Absorption of irrigation fluid during XPS™ GreenLight laser vaporization of the prostate: results from a prospective breath ethanol monitoring study

Purpose

To assess whether and to what extent irrigation fluid absorption occurs during laser vaporization (LV) of the prostate using the 180 W XPS? GreenLight laser.

Methods

This prospective investigation was performed in a tertiary care center with a consecutive series of patients undergoing 180 W LV of the prostate. Intraoperative irrigation was performed with isotonic saline containing 1 % ethanol. The volume of irrigation fluid absorption was calculated from periodically performed breath ethanol measurements during LV. Additionally, intraoperative changes in biochemical and hematological blood parameters were assessed.

Results

Positive breath ethanol tests were detectable in 22 of 54 patients. The median absorption volume in these patients was 950 ml (range 208–4579 ml). Ten patients absorbed more than 2000 ml. Absorbers had smaller prostates, more capsular perforations and injuries to venous sinuses, and more total energy was applied with higher output power. Five patients had transient symptoms potentially related to fluid absorption. A significant drop in hemoglobin, hematocrit, venous pH and bicarbonate and an increase in chloride were detectable in the absorber group. These changes were significantly different in the non-absorber group.

Conclusions

Absorption of irrigation fluid did occur in a relevant proportion of patients undergoing XPS? GreenLight LV. High-volume absorption (≥2000 ml), which might be clinically relevant, was detectable in almost 20 % of all procedures. Absorption of saline irrigation fluid does not result in a classical TUR syndrome, but fluid and chloride overload can lead to serious complications, particularly in cardiovascular high-risk patients. Thus, patients with symptoms potentially related to fluid absorption should be monitored carefully.

     

Parathyroid hormone and bone mass after kidney transplantation

Metabolic bone disorder develops during chronic renal failure and chronic dialysis treatment, continues after successful kidney transplantation, and is further aggravated by corticosteroids and immunosuppressants. The recognized risk factors for bone loss, i.e. parathyroid hormone (PTH) secretion, age, duration of hemodialysis, sex and post-transplantation period, were examined in this cross-sectional study of 91 stable kidney transplant recipients. Patient age was 21-67 years, time spent on dialysis 1-216 months, and post-transplantation period 1-228 months. Bone mineral density was measured by dual energy x-ray absorptiometry at the lumbar spine, femoral neck and radius. T-scores (bone mineral density expressed as standard deviation of healthy young population) were used in statistical analyses to avoid sex differences in bone mass. PTH was measured by a commercial kit (9.07 +/- 11.81 pmol/L). The femoral neck and radius correlated negatively with PTH and hemodialysis duration both in simple correlations and multiple regression, and femoral neck additionally with age. The lumbar spine correlated negatively only with PTH. Post-transplantation time did not correlate significantly with the three densitometry sites. Also, the frequency of osteoporosis or osteopenia for the femoral neck and spine did not differ between the first 12 months and subsequent period, but was positively influenced by hemodialysis duration. There was no sex difference for the variables analyzed in the study. The results indicated that prolonged hemodialysis treatment and consequently increased PTH secretion had unfavourable effect on the femoral neck and radius bone in kidney transplant recipients. Regarding predictors in this study, only PTH was found to adversely affect the lumbar spine. Further deterioration of change in the skeletal status could not be demonstrated, which might be explained by the reduction in PTH secretion and possibly by improvement of the bone disorder.     

Stable and unstable chromosome aberrations measured after occupational exposure to ionizing radiation and ultrasound

Aim

To evaluate chromosome aberration and fluorescent in situ hybridization (FISH) assays as a method to estimate of health risk, we monitored 9 male subjects occupationally exposed to low doses of both ionizing radiation and ultrasound during a period of over 3 years.

Methods

Sampling was performed at 6-month intervals during a three-year period. First we used conventional chromosomal aberrations analysis. When the aberration frequency for a particular subject reached the background, we measured translocations in the final sample, using fluorescence in situ hybridization. Chromosome painting probes for chromosomes 1, 2, and 4 were used simultaneously.

Results

Dicentric and ring chromosomes were eliminated within a year. Translocations persisted and deviated from control values in all examinees. Translocations were detected long after unstable aberrations decreased to the background level.

Conclusion

Fluorescence in situ hybridization-based translocation detection was a reliable method for monitoring chronic occupational clastogen exposure. Chromosome aberration assay correlated with translocation frequency. Stable chromosomal aberrations reflected cumulative genome damage during job exposure.For the last 30 years, chromosome aberration assay and detection of unstable aberrations, dicentrics and acentric fragments, have been used for the estimation of genome damage caused by physical and chemical clastogens (1). Since physical dosimetry provides only limited information when it comes to complex exposures, biodosimetry has increasingly gained in importance. The introduction of ultrasound in medicine and industrial technology has made the evaluation of genome damage more complicated due to absence of personal dosimetry and still undefined mechanisms of its clastogenic and aneugenic potentials.The scientific importance of dicentric chromosome detection is significant. Biodosimetry based on dicentric calculations improved radiation protection and supplied data on the correlation between genome damage and other biomarkers related to ionizing radiation exposure, such as hematological parameters or development of neoplasms (1,2). However, a false perception was created that a decrease in the frequency of dicentrics means that the health-risk has disappeared.There is a need for reliable methods to assess past exposure to clastogens and the related risk. This is particularly the case for a large number of individuals exposed to various levels of ionizing radiation caused by nuclear accidents such as Chernobyl, atmospheric nuclear testing prior to the early 1960s, the atomic bombing at Hiroshima and Nagasaki, various medical radiological procedures, and occupational exposures for which dosimetric information may be poor or absent (3,4). Our study focused principally on the application and evaluation of a technology referred to as “chromosome painting” for investigating human exposure at workplace and its risk assessment. This technology employs the method of fluorescence in situ hybridization (FISH) with whole chromosome probes, which rapidly and accurately detect stable chromosome abnormalities, such as translocations, in individuals exposed in the past (5-8).The aim of our study was to compare the use of chromosomal aberrations and FISH method in the evaluation of health risk in individuals occupationally exposed to low doses of ionizing radiation and ultrasound in industry over long periods time, by biomonitoring the results of unstable and stable chromosome aberrations     

Radiographic cephalometry analysis of dimensions of condylar processus in persons with mandibular prognathism

INTRODUCTION/AIM: There are numerous factors that influence the formation of condylar processus: the growth and development of cranial base, growth and development of the jaws and alveolar extensions, teething, the way of intercuspidation, the overlap of incisors, functions of masticatory muscles, etc. Considering the fact that the above-mentioned factors significantly differ in persons with different morphological set of the face, we set a hypothesis that dimensions of condylar processus and the mandibular ramus considerably differ in persons with mandibular prognathism compared to eugnatic persons. The aim of this study was to establish the differences in dimensions of condylar processus between the above-mentioned groups. METHODS: Six parameters representing the dimensions of the condylar processus were measured on profile teleradiographs of 30 eugnatic persons and 30 paersons with mandibular prognathism: the height of condylar processus, the height of head of the mandible, width of the head, width of the neck, height of the ramus without the condylar processus and the overall height of the ramus. RESULTS: A considerable difference in the values of the parameters was found, as well as the distribution toward the values of reference. It was found that the height of the condylar processus was significantly greater in persons with mandibular prognathism, whereas the width of the head of the mandible, the width of the neck and the height of the ramus without the condylar processus was considerably decreased within the same group. The height of the head of the mandible and the overall height of the ramus was not significantly changed. CONCLUSION: In persons with mandibular prognathism, morphological features of the condylar processus are changed. The condylar processus lengthens on account of shortening of the lower part of the ramus, and the mentioned lengthening is the most prominent in its condylar neck area which is also the centre of its most intense growth.     

Comparison of Verisyse and Veriflex Phakic Intraocular Lenses for Treatment of Moderate to High Myopia 36 Months after Surgery

Purpose: To compare refractive stability, endothelial cell count (ECC), incidence of complications, and patients’ satisfaction between a rigid Verisyse (group I, n = 198) and foldable Veriflex (group II, n = 212) phakic intraocular lenses (pIOL) over 36 months postop. Materials and methods: This was a retrospective study. Patients’ satisfaction and incidence of photic phenomena were evaluated at one month and one year postop. Data were analyzed to determine difference between groups for astigmatism, mean spherical equivalent (MRSE), uncorrected (UDVA) and corrected (CDVA) monocular distance visual acuity, complication rate (acute and chronic), and ECC. Differences were considered statistically significant when p < 0.05. Results: Group II cases had significantly higher UDVA, CDVA, and lower astigmatism during the entire follow-up. There was no significant difference in mean MRSE or mean ECC postoperatively. In both groups, mean ECC reduced significantly at one month postop, followed by a gradual linear decline between 1 and 36 months of 22.4 cells/mm²/annum (group I) and 13.32 cells/mm²/annum (group II). Overall complication rates were ≤ 10% with no significant inter-group differences. Group I patients reported lower incidence of halos at one month but more problems with night vision at one year compared with group II. Overall satisfaction was high and total incidence of reported photic phenomena was low. Conclusion: Both Verisyse and Veriflex pIOLs are effective in correcting myopia. The Veriflex lens demonstrated better refractive outcome; however, subclinical inflammation observed in the Veriflex group and potential influence of inflammation on ECC loss require further investigation.     

Repetitive transcranial magnetic stimulation for treatment of elderly patients with depression – an open label trial

Background

RTMS has been developed as a novel tool for treating depression but the clinical significance of this treatment has been variable, especially in the older depressed subjects.

Methods

Medication-resistant depressed patients 60 years or older were treated for two weeks (10 sessions) with high-frequency rTMS delivered to the left dorsolateral prefrontal cortex at 100% of motor threshold. Each session consisted of 20 trains at 10Hz delivered in 8-second duration. The patients continued taking their psychotropic medications throughout the study.

Results

Nineteen of the 20 subjects completed the trial. One subject dropped out after 8 sessions because of discomfort. The average age of our patients was 66.8 years (6 males and 14 females). Six patients responded and there was a 31.6% mean reduction in Hamilton Depression Rating Scale (HDRS) scores from baseline at the end of the treatment. There was statistically significant decrease from baseline in both HDRS and HARS scores at the end of treatment. rTMS was generally well tolerated.

Conclusion

These preliminary finding suggests that rTMS may be an effective treatment alternative to a subpopulation of medication resistant older depressed patients.     

Flexible Percutaneous Pericardioscopy: Inherent Drawbacks and Recent Advances

Pericardioscopy enables endoscopic inspection and aimed biopsy of the parietal and visceral pericardium. To elucidate possible technical modifications contributing to the feasibility, diagnostic value and safety of the procedure, pericardioscopy with and Olympus HYF-1T flexible endoscope was performed in 32 patients (53.1% males, mean age 46.2 - 13.1 years) with pericardial effusions. In all patients, the intial step of the procedure was subxiphoid fluoroscopically controlled pericardiocentesis and drainage of the pericardial effusion. An Olympus FB-41ST biopsy forceps was applied for endoscopically guided pericardial biopsies. Standard sampling was used in 22/32 patients (3 to 6 samples/patient) and extensive sampling in 10/32 patients (18 to 20 samples/patient). In additional 12 patients pericardial biopsy was performed without pericardioscopy, under fluoroscopic control. Endoscopic visualization was clearly superior when pericardial effusion was partially replaced with 100 to 300 ml of air (29/32 procedures) in comparison to 3/32 procedures in which the pericardial effusion was replaced with warm normal saline (37 °C). In patients with hemorrhagic effusion (12/32), we either repeatedly injected and removed 100 to 150 ml volumes of normal saline (37 °C), or postponed pericardioscopy for 2 to 3 days of active drainage. The specificity of endoscopic findings is low and not decisive for the diagnosis. However, pericardioscopy is significantly contributing to the diagnostic value of pericardial biopsy, especially regarding establishing the new diagnosis and etiology of the pericardial disease. Sampling efficiency was also significantly higher for procedures using aimed pericardial biopsy with standard and extensive sampling compared to procedures performed under fluoroscopy: 86.2%, 87.3% and 43.7%, respectively. No major complications directly related to the procedure were encountered. Minor complications included: short-run ventricular tachycardia (6.3%), pain at the sheath entry site (75%) and transient fever (37.5%). In conclusion, pericardioscopy with Olympus HYF-1T, after air instillation, is a technically complex, but safe procedure that enables excellent visualization and extensive pericardial sampling with improved diagnostic value of pericardial biopsies. Zusammenfassung Ziel dieser Untersuchung war es zu prüfen, welchen Stellenwert die perkutane Perikardioskopie für Diagnostik und Therapie von Patienten mit ätiologisch unklaren Perikardergüssen einnimmt und welche Verbesserungsmöglichkeiten es für die Bildgebung gibt. Bei 32 Patienten mit Perikarderguss (53,1% Männer, mittleres Alter 46,2 - 13,1 Jahre) erfolgte die Perikardioskopie mit dem flexiblen Olympus-HYF-1T-Endoskop. Für die endoskopisch gesteuerte Perikardbiopsie wurde bei allen Patienten eine FB-41ST-Olympus-Biopsiezange verwendet. Bei 22/32 Patienten wurden drei bis sechs Proben/Patient entnommen (Gruppe 1, Standard Sampling) und bei 10/32 Patienten 18 bis 20 Proben/Patient (Gruppe 2, Extensive Sampling). Außerdem wurde die Bildqualität bei Instillation von 0,9%iger Kochsalzlösung mit der nach Instillation von Luft verglichen. Bei Patienten mit hämorrhagischem Perikarderguss (12/32) erfolgte eine Perikardspülung mit Kochsalzlösung. Die Perikardioskopie wurde zwei bis drei Tage nach Spülung und Drainage vorgenommen. Die optische Qualität der Perikardioskopie war deutlich besser nach Ersatz des Perikardergusses mit 100 bis 300 ml Luft (29/32 Prozeduren) im Vergleich zu den Patienten, bei denen der Erguss mit 0,9%iger Kochsalzlösung (37 °C) ersetzt worden war. Die Spezifität des endoskopischen Befundes allein ist gering. Dagegen trägt die Perikardioskopie insofern erheblich zur diagnostischen Wertigkeit der Epi-/Perikardbiopsie bei, als sie eine gezielte Biopsie makroskopisch auffälliger Stellen erlaubt. Die Ausbeute an Biopsien war mittels perikardioskopischer Steuerung des Bioptoms deutlich besser als unter reiner Röntgenkontrolle (86,2% in Gruppe 1, 87,3% in Gruppe 2 bei Biopsieentnahmen unter Perikardioskopie und 43,7% in Gruppe 3 unter alleiniger Röntgenkontrolle). Ventrikuläre Rhythmusstörungen (6,3%), intermittierendes Druckgefühl (75%) und kurzzeitige Temperaturerhöhungen (37,5%) waren die einzigen Komplikationen. Die Perikardioskopie mit dem Olympus HYF-1T, verbessert durch Luftinstillation, ist eine sichere Methode zur Visualisierung von Perikard und Epikard und zur Vorbereitung einer oder mehrerer Biopsien. Diese sind zusammen mit der Zytologie die Voraussetzung für eine exakte ätiologische Diagnose eines Perikardergusses.     

A genetic interaction between NDPK and AMPK in Dictyostelium discoideum that affects motility, growth and development

Many of the expanding roles of nucleoside diphosphate kinase have been attributed to its ability to interact with other proteins. One proposal is an interaction with the cellular energy sensor AMP-activated protein kinase, and here, we apply the simple eukaryotic organism, Dictyostelium discoideum as a test model. Stable cotransformants were created in which NDPK expression was knocked down by antisense inhibition, and AMPK activity was chronically elevated either by constitutive overexpression of its active, catalytic domain (AMPK??T) or as a result of mitochondrial dysfunction (created by antisense inhibition of expression of a mitochondrial chaperone protein, chaperonin 60). To investigate a biochemical interaction, transformants were created which contained constructs expressing FLAG-NDPK and hexahistidine-tagged full-length AMPK or AMPK??T. The protein extract from these transformants was used in coimmunoprecipitations. Knock down of NDPK expression suppressed the phenotypic defects that are caused by AMPK hyperactivity resulting either from overexpression of AMPK??T or from mitochondrial dysfunction. These included rescue of defects in slug phototaxis, fruiting body morphology and growth in a liquid medium. Coimmunoprecipitation experiments failed to demonstrate a biochemical interaction between the two proteins. The results demonstrate a genetic interaction between NDPK and AMPK in Dictyostelium in that NDPK is required for the phenotypic effects of activated AMPK. Coimmunoprecipitations suggest that this interaction is not mediated by a direct interaction between the two proteins.     

Cytogenetic evaluation,fluorescence in situ hybridization,and molecular study of psu idic(X)(pter-->q22.3::q22.3-->pter) chromosome abberation in a girl with moderate growth retardation

Combined cytogenetic, fluorescence in situ hybridization (FISH), and molecular analysis are useful in the diagnosis of sex chromosome aberrations. These methods were used in karyotype analysis of a 4-year-old girl with mild dysmorphism and growth retardation. Standard cytogenetic and FISH analysis was done on slides obtained from peripheral blood lymphocyte culture, and the molecular study was performed by using DNA polymorphism analysis. Both parents had normal karyotypes. Chromosome analysis of the proband identified the karyotype with 46 chromosomes and a late replicating dicentric X. Interphase FISH with an alpha satellite X centromere probe revealed two mosaic cell lines. Three signals were observed at 84.5% and one signal at 15.5% of the interphase cells. Molecular analysis showed that the dicentric X chromosome was of paternal origin. Based on this study, we concluded that the karyotype of the patient was 45,X/46,X, psu idic(X)(q22.3), with the trisomy Xpter-->q22.3 and monosomy Xqter-->q22.3. Dicentric X was the result of an isolocal break in both chromatids of the paternal X chromosome and subsequent rejoining of the broken ends, followed by the inactivation of one centromere. This study illustrates the usefulness of combined cytogenetic and molecular investigations for the detection of mosaicism, understanding the mechanism of the formation and parental origin of chromosomal rearrangement, and establishing the diagnosis.