Outcome of Percutaneous Nephrostomy for the Management of Pyonephrosis

ObjectiveThe aim of this study was to evaluate the efficacy of percutaneous nephrostomy (PCN) drainage for the interim management of pyonephrosis.MethodsNinety-two consecutive patients (29 men, 63 women; mean age, 57 years; range, 23-88) who underwent PCN for the treatment of pyonephrosis from 1996 to 1999 were evaluated retrospectively. The clinical presentation, bacteriology and patient outcomes were analyzed.ResultsThe majority (77%) of patients had underlying obstructing urinary calculi. Other causes of obstruction included strictures (9%), papillary necrosis (7%), pelvi-ureteric junction obstruction (4%) and malignant stricture (3%). The microorganisms cultured were Escherichia coli (30%), Klebsiella (19%), Proteus (8%), Pseudomonas (5%), Enterococcus (5%), and Candida spp (5%). The microorganisms were sensitive to gentamicin (79%), ceftriaxone (71%), cephalexin (54%), nitrofurantoin (40%), cotrimoxazole (35%), nalidixic acid (32%) and ampicillin (29%). Only 30% of bladder urine cultures were positive for microorganisms; the addition of PCN cultures improved this yield to 58%. The antibiotic regimen was revised according to the PCN culture whenever there was a discrepancy. After PCN, 69% of patients underwent minimally invasive procedures as definitive treatment of the obstructing lesion. Only 14% of patients required open surgery. There was low procedure-related morbidity (14%) and low overall mortality (2%).ConclusionsPCN cultures yield important bacteriological information. The procedure is associated with minimal morbidity, facilitates definitive treatment and provides therapeutic benefit. (Asian J Surg 2002;25(3):215-9

Bariatric surgery is expensive but improves co-morbidity: 5-year assessment of patients with obesity and type 2 diabetes

Background: Bariatric surgery can be effective in weight reduction and diabetes remission in some patients, but is expensive. The costs of bariatric surgery in patients with obesity and type 2 diabetes mellitus (T2DM) were explored here. Methods: Population‐based retrospectively gathered data on patients with obesity and T2DM from the Hong Kong Hospital Authority (2006–2017) were evaluated. Direct medical costs from baseline up to 60 months were calculated based on the frequency of healthcare service utilization and dispensing of diabetes medication. Charlson Co‐morbidity Index (CCI) scores and co‐morbidity rates were measured to compare changes in co‐morbidities between surgically treated and control groups over 5 years. One‐to‐five propensity score matching was applied. Results: Overall, 401 eligible surgical patients were matched with 1894 non‐surgical patients. Direct medical costs were much higher for surgical than non‐surgical patients in the index year (€36 752 and €5788 respectively; P < 0·001) mainly owing to the bariatric procedure. The 5‐year cumulative costs incurred by surgical patients were also higher (€54 135 versus €28 603; P < 0·001). Although patients who had bariatric surgery had more visits to outpatient and allied health professionals than those who did not across the 5‐year period, surgical patients had shorter length of stay in hospitals than non‐surgical patients in year 2‐5. Surgical patients had significantly better CCI scores than controls after the baseline measurement (mean 3·82 versus 4·38 at 5 years; P = 0·016). Costs of glucose‐lowering medications were similar between two groups, except that surgical patients had significantly lower costs of glucose‐lowering medications in year 2 (€973 versus €1395; P = 0.012). Conclusion: Bariatric surgery in obese patients with T2DM is expensive, but leads to an improved co‐morbidity profile, and reduced length of hospitalization

The relationship of retinal vessel caliber with erectile dysfunction in patients with type 2 diabetes

10.1167/iovs.13-12622Investigative Ophthalmology and Visual Science54127234-7239IOVS

Erratum: Bariatric surgery in Asia in the last 5 years (2005-2009) (Obesity Surgery DOI: 10.1007/s11695-011-0547-2)

10.1007/s11695-011-0566-zObesity Surgery222345-OBSU

Bariatric surgery in asia in the last 5 years (2005-2009)

10.1007/s11695-011-0547-2Obesity Surgery223502-506OBSU

Mitochondrial oxidative capacity and NAD+ biosynthesis are reduced in human sarcopenia across ethnicities

10.1038/s41467-019-13694-1Nature Communications10