Percutaneous extraction of retained biliary T-tubes: a new technique

Retained T-tubes are rare complications after biliary surgery. The authors present three cases of retained T-tubes in patients with transplanted liver that could not be removed by a standard manual traction. The authors describe a new simple percutaneous method that allows removal of these T-tubes without complication.     

Sjogren's syndrome: concomitant H. pylori infection and possible correlation with clinical parameters

OBJECTIVE: To identify whether or not there are clinical markers that correlate with Helicobacter pylori (H. pylori) infection in patients with Sjogren's syndrome (SS) and its implication to handling this group of patients. METHODS: Four groups of patients were studied. Group 1, 36 patients with primary SS; group 2, 31 patients with secondary SS; group 3, 46 patients with various connective tissue diseases not suffering from sicca symptoms, and group 4, 64 healthy controls. Clinical assessment was done and a score for disease manifestation was given for every SS patient. Serum IgG and IgM antibodies to H. pylori were assessed by ELISA. RESULTS: The prevalence and mean titer of H. pylori infection in patients with SS in group 1 (80.6%) and 2 (71%) were significantly higher than in group 3 (60.9%) and 4 (56.3%) (P < 0.01). There was significant correlation between H. pylori infection and age, disease duration, global score for disease status and C-reactive protein (CRP) in SS patients. On the other hand, there was no significant correlation with body mass index, and erythrocyte sedimentation rate (ESR). CONCLUSION: Patients with SS are more prone to have H. pylori infection in comparison to other connective tissue diseases. Serum antibody titer to H. pylori correlated with index for clinical disease manifestations, age, disease duration and CRP. Assessment of H. pylori infection in older patients suffering from active SS for a relatively long duration is recommended, especially those suffering form primary SS for more than 3 years.     

Plasma levels of endothelin-1, angiotensin II, nitric oxide and prostaglandin E in the venous and cavernosal blood of patients with erectile dysfunction

OBJECTIVES: To determine the alterations in the plasma levels of endothelin-1, angiotensin II, nitric oxide (NO) and prostaglandin E(2) (PGE(2)) in the venous and cavernosal blood of patients with organic and psychogenic erectile dysfunction (ED). PATIENTS, SUBJECTS AND METHODS: The study included 32 patients complaining of ED; they were subdivided into two equal groups with either organic or psychogenic ED. Fifteen healthy potent age-matched male volunteers were enrolled as a control group. For each patient, venous and cavernosal blood samples were obtained, while venous blood was obtained from the controls. RESULTS: There were significantly greater mean plasma levels of endothelin-1 and angiotensin II, and significantly lower mean plasma levels of NO and PGE(2), in the venous blood of patients with ED than in the controls. Patients with organic ED had significantly higher levels of endothelin-1 and significantly lower levels of NO in both venous and cavernosal blood than had those with psychogenic ED. There were significant positive correlations in both venous and cavernosal blood between endothelin-1 and angiotensin II, and between NO and PGE(2) in all patients with ED and the two subgroups. There were significant negative correlations between venous and cavernosal endothelin-1 and NO, endothelin-1 and PGE(2), angiotensin II and NO, and between angiotensin II and PGE(2). CONCLUSION: The present results suggest that endothelin-1 could be a clinical marker of diffuse endothelial disease manifested by ED. As angiotensin-converting enzyme (ACE) activity controls angiotensin II there might be a rationale for the use of ACE inhibitors to prevent or treat ED. NO and PGE(2) may provide new strategies for the pharmacological treatment of ED.     

Endoscopic confocal fluorescence microscopy of normal and tumor bearing rat bladder

PURPOSE: We evaluated the possibility of performing endoscopic fiber-optic confocal microscopy in a rat bladder model and we distinguished different cell types. MATERIAL AND METHODS: Rhodamine 123 (Molecular Probes, Eugene, Oregon) (100 microM) was instilled for 30 minutes in 5 tumor bearing rat bladders (AY27). Five normal rats served as controls. A Cell-viziotrade mark confocal microscopy fiber was placed transurethrally in contact with normal or transformed bladder wall. Frozen sections were obtained from the same spots and subjected to conventional fluorescence microscopy and anatomical-pathological analysis. RESULTS: The different cells types present in rat epithelium (umbrella, intermediate and basal cells) could easily be identified with the Cell-viziotrade mark device due to their differences in morphology and fluorescence intensity. Individual AY-27 cells could not be demarcated due to the strong fluorescence signal but the entire tumor appeared as a brightly homogenous fluorescent blot surrounded by small inflammatory cells. CONCLUSIONS: We report the feasibility of endoscopic, in vivo, fiber-optic confocal microscopy in the rat bladder. We distinguished tumors from normal epithelium and visualized the different epithelial cell types in nontransformed rat bladder epithelium.     

Transcutaneous electrocavernosography: a tool for recording the electromyographic activity of the corpora cavernosa

PURPOSE: The electric activity of the corpora cavernosa (CC) is recorded by needle electrodes introduced into the CC. We investigated the hypothesis that transcutaneous electrocavernosography (ECG) would register electric waves similar to those recorded by the needle ECG but noninvasively. MATERIALS AND METHODS: The ECG was recorded transcutaneously in 35 healthy volunteers (mean age 37.6 +/- 4.8 SD years). Two silver-silver chloride electrodes were applied on the dorsum of the penis over 1 of the CC. A reference electrode was applied to the thigh. Intracavernosal ECG using 2 needle electrodes introduced into the CC was performed in the same subjects. At least two 20 minutes sessions were recorded for each subject. RESULTS: Slow waves (SWs) were registered transcutaneously. The waves from the 2 electrodes in each individual had the same frequency, amplitude and conduction velocity. They had a regular rhythm and were reproducible. The SWs were followed or superimposed by action potentials which occurred randomly. The transcutaneously recorded SWs were confirmed by the intracavernous route. Both routes had similar ECG recordings. CONCLUSIONS: The study demonstrated that the transcutaneous ECG recorded electric waves similar to those registered by the intracavernosal route. The transcutaneous ECG is simple, easy, non-invasive, and may be included as an investigative tool in the diagnosis of erectile dysfunction.     

Should plain X-rays be routinely performed after blunt knee trauma? A prospective analysis

BACKGROUND: We tested the hypothesis that it was possible to decrease the number of performed x-rays after a knee trauma without delayed fracture diagnosis by using the Ottawa knee rules. METHODS: Patients had routine x-rays of the injured knee during the first stage of the study and selective x-rays during the second stage. All patients were followed up to 6 months after the trauma. RESULTS: 138 patients were included in the first stage; 57 had negative Ottawa criteria: no fracture was observed; following the Ottawa rules, 41% of the x-rays could have been avoided. 178 patients were included in the second stage; 63 patients had negative Ottawa criteria: no fracture was diagnosed during the whole follow-up; 35% of the x-rays have been avoided. CONCLUSIONS: Ottawa rules allowed decreasing the number of x-rays performed after a knee trauma by 35% with a sensitivity for a knee fracture detection of 100%.     

Simit epidemiological multicentric study on hospitalized immigrants in Italy during 2002

The aim of this article is to retrospectively evaluate the patient characteristics and the most common infectious diseases in immigrant patients hospitalized in 46 Italian infectious disease clinics during 2002. The main Italian infectious disease clinics were invited to fill in a questionnaire that regarded the number and type of hospital admissions, the country of origin, and demographic features (age, sex, and resident state) of immigrants. A total of 46 clinics including 2255 patients participated in the study. Most patients were men (63%) with an age between 16 and 40 years (63.4%) covered by the National Health Service (71%) and coming from Africa (44.3%). The main infectious diseases observed were: 378 (16.76%) cases of HIV infection, 303 (13.43%) cases of tuberculosis diseases, 282 (12.5%) cases of various forms of viral hepatitis, 177 (7.84%) cases of respiratory diseases, and 196 (8.69%) gastrointestinal diseases. Tropical diseases found were 134 (5.94%) including 95 cases of malaria (70.9%). In conclusion, a broad range of diseases was noted in immigrants which were directly correlated with conditions of poverty. Only a few tropical diseases were diagnosed and therefore the immigrant should not be considered as an infectious disease carrier.