Effects of preoperative radiotherapy for primary resectable rectal adenocarcinoma on male sexual and urinary function

PURPOSE: The purpose of this study was to determine whether preoperative radiotherapy had an influence on the urinary and sexual function of patients having a sphincter-saving, nerve-preserving total mesorectal excision. METHODS: Urinary and sexual function of male patients undergoing sphincter-saving, nerve-preserving total mesorectal excision for primary resectable rectal carcinoma between January 1998 and December 1999 were evaluated retrospectively. Assessment was by standardized questionnaires. RESULTS: Fifty male patients met the inclusion criteria. Three patients had died (hepatic metastases), and five were living outside the European community and could not be contacted. Sixteen patients underwent preoperative radiotherapy (Group 1), and 26 patients were not treated preoperatively (Group 2). There was no perioperative mortality. Age, tumor stage, and localization of the tumor were comparable. Median follow-up was 20 months. Urinary function was not significantly different. One patient in Group 1 and 2 patients in Group 2 were impotent before surgery. All remaining patients in Group 2 (n = 24) and 11 of 15 remaining patients in Group 1 were sexually active (P = 0.016). All sexually active patients (n = 24) in Group 2 and 9 of the 11 sexually active patients in Group 1 have normal ejaculation (P = 0.09). CONCLUSION: Preoperative radiotherapy for primary resectable rectal carcinoma treated by total mesorectal excision with autonomic nerve preservation may impair male sexual function.     

The use of contrast echocardiography: a matter of clinical judgement.

In their editorial, Buck and Erbel¹ raise the important questionin which settings application of contrast agents to an echocardiographicexamination is appropriate. There is no doubt that the beautyof echocardiography relates to its ease of use. We should acknowledgethat highest accuracy in the determination of left ventricularfunction is     

Rabies Virus Populations in Humans and Mice Show Minor Inter-Host Variability within Various Central Nervous System Regions and Peripheral Tissues

Rabies virus (RABV) has a broad host range and infects multiple cell types throughout the infection cycle. Next-generation sequencing (NGS) and minor variant analysis are powerful tools for studying virus populations within specific hosts and tissues, leading to novel insights into the mechanisms of host-switching and key factors for infecting specific cell types. In this study we investigated RABV populations and minor variants in both original (non-passaged) samples and in vitro-passaged isolates of various CNS regions (hippocampus, medulla oblongata and spinal cord) of a fatal human rabies case, and of multiple CNS and non-CNS tissues of experimentally infected mice. No differences in virus populations were detected between the human CNS regions, and only one non-synonymous single nucleotide polymorphism (SNP) was detected in the fifth in vitro passage of virus isolated from the spinal cord. However, the appearance of this SNP shows the importance of sequencing newly passaged virus stocks before further use. Similarly, we did not detect apparent differences in virus populations isolated from different CNS and non-CNS tissues of experimentally infected mice. Sequencing of viruses obtained from pharyngeal swab and salivary gland proved difficult, and we propose methods for improving sampling.     

Surgical treatment of chronic mallet finger

The literature to find the best approach to correct a chronic mallet finger deformity has been reviewed. All the evidence we found was type IV mallet finger injury, based on the CEBM classification. In the European literature, if correction of the proximal interphalangeal joint is not needed, and surgery is to be done on the distal interphalangeal joint only, then the most frequently reported technique involves the conversion of the chronic injury into an acute one by excising the scar and part of the joint capsule, and the extensor tendon is reattached with minor variations. An 80% to 100% success rate can be expected. In the US literature, the Fowler release is favored, but it does not reliably correct a flexion deformity of more than 35 degrees. Spiral retinacular reconstruction provides an excellent solution if the associated swan neck deformity needs to be corrected.     

Effect of hyperthyroidism on hepatic lipogenesis in rats: studies in vivo and in vitro

Lipogenic rates (measured with 3H2O) in hepatocytes from fed or starved euthyroid rats were similar in magnitude to those measured in livers in vivo. Hepatic lipogenesis in vivo in fed triiodothyronine (T3)-treated rats was greater than in fed control rats, but rates in vitro were only 16% of those of control rats. It is concluded that hepatic lipogenesis in vivo in T3-treated rats utilizes precursors from extrahepatic tissues. Glycogen depletion of hepatocytes from fed control rats decreased lipogenesis, and rates were then similar to those in hepatocytes from fed T3-treated rats. Addition of lactate (2 mmol/l) and pyruvate (0.2 mmol/l) had little stimulatory effect on lipogenesis in hepatocytes from fed control rats, but increased lipogenesis in glycogen-depleted hepatocytes (by 86%), hepatocytes from starved rats (by 25%) and hepatocytes from T3-treated rats (by 60%). In the presence of lactate and pyruvate, 3-mercaptopicolinate (3-MPA) (an inhibitor of gluconeogenesis) did not affect lipogenesis in hepatocytes from fed control rats but substantially increased lipogenesis in hepatocytes from starved euthyroid rats or fed hyperthyroid rats. Thus, in hepatocytes from starved euthyroid rats or fed hyperthyroid rats gluconeogenesis competes with lipogenesis for available precursors (lactate and pyruvate). In contrast, in fed rats carbon flux is predominantly towards lipogenesis. Effects of 3-MPA in the presence of lactate and pyruvate were much less in glycogen-depleted cells from fed rats than in hepatocytes from starved or T3-treated rats.(ABSTRACT TRUNCATED AT 250 WORDS)     

A novel modelling and experimental technique to predict and measure tissue temperature during CO2 laser stimuli for human pain studies

Laser nerve stimulation is now accepted as one of the preferred methods for applying painful stimuli to human skin during pain studies. One of the main concerns, however, is thermal damage to the skin. We present recent work based on using a CO₂ laser with a remote infrared (IR) temperature sensor as a feedback system. A model for predicting the subcutaneous skin temperature derived from the signal from the IR detector allows us to accurately predict the laser parameters, thus maintaining an optimum pain stimulus whilst avoiding dangerous temperature levels, which could result in thermal damage. Another aim is to relate the modelling of the CO₂ fibre laser interaction to the pain response and compare these results with practical measurements of the pain threshold for various stimulus parameters. The system will also allow us to maintain a constant skin temperature during the stimulus. Another aim of the experiments underway is to review the psychophysics for pain in human subjects, permitting an investigation of the relationship between temperature and perceived pain.     

Postmyotomy recollection of premyotomy symptoms of achalasia is very accurate,supporting longitudinal studies of symptom improvement

Background Recollection of preoperative symptom frequency and severity may change postoperatively, thus invalidating longitudinal studies. This study was undertaken to compare symptoms of achalasia before myotomy to patients’ postoperative recollection of premyotomy symptoms. Methods A total of 173 patients, 54% male, of median age 48 years, have undergone laparoscopic Heller myotomy and have been followed through a prospectively maintained registry. Preoperatively, patients scored the frequency and severity of their symptoms on a Likert scale: 0 (never/very bothersome) to 10 (always/very bothersome). Similarly, after laparoscopic Heller myotomy, patients scored the frequency and severity of their symptoms, and re-scored their preoperative symptoms. Data are presented as median, mean ± SD. Results Before myotomy, dysphagia, regurgitation, choking, chest pain, vomiting, and heartburn were particularly notable; symptom scores nearly globally improved after myotomy (p < 0.05 for all, Wilcoxon matched pairs test), especially obstructive symptoms. Postmyotomy recollection of premyotomy symptom frequency and severity was neither substantively nor consistently different from premyotomy scoring. Conclusions Before myotomy, patient symptom scores reflected the deleterious impact of achalasia. After myotomy, patient symptom scores dramatically improved, reflecting the favorable impact of laparoscopic Heller myotomy. Even years after myotomy, patient recollection of premyotomy symptom severity and frequency is very accurate and supports longitudinal studies of symptom improvement after myotomy. Presented at the 25th Annual Meeting of the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES), Dallas, Texas, 26–29 May 2006