Robotic transperineal prostate biopsy: pilot clinical study.

OBJECTIVE: To develope a robot (BioXbot) that performs mapping transperineal prostate biopsy (PB) with two perineal skin punctures under ultrasound guidance. Our pilot study's clinical endpoints were complications and its technical endpoints were the duration for each phase. METHODS: This institution review board-approved prospective clinical trial included patients with indications for PB. Two urologists performed these PBs. In the lithotomy position and under general anesthesia, the transrectal biplane ultrasound probe acquired transverse images of the prostate gland. The urologist defined its boundaries and planned the biopsy. It guided the PB in 3 axes, passing through a single perineal skin puncture for each prostate side. After each biopsy, it automatically moved to the next position. The steps were repeated on the contralateral side. RESULTS: Our 20 patients had a mean prostate-specific antigen of 8.4 ± 4.9 ng/mL. Two patients had 2 previous biopsies, whereas the rest had one. The mean number of biopsies taken was 28.5 ± 6.2 in a mean total procedure time of 32.5 ± 3.2 minutes. We detected 3 patients with prostate cancer with Gleason score 3 + 3. Two patients required brief bladder catheterization after their biopsy. Their prostate volumes were >50 mL and the number of biopsies taken was >30 cores. There was no mechanical failure, sepsis, bleeding per-rectal, or perineal hematoma. CONCLUSION: This pilot study demonstrated BioXbot's safety and feasibility as a biopsy platform. It can potentially be used for image-guided PB and focal therapy.

Granular Leidenfrost effect in vibrated beds with bumpy surfaces.

The effects of subjecting a bed of granular materials to horizontal vibrations by a bumpy oscillating surface have been investigated computationally in this study. The behaviour of the granular bed is determined by the vibration conditions applied which include the vibrating frequency and amplitude as well as the bumpiness of the oscillating surface. Under sufficiently vigorous vibration conditions, the granular Leidenfrost effect whereby the entire granular bed is levitated above the vibrating base by a layer of highly energetic particles may be observed. Granular temperature profiles of systems that exhibit the granular Leidenfrost effect indicate an unequal distribution of energy between particles near the vibrating base and those in the bulk. A bumpy oscillating surface was also observed to be more effective at introducing perturbations and transferring energy into a granular bed. The granular Leidenfrost effect can be induced by the application of larger grain sizes of particles constituting the bumpy vibrating base under vibration conditions that are normally insufficient for the onset of the effect. Lastly, a phase diagram which can be utilized for predicting the behaviours of granular beds that are subjected to oscillations by various types of bumpy surfaces has been constructed based on the simulation results obtained.

Suicide by burning barbecue charcoal: three case reports.

We report three cases of suicide in Scotland where barbecue charcoal was purposely burned in confined areas (an outbuilding, a car and a bedroom). External examination of the three cases revealed a distinctive 'cherry red' discolouration to the post-mortem lividity and blood and there were no marks or injuries to the bodies to give any cause for concern. Toxicological analysis of femoral blood samples revealed fatal levels of carbon monoxide (70%, 85% and 80% respectively). Considering the history, circumstances and external findings, a 'View and Grant' examination was conducted in all three cases and the cause of death was attributed to carbon monoxide poisoning due to inhalation of burning charcoal fumes. This particular method of suicide is not common in Europe and is more widely reported in the Far East.

Endogenous source of bacteria in tracheal tube and proximal ventilator breathing system in intensive care patients.

Although bacteria from both the ventilator breathing system and the gastrointestinal tract have been implicated in the pathogenesis of ventilator-associated pneumonia, an endogenous source of bacteria in the proximal respiratory breathing system has yet to be demonstrated conclusively. We investigated a potential route of bacterial colonization from the stomach contents to the efferent limb of the ventilator breathing system by bacterial culture of daily specimens from six sites in 20 surgical intensive care patients. Gram-negative bacilli were isolated in a progressively increasing proportion of samples at successive sampling points, consistent with an endogenous-to-external route of spread (patients, chi-square = 14.12, P < 0.02; samples, chi-square = 106.15, P < 0.001). Identical strains of gram-negative bacilli, confirmed by REPS typing, were found at two or more sites in seven patients. In all seven, gram-negative bacilli were first isolated from a site in the patient. In none of the 20 patients was there evidence of a sequence of colonization from the ventilator tubing or Y-piece connector towards the patient. Probable colonization sequences plotted from the time of first isolation supported the proposed sequence in six patients, and in five began with the stomach contents. Isolation sequences contrary to the proposed direction of colonization involved four bacterial species and two patients, and did not extend beyond two sample sites. These findings imply that the retrograde route of bacterial colonization of the ventilated lung extends into the proximal respiratory breathing system and may help to identify additional targets for preventive intervention.

Bacteria, viruses, yeasts and protozoans associated with diarrheal disease in Singapore.

Labile toxin producing enterotoxic E. coli (ETEC) were the commonest pathogen isolated from diarrheal stools of hospitalized children (21%) and adults (26%) in Singapore. Salmonellas ranked a close second in children (19%). Other bacterial pathogens were isolated from less than 5% of subjects. Blastocystis hominis was detected in 4.3% of diarrheal stools when a simple sedimentation technique was used. Cryptosporidium was not detected at all. An analysis of yeast counts in smears of diarrheal and non-diarrheal stools suggested they were etiologically associated with at least 6% of diarrhea in children and 19% in adults. Testing for rotaviruses by Latex agglutination and for adenovirus by electronmicroscopy showed an association with 6 per cent and 3 per cent diarrhea respectively. The study highlighted a need for: case control studies on ETEC and B. hominis; studies on the epidemiology of diarrhea by yeasts; establishing the true incidence of adenovirus diarrhea; studies on the prevalence and seasonality of rotavirus infection in Singapore.

Legionella species, serogroups and subgroups found in the environment in Singapore.

Over a period of seven months, 87 samples of water collected from 48 air-conditioning cooling-towers on 15 sites in Singapore yielded 19 strains of Legionella. Legionellas were found in 7 of the 15 sites. The strains isolated fell into 7 species, serogroups or subgroups of the genus Legionella. Only 11% of them belonged to the more pathogenic Pontiac subgroup of Legionella pneumophila serogroup 1.

The specificity of a rapid method of assay for the presence of Legionella species in water.

A rapid method of assay, using a monoclonal antibody linked to alkaline phosphatase, was used for the detection of the Pontiac subgroup of Legionella pneumophila serogroup 1. It was tested for its specificity against 53 strains of Legionella recently isolated from the environment in Singapore and Malaysia. The specificity and sensitivity of this method of assay was confirmed, though there is some concern that the specificity was too narrow, and there are reservations about the criteria suggested for interpreting the results.

Intestinal bacterial flora of the household lizard, Gecko gecko.

A total of 114 isolates was recovered from the intestines of 43 househould lizards, Gecko gecko. Among the important ones were Staphylococcus aureus, Salmonella typhimurium, Pseudomonas aeruginosa, Proteus mirabilis and Edwardsiella tarda.

Ecology of mycoplasmas in clinically healthy cats.

Mycoplasmas were isolated from various sites and organs of a series of 319 clinically healthy cats. They include M. felis, M. gateae, M. Arginini, A. laidlawii, feline ureaplasmas, M. pulmonis, M. arthritidis, and M. gallisepticum. In addition, there were 10 strains of mycoplasmas which could not be identified with the specific antiserums by growth inhibition tests. Antibody against M. felis was demonstrated by haemagglutination-inhibition and complement-fixation tests in cats which were over 6 months of age. However, no such antibody against M. felis was detected in animals which were less than 6 months old. No antibody against A. laidlawii, M. gateae, M. arginini and feline ureaplasmas was demonstrated by the same serological methods. The significance of these mycoplasmas in cats is described.

Significance and pathogenic role of Mycoplasma arginini in cat diseases.

Eighty-one strans of Mycoplasma arginini were isolated from swabs and tissues cultured from a series of 555 cats. The majority of these strains (84%) were recovered from the oropharyngeal regions. M. arginini was experimentally inoculated into young kittens. No clinical disease was produced. However, there was rapid colonization in the inoculated sites.

Torulopsis glabrata infections in Singapore: a 4-year study.

During the period 1971-4, Torulopsis glabrata formed 42% of yeasts isolated from 5677 clinical specimens from patients with cancers, diabetes mellitus, chronic renal failure, pregnacy or major surgical operations complicated by mycotic infections. The significance of T. glabrata in these patients is discussed.

Torulopsis glabrata--urinary tract infections in diabetic patients in Singapore.

Urinary tract infections result mostly from ascending infection by micro-organisms introduced by way of the urethra. Bacteria are the usual causative agents. Occasionally, yeasts notably Candida albicans, are involved. Females are more prone to acute infections than males because of shorter urethra and the higher risks of contamination in the females.