Postinjury Abdominal Compartment Syndrome: Are We Winning the Battle?

Postinjury (primary) abdominal compartment syndrome (ACS) was described more than 15 years ago as severe abdominal distension with high peak airway pressures, CO₂ retention, and oliguria, which led to unplanned re-exploration after damage-control laparotomy. Later, a more elusive type of ACS was recognized, which develops without abdominal injuries (secondary ACS). Both syndromes were recently characterized, their independent predictors were identified, and preventive strategies were developed to reduce their incidence. Once viewed as a syndrome with almost uniform mortality, systematic preventative strategies and therapeutic efforts have reduced the prevalence, morbidity, and mortality of the syndrome. This review was designed to summarize the recent advances in the management of ACS, to classify the currently available evidence, and to identify future directions of research and clinical care.     

The potential for estradiol and ethinylestradiol degradation in English rivers

Water samples were collected in spring, summer, and winter from English rivers in urban/industrial (River Aire and River Calder, Yorkshire, UK) and rural environments (River Thames, Oxfordshire, UK) to study the biodegradation potential of the key steroid estrogen 17beta-estradiol (E2) and its synthetic derivate ethinylestradiol (EE2). Microorganisms in the river water samples were capable of transforming E2 to estrone (E1) with half-lives of 0.2 to 9 d when incubated at 20 degrees C. The E1 was then further degraded at similar rates. The most rapid biodegradation rates were associated with the downstream summer samples of the River Aire and River Calder. E2 degradation rates were similar for spiking concentrations throughout the range of 20 ng/L to 500 microg/L. Microbial cleavage of the steroid ring system was demonstrated by release of radiolabeled CO2 from the aromatic ring of E2 (position 4). When E2 was degraded, the loss of estrogenicity, measured by the yeast estrogen screen (YES) assay, closely followed the loss of the parent molecule. Thus, apart from the transient formation of E1, the degradation of E2 does not form other significantly estrogenic intermediates. The E2 could also be degraded when incubated with anaerobic bed sediments. Compared to E2, EE2 was much more resistant to biodegradation, but both E2 and EE2 were susceptible to photodegradation, with half-lives in the order of 10 d under ideal conditions.     

Follow-up visits after IUD-insertion: sense or nonsense? A technology assessment study to analyze the effectiveness of follow-up visits after IUD insertion

The objective of this study is to evaluate whether regular follow-up after insertion of an IUD protects against the risk and side effects of this contraceptive device. To study the effectiveness of the follow-up visits done after IUD insertion, we compared a group of women with regular follow-up visits (group A: after 6 weeks, 3, 6 and 12 months) with women who had non-regular follow-up visits (group B: after 6 weeks and annually) for pregnancy, expulsion rates and discontinuation. A total of 280 women were included (group A: 199, group B: 81). Three pregnancies and 2 unnoticed expulsions were observed. The detection rate of an unnoticed expulsion is 0.35 and 0.11 per 100 visits for, respectively, the visit 6 weeks after insertion and all successive visits. Women in group A came significantly more frequently for unscheduled visits [relative risk (RR): 1.6; 95% confidence interval (CI): 1.03-2.4]. The number of discontinuations, pregnancies and expulsions did not differ between groups, but women in group B had their IUD removed earlier (p < 0.01). We conclude that regular follow-up after the insertion of an IUD is not effective.     

Puberty stage and spontaneous descent of acquired undescended testis: implications for therapy?

We assessed spontaneous descent of acquired undescended testis (UDT) at puberty. 299 Boys (aged 1.2-16.5 years, mean 9.4) with 350 acquired-UDT were examined annually during a 12.6-year period (mean 3.1). An acquired-UDT was defined as a previously intrascrotal testis which can no longer be manipulated into a stable scrotal position. Each year, position of the testis and pubertal development according to Tanner's stages were assessed. Early puberty was defined as puberty stage G2 (testicular volume 4-9 mL), mid-puberty as puberty stages G3 (testicular volume 10 mL) and G4 (testicular volume 11-15 mL), and late puberty as puberty stage G5 (testicular volume >15 mL). Follow-up was completed if spontaneous descent had occurred, if mid-pubertal orchidopexy (ORP) had to be performed, if the boy was lost for follow-up, or if pre-pubertal ORP was performed in another hospital. In 139 boys with 164 acquired-UDT follow-up was meanwhile completed. Twelve boys with 14 UDT were lost for follow-up. In an additional 16 boys with 21 UDT, ORP was performed in another hospital. In 98 of the remaining 129 (76.0%) acquired-UDT spontaneous descent at puberty occurred. Mean follow-up was 2.5 years (range 0.2-8.5). In 70 of 98 testes (71.4%) descent occurred in early puberty, in 26 of 98 testes (26.5%) in mid-puberty, and in two testes in late puberty. In 31 of 129 testes (24.0%) ORP had to be performed at mid (30 cases) or late (one case) puberty. In this series, 98 of 129 acquired-UDT (76.0%) descended spontaneously at puberty, whereas in 31 of 129 (24.0%) pubertal ORP was performed. If ORP is postponed until puberty stage G3 (testicular volume of 10 mL) three of four acquired-UDT will descend spontaneously.     

The high scrotal (“gliding”) testis revised

BACKGROUND: At present, the high scrotal testis is considered a distinct and separate entity of undescended testis. OBJECTIVES: The aim of this study was to assess whether high scrotal testis is actually either a congenital- or acquired-undescended testis. DISCUSSION: In 527 consecutive boys (aged 0.4 to 16.5 years, mean 7.5) referred for non-scrotal testis, the number of high scrotal testis was prospectively determined. According to previous testis position, the high scrotal testis was classified into congenital- and acquired-high scrotal testis. In congenital-high scrotal testis orchidopexy was performed whereas spontaneous descent at puberty was awaited in acquired-high scrotal testis. In 210 testes, the gonad was diagnosed as high scrotal. In six testes the condition was congenital and 204 testes were diagnosed as acquired. All cases of congenital-high scrotal testis were treated surgically. In 100 acquired-high scrotal testis follow-up was performed. Of these, 75 testes descended spontaneously at puberty. CONCLUSION: We propose that the high scrotal testis should be regarded, not as a distinct and separate entity, but as a part of the spectrum of either congenital-undescended testis or acquired-undescended testis. Since spontaneous descent can occur at puberty in acquired-high scrotal testis, therapy may be different between both forms.     

Reduction in the number of orchidopexies for cryptorchidism after recognition of acquired undescended testis and implementation of expectative policy

BACKGROUND: Since the mid-1990s, acquired undescended testis has gradually been recognised as a separate entity for which the efficacy of prepubertal surgery has not been univocally been demonstrated. Therefore, in our hospital, orchidopexy was no longer routinely performed for acquired undescended testis. AIM: To investigate the effect of expectative policy in our hospital on the number of orchidopexies. METHODS: Two 5-year periods were compared. Period A (1991-1995), in which undescended testis was treated surgically, and period B (2000-2004), in which prepubertal orchidopexy in our hospital was no longer performed for acquired undescended testis. In addition, a comparison was made between the percentage reduction in hospital and national figures. RESULTS: In period B, the number of orchidopexies in our hospital was reduced by 61.8% (from 387 to 148), mainly in the age group >6 years. Nationally, during the same period, the number of orchidopexies decreased only by 2.4% (from 18 024 to 17 591). CONCLUSION: The results of this study confirm that recognition of acquired undescended testis is crucial for reducing the high number of (late) orchidopexies.     

An exploration of chronic pain patients’ perceptions of home telerehabilitation services

Objectives To explore patients’ perceptions regarding prospective telerehabilitation services and the factors that facilitate or impede patients’ intentions to use these services. Design Using semi‐structured interviews, patients reflected on the pros and cons of various scenarios of prospective telerehabilitation services. Patients’ arguments were first arranged according to the Unified Theory of Acceptance and Use of Technology (UTAUT). Next, using inductive analysis, the data for each UTAUT component were analysed and arranged into subthemes. Setting and participants Twenty‐five chronic pain patients were selected from a rehabilitation centre in the Netherlands. Results Overall, participants considered telerehabilitation helpful as a complementary or follow‐up treatment, rather than an autonomous treatment. Arguments mainly related to the UTAUT constructs of ‘performance expectancy’ and ‘facilitating conditions’. Patients valued the benefits such as reduced transportation barriers, flexible exercise hours and the possibility to better integrate skills into daily life. However, many patients feared a loss of treatment motivation and expressed concerns about both reduced fellow sufferer contact and reduced face‐to‐face therapist contact. Few arguments related to ‘social norms’ and ‘effort expectancy’. Conclusions The effect of telerehabilitation on healthcare strongly depends on patients’ willingness to use. Our study showed that chronic pain patients valued the benefits of telerehabilitation but hesitate to use it as an autonomous treatment. Therefore, future initiatives should maintain traditional care to some degree and focus on patients’ attitudes as well. Either by giving information to increase patients’ confidence in telerehabilitation or by addressing reported drawbacks into the future design of these services. Further quantitative studies are needed to explore patients’ intentions to use telerehabilitation.