Presence Of Long-term Complications Research Articles

Urethrovesical segment ultrasound for the efficacy evaluation of surgical treatment of stress urinary incontinence

Hypothesis/Aims of study. At present, there is no doubt about the importance of the problem of female stress urinary incontinence (SUI) and the search for the best way to eliminate it. Sling operations in SUI treatment are the most popular in world and domestic practice. However, they are not without certain complications. In this regard, it becomes relevant to determine the factors for predicting their effectiveness and safety. The aim of this study was to conduct a comparative study of the effectiveness of two anti-stress operations: TVT-Obturator and urethrovesicopexy with vaginal flap, by using echography of the urethrovesical segment.
 Study design, materials and methods. During the period from 2011 to 2018, 105 incontinent patients were examined and operated on. Two groups were formed: Group 1 consisted of 52 patients who underwent TVT-Obturator surgery, Group 2 included 52 patients who underwent urethrovesicopexy with vaginal flap. In all patients, the anatomical topographic position of the bladder and urethrovesical segment, the internal urethral sphincter status, as well as the angles and were determined, based on which the conclusion about the type of SUI was made and, accordingly, the adequate method of surgical intervention was determined.
 Results. Before the operation, the angle averaged 37.2 10.11, with 24.7 4.64 a year after the operation and 26.8 3.72 five years after the operation. Rotation of the angle in the study groups 20 before surgery did not significantly affect the presence of long-term complications, urinary retention after a year and five years, and recurrence of urinary incontinence. After the operation, there was an increase in the angle after a year (p = 0.0032) and five years (p = 0.0035) and in the total urethral length after a year (p = 0.0022), but after five years, this parameter did not differ significantly from that before surgery (p = 0.29).
 Conclusion. TVT-Obturator and urethrovesicopexy with vaginal flap are equally effective (p 0.05) in the surgical treatment of female SUI in both the nearest postoperative period (96.2% and 94.3%, respectively) and the distant period (90.4% and 88.7%, respectively).

Longitudinal Validation of Hemoglobin A1c Criteria for Diabetes Diagnosis: Risk of Retinopathy

Receiving a diagnosis of diabetes has significant physical, emotional, and financial consequences (1). The development of precise diagnostic criteria is critical both to avoid the unnecessary burden of treatment in individuals who do not have the disease and to promptly identify individuals who are at risk for developing complications from diabetes so they can be appropriately counseled on disease management. Traditionally, the diagnosis of diabetes was based on glucose levels associated with the progression to overt, symptomatic disease. In 1997, the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus refocused the basis of the diagnosis to the relationship between glucose levels and the presence of long-term complications (2). This recommendation was based on the available epidemiological literature demonstrating the association between various glucose measures and microvascular complications of diabetes—particularly retinopathy, which tends to have a stronger correlation to glycemia (2–4). These studies were mainly cross-sectional, although one study did examine microvascular complications longitudinally (4). Most recently, an international expert committee and the American Diabetes Association further specified that diabetes should be diagnosed if hemoglobin A1c is ≥6.5% (5,6). This was based in part on additional studies showing a …

Peri-operative glucose control and development of surgical wound infections in patients undergoing coronary artery bypass graft

Elevated blood glucose following coronary artery bypass graft (CABG) is associated with an increased risk of surgical wound infection (SWI). It is unclear whether hyperglycaemia, the diabetic state, the longstanding vascular effects of diabetes, or the systematic inflammatory response confers the increased vulnerability to SWI. This study was designed to examine the significance of postoperative blood glucose control as a risk factor for SWI after vein graft harvesting on the leg and sternotomy. Patients with and without diabetes had a CABG within 60 days to be eligible. The present study was part of a larger protocol investigating SWI following CABG in a total of 374 patients. Potential risk factors, duration of diabetes, pre-operative glycated haemoglobin (HbA(1c)) and presence of long-term complications were recorded. All patient records were reviewed retrospectively to record 10% glucose infusions during the operation, and blood glucose concentrations and insulin therapy on postoperative days 0, 1 and 2. Patients were contacted by telephone 30 and 60 days after surgery and interviewed in accordance with a questionnaire about symptoms and signs of wound infection. In the present study, it was not possible to separate the effect of diabetes as a risk factor for SWI from that of hyperglycaemia. However, in the subgroup of patients without a pre-operative diagnosis of diabetes, increased blood glucose concentrations during postoperative days 0, 1 and 2 was associated with an increased risk of mediastinitis.

Long-term urologic, orthopedic, and psychological outcome of posterior urethral rupture in children

Objectives To evaluate the long-term urologic, orthopedic, and psychological outcome of children after posterior urethral rupture (PUR) due to pelvic trauma. Methods We retrospectively reviewed the records of 49 children with PUR from 1986 to 2000. The long-term urologic results were determined by voiding function, continence, and erectile function. The orthopedic results were determined by pelvic radiography and a questionnaire. Psychiatric diagnoses were made using the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV), criteria and the Structured Clinical Interview for DSM-IV Axis I Disorders. Results The mean follow-up was 12 years (range 4 to 17). The average age was 8 years at the time of the trauma and 20 years at the last follow-up. Urethral continuity was achieved in 97.9% of the children. Of the 49 patients, 19 had at least one urologic complication, 18 had orthopedic pathologic findings, and 21 had psychiatric diagnoses. The number of urologic procedures required (more than three), presence of long-term complications, and total number of hospitalizations (more than three) secondary to the injury significantly affected the development of a psychological disorder. Conclusions The results of our study have shown that posttraumatic PUR in children is associated with a significant rate of long-term complications. Nonoperative treatment of pediatric pelvic fractures associated with PUR has been quite successful. Repeated operations, the presence of long-term urologic complications, and frequent and long hospital stays result in serious attendant psychological problems. Therefore, careful and prolonged follow-up of posttraumatic urethral injury with a multidisciplinary approach is necessary to provide better outcomes and a better quality of physical and social life for these children.

Simple Noninvasive Measurement of Skin Autofluorescence

Accumulation of advanced glycation end products (AGEs) is thought to play a role in the pathogenesis of chronic complications of diabetes mellitus and renal failure. Several studies indicate that AGE accumulation in tissue may reflect the cumulative effect of hyperglycemia and oxidative stress over many years. Simple quantitation of AGE accumulation in tissue could provide a tool for assessing the risk of long-term complications. Because several AGEs exhibit autofluorescence, we developed a noninvasive autofluorescence reader (AFR). Skin autofluorescence measured with the AFR correlates with collagen-linked fluorescence and specific skin AGE levels from skin biopsy samples. Furthermore, skin autofluorescence correlates with long-term glycemic control and renal function, and preliminary results show correlations with the presence of long-term complications in diabetes. The AFR may be useful as a clinical tool for rapid assessment of risk for AGE-related long-term complications in diabetes and in other conditions associated with AGE accumulation.

Coronary artery changes in patients with Kawasaki disease

Kawasaki disease (KD) is an acute, self-limiting, systemic vasculitis of unknown aetiology, which most commonly occurs in children aged 6 mo to 5 y, with a peak incidence at 9-11 mo. The inflammatory process preferentially involves the coronary arteries, potentially resulting in coronary arteritis, aneurysmal lesions, arterial thrombotic occlusion and sudden death. Kawasaki disease is the most common cause of acquired coronary vessel abnormalities in children. The cause of KD is not known, but evidence is presented for an inflammatory response and a genetic predisposition. The diagnostic tests are not yet defined, but treatment with immunoglobulin and aspirin is effective at reducing the risk of cardiac complications from 25% to 4.7% in the UK. Sequelae may occur, either acutely with myocardial, endocardial or pericardial inflammation, or many years after the original illness. There may be abnormalities of myocardial blood flow as assessed by MRI, radio-nucleide studies or echo Doppler. Such abnormalities of coronary arteries may require ongoing medication, interventional catheterization or even cardiac surgery. In the future, we hope to have more accurate diagnostic tests or prophylaxis against the disease, in addition to improved means of determining the susceptibility to or presence of long-term complications.

Clinical characteristics of type 1 diabetic patients with and without severe hypoglycemia.

To investigate the frequency of severe hypoglycemia (SH) and hypoglycemic coma and to identify clinical and behavioral risk indicators in a nonselected population of type 1 diabetic patients. This study involved a retrospective clinical survey of 195 consecutive patients using a questionnaire addressing the frequency of SH (i.e., help from others required) and hypoglycemic coma during the previous year, general characteristics, behavior, hypoglycemia awareness, and the Hypoglycemia Fear Survey Data regarding diabetes, treatment, long-term complications, comorbidity, and comedication were obtained from the patients' medical records. A total of 82% of subjects were receiving intensive insulin treatment, and mean +/- SD HbA(1c) was 7.8 +/- 1.2%. Mean duration of diabetes was 20 +/- 12 years. The occurrence of SH (including hypoglycemic coma) was 150 episodes/100 patient-years and affected 40.5% of the population. Hypoglycemic coma occurred in 19% of subjects (40 episodes/100 patient-years). SH without coma was independently related to nephropathy (odds ratio [OR] 4.8 [95% CI 1.5-15.1]), a threshold for hypoglycemic symptoms of <3 mmol/l (4.8 [1.8-12.0]), and a daily insulin dose 0.1 U/kg higher (1.3 [1.0-1.6]) (all ORs were adjusted for diabetes duration and use of comedication). Hypoglycemic coma was independently related to neuropathy (3.9 [1.5-10.4]), (nonselective) beta-blocking agents (14.9 [2.1-107.4]), and alcohol use (3.5 [1.3-9.1]) (all ORs were adjusted for diabetes duration). SH and hypoglycemic coma are common in a nonselected population with type 1 diabetes. The presence of long-term complications, a threshold for symptoms of <3 mmo/l, alcohol use, and (nonselective) beta-blockers were associated with SH during the previous year. If prospectively confirmed, these results may have consequences for clinical practice.