Persistent Urinary Tract Infections: Prevention and Management

Persistent urinary tract infections (UTIs) present a common and challenging problem for both primary care and urologists. They are either the result of bacterial reinfection or persistence, and the management varies depending on the underlying cause. Appropriate investigations are crucial in ruling out any underlying urinary tract abnormalities and identifying the causative organism. We review the underlying pathophysiology and up-to-date management strategies available to the practising urologist.     

‘A reservoir within a reservoir’ – An unusual complication associated with a defunctioned inflatable penile prosthesis reservoir

INTRODUCTION

Inflatable penile prostheses (IPP) have been a successful method of treating men with erectile dysfunction since the early 1970s. IPP are comprised of two intracorporal cylinders, a scrotal pump and a fluid reservoir.

PRESENTATION OF CASE

We present a case of a retained reservoir in a sixty eight year old gentlemen presenting with a cystic abdominal mass and bothersome LUTS, 15 years after the removal of the penile components of a three-piece penile prosthesis. Percutaneous drainage of the cyst was performed, with four litres of purulent fluid evacuated. A midline laparotomy was required to remove the reservoir and drain the collection completely.

DISCUSSION

Inflammatory reaction and subsequent erosion of an IPP reservoir is an infrequent but severe complication of IPP insertion, replacement or infection. Infection remains the primary indication for penile prosthesis removal and in this setting removal of the reservoir is routine. A thorough literature search has identified that in the non-infective setting, the routine removal of the original reservoir is not standard practice during three-component IPP replacement. In patients with a history of IPP presenting with new LUTS, reservoir erosion should be considered in the differential diagnosis and investigation with cystoscopy and computed tomography included early in the investigatory armament of the urologist.

CONCLUSION

It is our belief that a defunctionalized reservoir serves no purpose; rather it can only cause trouble in the future. Consequently, at our institution we do not leave defunctionalized reservoirs in situ.     

The angiogenic switch occurs at the adenoma stage of the adenoma carcinoma sequence in colorectal cancer

OBJECTIVE: The aim of this study was to examine the relationship between tissue factor (TF), vascular endothelial growth factor (VEGF) and the onset of angiogenesis in the adenoma-carcinoma sequence (ACS), the stepwise process encompassing colorectal cancer (CRC) disease progression. PATIENTS AND METHODS: 210 surgical specimens comprising the ACS were immunohistochemically stained for endothelial cells (CD31), VEGF and TF. Angiogenesis quantified using Chalkley grid analysis (microvascular density; MVD), and VEGF/TF expression were semiquantitatively graded and correlated with standard prognostic indicators including 5 year follow-up. VEGF and TF were measured by ELISA in tumour specimens and normal mucosa from an additional 90 CRC patients. RESULTS: There was a significant increase in MVD across the ACS (p < 0.0005) with significant correlations with Dukes' stage (p = 0.01) and lymph node involvement (p = 0.02). The greatest increase in MVD was related to the onset of dysplasia, with an associated significant increase in VEGF expression (p < 0.0005). There was a significant relationship between VEGF and TF expression in the initial phase of the ACS (k = 0.44, p < 0.005), although no correlation between VEGF or TF, and MVD, tumour size, Dukes' classification, lymph node involvement or survival was found. CONCLUSIONS: These findings are the first to suggest that the angiogenic switch occurs at the onset of dysplasia in the ACS, and provide further evidence of the close association between VEGF and TF in the early stages of CRC development.     

Collaborative eye tracking: a potential training tool in laparoscopic surgery

Background

Eye-tracking technology has been shown to improve trainee performance in the aircraft industry, radiology, and surgery. The ability to track the point-of-regard of a supervisor and reflect this onto a subjects’ laparoscopic screen to aid instruction of a simulated task is attractive, in particular when considering the multilingual make up of modern surgical teams and the development of collaborative surgical techniques. We tried to develop a bespoke interface to project a supervisors’ point-of-regard onto a subjects’ laparoscopic screen and to investigate whether using the supervisor’s eye-gaze could be used as a tool to aid the identification of a target during a surgical-simulated task.

Methods

We developed software to project a supervisors’ point-of-regard onto a subjects’ screen whilst undertaking surgically related laparoscopic tasks. Twenty-eight subjects with varying levels of operative experience and proficiency in English undertook a series of surgically minded laparoscopic tasks. Subjects were instructed with verbal queues (V), a cursor reflecting supervisor’s eye-gaze (E), or both (VE). Performance metrics included time to complete tasks, eye-gaze latency, and number of errors.

Results

Completion times and number of errors were significantly reduced when eye-gaze instruction was employed (VE, E). In addition, the time taken for the subject to correctly focus on the target (latency) was significantly reduced.

Conclusions

We have successfully demonstrated the effectiveness of a novel framework to enable a supervisor eye-gaze to be projected onto a trainee’s laparoscopic screen. Furthermore, we have shown that utilizing eye-tracking technology to provide visual instruction improves completion times and reduces errors in a simulated environment. Although this technology requires significant development, the potential applications are wide-ranging.     

Systematic analysis of gingival s-tate and salivary variables as predictors of caries from 5 to 7 years of age

Abstract – The aim was to assess the caries predictive ability of gingival state, salivary counts of lactobacilli and S. mutans , salivary secretion rate and buffer capacity of the saliva from the ages of 5 to 7 yr. The material comprised 105 children who were examined once a year. All available screening levels were systematically tested for the single variables as well as for combinations of two or three variables. The screening levels were set where the highest possible sensitivity and specificity were reached simultaneously. The predictive values for positive and negative tests were then calculated. The S. mutans count turned out to have the best combination of sensitivity (0.41) and specificity (0.83). The single variables gingival state and S. mutans had constant screening levels, while the values for lactobacilli and buffer capacity varied. The saliva secretion rate could not be measured at 5 yr of age. Systematic analyses of predictive ability of combinations of two or three variables were then performed and did not result in any clinically significant improvements of the predictive ability. The observed low predictive ability might be explained by the fact that 1) many children changed their habits during the period of investigation and 2) they were examined and treated once a year according to their individual needs, which meant variations in conservative as well as in preventive treatment.     

1985年至2006年新疆新发尘肺诊断病例的分析

[目的]分析新疆维吾尔族自治区疾病预防控制中心1985年至2006年间登记的新发尘肺病例的患病状况及特点,为尘肺病的防治提供决策参考。[方法]采用回顾性资料分析法对新疆维吾尔族自治区疾病预防控制中心登记的1985年至2006年经X线摄片确诊的3687例尘肺病资料进行录入和统计分析。[结果]1985年至2006年尘肺累积病例数3687例,其中,Ⅰ期尘肺2644例、Ⅱ期841例、Ⅲ期202例。尘肺合并结核率20.50%（756/3687）。前5位尘肺种类依次为煤工尘肺、矽肺、水泥尘肺、铸工尘肺、电焊工尘肺,分别占46.46%、30.62%、7.59%、3.99%和2.63%。其中,煤工尘肺和矽肺总病例达2842例,占77.08%。发病工种集中在采煤采矿、掘进采掘、井下操作、风钻粉碎、水泥制造运输等工种;接尘工人从事的工种、工龄、年龄是影响尘肺发生的主要因素（除接尘浓度外）。[结论]新疆尘肺病例构成前5位依次为煤工尘肺、矽肺、水泥尘肺、铸工尘肺、电焊工尘肺;尘肺合并结核率较高,尘肺病控制有待加强。     

Systematic review: the etiology of esophageal squamous cell carcinoma in low-income settings

Introduction: Esophageal carcinoma causes over 380 000 deaths per year, ranking sixth worldwide in mortality amongst all malignancies. Globally, the squamous cell subtype is most common and accounts for 80% of esophageal cancers. Nonetheless, esophageal squamous cell carcinoma is much more poorly understood than esophageal adenocarcinoma, including what is driving such high prevalences, why it often presents in young patients, and shows such marked geographical delineations

Areas covered: The current literature was searched for articles focusing on aetiopathogenesis of squamous cell esophageal carcinoma via a systematic review, particularly in low-resource settings. This was supplemented by papers of interest known to the authors.

Expert commentary: Current putative mechanisms include polycyclic aromatic hydrocarbons, nitrosamines, acetaldehyde, cyclo-oxygenase-2 pathways, androgen and their receptor levels, as well as smoking & alcohol, micronutrient deficiencies and diet, mycotoxins, thermal damage, oral hygiene and microbiotal factors, inhaled smoke, viral infections such as HPV, and chronic irritative states. Etiology is likely multifactorial and varies geographically. Though smoking and alcohol play a predominant role in high-income settings, there is strong evidence that mycotoxins, diet and temperature effects may play an under-recognized role in low and middle-income settings.