Urogenital fistulas are a group of conditions in which the urinary tract is apparently connected to another organ system. Causes of fistula range from congenital anomalies, malignancy, trauma, infection or inflammatory conditions, ischemia, parturition, and iatrogenic sources – including surgery and radiation. Signs and symptoms of urinary tract fistula are variable and depend on the organ system involved and the size of the fistula. For patients who are appropriate surgical candidates, elective surgical repair is the mainstay of treatment of urinary tract fistula. Surgical techniques can be complex, but rely on the same key concepts: adequate exposure of the fistula tract; careful dissection and separation of the tissue layers, while minimizing cautery; multi-layer closure; watertight closure of each layer; meticulous hemostasis to prevent hematoma formation, but preserve vascular supply of tissues; use of well-vascularized tissue flaps; tension-free, non-overlapping suture lines; biopsy of tissues concerning for malignancy. This review contains 6 figures, 5 tables, and 82 references. Keywords: urogenital fistula, female bladder, vesical fistula, urinary bladder fistula, vesicovaginal fistula, urethrovaginal fistula, vaginal fistula, urethral diverticulum, urethral diverticulectomy, female urethra
{"title":"Urogenital Fistulas and Female Urethral Diverticula","authors":"L. Cox, E. Rovner","doi":"10.2310/TYWC.11071","DOIUrl":"https://doi.org/10.2310/TYWC.11071","url":null,"abstract":"Urogenital fistulas are a group of conditions in which the urinary tract is apparently connected to another organ system. Causes of fistula range from congenital anomalies, malignancy, trauma, infection or inflammatory conditions, ischemia, parturition, and iatrogenic sources – including surgery and radiation. Signs and symptoms of urinary tract fistula are variable and depend on the organ system involved and the size of the fistula. For patients who are appropriate surgical candidates, elective surgical repair is the mainstay of treatment of urinary tract fistula. Surgical techniques can be complex, but rely on the same key concepts: adequate exposure of the fistula tract; careful dissection and separation of the tissue layers, while minimizing cautery; multi-layer closure; watertight closure of each layer; meticulous hemostasis to prevent hematoma formation, but preserve vascular supply of tissues; use of well-vascularized tissue flaps; tension-free, non-overlapping suture lines; biopsy of tissues concerning for malignancy.\u0000This review contains 6 figures, 5 tables, and 82 references.\u0000Keywords: urogenital fistula, female bladder, vesical fistula, urinary bladder fistula, vesicovaginal fistula, urethrovaginal fistula, vaginal fistula, urethral diverticulum, urethral diverticulectomy, female urethra","PeriodicalId":196621,"journal":{"name":"DeckerMed Transitional Year Weekly Curriculum™","volume":"76 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116280530","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Previously published literature has estimated that approximately 16.5% of American adults have OAB, and up to 37% of OAB patients have concomitant urinary incontinence (OAB-wet). In fact, OAB is one the most common urologic disorders, accounting for more than 2 million physician office visits in the United States (2007). Nonneurogenic OAB is a symptom complex, which is defined by the International Continence Society standardization committee as urgency, with or without urgency incontinence, usually with frequency and nocturia, in the absence of proven infection or other obvious pathology. Urgency with at least one other symptom is essential to diagnose OAB and is the cornerstone component of OAB. To date, there is a paucity of validated instruments to define urinary urgency, and therefore, the diagnosis of OAB is based on patient symptomatology. Diagnosis does not rely on urodynamic findings or characteristics and therefore a thorough history and physical examination are essential. Treatment for this nonsurgical condition is therefore aimed toward symptom control. This review provides the reader with a better understanding of the voiding cycle and available medical treatment options for nonneurogenic overactive bladder (OAB). This review contains 11 figures, 7 tables, and 90 references. Key Words: anticholinergic, β3 agonist, botulinum toxin, chemodenervation, cialis, intradetrusor onabotulinumtoxinA, micturation cycle, mirabegron, overactive bladder, phosphodiesterase type 5 inhibitors, urinary retention
{"title":"Medications and Botulinum Toxin for Overactive Bladder","authors":"Kirin K. Syed, A. Gousse","doi":"10.2310/TYWC.11064","DOIUrl":"https://doi.org/10.2310/TYWC.11064","url":null,"abstract":"Previously published literature has estimated that approximately 16.5% of American adults have OAB, and up to 37% of OAB patients have concomitant urinary incontinence (OAB-wet). In fact, OAB is one the most common urologic disorders, accounting for more than 2 million physician office visits in the United States (2007). Nonneurogenic OAB is a symptom complex, which is defined by the International Continence Society standardization committee as urgency, with or without urgency incontinence, usually with frequency and nocturia, in the absence of proven infection or other obvious pathology. Urgency with at least one other symptom is essential to diagnose OAB and is the cornerstone component of OAB. To date, there is a paucity of validated instruments to define urinary urgency, and therefore, the diagnosis of OAB is based on patient symptomatology. Diagnosis does not rely on urodynamic findings or characteristics and therefore a thorough history and physical examination are essential. Treatment for this nonsurgical condition is therefore aimed toward symptom control. This review provides the reader with a better understanding of the voiding cycle and available medical treatment options for nonneurogenic overactive bladder (OAB).\u0000This review contains 11 figures, 7 tables, and 90 references.\u0000Key Words: anticholinergic, β3 agonist, botulinum toxin, chemodenervation, cialis, intradetrusor onabotulinumtoxinA, micturation cycle, mirabegron, overactive bladder, phosphodiesterase type 5 inhibitors, urinary retention","PeriodicalId":196621,"journal":{"name":"DeckerMed Transitional Year Weekly Curriculum™","volume":"31 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114759548","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Hypertensive Crises","authors":"Akinyi Ragwar, J. Siegelman, E. Espino","doi":"10.2310/tywc.4704","DOIUrl":"https://doi.org/10.2310/tywc.4704","url":null,"abstract":"<jats:p />","PeriodicalId":196621,"journal":{"name":"DeckerMed Transitional Year Weekly Curriculum™","volume":"8 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134337999","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The respiratory tract can be infected by a diverse group of viruses that produce syndromes ranging in severity from mild colds to fulminant pneumonias. Respiratory viral infections are a leading cause of morbidity, hospitalization, and mortality throughout the world; influenza and pneumonia were the most prevalent infectious causes of death during the 20th century in the United States. This review contains 8 figures, 26 tables and 87 references. Keywords: Virus, infection, respiratory tract, antiviral, pneumonia, croup, pharyngitis, epidemic, pandemic, outbreak
{"title":"Respiratory Viral Infections","authors":"Michael G. Ison","doi":"10.2310/TYWC.1143","DOIUrl":"https://doi.org/10.2310/TYWC.1143","url":null,"abstract":"The respiratory tract can be infected by a diverse group of viruses that produce syndromes ranging in severity from mild colds to fulminant pneumonias. Respiratory viral infections are a leading cause of morbidity, hospitalization, and mortality throughout the world; influenza and pneumonia were the most prevalent infectious causes of death during the 20th century in the United States. This review contains 8 figures, 26 tables and 87 references. Keywords: Virus, infection, respiratory tract, antiviral, pneumonia, croup, pharyngitis, epidemic, pandemic, outbreak","PeriodicalId":196621,"journal":{"name":"DeckerMed Transitional Year Weekly Curriculum™","volume":"25 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131509903","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Glycemic Control in the Intensive Care Unit","authors":"E. Nohra, G. Bochicchio","doi":"10.2310/surg.2258","DOIUrl":"https://doi.org/10.2310/surg.2258","url":null,"abstract":"<jats:p />","PeriodicalId":196621,"journal":{"name":"DeckerMed Transitional Year Weekly Curriculum™","volume":"17 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131742043","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Cardiac Catheterization and Intervention","authors":"D. Kumbhani, Deepak L. Bhatt","doi":"10.2310/tywc.1403","DOIUrl":"https://doi.org/10.2310/tywc.1403","url":null,"abstract":"<jats:p />","PeriodicalId":196621,"journal":{"name":"DeckerMed Transitional Year Weekly Curriculum™","volume":"4 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115118868","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Inotropes and vasopressors play a key role in the management of shock. The goal of therapy is to restore end-organ perfusion by augmenting cardiac output (CO) and vascular tone. Clinical trial data have thus far failed to identify precise hemodynamic end points associated with better outcomes; in any event, such end points are highly likely to be determined on an individualized basis, reflecting patients’ chronic arterial blood pressure, baseline cardiac function, and other pathophysiologic factors (e.g., end-stage renal failure, cardiac ischemia).1 Inotropes enhance cardiac contractility and CO; vasopressors raise blood pressure. The impact of these drugs in restoring hemodynamic parameters to “normal” values has principally been used to evaluate their effectiveness, with clinical practice guided by extrapolation from animal studies and pharmacologic trials.2 However, these drugs have important extra-cardiovascular effects on metabolic, neurohormonal, and autonomic regulation that are also injurious. This review discusses the mechanisms and evidence base for inotropes and vasopressors in various types of shock. This review contains 3 figures, and 39 references. Keywords: inotropes, vasopressors, catecholamines, monitoring, shock states, cardiogenic, hemorrhagic, septic, neurogenic
{"title":"Inotropes and Vasopressors for Shock","authors":"A. Patel, G. Ackland","doi":"10.2310/tywc.8001","DOIUrl":"https://doi.org/10.2310/tywc.8001","url":null,"abstract":"Inotropes and vasopressors play a key role in the management of shock. The goal of therapy is to restore end-organ perfusion by augmenting cardiac output (CO) and vascular tone. Clinical trial data have thus far failed to identify precise hemodynamic end points associated with better outcomes; in any event, such end points are highly likely to be determined on an individualized basis, reflecting patients’ chronic arterial blood pressure, baseline cardiac function, and other pathophysiologic factors (e.g., end-stage renal failure, cardiac ischemia).1 Inotropes enhance cardiac contractility and CO; vasopressors raise blood pressure. The impact of these drugs in restoring hemodynamic parameters to “normal” values has principally been used to evaluate their effectiveness, with clinical practice guided by extrapolation from animal studies and pharmacologic trials.2 However, these drugs have important extra-cardiovascular effects on metabolic, neurohormonal, and autonomic regulation that are also injurious. This review discusses the mechanisms and evidence base for inotropes and vasopressors in various types of shock.\u0000This review contains 3 figures, and 39 references.\u0000Keywords: inotropes, vasopressors, catecholamines, monitoring, shock states, cardiogenic, hemorrhagic, septic, neurogenic","PeriodicalId":196621,"journal":{"name":"DeckerMed Transitional Year Weekly Curriculum™","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130107853","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Systemic lupus erythematosus (SLE) is a chronic systemic autoimmune illness characterized by autoantibodies directed at nuclear antigens that cause clinical and laboratory abnormalities, such as rash, arthritis, leukopenia and thrombocytopenia, alopecia, fever, nephritis, and neurologic disease. Most or all of the symptoms of acute lupus are attributable to immunologic attack on the affected organs. Many complications of long-term disease are attributable to both the disease and its treatment. Intense sun exposure, drug reactions, and infections are circumstances that induce flare; the aim of treatment is to induce remission. This chapter is divided into sections dealing with SLE’s definitions; epidemiology; pathogenesis; disease classification, diagnosis, and differential diagnosis; and treatment. This review contains 10 figures, 12 tables, and 97 references. Key Words: Systemic lupus erythematosus, Dermatomyositis, Sjögren syndrome, rheumatoid arthritis, systemic sclerosis, Discoid lupus erythematosus, truncal psoriasiform, annular polycyclic rash
{"title":"Systemic Lupus Erythematosus","authors":"K. Kirou, M. Lockshin","doi":"10.2310/tywc.1049","DOIUrl":"https://doi.org/10.2310/tywc.1049","url":null,"abstract":"Systemic lupus erythematosus (SLE) is a chronic systemic autoimmune illness characterized by autoantibodies directed at nuclear antigens that cause clinical and laboratory abnormalities, such as rash, arthritis, leukopenia and thrombocytopenia, alopecia, fever, nephritis, and neurologic disease. Most or all of the symptoms of acute lupus are attributable to immunologic attack on the affected organs. Many complications of long-term disease are attributable to both the disease and its treatment. Intense sun exposure, drug reactions, and infections are circumstances that induce flare; the aim of treatment is to induce remission. This chapter is divided into sections dealing with SLE’s definitions; epidemiology; pathogenesis; disease classification, diagnosis, and differential diagnosis; and treatment.\u0000\u0000This review contains 10 figures, 12 tables, and 97 references.\u0000Key Words: Systemic lupus erythematosus, Dermatomyositis, Sjögren syndrome, rheumatoid arthritis, systemic sclerosis, Discoid lupus erythematosus, truncal psoriasiform, annular polycyclic rash","PeriodicalId":196621,"journal":{"name":"DeckerMed Transitional Year Weekly Curriculum™","volume":"10 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130720208","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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