Transurethral Resection of the Bladder Tumour as a Treatment Method in Children with Transitional Cell Carcinoma of the Bladder--Analysis of Our Material and Literature Review

BACKGROUND

Bladder cancer occurs mainly in adults. In children, younger than 10 years in particular, it is very rare.

OBJECTIVES

The aim of the study is to retrospectively evaluate the efficacy of transurethral resection of the bladder tumour (TUR-BT) of transitional cell carcinoma (TCC) of the bladder in children.

MATERIAL AND METHODS

Transurethral resection of the bladder tumour was performed in 7 boys aged 4 to 17 years (median 12.1 years). In all cases laboratory tests, ultrasound, and cystoscopic tumour biopsy were carried out prior to the resection. Doxorubicin was additionally instilled intravesically as one dose in two patients. The Foley catheter was left in the bladder for 1 to 4 days (median 1.85 days). The follow-up period ranged from 10 months to 10 years (median 4 years).

RESULTS

Papillary urothelial neoplasm of low malignant potential (PUNLMP) was diagnosed in 5 patients and urothelial papilloma in 2. Local recurrence was observed in one case two years after the resection. In all other cases complete remission was achieved.

CONCLUSIONS

Transitional cell carcinoma of the bladder in children is usually benign and endoscopic treatment (TUR-BT) seems to be the treatment of choice. To determine a follow-up schedule a more substantial group of children with bladder cancer should be analysed.

[Acute compartment syndrome in clinical toxicology]

In this article we described the basic information about diagnosis and treatment of acute compartment syndrome (acs). Rhabdomyolysis caused by standstill position, intramuscular injections of different xenobiotics, and hypo- and hyperthermia is the most common cause of acs among acute poisoned patients. The diagnosis may based on physical examination and direct measurement of tissue pressure. Treatment include prevention, and symptomatic therapy. In case of lack respond to symptomatic treatment the fasciotomy is needed.

[Minor head injury in children--proposed algorithm for clinical management]

AIM

Objective analysis of clinical and epidemiological aspects of minor head injuries in children with an attempt to elaborate a practical algorythm for diagnostic management.

MATERIAL AND METHODS

All children aged 3 to 18 years with minor head injury treated in the years 2005-2006 in the Department of Paediatric Surgery and Traumatology in Grudziadz, were included in a prospective study. In all, 884 children were enrolled into this analysis. Their medical data were reviewed with an emphasis on circumstances of injury, clinical signs and symptoms, diagnostic and therapeutic management its evaluation and final outcome.

RESULTS

Loss of consciousness and/or postinjury amnesia were noted in 88 patients (9.3%). Skull x-ray carried out in 486 children revealed bone fracture in 4 cases. 473 (53.5%) children were hospitalised, while 411 (46.5%) were discharged after initial examination for home the care. Among 82 children who had computed tomography, intracranial pathology was found in 17. None of the patients from either group required surgical intervention and all were discharged in a good condition.

CONCLUSIONS

From clinical point of view, it seems relevant to separate the group of patients with minimal head injury requiring no diagnostic study and hospitalization. Loss of consciousness and posttraumatic amnesia in children with minor injury should be treated as an indication for computed tomography and/or observation of the patient in hospital. The role of conventional x-ray in minor head injury is minimal. The presented practical diagnostic algorythm for children with minor head trauma, treated in emergency departments in Poland appears to be fully justified and important.

[Spectrum of patients in prehospital emergency services. What has changed over the last 20 years?]

BACKGROUND

In Germany the physician staffed emergency systems have announced an increase in rescue missions over the years. The aim of this study is to analyse the development of the spectrum of patients in an emergency system over the last 20 years in order to highlight the significant changes.

METHODS

In a retrospective study we analyzed the prehospital chart views from 2004, 1992 and 1984 with respect to patients' demography, type of rescue mission, degree of internal disease or injury (NACA), state of consciousness (GCS), as well as prehospital interventions performed by prehospital emergency physician.

RESULTS

In 2004 (3,825), the absolute number of missions was 2 and 4 times higher than 1992 (2,114) and 1984 (957), resp. In all of these investigated time periods non-trauma missions (74%; 2,812 vs. 66%; 1,390 vs. 51%; 485) were leading, followed by trauma missions (18%; 690 vs. 22%; 464 vs. 39%; 375), aborted missions (3%; 126 vs. 7%; 154 vs. 6%; 56), and dead on arrival (5%; 197 vs. 5%; 106 vs. 4%; 41). Although, the percentage of patients with NACA IV-VI (39% vs. 50%) or patients with GCS < or =8 (18% vs. 34%) was lower in 2004, the absolute number of patients in each category was higher than in 1984 (NACA IV-VI: 1,434 vs. 448, p<0.01; GCS: 672 vs. 303, p<0.01).

CONCLUSIONS

The results of this study demonstrate, that the percentage of trauma, severely ill/injured or unconscious patients is lower than in previous years. However, the higher absolute numbers of patients demonstrate that the emergency physician now encounters more critically ill/injured, unconscious and trauma patients. It does not seem necessary to question the qualifications for an emergency physician, which have previously been considered essential for the management of acute life-threatening situations.

Active bacterial core surveillance of the emerging infections program network

Active Bacterial Core surveillance (ABCs) is a collaboration between the Centers for Disease Control and Prevention and several state health departments and universities participating in the Emerging Infections Program Network. ABCs conducts population-based active surveillance, collects isolates, and performs studies of invasive disease caused by Streptococcus pneumoniae, group A and group B Streptococcus, Neisseria meningitidis, and Haemophilus influenzae for a population of 17 to 30 million. These pathogens caused an estimated 97,000 invasive cases, resulting in 10,000 deaths in the United States in 1998. Incidence rates of these pathogens are described. During 1998, 25% of invasive pneumococcal infections in ABCs areas were not susceptible to penicillin, and 13.3% were not susceptible to three classes of antibiotics. In 1998, early-onset group B streptococcal disease had declined by 65% over the previous 6 years. More information on ABCs is available at www.cdc.gov/ncidod/dbmd/abcs. ABCs specimens will soon be available to researchers through an archive.

Optical imaging of cat auditory cortical organization after electrical stimulation of a multichannel cochlear implant: differential effects of acute and chronic stimulation

OBJECTIVE

To study the effects of electrical stimulation on cortical activation patterns.

MATERIALS AND METHODS

Optical imaging of auditory cortex in cats that are acutely and chronically electrically stimulated with cochlear implants.

RESULTS

Chronic electrical stimulation results in expansion of cortical territory and overlap.

CONCLUSION

Effects of chronic electrical stimulation are comparable to use-dependent cortical plastic reorganization.

Optical imaging of cat auditory cortex cochleotopic selectivity evoked by acute electrical stimulation of a multi-channel cochlear implant

We measured reflectance changes by means of optical imaging of intrinsic signals to study the effects of acute electrical cochlear stimulation on the topography of the cat auditory cortex. After single-pulse electrical stimulation at selected sites of a multichannel implant device, we found topographically restricted response areas representing mainly the high-frequency range in AI. Systematic variation of the stimulation pairs and thus of the cochlear frequency sites revealed a systematic and corresponding shift of the response areas that matched the underlying frequency organization. Intensity functions were usually very steep. Increasingly higher stimulation currents evoked increasingly larger response areas, resulting in decreasing spatial, i.e. cochleotopic, selectivity; however, we observed only slight positional shifts of the focal zones of activity. Electrophysiological recordings of local field potential maps in the same individual animals revealed close correspondence of the locations of the cortical response areas. The results suggest that the method of optical imaging can be used to map response areas evoked by electrical cochlear stimulation, thereby maintaining a profound cochleotopic selectivity. Further experiments in chronically stimulated animals will shed more light on the degree of functional and reorganizational capacities of the primary cortex and could be beneficial for our understanding of the treatment of profound deafness.

Optical imaging of rat somatosensory cortex reveals representational overlap as topographic principle

We measured reflectance changes by means of optical imaging of intrinsic signals to study the topography of the paw representations in rat somatosensory cortex. Following circumscribed tactile stimulation of single digits or pads, we found large and partially overlapping areas of reflectance changes (delta R). The diameters of their focal zones defined at 75% maximal delta R were in the range of 150 microns and preserved all details of the underlying maps. Zones of overlap were in the range 15-25% measured at half-maximal delta R. In contrast, we found sharp boundaries with no overlap between the fore- and hindpaw representations. The data suggest that large and overlapping cortical maps constitute a normal type of neural representation supporting the idea of a distributed neural processing scheme.

Is there an increase of reproductive rates in schizophrenics? II. An investigation in Nordbaden (SW Germany): methods and description of the patient sample

For an investigation on the question of whether fertility rates of schizophrenics have been increasing in recent times, two cohorts of patients were defined on an epidemiological basis. The patients were first admissions during either 1949-50 (n = 183) or 1965-67 (n = 228). The conditions of case definition as well as their demographic and psychiatric characteristics are described. These data are necessary for the evaluation of reproductive rates observed in the patient sample. Furthermore, the two cohorts of patients may be of general interest, because they comprise patients first admitted to a hospital who were completely ascertained in a certain region and time period. They reflect certain changes in hospitalization practice in Germany.

Is there an increase of reproductive rates in schizophrenics? III. An investigation in Nordbaden (SW Germany): results and discussion

Two cohorts of schizophrenic patients admitted to a psychiatric hospital for the first time either during 1949-50 or 1965-67 were compared with matched controls for reproductive rates before and 13 years after onset of psychosis. Patients of both admission periods had reduced marriage rates. After onset of the disease the rate of reproduction was decreased in males of both periods, but not in females. Patients of both periods did not differ from control values with respect to marital fertility. It has repeatedly been reported that fertility of schizophrenics has been increasing in recent times. Comparison of total reproduction, rate of marriage and marital fertility in patients of the two admission periods and matched controls did not yield any evidence for increasing rates. Instead, the results favour the idea that the patients parallel at a lower level the general decline of birth rates observed in Western Germany.

Is there an increase of reproductive rates in schizophrenics? I. Critical review of the literature

It is well-known that the fertility of schizophrenic patients, particularly males, is below the population average. The main measures of fertility (reproductivity) are marriage rate, marital fertility, and rate of reproduction. A review of the literature reveals the rate of reproduction of schizophrenic patients to be 30% to 80% of the general population, the reduction being mainly due to reduced probability of marriage. At least one investigation presented evidence for an increase in marriage rate and rate of reproduction in schizophrenic patients relative to the general population in recent time. If this increase were to be confirmed it would undoubtedly have practical as well as theoretical implications. The hypothesis of a compensatory higher fertility of healthy relatives of schizophrenics based on a physiological advantage is empirically unproven. Additionally, the concept of a balanced polymorphism in schizophrenia rests on a superficial analogy with Mendelian traits.