Intractable Hematuria Due to Advanced Cardiac Failure and Venous Stasis

Intractable&nbsp;&nbsp; gross&nbsp;&nbsp; hematuria&nbsp;&nbsp; without&nbsp;&nbsp; an&nbsp;&nbsp; obvious&nbsp;&nbsp; or&nbsp;&nbsp; common urologic&nbsp;&nbsp; pathology&nbsp;&nbsp; needs&nbsp;&nbsp; more&nbsp;&nbsp; effort&nbsp;&nbsp; for&nbsp;&nbsp; correct&nbsp;&nbsp; diagnosis&nbsp;&nbsp; and appropriate&nbsp; management.&nbsp; In&nbsp; this&nbsp; case,&nbsp; we&nbsp; report&nbsp; on&nbsp; a&nbsp; patient&nbsp; with intractable&nbsp; hematuria&nbsp; originating&nbsp; from&nbsp; varicose&nbsp; vessels&nbsp; of&nbsp; urinary bladder due to advanced venous stasis after severe cardiac failure.Case ReportA 66-year-old male was consulted for massive hematuria and clot retention&nbsp; subsequent&nbsp; to&nbsp; urethral&nbsp; catheterization&nbsp; after&nbsp; admission&nbsp; into intensive&nbsp; care&nbsp; unit&nbsp; because&nbsp; of&nbsp; cardiac&nbsp; decompensation.&nbsp; His&nbsp; medical history revealed cardiomyopathy and aortic metallic valve replacement 20&nbsp; years&nbsp; ago&nbsp; and&nbsp; gout&nbsp; disease&nbsp; for&nbsp; 25&nbsp; years.&nbsp; He&nbsp; had&nbsp; been&nbsp; on&nbsp; oral anticoagulation&nbsp; with&nbsp; warfarin&nbsp; for&nbsp; 20&nbsp; years.&nbsp; On&nbsp; physical&nbsp; examination severe&nbsp; ascites&nbsp; and&nbsp; pulmonary&nbsp; effusion,&nbsp; and&nbsp; extensive&nbsp; venous&nbsp; stasis in&nbsp; lower&nbsp; trunk&nbsp; was&nbsp; found.&nbsp; Central&nbsp; venous&nbsp; pressure&nbsp; was&nbsp; 30&nbsp; cmH2O. His&nbsp; blood&nbsp; biochemistry&nbsp; work-up&nbsp; revealed&nbsp; moderate&nbsp; hyponatremia (132&nbsp; meq/L)&nbsp; and&nbsp; a&nbsp; serum&nbsp; creatinin&nbsp; of&nbsp; 2.6&nbsp; mg/dl&nbsp; (normal&nbsp; 0.5&nbsp; to&nbsp; 1.4). Anticoagulation was terminated at first. Prothrombin time / INR level returned&nbsp; within&nbsp; normal&nbsp; limits&nbsp; following&nbsp; cessation&nbsp; of&nbsp; warfarin&nbsp; and&nbsp; he had only mild anemia. </p

Surgical reintervention requirements following GreenLight PVP: A single-center experience using three different laser device models

ABSTRACTObjective To assess the incidence, risk factors, and timing of specific causes of reoperations following PVP.Material and Methods A retrospective analysis of data on men who underwent GreenLight PVP between 2004 and 2019 in a single center and required surgical intervention for bladder neck contracture (BNC), urethral stricture (US), or persistent/recurrent prostate adenoma.Results The overall rate of reoperations was 13.8% during a 61-month median follow-up of 377 patients. Reoperations were due to BNC, US, and adenoma in 7.7%, 5.6%, and 4.8% of cases, respectively. The median interval until reoperation for US (11 months) was significantly shorter. None of the risk factors had any relevance to US. In patients who underwent reoperation for BNC, lasing time and energy were significantly lower, and the prostate volume was smaller; however, the multivariate analysis only identified shorter lasing time as a predictor. In patients who had reoperation for persistent/recurrent adenoma, the PSA was increased, while the prostate volume was non-significantly high, and performance by less-experienced surgeons was associated with a higher rate of reoperations (p < 0.05). A longer lasing time predicted an increased risk of reoperation for adenoma in multivariate analysis.Conclusions An unselective utilization of PVP may result in a relatively high rate of reoperations. The correlation of BNC with shorter lasing time may imply a higher risk after PVP of smaller prostates. A longer lasing time predicts an increased risk of reoperation due to persistent/recurrent adenoma, which may be related to higher prostate volumes and inefficient PVP by less-experienced surgeons

The Impact of Pallative Care Course on Nursing Students’ Knowledge on Palliative Care

Amaç: Bu çalışma, hemşirelerin palyatif bakıma ilişkinbilgi düzeylerini saptamak ve bu konuda yapılan eğitiminetkisini belirlemek amacıyla yapılmıştır.Yöntem: Bu çalışmada, öğrencilere ön test/son test yapılarak yarı deneysel bir çalışma tasarımı kullanılmıştır.Çalışmanın örneklemini hemşirelik bölümünde palyatifbakım dersini alan 52 öğrenci oluşturmuştur. Araştırmanınverileri “Tanıtıcı Özellikler Formu” ve “Palyatif BakımBilgi Testi” kullanılarak toplanmıştır. Verilerin değerlendirilmesinde yüzdelik hesaplama, ortalama ve Wilcoxon testikullanılmıştır.Bulgular: Araştırma sonucunda öğrencilerin palyatifbakım dersini almadan önce palyatif bakım bilgi testinden20 puan üzerinden “10.11.6” puan aldıkları, dersinsonunda ise “15.21.6” puan aldıkları belirlenmiştir.Öğrencilerin dersi almadan önce ve aldıktan sonrası puanortalamaları arasında istatistiksel olarak anlamlı bir farkolduğu saptanmıştır (p0.05).Sonuç: Öğrencilere verilen palyatif bakım dersinin öğrencilerin bilgilerini olumlu yönde etkilediği ve bilgi düzeylerini yükselttiği belirlenmiştir. Palyatif bakım dersininhemşirelik müfredat programlarına seçmeli ya da zorunluders olarak eklenmesi önerilmektedir.Objective: This study was carried out to determine the levelof knowledge of nursing students about the palliative careand the effects of the training provided within this context.Method: In the study, a quasi-experimental research designwith pre-test/post-test was used. The sample included 52students enrolled in palliative care courses at KırıkkaleUniversity Department of Nursing in the fall semester of anacademic year. The data of the survey were collected bymeans of a questionnaire prepared using “DescriptiveCharacteristics Form”and “Palliative Care KnowledgeTest”. In the evaluation of the data, percentile and mean (SD) and Wilcoxon test were utilized.Results: In our study, it has been determined that the students got an average of 10.1 1.6 points over 20 pointsbefore the course about the palliative care knowledge test ,while their average point raised to 15.2 1.6 points afterthey took the course. The difference between the mean scores was found to be statistically significant (p0.05).Conclusions: It has been determined that palliative carecourses effected the participating students favourably, andincreased their knowledge levels It has been recommendedthat palliative care courses should be included in the curriculum of nursing as a obligatory or selective lessons