Plasma concentrations of coffee polyphenols and plasma biomarkers of diabetes risk in healthy Japanese women.

Coffee consumption has been reported to reduce the risk of type 2 diabetes in experimental and epidemiological studies. This anti-diabetic effect of coffee may be attributed to its high content in polyphenols especially caffeic acid and chlorogenic acid. However, the association between plasma coffee polyphenols and diabetic risks has never been investigated in the literature. In this study, fasting plasma samples were collected from 57 generally healthy females aged 38-73 (mean 52, s.d. 8) years recruited in Himeji, Japan. The concentrations of plasma coffee polyphenols were determined by liquid chromatography coupled with mass tandem spectrometer. Diabetes biomarkers in the plasma/serum samples were analysed by a commercial diagnostic laboratory. Statistical associations were assessed using Spearman's correlation coefficients. The results showed that plasma chlorogenic acid exhibited negative associations with fasting blood glucose, glycated hemoglobin and C-reactive protein, whereas plasma total coffee polyphenol and plasma caffeic acid were weakly associated with these biomarkers. Our preliminary data support previous findings that coffee polyphenols have anti-diabetic effects but further replications with large samples of both genders are recommended.

B-type natriuretic peptide in lymphedema.

Lymphedema often responds to compression therapy which can also cause undesirable cardiac overload if heart failure coexists. We hypothesized that the biomarker B-type natriuretic peptide (BNP) can be used to screen lymphedema patients for undetected cardiac dysfunction. We studied unselected consecutive patients with lymphedema to determine their BNP status and compared these data with those obtained from healthy subjects without known cardiovascular diseases. Out of a total of 305 subjects with lymphedema screened, 102 (33%) consented to take part in this study. The majority (87%) were female with a mean age of 60.5 +/- 13.2 (SD) years, and 47% had just lower limb swelling. The groups were equally divided between cancer and non-cancer related causes. There were 45 females and 4 males under 60 years old, and 44 female and 9 male patients over 60 years old. Median (IQR) BNP (ng/L) were as follows: <60 years females = 17.9 (15.2) (median [RR: 3 - 64] and males = 12.4 (14.7) [RR: 0.2 - 44], >60 years females = 35.8 (57.9) [RR: 2 -247)] and males = 47.2 (44.1) [RR: 2 - 238]. For this population, the BNP concentration 100 ng/L was adopted as the value to exclude heart failure. Using this definition, 7 lymphedema subjects had BNP concentrations of 120 (19.8) ng/L, and all were found to have cardiac abnormalities on echocardiography. This study demonstrated that 93% of unselected subjects with lymphedema had BNP concentrations that exclude a diagnosis of heart failure. Those subjects with elevated BNP were found on subsequent echocardiography to have cardiac abnormalities. The use of a BNP assay is of potential value in screening patients who are more likely to have cardiac failure. Indicative factors include bilateral leg swelling, over the age of 50 years, breathlessness, where there is no known cause for the swelling. A BNP assay using a BNP concentration threshold of 100 ng/L (29 pmol/L) will identify those patients who require more detailed investigations.

Left ventricular volume reduction without ventriculectomy.

Partial left ventriculectomy (the Batista procedure) to achieve left ventricular volume reduction (LVVR) has been advocated as an alternative to cardiac transplantation in patients with end-stage dilated left ventricles. Here, we describe a new technique of LVVR that uses realignment of the papillary muscles, thus avoiding ventriculectomy, and report preliminary results. Eight patients (all male, mean age 49.3 [range 38 to 70] years) underwent LVVR between October 1998 and March 2000 as an adjunct to surgical coronary revascularization. Five were assessed with echocardiography and cardiopulmonary exercise testing before and after (mean follow-up time 267 [range 94 to 416] days) the operation. LVVR significantly improved left ventricular end-diastolic volume (254 +/- 32 to 218 +/- 36 mL, p = 0.03), left ventricular ejection fraction (20.14% +/- 1.36% to 31.28% +/- 2.32%, p = 0.007), and exercise duration (from 394 +/- 88 to 611 +/- 79 seconds, p = 0.03). A nonsignificant improvement in maximal oxygen consumption was also observed. This technique of LVVR is relatively simple to perform and is accomplished through a small apical cardiotomy. Preliminary results show an encouraging functional improvement following surgery. Future controlled studies are required to assess this novel technique further.

Synchronous bilateral carcinoma of the ureter in association with unilateral incomplete duplication of the ureter.

A case of bilateral synchronous ureteral tumors, in association with a unilateral incomplete duplication of ureter, is presented. This patient underwent right nephroureterectomy with removal of a cuff of bladder, partial resection of left ureter, and ileal loop interposition between renal pelvis and bladder. Followup showed no recurrence in the residual urinary tract 2-years postoperatively.

Survey of postoperative pain in University Hospital Kuala Lumpur.

One hundred and eighty-three patients undergoing surgery were interviewed twenty-four hours following surgery to assess the quality of pain relief they received in the immediate postoperative period. Interviews were conducted using a standard questionnaire for all patients. They were asked to (1) rate the quality of pain relief they obtained on a Visual Pain Analogue Scale (VPAS-0 being no pain and 10 being the worst imaginable pain); (2) state whether they were happy and satisfied with the pain relief they received; (3) if dissatisfied, they were asked to give their reasons. 37.7% (69 patients) had moderate to severe pain--pain score greater than 6 on the VPAS. Most of these patients had undergone abdominal or major orthopaedic surgery. 32.7% (60 patients) were unhappy with their postoperative pain control. The main reasons for complaint from the patients were that analgesic injections were either not given promptly or were not given at all. The survey also highlighted the inadequate under-administration of narcotic injections in the postoperative period despite orders being written up. It showed there is an urgent need for setting up an Acute Pain Service for better postoperative pain control. An anaesthesiology based Acute Pain Service was started in October 1992.

Coronary angioplasty in high risk patients with percutaneous cardiopulmonary support.

Cardiopulmonary Support (CPS) was employed electively in 13 patients during high risk percutaneous transluminal coronary angioplasty (PTCA) in accordance with a selection criteria, which included at least two of the following; (i) left ventricular ejection fraction of less than 35%, (ii) target vessel(s) supplying more than 50% of the viable myocardium, and (iii) patients refused coronary bypass surgery. The mean age of the patients was 56.8 +/- 10.7 years (range 39-77). PTCA was attempted in a total of 35 lesions in 12 patients; 29 lesions were successfully dilated (technical success rate of 82.9%). On average, 2.7 lesions were attempted in each patient, and 2.2 lesions were successfully dilated per patient. In one patient the procedure was abandoned due to dissection of the iliac artery during cannulation. One patient died of a large pulmonary embolism 72 h after the procedure. All the surviving 11 patients who had successful PTCA on CPS showed symptomatic improvement during a mean follow-up period of 18.5 +/- 4.3 months (range 11 to 24 months). The commonest complication encountered following the CPS-assisted PTCA was local haematoma (nine of 13 patients), but all patients required transfusion due to significant periprocedural blood loss. Our early experience suggests that CPS enhances the safety of undertaking PTCA in high risk patients.

[Testis yolk sec tumor--a case report].

A 16-months old normal boy, a right testicular mass was discovered incidentally by his grandmother. Right inguinal orchiectomy was performed. Histological examination showed yolk sac tumor of testis. A preoperative alpha-fetoprotein level was markedly elevated at 13568.9 ng/ml, by the end of the twelve postoperative months, the serum alpha-fetoprotein levels was 118 ng/ml. The patient is doing well one-year postoperatively.

Xanthogranulomatous cystitis: a case report and review of the literature.

Xanthogranulomatous cystitis is a rare benign chronic inflammatory disease of unknown aetiology. We report a case of xanthogranulomatous cystitis. The patient is well more than 15 years after partial cystectomy. The relevant literature is reviewed.

[Foreign body in the urinary bladder].

Foreign bodies in the urinary bladder are not uncommon, however, only a few cases have been reported in recent literature. This is not a fatal disease, however, it may lead to serious complications such as chronic cystitis, urolithiasis, or rectal abscess formation. These foreign bodies were inserted for autoerotic or unknown reasons by patients. In this paper we report 4 cases of foreign bodies in the urinary bladder. They include a cucumber, glass tube, chewing gum, and filliform catheter. We found that most of the foreign bodies in the urinary bladder can be removed endoscopically, but if the patients also had a lower urinary tract obstructive disease, removal necessitated surgical procedures. All of the four cases had no urological complications for at least one year after treatment.

[Complications of transurethral resection of prostate].

A total of 342 benign prostatic hypertrophy patients were treated at the Department of Urology, Kaohsiung Medical College Hospital from January 1972 to December 1988. Median duration of operating time was 74.4 minutes, 67 patients (20%) required a blood transfusion and the mean volume of blood per patient transfused was 1019.4 ml. Median post-operative catheter management was 7 days and the median post-operative ward time was 8.6 days. Two patients (0.5%) had a bladder lesion with peritoneal perforation and required a secondary operation for bladder suture. Secondary hemorrhaging return for treatment of clotting was seen in 11 cases (3.2%). Stress incontinence was noted in 11 cases (3.2%). Anterior urethral stricture was noted in 9 cases (2.6%), impotence occurred in only one case (0.3%) and TUR syndrome in 2 (0.6%). There were two post-operative deaths, for a mortality rate of 0.6 percent. The causes of death were sepsis in one patient and acute renal failure in the other.

[Teratoma of testis--a case report].

A case of mature testicular teratoma in a 5-year-old child is presented. The level of serum beta-human chorionic gonadotropin (beta-HCG), alpha-fetoprotein (alpha-AFP), and carcinoembryonic antigen (CEA) were all within normal limit one year post-operatively. We discussed the clinical features, treatment and the result of this patient and reviewed the literature.

[Renal pelvic tumor associated with contralateral renal cyst--a case report].

A 74-year-old female presented with a two years history of malaise, weakness and intermittent gross hematuria. Two years earlier, left renal cyst had been diagnosed by excretory urography, abdominal sonography and computed-tomography. Initially she was treated conservatively with oral antibiotics, however medical management had not been successful in improving her condition. Finally she was transfer to our ward for further evaluation and treatment. Cystoscopic examination demonstrated no abnormality, except for bloody urine efflux from the right ureteric orifice. Right retrograde pyelograms confirmed a solitary filling defect in the upper calyx of right kidney. Because of immediate concern for right renal pelvic tumor and contralateral renal cyst, a midline transperitoneal exploration was made. The right nephroureterectomy with cuff of bladder was removed and left unroofing of cyst was carried out. Convalescence was uneventful. The pathologic examination revealed moderately differentiated transitional cell carcinoma of right kidney with a simple renal cyst of left kidney. We suggest that cases with a clinical diagnosis of renal cyst based on the presence of gross hematuria, a normals excretory urogram and computed tomogram, generally require further evaluation especially by cystoscope and retrograde pyelogram to determine the source of bleeding.

Detection of blood group surface antigens of urinary bladder tumours using monoclonal antibodies with the avidin-biotin complex technique.

We examined 8 normal bladder transitional epithelia and 65 transitional cell carcinomas of the urinary bladder of various stages and grades for the presence of ABO(H) blood group surface isoantigens using the immunoperoxidase staining via the Avidin-Biotin Complex (ABC) methods. It was found that 27% of patients with grade I tumours, 50% with grade II tumours and 82% with grade III tumours had loss of cell surface isoantigens. When correlated with the clinical stage the tumours showed no surface isoantigens in stage D, while 65% of patients with stage A tumours were positive for surface antigens. From among 37 patients (57%), 28 (43%) survived for more than five years. Our results suggest that surface antigens of transitional cell carcinoma of the urinary bladder tended to disappear as the histologic changes of the tumour progressed. It also was noted that a loss of ABH(O) surface isoantigens was a bad prognostic sign.

[Transvesical prostatectomy for benign prostatic hyperplasia--a 364 cases analysis].

During a 16 year period from January 1972 to December 1988, transvesical prostatectomies were performed on 364 patients with benign prostatic hyperplasia in the Department of Urology, Kaohsiung Medical College Hospital. The average operational procedure time was 116.1 minutes and the average amount of tissue resected was 38.3 grams. The most common complications were wound infections (6.8%), stress incontinence (1.92%), urethral stricture (4.12%) and impotence (0.27%). In this series, epididymitis and/or orchitis was noted in 4.3% of those who underwent vasectomies and 1.8% of those who did not; thus, epididymitis cannot be prevented by a prophylactic vasectomy. There was one postoperative death (mortality rate-0.27%). The present study found that 6.86% of the transvesical prostatectomy patients will require longer hospitalization and greater amounts of antibiotics due to post-operative wound infection; therefore the use of transvesical prostatectomy will decline and only be recommended for fit patients with others genitourinary diseases such as bladder diverticulum or giant bladder calculus.