Presentation patterns of invasive cancer of the cervix: results from Parirenyatwa Oncology and Radiotherapy Centre, Harare, Zimbabwe 1998-2010.

MAIN OBJECTIVE: The study sought to identify the presentation patterns of invasive uterine cancer of the cervix (CaCx) in Zimbabwe in terms of histology, stage of the disease, ages of patients and socio-economic status. DESIGN: Retrospective study from 1998 to 2010. SUBJECTS: All patients who registered for the first time with invasive CaCx over a systematically selected sample period of four years (1998, 2002, 2006 & 2010). SETTING: The main referral Radiotherapy and Oncology centre in Harare the capital city of Zimbabwe. RESULTS: Majority of patients (91.75%) presented with squamous cell carcinoma, 5.5% presented with adenocarcinomas and 2.75% presented with other types of histology. Late presentation was noted with the majority of the patients (89%) presenting with stage IIB and above. The common ages of patients at presentation were between 40 to 60 years. The majority of the patients (59.5%) were of low socio-economic status. CONCLUSION: In the developed countries CaCx is reducing in frequency, presentation tends to be early, treatment effective and there is decreasing mortality rate from this disease. However in developing countries the situation is not as positive and the disease remains a major concern. This is shown by the presentation pattern of patients with invasive CaCx in Zimbabwe. The patients are shown to present with late stage disease of the squamous cell type, primarily in the age ranges of 40 to 60 years and with the majority of the patients belonging to the low socio-economic status group.

Cannabinoids in Urology. Which Benign Conditions Might They Be Appropriate to Treat: A Systematic Review.

There is growing evidence suggesting cannabinoids may provide suitable alternatives to conventional treatments in an increasing number of clinical settings. This review evaluates how cannabinoids are used to treat certain benign urological pathologies and to clarify the clinical value of this data. This review includes 62 papers and was undertaken per PRISMA's guidelines, it evidences the therapeutic potential of cannabinoids in the management of specific benign urological diseases, most notably neurogenic bladder dysfunction (clinical studies), renal disease (animal studies), and interstitial cystitis (animal studies). However, whilst cannabinoids are increasingly used, they cannot be considered reliable alternatives to more recognised treatments.

The impact of morphine treatment on bladder cancer cell proliferation and apoptosis: in vitro studies.

AIM: The aim of this study was to determine the effect of morphine on bladder cancer cell proliferation and apoptosis in vitro. MATERIALS AND METHODS: MTT assay was used to measure percentage growth of RT-112 human bladder cancer cells after 72 hours of morphine/morphine + naloxone treatment. Expression of µ-opioid receptors was assessed by Western blot and finally, apoptotic assay with CellEvent Caspase-3/7 Green Detection Reagent was carried out using confocal microscopy. RESULTS: The MTT assays showed that morphine increased RT-112 cell growth. Naloxone inhibited this growth enhancing effect. Western blot analysis regarding µ-opioid receptor expression in RT-112 cells remains inconclusive. Morphine was also found to decrease the rate of apoptosis of RT-112 cells, an effect which naloxone inhibited. CONCLUSIONS: This study provides evidence that morphine, at clinically relevant doses, causes RT-112 bladder cancer cell proliferation, possibly opioid receptor mediated and at least some of this effect might be due to decreased apoptosis. Clinically, this suggests that in patients with bladder cancer, managing pain with morphine might have detrimental consequences on patient outcomes and alternative pain relief should be considered if possible.

Health related quality of life (HRQoL) after cystectomy: comparison between orthotopic neobladder and ileal conduit diversion.

INTRODUCTION: Radical cystectomy and urinary diversion carries a high morbidity. Quality of life and body image are important considerations for urinary diversion (UD). We wanted to conduct a systematic review of literature to see which form UD offers a better quality of life (QoL). METHODS: We searched MEDLINE, Pubmed, EMBASE, CINAHL and the Cochrane library for studies using the following key words: 'quality of life' and 'ileal conduit', 'orthotopic neobladder', 'continent diversion' and 'urinary diversion'. All English language articles on UD surgery were included in the original search from 1990 to 2014. To improve the quality of evidence, we stratified our inclusion criteria into studies that report on QoL in both forms of UD using at least one validated questionnaire. RESULTS: Twenty-one studies (2285 patients) were included in our study all of which used at least one validated tool. The most frequently used tools were the SF-36, EORTC QLQ-C30 and FACT BL (10, 8, 5 studies respectively). None of the studies were randomised and only 4 studies were prospectively designed. Sixteen studies reported no difference in QoL between the two types of urinary diversion and four studies reported a better QoL with orthotopic neobladder of which 2 studies had younger and fitter patients. On the other hand, one study reported a better QoL in ileal conduit patients. CONCLUSION: Orthotopic neobladder urinary diversion shows a marginally better quality of life scores compared to ileal conduit diversion especially when considering younger and fitter patients.

Differentiating the sedative, psychomotor and amnesic effects of benzodiazepines: a study with midazolam and the benzodiazepine antagonist, flumazenil.

Sixteen healthy volunteers were administered midazolam followed by placebo or the benzodiazepine antagonist, flumazenil, in a double-blind, cross-over study. Flumazenil reversed midazolam-induced sedation on the subjective, psychophysiological and motor indices used. In contrast, there was little evidence of any reversal of amnesic effects, which were assessed using both direct (explicit) and indirect (implicit) measures of memory. Results are discussed in terms of dissociating the sedative and amnesic effects of benzodiazepines.

Antibiotic susceptibility and biochemical properties of Streptococcus faecalis strains reacting with both D and G antisera.

Thirty one of 60 consecutive isolates of Streptococcus faecalis produced a reaction in both D and G streptococcal grouping sera. A close correlation was found between this grouping reaction and haemolysin production, resistance to erythromycin, tetracycline, and trimethoprim, and delayed fermentation of sorbitol.

Transurethral resection of prostate under sedation and local anesthesia (sedoanalgesia). Experience in 100 patients.

One hundred male patients (average age 68.2 yrs) with acute retention (n = 20) or with symptoms of outflow obstruction (n = 80) underwent transurethral resection of the prostate (TURP) under sedation (midazolam) and local anesthesia (lidocaine)--referred to as sedoanalgesia technique. Procedures lasted twenty-four minutes on average (range 15-35 min), and the weight of prostatic tissue resected ranged from 2-35 g (average 11.1 g). There were no complications related to the use of midazolam or lidocaine. The technique of sedoanalgesia proved safe and acceptable to all patients regardless of their pre-existing medical condition. Where the weight of prostate to be resected is estimated to be less than 40 g, TURP under sedoanalgesia proves an effective alternative to general or regional anesthesia.

High cervical split cord malformation and neurenteric cyst associated with congenital mirror movements: case report.

A 48-year-old woman with congenital mirror movements of the hands presented with a high cervical split spinal cord malformation and a ventrally located neurenteric cyst. The clinical, radiological, and surgical features are presented. A brief discussion of the literature and embryology pertaining to split cord malformations and mirror movements is included. To our knowledge, this is the first case of radiographically and surgically proven split cord malformation associated with either mirror movements or a neurenteric cyst presenting in an adult.

Frequent type 2 neurofibromatosis gene transcript mutations in sporadic intramedullary spinal cord ependymomas.

OBJECTIVE: To further investigate the role of Type 2 neurofibromatosis (NF2) gene transcript mutations in the sporadically occurring counterparts of NF2-associated tumors. METHODS: Reverse transcription-polymerase chain reaction followed by agarose gel electrophoresis, single strand conformation polymorphism analysis, and automated deoxyribonucleic acid sequence analysis were used to screen for mutations in the NF2 gene transcript in seven unrelated patients with sporadic intramedullary spinal cord ependymomas. RESULTS: Five of seven intramedullary spinal cord ependymomas harbored detectable mutations. All of these mutations occurred in the region of the transcript that is homologous to known cytoskeletal proteins and resulted in significant truncation of the predicted protein product. CONCLUSION: Mutations of the NF2 transcript occur in the majority of sporadic intramedullary spinal cord ependymomas. These mutations are frequent in a region of the transcript that is homologous to a family of cytoskeletal proteins, and they probably render the protein product inactive. These results add to the body of knowledge concerning the role of the NF2 gene transcript in tumorigenesis.

Intracerebral clysis in a rat glioma model.

OBJECTIVE: Intracerebral clysis (ICC) is a new term we use to describe convection-enhanced microinfusion into the brain. This study establishes baseline parameters for preclinical, in vivo, drug investigations using ICC in a rat glioma model. METHODS: Intracranial pressure was measured, with an intraparenchymal fiber-optic catheter, in male Fischer rats 10, 15, 20, and 25 days after implantation of C6 glioma cells in the right frontal lobe (n = 80) and in control rats without tumor (n = 20), before and during ICC. A 25% albumin solution (100 microl) was infused through an intratumoral catheter at 0.5, 1.0, 2.0, 3.0, and 4.0 microl/min. Infusate distribution was assessed by infusion of fluorescein isothiocyanate-dextran (Mr 20,000), using the aforementioned parameters (n = 36). Brains were sectioned and photographed under ultraviolet light, and distribution was calculated by computer analysis (NIH Image for Macintosh). Safe effective drug distribution was demonstrated by measuring tumor sizes and apoptosis in animals treated with N,N'-bis(2-chloroethyl)-N-nitrosourea via ICC, compared with untreated controls. Magnetic resonance imaging noninvasively confirmed tumor growth before treatment. RESULTS: Intracranial pressure increased with tumor progression, from 5.5 mm Hg at baseline to 12.95 mm Hg on Day 25 after tumor cell implantation. Intracranial pressure during ICC ranged from 5 to 21 mm Hg and was correlated with increasing infusion volumes and increasing rates of infusion. No toxicity was observed, except at the higher ends of the tumor size and volume ranges. Fluorescein isothiocyanate-dextran distribution was greater with larger infusion volumes (30 microl versus 10 microl, n = 8, P < 0.05). No significant differences in distribution were observed when different infusion rates were compared while the volume was kept constant. At tolerated flow rates, the volumes of distribution were sufficient to promote adequate drug delivery to tumors. N,N'-Bis(2-chloroethyl)-N-nitrosourea treatment resulted in significant decreases in tumor size, compared with untreated controls. CONCLUSION: The C6 glioma model can be easily modified to study aspects of interstitial delivery via ICC and the application of ICC to the screening of potential antitumor agents for safety and efficacy.

Atlantoaxial degenerative articular cysts.

Cysts associated with spinal joints are not a common cause of neurological symptoms. The authors report a series of five patients with cysts of the atlantodental articulation and review five additional cases from the literature. The patients ranged from 60 to 85 years of age and included three men and seven women. No patient had evidence of rheumatoid arthritis or previous trauma. The cysts caused ventral cervicomedullary compression, did not enhance on magnetic resonance imaging, and were not associated with widening of the anterior atlantodental interval or osseous degeneration of the dens. All patients improved postsurgery. Fusion was required if a transoral procedure was performed. Patients undergoing posterior decompressions were clinically and radiographically stable after operation.

L-phenylisopropyladenosine (L-PIA) diminishes halothane anesthetic requirements and decreases noradrenergic neurotransmission in rats.

The effect of L-phenylisopropyladenosine (L-PIA), the A1 adenosine agonist, on the depth of anesthesia was investigated in halothane-anesthetized rats. L-PIA treatment reduced the minimum anesthetic concentration (MAC) of halothane that prevented 50% of animals from moving in response to a painful stimulus by 49%. MAC experiments performed with L-PIA given in conjunction with A1 adenosine receptor antagonists which either permeate the blood-brain barrier (8-phenyltheophylline [8-PT] or do not (8-sulphophenyltheophylline [8-So-PT]) indicate that central mechanisms are involved. Noradrenergic neurotransmission was diminished following L-PIA administration in halothane-anesthetized rats in all brain regions. These data suggest that acute L-PIA treatment decreases central noradrenergic neurotransmission and may represent the mechanism for the decrease in halothane dose to achieve an anesthetic endpoint anesthetic response to halothane.

An assessment of resedation following flumazenil-induced antagonism of intravenous midazolam: comparison of psychomotor and amnesic recovery with a non-sedated reference group.

The specific benzodiazepine antagonist flumazenil can enhance patient recovery following local anaesthetic day-case surgery performed under sedation. However, in view of its short elimination half-life, concerns have been expressed about the risk of resedation following its use. An open, randomised, parallel group study was designed to explore this question. Eighty-five patients were studied. Group A (n=43) patients underwent local anaesthetic cystoscopy with intravenous (i.v.) midazolam sedation. Following cystoscopy, and 30 min after the injection of midazolam, a bolus dose of flumazenil (0.5 mg i.v.) was given. Group B (n=42) patients underwent no operation and received no drugs but, in all other respects, were treated in an identical fashion to patients in group A. Tests of psychomotor function and memory were administered at baseline and again at 0.5, 1, 2, 3 and 4 h (or equivalent times for group B patients) following the injection of flumazenil. The test results showed no evidence of resedation, but there was evidence of incomplete reversal, as shown by significant differences in critical flicker fusion and delayed word recall at the 0.5-h test point. Group B patients showed no evidence of practice effects but did demonstrate an impairment in test performance possibly related to motivational factors. In conclusion, this study provides no evidence of resedation when using flumazenil to reverse the acute effects of midazolam. Incomplete reversal of amnesia need not delay patient discharge but has important implications with respect to the timing and nature of information imparted to patients prior to their release from hospital.

The differential effects of flumazenil on the psychomotor and amnesic actions of midazolam.

Forty-four patients given midazolam prior to day-care urological surgery had the benzodiazepine antagonist, flumazenil, or placebo administered postoperatively. Flumazenil reversed the psychomotor impairments induced by midazolam but not its amnesic effects. There was no evidence of resedation for up to 6 h following the use of flumazenil.

Differential-pulse anodic voltammetric determination of phosphate, silicate, arsenate and germanate as beta-heteropolymolybdates at a stationary glassy-carbon electrode.

Anodic voltammetry at a stationary glassy-carbon electrode has beeen applied to the determination of phosphate (in the presence of silicate), silicate (in the presence of phosphate), arsenate and germanate as beta-heteropolymolybdates stabilized with acetone, with the solution conditions of existing calorimetric procedures. bl.

Determination of reduced glutathione in human whole blood by high-performance liquid chromatography with electrochemical detection by a graphite-epoxy resin electrode chemically modified with cobalt phthalocyanine.

High-performance liquid chromatography with electrochemical detection by means of a re-polishable graphite-epoxy resin composite electrode, modified with the electrocatalyst cobalt phthalocyanine, has been used for the determination of reduced glutathione (GSH) in 25-mul samples of whole blood. The mobile phase was O.O5M phosphate buffer (pH 2.3) containing 1 mM EDTA, used in conjunction with a Waters muBondapak ODS chromatography column. The use of the electrocatalyst reduced the overpotential for the oxidation of GSH at a carbon electrode by approximately 750 mV, and the applied potential used was +0.5 V vs. Ag/AgCl. The mean recovery of GSH added during the sample pretreatment step was 95%; the assay imprecision was 1-2% for triplicate analyses of the whole blood samples.

Surgical approaches to the thoracolumbar spine.

Surgical treatment of diseases involving the thoracolumbar spine offers a unique challenge to the spine surgeon. Although more familiar posterior techniques are useful for a variety of thoracolumbar problems, the management of disease in this region is often optimized by an anterior approach. Thoracolumbar surgery requires an understanding of the relevant surgical anatomy, the pathologic processes affecting this region, and the relative indications and contraindications for particular operative strategies. It is also essential to be familiar with the management of potential morbidity, methods for avoiding complications, and the selection of particular fusion techniques and instrumentation devices associated with specific operative strategies.

Sedation for day-case urology: an assessment of patient recovery profiles after midazolam and flumazenil.

The specific antagonist flumazenil has been shown to reverse the central actions of benzodiazepines. Its use, in day-case procedures performed under benzodiazepine sedation, offers the potential for enhanced patient recovery. However, concern has been expressed over the possibility of resedation given the short elimination half-life of flumazenil. A randomised, double-blind, placebo controlled trial was therefore designed to assess patient recovery profiles after flumazenil. A total of 44 adults were entered into the trial. Recovery was assessed by means of a battery of psychomotor tests performed pre- and postoperatively. Psychomotor function in patients receiving flumazenil returned to, or near to, baseline levels within 15 min of administration--an improvement maintained throughout the 6 h test period. Patients receiving placebo did not recover fully until the 2 h test point--significant differences between the two groups existing at 15 min and 1 h. In this study, flumazenil effectively reversed midazolam-induced sedation without evidence of resedation. The implications for day-case surgery are discussed.

Day-case surgery: enhanced recovery with flumazenil.

In an open, randomized, parallel group study of 84 adult patients undergoing elective day-case urological surgery the specific benzodiazepine antagonist flumazenil was shown to reverse effectively subjective postoperative sedation due to midazolam and enabled 83% of patients to recover and be ready for potential discharge within 15 min of surgery (control group 24% p less than 0.001). The significantly shorter recovery time has benefits in terms of increased patient cooperation and reduced demands on postoperative nursing care. The implications of these findings for day-case surgery are discussed.