HighlightsInguinal bladder hernia was accidentally found during surgical procedure for incarcerated inguinal hernia.During procedure urinary bladder wall was lesioned.Physicians should think of this condition in elderly, obese male, with sudden onset of lower urinary tract symptoms.Treatment of this condition is surgical, exception are unfit, asymptomatic patients.Urologist should be consulted to exclude urological malignancy – bladder cancer.
Selective electrical pudendal nerve stimulation calibrated to achieve a "maximal motor response" as recorded electromyographically in the periurethral sphincter was found to increase the micturition threshold in three neurological patients with detrusor hyperreflexia. Such electrical stimulation (0.2-ms long pulses at 5 Hz and up to 2.0 mA) could conceivably be also supplied by an implanted "vesicoinhibitory" stimulator, and this report is considered as a pilot study towards formulation of such a therapeutic approach.
IntroductionChanges in immune function after surgery may influence overall outcome, length of hospital stay, susceptibility to infection and perioperative tumour dissemination in cancer patients. Our aim was to elaborate on postoperative differences in the immune status and the intensity of the systemic inflammatory response between two groups of prospectively enrolled patients with colorectal cancer, namely patients undergoing laparoscopically assisted or open colorectal surgery.Material and methodsBlood samples from 77 patients were taken before surgery and then 3 h, 24 h and 4 days after surgery. The inflammatory response was determined by leukocyte counts, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and procalcitonin levels (PCT). Immune status was determined by phenotypic analysis of lymphocyte populations and the activation of mononuclear cells. CD64 expression and cytokine expression were also determined.ResultsPatients undergoing laparoscopically assisted surgery had less intraoperative blood loss (p = 0.002), earlier resumption of diet (p = 0.002) and shorter hospital stay (p = 0.02). Numbers of total leukocytes (p = 0.12), CRP (p = 0.002) and PCT (p = 0.23) were remarkably higher 4 days after surgery in patients who underwent an open colorectal procedure. There was an important decrease in monocyte HLA-DR expression 3 h after surgery in patients undergoing laparoscopically assisted surgery (p = 0.03).ConclusionsOur study suggests that minimally invasive surgery provides better short-term clinical outcomes for patients with resectable colorectal cancer. The acute inflammatory response is less pronounced. Post-surgical immunological disturbance in both groups is similar, but we observed a divergent effect of different surgical approaches on the expression of HLA-DR on monocytes. However, our results corroborate the results of previous studies.
Peritoneal dialysis (PD) is a generally accepted method for treatment of patients with the end-stage renal disease. A larger proportion of PD patients transfer to haemodialysis every year than the converse. Many of the underlying causes of transfer to haemodialysis are preventable. Infectious complications still remain the most common reason for transfer of PD patients to haemodialysis, catheter-related problems are the second most common cause. For PD to be effective it is very important to provide a quality peritoneal access with the insertion of PD catheter with minimum complications. With the development of minimally invasive and laparoscopic surgery, laparoscopic insertion of PD catheter is becoming widely accepted method, which showed to be effective with minor complications. In our institution, laparoscopic insertion of PD catheter in adult patients is a standard method for providing peritoneal access for chronic peritoneal dialysis.
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