Squeeze maneuver: an easy way to manage radiological contrast-medium extravasation.

BACKGROUND: Contrast-medium extravasation injuries may be self-limited to catastrophic. Adequate prophylactic measures are enforced when risk factors for extravasation are present, and prompt treatment can avoid serious complications. PURPOSE: To describe the squeeze maneuver, an effective method for the treatment of symptomatic contrast-medium extravasation. MATERIAL AND METHODS: Over a 3-month period, eight patients with >50 ml contrast-medium extravasation resulting in vascular compromise of the fingers were managed with the squeeze maneuver as follows. The intravenous catheter used for contrast-medium injection was removed, and the skin around the insertion site was cleaned with povidone-iodine. An 18-gauge needle was then used to puncture five to eight openings near the catheter insertion site as deeply as possible. We then began squeezing from the periphery of the swelling toward the needle holes. As the contrast medium drained, it was swabbed away with iodine-soaked cotton swabs. RESULTS: In all eight patients, the maneuver was successful with immediate resolution of the vascular compromise. CONCLUSION: The squeeze maneuver provides an easy way to manage radiological contrast-medium extravasation and can be performed immediately in the CT suite.

In vitro effect of hyperbaric oxygen on the chemolysis of infective stones.

BACKGROUND: In order to extend the feasibility of hyperbaric oxygen therapy in the urological field, the present study aimed to investigate the dissolution activity of human infective stones in UROCITRA solution under hyperbaric oxygen condition. METHODS: The dissolution activity of 7 struvite and 11 mixed struvite and carbonate apatite stones in UROCITRA solution were studied under 2.5 atmosphere (atm) hyperbaric oxygen (HBO) status in a Sigma I N-124 monoplace chamber. Another 7 struvite and 10 mixed struvite and carbonate apatite stones were also studied under normal condition. Chemolysis was performed in a drip device with a 150-ml/hour continuous flow rate. RESULTS: Under 2.5 atm HBO status, the PO2 of UROCITRA solution was 365 +/- 44 mmHg, which was significantly higher than that of tap water (113 +/- 62 mmHg) and UROCITRA solution (125 +/- 12 mmHg) under normobaric condition (p < 0.001). The decreases in the stone weight of struvite under normobaric condition were 31 +/- 8.8% after 2 h and 48 +/- 15% after 4 h of treatment. The HBO-enriched UROCITRA solution did not increase the dissolution activity as reflected by comparable decreases in the dried stone weight (31.2 +/- 14.6% and 54 +/- 19% at the 2nd and 4th post-treatment hours, respectively, p > 0.05). Similarly, there was no significant difference in the percent stone weight decrease of the mixed struvite and carbonate apatite stones under either HBO or normobaric condition. The dissolution responsiveness of struvite was significantly greater than that of the mixed struvite and carbonate apatite stones. CONCLUSIONS: The chemolysis of struvite in UROCITRA solution is significantly greater than that of the mixed struvite and carbonate apatite stones. However, the UROCITRA solution enriched with HBO does not enhance the dissolution of infective stones.

Tea consumption: fluid intake and bladder cancer risk in Southern Taiwan.

OBJECTIVES: To determine whether tea consumption and intake of other beverages increases bladder cancer risk. METHODS: A case-control study was conducted in Kaohsiung, Taiwan between August 1996 and June 1997. Index patients studied were consecutive patients with histologically confirmed, newly diagnosed bladder cancer in two major hospitals. For each patient, 4 controls were selected from patients with non-neoplastic and nonurologic diseases undergoing surgical operations in the same hospital and individually matched by sex, age, and date of admission. Using a structured questionnaire, a trained interviewer interviewed 40 patients and 160 controls. Conditional logistic regression analysis adjusting for ethnicity, family history, and smoking status and matching variables were used to estimate the odds ratio (OR) and 95% confidence interval (CI). RESULTS: Tea consumption overall was associated with increased bladder cancer risk (OR 3.29, 95% CI 1.34 to 8.05). Compared with non-tea drinkers, the odds ratios of bladder cancer for oolong tea drinkers was 3.00 (95% CI 1.20 to 7.47); for non-oolong tea drinkers (black and/or other green tea), it was 14.86 (95% CI 2.13 to 103.83). The risk was greater among those who began to drink tea before age 40 (OR 9.50, 95% CI 2.39 to 37.75) and those who had been drinking tea for more than 30 years (OR 17.75, 95% CI 3.00 to 105.17). Coffee, tap water, and alcohol consumption were associated with a slightly increased risk, and both soy juice and rice juice consumption were associated with reduced risk; none of these odds ratio estimates were statistically significant, however. CONCLUSIONS: Our results suggest that tea consumption is associated with an increased risk of bladder cancer.

NMR studies of internal dynamics of serine proteinase protein inhibitors: Binding region mobilities of intact and reactive-site hydrolyzed Cucurbita maxima trypsin inhibitor (CMTI)-III of the squash family and comparison with those of counterparts of CMTI-V of the potato I family.

Serine proteinase protein inhibitors follow the standard mechanism of inhibition (Laskowski M Jr, Kato I, 1980, Annu Rev Biochem 49:593-626), whereby an enzyme-catalyzed equilibrium between intact (I) and reactive-site hydrolyzed inhibitor (I*) is reached. The hydrolysis constant, Khyd, is defined as [I*]/[I]. Here, we explore the role of internal dynamics in the resynthesis of the scissile bond by comparing the internal mobility data of intact and cleaved inhibitors belonging to two different families. The inhibitors studied are recombinant Cucurbita maxima trypsin inhibitor III (rCMTI-III; Mr 3 kDa) of the squash family and rCMTI-V (Mr approximately 7 kDa) of the potato I family. These two inhibitors have different binding loop-scaffold interactions and different Khyd values--2.4 (CMTI-III) and 9 (CMTI-V)--at 25 degrees C. The reactive-site peptide bond (P1-P1') is that between Arg5 and Ile6 in CMTI-III, and that between Lys44 and Asp45 in CMTI-V. The order parameters (S2) of backbone NHs of uniformly 15N-labeled rCMTI-III and rCMTI-III* were determined from measurements of 15N spin-lattice and spin-spin relaxation rates, and [1H]-15N steady-state heteronuclear Overhauser effects, using the model-free formalism, and compared with the data reported previously for rCMTI-V and rCMTI-V*. The backbones of rCMTI-III [(S2) = 0.71] and rCMTI-III* [(S2) = 0.63] are more flexible than those of rCMTI-V [(S2) = 0.83] and rCMTI-V* [(S2) = 0.85]. The binding loop residues, P4-P1, in the two proteins show the following average order parameters: 0.57 (rCMTI-III) and 0.44 (rCMTI-III*); 0.70 (rCMTI-V) and 0.40 (rCMTI-V*). The P1'-P4' residues, on the other hand, are associated with (S2) values of 0.56 (rCMTI-III) and 0.47 (rCMTI-III*); and 0.73 (rCMTI-V) and 0.83 (rCMTI-V*). The newly formed C-terminal (Pn residues) gains a smaller magnitude of flexibility in rCMTI-III* due to the Cys3-Cys20 crosslink. In contrast, the newly formed N-terminal (Pn' residues) becomes more flexible only in rCMTI-III*, most likely due to lack of an interaction between the P1' residue and the scaffold in rCMTI-III. Thus, diminished flexibility gain of the Pn residues and, surprisingly, increased flexibility of the Pn' residues seem to facilitate the resynthesis of the P1-P1' bond, leading to a lower Khyd value.

The effects of Qi-Qong ocular exercise on accommodation.

Visual-training methods in management of myopia are suggested as possibly leading to normal vision or an improvement in the refractive state. The purpose of this work was to investigate the hypothesis that a Qi-Qong ocular exercise improves visual function by training the accommodation bias. Variations of pupil size, accommodative amplitude, latency and speed of accommodative response and accommodative adaptation were evaluated objectively. The accommodative state was monitored with an objective infrared refractometer (Nidek AA-2000). Subjects were divided into two groups: experimental (n = 9), and control (n = 8). Subjects of the experimental group undertook the Qi-Qong ocular exercise for at least three years, and were able to perform the exercise smoothly and gently. Subjects of the control group had no knowledge of the Qi-Qong ocular exercise, but were given the same testing procedures as the experimental group. Results showed that Qi-Qong ocular exercise can improve the accommodative amplitude and accelerate the accommodative response slightly, but there was no effect on the latency of accommodative response. Furthermore, the level of accommodative adaptation was elevated, and the pupil became slight miotic. Therefore, the mechanism of visual improvement may undergo a great accommodative adaptation and produce a pinhole effect by miosis of the pupil. Methods of visual training can produce a false image of visual improvement from an enhanced parasympathetic response to a task, but this effect may be a factor that induces progression of myopia.

Local chemolysis of obstructive uric acid stone with 0.1 M THAM and 0.02% chlorhexidine.

We used a modified chemolytic solution by combining 0.1 M THAM (tris[hydroxymethyl] aminomethane) with 0.02% chlorhexidine to treat 10 obstructive uric acid stone patients. A total of 23 local chemolysis sessions were performed. Five patients received 13 sessions (average: 2.6) as an adjuvant chemolysis after extracorporeal shock wave lithotripsy 5 patients received 10 sessions (average: 2) as a primary treatment. The average time of local chemolysis was 2.3 days, ranging from 1 to 4 days. In the 23 local chemolysis sessions, only one patient developed two episodes of fever (8.7%), which were managed successfully by conservative treatment. The mean values of effective renal plasma flow of treated kidney was increased from 108.2 to 155.6 ml/min (p < 0.05). The stone-free rate assessed by IVP and ultrasonography at 3 months follow-up was 80%. Our results indicate that the combined use of 0.1 M THAM and 0.02% chlorhexidine is an effective and safe method to treat obstructive uric acid stones.

Acupuncture in the treatment of renal colic.

A prospective randomized study was performed to compare the effect of acupuncture and intramuscular Avafortan injection in the treatment of renal colic. Our results showed that acupuncture is as effective in relieving renal colic as Avafortan but it had a more rapid analgesic onset (3.14 +/- 2.88 minutes versus 15.44 +/- 7.55 minutes, p less than 0.05). Of the patients in the Avafortan group 7 (43.8%) had side effects, including skin rash in 3, tachycardia in 2, drowsiness in 1 and facial flush in 1. No side effects were noted in the acupuncture group. During 2 hours of observation acupuncture and Avafortan seemed to be ineffective in promoting stone passage. However, patients receiving Avafortan treatment were more likely to have paralytic ileus. In summary, acupuncture can be a good alternative for the treatment of renal colic.