Medical photography and the reconstructive urologist: A 6-month prospective study

Medical photography has multiple, important roles. The education of medical practitioners, documentation of disease, response to treatment, research, publication, intraoperative recording and trauma documentation all rely on medical photography. Additionally, there are important medicolegal implications pertaining to medical photography across many medical disciplines. Other than specific image use to document cases, there remains a paucity of urological literature regarding the use of medical photography in Urology. The aims of this 6-month study were to document the use of medical photography by a Reconstructive Urological Service in a tertiary referral centre and to assess the range of urological conditions photographed. A secondary aim was to specifically document intraoperative use of the medical photography.

Preputial advancement flap for delayed urethrocutaneous fistula of the glans following urethral insertion of an 'AAA' battery

INTRODUCTION

Foreign body insertion associated with sexual gratification is known as polyembolokoilomania. Following removal of the foreign body, long-term complications are infrequently seen. Whilst conservative and endoscopic approaches usually suffice, in extreme cases open surgical approaches are required. We describe an unusual case of polyembolokoilomania in a 25-year-old male involving a single 'AAA' battery who developed a urethrocutaneous fistula requiring delayed reconstructive surgery.

CASE PRESENTATION

Following an initial successful open extraction of an 'AAA' battery from the mid penile urethra the patient developed a delayed urethrocutaenous fistula of the glans. This was managed using a single stage closure with a preputial graft on its vascular pedicle thereby preserving the foreskin and avoiding a buccal graft. No intra-operative or post-operative complications occurred with a catheter left in situ for 2 weeks. Formal histology confirmed a foreign body type reaction. Following outpatient review successful cosmetic, functional, and sexual outcomes were recorded with questionnaires and medical photography.

CONCLUSION

Preputial advancement flap with foreskin preservation for distal urethrocutaenous fistula is a successful method of treating delayed urethrocutaenous fistula of the distal urethra in cases of polyembolokoilomania.

Emergency Urology procedures during the COVID-19 pandemic in the UK: A 3-month prospective study

OBJECTIVE

COVID-19 resulted in Regional tiered restrictions being introduced across the UK with subsequent implications for planned and emergency surgical care. Specific to Merseyside, Tier 4, Tier 2 and Tier 5 restrictions were introduced in late 2020 and early 2021. The purpose of this study was to examine the nature and workload of emergency urological procedures during three different national lockdown Tiers in the North West of England.

METHOD

A 3-month prospective study examining all emergency urological activity was conducted from November 2020 when Tier 4 restrictions were introduced and included Tier 2 restrictions in December and then concluded at the end of January 2021 when Tier 5 restrictions were in place. Data was obtained by identifying patients using the electronic theatre listing system.

RESULTS

A total of 71 emergency cases were performed (24 in November (Tier 4), 28 in December (Tier 2), 19 in January 2021 (Tier 5)) with 15 different types of procedures performed. The most frequently performed procedure was stent insertion (36), followed by scrotal exploration (10). The least commonly performed procedure was suprapubic catheter insertion under general anaesthesia (1). One patient required transfer to a different hospital. In total 6 calls were made by general surgery and 3 by gynaecology for urgent urological assistance in theatre. Three urology patients returned to the theatre as emergencies following elective procedures.

CONCLUSION

Unlike the Spring lockdown, acute urological presentations requiring operative intervention still presented daily. Of the 71 cases performed, most occurred in Tier 2. Stent insertion was the most commonly performed procedure, with the majority of the cases performed by registrars.

Letter to the Editor re: Evaluation of the Clinical Effects of Abobotolinum Toxin A (Dysport) Injection in the Treatment of Neurogenic Lower Urinary Tract Dysfunction

N/A  As submitted as a letter to the editor.

Diastolic stress echocardiography in patients with normal resting diastolic function: prognostic utility in presence and absence of myocardial ischemia

Background

Abnormal diastolic response to exercise is reportedly associated with worse cardiovascular events. However, this has not been well studied in patients with normal diastolic function at rest.

Purpose

We sought to study diastolic response to exercise in patients referred for exercise stress echocardiography (ExE) and to explore its association with adverse outcomes in the presence and absence of exercise-induced myocardial ischemia.

Methods

In a retrospective study, patients referred for ExE to assess myocardial ischemia between April 2017 and December 2018 were enrolled. Patients were included if they had guideline-defined normal diastolic function at rest and availability of a full set of post exercise diastolic variables (post exercise tissue Doppler derived septal mitral annular early diastolic velocity (e'), ratio of pulsed Doppler derived mitral forward flow early diastolic velocity (E) over e' (E/e') and continuous wave Doppler derived maximum tricuspid regurgitation velocity (TRV)). The patients were followed for a median of 3.4 years for the occurrence of composite death, acute coronary syndrome, cardiac hospitalization, and need of follow-up ischemia testing. Abnormal exercise diastolic variables were defined as e' <7 cm/s, E/e' >15, and TRV >2.8 m/s.

Results

We studied 492 patients [age: 55.7±12.9 year, 268 (54%) women, EF: 61±5.8%]. Mean achieved metabolic equivalents of tasks (METs) was 9.7±3.1, and a total of 49 (10%) patients had evidence of exercise-induced ischemia. At rest, mean left atrial volume index was 25.4±12 ml, e' was 8±2 cm/s, E/e' was 9.5±2.4, and TRV was 2.1±0.44 m/s. Post exercise e' was 10±3 cm/s [<7cm/s in 63 (13%)], E/e' was 11.1±3.9 [>15 in 95 (19%)], and TRV was 2.37±0.68 m/s [>2.8 m/s in 152 (31%)]. Ischemic ExE was found to be strongly associated with the outcome (HR: 4.46, 95% CI: 2.8 to 7.1, p<0.001). In addition, all diastolic variables predicted the outcome in isolation if they were abnormal (e': 2.28, 95% CI: 1.4 to 3.7, p=0.001, E/e': 1.81; 95% CI: 1.15 to 2.84, p=0.01; TRV: 1.58, 95% CI: 1.17 to 2.13, p=0.003). When combined, however, association with the outcome was seen only when 2 or 3 of these variables were abnormal simultaneously (Figure 1A). When patients were stratified by ischemia and abnormal diastolic variables (figure 1B), patients with 2 or 3 abnormal variables were more likely to experience the outcome compared to patients with 0 or 1 abnormal variables in both absence of ischemia (p<0.001) and presence of ischemia (p=0.016). The stratified groups were different in their clinical and exercise profiles, with worse profiles in patients with both ischemia and 2 or 3 abnormal variables, and best profiles in patients with no ischemia and 0 or 1 abnormal variables.

Conclusions

In patients referred for ExE to assess ischemia with normal baseline diastolic function, exercise can unmask abnormal diastolic properties and stratify patients' risk regardless of the overt myocardial ischemia.

Funding Acknowledgement

Type of funding sources: None.

Impact of the COVID-19 pandemic on hospitalizations for acute coronary syndromes: a multinational study

BACKGROUND

COVID-19 has challenged the health system organization requiring a fast reorganization of diagnostic/therapeutic pathways for patients affected by time-dependent diseases such as acute coronary syndromes (ACS).

AIM

To describe ACS hospitalizations, management, and complication rate before and after the COVID-19 pandemic was declared.

DESIGN

Ecological retrospective study. Methods: We analyzed aggregated epidemiological data of all patients > 18 years old admitted for ACS in twenty-nine hub cardiac centers from 17 Countries across 4 continents, from December 1st, 2019 to April 15th, 2020. Data from December 2018 to April 2019 were used as historical period.

RESULTS

A significant overall trend for reduction in the weekly number of ACS hospitalizations was observed (20.2%; 95% confidence interval CI [1.6, 35.4] P = 0.04). The incidence rate reached a 54% reduction during the second week of April (incidence rate ratio: 0.46, 95% CI [0.36, 0.58]) and was also significant when compared to the same months in 2019 (March and April, respectively IRR: 0.56, 95%CI [0.48, 0.67]; IRR: 0.43, 95%CI [0.32, 0.58] p < 0.001). A significant increase in door-to-balloon, door-to-needle, and total ischemic time (p <0.04 for all) in STEMI patents were reported during pandemic period. Finally, the proportion of patients with mechanical complications was higher (1.98% vs. 0.98%; P = 0.006) whereas GRACE risk score was not different.

CONCLUSIONS

Our results confirm that COVID-19 pandemic was associated with a significant decrease in ACS hospitalizations rate, an increase in total ischemic time and a higher rate of mechanical complications on a international scale.

1234 Emergency Urology Procedures During COVID-19 Pandemic: A 2 Monthly Prospective Study

Introduction

COVID-19 resulted in Regional tiered restrictions being introduced across the UK with subsequent implications for planned and emergency care. Specific to Merseyside Tier 4 and Tier 2 restrictions were introduced in late 2020. At the onset of the pandemic in the Spring, elective work ceased, and emergency admissions were minimal. The purpose of this study was to examine the volume and nature of all emergency admissions to a Urology unit in Merseyside in the 2nd wave of the pandemic during two different tiers of national restrictions.

Method

A prospective audit examining all emergency urological activity was conducted in Whiston Hospital from October 2020 when the Tier 4 restrictions were introduced to Tier 2 was introduced. Data was obtained by identifying patients using the electronic theatre listing system.

Results

A total of 52 emergency cases were performed (24 in November Tier 4, 28 in December Tier 2). A total of 12 different procedures were performed. The commonest procedure performed was stent insertion (26), followed by scrotal exploration (7). One patient required transfer to a different hospital. In total 4 calls were made by general surgery and 2 by gynaecology for urological assistance in theatre. Two urology patients returned to theatre. Direct Consultant involvement occurred in 19 cases (37%).

Conclusions

Unlike the Spring lockdown acute urology operations presented despite regional restrictions. A total of 52 cases were performed with more occurring in Tier 2. Stent insertion was the commonest procedure with the majority of the cases performed by registrars.

Prophylactic intravenous gentamicin with sedation-free cystoscopic injection of BoNT-A: No demonstrable adverse extravesical neuromuscular effects in a pilot safety study of 220 idiopathic overactive bladder patients

Objectives:

To determine whether administration of single dose prophylactic intravenous gentamicin prior to intravesical injection of botulinum toxin type A (BoNT-A) is associated with adverse extravesical neuromuscular effects in idiopathic overactive bladder syndrome.

Patients and methods:

A retrospective analysis of 220 consecutive idiopathic overactive bladder patients following sedation-free flexible cystoscopic injection of intravesical BoNT-A. All patients received a single dose of intravenous gentamicin (160 mg) followed by 100-200 IU of BoNT-A. They were followed up at intervals to determine whether they had experienced any adverse extravesical neuromuscular side effects.

Results:

None of our patients developed adverse extravesical neuromuscular side effects from intravesical botulinum injections with concomitant administration of intravenous gentamicin.

Conclusion:

Single dose intravenous gentamicin is safe to use as a prophylaxis for intravesical BoNT-A injections of 200 IU or below in idiopathic overactive bladder patients.

Level of evidence:

Not applicable.

Acute urinary retention in a 27-year-old male secondary to benign prostatic hyperplasia treated with Holmium Enucleation of the Prostate (HOLEP)

INTRODUCTION

Benign prostatic hyperplasia (BPH) is common in the ageing male. Clinical manifestations like retention impact on a patient's quality of life. Alterations in androgen activity at the androgen receptor complex level in the prostate contribute to prostatic hyperplasia with the highest incidence occurring in males in their 70's. There remains a paucity of cases in young males who develop acute urinary retention secondary to BPH. We present a case of a 27-year-old male who developed acute urinary retention secondary to BPH who required a Holmium Laser Enucleation of his Prostate (HOLEP).

CASE DESCRIPTION

A 27 year old man was admitted in acute urinary retention. BPH was diagnosed via way of radiological imaging and histological assessment. After pre-operative sperm banking and suprapubic catheterisation, the patient underwent a HOLEP. He had biochemically confirmed hypogonadotrophic hypogonadism which was at odds with his muscular, physical appearance. Total testosterone levels had fluctuated following admission suggesting an exogenous substance was interfering with the hypothalamic-pituitary-gonadal axis but he denied exogenous steroid use.

RESULT

The patient successfully passed his voiding trial on the second post-operative day and remained catheter free. Post-operative uroflowmetry and sexual function remain unknown as patient disengaged with follow up.

CONCLUSION

HOLEP prostatectomy is a safe and effective way of managing BPH in younger patients following sperm banking and assessment by endocrinology.

Fungal deterioration of limestone false-door monument

Unfortunately, monuments all over the world may become discolored and degraded as a result of the growth and activity of fungi. Biodeterioration is an irreversible damage that is caused by microbial colonization on the surface of buildings. Different fungi were isolated from limestone False-door in Kom Aushim museum- El-Fayoum governorate, Egypt. These include; Aspergillus niger, A. fumigatus, A. sulphureus, A. flavus, Alternaria alternata, Alternaria spp., and Cladosporium herbarium. Fungal grow on modern limestone surfaces after 60 days of infection. Transmission electron microscope demonstrated the penetration and presence of fungal threads inside limestone. Environmental Scanning electron microscope attached with EDX Unit revealed an increase in carbon and magnesium ions from 9.16 to 12.17% and 1.41–1.51%, respectively after fungal infection of limestone, while other ions decreased after infection; aluminum from 1.96 to 1.39%, silicon from 7.40 to 3.57%, potassium from 0.44 to 0.41%, calcium from 41.41 to 35.04 % and iron from 1.08 to 0.90 %. p-Chloro-m-crysol is the most potent to inhibit the growth of isolated fungi at MIC 50 ppm for most fungal species.

Structural modification of azolylacryloyl derivatives yields a novel class of covalent modifiers of hemoglobin as potential antisickling agents

The intracellular polymerization and the concomitant sickling processes, central to the pathology of sickle cell disease, can be mitigated by increasing the oxygen affinity of sickle hemoglobin (HbS). Attempts to develop azolylacryloyl derivatives to covalently interact with βCys93 and destabilize the low-O2-affinity T-state (deoxygenated) HbS to the polymer resistant high-O2-affinity R-state (liganded) HbS were only partially successful. This was likely due to the azolylacryloyls carboxylate moiety directing the compounds to also bind in the central water cavity of deoxygenated Hb and stabilizing the T-state. We now report a second generation of KAUS compounds (KAUS-28, KAUS-33, KAUS-38, and KAUS-39) without the carboxylate moiety designed to bind exclusively to βCys93. As expected, the compounds showed reactivity with both free amino acid l-Cys and the Hb βCys93. At 2 mM concentrations, the compounds demonstrated increased Hb affinity for oxygen (6% to 15%) in vitro, while the previously reported imidazolylacryloyl carboxylate derivative, KAUS-15 only showed 4.5% increase. The increased O2 affinity effects were sustained through the experimental period of 12 h for KAUS-28, KAUS-33, and KAUS-38, suggesting conserved pharmacokinetic profiles. When incubated at 2 mM with red blood cells from patients with homozygous SS, the compounds inhibited erythrocyte sickling by 5% to 9%, respectively in correlation with the increase Hb-O2 affinity. These values compare to 2% for KAUS-15. When tested with healthy mice, KAUS-38 showed very low toxicity.

Identification of a novel class of covalent modifiers of hemoglobin as potential antisickling agents

Aromatic aldehydes and ethacrynic acid (ECA) exhibit antipolymerization properties that are beneficial for sickle cell disease therapy. Based on the ECA pharmacophore and its atomic interaction with hemoglobin, we designed and synthesized several compounds - designated as KAUS (imidazolylacryloyl derivatives) - that we hypothesized would bind covalently to βCys93 of hemoglobin and inhibit sickling. The compounds surprisingly showed weak allosteric and antisickling properties. X-ray studies of hemoglobin in complex with representative KAUS compounds revealed an unanticipated mode of Michael addition between the β-unsaturated carbon and the N-terminal αVal1 nitrogen at the α-cleft of hemoglobin, with no observable interaction with βCys93. Interestingly, the compounds exhibited almost no reactivity with the free amino acids, L-Val, L-His and L-Lys, but showed some reactivity with both glutathione and L-Cys. Our findings provide a molecular level explanation for the compounds biological activities and an important framework for targeted modifications that would yield novel potent antisickling agents.

Cystic renal cell carcinoma arising from multilocular cystic nephroma of the same kidney

Multilocular cystic nephroma is an uncommon benign entity grouped among the cystic non-genetic diseases. It is characterized by variable-sized, non-communicating cysts separated by irregular thin walled septa. Though multilocular cystic nephroma is usually considered a benign lesion, malignant changes in the cysts should not be overlooked.

Laparoscopic radical prostatectomy a review of the literature and comparison with open techniques

BACKGROUND

The development of laparoscopic radical prostatectomy (LRP) has been one of the surgical advances in the treatment of localized prostate cancer. The procedure aims to combine the advantages of minimal access surgery with resection based on established oncological principles with cure rates and functional results that are at least comparable to open radical prostatectomy (ORP).

OBJECTIVES

This review compares the advantages and disadvantages of the LRP to the ORP with regard to the real benefits to the patient. The impact on the urological practice was also addressed by the review.

METHODS

A comprehensive literature review of the published series/cases of both open and laparoscopic radical prostatectomy was performed.

RESULTS

LRP is a feasible and reproducible procedure for the treatment of localized prostate cancer. Although its technique is standardized, LRP is technically demanding and it takes longer time than ORP.

CONCLUSION

The current published results of LRP show no advantages over that of the ORP. If long-term data shows better results in terms of functional and oncological outcomes, LRP may challenge or even replace the standard ORP in the treatment of localized prostate cancer.

Assessing the benefits of "gaze-down" display location in complex tasks

BACKGROUND

Location of the image display is one of several factors that influence perceptual processing and endoscopic manipulation in minimal access surgery. Previous studies have proved the benefits of the gaze-down stance, as compared with the conventional gaze-up stance. This study investigates the effect of the gaze-down stance on the performance of a task with varying manipulative and perceptual demands.

METHODS

The participants in this study were 20 medical students. Each student performed endoscopic touching tasks under standard conditions using the Dundee Projection System (DPS) display, positioned to provide gaze-up and gaze-down stances. To increase task complexity, two kinds of manual coordination (unilateral vs bilateral) and three endoscope positions (different positions of misalignment) were used. The outcome measures were task execution time and number of errors.

RESULTS

Overall, the gaze-down stance reduced time and errors, as compared with the gaze-up display. However, the benefit obtained from the gaze-down stance was more significant in the more difficult tasks (bilateral task and 90 degrees misalignments).

CONCLUSIONS

The gaze-down stance reduces task time and errors, as compared with a gaze-up stance. The reduction in time and errors is more appreciable as task complexity increases.

Treatment strategy of inguinal hernia in infants and children in Eastern Libya

OBJECTIVE

The aim of the study is to evaluate and improve the treatment strategy of inguinal hernia in children.

METHODS

A retrospective analysis was performed on the hospital notes and operation records of 827 (681 boys and 146 girls) children who underwent inguinal herniotomy at Al-Fatah Children Hospital, Benghazi, Libya, between 1998 and 2002.

RESULTS

Eight hundred and sixty-five inguinal herniotomies were performed on 827 children. In 497 patients, operations were performed on the right side, in 292 on the left side, and in 38 bilateral. Thirty-nine (4.7%) children presented as emergencies with irreducible hernia, of which 29 (74.4%) patients underwent emergency herniotomies while the remaining 10 (25.6%) patients could be treated with conservative measures at the time of admission. Postoperative complication rate for elective was 6.3% and for emergency groups was 24%. The overall postoperative complication rate was 6.6%. There were 5 recurrences giving a recurrence rate of 0.5%.

CONCLUSION

Early detection and repair of inguinal hernia in infancy and childhood is essential to decrease the potential operative morbidity rate. This needs an increase in parental awareness. Quick and prompt referral of irreducible hernias for surgery is strongly recommended.

Novel triazolo[4,3-a]quinazolinone and bis-triazolo[4,3-a:4,3'-c]quinazolines: synthesis and antitoxoplasmosis effect

Several quinazoline derivatives containing substituted thiosemicarbazido and S-methylisothiosemicarbazido groups at the 2-position and at both the 2- and 4-positions have been synthesized. Treatment of the S-methylthiosemicarbazides with morpholine or diethylamine did not give the corresponding guanidines. Instead, they underwent cyclodesulfurization into the condensed ring systems, [1,2,4]triazolo[4,3-a]quinazolinones and bis-[1,2,4]triazolo[4,3-a:4'.3'-c]quinazolines. Evaluation of the products for antitoxoplasmosis effect by studying the ultrastructure morphology of the organisms using scanning electron microscopy (SEM) indicated their efficacy in causing structural deformity of Toxoplasma gondii. Such a deformity plays an important role in obstructing the entry of the organisms into host cells.

Phylogenetic characterization of novel transport protein families revealed by genome analyses

As a result of recent genome sequencing projects as well as detailed biochemical, molecular genetic and physiological experimentation on representative transport proteins, we have come to realize that all organisms possess an extensive but limited array of transport protein types that allow the uptake of nutrients and excretion of toxic substances. These proteins fall into phylogenetic families that presumably reflect their evolutionary histories. Some of these families are restricted to a single phylogenetic group of organisms and may have arisen recently in evolutionary time while others are found ubiquitously and may be ancient. In this study we conduct systematic phylogenetic analyses of 26 families of transport systems that either had not been characterized previously or were in need of updating. Among the families analyzed are some that are bacterial-specific, others that are eukaryotic-specific, and others that are ubiquitous. They can function by either a channel-type or a carrier-type mechanism, and in the latter case, they are frequently energized by coupling solute transport to the flux of an ion down its electrochemical gradient. We tabulate the currently sequenced members of the 26 families analyzed, describe the properties of these families, and present partial multiple alignments, signature sequences and phylogenetic trees for them all.

Synthesis, estrogen receptor binding affinity and biological evaluation of some 2-substituted estrone derivatives

This report details the preparation of modified estrogens which are structurally designed to possess estrogenic and/or antiestrogenic activity. The prominent feature of these estrogens is the introduction of a novel side chain in the 2-position of ring A of the steroid nucleus. Their synthesis includes the use of transformations based upon Mannich base chemistry: preparation of the intermediate 2-dimethylamino-methylestrone via aminomethylation of estrone and introduction of various functionalities via reaction of this Mannich base with different reagents. When evaluated for their interaction with the estrogen receptor by competitive binding assays, the tested products were found to be relatively weak competitors at 0 degree C. The uterotrophic and post-coital antifertility assays indicated effects varying in magnitude relative to estradiol. Ethyl[(2'-acetyl-3'-(3-hydroxyestra-17-oxo-1,3,5 (10)-trien-2-yl)]propionate (15) showed uterotrophic and antiimplantation activities of 95% and 20% respectively.

Novel steroidal 1,4-diketones and pyridazine derivatives as potential antiestrogens

A series of steroidal 1,4-diketone derivatives was synthesized by acid-catalyzed condensation of 2-acetylestradiol-17 beta-acetate with substituted phenylglyoxals. Conversion of the products into the corresponding pyridazine derivatives was achieved by reaction with hydrazine hydrate. The synthesized compounds were evaluated for their uterotrophic, antiuterotrophic, and antifertility activities in mature female albino rats. Among the compounds tested, the phenyl 2, p-bromophenyl 3, and p-methoxyphenyl 5 diketone derivatives displayed uterotrophic activity of 72%, 72%, and 91%, respectively. The gradation of antiestrogenic activity was assessed in vivo by the inhibition of the estrone-stimulated uterine growth. Compounds 2-5 showed moderate antiestrogenic activity of 53-56%. None of the tested compounds elicited antifertility activity as assessed by the post-coital antiimplantation activity test.

Comorbidity of axis I and axis II diagnoses in a sample of Egyptian patients with neurotic disorders

Neurosis and personality disorder (PD) are two of the most used but least clarified and understood terms in psychiatry. The separation of PD by the American Psychiatric Association in DSM-III and -IV as a discrete axis of classification has been a major advance in psychiatric nosology. Also with the advent of DSM-III and its multiaxial system, it was recognized that both PD and clinical syndromes can coexist, and in some cases this coexistence may have implications on treatment response and prognosis. This study was performed on 200 neurotic patients in an attempt to investigate possible correlations between various neurotic subcategories and personality types. Our results confirm that PD and personality abnormality are significantly higher in neurotic patients than in controls and need to be considered in diagnostic assessment. Some comorbidity was shown between borderline PD and somatoform disorder; compulsive PD and obsessive-compulsive disorder (OCD), and generalized anxiety disorder (GAD); and avoidant PD and phobia. However, our data failed to show a correlation between the presence of an additional PD and particular neurotic symptomatology. It seems that the association between neurotic disorders and PD should not be taken to indicate a direct causative relationship. It is likely that personality is just one of the predisposing factors that influence the individual response to psychological trauma and determine the form of neurosis. The most prevalent PD was found to be PD NOS, followed by borderline, compulsive, avoidant, and finally histrionic PDs. The term, multiple PD, should be given substance to characterize the diagnosis as a disorder, rather than leaving it at its current status of what seems to be a nondistinct clinical picture. Extensive research has to be undertaken in an attempt to decide which specific PDs most deserve to be included in the official nomenclature.

Instantaneous lead entrapment: an unusual complication of nonthoracotomy implantation of an endocardial defibrillation lead

Nonthoracotomy implantation of implantable cardioverter defibrillators is performed with transvenous leads that are similar to pacemaker leads and are subject to the same potential problems. We report an unusual complication of lead placement in which an electrode immediately became entrapped in the superior rim of the tricuspid valve, resisting all efforts at removal.

Synthesis and evaluation of novel N-substituted N'-(3-hydroxy-17-oxoestra-1,3,5(10)-trien-2- and -4-yl)thiourea derivatives for binding to the estrogen receptor and cytotoxic activity on MCF-7 cells

A novel series of estrone derivatives having a free 3-phenolic group with the 2- or 4-position substituted with a thiourea function was synthesized. None of the products showed significant binding to the estrogen receptor, and the cytotoxic activity on MCF-7 cells for VII and X was weak.

Synthesis and biological evaluation of new 2,3-dihydrothiazole derivatives for antimicrobial, antihypertensive, and anticonvulsant activities

A novel series of 2-arylimino-2,3-dihydrothiazole derivatives, substituted in the 3-position with a beta-phenethyl moiety and the 4-position with substituted aryl functions, was synthesized as potential antimicrobial, antihypertensive and anticonvulsive agents. While no antimicrobial or significant antihypertensive activity was observed for the products, XII, XIII, and XXI displayed potent anticonvulsant activity.