scholarly journals Development of a Management Algorithm for Acute and Chronic Radiation Urethritis and Cystitis

2021 ◽  
pp. 1-12
Author(s):  
Ben G.L. Vanneste ◽  
Evert J. Van Limbergen ◽  
Tom A. Marcelissen ◽  
Joep G.H. van Roermund ◽  
Ludy C. Lutgens ◽  
...  
Keyword(s):  
Aminocaproic Acid ◽  
Focal Therapy ◽  
Oral Drugs ◽  
Invasive Treatment ◽  
Chronic Radiation ◽  
Management Algorithm ◽  
Assessment And Treatment ◽  
Local Bleeding ◽  
Life Threatening ◽  
Evidenced Based

<b><i>Objective:</i></b> The purpose of this review was to summarize the current literature on the assessment and treatment of radiation urethritis and cystitis (RUC) for the development of an evidenced-based management algorithm. <b><i>Material and Methods:</i></b> The PubMed/MEDLINE database was searched by a multidisciplinary group of experts in January 2021. <b><i>Results:</i></b> In total, 48 publications were identified. Three different types of RUC can be observed in clinical practice: inflammation-predominant, bleeding-predominant, and the combination of inflammation- and bleeding-RUC. There is no consensus on the optimal treatment of RUC. Inflammation-predominant RUC should be treated symptomatically based on the existence of bothersome storage or voiding lower urinary tract symptom as well as on pain. When bleeding-predominant RUC has occurred, hydration and hyperbaric oxygen therapy (HOT) should be used first and, if HOT is not available, oral drugs instead (sodium pentosane polysulfate, aminocaproic acid, immunokine WF 10, conjugated estrogene, or pentoxifylline + vitamin E). If local bleeding persists, focal therapy of bleeding vessels with a laser or electrocoagulation is indicated. In case of generalized bleeding, intravesical installation should be initiated (formalin, aluminium salts, and hyaluronic acid/chondroitin). Vessel embolization is a less invasive treatment with potentially less complications and good clinical outcomes. Open- or robot-assisted surgery is indicated in patients with permanent, life-threatening bleeding, or fistulae. <b><i>Conclusions:</i></b> Treatment of RUC, if not self-limiting, should be done according to the type of RUC and in a stepwise approach. Conservative/medical treatment (oral and topic agents) should primarily be used before invasive (transurethral) treatments.

scholarly journals ADHD: science, stigma and service implications

2018 ◽  
Vol 35 (3) ◽  
pp. 169-172
Author(s):  
B. Gavin ◽  
F. McNicholas
Keyword(s):  
Treatment Practice ◽  
Hyperactivity Disorder ◽  
Adult Services ◽  
Effective Interventions ◽  
Clinical Presentations ◽  
Assessment And Treatment ◽  
Treatment Practice Guidelines ◽  
Psychological Medicine ◽  
Evidenced Based ◽  
Personal Reflections

We are delighted to dedicate an edition of the Irish Journal of Psychological Medicine to the topic of attention-deficit hyperactivity disorder (ADHD). ADHD accounts for the majority of clinical presentations to Child and Adolescent Mental Health Services, both in terms of new assessments and ongoing attendances. Papers presented in this edition reflect on the evolving construct of ADHD, drawing from science, clinical practice and public opinion. Current and evidenced-based assessment and treatment practice guidelines are reviewed. International longitudinal studies allow us to understand the personal and societal cost, which can persist for many years post-diagnosis. Despite continuation to adulthood in many young people, follow on adult services are lacking. It is fitting that submissions, by way of personal reflections and opinion pieces, are also included from adult colleagues as they reflect on their experiences in this area. Given the recent development of a national clinical programme in ADHD in Ireland, coupled with a growing evidence for effective interventions, it is hoped that this special edition will highlight the need for appropriate and accessible ADHD treatments across the lifespan.

Cardiovascular assessment and care

2020 ◽  
pp. 57-100
Author(s):  
Christine Spiers
Keyword(s):  
Early Recognition ◽  
Rapid Assessment ◽  
Cardiac Monitoring ◽  
Compensatory Mechanisms ◽  
The United Kingdom ◽  
Cardiovascular Assessment ◽  
Assessment And Treatment ◽  
Cardiac Assessment ◽  
Life Threatening ◽  
Coronary Syndromes

Cardiovascular disease remains a major cause of death in the United Kingdom. The early recognition of cardiovascular deterioration in the acutely ill patient is an essential skill for practitioners in acute care. This chapter offers an overview of the cardiovascular system and normal physiological and compensatory mechanisms which support cardiovascular function. Cardiac assessment is explored in some detail including symptom review, cardiac monitoring, and chest pain assessment. The complex subject of arrhythmia interpretation and management is reviewed in some depth. The chapter concludes with a focus on the management of acute coronary syndromes, heart failure, and cardiogenic shock. All three conditions are potentially life-threatening and rapid assessment and treatment is essential to prevent mortality; evidence-based management of these conditions is considered in detail within this chapter.

scholarly journals Successful Embolization of Posterior Inferior Pancreaticoduodenal Artery Pseudoaneurysm on the Grounds of Chronic Pancreatitis—Case Report and Literature Review

Medicina ◽  
2020 ◽  
Vol 56 (11) ◽  
pp. 617
Author(s):  
Milica Mitrovic ◽  
Vladimir Dugalic ◽  
Jelena Kovac ◽  
Boris Tadic ◽  
Stefan Milosevic ◽  
...  
Keyword(s):  
Chronic Pancreatitis ◽  
Color Doppler ◽  
Abdominal Mass ◽  
Subsequent Development ◽  
Invasive Treatment ◽  
Total Size ◽  
Artery Pseudoaneurysm ◽  
Life Threatening ◽  
Vascular Arcade ◽  
Endovascular Coil Embolization

Pancreatic pseudoaneurysm is a rare but life-threatening clinical entity. In this paper, we present a case of a 74-year-old man, who was admitted to our clinic with a diagnosis of an acute on chronic pancreatitis complicated by walled-off-pancreatic-necrosis, with subsequent development of peripancreatic pseudoaneurysm. After initial conservative management, the patient recovered and was discharged from the hospital. However, he soon returned feeling anxious due to a pulsatile abdominal mass. Abdominal Color–Doppler examination, CT scan, and angiography revealed large pancreatic necrotic collection in the total size of 9 cm, with centrally enhancing area of 3.5 cm that corresponded to pseudoaneurysm originating from the posterior pancreaticoduodenal vascular arcade. Considering the size, location of the pseudoaneurysm, feeding vessel, and poor general patients condition, we opted for minimally invasive treatment. Pseudoaneurysm was successfully managed by endovascular coil embolization, i.e., “sandwich technique”.

Intestinal Transplantation in Pediatric Patients

2002 ◽  
Vol 12 (2) ◽  
pp. 97-115 ◽  
Author(s):  
Beverly Kosmach Park
Keyword(s):  
Medical Management ◽  
Management Strategies ◽  
Intestinal Failure ◽  
Intestinal Transplantation ◽  
Term Survival ◽  
Short Gut Syndrome ◽  
Assessment And Treatment ◽  
Life Threatening ◽  
End Stage ◽  
Intestine Transplantation

Intestine transplantation has evolved into a feasible alternative for children with permanent intestinal failure and life-threatening complications related to total parenteral nutrition. Although the first transplantations were done nearly 40 years ago, long-term survival has only been achieved in the last decade. Nearly 700 intestinal transplantations have been performed internationally since 1985, with an overall patient survival of greater than 50%. Improvements in patient selection, medical management, and assessment and treatment for rejection and infection have contributed to the increased survival. This article will discuss current results and medical management strategies for this innovative type of transplantation for children with end-stage short gut syndrome.

Cerebral Salt Wasting

2017 ◽  
Author(s):  
Mark A. Henry ◽  
Avinash B. Kumar
Keyword(s):  
Serum Sodium ◽  
Extracellular Fluid ◽  
Cerebral Salt Wasting ◽  
Delivery Of Care ◽  
Salt Wasting ◽  
Neurological Illness ◽  
Assessment And Treatment ◽  
Life Threatening ◽  
Biochemical Level ◽  
Timely Delivery

Human survival (on a biochemical level) depends on the body’s critical ability to regulate the osmolality and salinity of extracellular fluid. When functioning in a normal state, the osmoregulatory system stringently maintains the serum sodium in a narrow range. Alterations in the serum sodium and water balance have significant and sometimes life-threatening impact on patients—especially when they occur in conjunction with serious intracranial pathology. This chapter, including the case discussion, illustrates the conundrum of hyponatremia and high urine output states complicating neurological illness. A thorough understanding of the pathophysiology, assessment, and treatment of these conditions is essential for the timely delivery of care and optimal patient outcomes.

Intoxication and drugs in facilities

2015 ◽  
Author(s):  
Jason D. Ourada ◽  
Kenneth L. Appelbaum
Keyword(s):  
Mental Health ◽  
Substance Use ◽  
Active Substance ◽  
Mental Health Problems ◽  
Interdisciplinary Approach ◽  
Clinical Intervention ◽  
Comprehensive Treatment ◽  
Therapeutic Alliances ◽  
Assessment And Treatment ◽  
Life Threatening

Active abuse of substances by inmates poses a challenge for correctional psychiatrists. Substance use disorders (SUD) are common among inmates, with higher prevalence usually found in those with general psychiatric conditions. Knowledge about substance use in correctional facilities fosters competent clinical intervention and enhances management at all levels. Psychiatrists working in jails and prisons have the challenging task of maintaining therapeutic alliances with patients who have co-occurring SUDs and also may be actively using substances. Patients might not spontaneously report use during incarceration because they fear retribution by correctional staff or not receiving needed treatment for medical and mental health problems. Psychiatrists need to remain aware of this and to screen for SUD and active substance use as part of comprehensive treatment planning. The clinical challenges in jails and prisons differ, and the substances found in facilities vary geographically. Active substance abuse by inmates presents clinical and systemic challenges for correctional psychiatrists. The interplay among mental health, medical, and custody staff regarding screening, detection, triage, management, and treatment lies at the heart of these challenges. Correctional psychiatrists make important contributions by providing direct assessment and treatment to inmates, and by offering educational, clinical, and policy consultations to other staff. These contributions help prevent potentially life-threatening complications of intoxication and withdrawal, ensure integrated and evidence-based care, and avoid misguided or ill-informed disciplinary or other institutional practices. This chapter highlights these differences, outlines clinical management, and describes an interdisciplinary approach to intervention.

scholarly journals Equipment Failure: An Analysis of 2000 Incident Reports

1993 ◽  
Vol 21 (5) ◽  
pp. 673-677 ◽  
Author(s):  
R. K. Webb ◽  
W. J. Russell ◽  
I. Klepper ◽  
W. B. Runciman
Keyword(s):  
New Zealand ◽  
Crisis Management ◽  
Equipment Failure ◽  
Electrical Shock ◽  
Power Failure ◽  
Management Algorithm ◽  
Life Threatening ◽  
Zealand College ◽  
Incident Reports ◽  
Warming Devices

Of the first 2000 incidents reported to the Australian Incident Monitoring Study, 177 (9%) were due to “pure” equipment failure according to pre-defined criteria. Of these 107 (60%) involved anaesthetic equipment, 42 (24%) involved monitors, 17 (10%) other theatre equipment and 11 (6%) the gas or electricity supply. Ninety-seven (55% of the 177) were potentially life-threatening; of these two-thirds would be detected by the array of monitors recommended by the Australian and New Zealand College of Anaesthetists and all but 9 of the remainder would be handled by application of the crisis management algorithm recommended elsewhere in this symposium. Of the 9 remaining, 2 were electrical shock, 3 overheating of a humidifier or blood warmer, 2 the unavailability of a spare laryngoscope and 1 the consequence of a power failure. Meticulous adherence to the equipment checking and monitoring guidelines of the Australian and New Zealand College of Anaesthetists and application of a suitable crisis management algorithm should protect the patient from potentially life-threatening equipment failure in virtually all cases except electric shock, power failure and overheating of warming devices.

Minimally Invasive Treatment of a Life-threatening Hemorrhagic Complication of Drain Removal

2013 ◽  
Vol 79 (4) ◽  
pp. 141-142
Author(s):  
Saira Naseer ◽  
Sarim Idrees ◽  
Charles S. Joels ◽  
J. Daniel Stanley
Keyword(s):  
Minimally Invasive ◽  
Minimally Invasive Treatment ◽  
Hemorrhagic Complication ◽  
Invasive Treatment ◽  
Drain Removal ◽  
Life Threatening

Incorporating intra-lesional injection of mitomycin C in the management algorithm for bladder neck contractures and vesicourethral anastomotic strictures

2020 ◽  
pp. 205141582096190
Author(s):  
Henry H Yao ◽  
Shomik Sengupta ◽  
Justin Chee
Keyword(s):  
Success Rate ◽  
Mitomycin C ◽  
Bladder Neck ◽  
Repeated Treatment ◽  
Minimal Risk ◽  
Invasive Treatment ◽  
Level Of Evidence ◽  
Serious Adverse Events ◽  
Management Algorithm ◽  
Anastomotic Strictures

Objective: This study aims to describe the experience of a single-surgeon series with the use of intra-lesional mitomycin C (MMC) in the treatment of bladder neck contracture (BNC) and vesicourethral anastomotic stenosis (VUAS). Patients and methods: From July 2014 to January 2019, patients who underwent bladder neck incision (BNI) and intra-lesional MMC injection performed by a single surgeon were included in this retrospective study. Clinico-pathological data were extracted from medical records. The primary outcome was recurrence rate following BNI and MMC injection. Results: Ten patients were included in the study. The median age was 68 years. The cause of BNC or VUAS was secondary to radical prostatectomy in eight patients and to endoscopic prostatectomy in two patients. The median follow-up was 16.4 months. The success rate was 70% after first treatment with BNI and MMC injection, and 80% after repeated treatment. There were no serious adverse events or complications related to the MMC injection. Conclusion: BNI and intra-lesional MMC injection is a minimally invasive treatment for refractory bladder neck contractures with a good success rate and minimal risk of side effects when a low dose of MMC is used. Further prospective multicentre study is warranted. Level of evidence: Level 4.

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