Infertility treatment, a matter of a lovely sperm？

Nowadays, the efficiency of the infertil-ity treatment is relatively low. One of the cues to counteract this problem relies on the optimum selection of spermatozoa. We developed a new method （sperm selection assay （SSA）） based on the chemical attrac-tion of spermatozoa that are at the best functional state. Additionally, the SSA leads spermatozoa to complete and/or acquire the competence to fertilize the egg. These effects are equally observed either in nor-mal or subfertile semen samples. Those cap-abilities of SSA may improve the success of current infertility treatment.     

How do you stretch a bladder? A survey of UK practice,a literature review,and a recommendation of a standard approach

AIMS: To assess how and why hydrodistension of the bladder is performed by UK urologists and to compare this practise with the published literature on distension. To suggest a standardised technique for hydrodistension to allow comparison of diagnostic and therapeutic studies. METHODS: A questionnaire was sent to all UK consultant urologists. Questions addressed the indications for short bladder distension (SBD), details of technique, evaluation of outcome, and awareness of evidence base. The literature on bladder distension was reviewed. RESULTS: The majority of respondents perform SBD, principally in the diagnosis and therapy of interstitial cystitis (IC). There was considerable variation in the duration of distension, repetition of distension, the pressure used for distension, and the measurement of bladder capacity. The literature on the technique of hydrodistension is imprecise and no respondent was able to cite literature to support his or her practice. We suggest a simple, more objective technique for performing hydrodistension. CONCLUSIONS: SBD is widely used. There is marked variability in technique and little more than anecdotal evidence to support any particular approach. Research into the evaluation and treatment of painful bladder syndrome in general and IC in particular would be facilitated by the adoption of a standardised technique.     

Is a hollow centralizer necessary when using a polished,tapered, cemented femoral stem?

Background and purpose — A tapered, polished and collarless stem is normally equipped with a hollow centralizer to prevent the stem from becoming end-bearing in the cement as the stem subsides. In a randomized clinical trial, we evaluated such a stem (MS-30), which was initially introduced with a solid centralizer but was later recommended to be fitted with a hollow centralizer. We hypothesized that while the stem would sink more, it would become rotationally stable and have less retroversion with a hollow centralizer than with a solid centralizer.

Patients and methods — We randomized 60 patients with primary hip arthritis to receive either a hollow centralizer or a solid centralizer with the stem. The effect was evaluated over a 10-year follow-up period with repeated RSA examinations, conventional radiographs, and clinical follow-ups using the WOMAC and SF-12 questionnaires.

Results — At 10-year follow-up, the group with hollow centralizers had subsided more than the group with solid centralizers (1.99?mm (hollow) as opposed to 0.57?mm (solid); p < 0.001). However, rotation was similar at 10-year follow-up (mean retroversion 1.34° (hollow) and 1.30° (solid)). Both groups showed excellent 10-year results, with similar clinical outcome, and none of the stems were radiographically loose or had been revised.

Interpretation — As expected, there was more subsidence in the group with hollow centralizers, and with similar magnitude to that reported in earlier RSA studies on conceptually similar prostheses. Interestingly, there was no difference in the rotational behavior of the prostheses. This stem type appears to have a design that, regardless of the type of centralizer and the possibility of subsidence, withstands the rotational forces it is subjected to very well. This study does not support the need for a hollow centralizer for these types of stems.     

The Internet in medicine. A help,a problem,a cause of errors...?

The Internet has been a breakthrough for Professional Medical Training. Medline databases are increasingly being used by the scientific community at large. Patients have also started to use the Internet as a source of information on their illnesses, and look in the web for a second opinion. This paper shows the advantages derived for the patients from using the Internet as well as the risks involved from a poorly understood, even not scientifically validated information. The Urology Associations themselves should take responsibility of the web sites in a unambiguous way, by including evidence-based medicine, offering assistance to those patients who want to compare their specialist's opinion with that obtainable in the Internet, and with the doctors themselves directing those who show a real interest to the most suitable web sites.     

Albuminuria, not only a cardiovascular/renal risk marker, but also a target for treatment?

Albuminuria has been identified as a marker for predicting both cardiovascular and renal risk. From normal to overt proteinuria levels, albuminuria shows a continuous marked increase in risk. This is independent of other well-known cardiovascular and renal risk markers and factors, such as blood pressure, cholesterol, smoking, overweight, and others. The predictive power is not only present in already diseased populations with either nondiabetic or diabetic renal disease, but also in hypertensive and even in otherwise healthy populations. New antihypertensive intervention strategies, such as angiotensin-converting enzyme (ACE) inhibitors and angiotensin II (Ang II) receptor-antagonists are claimed to have cardioprotective and renoprotective benefits that go beyond blood pressure control. Interestingly, these new therapeutic classes share the ability to lower urinary albumin excretion by an average of 40%, a characteristic that is not observed with the other antihypertensive drug classes. This short-term-induced antiproteinuric effect appears to predict the long-term cardiovascular and renal protection: the more albuminuria is lowered, the more that individual (or group) is protected. These data suggest that albumin is not only a risk marker for cardiovascular and or renal disease, but it may also be a useful target for therapy. Monitoring of albuminuria should be daily practice in subjects at risk for cardiovascular and renal disease. In addition to new clinical trials that prove that albumin can be targeted to obtain cardiovascular protection, guidelines should be made to help the physician in deciding how to measure albumin in the urine, what are normal levels, how to target "abnormal" levels, and how low we should go.     

If a picture is worth a thousand words, what is a trauma computerized tomography panel worth?

Background

There has been a progressive increase in the use of computerized tomography (CT) scans for evaluating trauma patients. The purpose of this study was to quantify that trend and consider the implications it holds for resource use.

Methods

Data were combined from the trauma registry and the radiology department’s administrative information system at a level I trauma center to define the radiographic use patterns applied to all trauma activations during a 3-month sampling period in each of 4 years.

Results

Trauma activations increased by 21% whereas total radiographic studies increased by 82%. The proportion of CT scans to total studies increased progressively from 18% to 27%. The average number of CT studies per patient increased from 2.68 ± 3.09 to 6.88 ± 7.50. CT use increased for patients presenting by primary or secondary transport, regardless of triage classification. In the final sampling period, CT scans alone generated an average of 3,726 images per day to be reviewed.

Conclusions

Increasing use of multi-image studies is facilitated by improvements in technology and medical-legal pressures. However, extensive imaging can stress overburdened trauma systems. Additional studies are needed to assess the implications of increasing radiographic use on trauma outcomes.