Simultaneous Treatment of Female Urethral Diverticulum and Stress Urinary Incontinence with Urethral Diverticulectomy and Suburethral Synthetic Mesh Sling

Objectives: Pubovaginal fascial sling along with urethral diverticulectomy has been advised as the most appropriate anti‐incontinence procedure for female stress urinary incontinence (SUI) with concomitant urethral diverticula (UD). We believe that suburethral synthetic mesh tape sling can also be safely used in some patients with concomitant SUI and UD. Herein, we present our experience for simultaneous treatment of UD and SUI with urethral diverticulectomy and suburethral synthetic mesh tape sling. Methods: From 2003 to 2008, there are three patients with UD and SUI in our institution. They received transvaginal urethral diverticulectomy and suburethral synthetic mesh tape sling simultaneously. Videourodynamics was done before and three months after the surgery. Results: Preoperative pelvis magnetic resonance imaging and videourodynamic study showed UD over distal urethra and SUI in all three patients. Urinalysis disclosed mild pyuria in two of the patients, and they both received intravenous antibiotics treatment to eradicate the infection prior to the surgery. They all underwent urethral diverticulectomy with suburethral synthetic mesh tape sling. The postoperative videourodynamic study showed no recurrence of UD and SUI. With a mean follow up of 33.3 months, there was no infection or exposure of synthetic mesh tape. Conclusions: In patients with UD and SUI, suburethral sling using synthetic mesh can be as effective and safe as facial sling in selected patients.     

Kidney and liver transplants from donors after cardiac death: initial experience at the London Health Sciences Centre

Background

The disparity between the number of patients waiting for an organ transplant and availability of donor organs increases each year in Canada. Donation after cardiac death (DCD), following withdrawal of life support in patients with hopeless prognoses, is a means of addressing the shortage with the potential to increase the number of transplantable organs.

Methods

We conducted a retrospective, single-centre chart review of organs donated after cardiac death to the Multi-Organ Transplant Program at the London Health Sciences Centre between July 2006 and December 2007. In total, 34 solid organs (24 kidneys and 10 livers) were procured from 12 DCD donors.

Results

The mean age of the donors was 38 (range 18–59) years. The causes of death were craniocerebral trauma (n = 7), cerebrovascular accident (n = 4) and cerebral hypoxia (n = 1). All 10 livers were transplanted at our centre, as were 14 of the 24 kidneys; 10 kidneys were transplanted at other centres. The mean renal cold ischemia time was 6 (range 3–9.5) hours. Twelve of the 14 kidney recipients (86%) experienced delayed graft function, but all kidneys regained function. After 1-year follow-up, kidney function was good, with a mean serum creatinine level of 145 (range 107–220) μmol/L and a mean estimated creatinine clearance of 64 (range 41–96) mL/min. The mean liver cold ischemia time was 5.8 (range 5.5–8) hours. There was 1 case of primary nonfunction requiring retransplantation. The remaining 9 livers functioned well. One patient developed a biliary anastomotic stricture that resolved after endoscopic stenting. All liver recipients were alive after a mean follow-up of 11 (range 3–20) months. Since the inception of this DCD program, the number of donors referred to our centre has increased by 14%.

Conclusion

Our initial results compare favourably with those from the transplantation of organs procured from donors after brain death. Donation after cardiac death can be an important means of increasing the number of organs available for transplant, and its widespread implementation in Canada should be encouraged.     

Variation in DRD2 dopamine gene predicts Extraverted personality

Quantitative geneticists estimate the heritability of Extraverted personality to be around 40–60%. Theory and research which links Extraversion with variation in dopaminergic function suggests that dopaminergic genes should be a start-point for molecular genetic investigations of this trait. Recent endeavours in this area have met with some encouragement but also setbacks. In this study, we investigate the relationship between Extraversion and the DRD2 TaqIA/ANKK1 polymorphism in 224 university students. Presence of at least one copy of the A1 allele was associated with significantly higher Extraversion. The robustness of this finding was confirmed through bootstrap analysis. Findings are discussed in relation to the broader literature, in particular, methodological issues which may have obscured this finding in previous research.     

Skin cooling aids cerebrovascular function more effectively under severe than moderate heat stress

Skin surface cooling has been shown to improve orthostatic tolerance; however, the influence of severe heat stress on cardiovascular and cerebrovascular responses to skin cooling remains unknown. Nine healthy males, resting supine in a water-perfusion suit, were heated to +1.0 and +2.0°C elevation in body core temperature (T _c). Blood flow velocity in the middle cerebral artery (transcranial Doppler ultrasound), mean arterial pressure (MAP; photoplethysmography), stroke volume (SV; Modelflow), total peripheral resistance (TPR; Modelflow), heart rate (HR; ECG) and the partial pressure of end-tidal carbon dioxide (P_ETCO₂) were measured continuously during 1-min baseline and 3-min lower body negative pressure (LBNP, −15 mm Hg) when heated without and again with skin surface cooling. Nine participants tolerated +1°C and six participants reached +2°C. Skin cooling elevated (P = 0.004) MAP ~4% during baseline and LBNP at +1°C T _c. During LBNP, skin cooling increased SV (9%; P = 0.010) and TPR (0.9 mm Hg L⁻¹ min, P = 0.013) and lowered HR (13 b min⁻¹, P = 0.012) at +1°C T _c and +2°C T _c collectively. At +2°C T _c, skin cooling elevated P_ETCO₂ ~4.3 mm Hg (P = 0.011) and therefore reduced cerebral vascular resistance ~0.1 mm Hg cm⁻¹ s at baseline and LBNP (P = 0.012). In conclusion, skin cooling under severe heating and mild orthostatic stress maintained cerebral blood flow more effectively than it did under moderate heating, in conjunction with elevated carbon dioxide pressure, SV and arterial resistance.