Five‐Year Follow‐up After Sacral Neuromodulation: Single Center Experience

Objective. We studied long‐term clinical efficacy of sacral neuromodulation (SNM) therapy in patients with refractory urgency incontinence (UI), urgency/frequency (UF) and voiding difficulty (VD), together with urodynamic data at baseline and six   months postimplant. Materials and Methods. Twenty‐two patients were implanted with a neurostimulator after a positive response to a percutaneous nerve evaluation test defined as a greater than 50% improvement in symptoms. Results. At five‐year follow‐up, the number of incontinent episodes and pad usage per day decreased significantly in 10 out of 15 UI patients. Two of five UF patients were successfully treated with SNM; the number of daily voids for all UF patients decreased from 25 to 19 and average voided volume increased from 98 to 212 mL. One of the two VD patients was able to void to completion. Mean first sensation of filling at the six‐month urodynamic investigation for the UI and UF patients increased from 78 to 241 mL and 141 to 232 mL, respectively, and the maximum bladder capacity increased from 292 to 352 mL and 223 to 318 mL, respectively. Five of 22 patients underwent device explant and one patient still has an inactive stimulator implanted. Conclusion. SNM is an effective treatment modality that offers sustained clinical benefit in the majority of patients with refractory UI, UF, and VD that do not respond to other, more conservative therapies.     

Role of ventricular assist devices in the German heart allocation system

The Eurotransplant (ET) allocation algorithm, newly implemented in 2000, gives priority for heart transplantation (HTx) to patients with high urgency (HU) status, but now this status is rescinded upon ventricular assist device (VAD) implantation and only regained if severe complications occur during mechanical circulatory support (MCS). We studied the effects of this change on the patients in our institute who were waiting for HTx with MCS. The median duration of MCS until HTx in adult patients gradually increased from 3.1 months in 1994, reaching a peak of 16.7 months in 2000, and then gradually decreased to 6.0 months in 2003. Among the patients with VAD implantation as a bridge to HTx, two patients were on MCS for more than 1 year (the longest duration of MCS being 1.6 years) at the end of 1999, and this figure increased to nine patients and a maximum MCS duration of 3.7 years at the end of 2003. These data imply that the patients in whom a complication occurred in the early phase of MCS and who had overcome this complication underwent HTx early with HU status, and those who were stable during MCS waited a long time for HTx. Furthermore, the number of patients in the latter group is increasing. The new allocation algorithm imposes on patients with MCS waiting for HTx who are relatively young and free from complications and serious coexisting disease, very long-term MCS without an end to VAD bridging, which is almost equivalent to destination therapy. Part of this paper was presented at the 42nd JSAO Conference (Tokyo, October 5–7, 2004)     

Epidemiology of hypertensive crisis in the Buea Regional Hospital,Cameroon

Hypertensive crisis (HC) includes hypertensive urgency (HU) and hypertensive emergency (HE). There is scarcity of data on the epidemiology of patients presenting with HC in Cameroon. The aim of this study was to determine the prevalence, clinical characteristics, and outcome of HU and HE. We conducted a cross‐sectional study from June 2018 until June 2019. The criteria to define a hypertensive crisis were systolic and/or diastolic blood pressure ≥180/110 mm Hg. We compared HU vs HE. Out of the 1536 patients admitted, 95(6.2%) had a HC. There were 49(51.6%) men and 56 (58.9%) had a HE. The mean age was 51.1 ± 14.9 years. A history of hypertension was found in 75.3% of the patients but only 24.2% were on treatment. 33.7% consumed alcohol and 24.2% had chronic kidney disease. Headache (34.7%), dyspnea (34.7%), and neurological deficit (23.2%) were the most common symptoms. Patients with HE had higher systolic and diastolic blood pressures though the difference was not significant. The most frequent forms of HE were acute left ventricular failure with pulmonary edema (44.6%), intracerebral hemorrhage (21.4%), and cerebral infarction (16.1%). The most commonly prescribed medication was labetalol (44.2%). Mean length of hospital stay was 8.4 days. Patients with HE had a longer hospital stay (9.8 vs 6.3 days, P < .001). In‐hospital case fatality was 6.3%. Hypertensive crisis accounted for 6.2% of admissions in the medical unit with HE being more common than HU. Acute left ventricular failure with pulmonary edema and stroke were the most frequent target organ lesions in HE.     

Study of the Rectal Electric Activity of the Uninhibited Rectal Detrusor (Overactive Rectum): A New Concept of Pathogenesis

Abstract

Background/Objective: One of the causes of fecal incontinence is uninhibited rectal detrusor syndrome (URDS). Patients with this condition either perceived the first rectal sensation after the onset of involuntary rectal contraction or not at all. We investigated the hypothesis that the abnormal rectal contractility in URDS may be caused by deranged rectal electric activity.

Methods: Twenty-five patients with URD (14 women and 11 men; age, 44.7 ± 10.3 years) and 10 healthy volunteers (6 women and 4 men; age, 42.8 ± 8.7 years) were studied. URDS was diagnosed by rectometry and provocative test. A transcutaneous EMG was performed with one electrode placed lateral to each sacroiliac joint and the third one midway between the greater trochanter and the ischial tuberosity. Two 20- minute recording sessions were performed for each subject.

Results: Slow waves (SWs) with regular rhythm and similar parameters (frequency, amplitude, conduction velocity) from the 3 electrodes were recorded from the healthy volunteers. They showed a significant increase in the parameters on saline filling of the rectum. The SWs of patients with URDS exhibited a “dysrhythmic” pattern with irregular parameters, which were different in the 3 electrodes and inconsistent during recording. They showed areas of tachyrhythmia, bradyrhythmia, and arrhythmia. On provoking rectal overactivity, the SWs showed an increased dysrhythmic activity.

Conclusions: The patients with URD exhibited a “dysrhythmic” electric pattern with areas of variable electric activity. The tachyrhythmic areas seem to initiate the urgency and fecal incontinence of URDS. It is suggested that a disordered rectosigmoid pacemaker causes the dysrhythmic waves.     

索利那新和奥昔布宁治疗老年经尿道前列腺电切术后膀胱痉挛的比较研究

目的比较索利那新和奥昔布宁治疗老年经尿道前列腺电切术后膀胱痉挛的临床疗效。方法选取2016年2月—2017年2月在儋州市人民医院治疗的老年经尿道前列腺电切术后膀胱痉挛患者90例,按照治疗方法的不同分为对照组(45例)和治疗组(45例)。对照组口服盐酸奥昔布宁片,5 mg/次,2次/d。治疗组口服琥珀酸索利那新片,5 mg/次,2次/d。所有患者均在拔出尿管后3 d停药。评价两组患者临床疗效,同时比较治疗前后两组患者膀胱痉挛次数和持续时间,尿频和尿急次数,OABSS和PPBC评分。结果治疗后,对照组和治疗组总有效率分别为82.22%、97.78%,两组比较差异具有统计学意义(P0.05)。治疗2、3 d后,治疗组膀胱痉挛次数和持续时间均明显少于对照组(P0.05)。治疗1、3 d后,治疗组患者尿频、尿急次数均显著少于对照组(P0.05)。治疗后,两组OABSS和PPBC评分均明显下降(P0.05);且治疗组患者OABSS和PPBC评分明显低于对照组(P0.05)。结论索利那新治疗老年经尿道前列腺电切术后膀胱痉挛效果显著,可有效改善患者临床症状,具有一定的临床推广应用价值。     

萆薢分清丸联合头孢唑肟钠治疗尿路感染的临床研究

目的探讨萆薢分清丸联合头孢唑肟钠治疗尿路感染的临床疗效。方法选取2015年11月—2017年1月在上海市宝山区中西医结合医院进行治疗的尿路感染患者200例,随机分为对照组(100例)和治疗组(100例)。对照组患者静脉滴注注射用头孢唑肟钠,2 g/次,2次/d。治疗组在对照组的基础上口服萆薢分清丸,6 g/次,2次/d。两组患者均连续治疗7 d。观察两组患者临床效果,比较两组患者治疗前后临床症状改善时间和血清细胞因子水平。结果治疗后,对照组和治疗组临床有效率分别为83.00%和97.00%,两组比较差异具有统计学意义(P0.05)。治疗后,治疗组患者尿频、尿急和尿痛改善时间比对照组显著缩短,两组比较差异具有统计学意义(P0.05)。治疗后,两组患者血清降钙素原(PCT)、C反应蛋白(CRP)和白细胞介素-6(IL-6)水平均显著降低,同组比较差异具有统计学意义(P0.05);且治疗组患者的细胞因子水平明显低于对照组,两组比较差异具有统计学意义(P0.05)。结论萆薢分清丸联合头孢唑肟钠可有效改善尿路感染患者临床症状,降低机体PCT水平,具有一定的临床推广应用价值。