Sigmoidorectal (Mainz II) pouch for continent urinary diversion in bladder cancer

BACKGROUND: We aimed to assess the feasibility, safety, and outcome of the sigmoidorectal (Mainz II) pouch for urinary diversion in patients with invasive bladder cancer. METHODS: Twenty-nine patients (25 men and four women), aged 65-76 years, who had undergone radical cystectomy and the sigmoidorectal pouch procedure for invasive bladder cancer were included in this study. Postoperative evaluations included metabolic testing, standard laboratory screening, renal ultrasonography, pouchography, and intravenous urography or pouchoscopy when indicated. RESULTS: The median operative time was 175 min. Urine leakage was encountered in two patients (6.8%), deep vein thrombosis in one (3.4%), and ileus necessitating surgery in another one. Two patients developed pyelonephritis due to ureterocolonic stricture, which was treated with antegrade balloon dilatation. No local relapses of bladder cancer were found. All patients were continent during the day, but one patient was occasionally incontinent during the night. In the long term, six patients (20.6%) developed metastatic disease, and five patients (17.2%) died because of cancer-related causes. Overall survival was 100, 96 and 60% at 1, 2 and 3 years after the operation, respectively. The mean survival was 36.8 +/- 1.9 months, which was statistically significantly associated with the M stage (P < 0.001), but not with the T (P = 0.091) or N (P = 0.081) stages. CONCLUSIONS: The sigmoidorectal (Mainz II) pouch seems to be a feasible, safe and effective method for continent urinary diversion. It is able to provide good quality of life, and ensure good overall survival rates.     

Implantation of a Carotid Baroreceptor Stimulator in Patients with Pacemakers and Hypertension

Background: The Rheos® System (CVRx, Minneapolis, MN, USA) is an implantable device used to lower blood pressure in patients with resistant hypertension by stimulation of the carotid baroreceptors. It is unknown if interaction might exist between Rheos and conventional pacemakers. Methods: Compatibility of the Rheos device was tested in four patients with preexisting pacemakers. Intra‐ and postoperative testing was completed with pacemaker and Rheos settings programmed to provoke interaction. Intracardiac electrograms were printed to determine interaction with the pacemaker. Results: No interaction was observed at maximum atrial and ventricular sensitivity settings and maximum bilateral Rheos output settings. Conclusion: Concomitant device therapy with Rheos device and pacemakers can be achieved without interaction. (PACE 2011; 34:354–356)     

Tooth- and Tissue-Supported Provisional Restorations for the Treatment of Patients with Extended Edentulous Spans

Dental implants have been used successfully for decades in the treatment of edentulous patients and offer great comfort compared with complete dentures. However, completely edentulous patients or patients with several teeth with poor prognosis that will be all extracted have to be provided with an interim complete denture until the implants have been uncovered. Complete dentures are a less attractive option for the patients because of functional, esthetic, and psychological reasons. The use of complete dentures over implants during the patients' healing period has been associated with numerous complications.
The aim of this paper was to present a new type of provisional restoration supported by hopeless teeth and soft tissues.

CLINICAL SIGNIFICANCE

These provisional restorations can be used during the osseointegration period to avoid the use of a complete denture. The teeth can thus be restored with fixed restorations during the whole osseointegration period to provide better comfort and avoid the psychological stress of using a removable prosthesis. Additionally, the problems associated with dentures over implants or grafts (pressure, implant exposure, etc.) can be eliminated.     

A case of tachydysrhythmia

A case of atrial fibrillation, with a fast ventricular response, which developed under enflurane anaesthesia is described in a patient previously treated with digitalis and propranolol. The intravenous administration of propranolol was ineffective whereas that of neostigmine and atropine, 2 hours later, was successful and reduced the ventricular rate to normal values.     

The confirmatory factor analysis of the job diagnostic survey: the oncology nursing setting

Aim To explore the factorial validity of the five-factor measurement model of the job diagnostic survey (JDS) in oncology settings. Background The research comes as a response to the lack of studies examining the factorial dimensions of the instrument in specific nursing populations. Methods This was a cross-sectional, census survey design including all the oncology departments in Cyprus. The final sample included 398 oncology nurses. Results A confirmatory factor analytic model, based on previous research, was tested. A unidimensional model including all five job characteristics items was found to be the best explanation of the data. This model produced fair-to-good internal consistency estimates. Conclusion The findings supported a shorter version of the JDS as a reliable and factorially valid instrument for use with the oncology nursing population. These promising results should pave the way for further research and the search for more conclusive evidence on the construct validity of the shorter version of the JDS. Implications for Nursing Management Nurse managers should use scales such as the JDS in order to evaluate the oncology nurses’ job satisfaction, work attitudes and motivation and redesign the job accordingly.     

Hydatid cyst of the seminal vesicle

We present a rare case of a hydatid cyst involving the seminal vesicle of a 48-year-old man. Urinary retention was the initial symptom. Both imaging and clinical evaluation revealed a substantial retrovesical cystic mass. The histopathological report was 'hydatid cyst of the seminal vesicle'.     

Extracorporeal shock wave lithotripsy produces a lower stone-free rate in patients with stones and renal cysts

BACKGROUND: Renal cysts have a space-occupying effect and therefore can distort the pelvicalyceal anatomy. This distortion often produces abnormalities in normal urinary drainage. In the same way, it may effect the ability of the kidneys to become stone free after extracorporeal shock wave lithotripsy (ESWL). The purpose of the current study is to evaluate the effect of renal cysts on the outcome of ESWL. METHODS: We studied 15 patients who had renal stones and coexistent renal cysts. Four patients had polycystic disease, five patients had multiple cysts and six patients has solitary ones. All cysts produced a distortion to the calyceal system of the kidneys, a fact confirmed by intravenous urography (IVU) and computed tomography (CT). All patients underwent ESWL and their stone-free status was evaluated 1 month later by ultrasound and plain kidney ureter bladder (KUB) X-ray. RESULTS: We had a total 60% (9/15) stone-free patients in our study group and a stone fragmentation rate of 100%. Patients with more cysts had lower stone-free rates. Patients with polycystic kidneys had a 25% (1/4) stone-free rate, while patients with multiple cysts and solitary cysts had, 60% (3/5) and 83.3% (5/6), respectively. These results are lower than the rates reported in patients without renal cysts. CONCLUSIONS: We believe that renal cysts may interfere with the passage of stone fragments, due to the impediment of drainage and urinary stasis from the stretching and distortion of the calyceal system by the renal cysts.     

FDA Perspectives on the Use of Teratology Data for Human Risk Assessment

FDA Perspectives on the Use of Teratology Data for Human RiskAssessment. FRANKOS, V. H. (1985). Fundam. Appl. Toxicol. 5,615–625.