To cystoscope or not to cystoscope patients with traumatic spinal cord injuries managed with indwelling urethral or suprapubic catheters? That is the question!

STUDY DESIGN: Retrospective review of findings during cystourethroscopic surveillance of symptomatic and asymptomatic patients with indwelling urethral catheters (IUC) and suprapubic catheters (SPC) monitored between January 2003 and December 2008. OBJECTIVES: To audit and compare findings between symptomatic and asymptomatic patients and between SPC and IUC population. To systematically review the literature including the recent National Institute for Health and Clinical Excellence guidelines on cystoscopic surveillance. METHODS: Theater management system and the electronic patient records used to retrieve demographics, injury details and operative findings. RESULTS: Of 925 cystoscopies performed in 507 patients, 449 were performed in 277 patients with IUC/SPC. Only 419 procedures (SPC 264; IUC 155) in 262 patients fit the inclusion criteria. Thirty procedures in fifteen non traumatic patients were excluded. Statistically there was no significant difference in incidence of findings between the symptomatic and asymptomatic group. Recurrent blockage of catheter was predominant in the SPC group and symptomatic urinary tract infections (UTIs) were the most common indications in the IUC group. In the asymptomatic group, there were 44 squamous metaplastic changes in 27 patients. Two of these patients had keratinizing variants. The duration of catheterization ranged from 20 months to 27 years and mean of 13.7 years. The average duration between two cystoscopies in the symptomatic group was 16 months compared with an average 21 months in the asymptomatic group. CONCLUSION: Cystourethroscopic surveillance in high-risk patients with IUC/SPC is essential to diagnose and manage at an early-stage complications associated with IUC/SPC, minimize symptomatology, mitigate aggravation of complications, maintain good health and probably good quality of life.

Laboratory tests of low density astrophysical nuclear equations of state.

Clustering in low density nuclear matter has been investigated using the NIMROD multidetector at Texas A&M University. Thermal coalescence modes were employed to extract densities, ρ, and temperatures, T, for evolving systems formed in collisions of 47A MeV (40)Ar+(112)Sn, (124)Sn and (64)Zn+(112)Sn, (124)Sn. The yields of d, t, (3)He, and (4)He have been determined at ρ=0.002 to 0.03 nucleons/fm(3) and T=5 to 11 MeV. The experimentally derived equilibrium constants for α particle production are compared with those predicted by a number of astrophysical equations of state. The data provide important new constraints on the model calculations.

Experimental determination of in-medium cluster binding energies and Mott points in nuclear matter.

In-medium binding energies and Mott points for d, t, 3He and α clusters in low-density nuclear matter have been determined at specific combinations of temperature and density in low-density nuclear matter produced in collisions of 47A MeV 40Ar and 64Zn projectiles with 112Sn and 124Sn target nuclei. The experimentally derived values of the in-medium modified binding energies are in good agreement with recent theoretical predictions based upon the implementation of Pauli blocking effects in a quantum statistical approach.

Traumatic spinal injury and spinal cord injury: point for active physiological conservative management as compared to surgical management.

The controversy about surgical vs conservative treatment of the injured spine with cord damage is centuries old. Until the end of the Second World War the majority of patients died or lived a short miserable life. Subsequently, Guttmann, an experienced neurosurgeon, realised surgery was not beneficial and sometimes detrimental to the person with spinal cord injury. Guttman, Frankel and others demonstrated with expert conservative management of the spine and the multi-system consequences of cord damage most patients made some neurological recovery and most with incomplete cord injury recovered ambulation regardless of X-ray findings. Attention to the non-medical effects of paralysis and post discharge supervision enabled persons with SCIs to enjoy complication free, dignified, productive and even competitive lives in sport and employment. The introduction of CT, MRI and safe anaesthesia led to the beliefs that surgical realignment, stabilisation and/or decompression improved neurologic outcome, facilitated early mobilisation and completion of rehabilitation, shortened hospitalisation, facilitated management and reduced cost. However, there is no supporting evidence for these claims. This manuscript describes the rationale and outcomes of conservative management and the weakness of the arguments for surgical management.

Trends of total reaction cross sections for heavy ion collisions in the intermediate energy range

Direct measurements of total reaction cross sections (sigma R) have been performed in the energy range of 10-300 MeV/nucleon for heavy ion collisions. A decrease of sigma R with increasing energy was observed for a wide range of masses of the colliding systems. The data suggest that sigma R reaches a minimum located around 300 MeV/nucleon independently of the projectile target combination. A dependence of sigma R on mass asymmetry of the svstem is also demonstrated. Trends of sigma R in this energy range are well reproduced by the predictions of a simple microscopic model based on individual nucleon-nucleon collisions. Our data have been employed in this framework to derive a new semi-empirical parametrization of sigma R. Most of the experimental results in the intermediate and high energy range have been reproduced by this parametrization using a single energy-dependent parameter.