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Techniques in Vascular and... Dec 2017Biliary and urinary obstructions can be managed endoscopically or cystoscopically, surgically or by percutansous intervention or drainage. If the obtructed system is... (Review)
Review
Biliary and urinary obstructions can be managed endoscopically or cystoscopically, surgically or by percutansous intervention or drainage. If the obtructed system is infected, emergent decompression is needed. Early recognition and treatment is paramount in both conditions. Acute cholangitis can present many different ways, from mild symptoms to fulminant sepsis. It is usually a result of ascending bacterial colonization and biliary obstruction resulting in bacterial overgrowth. Therefore, those patients with recent biliary instrumentation or previous biliary modification are at higher risk. Charcot's triad of fever, right upper quadrant abdominal pain, and jaundice is only seen in 50%-70% of patients. Fever is seen in over 90% of cases, pain is seen in 70% of cases, and jaundice is seen in 60% of cases. Altered mental status and hypotension are associated with severe cases. All 5 symptoms of fever, right upper quadrant abdominal pain, jaundice, altered mental status, and hypotension are referred to as Reynold's Pentad. Acute pyonephrosis can also present many different ways, from minimal symptoms to fulminant sepsis. Fever, chills, and flank pain are the classic symptoms, although some patients may be relatively asymptomatic. Pyonephrosis may present with a classic triad of fever, flank pain, and hydronephrosis, or simply hydronephrosis and sepsis. Pyonephrosis usually occurs as a result of urinary obstruction with either an ascending infection of the urinary tract or hematogenous spread of a bacterial pathogen as the culprit. Up to 75% of cases are related to urinary stone disease. Patients are at increased risk for pyonephrosis when they haven anatomic urinary tract obstruction, certain chronic diseases (diabetes meliitus and AIDS), or are immunosuppressed due to immunodeficiency or medications, (chronic steroid therapy).
Topics: Adolescent; Aged, 80 and over; Angiography; Cholangitis; Cholestasis; Drainage; Endovascular Procedures; Female; Humans; Jaundice, Obstructive; Kidney Calculi; Male; Nephrostomy, Percutaneous; Radiography, Interventional; Risk Factors; Treatment Outcome; Ultrasonography; Ureteral Obstruction
PubMed: 29224663
DOI: 10.1053/j.tvir.2017.10.010 -
Current Urology Reports Apr 2016The non-specific symptoms the patients express upon the presentation of female bladder outlet obstruction make it a challenge to diagnose. There are subtle differences... (Review)
Review
The non-specific symptoms the patients express upon the presentation of female bladder outlet obstruction make it a challenge to diagnose. There are subtle differences between the obstructed patient and those whose bladders are underactive and/or fail to mount a detrusor contraction. These disparities can be extracted through a thorough history and examination. At times, the clinician may utilize nomograms, non-invasive uroflow, and urodynamics with the addition of fluoroscopy to establish the diagnosis of obstruction. Management of the obstruction depends on the nature of the condition, whether functional or anatomical. The increase in the number of sling procedures performed to treat stress urinary incontinence has resulted in a rise in the number of iatrogenic obstructions. The temporal relationship between surgery and obstruction is the key to identifying the problem.
Topics: Female; Humans; Nomograms; Urinary Bladder Neck Obstruction; Urinary Incontinence, Stress; Urodynamics
PubMed: 26902625
DOI: 10.1007/s11934-016-0586-2 -
The Journal of Small Animal Practice Jun 2018Feline ureteral obstructions are an increasingly recognised and challenging diagnostic and management problem. Many cats with ureteral obstructions are critically ill at... (Review)
Review
Feline ureteral obstructions are an increasingly recognised and challenging diagnostic and management problem. Many cats with ureteral obstructions are critically ill at the time of diagnosis, especially if there is dysfunction of the contralateral kidney. They may present with varying severities of acute kidney injury, electrolyte disturbances, and may have comorbidities such as heart disease that complicate perioperative and long-term management. Medical management, which may consist of rehydration and restoration of intravascular volume with intravenous fluid therapy, osmotic diuresis, ureteral muscle relaxation, and antimicrobials for infection, is important in feline ureteral obstruction patients. Despite medical management, many cats with ureteral obstructions will require decompression of the obstructed kidney to relieve pressure-nephropathy and restore urine flow. However, some cats may be too unstable for traditional medical management and require more emergent intervention to relieve the obstruction and address the life-threatening sequelae to acute kidney injury, such as hyperkalaemia and fluid overload. Both surgical and interventional methods to address ureteral obstructions have been described in veterinary medicine, though debate continues as to the ideal approach.
Topics: Acute Kidney Injury; Animals; Cat Diseases; Cats; Fluid Therapy; Ureteral Obstruction; Urinary Calculi
PubMed: 29767451
DOI: 10.1111/jsap.12844 -
Actas Urologicas Espanolas 2002Obstructive uropathy is a result of the particular tubular configuration of the urinary tract and involves virtually all its organs. This review analyses upper urinary... (Review)
Review
Obstructive uropathy is a result of the particular tubular configuration of the urinary tract and involves virtually all its organs. This review analyses upper urinary tract obstructions as well as a number of lower urinary tract conditions whenever the circumstances of the urological disease progress so advises it. A comprehensive exposition is made of the different types of obstruction, the basic pathophysiological principles and the respective anatomical transposition. The pathophysiological features characterising intrauterine obstructions, obstructions occurring during pregnancy and in the elderly are also highlighted. Finally an updated analysis is made of the diagnostic contribution made by all techniques susceptible to be used when dealing with obstructive uropathies highlighting the prognostic relevance of early diagnosis and treatment. The hope placed in the use of modern techniques to establish a differential diagnosis of chronic obstructive uropathy is also emphasised.
Topics: Humans; Ureteral Obstruction
PubMed: 12645370
DOI: 10.1016/s0210-4806(02)74311-8 -
Sleep & Breathing = Schlaf & Atmung Mar 2022Selective hypoglossal nerve stimulation (sHNS) constitutes an effective surgical alternative for patients with obstructive sleep apnea (OSA). sHNS results in tongue...
PURPOSE
Selective hypoglossal nerve stimulation (sHNS) constitutes an effective surgical alternative for patients with obstructive sleep apnea (OSA). sHNS results in tongue protrusion and consecutive alleviation of obstructions at the tongue base level (lower obstructions). Furthermore, obstructions at the soft palate level (upper obstructions) may be prevented through palatoglossal coupling as seen on sleep endoscopy. However, it has not been studied if the distribution of obstruction level during a whole night measurement is a relevant factor for the treatment outcome.
METHODS
Obstruction levels were measured with a manometry system during a whole night of sleep in 26 patients with OSA (f = 1, m = 25; age 59.4 ± 11.3; BMI = 29.6 ± 3.6) either before (n = 9) or after sHNS implantation (n = 12). Five patients received a measurement before and after implantation. Obstructions were categorized into velar (soft palate and above), infravelar (below soft palate), and multilevel obstructions. An association between obstruction level and treatment outcome was calculated.
RESULTS
The mean distribution of preoperative obstruction level could be divided into the following: 38% velar, 46% multilevel, and 16% infravelar obstructions. Patients with a good treatment response (defined as AHI < 15/h and AHI reduction of 50%) had fewer preoperative velar obstructions compared to non-responder (17% vs. 54%, p-value = 0.006). In patients measured after sHNS implantation, a significantly higher rate of multilevel obstructions per hour was measured in non-responders (p-value = 0.012).
CONCLUSIONS
Selective hypoglossal nerve stimulation was more effective in patients with fewer obstructions at the soft palate level. Manometry may be a complementary diagnostic procedure for the selection of patients for HNS.
Topics: Adult; Aged; Electric Stimulation Therapy; Female; Humans; Hypoglossal Nerve; Male; Middle Aged; Sleep Apnea, Obstructive; Treatment Outcome
PubMed: 34091793
DOI: 10.1007/s11325-021-02396-y -
Journal of the West African College of... 2023Intestinal obstruction is a common general surgical emergency with high morbidity and mortality. Its aetiology varies widely between and within geographic regions, with...
BACKGROUND
Intestinal obstruction is a common general surgical emergency with high morbidity and mortality. Its aetiology varies widely between and within geographic regions, with gender, age, and time. Obstructed inguinal hernia is still considered the most common cause of intestinal obstruction in Sub-Saharan Africa and other low-income countries, but its incidence appears to be on the decrease as other causes of intestinal obstruction become more common in a particular society.
AIM
To examine the spectrum of causes of intestinal obstruction in a tertiary hospital in southern Nigeria and compare the results with earlier studies in the region and Nigeria.
MATERIALS AND METHODS
A cross sectional, single-hospital study of adults diagnosed with and having clinical and radiological features of acute intestinal obstruction.
RESULTS
Seventy patients were enrolled in the study, comprising of 35 (50%) males and 35 (50%) females, M:F = 1:1. The mean patient age was 44.8 years. Two peak age incidences of intestinal obstruction were observed in the 36-45 and 56-65 years age groups. Post-operative adhesion 13 (18.5%), obstructed external abdominal hernia 13 (18.5%), colonic cancer 11 (16%), and intussusception seven (10%) were the primary causes of intestinal obstruction. Obstructed inguinal hernia was commonly encountered in males while adhesions and colonic cancers were common in females.
CONCLUSION
Obstructed external abdominal hernias and post-operative adhesion are at par as the main primary causes of intestinal obstruction. Colon cancer and intussusception are increasingly causing more obstructions.
PubMed: 37538209
DOI: 10.4103/jwas.jwas_213_22 -
Seminars in Thoracic and Cardiovascular... 2009Central airway obstruction is a complex problem that requires a careful multidisciplinary evaluation. The central airways can be obstructed by intrinsic exophytic tumor,... (Review)
Review
Central airway obstruction is a complex problem that requires a careful multidisciplinary evaluation. The central airways can be obstructed by intrinsic exophytic tumor, by extrinsic mass compression or by dynamic collapse. Both benign and malignant processes can obstruct the airway lumen. This article reviews the core principles and techniques available to the interventionalist managing central airway obstruction.
Topics: Airway Obstruction; Bronchoscopy; Cryosurgery; Electrocoagulation; Humans; Trachea; Tracheal Stenosis
PubMed: 19942126
DOI: 10.1053/j.semtcvs.2009.08.002 -
Topics in Companion Animal Medicine Aug 2020Small intestinal foreign body obstructions occur commonly in dogs, accounting for 80% of all canine intestinal obstructions. Such obstructions induce local aberrations... (Review)
Review
Small intestinal foreign body obstructions occur commonly in dogs, accounting for 80% of all canine intestinal obstructions. Such obstructions induce local aberrations in secretion, absorption, and intestinal motility that can precipitate devastating systemic consequences, including a systemic inflammatory response, sepsis, and multiorgan dysfunction. Radiographic diagnosis is poorly sensitive relative to ultrasonography for diagnosing the presence of obstructive foreign material. Emergent surgical intervention is indicated for dogs with obstructive foreign material due to an inability to assess the degree of compromise of the intestinal wall that may precipitate intestinal perforation and to mitigate progression of life-threatening electrolyte and acid-base imbalances secondary to sequestration and emesis. Intraoperatively, an enterotomy or resection and anastomosis may be required to remove the obstructive material. A number of subjective and objective techniques for assessing the viability of intestinal tissue have been described due to the poor accuracy associated with surgeon assessment of color, peristalsis, pulsation, bleeding, and mural thickness alone. Such techniques have the potential to alter the surgeon's decision-making regarding performance of an enterotomy or resection and anastomosis, potentially reducing morbidity associated with intestinal surgery.
Topics: Animals; Dog Diseases; Dogs; Foreign Bodies; Intestinal Obstruction; Intestine, Small; Radiography, Abdominal; Tissue Survival; Ultrasonography
PubMed: 32690289
DOI: 10.1016/j.tcam.2020.100438 -
Current Pain and Headache Reports Jun 2001Malignant-associated bowel obstruction remains a common and perplexing problem for patients with advanced gynecologic and gastrointestinal malignancies. The ability to... (Review)
Review
Malignant-associated bowel obstruction remains a common and perplexing problem for patients with advanced gynecologic and gastrointestinal malignancies. The ability to locate and define its cause preoperatively has improved with the advent of computed tomography. Initial clinical experience with half-Fourier acquisition single-shot turbo spin-echo magnetic resonance imaging (HASTE MRI) and virtual colonoscopy is exciting. The surgical approach for primary obstructing colon cancer has become more aggressive, with experienced surgical groups doing one-stage procedures. Yet to be defined are guidelines for surgical management of obstructions occurring in the face of recurrent disease. Stent placement for upper and lower bowel obstructions is an option in nonoperable patients. Pharmacologic symptom management for intestinal obstructions consists of an opioid, an anticholinergic, and an antiemetic. Octreotide, either alone or added to the original regimen, will palliate symptoms that are resistant to the three-drug combination.
Topics: Female; Genital Neoplasms, Female; Humans; Intestinal Neoplasms; Intestinal Obstruction
PubMed: 11400696
DOI: 10.1007/s11916-001-0040-z -
Tierarztliche Praxis. Ausgabe K,... Oct 2023Odontogenic cysts may be of developmental or inflammatory origin. They are frequently observed in brachycephalic dogs. Due to their expansive growth, cysts in the...
OBJECTIVE
Odontogenic cysts may be of developmental or inflammatory origin. They are frequently observed in brachycephalic dogs. Due to their expansive growth, cysts in the maxilla may extend into the nasal cavity, obstruct the nasal airway and cause nasal discharge. Epithelial cysts may lead to a comparable clinical picture. A new endonasal endoscopic intervention for the removal of these cysts is described.
MATERIAL AND METHODS
Four brachycephalic dogs (Boxer, Chihuahua, French bulldog, Pug) with unilateral cysts obstructing the nasal cavity were included in the study. The animals underwent clinical examination, computed tomography (CT) imaging and rhinoscopy examination. Histopathologic evaluation of the cyst wall was performed. In addition to dental surgery and conventional extraction of the involved tooth, the cyst wall was removed by endoscopic intervention via the physiologic nasal opening. Clinical course following treatment was assessed by rhinoscopy and CT.
RESULTS
The main clinical signs were unilateral or bilateral serous to hemorrhagic nasal discharge. Nasal airflow was restricted in all patients. Removal of the cysts and involved teeth did not lead to any intra- and postoperative complications. No recurrence of the cysts was observed. Histologic diagnosis consisted of an epidermoid cyst, a follicular cyst, a radicular cyst, and a canine odontogenic parakeratinized cyst (COPC). Neoplastic transformation was excluded in all cases.
CONCLUSIONS
Removal of the cyst wall may be performed by means of minimally invasive endoscopic intervention via the physiologic nasal entrance. The procedure is curative and carries the risk of only few complications. In cases in which treatment is restricted to extraction of the affected tooth, the nasal airway may remain obstructed due to a calcified cyst wall.
CLINICAL RELEVANCE
In brachycephalic dogs, oronasal defects due to dental pathology are the most common reason for chronic nasal discharge, whereas in normocephalic dogs nasal neoplasia are. Odontogenic cysts carry importance as differential diagnosis of nasal discharge.
Topics: Animals; Dogs; Craniosynostoses; Dog Diseases; Endoscopy; Nasal Obstruction; Nose Neoplasms; Odontogenic Cysts
PubMed: 37956662
DOI: 10.1055/a-2157-1370