Patulous eustachian tube after percutaneous balloon microcompression for trigeminal neuralgia: case report.

OBJECTIVE: To report a case of patulous eustachian tube which occurred after percutaneous balloon microcompression of the Gasserian ganglion. METHOD: Retrospective case review. RESULTS: A 41-year-old man was referred to our audiovestibular medicine department following episodes of autophony. These symptoms appeared two weeks after percutaneous balloon microcompression performed to treat severe trigeminal neuralgia secondary to multiple sclerosis. A diagnosis of patulous eustachian tube was indicated by clinical examination and tympanometry. The symptoms were present for less than six months and improved without any specific treatment. CONCLUSION: Percutaneous balloon microcompression is a procedure used for refractory trigeminal neuralgia that can cause transient sensory and motor deficits of any of the trigeminal nerve branches. It is proposed that injury to the mandibular division in this case caused temporary tensor veli palatini dysfunction with consequent patulous eustachian tube.

Holmium laser versus transurethral resection of the prostate: a randomized prospective trial with 1-year followup.

PURPOSE: The high-powered holmium:YAG laser can be used for incision, ablation and resection of the prostate. The technique of holmium laser resection of the prostate is compared to transurethral prostatic resection for surgical management of benign prostatic hyperplasia in this prospective randomized study. MATERIALS AND METHODS: A total of 120 urodynamically obstructed cases were randomized to holmium laser or transurethral prostatic resection. All eligible patients were assessed preoperatively and at 3 weeks, and 3, 6 and 12 months postoperatively with an American Urological Association symptom score, peak urinary flow rate, and questionnaires concerning sexual function and continence. Preoperative pressure flow study, ultrasound prostate volume assessment and post-void residual volume measurement were repeated at the 6-month visit. All complications were noted. RESULTS: Holmium laser and transurethral resections resulted in significant improvements in symptom score, quality of life score, peak urinary flow rate and post-void residual urine measurements. Operating time was significantly longer in the holmium group but nursing contact time, catheter time and hospital stay were significantly less compared to the transurethral prostatic resection group. Urodynamic results were equivalent at 6 months. There were fewer side effects in the holmium group. Effects on continence, potency and symptoms were similar with 1-year followup. CONCLUSIONS: Holmium and transurethral resections of the prostate appear to be equivalent in surgical management of bladder outflow obstruction due to benign prostate hyperplasia. Perioperative morbidity was less in the holmium group.

Predicting malaria infection in Gambian children from satellite data and bed net use surveys: the importance of spatial correlation in the interpretation of results.

In line with the renewed World Health Organization Global Malaria Control Strategy, we have advocated the use of satellite imagery by control services to provide environmental information for malaria stratification, monitoring, and early warning. To achieve this operationally, appropriate methodologies must be developed for integrating environmental and epidemiologic data into models that can be used by decision-makers for improved resource allocation. Using methodologies developed for the Famine Early Warning Systems and spatial statistics, we show a significant association between age related malaria infection in Gambian children and the amount of seasonal environmental greenness as measured using the normalized difference vegetation index derived from satellite data. The resulting model is used to predict changes in malaria prevalence rates in children resulting from different bed net control scenarios.

The results of holmium laser resection of the prostate.

OBJECTIVE: To assess the results of holmium-laser resection of the prostate (HOLRP) in the treatment of benign prostatic hyperplasia. PATIENTS AND METHODS: Between 1994 and 1997, 967 patients underwent HOLRP in Tauranga, New Zealand, and in Derby, United Kingdom. The patients were followed at 1, 3 and 6 months after treatment using measurements of symptom score and urinary flow rate. RESULTS: There was a large and sustained improvement in symptom scores and urinary flow rates, with no mortality and low morbidity. CONCLUSION: We recommend this technique as an alternative to transurethral resection in the surgical treatment of bladder outlet obstruction due to benign prostatic hypertrophy.

Holmium laser resection of the prostate versus neodymium:yttrium-aluminum-garnet visual laser ablation of the prostate: a randomized prospective comparison of two techniques for laser prostatectomy.

OBJECTIVES: To directly compare holmium laser resection of the prostate (HoLRP) with neodymium:yttrium-aluminum-garnet visual laser ablation of the prostate (VLAP), which represent two fundamentally different methods of laser prostatectomy. METHODS: In a randomized, prospective comparison, a total of 44 men with symptomatic benign prostatic hyperplasia (BPH) were treated with either HoLRP or VLAP. Standard preoperative assessment included American Urological Association (AUA) symptom score, peak urinary flow rates (Qmax), ultrasound prostate volume, and residual urine measurements. Pressure-flow urodynamics were performed preoperatively and at 3 months postoperatively. Intraoperative and perioperative factors were assessed. The patients were followed at 1, 3, 6, and 12 months following the procedure. RESULTS: There were no significant differences between the patient groups for any preoperative parameter. The mean total operating time was longer in the HoLRP group (52 minutes) compared with the VLAP group (41 minutes) (P <0.01). The mean catheter times were 1.4 days (HoLRP) and 11.6 days (VLAP) (P <0.001). These times included the 9% of patients undergoing HoLRP and 36% of patients undergoing VLAP who required recatheterization. Immediate postoperative dysuria scores were higher in the VLAP group compared with the HoLRP group. There were no significant differences in AUA scores between the two treatment groups at any postoperative interval. The Qmax values were greater at follow-up in the HoLRP group, but statistical significance was not achieved at 12 months. However, both PdetQmax and Schäfer grade measurements taken at 3 months postoperatively were significantly lower in the patients undergoing HoLRP. Three patients (14%) required reoperation in the VLAP treatment arm but no patient who underwent HoLRP has required reoperation to date. CONCLUSIONS: HoLRP results in significantly improved patient outcomes compared to VLAP.

Holmium: YAG laser resection of prostate (HoLRP) for patients in urinary retention.

We examined the holmium:YAG (Ho:YAG) laser as a tool to perform acute resection of obstructing prostatic tissue in the subgroup of men with benign prostatic hyperplasia (BPH) who present in urinary retention. A total of 36 men presented in acute urinary retention requiring catheterization before undergoing Ho:YAG laser resection of the prostate (HoLRP). Their mean age was 67 years. The mean laser energy delivery was 102 kJ (range 42-315 kJ). The mean postoperative catheterization time was 1.5 days (range 1-8 days), and only 3 men required a catheter for more than 48 hours. There were no acute perioperative complications. Improvement in voiding was immediate and sustained through 6 months of follow-up. At 6 months, the mean peak urinary flow rate was 22.5 mL/sec, and the AUA Symptom Index Score was 5.7. A meatal stricture requiring dilation in one man represents the sole late complication observed in this series. Late recurrence of urinary retention has occurred in two men who had contributing medical problems, for an overall treatment failure rate of 5.6%. Thus, HoLRP represents an effective surgical therapy for patients with bladder outlet obstruction presenting in urinary retention. Morbidity is minimal compared with electrocautery resection, while the efficacy and immediacy of voiding improvement appear similar.

Holmium:YAG laser resection of the prostate: preliminary experience with the first 400 cases.

AIM: To report the development of the technique of laser resection of the prostate using the holmium:YAG (Ho:YAG) laser and to present preliminary results. METHODS: Four hundred and eleven patients underwent Ho:YAG laser resection of the prostate (HoLRP). Preoperative and postoperative symptom scores, and flow rates were assessed. A description of the technique and its development is presented. RESULTS: The mean American Urological Association (AUA) symptom score reduced from 23.6 to 4.9, and the mean peak urinary flow rate improved from 7.7 ml/s to 22.6 ml/s at 6 months postoperatively. The mean hospital stay was 1.3 days and complication rates were lower than those generally associated with electrosurgical transurethral resection of the prostate (TURP). CONCLUSION: Transurethral resection of the prostate using Ho:YAG laser produces early results equivalent to or better than those usually associated with electrosurgical TURP, with a shorter hospital stay and a lower rate of complications.

The use of the holmium laser in the treatment of benign prostatic hyperplasia.

The holmium wavelength (2.1 microns) can be used for incision, ablation, and resection of prostate tissue. Four different techniques for the surgical management of benign prostate hyperplasia (BPH) have evolved using the holmium laser either alone or in combination with Nd:YAG energy. The results in 650 patients undergoing these procedures are presented. The holmium laser has been used most recently to perform a transurethral resection of the prostate in 381 patients to date. This procedure appears to be the most efficient way of using the holmium laser for the removal of obstructing prostatic tissue.

Holmium laser resection of the prostate: preliminary results of a new method for the treatment of benign prostatic hyperplasia.

OBJECTIVES: To assess the early efficacy and safety of holmium laser resection of the prostate (HoLRP) for the treatment of patients with symptomatic benign prostatic hyperplasia (BPH). METHODS: The initial 84 patients undergoing HoLRP at this institution are reported. All patients underwent standard urologic evaluation for BPH with American Urological Association (AUA) symptom score, peak urinary flow rate (Qmax), ultrasound prostate volume estimation, prostate-specific antigen and digital rectal examination. The patients were reassessed at 1 month (72 patients) and 3 months (48 patients) postoperatively. The resection time, total operating time, holmium energy used (kilojoules), catheter time, and hospital stay were all recorded. RESULTS: The mean patient age was 65.3 years (49 to 80). The mean AUA score improved from 21.3 preoperatively to 7.6 at 1 month and 4.1 at 3 months. The mean Qmax likewise increased from 7.5 mL/s preoperatively to 17.8 mL/s at 1 month and 19.3 mL/s at 3 months. Two patients (2%) required bladder irrigation for heavy hematuria perioperatively and 4 patients (5%) required recatheterization. Few patients experienced irritative urinary symptoms and to only a mild degree. CONCLUSIONS: The technique of HoLRP produces a cavity identical in appearance to transurethral resection of the prostate. It is a relatively bloodless procedure that results in a short catheter time, immediate symptomatic improvement, and minimal postoperative irritative symptoms. The short-term results are excellent but longer-term follow-up is necessary.

A technique for the tensile testing of demineralised bone.

The purpose of this study was to devise a method for the tensile testing of the organic component of demineralised bone. It was hoped that the method could be applied to determine whether an observed reduction in the strength of bone in copper-deficient rats could be attributed to a reduction in the cross-linking of collagen. Tensile testing of a fully demineralised specimen proved impossible to perform because of the difficulty in gripping the material, which tended to slide out of its holding clamps. The technique devised involved the demineralisation of only the diaphysis of the bone, leaving the bone ends intact. This enabled the bone to be gripped firmly at both ends in an Instron tensile testing machine. Elongation under loading of the demineralised diaphysis was measured by the Instron and a video recording was made of the elongation of the central portion. The strain was found to be uniform. Tensile strength was found to correlate with copper levels in the liver (r = 0.54, p < 0.05), although no significant differences were found between the strength, the stiffness, or the strain to failure for bone from the copper-deficient animals and bone from the normal controls. The test method itself should be useful in other studies in which the tensile properties of the organic phase of bone need to be measured.

Impaired mechanical strength of bone in experimental copper deficiency.

Copper, through its role as cofactor for lysyl oxidase, is essential for intra- and inter-molecular cross-links in collagen. Copper deficiency, in man and in animals, is associated with bone fragility ascribed to defective cross-links. To assess bone strength in copper-deficient animals, we designed a sensitive torsion-testing apparatus according to biomechanical considerations. Femora from 7 copper-deficient rats and from their pair-fed controls were tested in torsional loading until fracture. Significant decreases in the maximal sustained torque (t = 2.93, p < 0.05), in the ultimate angular deformation (t = 2.52, p < 0.05) and in the toughness (t = 2.88, p < 0.05) were demonstrated. In a complementary study, it was shown that the ash weight and the calcium content of the femora from the copper-deficient animals did not differ from those of the controls. It was likely, therefore, that the impaired mechanical strength was related to defects in the collagen component of bone.

Pseudologia Fantastica: a case study of a man charged with murder.

A case of Pseudologia Fantastica is presented in a man charged with murder. Psychological assessment revealed him to be highly compliant and suggestible, consistent with early research (Healy and Healy, 1915) which showed pathological liars to be suggestible to misleading information. A specific dyslexic disorder is also demonstrated, and the possible mechanisms behind the man's lying considered. Some implications regarding the reliability of the man's varying confessions to the police are discussed, and parallels are drawn between this case and that of Timothy Evans, who in 1950 was hanged for murder.