Bipolar versus monopolar transurethral resection of the prostate: a prospective randomized trial focusing on bleeding complications.

PURPOSE: We compare monopolar vs bipolar transurethral resection of the prostate in patients with benign prostatic hyperplasia, focusing on functional outcomes as well as rates of bleeding complications and the transurethral resection syndrome. MATERIALS AND METHODS: A total of 137 patients with benign prostatic hyperplasia (mean age 67 years, range 47 to 91) were prospectively randomly assigned to undergo monopolar (67) or bipolar (70) transurethral resection of the prostate. Patient characteristics of the 2 groups were similar. Hemoglobin (as a marker of blood loss) was measured preoperatively and perioperatively. I-PSS, I-PSS-QoL score, maximal flow rate and post-void residual urine volume were assessed preoperatively and 3 and 12 months postoperatively. Duration of surgery, indwelling catheter use and hospitalization were also documented, as were postoperative clot retention requiring removal by catheterization or surgery, and rates of bladder neck and/or urethral strictures. RESULTS: No significant perioperative differences were found in duration of surgery, catheterization or hospitalization, or in blood loss or rates of blood transfusion and transurethral resection syndrome. Postoperatively there were no significant differences in I-PSS or I-PSS-QoL scores, or rates of rehospitalization, clot retention, blood transfusions, reoperation or urethral strictures. However, bladder neck stricture occurred significantly more often in the bipolar group (8.5% vs 0%, p = 0.02). The 3 and 12-month followup showed significant and equal improvement in micturition in the 2 groups. CONCLUSIONS: Bipolar and monopolar transurethral resection of the prostate are effective and safe techniques for the surgical treatment of benign prostatic hyperplasia. The only significant difference between them was a significantly higher rate of bladder neck strictures with bipolar resection of the prostate.

One- vs 4-week stent placement after laparoscopic and robot-assisted pyeloplasty: results of a prospective randomised single-centre study.

OBJECTIVES: To determine whether 1-week stenting of the pelvi-ureteric anastomosis of laparoscopic or robot-assisted pyeloplasty is as effective as 4-week stenting, based on their respective success rates. PATIENTS AND METHODS: A total of 100 patients with pelvi-ureteric junction obstruction were treated by Anderson-Hynes pyeloplasty and the anastomosis was stented using a 6-F JJ catheter for either 1 week (1W series) or 4 weeks (4W series), based on a randomisation protocol. Postoperative follow-up was performed at 3 months using intravenous urography (IVU), at 6 months using diuretic renography and at 1, 3 and 5 years using ultrasonography. Statistical analysis was performed using a one-sided Z-test, Pearsons's chi-squared test and a Wilcoxon rank sum test. RESULTS: The primary outcome measure, success rate, which was defined as no obstruction on IVU and diuretic renography, was 100% in the 1W series and not inferior to the success rate of 98% in the 4W series (P = 0.006). The following secondary outcome measures were not significantly different between the 1W and the 4W series with regard to residual symptoms (10 vs 6%; P = 0.48), rate of complications (4 vs 6%; P = 0.65), need for synchronous robot-assisted pyelolithotomy (4 vs 8%; P = 0.47), improvement in split renal function (1 vs 0%; P = 0.59) and duration of surgery (200 vs 192 min; P = 0.87). Only length of hospital stay was significantly different; this was shorter in the 1W series (5 vs 6 days; P = 0.01). CONCLUSIONS: Stenting of the pelvi-ureteric anastomosis after laparoscopic or robot-assisted pyeloplasty for 1 week is as effective as stenting for 4 weeks. Both procedures, laparoscopic or robot-assisted pyeloplasty have an excellent success rate.

When and how should we test the tightness of the vesicourethral anastomosis after retropubic radical prostatectomy?

OBJECTIVE: To determine when the vesicourethral anastomosis (VUA) becomes tight after retropubic radical prostatectomy (RRP) and if an additional lateral view cystography provides significantly more information than the only anterior-posterior view. PATIENTS AND METHODS: Pressure-controlled cystography with anterior-posterior and lateral views was performed on postoperative days (POD) 3, 6 and 9 and evaluated in 100 consecutive patients after RRP. RESULTS: On POD 3, 6 and 9, 82, 80 and 82% of all VUA, respectively, were tight. 85% of all tight VUA on POD 3 remained tight on POD 6 and 9. Of the 52 extravasations in a total of 300 cystographies, 65% were recognizable in the anterior-posterior as well as in the lateral view cystography, 6% were seen only in the anterior-posterior view and 29% only in the lateral view. CONCLUSIONS: The VUA after RRP is tight in about 80% of the cases on POD 3, 6 and 9. A tight VUA on POD 3 does not exclude later extravasation on POD 6 and 9 (14%). About one third (29%) of all extravasations of VUA are seen only in the lateral view cystography after RRP.

[Management of pediatric septic shock]. / Prise en charge du choc septique chez l'enfant.

Septic shock is a frequent admission cause in intensive care unit. In spite of the important progresses in the understanding of his physiopathology, mortality due to septic shock is about 20%. Recently, it has been demonstrated that an early goal-directed therapy permitted to improve the patient prognosis. With a good hemodynamic management and early antibiotherapy, mortality could be reduced.

The value of stereolithographic models for preoperative diagnosis of craniofacial deformities and planning of surgical corrections.

The purpose of this study was to assess the importance of stereolithographic models (SLMs) for preoperative diagnosis and planning in craniofacial surgery and to examine whether these models offer valuable additional information as compared to normal CT scans and 3D CT images. Craniofacial SLMs of 20 patients with craniomaxillofacial pathology were made. A helical volume CT scan of the anatomic area involved delivered the necessary data for their construction. These were built with an SLA 250 stereolithography apparatus (3D-Systems, Valencia, CA, USA), steered by FORM-IT/DCS software (University of Zurich, Switzerland). The stereolithography models were classified according to pathology, type of surgery and their relevance for surgical planning. Though not objectively measurable, it was beyond doubt that relevant additional information for the surgeon was obtained in cases of hypertelorism, severe asymmetries of the neuro- and viscerocranium, complex cranial synostoses and large skull defects. The value of these models as realistic "duplicates" of complex or rare dysmorphic craniofacial pathology for the purpose of creating a didactic collection should also be emphasized. The models proved to be less useful in cases of consolidated fractures of the periorbital and naso-ethmoidal complex, except where there was major dislocation.

[Bioavailability of digoxin and beta-methyl-digoxin in patients with liver and gastro-intestinal diseases ]. / Biologische Verfügbarkeit von Digoxin und Beta-Methyldigoxin bei Hepatopathien und Magen-Darm-Erkrankungen.

The bioavailability of digoxin and beta-methyl-digoxin (BMD) was tested with a single dose on the grounds of peak serum concentration, tmax, area under the serum concentration-time curve and the cumulative 24 hour urinary excretion on one group of patients with liver disease (n = 20) and one with gastrointestinal disease (n = 10). Despite the smaller dose (0.5 mg BMD against 0.75 mg digoxin), peak serum concentration was significantly higher with BMD in both groups and was also reached earlier than with digoxin. The extent of absorption was also higher in both groups with BMD than with digoxin. A comparison of the results on hand with the results obtained in corresponding tests on healthy persons showed no significant differences with BMD. The excellent bioavailability of BMD was therefore also proved on patients with gastrointestinal diseases, whereas with digoxin the absorption in these patients was retarded, compared with healthy persons, but the extent of absorption was not reduced either. In gastrointestinal diseases with unknown conditions of absorption, the better bioavailability of BMD is probably of advantage, when compared with digoxin. According to medical literature, t/2 of BMD may be prolonged in liver diseases, so that in such cases the dose of BMD has to be adjusted or the use of digoxin is recommended.

[Early detection and determination of the incidence of side effects in the hospital by intensive (comprehensive) drug monitoring]. / Früherfassung und Bestimmung der Häufigkeit von Nebenwirkungen im Spital durch intensives (komprehensives) Drug Monitoring.

In the "Comprehensive Hospital Drug Monitoring Berne" (CHDMB) the frequency of adverse drug reactions can be either determined by counting individual patients with probable or proven reactions to a drug or by mathematic-statistical analysis of exposed and nonexposed patients with and without the reaction. These two methods are used to show the frequency of a maculopapular rash in connection with three antiinfectious drugs. The mathematic-statistical frequency of a maculopapular rash was 11.0% for aminopenicillins, 3.7% for other penicillins, and 3.4% for co-trimoxazole and sulfonamides compared to 1.2% in patients treated with other than the especially mentioned drug groups. Two new adverse reactions were detected by this system: arterial hypotension due to novaminesulfon-dipyrone (Novalgin) and drug fever to the antidepressive drug nomifensin (Alival). Also the frequency of some other, not unusual adverse reactions is demonstrated.

[Starting experience with non-invasive ventilation in paediatric intensive care unit]. / Ventilation non invasive en réanimation pédiatrique: un début d'expérience.

Non-invasive ventilation in pressure support (NIV) is well described in the adult and child over 5 years. However, its use in children less than 1 year of age remains anecdotal. We report our preliminary experience with the use of NIV in six children aged from 5 days to 10 months. NIV was delivered with a flow generator (VPAP IIST, Resmed Ltd, North Ryde, NSW, Australia) in association with specific tubings and a nasal mask. The use of NIV resulted in a significant decrease of both the respiratory rate (from 53 to 39 breaths per min, p < 0.01) and the PvCO(2) (from 9.33 to 6.28 kPa, p < 0.01). These results show that NIV can be used in children under 1 year of age with improvement of physiological parameters.

[Sclerosing peritonitis and practolol (author's transl)]. / Sklerosierende Peritonitis durch Practolol.

Skin manifestations, eye complications, a nephrotic syndrome, appearance of lupus erythematosus cells and antinuclear antibodies, sometimes combined with a systemic side effects of the beta adrenergic blocker Practolol. Another side effect is though to be sclerosing peritonitis. The latter is identical with the idiopathic fibroplastic peritonitis, described at the turn of this fibroplastic peritonitis, described at the turn of this century by German authors. Our own observation of a case of sclerosing peritonitis is compared with the literature. There is strong evidence for a causal relationship between longstanding Practolol-therapy and sclerosing peritonitis. Practolol was withdrawn from the market in 1975.

[Mesenteric infarct during digitalis poisoning]. / Mesenterialinfarkt bei Digitalisintoxikation

So-called nonocclusive or spastic mesenteric infarction is a well-known complication of severe circulatory failure with low cardiac output and hypotension. In recent years, acute mesenteric insufficiency has been described in connection with certain drugs. Clinical and experimental evidence suggests a relationship between digitalis therapy, especially overdigitalization, and nonocclusive mesenteric infarction. Two cases are presented in support of this hypothesis. Both patients had digitalis intoxication and died from nonocclusive mesenteric infarction proven by surgery, autopsy and, in one case, arteriography. No cause other than digitalis intoxication (shock, severe cardiac failure or other drugs) could be found. Despite the frequent occurrence of digitalis intoxication, nonocclusive mesenteric infarction is a rare event. Interruption of digitalis therapy does not alter the usually fatal outcome. Experimental data with glucagon and phenoxybenzamine suggest that a therapeutic trial with these drugs might be worth while. Digitalis should be used with caution in shocked patients, since in these the splanchnic circulation is usually critical.

The response to potassium of the Na-K pump ATPase in low-K red blood cells from cattle at birth and in later life.

It is shown that in low-K red blood cells of cattle the apparent affinity for K(1/Kapp K) at an inhibitory site of the Na-K ATPase increases markedly during the first 3 months of life. This site probably is the Na accepting site at the internal membrane surface and the change in Kapp K reflects an increase in KNa/KK, the ratio of the true dissociation constants. This effect may explain the concomitant fall in cellular K concentration.

Digitoxin intoxication with severe thrombocytopenia: reversal by digoxin-specific antibodies.

As a result of overdosage a 77-year-old patient with heart disease developed digitoxin intoxication, associated with arrhythmias, extracardiac symptoms of intoxication and severe thrombocytopenia. Treatment with digoxin-specific antibody fragments relieved the signs and symptoms of intoxication within a few hours. The rise in platelet count from the pretreatment value of 26 000/mm3 to 47 000 within 12 h and to over 60 000/mm3 within 16 h of starting the antibody infusion may also be attributed to the treatment with antibodies. Such a rapid recovery from digitoxin-induced thrombocytopenia has not hitherto been described. Digoxin-specific antibodies, obtained by immunization of sheep with a digoxin-albumin conjugate, were used to treat intoxication with digitoxin, since cross-reaction had been demonstrated in vitro and in animal experiments. The present paper briefly discusses the mode of action and the general problems relating to the antibody therapy of digitalis poisoning.

A new filtering algorithm for medical magnetic resonance and computer tomography images.

Inner views of tubular structures based on computer tomography (CT) and magnetic resonance (MR) data sets may be created by virtual endoscopy. After a preliminary segmentation procedure for selecting the organ to be represented, the virtual endoscopy is a new postprocessing technique using surface or volume rendering of the data sets. In the case of surface rendering, the segmentation is based on a grey level thresholding technique. To avoid artifacts owing to the noise created in the imaging process, and to restore spurious resolution degradations, a robust Wiener filter was applied. This filter working in Fourier space approximates the noise spectrum by a simple function that is proportional to the square root of the signal amplitude. Thus, only points with tiny amplitudes consisting mostly of noise are suppressed. Further artifacts are avoided by the correct selection of the threshold range. Afterwards, the lumen and the inner walls of the tubular structures are well represented and allow one to distinguish between harmless fluctuations and medically significant structures.

[Hemolytic autoimmune anemia caused by (+)-cyanidanol-3 (Catergen)]. / Durch (+)-Cyanidanol-3 (Catergen) induzierte immunhämolytische Anämie.

Several episodes of acute intravascular immune hemolysis in a 68 year old patient induced by (+)-cyanidanol-3 (Catergan) are reported. Clinical and serological criteria of the so-called immune-complex mechanism of immune drug-induced hemolysis were realised. The meaning of the additional marked affinity of the drug to the erythrocytic surface remains unclear. The patient's serum was cross-reactive with rutine but not with troxerutine.

[The treatment of digitalis poisoning with antibiotics (author's transl)]. / Zur Antikörpertherapie der Digitalisintoxikation.

Digitalis intoxication occurs frequently and proves fatal in 5-10% of all cases. Treatment is limited to symptomatic measures. Glycoside-specific antibodies offer a new way of treatment of digitalis intoxication. In our experiments with cats, they were found to be highly effective in reversing digoxin-induced arrhythmias. Specific antibodies have previously been employed in a patient with suicidal digoxin intoxication. We report a case of nonsuicidal Lanatosid-C intoxication treated with F(ab')2-fragments of digoxin-specific antibodies from the sheep. The treatment was successful and without side-effects. Serum concentration of free digoxin and total digoxin measured during and after treatment showed a decrease of free and a sharp raise in total digoxin. For clinical use, antibody fragments are superior to intact antibodies. Problems and possible indications concerning the treatment of digitalis intoxication with antibodies are briefly discussed.