The management options for ureteral obstruction are diverse, including retrograde ureteral stent insertion or antegrade nephrostomy placement, with or without eventual antegrade stent insertion. There is currently no ...The management options for ureteral obstruction are diverse, including retrograde ureteral stent insertion or antegrade nephrostomy placement, with or without eventual antegrade stent insertion. There is currently no consensus on the ideal treatment or treatment pathway for ureteral obstruction owing, in part, to the varied etiologies of obstruction and diversity of institutional practices. Additionally, different clinicians such as internists, urologists, oncologists and radiologists are often involved in the care of patients with ureteral obstruction and may have differing opinions concerning the best management strategy. The purpose of this manuscript was to review available literature that compares percutaneous nephrostomy placement vs ureteral stenting in the management of ureteral obstruction from both benign and malignant etiologies.展开更多
Acute kidney injury （AKI） is commonly seen amongst critically ill and hospitalized patients. Individuals with certain co-morbid diseases have an increased risk of developing AKI. Thus, recognizing the co-morbidities...Acute kidney injury （AKI） is commonly seen amongst critically ill and hospitalized patients. Individuals with certain co-morbid diseases have an increased risk of developing AKI. Thus, recognizing the co-morbidities that predispose patients to AKI is important in AKI prevention and treatment. Some of the most common co-morbid disease processes that increase the risk of AKI are diabetes, cancer, cardiac surgery and human immunodefciency virus （HIV） acquired immune defciency syndrome （AIDS）. This review article identifies the increased risk of acquiring AKI with given co-morbid diseases. Furthermore, the pathophysiological mechanisms underlying AKI in relation to co-morbid diseases are discussed to understand how the risk of acquiring AKI is increased. This paper reviews the effects of various co-morbid diseases including： Diabetes, cancer, cardiovascular disease and HIV AIDS, which all exhibit a significant increased risk of developing AKI. Amongst these co-morbid diseases, inflammation, the use of nephrotoxic agents, and hypoperfusion to the kidneys have been shown to be major pathological processes that predisposes individuals to AKI. The pathogenesis of kidney injury is complex, however, effective treatment of the co-morbid disease processes may reduce its risk. Therefore, improved management of co-morbid diseases may prevent some of the underlying pathology that contributes to the increased risk of developing AKI.展开更多
Objective Absence of significant epicardial coronary artery disease （CAD） in patients with acute onset of chest pain and elevation of myocardial necrosis markers is occasionally observed. The aim of this study was t...Objective Absence of significant epicardial coronary artery disease （CAD） in patients with acute onset of chest pain and elevation of myocardial necrosis markers is occasionally observed. The aim of this study was to analyse the clinical characteristics and outcome of such patients with advanced age. Methods We retrospectively analysed 4,311 patients with acute onset of chest pain plus necrosis marker elevation. Two hundred and seventy two patients without CAD on angiogram （6.3%） were identified. Out of them, 50 （1.2%） patients 〉 75 years （Group Ⅰ） were compared with （1） 222 acute coronary syndrome （ACS） patients without CAD on angiogram 〈 75 years （Group Ⅱ）, and （2） 610 consecutive patients ≥ 75 years with Non-ST-elevation Myocardial Infarction （NSTEMI） undergoing percutaneous coronary intervention （Group Ⅲ）. Results Group 1 compared to Group III patients made up for more females （64.0% vs. 49.2%; P 〈 0.0001）, and had more severe anginal symptoms on presentation [Canadian Cardiovascular Society （CCS） class Ⅰ/Ⅱ, 26.0% vs. 49.8%; P = 0.02]. Group I patients also had lower troponin levels （0.62 ± 0.8 ng/mL vs. 27 ± 74 ng/mL; P 〈 0.02）, lower leukocyte count （9.4 ± 3.13 × 10^9 vs. 12 ± 5.1 × 10^9; P = 0.001 ） and better preserved left ventricular function （56.7% ± 14.3 % vs. 45% ± 1 1%; P 〈 0.0001 ）. Event-free survival （cardiac death, myocardial infarction, recurrent angina, and re-hospitalisation） was more frequent in Group Ⅰ and Ⅱ patients compared to Group III patients （64.9%, 66.7%, and 41.6%, respectively; P 〈 0.0001）. Conclusions ACS in patients 〉 75 years without CAD is very infrequent, associated with a （1） similar outcome compared to ACS patients 〈 75 years without CAD, and （2） significant better outcome compared to NSTEMI patients 〉 75 years.展开更多
文摘The management options for ureteral obstruction are diverse, including retrograde ureteral stent insertion or antegrade nephrostomy placement, with or without eventual antegrade stent insertion. There is currently no consensus on the ideal treatment or treatment pathway for ureteral obstruction owing, in part, to the varied etiologies of obstruction and diversity of institutional practices. Additionally, different clinicians such as internists, urologists, oncologists and radiologists are often involved in the care of patients with ureteral obstruction and may have differing opinions concerning the best management strategy. The purpose of this manuscript was to review available literature that compares percutaneous nephrostomy placement vs ureteral stenting in the management of ureteral obstruction from both benign and malignant etiologies.
文摘Acute kidney injury （AKI） is commonly seen amongst critically ill and hospitalized patients. Individuals with certain co-morbid diseases have an increased risk of developing AKI. Thus, recognizing the co-morbidities that predispose patients to AKI is important in AKI prevention and treatment. Some of the most common co-morbid disease processes that increase the risk of AKI are diabetes, cancer, cardiac surgery and human immunodefciency virus （HIV） acquired immune defciency syndrome （AIDS）. This review article identifies the increased risk of acquiring AKI with given co-morbid diseases. Furthermore, the pathophysiological mechanisms underlying AKI in relation to co-morbid diseases are discussed to understand how the risk of acquiring AKI is increased. This paper reviews the effects of various co-morbid diseases including： Diabetes, cancer, cardiovascular disease and HIV AIDS, which all exhibit a significant increased risk of developing AKI. Amongst these co-morbid diseases, inflammation, the use of nephrotoxic agents, and hypoperfusion to the kidneys have been shown to be major pathological processes that predisposes individuals to AKI. The pathogenesis of kidney injury is complex, however, effective treatment of the co-morbid disease processes may reduce its risk. Therefore, improved management of co-morbid diseases may prevent some of the underlying pathology that contributes to the increased risk of developing AKI.
文摘Objective Absence of significant epicardial coronary artery disease （CAD） in patients with acute onset of chest pain and elevation of myocardial necrosis markers is occasionally observed. The aim of this study was to analyse the clinical characteristics and outcome of such patients with advanced age. Methods We retrospectively analysed 4,311 patients with acute onset of chest pain plus necrosis marker elevation. Two hundred and seventy two patients without CAD on angiogram （6.3%） were identified. Out of them, 50 （1.2%） patients 〉 75 years （Group Ⅰ） were compared with （1） 222 acute coronary syndrome （ACS） patients without CAD on angiogram 〈 75 years （Group Ⅱ）, and （2） 610 consecutive patients ≥ 75 years with Non-ST-elevation Myocardial Infarction （NSTEMI） undergoing percutaneous coronary intervention （Group Ⅲ）. Results Group 1 compared to Group III patients made up for more females （64.0% vs. 49.2%; P 〈 0.0001）, and had more severe anginal symptoms on presentation [Canadian Cardiovascular Society （CCS） class Ⅰ/Ⅱ, 26.0% vs. 49.8%; P = 0.02]. Group I patients also had lower troponin levels （0.62 ± 0.8 ng/mL vs. 27 ± 74 ng/mL; P 〈 0.02）, lower leukocyte count （9.4 ± 3.13 × 10^9 vs. 12 ± 5.1 × 10^9; P = 0.001 ） and better preserved left ventricular function （56.7% ± 14.3 % vs. 45% ± 1 1%; P 〈 0.0001 ）. Event-free survival （cardiac death, myocardial infarction, recurrent angina, and re-hospitalisation） was more frequent in Group Ⅰ and Ⅱ patients compared to Group III patients （64.9%, 66.7%, and 41.6%, respectively; P 〈 0.0001）. Conclusions ACS in patients 〉 75 years without CAD is very infrequent, associated with a （1） similar outcome compared to ACS patients 〈 75 years without CAD, and （2） significant better outcome compared to NSTEMI patients 〉 75 years.
