Crohn's Disease and Urinary Bladder Mass

The presence of a bladder mass in a patient with inflammatory bowel disease poses a diagnostic dilemma. We present the case of a 26-year-old male with a bladder mass who had not previously been diagnosed with Crohn's disease. Initial biopsies of the bladder mass were consistent with inflammatory changes, but superficial transitional cell carcinoma could not be reliably excluded. Subsequent evaluation confirmed the presence of Crohn's disease with bladder involvement, and the patient underwent bowel resection and partial cystectomy. Pathologic evaluation demonstrated Crohn’s disease and no evidence of malignancy. Accurate differentiation of benign and malignant bladder masses in patients with inflammatory bowel disease may be difficult and requires cooperation between pathologists and clinicians

Effect of remote ischaemic conditioning on clinical outcomes in patients with acute myocardial infarction (CONDI-2/ERIC-PPCI): a single-blind randomised controlled trial.

BACKGROUND: Remote ischaemic conditioning with transient ischaemia and reperfusion applied to the arm has been shown to reduce myocardial infarct size in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI). We investigated whether remote ischaemic conditioning could reduce the incidence of cardiac death and hospitalisation for heart failure at 12 months. METHODS: We did an international investigator-initiated, prospective, single-blind, randomised controlled trial (CONDI-2/ERIC-PPCI) at 33 centres across the UK, Denmark, Spain, and Serbia. Patients (age >18 years) with suspected STEMI and who were eligible for PPCI were randomly allocated (1:1, stratified by centre with a permuted block method) to receive standard treatment (including a sham simulated remote ischaemic conditioning intervention at UK sites only) or remote ischaemic conditioning treatment (intermittent ischaemia and reperfusion applied to the arm through four cycles of 5-min inflation and 5-min deflation of an automated cuff device) before PPCI. Investigators responsible for data collection and outcome assessment were masked to treatment allocation. The primary combined endpoint was cardiac death or hospitalisation for heart failure at 12 months in the intention-to-treat population. This trial is registered with ClinicalTrials.gov (NCT02342522) and is completed. FINDINGS: Between Nov 6, 2013, and March 31, 2018, 5401 patients were randomly allocated to either the control group (n=2701) or the remote ischaemic conditioning group (n=2700). After exclusion of patients upon hospital arrival or loss to follow-up, 2569 patients in the control group and 2546 in the intervention group were included in the intention-to-treat analysis. At 12 months post-PPCI, the Kaplan-Meier-estimated frequencies of cardiac death or hospitalisation for heart failure (the primary endpoint) were 220 (8·6%) patients in the control group and 239 (9·4%) in the remote ischaemic conditioning group (hazard ratio 1·10 [95% CI 0·91-1·32], p=0·32 for intervention versus control). No important unexpected adverse events or side effects of remote ischaemic conditioning were observed. INTERPRETATION: Remote ischaemic conditioning does not improve clinical outcomes (cardiac death or hospitalisation for heart failure) at 12 months in patients with STEMI undergoing PPCI. FUNDING: British Heart Foundation, University College London Hospitals/University College London Biomedical Research Centre, Danish Innovation Foundation, Novo Nordisk Foundation, TrygFonden

Botulinum toxin injection: a review of injection principles and protocols

Despite the favorable outcomes seen using botulinum toxin (BTX) for voiding dysfunction using BTX, a standardized technique and protocol for toxin injection is not defined. We reviewed the current literature on intravesical BTX injection for DO (detrusor overactivity). Specific attention was placed on defining optimal injection protocol, including dose, volume, and injection sites. In addition, we sought to describe a standard technique to BTX injection

Surgical technique using AdVance™ Sling placement in the treatment of post-prostatectomy urinary incontinence

OBJECTIVES: To describe and illustrate a new minimally invasive approach to the treatment of male stress urinary incontinence following prostatectomy. SURGICAL TECHNIQUE: Our initial experience consisted of four patients treated with the Advance sling for post-prostatectomy urinary incontinence. Sling placement involves the following steps: 1. Urethral dissection and mobilization, 2. Identification of surgical landmarks, 3. Placement of needle passers through the obturator foramen, 4. Mesh advancement, 5. Mesh tensioning and fixation, 6. Incision closure. COMMENTS: Based on our initial experience, we believe that the Advance Male Sling System may be a safe technique for the treatment of male stress urinary incontinence. This technique is easy to perform and may offer a reproducible, transobturator approach. Further patient accrual is ongoing to assess the safety and reproducibility of this technique. Also, additional study will focus on efficacy standards and complication rates