The Early Impact of COVID-19 on Urological Service Provision.

Aim COVID-19 has posed an unprecedented challenge to healthcare systems. We aimed to observe the impact on urological care delivery in an Irish university hospital. Methods Data on urological activity was prospectively collected for 3 months from March 2020. A retrospective review of the same period in 2019 was performed for control data. Results Over the 2020 study period, 356 urological admissions were recorded; a 23.1% decrease from the 2019 corresponding period(n=463). A 21.7% decrease in flexible cystoscopies was seen (162 versus 207). 125 theatre cases (36 off-site) were performed in the 2020 period, versus 151 in 2019. Emergency case load remained stable, with 69 cases in the 2020 period. The percentage of trainee-performed cases was preserved. COVID-era outpatient activity increased, to involve 559 clinic consultations compared to 439 the preceding year; a reflection of annual growth in service demand and facilitated by virtual clinic application (n=403). There were 490 instances of patients cancelling/failing to attend outpatient appointments, compared to 335 in 2019. Conclusion The Irish COVID-19 outbreak has created obstacles for urological care. Nonetheless, urgent/emergent urological cases persist. Our unit has managed this to-date with flexible adaptation of service delivery. The global challenge posed by COVID-19 will demand ongoing resourcefulness to minimise impact on patients with time-sensitive urological conditions.

Single centre experience of hypothermic machine perfusion of kidneys from extended criteria deceased heart-beating donors: a comparative study.

INTRODUCTION: Kidneys from extended criteria donors are associated with higher rates of delayed graft function (DGF). Hypothermic machine perfusion (MP) for storage is associated with more favourable outcomes. METHODS: A retrospective analysis was performed in 93 patients where the kidney was stored using hypothermic MP (LifePort(®)) and compared to an age-matched control group where the kidney was stored in cold static storage (CSS) using University of Wisconsin solution. RESULTS: Median age was similar in both groups (59.2 years in MP vs 59.9 years in CSS, p = 0.5598). Mean cold storage time was 15.6 h in MP vs 17.9 h in CSS. Post transplant mean serum creatinine was as follows; MP group-144.7 µmol/L at 1 month; 138.3 µmol/L at 3 months and 129.5 µmol/L at 12 months. In the CSS group-163 µmol/L at 1 month; 154.9 µmol/L at 3 months and 140.2 µmol/L at 12 months. There was a statistically significant difference at 1 month (p = 0.0096) and 3 months (p = 0.0236). DGF was defined as the need for haemodialysis within 7 days post transplant. In the MP group, DGF occurred in 17.2 % patients with mean of 6 days (range 1-18). In the CSS group, 25.8 % patients with mean of 8.1 days (range 3-25). One-year graft survival rate was better in the MP group (97.85 vs 96.77 %). CONCLUSION: Our experience to date recommends the use of hypothermic MP for storage of kidneys from extended criteria deceased heart-beating donors.

A single centre experience of active surveillance as management strategy for low-risk prostate cancer in Ireland.

INTRODUCTION: Active surveillance (AS) is a management strategy for addressing the widely acknowledged problem of over diagnosis and over treatment of clinically indolent prostate cancer. METHODS: A total of 80 patients were enrolled on the AS program in our institution between January 2008 and June 2012. All data were collected prospectively in a secure database. RESULTS: The mean age of patients enrolled was 62.7 years (range 50-72). Median PSA at enrolment was 5.6 ng/mL (range 1.2-13.4). The mean follow-up was 32 months (range 2-54). In total, 85 % of patients had a repeat biopsy after 1-year with 30 % having another biopsy after 3 years. Overall, 45 % of patients remain on AS. In the remainder; 42.5 % of patients have been removed from AS for definitive treatment, while 8.75 % of patients are now on watchful waiting, 2.5 % of patients self discharged from the program and one patient died of cardiovascular disease. The prostate cancer specific survival rate is 100 %. Reasons for removal from AS and referral for treatment were; 67.6 % of patients had upgrade of disease on repeat biopsy, 17.6 % of patients had PSA progression, 11.8 % patients had progression of disease on MRI, and one patient developed a palpable nodule. Regarding definitive treatment; 52.9 % of patients have been for referred for external beam radiotherapy, 14.7 % have been referred for brachytherapy, 29.4 % have been referred for surgery and one patient has refused definitive treatment. CONCLUSION: Our findings to date support active surveillance as a valid strategy for early, localised prostate cancer.

Survival and progression in high grade tumour subset of G2 and G3 pT1 bladder transitional cell carcinoma.

AIMS: The newer 1998 WHO/ISUP grading system for bladder transitional cell carcinoma combined grade 3 (G3) and high grade tumour subset of grade 2 (G2) of the older 1973 WHO grading system into one homogenous high grade group. We evaluated for possible differences in survival and progression between these 2 grades in pT1 bladder tumours. METHODS: From Jan 1(st) 1991-Dec 31(st) 2003, 105 (61 G2 and 44 G3) pT1 bladder tumours fulfilled the 1998 WHO/ISUP high grade criteria. Survival and progression of these tumours were assessed. RESULTS: Of the 44 patients with G3 tumours, 20 are alive versus 22 of the 61 patients with high grade tumour subset of G2 (P=0.04). Of the 44 patients with G3 tumours, 13 progressed versus 12 of the 61 patients with high grade tumour subset of G2 (P=0.02). In multivariate analysis, G3 was a significant predictor of tumour progression (P=0.05) and marginally non-significant predictor of poor patient survival (P=0.056). CONCLUSIONS: A notable difference in survival and progression between high grade tumour subset of G2 and G3 is observed.

Magic nucleus 132Sn and its one-neutron-hole neighbor 131Sn.

Prompt and delayed gamma-ray cascades in doubly magic 132Sn and its neighbor 131Sn have been studied at Gammasphere using a 248Cm fission source. Isotopic assignments of unknown gamma rays were based on coincidences with known transitions in A = 112-116 Pd fission partners. The yrast level spectra of both tin nuclei are interpreted using empirical nucleon-nucleon interactions from the 132Sn and 208Pb regions. Results include identification of the (nuf(7/2)h(-1)(11/2))9(+) aligned state in 132Sn and of extensive (nuf(7/2)h(-2)(11/2)), (nuf(7/2)d(-1)(3/2)h(-1)(11/2)) and (nuh(-1)(11/2)x3(-)) multiplets in 131Sn. The previously reported beta(-) decay of an unusual 131In high-spin isomer to levels in 131Sn is also elucidated.

Phase transitions above the Yrast line in 154Dy.

Spectra of the E2 quasicontinuum gamma rays feeding different spin regions of the 154Dy yrast line have been extracted. These are compared with corresponding theoretical spectra obtained by numerical simulations based on temperature-dependent Hartree-Fock theory, with thermal shape fluctuations. In this manner, different regions of the spin-energy plane can be examined. The results support the predictions of a smeared-out phase transition at high spin above the yrast line.

Operative correction of an unstable total hip arthroplasty.

We reviewed the results of reoperation in ninety-five patients who had acute subluxation (ten patients) or dislocation (eighty-five patients) of the hip after conventional cemented total hip-replacement arthroplasty. Postoperatively, fifty-eight patients (61 per cent) had no subsequent dislocation or subluxation. Seven of thirty-seven patients who had had recurrent dislocation had occasional subluxation during follow-up. Of the remaining thirty patients in whom instability persisted after the reoperation, twenty-eight had at least one dislocation, and nine had bothersome subluxation. Ten of these thirty-seven patients had another operation for the persistent instability. The causes of instability were classified as malrotation of the component, disruption of the trochanteric-abduction mechanism, impingement, or multiple and unknown, and appropriate treatment was provided. The component was revised in forty-five patients, revision and advancement of the trochanteric component was done in twenty-five patients, and impinging bone or cement was removed from six patients; a combination of these procedures was done in nineteen patients. Over-all, fifty-eight procedures (61 per cent) were successful (no additional subluxations or dislocations). We concluded that the results of operative treatment for an unstable total hip replacement can be optimized when a precise determination of the cause of the instability is made and appropriate measures are applied.

Plantar fasciotomy for intractable plantar fasciitis: clinical results and biomechanical evaluation.

Thirteen consecutive patients underwent plantar fasciotomy in 16 feet for intractable plantar fasciitis and had follow-up from 4.5 to 15 years. Plantar fasciotomy was successful (good or excellent results) for 71% of the 14 feet operated on and for which follow-up data were available. However, time to full recovery was prolonged, additional treatment was frequently required, and abnormalities of foot function persisted. Flattening of the longitudinal arch occurred. Dynamic force-plate studies showed differences in peak vertical, fore-aft, and lateral-medial forces between patients and matched controls. More rapid progression of weightbearing along the longitudinal axis of the foot during stance phase in patients indicated avoidance of heel loading.

Treatment of painful subluxation or dislocation at the second and third metatarsophalangeal joints by partial proximal phalanx excision and subtotal webbing.

Pain at the second or third metatarsophalangeal joint associated with objective instability and roentgenographic displacement is a common forefoot problem. In 53 patients (60 feet), surgical correction of the painful deformity was completed by resecting the bases of the proximal phalanges of Toes 2 and 3 combined with subtotal webbing of the toes. At an average follow-up period of 29.8 months, 38% were wholly satisfied; 37%, satisfied with minor reservations; 15%, satisfied with major reservations; and 10% were not satisfied. When graded for pain, cosmesis, and footwear use, the most improvement was noted for pain symptoms. No significant effect of earlier forefoot surgery was noted. Residual complaints, such as persistent pain and unstable sensation of the webbed toes, were rarely disabling and usually minor compared to the preoperative status.

Total shoulder arthroplasty with a tissue-ingrowth glenoid component.

A newly designed, uncemented, tissue-ingrowth glenoid component with a porous surface was used in association with the Neer humeral head prosthesis for 32 total shoulder arthroplasties in 29 patients. The diagnoses for the shoulders were osteoarthritis in 17, rheumatoid arthritis in eight, and traumatic arthritis in seven. Follow-up evaluations averaged 51 months (range, 29 to 80 months). Five complications occurred, necessitating four reoperations: two for glenoid component dissociation, one for humeral loosening, and one for infection. Little or no pain was experienced after the operation in 27 (96%) of the 28 shoulders that required no additional surgery. Average active abduction was 145°, average external rotation was 59°, and median internal rotation was to 112. Three glenoid components had probable loosening on radiographic examination. Eight shoulders had some degree of instability; a complication related to the glenoid component (polyethylene dissociation) or probable loosening not yet requiring reoperation developed in four of these (p < 0.02). These data support the continuing use of an uncemented, tissue-ingrowth glenoid component in arthritic shoulders with adequate bone support. Joint instability must be avoided to lessen complications and the need for revision surgery.

Ice hockey injuries. A review.

Ice hockey is a fast-paced game involving both finesse and controlled aggression. Injuries are related to direct trauma (80%) and overuse (20%), with high puck velocities, aggressive stick use, and body checking (collisions) accounting for most of these. A participant can anticipate an injury after playing 7 to 100 hours of hockey, depending on his age, and most injuries are caused during the actual game rather than during practice. Although facial injuries are common, they are decreasing because of adequate use of helmets and masks. Conversely, cervical spine injuries are being reported more frequently. Injuries to the upper extremity include acromioclavicular joint dislocations, scaphoid fractures, and 'gamekeeper's thumb.' Injuries to the lower extremity predominantly involve soft tissue, with strains of the hip adductor, tears of the medial collateral ligament of the knee, and contusions of the thigh are common. Scientific studies have reduced injury by providing improved protective equipment, stricter rules and their enforcement, and effective training and conditioning.

Epidemiology of ocular herpes simplex. Incidence in Rochester, Minn, 1950 through 1982.

Over the period 1950 through 1982, 122 Rochester, Minn residents had their first episode of ocular herpes simplex virus infection, for an age- and sex-adjusted incidence of 8.4 new cases per 100,000 person-years (95% confidence intervals [CI], 6.9 to 9.9 cases). These initial episodes involved lid or conjunctiva in 54%, superficial cornea in 63%, deeper cornea in 6%, and uveitis in 4%. An additional 29 residents had episodes of ocular herpes other than their first. Altogether, these 151 residents had 294 episodes of ocular herpes simplex infection, for an adjusted incidence of 20.7 episodes per 100,000 person-years (95% CI, 18.3 to 23.1 episodes). Age-adjusted rates by sex were comparable. There were no seasonal trends in incidence, but rates increased with time. On January 1, 1980, the prevalence of a history of ocular herpes simplex infection was 149 per 100,000 population (95% CI, 115 to 183).

Dedifferentiated chondrosarcoma of bone.

Dedifferentiated chondrosarcoma is a highly malignant variant of chondrosarcoma. Approximately 11% of chondrosarcomas can be expected to dedifferentiate into more anaplastic lesions. Radiographic evidence of a benign-appearing cartilage lesion adjacent to a lytic, highly aggressive lesion suggests dedifferentiation. Despite radical surgical treatment, the prognosis is unfavorable, with a 5 year survival rate of 10%.

Intraosseous ganglion cysts.

An illustrative case report of intraosseous ganglion cyst is presented. Intraosseous ganglion cysts are uncommon, juxta-articular, and benign. They are thought to arise from an intramedullary metaplastic event. Intraosseous ganglia are most common in middle-aged patients. They usually involve the tibia but also are located in other skeletal sites. The lesion is typically epiphyseal and appears benign. It is successfully treated with curettage and bone graft if it is symptomatic or progressively increasing in size. It is important to avoid extensive surgical procedures. Recurrence is unlikely.

Epidemiology of ankle fractures in Rochester, Minnesota.

The epidemiology of ankle fractures was examined among Rochester, Minnesota, residents during the 3-year period 1979-1981. Ankle fractures occurred with an overall age- and sex-adjusted incidence rate of 187 per 100,000 person-years; this is higher than in earlier population-based studies. The most frequent cause of ankle fractures was sports-related trauma. The incidence of fractures associated with moderate trauma, on the other hand, increased markedly in middle-aged women, but declined in elderly women. Diabetes mellitus and obesity were associated with fractures in middle-aged and older adults. Of accepted classifications, the Lauge-Hansen system provided the most clinically relevant information.

Endoneural and epineural blood flow evaluation with free vascularized and conventional nerve grafts in the canine.

Blood flow distribution in conventional and vascularized canine nerve grafts was analyzed. Between 4 and 6 days after operation, blood flow at both the fascicular (endoneural) and the nerve-sheath (epineural) levels was significantly greater in the nonvascularized nerve grafts than in their vascularized counterparts (P less than 0.025 and P less than 0.001, respectively). The superior flow rates of the conventional grafts illustrate the efficiency of nerve revascularization, even to the fascicular level. This finding does not support a possible endoneural vascular advantage of vascularized nerve graft and suggests the need for further analysis of the role of vascularized nerve grafting.

Medical planning for a major event: the Pope's visit to Coventry Airport, 30 May 1982.

The five-hour day visit by the Pope to Coventry Airport on 30 May 1982 required a major exercise in medical planning. First- and second-line first-aid facilities were provided by the British Red Cross Society and the St John Ambulance Association. Hospital facilities were provided in a 30-bed Territorial Army field hospital. The visit attracted a crowd of 350,000; 1424 casualties were seen at first-aid stations and 152 at the field hospital. Twenty patients required transfer to NHS hospitals for further treatment, and one woman died. Most ailments experienced were headaches and effects of heat, blisters, and abdominal symptoms. The field hospital treated a wide range of conditions including cardiac conditions, fractures, premature labour, and acute abdominal emergencies.

Focal plane temperature stability requirements for thermal imaging systems using extrinsic Si:ln detectors.

The use of Si:In IR detectors in high performance thermal imaging systems imposes a stringent requirement on the temperature stability of the focal plane. In this paper, we calculate that temperature fluctuations of the focal plane must be kept to less than either 12 mK or 1.2 mK for thermal imaging systems capable of resolving 0.1 degrees C or 0.01 degrees C temperature differences, respectively, in the scene being imaged.