98 research outputs found
Reconstruction of the urethra with a SurgisisÂź onlay patch in urethral reconstructive surgery: two case reports
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Unpacking dynamics of diverse nested resource systems through a diagnostic approach
The socialâecological systems (SES) framework (Ostrom 2009, Science. 325(5939):419â22) typologically decomposes SES characteristics into nested, tiered constituent variables. Yet, aligning the frameworkâs concepts of resource system (RS) and resource unit (RU) with realities of individual case studies poses challenges if the underlying SES is not a single RS, but a mid to large-scale nested RS (NRS). Using a diagnostic approach, we describe NRSsâand the activities and networks of adjacent action situations (NAAS) containing them. An NRS includes the larger RS and multiple interlinked semi-autonomous subsidiary RSs, each of which support simultaneous, differently managed appropriation of individual RUs. We further identify NAASs operating within NRSs in two diverse empirical casesânetworks of lake systems in Bengaluru, India and German wheat breeding systemsârepresenting a lever towards understanding transformation of SESs into sustainable futures. This paper contributes towards unpacking and diagnosing complexities within mid to large-scale RSs and their governance. It provides a generalizable, rigorous approach to SES case study analyses, thereby advancing methods for synthesis in sustainability science
UBCÂźRapid Test for detection of carcinoma in situ for bladder cancer
UBCÂźRapid Test is a test that detects fragments of cytokeratins 8 and 18 in
urine. We present results of a multicentre study measuring UBCÂźRapid Test in
bladder cancer patients and healthy controls with focus on carcinoma in situ
(CIS) and high-grade bladder cancer. From our study with N = 452 patients, we
made a stratified sub-analysis for carcinoma in situ of the urinary bladder.
Clinical urine samples were used from 87 patients with tumours of the urinary
bladder (23 carcinoma in situ, 23 non-muscle-invasive low-grade tumours, 21
non-muscle-invasive high-grade tumours and 20 muscle-invasive high-grade
tumours) and from 22 healthy controls. The cut-off value was defined at 10.0
”g/L. Urine samples were analysed by the UBCŸRapid Test point-of-care system
(concile Omega 100 POC reader). Pathological levels of UBC Rapid Test in urine
are higher in patients with bladder cancer in comparison to the control group
(p < 0.001). Sensitivity was calculated at 86.9% for carcinoma in situ, 30.4%
for non-muscle-invasive low-grade bladder cancer, 71.4% for nonmuscle-invasive
high grade bladder cancer and 60% for muscle-invasive high-grade bladder
cancer, and specificity was 90.9%. The area under the curve of the
quantitative UBCÂźRapid Test using the optimal threshold obtained by
receiveroperated curve analysis was 0.75. Pathological values of UBCÂźRapid
Test in urine are higher in patients with high-grade bladder cancer in
comparison to low-grade tumours and the healthy control group. UBCÂźRapid Test
has potential to be more sensitive and specific urinary protein biomarker for
accurate detection of high-grade patients and could be added especially in the
diagnostics for carcinoma in situ and non-muscle-invasive high-grade tumours
of urinary bladder cancer
Protocol for a Randomized Phase II Trial for Mesh Optimization by Autologous Plasma Coating in Prolapse Repair: IDEAL Stage 3
Introduction: Mesh-related complications especially after vaginal implantation have raised awareness lately because of severe adverse reactions and legal aspects. About 20% of patients suffer from complications after mesh insertion in the anterior vaginal wall. Autologous plasma coating of meshes prior to implantation has shown potential to improve the biocompatibility of meshes in vivo and in vitro. This innovative approach has been developed according to the IDEAL recommendations for surgical innovations. The method has still to be assessed at stage 3 accordingly. Methods: A protocol is developed for a prospective single-blinded randomized controlled phase II trial for biocompatibility optimization of anterior vaginal meshes for prolapse repair by autologous plasma coating versus non-coated meshes. Results: The protocol aims at fulfilling the requirements for stage 3 (assessment) according to IDEAL. Eligible for inclusion are women with primary cystocele, requiring a surgical procedure, suitable for randomization, and willing to be randomized. Participants will be followed up by postal questionnaires (6 months post surgery and 12 months post randomization) and will also be reviewed in clinic 12 and 24 months post surgery. Primary endpoint is the assessment of mesh-related complications following the ClavienâDindo classifications. QoL, sexual function assessment, efficacy, and validation of an already developed long-term register are considered secondary endpoints. To afford a calculated 10% reduction of postoperative complications through plasma-coated meshes vs. non-coated meshes at 1-year follow-up, a total 214 women in each arm will be necessary to achieve 80% power at a significance level of 5%. Conclusion: The protocol for this randomized clinical trial represents the conditions to assess the surgical innovation of plasma coating of meshes in order to improve the meshesâ biocompatibility at stage 3 according to the IDEAL recommendations. © 2017 Springer Healthcar
Successful transureteropyelostomy after heminephrectomy of a bilateral hydronephrotic horseshoe kidney: a case report
<p>Abstract</p> <p>Introduction</p> <p>Horseshoe kidney is a rare congenital malformation that is found in approximately 0.25% of the general population and usually remains asymptomatic.</p> <p>Case presentation</p> <p>We report a successful transureteropyelostomy after heminephrectomy of the non-functional right moiety in a 25-year-old man with horseshoe kidney who had a combined 50% functional loss and hydronephrosis due to multiple distal ureteral strictures on the functionally remaining left side. Continuous ureteral stenting of the remaining part of the former horseshoe kidney was avoided during a follow-up of 2 years.</p> <p>Conclusion</p> <p>Urologists are often faced with technically difficult cases that are not responsive to standard operative procedures, and this case illustrates an individual surgical approach in a clinical situation.</p
Idiopathic giant abdominal lymph cyst: a case report
<p>Abstract</p> <p>Introduction</p> <p>Giant lymph cysts are a relatively frequent complication after surgical procedures in the abdomen, often after kidney transplantation, but there are also cases after pelvic surgery such as lymphadenectomy and others. In the recent literature, there have been no reported cases of idiopathic giant lymphocyst.</p> <p>Case presentation</p> <p>We present the case of a 76-year-old Caucasian man who had a lymph cyst he had known of for more than 15 years. Laparoscopic treatment was necessary because of hydronephrosis of the left kidney.</p> <p>Conclusion</p> <p>This case shows that laparoscopic drainage and partial resection of the lymph cyst is a safe and effective treatment.</p
Prostate specific antigen (PSA) as predicting marker for clinical outcome and evaluation of early toxicity rate after high-dose rate brachytherapy (HDR-BT) in combination with additional external beam radiation therapy (EBRT) for high risk prostate cancer
High-dose-rate brachytherapy (HDR-BT) with external beam radiation therapy (EBRT) is a common treatment option for locally advanced prostate cancer (PCa). Seventy-nine male patients (median age 71 years, range 50 to 79) with high-risk PCa underwent HDR-BT following EBRT between December 2009 and January 2016 with a median follow-up of 21 months. HDR-BT was administered in two treatment sessions (one week interval) with 9 Gy per fraction using a planning system and the Ir192 treatment unit GammaMed Plus iX. EBRT was performed with CT-based 3D-conformal treatment planning with a total dose administration of 50.4 Gy with 1.8 Gy per fraction and five fractions per week. Follow-up for all patients was organized one, three, and five years after radiation therapy to evaluate early and late toxicity side effects, metastases, local recurrence, and prostate-specific antigen (PSA) value measured in ng/mL. The evaluated data included age, PSA at time of diagnosis, PSA density, BMI (body mass index), Gleason score, DâAmico risk classification for PCa, digital rectal examination (DRE), PSA value after one/three/five year(s) follow-up (FU), time of follow-up, TNM classification, prostate volume, and early toxicity rates. Early toxicity rates were 8.86% for gastrointestinal, and 6.33% for genitourinary side effects. Of all treated patients, 84.81% had no side effects. All reported complications in early toxicity were grade 1. PSA density at time of diagnosis (p = 0.009), PSA on date of first HDR-BT (p = 0.033), and PSA on date of first follow-up after one year (p = 0.025) have statistical significance on a higher risk to get a local recurrence during follow-up. HDR-BT in combination with additional EBRT in the presented design for high-risk PCa results in high biochemical control rates with minimal side-effects. PSA is a negative predictive biomarker for local recurrence during follow-up. A longer follow-up is needed to assess long-term outcome and toxicities
Effect of platelet-rich plasma on polypropylene meshes implanted in the rabbit vagina: histological analysis
New strategies to improve results of mesh surgeries for vaginal prolapses repair â an update
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