Single nucleotide polymorphisms in the growth hormone and insulin-like growth factor-1 genes are associated with milk production, body condition score and fertility traits in dairy cows.

The somatotrophic axis (GH-IGF) is a key regulator of animal growth and development, affecting performance traits that include milk production, growth rate, body composition, and fertility. The aim of this study was to quantify the association of previously identified SNPs in bovine growth hormone (GH1) and insulin-like growth factor 1 (IGF-1) genes with direct performance trait measurements of lactation and fertility in Holstein-Friesian lactating dairy cows. Sixteen SNPs in both IGF-1 and GH1 were genotyped across 610 cows and association analyses were carried out with traits of economic importance including calving interval, pregnancy rate to first service and 305-day milk production, using animal linear mixed models accounting for additive genetic effects. Two IGF-1 SNPs, IGF1i1 and IGF1i2, were significantly associated with body condition score at calving, while a single IGF-1 SNP, IGF1i3, was significantly associated with milk production, including milk yield (means ± SEM; 751.3 ± 262.0 kg), fat yield (21.3 ± 10.2 kg) and protein yield (16.5 ± 8.0 kg) per lactation. Only one GH1 SNP, GH33, was significantly associated with milk protein yield in the second lactation (allele substitution effect of 9.8 ± 5.0 kg). Several GH1 SNPs were significantly associated with fertility, including GH32, GH35 and GH38 with calving to third parity (22.4 ± 11.3 days) (GH32 and GH38 only), pregnancy rate to first service (0.1%) and overall pregnancy rate (0.05%). The results of this study demonstrate the effects of variants of the somatotrophic axis on milk production and fertility traits in commercial dairy cattle.

De novo HLA sensitization and antibody mediated rejection following pregnancy in a heart transplant recipient.

Here we report a case wherein both donor-specific and third-party, paternal, HLA class II specific antibodies developed following a spontaneous miscarriage resulting in antibody-mediated rejection in a patient who had undergone an orthotopic cardiac transplant six years earlier.

Underutilization of echocardiography for patent foramen ovale in divers with serious decompression sickness.

The presence of a patent foramen ovale (PFO) in compressed gas diving has been considered a risk factor for serious decompression illness (DCS) for more than 20 years. We conducted a ten year retrospective chart review aimed at determining if physicians treating DCS in a university medical center setting used echocardiography to assess PFO in patients with severe DCS, and if so whether PFO is over-represented in that population. Over the ten-year period, 113 divers underwent recompression therapy for decompression sickness. Of these patients, 48 had serious DCS defined by at least one objective neurological finding. We reviewed medical records for the presence of agitated saline contrast echocardiogram testing and whether or not PFO was present. Only 12 of 48 patients with serious DCS underwent transthoracic agitated saline contrast echocardiogram testing. Of these 12 patients, 6 (50%) had a resting PFO. Binomial proportion testing yielded 95% confidence limits of 21% and 79%. Given 27% PFO prevalence in the general population, PFO may be over-represented in our group of most seriously injured DCS patients yet 75% of patients with objective neurological signs did not undergo echocardiography.

An MRSA outbreak in a urology ward and its association with Nd:YAG coagulation laser treatment of the prostate.

An outbreak of methicillin resistant Staphylococcus aureus (MRSA) involving 88 patients in a general urology ward is described. Symptomatic bacteraemia and epididymo-orchitis occurred in 10 and 8% of patients respectively. Patients had a particularly high risk of acquiring serious MRSA infection after endoscopic neodymium yttrium aluminium garnet (Nd:YAG) laser treatment of the prostate. Appreciation of the mode of transmission of MRSA, a programme of continuing education for all medical and nursing staff, simple changes in ward protocol and advances in surgical laser technique contributed to the control of the outbreak.

Urinary incontinence: prevalence, need for treatment, and effectiveness of intervention by nurse.

OBJECTIVE: To measure the unmet need of patients with regular urinary incontinence (incontinence twice or more a month) treatable by a nurse. DESIGN: Self completed postal questionnaire and randomised controlled trial of assessment and intervention by a nurse. SETTING: One urban and one rural general practice in Somerset. SUBJECTS: 7300 adults randomly selected from 10,300 aged 35 and over on the combined practice lists. 515 women and 185 men with regular incontinence were offered assessment and treatment, of whom 134 women and 49 men had no intervention for three months (historical controls). They then joined the assessment and treatment programme. INTERVENTION: Four sessions of pelvic floor exercises and bladder retraining supervised by non-specialist nurse who had taken a three week course on assessing and treating uncomplicated incontinence. MAIN OUTCOME MEASURES: Number of patients desiring treatment; self reported cure, improvement, or deterioration in continence after three months. RESULTS: The questionnaire achieved a 79% response. Validated responses showed a prevalence of 4.4% in men and 16.4% in women aged 35-64. 315 (45%) of the 700 patients offered assessment refused it and seven had moved away or died, 64 men and 41 women were referred to their general practitioner. 197 of 292 treated women (68%) reported cure or improvement compared with seven (5%) of controls. 22 of the 86 men desiring treatment were suitable for intervention by the nurse. Seventeen were cured or improved compared with none of the men in the control group. CONCLUSIONS: About half the people with regular urinary incontinence took up the offer of treatment (9.2% of women and 3.4% of men in the study population). This condition can be effectively managed by a nurse with limited training.

Effect of level and duration of dietary n-3 polyunsaturated fatty acid supplementation on the transcriptional regulation of Delta9-desaturase in muscle of beef cattle.

The objective of this study was to examine the effect of level and duration of feeding of an n-3 PUFA-enriched fish oil (FO) supplement in combination with soybean oil (SO) on the transcriptional regulation of Delta(9)-desaturase gene expression in bovine muscle. Beef bulls (n = 40) were assigned to 1 of 4 iso-lipid and isonitrogenous concentrate diets fed for ad libitum intake for a 100-d finishing period. Concentrates were supplemented with one of the following: 1) 6% SO (CON); 2) 6% SO + 1% FO (FO1); 3) 6% SO + 2% FO (FO2); or 4) 8% palmitic acid for the first 50 d and 6% SO + 2% FO for the second 50 d [FO2(50)]. Samples of LM were harvested and concentrations of fatty acids were measured. Total RNA was isolated and the gene expression of Delta(9)-desaturase was determined. The mRNA expression of putative regulators of Delta(9)-desaturase gene expression, sterol regulatory element binding protein-1c (SREBP-1c) and peroxisome proliferator activated receptor-alpha (PPAR-alpha), were also measured in the CON and FO2 groups. Expression of mRNA for Delta(9)-desaturase was decreased (P < 0.05) 2.6-, 4.4-, and 4.9-fold in FO1, FO2(50), and FO2 compared with CON, respectively. Expression of Delta(9)-desaturase mRNA tended to be reduced (P = 0.09) by increasing FO from 1 to 2%, but was not affected by duration of supplementation (P > 0.24). Expression of mRNA for SREBP-1c was decreased 2-fold in FO2 compared with CON (P < 0.05), whereas expression of PPAR-alpha was not affected (P > 0.30). There was a positive relationship between Delta(9)-desaturase and SREBP-1c gene expression (P < 0.01), but the expression of both genes was negatively related to tissue concentrations of n-3 PUFA (P < 0.05) and positively related to concentration of n-6 PUFA (P < 0.01). Simultaneous enhancement of tissue concentrations of CLA and n-3 PUFA concentrations in bovine muscle may be hindered by negative interactions between n-3 PUFA and Delta(9)-desaturase gene expression, possibly mediated through reduced expression of SREBP-1c.

Genitourinary tuberculosis: study of 20 patients.

In the past year 20 new cases of genitourinary tuberculosis were referred for treatment at Wrightington Hospital. Many of these patients had waited a long time between diagnosis and referral and the start of effective treatment. We suggest that a new short course of chemotherapy should be used, and surgery undertaken during the first three months of treatment, but after the patient has had at least four weeks' drug treatment. After chemotherapy follow-up may be reduced to two years. Genitourinary tuberculosis remains a serious disease and should be managed by a urologist.

Teflon injection in female stress incontinence. Effect on urethral pressure profile and flow rate.

Thirty-six females with genuine stress incontinence (GSI) were treated by bladder neck teflon injection. Urethral pressure profilometry (UPP) and uroflowmetry were performed both pre- and post-operatively on 18 patients. In 24 patients who were either completely cured or improved by this procedure, the mean urine flow rate was reduced by 23% and the mean functional profile length increased by 9% compared with pre-operative values. Although these findings appear to explain the mechanism by which teflon improves continence, these differences were not statistically significant. Fourteen of the 18 patients who had not responded to previous anti-incontinence procedures were successfully treated by teflon injection. The improved response rate in these patients was not statistically significant. It was not possible to predict with certainty those patients most likely to respond to teflon injection. However, in women with normal or near normal pelvic floor anatomy the procedure had an acceptable success rate. In view of the simplicity, lack of morbidity and the ease with which it can be performed and repeated, bladder neck teflon injection deserves consideration as an alternative, particularly where open surgery has failed.

The 'hitch-stitch' and drain technique for the prevention of inguinoscrotal haematoma following complicated inguinoscrotal surgery.

A method to prevent inguinoscrotal haematoma following hernia and hydrocele repair is presented. The technique was used in 34 consecutive patients, none of whom developed a significant postoperative haematoma or complications.

Primary vesical sensory urgency. A clinical trial of bromocriptine.

A randomised double blind crossover trial of Bromocriptine against an inert placebo was performed in 14 patients with primary sensory urgency. Bromocriptine was found to have no therapeutic advantage for these patients and the possible explanations for this finding are discussed.

Videoprostatectomy. Guidelines for choosing an effective microvideo operating system.

Videoprostatectomy is gaining increasing acceptance by urologists. Guidelines are suggested to assist in the selection of a suitable video operating system and to optimise both the quality of the video image and safety of operation.

Periurethral Teflon for stress urinary incontinence: medium-term results.

Medium-term results are presented for the periurethral injection of Teflon in the treatment of stress urinary incontinence. Follow-up data were obtained on 36 women by means of case note review and the completion of a postal questionnaire. Mean follow-up was 5.1 years. Subjective results showed 12 patients to be dry or much improved while the remaining 24 patients did not obtain significant benefit from the procedure. Repeat injections in 12 women resulted in only 3 obtaining useful improvement, while a subgroup of patients who had undergone previous procedures showed a better response. No significant complications were observed. Periurethral Teflon injection is a minor surgical procedure which can produce worthwhile improvement, although an initially good result may not be sustained with longer follow-up. This method may be advocated as treatment for poor risk patients who are unsuitable for surgery, particularly when previous attempts at formal surgical correction have been unsuccessful.

Vaginal ureterolithotomy.

The vaginal approach to the low ureteric calculus may provide an easy, rapid and safe solution to a difficult surgical problem. It is important to select the case with care and, provided basic surgical principles are followed, the complications should be minimal. 3 recent successful cases are described and a further 2 in which the technique failed due to proximal displacement of the stone. The importance of adequately immobilising the calculus prior to ureterotomy is emphasised.

Staghorn calculi of the kidneys. A. Clinical review.

A series of 91 staghorn calculi are reviewed. Possible aetiological factors are analysed. A high incidence of hypercalciuria was found, and the significance of this is discussed. The rates of complete stone clearance after conservative surgery are considered for different types of staghorn calculus and it is felt that local circulatory arrest with kidney cooling may be of value in removing stones due to Proteus. The place of elective nephrectomy in the management of staghorn calculi is discussed. Nephrectomy may be the treatment of choice in the management of large, unilateral stones in older patients.

An evaluation of urologist-operated ultrasound and its use in the urological out-patient clinic.

The value of urologist-operated real time ultrasound scanning was assessed in the urological out-patient clinic. In terms of accuracy, the urologists' ultrasound scans of the genito-urinary tract proved comparable with those of the radiologists. The techniques were quickly learned and scanning added little to the consultation time. Scanning during clinic time was shown to be both time-saving and cost-effective by allowing more rapid assessment of the patient and a speedier diagnosis. In economic terms considerable savings could be made by reducing the need for formal ultrasound referrals, since patients scanned at the out-patient clinic would be spared two further trips to hospital, one for the formal examination and another for the out-patient clinic review. Clinic turnover thus becomes more efficient and inconvenience to the patient and transport costs are lessened.

Multiple use of fibres in the visual laser ablation of the prostate.

OBJECTIVE: To investigate the possibility of re-using laser fibres for the visual laser ablation of the prostate (VLAP). PATIENTS AND METHODS: Thirty-four patients, each with a mean maximum urinary flow rate of < 14.0 mL/s and an American Urological Association symptom score of > 19, were evaluated. All underwent VLAP: laser energy, generated by a Neodymium:YAG system, was delivered with a side-firing fibre. The laser generator was fitted with a custom-built power meter that measured the energy delivered by the fibre. Fibres were re-used until the energy output fell below 60 W despite increases in laser generator power. Each patient was followed for at least 12 months. RESULTS: A total of seven fibres was used to treat the 34 patients; between one and nine patients were treated with each fibre. The outcome obtained with the first use of a fibre compared well with those obtained with each subsequent use. After 12 months, 25 patients (74%) expressed satisfaction with the results of their operation. Five patients (15%) had urinary tract infections. As each fibre costs about pound 650, multiple use saved a mean of pound 516 for each patient treated. CONCLUSION: This evaluation implies that there is no justification for the single use of laser fibres on the basis of efficacy, provided that a power meter is used to monitor the efficiency of the delivery device.

A prospective randomized controlled trial of hybrid laser treatment or transurethral resection of the prostate, with a 1-year follow-up.

OBJECTIVE: To compare the clinical outcome after hybrid laser treatment of the prostate, combining potassium titanyl phosphate (KTP) and Nd:YAG lasers, with transurethral resection of the prostate (TURP). PATIENTS AND METHODS: A prospective randomized trial was conducted to compare laser treatment and TURP. The hybrid laser treatment technique involved performing initial 30 W KTP vaporizing bladder neck incisions and prostatotomies followed by a 'free-paint' application of 60 W Nd:YAG coagulation energy. Patients were re-assessed after 6 weeks, 6 months and 1 year, using the International Prostate Symptom Score (IPSS) and uroflowmetry. TURP was conducted using conventional methods. RESULTS: In all, 204 patients were randomized into the study; at 6 weeks there were significant differences between the groups for the IPSS (12.4 vs 9.1, P=0.001) and maximum urinary flow rates (16.1 vs 20.8 mL/S, P<0. 001) in favour of the TURP group. At 6 months and one year this difference had disappeared. Similar numbers of patients in each group complained of bothersome postoperative urinary symptoms (23% vs 19%). Blood transfusions (5% vs none) and urethral strictures (9% vs 2%) were more common after TURP, whereas more early infective complications occurred after hybrid laser treatment (24% vs 5%). Only one patient in each group required re-operation because of poor resolution of symptoms. CONCLUSIONS: At one year, hybrid KTP/Nd:YAG laser treatment of the prostate was equivalent to TURP in the improvements in IPSS, maximum urinary flow rate and post-void residual urine.

Quality of life changes following KTP/Nd:YAG laser treatment of the prostate and TURP.

OBJECTIVE: To compare health-related quality of life (HRQL) changes in patients receiving hybrid KTP/Nd:YAG laser treatment of the prostate with TURP. PATIENTS AND METHODS: Patients complaining of symptomatic benign prostatic enlargement were studied. Their symptoms (IPSS), disease-specific (BPH Impact Index (BPHII)) and generic HRQL (Short Form-36 (SF-36)) was evaluated before and at 6 weeks, 6 months and 1 year following treatment. RESULTS: 204 patients were randomized into the study. Patients in both groups reported an improvement in IPSS and BPHII at each postoperative assessment, but there were significant differences between the two groups at the 6-week stage in favor of the TURP group. At 6 weeks, patients in the laser group reported significantly worse scores in the SF-36 domains of bodily pain, social function and role emotional when compared to the TURP group. These differences disappeared at both the 6-month and 1-year follow-up assessments. CONCLUSIONS: Although hybrid KTP/Nd:YAG laser treatment and TURP differed in the way they affected patients in the early postoperative period, at 1 year, patients reported similar improvements in symptoms and enjoyed a similar disease-specific and generic HRQL.

The surgical management of tuberculous lower ureteric stricture.

25 years' experience of the open surgical management of the lower ureteric stricture is reviewed. An extravesical anti-reflux tunnel procedure has been found to be simple and effective. There is still a place for the Boari procedure or psoas hitch, particularly in the management of a long stricture of when gross thickening of the ureter makes the formation of a tunnel of effective length impracticable.

A further assessment of bladder transection in the management of adult enuresis and allied conditions.

The use of bladder transection for the management of adult enuresis and allied conditions is reported. The beneficial effects of the operation, assessed by an improvement of symptoms and measured objectively by urodynamic investigation, have been found to be maintained during 4 years' experience of the procedure.