12 research outputs found
Outcomes of outpatient ureteral stenting without fluoroscopy at Groote Schuur Hospital, Cape Town, South Africa
Background. Ureteral stenting is generally a theatre-based procedure that requires a multidisciplinary team and on-table imaging. Limited hospital bed numbers and theatre time in our centre in Cape Town, South Africa, have led us to explore an alternative approach.Objectives. To see whether outpatient insertion of ureteric stents under local anaesthesia without fluoroscopy was a possible and acceptable alternative to theatre-based ureteral stenting.Methods. Ureteral stenting (double-J stents and ureteric catheters) was performed with flexible cystoscopy under local anaesthesia and chemoprophylaxis, but without fluoroscopic guidance, in an outpatient setting. Every patient had an abdominal radiograph and an ultrasound scan of the kidney after the procedure to confirm stent position.Results. Three hundred and sixteen procedures (276 double-J stents and 40 ureteric catheters) were performed in 161 men and 155 women. The overall success rate for the procedures was 85.4%, independent of gender (p=0.87), age (p=0.13), type of device inserted (p=0.81) or unilateral/bilateral nature of the procedure (p=1.0). Procedures with a successful outcome were performed in a significantly (p<0.0001) shorter median time (10 minutes (interquartile range (IQR) 5 - 15)) than failed procedures (20 minutes (IQR 10 - 30)). Patients with a pain score of >5 experienced a significantly (p=0.02) greater proportion of failure (27.3%) than patients with a pain score of ≤5 (12.5%). Difficulties were encountered in 23.7% of procedures, with a significantly higher proportion being registered in failed interventions compared with successful ones (82.6% v. 13.7%; p<0.0001).Conclusions. The procedure was easily mastered and technically simple, and represents savings in cost, time and human resources in our setting.
International Consensus Statement on Rhinology and Allergy: Rhinosinusitis
Background: The 5 years since the publication of the first International Consensus Statement on Allergy and Rhinology: Rhinosinusitis (ICAR‐RS) has witnessed foundational progress in our understanding and treatment of rhinologic disease. These advances are reflected within the more than 40 new topics covered within the ICAR‐RS‐2021 as well as updates to the original 140 topics. This executive summary consolidates the evidence‐based findings of the document. Methods: ICAR‐RS presents over 180 topics in the forms of evidence‐based reviews with recommendations (EBRRs), evidence‐based reviews, and literature reviews. The highest grade structured recommendations of the EBRR sections are summarized in this executive summary. Results: ICAR‐RS‐2021 covers 22 topics regarding the medical management of RS, which are grade A/B and are presented in the executive summary. Additionally, 4 topics regarding the surgical management of RS are grade A/B and are presented in the executive summary. Finally, a comprehensive evidence‐based management algorithm is provided. Conclusion: This ICAR‐RS‐2021 executive summary provides a compilation of the evidence‐based recommendations for medical and surgical treatment of the most common forms of RS
Multifocal spinal and extra-spinal Mycobacterium chelonae osteomyelitis in a renal transplant recipient
Only localized cases of Mycobacterium chelonae osteomyelitis have been
reported. In this article, a 55-year-old immunosuppressed man with M.
chelonae osteomyelitis and multiple spinal and extra-spinal involvement
is presented. The patient had nodulo-pustular skin lesions,
spondylodiscitis at multiple levels, and osteolytic lesions at
extra-spinal locations. Biopsy and cultures of the osseous lesions
showed M. chelonae osteomyelitis. The patient started antimycobacterial
chemotherapy with ciprofloxacin and clarithromycin. Progressive cervical
kyphosis associated with anterior wedged deformity of the C5 vertebra
and posterior C5-C6 spondylolisthesis resulted in compression of the
spinal cord and neurological impairment. The patient underwent anterior
decompression and C4-C6 arthrodesis using a titanium mesh cage and
cervical plate. About 15 months after the initiation of chemotherapy and
5 months after surgery, the patient was pain free, with significant
improvement of his neurological function. In the presence of
immunosuppression, the physician should be alert for unusual or
opportunistic pathogens of osteomyelitis. Long-term antimicrobial
chemotherapy and surgical intervention is the cornerstone of successful
treatment of multifocal bone M. chelonae infection
Lactic acid polymers as biodegradable carriers of fluoroquinolones: An in vitro study
A biodegradable polymer of DL-dilactide that facilitates release of
ciprofloxacin or pefloxacin at levels exceeding MICs for the causative
microorganisms of chronic osteomyelitis is described. Duration and peak
of release were found to depend on the molecular weight of the polymer.
Its characteristics make it promising for treating chronic bone
infections
Lack of effect of acute repaglinide administration on postprandial lipaemia in patients with type 2 diabetes mellitus
The effect of acute repaglinide administration (2 mg) on postprandial
glycaemia and lipaemia has been examined in 20 subjects with type 2
diabetes mellitus. Each subject received in the morning, after a 12 to
14 h fast, a standard mixed meal (total energy 783 kcal), preceded by
one tablet of 2 mg repaglinide or placebo. Chylomicrons and
chylomicron-deficient plasma were prepared by ultracentrifugation.
Triglyceride levels in CM fraction (CM-triglycerides) in total plasma as
well as in CM-deficient plasma (non-CM-triglycerides) were determined. A
significant reduction in postprandial glycaemia was observed after
repaglinide administration compared to placebo (p < 0.001). Plasma
concentrations of total triglycerides, CM-triglycerides,
non-CM-triglycerides, free fatty acids and the other plasma lipids
measured, were not significantly different between the two phases of the
study. It is concluded that, in contrast to sulphonylureas, acute
repaglinide administration does not improve postprandial lipaemia in
patients with type 2 diabetes
Outcomes of outpatient ureteral stenting without fluoroscopy at Groote Schuur Hospital Cape Town South Africa
Background. Ureteral stenting is generally a theatre-based procedure that requires a multidisciplinary team and on-table imaging. Limited hospital bed numbers and theatre time in our centre in Cape Town, South Africa, have led us to explore an alternative approach.Objectives. To see whether outpatient insertion of ureteric stents under local anaesthesia without fluoroscopy was a possible and acceptable alternative to theatre-based ureteral stenting.Methods. Ureteral stenting (double-J stents and ureteric catheters) was performed with flexible cystoscopy under local anaesthesia and chemoprophylaxis, but without fluoroscopic guidance, in an outpatient setting. Every patient had an abdominal radiograph and an ultrasound scan of the kidney after the procedure to confirm stent position.Results. Three hundred and sixteen procedures (276 double-J stents and 40 ureteric catheters) were performed in 161 men and 155 women. The overall success rate for the procedures was 85.4%, independent of gender (p=0.87), age (p=0.13), type of device inserted (p=0.81) or unilateral/bilateral nature of the procedure (p=1.0). Procedures with a successful outcome were performed in a significantly (p<0.0001) shorter median time (10 minutes (interquartile range (IQR) 5 - 15)) than failed procedures (20 minutes (IQR 10 - 30)). Patients with a pain score of >5 experienced a significantly (p=0.02) greater proportion of failure (27.3%) than patients with a pain score of ≤5 (12.5%). Difficulties were encountered in 23.7% of procedures, with a significantly higher proportion being registered in failed interventions compared with successful ones (82.6% v. 13.7%; p<0.0001).Conclusions. The procedure was easily mastered and technically simple, and represents savings in cost, time and human resources in our setting.Â