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PubMedDate not supplied

Influence of posture change on intrarenal arterial resistive index measurement.

BACKGROUND: We investigated the influence of posture change on intrarenal arterial resistive index measurement in 80 subjects (38 male, 42 female). METHODS: Three interlobar arteries in the superior, middle, and inferior parts of the right kidney in each subject were examined by color Doppler ultrasound in two different positions (left lateral decubitus and supine). Based on the movement of the kidney caused by posture change, 23 subjects were classified as having a highly mobile kidney (group I) and the other 57 subjects were classified as not having a highly mobile kidney (group II). RESULTS: Fifty-eight kidneys (72.5%), 19 in group I (82.6%) and 39 in group II (68.4%), showed higher resistive index values in the lateral decubitus position than in the supine position. The influence of posture change on resistive index measurement was significant ( p < 0.001 for all subjects, p < 0.01 for group I, p < 0.05 for group II). The ranges of resistive index differences caused by posture change were 0-0.13 for group I and 0-0.11 for group II. The difference in resistive index caused by posture change was not significant between groups. CONCLUSION: Posture change is a potential confounding factor for intrarenal resistive index measurement.

Adult↗
PubMed1999

3D MR gastrography: exoscopic and endoscopic analysis of the stomach.

The aim of this study was to evaluate the feasibility of MR gastrography, based on 3D MRI following the oral administration of Gd-DOTA-enriched blueberry juice, in order to depict alterations of the gastric wall. The stomachs of three volunteers and three patients were examined on a 1.5-T MR system. Following ingestion of 400 ml of blueberry juice spiked with 2 ml of Gd-DOTA, each subject underwent 3D MR imaging in three positions: 45 degrees left lateral decubitus, supine, and 45 degrees right lateral decubitus. In each position, a coronal 3D SPGR acquisition consisting of 60 continuous 2-mm slices was acquired over a 35-s breathhold (TR/TE = 4.0/1.8 ms, 40 degrees flip angle, 0.5 excitations, voxel size of 1.25 x 1.66 x 2.00 mm). Multiplanar reformats (MPR), maximum intensity projections (MIP), surface shaded displays (SSD), and virtual intraluminal endoscopic views (VIE) were calculated. Magnetic resonance gastroscopy was tolerated well by all subjects without adverse effects. Based on the 3D MRI data sets acquired in various patient positions, all regions of the stomach and the proximal duodenum were visualized to good advantage. Whereas MPR and MIP provided a morphologic overview, SSD and VIE images permitted analysis of the gastric mucosa. Normal mucosa could be differentiated from the course and irregular pattern characterizing carcinomatous infiltration. The 3D SPGR data sets acquired following ingestion of oral Gd-DOTA-spiked blueberry juice permits exoscopic and virtual endoscopic viewing of the stomach.

Adult↗
PubMed2002

Technical standardization of laparoscopic splenectomy: experience with 105 cases.

BACKGROUND: Some reports have suggested that laparoscopic splenectomy (LS) can be successfully performed in adults. However, several aspects of this procedure remain as yet undefined; therefore, several attempts have been made to modify the standard technique to try to optimize the procedure. Herein we analyze our experience with 105 laparoscopic splenectomies. METHODS: From 1993 to 2000, 105 patients underwent LS at our hospital. Twelve of these patients also underwent a concomitant cholecystectomy. There were 66 women and 39 men whose ages ranged between 4 and 78 years (median, 27.7). All patients underwent an elective laparoscopic splenectomy. Seventy five patients had thrombocytopenia (ITP), 14 had hereditary spherocytosis, eight were affected by b-thalassemia, two had splenic cysts, two had lymphoma, (two had myeloid chronic leukemia, one patient presented with a splenic abscess and one had incurred an iatrogenic spleen lesion during adrenalectomy. The first patients in this series were positioned in dorsal decubitus; however, as the team's experience increased, the right lateral decubitus became the position of choice because it provides better exposure of the splenic hilum. This procedure requires the use of only four trocars. RESULTS: Mean operating time was 95 min (range, 35-320). Hospital stay ranged from 2 to 21 days (median, 4.5). There was only one conversion to open surgery. One patient died in the postoperative period due to the evolution of a preexisting malignant disease. We recorded nine complications-four subphrenic abscesses, two cases of pleuritis, two episodes of postoperative bleeding, and one intestinal infarction 16 days after surgery. Only two patients needed redo surgery. CONCLUSIONS: We believe that the laparoscopic approach is a valid alternative to open splenectomy, but mastery of some of the technical details of this procedure could greatly help avoid its complications. On the basis of our experience, it seems that the lateral approach should be considered the position of choice because it provides exposure and easier dissection of the splenic hilar structures. We also found that a 30 degrees scope and an ultrasonic dissector allowed for perfect vision and optimal hemostasis during the procedure. At the end of procedure, the spleen should be fragmented and then extracted using an extraction bag.

Adolescent↗
PubMed1996

Laparoscopic bilateral adrenalectomy following failed hypophysectomy.

BACKGROUND: Laparoscopic adrenalectomy has recently been shown to be a safe and effective means of treating adrenal pathology with much lower morbidity than the traditional approach. The majority of reports in the literature involve removal of adrenal tumors. Although open bilateral adrenalectomy has been utilized for persistent Cushing's syndrome following attempted hypophysectomy, there is little data available describing the application of laparoscopic adrenal surgery to this problem. METHODS: Four patients with persistent Cushing's syndrome after attempted treatment with hypophysectomy underwent laparoscopic bilateral adrenalectomy at our institution. One procedure was done transabdominally in the supine position. Three procedures were done transabdominally using sequential lateral decubitus positions. RESULTS: All procedures were completed laparoscopically. The mean operative time was 4.6 h (range 3.9-5.25). Repositioning and reprepping the patients resulted in a slight increase in operative time, but visualization was improved using the lateral decubitus position. Average blood loss: 156 cc (range 50-300). One patient required early reoperation for bleeding from the left adrenal bed, which was controlled laparoscopically. Three patients were eating the following day and were discharged on postoperative days 1, 2, and 5. The fourth patient remained hospitalized for 18 days due to problems unrelated to surgery. After a mean follow-up of 10 months, all patients have done well and have no clinical or biochemical evidence of recurrent disease. CONCLUSION: Our clinical experience indicates that laparoscopic bilateral adrenalectomy is a viable treatment option for Cushing's syndrome following failed hypophysectomy.

Adrenalectomy↗
PubMed1999

Laparoscopic adrenalectomy. A review of 30 initial cases.

BACKGROUND: Laparoscopic adrenalectomy is a good option for removal of the adrenal gland that is becoming preferred over the conventional open technique. METHODS: We reviewed the initial 30 laparoscopic adrenalectomies (in 27 patients) that were performed at our institution from 1995 to 1998. We used the lateral decubitus transperitoneal approach in 26 cases and the retroperitoneal approach in only one case. The indications for adrenalectomy were Conn's adenoma in eight patients, pheochromocytoma in six, Cushing's syndrome in five, nonfunctional adenomas in seven, and metastasis in one case. RESULTS: Only two patients (7%) were converted to laparotomy. Operating time ranged from 75 to 240 min. Average adrenal gland size was 6.1 cm (range, 4-9 cm). There was no mortality, and morbidity occurred in only two patients (8%)-one case of self-limited gastrointestinal bleeding and one case of hypercapnia and subcutaneous emphysema (in the only patient operated by the retroperitonal approach). Mean hospital stay was 3 days (range, 1-6). CONCLUSIONS: Laparoscopic adrenalectomy is a safe and useful procedure for nearly all adrenal pathologies. Lateral decubitus transperitoneal approach is the procedure of choice in most cases.

Adenoma↗
PubMed1998

Aerobic and anaerobic infection associated with malignancy.

The goal of this work was to study the microbiology and clinical characteristics of patients with infections associated with malignancy treated over a period of 17 years. A total of 668 specimens were obtained from 605 patients. The malignancies include 224 hematological malignancies and 381 nonhematogenic malignancies. Anaerobic bacteria only were isolated in 201 (30%) specimens, aerobic bacteria in 226 (34%), mixed aerobic-anaerobic bacteria in 231 (35%) and Candida spp. in 10 (1%). A total of 683 anaerobic (1.0 isolates per specimens) and 592 aerobic or facultative (0.9 per specimen) organisms were recovered. The predominant anaerobic bacteria included Bacteroides fragilis group isolates (181), Peptostreptococcus spp. (166), Prevotella spp. (106), Clostridium spp. (70), and Fusobacterium spp. (43). The predominant aerobic bacteria included Escherichia coli (133), Staphylococcus aureus (100), Klebsiella pneumoniae (48), and Pseudomonas aeroginosa (45). The type of infections included abscesses (221), bacteremia (198), wounds (175), including 61 cellulitis, 24 post-surgical wounds and 23 decubitus ulcers), peritonitis (48), empyema (12), cholecystitis (6) and thrombophlebitis (5). S. aureus and Peptostreptococcus spp. were isolated from all sites. However, organisms of the oropharyngeal flora (Prevotella and Fusobacterium spp.) predominated in local infections and bacteremia that originated from this site (head and neck wounds and abscesses and pulmonary infections), and organisms of the gastrointestinal tract flora predominated in infections that originated from this site (peritonitis, abdominal abscesses and decubitus ulcers). This retrospective study demonstrates polymicrobial features of many infections associated with malignancies.

Adolescent↗
PubMed2000

Effects of sevoflurane compared with those of isoflurane on arterial oxygenation and hemodynamics during one-lung ventilation.

PURPOSE: This study was designed to compare the effects of sevoflurane and isoflurane on Pao(2) and hemodynamic variables during one-lung ventilation (OLV) in surgical patients. METHODS: Twelve patients undergoing an esophageal procedure with thoracotomy for which a long period of OLV was required were studied using a randomized crossover design. Group 1 received 1.2% isoflurane from the induction of anesthesia until 30 min after starting OLV, and then received 1.7% sevoflurane during the remaining period. In group 2, the order of the anesthetics was reversed. All experimental procedures were performed in the left lateral decubitus position with the chest opened. Arterial and mixed venous blood gases and cardiac outputs were analyzed immediately before OLV, during OLV, and after resumption of two-lung ventilation (TLV). RESULTS: OLV produced lower PaO(2) and higher venous admixture (Q(s)/Q(t)) values than TLV. However, there was no significant difference between sevoflurane and isoflurane in PaO(2) or Q(s)/Q(t) during OLV. Other hemodynamic variables except for PVO(2) showed no significant differences between the anesthetics. CONCLUSION: The effects of sevoflurane on PaO(2) and the hemodynamic variables were similar to those of isoflurane during TLV and OLV in the lateral decubitus position.

Clinical Trial↗
PubMed2004

Intermittent pneumatic compression is effective in preventing symptomatic pulmonary embolism after thoracic surgery.

PURPOSE: Postoperative pulmonary embolism (PE) remains a fatal complication even in thoracic surgery. We have used intermittent pneumatic compression for the prophylaxis of postoperative PE since 1998, and herein examined its effectiveness. METHODS: Seven hundred and six patients, whose medical records showed use/no use of pneumatic compression for prophylaxis of PE, underwent general thoracic surgery in our department from December 1995 to December 2000. Their clinical records were reviewed, and variables were compared between patients who experienced clinically apparent PE and patients who did not have PE. RESULTS: Three hundred and forty-four patients did not receive any prophylactic treatment, and 7 of these (2.0%) experienced postoperative PE. Three hundred and sixty-two patients received prophylactic pneumatic compression and none of these developed PE. There was a statistical correlation between the occurrence of PE and the application of pneumatic compression (Chi(2)-test, P = 0.006). Six of the seven patients with PE were operated on in the right decubitus position, and the operative position and the prevalence of PE was also significantly correlated (Chi(2)-test, P = 0.024). Other factors, such as age, sex, operative time, duration until patients became fully ambulatory, body mass index, and character of the disease, did not have significant correlation with the occurrence of PE. CONCLUSIONS: Pneumatic compression was found to effectively prevent postoperative PE. The right decubitus position is considered to be a risk factor for the development of postoperative PE in thoracic surgery.

Aged↗
PubMed1985

Diagnostic strategies in osteomyelitis.

Technetium-99 (99Tc) pyrophosphate bone scanning often identifies patients with osteomyelitis before roentgenographic findings appear. However, recent studies have shown that 99Tc bone scanning often gives false-negative results, especially in neonates. The accuracy of computed tomographic scanning and indium-111 leukocyte scanning for diagnosis of early osteomyelitis has not been established. 99Tc bone scanning often gives false-positive results in patients with other conditions leading to bone injury and repair, such as trauma or recent surgery, further limiting the usefulness of this imaging procedure. Newer imaging techniques have not been adequately evaluated to establish their specificity. Because of their high cost and unproved accuracy, these new imaging procedures should not be routinely applied until their usefulness has been established. Bone biopsy remains the procedure of choice for establishing the diagnosis in patients suspected clinically to have osteomyelitis with negative findings on roentgenography and 99Tc bone scanning. Although Staphylococcus aureus is the leading cause of osteomyelitis, other pathogens cause 30 to 40 percent of cases. Aspiration or biopsy of the involved bone is usually required to choose appropriate antibiotic therapy. Bone biopsy is essential in chronic osteomyelitis, since cultures of sinus drainage are unreliable. Osteomyelitis in diabetics with foot infection and in association with decubitus ulcers presents special problems. Radionuclide scanning often give false-positive results in these patients. Proper diagnosis usually requires careful assessment of clinical and roentgenographic findings. Although bone biopsy seems useful in diagnosing osteomyelitis underlying decubitus ulcers, its role in diabetic patients with foot infections is not established. I do not recommend biopsy of foot bones in diabetic patients, since culture of bone biopsy specimens often give unreliable results in these situations because of contamination with ulcer organisms.

Acute Disease↗
PubMed1991

The bedside assessment of splenic enlargement.

STUDY OBJECTIVE: To evaluate the clinical assessment of splenic enlargement using specific bedside maneuvers including Traube's space percussion, the splenic percussion sign, Middleton's maneuver, supine palpation, and right lateral decubitus palpation. DESIGN: Quasi-experimental prospective study of cases and controls selected according to the results of abdominal ultrasonographic examinations. SETTING: Selected inpatients of a tertiary care hospital. MAIN RESULTS: Comparing the areas under the receiver operating characteristic curves for each bedside maneuver demonstrated that Traube's space percussion and palpation were significant discriminators (p less than 0.001) of splenic enlargement with respective areas of 0.70 +/- 0.04 and 0.76 +/- 0.04. No one palpation maneuver was superior to another, and right lateral decubitus palpation was not useful when performed after supine palpation. The splenic percussion sign (sensitivity 79%, specificity 46%) was no better than Traube's space percussion (sensitivity 62% and specificity 72%) in assessing splenic enlargement. The palpation maneuvers appeared more sensitive and more specific than Traube's space percussion. Palpation was a significant clinical discriminator when performed on patients who exhibited percussion dullness of Traube's space (area = 0.87 +/- 0.04, p less than 0.0001) but was of little value among those without percussion dullness (area = 0.55 +/- 0.08). Also, palpation was significantly more accurate when performed on lean patients versus obese patients (areas = 0.83 +/- 0.04 versus 0.65 +/- 0.08, p less than 0.05). When a positive bedside examination was defined as positive palpation and positive percussion (concordant-positive), the combined test sensitivity and specificity were 46% and 97% respectively. CONCLUSIONS: The optimal clinical assessment of splenic enlargement includes the percussion of Traube's space. If Traube's space is dull, palpation of the spleen is warranted. This assessment is most accurate in lean patients.

Adult↗
PubMed1986

Adrenergic receptors in insensitive skin of spinal cord injured patients.

The factors responsible for the increased susceptibility to decubitus ulcers of the insensitive skin of spinal cord injury (SCI) patients are not known. Autonomic dysfunction leading to defective vascularity is a possibility. SCI removes cerebral control of the isolated nervous system which may mimic denervation hypersensitivity of autonomic neural synapses, where an increase in number and a scattering of the receptors on the postsynaptic membrane leads to abnormal responses. Since adrenergic receptors mediate vascular tone and regulate blood flow in the skin, it would be of great interest to determine whether the number and the concentration of receptors in the insensitive skin of SCI patients is modified as a function of time since injury. To achieve this aim, alpha and beta adrenergic receptors were measured in biopsies obtained from intact skin used to surgically repair decubitus ulcers in SCI patients admitted to The Institute for Rehabilitation and Research. Receptors were identified by competitive radioligand-binding assays in whole skin homogenates. Patients were divided into two groups: patients injured less than five years ("early") and patients injured more than five years ("late"). Alpha and beta adrenergic receptors in both cervical and thoracic SCI patients decreased in density in the "late" patients. The small sample size and the inherent large errors of the assay precluded achievement of statistically significant differences. Nevertheless, a definite trend is seen: Disconnection of the adrenergic neurons from brain integration may mimic denervation and lead to abnormal vascular responses in the insensitive skin.

Adult↗
PubMed1980

Single-exhalation method for study of lobar and segmental lung function by mass spectrometry in man.

A single-exhalation method, based on a modification of the conventional single-breath technique, was applied to study lung function in normal subjects during fiberoptic bronchoscopy. After a single inspiration of a test gas mixture (1% He, 1% C2H2, 0.07% C18O in air), the test gas concentrations were continuously monitored during subsequent slow exhalation, using a respiratory mass spectrometer that sampled either at the lips (Whole-lung test) or, through the bronchoscope, at various sites within the bronchial tree (Regional test). Changes in concentrations of the test gases with time allowed estimation of alveolar ventilation (Va), blood flow (Q), and diffusing capacity (DLCO), per unit accessible lung volume (Va). In the Whole-lung test, both DLCO and Q agreed closely with values obtained in the same subject by a rebreathing method. No differences were observed between the upright and the lateral decubitus positions. In teh Regional test, VA/VA, DLCO/VA and Q/VA were larger in the dependent than in the upper lung, when sampling was from the main bronchi in the lateral decubitus positions. Sampling from lobar bronchi in the upright position revealed an increase from top to bottom in VA/VA, DLCO/CA and Q/VA, this being most marked for Q. These results are compatible with the regional variations that have been shown by radioactive techniques and have been attributed to gravitational forces. The method appears to be suitable for the study of lobar and segmental lung function in patients with lung disease.

Bronchoscopy↗
PubMed1984

Effect of posture on inter-regional distribution of pulmonary ventilation in man.

Regional ventilation per unit alveolar volume (V/VA) and regional lung expansion (FRCR/TLCR) were measured in twelve normal male human subjects in seated, supine, lateral decubitus and prone postures using a gamma camera and inhalation of the radioactive gases 81Krm (half-life 13 sec) and 85Krm (half-life 4.4 h). FRCR/TLCR decreased from superior to inferior in all postures except prone where it was uniform; V/VA increased from superior to inferior except in the prone position where it was uniform. In the horizontal axis FRCR/TLCR and V/VA were uniformly distributed except for cranial to caudal gradients (with lower values caudally) in supine and lateral decubitus postures. In the prone posture V/VA tended to be higher in caudal lung zones.

Adult↗
PubMed1982

Precise positioning of patients for radiation therapy.

We have developed a number of immobilization schemes which permit precise daily positioning of patients for radiation therapy. Pretreatment and post-treatment radiographs have been taken with the patient in the treatment position and analyzed to determine the amount of intratreatment movement. Studies of patients in the supine, seated and decubitus positions indicate mean movements of less than 1 mm with a standard deviation of less than 1mm. Patients immobilized in the seated position with a bite block and a mask have a mean movement of about 0.5 mm +/- 0.3 mm (s.d.), and patients immobilized in the supine position with their necks hyperextended for submental therapy evidence a mean movement of about 1.4 mm +/- 0.9 mm (s.d.). With the exception of those used for the decubitus position, the immobilization devices are simply fabricated out of thermoplastic casting materials readily available from orthopedic supply houses. A study of day-to-day reproducibility of patient position using laser alignment and pretreatment radiographs for final verification of position indicates that the initial laser alignment can be used to position a patient within 2.2 mm +/- 1.4 mm (s.d.) of the intended position. These results indicate that rigid immobilization devices can improve the precision of radiotherapy, which would be advantageous with respect to both tumor and normal tissue coverage in certain situations.

Casts, Surgical↗
PubMed1995

Effect of body position on gas exchange in patients with unilateral pleural effusion: influence of effusion volume.

The objective of this study was to evaluate the effect of lateral body position on gas exchange in patients with unilateral pleural effusion, with special reference to the influence of effusion volume. Thirty consecutive patients with unilateral pleural effusion, without evidence of parenchymal pulmonary involvement, were entered into the study. Arterial blood gas tensions (PaO2, PaCO2) were randomly measured in both right and left lateral decubitus body positions, while breathing room air. To assess the influence of the effusion volume, roentgenographic and functional parameters were used. Among the latter, FVC, FEV1, TLC and RV were determined. The influence of the presence or absence of pleuritic pain on gas exchange was also assessed. There was no significant difference in PaCO2 between right and left lateral decubitus body positions (31.1 +/- 4.2 vs. 31.0 +/- 4.5 mmHg). The differences in PaO2 between the two body positions ranged from 0.5-25 mmHg (mean 9.3 +/- 6.6 mmHg). Mean PaO2 with the normal-side (control) down (PaO2-N) (81.4 +/- 8.5 mmHg) was higher, but without significant statistical difference, than mean PaO2 with the effusion-side down (PaO2-E) (78.0 +/- 12.5 mmHg). PaO2-N was higher than PaO2-E in 22 of 30 patients (conventional), and lower in eight patients (paradoxical). No consistent relationship was found for alterations in PaO2 in different positions with the volume of effusion, either when estimated by a roentgenographic method or when using spirometric or plethysmographic values.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed2006

Time efficiency of CT colonography: 2D vs 3D visualization.

We aimed to compare the time efficiency of three visualization methods in CT colonography and to identify the colonic factors influencing the time for interpretation. Twenty CT colonographic examinations were prospectively analysed. Three reading methods were adopted: method 1, primary 2D analysis with the use of virtual endoscopy as problem solver, method 2, primary standard virtual endoscopy with semiautomatic navigation through the colon and use of 2D images as problem solver; method 3, primary virtual endoscopy with automatic navigation and the use of 2D images as problem solver. In method 1, time for 2D analysis ranged between 6 and 18min (mean 12) for evaluation of both supine and prone decubitus with a synchronization method. In method 2, time for 3D manual navigation in supine plus prone ranged between 9 and 24min (mean 17). In method 3, time for automated navigation ranged between 6 and 20min (mean 12) for evaluation of both supine and prone decubitus. A statistically significant difference was found between time efficiency of methods 1 and 2 (p=0.009, t-test, unequal variances). Methods 2 and 3 showed a tendency to significant differences (p=0.054, t-test, unequal variances). Faecal or fluid residuals were reported as major drawbacks in 3D navigations, requiring constant correlation with 2D images; tortuous folds influenced mostly the 2D analysis; diverticula were reported as influencing factor in all three methods. No differences in sensitivity and specificity were observed between the three viewing methods. The 3D semiautomatic navigation method* tended to increase the time for interpretation in almost all cases. There is, in particular, greatest time efficiency for 2D analysis as compared with 3D manual analysis. Two-dimensional and automated 3D navigation reading have comparable time efficiencies in a routine clinical setting.

Colonography, Computed Tomographic↗
PubMed2007

Staging rectourinary fistulas to guide surgical treatment.

PURPOSE: Surgical management for rectourinary fistulas remains a reconstructive challenge. There are few guidelines to direct the surgeon to the most successful and least morbid technique. We developed a rectourinary fistula staging system that allows selection of the most appropriate technique for the patient. We present the details of the staging system and surgical outcomes. MATERIALS AND METHODS: From July 1999 to July 2005 we treated 14 male patients with rectourinary fistula. Mean patient age was 68 years (range 62 to 73). Etiology was rectal injury during open radical prostatectomy in 5 patients, laparoscopic prostatectomy in 1, radiation induced fistula for prostate cancer treatment (brachytherapy and external beam radiation therapy) in 2, neoadjuvant external beam radiation therapy in 2, ischial decubitus ulcer in 3 with spinal cord injury, and cryotherapy and external beam radiation therapy in 1. Cases were staged as stage I--low (less than 4 cm from anal verge and nonirradiated), stage II--high (more than 4 cm from anal verge and nonirradiated), stage III--small (less than 2 cm irradiated fistula), stage IV--large (more than 2 cm irradiated fistula) and stage V--large (ischial decubitus fistula). Diverting colostomy was performed for stages III to V 6 weeks before definitive therapy. RESULTS: Patients were discharged home after 48 hours. A 22Fr urethral catheter maintained bladder drainage for 3 weeks until cystogram confirmed rectourinary fistula closure. Complications were superficial wound infection and postoperative reexploration of the gracilis flap due to bleeding in 1 case each. All patients were cured after a single operation. CONCLUSIONS: The surgical challenges of a variety of rectourinary fistula repairs can be managed with minimal morbidity and a high success rate using proper staging to guide urinary tract reconstruction.

Aged↗
PubMed1997

Impaired blood flow response following pressure load in diabetic patients with cardiac autonomic neuropathy.

OBJECTIVE: An impaired blood flow response is associated with an increased risk of developing decubitus ulcers. This study investigated whether diabetic patients with autonomic neuropathy show an impaired blood flow response following pressure load, compared with healthy controls. DESIGN: Before-after trial. SETTING: University hospital. PATIENTS: Eighteen patients with type I diabetes and autonomic neuropathy, and 15 healthy volunteers. RESULTS: The blood flow response starts with a latency period, followed by a temperature increase (described by the "time constant"). The blood flow response in both groups showed significant (p < .01) differences. In diabetic patients, the latency time was 312 +/- 221 sec, the time constant was 339 +/- 149 sec, and the recovery time was 538 +/- 184 sec. In controls, latency time was 83 +/- 47 sec, time constant was 79 +/- 69 sec, and recovery time was 162 +/- 103 sec. The velocity of the blood flow response decreased with increasing duration of diabetes mellitus (p = .02). CONCLUSIONS: Diabetic patients with autonomic neuropathy show an impaired blood flow response after pressure relief. This finding suggests that these patients have an increased risk of developing decubitus ulcers.

Adult↗