Postprostatectomy incontinence: Pathophysiology and management

Postprostatectomy incontinence in men is a devastating condition impacting the quality of life profoundly. Various types of male sling procedures have been introduced over the years. The bone-anchored male sling appears to be effective and safe in intermediate-term follow-up. It is certainly more effective than collagen implant and may provide an alternative treatment option in patients with mild to moderate incontinence. In the short term, other novel procedures seem promising. In spite of new technology, the artificial urinary sphincter continues to provide high patient satisfaction and cure rates.     

The Effect of Basic Fibroblast Growth Factor on the Reversion of Omental Adipocytes from Lean and Obese Patients

Background: this study was designed to characterize some of the biochemical and molecular genetic changes during reversion of human fat cells. Methods: mature adipocytes were isolated from greater omental fat tissue of eight lean and 14 massively obese persons by established methodology. Results: at day 7 of adherence to Leighton tubes, there was appreciable depletion of triacylglycerol, as well as assumption of an elongated contour. Relatedly, there was an increase in the expression of β-actin mRNA and a significant decrease in the specific activity of cytosolic glycerophosphate dehydrogenase. The decrement in the specific activity of glycerophosphate dehydrogenase, after 7 days in culture, was significant at p < 0.001. Basic fibroblast growth factor at 10 ngml^-1 accelerated significantly (p < 0.03) the decrease in the specific activity of glycerophosphate dehydrogenase in adipose cells from lean subjects. In contrast, basic fibroblast growth factor had no significant influence on cells from massively obese persons. Conclusion: such resistance may contribute to the intractability of massive obesity.     

Congenital hepatic fibrosis (asymptomatic and latent form) and multiple gastric ulcers

Summary Congenital hepatic fibrosis (asymptomatic and latent form) was diagnosed in a 67-year-old male during laparotomy for a gastric ulcer. The gastrectomy specimen revealed multiple chronic ulcers with healing in the form of villous mucosal hyperplasia. The pathological diagnosis of congenital hepatic fibrosis and similar hamartomatous lesions is discussed. A possible relationship between congenital hepatic fibrosis and gastroduodenal ulceration is envisaged.     

Management of Infective Endocarditis in Pregnancy

EDITORIAL COMMENT: : We accepted this paper for publication to remind readers that bacterial endocarditis can occur in pregnancy and requires prompt diagnosis and treatment for favourable results. Fever and/or urinary symptoms should suggest the diagnosis especially when the women is known to have a cardiac murmur. We were interested to read how echocardiography can reveal the presence of vegetations on affected valves. Our cardiologist reviewer was not 100% convinced that the diagnosis was proven in Case 1 since 'many patients would have bacteraemic episodes with a known cardiac lesion which does not necessarily go on to produce endocarditis'. Our reviewer considered the diagnosis in Case 2 to be clear-cut, but was surprised how successful antibiotic therapy alone was in view of the evidence of peripheral embolization.