Urethral injury associated with minimally invasive mid-urethral sling procedures for the treatment of stress urinary incontinence: a case series and systematic literature search

The introduction of the TVT™ has brought about dramatic changes in our practice as regards surgery for stress urinary incontinence, although the risk of bladder injury has caused concern. The subsequent development of tapes introduced through the obturator foramina may limit the rate of bladder injury, and some have suggested that cystoscopy is no longer required during stress incontinence surgery. Several cases of urethral injury referred to our unit have caused us concern about this approach. We present here brief details of these cases along with a systematic search of the literature on urethral injury following mid-urethral tape procedures.     

CONCURRENT MYELITIS AND GUILLAIN-BARRÉ SYNDROME AFTER VARICELLA INFECTION

Myelitis and Guillain-Barré syndrome occurring concurrently after varicella infection is very rare. A 34-year-old man presented with progressive flaccid tetraparesis, facial palsy, respiratory failure, sensory loss and urinary incontinence one week after varicella infection. Clinical, imaging and electrodiagnostic studies supported the diagnosis of myelitis and Guillain-Barré syndrome. He improved with intravenous acyclovir and gammaglobulin.     

Decreasing prevalence of antimicrobial resistance in non-typhoidal Salmonella isolated from children with bacteraemia in a rural district hospital, Kenya

We analysed 336 non-typhoidal Salmonella (NTS) isolated from children <13 years of age with bacteraemia admitted to a rural district hospital in Kenya from 1994 to 2005. Pulsed-field gel electrophoresis was used to determine genetic relatedness of strains, and antimicrobial susceptibility testing was also performed. Most NTS were either Salmonella enterica serovar Typhimurium (n=114; 33.9%) or S. enterica serovar Enteritidis (n=128; 38.1%), with minimal genotypic diversity over the study period. The NTS showed a remarkable decrease in levels of resistance especially to two commonly available antimicrobials (amoxicillin and co-trimoxazole), from high of 69.2% and 68.4% during 1994-1997 to 11% and 13%, respectively, in 2002-2005 (P<0.01). All NTS remained fully susceptible to cefotaxime and ciprofloxacin. Our findings show that commonly available drugs may still be useful for treatment of invasive NTS infections in this rural population.     

Using diaries to measure parameters of transactional sex: an example from the Trans-Africa highway in Kenya

Conventional methods of elicitation have severe limitations where sensitive information is being sought, resulting from both self-disclosure and recall bias. The use of diaries largely circumvents both of these problems. Four hundred and three female sex workers based on a section of the Trans-Africa Highway in Kenya completed standard diaries for consecutive 28-day periods. Variables measured included numbers and types of different clients, condom use, occupation of client, movement patterns and days of menses. Mean numbers of sexual partners, liaisons and sex acts and inter-relationships between the variables measured are analysed. The study affirms the value of diaries as an elicitation method for studying transactional sex in a resource-poor setting. Usable diaries were received from 70% of those who had agreed to participate in the study. The diaries yield detailed quantitative data that describe the characteristics and dynamics of transactional sex on a major highway in Africa and provide information that may be used to estimate HIV transmission rates.     

One-stage Fowler-Stephens orchidopexy for impalpable undescended testis

Background The Fowler-Stephens orchidopexy (FSO) is a well-described treatment for high maldescended testes where the limiting factor for successful placement in the scrotum is short testicular vessels. The operation involves division of these vessels. The testicular blood supply is then dependent on collaterals from the vasal artery. Aims To assess the long-term outcome of patients who underwent this procedure in our institution. Methods The medical records of 20 patients who underwent 22 FSO from 1978 to 1999 by one urologist (HB) were reviewed. Outcome was assessed in terms of testicular position and size. Results Age at operation ranged from 2 to 14 years (mean 5.8 years). All patients had a one-stage FSO and in two of them the procedure was bilateral. In five patients, FSO was preceded by a diagnostic laparoscopy. Mean follow up was 22 months (range 0–121 months). Overall, results were considered good in 18 of 22 testes (82%). Conclusion Our results for the one-stage FSO are comparable with other procedures for the management of high maldescended testis.     

Daily iron supplementation is more efficacious than twice weekly iron supplementation for the treatment of childhood anemia in western Kenya

A recent meta-analysis of 14 clinical trials indicated that daily compared with intermittent iron supplementation resulted in significantly greater hematological improvement in pregnant women. No such definitive beneficial effect was demonstrated in preschool children. We compared the efficacy of daily and twice weekly iron supplementation for 6 wk under supervised and unsupervised conditions in the treatment of mild and moderate anemia [hemoglobin (Hb) 50-109 g/L] in children aged 2-59 mo living in a malaria-endemic area of western Kenya. The study was a cluster-randomized trial using a factorial design; participants were aware of the treatment assigned. All children (n = 1049) were administered a single dose of sulfadoxine-pyrimethamine at enrollment followed by 6 wk of daily supervised iron supplementation [3-6 mg/(kg.d)], twice weekly supervised iron supplementation [6-12 mg/(kg.wk)], daily unsupervised iron supplementation, or twice weekly unsupervised iron supplementation. In the supervised groups, Hb concentrations at 6 and 12 wk (6 wk postsupplementation) were significantly higher in children given iron daily rather than twice weekly [mean (95% CI) difference at 6-wk: 4.2 g/L (2.1, 6.4); 12-wk: 4.4 g/L (1.8, 7.0)]. Among the unsupervised groups, Hb concentrations were not different at 6 wk [mean (95% CI) difference: 0.86 g/L (-1.4, 3.1)], but significantly higher at 12 wk for those assigned daily iron [mean (95% CI) difference: 3.4 g/L (0.79, 6.0), P = 0.02]. In this malarious area and after initial antimalarial treatment, 6 wk of daily iron supplementation results in better hematological responses than twice weekly iron supplementation in the treatment of anemia in preschool children, regardless of whether adherence can be ensured.     

Hemolysis and thrombocytopenia following oxaliplatin administration

Oxaliplatin is a platinum derivative with an overall excellent safety profile that has a major role in the treatment of colorectal cancer. With a proven role now in the adjuvant setting, rare but potentially life‐threatening toxicities become a more significant issue. We report here a case of significant postinfusion hemolysis and thrombocytopenia in a patient undergoing adjuvant chemotherapy for stage III colon cancer, and review the literature. Six cases of hemolysis following oxaliplatin treatment have previously been reported, all in the setting of advanced colorectal cancer, with one case resulting in death. In three of the seven reports (including the present case), warning signs of low grade hemolysis were apparent during preceding cycles, with fever and/or back pain during the infusion being the most common feature. Our case appears to be the first reported with a direct antiglobulin test‐negative hemolysis with thrombocytopenia, with each of the previous reports postulating an autoimmune basis. Hemolysis and/or thrombocytopenia are potentially life‐threatening complications of oxaliplatin chemotherapy. With the increasing use of oxaliplatin in the adjuvant setting, clinicians need to be aware of this entity and the possible clinical warning signs that may be evident in preceding cycles.     

Short-term fasting and the reversal of the stage of promotion in rat hepatocarcinogenesis: role of cell replication, apoptosis, and gene expression

Studies of the multistage nature of hepatocarcinogenesis in the rat have led to the development of models having significant potential application to carcinogenesis in other tissues as well as other species. Whereas the initial and final stages of carcinogenesis- initiation and progression-involve genetic changes and are operationally irreversible, the intermediate stage of promotion is operationally reversible and can be modulated by a variety of environmental factors. Numerous investigations have demonstrated that chronic caloric restriction modifies neoplastic development, primarily during the stage of promotion, so that fewer lesions develop. Short- term fasting of rats, initiated with a nonnecrogenic dose of diethylnitrosamine (DEN) and promoted with 0.05% phenobarbital (PB) for 4 weeks, results in loss of virtually all of the measurable altered hepatic foci (AHF) after two 5-day periods of fasting with an intermediate 2-day period of feeding. This change was accompanied by a marked decrease in bromodeoxyuridine (BrdU) labeling of hepatocytes within AHF together with a significant increase in apoptosis of such cells measured by nick end-labeling. Similar but lesser effects were noted in surrounding, nonfocal hepatocytes. On refeeding, both the numbers and volume percentage of AHF returned within 2 weeks to values seen in nonfasted controls. Administration of PB during the fasting period did not alter these results, although AHF reappeared more rapidly in such animals on refeeding. Nuclear DNA fragmentation was evident in samples of whole liver from fasted animals. During this same period the expression of c-myc mRNA increased 3- to 9-fold, while levels of albumin and insulin-like growth factor I mRNAs decreased significantly. This study demonstrates a model system in which the reversibility of the effects of promoting agents may be rapidly determined and the effects of chemopreventive inhibitors of promotion may be rapidly evaluated.