44Sacral extracorporeal magnetic stimulation is an effective treatment for pelvic floor dyssynergia; Comparative study with biofeedback therapy

Background: Recent development of extracorporeal magnetic stimulation (ECMS) which uses current‐changing magnetic fields allows the induction of electrical stimulation in the desired deep tissue. Recent study showed the sacral nerve stimulation reduces corticoanal excitability that may play a functional role in anal continence mechanisms. Preliminary study shows that ECMS of sacral nerve can modify pelvic floor function and expel rectal balloon in patients with pelvic floor dyssynergia (PFD). Aims: To evaluate the effect of ECMS compared with biofeedback therapy (BF) in patients with PFD. Methods and Materials: Thirty‐eight patients who fulfilled Rome II criteria for PFD by colon transit time and anorectal function tests, were randomly treated with 8 sessions of ECMS (2/weeks; n = 19) at prone position or BF (2/weeks; n = 19) at sitting position. Stimulation parameters were set at 50–80% of maximum intensity, 10 and 50 Hz frequency, 3 s burst length with 3 and 6 s off using arm‐typed stimulator (BioCom‐1000, Mcube Co., Korea). Symptom scores for constipation with/without anorectal function test were repeatedly measured after each treatment. Response was defined as 50% or more decreased symptom score after treatment (partial response: 30–50%, poor: <30%). Results: Fifteen patients (age 49.1 ± 13.4 years, mean ± SD; 4 men) completed 8 session of BF and 14 patients (54.5 ± 17.6 years, 3 men) completed 8 session of ECMS. Four patients of BF group discontinued treatment due to unsatisfactory therapeutic effect (n = 1) and withdrew consent (n = 3) and 5 patients of ECMS group discontinued treatment because of same reasons (n = 1, 4). Total symptom scores were significantly decreased after treatment of 8 session in both treatment groups (13.4 ± 6.6 vs. 4.3 ± 4.0 for BF, p = 0.009; 14.9 ± 5.6 vs. 3.4 ± 4.0 for ECMS, p < 0.001). Bowel movements per week were also significantly increased after treatment in both groups (median 2 vs. 7 for BF, p = 0.035; median 2 vs. 7 for ECMS, p = 0.008). Thirteen out of 15 patients showed response in BF group and 12 out of 14 showed good response in ECMS group. No adverse effects in both groups. Conclusions: ECMS is as effective as BF for the treatment of PFD. Long‐term effect of ECMS for the patients with pelvic floor dyssynergia need to be evaluated in the near future.     

The influence of menthol on thermoregulation and perception during exercise in warm, humid conditions

Menthol has recently been added to various cooling products that claim to enhance athletic performance. This study assessed the effect of two such solutions during exercise in warm, humid conditions. Twelve participants (22 ± 2.9 years; [(V)\dot]\textO_2\textpeak \dot{V}{\text{O}}_{{2{\text{peak}}}} 47.4 ± 6.2 mL kg⁻¹ min⁻¹) completed a peak power (PO_peak) test and three separate exercise bouts in 30°C and 70% relative humidity after being sprayed with 100 mL of water containing either 0.05 or 0.2% l-menthol, or a control spray. During each trial, participants underwent 15 min of rest, spraying, 15 min of rest and 45 min of exercise at 45% of PO_peak. The following variables were measured: rectal temperature (T _re), sweat rate (SR), skin blood flow (SBF), heart rate (HR), thermal comfort (TC) and sensation (TS) votes, irritation (IRR) and rating of perceived exertion (RPE). Mean skin (MST) and body temperatures ( [`(T)]<sub>\textbody</sub> \bar{T}_{\text{body}} ) were calculated. There was no significant difference in MST, [`(T)]_\textbody \bar{T}_{\text{body}} SR, SBF, HR, TC or RPE between conditions. Spraying with 0.2% menthol significantly (P < 0.05) elevated T _re by 0.2°C compared to the other conditions. Both menthol sprays caused participants to feel significantly cooler than control spraying (P = 0.001), but 0.2% spraying induced significantly cooler sensations (P = 0.01) than 0.05% spraying. Both menthol sprays induced greater irritation (P < 0.001) than control spraying. These findings suggest that 0.05% menthol spraying induced cooler upper body sensations without measurable thermoregulatory impairment. T _re was significantly elevated with 0.2% spraying. Irritation persisted with both menthol sprays while TC remained unchanged, suggesting a causal relationship. The use in sport of a spray similar to those tested here remains equivocal.     

Clinical Activity and Polymerase Chain Reaction Evidence of Chlamydial Infection after Repeated Mass Antibiotic Treatments for Trachoma

It is unclear how the prevalence of clinically active trachoma correlates with the prevalence of ocular chlamydial infection at the community level. In 24 villages from a cluster-randomized clinical trial of mass azithromycin distributions in Ethiopia, the correlation between the prevalence of clinical activity (on examination) and chlamydial infection (by polymerase chain reaction) was moderately strong before mass antibiotic treatments (Pearson''s correlation coefficient r = 0.75, 95% confidence interval [CI] = 0.52–0.87), but decreased at each time point during four biannual treatments (at 24 months, r = 0.15, 95% CI = −0.14–0.41). One year after the final treatment, the correlation coefficient had increased, but not to the pre-treatment level (r = 0.55, 95% CI = 0.30–0.73). In a region with hyperendemic trachoma, conjunctival examination was a useful indicator of the prevalence of chlamydial infection before treatments, less useful during mass treatments, but regained utility by one year after treatments had stopped.     

Psychiatric illness in hip fracture

OBJECTIVE: to review the literature on the prevalence and effect on outcome of psychiatric illness in older people with hip fracture. METHODS: searching of medical databases and bibliographies to identify relevant studies. Application of predetermined quality criteria for prevalence and outcome studies. RESULTS: 19 studies met criteria for a prevalence study. Rates of psychiatric illness varied, with depression in 9-47%, delirium in 43-61% and unspecified cognitive impairment in 31-88%. Four studies met criteria for an outcome study. Psychiatric illness resulted in increased mortality and dependence and decreased activities of daily living skills. No individual study examined the prevalences and effect on outcome of depression, delirium and dementia separately. CONCLUSIONS: depression, delirium and dementia are common in older people with hip fracture. Further research is required to examine the effect on outcome of psychiatric illness, and the effect of psychiatric interventions in this setting.     

Ultrastructural evidence of a merocrine secretion in the human endolymphatic sac

The results of a light and transmission electron microscopic analysis of an endolymphatic sac (ES) from a patient suffering from episodic vertigo, tinnitus, and hearing loss are presented. A biopsy of the intraosseous portion of the ES was obtained during a translabyrinthine approach to section the vestibular nerve in the internal acoustic meatus. The material consisted mainly of tubular epithelial structures filled with heavily stained material. Pathologically dilated and degranulated rough endoplasmic reticuli and disaggregation of polyribosomes with accumulation of solitary ribosomes in the cytosol and endoplasmic reticulum suggested a disturbed epithelial cell protein synthesis. Ultrastructural evidence of an increased merocrine secretion of glycoprotein conjugates into the ES was noted. This made it possible to analyze the presumed intracellular secretory pathways. An increased number of intraepithelial lymphocytes and monocytes was observed. Since the inner ear had been subjected to surgical intervention before the vestibular nerve section, no conclusions can be drawn as to whether the patient's symptoms were related to the disturbed protein metabolism and hypersecretion of glycoprotein conjugates into the ES. The findings support earlier experimental results that indicate that the ES has not only a resorptive function but also a secretory one.     

Middle fossa acoustic tumor surgery: results in 106 cases

Although the middle cranial fossa approach has been used less frequently in recent years than in the past, it continues to be a useful technique for the removal of small acoustic tumors with possible hearing preservation. The approach provides complete exposure of the contents of the internal auditory canal, thus allowing positive facial nerve identification and facilitating total tumor removal. This paper reports the results of 106 middle fossa acoustic tumor removals over a 25-year period. Measurable postoperative hearing remained in 59% of cases. In 89% of cases, normal or near-normal postoperative facial nerve function was obtained. Total tumor removal was achieved in 98% of cases. Preoperative selection criteria are discussed, and postoperative complications are reported.