Value of prolonged scrotal drainage after penile prosthesis implantation: a multicenter prospective nonrandomized pilot study.

We aimed to understand the risks and benefits of post-inflatable penile prosthesis (IPP) implantation drainage and optimal duration. Our patients were divided into 3 groups: Group 1 (n = 114) had no drain placed, Group 2 had a drain placed for 24 h (n = 114) and Group 3 had a drain placed for 72 h (n = 117). Postoperative scrotal hematoma and prosthesis infection rates were compared between the groups. The patients from Group 3 demonstrated a statistically significant lower incidence of hematoma on the 10th postoperative day: (n = 1, 0.9%) compared to Group 2: (n = 11, 9.6%) and Group 1: (n = 8, 7%), (p = 0.013). However, on the 3rd postoperative day, there was a statistically significant lower incidence of hematoma in both Groups 3 and 2: (0.9% and 6.1%, respectively) vs. Group 1: (11.4%), (p = 0.004). Hematoma rates followed the same group order after the first day of surgery: 1.7% (n = 2), 5.3% (n = 6), and 8.8% (n = 10), respectively, (p = 0.05). Five patients (4.4%) in Group 1 and four patients (3.5%) in Group 2 developed an IPP associated infection, opposed to only a single patient (0.85%) in Group 3, (p = 0.210). We concluded that prolonged scrotal drainage for 72 h after virgin IPP implantation significantly reduces hematoma and infection rates.

Anatomic considerations of inflatable penile prosthetics: lessons gleaned from surgical body donor workshops.

Surgical implantation of an inflatable penile prosthesis (IPP) remains the gold-standard treatment for severe erectile dysfunction. The ideal surgical technique requires a thorough understanding of the relevant anatomy. This includes anatomic considerations related to, but not limited to, dissection and exposure of penoscrotal fasciae and tissues, corporal configuration, and abdominal structures. Insights obtained from pre-dissected anatomic specimens can obviate urethral injury, nerve damage, corporal perforation, inappropriate sizing, crossover, or implant malposition. We present penile implant-specific anatomic dissections and topographic landmarks identified over the last decade in the course of surgical training programs provided for IPP implantation.

Bidirectional MMWoF-wireless convergence system based on a 1610†nm L-band quantum-dash laser.

We report bidirectional 25/28 GHz millimeter wave (MMW)-over-fiber (MMWoF) and MMWoF-wireless (MMWoF-WL) transmission systems employing a single self-injection locked InAs/InP quantum-dash dual-mode laser (QD-DML) as a MMW source. Besides, we demonstrate the entire system exploiting the challenging mid-L-band wavelength window (1610 nm) to substantiate this source's potential, which exhibits tunability from C- to L-bands, in next-generation optical networks covering these wavelengths' window operations. While exhibiting 28 GHz mode spacing between the two optical carriers of QD-DML, a downstream (DS) transmission of 4.0 Gbaud (8 Gbits/s) quadrature-phase-shift-keying (QPSK) signal is conducted over this carrier. In addition, a simultaneous 2.0 Gbaud (8 Gbits/s) 16-level quadrature amplitude modulation (16-QAM) upstream (US) transmission on a 25 GHz MMW beat-tone is also achieved by exploiting one of the DS optical tones. A rigorous transmission characterization of variable DS and US QPSK/16-QAM data rates over MMWoF (10 km SMF) and MMWoF-WL (10 km SMF and up to 4 m wireless) are performed, showing a strong influence of phase noise on the DS link and hence the receiver sensitivity.

The Case of the Migrating Loop Recorder.

The role of ambulatory electrocardiographic monitoring has changed considerably in recent years with the increased use of implantable loop recorders with their shrinking size. With an excellent safety profile from previous studies, their use is generally seen as a low-risk procedure. Despite this, unexpected complications can occur, including unexpected migration. (Level of Difficulty: Intermediate.).

Raman fiber-optical method for colon cancer detection: Cross-validation and outlier identification approach.

Endoscopy plays a major role in early recognition of cancer which is not externally accessible and therewith in increasing the survival rate. Raman spectroscopic fiber-optical approaches can help to decrease the impact on the patient, increase objectivity in tissue characterization, reduce expenses and provide a significant time advantage in endoscopy. In gastroenterology an early recognition of malign and precursor lesions is relevant. Instantaneous and precise differentiation between adenomas as precursor lesions for cancer and hyperplastic polyps on the one hand and between high and low-risk alterations on the other hand is important. Raman fiber-optical measurements of colon biopsy samples taken during colonoscopy were carried out during a clinical study, and samples of adenocarcinoma (22), tubular adenomas (141), hyperplastic polyps (79) and normal tissue (101) from 151 patients were analyzed. This allows us to focus on the bioinformatic analysis and to set stage for Raman endoscopic measurements. Since spectral differences between normal and cancerous biopsy samples are small, special care has to be taken in data analysis. Using a leave-one-patient-out cross-validation scheme, three different outlier identification methods were investigated to decrease the influence of systematic errors, like a residual risk in misplacement of the sample and spectral dilution of marker bands (esp. cancerous tissue) and therewith optimize the experimental design. Furthermore other validations methods like leave-one-sample-out and leave-one-spectrum-out cross-validation schemes were compared with leave-one-patient-out cross-validation. High-risk lesions were differentiated from low-risk lesions with a sensitivity of 79%, specificity of 74% and an accuracy of 77%, cancer and normal tissue with a sensitivity of 79%, specificity of 83% and an accuracy of 81%. Additionally applied outlier identification enabled us to improve the recognition of neoplastic biopsy samples.

Ink jet printing of bio-treated linen, polyester fabrics and their blend.

Cellulosic fabrics were surface modified using Brewer's yeast filtrate and cellulase enzymes (Valumax A828, Valumax A356) to enhance its affinity to ink jet printing. The effect of enzymes on the surface structure and morphology of the cellulosic fabrics used has been illustrated using scanning electron microscope. Related test as tensile strength have been measured. The bio-treated cellulosic fabrics were digitally printed and the colour strength (K/S) and % increase in K/S were measured. Effect of different conditions (enzyme concentration, temperature and time) was investigated to obtain the optimum condition of each enzyme for each fabric that or which was indicated by higher colour strength. Results show a noticeable increase in the K/S especially for cellulosic linen and its blend compared to the standard samples. The optimum conditions to obtain the higher K/S by using Brewer's yeast filtrate and the other two cellulase enzymes in the pre-treatment of ink jet samples were obtained.

Utilization of biopolymer in resist printing of linen fabrics using reactive dyes.

A novel utilization of chitosan as a cationic biopolymer in the chemical resist printing of linen fabrics and its polyester blend using reactive dyes. The effects of ratio and concentration of various resist-printing agents and processing conditions are observed and discussed. The concentration of chitosan, type of resist agent, and the ratio of chitosan to resist agent were varied to determine their effects on the efficiency of resist-printing. Regardless of the type of fabric, the resist effect on printed fabrics expressed as % decrease in K/S was obtained at optimal chitosan concentration of 1% with a mixture of chitosan/maleic acid as a resist salt at a ratio of 25:75. Thus, chitosan can be used pure or in admixture with different resist salts successfully in chemical resist printing.

Preparation, characterization and technological evaluation of CMC derived from rice-straw as thickening agents in discharge, discharge-resist and burn-out printing.

Carboxymethyl cellulose samples of different D.S. values were prepared from rice straw via pulping followed by etherification with monochloroacetic acid under the catalytic action of sodium hydroxide. The prepared derivatives were assessed for D.S., rheological properties as well as suitability as thickening agents in different printing styles. It was found that carboxymethyl cellulose derived from rice straw is characterized by a non-Newtonian pseudoplastic behavior and its apparent viscosity at any specific rate of shear depends on the D.S. All the prepared derivatives could be used successfully as thickening agents in discharge and/or discharge/resist printing of cotton fabrics. Furthermore, they could be used also as thickening agent for burn-out printing style of wool/polyester blended fabrics using sodium hydroxide. Attractive samples could be obtained via using these techniques.

Vómitos persistentes en mujer hipertensa / Persistent vomiting in a hypertensive woman

Numerosos documentos insisten en la necesidad deun control estricto de la presión arterial (PA). Contrasta la escasa información publicada al respecto de la reducción tensional estricta y sus potenciales consecuencias negativas. Presentamos una paciente con hipertensión arterial (HTA) crónica esencial en tratamiento farmacológico y dos ingresos hospitalarios por vómitos secundarios a hiponatremia (hNa+) por tiazidas. Discutimos las causas más comunes de hNa+ enel paciente hipertenso, igualmente con muy escasabibliografía. El caso expuesto ilustra varios errores comunes en la praxis clinica habitual: erróneo diagnóstico de HTA por incorrecta técnica de medida de laPA, inicio precoz de tratamiento farmacológico basadoúnicamente en valores de PA e inadecuado empleode la automedida domiciliaria de PA (AMPA). Todoello llevó a una iatrogenia y a la realización demaniobras invasivas en una paciente con una HTA debata blanca donde se echa de menos un abordaje menosfragmentario y más acorde con las guías terapéuticasen uso

Many documents stress the need for strict control ofblood pressure (BP) on the contrary to the scarce information published regarding strict tension reductionand its potential negative consequences.We present apatient suffering chronic essential AHT under drugtreatment and with two admissions to hospital dueto vomiting secondary to hyponatremia (hNa+) due tothiazides. We discuss the most common causes ofhNa+ in the hypertensive patient, this also being veryscarce in the literature. The case presented illustratesseveral common errors in the common clinical practice:erroneous diagnosis of AHT due to incorrect measurementtechnique of BP, early onset of drug treatmentonly based on BP values and inadequate use ofABPM. All of this led to an iatrogeny and conductionof invasive maneuvers in a female patient with whitecoat hypertension in whom a less fragmented approachand one more in agreement with the therapheuticguidelines in use should have been used

Uterine sarcoma: 14 years experience in KCCC.

AIM OF THE WORK: To asses the profile, pattern of failure and survival for patients with uterine sarcoma seen in KCCC. MATERIAL AND METHODS: A total of 23 records for patients with uterine sarcoma attending KCCC between July 1993 to May 2007 were available for review. The medical records were assessed for the profile of the disease, histological types, types of treatment, pattern of failure and survival. All cases were proven histologically. The majority of cases 15/23 (65.2%) were endometrial stromal sarcoma, 4/23 (17.4%) had leiomyosarcoma and 4/23 (17.4%) had carcinosarcoma. Twenty two out of 23 patients (95.6%) had surgery and 8/22 (36.4%) were given adjuvant post-operative pelvic radiotherapy. Three patients were treated with palliative intent by radiation. Five patients received palliative chemotherapy. RESULTS: The mean age of all patients was 53.17+/-11.06 (range 34-80 years). The majority of patients 15/23 (65.2%) had stage I disease. High tumor grade was seen in 12/23 (52.2%) of patients. The pattern of failure was local in only 2 patients, systemic in 4 patients and both local and systemic in 5 patients. The overall DFS-5 years was 59.6%.The 5 y-DFS for patients treated by surgery & RT was 87.5% compared to 36.4% for those treated by surgery alone. Patients with early disease (stage I) had a 5 year DFS of 74% compared to 33.3% for those with advanced disease (stages III&IV). Patients with high grade tumors had a 5 year- DFS of 27% versus 100% for those with low grade tumors. CONCLUSION: Stage and grade are important predictors of survival. Post-operative adjuvant pelvic irradiation is associated with improved 5-years DFS.

Prognostic value of hemoglobin levels prior to radiotherapy for cervical cancer--Kuwait experience.

OBJECTIVE: To evaluate hemoglobin (Hb) levels before and during radiotherapy and its role as prognostic factor on treatment results of patients treated for cancer cervix. MATERIALS AND METHODS: One hundred and seven patients with cervical cancer were registered and managed at KCCC during 1995 - 1999. The pre-treatment and mid treatment Hb levels were found for 47 patients only. Follow-up was done for these cases aiming at evaluation the overall and disease-free survival. Statistical analysis was done using SPSS statistical package version 10.0. RESULTS: The median age of patients were 45 and ranged between 26-80 years. Kuwaiti patients represented 21.3% of cases. The most common stage was Stage IIb representing 51.1% followed by IIIb representing 27.7%. Stage Ib and IIa represented 12.8%. About 89.4% were squamous cell carcinoma, while adenocarcinoma was 6.4%. Treatment outcome revealed 18 relapses (38.3%). Disease-free survival for cases with pre-treatment Hb level < 12 was 16.3%, while for those with Hb level > or = 12 g/dL it was 62.9%. The difference was statistically significant (P = 0.02). CONCLUSION: Patients with pre-treatment Hb < 12 g/dL had a significantly lower disease-free survival.

Use of multiple fluorophores for evaluating microvascular permeability in control rats and rats with sepsis.

Capillary leak accompanying systemic inflammatory response conditions is a significant clinical problem. In the present study, we describe and verify a method for studying capillary leak that is based on the injection of proteins that differ significantly in size and have spectrally distinguishable fluorophores. Control (n=11) and post-CLP (caecal ligation and puncture; n=14) Sprague-Dawley rats were injected with tracer amounts of albumin and PEG-Alb [albumin covalently linked to methoxy-poly(ethylene glycol)] labelled with fluorescein and Texas Red. Blood samples were withdrawn between 5 min and 144 h, and the fluorescence of the labelled proteins was determined. The relative retention of the PEG-Alb and albumin was assessed via measurement of the TER (transcapillary escape rate; in %/h) and the t(50%) estimate, defined as the time when the actual concentration reached 50% of its baseline. The concentration-time trends for both albumin and PEG-Alb tracers exhibited two-compartmental behaviour and were analysed using bi-exponential modelling. Retention times were significantly greater for PEG-Alb in both control and CLP rats. TER(PEG-Alb) was significantly lower than TER(albumin) for both control (8.1+/-5.6 compared with 14.8+/-7.1 %/h respectively; P<0.01) and CLP (14.8+/-6.6 compared with 22.5+/-7.3 %/h respectively; P<0.001) rats. The t(50%[PEG-Alb]) was substantially greater than the corresponding t(50%[albumin]) for both control (29.8+/-9.8 compared with 7.2+/-2.0 h respectively; P<0.001) and CLP (12.9+/-5.6 compared with 5.1+/-1.6 h respectively; P<0.001) rats. The result was similar irrespective of the fluorophore-protein combination, validating the multifluorophore technique. In conclusion, the double-fluorophore approach described in the present study may provide the future basis for a method to quantify capillary leak in disease.

Patterns of failure in cervical carcinoma and outcome of salvage therapy: a retrospective study.

OBJECTIVE: The objective of this study was to study the patterns of failure after definitive therapy in cervical cancer, the treatment given to patients after recurrence and the final outcome in these patients. MATERIALS AND METHODS: Case records of 105 patients of cervical cancer of clinical Stages I to IV treated with definitive radiation or surgery with or without post-operative radiotherapy at Kuwait Cancer Control Centre (KCCC), Kuwait from 1995 to 1999 were retrospectively analyzed. Patients who developed recurrence were studied for the pattern of their recurrences, the type of treatment received by them after their recurrence and the results of their salvage therapy. RESULTS: The sites of failure were classified as pelvic only (P), pelvic+ distant metastasis (P+DM), or distant metastasis only (DM). Out of the thirty patients in stage Ib, the sites of first failure were, P = 5 (16.6%), P+DM = 1 (3.2%), DM = 1 (3.2%); of the fourteen patients in stage IIa, P = 2 (14%), P+DM = 1 (7%), DM = 2 (14%); of the 36 patients in stage IIb, P = 3 (8%), P+DM = 6 (16.5%), DM = 5 (14%); of the 14 patients in stage IIIb, P = 5 (35.5%), P+DM = 1 (7%), DM =0 (0%); of the 5 patients in stage IVa, 3 patients absconded after treatment and the failure rate was, P =0 (0%), P+DM = 0 (0%), DM = 1 (50%). The therapy after failure was surgery, irradiation, chemotherapy or supportive care. The median survival was evaluated as a function of time to failure after initial treatment and was 6, 6, 9, and 30 months for those failing less than 6, 6-12, 13-24 & 25-36 months after initial treatment respectively. The cohort treated initially with surgery had a better outcome of salvage therapy at relapse. CONCLUSIONS: Long term survival can be achieved in a small percentage of selected patients who fail treatment with definitive radiation or surgery for invasive carcinoma of the uterine cervix. The probability of survival is greater for those who fail more than 24 months after initial treatment than for those who fail before 24 months. The chance of survival is also related to the initial type of treatment, site of recurrence & type of salvage therapy. The complications of salvage treatment of recurrent disease should be minimized.

Renal cell carcinoma: the experience of Kuwait Cancer Control Center, Kuwait.

OBJECTIVES: This retrospective study was undertaken to analyze the profile of patients presenting with renal cell carcinoma (RCC) and treatment outcomes. SUBJECTS AND METHODS: Records of 49 patients (36 male, 16 female, 21-75 years) treated at the Kuwait Cancer Control Center, Kuwait for RCC during the period 1993-1998 were analyzed. Forty-one patients had a nephrectomy, 18 postoperative radiotherapy and 1 patient also received adjuvant immunotherapy with interferon. Patients with metastatic disease were treated with a variety of agents including interferon, chemotherapy (vinblastine) or a hormonal agent (megestrol acetate). Data analysis was performed using SPSS statistical software package. Overall survival and disease-free survival were calculated using the Kaplan-Meier method. RESULTS: Twenty-nine patients presented with symptoms classically associated with RCC. Metastases at diagnosis were seen in 9 patients (18%), with lung being the most frequent site. The commonest tumor subtype was clear cell carcinoma (32.6%). Thirty-nine patients (80%) achieved a complete response to treatment and relapse was documented in 10 patients (26%). The majority of failures were distant, with lung metastases being the most common. Response to salvage treatment was poor. Overall survival was 83% at 2 years. The disease-free survival was 68 and 45% at 2 and 5 years, respectively. CONCLUSIONS: Although many patients presented with advanced local disease, a majority achieved complete response after radical surgery with or without postoperative radiation therapy. Salvage of metastatic disease proved difficult with interferon, chemotherapy.

Plasma expansion by polyethylene-glycol-modified albumin.

Systemic inflammatory response conditions are associated with capillary leak and haemodynamic compromise. Fluid resuscitation to reverse the ensuing hypovolaemia is, however, complicated by the decreased endothelium reflection coefficient to albumin and other colloids. We developed PEG-Alb (albumin covalently linked to polyethylene glycol) as a potential resuscitative agent. PEG was covalently linked to human albumin at multiple sites on the protein. The modified protein was heterogeneous when examined by SDS/PAGE, size-exclusion chromatography and SELDI-TOF MS (surface-enhanced laser-desorption ionization-time of flight MS). Based on size-exclusion chromatography and osmotic pressure data, the effective volume of PEG-Alb is increased 13- to 16-fold compared with unmodified albumin. In an LPS (lipopolysaccharide) model of shock, rats treated with PEG-Alb showed better blood pressure, lower Hct (haematocrit) consistent with haemodilution and less lung injury than rats treated with unmodified albumin or saline. In a CLP (caecal ligation and puncture) model of sepsis, PEG-Alb was more effective than albumin or saline in maintaining blood pressure and in decreasing Hct. When fluorescein-labelled PEG-Alb and Texas Red-labelled albumin were administered to rats with LPS- or CLP-induced shock, PEG-Alb was retained within blood vessels, whereas albumin extravasates into the interstitial space. Based on these data, PEG-Alb appears to be retained within blood vessels in models of capillary leak. PEG-Alb may ultimately be effective in the clinical treatment of shock associated with capillary leak.

The c-myc x E2F-1/p21 interactive gene expression index augments cytomorphologic diagnosis of lung cancer in fine-needle aspirate specimens.

Morphological analysis of cytologic samples obtained by fine-needle aspirate (FNA) or bronchoscopy is an important method for diagnosing bronchogenic carcinoma. However, this approach has only about 65 to 80% diagnostic sensitivity. Based on previous studies, the c-myc x E2F-1/p21WAF1/CIP1 (p21 hereafter) gene expression index is highly sensitive and specific for distinguishing normal from malignant bronchial epithelial tissues. In an effort to improve sensitivity of diagnosing lung cancer in cytologic specimens, we used Standardized Reverse Transcriptase Polymerase Chain Reaction (StaRT-PCR) to measure the c-myc x E2F-1/p21 index in cDNA samples from 14 normal lung samples (6 normal lung parenchyma and 8 normal bronchial epithelial cell [NBEC] biopsies), and 16 FNA biopsies from 14 suspected tumors. Based on cytomorphologic criteria, 11 of the 14 suspected tumors were diagnosed as bronchogenic carcinoma and three specimens were non-diagnostic. Subsequent biopsy samples confirmed that the three non-diagnostic samples were derived from lung carcinomas. The index value for each bronchogenic carcinoma was above a cut-off value of 7000 and the index value of all but one normal sample was below 7000. Thus the c-myc x E2F-1/p21 index may augment cytomorphologic diagnosis of bronchogenic carcinoma biopsy samples, particularly those considered non-diagnostic by cytomorphologic criteria.