Pub Date : 2018-11-12DOI: 10.7326/0003-4819-55-4-710_1
B. Dworetzky, Jong Woo Lee
Epilepsy is a chronic disorder of the brain characterized by recurrent unprovoked seizures. A seizure is a sudden change in behavior that is accompanied by electrical discharges in the brain. Many patients presenting with a first-ever seizure are surprised to find that it is a very common event. A reversible or avoidable seizure precipitant, such as alcohol, argues against underlying epilepsy and therefore against treatment with medication. This chapter discusses the epidemiology, etiology, and classification of epilepsy and provides detailed descriptions of neonatal syndromes, syndromes of infancy and early childhood, and syndromes of late childhood and adolescence. The pathophysiology, diagnosis, and differential diagnosis are described, as are syncope, migraine, and psychogenic nonepileptic seizures. Two case histories are provided, as are sections on treatment (polytherapy, brand-name versus generic drugs, surgery, stimulation therapy, dietary treatments), complications of epilepsy and related disorders, prognosis, and quality measures. Special topics discussed are women?s issues and the elderly. Figures illustrate a left midtemporal epileptic discharge, wave activity during drowsiness, cortical dysplasias, convulsive syncope, rhythmic theta activity, right hippocamal sclerosis, and right temporal hypometabolism. Tables describe international classifications of epileptic seizures and of epilepsies, epilepsy syndromes and related seizure disorders, differential diagnosis of seizure, differentiating epileptic versus nonepileptic seizures, antiepileptic drugs, status epilepticus protocol for treatment, when to consider referral to a specialist, and quality measures in epilepsy. This review contains 7 figures, 10 tables, and 33 references. Key Words: Seizures, focal (partial)seizure, generalized seizures, Myoclonic seizures, Atonic seizures, Concurrent electromyographyTonic-clonic (grand mal) seizures
{"title":"Epilepsy and Related Disorders","authors":"B. Dworetzky, Jong Woo Lee","doi":"10.7326/0003-4819-55-4-710_1","DOIUrl":"https://doi.org/10.7326/0003-4819-55-4-710_1","url":null,"abstract":"Epilepsy is a chronic disorder of the brain characterized by recurrent unprovoked seizures. A seizure is a sudden change in behavior that is accompanied by electrical discharges in the brain. Many patients presenting with a first-ever seizure are surprised to find that it is a very common event. A reversible or avoidable seizure precipitant, such as alcohol, argues against underlying epilepsy and therefore against treatment with medication. This chapter discusses the epidemiology, etiology, and classification of epilepsy and provides detailed descriptions of neonatal syndromes, syndromes of infancy and early childhood, and syndromes of late childhood and adolescence. The pathophysiology, diagnosis, and differential diagnosis are described, as are syncope, migraine, and psychogenic nonepileptic seizures. Two case histories are provided, as are sections on treatment (polytherapy, brand-name versus generic drugs, surgery, stimulation therapy, dietary treatments), complications of epilepsy and related disorders, prognosis, and quality measures. Special topics discussed are women?s issues and the elderly. Figures illustrate a left midtemporal epileptic discharge, wave activity during drowsiness, cortical dysplasias, convulsive syncope, rhythmic theta activity, right hippocamal sclerosis, and right temporal hypometabolism. Tables describe international classifications of epileptic seizures and of epilepsies, epilepsy syndromes and related seizure disorders, differential diagnosis of seizure, differentiating epileptic versus nonepileptic seizures, antiepileptic drugs, status epilepticus protocol for treatment, when to consider referral to a specialist, and quality measures in epilepsy. \u0000\u0000This review contains 7 figures, 10 tables, and 33 references.\u0000Key Words: Seizures, focal (partial)seizure, generalized seizures, Myoclonic seizures, Atonic seizures, Concurrent electromyographyTonic-clonic (grand mal) seizures","PeriodicalId":196621,"journal":{"name":"DeckerMed Transitional Year Weekly Curriculum™","volume":"244 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133880123","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}
Until the advanced stages of cirrhosis, the identification of liver disease can be challenging for clinicians. In the earlier stages of the condition, most forms of chronic liver disease are asymptomatic or associated with vague and rather nonspecific complaints, such as fatigue. Even in the setting of cirrhosis, liver enzymes may be normal or mildly elevated. Patients with liver disease are currently recognized through a variety of routes, including screening programs, routine laboratory testing, and imaging performed for other complaints. This review contains 5 figures, 10 tables and 64 references Key Words: Primary biliary cirrhosis, Variceal hemorrhage, hepatocellular carcinoma, Hepatitis A, B and C, Discriminant function, Liver biopsy, Alcoholic liver disease, Autoimmune hepatitis, Hemochromatosis, Nonalcoholic fatty liver disease, Wilson disease
{"title":"Evaluating the Patient with Liver Disease","authors":"A. Muir","doi":"10.2310/IM.1313","DOIUrl":"https://doi.org/10.2310/IM.1313","url":null,"abstract":" Until the advanced stages of cirrhosis, the identification of liver disease can be challenging for clinicians. In the earlier stages of the condition, most forms of chronic liver disease are asymptomatic or associated with vague and rather nonspecific complaints, such as fatigue. Even in the setting of cirrhosis, liver enzymes may be normal or mildly elevated. Patients with liver disease are currently recognized through a variety of routes, including screening programs, routine laboratory testing, and imaging performed for other complaints.\u0000\u0000This review contains 5 figures, 10 tables and 64 references\u0000Key Words: Primary biliary cirrhosis, Variceal hemorrhage, hepatocellular carcinoma, Hepatitis A, B and C, Discriminant function, Liver biopsy, Alcoholic liver disease, Autoimmune hepatitis, Hemochromatosis, Nonalcoholic fatty liver disease, Wilson disease","PeriodicalId":196621,"journal":{"name":"DeckerMed Transitional Year Weekly Curriculum™","volume":"53 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122523968","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}
Shock remains a diagnosis of significant mortality and morbidity. The current definition defines shock as an acute clinical syndrome that results from inadequate tissue perfusion, which is significantly different from the previous definition of hypotension. Clinical manifestation varies broadly, and is based on the underlying etiology, degree of organ perfusion, and previous organ dysfunction. This review covers the classification, pathogenesis and organ response, evaluation, and management of shock. Figures show the balance between oxygen delivery and oxygen consumption, perfused capillary density, the Krogh Cylinder Model demonstrating the Anoxic-Hypercapnic Lethal Corner, the relation between systolic blood pressure, mean arterial pressure, and diastolic arterial pressure, glycolysis, and the approach to the patient with shock. Tables list clinical and metabolic markers of perfusion alteration to the organs, hemodynamic parameters in different types of shock, normal hemodynamic parameters, problems associated with the use of pulmonary artery catheter, clinical presentation of hypovolemic shock according to severity, causes of cardiogenic shock and cardiogenic pulmonary edema, and receptor activity of different vaspressors and clinical indication. This review contains 6 figures, 7 tables, and 55 references. Key Words: Shock; Hypovolemic shock; Cardiogenic shock; Neurogenic shock; Vasogenic shock; Septic shock; Obstructive shock
{"title":"Diagnosis and Treatment of States of Shock","authors":"A. Taha","doi":"10.2310/tywc.8002","DOIUrl":"https://doi.org/10.2310/tywc.8002","url":null,"abstract":"Shock remains a diagnosis of significant mortality and morbidity. The current definition defines shock as an acute clinical syndrome that results from inadequate tissue perfusion, which is significantly different from the previous definition of hypotension. Clinical manifestation varies broadly, and is based on the underlying etiology, degree of organ perfusion, and previous organ dysfunction. This review covers the classification, pathogenesis and organ response, evaluation, and management of shock. Figures show the balance between oxygen delivery and oxygen consumption, perfused capillary density, the Krogh Cylinder Model demonstrating the Anoxic-Hypercapnic Lethal Corner, the relation between systolic blood pressure, mean arterial pressure, and diastolic arterial pressure, glycolysis, and the approach to the patient with shock. Tables list clinical and metabolic markers of perfusion alteration to the organs, hemodynamic parameters in different types of shock, normal hemodynamic parameters, problems associated with the use of pulmonary artery catheter, clinical presentation of hypovolemic shock according to severity, causes of cardiogenic shock and cardiogenic pulmonary edema, and receptor activity of different vaspressors and clinical indication.\u0000This review contains 6 figures, 7 tables, and 55 references.\u0000Key Words: Shock; Hypovolemic shock; Cardiogenic shock; Neurogenic shock; Vasogenic shock; Septic shock; Obstructive shock","PeriodicalId":196621,"journal":{"name":"DeckerMed Transitional Year Weekly Curriculum™","volume":"157 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125228759","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}
Upper airway obstruction is a common reason that children present for emergency care, and causes range from simple and benign etiologies to life-threatening conditions requiring emergent intervention. Both congenital and acquired conditions can result in airway obstruction at various levels, and due to the high risk of acute decompensation associated with some of these conditions, rapid diagnosis and treatment are essential. This review covers assessment and stabilization, diagnosis, and treatment of foreign-body aspiration, croup, bacterial tracheitis, epiglottitis, peritonsillar abscess, and retropharyngeal abscess. Figures show a diagram of the pediatric airway, an anteroposterior radiograph of the neck demonstrating the characteristic “steeple sign” in croup, an algorithm for the treatment of croup, lateral radiographs demonstrating a thickened epiglottis, consistent with a diagnosis of epiglottitis, and a widening of the prevertebral soft tissues of the neck, consistent with a diagnosis of retropharyngeal abscess. Tables list causes of upper airway obstruction by anatomic location, symptoms of upper airway obstruction by anatomic location, severity of croup, and microbiology of deep neck abscesses. This review contains 5 figures, 13 tables, and 32 references Key words: Upper airway obstruction; Pediatric upper airway obstruction, Foreign-body aspiration, Croup, Bacterial tracheitis, Epiglottitis, Peritonsillar abscess, Retropharyngeal abscess, Stridor
{"title":"Pediatric Upper Airway Obstruction","authors":"M. Chan, S. Schmidt","doi":"10.2310/PEDS.4408","DOIUrl":"https://doi.org/10.2310/PEDS.4408","url":null,"abstract":"Upper airway obstruction is a common reason that children present for emergency care, and causes range from simple and benign etiologies to life-threatening conditions requiring emergent intervention. Both congenital and acquired conditions can result in airway obstruction at various levels, and due to the high risk of acute decompensation associated with some of these conditions, rapid diagnosis and treatment are essential. This review covers assessment and stabilization, diagnosis, and treatment of foreign-body aspiration, croup, bacterial tracheitis, epiglottitis, peritonsillar abscess, and retropharyngeal abscess. Figures show a diagram of the pediatric airway, an anteroposterior radiograph of the neck demonstrating the characteristic “steeple sign” in croup, an algorithm for the treatment of croup, lateral radiographs demonstrating a thickened epiglottis, consistent with a diagnosis of epiglottitis, and a widening of the prevertebral soft tissues of the neck, consistent with a diagnosis of retropharyngeal abscess. Tables list causes of upper airway obstruction by anatomic location, symptoms of upper airway obstruction by anatomic location, severity of croup, and microbiology of deep neck abscesses.\u0000 \u0000This review contains 5 figures, 13 tables, and 32 references\u0000Key words: Upper airway obstruction; Pediatric upper airway obstruction, Foreign-body aspiration, Croup, Bacterial tracheitis, Epiglottitis, Peritonsillar abscess, Retropharyngeal abscess, Stridor","PeriodicalId":196621,"journal":{"name":"DeckerMed Transitional Year Weekly Curriculum™","volume":"6 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125318968","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}
Infection stones are a well-known clinical entity that can cause significant long-term morbidity and even mortality if not treated appropriately. Infection stones are primarily composed of magnesium ammonium phosphate and calcium carbonate apatite. These stones form in alkaline urine containing ammonium. This environment is generated by infection with urease-producing organisms. Definitive treatment is aimed at removal of all stone. Percutaneous nephrolithotomy is typically the procedure of choice. Medical therapy can be used as an adjunct to surgery or as primary treatment in patients who are not surgical candidates. This review contains 8 highly rendered figures, 4 tables, and 72 references Key words: Infection stone; struvite; percutaneous nephrolithotomy; urease; dissolution therapy; magnesium ammonium phosphate; calcium carbonate apatite
{"title":"Pathophysiology and Treatment of Infection Stones","authors":"Patrick T. Gomella, Patrick W. Mufarrij","doi":"10.2310/tywc.11016","DOIUrl":"https://doi.org/10.2310/tywc.11016","url":null,"abstract":"Infection stones are a well-known clinical entity that can cause significant long-term morbidity and even mortality if not treated appropriately. Infection stones are primarily composed of magnesium ammonium phosphate and calcium carbonate apatite. These stones form in alkaline urine containing ammonium. This environment is generated by infection with urease-producing organisms. Definitive treatment is aimed at removal of all stone. Percutaneous nephrolithotomy is typically the procedure of choice. Medical therapy can be used as an adjunct to surgery or as primary treatment in patients who are not surgical candidates.\u0000This review contains 8 highly rendered figures, 4 tables, and 72 references\u0000Key words: Infection stone; struvite; percutaneous nephrolithotomy; urease; dissolution therapy; magnesium ammonium phosphate; calcium carbonate apatite","PeriodicalId":196621,"journal":{"name":"DeckerMed Transitional Year Weekly Curriculum™","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123172487","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}
In the management of neurogenic bladder (NGB), the goals are first and foremost to protect the upper tract from damage. The second treatment goal is to maintain urinary continence, but all the while maintaining the patient’s quality of life. These goals are achieved by treating most patients with NGB in a targeted fashion based on urodynamic findings. Medical therapy optimization and appropriate bladder drainage are the cornerstones of NGB management. Detrusor overactivity, poor bladder compliance, and incontinence related to these are best initially managed with antimuscarinic agents,; however, there is an increasing role for the new beta3 agonists. In the event these therapies fail, botulinum toxin is often the next choice; however, is an expensive treatment, and some patients may be treated with combination drug therapy. Nocturnal polyuria is also extremely common in this group of patients and is quite bothersome. After other risk factors have been excluded, medical treatment with desmopressin may be a suitable alternative. This review contains 3 highly rendered figures, 2 tables, and 85 references Key words: adrenergic alpha blockers, antimuscarinics, botulinum toxin, desmopressin, imipramine, mirabegron, multiple sclerosis, neurogenic bladder, spinal cord injury
{"title":"Medical Management of Neurogenic Bladder","authors":"A. Cameron, J. Stoffel","doi":"10.2310/tywc.11051","DOIUrl":"https://doi.org/10.2310/tywc.11051","url":null,"abstract":"In the management of neurogenic bladder (NGB), the goals are first and foremost to protect the upper tract from damage. The second treatment goal is to maintain urinary continence, but all the while maintaining the patient’s quality of life. These goals are achieved by treating most patients with NGB in a targeted fashion based on urodynamic findings. Medical therapy optimization and appropriate bladder drainage are the cornerstones of NGB management. Detrusor overactivity, poor bladder compliance, and incontinence related to these are best initially managed with antimuscarinic agents,; however, there is an increasing role for the new beta3 agonists. In the event these therapies fail, botulinum toxin is often the next choice; however, is an expensive treatment, and some patients may be treated with combination drug therapy. Nocturnal polyuria is also extremely common in this group of patients and is quite bothersome. After other risk factors have been excluded, medical treatment with desmopressin may be a suitable alternative.\u0000\u0000This review contains 3 highly rendered figures, 2 tables, and 85 references\u0000Key words: adrenergic alpha blockers, antimuscarinics, botulinum toxin, desmopressin, imipramine, mirabegron, multiple sclerosis, neurogenic bladder, spinal cord injury","PeriodicalId":196621,"journal":{"name":"DeckerMed Transitional Year Weekly Curriculum™","volume":"14 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125551084","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}
This review addresses the new staging criteria applied to classify renal trauma accurately. We discuss the unique differences in the etiology and management of renal trauma between adults and children. The commentary defines the differences in managing low-, medium-, and high-velocity traumatic injuries compared with blunt renal trauma, and the criteria and methods used to screen for these injuries in children are provided. Absolute and relative indications for surgical exploration of traumatic renal injuries are examined. Management of the complications of acute and delayed renal hemorrhage, asymptomatic and symptomatic urinomas, chronic pain, and hypertension is discussed. Recommendations for physical activity following the traumatic loss of a kidney are reviewed. This review contains 10 figures, 7 tables and 49 references Key words: false aneurysm, hematuria, kidney, nonpenetrating wounds, penetrating wounds, renal hypertension, renal trauma, therapeutic embolization, traumatic shock, urinoma
{"title":"Pediatric Renal Trauma","authors":"D. Husmann","doi":"10.2310/tywc.11030","DOIUrl":"https://doi.org/10.2310/tywc.11030","url":null,"abstract":"This review addresses the new staging criteria applied to classify renal trauma accurately. We discuss the unique differences in the etiology and management of renal trauma between adults and children. The commentary defines the differences in managing low-, medium-, and high-velocity traumatic injuries compared with blunt renal trauma, and the criteria and methods used to screen for these injuries in children are provided. Absolute and relative indications for surgical exploration of traumatic renal injuries are examined. Management of the complications of acute and delayed renal hemorrhage, asymptomatic and symptomatic urinomas, chronic pain, and hypertension is discussed. Recommendations for physical activity following the traumatic loss of a kidney are reviewed.\u0000\u0000This review contains 10 figures, 7 tables and 49 references\u0000 Key words: false aneurysm, hematuria, kidney, nonpenetrating wounds, penetrating wounds, renal hypertension, renal trauma, therapeutic embolization, traumatic shock, urinoma","PeriodicalId":196621,"journal":{"name":"DeckerMed Transitional Year Weekly Curriculum™","volume":"37 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126647642","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}
Nephrolithiasis is a common condition that practicing urologists will encounter and manage. The pregnant patient presents unique challenges when it comes to the diagnosis and treatment of stones. Altered anatomy and physiology, considerations of the fetus, and various imaging and procedural contraindications make navigating the care of pregnant patients with nephrolithiasis more complex than that of the general population. This review presents an algorithmic approach to the diagnosis and management of nephrolithiasis in the pregnant patient. Certain areas that are highlighted include diagnostic imaging modalities and the pros and cons of each with regard to the pregnant patient. Also discussed in detail are various treatment options, including medical management and available surgical interventions. As renal colic is the most common reason for nonobstetric hospitalization in pregnant women, it is important that they are managed with a multidisciplinary approach. This review contains 2 highly rendered figures, 4 tables, and 26 references Key words: low-dose CT, medical expulsive therapy, nephrolithiasis, obstructive hydronephrosis, percutaneous nephrostomy, physiologic hydronephrosis, pregnancy, renal colic, resistive index, ureteral stent, ureteroscopy
{"title":"Nephrolithiasis in Pregnancy","authors":"E. Raffin, V. Pais Jr","doi":"10.2310/tywc.11001","DOIUrl":"https://doi.org/10.2310/tywc.11001","url":null,"abstract":"Nephrolithiasis is a common condition that practicing urologists will encounter and manage. The pregnant patient presents unique challenges when it comes to the diagnosis and treatment of stones. Altered anatomy and physiology, considerations of the fetus, and various imaging and procedural contraindications make navigating the care of pregnant patients with nephrolithiasis more complex than that of the general population. This review presents an algorithmic approach to the diagnosis and management of nephrolithiasis in the pregnant patient. Certain areas that are highlighted include diagnostic imaging modalities and the pros and cons of each with regard to the pregnant patient. Also discussed in detail are various treatment options, including medical management and available surgical interventions. As renal colic is the most common reason for nonobstetric hospitalization in pregnant women, it is important that they are managed with a multidisciplinary approach.\u0000This review contains 2 highly rendered figures, 4 tables, and 26 references\u0000Key words: low-dose CT, medical expulsive therapy, nephrolithiasis, obstructive hydronephrosis, percutaneous nephrostomy, physiologic hydronephrosis, pregnancy, renal colic, resistive index, ureteral stent, ureteroscopy","PeriodicalId":196621,"journal":{"name":"DeckerMed Transitional Year Weekly Curriculum™","volume":"69 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127417503","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}
Radiation is a standard treatment approach in the treatment of prostate cancer, in either a definitive or postoperative setting. There is mounting evidence of improved cancer outcomes with higher doses of radiation in all risk categories, including low-risk prostate cancer patients. Technical advances with the emergence of inverse planning intensity-modulated techniques combined with image guidance have allowed for dose escalation using external-beam radiation therapy (EBRT). However, despite more accurate treatment delivery, dose-escalated radiation has consistently translated into increased toxicity. Stereotactic body radiotherapy and brachytherapy offer great means of dose escalation to the prostate without increasing the dose to the surrounding organs. Radiation options for low-risk patients include hypofractionated EBRT and brachytherapy monotherapy. Intermediate-risk patients can be divided into favorable and unfavorable groups. For favorable-risk disease, monotherapeutic approaches could be considered, whereas for unfavorable intermediate-risk and high-risk disease, a combination of therapies must be considered. In the postoperative setting, adjuvant radiation improves biochemical outcomes in patients with adverse pathologic features (pT3 and/or positive margins). This review contains 2 figures, 5 tables, 1 video and 135 refereces Key words: prostate cancer, radiation therapy, brachytherapy, stereotactic ablative body radiation, hypofractionation, hormonal therapy
{"title":"Role of Radiotherapy in Localized Prostate Cancer","authors":"J. Helou, A. Loblaw","doi":"10.2310/tywc.11096","DOIUrl":"https://doi.org/10.2310/tywc.11096","url":null,"abstract":"Radiation is a standard treatment approach in the treatment of prostate cancer, in either a definitive or postoperative setting. There is mounting evidence of improved cancer outcomes with higher doses of radiation in all risk categories, including low-risk prostate cancer patients. Technical advances with the emergence of inverse planning intensity-modulated techniques combined with image guidance have allowed for dose escalation using external-beam radiation therapy (EBRT). However, despite more accurate treatment delivery, dose-escalated radiation has consistently translated into increased toxicity. Stereotactic body radiotherapy and brachytherapy offer great means of dose escalation to the prostate without increasing the dose to the surrounding organs. Radiation options for low-risk patients include hypofractionated EBRT and brachytherapy monotherapy. Intermediate-risk patients can be divided into favorable and unfavorable groups. For favorable-risk disease, monotherapeutic approaches could be considered, whereas for unfavorable intermediate-risk and high-risk disease, a combination of therapies must be considered. In the postoperative setting, adjuvant radiation improves biochemical outcomes in patients with adverse pathologic features (pT3 and/or positive margins).\u0000 \u0000This review contains 2 figures, 5 tables, 1 video and 135 refereces\u0000Key words: prostate cancer, radiation therapy, brachytherapy, stereotactic ablative body radiation, hypofractionation, hormonal therapy","PeriodicalId":196621,"journal":{"name":"DeckerMed Transitional Year Weekly Curriculum™","volume":"27 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132642791","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}
Stress urinary incontinence (SUI) is a prevailing condition affecting women’s physical, psychological, and social well-being. SUI is the most common type of urinary incontinence, with an estimated prevalence of 8 to 33%. Despite increased awareness, it is still commonly underreported. Identifying the problem and developing an individualized assessment and treatment plan are essential for achieving the best outcome and quality of life for these women. Numerous tools exist that may aid clinicians in making an appropriate diagnosis and then selecting the optimal treatment, including behavioral, medical, and surgical approaches. Although a plethora of treatment options exist for SUI, conservative management is considered an effective first-line option for most patients. The purpose of this review is to discuss the current understanding of SUI in women and to outline the evaluations and conservative management options with the best available scientific evidence. This review contains 3 highly rendered figures, 2 tables, and 57 references Key words: Stress Urinary Incontinence, Conservative management, Pelvic Floor Exercises, Pessary, Vaginal inserts, medical treatment
{"title":"Stress Urinary Incontinence Assessment and Conservative Treatments","authors":"S. Kalra, B. Brucker","doi":"10.2310/tywc.11022","DOIUrl":"https://doi.org/10.2310/tywc.11022","url":null,"abstract":"Stress urinary incontinence (SUI) is a prevailing condition affecting women’s physical, psychological, and social well-being. SUI is the most common type of urinary incontinence, with an estimated prevalence of 8 to 33%. Despite increased awareness, it is still commonly underreported. Identifying the problem and developing an individualized assessment and treatment plan are essential for achieving the best outcome and quality of life for these women. Numerous tools exist that may aid clinicians in making an appropriate diagnosis and then selecting the optimal treatment, including behavioral, medical, and surgical approaches. Although a plethora of treatment options exist for SUI, conservative management is considered an effective first-line option for most patients. The purpose of this review is to discuss the current understanding of SUI in women and to outline the evaluations and conservative management options with the best available scientific evidence.\u0000This review contains 3 highly rendered figures, 2 tables, and 57 references\u0000Key words: Stress Urinary Incontinence, Conservative management, Pelvic Floor Exercises, Pessary, Vaginal inserts, medical treatment","PeriodicalId":196621,"journal":{"name":"DeckerMed Transitional Year Weekly Curriculum™","volume":"2013 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127429960","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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