Well-designed interventional studies with special focus on this issue are needed to provide evidence based recommendations.

Preparation of cross-linked cellulose nanofibril aerogel with water absorbency and shape recovery

Cellulose nanofibril (CNF) aerogels are promising materials for various applications because of their highly porous and ultralight characteristics. The fiber network of CNF aerogels held together by hydrogen bonding and mechanical entanglement of adjacent fibers is easily destroyed when it is exposed to water. In this study, cross-linked CNF aerogels were prepared using maleic acid and sodium hypophosphite as cross-linking agents. In the first step of treatment, CNF dispersed in water was reacted with maleic acid to form an ester linkage. Sodium hypophosphite was then added to the maleic acid-functionalized CNF suspension and the suspension was rapidly frozen using liquid nitrogen. CNF aerogel was obtained after freeze drying. The cross-linking of the cellulose was formed by the reaction between the carbon–carbon double bond of maleic acid-functionalized CNF and hypophosphite. The cross-linked CNF aerogel exhibited good network stability in water and springiness after compression.

Impact of at-home self-rehabilitation of the perineum on pelvic floor function in patients with stress urinary incontinence: Results from a prospective study using three-dimensional ultrasound

Pelvic floor muscle training (PFMT) is the first step of treatment for stress urinary incontinence (SUI). Patients must perform self-retraining exercises of the perineal muscles at home in order to maintain the benefit of the physiotherapy. The aim of this study is to assess the benefit of a perineal electro-stimulator, using three-dimensional ultrasound, during this home-care phase. A longitudinal prospective study was conducted between May2012 and May2013. All patients with de novo SUI benefited from PFMT followed by a self-maintenance of perineal rehabilitation at home with the Keat(®) Pro system. The primary endpoint was the biometric of the levator ani and it was assessed by three-dimensional perineal ultrasound at inclusion, after conventional rehabilitation and at the end of the study after self-rehabilitation. Ten patients were included. All patients (100%) showed a clinical improvement of SUI. The quality of life was significantly improved after PFMT vs. inclusion (P=0.014) and after self-rehabilitation vs. after PFMT (P=0.033). Levator ani muscles were significantly thicker after conventional rehabilitation than at baseline (P=0.004) and significantly thicker after self-rehabilitation than after PFMT (P=0.009). Conducting self-rehabilitation in addition to conventional PFMT objectively improves the perineal muscle building achieved after conventional rehabilitation.

Bed rest in singleton pregnancies for preventing preterm birth

Bed rest in hospital or at home is widely recommended for the prevention of preterm birth. This advice is based on the observation that hard work and hard physical activity during pregnancy could be associated with preterm birth and with the idea that bed rest could reduce uterine activity. However, bed rest may have some adverse effects on other outcomes. To evaluate the effect of prescription of bed rest in hospital or at home for preventing preterm birth in pregnant women at high risk of preterm birth. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (18 December 2014), the Cochrane Central Register of Controlled Trials (The Cochrane Library, 2014, Issue 12), MEDLINE (December 2014), EMBASE (December 2014), LILACS (December 2014), and bibliographies of relevant papers. Randomized, cluster-randomized and quasi-randomized controlled trials with reported data that assess clinical outcomes in women at high risk of spontaneous preterm birth who were prescribed bed rest in hospital or at home for preventing preterm birth, and their babies. Two review authors independently assessed eligibility, trial quality and extracted data. Two studies met the inclusion criteria. One study was not considered for the meta-analysis, since data combined singleton and multiple pregnancies. No differences in any maternal and perinatal outcomes were reported by the authors. This study was at low risk of selection, performance, detection and attrition bias. Only data from one study were included in the meta-analysis (1266 women). This study was at unclear risk of bias for most domains due to lack of reporting. Four hundred and thirty-two women were prescribed bed rest at home and a total of 834 women received a placebo (412) or no intervention (422). Preterm birth before 37 weeks was similar in both groups (7.9% in the intervention group versus 8.5% in the control group; risk ratio (RR) 0.92, 95% confidence interval (CI) 0.62 to 1.37). No other results were reported for any of the other primary or secondary outcomes. There is no evidence, either supporting or refuting the use of bed rest at home or in hospital, to prevent preterm birth. Although bed rest in hospital or at home is widely used as the first step of treatment, there is no evidence that this practice could be beneficial. Due to the potential adverse effects that bed rest could have on women and their families, and the increased costs for the healthcare system, clinicians should discuss the pros and cons of bed rest to prevent preterm birth. Potential benefits and harms should be discussed with women facing an increased risk of preterm birth. Appropriate research is mandatory. Future trials should evaluate both the effectiveness of bed rest, and the effectiveness of the prescription of bed rest, to prevent preterm birth.

Clinical characteristics of ceftriaxone plus metronidazole in complicated intra-abdominal infection

PurposeEmpirical antibiotics in complicated intra-abdominal infection (c-IAI), such as secondary peritonitis are a first step of treatment. Empirical antibiotic regimen is very diverse. Ceftriaxone plus metronidazole regimen (CMR) is one of the empirical antibiotic regimens used in treatment of c-IAI. However, although CMR is a widely used empirical antibiotic regimen, study regarding success, failure or efficacy of CMR has been poorly understood. This retrospective study is conducted to compare the clinical efficacy of this regimen in c-IAI according to clinical characteristics.MethodsThe subjects were patients in this hospital who were diagnosed as secondary peritonitis between 2009 and 2013. Retrospective analysis was performed based on the records made after surgery regarding clinical characteristics including albumin level, blood pressure, pulse rate, respiration rate, smoking, age, sex, body mass index, hemoglobin, coexisting disease, leukocytosis, and APACHE (acute physiology and chronic health evaluation) II score.ResultsA total of 114 patients were enrolled. In univariated analysis, the success and failure of CMR showed significant association with preoperative low albumin, old age, and preoperative tachycardia. In multivariated analysis, low albumin and preoperative tachycardia were significant.ConclusionIt is thought that an additional antibiotic treatment plan is necessary in patients with low albumin and tachycardia when the empirical antibiotic regimen is CMR in c-IAI. Conduct of research through well-designed prospective randomized clinical study is also necessary in order to evaluate the appropriateness of CMR and decide on a proper empirical antibiotic regimen between many regimens in c-IAI based on our country.

TWO-STAGE SURGICAL TREATMENT OF A CHILD OF ONE YEAR FROM CONGENITAL HEART DISEASE AND BILIARY CIRRHOSIS

Aim: Clinical case of successful two-stage surgical treatment of a 1-year-old child with congenital heart disease and biliary cirrhosis is represented in this article. At the fi rst day of life laparotomy was performed because of high intestinal obstruction. Kasai procedure and Roux-en-Y choledochojejunostomy were per- formed on 12 th day and at the end of second month of life, respectively. Liver biopsy showed the signs of biliary cirrhosis. At the same time ventricular septal defect and atrial septal defect with pulmonary hyper- tension were diagnosed. The fi rst step of treatment was the surgical septal defects closure. No complications during procedure, cardiopulmonary bypass and post-operative period were registered. There were no nega- tive effects on liver function after cardiac surgery. 11 months later living-donor liver transplantation was performed without any complications. Patient was discharged at 35 th post-transplant day with stable graft function.

Chronic kidney disease and erectile dysfunction.

Erectile dysfunction (ED) is a common condition among male chronic kidney disease (CKD) patients. Its prevalence is estimated to be approximately 80% among these patients. It has been well established that the production of nitric oxide from the cavernous nerve and vascular endothelium and the subsequent production of cyclic GMP are critically important in initiating and maintaining erection. Factors affecting these pathways can induce ED. The etiology of ED in CKD patients is multifactorial. Factors including abnormalities in gonadal-pituitary system, disturbance in autonomic nervous system, endothelial dysfunction, anemia (and erythropoietin deficiency), secondary hyperparathyroidism, drugs, zinc deficiency, and psychological problems are implicated in the occurrence of ED. An improvement of general conditions is the first step of treatment. Sufficient dialysis and adequate nutritional intake are necessary. In addition, control of anemia and secondary hyperparathyroidism is required. Changes of drugs that potentially affect erectile function may be necessary. Further, zinc supplementation may be necessary when zinc deficiency is suspected. Phosphodiesterase type 5 inhibitors (PDE5Is) are commonly used for treating ED in CKD patients, and their efficacy was confirmed by many studies. Testosterone replacement therapy in addition to PDE5Is may be useful, particularly for CKD patients with hypogonadism. Renal transplantation may restore erectile function. ED is an early marker of cardiovascular disease (CVD), which it frequently precedes; therefore, it is crucial to examine the presence of ED in CKD patients not only for the improvement of the quality of life but also for the prevention of CVD attack.

Morbid Obesity in Diabetes Mellitus Type 2 and Exenatide

Worldwide, the prevalence of diabetes and obesity is increasing in recent years in developed countries. The first step of treatment is changes in lifestyle and in case of failure to initiate drug treatment. In our case, the patient with morbid obesity and glucose intolerance to metformin therapy was initiated without achieving weight loss and loss of glycemic control after 6 months of treatment. It was decided to add exenatide as an alternative to bariatric surgery. At the end of the study (12 months), it showed a weight reduction of 20.8% (Table 1), 20.83% BMI, glycosylated hemoglobin decrease of 2 points, and improved the lipid profile. So exenatide may be an acceptable option in the use of patient profile. It would be necessary to seek a new alternative treatment with minimal side effects and less healthcare costs.

Effect of the timing of orchiectomy on survival in patients with metastatic germ cell tumors of testis

ObjectivesClassically, orchiectomy (OE) is the first step of treatment in patients with metastatic germ cell tumors (mGCTs) of testis. However, some patients have severe symptoms of disease, which require immediate beginning of chemotherapy (CT) followed by OE. This retrospective analysis was performed to find the effect of time constraints of delayed OE on survival in patients with mGCT. Methods and materialsWe analyzed the data of 1,483 CT-naive patients with advanced mGCT of the testis treated in our Department from 1986 to 2009. Delayed OE was performed on 71 (4.8%) patients: seminoma in 8 patients (11.2%), nonseminomatous tumor in 50 patients (70.4%), and unknown tumor histology in 13 patients (18.4%). Twenty percent, 40%, and 40% of patients belonged to good, intermediate, and poor International Germ Cell Cancer Consensus Group prognostic groups, respectively. Median time from the beginning of the CT to OE was 18 (range, 1–250) days. OE was performed on 39 (55%), 21 (29.5%), and 11 (15.5%) patients during cycle 1, cycle 2 to completion of CT, and after the finishing of induction CT, respectively. Median follow-up time was 156 (range, 3–241) months. Etoposide and cisplatin-based CTs were received by 66 patients (93%). ResultsThree-year overall survival (OS) of all 1,483 patients was 75%. An excellent primary tumor response to CT was observed among the patients, who had delayed OE after completion of CT (n = 11): only mature teratoma (n = 4) and tumor necrosis (n = 7) were found. The 3-year OS in patients with delayed OE was 63%. OE performed after completion of CT was associated with better prognosis. The 3-year OS in patients with delayed OE performed during the cycle 1 (group 1) was 67%, cycle 2 to completion of CT (group 2) was 39%, and after finishing of CT (group 3) was 88% (groups 1 vs. 3: hazard ratio 3.7, 95% confidence interval 0.69–10.1, P = 0.15; groups 2 vs. 3: P = 0.01, hazard ratio 8.1, 95% confidence interval 1.32–18.,72). It seems that if OE had been performed during CT, the beginning of the successive cycle was delayed and dose intensity of CT was decreased. ConclusionsIn case of severe symptoms of disease, which require an immediate start of CT, performing OE simultaneously with other surgeries after completion of induction CT was associated with better OS, when compared with performing OE during induction CT.

Korean medication algorithm for bipolar disorder: Second revision

The Feasibility Study of the Korean Medication Algorithm Project for Bipolar Disorder 2002 (KMAP-BP 2002) revealed its clinical usefulness in 2005. Since much more data had become available since 2002, it was revised in 2006 as KMAP-BP 2006. For the same reason, revision of KMAP-BP 2006 is now necessary. The questionnaire, amended on the basis of KMAP-BP 2006 and new data, was sent to 94 experts, 65 of whom replied. In an acute manic episode, a combination of a mood stabilizer (MS) with an atypical antipsychotic (AAP) is recommended as first-line strategy. Monotherapy with MS is first-line in a hypomanic episode. Triple combination of a MS, an AAP, and an antidepressant (AD), is the first-line strategy in non-psychotic severe depression. Also MS+AAP and MS+AD are recommended as first-line. In psychotic bipolar depression, MS+AAP+AD, MS+AAP and AAP+AD are first-line strategies. In bipolar depression, lithium, lamotrigine and valproic acid are selected as first-line MS and quetiapine, olanzapine and aripiprazole are preferred antipsychotics. In maintenance treatment, a combination of MS with AAP and monotherapy of MS are recommended as first-line. In treating bipolar disorder, even the first step of treatment, the expert consensus has changed from our studies in 2002 and 2006.

Video-Assisted Retroperitoneal Debridement (VARD) of Infected Necrotizing Pancreatitis: An Update

The treatment of necrotizing pancreatitis has changed considerably over the last decades. Intervention is now primarily performed in case of infected necrosis, is preferably delayed to approximately 4 weeks after onset of disease and minimally invasive techniques have gained popularity. Percutaneous catheter drainage obviates the need for additional necrosectomy in around 30 % of patients and should, therefore, be the first step of treatment. Minimally invasive necrosectomy can be performed as a next step in those patients who do not improve after drainage. This review discusses the background, technique, and results of the literature of a form of minimally invasive retroperitoneal necrosectomy: video-assisted retroperitoneal debridement.

High-grade spondyloretrolisthesis in a 12-year-old girl with neurofibromatosis type 1

Neurofibromatosis (NF) type 1 is characterized by several skin, endocrine, central nervous system and musculoskeletal manifestations, spine deformities being the most common, affecting up to 64% of patients. Thoracic kyphoscoliosis is the most common deformity observed; however, high-grade spondylolisthesis and dural defects such as dural ectasia can also be found. The aim of this study is to describe a case of high-grade spondyloretrolisthesis in an NF-1 patient, associated with dural ectasia and extensive lumbar laminectomies, and to discuss our management and review the current literature on this controversial topic. A 12-year-old girl with NF-1 who had undergone extensive lumbar laminectomies in an outside facility presented to our emergency department complaining of back pain and lower limbs upper motor neuron symptoms. Image studies showed a high-grade lumbar spondyloretrolisthesis associated with dural ectasia. The first step of treatment was spine immobilization using a Boston brace. An anterior approach was used, and an L2 corporectomy was performed, using a Moss type cage between L1 and L3 with an instrumented arthrodesis and autologous bone graft for stabilization purposes. The second step planned was a posterior approach for arthrodesis and instrumentation, but after an extensive discussion with the parents and the patient, the parents did not agree to the procedure planned for the patient. A brace was used for 1 year while rehabilitation was performed. At the 1-year follow-up, there was a 70° kyphosis at the thoracolumbar junction but it was clinically stable, with an acceptable sagittal balance. Dural ectasia is not a common finding in children with NF-1; however, it should be identified as its presence may predispose to spine instability and as a consequence the development of a high-grade spondyloretrolisthesis. Even though a few cases have been reported, we believe that it is important to consider the option of a double approach to achieve a better correction in both planes and a good outcome. If an extensive laminectomy is involved, it is mandatory to perform a posterior fusion and instrumentation.

Guided online treatment in routine mental health care: an observational study on uptake, drop-out and effects

BackgroundDue to limited resources patients in the Netherlands often have to wait for a minimum of six weeks after registration for mental health care to receive their first treatment session. Offering guided online treatment might be an effective solution to reduce waiting time and to increase patient outcomes at relatively low cost. In this study we report on uptake, drop-out and effects of online problem solving treatment that was implemented in a mental health center.MethodsWe studied all 104 consecutive patients aged 18–65 years with elevated symptoms of depression, anxiety and/or burnout who registered at the center during the first six months after implementation. They were offered a five week guided online treatment. At baseline, five weeks and twelve weeks we measured depressive (BDI-II), anxiety (HADS-A) and burnout symptoms (MBI).ResultsA total of 55 patients (53%) agreed to start with the online treatment. Patients who accepted the online treatment were more often female, younger and lower educated than those who refused. There were no baseline differences in clinical symptoms between the groups. There were large between group effect sizes after five weeks for online treatment for depression (d = 0.94) and anxiety (d = 1.07), but not for burnout (d = −.07). At twelve weeks, when both groups had started regular face-to-face treatments, we no longer found significant differences between the groups, except for anxiety (d = 0.69).ConclusionThe results of this study show that the majority of patients prefer online guided online treatment instead of waiting for face-to-face treatment. Furthermore, online PST increases speed of recovery and can therefore be offered as a first step of treatment in mental healthcare.

Early amniotic membrane transplantation for toxic keratopathy secondary to topical proparacaine abuse: a report of seven cases

Purpose: The aim of this study is to evaluate the effect of early amniotic membrane transplantation (AMT) in patients with topical proparacaine-related toxic keratopathy.Materials and methods: Between 2008 and 2011, eight eyes of seven patients with toxic keratopathy related to 0.5% proparacaine abuse underwent early AMT (within 1 to 5 days following the diagnosis). Clinical findings and treatment outcomes of these cases were evaluated retrospectively.Results: The median time of topical anesthetic abuse until admission to our clinic was 28 (10–112) days. One case was referred due to achanthamoeba keratitis; two cases due to intractable corneal ulcer and melting. At initial examination, visual acuities varied between hand motions and 0.4 (in decimal notation). Biomicroscopic evaluation at presentation revealed epithelial defects, corneal ulcers, stromal ring infiltrate, stromal edema and corneal melting with varying degrees. At third month after AMT, the visual acuities varied between hand motions and 0.9, and all the patients had corneal stromal opacities with varying densities. One patient, who did not respond to medical and surgical treatment and developed secondary infections that invaded intraocular structures, underwent evisceration.Conclusion: Topical anesthetic abuse can lead to serious ocular complications. After proper diagnosis, the first step of treatment is the cessation of drug abuse. In addition to medical treatment, early AMT has an advantage of early pain relief and consequential elimination of the need for topical anesthetic instillation.

Superior Mesenteric Artery Syndrome: A Rare Cause of Intestinal Obstruction. Diagnosis and Surgical Management

Superior mesenteric artery syndrome is a rare but well-known clinical entity characterized by compression of the third or transverse portion of the duodenum against the aorta by the superior mesenteric artery, resulting in chronic, intermittent, or acute, complete or partial, duodenal obstruction. The treatment for this arteriomesenteric compression includes conservative measures and surgical intervention. The aim of the study was to evaluate our surgical management and outcomes of the patients with superior mesenteric artery syndrome. The cases with superior mesenteric artery syndrome admitted between January 2000 and January 2010 were retrospectively investigated from the patients' records. All six patients had a history of chronic abdominal pain, nausea, postprandial early satiety, vomiting, and weight loss. Diagnostic methods included barium esophagogastroduodenography, upper gastrointestinal endoscopy, and computed tomography. Medical management was the first step of treatment in all cases before surgery. Of those, four underwent Roux-en-Y duodenojejunostomy and two underwent gastroenterostomy. Postoperative periods were uneventful and mean duration of hospitalization after the operations was 7days. Conservative initial treatment is usually followed by surgical intervention for the main problem that is the narrowing of the aortomesenteric angle in patients with superior mesenteric artery syndrome. This syndrome should be considered in the differential diagnosis in patients with chronic upper abdominal pain. Duodenojejunostomy is the most frequently used procedure with a high success rate.

Particularités de la prise en charge de l’incontinence urinaire d’effort de la femme obèse

Obesity, defined as a BMI over 30, is an increasing health problem all over the world. In most studies, a stronger association is observed between increasing weight, urinary incontinence and genital prolapse. Urinary incontinence (UI) prevalence is greater than 5 for women obviously obese. Specifically, stress UI management needs specificities in this population. Weight loss and pelvic floor muscles training are the first step of treatment. A 10% weight loss induces a 50% reduction of episodes of leakage. Unfortunately, weight reduction is usually non-lasting. In stress UI with urethral mobility, sub-urethral sling should be the second step. BMI < 35 seemed to be the best cutoff level. In that case, cure and complications rates are the same than in normal weight women. Above 35, there is a sharp decrease in cure rate (around 50%), and an increased risk of de novo urgencies and postoperative complications. For that obese women population, obesity surgery shows similar results than tension free vaginal tape. From a technical point of view, bladder injury is specific to retropubic access and should be avoided with transobturator access. On the other hand, retropubic access is likely to give longer lasting results on obese women whenever an intrinsic sphincter deficiency, a low urethral mobility and high intra-abdominal pressures are risk factors for failure.

Effektivität computer- und internetgestützter kognitiver Verhaltenstherapie bei Depression

The aim of this study was to conduct a systematic literature search in order to assess effectiveness of computer- and internet-based cognitive behavioural therapy (CCBT). Medline, Cochrane Library, Web of Science and PsycINFO were searched for relevant articles. Only RCTs were included. Effect sizes were calculated and quality of studies was assessed. 16 studies were retrieved and included. Effect sizes depended on therapist time involvement and control group intervention (waiting list vs. active control group) and ranged between 0.0 and 1.1. CCBT provides an effective and potentially cost-effective interventional strategy for depressive disorders. Effects of no and minimal contact therapies are confounded with conditions of control groups and need further investigation. While patients with Major Depression seem to benefit from computer-based therapy with regular therapist contact, it remains unclear whether unattended self-help interventions over the internet are effective for this patient population. However, these interventions are effective in patients with mild to moderate depressive symptomatology. CCBT may serve as a first step of treatment within stepped care approaches and may help to offer treatment to individuals in remote areas and to decrease barriers to seek psychiatric care caused by stigma perception.