The urodynamic evaluation of lower urinary tract symptoms in men

Urodynamic investigation is recommended when it influences the management of patients and is used before invasive therapies for lower urinary tract dysfunction. Urodynamics has been shown to improve symptomatic and objective outcomes after surgical treatment of bladder outlet obstruction (BOO) of which benign prostatic obstruction (BPO) is the principal cause. The diagnosis of BOO is made from pressure-flow studies (PFS) of micturition using the International Continence Society nomogram, which places patients in three categories: obstructed (BOO index [BOOI] ≥ 40); equivocal (no definite obstruction; BOOI 20–40); and no obstruction (BOOI ≤ 20). PFS are reliable and reproducible; however, they are invasive tests, and efforts to find sensitive and specific methods of diagnosing BPO without catheterization are under way. Promising noninvasive techniques include the penile compression release index, the condom catheter method, and the penile cuff technique. Uroflowmetry and the ultrasound estimation of residual urine remain useful screening tests. Due to its diagnostic and prognostic value, urodynamics is recommended to assess lower urinary tract symptoms before surgery to relieve BOO.     

Outcomes of trauma patients: direct transport versus transfer after stabilisation at another hospital

BackgroundIn this study, we attempted to identify differences in the outcomes of patients with severe trauma who were directly transported to our hospital, and those who were stabilised initially at other hospitals in south-central Taiwan.MethodsWe performed a prospective observational study to review the records of 231 patients with major trauma (Injury Severity Scores (ISS) >15) who visited our hospital's emergency department from January 2010 to December 2010. Among these patients, 75 were referred from other hospitals. Logistic regression was performed to assess the effects of transfer on mortality.ResultsPatients in the transfer group had a shorter interval between trauma and admission to the first hospital (25.3 min vs. 28.1 min), and the average interval between the two hospital arrivals was 138.3 min. Transfer from another hospital was not significantly correlated with mortality in this study (odds ratio: 1.124, 95% confidence interval: 0.276–4.578).ConclusionIn trauma patients with ISS > 15, there is no difference in mortality between those transferred from another hospital after initial stabilisation and those who visited our emergency department directly.     

Geographic factors are associated with increased risk for out-of hospital cardiac arrests and provision of bystander cardio-pulmonary resuscitation in Singapore

Background

Bystander Cardio-Pulmonary Resuscitation (BCPR) can improve survival for Out-of-Hospital Cardiac Arrest (OHCA). This study aimed to investigate the geographic variation of BCPR provision and survival to discharge outcomes among residential OHCA cases, evaluate this variation with individual and population characteristics and identify high-risk residential areas with low relative risk (RR) of BCPR and high RR of OHCA at the development guide plan (DGP) census tract levels in Singapore.

Methods

This was a retrospective, secondary analysis of two prospectively-collected registries in Singapore from 2001 to 2011. We used Bayesian conditional autoregressive spatial models to examine predictors at the DGP level and calculate smoothed RR to identify high-risk areas. We used multi-level mixed-effects logistic regression models to examine the independent effects of individual and neighborhood factors.

Results

We found a total of 3942 OHCA with a BCPR rate of 20.3% and a survival to discharge rate of 1.9% and 3578 cases eligible for BCPR. After adjusting for age, witnessed status, presumed cardiac etiology and longer response time, the risk of BCPR provision significantly increased by 0.02% for every 1% increase in the proportion of household size 5 and above in the DGP area (odds ratio1.02, 95%CI = 1.002–1.038, p < 0.026). We identified 10 high-risk residential areas with low RR of BCPR and high RR of OHCA.

Conclusion

This study informed that neighborhood household size could have played a significant role in the provision of BCPR and occurrence of high-risk areas. It demonstrates the public health potential of combining geospatial and epidemiological analysis for improving health.     

Age-Related Hip Proprioception Declines: Effects on Postural Sway and Dynamic Balance

Objective

To evaluate the effects of age on hip proprioception, and determine whether age-related hip proprioception declines disrupt balance.

Design

Survey of proprioception and balance differences between 3 age groups.

Setting

University balance laboratory.

Participants

Volunteer sample of independent community-dwelling adults (N=102) without sensory or other neurologic impairments in 3 age groups: younger (mean age, 24.6y; range, 19–37y), mid-aged (mean age, 53.3y; range, 40–64y), and older adults (mean age, 76.3y; range, 65–94y).

Interventions

Not applicable.

Main Outcome Measures

Hip joint position sense (JPS) and kinesthesia were measured using a custom-built device. JPS error was determined by the magnitude of matching errors during vision and no-vision conditions. Kinesthesia was evaluated by the ability to detect passive limb rotation without vision. Postural sway was assessed during static stance and measured using root mean square of center of pressure (COP) displacement and velocity of COP displacement. Clinical balance and fear of falling were assessed with the mini-Balance Evaluation Systems Test (mini-BESTest) and Activities-specific Balance Confidence Scale, respectively.

Results

Both older and mid-aged adults had significantly increased JPS error compared with younger adults (P<.05). Kinesthesia accuracy was significantly decreased in older adults compared with mid-aged and younger adults (P≤.01). Both measures of proprioception error correlated with age (P≤.001). There were no relationships between hip proprioception error and postural sway during static stance. However, older adults with lower proprioceptive error had significantly higher mini-BESTest scores of dynamic balance abilities (P=.005).

Conclusions

These results provide evidence of significant hip proprioception declines with age. Although these declines are not related to increases in postural sway, participants with hip proprioception declines demonstrated disrupted dynamic balance, as indicated by decreased mini-BESTest scores.     

The modern management of Barrett’s oesophagus and related neoplasia: role of pathology

Modern management of Barrett’s oesophagus and related neoplasia essentially focuses upon surveillance to detect early low‐risk neoplastic lesions and offering organ‐preserving advanced endoscopic therapies, while traditional surgical treatments of oesophagectomy and lymph node clearance with or without chemoradiation are preserved only for high‐risk and advanced carcinomas. With this evolution towards figless invasive therapy, the choice of therapy hinges upon the pathological assessment for risk stratifying patients into those with low risk for nodal metastasis who can continue with less invasive endoscopic therapies and others with high risk for nodal metastasis for which surgery or other forms of treatment are indicated. Detection and confirmation of neoplasia in the first instance depends upon endoscopic and pathological assessment. Endoscopic examination and biopsy sampling should be performed according to the recommended protocols, and endoscopic biopsy interpretation should be performed applying standard criteria using appropriate ancillary studies by histopathologists experienced in the pathology of Barrett’s disease. Endoscopic resections (ERs) are both diagnostic and curative and should be performed by clinicians who are skilled with advanced endoscopic techniques. Proper preparation and handling of ERs are essential to assess histological parameters that dictate the curative nature of the procedure. Those parameters are adequacy of resection and risk of lymph node metastasis. The risk of lymph node metastasis is determined by depth invasion and presence of poor differentiation and lymphovascular invasion. Those adenocarcinomas with invasion up to muscularis mucosae (pT1a) and those with superficial submucosal invasion (pT1b) up to 500 µ with no poor differentiation and lymphovascular invasion and negative margins may be considered cured by endoscopic resections.     

Complications in tunneled CVL versus PICC lines in very low birth weight infants.

OBJECTIVE:Comparison of complications associated with tunneled central venous lines (TCVLs) versus peripherally inserted central catheters (PICCs) in infants <1500 g. STUDY DESIGN:A retrospective cohort study at a university medical center. A total of 96 catheters were placed in 60 infants between 4/94 and 3/99. A retrospective review of these infants' medical record was done to review associated complications of catheter placement. RESULTS:Both groups had similar weights and gestational ages. The duration of catheterization was 28 days in TCVLs and 11 days in PICCs (p<0.05). Total, infectious, and mechanical complications between the two groups were similar. Survival function estimates showed no difference between the two groups up to the 15th day of catheterization. CONCLUSION:There is no difference in efficacy or associated complications between the two groups. If one could anticipate needing a catheter longer than 15 days, then a TCVL might be the better choice.     

Benign prostatic hyperplasia--video image analysis and its relationship to androgen and epidermal growth factor receptor expression.

Androgens are essential for the development and maintenance of the prostate. However, prostatic growth may be mediated by epidermal growth factor (EGF) and the expression of the EGF receptor (EGFR) may be influenced by the androgenic milieu. We have characterized the expression of cytosolic androgen receptor (ARc), nuclear salt extractable androgen receptor (ARn) and EGFR in 89 consecutive cases of benign prostatic hyperplasia, 84 of which were treated by transurethral prostatic resections. Image analysis morphometry was performed on the histological sections to determine the epithelial content of the gland. Our results indicate that there is a vast heterogeneity of receptor expression in benign prostatic hyperplasia. Expression of ARc ranged from zero to 1312 fmol/gm. tissue (mean +/- SD 265 +/- 290), ARn ranged from zero to 531 fmol/gm. tissue (mean +/- SD 145 +/- 98) and EGFR ranged from zero to 316 fmol/gm. tissue (mean +/- SD 121 +/- 76). A statistically significant association was found between expression of ARn and EGFR, and these were both significantly correlated with the epithelial content of the gland.     

Improved reproducibility in measuring LV volumes and mass using multicoil breath-hold cine MR imaging

There is a generally recognized need for improvement in quality of fast cardiac MR images. Consequently, breath-hold cine MR images were obtained with multiple surface coils connected to phased array receivers, and C/N, intra-observer and inter-observer variabilities for LV volumes and mass were evaluated. Two sets of short-axis images of the LV, one with multiple surface coils and another with a body coil, were acquired in eight subjects with a fast cine MR sequence using k-space segmentation (TR/TE=7/2.2 msec, temporal resolution=56 msec). C/N with multicoil imaging was 32.2 ± 7.6 (mean ± SD), significantly higher than that with a body coil (11.0 ± 3.3, P < .01). The mean percentage differences in intra-observer and inter-observer measurements with multicoil imaging were significantly better than those with a body coil. In conclusion, multicoil imaging provides significant gain in C/N on breath-hold cine MRI of the heart. In addition, intra-observer and inter-observer reproducibilities are improved with multicoil imaging.     

A rare anatomical variation of the C7 pedicle and intraspinal course of the C7 nerve root

We report a 58 year old man who presented with severe C7 radiculopathy which failed to respond to conservative measures. Subsequent CT and MR imaging of his cervical spine demonstrated C6/7 foraminal stenosis as well as unusual low take-off of the C7 nerve root in relation to a congenital low-set C7 pedicle, findings which were subsequently confirmed intra-operatively. The relevance of the bony and neural anatomy is described and its implications for surgical management are discussed. To our knowledge, this anatomical anomaly has not been previously highlighted in the published English literature.