Men's experiences of vasectomy: a grounded theory study

This paper presents a theoretical model derived from a grounded theory analysis of interviews with 19 men who had had a vasectomy three years previously. The aim was to track men's experience of vasectomy through decision making, surgery and adjustment and to develop a model to shed light on the process. Early studies of vasectomy had suggested that men adopt more stereotypically masculine behaviours after vasectomy and their authors had conjectured that these were compensatory for a diminished sense of masculinity. Interesting findings from the present study suggest that, for these participants at least, vasectomy often enhanced their sense of masculinity. Surgery was sometimes construed as a “bloodbath” heroically endured and part of the construction of a valued identity of a “family man”. Peer pressure, particularly in the workplace, appeared to be a powerful motivator when making the decision to be sterilized and the authors suggest that vasectomy can be a passport to membership of a socially valued group.     

Comparaison de l’Airtraq™ et du laryngoscope Macintosh pour l’intubation trachéale chez l’adulte avec stabilisation manuelle en ligne du rachis cervical

Introduction

Airtraq laryngoscope is a new and single use device for endotracheal intubation. Few studies showed the superiority of the Airtraq comparing to Macintosh laryngoscope in the setting of difficult intubation.

Study design

To compare the performance of these two laryngoscopes by simulating a situation of reduced mobility of the cervical spine by applying the Manual in-line stablization (MILS) maneuver.

Patients and methods

After obtaining the approval of the ethic committee, we realized a prospective single blind randomized study. During a 6-month period, 120 consenting patients scheduled for ORL or ophthalmologic surgery were included. They all had general anesthesia and orotracheal intubation. These patients were randomly and equally divided in two groups (n = 60), depending on the type of the laryngoscope used (Airtraq or Macintosh). Were excluded from the study the patients with history or criteria predicting difficult intubation. Each patient was intubated by one of the five experimented anesthetists selected for this work. The principle judgment criteria were: i) the time taken for the orotracheal intubation and ii) the intubation difficulty score (IDS). The secondary judgment criterion was the hemodynamic modifications after the endotracheal intubation.

Results

Demographic and upper airway track variables were comparable between the two groups. There was no case of failure of intubation in this serie. Nonetheless, all the patients of the Airtaq group were intubated from the first attempt, whereas half of the patients of the Macintosh group were intubated after the third attempt. Comparing to the Macintosh, the Airtraq reduces the time taken for the orotracheal intubation (14 ± 1 s vs 19 ± 3 s, P = 0.01), the necessity of additional maneuver to facilitate the intubation, and the intubation difficulty score (0.7 ± 0.3 vs 3.8 ± 1, P < 0.001). Orotracheal intubation using the Airtraq laryngoscope caused less hemodynamic stimulation than using the Macintosh.

Conclusion

Our study showed the usefulness of the Airtraq laryngoscope for endotracheal intubation for patients presenting conditions of difficult intubation such as reduced mobility of the cervical spine.     

Timing of premature physeal closure in Legg-Calve-Perthes Disease

Purpose

Premature physeal closure of the proximal femoral physis has been reported in Legg-Calve-Perthes Disease (LCPD). However, the timing of its occurrence had not yet been reported. We proposed (1) to determine the timing of premature physeal closure in unilateral LCPD with serial radiographic evaluation, and (2) to evaluate the relationship between the premature physeal closure and Herring classification, leg-length discrepancy (LLD), Stulberg classification, and trochanteric overgrowth.

Methods

We performed a retrospective study with serial radiographs of 27 patients diagnosed with LCPD. The difference in the timing of physeal closure between the hips was calculated. The involved hip was classified according to Herring classification. The LLD and ATD index at latest follow up was measured. The mean values were calculated and statistical comparison of variables was done using the Fisher’s exact test.

Results

The mean difference of physeal closure at the involved hip compared to the uninvolved side was 3.5 years (range, two to five years). Hips demonstrating premature physeal closure were associated with Herring B/C and C (p?=?0.01) and LLD >1 cm (p?=?0.02). There is no correlation between Stulberg classification, trochanteric overgrowth and premature physeal closure (p?=?0.06 and p?=?0.19).

Conclusions

We may expect premature physeal closure of the proximal femoral physis in patients with LCPD to occur 3.5 years earlier than normal hips. Presence of premature physeal closure can be an adjunct diagnostic tool in the prognostication of LCPD outcomes. Future studies directed toward premature physeal closure in LCPD and associated growth disturbances are necessary.     

Effects of dietary phosphorus restriction on the production of 1,25(OH)2D3 (calcitriol) in patients with moderated renal failure

Calcitriol deficiency and phosphate retention are two main factors in the pathogenesis of renal hyperparathyroidism. In spite of normal serum levels, phosphate may have an important role even in moderate RI. The aim of this study was to evaluate the effect of dietary phosphorus restriction on serum levels of calcitriol in patients with moderate RI. We studied 21 patients (7 F/14 M); mean age 61.7 +/- 15 years old; corrected creatinine clearance 51.4 +/- 14 ml/m. Serum PTH, calcitriol 25(OH)D3, calcium, phosphorus and urinary excretion of calcium and phosphorus were measured before and after 30 days on phosphorus restricted diet (700 mg/day). RESULTS: [table: see text] CONCLUSIONS: Our patients with moderate RI have elevated serum levels of PTH while calcitriol was in the lower normal range. Dietary phosphorus restriction resulted in a significant decrease in PTH levels and a significant increase in serum calcitriol concentrations. The levels of 25(OH)D3 did not change in this study.     

Layer-by-Layer Electrode Fabrication for Improved Performance of Porous Polyimide-Based Supercapacitors

Nanoporous polymers are becoming increasingly interesting materials for electrochemical applications, as their large surface areas with redox-active sites allow efficient adsorption and diffusion of ions. However, their limited electrical conductivity remains a major obstacle in practical applications. The conventional approach that alleviates this problem is the hybridisation of the polymer with carbon-based additives, but this directly prevents the utilisation of the maximum capacity of the polymers. Here, we report a layer-by-layer fabrication technique where we separated the active (porous polymer, top) layer and the conductive (carbon, bottom) layer and used these “layered” electrodes in a supercapacitor (SC). Through this approach, direct contact with the electrolyte and polymer material is greatly enhanced. With extensive electrochemical characterisation techniques, we show that the layered electrodes allowed a significant contribution of fast faradic surface reactions to the overall capacitance. The electrochemical performance of the layered-electrode SC outperformed other reported porous polymer-based devices with a specific gravimetric capacitance of 388 F·g⁻¹ and an outstanding energy density of 65 Wh·kg⁻¹ at a current density of 0.4 A·g⁻¹. The device also showed outstanding cyclability with 90% of capacitance retention after 5000 cycles at 1.6 A·g⁻¹, comparable to the reported porous polymer-based SCs. Thus, the introduction of a layered electrode structure would pave the way for more effective utilisation of porous organic polymers in future energy storage/harvesting and sensing devices by exploiting their nanoporous architecture and limiting the negative effects of the carbon/binder matrix.