The presentation of malrotation of the intestine in adults.

Three cases of intestinal malrotation presenting in adults are reported. Each illustrates various aspects of symptomatology, investigation and treatment which are discussed.

The influence of histological diagnosis on the postoperative complication rate following trans-urethral resection of prostate (TURP).

BACKGROUND: A number of studies have shown that the early mortality following TURP is higher for patients with prostate cancer than those with benign disease. This study examines the effect of the histological diagnosis on the predischarge complication rate following TURP. METHODS: Information on the postoperative, predischarge complications of 3036 patients, who underwent TURP over the last decade at our institution, was collated from the urology department database (AuditBase for Windows). The information on this database is collected prospectively, at the point of care and validated at monthly audit meetings. Statistical analyses were performed using chi2 and difference of proportion where n > 60. Statistical significance was taken as P < 0.05. RESULTS: The postoperative, predischarge major complication rate for patients with benign disease was 2.1%. This was not statistically different from the 2.3% complication rate seen in patients with malignant disease. Patients suffering a postoperative complication stayed in hospital significantly longer than those who had a straightforward postoperative course (P < 0.001); however, patients with malignant histology suffering a postoperative complication did not stay statistically significantly longer than those with benign histology suffering a postoperative complication (P < 0.1). CONCLUSIONS: Patients undergoing TURP for prostate cancer do not suffer more postoperative, predischarge complications or stay in hospital longer than patients undergoing TURP for benign disease.

Intracorporeal papaverine injection in androgen deprived men.

The intracorporeal injection of papaverine (ICP) is now a well recognized therapeutic option in the management of impotence. The current treatment of advanced prostatic carcinoma causes erectile failure. Although intracorporeal papaverine can induce erections in these men, libido is also reduced so that the role of ICP is limited to those men complying with the wishes of a highly motivated partner.

Positron emission tomography with CT in the evaluation of non-small cell lung cancer in populations with a high prevalence of tuberculosis.

OBJECTIVE AND BACKGROUND: To determine the utility of positron emission tomography with CT (PET-CT) in the evaluation of non-small cell lung cancer (NSCLC) in an Asian context where tuberculosis rates are moderately high. METHODS: Case records of consecutive patients with NSCLC undergoing PET-CT at the Singapore General Hospital over a 1-year period were retrospectively reviewed. The authors evaluated the sensitivity and specificity of PET-CT at their institution using surgical pathology or the tincture of time as the gold standard. RESULTS: A total of 54 patients underwent PET-CT during this period. Seven patients were evaluated for solitary pulmonary nodule, for which PET-CT gave a sensitivity of 100% and specificity of 75%. There was one patient with false positive PET-CT due to active tuberculosis. In total, 41 patients underwent PET-CT for staging of NSCLC. There was one false positive (patient was found to have active tuberculous lymphadenitis) and one false negative for NSCLC. This gave a sensitivity of 92.3% and a specificity of 95%. Histology from the adrenal glands was available in two patients with PET-CT that was positive for adrenal metastases. One proved to be benign whereas the other was consistent with metastasis. Two patients had PET-CT positive for liver metastases, which was verified by histology. Two patients with positive PET-CT for lesions in the colon turned out to be benign histologically. CONCLUSIONS: Positron emission tomography with CT for the evaluation and follow-up of solitary pulmonary nodule and NSCLC can provide additional useful information to conventional radiology for treatment planning and a non-invasive determination of prognosis. However, physicians need to be aware of the limitations of this imaging modality, particularly when tuberculosis has a high prevalence in the population.

Clips or sutures for herniorrhaphy wounds?

This study compares the pain experienced by fifty patients following bilateral herniorrhaphy using two different methods of wound closure. No significant difference was found between the use of Michel clips and interrupted monofilament nylon sutures. Clips were preferred by a significant majority of patients, probably because they cause less pain on removal. The use of Michel clips should not be limited by the belief that they cause more pain than conventional sutures.

Vacuum constriction devices: second-line conservative treatment for impotence.

Intracavernosal pharmacotherapy is not a universally successful treatment of impotence. Vacuum constriction devices are reported to be an effective non-operative alternative. This study investigated the value of these devices in 45 impotent men who had failed to become established on intracavernosal papaverine. Although 38 were able to obtain an erection-like state using a vacuum constriction device, only 12 were able to enjoy satisfactory sexual intercourse and, of these, just 7 men found them of sufficient benefit to warrant purchase. Success is not predicted by aetiology. Vacuum constriction devices are of some use, but a trial period of use should be allowed to each patient before purchase.

Non-invasive assessment of arteriogenic impotence: a comparative study.

This study was undertaken to determine the relative accuracy of computerised Doppler waveform analysis and colour coded duplex ultrasonography in the diagnosis of arteriogenic impotence. Twenty men with ostensibly normal penile haemodynamics were compared with 50 men whose impotence was considered due to compromised penile haemodynamics. In each patient the penile arterial inflow was assessed by both methods of investigation, which were performed at an interval of 2 weeks. The results demonstrated both techniques to be sensitive in detecting penile artery insufficiency but colour coded duplex ultrasonography was significantly more accurate.

Multiple use of fibres in the visual laser ablation of the prostate.

OBJECTIVE: To investigate the possibility of re-using laser fibres for the visual laser ablation of the prostate (VLAP). PATIENTS AND METHODS: Thirty-four patients, each with a mean maximum urinary flow rate of < 14.0 mL/s and an American Urological Association symptom score of > 19, were evaluated. All underwent VLAP: laser energy, generated by a Neodymium:YAG system, was delivered with a side-firing fibre. The laser generator was fitted with a custom-built power meter that measured the energy delivered by the fibre. Fibres were re-used until the energy output fell below 60 W despite increases in laser generator power. Each patient was followed for at least 12 months. RESULTS: A total of seven fibres was used to treat the 34 patients; between one and nine patients were treated with each fibre. The outcome obtained with the first use of a fibre compared well with those obtained with each subsequent use. After 12 months, 25 patients (74%) expressed satisfaction with the results of their operation. Five patients (15%) had urinary tract infections. As each fibre costs about pound 650, multiple use saved a mean of pound 516 for each patient treated. CONCLUSION: This evaluation implies that there is no justification for the single use of laser fibres on the basis of efficacy, provided that a power meter is used to monitor the efficiency of the delivery device.