Rectourethral fistula following laparoscopic radical prostatectomy

PURPOSE

To review the outcome of rectourethral fistula sustained during laparoscopic radical prostatectomy.

METHODS

A retrospective chart review of all cases managed at a tertiary referral center. Data abstracted included demographics, presenting symptoms, additional interventions, healing, and long-term functional outcome.

RESULTS

Between 2004 and 2009, 10 patients were treated for rectourethral fistula following laparoscopic radical prostatectomy. Mean age was 60 years. Two patients were converted to open prostatectomy for primary repair of the rectal laceration without fecal diversion. The remaining 8 patients (80%) had unrecognized injury at the time of prostatectomy and presented postoperatively. Mean time from radical prostatectomy to presentation with fistula symptoms was 9.5 days. Seven patients (70%) required 1 or more operations to treat or control the symptoms of the rectourethral fistula (median 2.3, mean 2, range 1-4 operations). Three patients (30%) required colostomy within 1 month of radical prostatectomy due to severity of symptoms. Spontaneous healing of the fistula was noted in 6 patients (60%) following diversion (urinary ± fecal diversion), and a minority of patients (30%) required an operation to close the fistula. One patient (10%) required cystectomy for positive margins. During a mean follow-up of 27 months, no recurrent fistula was observed in any of the patients. All patients had normal anal continence, but the majority of patients were incontinent of urine.

CONCLUSIONS

Patients who develop a rectourethral fistula following laparoscopic radical prostatectomy often require additional operations for symptoms control and/or healing of the fistula. Urinary continence is affected in the majority of patients.

Growth response of Pinus densiflora seedlings inoculated with three indigenous ectomycorrhizal fungi in combination

Pinus densiflora seedlings were inoculated with three indigenous ectomycorrhizal fungi (Cenococcum geophilum, Rhizopogon roseolus and Russula densifolia) in single-, two-, and three-species treatments. After 8 months, the colonization rates of each ectomycorrhizal species, seedling growth and the nutrition were assessed in each treatment. P. densiflora seedlings inoculated with different ECM species composition showed an increase in height and basal diameter and improved seedling root and shoot nutrition concentrations compared to control treatment. Generally, combined inoculation had a more positive influence on the seedlings than the single inoculation. The three-species inoculation presented the highest growth and basal diameter and concentration of most nutrients except potassium. In conclusion, the results provided strong evidence for benefits of combined inoculation with the indigenous ectomycorrhizal fungi on P. densiflora seedlings under controlled conditions.

Expression and localisation of glucose transporter 1 (GLUT1) in dairy goat mammary gland at different physiological stages

Glucose is the major energy source for mammary epithelial cells, as well as an important substrate for lactose synthesis. Mammary epithelial cells take up glucose from extracellular fluid into the cell through glucose transporter (GLUT). This study was aimed at investigating the expression of GLUT1 glucose transporter in dairy goat mammary gland during puberty, pregnancy, lactation, and involution. Using real-time reverse transcription PCR (qRT-PCR) and Western blotting, we analyzed the expression of GLUT1 mRNA and protein in dairy goat mammary gland. GLUT1 mRNA and protein expression increased during pregnancy and lactation, especially at peak lactation, and decreased strongly after weaning. Furthermore, the location of GLUT1 protein was determined by immunofluorescence laser confocal microscopy. GLUT1 protein localised to the basal and apical plasma membrane of epithelial cells, and also in the cytoplasm. The results from this study showed that GLUT1 is expressed in the dairy goat mammary gland with the greatest expression found in mammary epithelial cells during pregnancy and lactation.Key words: Expression, glucose transporter, goat, mammary gland

Heparin-binding EGF-like growth factor is present in human amniotic fluid and breast milk

BACKGROUND/PURPOSE

Heparin-binding EGF-like growth factor (HB-EGF) is a member of the epidermal growth factor (EGF) family that has been implicated in the healing of various organ injuries. Endogenous HB-EGF production is upregulated in response to injury to the kidney, liver, brain, skin, and intestine. Exogenous administration of HB-EGF protects against intestinal epithelial cell apoptosis and necrosis and intestinal ischemia/reperfusion (I/R) injury. This study examines the presence of endogenous HB-EGF in human amniotic fluid and breast milk, fluids that are in intimate contact with the developing and neonatal gastrointestinal tract.

METHODS

Breast milk samples were collected from lactating women and amniotic fluid was gathered from full-term uteri (cesarian sections) or preterm uteri (amniocentesis). Crude and partially purified breast milk and amniotic fluid samples were analyzed for HB-EGF levels using an HB-EGF-specific enzyme-linked immunosorbent assay (ELISA).

RESULTS

Analysis results showed detectable HB-EGF levels in human amniotic fluid and breast milk, ranging from 0.2 to 230 pg/mL. Breast milk and amniotic fluid subjected to heparin affinity or HB-EGF-affinity column chromatography showed bioactivity eluting at positions consistent with those known for native HB-EGF.

CONCLUSIONS

This study represents the first report of detectable HB-EGF in human amniotic fluid and breast milk. The presence of HB-EGF in these fluids may serve a role in the development of the gastrointestinal tract in utero, and in protection against gut mucosal injury after birth.

Phytochrome A mediates blue light and UV-A-dependent chloroplast gene transcription in green leaves

We characterized the photobiology of light-activated chloroplast transcription and transcript abundance in mature primary leaves by using the following two systems: transplastomic promoter-reporter gene fusions in tobacco (Nicotiana tabacum), and phytochrome (phyA, phyB, and hy2) and cryptochrome (cry1) mutants of Arabidopsis. In both dicots, blue light and UV-A radiation were the major signals that activated total chloroplast and psbA, rbcL, and 16S rrn transcription. In contrast, transcription activities in plants exposed to red and far-red light were 30% to 85% less than in blue light/UV-A, depending on the gene and plant species. Total chloroplast, psbA, and 16S rrn transcription were 60% to 80% less in the Arabidopsis phyA mutant exposed to blue light/UV-A relative to wild type, thus definitively linking phyA signaling to these photoresponses. To our knowledge, the major role of phyA in mediating the blue light/UV-A photoresponses is a new function for phyA in chloroplast biogenesis at this stage of leaf development. Although rbcL expression in plants exposed to UV-A was 50% less in the phyA mutant relative to wild type, blue light-induced rbcL expression was not significantly affected in the phyA, phyB, and cry1 mutants. However, rbcL expression in blue light was 60% less in the phytochrome chromophore mutant, hy2, relative to wild type, indicating that another phytochrome species (phyC, D, or E) was involved in blue light-induced rbcL transcription. Therefore, at least two different phytochromes, as well as phytochrome-independent photosensory pathways, mediated blue light/UV-A-induced transcription of chloroplast genes in mature leaves.

Effects of local infusion of TGFbeta on bone ingrowth in rabbit chambers

The local delivery of exogenous growth factors may help achieve a stable, long-lasting prosthetic interface around primary and revision joint replacements. This study examines the effects of local infusion of transforming growth factor beta (TGFbeta) in an in vivo model of tissue differentiation within bone. The Drug Test Chamber was implanted in the proximal medial tibial metaphysis of 8 mature rabbits unilaterally. The chamber contained a 1 x 1 x 5 mm canal for tissue ingrowth. The chamber was connected to an osmotic diffusion pump via polyvinyl tubing. 3.5 microg of recombinant TGFbeta1 was infused for 1 day or 1 week with subsequent harvesting of the ingrown tissue after 3 weeks. Each TGFbeta treatment was followed by two, 3-week infusions of carrier alone and harvesting of the ingrown tissue. TGFbeta for 1 day increased, and TGFbeta for 1 week decreased the percentage of bone in the chamber, compared to the initial control harvest after carrier alone. These changes, however, did not reach statistical significance. The number of vitronectin receptor positive cells in total, adjacent to bone and away from bone was higher after treatment with TGFbeta for 1 day, compared to 1 week. In an "unperturbed" bone ingrowth system (i.e., if bone ingrowth is not initially suppressed by other stimuli), this dose of TGFbeta did not enhance bone ingrowth using the DTC model.

The characterization of macrophages and osteoclasts in tissues harvested from revised total hip prostheses

The differentiation and maturation of macrophages and osteoclasts at the prosthetic interface in cases of implant loosening are poorly understood. Using histochemical and immunohistochemical staining methods, we compare macrophage differentiation in tissues from revised hip replacements in patients with specific clinical-radiological appearances. Periprosthetic tissues were harvested from 12 cemented acetabular and 12 cemented femoral components in 24 patients undergoing revision hip replacement. The prostheses were all radiographically and clinically loose. Six acetabular and six femoral components demonstrated radiographic ballooning osteolysis. Serial 6 microm frozen sections of the periprosthetic tissues were processed with hematoxylin and eosin for general tissue morphology, and analyzed for the presence of tartrate resistant acid phosphatase (TRAP, an osteoclast marker). Immunoperoxidase staining using monoclonal antibodies to CD68 (macrophages and osteoclasts) and CD51 (the alpha chain of the vitronectin receptor, an osteoclast marker) was also performed. Approximately 8-30% of the total cells in the tissues were positive for TRAP and the vitronectin receptor, and comprised a subset of the CD68 positive macrophages and macrophage polykaryons. However, there were no statistically significant differences between specific groups (femoral vs. acetabular, osteolysis vs. no osteolysis) for the numbers or percentages of macrophages or osteoclast-like cells. Once prosthetic loosening has occurred, few differences in the macrophage-osteoclast profile of tissues from different periprosthetic locations, with and without osteolysis, are noted. This suggests a final common biologic pathway for periprosthetic bone resorption, once implant loosening has transpired.

Effects of TGFβ on bone ingrowth in the presence of polyethylene particles

We implanted bone harvest chambers (BHCs) bilaterally in ten mature male New Zealand white rabbits. Polyethylene particles (0.3 ± 0.1 −m in diameter, 6.4×1012 particles/ml) were implanted for two, four or six weeks bilaterally in the BHCs, with subsequent removal of the ingrown tissue after each treatment. In addition to the particles, one side also received 1.5 −g of recombinant transforming growth factor ß1 (TGFβ1).

At two weeks, the bone area as a percentage of total area was less in chambers containing TGFβ compared with those with particles alone (7.8 ± 1.3% v 16.9 ± 2.7% respectively; 95% confidence interval (CI) for difference -14.0 to -4.30; p = 0.002). At four weeks, the percentage area of bone was greater in chambers containing TGFβ compared with those with particles alone (31.2 ± 3.4% v 22.5 ± 2.0% respectively; 95% CI for difference 1.0 to 16.4; p = 0.03). There were no statistical differences at six weeks, despite a higher mean value with TGFβ treatment (38.2 ± 3.9% v 28.8 ± 3.5%; 95% CI for difference -4.6 to 23.3; p = 0.16). The number of vitronectin-receptor-positive cells (osteoclast-like cells) was greater in the treatment group with TGFβ compared with that with particles alone; most of these positive cells were located in the interstitium, rather than adjacent to bone.

TGFβ1 is a pleotropic growth factor which can modulate cellular events in the musculoskeletal system in a time- and concentration-dependent manner. Our data suggest that there is an early window at between two and six weeks, in which TGFβ may favourably affect bone ingrowth in the BHC model. Exogenous growth factors such as TGFβ may be a useful adjunct in obtaining osseointegration and bone ingrowth, especially in revisions when there is compromised bone stock and residual particulate debris.

Effects of TGFbeta on bone ingrowth in the presence of polyethylene particles

We implanted bone harvest chambers (BHCs) bilaterally in ten mature male New Zealand white rabbits. Polyethylene particles (0.3+/-0.1 microm in diameter, 6.4 x 10(12) particles/ml) were implanted for two, four or six weeks bilaterally in the BHCs, with subsequent removal of the ingrown tissue after each treatment. In addition to the particles, one side also received 1.5 microg of recombinant transforming growth factor beta1 (TGFbeta1). At two weeks, the bone area as a percentage of total area was less in chambers containing TGFbeta compared with those with particles alone (7.8+/-1.3% v 16.9+/-2.7% respectively; 95% confidence interval (CI) for difference -14.0 to -4.30; p = 0.002). At four weeks, the percentage area of bone was greater in chambers containing TGFbeta compared with those with particles alone (31.2+/-3.4% v 22.5+/-2.0% respectively; 95% CI for difference 1.0 to 16.4; p = 0.03). There were no statistical differences at six weeks, despite a higher mean value with TGFbeta treatment (38.2+/-3.9% v 28.8 +/-3.5%; 95% CI for difference -4.6 to 23.3; p = 0.16). The number of vitronectin-receptor-positive cells (osteoclast-like cells) was greater in the treatment group with TGFbeta compared with that with particles alone; most of these positive cells were located in the interstitium, rather than adjacent to bone. TGFbeta1 is a pleotropic growth factor which can modulate cellular events in the musculoskeletal system in a time- and concentration-dependent manner. Our data suggest that there is an early window at between two and six weeks, in which TGFbeta may favourably affect bone ingrowth in the BHC model. Exogenous growth factors such as TGFbeta may be a useful adjunct in obtaining osseointegration and bone ingrowth, especially in revisions when there is compromised bone stock and residual particulate debris.

"Doing the month": an exploration of postpartum practices in Chinese women

An ethnographic approach was used to explore the cultural practices of Hong Kong Chinese women during the postpartum period. Seven multiparous women were interviewed and asked to reflect on their self-care practices within the family home during the month after the birth of their first child. Content analysis was applied to the interviews and major categories identified: good food and bad blood, poisonous sex, dirt and prohibitions, rest and appeasing the placenta god, and competing loyalties. The indication is that these Chinese mothers had attempted to follow their personally constructed interpretations of traditional customary practices, being influenced by close family members, neighbors, and historical precedent. These women further outlined a number of personal variations to traditional practices in the face of increasingly Western influences. We provide insights into the complexity of issues modern Hong Kong Chinese women face in the first postpartum month and on a more global level highlight the importance of culturally sensitive and congruent nursing practice.

Intraoperative localization of renal calculi using the Polarex 2 C-arm image intensifier

We present our experience with the C-arm image intensifier in the localization of renal calculi. We have found this technique to be exceptionally easy to use and extraordinarily efficient. However, unless the disk images are used primarily, rather than continuous fluoroscopy, the radiation exposure can be significant. This technique can be somewhat limiting in that exceptionally small stones or poorly opacified stones cannot be picked up easily.