- LigasureTM hemorrhoidectomy: how we do. [Journal Article]
- MGMinerva Gastroenterol Dietol 2016 Oct 21
- CONCLUSIONS: If technical guidelines are respected rigorously and the device is applied correctly, feared late complications, such as impaired faecal continence, anal stricture and post operative pain can be minimized.
- Postoperative urinary retention in patients undergoing elective spinal surgery. [Journal Article]
- JNJ Neurosurg Spine 2016 Oct 21; :1-6
- OBJECTIVE Postoperative urinary retention (POUR) is a common problem leading to morbidity and an increased hospital stay. There are limited data regarding its baseline incidence in patients undergoin...
OBJECTIVE Postoperative urinary retention (POUR) is a common problem leading to morbidity and an increased hospital stay. There are limited data regarding its baseline incidence in patients undergoing spinal surgery and the risk factors with which it may be associated. The purpose of this study was to evaluate the incidence of POUR in elective spine surgery patients and determine the factors associated with its occurrence. METHODS The authors retrospectively reviewed the records of patients who had undergone elective spine surgery and had been prospectively monitored for POUR during an 18-month period. Collected data included operative positioning, surgery duration, volume of intraoperative fluid, length of hospital stay, and patient characteristics such as age, sex, and medical comorbidities. Dialysis patients or those with complete urinary retention preoperatively were excluded from analysis. RESULTS Of the 397 patients meeting the study inclusion criteria, 35 (8.8%) developed POUR. An increased incidence of POUR was noted in those who underwent posterior lumbar surgery, those with benign prostatic hypertrophy (BPH), those with chronic constipation or prior urinary retention, and those using a patient-controlled analgesia pump postoperatively. An increased incidence of POUR was seen with a longer operative time but not with intraoperative intravenous fluid administration. A significant relationship between the female sex and POUR was noted after controlling for BPH, yet there was no association between POUR and diabetes or intraoperative instrumentation. Postoperative retention significantly prolonged the hospital stay. Three patients developed epidural hematomas necessitating operative reexploration, and while they experienced POUR, they also developed the full constellation of cauda equina syndrome. CONCLUSIONS Awareness of the risk factors for POUR may be useful in perioperative Foley catheter management and in identifying patients who need particular vigilance when they are due to void postprocedure. A greater understanding of POUR may also prevent longer hospital stays in select at-risk patients. Postoperative retention is rarely caused by a postoperative cauda equina syndrome due to epidural hematoma, which is also associated with saddle anesthesia, leg pain, and weakness, yet the delineation of isolated POUR from this urgent complication is necessary for optimal patient care.
- An unusual cystic presentation of ductal carcinoma of the prostate. [Journal Article]
- UUrologia 2016 Jun 8; :0
- A 74-year-old male came to our clinic for rectal tenesmus, lower urinary tract symptoms and a previous episode of acute retention of urine. Computed tomography (CT) and magnetic resonance imaging (MR...
A 74-year-old male came to our clinic for rectal tenesmus, lower urinary tract symptoms and a previous episode of acute retention of urine. Computed tomography (CT) and magnetic resonance imaging (MRI) scan of abdomen showed a multiloculated, cystic formation of 12 cm in the pelvic cavity to the left, with compression of the prostate, bladder, sigmoid and rectum, and its extension imprinted the back of the pubis and back bladder. Saturation prostate biopsy was negative for carcinoma. The histology of transurethral resection of bladder formation revealed flogistic tissue. Cistoprostatectomy and ureteroileal pouch with Wallace anastomosis, removal of the rectum and colostomy with Hartmann pouch were performed. The histopatology showed a ductal carcinoma of the prostate.
- Urinary Analysis of Fluid Retention in the General Population: A Cross-Sectional Study. [Journal Article]
- PlosPLoS One 2016; 11(10):e0164152
- CONCLUSIONS: Fluid retention consistent with moderate dehydration is common in healthy staff working in a Swedish hospital.
- Escitalopram-Associated Acute Urinary Retention in Elderly Men With Known or Latent Benign Prostatic Hyperplasia: A Case Series. [Journal Article]
- CNClin Neuropharmacol 2016 Oct 18
- Lower urinary tract outflow dysfunction is frequent in older men and a potential cause of serious complications such as acute urinary retention (AUR). Drug-induced AUR has only rarely been reported w...
Lower urinary tract outflow dysfunction is frequent in older men and a potential cause of serious complications such as acute urinary retention (AUR). Drug-induced AUR has only rarely been reported with selective serotonin reuptake inhibitors including escitalopram; reported cases had no history of urinary outflow dysfunction. We herein report the development of AUR after the introduction of escitalopram at a standard dose in 3 male patients with previously diagnosed or unknown/latent and nonsymptomatic benign prostatic hyperplasia. Urinary retention receded after escitalopram discontinuation in 2 cases but led to emergent prostatectomy in the third. This case series highlights escitalopram's potential association with AUR in elderly men with known or latent benign prostatic hyperplasia. Further studies are warranted to investigate whether compromised or marginal urinary outflow should be considered a contraindication for treatment with escitalopram.
- Levetiracetam (Keppra), urinary retention and literature search. [Journal Article]
- NJNeth J Med 2016; 74(8):371
- Endometrial stromal sarcoma: An aggressive uterine malignancy. [Journal Article]
- JRJ Radiol Case Rep 2016; 10(9):35-43
- Endometrial stromal sarcoma (ESS) is an aggressive uterine sarcoma. We report a case of a large endometrial stromal sarcoma in a 42 year nulliparous woman with chronic kidney disease presenting with ...
Endometrial stromal sarcoma (ESS) is an aggressive uterine sarcoma. We report a case of a large endometrial stromal sarcoma in a 42 year nulliparous woman with chronic kidney disease presenting with acute urinary retention and irregular per vaginal bleeding. Ultrasound and Doppler imaging revealed a heterogeneous mass in the endometrial cavity with internal vascularity. Magnetic resonance imaging (MRI) revealed a large lobulated mass in the endometrial cavity extending into the vagina, causing local mass effect. Multiple linear hypointense bands on magnetic resonance T2 weighted (T2wt) images were characteristic of ESS. MRI is a very useful imaging modality in characterizing the lesion and also for the staging. It is necessary to distinguish these tumors from benign as well as other uterine malignancies for better management. We also review relevant literature discussing imaging findings of ESS.
- Urinary retention. [Journal Article]
- NONurs Older People 2010 Sep 23; 22(8):15
- Hip fracture is a significant cause of disability and mortality. Incidence of urinary retention (inability to empty the bladder completely) is high in these patients. This can cause pain and overflow...
Hip fracture is a significant cause of disability and mortality. Incidence of urinary retention (inability to empty the bladder completely) is high in these patients. This can cause pain and overflow incontinence and can lead to urine infection or pylonephritis resulting in an extended hospital stay.
- BR 08-1 HIGH SODIUM INTAKE REDUCTION IN DIABETES WITH HYPERTENSION. [Journal Article]
- JHJ Hypertens 2016; 34 Suppl 1 - ISH 2016 Abstract Book:e544
- Management of hypertension in diabetes is critical for reducing cardiovascular mortality and morbidity. Dietary approaches for controlling high blood pressure have historically focused on sodium. Thu...
Management of hypertension in diabetes is critical for reducing cardiovascular mortality and morbidity. Dietary approaches for controlling high blood pressure have historically focused on sodium. Thus, many guidelines recommend that patients with type 2 diabetes reduce high sodium intake. Nonetheless, the potential benefits of sodium reduction are debatable. The kidney has a crucial role in glucose filtration and reabsorption in addition to its regulation of fluid and electrolyte homeostasis. A key factor linking sodium uptake and glucose transport is the sodium-glucose cotransporter 2 (SGLT2) in renal proximal tubular cells. In hyperglycemic states, the renal proximal tubule raises its capacity to reabsorb glucose and sodium from the proximal tubule in response to hyperglycemia because of increased SGLT2 activity. Selective SGLT2 inhibitors improve glycemic control and slightly lower blood pressure in diabetic patients.In the past decade, activation of peroxisome proliferator-activated receptors (PPARs) has become a novel effective treatment for cardiometabolic diseases. The kidney differentially expresses all three PPAR subtypes, PPARα, PPARγ and PPARδ. Although PPARγ agonists are widely used to treat type 2 diabetes, sodium and water retention still poses a significant limitation to its clinical application. PPARδ is expressed ubiquitously, including in adipose tissues and the kidney. The activation of PPARδ alleviates dyslipidemia, hyperglycemia, and insulin resistance in rodents of obesity and diabetes. Importantly, PPARδ activation by its agonists exerts renal protective effects in diabetic mice. Furthermore, the PPARδ agonists increased adipose adiponectin expression, which are shown to exert multiple beneficial effects against cardiometabolic disorders. However, it is unknown whether PPARδ can regulate renal sodium handing and glucose transport. We hypothesized that PPARδ participates in sodium transport and glucose reabsorption in the kidney, resulting in improved sodium and glucose homeostasis. Here, we present ample evidence to reveal that adipose PPARδ activation promotes natriuresis and glycosuria in mice on high salt diet, which is associated with SGLT2 inhibition in the renal proximal tubule. Our evidence confirms that adipose PPARδ-mediated adiponectin plays a crucial role in the inhibition of renal SGLT2. We also revealed that under physiological circumstances, high sodium intake-induced natriuresis is impaired in diabetic mice because of increased SGLT2 activity. We further observe that type 2 diabetic patients with uncontrolled hyperglycemia have reduced natriuresis, and plasma adiponectin level is closely related to natriuresis in diabetic patients. Overall, the PPARδ-mediated adiponectin maintains equilibrium between urinary glucose transport and sodium reabsorption through regulation of SGLT2 in the kidney, however, this mechanism is impaired in diabetes.Diabetes and hypertension are often comorbid in patients. Both clinical trials and experimental studies imply that the excess sodium intake raises cardiometabolic risk. Type 2 diabetic patients are more susceptible to hypertension because of their increased exchangeable sodium and salt sensitivity compared with non-diabetic individuals. High sodium intake leads to insulin resistance and greater glomerular pressure, resulting in high blood pressure and albuminuria in type 2 diabetic patients. Our study shows that high sodium intake reduced body weight and fasting blood glucose level while it increased natriuresis in wild type mice. However, this effect was blunted in adipose-specific PPARδ knockout mice and also in diabetic db/db mice. Furthermore, we demonstrate that long-term high sodium intake specifically stimulates adipose PPARδ expression which is associated with elevating tissue sodium content in mice. These findings suggest that PPARδ participates in the regulation of sodium homeostasis. This effect is strikingly different from that of PPARγ agonists, thiazolidinediones that cause sodium and fluid retention.Adiponectin is a secreted protein in adipose tissue and its production is stimulated by PPARδ activation. Our study shows that high sodium intake also increased plasma adiponectin level, and its expression in both the perirenal fat and renal cortex. We also showed that adiponectin suppresses SGLT2 expression at the transcriptional level. Reducing sodium retention is a critical issue in the management of diabetic patients. Although diuretics are commonly used to reduce sodium retention, long-term diuretic treatment is associated with higher mortality in diabetic patients with hypertension. We show that renal SGLT2 dysfunction was found in diabetic db/db mice and inhibition of SGLT2 by dapagliflozin lowered natriuresis and glycosuria in these mice. Diabetic patients with uncontrolled hyperglycemia reduced natriuresis compared with well-treated patients. Furthermore, natriuresis was largely influenced by blood glucose level in diabetic patients. This finding suggests that well-controlled hyperglycemia may be more effective to alleviate sodium retention in diabetes regardless of their hypoglycemia drugs used. In addition, we reported before that telmisartan, an angiotensin II receptor blocker (ARB), reduced adipogenesis through activation of adipose PPARδ and improved insulin resistance through stimulation of PPARδ in skeletal muscle of mice (He et al., Hypertension, 2010; Li et al., Diabetes, 2013). ARB is also reported to increase plasma adiponectin level and inhibit renal SGLT2 expression in diabetic rats. Therefore, the potential benefit of ARB in the regulation of sodium and glucose homeostasis warrants further investigation.In summary, we reveal a previously unrecognized role of adipose PPARδ activation-induced natriuresis in mice. Our mechanistic study suggests that this renal benefit is associated with adiponectin-mediated inhibition of renal SGLT2. However, this pathway for maintaining appropriate sodium metabolism in response to high sodium intake is impaired in diabetes, and this defect might result in hyperglycemia-induced sodium retention. We also show that maintaining euglycemia status is a critical factor influencing natriuresis. Our findings provide insights into the physiological role of the PPARδ/adiponectin/SGLT2 pathway in the regulation of sodium and glucose homeostasis. Activation of PPARδ through promotion of adiponectin may represent a promising tool in the management of hypertensive diabetic patients who are exposed to high sodium intake.
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- OS 05-06 IN PRIMARY ALDOSTERONISM, MINERALOCORTICOIDS AND POTASSIUM INFLUENCE ABUNDANCE OF THE THIAZIDE SENSITIVE SODIUM-CHLORIDE COTRANSPORTER. [Journal Article]
- JHJ Hypertens 2016; 34 Suppl 1 - ISH 2016 Abstract Book:e59
- CONCLUSIONS: Mineralocorticoid administration causes a rapid and progressive increase in abundance and phosphorylation of NCC in humans. NCC abundance is stimulated to a greater extent than phosphorylation, possibly via stimulation of the WNK4 pathway. These effects may be driven by changes in plasma potassium.