Vasectomy: an update

Vasectomy remains an important option for contraception. Research findings have clarified many questions regarding patient selection, optimal technique, postsurgical follow-up, and risk of long-term complications. Men who receive vasectomies tend to be non-Hispanic whites, well educated, married or cohabitating, relatively affluent, and have private health insurance. The strongest predictor for wanting a vasectomy reversal is age younger than 30 years at the time of the procedure. Evidence supports the use of the no-scalpel technique to access the vasa, because it is associated with the fewest complications. The technique with the lowest failure rate is cauterization of the vasa with or without fascial interposition. The ligation techniques should be used cautiously, if at all, and only in combination with fascial interposition or cautery. A single postvasectomy semen sample at 12 weeks that shows rare, nonmotile sperm or azoospermia is acceptable to confirm sterility. No data show that vasectomy increases the risk of prostate or testicular cancer.     

Perimenopause: an update

The field of perimenopause research is advancing our understanding of the physiological changes related to the menopausal transition and approaches to managing symptoms and preventing disease of advanced age. The impact of the perimenopause on women's health will become evident with the aging of the population.     

Gout: an update

Arthritis caused by gout (i.e., gouty arthritis) accounts for millions of outpatient visits annually, and the prevalence is increasing. Gout is caused by monosodium urate crystal deposition in tissues leading to arthritis, soft tissue masses (i.e., tophi), nephrolithiasis, and urate nephropathy. The biologic precursor to gout is elevated serum uric acid levels (i.e., hyperuricemia). Asymptomatic hyperuricemia is common and usually does not progress to clinical gout. Acute gout most often presents as attacks of pain, erythema, and swelling of one or a few joints in the lower extremities. The diagnosis is confirmed if monosodium urate crystals are present in synovial fluid. First-line therapy for acute gout is nonsteroidal anti-inflammatory drugs or corticosteroids, depending on comorbidities; colchicine is second-line therapy. After the first gout attack, modifiable risk factors (e.g., high-purine diet, alcohol use, obesity, diuretic therapy) should be addressed. Urate-lowering therapy for gout is initiated after multiple attacks or after the development of tophi or urate nephrolithiasis. Allopurinol is the most common therapy for chronic gout. Uricosuric agents are alternative therapies in patients with preserved renal function and no history of nephrolithiasis. During urate-lowering therapy, the dose should be titrated upward until the serum uric acid level is less than 6 mg per dL (355 micromol per L). When initiating urate-lowering therapy, concurrent prophylactic therapy with low-dose colchicine for three to six months may reduce flare-ups.     

Rosacea: an update

Rosacea is a common inflammatory skin disease affecting the central face of adults. Its etiology is unknown. Early diagnosis and appropriate treatment, usually with topical or systemic antibiotics or both, minimizes symptoms and helps to prevent complications.     

Anandamide: an update

Endocannabinoid system has attracted the researchers to investigate into its ever fascinating roles governing many of the physiological functions in the human body. The prime endogenous cannabinoids are arachidonoylethanolamide also called anandamide and 2-arachidonoylglycerol. Recent pharmacological advances point out that this system of molecules are in initial stages and by updating our current knowledge, we could innovatively design molecules for suitable interventions that could be potentially beneficial to the mankind.     

Tigecycline: an update

Tigecycline is a broad-spectrum antibiotic with activity against difficult-to-treat pathogens such as methicillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococcus spp., Acinetobacter baumannii, and Gram-negative bacterial strains that produce extended-spectrum β-lactamases. Minimal organ toxicity and lack of dosage adjustment in most patients are important considerations for tigecycline use. Tigecycline has been shown to be as effective and safe as standard antimicrobial therapy for treatment of adults with complicated intra-abdominal infections, complicated skin and skin structure infections, and community-acquired bacterial pneumonia. The clearest applications of tigecycline are for on-label indications. Whether tigecycline should be utilized as therapy for other infections including hospital-acquired infections with a high likelihood of multidrug-resistant pathogens is a complex issue that requires ongoing assessment. This article offers an updated overview of tigecycline clinical studies, current microbial resistance patterns, pharmacokinetic/pharmacodynamic investigations, and safety analyses.     

Clonorchiasis: an update

The ability of Clonorchis sinensis to cause severe hepatobiliary disease is illustrated by the case we have reported, in which biliary obstruction and hepatic fibrosis resulted from the pathologic process associated with chronic clonorchiasis. Immunodiagnostic tests are currently limited, and diagnosis, as illustrated by our case, relies on identification of the fluke, usually as the adult or egg stage in clinical specimens. Praziquantel has revolutionized therapy of this disease, but surgical drainage may be necessary to relieve biliary obstruction. Physicians caring for emigrants or travelers from the Clonorchis endemic belt need to be aware of the manifestations of clonorchiasis to enhance diagnosis and therapy.     

Noncompliance: an update

Health care providers have focused much attention on the area of patient compliance during recent decades. With the establishment of noncompliance as a nursing diagnosis, attention to this issue by nurses has continued and has included controversy. This study reported herein explored the use of noncompliance as a nursing diagnosis in clinical practice, the defining characteristics necessary for arriving at the diagnosis of noncompliance, and alternative diagnoses used if noncompliance is not used. A survey questionnaire was completed by 104 nurses who reside in Illinois and are members of the North American Nursing Diagnosis Association (NANDA). Fifty-three of the respondents reported that they do not. Conclusions derived from the study include: (1) Questions continue to exist regarding the acceptability/utility of this diagnosis; (2) respondents generally indicated consensus with the NANDA listing of defining characteristics and etiologies but identified additional characteristics and etiologies.     

Diabetes management: an update

The diabetic diet is no longer as rigid as it once was. Oral hypoglycemic agents continue to have a place in management, and the declining cost of human insulin makes it an increasingly attractive option. Home glucose testing is the preferred monitoring method, and its use is becoming more common. Regardless of the management method used, close control offers the potential benefit of fewer diabetic complications but also presents increased hazards from hypoglycemia.     

Teenage pregnancy: an update

In 1999 the DOH set a target to reduce conceptions in under 18s by 50% by the year 2010. In this the Government, supported by the Children Act (1989), highlighted the fact that it would be the responsibility of every health care professional and local authority to help achieve this goal. This paper discusses current issues in relation to teen pregnancies, dispels popular misconceptions and suggests ways in which Accident and Emergency nurses can contribute.     

Travel vaccination: an update

Foreign tourism and travel are increasing in popularity, with more than six million visits being made to developing countries annually (ONS 2002). In this article, Jeannett Martin outlines the vaccine-preventable diseases associated with foreign travel and discusses routine vaccination required-for-entry vaccines and recommended vaccines.     

Cardioembolic stroke: an update

Cardioembolic stroke accounts for approximately 15% of all strokes and is thought to be one of the more preventable types of strokes. Features that have been reported to support cardioembolism as a mechanism for ischemic stroke have included documented cardiac source of embolism, maximal neurologic deficit at onset, multiple cerebrovascular territories involved, enhanced tendency toward hemorrhagic transformation, enhanced risk of syncope or seizure associated with presentation, and lower likelihood of premonitory transient ischemic attacks. Features that tend to make cardioembolic stroke less likely include significant cerebral atherosclerosis, step-wise progression of the neurologic deficit within a finite period of time, vascular distribution such as entire internal carotid artery territory with combined middle cerebral artery and anterior cerebral artery involvement or watershed distribution, and premonitory transient ischemic attacks. A number of cardiac conditions can promote thromboembolism, and there is risk stratification reflective of the specific condition or coexistent conditions. Anticoagulant therapy generally has been found to be the most effective means of preventing cardiogenic brain embolism, but the intensity of anticoagulation needs to be optimized to reflect the risk-to-benefit ratio for the particular patient.     

Pulmonary sarcoidosis: an update

Sarcoidosis is a multisystem disease characterized by the presence of noncaseating granulomas, the exact etiology of which is yet to be determined. Pulmonary involvement occurs in the majority of patients and its severity ranges from asymptomatic involvement of mediastinal lymph nodes to progressive pulmonary fibrosis and chronic respiratory failure that is insensitive to treatment. Diagnosis of pulmonary sarcoidosis requires a compatible clinical picture supported by radiologic and pathologic data. A recent development in establishing the diagnosis of pulmonary sarcoidosis is endobronchial ultrasound that increases the yield of transbronchial needle aspiration of hilar and/or mediastinal lymph nodes. Fluorodeoxyglucose positron emission tomography (FDG-PET) is highly sensitive in detecting occult sites of disease and is of value in guiding biopsies of these sites. A combined imaging modality using both FDG-PET and CT scan is more sensitive than PET alone and is now the standard of care in patients requiring biopsies of active lesions. Biologic agents like anti-tumor necrosis factor antibodies are being used as second line treatment in those patients dependent on steroids or in cases of refractory sarcoidosis. Lung transplantation is the final option in suitable patients with end-stage pulmonary sarcoidosis.     

Bladder cancer: an update

Bladder cancer remains a significant public health problem in the UK with considerable health and economic consequences. This article focuses on the anatomical, pathological, diagnostic and treatment perspectives of bladder cancer to help equip nurses with a thorough knowledge of the disease to help diagnose, treat and monitor patients with bladder cancer and to impart this knowledge onto patients to help them make informed decisions regarding their care.     

Vascular surgery: an update

Caring for patients with vascular illnesses has become increasingly more complex and has changed dramatically over the past 10 years, with a widening array of diagnostic and treatment options. Carotid artery stenting has the potential to become a viable alternative to open surgery in high-risk patients with carotid artery disease (i.e., patients older than 80 years and those with previous neck surgery or irradiation, contralateral carotid artery occlusion, contralateral laryngeal nerve injury, or angina). However, the effectiveness of carotid artery stenting as a therapy is still being evaluated in randomized trials. Endovascular aortic aneurysm repair is an option for patients who desire or require a less invasive modality and who have suitable aortic anatomy. Surgical reconstruction remains the standard treatment for ischemic rest pain and tissue loss (critical limb ischemia). Balloon angioplasty and stenting are treatment options for peripheral vascular disease, although treatment is dependent on the arterial segment or segments involved.