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Medicina
Volume 55
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Medicina, Volume 55, Issue 3 (March 2019) – 23 articles

Cover Story (view full-size image): This systematic review discusses how metabolic alterations cause a favorable environment for tumor progression and inflammatory state that predisposes to vascular disease and aggressive prostate cancer. Therefore, a careful evaluation of cardiovascular risk factors should be carried out from the initial diagnosis of prostate cancer to discover new markers for aggressive prostate cancer and, more importantly, to identify novel personalized integrative therapies targeting critical metabolic changes that sustain the proliferation, migration, and invasion of prostate cancer. View Paper here.
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12 pages, 310 KiB  
Article
Pharmacotherapy Literacy and Parental Practice in Use of Over-the-Counter Pediatric Medicines
by Dušanka Krajnović, Stana Ubavić and Nataša Bogavac-Stanojević
Medicina 2019, 55(3), 80; https://doi.org/10.3390/medicina55030080 - 26 Mar 2019
Cited by 12 | Viewed by 2895
Abstract
Background and objectives: Pharmaceutical literacy skills of parents are crucial for appropriate and safe medication use in pre-school children (ages 1–7 years). A recent study on pharmacotherapy literacy from Serbia showed that one in five parents have difficulty understanding common information about the [...] Read more.
Background and objectives: Pharmaceutical literacy skills of parents are crucial for appropriate and safe medication use in pre-school children (ages 1–7 years). A recent study on pharmacotherapy literacy from Serbia showed that one in five parents have difficulty understanding common information about the use of medicines. Because antipyretics are considered to be the most frequently used group of over-the-counter (OTC) medications during the pre-school period, we aimed to: (i) examine parental practice and expectations in antipyretic medication use, and (ii) analyze associations of parental practice and expectations related to socio-economic status and pharmacotherapy literacy. Materials and methods: A cross-sectional survey using a self- report validated specific instrument was conducted with the parents of pre-school children in kindergartens in Belgrade, Serbia. Pharmacotherapy literacy refers to the knowledge and personal skills needed to meet the complex demands of medicine use in both healthcare and non-healthcare settings. A comprehensive literature review, expert-focus group consultation, and pre-testing were employed in 4-item multiple-choice test development to explore practice and expectations related to the use of OTC pediatric antipyretic medicines. Results: The final analytical cohort was comprised of 813 participants, the majority (63.3%) chose a medicine based on a physician’s suggestion and only 15.4% of parents reported they would follow the advice of a pharmacist. More than a half of parents (54.1%) would need advice about antipyretic medicine from a pharmacist, firstly in a simpler language. Parents satisfied with the information given by a pharmacist had higher pharmacotherapy literacy, compared to parents with lower levels (OR–0.718, 95%CI (0.597–0.865), p < 0.001). Men had a higher expectation of pharmacists to explain medicine use in a simpler language (OR–1.630, 95%CI (1.063–2.501), p = 0.025), as well as parents with three or more children (OR–2.527, 95%CI (1.43–4.459), p = 0.001). Parents with higher knowledge about medicine use were less likely to ask for simpler information (OR–0,707; 95%CI (0,583–0,856), p < 0,001). Conclusions: Our main finding is that practice in antipyretic OTC medicine use was associated with levels of parental pharmacotherapy literacy. The expectations of pharmacists were higher among parents with lower levels of pharmacotherapy literacy, who expected more information in a simpler and more precise language. This study highlighted the need for pharmacists to identify risks in parental practice and to provide information about medicines to parents of pre-school children in a simpler and more appropriate way. Full article
14 pages, 2305 KiB  
Review
How to Manage Impacted Third Molars: Germectomy or Delayed Removal? A Systematic Literature Review
by Edoardo Staderini, Romeo Patini, Federica Guglielmi, Andrea Camodeca and Patrizia Gallenzi
Medicina 2019, 55(3), 79; https://doi.org/10.3390/medicina55030079 - 26 Mar 2019
Cited by 30 | Viewed by 6500
Abstract
Objectives: The aim of this systematic review is to evaluate and compare the risks and benefits of germectomy and delayed removal of third molars and develop a patient management algorithm for second molar eruption in syndrome/incompliant patients. Materials and Methods: A literature search [...] Read more.
Objectives: The aim of this systematic review is to evaluate and compare the risks and benefits of germectomy and delayed removal of third molars and develop a patient management algorithm for second molar eruption in syndrome/incompliant patients. Materials and Methods: A literature search was performed in the following databases; the Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, Scopus, and Web of Science. Last search was done on July 2nd, 2018 including articles published from the last 18 years. The search aimed to identify all relevant studies written in English language. Gray literature was excluded. Risk of bias was evaluated with specific predetermined criteria. This systematic literature review was reported according to the PRISMA-P statement and was registered in the PROSPERO database with the following protocol ID: 104261. Results: Literature search war performed on July 2018 and updated on February 2019. A total of 1610 articles were screened. After abstract screening and discarding duplicates, 86 full-text articles were obtained and subjected to additional evaluation. Four articles were included in the review. Three studies were considered as having a medium risk of bias and one was assessed as at high risk. Due to the heterogeneity of presenting results and a very low number of included studies a quantitative analysis was not possible. Only qualitative analysis was made. Considering the limited number of studies included and the level of risk of bias there is no sufficient evidence to state the benefits of preventive removal of impacted third molars, especially in patients with poor oral hygiene due to intellectual disability. Early germectomy represents an elective approach of pathologic alteration of tooth germ; orthodontic issues meet appropriate indication for a delayed removal. Conclusions: Given the best evidence-based information regarding patients’ medical condition, we highlight the need to provide an ethical-based comprehensive approach in the diagnostic workflow and the assessment of treatment outcome. Full article
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7 pages, 1010 KiB  
Case Report
Congenital Hypopigmentary Disorders with Multiorgan Impairment: A Case Report and an Overview on Gray Hair Syndromes
by Laura Cristina Gironi, Francesca Zottarelli, Gianfranco Savoldi, Lucia Dora Notarangelo, Maria Eleonora Basso, Ivana Ferrero, Fabio Timeus, Franca Fagioli, Luigi Maiuri, Enrico Colombo and Paola Savoia
Medicina 2019, 55(3), 78; https://doi.org/10.3390/medicina55030078 - 25 Mar 2019
Cited by 9 | Viewed by 6288
Abstract
The term congenital hypopigmentary disorders refers to a wide group of heterogeneous hereditary diseases, clinically characterized by inborn pigmentary defects of the iris, hair, and/or skin. They include Gray Hair Syndromes (GHSs), a rare group of autosomal recessive genodermatosis hallmarked by inborn silvery [...] Read more.
The term congenital hypopigmentary disorders refers to a wide group of heterogeneous hereditary diseases, clinically characterized by inborn pigmentary defects of the iris, hair, and/or skin. They include Gray Hair Syndromes (GHSs), a rare group of autosomal recessive genodermatosis hallmarked by inborn silvery gray hair. GHSs encompass Griscelli, Chediak–Higashi, Elejalde, and Cross syndromes, which are all characterized by a broad spectrum of severe multisystem disorders, including neurological, ocular, skeletal, and immune system impairment. In this manuscript, we describe in detail the clinical, trichoscopic, and genetic features of a rare case of Griscelli syndrome; moreover, we provide an overview of all the GHSs known to date. Our report highlights how an accurate clinical examination with noninvasive methods, like trichoscopy, may play a crucial rule in diagnosis of rare and potentially lethal genetic syndromes such as Griscelli syndrome, in which timely diagnosis and therapy may modify the clinical course, quality of life, and likelihood of survival. Full article
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10 pages, 1020 KiB  
Article
Energy Expenditure of a Single Sit-to-Stand Movement with Slow Versus Normal Speed Using the Different Frequency Accumulation Method
by Takashi Nakagata, Yosuke Yamada, Yoichi Hatamoto and Hisashi Naito
Medicina 2019, 55(3), 77; https://doi.org/10.3390/medicina55030077 - 25 Mar 2019
Cited by 6 | Viewed by 3663
Abstract
Background and objectives: The purpose of this study was to compare the energy expenditures (EE) of a single sit-to-stand (STS) movements with slow and normal speeds using a multi-stage exercise test. Materials and Methods: Twelve young males, aged 21–27 years (age, 23.0 ± [...] Read more.
Background and objectives: The purpose of this study was to compare the energy expenditures (EE) of a single sit-to-stand (STS) movements with slow and normal speeds using a multi-stage exercise test. Materials and Methods: Twelve young males, aged 21–27 years (age, 23.0 ± 1.7 years; height, 171.2 ± 6.1 cm; weight, 64.3 ± 5.6 kg), performed repeated 3-s stand-up and 3-s sit-down (slow) or 1-s stand-up and 1-s sit-down (normal) movement on two different days with random order. All the participants completed multi-stage tests at different STS frequencies per minute. The slope and intercept of the linear regression relationship between the EE (kcal/min) and the STS frequency were obtained, and the slope of the regression was quantified as the EE of an STS. Results: The metabolic equivalents (METs) of the STS-slow was 4.5 METs for the frequency of 10 times/min (in total 1 min), and the net EE was 5.00 ± 1.2 kcal/min. The net EE of the STS-slow was 0.37 ± 0.12 kcal, which was significantly greater than that during the STS-normal (0.26 ± 0.06 kcal). The difference between the EEs of the STS-slow and STS-normal was significantly greater in taller and heavier subjects. Conclusions: We concluded that the intensity of STS-slow movement is moderate, and the EE during an STS-slow (0.37 ± 0.12 kcal) is higher than that during an STS-normal (0.26 ± 0.06 kcal). Our study results will help exercise and/or health professionals prescribe physical activity programs using STS movement for healthy young population groups. Full article
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13 pages, 755 KiB  
Article
Vaspin in Serum and Urine of Post-Partum Women with Excessive Gestational Weight Gain
by Marcin Trojnar, Jolanta Patro-Małysza, Żaneta Kimber-Trojnar, Monika Czuba, Jerzy Mosiewicz and Bożena Leszczyńska-Gorzelak
Medicina 2019, 55(3), 76; https://doi.org/10.3390/medicina55030076 - 23 Mar 2019
Cited by 10 | Viewed by 2830
Abstract
Background and objectives: Data concerning vaspin in obstetric aspects are limited and conflicting. The aim of the study was to evaluate vaspin concentrations in the serum and urine of women with excessive gestational weight gain (EGWG) in the early post-partum period (i.e., [...] Read more.
Background and objectives: Data concerning vaspin in obstetric aspects are limited and conflicting. The aim of the study was to evaluate vaspin concentrations in the serum and urine of women with excessive gestational weight gain (EGWG) in the early post-partum period (i.e., 48 h after delivery), when placental function no longer influences the results. Materials and Methods: The study subjects were divided into two groups of 28 healthy controls and 38 mothers with EGWG. Maternal body composition and hydration status were evaluated by the bioelectrical impedance analysis (BIA) method. Concentrations of vaspin, fatty acid-binding protein 4 (FABP4), leptin, and ghrelin were determined via enzyme-linked immunosorbent assay (ELISA). Results: Serum vaspin levels were lower in the EGWG group, whereas no significant differences were noted between the groups, with regard to the urine vaspin concentrations. In both studied groups, the serum vaspin concentrations correlated positively with the urine FABP4 levels and negatively with gestational weight gain, body mass index gain in the period from pre-pregnancy to 48 h after delivery (ΔBMI), and fat tissue index (FTI). In the multiple linear regression models, the serum vaspin concentrations were positively dependent on the serum FABP4 levels, as well as negatively dependent on triglycerides, FTI, and ΔBMI. Conclusions: Our study revealed that the EGWG mothers were characterized by significantly lower serum vaspin concentrations in the early post-partum period compared with the subjects that had appropriate gestational weight gain. Our observation supports previous hypotheses that vaspin might be used as a marker of lipid metabolism in pregnancy and maternal adipose tissue. Considering the fact that FABP4 is widely referred to as a pro-inflammatory adipokine, further research on the protective role of vaspin seems crucial, especially in the context of its relationship to FABP4. Full article
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8 pages, 283 KiB  
Article
Short-Term Predictors for Weight Correction Success of the First Paediatric Weight Correction Programme in Children’s Clinical University Hospital in Riga
by Jurgita Gailite, Dana Apela, Iveta Dzīvīte-Krišāne and Dace Gardovska
Medicina 2019, 55(3), 75; https://doi.org/10.3390/medicina55030075 - 21 Mar 2019
Cited by 3 | Viewed by 2176
Abstract
Background and objectives: The efficacy of a weight correction programme can be affected by such predictors as the number of contact hours, gender, age, baseline weight, parental weight status, psycho-emotional status, insulin resistance, and socioeconomic status. The aim of this current study was [...] Read more.
Background and objectives: The efficacy of a weight correction programme can be affected by such predictors as the number of contact hours, gender, age, baseline weight, parental weight status, psycho-emotional status, insulin resistance, and socioeconomic status. The aim of this current study was to evaluate the overall efficacy of the Weight Correction Programme at Children’s Clinical University Hospital, and explore the impact of the probable predictors. We evaluated the efficacy depending on gender, age, parental weight status, signs of depression, baseline body mass index z-score (z-BMI), and baseline waist circumference. Materials and Methods: The data were gathered from medical records. The inclusion criteria were as follows: Entered the programme by 13 June 2017, at least five years old, follow-up data available. All the respondents were divided into two age groups: <10 years old and ≥10 years old. Results: The study included 181 respondents. They were 5 to 17 years old on the first day of participation in the Weight Correction Programme. Results indicated that 117 (65%) patients managed to reduce z-BMI and 69 (38%) patients achieved clinically significant reduction of z-BMI. Boys had four times higher odds (odds ratio (OR) = 4,22; CI 1.37–13.05; p = 0.012) to reduce their z-BMI by at least 0.20 units than girls. The respondents of the older age group (≥10 years) had a better chance to reduce z-BMI than the younger ones (OR = 11,51; CI 2.04–64.83; p = 0.006). The odds to reduce z-BMI were lower by 7% for every extra cm of waist circumference (OR = 0.93; CI 0.88–0.99; p = 0.014) for reducing z-BMI. The follow-up time was also a positive predictor, and with every month the odds for clinically significant z-BMI reduction increased by 7% (OR = 1.07; CI 1.00–1.15; p = 0.047). The parental weight status, signs of depression, and baseline z-BMI were not significant predictors. Conclusions: More than half of the patients of the respondents managed to reduce their z-BMI. Female gender, younger age, and larger waist circumference were negative predictors. Full article
10 pages, 1927 KiB  
Article
Epidemiological Survey and Retrospective Analysis of Salmonella Infections between 2000 and 2017 in Warmia and Masuria Voivodship in Poland
by Paula Dmochowska, Maria Spyczak von Brzezinski, Jacek Żelazowski, Joanna Wojtkiewicz, Susanne Jung and Joanna M. Harazny
Medicina 2019, 55(3), 74; https://doi.org/10.3390/medicina55030074 - 20 Mar 2019
Cited by 3 | Viewed by 2703
Abstract
Background and Objectives: Salmonellosis is a major foodborne bacterial infection throughout the world. Epidemiological surveillance is one of the key factors to reduce the number of infections caused by this pathogen in both humans and animals. The first outcome measure was the [...] Read more.
Background and Objectives: Salmonellosis is a major foodborne bacterial infection throughout the world. Epidemiological surveillance is one of the key factors to reduce the number of infections caused by this pathogen in both humans and animals. The first outcome measure was the prevalence of non-typhoid Salmonella (NTS) infections between 2000 and 2017 among the population of the predominantly agricultural and touristic Polish region of Warmia and Masuria (WaM). The second outcome measure was the comparison of the NTS hospitalization rate of all registered NTS cases, an investigation of the monthly reports of infections, and the exploration of the annual minimal and maximal NTS infection number in WaM in the above-mentioned time period. The last outcome was a comparison of the prevalence of NTS infections in the region and in its administrative districts by considering both rural and urban municipalities three years before and three years after the accession of Poland into the European Union (EU) in 2004. Materials and Methods: The total number of infections and hospitalizations in the 19 districts of the WaM voivodship in Poland was registered monthly between 2000–2017 by the Provincial Sanitary-Epidemiological Station in Olsztyn, Poland. Results: Between 2000 and 2017, the number of diagnosed salmonellosis cases decreased significantly in WaM; the decrease was higher in urban districts than in rural ones, and the ratio of hospitalizations and the total number of NTS cases increased significantly across all districts. The lowest number of cases was reported in the winter months and was stable from 2007, whereas the highest number was reported in the summer months with a higher tendency of outbreaks. Conclusion: The falling number of salmonellosis cases in 2000–2017 in WaM reflects the general trend in Poland and Europe. The decrease of NTS infections in WaM is related to the accession of Poland into the EU. Full article
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10 pages, 1516 KiB  
Article
Prognostic Value of Left Ventricular Function and Mechanics in Pulmonary Hypertension: A Pilot Cardiovascular Magnetic Resonance Feature Tracking Study
by Lina Padervinskienė, Aušra Krivickienė, Deimantė Hoppenot, Skaidrius Miliauskas, Algidas Basevičius, Irena Nedzelskienė, Antanas Jankauskas, Paulius Šimkus and Eglė Ereminienė
Medicina 2019, 55(3), 73; https://doi.org/10.3390/medicina55030073 - 20 Mar 2019
Cited by 21 | Viewed by 3637
Abstract
Background and objective: Cardiovascular magnetic resonance (CMR) - based feature tracking (FT) can detect left ventricular (LV) strain abnormalities in pulmonary hypertension (PH) patients, but little is known about the prognostic value of LV function and mechanics in PH patients. The aim [...] Read more.
Background and objective: Cardiovascular magnetic resonance (CMR) - based feature tracking (FT) can detect left ventricular (LV) strain abnormalities in pulmonary hypertension (PH) patients, but little is known about the prognostic value of LV function and mechanics in PH patients. The aim of this study was to evaluate LV systolic function by conventional CMR and LV global strains by CMR-based FT analysis in precapillary PH patients, thereby defining the prognostic value of LV function and mechanics. Methods: We prospectively enrolled 43 patients with precapillary PH (mean pulmonary artery pressure (mPAP) 55.91 ± 15.87 mmHg, pulmonary arterial wedge pressure (PAWP) ≤15 mmHg) referred to CMR for PH evaluation. Using FT software, the LV global longitudinal strain (GLS) and global circumferential strain (GCS), also right ventricular (RV) GLS were analyzed. Results: Patients were classified into two groups according to survival (survival/non-survival). LV GLS was significantly reduced in the non-survival group (−12.4% [−19.0–(−7.8)] vs. −18.4% [−22.5–(−15.5)], p = 0.009). By ROC curve analysis, LV GLS > −14.2% (CI: 3.229 to 37.301, p < 0.001) was found to be robust predictor of mortality in PH patients. Univariable analysis using the Cox model showed that severely reduced LV GLS > −14.2%, with good sensitivity (77.8%) and high specificity (93.5%) indicated an increase of the risk of death by 11-fold. LV GLS significantly correlated in PH patients with RV ESVI (r = 0.322, p = 0.035), RV EF (r = 0.444, p < 0.003). Conclusions: LV systolic function and LV global longitudinal strain measurements using CMR-FT correlates with RV dysfunction and is associated with poor clinical outcomes in precapillary PH patients. Full article
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10 pages, 2009 KiB  
Article
Assessing the Sensitizing and Allergenic Potential of the Albumin and Globulin Fractions from Amaranth (Amaranthus hypochondriacus) Grains before and after an Extrusion Process
by Feliznando Isidro Cárdenas-Torres, Cuauhtémoc Reyes-Moreno, Marcela de Jesús Vergara-Jiménez, Edith Oliva Cuevas-Rodríguez, Jorge Milán-Carrillo, Roberto Gutiérrez-Dorado, Jesús Gilberto Arámburo-Gálvez, Noé Ontiveros and Francisco Cabrera-Chávez
Medicina 2019, 55(3), 72; https://doi.org/10.3390/medicina55030072 - 20 Mar 2019
Cited by 7 | Viewed by 3369
Abstract
Background: The first cases of food allergy to amaranth grain have recently been published. This pseudocereal is considered hypoallergenic, and there is scarce information about the allergenic potential of amaranth proteins, either before or after food processing. Objective: To evaluate, in a mouse [...] Read more.
Background: The first cases of food allergy to amaranth grain have recently been published. This pseudocereal is considered hypoallergenic, and there is scarce information about the allergenic potential of amaranth proteins, either before or after food processing. Objective: To evaluate, in a mouse model of food allergy, the sensitizing and allergenic potential of extruded and non-extruded albumin and globulin fractions from amaranth grains. Materials and Methods: Amaranth (Amaranthus hypochondriacus) flour was obtained and the albumin and globulin fractions isolated. These protein fractions were also obtained after flour extrusion. An intraperitoneal 28-day protocol was carried out to evaluate the sensitizing and allergenic potential of the proteins. The common and rarely allergenic proteins ovalbumin and potato acidic phosphatase were utilized as reference. Specific IgE and IgG antibodies were evaluated for all the proteins tested. Mast cell protease-1 (mMCP-1) responses were evaluated in serum samples collected after intragastric challenges with the proteins of interest. All serological evaluations were carried out using ELISA. Results: Mice were sensitized to the non-extruded albumin fraction from amaranth grains and to ovalbumin (p = 0.0045). The extrusion process of amaranth proteins abrogated the IgE responses triggered under non-extruded conditions (p = 0.0147). mMCP-1 responses were significantly detected in the group of mice sensitized to ovalbumin (p = 0.0138), but not in others. Conclusions: The non-extruded albumin fraction from amaranth has the potential to sensitize BALB/c mice, but this sensitizing potential fails to induce detectable serum levels of the mast cell degranulation marker mMCP-1 after intragastric challenges. Furthermore, the extrusion process abolished the sensitization potential of the amaranth albumins. Full article
(This article belongs to the Special Issue Food Allergies)
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5 pages, 283 KiB  
Case Report
New versus Old Oral Anticoagulants: How Can We Set the Scale Needle? Considerations on a Case Report
by Francesca Antonia Arcadi, Simona Portaro, Roberto Giorgianni, Antonino Naro, Carmela Casella, Carmelo Genovese, Silvia Marino and Rocco Salvatore Calabrò
Medicina 2019, 55(3), 71; https://doi.org/10.3390/medicina55030071 - 17 Mar 2019
Cited by 1 | Viewed by 2736
Abstract
Ischemic stroke is a complex multifactorial disorder. Anticoagulation is a growing research area, with the main goal of preventing systemic embolization and stroke. We report the case of a 41-year-old woman with antiphospholipid syndrome who was unsuccessfully treated with Dabigatran, a new oral [...] Read more.
Ischemic stroke is a complex multifactorial disorder. Anticoagulation is a growing research area, with the main goal of preventing systemic embolization and stroke. We report the case of a 41-year-old woman with antiphospholipid syndrome who was unsuccessfully treated with Dabigatran, a new oral anticoagulant, as she developed a major stroke involving the right carotid artery, due to deep venous thrombosis with pulmonary embolism. We therefore suggest a closer monitoring of the safety and efficacy of dabigatran. Moreover, in the presence of multifactorial causes of pro-coagulation, we believe that warfarin should remain the mainstay of oral anticoagulation. Full article
7 pages, 263 KiB  
Review
Acute Exacerbation of Idiopathic Pulmonary Fibrosis
by Tomoo Kishaba
Medicina 2019, 55(3), 70; https://doi.org/10.3390/medicina55030070 - 16 Mar 2019
Cited by 37 | Viewed by 9057
Abstract
Idiopathic pulmonary fibrosis (IPF) is the most common form of idiopathic interstitial pneumonia. Idiopathic pulmonary fibrosis is often seen in elderly men who smoke. A diagnosis of IPF is based on a combination of a detailed clinical history, specific physical examination, laboratory findings, [...] Read more.
Idiopathic pulmonary fibrosis (IPF) is the most common form of idiopathic interstitial pneumonia. Idiopathic pulmonary fibrosis is often seen in elderly men who smoke. A diagnosis of IPF is based on a combination of a detailed clinical history, specific physical examination, laboratory findings, pulmonary function tests, high-resolution computed tomography (HRCT) of the chest, and histopathology. Idiopathic pulmonary fibrosis has a heterogeneous clinical course, from an asymptomatic stable state to progressive respiratory failure or acute exacerbation (AE). Acute exacerbation of IPF has several important differential diagnoses, such as heart failure and volume overload. The International Working Group project proposed new criteria for defining AE of IPF in 2016, which divides it into triggered and idiopathic AE. On the basis of these criteria, physicians can detect AE of IPF more easily. The recent international IPF guidelines emphasized the utility of chest HRCT. In addition, two antifibrotic agents have become available. We should focus on both the management and prevention of AE. The diagnostic process, laboratory findings, typical chest imaging, management, and prognosis of AE are comprehensively reviewed in this article. Full article
(This article belongs to the Special Issue Idiopathic Pulmonary Fibrosis Research)
11 pages, 3173 KiB  
Article
Gait Training Using the Honda Walking Assistive Device® in a Patient Who Underwent Total Hip Arthroplasty: A Single-Subject Study
by Kazunori Koseki, Hirotaka Mutsuzaki, Kenichi Yoshikawa, Yusuke Endo, Takayuki Maezawa, Hanako Takano, Arito Yozu and Yutaka Kohno
Medicina 2019, 55(3), 69; https://doi.org/10.3390/medicina55030069 - 14 Mar 2019
Cited by 13 | Viewed by 4836
Abstract
Background and objectives: The Honda Walking Assistive device® (HWA) is a light and easy wearable robot device for gait training, which assists patients’ hip flexion and extension movements to guide hip joint movements during gait. However, the safety and feasibility of robot-assisted [...] Read more.
Background and objectives: The Honda Walking Assistive device® (HWA) is a light and easy wearable robot device for gait training, which assists patients’ hip flexion and extension movements to guide hip joint movements during gait. However, the safety and feasibility of robot-assisted gait training after total hip arthroplasty (THA) remains unclear. Thus, we aimed to evaluate the safety and feasibility of this gait training intervention using HWA in a patient who underwent THA. Materials and methods: The patient was a 76-year-old woman with right hip osteoarthritis. Gait training using HWA was implemented for 20 sessions in total, five times per week from 1 week to 5 weeks after THA. Self-selected walking speed (SWS), step length (SL), cadence, timed up and go (TUG), range of motion (ROM) of hip extension, and hip abduction and extension torque were measured preoperatively, and at 1 (pre-HWA), 2, 3, 4, 5 (post-HWA), and 10 weeks (follow-up) after THA. The gait patterns at SWS without HWA were measured by using three-dimensional (3D) gait analysis and an integrated electromyogram (iEMG). Results: The patient completed 20 gait training sessions with no adverse event. Hip abduction torque at the operative side, hip extension torque, SWS, SL, and cadence were higher at post-HWA than at pre-HWA. In particular, SWS, TUG, and hip torque were remarkably increased 3 weeks after THA and improved to almost the same levels at follow-up. Maximum hip extension angle and hip ROM during gait were higher at post-HWA than at pre-HWA. Maximum and minimum anterior pelvic tilt angles were lower at post-HWA than at pre-HWA. The iEMG of the gluteus maximus and gluteus medius in the stance phase were lower at post-HWA than preoperatively and at pre-HWA. Conclusions: In this case, the gait training using HWA was safe and feasible, and could be effective for the early improvement of gait ability, hip function, and gait pattern after THA. Full article
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14 pages, 869 KiB  
Article
Evaluation of the Second Follicular Wave Phenomenon in Natural Cycle Assisted Reproduction: A Key Option for Poor Responders through Luteal Phase Oocyte Retrieval
by Konstantinos Sfakianoudis, Mara Simopoulou, Evangelos Maziotis, Polina Giannelou, Petroula Tsioulou, Anna Rapani, Agni Pantou, Konstantina Petroutsou, Irene Angeli, Efthymios Deligeoroglou, Michael Koutsilieris and Konstantinos Pantos
Medicina 2019, 55(3), 68; https://doi.org/10.3390/medicina55030068 - 14 Mar 2019
Cited by 13 | Viewed by 5214
Abstract
Background: Emergence of Luteal Phase Oocyte Retrieval (LuPOR) may revolutionize the practice regarding the time-sensitive nature of poor responders ascertaining a higher number of oocytes, in a shorter amount of time. This may be especially important in view of employing the approach [...] Read more.
Background: Emergence of Luteal Phase Oocyte Retrieval (LuPOR) may revolutionize the practice regarding the time-sensitive nature of poor responders ascertaining a higher number of oocytes, in a shorter amount of time. This may be especially important in view of employing the approach of natural cycles for Poor Responders. We suggest the acronym LuPOR describing the clinical practice of luteal phase oocyte retrieval. The aim of the study is to offer insight regarding the identity of LuPOR, and highlight how this practice may improve management of the special subgroup of poor responders. Materials and Methods: The present retrospective observational clinical study includes the collection and statistical analysis of data from 136 poor responders who underwent follicular oocyte retrieval (FoPOR) and subsequent LuPOR in natural cycles, during their In Vitro Fertilization (IVF) treatment, from the time period of 2015 to 2018. All 136 participants were diagnosed with poor ovarian reserve (POR) according to Bologna criteria. The 272 cycles were categorized as follows: 136 natural cycles with only FoPORs (Control Group) and 136 natural cycles including both FoPORs and LuPORs. Results: Our primary results indicate no statistically significant differences with regards to the mean number of oocytes, the maturation status, and fertilization rate between FoPOR and LuPOR in natural cycles. Secondarily, we demonstrate a statistically significant higher yield of oocytes (2.50 ± 0.78 vs. 1.25 ± 0.53), better oocyte maturity status (1.93 ± 0.69 vs. 0.95 ± 0.59) and higher fertilization rate (1.31 ± 0.87 vs. 0.61 ± 0.60) in natural cycles including both FoPOR and LuPOR, when compared to cycles including only FoPOR. Conclusion: Our study may contribute towards the establishment of an efficient poor responders’ management through the natural cycle approach, paving a novel clinical practice and ascertaining the opportunity to employ oocytes and embryos originating from a luteal phase follicular wave. Full article
(This article belongs to the Special Issue Clinical Embryology and Reproductive Medicine)
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6 pages, 2684 KiB  
Case Report
An Atypical Case of Idiopathic Pulmonary Fibrosis in a Patient from Africa
by Ida Pesonen, Cristian Ortiz and Giovanni Ferrara
Medicina 2019, 55(3), 67; https://doi.org/10.3390/medicina55030067 - 14 Mar 2019
Viewed by 3491
Abstract
A 39 years old African man presented with fatigue, loss of weight and night sweats; radiology showed a possible usual interstitial pneumonia pattern. The patient missed follow-up visits, and presented again after 3 years with productive cough and general illness. Pulmonary function tests [...] Read more.
A 39 years old African man presented with fatigue, loss of weight and night sweats; radiology showed a possible usual interstitial pneumonia pattern. The patient missed follow-up visits, and presented again after 3 years with productive cough and general illness. Pulmonary function tests showed a decline of FVC compared to a previous investigation. The CT scans showed progression of the interstitial lung disease, and a multidisciplinary conference recommended to proceed with a surgical lung biopsy. Histopathology showed an atypical pattern, with bronchiolar metaplasia. A new multidisciplinary conference made a diagnosis of IPF, and the patient was treated with antifibrotic drugs with a good effect, reaching stability of lung function. This case report highlights the need to improve knowledge and to better characterize rare pulmonary diseases, and especially IPF, among African patients. Full article
(This article belongs to the Special Issue Idiopathic Pulmonary Fibrosis Research)
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11 pages, 479 KiB  
Article
Pre-Exercise Rehydration Attenuates Central Fatigability during 2-Min Maximum Voluntary Contraction in Hyperthermia
by Kazys Vadopalas, Aivaras Ratkevičius, Albertas Skurvydas, Saulė Sipavičienė and Marius Brazaitis
Medicina 2019, 55(3), 66; https://doi.org/10.3390/medicina55030066 - 12 Mar 2019
Cited by 1 | Viewed by 3177
Abstract
Background and objectives: Hyperthermia with dehydration alters several brain structure volumes, mainly by changing plasma osmolality, thus strongly affecting neural functions (cognitive and motor). Here, we aimed to examine whether the prevention of significant dehydration caused by passively induced whole-body hyperthermia attenuates peripheral [...] Read more.
Background and objectives: Hyperthermia with dehydration alters several brain structure volumes, mainly by changing plasma osmolality, thus strongly affecting neural functions (cognitive and motor). Here, we aimed to examine whether the prevention of significant dehydration caused by passively induced whole-body hyperthermia attenuates peripheral and/or central fatigability during a sustained 2-min isometric maximal voluntary contraction (MVC). Materials and Methods: Ten healthy and physically active adult men (21 ± 1 years of age) performed an isometric MVC of the knee extensors for 2 min (2-min MVC) under control (CON) conditions, after passive lower-body heating that induced severe whole-body hyperthermia (HT, Tre > 39 °C) with dehydration (HT-D) and after HT with rehydration (HT-RH). Results: In the HT-D trial, the subjects lost 0.94 ± 0.15 kg (1.33% ± 0.13%) of their body weight; in the HT-RH trial, their body weight increased by 0.1 ± 0.42 kg (0.1% ± 0.58%). After lower-body heating, the HT-RH trial (vs. HT-D trial) was accompanied by a significantly lower physiological stress index (6.77 ± 0.98 vs. 7.40 ± 1.46, respectively), heart rate (47.8 ± 9.8 vs. 60.8 ± 13.2 b min−1, respectively), and systolic blood pressure (−12.52 ± 5.1 vs. +2.3 ± 6.4, respectively). During 2-min MVC, hyperthermia (HT-D; HT-RH) resulted in greater central fatigability compared with the CON trial. The voluntary activation of exercising muscles was less depressed in the HT-RH trial compared with the HT-D trial. Over the exercise period, electrically (involuntary) induced torque decreased less in the HT-D trial than in the CON and HT-RH trials. Conclusions: Our results suggest that pre-exercise rehydration might have the immediate positive effect of reducing physiological thermal strain, thus attenuating central fatigability even when exercise is performed during severe (Tre > 39 °C) HT, induced by passive warming of the lower body. Full article
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7 pages, 627 KiB  
Case Report
A Patient with GOLD Stage 3 COPD « cured » by One-Way Endobronchial Valves
by Eric Marchand, Jean-Paul d'Odemont and Michael V Dupont
Medicina 2019, 55(3), 65; https://doi.org/10.3390/medicina55030065 - 11 Mar 2019
Viewed by 3599
Abstract
Lung hyperinflation is a main determinant of dyspnoea in patients with chronic obstructive pulmonary disease (COPD). Surgical or bronchoscopic lung volume reduction are the most efficient therapeutic approaches for reducing hyperinflation in selected patients with emphysema. We here report the case of a [...] Read more.
Lung hyperinflation is a main determinant of dyspnoea in patients with chronic obstructive pulmonary disease (COPD). Surgical or bronchoscopic lung volume reduction are the most efficient therapeutic approaches for reducing hyperinflation in selected patients with emphysema. We here report the case of a 69-year old woman with COPD (GOLD stage 3-D) referred for lung volume reduction. She complained of persistent disabling dyspnoea despite appropriate therapy. Chest imaging showed marked emphysema heterogeneity as well as severe hyperinflation of the right lower lobe. She was deemed to be a good candidate for bronchoscopic treatment with one-way endobronchial valves. In the absence of interlobar collateral ventilation, 2 endobronchial valves were placed in the right lower lobe under general anaesthesia. The improvement observed 1 and 3 months after the procedure was such that the patient no longer met the pulmonary function criteria for COPD. The benefit persisted after 3 years. Full article
(This article belongs to the Special Issue Case-Based Reviews in COPD)
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9 pages, 11202 KiB  
Article
Gastroprotective Effect of Zingerone on Ethanol-Induced Gastric Ulcers in Rats
by Neda Sistani Karampour, Ardeshir Arzi, Anahita Rezaie, Marzieh Pashmforoosh and Fatemeh Kordi
Medicina 2019, 55(3), 64; https://doi.org/10.3390/medicina55030064 - 11 Mar 2019
Cited by 84 | Viewed by 6199
Abstract
Background and objectives: Zingerone is an ingredient of ginger (Zingiber officinale) with different pharmacological activities. Several studies have investigated the effect of zingerone on various gastrointestinal diseases, including irritable bowel syndrome and diarrhea. This study is aimed to evaluate the effect [...] Read more.
Background and objectives: Zingerone is an ingredient of ginger (Zingiber officinale) with different pharmacological activities. Several studies have investigated the effect of zingerone on various gastrointestinal diseases, including irritable bowel syndrome and diarrhea. This study is aimed to evaluate the effect of zingerone on ethanol-induced gastric ulcers in rats. Materials and Methods: Gastric ulcers were induced by ethanol (96%, 5 mL/kg, po) in male wistar rats and zingerone (50, 100, and 200 mg/kg) was administrated orally. Normal saline and ranitidine were used as negative and positive control, respectively. In this study, the number and length of ulcers, and malondialdehyde (MDA) and nitric oxide (NO) levels in stomach tissues were determined. Results: The findings showed that the mean number and length of gastric ulcers were significantly lower in zingerone-received groups than ethanol group (P < 0.05). The level of malondialdehyde was decreased in the stomach of zingerone groups (P < 0.05) compared to the ethanol group. In addition, zingerone treatment prevented the decrease of nitric oxide level by ethanol in the stomach tissue. Conclusions: The present study showed that zingerone has a protective effect on the ethanol-induced gastric ulcer, which may be due to its free radical scavenging activity. Full article
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8 pages, 1244 KiB  
Case Report
Exercise-Associated Hyponatremia During a Self-Paced Marathon Attempt in a 15-Year-Old Male Teenager
by Beat Knechtle, Jonah Bamert, Thomas Rosemann and Pantelis T. Nikolaidis
Medicina 2019, 55(3), 63; https://doi.org/10.3390/medicina55030063 - 7 Mar 2019
Cited by 4 | Viewed by 2806
Abstract
Background and objective: The increased participation in endurance sports such as marathon running has attracted scientific interest especially with regard to adult athletes. However, few studies have examined the impact of a marathon race on children and adolescents. Therefore, the aim of [...] Read more.
Background and objective: The increased participation in endurance sports such as marathon running has attracted scientific interest especially with regard to adult athletes. However, few studies have examined the impact of a marathon race on children and adolescents. Therefore, the aim of the present case study was two-fold: first, to describe pacing during a marathon race, and second, to examine acute responses of blood physiology and biochemistry parameters during the race (i.e., pre- and post-race) as well as five consecutive days after the race. Materials and Methods: Participant was a 15-year-old boy who completed a self-paced marathon attempt for the first time and finished in 5 h 19 m 53 s. Positive pacing (i.e., a running speed that decreased throughout race) with a final end spurt was observed. Results: An increase in fluid intake across race was shown. Exercise-associated hyponatremia (EAH, i.e., plasma sodium concentration <135 mmol/L) was found post-race. C-reactive protein (CRP) did not correlate either with creatine kinase (CK) (r = 0.457, p = 0.302) or with lactate dehydrogenase (LDH) (r = 0.156, p = 0.739); however, leukocytes correlated very largely with LDH (r = 0.889, p = 0.007) but not with CK (r = 0.696, p = 0.082). CK and LDH related almost perfectly with creatinine (r = 0.937, p = 0.002 and r = 0.959, p = 0.001, respectively); also, creatinine clearance correlated very largely with CK (r = −0.782, p = 0.038) but not with LDH (r = −0.733, p = 0.061). Leukocytes, aspartate aminotransferase, LDH, and CK deviated from physiological range post-race, but returned to normal values during the five-day recovery period. Conclusions: In summary, a male teenager at the age of 15 years was able to run a marathon in under 6 h without significant harmful effects on health. He developed mild and asymptomatic EAH and an increase in leucocytes, CRP, CK, and LDH as markers of inflammation and skeletal muscle damage. EAH after the marathon was resolved within one day of recovery. Full article
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19 pages, 1495 KiB  
Review
Metabolic Alterations, Aggressive Hormone-Naïve Prostate Cancer and Cardiovascular Disease: A Complex Relationship
by Simona Di Francesco, Iole Robuffo, Marika Caruso, Giulia Giambuzzi, Deborah Ferri, Andrea Militello and Elena Toniato
Medicina 2019, 55(3), 62; https://doi.org/10.3390/medicina55030062 - 7 Mar 2019
Cited by 12 | Viewed by 4690
Abstract
Background: Epidemiological studies suggest a possible relationship between metabolic alterations, cardiovascular disease and aggressive prostate cancer, however, no clear consensus has been reached. Objective: The aim of the study was to analyze the recent literature and summarize our experience on the [...] Read more.
Background: Epidemiological studies suggest a possible relationship between metabolic alterations, cardiovascular disease and aggressive prostate cancer, however, no clear consensus has been reached. Objective: The aim of the study was to analyze the recent literature and summarize our experience on the association between metabolic disorders, aggressive hormone-naïve prostate cancer and cardiovascular disease. Method: We identified relevant papers by searching in electronic databases such as Scopus, Life Science Journals, and Index Medicus/Medline. Moreover, we showed our experience on the reciprocal relationship between metabolic alterations and aggressive prostate cancer, without the influence of hormone therapy, as well the role of coronary and carotid vasculopathy in advanced prostate carcinoma. Results: Prostate cancer cells have an altered metabolic homeostatic control linked to an increased aggressivity and cancer mortality. The absence of discrimination of risk factors as obesity, systemic arterial hypertension, diabetes mellitus, dyslipidemia and inaccurate selection of vascular diseases as coronary and carotid damage at initial diagnosis of prostate cancer could explain the opposite results in the literature. Systemic inflammation and oxidative stress associated with metabolic alterations and cardiovascular disease can also contribute to prostate cancer progression and increased tumor aggressivity. Conclusions: Metabolic alterations and cardiovascular disease influence aggressive and metastatic prostate cancer. Therefore, a careful evaluation of obesity, diabetes mellitus, dyslipidemia, systemic arterial hypertension, together with a careful evaluation of cardiovascular status, in particular coronary and carotid vascular disease, should be carried out after an initial diagnosis of prostatic carcinoma. Full article
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14 pages, 805 KiB  
Article
Distribution and Characteristics of Hypouricemia within the Japanese General Population: A Cross-Sectional Study
by Shin Kawasoe, Kazuki Ide, Tomoko Usui, Takuro Kubozono, Shiro Yoshifuku, Hironori Miyahara, Shigeho Maenohara, Mitsuru Ohishi and Koji Kawakami
Medicina 2019, 55(3), 61; https://doi.org/10.3390/medicina55030061 - 4 Mar 2019
Cited by 13 | Viewed by 2915
Abstract
Background and objectives: There is insufficient epidemiological knowledge of hypouricemia. In this study, we aimed to describe the distribution and characteristics of Japanese subjects with hypouricemia. Materials and Methods: Data from subjects who underwent routine health checkups from January 2001 to December 2015 [...] Read more.
Background and objectives: There is insufficient epidemiological knowledge of hypouricemia. In this study, we aimed to describe the distribution and characteristics of Japanese subjects with hypouricemia. Materials and Methods: Data from subjects who underwent routine health checkups from January 2001 to December 2015 were analyzed in this cross-sectional study. A total of 246,923 individuals, which included 111,117 men and 135,806 women, met the study criteria. The participants were divided into quartiles according to their serum uric acid (SUA) levels. We subdivided the subjects with hypouricemia, which was defined as SUA level ≤ 2.0 mg/dL, into two groups and compared their characteristics, including their cardiovascular risks. Results: The hypouricemia rates were 0.46% overall, 0.21% for the men and 0.66% for the women (P < 0.001). The number of the subjects with hypouricemia showed two distributions at SUA levels of 0.4–1.1 mg/dL (lower hypouricemia group), which included a peak at 0.7–0.8 mg/dL, and at SUA levels of 1.4–2.0 mg/dL (higher hypouricemia group). The men in the higher hypouricemia group had lower body mass indexes (BMI) and triglyceride (TG) levels and had higher fasting blood glucose levels than those in the lower hypouricemia group. The women in the higher hypouricemia group were younger; had lower BMI, total protein, TG, total cholesterol and low-density lipoprotein cholesterol levels; and had higher estimated glomerular filtration rates levels compared to those in the lower hypouricemia group. Conclusions: The characteristics of the individuals in the lower and higher hypouricemia groups differed significantly, indicating different pathophysiologies within each group. Full article
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10 pages, 447 KiB  
Article
The Effects of Tai Chi Chuan Versus Core Stability Training on Lower-Limb Neuromuscular Function in Aging Individuals with Non-Specific Chronic Lower Back Pain
by Liye Zou, Yanjie Zhang, Yang Liu, Xiaopei Tian, Tao Xiao, Xiaolei Liu, Albert S. Yeung, Jing Liu, Xueqiang Wang and Qing Yang
Medicina 2019, 55(3), 60; https://doi.org/10.3390/medicina55030060 - 3 Mar 2019
Cited by 41 | Viewed by 9751
Abstract
Objectives: For this paper, we aimed to investigate the effects of Tai Chi Chuan (TCC) versus the Core Stability Training (CST) program on neuromuscular function (NF) in the lower extremities among aging individuals who suffered from non-specific chronic lower back pain (NLBP). [...] Read more.
Objectives: For this paper, we aimed to investigate the effects of Tai Chi Chuan (TCC) versus the Core Stability Training (CST) program on neuromuscular function (NF) in the lower extremities among aging individuals who suffered from non-specific chronic lower back pain (NLBP). Regarding the design, during a 12-week intervention, a single-blinded randomized controlled trial was used to compare two intervention groups with a control group on the parameters of NF. Methods: Forty-three Chinese community-dwellers were randomly assigned into two intervention groups (three sessions per week, with each session lasting 60 min in TCC and CST) and a control group. The patient-based Visual Analogue Scale (VAS) was used to measure the level of perceived pain, while parameters of NF as primary outcomes were measured by the Biodex System 3 Isokinetic Dynamometer. Results: For the knee joint, we observed significant differences in the endurance of left extension at a speed of 60°/s: (1) between TCC and control groups (p < 0.01); (2) between CST and control groups (p < 0.01). For the ankle joint, significant differences between CST and control groups were observed on the peak torque of left dorsiflexion (p < 0.05) and the endurance of the left plantar flexion at a speed of 60°/s (p < 0.05). In addition, we observed a significant difference between TCC and control groups in the endurance of the right plantar flexion (p < 0.05). Conclusions: Chen-style TCC and CST were found to have protective effects on NF in aging individuals with NLBP, while alleviating non-specific chronic pain. Full article
(This article belongs to the Special Issue Physical Activity and Physical Fitness in the Prevention and Control of Non-Communicable Diseases)
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10 pages, 645 KiB  
Article
The Spectrum of Small Intestinal Lesions in Patients with Unexplained Iron Deficiency Anemia Detected by Video Capsule Endoscopy
by Antonella Contaldo, Giuseppe Losurdo, Francesca Albano, Andrea Iannone, Michele Barone, Enzo Ierardi, Alfredo Di Leo and Mariabeatrice Principi
Medicina 2019, 55(3), 59; https://doi.org/10.3390/medicina55030059 - 27 Feb 2019
Cited by 13 | Viewed by 3239
Abstract
Background and objectives: Video-capsule endoscopy (VCE) has shown a large range (38–83%) of diagnostic yield in unexplained iron deficiency anemia (IDA) and obscure-occult bleeding. Therefore, we retrospectively investigated the VCE-detected spectrum and the prevalence of small bowel injuries and associated risk factors [...] Read more.
Background and objectives: Video-capsule endoscopy (VCE) has shown a large range (38–83%) of diagnostic yield in unexplained iron deficiency anemia (IDA) and obscure-occult bleeding. Therefore, we retrospectively investigated the VCE-detected spectrum and the prevalence of small bowel injuries and associated risk factors in inpatients with both of the above reported conditions. Methods: We selected inpatients with IDA (hemoglobin <12 g/dL in women, <13 g/dL in men) and obscure-occult bleeding. We excluded VCE indications other than IDA. Complete medical histories and laboratory tests were collected. All subjects underwent PillCam SB2/SB3. The VCE feature Lewis score was calculated when appropriate. We used the t-test and Fisher’s exact test for continuous and categorical variables, respectively, in univariate analysis. For multivariate analysis, we used binomial logistic regression. Results: We retrieved 109 patients (female:male ratio of 53:56; age 63.4 ± 18.9 years). Eighty patients (73.4%) showed ≥1 small bowel lesions. The Lewis score was calculated in 41 patients: 13 (31.7%) showed a mild (<135) and 28 (68.3%) a moderate-severe (135–790 and >790, respectively) score. In univariate analysis, the small bowel transit time (6.2 ± 2.9 versus 5.2 ± 2.1 h; p = 0.049) and non-steroidal anti-inflammatory drug use for at least two weeks (17.5% versus 0%; p = 0.01) were significantly higher in subjects with injuries. These associations were not confirmed at multivariate analysis. The severity of a lesion directly correlated with proton pump inhibitor (PPI) use and duration (not confirmed in multivariate analysis). VCE can reveal the source of obscure-occult bleeding in a high percentage of unexplained IDAs. A wide spectrum of endoscopic pictures may be found. Known as well as supposed risk factors for small bowel lesions may be detected. Full article
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9 pages, 1343 KiB  
Article
Endoscopic, Single-Session Management of Encrusted, Forgotten Ureteral Stents
by Volkan Ulker and Orcun Celik
Medicina 2019, 55(3), 58; https://doi.org/10.3390/medicina55030058 - 26 Feb 2019
Cited by 16 | Viewed by 6266
Abstract
Background and Objectives: Remained or forgotten ureteral double-J stents may cause serious complications. Removing of an encrusted, forgotten stent can be challenging. We present our experience with heavily encrusted ureteral stents and discuss the endourologic treatment options as well as their effectivity. Materials [...] Read more.
Background and Objectives: Remained or forgotten ureteral double-J stents may cause serious complications. Removing of an encrusted, forgotten stent can be challenging. We present our experience with heavily encrusted ureteral stents and discuss the endourologic treatment options as well as their effectivity. Materials and Methods: Eleven men and six women (mean 48.58 ± 14.48 years of age) with 18 encrusted forgotten stents (mean 16.4 ± 13.25 months of indwelling) were treated at our clinic. All patients underwent the operation after negative urine cultures were obtained. Their medical records were retrospectively reviewed and analyzed in terms of number of interventions required to remove the stent, operation time, complications, hospital stay and stone-free rate. Results: According to the Forgotten-Encrusted-Calcified (FECal) classification, the most common form of stent encrustation was grade III (64.7%) and 17.6% of the stents were fragmented. Four of 17 patients were initially treated with extracorporeal shock-wave lithotripsy. The patients required a mean of two endoscopic interventions for removing the encrusted stent and all stents were removed endoscopically in a single session. The mean operating time was 63.3 ± 41.8 minutes. Cystolithotripsy followed by ureteroscopy was the most common intervention (41.1%). Of the 17 patients, peroperative and postoperative complications were Clavien grade I in two, grade II in two and grade IIIb in one. The mean hospital stay was 1.3 ± 0.99 days. All patients were stone-free after a month of stent removal. Conclusions: The endourological removal of the encrusted forgotten stents in a single session is feasible and effective with a minimal morbidity. The treatment strategy should be to minimize the number of interventions. Full article
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