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Background
Incisional hernia is a frequent complication in abdominal surgery. This article describes the development of a prospective randomized clinical trial designed to determine whether watchful waiting is an acceptable alternative to surgical repair for patients with oligosymptomatic incisional hernia.Methods/Design
This clinical multicenter trial has been designed to compare watchful waiting and surgical repair for patients with oligosymptomatic incisional hernia. Participants are randomized to watchful waiting or surgery and followed up for two years. The primary efficacy endpoint is pain/discomfort during normal activities as a result of the hernia or hernia repair two years after enrolment, as measured by the hernia-specific Surgical Pain Scales (SPS). The target sample size of six hundred thirty-six patients was calculated to detect non-inferiority of the experimental intervention (watchful waiting) in the primary endpoint. Sixteen surgical centers will take part in the study and have submitted their declaration of commitment giving the estimated number of participating patients per year. A three-person data safety monitoring board will meet annually to monitor and supervise the trial.Discussion
To date, we could find no published data on the natural course of incisional hernias. To our knowledge, watchful waiting has never been compared to standard surgical repair as a treatment option for incisional hernias. A trial to compare the outcome of the two approaches in patients with oligosymptomatic incisional hernias is urgently needed to provide data that can facilitate the choice between treatment options. If watchful waiting was equal to surgical repair, the high costs of surgical repair could be saved. The design for such a trial is described here. This multicenter trial will be funded by the German Research Foundation (DFG). The ethics committee of the Charité has approved the study protocol. Approval has been obtained from ten study sites at time of this submission. The electronic Case Report Forms have been created. The first patient was to be randomized November 14th, 2011. An initiation meeting took place in Berlin January 9th, 2012.Trial Registration
ClinicalTrials.gov: NCT01349400 相似文献3.
Y. Sow A. Thiam B. Fall M. Coulibali A. Sarr B. Diao P. A. Fall A. K. Ndoye M. Ba B. A. Diagne 《Andrologie》2012,22(2):102-107
Objective
Describe the clinical and therapeutic aspects of penile cancer in Senegal.Patients and methods
We conducted a retrospective study that looked at records of patients followed for penile cancer in the urology service of the Aristide Le Dantec hospital between January 2000 and December 2011.Results
Eight patients of mean age of 51.5, with extremes of 27 and 77 have been identified. They were all circumcised in childhood. Clinical examination had highlighted ulcerated and burgeoning tumor affecting glans and a part of the penis in five cases; in two cases, it concerned the entire penis, while one case was limited to the glans. Patients were thus classified according cT3 (three cases) and cT1 (one case). The histological type of the tumour was, in all patients, squamous cell carcinoma. There was no secondary location in the thoracic-flow-pelvic scanner. Therapeutically, a partial penectomy was conducted in five cases, a total penectomy with ganglionic flushing in one case. Two patients refused surgical treatment. There was no recurrence in five patients who underwent a partial amputation of the penis. Overall survival was therefore of 83.3 for surgical patients.Conclusion
cancer of the penis is rare in Senegal. The support is delicate because of late diagnosis associated with advanced lesions, hence the importance of awareness of the population. 相似文献4.
Yaya Sow Babacar Diao Papa Ahmed Fall Alain Khassim Ndoye Honoré Berthe Boubacar Fall Paul Banderembako Baye Assane Diagne 《Andrologie》2007,17(3):236-240
Purpose
To assess the clinical features and describe treatment difficulties associated with glandular amputation during circumcision in our daily urological practice in Senegal and to warn about the risks of this procedure, which remain underestimated in this country.Patients and Methods
The authors report a retrospective series of 19 patients who suffered glandular amputation during circumcision and who were admitted to their urology unit. The medical charts of patients hospitalised during this period were studied.Results
The mean age of these patients was 7.6 years. 84.2% of patients presented with complete glandular amputation. The mean time to consultation was 17.6 months generally in a context of urinary tract complications. Surgical treatment consisted of meatoplasty in 68.4% of cases. Four cases were treated by glandular reimplantation which unfortunately failed.Conclusion
The severity of this complication and the difficulties of management in our regions must encourage prevention. 相似文献5.
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A. Dekou P. -G. Konan E. Gowe C. Vodi B. Kouame A. Fofana G. -A. Ouegnin K. Manzan 《Andrologie》2011,21(4):247-253
Objective
To present the various types of surgical reconstruction of Fournier’s gangrene and their outcome.Patients and methods
It is a retrospective study conducted on 14 patients with Fournier’s gangrene treated at the Urology Department of Teaching Hospital of Cocody (Abidjan-Côte d’Ivoire) between January 2000 and June 2009.Results
The mean age of the patients was 39 years (range: 20–67 years). All the patients were black and presented infectious symptoms, which were treated by hydroelectrolytic reanimation and ant biotherapy. The lesions reached down all the penis and the scrotum in 64.29% of the cases (N = 9) and on the scrotum and perinea in 35.71% of the cases (N = 5). The lesions require extensive debridement and local bandages. All of the patients were cured (100%). In three patients (21.43%), the lesions with bandages only to tiny scrotum lesions healed spontaneously. In nine patients (64.29%), it got healed after debridement suture without tension of the scrotum skin, and in the two patients (14,28%), the one with wide wound of penis, scotum and perinea, then the other with penile skin loss, were healed after skin graft taken with inner face of the thigh.Conclusion
Fourniers gangrene still remains a severe disease. Management of this gangrene requires a multidisciplinary approach. The plastic surgical reconstruction restores an adequate environment to penis and scrotum, which does not compromise the quality of the sexual relations and the reproductive function of the testicles, especially in young men. 相似文献7.
Background
Risk sharing schemes represent an innovative and important approach to the problems of rationing and achieving cost-effectiveness in high cost or controversial health interventions. This study aimed to assess the feasibility of risk sharing schemes, looking at long term clinical outcomes, to determine the price at which high cost treatments would be acceptable to the NHS.Methods
This case study of the first NHS risk sharing scheme, a long term prospective cohort study of beta interferon and glatiramer acetate in multiple sclerosis (MS) patients in 71 specialist MS centres in UK NHS hospitals, recruited adults with relapsing forms of MS, meeting Association of British Neurologists (ABN) criteria for disease modifying therapy. Outcome measures were: success of recruitment and follow up over the first three years, analysis of baseline and initial follow up data and the prospect of estimating the long term cost-effectiveness of these treatments.Results
Centres consented 5560 patients. Of the 4240 patients who had been in the study for a least one year, annual review data were available for 3730 (88.0%). Of the patients who had been in the study for at least two years and three years, subsequent annual review data were available for 2055 (78.5%) and 265 (71.8%) patients respectively. Baseline characteristics and a small but statistically significant progression of disease were similar to those reported in previous pivotal studies.Conclusion
Successful recruitment, follow up and early data analysis suggest that risk sharing schemes should be able to deliver their objectives. However, important issues of analysis, and political and commercial conflicts of interest still need to be addressed. 相似文献8.
S. A. M. Said R. L. G. Nijhuis J. W. op den Akker G. P. Kimman K. G. Van Houwelingen D. Gerrits A. B. Huisman R. H. J. A. Slart D. M. Nicastia E. M. Koomen A. C. Tans N. Y. Y. Al-Windy U. Sonker T. Slagboom A. C. B. Pronk 《Netherlands heart journal》2011,19(4):183-191
Background
Coronary artery fistulas (CAFs) are infrequent anomalies, coincidentally detected during coronary angiography (CAG).Aim
To elucidate the currently used diagnostic imaging modalities and applied therapeutic approaches.Materials and Methods
Five Dutch patients were found to have CAFs. A total of 170 reviewed subjects were subdivided into two comparable groups of 85 each, treated with either percutaneous ‘therapeutic’ embolisation (PTE group) or surgical ligation (SL group).Results
In our series, the fistulas were visualised with several diagnostic imaging tests using echocardiography, multidetector computed tomography, and CAG. Four fistulas were unilateral and one was bilateral; five originated from the left and one originated from the right coronary artery. Among the reviewed subjects, high success rates were found in both treatment groups (SL: 97% and PTE: 93%). Associated congenital or acquired cardiovascular disorders were frequently present in the SL group (23%). Bilateral fistulas were present in 11% of the SL group versus 1% of the PTE group. The fistula was ligated surgically in one and abolished percutaneously in another. Medical treatment including metoprolol was conducted in two, and watchful waiting follow-up was performed in one.Conclusions
Several diagnostic imaging techniques are available for assessment of the anatomical and functional characteristics of CAFs. 相似文献9.
L. Niang I. Thiam M. Ndoye A. Ouattara Y. Magloire M. Jalloh I. Labou S. M. Gueye 《Andrologie》2012,22(4):263-267
Objectives
To describe the epidemiological, clinical and therapeutic characteristics of penile fracture in the department of Urology-Andrology of h?pital général de Grand Yoff, Dakar, Sénégal.Materials and methods
We reviewed the medical records of cases of penile fracture managed at the h?pital général de Grand Yoff from January 2001 to December 2011. The data of interest were: age at diagnosis, geographic origin, clinical presentation, surgical findings, treatment and outcomes.Results
In ten years, 25 cases of penile fracture were found with an average of 2,5 cases per year and patients mean age of 36 years with 22 and 60 years as extremes. The circumstances of occurrence were mainly forced manipulation (52%) and coitus (32%). Pain associated with penile curvature, swelling localized to the penis or extending to the pubis or the perineum were the major clinical findings. A prompt emergency (mean time for providing care was 2 hours ranging from 45 minuts to 2 days) surgical explorationwith suture of the albuginea of the corpus cavernosum was the treatment in all cases.Conclusion
Penile fracture is a relatively uncommon urological emergency in our setting. The diagnosis is easy, mostly based on clinical examination. A prompt and appropriate surgical management is the key to cosmetic and functional outcomes. 相似文献10.
Abel A Nathan Viswanathan Mohan Subash S Babu Soumi Bairagi Madhulika Dixit 《BMC endocrine disorders》2011,11(1):1-8
Background
Patients with acute myocardial infarction and newly detected abnormal glucose regulation have been shown to have a less favourable prognosis compared to patients with normal glucose regulation. The importance and timing of oral glucose tolerance testing (OGTT) in patients with acute myocardial infarction without known diabetes is uncertain. The aim of the present study was to evaluate the impact of abnormal glucose regulation classified by an OGTT in-hospital and at three-month follow-up on clinical outcome in patients with acute ST elevation myocardial infarction (STEMI) without known diabetes.Methods
Patients (n = 224, age 58 years) with a primary percutanous coronary intervention (PCI) treated STEMI were followed for clinical events (all-cause mortality, non-fatal myocardial re-infarction, recurrent ischemia causing hospital admission, and stroke). The patients were classified by a standardised 75 g OGTT at two time points, first, at a median time of 16.5 hours after hospital admission, then at three-month follow-up. Based on the OGTT results, the patients were categorised according to the WHO criteria and the term abnormal glucose regulation was defined as the sum of impaired fasting glucose, impaired glucose tolerance and type 2-diabetes.Results
The number of patients diagnosed with abnormal glucose regulation in-hospital and at three-month was 105 (47%) and 50 (25%), respectively. During the follow up time of (median) 33 (27, 39) months, 58 (25.9%) patients experienced a new clinical event. There were six deaths, 15 non-fatal re-infarction, 33 recurrent ischemia, and four strokes. Kaplan-Meier analysis of survival free of composite end-points showed similar results in patients with abnormal and normal glucose regulation, both when classified in-hospital (p = 0.4) and re-classified three months later (p = 0.3).Conclusions
Patients with a primary PCI treated STEMI, without previously known diabetes, appear to have an excellent long-term prognosis, independent of the glucometabolic state classified by an OGTT in-hospital or at three-month follow-up.Trial registration
The trial is registered at http://www.clinicaltrials.gov, NCT00926133. 相似文献11.
Purpose
to determine diagnosis and prognosis value of MRI in Peyronie’s disease.Material and Methods
thirty one penile MR examinations have been performed in 28 patients aged between 21 and 73. (1 tesla; surface coil; sagittal SET1, axial SET2 weighted, T1 before and after Gadolinium)Results
Conclusion
MRI can be helpfull in the pretreatment assessment and int he follow-up of Peyronie’s disease. 相似文献12.
B. Fall P. A. Fall B. Diao M. R. Kpatcha Y. Sow F. A. Kabore M. Ali A. K. Ndoye M. Ba B. A. Diagne 《Andrologie》2009,19(1):45-49
Objectives
To describe the epidemiological, clinical, biological and therapeutic features of Fournier’s gangrene and identify the prognostic factors.Patients and methods
We conducted a retrospective study on 102 cases of Fournier’s gangrene treated at the urology department of the university teaching hospital Aristide- Le-Dantec (Dakar) between January 2001 and December 2007.Results
The mean age of the patients was 50.0 ± 15.7 years (range: 20–93 years). The mean duration of hospital stay was 8.0 ± 7.1 days (range: 1–33 days). The lesions were located on the scrotum in 61.7% of cases, on the scrotum and penis in 17.6% of cases and on the penis alone in 3.9% of the cases. Perineal involvement was found in 14.7% of the cases. No etiologic factors (idiopathic) were found in 26 cases (25.5%) and 70 patients (68.6%) had Fournier’s gangrene secondary to urethral stricture. The most common predisposing factors were diabetes mellitus (13.7%), hypertension (5.9%), and renal failure (5.9%). Biological examination revealed that 79.4% of patients had a leukocytosis higher than 12,000/ml and the mean rate of haemoglobin was 9.8 ± 2.8 g/dl (range: 3.3–13.9 g/dl). The most common antibiotherapy associated a third generation cephalosporin, aminoside and metronidazole (46.1%). Twenty-one patients (20.6%) underwent extensive debridement only and eighty-one (79.4%) underwent extensive debridement and cystostomy. The death rate was 15.7%. Among the patients whose Fournier’s gangrene was idiopathic or secondary to urethral stricture, the statistically significant factors for a poor outcome were age, the secondary character of the gangrene, the extent of the lesions, and association with diabetes mellitus and/or hypertension.Conclusion
Fournier’s gangrene is still a frequent and lethal disease. Its good management requires a multidisciplinary approach. 相似文献13.
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Vivian E Strong Charles J Galanis Christopher C Riedl Valerie A Longo Farhad Daghighian John L Humm Steven M Larson Yuman Fong 《Annals of surgical innovation and research》2009,3(1):1-5
Background
The emergency treatment of incisional hernias is infrequent but it can be complicated with strangulation or obstruction and in some cases the surgical approach may also include an intestinal resection with the possibility of peritoneal contamination. Our study aims at reporting our experience in the emergency treatment of complicated incisional hernias.Methods
Since January 1999 till July 2008, 89 patients (55 males and 34 females) were treated for complicated incisional hernias in emergency. The patients were divided in two groups: Group I consisting of 33 patients that were treated with prosthesis apposition and Group II, consisting of 56 patients that were treated by performing a direct abdominal wall muscles suture.Results
All the patients underwent a 6-month follow up; we noticed 9 recurrences (9/56, 16%) in the patients treated with direct abdominal wall muscles suture and 1 recurrence (1/33, 3%) in the group of patients treated with the prosthesis apposition.Conclusions
According to our experience, the emergency treatment of complicated incisional hernias through prosthesis apposition is always feasible and ensures less post-operative complications (16% vs 21,2%) and recurrences (3% vs 16%) compared to the patients treated with direct muscular suture. 相似文献15.
Stephanie Blindenbach Jisca W. F. A. Vrancken Hans van der Zeijden Herre J. Reesink Folkert Brijker Martin Smalbrugge Elizabeth M. Wattel 《Tijdschrift voor gerontologie en geriatrie》2017,48(3):112-120
Introduction
Frail COPD patients are frequently not accepted for regular pulmonary rehabilitation programs due to low physical condition and functional limitations. Rehabilitation programs in nursing homes for geriatric patients with COPD have been developed. The effects of such programs are largely unknown.Aims
To assess the course of COPD-related hospital admissions and exercise tolerance in a cohort of frail COPD patients participating in geriatric COPD rehabilitation.Methods
Retrospective observational study with a follow up of 12 months after discharge from rehabilitation. COPD related hospital admission days were measured in the year before and after participating rehabilitation. Exercise tolerance was measured by the six minute walk test (6MWT) at admission and at discharge from rehabilitation.Results
Fifty-eight participants accomplished the rehabilitation program. Twelve patients died in the first year after discharge. The median number of hospital admission days in the year before participating rehabilitation was 21 (IQR 10–33). The first year after discharge this was decreased to a median of 6 (IQR 0–12). The 6MWT increased from 194 (SD 85) meters at admission to 274 (SD 95) meters at discharge (mean difference 80 m, SD 72; p < 0.05).Conclusions
Geriatric COPD rehabilitation in a nursing home setting seems to reduce hospital admissions in frail COPD patients and to increase exercise tolerance.16.
M. A. Alma S. F. Van der Mei W. N. Feitsma J. W. Groothoff T. G. Van Tilburg T. P. B. M. Suurmeijer 《Tijdschrift voor gerontologie en geriatrie》2013,44(3):132-142
Objectives
To describe the degree of loneliness among the visually impaired elderly and to make a comparison with a matched reference group of the normally sighted elderly. In addition, we examined self-management abilities (SMAs) as determinants of loneliness among the visually impaired elderly.Methods
In a cross-sectional study, 173 visually impaired elderly persons completed telephone interviews. Loneliness and SMAs were assessed with the Loneliness Scale of De Jong Gierveld and the SMAS-30, respectively.Results
The prevalence of loneliness among the visually impaired elderly was higher compared to the reference group (50% vs 29%; p?<?.001). Multivariate hierarchical regression analysis showed that the SMA self-efficacy, partner status, and self-esteem were determinants of loneliness. Severity and duration of visual impairment had no effect on loneliness.Discussion
The relationship between SMAs (i.e., self-efficacy) and loneliness is promising, since SMAs can be learned through training. Consequently, self-management training may reduce feelings of loneliness. An adapted version of this paper was published in Journal of Aging and Health, doi:10.1177/0898264311399758 相似文献17.
Mourad Hadj Slimen Hammadi Fakhfakh Mohamed Gassara Sofiane Kechaou Ali Bahloul Mohamed Nabil Mhiri 《Andrologie》2008,18(4):264-273
Introduction
Priapism is a prolonged, painful and persistent erection, unrelated to sexual stimulation. The management of priapism is complex and requires various medical or surgical treatments. The authors review the aetiology, treatment and outcome of priapism.Material and methods
26 cases of low-flow priapism were collected over a period of 23 years (1985–2007), corresponding to 22 adults and 4 children (average age: 32 years) with various types of priapism. The time to appropriate management after onset of priapism varied according to the aetiology and the time to consultation (range: 16 hours to 15 days).Results
Complete and persistent detumescence for the first 24 hours was obtained in 84% of cases, sometimes with multiple successive procedures. No case of early recurrence was observed. 21 patients were regularly followed for a period of 3 months to 10 years (mean follow-up: 2 years). There were 9 (42.9%) successes (recovery of normal erectile function), 4 partial results (19%) and 9 (30.1%) failures (complete erectile dysfunction).Conclusion
Low-flow priapism must be considered to be a serious andrological emergency. Medical treatment can be effective in early forms, but surgery must not be delayed to prevent permanent erectile dysfunction secondary to extensive corpora cavernosa fibrosis. 相似文献18.
Renata Hillenbrand Andreas Hillenbrand Florian Liewald Julian Zimmermann 《BMC cardiovascular disorders》2008,8(1):1-6
Background
Hyperhomocysteinemia has been identified as a potential risk for atherosclerotic disease in epidemiologic studies. This study investigates the impact of elevated serum homocysteine on restenosis after carotid endarterectomy (CEA).Methods
In a retrospective study, we compared fasting plasma homocysteine levels of 51 patients who developed restenosis during an eight year period after CEA with 45 patients who did not develop restenosis. Restenosis was defined as at least 50% stenosis and was assessed by applying a routine duplex scan follow up investigation. Patients with restenosis were divided into a group with early restenosis (between 3 and 18 months postoperative, a total of 39 patients) and late restenosis (19 and more months; a total of 12 patients).Results
The groups were controlled for age, sex, and risk factors such as diabetes, nicotine abuse, weight, hypertension, and hyperlipidemia. Patients with restenosis had a significant lower mean homocysteine level (9.11 μmol/L; range: 3.23 μmol/L to 26.49 μmol/L) compared to patients without restenosis (11.01 μmol/L; range: 5.09 μmol/L to 23.29 μmol/L; p = 0.03). Mean homocysteine level in patients with early restenosis was 8.88 μmol/L (range: 3.23–26.49 μmol/L) and 9.86 μmol/L (range 4.44–19.06 μmol/L) in late restenosis (p = 0.50).Conclusion
The finding suggests that high plasma homocysteine concentrations do not play a significant role in the development of restenosis following CEA. 相似文献19.
Objective
The goal of this study is the evaluation of the functionnal results and the complications of this type of surgery. Such questions have been poorly discussed in the literature.Methods
We report our experience on 80 inflatable prostheses that were implanted between october 1987 and october 1994. The mean follow-up is 3 years and the assessment of the objective (mechanical functioning of the prosthesis and complications) and sujective results (sexuality of the patients) is carried out on 68 patients.Results
The results are the following:20.
Sheung-Tak Cheng Rosanna WL Lau Emily PM Mak Natalie SS Ng Linda CW Lam Helene H Fung Julian CL Lai Timothy Kwok Diana TF Lee 《Trials》2012,13(1):1-10