Hypospadias repair without a bladder drainage catheter

We report on 44 consecutive patients who underwent 1-stage hypospadias repair based on a urethral splent (silicone pleated stent). The severity of hypospadias ranged from subcoronal in 12 cases and distal in 23 to midshaft in 4 and penoscrotal in 5. In the first 15 patients of this series the splent was used with a suprapubic tube. All patients were able to void within the first 36 hours postoperatively. The next 29 patients underwent repairs without the use of a bladder catheter, including 15 who had outpatient procedures. None of the 44 patients has required subsequent catheterization or hospitalization. There have been 2 fistulas in this series. The urethral splent permits normal voiding through and drainage of the neourethra in a variety of hypospadias repairs. The splent expands and contracts with the degree of edema and permits catheterization should this be necessary. The advantages of hypospadias repair without bladder drainage, such as short hospital stay, total ambulation, and decreased potential for infection and bladder spasm, can be realized with the use of a urethral splent.     

Guidelines for the collection, processing and storage of human bone marrow and peripheral stem cells for transplantation

SUMMARY. There are no current U.K. or international guidelines or regulations covering the production, processing and storage of haemopoietic cells such as to allow their engraftment following myeloablative therapy. This paper seeks to provide such guidelines. It enumerates how quality control and assurance can be applied to this area of transfusion medicine; procedural steps relating to bone marrow harvest on peripheral blood stem cell collection are outlined and recommended doses of nucleated cells suggested for both procedures. General specifications for identification, storage and transportation of bone marrow and peripheral blood stem cells are included and specific laboratory procedures related to the provision of haemopoietic cells for engraftment are outlined. Umbilical cord blood transplants and long-term bone marrow culture are alluded to but these are still in a research phase.     

Statistical issues arising from mouse micronucleus assay experiments of Ashby and co-workers.

Data from a series of mouse micronucleus assays have been reanalysed to illustrate various statistical issues raised by Ashby and co-workers during the development of the assay. Most of the statistical points discussed in these earlier papers can be explained by the stochastic nature of the data. Reanalysis shows that the type of data collected in mammalian micronucleus assays is amenable to analysis by standard biometric methods. It is concluded that statistical analysis has an important role in the exploration and interpretation of data from the micronucleus assay.     

Hemodynamic disturbances associated with endovascular embolization in newborn infants with vein of Galen malformation.

OBJECTIVE: To examine hemodynamic changes following endovascular embolization in newborn infants with vein of Galen malformation and severe cardiac failure in the first week of life. STUDY DESIGN: Over a recent 5-year period, nine such infants were identified. In seven of these infants, changes in arterial blood pressure were analyzed in relation to the timing of embolization procedures. RESULTS: A significant increase in arterial blood pressure was noted after most embolizations. In two infants, this systemic hypertension was severe and treated using intravenous antihypertensive drugs. Both infants subsequently developed complete infarction of both cerebral hemispheres with sparing of the brainstem and cerebellum. Mortality in the nine infants was 33%, and 83% of the survivors were neurologically normal or near normal at follow-up. CONCLUSION: The systemic hypertension observed following endovascular embolizations may provide a protective mechanism to maintain cerebral blood flow after reperfusion injury. Lowering blood pressure in this situation may therefore be detrimental.     

Parametric analysis of rank transformed data for statistical assessment of genotoxicity data with examples from cultured mammalian cells

The utility of rank transformation followed by parametric analysisof the ranks has been assessed for determination of the statisticalsignificance of genotoxicity data. Both non-parametric and parametricanalytical methods have defects when used to assess the significanceof results from routine regulatory tests. Superficially, therank transformation method followed by parametric analysis ofranks appears to be an ideal solution. However, we consideredthat such a test might suffer a substantial loss of power whenused to analyse normally distributed data with very low samplereplication. To test this hypothesis we took 22 data sets fromfive ‘borderline’ positive compounds in mouse lymphomatreat-and-plate assays where treatment-related increases werebetween 1.5- and 3-fold the control and analysed these resultsby Dunnett's t-test using rank transformed data and weighted,untransformed data. In theory these mouse lymphoma data shouldshow the rank transformation system at its worst in comparisonwith parametric methodology using weighted data. Surprisingly,the rank transformation methodology showed no loss of powerand, overall, performed more consistently than the weighteddata methodology. Based on this limited number of data sets,rank transformation followed by parametric analysis of ranksseems to be an approach very suitable for genotoxicity assaysin general, particularly where distributions are non-normalor of uncertain form. It combines the general applicabilityof non-parametric methods with the power of parametric analyses.However, the methodology still requires to be further validatedin use and by computer simulation.     

Evaluation and treatment of chemonucleolysis failures

Fifty patients underwent chemonucleolysis for the treatment of lumbar disk herniations unresponsive to conservative therapy. In patients treated with chymopapain, unrelieved sciatica was the most common cause of clinical treatment failure. Eight patients (16%) experienced no relief or only a transient reduction in their radicular symptoms following chymopapain injection. All eight patients were clinically reevaluated and underwent repeat neuroradiographic studies. Computed axial tomography and lumbar myelography demonstrated persistent nerve root compromise at the level of the injected disk space. Open diskectomy was performed in all eight cases. Postoperatively, seven patients noted complete resolution of their radicular symptoms; one patient had intermittent low back and leg pain following surgery.     

An audit of influenza and pneumococcal vaccination in rheumatology outpatients

Background  

Influenza and pneumococcal vaccination are recommended for a number of clinical risk groups including patients treated with major immunosuppressant disease modifying anti-rheumatic drugs. Such immunisation is not only safe but immunogenic in patients with rheumatic diseases. We sought to establish dual vaccination rates and significant influencing factors amongst our hospital rheumatology outpatients.