Sphincter injury after anal dilatation demonstrated by anal endosonography.

Anal dilatation is still used in the treatment of anal fissure and haemorrhoids. Using anorectal physiology and anal endosonography we have studied 12 men presenting with faecal incontinence following anal dilatation. Resting anal pressures were low, pudendal nerve latencies were normal; 11 men had a disrupted internal anal sphincter and in ten this was extensively fragmented. Three also had defects of the external anal sphincter. These findings demonstrate for the first time the nature of the structural injury which may be caused by anal dilatation.     

A final adjustment for staff allocation under environmental uncertainty

Through understanding the relationships between the previous day's (Sunday) demand and the remaining days' demand, a prediction model can be constructed. The staff level can be determined based on this prediction model. This model can also be applied in different hospital units or a staff environment other than hospitals.     

Scalp electrical recording during paralysis: quantitative evidence that EEG frequencies above 20 Hz are contaminated by EMG.

OBJECTIVE: To identify the possible contribution of electromyogram (EMG) to scalp electroencephalogram (EEG) rhythms at rest and induced or evoked by cognitive tasks. METHODS: Scalp EEG recordings were made on two subjects in presence and absence of complete neuromuscular blockade, sparing the dominant arm. The subjects undertook cognitive tasks in both states to allow direct comparison of electrical recordings. RESULTS: EEG rhythms in the paralysed state differed significantly compared with the unparalysed state, with 10- to 200-fold differences in the power of frequencies above 20 Hz during paralysis. CONCLUSIONS: Most of the scalp EEG recording above 20 Hz is of EMG origin. Previous studies measuring gamma EEG need to be re-evaluated. SIGNIFICANCE: This has a significant impact on measurements of gamma rhythms from the scalp EEG in unparalysed humans. It is to be hoped that signal separation methods will be able to rectify this situation.     

Automated measurement of 224Ra and 226Ra in water.

We present a new simple approach for automated, non-destructive measurement of the alpha-emitting radium isotopes ((223)Ra, (224)Ra, and (226)Ra) in water based on the emanation of their respective radon daughters ((219)Rn, (220)Rn, and (222)Rn). The method combines the high adsorption uptake of MnO(2) Resin for radium (K(d)=2.4 x 10(4)ml/g) over a wide pH range with the simplicity of the activity registration using a commercial radon-in-air analyzer (RAD7, DURRIDGE Company, Inc). Radium is first adsorbed onto the MnO(2) Resin by passing a water sample through the resin packed in a gas-tight glass cartridge. The same cartridge is then connected to the radon analyzer via a simple tubing system to circulate air through the resin and a drying system. The efficiency of the proposed system is determined by running standards prepared in the same manner. Our results indicate that the efficiency for (226)Ra is >22% if both (218)Po and (214)Po counts are collected. This is comparable with typical efficiencies for alpha spectrometry but with much less sample preparation. We estimate that an MDA of 0.8 pCi/L for (226)Ra may be obtained with this new approach using a 1L water sample and less than 4h of counting.     

Flavocoxid is as effective as naproxen for managing the signs and symptoms of osteoarthritis of the knee in humans: a short-term randomized,double-blind pilot study

Flavocoxid (Limbrel), a proprietary mixture of flavonoid molecules (baicalin and catechin), was tested against a traditional nonsteroidal anti-inflammatory drug, naproxen, for the management of the signs and symptoms of moderate osteoarthritis (OA) in humans. Discomfort and global disease activity were used as the primary end points, and safety assessments were also taken for both treatments as a secondary endpoint. In this double-blind study, 103 subjects were randomly assigned to receive either flavocoxid [500 mg twice daily (BID)] or naproxen (500 mg BID) in a 1-month onset of action trial. Outcome measures included the short Western Ontario and McMaster University Osteoarthritis Index, subject Visual Analogue Scale for discomfort and global response, and investigator Visual Analogue Scale for global response and fecal occult blood. Both flavocoxid and naproxen showed significant reduction in the signs and symptoms of knee OA (P ≤ .001). There were no statistically detectable differences between the flavocoxid and naproxen groups with respect to any of the outcome variables. Similarly, there were no statistically detectable differences between the groups with respect to any adverse event, although there was a trend toward a higher incidence of edema and nonspecific musculoskeletal discomfort in the naproxen group. In this short-term pilot study, flavocoxid was as effective as naproxen in controlling the signs and symptoms of OA of the knee and would present a safe and effective option for those individuals on traditional nonsteroidal anti-inflammatory drugs or cyclooxygenase-2 inhibitors. A low incidence of adverse events was reported for both groups.     

A stochastic model for determining the necessary staff level in a service industry

Determining sufficient staff levels and providing quality, economical and efficient service is a problem that is difficult for some staffing managers to solve. The objectives in this paper are to derive a stochastic model for determining the necessary staff levels in various service environments such as hospitals, banks, or in manufacturing settings where the demand for a good staff is erratic. In order to assess the proper staff levels, an equation must be used which involves previous service demand hours that are considered as a distribution integrated within the statistical capability scale distribution. The most important property of this staffing model is that the results are independent of the mix of the jobs, the variation of the in-service time for jobs, and the stationary or nonstationary job arrival rate.     

The many uses of the U tube

U tube placement was employed as an adjunct to complicated biliary procedures in 14 patients. We found the transhepatic tubes to be useful for stenting biliary anastomoses, maintaining biliary drainage, delivering localized irradiation, and acting as permanent external conduits. The tubes remained in placed an average of 15 months and as long as 40 months. The frequency of cholangitis was minimized by frequent tube exchange. The U-shaped configuration makes tube exchange easy and inexpensive to perform.     

Vasonatrin peptide: a unique synthetic natriuretic and vasorelaxing peptide.

This study reports the cardiovascular and renal actions of a novel and newly synthesized 27-amino acid peptide termed vasonatrin peptide (VNP). VNP is a chimera of atrial natriuretic peptide (ANP) and C-type natriuretic peptide (CNP). This synthetic peptide possesses the 22-amino acid structure of CNP, which is a cardiovascular selective peptide of endothelial origin and is structurally related to ANP. VNP also possesses the five-amino acid COOH terminus of ANP. The current study demonstrates both in vitro and in vivo that VNP possesses the venodilating actions of CNP, the natriuretic actions of ANP, and unique arterial vasodilating actions not associated with either ANP or CNP.     

Prostate cancer: Prevalence and treatment in African men

Epidemiological data from the United States of America (USA) indicate that the incidence and mortality of prostate cancer is higher among Black African-American men (AAM) than among White (Caucasian) American men (CAM). Earlier studies suggesting that prostate cancer is relatively rare among indigenous Black men in Africa are probably flawed by underreporting because recent studies indicate that the incidence rates among Black men are similar to those of White men living in Africa. The higher incidence of prostate cancer among AAM has been ascribed to racial differences in genetic susceptibility, dietary factors, or androgen metabolism. However, it may also be due to registration artefacts because in Africa the reported incidence rates of prostate cancer in different countries correlate directly with the per capita gross national product, suggesting improved access to medical facilities is responsible for higher reported incidence rates.

The greater prostate cancer mortality among AAM may result from higher tumour grade and stage and higher serum PSA at presentation, but it has also been suggested that prostate cancer is biologically more aggressive in AAM than in CAM. However, recent studies indicate that tumour grade and stage and serum PSA at presentation are similar in the races, with no difference in survival after multivariate analysis controlling for pretreatment cancer severity. This suggests that the higher prostate cancer mortality among AAM results from socio-economic factors and limited access to healthcare. Black men living inside as well as outside of Africa still tend to present with locally advanced or metastatic prostate cancer due to lack of early detection programmes.     

Atrial natriuretic factor inhibits hypertonic saline-mediated decreases in renal hemodynamics

The present study in the anesthetized dogs was designed to test the hypothesis that atrial natriuretic factor (ANF) attenuates whole kidney tubuloglomerular feedback (TGF) mediated decreases in renal blood flow (RBF) and glomerular filtration rate (GFR) produced by hypertonic saline (HS). Secondly, as adenosine (AD) has been implicated as a metabolic mediator of TGF, we also hypothesized that ANF would antagonize the renal actions of AD. To test this hypothesis, RBF and GFR were assessed in response to hypertonic saline (HS, 16%, i.r.) or adenosine (AD, 0.1 mumol/min, i.r.) in the presence and absence of exogenous ANF (100 ng/kg/min, i.r.). ANF attenuated HS-mediated reductions in GFR (HS, -39.6 +/- 9.8 ml/min vs. HS + ANF, -14.3 +/- 4.5 ml/min, P less than 0.05) and in RBF (HS, -143 +/- 35 ml/min vs. HS + ANF, -5 +/- 22 ml/min, P less than 0.05). GFR was reduced by AD (-9.2 +/- 3.0 ml/min, P less than 0.05), but maintained by AD + ANF (-0.4 +/- 2.0 ml/min, NS). A transient adenosine-mediated vasoconstriction was attenuated by ANF (AD, -54.5 +/- 3.6 ml/min vs. AD + ANF, -3.7 +/- 3.1 ml/min, P less than 0.005). We conclude that ANF at pharmacologic concentrations attenuates at the whole kidney level hypertonic saline and adenosine-mediated reductions in RBF and GFR.