No-scalpel vasectomy (NSV) procedure and nursing care

The no-scalpel vasectomy technique, introduced by a Chinese surgeon in 1974, is increasingly becoming the method of choice for permanent male sterilization. Conventional vasectomy is being challenged by the new procedure, which results in less pain, fewer infections, and a smaller wound. The use of 2 specially designed instruments lessens tissue damage from the procedure and reduces time required for the operation. In the United States, Dr. Mark Goldstein of Cornell Medical Center, New York City, has instructed surgeons in the no-scalpel technique. The Association for Voluntary Surgical Contraception has also promoted no-scalpel vasectomy, which is gaining popularity among urologists worldwide. The procedure was developed in China by Dr. Li Shunquiang of the Chongquing Family Planning Scientific Research Institute and has been performed on over 8 million men. Statistics reveal that this method produces a smaller singular incision and also reduces postoperative infection and hematoma. In China, the rate of hematoma in 179,741 men was 0.09% and the rate for infections was 0.91%. In a New York study, 238 men had no evidence of infection or hematoma following no-scalpel vasectomy. Since the technique was introduced in 1974, urologic surgeons have responded to the need to offer alternatives for male contraception. Under the direction of Dr. Shunquiang, surgeons received the necessary training to bring the no-scalpel vasectomy to their respective countries. Dr. Marc Goldstein was the first United States urologic surgeon to be trained in this method. By December 1990, data reported by the Association for Voluntary Surgical Contraception revealed that more than 125 United States physicians were trained in no-scalpel vasectomy. This new option is becoming an increasingly popular method for both patients and urologic surgeons.     

Characteristics of the demand for cranial computerized tomography: reasons and costs of the exam]

It was reviewed a series of 2860 cerebral computed tomography (CCT) in order to compare the main reasons at referral to investigation with the CCT results and the costs with normal and abnormal CCT. It was also studied the age and sex of the patients. Data were collected from one out of three diagnostic centers in Salvador, Brasil, for a three years period. The 2860 CCT exclude all investigation carried out for the follow-up of a previously diagnosed abnormality. CCT abnormalities were detected in 1152 (40.3%). The following reasons showed the highest proportion of abnormal CCT, for males and females respectively: demential syndrome (91.7 and 83.3%); cerebrovascular accidents (85.1 and 73.6%); infectious and parasitary diseases (76.5 and 78.6%); tumors (65.8 and 55.4%); and head injuries, 63.6% for males. In the female group, 65.0% of the CCT were normal, in a range of 65.0 to 80.0% for the age groups under 54 years old. In the male group, the highest proportion of normal CCT was found in the age groups: 25-34 (68.4%), < 15 (62.9%) and 35-44 (62.7%). The most common reasons for normal CCT for males and females were: headache (81.3 and 87.5%); dizziness/vertigo (79.3 and 78.6%); seizures (67.3 and 70.0%); psychomotor deficiency (72.0 and 67.7%) and "endocrine disorders", 75.0% for each sex. The highest proportion of normal CCT (65.3%) was requested by medical "convenios". The cost with normal CCT reached US$565,225 and with the abnormal ones, US$381,247. Costs with normal CCT were 2.2 higher for medical "convenios" as compared to those of the National Institute of Security requests and 2.8 more than those of private medicine.     

Therapeutic criteria in hydrocephalic children

The xanthine, hypoxanthine, and total oxypurine levels were determined in the CSF of 28 hydrocephalic patients (age from newborn to 2 years) and 8 healthy controls using HPLC. The Evans' index, the mean weekly increase in cranial circumference, and the intracranial pressure were also measured. Of the hydrocephalic patients 13 were self-compensated and the other 15 had a shunt implanted during the course of the study. The mean xanthine, hypoxanthine, and total oxypurine levels in the normal children were 5.20, 5.94, and 11.29 mol/l, respectively. In the self-compensated hydrocephalics these levels were 5.17, 5.71, and 10.79 mol/l, respectively. In the noncompensated hydrocephalics, they were 9.90, 9.91, and 19.82 mol/l. The differences between the latter group and the first two are statistically significant (P<0.001). The mean Evans' index and the mean weakly increase in cranial circumference in the self-compensated hydrocephalics were 0.35 and 0.25 cm, respectively. In the noncompensated hydrocephalics, they were 0.55 and 0.95 cm. The differences between the two groups are statistically significant (P<0.001). Two weeks after implantation of shunts in the noncompensated cases, the mean xanthine, hypoxanthine, and total oxypurine levels fell to 4.22, 4.57, and 8.80 mol/l, respectively. These changes are statistically significant (P<0.001). We think that the two criteria (clinical and biochemical) are equally useful for the prediction of self-compensation in hydrocephalic children and that the oxypurine values after shunt implantation can be used to monitor progress in noncompensated cases.     

Bidirectional cavopulmonary shunts: clinical applications as staged or definitive palliation

A standard Glenn anastomosis between the superior vena cava and the right pulmonary artery has been the accepted mode of treatment for patients with complex cyanotic congenital heart disease. We report our experience in 18 patients with such disease who underwent a bidirectional cavopulmonary shunt because of increasing cyanosis and growth cessation. All patients were considered less than "ideal" candidates for a Fontan procedure. We divided the patients into two groups: group 1 had azygos continuation and group 2 did not. Fourteen patients required hypothermic cardiopulmonary bypass. Bidirectional pulmonary blood flow was achieved in all patients. Only 1 death occurred (group 2). The improvement in oxygen saturation and overall clinical condition of these patients, together with the low mortality and morbidity, is encouraging. However, long-term follow-up is mandatory for a comprehensive evaluation of this surgical approach as definitive palliation or as a first stage for a Fontan operation.     

Mapping the human genome

A biochemist involved in the planning of the Workshop on International Cooperation for the Human Genome Project reports on the meeting's accomplishments. The October 1988 workshop, held in Valencia, Spain, under international auspices, brought together scientists from 24 countries to discuss the present status and future prospects of the Human Genome Project. While the overall objective of the meeting was to promote international cooperation in mapping the human genome, ethical issues also were discussed. Most participants agreed on the need to establish international rules to guide the project, but believed that controls on research could be imposed only by scientists. The workshop ended with the issuing of the Valencia Declaration on the Human Genome Project, the text of which is included with Grisolia's report.     

Years of potential life lost: application of an indicator for assessing premature mortality in Spain and Portugal

In this article, the authors present an analysis of causes of death in Spain and Portugal in 1984 based on a calculation of the "years of potential life lost" (YPLL) between the first and the 70th birthdays, the latter age corresponding approximately to the average life expectancy in both countries. This analysis of the YPLL led to a substantially different ranking of the main causes of death, based on what might be termed "premature mortality" compared with that obtained from more conventional mortality indices. According to this criterion, which is especially appropriate for the planning and evaluation of health interventions, the main causes of premature death (1-69 years) in the two countries of the Iberian peninsula are malignant tumours and, particularly in Portugal, violent deaths (especially motor-vehicle accidents, but also suicides). This is in contrast to the predominance of cardiovascular diseases indicated by other weightings of age-specific mortality rates. Portugal shows significantly worse YPLL rates than Spain not only for general mortality (45% higher than in Spain), but also for several major groups of causes. In Spain only malignant neoplasms, diabetes and chronic rheumatic heart diseases show higher specific mortality rates than in Portugal, based on traditional mortality indicators.(ABSTRACT TRUNCATED AT 250 WORDS)     

Kynurenic acid inhibits the activation of kainic and N-methyl-D-aspartic acid-sensitive ionotropic receptors by a different mechanism

The action of kynurenic acid on currents elicited by the activation of amino acid receptors was investigated in primary cultures of cortical neurons prepared from neonatal rats. Kynurenic acid was tested on currents elicited by both N-methyl-D-aspartic acid (NMDA) and kainate, using patch-clamp recording techniques in "outside-out" and "whole-cell" configurations. The inhibition by kynurenic acid was compared with that elicited by amino-phosphono-valeric acid (APV). Whole-cell currents, elicited by increasing doses of NMDA, were antagonized competitively by APV and non-competitively by kynurenic acid (ID50 70 microM); in contrast, kynurenic acid inhibited competitively the whole-cell currents elicited by kainic acid (ID50 500 microM). The non-competitive inhibition by kynurenic acid of the whole cell currents elicited by NMDA was antagonized competitively by glycine, a specific positive allosteric modulator of NMDA receptors; on the other hand glycine failed to change the inhibition by APV of the NMDA-elicited responses. Thus, kynurenic acid inhibits NMDA receptors allosterically (non-competitively) and kainic acid receptors isosterically (competitively).     

Alpha-SM actin expression as prognostic indicator in IgA nephropathy (Berger's disease)

Recent studies have demonstrated that α-Smooth Muscle actin expression in glomerular and tubulointerstitial compartments of renal tissue could represent a prognostic marker in several renal diseases. Our objective was to identify the prognostic value of α-SM actin actin expression on the evolution of renal damage in Primary IgA nephropathy (Berger’s Disease). 43 patients followed up from 1988 to 1999 at the University Hospital, Faculty of Medicine of Ribeirão Preto, University of São Paulo, Brazil, was studied. Clinical-laboratory data were obtained from the medical records of the patients using a protocol containing name, race, gender, origin, profession, age at clinical presentation of the disease and personal and family history. The parameters assessed in the approach to IgA nephropathy were serum creatinine, creatinine clearance, serum albumin, total serum protein, 24 hours proteinuria, glycaemia, serum sodium, potassium, calcium and phosphorus ions, analysis of urinary sediment, serum complement profile, blood count, and renal biopsy. Morphological evaluation was performed by renal biopsy using common light and immunofluorescence microscopy. Immunohistochemical studies were performed using a murine monoclonal antibody to α-SM actin. Our data showed that α-SM actin expression in the glomerular and tubulointerstitial compartments are not correlated with unfavorable clinical course of primary IgA nephropathy.     

Ellis-van Creveld syndrome: report of 15 cases in an inbred kindred.

An inbred kindred with 15 cases of the autosomal recessive Ellis-van Creveld syndrome is reported. The ages of the 12 living affected varied between 3 and 82 years. The main characteristics include polydactyly of the hands and feet and several other skeletal anomalies, oral manifestations, and malformations of the heart in 50% of the living affected.