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.     

An Electron Microscopic Study of the Bone Marrow of the Rat in an Experimental Myelogenous Leukemia

Alterations in the vascular sinus and hematopoietic compartment of rat bonemarrow were observed with electronmicroscopy during the pathogenesis of anacute myelogenous leukemia. As the disease progresses, the sinus wall becomesdamaged and disintegrates; normal hemicelements disappear, and the marrow compartment becomes packed with leukemicmyeloblasts. Viruslike particles are present in intercellular spaces and appear tobud from leukemic cells.

Submitted on December 14, 1970 Revised on April 29, 1971 Accepted on July 16, 1971     

Solution conformations of oligomers of α -aminoisobutyric acid°

The N-acetyl(Aib)nN' -methylamides (with n= 1, 2 and 3) and the N-acetyl-(Aib)3 methyl ester have been synthesized using an oxazolone procedure. An experimental conformational analysis of this series of oligomers has been carried out in water, DMSO-d6 and CDCI3 using n.m.r. techniques, and in chloroform using i.r. spectroscopy. Deuterium exchange rates of amide protons in DMSO-d6 and the rates of change of these proton chemical shifts with temperature in water, DMSO-d6 and CDCI3 indicate that the oligomeric N'-methylamides adopt conformations that have no hydrogen bonds when n = 1, one hydrogen bond when n = 2, and two hydrogen bonds when n = 3, and that Ac(Aib)3OMe has a conformation with one hydrogen bond. An analysis of the N-H stretching region of the i.r. spectra of these compounds in CHCI3 also suggests the existence of these conformational states. These data imply that the peptides adopt the 310-helical and not the α-helical conformation in solution. This conclusion supports the hypothesis that the Aib residue has asymmetric geometry at the C^α atom in solution, similar to that reported in the literature for the crystalline state.     

Problem Drinkers in Medical Wards: consumption patterns and disabilities in newly identified male cases

One hundred and sixty-one male medical inpatients were identified as problem drinkers according to criteria previously defined. This paper describes the pattern of their drinking and the associated medical and psychosocial problems. Over half had been admitted with an illness not typically related to alcohol and a similar proportion reported levels of consumption which have previously been considered safe. Classical symptoms of dependence were uncommon but specific enquiry revealed a broad range of social problems related to alcohol. Recognition of this profile is necessary if problem drinkers are to be identified at an early stage and to benefit from counselling.     

A DOUBLE-BLIND CROSS-OVER TRIAL OF FENOPROFEN AND PHENYLBUTAZONE IN ANKYLOSING SPONDYLITIS

Fenoprofen, 600 mg, three times daily, was compared with phenylbutazone,100 mg, three times daily, in 30 patients suffering from ankylosingspondylitis in a double-blind cross-over study. Assessmentswere made after an initial washout period and after each month-longtreatment period. Phenylbutazone significantly improved morningstiffness, finger-to-floor distance, chest expansion, overalljoint pain, spinal pain, the physician's assessment of diseaseactivity and ESR. Only chest expansion was significantly improvedby fenoprofen, and phenylbutazone was significantly better thanfenoprofen in its effects on finger-to-floor distance, morningstiffness, overall joint pain, spinal pain and the physician'sassessment of disease activity. Side-effects were of a minornature apart from one patient who developed rectal bleedingon phenylbutazone which recurred on rechallenging.     

PARA-INFLUENZA PNEUMONIA IN DiGEORGE SYNDROME TWO YEARS AFTER THYMIC EPITHELIAL TRANSPLANTATION

Abstract. Beard, Lorraine J., Robertson, Evelyn F. and Thong, Y. H. (Department of Paediatrics, University of Adelaide and Department of Chemical Pathology, Adelaide Children's Hospital Inc.). Para-influenza pneumonia in DiGeorge syndrome two years after thymic epithelial transplantation. Acta Paediatr Scand 69:403, 1980.—A patient with DiGeorge syndrome developed pneumonia caused by para-influenza virus type 3 two years after immunological reconstitution with foetal thymic epithelium. There was a transient reduction of mitogen-induced lymphocyte transformation at the time of the pneumonia. Although she recovered from the pneumonia, bronchitis persisted and the virus could still be isolated from her pharyngeal secretions 3½ months later.