Continent Catheterizable Vesicostomy: An Alternative Surgical Modality for Pediatric Patients With Large Bladder Capacity.

OBJECTIVE: To present a modified technique and early outcomes of a continent catheterizable vesicostomy in pediatric patients with either flaccid neurogenic bladder or intractable voiding dysfunction and large capacity bladder. METHODS: Six patients underwent the procedure from October 2014 to December 2015. A 4-cm Pfannenstiel incision was made, avoiding intraperitoneal dissection. After adequate mobilization, a 2-cm vertical flap at the dome of the bladder was identified and tubularized over a 12Fr catheter with 4-0 vicryl suture. The tubularized flap was then intussuscepted into the bladder with four 4-0 polydioxanone sutures, creating a continent mechanism. The catheterizable channel was then tunneled to the umbilicus, the channel ostomy matured, and the cystotomy closed in two layers. RESULTS: The median patient age was 8 (interquartile range [IQR] 12) years. All patients had urinary dysfunction requiring drainage from etiologies that included Eagle-Barrett syndrome (n = 2), Noonan syndrome (n = 1), Lennox-Gastaut syndrome (n = 1), and Spina bifida (n = 2). Median hospital length of stay was 8 (IQR 3) days. One patient had a superficial wound infection treated with antibiotics, and 1 patient required balloon dilation of the catheterizable channel at 3 months postoperatively, secondary to difficulty self-catheterizing. Five patients were successfully self-catheterizing at last follow-up. Median follow-up was 6 (IQR 5) months and there were no intra- or perioperative complications. CONCLUSION: Continent catheterizable vesicostomy is a novel technique for urinary drainage in patients with large bladder capacity that spares use of the appendix or ileum. Early results are encouraging, providing a catheterizable channel through the umbilicus without urinary leakage between catheterization.

Montmorency cherry juice reduces muscle damage caused by intensive strength exercise.

PURPOSE: Montmorency cherries contain high levels of polyphenolic compounds including flavonoids and anthocyanins possessing antioxidant and anti-inflammatory effects. We investigated whether the effects of intensive unilateral leg exercise on oxidative damage and muscle function were attenuated by consumption of a Montmorency cherry juice concentrate using a crossover experimental design. METHODS: Ten well-trained male overnight-fasted athletes completed two trials of 10 sets of 10 single-leg knee extensions at 80% one-repetition maximum. Trials were separated by 2 wk, and alternate legs were used in each trial. Participants consumed each supplement (CherryActive® (CA) or isoenergetic fruit concentrate (FC)) for 7 d before and 48 h after exercise. Knee extension maximum voluntary contractions (MVC) were performed before, immediately after, and 24 and 48 h after the damaging exercise. Venous blood samples were collected at each time point, and serum was analyzed for creatine kinase (CK) activity, nitrotyrosine, high-sensitivity C-reactive protein, total antioxidant capacity, and protein carbonyls (PC). Two-way repeated-measures ANOVA were used for statistical analysis of the data. RESULTS: MVC force recovery was significantly faster (24 h: CA 90.9% ± 4.2% of initial MVC vs FC 84.9% ± 3.4% of initial MVC; 48 h: CA 92.9% ± 3.3% of initial MVC vs FC 88.5% ± 2.9% of initial MVC (mean ± SEM); P < 0.05) after CA than FC consumption. Only serum CK and PC increased significantly from baseline, peaking 24 h after exercise (P < 0.001). The exercise-induced increase in CK activity was not different between trials. However, both the percentage (24 h after: CA 23.8% ± 2.9% vs FC 82.7% ± 11.7%; P = 0.013) and absolute (24 h after: CA 0.31 ± 0.03 nmol·mg(-1) protein vs FC 0.60 ± 0.08 nmol·mg(-1) protein; P = 0.079) increase in PC was lower in CA than FC trials. CONCLUSIONS: Montmorency cherry juice consumption improved the recovery of isometric muscle strength after intensive exercise perhaps owing to the attenuation of the oxidative damage induced by the damaging exercise.

Prospective randomized trial of empiric therapy with trimethoprim-sulfamethoxazole or doxycycline for outpatient skin and soft tissue infections in an area of high prevalence of methicillin-resistant Staphylococcus aureus.

To evaluate empirical therapy with trimethoprim-sulfamethoxazole or doxycycline for outpatient skin and soft tissue infections in an area of high prevalence of methicillin-resistant Staphylococcus aureus, a randomized, prospective, open-label investigation was performed. The overall clinical failure rate was 9%, with all failures occurring in the trimethoprim-sulfamethoxazole group. However, there was no significant difference between the clinical failure rate of empirical trimethoprim-sulfamethoxazole therapy and that of doxycycline therapy.

Cannabinoids for treatment of spasticity and other symptoms related to multiple sclerosis (CAMS study): multicentre randomised placebo-controlled trial.

BACKGROUND: Multiple sclerosis is associated with muscle stiffness, spasms, pain, and tremor. Much anecdotal evidence suggests that cannabinoids could help these symptoms. Our aim was to test the notion that cannabinoids have a beneficial effect on spasticity and other symptoms related to multiple sclerosis. METHODS: We did a randomised, placebo-controlled trial, to which we enrolled 667 patients with stable multiple sclerosis and muscle spasticity. 630 participants were treated at 33 UK centres with oral cannabis extract (n=211), Delta9-tetrahydrocannabinol (Delta9-THC; n=206), or placebo (n=213). Trial duration was 15 weeks. Our primary outcome measure was change in overall spasticity scores, using the Ashworth scale. Analysis was by intention to treat. FINDINGS: 611 of 630 patients were followed up for the primary endpoint. We noted no treatment effect of cannabinoids on the primary outcome (p=0.40). The estimated difference in mean reduction in total Ashworth score for participants taking cannabis extract compared with placebo was 0.32 (95% CI -1.04 to 1.67), and for those taking Delta9-THC versus placebo it was 0.94 (-0.44 to 2.31). There was evidence of a treatment effect on patient-reported spasticity and pain (p=0.003), with improvement in spasticity reported in 61% (n=121, 95% CI 54.6-68.2), 60% (n=108, 52.5-66.8), and 46% (n=91, 39.0-52.9) of participants on cannabis extract, Delta9-THC, and placebo, respectively. INTERPRETATION: Treatment with cannabinoids did not have a beneficial effect on spasticity when assessed with the Ashworth scale. However, though there was a degree of unmasking among the patients in the active treatment groups, objective improvement in mobility and patients' opinion of an improvement in pain suggest cannabinoids might be clinically useful.