The Manchester operation for uterine prolapse.

OBJECTIVE: To evaluate the clinical characteristics, complications, and satisfaction scores of patients who underwent the Manchester operation. METHODS: This retrospective observational study evaluated data from 204 women who underwent the Manchester operation at the Department of Obstetrics and Gynecology of Hacettepe University School of Medicine, Ankara, Turkey, from January 1985 to April 2004. RESULTS: Mean age was 34.68+/-4.24 years and parity 2.47+/-0.96; 85.8% of the patients were premenopausal; 176 patients (86.28%) had grade 3 and 28 (13.72%) had grade 2 uterine prolapse; 95.1% of the patients had associated cystoceles and 51.3% had associated rectoceles; and 81.4% had urinary incontinence. Regarding early postoperative complications, 27 patients (13.23%) had febrile morbidity; retroperitoneal hematoma occurred in 1 patient (0.49%); urinary retention occurred in 45 patients (22.05%), and cervical stenosis occurred in 23 patients (11.27%). At 1 year, 1 patient had undergone abdominal hysterectomy because of unsuccessful cervical dilatation; and a mean of 3.6 years following the operation, 8 patients (3.9%) had undergone the tension-free vaginal tape procedure plus a vaginal hysterectomy for recurrent stress urinary incontinence and uterine prolapse. The mean satisfaction/acceptance score for the operation was 8.52+/-2.13 (range, 2-10). CONCLUSION: A high degree of acceptance/satisfaction and a low morbidity rate show the Manchester operation to be a good option for the treatment of uterine prolapse in women who wish to keep their uterus.     

大学生色觉辨别能力与深度知觉的相关性分析

目的：评价色觉正常大学生的色觉辨别能力与深度知觉的关系。方法：选取巴什肯特大学医学专业学生52例,其中男性33例（63．46％）,女性19例（36．54％）,平均年龄21．18±2．52岁。参与学生视力正常（20／20）,且经Ishihara假同色测试法显示无先天性色觉缺陷。运用Gundogan方法确定主视眼（ DE ）。通过法－孟二氏100色度试验（FM100HT）检验色觉辨别能力,包括左右眼及双眼（TE）的总误差分（ TES ）、部分误差分（ LES ）。误差分分为三组：双眼、DE及非主视眼（ NDE ）。应用TNO检查双眼视觉与立体感,并根据480－15 arc／s范围的立体感水平分为四组。结果：FM100HT的误差分显示无性别差异的TES,蓝黄LES和红绿 LES 分别为61．22±30．32（58．50）[ mean ± SD],35．80±19.32（36．50）和25．42±14．65（24．00）。男性受试者（n＝31）分别为67．45±29．95（61．00）,40．25±18．83（39．00）和27．19±14．30（24．00）。女性受试者（n＝19）分别为51.05±28．84（47．00）,25．52±18．32（28．00）和22．52±31.13（23．00）。根据FM100 HT的误差分,得出女性颜色视觉辨别能力高于男性。通过FM100 HT将色觉辨别能力分为较高（6％,TES＝0～20）,中等（86％,TES＝20～100）和较低（8％, TES＞100）,中等水平最为常见（ P＜0.05）。 DE和NDE的红绿LES 分别为24．12±14．70和32．20±14．21, DE 和 NDE 的蓝黄 LES 分别为34．68±18.95和36．24±17．56。女性（ n＝19） DE和NDE的红绿色LES分别为21．89±15．06和31．00±22．42;男性（ n＝31）则为25．48±14．55和32．93±17．31。女性（ n＝19） DE和NDE 蓝黄色 LES 分别为29．63±18．62和33．42±17.38,男性（ n＝31）则为37．77±18．78和37．96±17．73。所有学生的TE,DE及NDE的TES和立体视觉水平均进行比较,差异均无统计学意义（P＝1）。研究表明色觉辨别能力和双眼深度知觉无关。结论：FM100 HT的TES显示：正常人不同个体立体视觉水平无差异,基于色觉分离的TNO检测的深度直觉与色觉辨别能力不相关。在之前的研究中, DE色觉辨别能力优于NDE。但目前研究表明在深度知觉方面DE并非优于NDE。     

CT findings in a child with reflux oesophagitis.

We report the case of a 7-month-old boy who presented with a history of vomiting since birth. A computed tomography study showed circumferential thickening of the lower oesophageal wall with enhancement of the mucosa. After a period of antireflux medication, the patient underwent simultaneous oesophageal dilatation and Nissen fundoplication. He is doing well at 2-year follow up.     

The Effects of Intravenous Levofloxacin on the QT Interval and QT Dispersion

The QT dispersion (QT_d) is a non-invasive means of identifying those patients at an increased risk of developing sudden cardiac death (SCD). Although levofloxacin has a minimal effect on the QT_c interval, isolated reports of QT prolongation, polymorphic ventricular tachycardia with a normal QT interval and TdP have been reported. The purpose of this study was to examine the effect of intravenous levofloxacin on the QT interval and QT_d. Of the 50 patients who were deemed candidates to receive intravenous levofloxacin, 29 met the eligibility criteria and were enrolled in this study. A 12-lead ECG was performed before the initiation of levofloxacin (baseline), and on days 3 and 5. The QT^c _min, QT^c _max and the QT_d were calculated. Measurements where made by two independent observers blinded to the patients’ clinical status. The QT_d increased significantly on days 3 and 5 following the initiation of therapy [QT_d (baseline) 33.3 ± 20 ms, QT_d (day 3) 64.4 ± 31.3 ms (p = 0.023), QT_d (day 5) 66.8 ± 20.3 ms, (p = 0.008)]. The increase in the QT_d was significantly longer in men than women. Although women had a shorter baseline QT_d compared to men, this did not achieve statistical significance. Intravenous levofloxacin was found to significantly increase the QT_d, which was more pronounced in men compared to women. Its effect on the QT_d may increase the risk of developing a potentially fatal ventricular arrhythmia. Therefore, care must be taken when prescribing this medication to patients with a pre-existing risk of developing SCD.     

Endovascular therapy for critical limb ischemia

AbstractChronic critical limb ischemia (CLI) occurs when arterial perfusion is reduced below a threshold level that results in rest pain and/or tissue breakdown in the lower extremities. Importantly, it is associated with high cardiovascular morbidity and mortality. Without prompt revascularization, CLI may result in loss of a limb (i.e. amputation) and/or life. The goal of endovascular therapy is the re-establishment of pulsatile, straight-line flow to the distal extremity. Percutaneous transluminal angioplasty (PTA) has been shown to be effective and safe in the setting of CLI, with limb salvage rates that compare favorably with surgical procedures. Stents are indicated for failed PTA, while adjunctive therapies such as lasers, thermal angioplasty and atherectomy devices lack data demonstrating improved efficacy compared with conventional lower extremity interventions. In addition to successful revascularization, the institution of lifestyle changes, atherosclerotic risk factor modification, and pharmacologic therapies are indicated to reduce cardiovascular morbidity and mortality.     

Acute renal failure associated with the use of intraperitoneal carboplatin: a report of two cases and review of the literature

Carboplatin, a new analogue of cisplatin used in the treatment of ovarian carcinoma, has been demonstrated to be less nephrotoxic than its predecessor. To date, hundreds of cycles of therapy have been given without a significant incidence of renal failure. We report herein two cases of acute, nonoliguric renal failure in patients receiving intraperitoneal (IP) carboplatin as chemotherapy for advanced ovarian carcinoma. Each patient had received extensive previous treatment with cisplatin. The baseline serum creatinine levels in the patients were 0.9 and 1.1 mg/dL, respectively. After four cycles of IP carboplatin in Patient 1 and five cycles of IP carboplatin in Patient 2, the serum creatinine levels abruptly rose to 9.0 and 9.5 mg/dL, respectively, within a week after administration of therapy. No other primary etiologies for acute renal failure could be identified in either patient. One patient required hemodialysis briefly. Renal biopsy specimens were obtained from both patients. Patient 1 had focal and moderate interstitial nephritis with mild periglomerular fibrosis. Patient 2 had an edematous interstitium with a diffuse mononuclear cell infiltrate, focal interstitial hemorrhage, and toxic changes in proximal and distal tubules on electron microscopy. Treatment with oral prednisone at 1 mg/kg/day with a rapid taper over 4 weeks was done in both cases with the serum creatinine levels eventually dropping to 4.6 and 2.0 mg/dL, respectively. Acute interstitial nephritis and renal failure to this extent have not been previously reported with carboplatin therapy. The literature regarding carboplatin is reviewed with respect to the pathophysiology of its nephrotoxicity.