stricture

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  • 文章类型: Journal Article
    背景:本研究的目的是评估和分析泌尿科医师中男性尿道狭窄疾病(MUSD)的日常临床实践。
    方法:考虑到最新的尿道狭窄疾病指南,就男性尿道狭窄疾病不同部位的各种治疗选择和偏好进行了调查。调查通过电子邮件和电话应用程序发送给泌尿科医生。
    结果:共有266名泌尿科医师完成了调查,并纳入最终分析。关于工作场所,62(23.3%),58(21.8%),71(26.7%),75名(28.2%)受访者在大学医院工作,培训和研究医院,州立医院,和私人执业医院,分别。关于男性尿道狭窄的诊断方法,88.7%的参与者会选择尿流图+排尿后残留(UF+PVR),64.6%的人会选择逆行尿道造影(RUG)。直视尿道内切开术(DVIU)是阴茎尿道狭窄(PUS)中最常用的方法,72.9%被选中。直视前路内尿道切开术是≤2cm和>2cm狭窄的最常见方法。63.1%,和30.8%,分别。用于增强尿道成形术的最优选移植物是颊粘膜(75.8%)。内镜下切开/切除术(经尿道电切术(TUR))是后尿道/膀胱尿道吻合口狭窄最常用的治疗方法(86.4%)。
    结论:本研究清楚地表明,在MUSD中,大多数泌尿科医师仍然更喜欢DVIU和尿道扩张术,这与当前的指导方针相矛盾。应鼓励泌尿科医师进行尿道成形术和/或将患者转诊至有经验的复发性MUSD中心。
    BACKGROUND: The aim of the present study is to evaluate and analyze the daily clinical practice for male urethral stricture disease (MUSD) among urologists.
    METHODS: Considering the latest guidelines on urethral stricture disease, a survey was developed regarding the various treatment options and preferences in different sites of male urethral stricture disease. The survey was sent to urologists via e-mail and phone application.
    RESULTS: A total of 266 urologists completed the survey and were included in the final analysis. In regard to workplace, 62 (23.3%), 58 (21.8%), 71 (26.7%), and 75 (28.2%) respondents worked in university hospitals, training and research hospitals, state hospitals, and private practice hospitals, respectively. In regard to the diagnostic method used in male urethral strictures, 88.7% of the participants would choose uroflowmetry + postvoiding residual (UF + PVR), and 64.6% would choose retrograde urethrography (RUG). Direct vision internal urethrotomy (DVIU) was the most frequently chosen method in penile urethral strictures (PUS), being chosen by 72.9%. Direct vision anterior internal urethrotomy was the most common method for both ≤2 cm and >2 cm strictures, 63.1%, and 30.8%, respectively. The most preferred graft for augmentation urethroplasty was buccal mucosa (75.8%). Endoscopic incision/resection (transurethral resection (TUR)) is the most frequently applied treatment method for posterior urethral/vesicourethral anastomotic strictures (86.4%).
    CONCLUSIONS: The present study clearly shows that most urologists still prefer DVIU and urethral dilatation to urethroplasty in MUSD, which contradicts current guidelines. Urologists should be encouraged to perform urethroplasty and/or refer patients to experienced centres for recurrent MUSD.
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  • 文章类型: Journal Article
    背景:在北丹麦地区,2011年后实施了区域活检指南,观察到对嗜酸性粒细胞性食管炎(EoE)的认识增加。这导致对EoE的认识提高,并在2007年至2017年间EoE患者的发病率增加了50倍。
    目的:本研究的目的是检查诊断延迟的进展,并发症,PPI治疗,自2017年以来对丹麦嗜酸性粒细胞性食管炎患者进行随访。
    方法:这是一项基于注册和人群的回顾性队列研究(DanEoE2队列),包括2018-2021年在北丹麦地区诊断为食管嗜酸性粒细胞增多症的346例成年患者。通过使用基于SNOMED系统的丹麦病理组织学注册表,DanEoE2队列包括所有可能的EoE患者。对数据进行分析,并与DanEoE队列(2007-2017)进行比较。
    结果:北丹麦地区在2018-2021年间诊断的EoE患者的诊断延迟已降至中位数1.5(5.5(2.0;12)对4.0(1.0;12),p=0.03)年。诊断前的狭窄减少了(12%对4%,p=0.003)。开始接受高剂量PPI的患者数量增加(56%对88%,p<0.001)。随着组织学随访数量的增加,人们对国家指南和随访的认识增强(67%对74%,p=0.05)。
    结论:DanEoE队列的比较显示诊断延迟减少,诊断前狭窄形成的减少,以及2017年后指南依从性的改善。未来的研究需要评估PPI治疗的症状或组织学缓解是否更能够预测患者发生并发症的风险。
    In the North Denmark Region an increased awareness of eosinophilic esophagitis (EoE) was observed after 2011 where a regional biopsy guideline was implemented. This resulted in an increased awareness of EoE and a 50-fold increase in the incidence of EoE patients between 2007-2017.
    The aims of this study were to examine the progress in diagnostic delay, complications, PPI treatment, and follow up since 2017 in Danish patients with eosinophilic esophagitis.
    This was a retrospective registry- and population-based cohort study (DanEoE2 cohort) including 346 adult patients with esophageal eosinophilia diagnosed between 2018-2021 in the North Denmark Region. The DanEoE2 cohort included all possible EoE patients by using the Danish Patho-histology registry based on the SNOMED-system. The data was analyzed and compared to the DanEoE cohort (2007-2017).
    The diagnostic delay of EoE patients diagnosed between 2018-2021 in the North Denmark Region had decreased with a median of 1.5 years (5.5 (2.0;12) years versus 4.0 (1.0;12) years, p=0.03). Strictures before diagnosis had decreased 8.4 % (11.6% versus 3.2%, p=0.003). The number of patients started on high-dose PPI increased (56% versus 88%, p<0.001). An intensified awareness regarding national guidelines and follow-up was observed as an increase in the number of histological follow up (67% versus 74%, p=0.05).
    Comparisons of the DanEoE cohorts showed a decrease in diagnostic delay, a decrease in stricture formation before diagnosis, and an improved guideline adherence after 2017. Future studies are needed to assess if symptomatic or histological remission on PPI treatment is more capable of predicting a patient\'s risk of developing complications.
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  • 文章类型: Journal Article
    溃疡性结肠炎和克罗恩病是炎症性肠病的主要形式。两者都代表胃肠道的慢性炎症,随着时间的推移,患者之间和个体内部的炎症和症状负担表现出异质性。最佳管理依赖于临床医生与患者合作理解和定制基于证据的干预措施。此16岁以上成人炎症性肠病管理指南由代表英国医生(英国胃肠病学会)的利益相关者制定,外科医生(大不列颠和爱尔兰结肠病学协会),专科护士(皇家护理学院),儿科医生(英国儿科胃肠病学会,肝病学和营养学),营养师(英国饮食协会),放射科医师(英国胃肠道和腹部放射学学会),全科医生(胃肠病学初级保健协会)和患者(克罗恩病和结肠炎英国)。对88247份出版物进行了系统审查,并进行了涉及81名多学科临床医生和患者的Delphi共识程序,以制定168项基于证据和专家意见的药理学建议。非药物和手术干预,以及在溃疡性结肠炎和克罗恩病的管理中提供最佳服务。提供了关于适应症的全面最新指导,开始和监测免疫抑制疗法,营养干预,pre,围手术期及术后管理,以及多学科团队的结构和功能以及初级和二级保健之间的整合。提出了20项研究重点,以告知未来的临床管理,在客观衡量优先重要性的同时,由2379名来自溃疡性结肠炎和克罗恩病患者的电子调查回复确定,包括患者,他们的家人和朋友。
    Ulcerative colitis and Crohn\'s disease are the principal forms of inflammatory bowel disease. Both represent chronic inflammation of the gastrointestinal tract, which displays heterogeneity in inflammatory and symptomatic burden between patients and within individuals over time. Optimal management relies on understanding and tailoring evidence-based interventions by clinicians in partnership with patients. This guideline for management of inflammatory bowel disease in adults over 16 years of age was developed by Stakeholders representing UK physicians (British Society of Gastroenterology), surgeons (Association of Coloproctology of Great Britain and Ireland), specialist nurses (Royal College of Nursing), paediatricians (British Society of Paediatric Gastroenterology, Hepatology and Nutrition), dietitians (British Dietetic Association), radiologists (British Society of Gastrointestinal and Abdominal Radiology), general practitioners (Primary Care Society for Gastroenterology) and patients (Crohn\'s and Colitis UK). A systematic review of 88 247 publications and a Delphi consensus process involving 81 multidisciplinary clinicians and patients was undertaken to develop 168 evidence- and expert opinion-based recommendations for pharmacological, non-pharmacological and surgical interventions, as well as optimal service delivery in the management of both ulcerative colitis and Crohn\'s disease. Comprehensive up-to-date guidance is provided regarding indications for, initiation and monitoring of immunosuppressive therapies, nutrition interventions, pre-, peri- and postoperative management, as well as structure and function of the multidisciplinary team and integration between primary and secondary care. Twenty research priorities to inform future clinical management are presented, alongside objective measurement of priority importance, determined by 2379 electronic survey responses from individuals living with ulcerative colitis and Crohn\'s disease, including patients, their families and friends.
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