Patient use of the internet for information in a lung cancer clinic.

STUDY OBJECTIVES: To determine how frequently patients attending a lung cancer clinic use the Internet for their own health information, to determine whether there are demographic differences between Internet users and nonusers, and to determine how patients compare the quality of Internet information with other sources of lung cancer information. DESIGN: Sequentially administered patient questionnaire. One hundred eighty-four patients were surveyed, and 139 patients (75.5%) completed the questionnaire. SETTING: A multidisciplinary thoracic oncology clinic in a Midwestern University hospital. PATIENTS OR PARTICIPANTS: Patients attending the multidisciplinary thoracic oncology clinic over a 3-month period. MEASUREMENTS AND RESULTS: The Internet was the most commonly used nonphysician source of information among our patients. Sixteen percent of the patients sought information on the Internet, but 60% expressed interest in using the Internet for information. Users were on average of higher income level and educational attainment but did not differ from nonusers by community size. Internet users rated the quality of information available on the Internet of similar quality to information from all sources. CONCLUSIONS: Older patients are increasing using the Internet for self-education in lung cancer. While certain barriers continue to exist, patients from rural areas use the Internet to the same degree, as do patients from urban areas. Patients do, however, overrate the quality of information on the Internet.

Varicocele: current concepts in pathophysiology, diagnosis, and treatment.

Although significant advances have been made in the understanding of varicoceles, a clear pathophysiologic mechanism remains elusive. Most likely, a varicocele is the result of a multifactorial process. Appreciation of the complex venous drainage of the testis remains a key to maximizing the chances for treatment success. Likewise, the advent of microsurgical repair has minimized complications. Fortunately, times have improved since the early nineteenth century, when the French surgeon Delpech (1772-1832) was killed by a disgruntled patient on whom he had performed a varicocele repair.

Laparoscopic augmentation cystoplasty: a comparison between native ileum and small intestinal submucosa in the porcine model.

OBJECTIVES: To determine the feasibility of laparoscopic augmentation cystoplasty (LAC) in the porcine model and to compare LAC using standard bowel vs a small intestinal submucosa (SIS) allograft. MATERIALS AND METHODS: Fourteen female pigs underwent LAC; six had standard ileal AC and eight AC with SIS. All the pigs had limited cystometrogram studies before surgery to determine bladder capacity. At 6 weeks after surgery the pigs were anaesthetized, the bladder capacities were re-assessed and then the pigs were killed; the bladders were harvested and examined histologically. RESULTS: In all, 12 of 14 pigs completed the 6-week survival period; two pigs from the SIS group died from urinary ascites secondary to anastomotic leaks at the cystoplasty site. There were no complications in the ileal augmentation group. The operative duration was similar in both groups. The bladder capacities increased significantly in both groups, although more reliably in the native ileum group. In two pigs in the SIS group there was no increase in bladder capacity. CONCLUSIONS: LAC is feasible in the porcine model and results in a significant increase in bladder capacity. AC using SIS does not appear to increase bladder capacity as reliably as native ileum, and has a higher complication rate.

Long-term outcome analysis of Starr plication for primary obstructive megaureters.

PURPOSE: The Starr technique of tapering megaureters was first reported in 1979. Although this method of ureteral plication is well known, to our knowledge there are no clinical studies regarding outcomes. We report the first long-term outcome results with the Starr technique for primary obstructive megaureters. MATERIALS AND METHODS: Three girls and 10 boys with a total of 16 primary obstructive megaureters (3 bilateral) underwent reimplantation with Starr plication between 1988 and 2000. Baseline and followup renal function (average followup 6.2 years) was determined with renal scan and/or 24-hour urinary creatinine clearance. Average age at operation was 5.6 years (range 2 months to 13 years). All ureters were plicated using the Starr technique with interrupted polydioxanone sutures performed by a single surgeon (CEH). Reimplantation methods were the Hendren technique in 7 and Politano-Leadbetter in 9. RESULTS: No ureter demonstrated obstruction postoperatively. One ureter refluxed, which resolved with subureteral collagen injection. Seven patients had mean preoperative and postoperative creatinine clearance +/- SD 72.9 +/- 14.8 and 102.1 +/- 10.9 cc per minute, respectively (p <0.05). Six patients underwent preoperative and postoperative renal scans. Average preoperative relative renal function on renal scan in the kidney with a megaureter was 53.0% +/- 6.7% (range 37% to 84%). Long-term followup (average 4.1 years) renal scan revealed a relative function of 53.3% +/- 9.2% (range 37% to 100%). CONCLUSIONS: Our data demonstrate that Starr plication is a safe procedure that provides long-term stabilization of renal function in the management of primary obstructive megaureter.