Urethral and prostatic colonization and infection in patients undergoing prostatectomy

We conducted a prospective trial to identify organisms colonizing the urethra and prostate and their role in the aetiology of infection after prostatectomy. Twenty-five patients were studied of whom six developed postoperative infection. The causative organisms were previously recovered from the urethra but not the prostate. There was a high rate of urethral colonization by streptococci (14/25) and a low incidence of prostatic colonization. We describe a novel method of sampling the prostate.     

Jugular venous valved conduit (Contegra) matches allograft performance in infant truncus arteriosus repair

Objective: Limited availability and durability of allograft conduits require that alternatives be considered. We compared bovine jugular venous valved (JVV) and allograft conduit performance in 107 infants who survived truncus arteriosus repair. Methods: Children were prospectively recruited between 2003 and 2007 from 17 institutions. The median z-score for JVV (n = 27, all 12 mm) was +2.1 (range +1.2 to +3.2) and allograft (n = 80, 9–15 mm) was +1.7 (range −0.4 to +3.6). Propensity-adjusted comparison of conduit survival was undertaken using parametric risk-hazard analysis and competing risks techniques. All available echocardiograms (n = 745) were used to model deterioration of conduit function in regression equations adjusted for repeated measures. Results: Overall conduit survival was 64 ± 9% at 3 years. Conduit replacement was for conduit stenosis (n = 16) and/or pulmonary artery stenosis (n = 18) or regurgitation (n = 1). The propensity-adjusted 3-year freedom from replacement for in-conduit stenosis was 96 ± 4% for JVV and 69 ± 8% for allograft (p = 0.05). The risk of intervention or replacement for branch pulmonary artery stenosis was similar for JVV and allograft. Smaller conduit z-score predicted poor conduit performance (p < 0.01) with best outcome between +1 and +3. Although JVV conduits were a uniform diameter, their z-score more consistently matched this ideal. JVV exhibited a non-significant trend towards slower progression of conduit regurgitation and peak right ventricular outflow tract (RVOT) gradient. In addition, catheter intervention was more successful at slowing subsequent gradient progression in children with JVV versus those with allograft (p < 0.01). Conclusions: JVV does match allograft performance and may be advantageous. It is an appropriate first choice for repair of truncus arteriosus, and perhaps other small infants requiring RVOT reconstruction.     

Influence of gender,BMI and body shape on theoretical injection outcome at the ventrogluteal and dorsogluteal sites

Aims and objectives

This study aimed to determine the influences of gender, BMI and observed body shape on subcutaneous fat and muscle thicknesses, and theoretical injection outcome, at the ventrogluteal and dorsogluteal intramuscular injection sites.

Background

Debate continues as to whether the dorsogluteal or ventrogluteal injection site is more reliable for a successful intramuscular injection outcome. Subcutaneous fat and muscle thicknesses at the injection site are direct determinants of intramuscular injection outcome. BMI and observed body shape influence gluteal subcutaneous fat and muscle thicknesses, and therefore injection outcome, with potentially distinct effects at the ventrogluteal and dorsogluteal sites.

Design

This was a cross‐sectional study.

Methods

Demographic data were collected, and subcutaneous fat and muscle thicknesses were quantified bilaterally at the dorsogluteal and ventrogluteal injection sites using ultrasound, for 145 participants (57% female).

Results

Subcutaneous fat and muscle were significantly thicker at the dorsogluteal than the ventrogluteal site, and 75% and 86% of participants would receive a successful intramuscular injection at these sites, respectively. There were significant effects of gender, BMI and observed body shape on subcutaneous fat thickness and theoretical injection outcome at both sites. Females, obese individuals and endomorph individuals had thicker subcutaneous fat and were more likely to have a subcutaneous injection outcome.

Conclusions

Gender, BMI and observed body shape could be used to guide site and needle length selection when administering gluteal intramuscular injections to increase the likelihood of a successful intramuscular injection outcome.

Relevance to clinical practice

Both gluteal injection sites should be avoided in obese individuals and endomorph individuals. An intramuscular injection will be successful: using a 32‐mm needle at the ventrogluteal site for all males and normal‐weight females and using a 38‐mm needle for all females at the ventrogluteal site, and for all males and at least 98% of females at the dorsogluteal site.     

Time of day effects on sympathoadrenal and pressor reactivity to exercise in healthy men

Summary To investigate the influence of time of day on sympathoadrenal and pressor reactivity during exercise, eight trained men [age, mean (SD), 24 (0.5) years; maximal oxygen uptake ( ), 4.7 l·min^–1] performed bouts of static (ST) and dynamic (DYN) exercise at 0600–0800 hours (AM) and at 1600–1800 hours (PM). The ST protocol utilized a two-leg isometric contraction at 30% maximum voluntary contraction until failure, and was monitored by a strain gauge interfaced from a leg extension apparatus to a computer. Heart rate (f_c) and blood pressure ( ) responses were recorded at rest, after 1 and 2 min of exercise, and at failure. Epinephrine (EPI) and norepinephrine (NE) levels were recorded before exercise, and after 2 min of exercise. The DYN exercise protocol involved stationary. cycling for consecutive 6-min periods at 60% and 80% . f_c, , EPI, and NE were recorded before exercise and at each workload. No differences were observed in preexercise or exercise f_c under any condition. Preexercise did not differ under any condition. The response to DYN was significantly higher at 80% during PM only. was significantly higher in ST-PM at 1 min, 2 min, and failure. Elevations in both systolic and diastolic P _a contributed to this difference. Preexercise EPI-ST-AM was significantly elevated vs PM, but no other preexercise data were significantly different. Absolute exercise levels were significantly higher for EPIST-PM vs AM only, but the percentage change from baseline was significantly (P<0.01) higher in ST-PM for EPI (+231% PM vs + 32% AM) and NE (+352% PM vs +216% AM). The EPI and NE responses to DYN exercise tended to be higher in AM, but were not significantly different. These data support a time of day pattern in sympathoadrenal and pressor reactivity to exercise that is dependent on the type of activity involved but independent of baseline patterns.     

An autoradiographic study of retinogeniculate pathways in the cat and the fox

The distribution of retinal afferents to the dorsal lateral geniculate nucleus of the cat and the fox has been studied using ocular injections of ³(H)-leucine and autoradiographic techniques. Whereas fiber degeneration methods have shown only five distinct layers in the lateral geniculate nucleus, autoradiographs show six well defined layers in both species. Laminae A and C receive afferents from the contralateral eye, while laminae A1 and C1 receive from the ipsilateral eye. A retinal input to the region lying between lamina C1 and the optic tract could not be demonstrated by fiber degeneration methods, but this region can now be divided into two distinct layers. The antero-dorsal of these two layers (lamina C2) receives afferents from the contralateral eye, while the postero-ventral layer, nearest the optic tract, appears to receive no direct afferents from either eye. Since the rapid component of the axoplasmic transport labels axon terminals to a greater extent than fibers of passage, the autoradiographic method demonstrates, more successfully than fiber degeneration methods, that there is no significant binocular overlap between the retinal projections to alternate geniculate layers.