Kidney Salvage Using the Fibrinogen- and Thrombin-Coated Sponge Tachosil® During Nephron-Sparing Surgery for the Resection of Large Renal Tumours

Nephron-sparing surgery can permit functional preservation of the kidney in carefully selected patients. We report nephron-sparing surgery in two patients with renal tumours ≥ 5 cm. Both patients were successfully treated, with kidney salvage facilitated through the use of the fibrinogen- and thrombin-coated collagen sponge, TachoSil® (Nycomed UK Ltd, UK).     

Lymphokine abnormalities in aplastic anemia: implications for the mechanism of action of antithymocyte globulin

Anti-thymocyte globulin (ATG) provides effective therapy for many patients with aplastic anemia, and its mechanism of action has been presumed to be secondary to lymphocytotoxicity. However, our studies of lymphocyte function in aplastic anemia show marked abnormalities of lymphokine production, which ATG may modulate. In 12 of 17 patients with aplastic anemia, interleukin 2 (IL2) production was markedly elevated in vitro (P less than .01 by paired statistical analysis). Expression of the IL2 receptor, or Tac antigen, on peripheral lymphocytes assessed by flow microfluorometry was also increased above the normal range in 11 of 15 cases. Studies of ATG suggested that it might act to stimulate lymphocyte function. In vitro, ATG is a mitogen, as measured by incorporation of 3H-thymidine into blood mononuclear cells; the response of cells to ATG from patients with aplastic anemia was exaggerated in comparison with normals. Cell proliferation was accompanied by production of IL2 to levels that were, in some cases, similar to those obtained with lectin stimulation. Finally, supernatants from lymphocytes cultured in the presence of ATG were able to replace adherent cells in providing growth factors for the support of nonadherent cells in methylcellulose hematopoietic colony assays. These results provide a mechanism for an "immunostimulatory" action of ATG in effecting hematopoietic response in some patients with aplastic anemia.     

Long-term outcomes of augmentation ileocystoplasty in patients with spinal cord injury: a minimum of 10 years of follow-up

Study Type – Therapy (case series) Level of Evidence 4 What's known on the subject? and What does the study add? Suprasacral spinal cord injuries can result in intractable detrusor overactivity adversely effecting patients’ quality of life. It can lead to high pressure bladder resulting in urinary incontinence and deterioration of upper tract function. Augmentation cystoplasty is an accepted procedure in treating refractory neurogenic detrusor overactivity. Several publications have reported on the short‐ to intermediate‐term outcomes with augmentation cystoplasty in patients with spinal cord injury. However, it is not known how these outcomes alter over a longer period. This study has a follow‐up of at least 10 years. It evaluates the durability of this procedure over the longer term. It also assesses the patients reported outcome over this period. This data can help counsel patients better when considering augmentation cystoplasty as a treatment option for the management of refractory neurogenic detrusor overactivity secondary to spinal cord injury.

OBJECTIVE

• ? To report the long‐term outcomes of augmentation ileocystoplasty (AIC) in patients with spinal cord injury (SCI), with a minimum follow‐up period of 10 years.

PATIENTS AND METHODS

• ? We retrospectively analysed all operations performed by a single surgeon at a specialist spinal unit.
• ? Outcomes were measured by comparing preoperative and follow‐up videocystometrograms (VCMGs).
• ? Complications were identified from case notes and the surgery database.
• ? Subjective assessment was through a previously validated questionnaire.

RESULTS

• ? The mean (range) follow‐up was 14.7 (10.5–20.3) years. There were 19 patients (12 males) with a mean (range) age at time of surgery of 28.9 (12–52) years. The mean (range) period from injury to surgery was 4.5 (0.3–22) years. All had suprasacral injuries.
• ? The VCMGs showed a significant improvement in bladder capacity and a decrease in intravesical pressures (P < 0.001).
• ? Long‐term complications included bladder stones (n= 4); urosepsis (n= 2); vesico‐ureteric reflux ([VUR]n= 2), VUR requiring ureteric re‐implantation (n= 1); neurogenic detrusor overactivity ([NDO]n= 1); and laparatomy for bowel obstruction (n= 1). Surveillance cystoscopies did not detect any bladder neoplasms.
• ? The response rate for the questionnaire survey was 14/17; 13/14 patients were satisfied with the operation such that they would consider it again or recommend it to a friend. No patient reported any significant changes in either bowel habit or sexual function.

CONCLUSIONS

• ? We found that AIC has excellent long‐term outcomes in the definitive management of refractory NDO in patients with SCI.
• ? The complications of AIC appear to be more than counterbalanced by a high level of patient satisfaction with the procedure and by the achievement of the primary aim of ensuring continence and upper tract safety in these patients.

     

Ethnoveterinary Application of Morinda Citrifolia Fruit Puree on a Commercial Heifer Rearing Facility with Endemic Salmonellosis

We have previously reported that Morinda citrifolia (noni) puree modulates neonatal calves developmental maturation of the innate and adaptive immune system. In this study, the effect of noni puree on respiratory and gastrointestinal (GI), health in preweaned dairy calves on a farm with endemic salmonellosis was examined. Two clinical trials were conducted whereby each trial evaluated one processing technique of noni puree. Trials 1 and 2 tested noni versions A and B, respectively. Puree analysis and trial methods were identical to each other, with the calf as the experimental unit. Calves were designated to 1 of 3 treatment groups in each trial and received either: 0, 15 or 30 mL every 12 hr of noni supplement for the first 3 weeks of life. Health scores, weaning age, weight gain from admission to weaning, and weaned by 6 weeks, were used as clinical endpoints for statistical analysis. In trial 1, calves supplemented with 15 mL noni puree of version A every 12 hr had a higher probability of being weaned by 6 weeks of age than control calves (P = 0.04). In trial 2, calves receiving 30 mL of version B every 12 hr had a 54.5% reduction in total medical treatments by 42 days of age when compared to controls (P = 0.02). There was a trend in reduced respiratory (61%), and GI (52%) medical treatments per calf when compared to controls (P = 0.06 and 0.08, respectively). There were no differences in weight gain or mortality for any treatment group in either trial.