[Use of Eductyl(®) suppository for rectal preparation before prostate biopsy: an observational survey]

BACKGROUND

Local preparation of rectum governs the possibly survenue of complications during transrectal ultrasound guided biopsies of prostate.

OBJECTIVE

To determine the efficacy and acceptability of rectal preparation (Eductyl(®) suppository) in patients undergoing a transrectal prostate biopsy.

PATIENTS AND METHODS

From May to August 2005, eight urologists (Bel-Air Urological Center, Bordeaux) included 137 patients (mean age 66.4 years) with an indication of prostate biopsies. All patients were administrated prophylactic antibiotic therapy. They used Eductyl(®) effervescent suppositories for local preparation, the day before and/or the morning of the exam.

RESULTS

Rectal vacuity was satisfactory or very satisfactory for 99% of patients. Introduction of probe and tracking of prostate were easy or very easy in 99% of cases. Eight days after the exam, only 35% of patients had suffered anal or rectal pain during a mean of 2 days. Most of patients recovered bowel function without requiring treatment and without any difficulty or pain. The bowel function recovery occurred the day of prostate biopsy and the day after for 28.4% and 62.2% of patients, respectively.

CONCLUSION

Urologists considered that the use of Eductyl(®) suppositories before prostate biopsies ensured a satisfactory rectal preparation and optimal conditions for the exam. Moreover, this preparation was well accepted by patients.

Differential regulation of five Pht1 phosphate transporters from maize (Zea mays L.)

Maize is one of the most important crops in the developing world, where adverse soil conditions and low fertilizer input are the two main constraints for stable food supply. Understanding the molecular and biochemical mechanisms involved in nutrient uptake is expected to support the development of future breeding strategies aimed at improving maize productivity on infertile soils. Phosphorus is the least mobile macronutrient in the soils and it is often limiting plant growth. In this work, five genes encoding Pht1 phosphate transporters which contribute to phosphate uptake and allocation in maize were identified. In phosphate-starved plants, transcripts of most of the five transporters were present in roots and leaves. Independent of the phosphate supply, expression of two genes was predominant in pollen or in roots colonized by symbiotic mycorrhizal fungi, respectively. Interestingly, high transcript levels of the mycorrhiza-inducible gene were also detectable in leaves of phosphate-starved plants. Thus, differential expression of Pht1 phosphate transporters in maize suggests involvement of the encoded proteins in diverse processes, including phosphate uptake from soil and transport at the symbiotic interface in mycorrhizas, phosphate (re)translocation in the shoot, and phosphate uptake during pollen tube growth.

Computational bone remodelling simulations and comparisons with DEXA results

Femoral periprosthetic bone loss following total hip replacement is often associated with stress shielding. Extensive bone resorption may lead to implant or bone failure and complicate revision surgery. In this study, an existing strain-adaptive bone remodelling theory was modified and combined with anatomic three-dimensional finite element models to predict alterations in periprosthetic apparent density. The theory incorporated an equivalent strain stimulus and joint and muscle forces from 45% of the gait cycle. Remodelling was simulated for three femoral components with different design philosophies: cobalt-chrome alloy, two-thirds proximally coated; titanium alloy, one-third proximally coated; and a composite of cobalt-chrome surrounded by polyaryletherketone, fully coated. Theoretical bone density changes correlated significantly with clinical densitometry measurements (DEXA) after 2 years across the Gruen zones (R2>0.67, p<0.02), with average differences of less than 5.4%. The results suggest that a large proportion of adaptive bone remodelling changes seen clinically with these implants may be explained by a consistent theory incorporating a purely mechanical stimulus. This theory could be applied to pre-clinical testing of new implants, investigation of design modifications, and patient-specific implant selection.

No effect of a type I collagen gel coating in uncemented implant fixation

Uncemented joint replacement with a variety of substrate materials, structures, and coatings are commonplace in arthroplasty. Even with specialized surgical preparation of bone, intimate contact between the implant and host bone may not always be achieved. This study evaluated the in vivo effect of fibrillar atelopeptide and PEG crosslinked collagens coatings placed directly into porous sintered bead structures on bone ingrowth using a skeletally mature bicortical, bilateral ovine tibia model. Bone ingrowth into the implants increased with time, although differences were not significant. At 4 weeks woven bone was present within the pores that remodeled with time. Significantly lower levels of ingrowth were observed in the intramedullary region of the implants when compared with the cortical region. Implant metal type did not affect ingrowth in both regions analyzed. Both fibrillar and crosslinked forms of dermal type I collagen did not significantly alter bone ingrowth.

Cemented fixation with PMMA or Bis-GMA resin hydroxyapatite cement: effect of implant surface roughness

Implant surface roughness is an important parameter governing the overall mechanical properties at the implant-cement interface. This study investigated the influence of surface roughness using polymethylmethcrylate (PMMA) and a Bisphenol-a-glycidylmethacyrlate resin-hydroxyapatite cement (CAP). Mechanical fixation at the implant-cement interface was evaluated in vitro using static shear and fatigue loading with cobalt chrome alloy (CoCr) dowels with different surface roughness preparations. Increasing surface roughness improved the mechanical properties at the implant-cement interface for both types of cement. CAP cement fixation was superior to PMMA under static and dynamic loading.

In vivo evaluation of resorbable bone graft substitutes in a rabbit tibial defect model

Calcium sulfate as a bone graft substitute is rapidly resorbed in vivo releasing calcium ions but fails to provide long-term three-dimensional framework to support osteoconduction. The setting properties of calcium sulfate however allow it to be applied in a slurry form making it easier to handle and apply in different situations. This study examines the in vivo response of calcium sulfate alone and as a carrier for a coralline hydroxyapatite in an established bilateral corticocancellous defect model in rabbits. Defects were filled flush to the anterior cortex with a resorbable porous ceramic alone and in combination with calcium sulfate slurry, calcium sulfate slurry alone or calcium sulfate pellets and examined at time points up to 52 weeks. Specimens where assessed using Faxitron X-ray, light and electron microscopy. Calcium sulfate in either slurry or pellet form does indeed support new bone formation alone however, complete filling of the bone defect is not observed. Calcium sulfate in slurry form does however improve the surgical handling of particulate bone graft substitutes such as Pro Osteon 200 R, which remained as an osteoconductive scaffold for up to 52 weeks and may have played an important role in the ultimate closure of the cortical windows.

The effect of two nonresorbable suture types on the mechanical performance over a metal suture anchor eyelet

An understanding of the mechanical properties of different suture materials is valuable when selecting the most appropriate suture and repair technique. Sutures should be strong, easy to handle and have high knot security. The introduction of suture anchors adds an additional variable regarding the effect of stress risers over the eyelet. Improving the mechanical properties of a suture may be a possible method to help avoid failure over stress risers such as the eyelet of suture anchor. This study examined the static and viscoelastic properties of a new polyethylene based non-resorbable suture (Fibrewire) over the eyelet of a standard anchor compared to braid polyester non-resorbable suture (Ethibond). Fibrewire had superior ultimate load properties compared to Ethibond (360.2 N+/-23.8 vs 191.9 N+/-17.3) as well as greater stiffness (61.3 N/mm+/-9.7 vs 8.1 N/mm+/-0.4) when tested in uniaxial tension through a metal anchor eyelet (Mitek) ( p<0.001). Fibrewire demonstrated greater stress relaxation than Ethibond ( p<0.05). Differences in the static and viscoelastic properties of suture may have implications in the post-operative period or during rehabilitation.

The effect of different cement insertion techniques on the bone-cement interface

Since the introduction of cemented total hip arthroplasty, the method of cement usage has evolved through several generations. These changes may have been responsible for an improvement in femoral component longevity. The nature of the bone-cement interface in first-generation cementing techniques has been described, but the bone-cement interface in more recent cementing techniques has not. This article describes the bone-cement interface after 2 different cementing techniques in a canine total hip arthroplasty model.

The effect of substrate roughness and hydroxyapatite coating thickness on implant shear strength

This study examined the role of substrate preparation and hydroxyapatite (HA) coating thickness on bone ongrowth and shear strength in a bilateral bicortical sheep model. Plasma-sprayed and grit-blasted titanium implants with different thickness HA coatings were examined at 4, 8, 12, and 26 weeks after implantation. Shear strength increased with time for all implants. Plasma-sprayed implants were superior to grit-blasted implants at all time points. The 100-microm-thick HA layer used in the present study provided greater fixation and ongrowth and less resorption compared with the 50-microm-thick layer. We did not observe any advantage in using a thicker HA coating for the titanium substrates examined.

Occurrence of pulmonary thromboembolism immediately after arthroplasty

INTRODUCTION

Respiratory complications are common after arthroplasty, with pulmonary thromboembolic disease (PTE) and fat emboli being the most serious. A scintigraphic study was designed to assess the occurrence of both diseases. A prospective tomographic study of perfusion was performed within 24 h of arthroplasty. Details of the detection of fat embolism will be presented elsewhere.

METHODS

Patients with previous PTE were excluded. Tomographic lung studies were acquired after 99mTc-macroaggregated albumin injection. Pre- and post-operative arterial blood gases (ABGs) and relevant chest radiography/computed tomography scans were obtained. ABGs were analysed as the difference in alveolar-arterial oxygen gradients, pre- and post-operatively (DA-a).

RESULTS

Forty patients were studied (16F, 24M) with a mean age of 71 years (range 36-88 years). Of these, 16 were hip and 24 knee arthroplasties. PTE was detected in 25 of 38 (66%) patients evaluated. The value of DA-a was significantly different between patients with PTE and without PTE (P>0.05). Administration of prophylactic pre-operative low molecular weight heparin makes no difference to the early onset of PTE.

CONCLUSION

There is a high incidence of PTE immediately after arthroplasty.

Reversal of medial compartment osteoarthritic uptake pattern after high tibial osteotomy

Two cases of osteoarthritis of the knee are presented that illustrate the typical medial compartment pattern of scintigraphic uptake. In both cases the patients had significant medial joint pain. After high tibial osteotomy, the pattern of uptake was altered and paralleled the improvement in symptoms. These observations prompt several important issues regarding the cause of the uptake and may provide a way to monitor treatment response.

Prognostic value of 99m Tc leukocyte scintigraphy in diabetic pedal osteomyelitis

While leukocyte scintigraphy is accurate in detection of pedal osteomyelitis, there has been little data relating the technique to outcomes. We designed a trial to examine the prognostic value of sequential 99m Tc labeled leukocyte scans to establish the diagnosis of osteomyelitis and after three to four weeks of culture-guided antibiotic therapy. Twenty-three diabetic patients with proven pedal osteomyelitis (21/23) or persistent uptake (2/23) on the sequence of scans were studied. Five additional episodes of osteomyelitis developed in the group over the period of the study. Eleven patients demonstrated persistent uptake in the sequential scans. Nine progressed to amputation. The remaining two patients were biopsy-negative for infection, did not have cutaneous ulceration and were thought to have rapidly progressive arthropathy. Sequential leukocyte scintigraphy accurately predicts the need for amputation and can circumvent ineffective prolonged antibiotic therapy.

Gene expression profiling of two related maize inbred lines with contrasting root-lodging traits

To assist breeding for increased resistance to root lodging in maize, an attempt was made to identify genes that are associated with root lodging by profiling mRNA expression from two inbreds with contrasting root-related traits. These two inbreds were derived from a common F(2) pool, selfed for several generations and showed 75% relatedness based on 106 genetic markers. Under field conditions, the two inbreds exhibited significant differences in root morphology and resistance to root lodging. Whole root tissue was collected at two developmental stages from inbred 100 and 101 grown in 2 years. RNA was isolated from both the V8 and V12 stages, a few weeks prior to flowering. The RNA samples from the 1997 growing season were analysed by GeneCalling analysis, an open-ended mRNA profiling method. From over 13 500 cDNA fragments detected from each of the V8- and V12-stage samples, 229 and 325 cDNA fragments, respectively, showed greater than 2-fold differences between the two inbred lines. A total of 69 cDNA fragments that showed 2-fold or greater differences for both inbred lines were observed at both developmental stages. The gene identity and expression differences of several cDNA fragments were determined and confirmed by RNA gel blot analysis. Two genes out of five identified were homologous to a cytochrome P450 and the impedance-induced protein, both showing high levels of expression in the roots of lodging resistant lines and low levels in the sensitive lines. These data provide the first clues of genes expressed in the roots during the formative stages of root development associated with root-lodging resistance.

Scintigraphic assessment of the acetabulum after arthroplasty with reference to cup geometry

A unique scintigraphic appearance has been noted in uncomplicated hip prostheses which have the acetabular component inserted after under-reaming or where a cone-shaped cup is inserted. We hypothesized that the pattern of increased uptake around the superior and inferior third of the cup with relatively reduced uptake in the medial third is due to preferential loading of the rim of the cup. A prospective study of ten patients with uncomplicated hip prostheses supports the hypothesis.

Morphometric and mechanical evaluation of titanium implant integration: comparison of five surface structures

Achieving a stable bone-implant interface is an important factor in the long-term outcome of joint arthroplasty. In this study, we employed an ovine bicortical model to compare the bone-healing response to five different surfaces on titanium alloy implants: grit blasted (GB), grit blasted plus hydroxyapatite (50 microm thick) coating (GBHA), Porocoat(R) (PC), Porocoat(R) with HA (PCHA) and smooth (S). Push-out testing, histology, and backscatter scanning electron microscope (SEM) imaging were employed to assess the healing response at 4, 8, and 12 weeks. Push-out testing revealed PC and PCHA surfaces resulted in significantly greater mechanical fixation over all other implant types at all time points (p <.05). HA coating on the grit-blasted surface significantly improved fixation at 8 and 12 weeks (p <.05). The addition of HA onto the porous coating did not significantly improve fixation in this model. Quantification of ingrowth/ongrowth from SEM images revealed that HA coating of the grit-blasted surfaces resulted in significantly more ongrowth at 4 weeks (p <.05).

Expression profiling of the maize flavonoid pathway genes controlled by estradiol-inducible transcription factors CRC and P

To determine the scope of gene expression controlled by the maize transcription factors C1/R and P, which are responsible for activating flavonoid synthesis, we used GeneCalling, an open-ended, gel-based, mRNA-profiling technology, to analyze cell suspension lines of the maize inbred Black Mexican Sweet (BMS) that harbored estradiol-inducible versions of these factors. BMS cells were transformed with a continually expressed estrogen receptor/maize C1 activator domain fusion gene (ER-C1) and either a fusion of C1 and R (CRC), P, or luciferase genes regulated by a promoter containing four repeats of an estrogen receptor binding site. Increasing amounts of luciferase activity, anthocyanins, and flavan-4-ols were detected in the respective cell lines after the addition of estradiol. The expression of both known and novel genes was detected simultaneously in these BMS lines by profiling the mRNA isolated from replicate samples at 0, 6, and 24 hr after estradiol treatment. Numerous cDNA fragments were identified that showed a twofold or greater difference in abundance at 6 and 24 hr than at 0 hr. The cDNA fragments from the known flavonoid genes, except chalcone isomerase (chi1), were induced in the CRC-expressing line after hormone induction, whereas only the chalcone synthase (c2) and flavanone/dihydroflavonol reductase (a1) genes were induced in the P-expressing line, as was expected. Many novel cDNA fragments were also induced or repressed by lines expressing CRC alone, P alone, or both transcription factors in unique temporal patterns. The temporal differences and the evidence of repression indicate a more diverse set of regulatory controls by CRC or P than originally expected. GeneCalling analysis was successful in detecting members of complex metabolic pathways and uncovering novel genes that were either coincidentally regulated or directly involved in such pathways.

Expression profiling of the maize flavonoid pathway genes controlled by estradiol-inducible transcription factors CRC and P

To determine the scope of gene expression controlled by the maize transcription factors C1/R and P, which are responsible for activating flavonoid synthesis, we used GeneCalling, an open-ended, gel-based, mRNA-profiling technology, to analyze cell suspension lines of the maize inbred Black Mexican Sweet (BMS) that harbored estradiol-inducible versions of these factors. BMS cells were transformed with a continually expressed estrogen receptor/maize C1 activator domain fusion gene (ER-C1) and either a fusion of C1 and R (CRC), P, or luciferase genes regulated by a promoter containing four repeats of an estrogen receptor binding site. Increasing amounts of luciferase activity, anthocyanins, and flavan-4-ols were detected in the respective cell lines after the addition of estradiol. The expression of both known and novel genes was detected simultaneously in these BMS lines by profiling the mRNA isolated from replicate samples at 0, 6, and 24 hr after estradiol treatment. Numerous cDNA fragments were identified that showed a twofold or greater difference in abundance at 6 and 24 hr than at 0 hr. The cDNA fragments from the known flavonoid genes, except chalcone isomerase (chi1), were induced in the CRC-expressing line after hormone induction, whereas only the chalcone synthase (c2) and flavanone/dihydroflavonol reductase (a1) genes were induced in the P-expressing line, as was expected. Many novel cDNA fragments were also induced or repressed by lines expressing CRC alone, P alone, or both transcription factors in unique temporal patterns. The temporal differences and the evidence of repression indicate a more diverse set of regulatory controls by CRC or P than originally expected. GeneCalling analysis was successful in detecting members of complex metabolic pathways and uncovering novel genes that were either coincidentally regulated or directly involved in such pathways.

Scintigraphic patterns of injury in amateur weight lifters

PURPOSE

Weight lifting is now a standard part of training in most sports. An increasing number of amateur athletes are doing strength training, mostly in unsupervised situations. A series of injuries in amateur weight lifters was analyzed by bone scintigraphy, with the aim of depicting specific patterns that would accurately identify the primary lesions.

METHODS

Twelve patients (10 men and 2 women) were studied whose ages ranged from 18 to 35 years. Patients were referred for bone scintigraphy with clinical diagnoses based on history, physical examination, and appropriate radiologic investigations. Diagnoses were confirmed by surgery, arthroscopy, arthrography, local steroid injection, and outcome.

RESULTS

Most of the injuries were in athletes undertaking free-weight training. Most injuries were in the upper limbs, particularly around the shoulder. Scintigraphic patterns of supraspinatus and bicipital tendons and also rotator cuff lesions were identified. Clavicular osteolysis, avulsion injuries, muscle damage, and vertebral lesions were also noted. Several abnormalities revealed by scintigraphy were clinically unsuspected.

CONCLUSIONS

Scintigraphic manifestations of several injuries, particularly around the shoulder, have a specific pattern. Recognition of these patterns can enhance the performance of bone scintigraphy. Scintigraphy also has the potential to detect clinically unsuspected disease.

A novel view for the scintigraphic assessment of the elbow

Using any imaging modality, the elbow is a complex joint to evaluate. The use of scintigraphy in the evaluation of the effects of acute or chronic trauma has largely been confined to epicondylitis. We developed a skyline view of the elbow that minimized the effect of overlap and assessed its incremental value in the scintigraphic assessment of several pathological conditions. Thirty-four abnormalities were evaluated in 20 patients with a range of pathologies, including epicondylitis, ligamentous avulsion injury, articular injury, fractures and synovitis. The incremental value of addition of the skyline view to the standard views was assessed in addition to the overall accuracy of scintigraphy. Overall, scintigraphy detected 27 of 34 abnormalities, with the standard views of the elbow accurately identifying 15 and the skyline view 23 abnormalities. This gave the skyline view an incremental value of 24% over the standard views. In conclusion, scintigraphy has the potential to identify a greater range of pathologies in the elbow than previously reported, due to the addition of the skyline view to the standard views.

Cytokines and matrix metalloproteinases mRNA expression in archival human tissues from failed total hip arthroplasty using in situ hybridization and color video image analysis

Reports on the histological and biochemical nature of periprosthetic fibrous/granulomatous tissue has, to date, been largely limited to frozen tissue sections. This study reports the cytokine and matrix metalloproteinase profiles found in periprosthetic interface tissues in THA which have failed due to aseptic loosening and in capsular tissues obtained at primary surgery. The study employs immunohistochemistry, in situ hybridization, and color video image analysis on formalin fixed and paraffin embedded sections.

Treatment of the neuropathic knee by arthroplasty

The neuropathic joint is one of the most difficult management problems in orthopaedic practice. The surgeon is often referred the patient late in the course of the disease, when there has been marked joint destruction so that non-operative measures are not suitable. We report a case of a severely deformed neuropathic knee joint, for which an uncemented total knee replacement was performed. The rationale for use of this procedure instead of arthrodesis, and discussion of the condition follow.

The influence of CO2 production and physiological deadspace on end-tidal CO2 during controlled ventilation: a study using a mechanical model

A mechanical lung model was used to investigate the effect of varying carbon dioxide production and deadspace on the end-tidal carbon dioxide levels achieved during mechanical ventilation when using the Bain, Humphrey ADE, and circle systems. Both factors had significant influence on end-tidal carbon dioxide concentration and could result in values in excess of those considered acceptable in clinical practice. The implications of the results are discussed.

Comparison of a clinical gait analysis method using videography and temporal-distance measures with 16-mm cinematography

The purpose of this study was to compare a clinical gait analysis method using videography and temporal-distance measures with 16-mm cinematography in a gait analysis laboratory. Ten children with a diagnosis of cerebral palsy (means age = 8.8 +/- 2.7 years) and 9 healthy children (means age = 8.9 +/- 2.4 years) participated in the study. Stride length, walking velocity, and goniometric measurements of the hip, knee, and ankle were recorded using the two gait analysis methods. A multivariate analysis of variance was used to determine significant differences between the data collected using the two methods. Pearson product-moment correlation coefficients were determined to examine the relationship between the measurements recorded by the two methods. The consistency of performance of the subjects during walking was examined by intraclass correlation coefficients. No significant differences were found between the methods for the variables studied. Pearson product-moment correlation coefficients ranged from .79 to .95, and intraclass coefficients ranged from .89 to .97. The clinical gait analysis method was found to be a valid tool in comparison with 16-mm cinematography for the variables that were studied.

Distillation Method for Determination of Moisture in Spices: Collaborative Study

AOAC method 30.005 for determination of moisture in spices by distillation was collaboratively studied to revalidate its reliability. Using toluene as the solvent system, repeatability and reproducibility were acceptable for basil. Using hexane as the solvent for red pepper produced less satisfactory results. The method has been adopted official first action.

Foot-and-mouth disease and the African buffalo (Syncerus caffer). II. Virus excretion and transmission during acute infection

Three groups of young buffalo in captivity were infected by exposing them to similar buffalo in the acute stages of infection induced by needle inoculation with SAT 1 or 2 viruses. Clear foot lesions developed in most of the buffalo from which the relevant virus types were re-isolated. During the first week following infection virus was found in blood, nasal secretions, saliva, preputial secretions and faeces. Air samples collected in the immediate vicinity of acutely infected buffalo were also found to contain virus. However, the regularity of virus detection as well as the quantity of virus in buffalo specimens was generally lower than for cattle infected with viruses of the same type. Conversely, virus was detected in the nasal secretions or saliva of 3 buffalo up to 4 weeks after infection, a situation which has not been encountered in cattle. Susceptible cattle and impala (Aepyceros melampus) were penned together with or in the immediate vicinity of infected buffalo and shared feeding and watering facilities with the buffalo. The pattern of transmission which emerged indicated that transfer of these viruses from buffalo to other species probably occurs only in the acute stages of infection and where there is direct physical contact between the species.

Neutropenia following acute chlorpromazine ingestion

A 5-year-old child is reported who, after an acute ingestion of chlorpromazine, developed an absolute neutropenia. The neutrophil count reached its nadir (210 cells/mm3) at 45 h postingestion. The child recovered and had a normal white blood cell count 17 d after ingestion. While neutropenia and agranulocytosis are not uncommon with chronic chlorpromazine therapy, neutropenia following an acute ingestion is unique but predictable in view of chlorpromazine's toxic effects on white cells. A white blood cell count on presentation of an acute chlorpromazine ingestion and at 24-48 h postingestion should allow detection of patients at risk for acute chlorpromazine-induced neutropenia.

The effect of relative humidity on swine vesicular disease virus in dried films before and during formaldehyde fumigation

Swine Vesicular Disease virus (SVDV) did not survive drying at high relative humidities (r.h.) but there was little virus loss at low r.h. Purified virus dried in films was inactivated by formaldehyde fumigation only at high r.h. Inactivation was also influenced by the suspending medium from which the virus was dried. Purified virus resuspended in distilled water and then dried, was rapidly killed, but that in tissue culture fluid survived.