Oxybutynin versus propantheline in patients with multiple sclerosis and detrusor hyperreflexia

Hyperreflexia is the most common urological finding in patients with multiple sclerosis. A prospective randomized study was done to compare the effectiveness of 2 commonly used drugs, oxybutynin and propantheline. Of the 34 patients entered into the trial 19 were treated with oxybutynin and 15 with propantheline. The urological symptoms (frequency, nocturia, hesitancy, urgency and urge incontinence) were graded according to severity from 0 to 3. Patients with urinary infection were excluded. Urodynamic examination, consisting of cystometrography and electromyography, was performed in all patients before treatment. Both groups of patients had comparable neurological, urological and urodynamic status before treatment. In 4 patients (21 per cent) treated with oxybutynin and in 4 (27 per cent) treated with propantheline side effects were so severe that the treatment had to be discontinued. Symptomatic response to oxybutynin was good in 10 patients (67 per cent), fair in 2 (13 per cent) and poor in 3 (20 per cent). Propantheline produced good symptomatic results in 4 patients (36 per cent), fair in 1 (9 per cent) and poor in 6 (55 per cent). The mean increase in maximum cystometric capacity on cystometrography was significantly larger in the oxybutynin group than in the propantheline group (144 +/- 115 versus 35 +/- 101). Our results indicate that oxybutynin is more effective than propantheline in the treatment of detrusor hyperreflexia in patients with multiple sclerosis.     

Molluskizid wirksame Spiro-α-methylen-γ-butyrolactone

α-Methylene-γ-butyrolactones with Molluscicidal Activity The α-methylene-γ-butyrolactones 1-28 were tested in vitro for molluscicidal activity against Biomphalaria glabrata. The racemic compound 25 shows the best activity. The synthesis was carried out by modified Reformatzky reaction of the corresponding carbonyl compounds and bromomethylacrylic acid ethyl ester. 7-10, 17 and 22-27 have been synthesized for the first time.     

Morphological changes in mice sperm head after exposure to radiation and to cyclophosphamide

Male mice Sfis:Pzh were exposed to X-rays, cyclophosphamide or combination of both agents. Each of agent was given in low (0.25 Gy, 25 mg/kg bw CP) or high (1.00 Gy, 100 mg/kg bw CP) doses. Germ cells were exposed to agents as spermatogonia. After 35 days sperm abnormalities test was performed. Exposure to one of agents only, did not enhance statistically significant frequency of morphologically abnormal spermatozoa. Combined treatment of spermatogonia to both agents in low as well in high doses induce clear biological effects, but only combination of high doses (1.00 Gy + 100 mg/kg bw CP) induce statistically significant effect. Results obtained in this study confirmed, that ability of different agents to induce sperm-shape abnormalities is related to its ability to induce mutations in germ cells.     

Critical review of the uroflowmetry

Uroflowmetry is the measurement of a urinary flow rate by using the flow meter. A urine flow rate is the volume of urine (millilitres) expelled from the bladder via the urethra per unit of time (second). It is expressed in ml/s.(1) Urine flow curve is the plot of velocity of the voided urine against time. The urine stream is affected by voiding pressure (detrusor power) and bladder outlet resistance. Therefore, uroflowmetry evaluates the interaction of the urinary bladder expelling strength and bladder outlet resistance. This is the initial, non-invasive urodynamic investigation for evaluation of patients with lower urinary tract symptoms (LUTS). Although, it is very simple and widely used urodynamic test, the results are nonspecific and required caution interpretations. In the next few pages we will review some aspects of this test, i.e. brief history, equipment, indications, procedure itself and interpretation of the results.     

Long-term follow-up of nonmyeloablative allogeneic stem cell transplantation for renal cell carcinoma: The University of Chicago Experience

Nonmyeloablative allogeneic stem cell transplantation (NST) has considerable activity in patients with metastatic renal cell carcinoma (RCC), although there are limited long-term follow-up data. Between February 1999 and May 2003, 18 patients with metastatic RCC underwent 19 matched-sibling NSTs after conditioning with fludarabine and cyclophosphamide with tacrolimus and mycophenolate mofetil as post-transplant immunosuppression. Among the four objective responses, all were partial and have relapsed with a median response duration of 609 days (range, 107-926). All responders are alive at a median of 41 months. Median overall survival for the entire cohort was 14 months. There were four early treatment-related deaths and one late treatment-related death. Eight patients died from progressive disease and five (28%) from treatment-related mortality. Stratifying transplant outcome as early death, intermediate (no response, no early death), or response, the combination of pre-treatment anemia and decreased performance status, was associated with adverse outcome (P = 0.015) and reduced survival (HR 5.4, 95% confidence interval of 1.4 to 21, P = 0.007). Responders demonstrated prolonged survival compared to nonresponders (P = 0.002). NST leads to durable responses in a minority of metastatic RCC patients. Appropriate patient selection is paramount. Anemia and decreased performance status may enable risk stratification.     

Summarizing benchmarks in the national database of nursing quality indicators using bootstrap confidence intervals

When summarizing the benchmarks for nursing quality indicators with confidence intervals around the means, bounds too high or too low are sometimes found due to small sample size or violation of the normality assumption. Transforming the data or truncating the confidence intervals at realistic values can solve the problem of out of range values. However, truncation does not improve upon the non-normality of the data, and transformations are not always successful in normalizing the data. The percentile bootstrap has the advantage of providing realistic bounds while not relying upon the assumption of normality and may provide a convenient way of obtaining appropriate confidence intervals around the mean for nursing quality indicators.     

Escherichia coli colonization patterns among human household members and pets, with attention to acute urinary tract infection

BACKGROUND: Within-household transmission of Escherichia coli may promote urinary tract infection (UTI) but is poorly understood. METHODS: Fecal samples from 228 individuals (152 humans [5 with acute UTI] and 76 pets) in 63 households were extensively processed for unique E. coli clones, as defined by random-amplified polymorphic DNA analysis and pulsed-field gel electrophoresis. Patterns of strain sharing (presence of a clone in multiple individuals) were assessed. RESULTS: Of 335 E. coli clones, 90 (27%) were recovered from multiple hosts (up to 11 per clone). Within-household strain sharing (1) involved 68% of households, including 3 of 5 households in which a member had a UTI; (2) was more frequent than across-household strain sharing (27% vs. 0.8% of potential sharing pairs; P< .001); (3) increased with household size (r2=0.93; P< .001); and (4) varied by host-pair type (pet-pet, 58%; human-human, 31%; human-pet, 17%). Sex partners shared strains more commonly than did other adults (31% vs. 7% of pairs; P= .08) but accounted for only 12% of within-household strain sharing. Conclusions: Within-household sharing of E. coli, including in households in which a member has a UTI, is common and can involve any combination of humans and pets. Identification of the underlying mechanism(s) could lead to novel preventive measures against UTI.     

Extracorporeal photopheresis therapy in the management of steroid-refractory or steroid-dependent cutaneous chronic graft-versus-host disease after allogeneic stem cell transplantation: feasibility and results

We conducted a retrospective analysis of all allogeneic stem cell transplantation (ASCT) patients started on extracorporeal photopheresis (ECP) for the management of steroid-dependent (SD) or steroid-refractory (SR) cutaneous chronic graft-versus-host disease (cGVHD) following ASCT during a 36-month period (9/98-8/01). Only SD or SR patients who were treated by ECP after day 100 and who received at least 4 weeks of ECP were considered evaluable for this analysis. Out of 64 ASCT patients reviewed, 32 patients met the inclusion criteria. All 32 patients had been previously treated with systemic corticosteroids with 11 (34%) being SR and 21 (66%) SD. Cutaneous cGVHD was extensive in 28 patients (88%) and was accompanied by visceral (hepatic, gastrointestinal) cGVHD in 23 patients (72%). The 32 evaluated patients had received a median of three prior therapies before ECP, most commonly systemic corticosteroids, tacrolimus, and mycophenolate mofetil. Patients received a median of 36 ECP sessions (range 12-98) over a median of 5.3 months (range 1-28), with a median of six sessions per month. The complete response (CR) rate was 22% (n=7) and the partial response rate was 34% (n=11). In all, 28 patients were on systemic corticosteroid therapy at ECP initiation and 18 patients achieved 50% dose reduction while on ECP, yielding a 64% steroid-sparing response rate. Of seven CRs, five are ongoing. A total of 11 (34%) patients have died after ECP, with all cases due to visceral cGVHD or cGVHD-related infectious complications. All 21 surviving patients remain on at least some immunosuppressive cGVHD therapy (including ECP in eight). Overall, ECP displays a substantial response rate and, in particular, steroid-sparing activity in SR/SD extensive cutaneous cGVHD. However, most patients continue to require at least some chronic therapy and cGVHD-related morbidity and mortality remain high.