Results of the tension-free vaginal tape procedure for stress incontinence: Patient''s perspective

BACKGROUND: To evaluate the results of the tension-free vaginal tape procedure (TVT) from a patient's perspective. METHODS: Between May 1999 and January 2002, 90 patients underwent a TVT for genuine stress incontinence (GSI) and mixed incontinence. Prior to the procedure, GSI was confirmed by clinical examination and urodynamic studies. Results were then audited from patient notes and the same patients were sent questionnaires to examine results from a patient perspective. RESULTS: Overall response rate to the questionnaire was 70 (77%). The mean age of the patients was 50.4 years (range 31-83 years). Sixty-one patients had spinal anesthesia, seven had general anesthesia and two had local anesthesia. Mean hospital stay was 3.36 days (range 2-14 days) and mean period from the operation to the time of the survey and audit was 16.34 months (range 3-28; SD 6.92). Thirty-nine (56%) of the 70 patients who answered said that the operation had cured their incontinence, 16 (23%) had an improvement in their symptoms, 7 (10%) had worsening of their symptoms and 8 (11%) felt that the operation did not make any difference. The overall success rate according to the patients' perspective was 79%, whereas our audit showed an overall success rate of 86% (77% and 82%, respectively, when we compared only the 66 patients who had both notes and replies available for analysis). CONCLUSION: Although a patient's perception regarding the success of TVT tends to differ from that of a clinician, it was not found to be statistically significant (P = 0.22, McNemar test). The TVT is a very successful operation, but realistic cure rates should be offered to patients.     

Protective immunity to malaria: studies with cloned lines of Plasmodium chabaudi and P. berghei in CBA/Ca mice. I. The effectiveness and inter-and intra-species specificity of immunity induced by infection

CBA/Ca mice were immunized by infection with cloned lines of Plasmodium berghei (isolates ANKA, KSP-11). Plasmodium chabaudi chabaudi (AS, CB) or Plasmodium chabaudi adami (DS) and then challenged with either homologous or heterologous parasites. Protective responses were assessed in immune mice relative to the controls by their ability to (i) extend the time taken for the mean parasitaemia to reach a predetermined level (1% or 0.1%) (ii) reduce peak parasitaemia (iii) resolve the parasitaemia sooner and/or (iv) control or eliminate recrudescences. At both the inter- and intra-species level, immunity appeared largely specific for the cloned line inducing it. At the interspecies level marginally effective cross-immunity was sometimes evident, thus P. berghei KSP-11 immune mice displayed some immunity against P.c. chabaudi AS, although immunity to this parasite was relatively ineffective against P. berghei ANKA or KSP-11. Cross-immunity was more apparent between the subspecies P.c. adami and P.c. chabaudi and between cloned lines of the latter parasite derived from the AS and CB isolates. These data reflect considerable inter- and intra-species structural and immunogenic differences in certain antigens of parasitized erythrocytes and merozoites, which have been identified in a number of murine malarias and associated with protective immunity. Similar differences recently identified in the equivalent antigens of the human parasite P. falciparum may therefore have important implications for protective immunity in man.     

Geriatric trauma: resource use and patient outcomes.

INTRODUCTION: Elderly patients who suffer trauma have a higher mortality and use disproportionately more trauma resources than younger patients. To compare these 2 groups and determine the outcomes and characteristics of elderly patients, we reviewed patients in these 2 groups admitted and treated in our tertiary care provincial trauma centre. METHODS: From the provincial trauma registry we selected a cohort of 40 geriatric patients (group 1) (> or = 65 yr of age) with an ISS of 16 or more who were admitted to and spent time in our trauma service for more than 48 hours and compared them with a similar randomly selected cohort of 44 patients (group 2) aged 20-30 years. Family physicians were contacted for follow-up of these patients 2 years after discharge. We considered length of hospital stay, complications, disposition of the patients and use of consultation services. RESULTS: Patients in group 1 had a mean age of 72.1 years (range from 65-98 yr) and a mean ISS of 27.3 (range from 17-50). Patients in group 2 had a mean age of 26.3 years (range from 22-29 yr) and a mean ISS of 26.3 (range from 17-54). Hospital stay was significantly longer in the group 1: 34.5 days (95% confidence interval [CI]: 24-44 d) versus 21.6 days (95% CI: 15-28 d). More elderly patients experienced complications (35 v. 13, p < 0.001) and required medical consultations (35 v. 26, p < 0.001). In-hospital death rates were 8% (3 of 40) and 4% (2 of 44) respectively (p = 0.3). Fewer geriatric patients could be discharged home (35% [14 of 40] v. 27% [22 of 44], p = 0.056) or to rehabilitation facilities (28% [11 of 40] v. 34% [15 of 44], p = 0.3). Five geriatric patients were discharged to nursing homes (p = 0.007). Of the geriatric patients discharged to rehabilitation facilities or home, 75% were independent 2 years after discharge. CONCLUSIONS: Aggressive care for geriatric trauma patients is warranted, and resources should be directed toward rehabilitation. Based on our findings, we expect that creating a directed care pathway for these patients, targetting complications and earlier discharge, will further improve their outcomes.     

Bovine lymphocyte antigens (BoLA) of bovine lymphocytes and derived lymphoblastoid lines transformed by Theileria parva and Theileria annulata

Summary The BoLA phenotypes of lymphocytes from seven cattle have been compared with those of 19 lymphoblastoid cell lines derived from them by infection in vitro with either Theileria parva or T. annulata. Two long-established lines were also studied. In all cases except one, the BoLA phenotypes of the lymphoblastoid lines were identical with those of the original animal from whose lymphocytes they were derived. The one exception was a chimeric twin where a minor population appeared to have been transformed by T. parva. The antigens present on this line were present in the parents of the chimera, but not detectable in its own peripheral blood. The implications of these results as they relate to the use of these cell lines in immunizing cattle against East Coast fever and tropical theileriosis are discussed.     

Pneumatosis Coli Associated with Sigmoid Volvulus and Colonoscopy

A case of interstitial emphysema involving the mesentery and serosa of the sigmoid colon after volvulus reduced by colonoscopy is presented. The case is reported as a form of pneumatosis intestinalis although it does not conform to the classical clinicopathologic picture of pneumatosis cystoides intestinalis. The infrequent occurrence of this condition in association with volvulus and/or colonoscopy is discussed.     

Evaluation of susceptibility testing methods for Burkholderia cepacia complex: a comparison of broth microdilution,agar dilution,gradient strip and EUCAST disc diffusion

ObjectivesTo evaluate the accuracy and reproducibility of antimicrobial susceptibility testing methods in Burkholderia cepacia complex (BCC).MethodsMinocycline, ciprofloxacin, trimethoprim/sulphamethoxazole, meropenem, ceftazidime and chloramphenicol were tested against 155 BCC strains using broth microdilution at 35 ± 1°C (BMD₃₅) in triplicate, then BMD at 30 ± 1°C (BMD₃₀), agar dilution at 30°C and 35°C (AD₃₀ and AD₃₅), gradient strip (GS) and EUCAST standardized disc diffusion (DD) testing methods once.ResultsBMD₃₅ reproducibility ranged from 70% to 84.5% for all agents. Correlations of MICs from BMD₃₅ with BMD₃₀ ranged from 63% to 85%, with AD₃₅ from 32.9% to 87% and with GS methods from 36% to 83.9%. Essential agreement (EA) of MICs by GS with BMD₃₅ ranged from 62.6% (trimethoprim-sulphamethoxazole) to 83.9% (minocycline). EA of EUCAST DD zone diameters using CLSI breakpoint criteria was between 85.8% and 97.4%, however Very Major Errors (VME) for trimethoprim/sulphamethoxazole were 31%.ConclusionsBMD at 35 ± 1°C was poorly reproducible for most agents and no method showed acceptable performance. Of particular concern were the GS results. Although this is the most commonly used method for determining MICs in laboratories, there was poor correlation with BMD₃₅ for meropenem and trimethoprim/sulphamethoxazole. EUCAST DD correlated poorly with BMD₃₅ MICs. This study confirms that no susceptibility method is capable of providing reproducible and accurate MICs when testing BCC.     

Cognitive Theories of Delusion Formation: The Contribution of Visual Scanpath Research

Recent findings from visual scanpath research are considered in relation to cognitive theories of delusion formation. Contemporary theories converge in proposing that both perceptual and cognitive aberrations are crucial to the development of delusional beliefs (Garety & Freeman, 1999). Deluded individuals have reliably demonstrated attributional and probabilistic reasoning biases, manifesting as hasty decision making and an inclination to blame other people for negative experiences (Bentall, Kinderman, & Kaney, 1994; Garety & Hemsley, 1994). Deluded people have also displayed attentional preference for threat-related material and a ''negative'' world view (Kaney, Wolfenden, Dewey, & Bentall, 1992; Kaney, Bowen-Jones, Dewey, & Bentall, 1997). In combination, these biases might reflect a general tendency for deluded individuals to ''jump to conclusions'' when evaluating others' intentions (Garety & Freeman, 1999), influenced by the perception of threat and persecution everywhere (Kaney et al., 1997). This thesis would be consistent with reports of an inability of paranoid patients to correctly infer the intentions of others during ''theory of mind'' tasks but would not predict a total lack of mentalising ability as proposed by Frith (1992). In visual scanpath paradigms, deluded schizophrenics tend to display excessive staring behaviour and to avoid gazing at facial features when viewing human faces (Phillips & David, 1997, 1998; Streit, Wolwer, & Gaebel, 1997; Williams et al., 1999). These abnormal scanpath strategies could underlie aberrations in social reasoning (including misinterpretation of others' intentions) and data gathering exhibited by deluded individuals. Exploration of the relationship between visual scanpaths and biases in social cognition is therefore warranted.