Significant Difference In Regards Research Articles

MP5-09 COMPARISON OF URINARY OUTCOMES IN SUTURE-LINE VERSUS NEO-ORIFICE ANASTOMOTIC TYPES IN THE STUDER NEOBLADDER

You have accessJournal of UrologyUrinary Diversion: Bladder Reconstruction, Augmentation, Substitution, Diversion1 Apr 2014MP5-09 COMPARISON OF URINARY OUTCOMES IN SUTURE-LINE VERSUS NEO-ORIFICE ANASTOMOTIC TYPES IN THE STUDER NEOBLADDER Kathryn Cunningham, Yasmin I. Bootwala, Graciela Nogueras-Gonzalez, Huong Truong, Clay Pendleton, and O. Lenaine Westney Kathryn CunninghamKathryn Cunningham More articles by this author , Yasmin I. BootwalaYasmin I. Bootwala More articles by this author , Graciela Nogueras-GonzalezGraciela Nogueras-Gonzalez More articles by this author , Huong TruongHuong Truong More articles by this author , Clay PendletonClay Pendleton More articles by this author , and O. Lenaine WestneyO. Lenaine Westney More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.392AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Studer and other investigators have postulated the negative effect of the “funnel-shaped” outlet resulting from utilizing the inferior aspect of the anterior neobladder wall closure for the urethral anastomosis. This technique has been linked to dysfunctional voiding. We aimed to compare the functional results of the two anastomotic types, the “funnel-shaped” or suture line and the neo-orifice technique. METHODS We reviewed the records of patients who underwent a Studer ileal neobladder reconstruction from 1/1/2000 to 5/30/2012 at our institution. In addition to demographic information, the charts were evaluated for anastomotic leak on post-operative cystogram, urinary incontinence (day and/or night), urinary retention and subsequent procedures to correct incontinence or outlet obstruction. Incontinence was defined as any leakage between regularly scheduled voids. RESULTS 363 of 465 patients met the inclusion criteria of follow-up greater than 6 months. The majority were male, 90.6% (n=329), with a mean age at cystectomy of 59.7 years. Mean follow up was 49 months (range, 6.1 - 138.7). Urethral anastomotic technique was divided between suture line and neo-orifice, 47% and 53%, respectively. Any urinary incontinence was identified in 41.8% of patients at last follow up, with 20.3% reporting daytime incontinence and 39.2% complaining of nighttime incontinence. Surgical intervention for urinary incontinence was performed on 23 patients (6.4%) including artificial urethral sphincter (15), male sling (4), ileal conduit/catheterizable diversion (3), and transurethral injection (1). There was no significant difference in regards to urinary incontinence, day or night, with respect to anastomotic type (p=.241) [RR= 1.158 , 95% CI .908 - 1.476]. Urinary retention occurred in 16% of patients, with surgical intervention required in 3.3%. No significant difference was seen in this outcome in regard to type of anastomosis (p=0.247) [RR=1.36, 95%CI .845 - 2.195]. Suture line anastomoses were more likely to have a leak identified on cystogram (24.1 vs. 15.2%, p=0.033, RR=1.59, 95% CI: 1.036 - 2.430). CONCLUSIONS Our data showed no significant difference in urinary functional outcomes – incontinence and retention - when comparing these two anastomotic types. However, the suture-line technique was shown to have a higher risk of anastomotic leak. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e85 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Kathryn Cunningham More articles by this author Yasmin I. Bootwala More articles by this author Graciela Nogueras-Gonzalez More articles by this author Huong Truong More articles by this author Clay Pendleton More articles by this author O. Lenaine Westney More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Correlation between iron stores and QTc dispersion in chronic ambulatory peritoneal dialysis patients

Aim: We aimed to investigate the QT dispersion and corrected QT (QTc) dispersion which are suggested as the signals of ventricular arrhythmias, in patients on maintenance CAPD and to evaluate the correlation between iron stores and these electrocardiographic parameters. Materials and method: Fifty-eight patients on maintenance CAPD and 19 healthy age- and sex-matched adults without cardiac disease were included. The PD patients were divided into two groups according to whether their computerized measurements of QTc dispersion were longer than 65 ms. Results: Although QT interval was statistically significantly shorter in control group (34 ± 28 vs. 43 ± 34 ms; p < 0.05), there was no significant difference in regards to the QTc, QT dispersion and QTc dispersion between two groups. PD patients with QTc dispersion longer than 65 ms had higher levels of serum ferritin (p = 0.038) and transferrin saturation (TSAT; p = 0.022) than the others. QTc dispersion were positively correlated with ferritin (r = 0.469, p < 0.01) and TSAT (r = 0.430, p < 0.01) in CAPD patients. Conclusion: Although prolonged QTc, QT dispersion and QTc dispersion were suggested as the markers of ventricular arrhythmias we did not find any significant difference in regards to these parameters between control patients and CAPD patients. But the high body iron stores in these patients increase the risk of increased QT dispersion. The concern over iron overload in dialysis patients is not only because of its oxidative toxicity, but also its precipitation of arrhythmias, which may be measured by the surrogate marker of QTc dispersion.

Photodynamic therapy for unresectable cholangiocarcinoma: contribution of single operator cholangioscopy for targeted treatment

Photodynamic therapy (PDT) for unresectable cholangiocarcinoma is associated with improvement in cholestasis and survival. Single operator cholangioscopy (SOC) has been used for targeted laser illumination. We analyzed our growing experience of SOC with direct PDT. This is a retrospective analysis of a consecutive series of patients prospectively entered into a registry. Forty-five patients (24 male, aged 67.3 ± 10.6 years) were treated with PDT for cholangiocarcinoma during a five-year period. Thirty-two patients were treated with ERCP and PDT alone, and 13 were treated with ERCP and PDT using SOC. The two groups were then compared to observe any statistically significant difference in regards to age, gender, serum bilirubin, MELD score, adverse effects, or survival. An overall median of 1 PDT session per patient (range: 1-9) was performed. Twenty-six total sessions of PDT using SOC were performed in 13 patients with a median of 2.0 sessions per patient (range: 1-6). Median global survival was 168 days (range: 26-1353). Median survival for the PDT-only group was 200 days, and median survival for the PDT-with-SOC group was 386 days (p = 0.45). There was a statistically significant difference (p < 0.0001) between the two groups in regards to fluoroscopy time, with the PDT-only group having a median time of 21.1 min and the PDT-with-SOC group having a median time of 11.1 min. PDT related complications included 7 cases of mild phototoxicity and one case of moderate phototoxicity requiring hospitalization. SOC permits targeted therapy during PDT and can be successfully performed without adverse events while simultaneously reducing exposure to radiation.

Pancreaticogastrostomy for High‐risk Gland After Pancreaticoduodenectomy: An Eligible Choice? Letter to the Editor

We read with interest the paper published by Dr. Niedergethmann and colleagues [1]. In this study, through ‘‘riskadapted pancreatic anastomosis,’’ the rate of pancreatic fistula (PF) after pancreaticoduodenectomy (PD) has been reduced. We give the authors particular credit for controlling the many variables involved in the performance of a pancreaticojejunostomy (PJ) or pancreaticogastrostomy (PG) and congratulate the authors on their work. In this study, PG revealed a PF rate of 7% and PJ accounted for 19% of PF. Patients with high-risk glands received perioperative octreotide until postoperative day 5 and a high dose of pantoprazole. Patients with standard anastomosis received neither octreotide nor high-dose pantoprazole. A meta-analysis of seven identified randomized controlled trials reporting comparisons between the octreotide group and without octreotide group, perioperative octreotide is associated with a significant reduction in the incidence of PF after elective pancreatic surgery [2]. My first question is whether a lower rate of PF after patients receiving PG was conducted by octreotide and pantoprazole. During January 2004 to December 2006, the rate of PF after patients receiving duct-to-mucosa PJ was 22%, but patients receiving duct-to-mucosa PJ showed a lower rate of PF (13%) during January 2007 to December 2008. I find this hard to explain only by RAP. My second question is whether it might be influenced by a learning curve of PG in your institution. A randomized, controlled trial by Bassi et al. reported a total of 151 patients with soft remnant who were randomized to receive PG or duct-to-mucosa PJ. Compared with duct-to-mucosa PJ, PG did not show any significant differences in the PF (13 vs. 16%) [3]. Another randomized, controlled trial by Bassi et al. reported 144 patients with soft residual tissue who were assigned randomly to receive a duct-to-mucosa PJ or a PJ; however, the two methods revealed no significant difference in regards to the PF (13 vs. 16%) [4]. Recently, a number of techniques of managing the soft pancreatic remnant have been studied in relation to the PF. Peng et al. have described a new technique of binding PJ after PD in their randomized, controlled trial. They reported a 0% incidence of PF, which is the lowest ever published in the literature [5]. Subsequently, in a series report, 45 consecutive patients with soft pancreas and nondilated main pancreatic duct underwent a binding PJ, and only four patients (8.9%) developed a PF [6]. An easier method reported by Hakamada et al. for performing a PJ for the soft pancreas using a fast-absorbable suture, PF was noted in 3% of the patients in the duct-to-mucosa contact method group [7]. The surgeon is an important factor for the prevention of PF. The reconstruction of pancreatic digestive continuity after PD performed with fine sutures, minimal handling, and a good blood supply is likely to yield a favorable result. Therefore, we suggested that a meticulous level of surgical skill and perioperative octreotide may be associated with a significant reduction in the incidence of PF. Y. S. Hu D. K. Feng (&) Department of Hepatobiliary Surgery, Xijing Hospital, Fourth Military Medical University, 17 Changle Western Road, Xi’an 710032, Shanxi Province, China e-mail: doukefeng2010@126.com

Targeted Busulfan and Cyclophosphamide as Compared to Busulfan and TBI as Preparative Regimens for Transplantation in Patients with Advanced MDS or Transformation to AML

Hematopoietic cell transplantation is the only curative therapy for patients with myelodysplasia (MDS). However, treatment-related toxicity and, in patients with advanced MDS (RAEB, RAEB-T) and those who have transformed to AML (tAML), post-transplant relapse continues to be problematic. We reviewed results in 128 patients with advanced MDS and tAML transplanted from HLA-identical related or unrelated donors after preparation with myeloablative conditioning regimens. Seventy-eight patients were conditioned with busulfan (Bu), prescribed dose 16 mg/kg, adjusted to achieve plasma concentrations of 800 - 900 ng/ml, plus cyclophosphamide (Cy), 2 × 60 mg/kg [tBuCy], and 50 patients were conditioned with Bu 7 mg/kg (without dose adjustment) and total body irradiation (TBI) 6 × 200 cGy given over 3 days [BuTBI]. There was no statistically significant difference in regards to overall survival, relapse-free survival (RFS), or non-relapse mortality (NRM) between the 2 regimens regardless of donor status. However, there was a trend towards higher rates of relapse (HR 1.33, P = 0.38) and lower rates of NRM (HR 0.61, P = 0.09) in patients conditioned with tBuCy. The increased rate of relapse seen with tBuCy was significant when restricted to only those patients with a diagnosis of RAEB (HR 4.50, P = 0.02). Patients given BuTBI had a higher incidence of GvHD; however, the incidence of GvHD regardless of grade did not differ significantly between patients who relapsed and those who did not. Thus, in patients with advanced MDS/tAML, the use of a less toxic conditioning regimen resulted in a non-significant overall gain in RFS largely due to lower rates of NRM. New concepts of conditioning regimens are needed which reduce toxicity without increasing the risk of relapse.

Role of omeprazole in prevention and treatment of postendoscopic variceal sclerotherapy esophageal complications

Endoscopic variceal sclerotherapy-related esophageal complications are quite common. The potential efficacy of omeprazole in the prevention and treatment of postsclerotherapy esophageal complications was evaluated in 47 patients with portal hypertension in randomized, placebo-controlled study. Twenty-one patients in the omeprazole group and 23 patients in the placebo group completed the study. The two treatment groups were similar in regards to the etiology of portal hypertension, Child's class, and clinical characteristics. Esophageal ulcers developed in 16 patients in the omeprazole group (2.43 ulcers/patient) and 18 patients in the placebo group (2.39 ulcers/patient). Most of the ulcers (> 90%) healed within 14 days in each group. Esophageal strictures requiring dilatation developed in two and one patient in the omeprazole and placebo groups, respectively. There was no statistically significant difference in regards to the complication rate between the two groups. We conclude that omeprazole is not effective for the prevention or treatment of postsclerotherapy esophageal complications.