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Central European Journal of Urology 2021Unilateral renal function often deteriorates with chronic ureteric obstruction. Our objectives were to determine the change in relative renal function (RRF) by MAG3...
INTRODUCTION
Unilateral renal function often deteriorates with chronic ureteric obstruction. Our objectives were to determine the change in relative renal function (RRF) by MAG3 renography after intervention for ureteric obstruction, and to identify clinical/epidemiological factors which influence long-term outcomes.
MATERIAL AND METHODS
We identified 228 patients from 2006 to 2017 who underwent MAG3 renography before and after intervention for unilateral ureteric obstruction. Patients were grouped into categories preoperatively - with normal RRF (43-57%) through mild (29-42%), moderate (15-28%) and severe (<15%) impairment of RRF. Patient demographics, types of obstructive uropathy and intervention employed were analysed. Each group was assessed for the absolute change in RRF and change in RRF category postoperatively.
RESULTS
The mean patient age was 50.4 years (SD 16.7), and 62.3% were female. Overall, the mean pre- and post-intervention RRF of the obstructed kidney did not differ significantly (32.30% vs. 32.20%, P = 0.835). Most patients remained in their preoperative RRF group: 85.9% of normal, 67.4% of mild, 64.4% of moderate and 73.3% of patients with severe RRF impairment did not change category.Patients with mildly impaired preoperative RRF showed a significant worsening postoperatively (36.37% vs. 34.58%, P = 0.024). The other three groups showed no significant change in RRF following intervention.Multivariate logistic regression analysis showed no statistically significant association between type of intervention, age, gender or diagnosis and improvement in postoperative RRF category.
CONCLUSIONS
Our results show that RRF does not improve significantly after intervention for ureteric obstruction. The aim should therefore be to maintain existing renal function and relieve symptoms.
PubMed: 33976918
DOI: 10.5173/ceju.2021.0274.R1 -
Journal of Minimally Invasive Surgery Sep 2021Although obstructive colon cancer can often be treated with first-stage resection with primary anastomosis, the results of the oncological outcome of using stenting as a...
Although obstructive colon cancer can often be treated with first-stage resection with primary anastomosis, the results of the oncological outcome of using stenting as a bridge of surgery in the literature are still controversial. Stent insertion for obstructed cancer provides an opportunity for bowel preparation and makes preoperative work-up and clinical staging possible. However, although stenting is becoming a more frequent treatment modality, studies with a significant number of patients acting as a bridge between surgery are still lacking. In this issue of , the study by Kim et al. highlights the efficacy of stent insertion as the initial treatment and analyzed the prognostic factors in symptomatic obstructive colon cancer. The study demonstrated that emergent surgery, vascular invasion, and omitting adjuvant chemotherapy were independent poor prognostic factors in long-term oncologic outcomes suggested that stent insertion should be considered an initial treatment for symptomatic obstructive colon cancer.
PubMed: 35600108
DOI: 10.7602/jmis.2021.24.3.123 -
The Israel Medical Association Journal... May 2023Esophageal cancer is comprised of adenocarcinoma and squamous cell carcinoma and is the sixth leading cause of cancer-related mortality worldwide. Upper endoscopy may... (Review)
Review
BACKGROUND
Esophageal cancer is comprised of adenocarcinoma and squamous cell carcinoma and is the sixth leading cause of cancer-related mortality worldwide. Upper endoscopy may reveal a partially or completely lumen-occluding mass at diagnosis, yet the prognostic significance of such a presentation is not clear.
OBJECTIVES
To investigate whether endoscopic obstructing lesions have a meaning regarding patient prognosis.
METHODS
We reviewed upper gastrointestinal endoscopic studies performed over a 20-year period (2000-2020). We compared overall survival, disease stage, histologic criteria, and anatomic location of the lesions in esophagus lumen-obstructing and non-obstructing tumors. Differences between the two groups were statistically evaluated.
RESULTS
Sixty-nine patients were diagnosed with histologically confirmed esophageal cancer. As assessed through endoscopy, 32/69 (46%) patients had obstructive and 37/69 (54%) had non-obstructive cancers. Median survival was significantly shorter in the lumen-obstructing lesions compared with the non-obstructing lesions (3.5 months vs. 10 months, P = 0.001). Female median survival displayed a trend toward shorter survival compared to males (3.5 months vs. 10 months, P = 0.059). There was no statistically significant difference in the percentages of advanced, stage IV disease in the obstructive group and the non-obstructive group (11/32 [34.3%] and 14/37 [37.8%], respectively P = 0.80).
CONCLUSIONS
Obstructive esophageal cancers predict shorter median overall survival compared with non-obstructive cancers, without any correlation between obstruction of the lesion and tumor metastatic stage.
Topics: Male; Humans; Female; Retrospective Studies; Esophageal Neoplasms; Endoscopy; Carcinoma, Squamous Cell; Prognosis; Endoscopy, Gastrointestinal
PubMed: 37245096
DOI: No ID Found -
Scientific Reports Nov 2020Congenital obstructive nephropathy hinders normal kidney development. The severity and the duration of obstruction determine the compensatory growth of the...
Congenital obstructive nephropathy hinders normal kidney development. The severity and the duration of obstruction determine the compensatory growth of the contralateral, intact opposite kidney. We investigated the regulation of renal developmental genes, that are relevant in congenital anomalies of the kidney and urinary tract (CAKUT) in obstructed and contralateral (intact opposite) kidneys after unilateral ureteral obstruction (UUO) in neonatal and adult mice. Newborn and adult mice were subjected to complete UUO or sham-operation, and were sacrificed 1, 5, 12 and 19 days later. Quantitative RT-PCR was performed in obstructed, intact opposite kidneys and sham controls for Gdnf, Pax2, Six4, Six2, Dach1, Eya1, Bmp4, and Hnf-1β. Neonatal UUO induced an early and strong upregulation of all genes. In contrast, adult UUO kidneys showed a delayed and less pronounced upregulation. Intact opposite kidneys of neonatal mice revealed a strong upregulation of all developmental genes, whereas intact opposite kidneys of adult mice demonstrated only a weak response. Only neonatal mice exhibited an increase in BMP4 protein expression whereas adult kidneys strongly upregulated phosphatidylinositol 3 kinase class III, essential for compensatory hypertrophy. In conclusion, gene regulation differs in neonatal and adult mice with UUO. Repair and compensatory hypertrophy involve different genetic programs in developing and adult obstructed kidneys.
Topics: Animals; Animals, Newborn; Apoptosis; Bone Morphogenetic Protein 4; Cell Proliferation; Female; Gene Expression Regulation, Developmental; Glial Cell Line-Derived Neurotrophic Factor; Kidney; Kidney Diseases; Male; Mice; Mice, Inbred C57BL; Reverse Transcriptase Polymerase Chain Reaction; Time Factors; Up-Regulation; Ureteral Obstruction; Urinary Tract
PubMed: 33168884
DOI: 10.1038/s41598-020-76328-3 -
International Journal of Chronic... 2016COPD is a major cause of death and morbidity worldwide, and is characterized by persistent airflow obstruction. The evaluation of obstruction is critically dependent on... (Review)
Review
BACKGROUND
COPD is a major cause of death and morbidity worldwide, and is characterized by persistent airflow obstruction. The evaluation of obstruction is critically dependent on sensitive methods for lung-function testing. A wide body of knowledge has been accumulated in recent years showing that these methods have been significantly refined and seems promising for detection of early disease.
OBJECTIVES
This review focuses on research on pulmonary function analysis in COPD performed in Brazil during this century.
MATERIALS AND METHODS
The literature was searched using a systematic search strategy limited to English language studies that were carried out in Brazil from the year 2000 onward, with study objectives that included a focus on lung function.
RESULTS
After we applied our inclusion and exclusion criteria, 94 articles addressed our stated objectives. Among the new methods reviewed are the forced-oscillation technique and the nitrogen-washout test, which may provide information on small-airway abnormalities. Studies investigating the respiratory muscles and thoracoabdominal motion are also discussed, as well as studies on automatic clinical decision-support systems and complexity measurements. We also examined important gaps in the present knowledge and suggested future directions for the cited research fields.
CONCLUSION
There is clear evidence that improvements in lung-function methods allowed us to obtain new pathophysiological information, contributing to improvement in our understanding of COPD. In addition, they may also assist in the diagnosis and prevention of COPD. Further investigations using prospective and longitudinal design may be of interest to elucidate the use of these new methods in the diagnosis and prevention of COPD.
Topics: Brazil; Evidence-Based Medicine; Humans; Lung; Predictive Value of Tests; Professional Practice Gaps; Prognosis; Pulmonary Disease, Chronic Obstructive; Reproducibility of Results; Research Design; Respiratory Function Tests; Severity of Illness Index
PubMed: 27468230
DOI: 10.2147/COPD.S54328 -
International Journal of Colorectal... Oct 2023The aim of this study was to compare baseline characteristics, 90-day mortality and overall survival (OS) between patients with obstructing and non-obstructing...
PURPOSE
The aim of this study was to compare baseline characteristics, 90-day mortality and overall survival (OS) between patients with obstructing and non-obstructing right-sided colon cancer at a national level.
METHODS
All patients who underwent resection for right-sided colon cancer between January 2015 and December 2016 were selected from the Netherlands Cancer Registry and stratified for obstruction. Primary outcome was 5-year OS after excluding 90-day mortality as assessed by the Kaplan-Meier and multivariable Cox regression analysis.
RESULTS
A total of 525 patients (7%) with obstructing and 6891 patients (93%) with non-obstructing right-sided colon cancer were included. Patients with right-sided obstructing colon cancer (OCC) were older and had more often transverse tumour location, and the pathological T and N stage was more advanced than in those without obstruction (p < 0.001). The 90-day mortality in patients with right-sided OCC was higher compared to that in patients with non-obstructing colon cancer: 10% versus 3%, respectively (p < 0.001). The 5-year OS of those surviving 90 days postoperatively was 42% in patients with OCC versus 73% in patients with non-obstructing colon cancer, respectively (p < 0.001). Worse 5-year OS was found in patients with right-sided OCC for all stages. Obstruction was an independent risk factor for decreased OS in right-sided colon cancer (HR 1.79, 95% CI 1.57-2.03).
CONCLUSION
In addition to increased risk of postoperative mortality, a stage-independent worse 5-year OS after excluding 90-day mortality was found in patients with right-sided OCC compared to patients without obstruction.
Topics: Humans; Retrospective Studies; Neoplasm Staging; Colonic Neoplasms; Netherlands; Prognosis
PubMed: 37796315
DOI: 10.1007/s00384-023-04541-3 -
Endoscopy International Open Oct 2020Luminal stenting is safe, effective, and at times the preferred method for relieving gastrointestinal obstruction. However, stent placement is not technically feasible...
Luminal stenting is safe, effective, and at times the preferred method for relieving gastrointestinal obstruction. However, stent placement is not technically feasible when lesions cannot be traversed with a guidewire, resulting in the need for more invasive methods of palliation and urgent/emergent surgical intervention. In this series, we report our experience with cap-assisted stenting to improve lumen visualization in obstructed segments of the gastrointestinal tract and salvage cases that may have otherwise resulted in technical failure. A clear cap (i. e. distal attachment) was affixed to the scope tip to facilitate visualization and stenting in two cases of gastroduodenal obstruction and three cases of colonic obstruction. Indications for stent placement included malignant obstruction, diverticulitis-associated obstruction, and Crohn's disease-associated stricture. In this report, we demonstrate that use of a clear cap facilitated endoscopic stenting in challenging cases of malignant and benign gastroduodenal and colonic obstruction. A clear cap for endoscopic stenting can be used in cases in which standard techniques are unsuccessful or those anticipated to be technically difficult at the outset. Cases with tortuous anatomy or particularly tight, friable, or exophytic obstructive lesions may benefit most from this novel technical modification.
PubMed: 33015347
DOI: 10.1055/a-1229-4000 -
International Journal of Chronic... 2022Chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA) are common diseases affecting millions worldwide. These two diseases have a complex...
BACKGROUND
Chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA) are common diseases affecting millions worldwide. These two diseases have a complex relationship that is not well understood. Previous small studies suggest an inverse relationship of disease severity of OSA with COPD airflow obstruction.
OBJECTIVE
The aim of this study was to determine if a relationship exists between severity of airflow obstruction in COPD and severity of OSA via apnea hypopnea index obtained during an in-lab baseline polysomnogram using a large quaternary care center cohort.
METHODS
From November 2015 through December 2018, 273 patients with confirmed COPD via spirometry and OSA via in-lab baseline polysomnogram were included.
CONCLUSION
No associations were noted between severity of airflow obstruction in COPD and disease severity of OSA. Given the heterogeneity of these diseases, further exploration of a relationship within disease subtypes is warranted.
Topics: Humans; Lung; Polysomnography; Pulmonary Disease, Chronic Obstructive; Severity of Illness Index; Sleep Apnea, Obstructive; Spirometry; Syndrome
PubMed: 35860813
DOI: 10.2147/COPD.S355897 -
Respiratory Care Feb 2017Noninvasive ventilation (NIV) titration may be difficult when dynamic airway obstruction episodes persist, even with high expiratory positive airway pressure (EPAP). We...
BACKGROUND
Noninvasive ventilation (NIV) titration may be difficult when dynamic airway obstruction episodes persist, even with high expiratory positive airway pressure (EPAP). We aimed to determine the usefulness of videolaryngoscopy during NIV for identifying mechanisms and sites of obstruction and for providing a guide for their resolution in difficult-to-titrate subjects.
METHODS
When obstructions during NIV were present in the built-in software, EPAP was raised to 12 cm HO. If obstructions persisted, a polygraphy during NIV was performed; if the events occurred with effort, a videolaryngoscopy with nasal and oronasal masks in awake subjects was performed.
RESULTS
In a population of 208 subjects in whom NIV was initiated, 13 were identified as difficult to titrate with persistent obstructions during NIV despite an EPAP of 12 cm HO. Videolaryngoscopy during NIV was able to identify the mechanism and the site of obstruction in all cases. The obstruction under oronasal mask ventilation was due to soft-palate (velum) collapse in 4 subjects, to epiglottic backward movement in 5 other subjects, and to tongue-base obstruction reducing the retroglossal space in 3 more. Videolaryngoscopy during NIV demonstrated improvement in 9 subjects (69%) upon changing to nasal mask and suggested a possible surgical approach in 2 (15%); in one of these 2 subjects, a successful uvulopalatopharyngoplasty was performed.
CONCLUSIONS
The use of videolaryngoscopy during NIV in difficult-to-titrate patients may help to identify the sites and mechanisms of obstruction and in some cases may improve quality of ventilation.
Topics: Aged; Aged, 80 and over; Airway Obstruction; Epiglottis; Female; Humans; Laryngoscopy; Male; Masks; Middle Aged; Noninvasive Ventilation; Palate, Soft; Pressure; Tongue
PubMed: 27879384
DOI: 10.4187/respcare.04784 -
International Journal of Chronic... 2018This study was conducted in order to investigate the diversity of respiratory physiology, including the respiratory impedance and reversibility of airway obstruction,...
INTRODUCTION
This study was conducted in order to investigate the diversity of respiratory physiology, including the respiratory impedance and reversibility of airway obstruction, based on quantitative computed tomography (CT) in patients with COPD.
PATIENTS AND METHODS
Medical records of 174 stable COPD patients were retrospectively reviewed to obtain the patients' clinical data, including the pulmonary function and imaging data. According to the software-based quantification of the degree of emphysema and airway wall thickness, the patients were classified into the "normal by CT" phenotype, the airway-dominant phenotype, the emphysema-dominant phenotype, and the mixed phenotype. The pulmonary function, including the respiratory impedance evaluated by using the forced oscillation technique (FOT) and the reversibility of airway obstruction in response to inhaled short-acting β-agonists, was then compared among the four phenotypes.
RESULTS
The respiratory system resistance at 5 and 20 Hz (R5 and R20) was significantly higher, and the respiratory system reactance at 5 Hz (X5) was significantly more negative in the airway-dominant and mixed phenotypes than in the other phenotypes. The within-breath changes of X5 (ΔX5) were significantly greater in the mixed phenotype than in the "normal by CT" and emphysema-dominant phenotypes. The FOT parameters (R5, R20, and X5) were significantly correlated with indices of the degree of airway wall thickness and significantly but weakly correlated with the reversibility of airway obstruction. There was no significant correlation between the FOT parameters (R5, R20, and X5) and the degree of emphysema.
CONCLUSION
There is a diversity of respiratory physiology, including the respiratory impedance and reversibility of airway obstruction, based on quantitative CT in patients with COPD. The FOT measurements may reflect the degree of airway disease and aid in detecting airway remodeling in patients with COPD.
Topics: Adrenergic beta-2 Receptor Agonists; Aged; Airway Resistance; Electric Impedance; Female; Forced Expiratory Volume; Humans; Male; Phenotype; Pulmonary Disease, Chronic Obstructive; Pulmonary Emphysema; Respiratory Function Tests; Retrospective Studies; Tomography, X-Ray Computed; Vital Capacity
PubMed: 29892193
DOI: 10.2147/COPD.S163129