The use of artificial urinary sphincter(AUS)for the treatment of stress urinary incontinence has become more prevalent,especially in the“prostate-specific antigen(PSA)-era”,when more patients are treated for localiz...The use of artificial urinary sphincter(AUS)for the treatment of stress urinary incontinence has become more prevalent,especially in the“prostate-specific antigen(PSA)-era”,when more patients are treated for localized prostate cancer.The first widely accepted device was the AMS 800,but since then,other devices have also entered the market.While efficacy has increased with improvements in technology and technique,and patient satisfaction is high,AUS implantation still has inherent risks and complications of any implant surgery,in addition to the unique challenges of urethral complications that may be associated with the cuff.Furthermore,the unique nature of the AUS,with a control pump,reservoir,balloon cuff,and connecting tubing,means that mechanical complications can also arise from these individual parts.This article aims to present and summarize the current literature on the management of complications of AUS,especially urethral atrophy.We conducted a literature search on PubMed from January 1990 to December 2018 on AUS complications and their management.We review the various potential complications and their management.AUS complications are either mechanical or nonmechanical complications.Mechanical complications usually involve malfunction of the AUS.Nonmechanical complications include infection,urethral atrophy,cuff erosion,and stricture.Challenges exist especially in the management of urethral atrophy,with both tandem implants,transcorporal cuffs,and cuff downsizing all postulated as potential remedies.Although complications from AUS implants are not common,knowledge of the management of these issues are crucial to ensure care for patients with these implants.Further studies are needed to further evaluate these techniques.展开更多
目的:探讨机械通气时应用最小闭合容量技术注气的气管导管的气囊压力与气道吸气峰压之间的关系。方法:37例用高容低张气囊气管导管插管的机械通气病人,应用最小闭合容量技术注气,并同步测定气囊压力和记录同一时间的气道吸气峰压,用统...目的:探讨机械通气时应用最小闭合容量技术注气的气管导管的气囊压力与气道吸气峰压之间的关系。方法:37例用高容低张气囊气管导管插管的机械通气病人,应用最小闭合容量技术注气,并同步测定气囊压力和记录同一时间的气道吸气峰压,用统计学方法分析气囊压力和气道吸气峰压之间的关系。结果:应用最小闭合容量技术注气的气囊压力为13+6 mmHg(4—26 mmHg),气道吸气峰压为23+7 am H2O(15-40 cm H2O);气囊压力与气道吸气峰压之间呈直线正相关(r=0.762,P<0.001,n=37)。结论:应用最小闭合容量技术的气囊压力水平与气道吸气峰压有关,并随后者的增高而增高,当气道吸气峰压较高时,有可能对气管造成缺血性损害。展开更多
Rotator cuff repair has been shown to have good longterm results. Unfortunately, a significant proportion of repairs still fail to heal. Many factors, both patient and surgeon related, can influence healing after repa...Rotator cuff repair has been shown to have good longterm results. Unfortunately, a significant proportion of repairs still fail to heal. Many factors, both patient and surgeon related, can influence healing after repair. Older age, larger tear size, worse muscle quality, greater muscle-tendon unit retraction, smoking, osteoporosis, diabetes and hypercholesterolemia have all shown to negatively influence tendon healing. Surgeon related factors that can influence healing include repair construct-single vs double row, rehabilitation, and biologics including platelet rich plasma and mesenchymalstem cells. Double-row repairs are biomechanically stronger and have better healing rates compared with single-row repairs although clinical outcomes are equivalent between both constructs. Slower, less aggressive rehabilitation programs have demonstrated improved healing with no negative effect on final range of motion and are therefore recommended after repair of most full thickness tears. Additionally no definitive evidence supports the use of platelet rich plasma or mesenchymal stem cells regarding improvement of healing rates and clinical outcomes. Further research is needed to identify effective biologically directed augmentations that will improve healing rates and clinical outcomes after rotator cuff repair.展开更多
Lesions of the rotator cuff(RC) are a common occurrence affecting millions of people across all parts of the globe. RC tears are also rampantly prevalent with an agedependent increase in numbers. Other associated fact...Lesions of the rotator cuff(RC) are a common occurrence affecting millions of people across all parts of the globe. RC tears are also rampantly prevalent with an agedependent increase in numbers. Other associated factors include a history of trauma, limb dominance, contralateral shoulder, smoking-status, hypercholesterolemia, posture and occupational dispositions. The challenge lies in early diagnosis since a high proportion of patients are asymptomatic. Pain and decreasing shoulder power and function should alert the heedful practitioner in recognizing promptly the onset or aggravation of existing RC tears. Partial-thickness tears(PTT) can be bursalsided or articular-sided tears. Over the course of time, PTT enlarge and propagate into full-thickness tears(FTT) and develop distinct chronic pathological changes due to muscle retraction, fatty infiltration and muscle atrophy. These lead to a reduction in tendon elasticity and viability. Eventually, the glenohumeral joint experiences a series of degenerative alterations- cuff tear arthropathy. To avert this, a vigilant clinician must utilize and corroborate clinical skill and radiological findings to identify tear progression. Modern radio-diagnostic means of ultrasonography and magnetic resonance imaging provide excellent visualization of structural details and are crucial in determining further course of action for these patients. Physical therapy along with activity modifications, antiinflammatory and analgesic medications form the pillars of nonoperative treatment. Elderly patients with minimal functional demands can be managed conservatively and reassessed at frequent intervals. Regular monitoring helps in isolating patients who require surgical interventions. Early surgery should be considered in younger, active and symptomatic, healthy patients. In addition to being costeffective, this helps in providing a functional shoulder witha stable cuff. An easily reproducible technique of maximal strength and sturdiness should by chosen among the armamentarium of the 展开更多
Calcific tendinitis within the rotator cuff tendon is a common shoulder disorder that should be differentiated from dystrophic calcification as the pathogenesis and natural history of both is totally different. Calcif...Calcific tendinitis within the rotator cuff tendon is a common shoulder disorder that should be differentiated from dystrophic calcification as the pathogenesis and natural history of both is totally different. Calcific tendinitis usually occurs in the fifth and sixth decades of life among sedentary workers. It is classified into formative and resorptive phases. The chronic formative phase results from transient hypoxia that is commonlyassociated with repeated microtrauma causing calcium deposition into the matrix vesicles within the chondrocytes forming bone foci that later coalesce. This phase may extend from 1 to 6 years, and is usually asymptomatic. The resorptive phase extends from 3 wk up to 6 mo with vascularization at the periphery of the calcium deposits causing macrophage and mononuclear giant cell infiltration, together with fibroblast formation leading to an aggressive inflammatory reaction with inflammatory cell accumulation, excessive edema and rise of the intra-tendineous pressure. This results in a severely painful shoulder. Radiological investigations confirm the diagnosis and suggest the phase of the condition and are used to follow its progression. Although routine conventional X-ray allows detection of the deposits, magnetic resonance imaging studies allow better evaluation of any coexisting pathology. Various methods of treatment have been suggested. The appropriate method should be individualized for each patient. Conservative treatment includes pain killers and physiotherapy, or "minimally invasive" techniques as needling or puncture and aspiration. It is almost always successful since the natural history of the condition ends with resorption of the deposits and complete relief of pain. Due to the intolerable pain of the acute and severely painful resorptive stage, the patient often demands any sort of operative intervention. In such case arthroscopic removal is the best option as complete removal of the deposits is unnecessary.展开更多
基金We would like to acknowledge Dr.Daniel Elliott(Department of Urology,Mayo Clinic,Rochester,MN,USA)for the use of his images.
文摘The use of artificial urinary sphincter(AUS)for the treatment of stress urinary incontinence has become more prevalent,especially in the“prostate-specific antigen(PSA)-era”,when more patients are treated for localized prostate cancer.The first widely accepted device was the AMS 800,but since then,other devices have also entered the market.While efficacy has increased with improvements in technology and technique,and patient satisfaction is high,AUS implantation still has inherent risks and complications of any implant surgery,in addition to the unique challenges of urethral complications that may be associated with the cuff.Furthermore,the unique nature of the AUS,with a control pump,reservoir,balloon cuff,and connecting tubing,means that mechanical complications can also arise from these individual parts.This article aims to present and summarize the current literature on the management of complications of AUS,especially urethral atrophy.We conducted a literature search on PubMed from January 1990 to December 2018 on AUS complications and their management.We review the various potential complications and their management.AUS complications are either mechanical or nonmechanical complications.Mechanical complications usually involve malfunction of the AUS.Nonmechanical complications include infection,urethral atrophy,cuff erosion,and stricture.Challenges exist especially in the management of urethral atrophy,with both tandem implants,transcorporal cuffs,and cuff downsizing all postulated as potential remedies.Although complications from AUS implants are not common,knowledge of the management of these issues are crucial to ensure care for patients with these implants.Further studies are needed to further evaluate these techniques.
文摘目的:探讨机械通气时应用最小闭合容量技术注气的气管导管的气囊压力与气道吸气峰压之间的关系。方法:37例用高容低张气囊气管导管插管的机械通气病人,应用最小闭合容量技术注气,并同步测定气囊压力和记录同一时间的气道吸气峰压,用统计学方法分析气囊压力和气道吸气峰压之间的关系。结果:应用最小闭合容量技术注气的气囊压力为13+6 mmHg(4—26 mmHg),气道吸气峰压为23+7 am H2O(15-40 cm H2O);气囊压力与气道吸气峰压之间呈直线正相关(r=0.762,P<0.001,n=37)。结论:应用最小闭合容量技术的气囊压力水平与气道吸气峰压有关,并随后者的增高而增高,当气道吸气峰压较高时,有可能对气管造成缺血性损害。
文摘Rotator cuff repair has been shown to have good longterm results. Unfortunately, a significant proportion of repairs still fail to heal. Many factors, both patient and surgeon related, can influence healing after repair. Older age, larger tear size, worse muscle quality, greater muscle-tendon unit retraction, smoking, osteoporosis, diabetes and hypercholesterolemia have all shown to negatively influence tendon healing. Surgeon related factors that can influence healing include repair construct-single vs double row, rehabilitation, and biologics including platelet rich plasma and mesenchymalstem cells. Double-row repairs are biomechanically stronger and have better healing rates compared with single-row repairs although clinical outcomes are equivalent between both constructs. Slower, less aggressive rehabilitation programs have demonstrated improved healing with no negative effect on final range of motion and are therefore recommended after repair of most full thickness tears. Additionally no definitive evidence supports the use of platelet rich plasma or mesenchymal stem cells regarding improvement of healing rates and clinical outcomes. Further research is needed to identify effective biologically directed augmentations that will improve healing rates and clinical outcomes after rotator cuff repair.
文摘Lesions of the rotator cuff(RC) are a common occurrence affecting millions of people across all parts of the globe. RC tears are also rampantly prevalent with an agedependent increase in numbers. Other associated factors include a history of trauma, limb dominance, contralateral shoulder, smoking-status, hypercholesterolemia, posture and occupational dispositions. The challenge lies in early diagnosis since a high proportion of patients are asymptomatic. Pain and decreasing shoulder power and function should alert the heedful practitioner in recognizing promptly the onset or aggravation of existing RC tears. Partial-thickness tears(PTT) can be bursalsided or articular-sided tears. Over the course of time, PTT enlarge and propagate into full-thickness tears(FTT) and develop distinct chronic pathological changes due to muscle retraction, fatty infiltration and muscle atrophy. These lead to a reduction in tendon elasticity and viability. Eventually, the glenohumeral joint experiences a series of degenerative alterations- cuff tear arthropathy. To avert this, a vigilant clinician must utilize and corroborate clinical skill and radiological findings to identify tear progression. Modern radio-diagnostic means of ultrasonography and magnetic resonance imaging provide excellent visualization of structural details and are crucial in determining further course of action for these patients. Physical therapy along with activity modifications, antiinflammatory and analgesic medications form the pillars of nonoperative treatment. Elderly patients with minimal functional demands can be managed conservatively and reassessed at frequent intervals. Regular monitoring helps in isolating patients who require surgical interventions. Early surgery should be considered in younger, active and symptomatic, healthy patients. In addition to being costeffective, this helps in providing a functional shoulder witha stable cuff. An easily reproducible technique of maximal strength and sturdiness should by chosen among the armamentarium of the
文摘Calcific tendinitis within the rotator cuff tendon is a common shoulder disorder that should be differentiated from dystrophic calcification as the pathogenesis and natural history of both is totally different. Calcific tendinitis usually occurs in the fifth and sixth decades of life among sedentary workers. It is classified into formative and resorptive phases. The chronic formative phase results from transient hypoxia that is commonlyassociated with repeated microtrauma causing calcium deposition into the matrix vesicles within the chondrocytes forming bone foci that later coalesce. This phase may extend from 1 to 6 years, and is usually asymptomatic. The resorptive phase extends from 3 wk up to 6 mo with vascularization at the periphery of the calcium deposits causing macrophage and mononuclear giant cell infiltration, together with fibroblast formation leading to an aggressive inflammatory reaction with inflammatory cell accumulation, excessive edema and rise of the intra-tendineous pressure. This results in a severely painful shoulder. Radiological investigations confirm the diagnosis and suggest the phase of the condition and are used to follow its progression. Although routine conventional X-ray allows detection of the deposits, magnetic resonance imaging studies allow better evaluation of any coexisting pathology. Various methods of treatment have been suggested. The appropriate method should be individualized for each patient. Conservative treatment includes pain killers and physiotherapy, or "minimally invasive" techniques as needling or puncture and aspiration. It is almost always successful since the natural history of the condition ends with resorption of the deposits and complete relief of pain. Due to the intolerable pain of the acute and severely painful resorptive stage, the patient often demands any sort of operative intervention. In such case arthroscopic removal is the best option as complete removal of the deposits is unnecessary.
