Comparative trial of sclerotherapy for hydroceles

We present a prospective single-blind trial of sclerotherapy for hydroceles with tetradecyl sulphate and rolitetracycline as sclerosants. Twenty-seven hydroceles were treated with tetradecyl sulphate and 28 with rolitetracycline. The median follow-up was 13 months. There were no statistically significant differences between the 2 drugs in respect of cure rate and complications. The overall cure rate for both drugs was 96%. Complications were rare and common to both drugs. Tetradecyl sulphate and rolitetracycline were found to be equally effective as sclerosants.     

Agreement between proxy- and self-report scores on PROMIS health-related quality of life domains in pediatric burn survivors: a National Institute on Disability,Independent Living,and Rehabilitation Research Burn Model System Study

Quality of Life Research - To examine agreement between pediatric burn survivor self- and caregiver proxy-report on multiple PROMIS domains and examine factors associated with differences between...     

Site of bone density measurement may affect therapy decision

Summary The purpose of this study was to determine whether bone mineral density (BMD) measurements at the lumbar spine and femoral neck provided comparable information to women planning to use that knowledge to help them make a decision about hormone replacement therapy. Eighty-eight healthy Caucasian women, aged 44–59 and within 0 to 5 years of menopause, participated in the study. BMD measurements were performed at the lumbar spine (L1-L4) and the femoral neck by dual energy X-ray absorptiometry (DXA). Criteria suggested by the National Osteoporosis Foundation were used to categorize women as at risk for osteoporosis, bone density more than one standard deviation (SD) below the young adult mean, or as low risk, bone density at or above this level. The re that 46 women would be classified into the low risk category on the basis of spinal BMD alone. However, 28 of these 46 women would fall into the at risk category when the femoral neck BMD was measured. Sixty-one percent of women informed they were at low risk on the basis of spinal BMD would be considered at risk based on femoral neck BMD. When femoral neck BMD was used as the primary risk indicator, 14% of the women classified as low risk would be at risk if spinal BMD were added. These results suggest that both lumbar spine and proximal femur measurements should be made when women are using bone density measurements as an aid in deciding whether or not to use hormone therapy in their postmenopausal years.     

In vitro comparability of dual energy X-ray absorptiometry (DEXA) bone densitometers

Summary Six Hologic QDR-1000 DEXA bone densitometers at different centers across the USA were compared to determine the intermachine variability. Nine scans in succession were acquired on each machine using a single anthropomorphic lumbar spine phantom (manufactured by Hologic). Values for BMC, area, and BMD were recorded for each measurement. Means, standard deviations (SD), and coefficients of variation (CV) were calculated for each machine. All the CVs (BMC, area, BMD) were less than 1% (range 0.3%–0.6%). The CV of the means at the six sites were 0.4%, 0.6%, and 0.5% for BMC, area, and BMD, respectively. Although several significant differences for BMC, area, and BMD were noted by ANOVA between machines at different sites, the difference between the highest and lowest means of the individual machines was only 1.1%, 1.31%, and 1.07% for BMC, area, and BMD. The small variations between the DEXA systems are encouraging for researchers involved in multicenter trials in which data are pooled.     

Venous infarction of the testis--a cause of non-response to conservative therapy in epididymo-orchitis. A case report

Acute epididymo-orchitis occasionally responds poorly to conservative measures. Testicular infarction may be one reason for this complication. Ultrasonography and radionuclide scanning can elucidate the cause. A patient with this complication is described.     

Worsening enterocolitis in neonates: diagnosis by CT examination of urine after enteral administration of iohexol

Perforation, a severe complication of necrotizing enterocolitis (NEC), has a high mortality rate. Recently, we presented a new technique for evaluation of NEC: measuring the CT attenuation coefficient of urine after oral administration of iohexol. We present three cases of neonates with NEC who demonstrated serial increases in urine CT attenuation coefficients, all of whom subsequently deteriorated clinically and radiographically. Surgery in all three cases confirmed severe necrosis and/or perforation. These three cases suggest that the CT attenuation coefficient of urine after oral administration of iohexol may be a more sensitive indicator of NEC severity, progression, and perforation than clinical evaluation and radiography. More investigation is necessary, but eventually, this noninvasive technique may be able to decrease morbidity and mortality by predicting the need for surgical intervention or more aggressive medical management of NEC before perforation occurs. Received: 23 December 1997 Accepted: 19 June 1998     

Trauma of the ureter.

Thirty-three ureteric injuries were treated over a 2-year period. The majority of patients presented late. The most common modes of repair were either ureteroneocystostomy or transuretero-ureterostomy. Complications were few and of little significance.     

Duloxetine vs placebo in the treatment of stress urinary incontinence: a four-continent randomized clinical trial

OBJECTIVES

To further assess, in a phase 3 study, treatment with duloxetine for women with stress urinary incontinence (SUI) in other geographical regions, including Argentina, Australia, Brazil, Finland, Poland, South Africa and Spain, as previous trials in North America and Europe provided evidence for the safety and efficacy of duloxetine as a pharmacological treatment for SUI in women.

PATIENTS AND METHODS

The study included 458 women aged 27–79 years enrolled in a double‐blind, placebo‐controlled trial. The patients with predominantly SUI were identified using a validated clinical algorithm. They were randomly assigned to receive placebo (231) or duloxetine 40 mg twice daily (227) for 12 weeks. The primary outcome variables included the incontinence episode frequency (IEF) and the Incontinence Quality of Life (I‐QOL) questionnaire. Van Elteren's test was used to analyse the percentage changes in IEF where the stratification variable was weekly baseline IEF (IEF <14 and ≥14). Analysis of covariance was used to analyse I‐QOL scores.

RESULTS

The mean baseline IEF was 18.4/week; 55% of patients had a baseline IEF of ≥ 14. There was a significantly greater median decrease in IEF with duloxetine with placebo (54% vs 40%, P = 0.05), with comparable significant improvements in quality of life (I‐QOL score increases of 10.3 vs 6.4, P = 0.007). The improvements with duloxetine were associated with significantly greater increases in voiding intervals than with placebo (20.4 vs 8.5 min, P < 0.001). The placebo response was 10.7% and 12.5% higher than those reported in two European and North American phase 3 trials. This may have been related to more patients being naïve for incontinence management in the current trial. Discontinuation rates for adverse events were 1.7% for placebo and 17.2% for duloxetine (P < 0.001), with nausea being the most common reason for discontinuation (3.1%); it was the most common adverse event with duloxetine, but was mild or moderate in most (81%), did not worsen in any patient and resolved within 7 days in 60% and within 1 month in 86% of continuing patients; 88% of women who experienced nausea while taking duloxetine completed the trial.

CONCLUSIONS

These results show improvements in incontinence and quality of life with duloxetine 40 mg twice daily for 12 weeks that are in keeping with those reported in two other recently completed phase 3 trials in Europe and North America.