Testicular outcome following laparoscopic second stage Fowler-Stephens orchidopexy

OBJECTIVE

To assess outcome after laparoscopic second-stage Fowler-Stephens orchidopexy (L2(nd)FSO).

PATIENTS AND METHODS

Retrospective review of 94 children (aged 0.75-16 years, median 2.75 years), who underwent L2(nd)FSO for 113 intra-abdominal testes between January 2000 and May 2009: 75 unilateral, 19 bilateral (11 synchronous; 8 metachronous). Follow-up (range 3 months-10.9 years, median 2.1 years) was available for 88 children (102 testes: 71 unilateral, 31 bilateral).

RESULTS

Testicular atrophy occurred in 9 out of 102 (8.8%), including 8 out of 71 (11.3%) unilateral and 1 out of 31 (3.2%) bilateral intra-abdominal testes (multivariate analysis: p = 0.59). Testicular ascent ensued in 9 out of 102 (8.8%), comprising four (5.6%) unilateral and five (16.1%) bilateral testicles (multivariate analysis: p = 0.11). Of the 18 bilateral testes brought to the scrotum synchronously none atrophied and four (22.2%) ascended, compared to one (7.7%) atrophy and one (7.7%) ascent among the 13 testes brought to the scrotum on separate occasions (Fisher exact test: p = 0.42 and p = 0.37, respectively). Mobilization of the testis through the conjoint tendon tended towards less ascent (multivariate analysis p = 0.08) but similar atrophy (p = 0.56) compared to mobilization through the deep-ring/inguinal canal. Logistical regression analysis identified no other patient or surgical factors influencing outcome.

CONCLUSIONS

This is the largest series of L2(nd)FSO to date. A successful outcome is recorded in 85 out of 102 (83.3%) testicles. Atrophy occurred in 8.8% and ascent in 8.8%.

Motorcycle trauma in a St Lucian hospital

OBJECTIVE

A motorcycle is a single-track, two-wheeled motor vehicle that is used worldwide for transportation. The use of the motorcycle has resulted in trauma that is associated with significant morbidity and mortality. The aim of this study is to document the pattern of motorcycle accidents and the demographics of the cyclists in St Lucia.

METHOD

This is a 15-month prospective study on all patients with motorcycle injuries that reported to the emergency room at the Victoria Hospital. Information on patients: age, gender helmet use, intake of alcohol/drugs before the motorcycling and mechanism of injury were obtained and filled into a prepared proforma by the attending physician. Those admitted were followed-up to know the outcome and complications of treatment.

RESULTS

Total number of patients studied was 136 in 115 accidents, males (M) were 127 while females (F) were 9, with M:F ratio of 14.1:1.0. There were 105, 28 and 3 riders, passengers and pedestrians respectively; 87.5% of the patients were below the age of 35 years. Fifty-three per cent of the accidents occurred over the weekend. The limbs were mostly injured, constituting 81.9% of the parts of the body injured.

CONCLUSION

The study revealed that young and productive males were mainly injured in motorcycle accidents and the injuries were more in the limbs. More than fifty per cent of the accidents were found to occur during the weekends and more than fifty per cent of the motorcyclists were not wearing crash helmets.

Receptor localization, native tissue binding and ex vivo occupancy for centrally penetrant P2X7 antagonists in the rat

BACKGROUND AND PURPOSE

The P2X7 receptor is implicated in inflammation and pain and is therefore a potential target for therapeutic intervention. Here, the development of a native tissue radioligand binding, localization and ex vivo occupancy assay for centrally penetrant P2X7 receptor antagonists is described.

EXPERIMENTAL APPROACH

Autoradiography studies using the P2X7 antagonist radioligand [³H]-A-804598 were carried out in rat brain and spinal cord. Subsequent in vitro binding and ex vivo occupancy assays were performed using rat cortex homogenate.

KEY RESULTS

P2X7 expression was shown to be widespread throughout the rat brain, and in the grey matter of the spinal cord. In binding assays in rat cortex homogenate, ∼60% specific binding was achieved at equilibrium. In kinetic binding assays, k(on) and k(off) values of 0.0021·min⁻¹·nM⁻¹ and 0.0070·min⁻¹ were determined, and the K(d) derived from kinetic measurements was consistent with that derived from saturation analysis. Novel P2X7 antagonists inhibited the binding of [³H]-A-804598 to rat cortex P2X7 receptors with K(i) values of <40 nM. In an ex vivo occupancy assay, a P2X7 antagonist dosed orally to rats caused a concentration-dependent inhibition of the specific binding of [³H]-A-804598 to rat cortex.

CONCLUSIONS AND IMPLICATIONS

The present study describes the development of an assay that allows localization of P2X7 receptors, the measurement of the binding affinity of P2X7 receptor antagonists in native tissue, and provides a means of determining central P2X7 receptor occupancy. These assays could form an important part of a P2X7 drug discovery programme.

A 15-year longitudinal analysis of trends in elective urological surgery - an evidence base for Modernising Medical Careers

INTRODUCTION

The impact of Modernising Medical Careers on the differential need for consultant urologists and urological surgeons is as yet unknown. This study's aim was to determine what changes there had been in operative urological activity so as to predict the need for urological surgeons in the future.

MATERIALS AND METHODS

A retrospective study of all elective operative urological surgery over a 15-year period was performed. The absolute numbers of patients presenting for different grades of surgery were aggregated and analysed using the Spearman's rank correlation test.

RESULTS

Aggregated data from 27,839 procedures demonstrated no change in the number of operations (r 0.01; NS) or the number of diagnostic endoscopic procedures (r 0.21; NS) carried out over the study period. There was a decrease in endoscopic surgery related to a 70% reduction in trans-urethral resection of the prostate (TURP) (r -0.89; P = <0.0001) and an increase in ureteroscopic interventions (r 0.82; P = 0.0002) for stone disease. There was no change in the amount of major surgery carried out (r -0.43; NS) over the 15 years.

CONCLUSIONS

There have been changes to the pattern of surgery urologists have provided over the last 15 years but the need for complex surgical interventions has not altered. This suggests there will be as great a need for operating surgeons in the future, as currently exists.

Bilateral testicular metastases from prostatic carcinoma

Testicular metastasis from carcinoma of the prostate is rare. We report a case of carcinoma of the prostate with bilateral testicular metastases 7 years after the initial diagnosis. The exact prognosis is not known but it usually indicates advanced disease. Although testicular metastasis is uncommon, it should be considered when a patient presents with a lump in the testis, particularly in a patient known to have another primary malignancy.

TROPONIN T AND N-TERMINAL PRO-BRAIN NATRIURETIC PEPTIDE CHANGES IN PATIENTS UNDERGOING TRANSURETHRAL RESECTION OF THE PROSTATE

PURPOSE

We investigated whether transurethral resection of the prostate (TURP) caused subclinical myocardial damage or cardiac dysfunction by measuring troponin T (Trop T) and N-terminal pro-brain natriuretic peptide (pro-BNP).

MATERIALS AND METHODS

A total of 52 consenting patients took part in this study. All had a detailed medical history including cardiac history taken. On the day of the operation all patients had troponin T, pro-BNP, full blood count and urea, electrolytes and creatinine measured preoperatively. A preoperative and postoperative electrocardiogram was performed. Patients in renal failure were excluded from analysis. During the operations factors such as blood loss, operative time, tissue resected and fluid absorption were monitored. On postoperative day 1 all the previously mentioned tests were repeated.

RESULTS

Mean patient age was 71 years (range 52 to 85). Eight patients had a history of associated cardiac problems. Mean preoperative and postoperative hemoglobin were 14.1 gm/dl (range 10.5 to 17) and 13.3 gm/dl (range 9.9 to 16.2), respectively. None of the patients had significant (greater than 1,000 ml) fluid absorption during TURP, which was calculated using ethanol tagged glycine. Mean blood loss measured with a photometer was 129.7 ml (range 0 to 1,800). Mean operative time was 28.4 minutes (range 5 to 50) and mean weight of prostatic tissue resected was 15.2 gm (range 1 to 47). Preoperative Trop T was less than 0.01 mcg/ml in all patients and mean pro-BNP was 39.2 pg/ml (range 0.5 to 866). Postoperative Trop T was less than 0.01 mcg/ml in all but 1 patient who experienced chest pain after TURP and had an increased Trop T (0.28 mcg/ml). Mean postoperative pro-BNP was 54.57 pg/ml (range 1 to 679). A total of 37 patients had an increase in pro-BNP which was still within the reference range for the age group. There were no significant electrocardiogram changes postoperatively. The Trop T changes were not statistically significant (Wilcoxon sign ranked test p = 0.31) although they may be clinically significant.

CONCLUSIONS

Our study indicates that in patients with no prior cardiac history TURP does not cause myocardial damage indicated by nonincrease of Trop T. There are slight increases in pro-BNP after TURP in some patients although the exact clinical significance is uncertain.

A qualitative and quantitative study of the lung of an ostrich,Struthio camelus

The ostrich lung, with its lack of interparabronchial septa, the presence of very shallow atria and exceptional morphometric refinement, structurally resembles those of small, energetic flying birds, whereas it also displays features characteristic of the flightless ratites in which the neopulmo is relatively poorly developed and a segmentum accelerans may be generally lacking. The large size of the bronchial system of the ostrich may help explain the unique shifts in the airflow pathways that must occur from resting to panting breathing, explaining its insensitivity to acid–base imbalance of the blood during sustained panting under thermal stress. The mass-specific volume of the lung is 39.1 cm3kg−1 and the volume density of the exchange tissue is remarkably high (78.31%). The blood–gas (tissue) barrier is relatively thick (0.56μm) but the plasma layer is very thin (0.14μm). In this flightless ratite bird, the mass-specific surface area of the tissue barrier (30.1 cm2g−1), the mass-specific anatomical diffusing capacity of the tissue barrier for oxygen (0.0022mlO2s−1Pa−1kg−1), the mass-specific volume of pulmonary capillary blood (6.25 cm3kg−1) and the mass-specific total anatomical diffusing capacity for oxygen (0.00073mlO2s−1Pa−1kg−1) are equivalent to or exceed those of much smaller highly aerobic volant birds. The distinctive morphological and morphometric features that seem to occur in the ostrich lung may explain how it achieves and maintains high aerobic capacities and endures long thermal panting without experiencing respiratory alkalosis.

Successful coronary stenting without warfarin or intravascular ultrasound

Although warfarin is typically recommended in the management of patients following coronary stent implantation, several studies have suggested a reduced incidence of subacute thrombosis if the antiplatelet drug ticlopidine is employed instead. Postdilatation with a high pressure balloon catheter is now commonly performed following stent deployment. However, there is uncertainty whether intravascular ultrasound is important in assessing adequacy of stent expansion. Some investigators have proposed a set of ultrasound criteria that need to be met in order to achieve optimal stent deployment. Others have reported low rates of subacute stent thrombosis using empiric high pressure postdilatation rather than an ultrasound-guided strategy. We retrospectively studied 100 consecutive patients in a single institution who received coronary stents for a variety of indications. No patient received warfarin or intravascular ultrasound, and all were followed for a minimum of six weeks. Subacute stent thrombosis did not occur in any patient. We conclude that an excellent result can be routinely obtained in stented patients without the use of intravascular ultrasound.

Coronary artery bypass graft pseudoaneurysm communicating with the right atrium: a case report and review

We report a pseudoaneurysm of the right coronary artery bypass graft with fistulous drainage into the right atrium. This patient presented with an acute myocardial infarction in a different vascular territory. Cardiac catheterization led to the diagnosis of the pseudoaneurysm. A review of pseudoaneurysms of aortocoronary bypass grafts is presented.

Pseudoaneurysm causing partial obliteration of the left atrium: case report and review

We describe a case of left ventricular pseudoaneurysm with subepicardial dissection onto the left atrial wall, mimicking a smooth left atrial mass, causing partial obliteration of the left atrial cavity. This patient presented with a transient ischemic attack, most likely resulting from a thromboembolic episode to the brain. Emergent surgery was successfully performed and the patient is doing well at 1-year follow-up, with no signs of left atrial compression by transthoracic echocardiography.