Surprising interobserver and intra-observer variability in pediatric testicular ultrasound volumes.

INTRODUCTION: Testicular volume (TV) can be obtained by either scrotal ultrasound (SU) or orchidometer. Scrotal ultrasound allows for a more objective measurement; however, the interobserver and intra-observer variability of TV measurements has not been rigorously studied. OBJECTIVE: The authors measured intra-observer and interobserver variability of SU TV measurements in pediatric patients to assess the reliability and reproducibility of SU. Special attention was paid to how often a 20% discrepancy in TV was noted as this has previously been utilized as an indication for varicocelectomy. DESIGN: Patients with an indication for SU or undergoing an ultrasound for another reason were prospectively recruited. Two different urologic specific ultrasound technicians (A and B) performed SU to assess interobserver variability. A second measurement was taken by technician A within 90 days to assess intra-observer variability (A vs A1). The technicians were blinded to other ultrasound results. RESULTS: Fourteen patients (28 testes, 56 volume measurements) were included in the intra-observer group and 17 patients (34 testes, 68 volume measurements) in the interobserver group. The mean time to repeat intra-observer ultrasound measurements (range) was 46 days (23-84). Mean age (range) in the intra-observer group was 14.3 years (11-19) and 14.1 years (11-19) in the interobserver group. Indication for ultrasound was varicocele (n = 6), scrotal pain (4), hydronephrosis (3), hydrocele (2), epididymal cyst (2), posterior urethral valves (1), and testis asymmetry (1). Utilizing Bland-Altman analysis and plots, variability was seen in both intra-observer and interobserver measurements. The mean values for testicular sizes for technician A and technician B were 13.0 ± 9.7 cm3 vs 13.8 ± 9.9 cm3, respectively. The mean values for TV measurement for technician A's first and second measurements (A, A1) were 14.3 ± 9.7 cm3 and 14.8 ± 8.9 cm3, respectively. An errant 20% difference in TV measurements for the same testis was seen in 25% (7 of 28) of intra-observer measurements and 35% (12 of 34) of interobserver measurements. These 20% differences were more common with a lower body mass index (odds ratio, OR = 0.74, p = 0.01) in the interobserver group, and lower TV was a predictor in the intra-observer group (OR: 0.82, p = 0.009). CONCLUSIONS: Variability exists in both interobserver and intra-observer measurements of TV by dedicated urologic ultrasonographers, and greater than 20% of differences in measured TV in same testicles occurred in over 25% of cases. Caution should be exercised in basing operative decisions and scientific studies on limited measurements of TV.

Influence of Mitochondrial Genetics on the Mitochondrial Toxicity of Linezolid in Blood Cells and Skin Nerve Fibers.

The antibiotic linezolid is a ribosomal inhibitor with excellent efficacy. Although the administration period has been reduced to 28 days, side effects, usually of hematologic or neuropathic origin, are still reported due to secondary inhibition of mitochondrial protein synthesis. Susceptibility to linezolid toxicity remains unknown. Therefore, the objective of this study was to gain an understanding of clinical heterogeneity in response to identical linezolid exposures through exhaustive examination of the molecular basis of tissue-dependent mitotoxicity, consequent cell dysfunction, and the association of mitochondrial genetics with adverse effects of linezolid administered for the recommended period. Peripheral blood mononuclear cells (PBMC) and skin nerve fibers from 19 and 6 patients, respectively, were evaluated before and after a 28-day linezolid treatment in order to assess toxic effects on mitochondria and cells. Mitochondrial DNA haplotypes and single nucleotide polymorphisms (SNPs) in ribosomal sequences where linezolid binds to mitochondrial ribosomes were also analyzed to investigate their genetic contributions. We found that linezolid reduced mitochondrial protein levels, complex IV activity, and mitochondrial mass in PBMC and was associated with a trend toward an increase in the rate of apoptosis. In skin tissue, mitochondrial mass increased within nerve fibers, accompanied by subclinical axonal swelling. Mitochondrial haplogroup U, mutations in 12S rRNA, and the m.2706A→G, m.3197T→C, and m.3010G→A polymorphisms in 16S rRNA showed a trend toward an association with increased mitochondrial and clinical adverse effects. We conclude that even when linezolid is administered for a shorter time than formerly, adverse effects are reported by 63% of patients. Linezolid exerts tissue-dependent mitotoxicity that is responsible for downstream cellular consequences (blood cell death and nerve fiber swelling), leading to adverse hematologic and peripheral nervous side effects. Multicentric studies should confirm genetic susceptibility in larger cohorts.

Vasoespasmo coronario en la inducción de la anestesia general / Coronary vasospasm in general anaesthesia induction

El vasoespasmo de la arteria coronaria en la inducción de la anestesia general es una complicación poco documentada en nuestro entorno, por su baja incidencia o por pasar desapercibida. Presentamos el caso de una mujer previamente sana, programada para artroscopia de hombro, que en la inducción anestésica presentó taquicardia ventricular, que revirtió espontáneamente a ritmo sinusal con elevación de ST en cara lateral, y que se diagnosticó y trató con una angiografía inmediata. La importancia del caso se basa en la escasa bibliografía encontrada y en ser de los pocos comunicados en pacientes sanos durante la inducción de la anestesia general y, con diagnóstico y resolución angiográfico inmediato(AU)

Coronary artery vasospasm in the induction of general anaesthesia is a rarely reported complication in our environment, owing to its low incidence or due to having disappeared. We present a case of a previously healthy woman, scheduled for shoulder arthroscopy, who in the anaesthetic induction had a ventricular tachycardia, which spontaneously reverted to sinus rhythm with ST elevation on the left side, and which was diagnosed and treated immediately by using angiography. The importance of the case is based on the lack of references found, and on being rarely reported in health patients during the induction of general anaesthesia, and with an immediate diagnosis and resolving using angiography(AU)

[Coronary vasospasm in general anaesthesia induction]. / Vasoespasmo coronario en la inducción de la anestesia general.

Coronary artery vasospasm in the induction of general anaesthesia is a rarely reported complication in our environment, owing to its low incidence or due to having disappeared. We present a case of a previously healthy woman, scheduled for shoulder arthroscopy, who in the anaesthetic induction had a ventricular tachycardia, which spontaneously reverted to sinus rhythm with ST elevation on the left side, and which was diagnosed and treated immediately by using angiography. The importance of the case is based on the lack of references found, and on being rarely reported in health patients during the induction of general anaesthesia, and with an immediate diagnosis and resolving using angiography.

[Infectious adverse events related to misuse of high-dose buprenorphine: a retrospective study of 42 cases]. / Complications infectieuses induites par le mésusage de la buprénorphine haut dosage (Subutex): analyse rétrospective de 42 observations.

PURPOSE: Misuse of high-dose buprenorphine (HDB), mainly by injection, is responsible of frequent infectious adverse events. METHODS: This is a retrospective study of infectious complications occurring in patients using HDB by injection. Forty-two cases were identified (29 men and ten women) and the data were collected between March 1999 and December 2008. RESULTS: The infectious complications included cutaneous infections (27 cases), endocarditis (nine cases), osteoarticular infections (four spondylodiscitis and one sacroiliitis), and a vascular embolism with decrease in visual acuity. CONCLUSION: The results of HDB maintenance treatment must be improved, both from the point of view of substitution and to limit its misuse by intravenous route injection. Health professionals have to play an important role in drug addict patients' education and supervision, to prevent buprenorphine injection and related infectious complications.

Functional dissection of Polycomb repressive complex 1 reveals the importance of a charged domain.

Silencing of homeotic genes requires the Polycomb repressive complex 1 (PRC1) family of protein complexes, which are composed of Polycomb-group (PcG) proteins and frequently include other subunits. We discuss here two aspects of PRC1 that might contribute to this activity. Inhibiting the action of remodeling factors via chromatin compaction is believed to be one mechanism by which PRC1 represses genes. We show that PRC1s from fly and mouse have conserved this activity as complexes. Additionally, we provide evidence that a different subunit in the mouse complex retains the conserved repression activity and that activity appears to be mediated by charge interactions. We show that Zeste interacts specifically with the Ph subunit of PRC1 and discuss the possibility of these factors contributing to spreading of PRC1 complexes. Our results suggest that one aspect of PRC1 repression is likely to be mediated by charge-charge interactions.

Descubrimiento de un caso de siringomielia tras una infiltración epidural / Syringomyelia discovered after epidural infusion

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Estudio de la concordancia en la valoración del estado de salud bucodental en una población mayor de 65 años de Área de Cobertura del Hospital Universitario Dr. Peset de Valencia / Study of the concordance in the assessment of the oral health status in the elderly withing the area of Hospital Universitario Dr. PEset, Valencia

El objetivo de este estudio es conocer la concordancia de la valoración del estado de salud oral de los ancianos no institucionalizados que residen en el Ärea de Salud del Hospital Universitario Dr. Peset de Valencia y determinado entre cuatro profesionales. Se realiza un estudio epidemiológico descriptivo durante el año 2000, a 30 ancianos de más de 65 años con el 100 por ciento de aceptación. Se les realiza cuatro exploraciones, por cuatro especialistas en salud bucodental de forma independiente, siguiendo las recomendaciones de la OMS publicadas en el manual Calibration of Examiners for Oral Health Epidemiological Surveys. El análisis se realizó en base al análisis de concordancia simple o indice de concordancia de Cohen´s Kappa. El resultado de este estudio apoya las declaraciones de calibración interexaminadores previo a cualquier estudio epidemiológico, de modo que si sus niveles de diagnóstico no se encuentran dentro de los límites de acuerdo deben ser excluidos de dicho estudio, independientemente de su experiencia profesional y clínica. El 100 por ciento de los ancianos estudiados tienen algún tipo de necesidad de tratamiento, el cual puede ser solventado por personal auxiliar como es la figura del higienista dental (AU)

Effects of vasoconstrictors in dentistry upon systolic and diastolic arterial pressure.

INTRODUCTION: Vasoconstrictors associated to local anesthetics habitually used in dental practice have been reported to influence arterial pressure, in the same way as other factors such as patient anxiety or stress. OBJECTIVES: The present study investigates the variations in systolic and diastolic arterial pressure in three groups of patients subjected to conventional dental treatment in the form of molar extraction, with the aim of determining whether such variations are attributable to the use of a vasoconstrictor or to other factors such as patient anxiety. MATERIALS AND METHODS: A total of 43 healthy males with normal blood pressure readings were grouped according to the type of anesthetic solution employed: Group I (2% lidocaine with epinephrine 1:80,000), Group 2 (3% mepivacaine with epinephrine 1:100,000) and Group 3 (3% mepivacaine with no associated vasoconstrictor). In all cases the Hamilton Anxiety Scale was applied, with blood pressure recordings before and after anesthetic injection, during dental extraction, and at the end of treatment. RESULTS: No statistically significant differences were observed in the blood pressure variations among the groups according to whether or not a vasoconstrictor was associated to the anesthetic solution in these healthy subjects. In increased systolic pressure was observed during extraction in all three study groups. CONCLUSION: Our findings suggest that the use of a vasoconstrictor in association to the local anesthetic solution does not substantially modify blood pressure. On the other hand, the observed increase in systolic pressure in all three treatment groups may be attributed to patient anxiety.

Development and laboratory evaluation of a new toothbrush with a novel brush head design.

Despite many developments in manual toothbrush design, plaque removal at the back of the mouth and at approximal surfaces remains inadequate, yet it is at these sites in particular that plaque accumulates and leads to the development of gingival disease. Improved oral hygiene can be achieved by better brushing technique and by increasing brushing time, but a change in behavior patterns is almost impossible to achieve for the majority of individuals. What is required is a brush head design that maximizes plaque removal, regardless of how the user brushes. As a result of a detailed investigation into the action of bistles during brushing, the Oral-B CrossAction toothbrush has been developed. It incorporates bristles angled at 16 degrees in a unique CrissCross design arranged along the horizontal axis of the toothbrush. Laboratory studies have demonstrated that this development significantly enhances interproximal penetration and cleaning effectiveness when compared with an identical brush head with vertical rather than angled bristles. Laboratory comparisons with more than 80 leading manual toothbrushes from around the world demonstrate a consistent, significant advantage for the new CrossAction toothbrush, both with respect to interproximal penetration and cleaning effectiveness. These results suggest that the CrossAction toothbrush has the potential to remove greater amounts of plaque, especially from the approximal surfaces, than conventional toothbrushes incorporating vertical bristles or more traditional tuft designs.

Compromiso nervio craneal en cáncer de próstata metastico / Craneal nerves compromised with metastasic prostate cancer

Es usual en el Cáncer de Próstata avanzado la metástasis ósea, pero no su localización en los huesos de la base del cráneo con compromiso de pares craneales. El propósito de este trabajo es presentar un caso clínico con afectación única del VI par craneal por invasión ósea metastásica con buena respuesta sintomático al tratamiento. Se trata de un paciente de 62 años con alteraciones del nervio motor ocular externo, debido a metástasis óseas de un cáncer de Próstata avanzado, diagnosticado 2 años antes. La sintomatología consistió en mareos, diplopia y cefalea. La TAC de Cráneo y el Centellograma Oseo demostraron metástasis en toda la calota y base del cráneo. Como tratamiento recibió radioterapia externa ( RTE) 4.000 cgy en los huesos de la base del cráneo. Se obtuvo la resolución completa del déficit neurológico, con el alivio de los síntomas concomitantes. Sin embargo a los 5 meses la enfermedad continuó su evolución hasta fallecer 2 meses después. La conclusión es que la aparición de la afectación neurológica descripta ensombrece el pronóstico, aunque el tratamiento radiante mejore transitoriamente los síntomas y la calidad de vida

A curriculum to develop critical care obstetric nursing staff.

Orientation of perinatal nursing staff to critical care obstetrics is vital to provide comprehensive, high-quality care for high-risk populations. One approach is to offer an intensive critical care obstetrics program in house that offers theoretical and practical experience and makes use of resources and talents within the institution.

Prevalence and risk factors for diabetes and diabetes-related amputations in American Indians in southern Arizona.

OBJECTIVE: To describe the prevalence of NIDDM and LEA using data from a computer-based patient data base. RESEARCH DESIGN AND METHODS: Diabetic patients with and without LEA, and nondiabetic patients were identified by computer search. Charts of diabetic patients were reviewed for confirmation of diagnosis of diabetes and diabetes-related amputation. The diabetic and nondiabetic populations were described, and certain risk factors were identified. RESULTS: The overall prevalence of NIDDM in this tribe in 1985-1986 was 18.3/100 adults (> or = 18 yr of age), whereas the prevalence of LEA/100 adults with NIDDM was 10.3%. Females were 1.3 times as likely to have diagnosed diabetes as males (95% CI 1.2-1.4), and males with diabetes were 1.4 times more likely to have had LEA than females with diabetes (95% CI 1.1-1.9). CONCLUSIONS: Automated health-care delivery data base used for this tribe can be used to maintain surveillance for diabetes and amputations in diabetic patients. Effective programs to prevent complications of diabetes, such as LEA, in this tribe are urgently needed.

Transurethral radio frequency thermotherapy for symptomatic benign prostatic hyperplasia.

A total of 90 patients with symptomatic benign prostatic hyperplasia (BPH) were treated with transurethral radio frequency thermotherapy. The treatment consisted of one 180-min session at 48 degrees C. All patients were evaluated before treatment and 80 (10 with urinary retention) were reevaluated at 3 months for follow-up. The analysis of the results of this group of patients is the subject of this presentation. Results were defined according to the variation in three parameters: nocturia, symptomatic score (Madsen) and urinary peak flow. Improvement (defined as a change of 50% or more in any of the three measured parameters) was found in 78% of the patients. Improvement in all of the above-mentioned parameters was found in 34.08% of the patients. In 29.82% of the patients improvement was found in two parameters and 14.02% of the patients improvement was found in one parameter and none in 21.30%. The percent variations in each parameter before and after treatment were: nocturia and symptom score decreased by 33.33% and 50%, respectively, and urinary peak flow increased by 33.65%. Age was the most important predictive factor. Of the patients under 65 years of age, 85% showed very good and good results. In comparison, only 42% of the patients over 65 years showed similar results. Immediate complications were 4 cases of acute urinary retention (5.71%) and 4 cases of urinary infection (5.71%). Transurethral radio frequency thermotherapy, having a low toxicity and complication rate, has comparable results to other nonsurgical treatment modalities. It is a viable alternative treatment for symptomatic BPH.(ABSTRACT TRUNCATED AT 250 WORDS)

A murine model of herpes simplex virus-induced ocular disease for antiviral drug testing.

Previous studies to determine the efficacy of new antiviral compounds in treating HSV ocular infections have used rabbit models. However, rabbits are expensive to purchase and maintain, and require the use of substantial amounts of test compounds. We have used the currently licensed antiviral trifluorothymidine in a murine model of HSV-induced ocular infection to demonstrate that the less expensive murine model can be used for the in vivo evaluation of potentially useful antiviral compounds. Treatment with TFT reduced the severity of blepharitis, vascularization of the cornea, stromal keratitis, and the percentage of animals developing symptoms. TFT treatment did not reduce the peak titers of infectious virus in the eyes of the infected animals, but did enhance clearance of virus from the tissues in a dose-dependent manner. Treatment with 1.0% TFT prevented the establishment of reactivatable latent infections. However, treatment with 0.01% or 0.1% TFT did not affect latency. The ED50 values for blepharitis, vascularization, and stromal keratitis ranged between 0.007% and 0.023%. These results are very similar to results obtained in rabbits and establish baseline data for comparing rabbit and murine models. This murine model provides a potentially less expensive alternative for in vivo drug testing.

Creating a unit-specific charging system.

A totally nurse-dependent charging system developed specifically for the labor and delivery suite at the University of Maryland Medical System is described in the article. This easy and effective method of charging was incorporated into an already existing patient census and classification system. The number of relative value units has increased by more than 30%, and the amount of revenue billed has increased by more than $800,000 in the first 10 months after implementation.