Transurethral resection versus transurethral incision of the prostate. A prospective randomized study

In this ongoing study, patients with an estimated prostate size of no more than 20 gm are randomized to undergo either transurethral resection of the prostate (TURP) or transurethral incision (TUIP) at the 6 o'clock position. To date, 93 patients have been included, and 3 months postoperatively, 80 to 90 per cent of the patients in each group reported improvement. There was also a significant decrease in symptom scores and a significant increase in maximum urinary flow rate, with great variation within each group but without difference between the groups. In both groups, there appears to be some deterioration over time. Operating time, estimated blood loss, time to catheter removal postoperatively, and duration of postoperative hospital stay were all significantly in favor of TUIP. Loss of ejaculation was reported by 37 per cent of patients after TURP and by 13 per cent after TUIP (not statistically significant). There was no difference between the groups in the need for further surgery. Therefore, TUIP is recommended as an alternative to TURP in patients with small prostates.     

Effects of argon laser iridotomy on the corneal endothelium

We studied 14 eyes of 14 patients undergoing argon laser peripheral iridotomy for occludable (narrow) anterior chamber angles. Preoperative and postoperative pachymetry and corneal endothelial cell counts by specular microscopy were obtained centrally and in both the treated and nontreated superior quadrants. No significant differences were found between preoperative and postoperative measurements of corneal thickness and endothelial cell counts in any area.     

Efficacy of Intraoperative Cooling Methods

Background: Patients may require perioperative cooling for a variety of reasons including treatment of a malignant hyperthermia crisis and induction of therapeutic hypothermia for neurosurgery. The authors compared heat transfer and core cooling rates with five cooling methods.

Methods: Six healthy volunteers were anesthetized with desflurane and nitrous oxide. The cooling methods were 1) circulating water (5 [degree sign] Celsius, full-length mattress and cover), 2) forced air (10 [degree sign] Celsius, full-length cover), 3) gastric lavage (500 ml iced water every 10 min), 4) bladder lavage (300 ml iced Ringer's solution every 10 min), and 5) ice-water immersion. Each method was applied for 40 min or until the volunteers' core temperatures approached 34 [degree sign] Celsius. The volunteers were rewarmed to normothermia between treatments. Core cooling rates were evaluated using linear regression.

Results: The first volunteer developed abdominal cramping and diarrhea after gastric lavage. Consequently, the technique was not again attempted. Bladder lavage increased heat loss 10 [nearly =] 10 W and decreased core temperature 0.8 +/- 0.3 [degree sign] Celsius/h (r2 = 0.99 +/- 0.002; means +/- SD). Forced-air and circulating-water cooling comparably increased heat flux, [nearly =] 170 W. Consequently, core cooling rates were similar during the two treatments at 1.7 +/- 0.5 [degree sign] Celsius/h (r2 = 0.99 +/- 0.001) and 1.6 +/- 1.1 [degree sign] Celsius/h (r2 = 0.98 +/- 0.02), respectively. Immersion in an ice water slurry increased heat loss [nearly =] 600-800 W and decreased core temperature 9.7 +/- 4.4 [degree sign] Celsius/h (r sup 2 = 0.98 +/- 0.01). Immersion cooling was associated with an afterdrop of [nearly =] 2 [degree sign] Celsius.     

Glutathione effects on vitamin D metabolism in control and streptozotocin diabetic rat

The circulating concentration of 1,25-dihydroxycholecalciferol [1,25-(OH)₂D₃] is a physiologic index of enzymatic activity of the renal 1-hydroxylase of 25-hydroxychole-calciferol (25-OH-D₃). Hydroxylation of 25-OH-D₃ and circulating 1,25-(OH)₂D₃ are decreased in the streptozotocin diabetic rat. We previously found that activity of another redox enzyme system, cytosolic superoxide dismutase, also decreased in streptozotocin diabetes, can be restored by treatment with glutathione. In the present experiment we tested the effect of glutathione treatment on vitamin D metabolism in control and diabetic rats. Enteral glutathione increased circulating 1,25-(OH)₂D₃ and decreased 25-OH-D₃ in both control and diabetic animals. These results suggest that exogenous glutathione increases 25-OH-D₃ 1-hydroxylation both under basal conditions in the normal animal and in diabetes-induced depression.     

Interference with sawfly (Arge pullata) poisoning in Fasciola hepatica-infected lambs

Lambs harbouring an 8-week-old infection with Fasciola hepatica, together with fluke-free animals, were dosed orally with 2 g per kg body weight of sawfly larvae (Arge pullata). Fluke-free, non-dosed lambs and lambs infected only with F. hepatica served as controls. Clinico-pathological observations on sawfly-dosed, fluke-free lambs revealed the characteristic picture of sawfly poisoning. Four of six animals had to be killed in extremis. In contrast, sawfly-dosed, fluke-infected lambs exhibited only moderate clinico-pathological signs of sawfly poisoning and no deaths occurred. A reduction in the sawfly-induced liver pathology as a consequence of the concurrent F. hepatica infection was also noted. Possible factors responsible for the antagonistic effect of F. hepatica infection on sawfly poisoning in lambs are discussed.     

Sclerosing epithelioid fiberosarcoma: short T2 on MR imaging

A case of sclerosing epithelioid fibrosarcoma and its appearance on MRI is presented. The tumor showed a zonal architecture on MRI with a large central core of very low signal intensity and a peripheral rim of intermediate to high signal intensity on T1- and T2-weighted spin echo pulse sequences. The core showed decreased cellularity with dense collagen deposition on histologic examination, and the peripheral zone increased cellularity with increased nuclear atypia. The presence of a prominent region of very low signal intensity on T1- and T2-weighted images can be seen with neural tumors, giant cell tumor of the tendon sheath, aggressive fibromatosis, and, in rare instances, with soft tissue sarcomas rich in collagen.     

Follow-up of patients who have undergone ileogastrostomy

Patients who have had ileogastrostomy for the treatment of morbid obesity require close, long-term follow-up. From a prospective study of a large number of variables in 12 consecutive patients, and from experience with more than 200 patients who have undergone this procedure since 1982, a protocol has evolved. The authors outline the associated morbid conditions, operative complications and biochemical alterations that are important in the management of these patients.     

Precipitate analysis from an indwelling total parenteral nutrition catheter

The composition of a precipitate obtained from a silastic right atrial catheter was determined. The precipitate was collected and washed with deionized water thoroughly before subjecting portions of it to organic and inorganic analysis. Inorganic analysis was conducted using scanning electron microscopy and x-ray spectroscopy for sodium, aluminum, silicone, sulfur, chlorine, and calcium. Phosphorus analysis was conducted by a commercial laboratory. Organic analysis was conducted by thin layer chromatography with cholesterol, phosphatidyl serine, phosphatidyl choline, phosphatidyl ethanolamine, and sphingomyelin as standards. Silicone, calcium, and phosphorus and three organic compounds, which could not be conclusively identified, were found. The precipitate was most likely calcium phosphate intermixed with silicone oil lubricant and residual total parenteral nutrition (TPN) solution. This formed in the catheter at body temperature probably due to incomplete catheter flushing.     

Seasonal patterns in the transmission of Schistosoma haematobium, S. mattheei and S. mansoni in the highveld region of Zimbabwe

The pattern of fluctuation in the population size of Bulinus globosus and Biomphalaria pfeifferi, in their infection rates with Schistosoma haematobium/S. mattheei and S. mansoni, respectively, and in the cercarial population size as monitored using hamster immersions, was elucidated in streams in the temperate highveld region of Zimbabwe over a 27-month period during 1982-1984. The results revealed that transmission of S. mansoni was erratic and unpredictable without a clearcut seasonal transmission pattern. In contrast, transmission of S. haematobium and S. mattheei exhibited a marked seasonal pattern, being most intensive during the hot, dry season (September-November) and markedly reduced during the cold, dry season (June-August). During the rainy (December-February) and warm, post-rainy (March-May) seasons transmission was moderate and variable, but occasionally intensive. The results also showed that rodent immersion is to be preferred to measurements of snail population size and snail infection rate in elucidating seasonality of transmission of schistosomiasis.