Background: Traditionally, monopolar transurethral resection was the standard surgery for bladder tumors. After developing the bipolar technique, it was noticed that patients’ morbidity was reduced. We aim to compare...Background: Traditionally, monopolar transurethral resection was the standard surgery for bladder tumors. After developing the bipolar technique, it was noticed that patients’ morbidity was reduced. We aim to compare bipolar and monopolar transurethral resection of bladder tumors in terms of efficacy, safety, and oncological outcomes. Patients and Methods: Clinical records of sixty patients with newly diagnosed bladder cancer who underwent either monopolar or bipolar transurethral resection between March 2019 and April 2021 were prospectively reviewed. Results: Thirty patients were included in each group. The mean age in monopolar and bipolar arms was 59.9 and 57.5 years, respectively. The obturator reflex occurred in 13.33% and 36.66% of the bipolar and monopolar arms, respectively (p = 0.032). Bladder perforation was reported in 2 cases in the monopolar arm. The resection time was significantly longer for the monopolar arm (25.45 Vs 22.85 minutes). Also, the monopolar arm reported longer mean irrigation (23.34 Vs 20.11, p = 0.039), with 1 TUR syndrome reported in the monopolar arm. The mean hemoglobin drop was more in the monopolar arm (0.9 Vs 0.5 gm/dl, p = 0.041). No statistical significance was reported regarding the histopathology results, and one patient in the monopolar group did not have muscle in his specimen. There was no statistically significant difference in recurrence and prognosis between both groups. Conclusions: The bipolar technique has demonstrated its reliability and efficiency as a surgical procedure, providing various advantages while minimizing the risk of complications.展开更多
Chronic low back pain consists of both nociceptive and neuropathic mechanisms and can be classified as a mixed pain syndrome. Neuropathic component of chronic low back pain has often been under-recognized and under-tr...Chronic low back pain consists of both nociceptive and neuropathic mechanisms and can be classified as a mixed pain syndrome. Neuropathic component of chronic low back pain has often been under-recognized and under-treated by the physicians. Recent studies have demonstrated that approximately 20%-55% of chronic low back pain patients have neuropathic pain symptoms. An altered peripheral, spinal, and supraspinal processing of pain arising as a result of a lesion affecting the nerves system are the major contributor to neuropathic low back pain. The clinical evaluation is still the gold standard for assessment and diagnosis of neuropathic low back pain. Although diagnosis can be difficult due to the lack of reliable gold standard diagnostic test for neuropathic low back pain, screening tools may help non-specialists, in particular, to identify potential patients with neuropathic low back pain who require further diagnostic evaluation and pain management. Several screening tools for neuropathic pain have been developed and tested with different patient populations. Among the screening tools, the pain DETECT questionnaire and the Standardized Evaluation of Pain are validated in patients with low back pain. The Standardized Evaluation of Pain may lead to more effectivein discriminating between neuropathic and nociceptive pain in patients with low back pain according to the higher rate of sensitivity and its validity in patients with low back pain. However, the most appropriate approach is still to combine findings on physical and neurologic examinations and patient's report in distinguishing neuropathic pain from nociceptive pain. The clinical examination including bedside sensory tests is still the best available tool for assessment and diagnosis neuropathic pain among patients with chronic low back pain. Due to the fact that chronic low back pain consists of both nociceptive and neuropathic mechanisms, a multimodal treatment approach is more rational in the management of patients with chronic low back pain. Therefore, combination therapy including drugs with different mechanisms of action should be given to the patients with chronic low back pain.展开更多
BACKGROUND Pre-clinical simulation-based training(SBT)in endoscopy has been shown to augment trainee performance in the short-term,but longer-term data are lacking.AIM To assess the impact of a two-day gastroscopy ind...BACKGROUND Pre-clinical simulation-based training(SBT)in endoscopy has been shown to augment trainee performance in the short-term,but longer-term data are lacking.AIM To assess the impact of a two-day gastroscopy induction course combining theory and SBT(Structured PRogramme of INduction and Training–SPRINT)on trainee outcomes over a 16-mo period.METHODS This prospective case-control study compared outcomes between novice SPRINT attendees and controls matched from a United Kingdom training database.Study outcomes comprised:(1)Unassisted D2 intubation rates;(2)Procedural discomfort scores;(3)Sedation practice;(4)Time to 200 procedures;and(5)Time to certification.RESULTS Total 15 cases and 24 controls were included,with mean procedure counts of 10 and 3(P=0.739)pre-SPRINT.Post-SPRINT,no significant differences between the groups were detected in long-term D2 intubation rates(P=0.332)or discomfort scores(P=0.090).However,the cases had a significantly higher rate of unsedated procedures than controls post-SPRINT(58%vs 44%,P=0.018),which was maintained over the subsequent 200 procedures.Cases tended to perform procedures at a greater frequency than controls in the post-SPRINT period(median:16.2 vs 13.8 per mo,P=0.051),resulting in a significantly greater proportion of cases achieving gastroscopy certification by the end of follow up(75% vs 36%,P=0.017).CONCLUSION In this pilot study,attendees of the SPRINT cohort tended to perform more procedures and achieved gastroscopy certification earlier than controls.These data support the role for wider evaluation of pre-clinical induction involving SBT.展开更多
文摘Background: Traditionally, monopolar transurethral resection was the standard surgery for bladder tumors. After developing the bipolar technique, it was noticed that patients’ morbidity was reduced. We aim to compare bipolar and monopolar transurethral resection of bladder tumors in terms of efficacy, safety, and oncological outcomes. Patients and Methods: Clinical records of sixty patients with newly diagnosed bladder cancer who underwent either monopolar or bipolar transurethral resection between March 2019 and April 2021 were prospectively reviewed. Results: Thirty patients were included in each group. The mean age in monopolar and bipolar arms was 59.9 and 57.5 years, respectively. The obturator reflex occurred in 13.33% and 36.66% of the bipolar and monopolar arms, respectively (p = 0.032). Bladder perforation was reported in 2 cases in the monopolar arm. The resection time was significantly longer for the monopolar arm (25.45 Vs 22.85 minutes). Also, the monopolar arm reported longer mean irrigation (23.34 Vs 20.11, p = 0.039), with 1 TUR syndrome reported in the monopolar arm. The mean hemoglobin drop was more in the monopolar arm (0.9 Vs 0.5 gm/dl, p = 0.041). No statistical significance was reported regarding the histopathology results, and one patient in the monopolar group did not have muscle in his specimen. There was no statistically significant difference in recurrence and prognosis between both groups. Conclusions: The bipolar technique has demonstrated its reliability and efficiency as a surgical procedure, providing various advantages while minimizing the risk of complications.
文摘Chronic low back pain consists of both nociceptive and neuropathic mechanisms and can be classified as a mixed pain syndrome. Neuropathic component of chronic low back pain has often been under-recognized and under-treated by the physicians. Recent studies have demonstrated that approximately 20%-55% of chronic low back pain patients have neuropathic pain symptoms. An altered peripheral, spinal, and supraspinal processing of pain arising as a result of a lesion affecting the nerves system are the major contributor to neuropathic low back pain. The clinical evaluation is still the gold standard for assessment and diagnosis of neuropathic low back pain. Although diagnosis can be difficult due to the lack of reliable gold standard diagnostic test for neuropathic low back pain, screening tools may help non-specialists, in particular, to identify potential patients with neuropathic low back pain who require further diagnostic evaluation and pain management. Several screening tools for neuropathic pain have been developed and tested with different patient populations. Among the screening tools, the pain DETECT questionnaire and the Standardized Evaluation of Pain are validated in patients with low back pain. The Standardized Evaluation of Pain may lead to more effectivein discriminating between neuropathic and nociceptive pain in patients with low back pain according to the higher rate of sensitivity and its validity in patients with low back pain. However, the most appropriate approach is still to combine findings on physical and neurologic examinations and patient's report in distinguishing neuropathic pain from nociceptive pain. The clinical examination including bedside sensory tests is still the best available tool for assessment and diagnosis neuropathic pain among patients with chronic low back pain. Due to the fact that chronic low back pain consists of both nociceptive and neuropathic mechanisms, a multimodal treatment approach is more rational in the management of patients with chronic low back pain. Therefore, combination therapy including drugs with different mechanisms of action should be given to the patients with chronic low back pain.
文摘BACKGROUND Pre-clinical simulation-based training(SBT)in endoscopy has been shown to augment trainee performance in the short-term,but longer-term data are lacking.AIM To assess the impact of a two-day gastroscopy induction course combining theory and SBT(Structured PRogramme of INduction and Training–SPRINT)on trainee outcomes over a 16-mo period.METHODS This prospective case-control study compared outcomes between novice SPRINT attendees and controls matched from a United Kingdom training database.Study outcomes comprised:(1)Unassisted D2 intubation rates;(2)Procedural discomfort scores;(3)Sedation practice;(4)Time to 200 procedures;and(5)Time to certification.RESULTS Total 15 cases and 24 controls were included,with mean procedure counts of 10 and 3(P=0.739)pre-SPRINT.Post-SPRINT,no significant differences between the groups were detected in long-term D2 intubation rates(P=0.332)or discomfort scores(P=0.090).However,the cases had a significantly higher rate of unsedated procedures than controls post-SPRINT(58%vs 44%,P=0.018),which was maintained over the subsequent 200 procedures.Cases tended to perform procedures at a greater frequency than controls in the post-SPRINT period(median:16.2 vs 13.8 per mo,P=0.051),resulting in a significantly greater proportion of cases achieving gastroscopy certification by the end of follow up(75% vs 36%,P=0.017).CONCLUSION In this pilot study,attendees of the SPRINT cohort tended to perform more procedures and achieved gastroscopy certification earlier than controls.These data support the role for wider evaluation of pre-clinical induction involving SBT.
