Oxygen treatment with special reference to treatment of complications incident to goiter

We believe that the therapeutic administration of oxygen by means of the chamber or tent is most helpful in a restricted group of cases, such as postoperative pulmonary edema, bronchopneumonia, and respiratory obstruction. The patients who show most marked benefit are those with evidence of anoxemia, or of impending anoxemia. Treatment should be begun as early as is possible, as in many instances the progress of pulmonary edema to pneumonia probably can be averted. Treatment should be continuous, or as nearly continuous as possible, until the pathologic process is well controlled. Binger and others have called attention to the deleterious effects of oxygen concentrations of 70 per cent or more. We have not raised the oxygen above 60 per cent for more than a few hours at a time. From these concentrations we have not seen harmful effect. Treatment with oxygen can be carried out more efficiently in oxygen chambers than in oxygen tents, although excellent results can be obtained in tents properly manipulated. We do not know that the life of any individual patient has been saved by oxygen treatment; however, we believe that at least an occasional patient is saved when marked lowering of the temperature and increased comfort can be secured in such a large series of patients who are seriously ill. Our results not only warrant the continuation of this method of treatment but indicate the advisability of more general adoption of efficient methods of the administration of oxygen in those diseases known to be benefited by its use. The patients who obtain the greatest benefit are those with postoperative pulmonary edema, bronchopneumonia, or respiratory obstruction accompanied by cyanosis or impending cyanosis.     

Urothelial overexpression of insulin‐like growth factor‐1 increases susceptibility to p‐cresidine‐induced bladder carcinogenesis in transgenic mice

To establish a role for insulin‐like growth factor‐1 (IGF‐1) in bladder cancer susceptibility, we tested the effect of p‐cresidine, a potent bladder carcinogen, in transgenic (TG) mice with human IGF‐1 expression in the bladder driven by the bovine keratin 5 promoter (referred to as BK5.IGF‐1 TG mice). Indomethacin was also tested to determine if the cyclooxygenase (COX) pathway is a target for bladder cancer prevention in this model. Thirty‐three female BK5.IGF‐1 TG mice and 29 female nontransgenic littermates were randomized to the following treatments: (1) AIN‐76A diet; (2) AIN‐76A diet with 0.5% p‐cresidine; or (3) AIN‐76A diet with 0.5% p‐cresidine + 0.00075% indomethacin. BK5.IGF‐1 TG mice, with twofold greater total serum IGF‐1 than nontransgenic mice, exhibited greatly increased susceptibility to p‐cresidine‐induced bladder tumors compared to nontransgenic mice. The most common type of bladder tumor in the BK5.IGF‐1 TG mice was transitional cell carcinoma, which is the predominant type of bladder cancer observed in developed countries. Indomethacin inhibition of bladder tumor development in BK5.IGF‐1 TG mice was not statistically significant. These results present further evidence for the role of IGF‐1 in bladder cancer progression. In addition, these transgenic mice provide a useful model for studying the role of the IGF‐1 pathway in bladder carcinogenesis and its prevention. © 2009 Wiley‐Liss, Inc.     

Impact of hot temperatures on death in London: a time series approach

STUDY OBJECTIVE: This study investigated the relation between heat and mortality in London to determine the temperature threshold at which death rates increase and to quantify the effect of extreme temperatures on mortality. DESIGN: Daily data on all cause mortality and temperature were obtained for a 21 year period and the relation between them investigated both graphically and by using non-parametric time series methods of analysis. SETTING: Greater London. PARTICIPANTS: Daily mortality counts in Greater London between January 1976 and December 1996. MAIN RESULTS: A plot of the basic mortality-temperature relation suggested that a rise in heat related deaths began at about 19 degrees C. Average temperatures above the 97th centile value of 21.5 degrees C (excluding those days from a 15 day "heatwave" period in 1976) resulted in an increase in deaths of 3.34% (95% CI 2.47% to 4.23%) for every one degree increase in average temperature above this value. It was found that the 1976 heatwave resulted in a particularly large number of deaths in comparison with other hot periods. CONCLUSIONS: These results suggest that heat related deaths in London may begin at relatively low temperatures. Hot days occurring in the early part of any year may have a larger effect than those occurring later on; and analysis of separate heatwave periods suggest that episodes of long duration and of highest temperature have the largest mortality effect.     

Bariatric surgery improves urinary incontinence in morbidly obese individuals

BACKGROUND: Urinary incontinence is common in obese individuals. We report on the prevalence of urinary incontinence in patients undergoing bariatric surgery and the effect of surgically induced weight loss on urinary incontinence. METHODS: The prospectively collected data from 201 consecutive candidates for bariatric surgery were evaluated. The patients were surveyed using a questionnaire regarding the duration of incontinence, stress/urge incontinence symptoms, and incontinence severity before and after undergoing bariatric surgery. Severity was quantified using a validated index developed Data are presented as the mean +/- standard deviation. RESULTS: Of 201 patients, 65 (32%) reported urinary incontinence. Of the 65 patients, 44 women and 1 man (age 49 +/- 11 years, body mass index 48 +/- 7 kg/m(2)) underwent Roux-en-Y gastric bypass (n = 42) or laparoscopic-assisted gastric banding (n = 3). Of the 38 patients who reported mild (2%), moderate (48%), and severe (50%) urinary incontinence preoperatively who had complete follow-up at > or = 6 months postoperatively, 19 (50%) had demonstrated resolution of urinary incontinence and 19 had reported residual slight-moderate (37%) or severe (13%) urinary incontinence. The overall severity score improved from 5.4 +/- 2.3 to 2.3 +/- 2.8 postoperatively (P <.001); the percentage of excess body weight loss was 61% +/- 19%. The patients reported subjective improvement within 4 months postoperatively or after a 50-lb weight loss. CONCLUSION: Urinary incontinence is prevalent in bariatric surgery patients. Surgically induced weight loss results in improvement or resolution of urinary incontinence in 82% of patients. The findings from this large cohort warrant additional investigation with urodynamic studies.     

Spontaneous Abortion: Short-term Complications Following Either Conservative or Surgical Management

Summary: Spontaneous abortion is a common gynaecological condition. It is a commonly held belief that medical morbidity associated with this condition is low and that routine treatment should be surgical evacuation of the uterus. This study was performed to study the short-term complications of spontaneous abortion and its management. Transvaginal sonography (TVS) was used to determine whether retained products of conception (POCs) were visible inside the uterus in women presenting with spontaneous abortion. If tissue was present, surgical evacuation of retained products of conception (ERPC) was performed. If the uterus was empty, the patients were managed expectantly. Four hundred and seventy women were treated with ERPC and 297 were managed expectantly. The complication rate was 3.0% in those managed expectantly compared with 5.8% for those treated by ERPC. Subjects with no POCs on TVS can therefore be managed expectantly without increasing the risk of morbidity associated with this condition.     

The Edmonton Obesity Staging System for Pediatrics: A proposed clinical staging system for paediatric obesity

Traditionally, clinical recommendations for assessing and managing paediatric obesity have relied on anthropometric measures, such as body mass index (BMI), BMI percentile and/or BMI z-score, to monitor health risks and determine weight management success. However, anthropometric measures do not always accurately and reliably identify children and youth with obesity-related health risks or comorbidities. The authors propose a new clinical staging system (the Edmonton Obesity Staging System for Pediatrics, EOSS-P), adapted from the adult-oriented EOSS. The EOSS-P is used to stratify patients according to severity of obesity-related comorbidities and barriers to weight management into four graded categories (0 to 3) within four main health domains: metabolic, mechanical, mental health and social milieu (the 4Ms). The EOSS-P is based on common clinical assessments that are widely available and routinely completed by clinicians, and has the potential to provide clinical and prognostic information to help evaluate and inform the management of paediatric obesity.