Qualitative and quantitative detection of urinary human complement factor H-related protein (BTA stat and BTA TRAK) and fragments of cytokeratins 8, 18 (UBC rapid and UBC IRMA) as markers for transitional cell carcinoma of the bladder.

OBJECTIVE: To evaluate the role of BTA stat, BTA TRAK, UBC Rapid, UBC IRMA and voided urinary cytology in the detection of bladder transitional cell carcinoma (TCC). METHODS: The study included 78 patients with TCC of the bladder (group A), 62 patients with a history of bladder TCC without tumor recurrence at the time of examination (B, control group), 20 patients with other malignancy of the urinary tract (C), 38 patients with non-malignant urinary tract diseases (D), 10 patients with urinary tract infection (E) and 10 healthy volunteers (F). Except in group F, voided urine was collected before cystoscopy or cystectomy. RESULTS: The specificity and sensitivity in bladder cancer detection were 87.1 and 74.4%, respectively with BTA stat, 79.3 and 48.7%, respectively with UBC Rapid, 100 and 33.3%, respectively with cytology, 72.6 and 75.6%, respectively with BTA TRAK, 64.5 and 70.5%, respectively with UBC IRMA. CONCLUSIONS: The BTA stat and BTATRAK tests are superior to UBC Rapid, UBC IRMA and urinary cytology in detection of bladder TCC. In daily practice however cytology remains the best adjunct to cystoscopy because of its high sensitivity in Tis and 100% specificity. Cystoscopy cannot be replaced by any of evaluated methods.

Causes and treatment of residual urine volume after orthotopic bladder replacement in women.

OBJECTIVES: Intact innervation of the female urethra is conditional for normal urination. In the past, urethrectomy was performed as part of cystectomy. After intense anatomical studies of the female pelvis, urethral-function-sparing cystectomy was developed. METHODS: Our clinical group consists of 41 female patients who were operated from 1993 to 1998 for bladder cancer, utilizing cystectomy with orthotopic bladder replacement. RESULTS: In 28 patients, complete daytime continence was restored and in 13 patients, daytime continence was socially satisfactory (1-2 pads were used due to mild stress incontinence). The drawback of orthotopic replacements in females is the frequent development of serious residual volume, which was seen in one third of the 41 patients. The functional results of orthotopic neobladders and therapy of residual urine volume were documented using urodynamic studies. CONCLUSIONS: Postvoiding residual volume may be caused by isolated dysfunction of the urethra and can be treated with clean intermittent self-catheterization or with alpha-blockers, which improve evacuation of the neobladder.

CT-guided intervention using a patient laser marker system.

To prove the usefulness of a simple laser marker system (LMS) in target definition as well as examination procedure for CT-guided interventions, 130 cases of diagnostic biopsies and lumbal sympathectomies were compared. In 75 cases LMS and in 55 cases a simple crossgrid was used. Taking advantage of the LMS, the parameters of intervention (cutaneous location, length, and angle) can be planned, exactly demonstrated, and it is possible to check the needle position during the whole procedure. Thus, the number of necessary control scans decreased to 30%, and corrections of needle location were reduced to approximately 30%. Moreover, the average target deviation of the needle decreased below 5 mm in 50% of cases, and the duration of interventional procedure was reduced considerably. It can be concluded that LMSs are recommended in CT-guided interventions for quality assurance, dose reduction, and improvement of handling. It will be especially advantageous in cases of small target volume, oblique needle path, and tilted gantry.

Effect of patient-controlled analgesia on pulmonary complications after coronary artery bypass grafting.

OBJECTIVE: To determine whether treatment with patient-controlled analgesia (PCA) alone or in combination with nonsteroidal anti-inflammatory drugs can prevent postoperative pulmonary complications after cardiac surgery, when compared with conventional nurse-controlled analgesia. DESIGN: Randomized controlled trial. SETTING: University Medical Center. PATIENTS: A total of 120 patients undergoing elective coronary artery bypass grafting. INTERVENTIONS: After extubation of the trachea, 120 patients were randomly allocated to three different methods of postoperative pain relief for 72 hrs. In group 1, patients received PCA with a bolus of 1.5 mg piritramide combined with a 10-min lockout interval. Group 2 patients were treated with a combination of PCA and administration of nonsteroidal anti-inflammatory drugs prescribed three times per day. Patients of group 3 received conventional nurse-controlled analgesia. Postoperative assessment included daily visual analog pain scoring (VAS) and chest radiographs. All chest radiographs were graded for the extent of atelectasis by a radiologist blinded as to treatment using a scale from 0 to 9 for each of the three lung fields of the right and left lungs. MEASUREMENTS AND MAIN RESULTS: Chest radiograph atelectasis scores and VAS values were similar among the three groups on the first and second days. On the third day, the chest radiograph atelectasis scores of the left lower and the right middle lung field were significantly better in the groups treated with PCA alone (4.7 +/- 3.0; 0.3 +/- 1.0) and in combination with nonsteroidal anti-inflammatory drugs (3.9 +/- 1.1; 0.4 +/- 1.2) than in the control group (5.5 +/- 3.1; 0.8 +/- 1.8). Furthermore, on the third day, the VAS values for maximum pain were higher in the control group (42.6 +/- 19.7) compared with the VAS values in the two groups with PCA (32.2 +/- 17.9 and 34.5 +/- 21.0). CONCLUSIONS: PCA significantly decreases postoperative pulmonary atelectasis in patients after coronary artery bypass grafting when compared with nurse-controlled analgesia. In addition, patients treated with PCA experienced a higher quality of analgesia. We therefore conclude that treatment with PCA may reduce respiratory complications after coronary artery bypass grafting.

[Reduction of radiation exposure for patient and investigator in interventional radiography]. / Reduktion der Strahlenexposition in der interventionellen Angiographie für Patient und Untersucher.

PURPOSE: In a retrospective analysis of vascular interventional procedures, relations between parameters of the examination and radiation exposure of patient and medical personnel are examined. MATERIAL AND METHOD: 1208 vascular interventional procedures are evaluated. Interventional procedures are divided into three groups: percutaneous transluminal angioplasty, implantation of a stent, thrombolysis. RESULTS: Mean values of the radiation dose of patient and radiology personnel are reported for these examinations. The mean value of the radiation dose of the physician was 7 microSv (maximum 24 microSv), that of the patient 1548 cGy.cm2 (maximum 8485 cGy.cm2). CONCLUSION: The quantity of X-rays to the patient may be lowered by using pulsed fluoroscopy and by reducing the number of radiographs. Reduction of the number of radiographs may be achieved by using the last-image hold and the road mapping mode. The operator's dose can be decreased by using additional radiation protection systems like a MAVIG-radiation protection wall. The radiation dose reduction was 61% for the physician and 17% for the patient.

Lobomycosis (keloidal blastomycosis): case reports and overview.

Lobomycosis is a deep fungal disease of the skin without involvement of internal organs or mucous membranes. The disease is characterized by skin nodules and plaques resembling keloid involving the earlobes, distal parts of the upper and lower extremities, and buttocks. In severe cases, large skin areas can be covered by disseminated or grouped and confluent nodules. Most cases are reported from South and Central America. The fungus Paracoccidioides (Glenosporella) loboi is abundant in lesions but is extremely difficult to culture. Lobomycosis is resistant to chemotherapy, but in some cases it can successfully be treated by excision. Although the diagnosis is easily established by its typical clinical, histologic, and microbiological features, it is often misdiagnosed by physicians not familiar with the disease. We describe here five patients and present an overview of this rare disease.

Cellular immunity in lobomycosis (keloidal blastomycosis).

The cellular immune response of twelve patients from the Brazilian Amazon basin with lobomycosis were assessed. Delayed skin reaction to bacterial and fungal antigens, skin allograft rejection, and sensitization to dinitrochlorobenzene were studied. Ninety-two percent of the patients were not reactive to dinitrochlorobenzene after sensitization; skin allograft rejection occurred in an average of 17 days. Delayed skin reaction to streptococcal, staphylococcal, trichophytin and candida antigens was negative in the majority of the patients. Reactivity to mycobacterial antigens, however, was very high. The results suggest that patients with lobomycosis are partially cellular immunodeficient.

[Histopathological aspects of tertiary pinta]. / Aspectos histopatológicos da pinta terciária.

A study was made of twenty-two biopsies of achromic lesions of Tikuna Indians, carriers of tertiary pinta, inhabitants of the Umariuassu island, on the Peruvian border, ten of the subjects had been treated two years previously with a single dose of penicillin. The histopathological picture was similar for both groups. In most cases (86.36%) slight hyperkeratosis was found on the epidermis, as well as acanthosis (18.18%), with atrophy in only two cases (9.09%). In all cases there was a reduction of the melanin of the basal layer. The inflammatory lymphocyte infiltrate was predominantly perivascular (88.18%). There wasn't any endothelial swelling.

Incidencia de dermatite de contato em Manaus. / Incidence of contact dermatitis in Manaus

Os autores estudaram a incidencia de dermatite de contato em Manaus, sob o ponto de vista de sexo, com predominio do feminino (58,28%) sobre o masculino (41,72%), de agentes sensibilizadores, destacando-se o bicromato de potassio (12,99%), mercaptobenzotiazol (11,90%) e sulfato de niquel (11,25%) dentre outros; de profissoes, salientando-se cozinheiras (28,80%) e pedreiros (10,6%); locais afetados e grupo etario, acometendo principalmente adultos jovens (34,85%)

Prevalencia de micoses superficiais em escolares de localidades da regiao amazonica ocidental(fronteira Brasil-Colombia). / Occurrence of superficial mycosis in students of the westrn amazon region (frontier Brazil-Colombia

Realizaram-se estudos micologicos em escolares nos vilarejos da fronteira Brasil-Colombia em julho de 1978, dentro da floresta amazonica. Observaram-se prevalencia da pityriasis versicolor em escolares de Ypiranga e Vila Bittencourt e de Piedra Negra em escolares de Cucui, seguidas da tinea capitis por Trichophyton tonsurans. Analisou-se a predominancia das micoses superficiais no sexo feminino