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المؤلفون: Heiko Reutter, Theresa Lange, Raimund Stein, Thomas M. Boemers, Karin Hirsch, Nadine Zwink, Ekkehart Jenetzky, Anne-Karoline Ebert, Wolfgang H. Rösch
المصدر: Journal of Pediatric Urology.
مصطلحات موضوعية: Adult, medicine.medical_specialty, Epispadias, Sexual Behavior, Urology, medicine.medical_treatment, 030232 urology & nephrology, Urinary Diversion, Risk Assessment, Introitus, Cystectomy, Young Adult, 03 medical and health sciences, 0302 clinical medicine, Germany, Surveys and Questionnaires, Body Image, medicine, Humans, Retrospective Studies, Gynecology, 030219 obstetrics & reproductive medicine, Obstetrics, business.industry, Bladder Exstrophy, medicine.disease, Self Concept, Sexual Dysfunction, Physiological, Sexual intercourse, Neck of urinary bladder, Cross-Sectional Studies, Treatment Outcome, Sexual dysfunction, Pediatrics, Perinatology and Child Health, Cohort, Quality of Life, Urologic Surgical Procedures, Female, medicine.symptom, Sexual function, business, Follow-Up Studies
الوصف: Standardized knowledge about genital function in adult female individuals with exstrophy-epispadias complex (EEC) is scarce. The aim of this study was to investigate sexual function using the standardized Female Sexual Function Index (FSFI), and to assess the influence of bladder and vaginal reconstruction and the presence of incontinence on FSFI results.Sixty-one females (aged ≥18 years) recruited by the German multicenter network for congenital uro-rectal malformations (CURE-Net) were asked to complete the FSFI and a self-designed semi-structured questionnaire assessing comprehensive medical data, gynecological, and psychosocial items. Twenty-one eligible females (34%) returned both questionnaires (mean ± standard deviation [SD] age of 26 ± 5.1 years).In 43% of participants, a staged or single-staged approach had been used for reconstruction, and these had their bladder in use. A primary or secondary urinary diversion (UD) after cystectomy had been performed in 38% of participants. Of the participants, 57% lived in a committed partnership, and 62% had sexual intercourse on a regular basis, with a further 19% experiencing pain or discomfort thereby. Introitus plasty was done in 43%. Mean total FSFI for all participants was 21.3 (SD 1.9). Most domain scores of patients after introitus plasty were similar compared with those without an operative vaginal approach, except for satisfaction (p = 0.057) and pain (p = 0.024). Comparing incontinent with continent patients, significant differences were found for desire (mean 4.6 vs. 3.5, p = 0.021), lubrication (mean 3.1 vs. 4.2, p = 0.049), and satisfaction (mean 1.6 vs. 3.6, p = 0.0065). In contrast pain was not significant between groups.Sexual activity rate in the present study was similar to that reported in the literature (81% vs. 89%), whereas dyspareunia rate was lower in our cohort (19% vs. 24%). The risk for sexual dysfunction seems to be lower in patients reconstructed with primary or secondary UD than patients with bladder in use. It is surprising that lubrification was better after UD than after bladder neck surgery. Incontinence and in some parts the history of an introitus plasty may play an additional role in development of sexual dysfunction in EEC. Although most of the female EEC patients lived in a committed partnership and had sexual intercourse, total FSFI values26.55 clearly indicate a risk of sexual dysfunction. Although continence itself played a major role, females reconstructed with UD seem to have better sexual function. Further evaluation of sexual outcome and improvement of care for these patients is mandatory.
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المؤلفون: Timolaos Rizos, Christopher Beynon, Thorsten Steiner, Roland Veltkamp, M. Laible, Oliver J. Müller, Jan C. Purrucker, Peter A. Ringleb, Markus A Möhlenbruch, Svenja Schüler, Peter Sander, Ekkehart Jenetzky
المساهمون: St Marys Development Trust
المصدر: Cerebrovascular diseases (Basel, Switzerland). 42(5-6)
مصطلحات موضوعية: Male, Time Factors, Vitamin K, Databases, Factual, INTRACRANIAL HEMORRHAGE, HEMATOMA EXPANSION, Kaplan-Meier Estimate, 030204 cardiovascular system & hematology, Vitamin k, Disability Evaluation, 0302 clinical medicine, 610 Medical sciences Medicine, Risk Factors, Germany, ORAL ANTICOAGULATION, Medicine, ASSOCIATION/AMERICAN-STROKE-ASSOCIATION, Aged, 80 and over, Prothrombin complex concentrate, Thromboembolic event, THROMBOEMBOLIC EVENTS, Blood Coagulation Factors, Treatment Outcome, Neurology, Anesthesia, Female, Cardiology and Cardiovascular Medicine, Life Sciences & Biomedicine, PROTHROMBIN COMPLEX, medicine.drug, Allergic reaction, Clinical Neurology, ANTICOAGULATION REVERSAL, Drug Hypersensitivity, 03 medical and health sciences, VITAMIN-K ANTAGONISTS, Predictive Value of Tests, Thromboembolism, Reversal treatment, Humans, In patient, International Normalized Ratio, Adverse effect, Blood Coagulation, Aged, Cerebral Hemorrhage, Retrospective Studies, HEALTH-CARE PROFESSIONALS, Intracerebral hemorrhage, Science & Technology, Neurology & Neurosurgery, business.industry, Coagulants, FRESH-FROZEN PLASMA, Anticoagulants, 1103 Clinical Sciences, Length of Stay, medicine.disease, Peripheral Vascular Disease, Vitamin K antagonists, Cardiovascular System & Cardiology, Neurosciences & Neurology, Neurology (clinical), 1109 Neurosciences, business, 030217 neurology & neurosurgery
الوصف: Background: Prothrombin complex concentrates (PCCs) are frequently used to reverse the effect of vitamin K antagonists (VKAs) in patients with non-traumatic intracerebral hemorrhage (ICH). However, information on the rate of thromboembolic events (TEs) and allergic events after PCC therapy in VKA-ICH patients is limited. Methods: Consecutive VKA-ICH patients treated with PCC at our institution between December 2004 and June 2014 were included into this retrospective observational study. We recorded international normalized ratio (INR) values before and after PCC treatment, baseline clinical characteristics including the premorbid modified Rankin Scale (pmRS) score, TE and allergic event that occurred during the hospital stay. All events were classified by 3 reviewers as being ‘related', ‘probably related', ‘possibly related', ‘unlikely related' or ‘not related' to treatment with PCC. To identify factors associated with TEs, log-rank analyses were applied. Results: Two hundred and five patients were included. Median INR was 2.8 (interquartile range (IQR) 2.2-3.8) before and 1.3 (IQR 1.2-1.4) after PCC treatment and a median of 1,500 IU PCC (IQR 1,000-2,500) was administered. Nineteen TEs were observed (9.3%); none were classified ‘related' but 9 were classified as ‘possibly' or ‘probably related' to PCC infusion (4.4%). One allergic reaction (0.5%), ‘unlikely related' to PCC, was observed. In the whole cohort, PCC doses >2,000-3,000 IU, ICH volumes >40 ml, National Institute of Health Stroke Scale values >10 and a pmRS >2 were associated with the development of TEs (p = 0.031, p = 0.034, p = 0.050 and p = 0.036, respectively). Conclusions: Overall, INR reversal with PCC appears safe. Though no clear relationship between higher PCC dosing and TEs was observed, PCC doses between >2,000 and 3,000 IU and higher morbidity at ICH onset were associated with TEs. Hence, individual titration of PCC to avoid exposure to unnecessarily high doses using point-of-care devices should be prospectively explored.
وصف الملف: application/pdf
URL الوصول: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::12e7e62947f7111018d88a3fc553524a
https://pubmed.ncbi.nlm.nih.gov/27536779 -
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المؤلفون: Ekkehart Jenetzky
المصدر: Pediatric surgery international. 23(12)
مصطلحات موضوعية: medicine.medical_specialty, Pediatrics, Prevalence, Anal Canal, Germany, Pediatric surgery, Epidemiology, medicine, Humans, Registries, Medical diagnosis, Diagnosis-Related Groups, Retrospective Studies, Anus Diseases, Inpatient care, business.industry, Incidence (epidemiology), Infant, Newborn, Rectum, Retrospective cohort study, General Medicine, Anus, medicine.anatomical_structure, Rectal Diseases, Pediatrics, Perinatology and Child Health, Surgery, business
الوصف: Without major registries, true prevalence of rare congenital diseases is not known. Estimations for occurrence of anorectal malformation (ARM) are based on monitoring centers and epidemiological studies. The new German economical system for payment of inpatient care (G-DRG) obligates the report of each hospitalization, including diagnoses and procedures. These codes and classifications originally developed for morbidity statistics are now misused for economical purposes. Is there an epidemiological use? We present a new method to estimate national wide prevalence rate of congenital malformations exemplarily for imperforated anus. Due to the new German DRG-system, treatment data collections of the years 2002–2005 are freely accessible. This method is applicable if a life saving surgery is mandatory for newborns and has to be ciphered by specific codes. Overall, in German hospitals 1,012 children below 1 year of age are surgically treated with a reconstructive anorectal surgery during the period of 4 years. In the same time 2,817,388 babies are born in Germany. Hence the national wide prevalence rate is about 3.6 (95% CI: 3.4–3.8) per 10,000 or 1:2,784 for all different types of anal atresia requiring surgery. Main ICD-10 diagnosis Q42 was given twice this rate, probably due to at least two hospitalizations in the newborn period. The economic data of the G-DRG system can be used to estimate yearly prevalence of some rare congenital diseases in Germany, in case of specific surgical procedures. It may be a useful supplement to smaller regional registries because of larger size. Further calculations for other epidemiological questions have to be faced.
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