Bilateral chronic proximal plantar fasciopathy: treatment with electrohydraulic orthotripsy

BACKGROUND: Patients presenting for treatment of chronic plantar fasciopathy often have bilateral involvement. When various nonoperative treatments fail, subsequent intervention may be problematic, especially since bilateral surgery (bilateral fascial release) may not be realistic because of variable, frequently restrictive postoperative weightbearing limitations. METHODS: Twenty-three patients (46 heels) were treated with electrohydraulic high-energy orthotripsy to the plantar entheses of both feet while under the same anesthesia (conscious sedation). Following orthotripsy, all patients immediately were fully weightbearing and resumed normal activities of daily living and work, usually within 24 hours. Progressive return to athletic activities was allowed. Patients were assessed by three outcome parameters: (1) pain measured objectively by a dolorimeter combined with the patient's subjective evaluation of the level of pain; (2) pain after 5 minutes of walking upon arising; and (3) pain with daily activities. All pain measurements were done by the visual analog scale. RESULTS: Patients initially experienced varied pain relief responses. This included earlier pain relief in one heel compared to the other, as well as better pain relief in one heel than the other at the 6- and 12-week evaluations, but with much less variance at the 1-year evaluation. By 3 months following orthotripsy, 28 heels (61%) had good or excellent results. These results were maintained or improved at 1 year. In 18 heels (39%), the outcome was fair or poor. Nineteen heels received a second orthotripsy application; one patient requested a second orthotripsy treatment of only one heel, while nine patients requested a second treatment of both heels. The outcome showed further improvement following the second application of orthotripsy. At 1 year after one or two orthotripsy applications, 19 patients (38 heels) were satisfied with the results in both heels (83%), while four patients (eight heels) still had an unsatisfactory outcome (17%). CONCLUSION: Electrohydraulic high-energy orthotripsy is a reasonable nonincisional method for treating patients with bilateral chronic proximal plantar fasciopathy under a single anesthetic without the prolonged nonweightbearing status often recommended for patients following unilateral open or endoscopic fascial release.     

Urine dendritic cells: a noninvasive probe for immune activity in bladder cancer?

OBJECTIVES: To test the hypothesis that dendritic cells (DC), antigen-presenting cells with the potential to stimulate primary T-cell responses, may appear in the urine of patients with bladder cancer, and that their characteristics may reflect those of DC in cancer tissue. PATIENTS AND METHODS: Cells from digested tissue of transurethral resection specimens from eight patients and urine from 18 with bladder cancers were analysed using flow cytometry, immunohistochemistry and electron microscopy. Urine samples from 12 patients were also analysed during intravesical bacillus Calmette-Guerin (BCG) therapy. RESULTS: Immature DC positive for major histocompatibility complex class II antigens, negative for markers of other leukocyte lineages and with low levels of co-stimulatory markers, were identified in CD45-positive cells isolated immediately from cancer tissue or amongst cells migrating from tissue fragments after overnight culture. Immature-phenotype DC were also identified in the urine of patients with bladder cancer. Their identity was confirmed by immunohistochemistry and electron microscopy. Using these methods, DC were monitored from the bladder during BCG installation for bladder cancer in 12 patients for a mean of 10 months. Of six patients who developed a recurrence of their bladder cancer over this period, all but one showed a lower percentage of DC in their urine at the end of their initial treatment. CONCLUSION: We identified DC in the urine of patients with bladder cancer for the first time. We speculate that variability in the percentage of urinary DC may reflect changes in immunological activity at the tumour site; prospective studies are required to evaluate the relevance of these DC counts and characteristics to clinical outcome.     

Incidence and Drug Susceptibility pattern of Mycobacterium tuberculosis in HIV infected Patien

Incidence of HIV infection in patients with tuberculosis was found out by serological method (ELISA) with confirmation by Western Blot analysis. Out of 2116 tuberculosis patients tested for HIV, 150 cases were found to be positive for HIV infection (5.73%). Drug susceptibility to first line antitubercular drugs was carried out in 1378 isolates from HIV negative cases and 68 isolates from AIDS cases. The overall resistance pattern to one or more drugs was seen in 13.78% of isolates from HIV negative cases as compared to 7.2% isolates in AIDS cases. Multidrug resistance (MDR) was seen in 8.9% of isolates from HIV negative cases as compared to 4.4% of isolates from AIDS cases.Key Words: Antibiotic susceptibility, HIV, Tuberculosis     

The acute and delayed effects of hydrostatic dilation on rat femoral arteries

The technique of intraoperative vessel dilation is sometimes used to facilitate microvascular anastomosis and prevent vasospasm. Although this technique is not new, its application has not gained widespread acceptance mainly due to concerns raised about potential damage to the vessels acutely and during the postoperative period, leading to decreased vessel patency. The goal of this study was to determine the acute and delayed histologic effects of hydrostatic dilation on rat femoral arteries and to compare the response of dilated arteries to vasodilating and vasoconstricting agents. The femoral arteries in 22 rats were used in 2 experimental groups; 9 in the acute group and 13 in the delayed group. Six animals served as controls. After the vessels were exposed, a microcatheter was inserted into a segment of the vessel that had been isolated between 2 vessel clamps. Saline was infused into the artery until a pressure of 300 mm Hg was attained and then maintained for 60 seconds. In the acute group, the animals were euthanized at the end of the dilation, while in the delayed group the animals were euthanized 24 hours later. Hydrostatic dilation of rat femoral arteries was found to increased vessel diameter acutely, with subsequent relief and prevention of vasospasm during the ensuing 24 hours. Histologically, there was no increased damage of the vessel walls in the dilated vessels compared with control vessels. Based on the data reported in this study, hydrostatic dilation of rat microvessels appears to be safe and may be used to technically facilitate microanastomoses and decrease vasospasm.     

Contraceptive risk and compensatory behaviour in young people in education post-16 years: a cross-sectional study

OBJECTIVES: To describe contraceptive risk and compensatory behaviour, using condoms or emergency contraception (EC), in young people in education aged 16-24 years. DESIGN: Cross-sectional study. SUBJECTS: A total of 1135 students aged 16-24 years. SETTING: Educational establishments in and around London, UK. RESULTS: Seventy-six percent of women and 55% of men reported having experienced sex either without contraception or when a condom split or came off. Most participants (or their sexual partners) who reported such risks had compensated by using EC at least once (72% women, 55% men) but only a minority had compensated on each occasion of risk (37% women and 22% men). Of the oral contraceptives users the majority (83%) had experienced a pill 'problem' and the majority of these participants had compensated for such problems by using condoms (79%). Fewer than half of the women who experienced pill problems (45%) compensated by using condoms on each occasion. Less than a quarter (23%) of those who experienced pill problems but did not compensate by using condoms ever compensated by using EC. CONCLUSIONS: This study demonstrates high levels of primary contraceptive risk and low levels of consistent compensatory condom or EC use. The findings suggest that there would be large increases in EC use and repeated use if all primary contraceptive risks were followed by compensatory action. Interventions to increase contraceptive use should focus not only on initiation of contraception use but acknowledge that risks do happen and promote both continuing use and compensatory behaviour.     

Expectant or surgical management of miscarriage: a qualitative study

OBJECTIVE: To explore women's reasons for selecting either expectant or surgical management of first trimester miscarriage and to examine the impact of treatment upon them. DESIGN: A qualitative study using interviews. SETTING: The Early Pregnancy and Gynaecology Assessment Unit at a London hospital. SAMPLE: Thirteen women diagnosed as having a first trimester miscarriage who had opted for either expectant management (n= 5), surgical management (n= 5) or who had undergone both (n= 3). METHODS: Qualitative in depth interviews. MAIN OUTCOME MEASURES: The experience of management. RESULTS: The choice of expectant management was motivated by desire for a natural solution and a fear of operation. Women described how pain and bleeding had made them anxious, that something was wrong and how they felt unprepared for how gruelling the experience would be. Some also described how their support had dwindled as the miscarriage progressed. In contrast, women who chose surgery valued a quick resolution and focussed on the support from hospital staff, although some commented that their emotional needs had not always been met. CONCLUSION: If expectant management is to be more widely offered, women should be told not only of the likely clinical effect of letting a miscarriage run its course but also how women experience this.     

Organic solvent induced chronic toxic encephalopathy: extent of recovery, and associated factors, following cessation of exposure

AIMS: to determine extent and nature of recovery of solvent induced chronic toxic encephalopathy (CTE). METHOD: 21 confirmed cases had repeat neuropsychological and clinical assessments 6-42 (mean 27) months after ceasing exposure. An exposure score was calculated for each. RESULTS: less than half (42.8%) showed evidence of improvement, which showed no association with time away from solvents or exposure score. The more severely affected at first diagnosis were nearly four times more likely to improve (RR 3.85 (95%CI 1.03, 14.38), p = 0.03). Those with no subjective improvement were five times more likely to have been on antidepressants (RR 5.25 (95%CI 0.83, 33.2), p=0.02). CONCLUSIONS: The largely irreversible nature of Type 2 CTE is confirmed. The study results suggest that severity of effect and partial recovery are not dose related but multifactorial, with individual susceptibility probably important. Concomitant depression may also adversely influence recovery.