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Prevalence, clinical characteristics and precursors in patients with Takotsubo cardiomyopathy complicated by thromboembolism
Several acute complications associated with Tacotubo’s cardiomyopathy (TTC) have been described in the scientific literature lately. No, the incidence and clinical significance of the acute thromboembolic processes in TTS has not yet been established.
A study of scientists from Heidelberg University, Mannheim, Germany, diagnosed patients with TTC between January 2003 and September 2015. This study was initiated to identify predictors, clinical significance, and short-term and long- term treatment in patients with TTS associated with acute thromboembolism.
As a result, it was found that the incidence of acute thromboembolic complications with TTC was about 12.2%. They included ventricular thrombi, cerebrovascular events, pathology of retinal arteries, brachial, renal, splenic arteries and aorta. The most frequent complication in the initial stage of the disease was cardiogenic shock (20%), which was accompanied by the development of pulmonary edema (20%). It is important to note that patients with thromboembolism had higher levels of C-reactive protein (CRP) compared to the non-erboembolic group of patients (P = 0.02). Certain thromboembolic states were characterized by the presence of ST-segment elevation in the electrocardiogram (P = 0.02). Chest pain was the main symptom in this category of patients (p = 0.09).Besides, significant involvement of the right ventricle in the pathological process was noted (according to the estimation of transthoracic echocardiography, P = 0.08). The Kaplan-Meier analysis showed a significantly higher mortality rate during the mean-follow-up period of three years in the thromboembolism group (P = 0.02).
Thus, the results of the study confirmed the relative total risk of thromboembolic events with TTS. Inflammation can also play an important role in the development of thromboembolic complications. Involving the right ventricle process, raising the ST-segment ECG can be positive predictive criteria in such cases. In order to reduce the risk of anemic outcome, it is recommended to begin anticoagulant therapy in all patients at high risk.
Existing methods of lengthening the penis in the treatment of Peyronie’s disease. Overview
Shortening of the penis is one of the most common complaints of men with Peyronie’s disease (BP), both before and after surgery. This has a significant negative impact on the patient’s quality of life.
Based on the Columbia University Medical Center, the Department of Urology, a systematic review of the methods by which the length of the penis can be preserved or enlarged. The review was based on the search in the PUBMED database of articles published between 1990 and 2015. The articles with the key words “Peyronie’s disease”, “penis length” and / or “lengthening of the penis” about subjective or objective results of penile length changes. The review included only English-language articles that concerned BP and the size of the penis.
The researchers did not find any evidence in the literature about the advantageous effectiveness of the technique in the shortening of the penis in front of the other. The classic operation of installing an inflatable prosthesis of the penis, the procedure of plication and the procedure of Nesbit. Excision of plaques and transplantation can increase the length of the penis, but can not be complicated in the postoperative period by erectile dysfunction. There are several surgical procedures that are based on the use of an inflatable prosthesis in men with concomitant erectile dysfunction, while maintaining the length of the penis and improving sexual function.These include the subcoronal prosthetics of the penis, the peripheral technique of Egidio (Egydio), the sliding and modified sliding techniques and the technique of “multiple slices”. In addition, such adjuvant therapies as penile stretching therapy, postoperative penile inflation protocols, suspension techniques for ligament relaxation, lipectomy and surgical methods for treating penile engorgement aimed at subjective or objective penis enlargement in men are associated with a high risk of depression length in the postoperative period. Therefore, they can not be recommended as a routine.Lipectomy and surgical methods of treating the engorgement of the glans penis, at a deliberate or objective increase in the length of the penis in men, are accompanied by a high risk of depression in the postoperative period. Therefore, they can not be recommended as a routine. Lipectomy and surgical methods of treating the engorgement of the glans penis, at a deliberate or objective increase in the length of the penis in men, are accompanied by a high risk of depression in the postoperative period. Therefore, they can not be recommended as a routine.
Given that in most cases shortening the length of the penis in men is accompanied by psychological problems, it is extremely important for the surgeon with sufficient experience and knowledge to direct his attempts to maintain or increase penis length in men who underwent surgery. At present, there are a number of scientifically based, safe and effective ways to increase penis length and several developing adjuvant therapies that can provide the necessary length.
