The practical assessment and management of bladder outflow obstruction

The initial management of bladder outflow obstruction typically related to benign prostatic hyperplasia (BPH) falls to a large extent within the remit of general practice. Referral onwards to secondary care typically arises following the failure to respond to conservative measures or when complications have supervened; the most significant of which is urinary retention. In the hospital setting, anaesthesia, constipation and immobility are the common precipitants. What follows is a practical guide to the management of these situations and provides an overview of the conservative, medical, minimally invasive and surgical treatments available.     

Präklinik, Schockraum und Intensivstation

Within the treatment algorithm for accident victims there is an additional risk potential beyond those associated with the complex treatment procedures in primary medical care, and it is inherent in the interfaces between the different treatment sectors. Besides the substantial loss of time and information, such factors as technical incompatibilities between items of equipment, differing treatment concepts and responsibilities and difficulties in transfer and positioning can put the patient at risk. The entire process involves multiple interfaces both between preclinical and clinical medical care and within the various treatment sectors, e.g. when a preclinical patient is transferred from ground medical staff to the air rescue team. The goal of an efficient treatment algorithm should be the reduction of multiple interfaces in order to optimize the various procedures. Future concepts directed at optimizing trauma management should therefore make some contribution to interface reduction.     

Benign ovarian cysts in England and Wales and in the United States.

OBJECTIVE: To compare the rates of hospital admission for management of ovarian cysts in England and Wales and the United States between 1972 and 1974 and 1984 and 1986; and to determine whether these rates are related to rates of early diagnosis of ovarian cancer. DESIGN: Analysis of published and unpublished hospital discharge data based on national samples, the Hospital In-patient Enquiry (HIPE), a 10% hospital discharge sample for England and Wales, and the National Hospital Discharge Survey (NHDs), a 5% sample for the United States. MAIN OUTCOME MEASURES: Age-specific discharge rates for primary and secondary diagnoses of ovarian cyst or benign ovarian tumour. RESULTS: There was an age-adjusted increase in discharge rates of about 8% in both countries; discharge rates in the United States were approximately double those in England and Wales in both time periods. There was no difference in the rates of early diagnosis of ovarian cancer. CONCLUSIONS: Ovarian cysts are a common cause of hospital admission in both countries. The higher rates in the United States are not associated with earlier diagnosis of ovarian cancer.     

Measuring maternal mortality: An overview of opportunities and options for developing countries

Background  

There is currently an unprecedented expressed need and demand for estimates of maternal mortality in developing countries. This has been stimulated in part by the creation of a Millennium Development Goal that will be judged partly on the basis of reductions in maternal mortality by 2015.     

The CTLA-4 gene region of chromosome 2q33 is linked to, and associated with, type 1 diabetes. Belgian Diabetes Registry

Susceptibility to autoimmune insulin-dependent (type 1) diabetes mellitus is determined by a combination of environmental and genetic factors, which include variation in MHC genes on chromosome 6p21 (IDDM1) and the insulin gene on chromosome 11p15 (IDDM2). However, linkage to IDDM1 and IDDM2 cannot explain the clustering of type 1 diabetes in families, and a role for other genes is inferred. In the present report we describe linkage and association of type 1 diabetes to the CTLA-4 gene (cytotoxic T lymphocyte associated-4) on chromosome 2q33 (designated IDDM12). CTLA-4 is a strong candidate gene for T cell- mediated autoimmune disease because it encodes a T cell receptor that mediates T cell apoptosis and is a vital negative regulator of T cell activation. In addition, we provide supporting evidence that CTLA-4 is associated with susceptibility to Graves' disease, another organ- specific autoimmune disease.