Accuracy of polar F6 in estimating the energy cost of aerobic dance bench stepping in college-age females.

AIM: This study: 1) examined the accuracy of the Polar F6 for estimating energy expenditure (EE) in a sample of college-age women during aerobic dance bench stepping (ADBS) using predicted maximal oxygen consumption (VO2max) and maximal heart rate (HRmax), and 2) determined whether the use of actual measures of VO2max and HRmax improves the accuracy of the Polar F6 for estimating EE. METHODS: Thirty-two females had their VO2max and HRmax predicted by the Polar F6 heart rate monitor (HRM), and then performed a graded maximal exercise treadmill test to determine their actual VO2max and HRmax. The participants then followed a 20-min ADBS routine while stepping up and down off of a 15.24-cm bench at a cadence of 126 beats.min-1. During ADBS, the participants wore two F6 HRM that simultaneously collected data. To estimate EE, one HRM utilized their predicted VO2max and HRmax (PHRM) while the other HRM utilized their actual VO2max and HRmax (AHRM). RESULTS: The predicted HRmax significantly overestimated actual HRmax by 3.75 beats.min-1 on average, and the predicted VO2max overestimated actual VO2max by 2.63 ml.kg-1.min-1 on average (P<0.01). However, there were no significant differences between the PHRM and AHRM (P≥0.05). When compared to indirect calorimetry, the PHRM and AHRM significantly overestimated average EE by 28% (2.4 kcal.min-1) and 27% (2.0 kcal.min-1), respectively (P<0.05). CONCLUSIONS: Even when using actual measures of VO2max and HRmax, the Polar F6 is inaccurate in estimating EE during ADBS for college-age females.

Estimation of extracellular fluid volume from plasma clearance on technetium-99m DTPA by a single-injection, two-sample method.

A simple method is presented for estimating extracellular fluid volume from the plasma clearance of [99mTc])DTPA or [169Yb]DTPA. Two plasma samples are required, at 1 and 3 hr, following a single intravenous injection. (The same plasma samples can be used for measurement of glomerular filtration rate.) Using the complete plasma clearance curve as a reference (eight samples at 10 to 240 min), the error of the two-sample method in 40 patients was 1.5 I for [99mTc]DTPA, 2.1 I for [169Yb]DTPA (residual standard deviation).

Quality control of Tc-99m DTPA for measurement of glomerular filtration: concise communication.

When technetium-99m DTPA is used to measure glomerular filtration rate (GFR), the accuracy depends on the supplier of the radiopharmaceutical. The error in GFR is due to protein binding, as we have shown by direct measurement. In 19 patients, GFR measured with Tc-DTPA and corrected for protein binding agreed with that measured simultaneously using Yb-169 DTPA (correlation coefficient 0.991). Without correction, Tc-DTPA gave falsely low values in patients having good renal function, in whom unbound activity cleared rapidly while bound activity remained in the circulation. When Tc-DTPA is used to measure GFR, the in vivo protein binding should be measured and used to correct the data.

Measurement of glomerular filtration rate: single injection plasma clearance method without urine collection.

Glomerular filtration rate (GFR) can be calculated from the plasma clearance of any of several radiopharmaceuticals that are excreted by glomerular filtration. Simplified methods have been proposed that require only one or two plasma samples in lieu of a more complete clearance curve. We examined the error introduced by this simplification. Forty patients were studied using a dual-isotope technique employing [99mTc]DTPA and [169Yb]DTPA, obtaining eight plasma samples for each clearance curve at intervals from 10 to 240 min after injection. Data were fit to several empirical or semiempirical formulae and also to a two-compartment computer model that permitted GFR estimation from only one or two data points. The computer model gave good fit, but so did several simpler methods. The error that results from replacing the complete clearance curve by a single 3-hr sample was about 8 ml/min (residual s.d.). By using two samples (at 1 and 3 hr), the error could be reduced to 4 ml/min. Recommended one- and two-sample methods are presented.

Intrapartum fetomaternal bleeding in Rh-negative women.

In a series of 1206 consecutive Rh-negative women who delivered Rh-positive infants, fetal erythrocytes were found in the maternal blood of 175 (14.5%) during the postpartum period. In 12 (1.0%) there was evidence of a larger fetomaternal hamorrhage than would be neutralized by a single 300-microgram dose of Rh-immune globulin. Except for manual removal of the placenta, no correlation was found between large fetomaternal hemorrhages and obstetric manipulations, complications, or surgery. Thus, the authors believe that all Rh-negative patients should be screened post partum to ascertain the adequacy of Rh-immune globulin prophylaxis.

Retrospective review of sexual and marital satisfaction of spinal cord injury and diabetic males post penile injection or implant.

This study compares sexual activity and sexual and marital satisfaction in spinal-cord-injured (SCI) and diabetic men who had received either a penile prosthesis or papaverine/phentolamine injections for the treatment of impotence. Questionnaires were used retrospectively to assess changes pre- and post-procedure in 30 SCI and 26 diabetic males. Regardless of whether they received a penile prosthesis or injections, both diabetic and SCI males reported increases in diversity and frequency of sexual activities and satisfaction with sexual activities post-implant/injection. When compared with a normative sample, both diabetic and SCI males were found to have poorer body image post-implant/injection. They also reported more disagreement with their partners but engaged in more activities together.

Full thickness skin graft urethroplasty for anterior urethral strictures.

Thirty-two free full thickness skin graft urethroplasties were performed over a thirty-nine-month period. Follow-up of more than six months was available in 27 patients. Results were good or fair in 26 patients (96 per cent). Only 1 patient has been classified as a failure and required reoperation.

Free full thickness (patch) graft urethroplasty: long-term follow-up.

Thirty-two patients underwent free, full thickness skin (patch) graft urethroplasties between September, 1974, and May, 1978. Sixty-five per cent of the 23 patients available for five-year follow-up had good results from grafts ranging from 3 to 14 cm in length. In patients with good one-year results strictures did not develop during the review period, suggesting the need for only short-term follow-up in this group.

Year-to-year changes in effective renal plasma flow in asymptomatic spinal cord injury patients.

Year-to-year variations in effective renal plasma flow (ERPF) measurements were determined in 78 patients with spinal cord injury who had no urologic complications or surgery or bouts of chills and fever between consecutive annual follow-up examinations. The effects of age, gender, level and degree of lesion, and time since injury on the degree of variability were also determined. None of the factors considered had a statistically significant effect (P greater than 0.05) on year-to-year variations in ERPF. About 90 per cent of the individual kidney ERPF measurements were within 100 ml/min of the measurement made in the previous year, and 90 per cent of the total ERPF measurements were within 175 ml/min of the previous year's measurement. Follow-up of patients whose year-to-year variability exceeded these limits showed that most subsequently regressed toward the mean spontaneously. These data suggest that kidney blood flow varies considerably from year to year in otherwise healthy patients with spinal cord injury and that changes of 100 ml/min or more for an individual kidney or 175 ml/min or more for both kidneys together are common, but probably of little clinical significance, provided the absolute levels of ERPF remain within normal limits.

Factors predicting efficacy of phentolamine-papaverine intracorporeal injection for treatment of erectile dysfunction in diabetic male.

Thirty-three diabetic men were instructed in the use of phentolamine-papaverine injections for the treatment of erectile dysfunction over a two-year period. Of these, 12 reported a satisfactory response and 21 reported a nonsatisfactory response. The responders and the nonresponders were retrospectively studied to identify characteristics that would predict a satisfactory response. No difference was found between the two groups in the duration of diabetes, the presence of retinopathy, neuropathy, nephropathy, peripheral vascular disease, or ischemic heart disease. The utilization of insulin, the prevalence of type II diabetes, or the use of drugs which would cause impotence, did not differ between the two groups. There was no difference in the serum testosterone levels between the two groups. Age was the only predictive factor. Only 1 of 14 patients over age sixty had a satisfactory response to treatment while 11 of 19 patients under age sixty had a satisfactory response. Five of the responders and 2 of the nonresponders proceeded to penile implant surgery and reported satisfactory results. While older diabetic men may choose a trial of intracorporeal injections, they should be counselled regarding the high failure rate and alternative forms of therapy.

Enhanced detection of asymptomatic renal masses with routine tomography during excretory urography.

In a prospective study of a diagnositc scheme for evaluating renal masses, it was observed that a significant number of masses (29 per cent) would have been undetected without the aid of routine tomography. The renal masses detected with the aid of tomography are either small or peripheral lesions which cause no impingement upon the renal collecting system. Without specific symptoms referable to a renal mass and without hematuria, many renal masses will be overlooked on standard excretory urography. The general improvement in diagnostic quality, the ease with which this procedure may be added to excretory urography, and the minimal expense involved would be additional factors which should justify the use of routine tomography with excretory urography in any radiology department.

The Hytrin Community Assessment Trial study: a one-year study of terazosin versus placebo in the treatment of men with symptomatic benign prostatic hyperplasia. HYCAT Investigator Group.

OBJECTIVES: To determine the clinical effectiveness and safety of alpha(1)-blockade therapy versus placebo in the treatment of men with moderate to severe symptoms of prostatism in a community-based population under usual care conditions. METHODS: The Hytrin Community Assessment Trial is a prospective, placebo-controlled, randomized, double-blinded, 1-year clinical trial, conducted at 15 academic medical centers (regional sites) and 141 private urology practices (satellite sites). A total of 2084 men at least 55 years old with moderate to severe symptoms of benign prostatic hyperplasia (BPH) as determined by an American Urological Association (AUA) Symptom Score (AUA-SS) of 13 or more points and a bother score (AUA-BS) of 8 or more were enrolled. Randomized patients at regional sites were required to have a peak urinary flow rate less that 15 mL/s with voided volume of at least 150 mL. Treatment with terazosin was initiated with 1 mg daily for 3 days, followed by 2 mg daily for 25 days. Thereafter, patients were titrated stepwise to 5 or 10 mg if they failed to achieve a 35% or greater improvement in the AUA-SS. Primary outcome measures were AUA-SS, AUA-BS, BPH Impact Index (BII), disease-specific quality of life (QQL) score, and treatment failure as defined as discontinuation due to persistent or worsening symptoms or need for surgical intervention for BPH. Secondary outcome measures were peak urinary flow rate and postvoid residual urine volume. RESULTS: AUA-SS (0 to 35 point scale) improved from a baseline mean of 20.1 points by 37.8% during terazosin (n=976) and by 18.4% during placebo (n=973) treatment (P<0.001). Similarly, statistically superior improvements were observed in regard to the AUA-BS, BII, and the QQL score in the terazosin-treated patients. Peak urinary flow rate improved from a baseline of 9.6 mL/s (both regional treatment groups) by 2.2 mL/s in the terazosin group (n=137) and by 0.7 mL/s in the placebo group (n=140) (P< or = 0.05). Treatment failure occurred in 11.2% of terazosin- and 25.4% of placebo-treated patients (P<0.001; Kaplan-Meier adjusted withdrawal rates of 365 days). Withdrawal from study drug treatment due to adverse events occurred in 19.7% of terazosin- and 15.2% of placebo-treated patients (P<0.001). CONCLUSIONS: Terazosin given once daily in a dose ranging from 2 to 10 mg in community-based urology practices under conditions simulating usual care is effective in reducing the symptoms, perception of bother, and the impairment of QQL due to urinary symptoms in men with moderate to severe symptoms of prostatism. This effect is superior to placebo and maintained over 12 months of follow-up. Clinical research outcome studies in BPH can be conducted in community-based practices, thus simulating as closely as possible "usual care" conditions.

Neurogenic urinary tract infection.

Even though renal failure secondary to the urologic complications of chronic or recurrent urinary tract infection has decreased markedly due to advances in diagnostic, preventive, and therapeutic measures, infection and its sequelae continue to be major problems in patients with spinal cord injury regardless of the bladder emptying method employed. Although lower urinary tract complications have decreased with intermittent catheterization, the effects of increased intravesicular pressure, inflammation, and chronic bacterial colonization or invasion of the urinary tract on long-term renal function are still undetermined. Thorough evaluation of the urologic status on a regular basis in all patients with spinal cord injury is encouraged. Treatment of urinary tract infection should be guided by scientific data and drug susceptibilities of etiologic bacteria. The general consensus is that the presence of asymptomatic bacteriuria, particularly in the absence of pyuria, usually does not warrant antibiotic treatment, and that prophylaxis or suppression of infection with systemic antibiotics is not effective for any considerable length of time. Preservation of renal function is the ultimate goal of all bladder management strategies.

Compliance with annual urologic evaluations and preservation of renal function in persons with spinal cord injury.

We located 59 persons with spinal cord injury (SCI) who had not been examined for 3-15 years and paid them to undergo evaluation and comparison with 101 controls examined on an annual basis. Renal function during the first year post-injury and at follow-up was measured by radioisotopic scanning to determine effective renal plasma flow (ERPF) and information was obtained regarding occurrence of specific secondary complications. Subjects and controls were alike with respect to demographic characteristics, injury-related variables and occurrence of specific secondary complications. Mean initial and follow-up ERPF values adjusted for increasing age were not significantly different for subjects and controls, nor was there significant change within individuals over time. Although serial examination of the urinary tract following SCI is important, after the first few years it may be acceptable to lengthen the periods between examinations or substitute less expensive, noninvasive diagnostic techniques. SCI care centers should carefully evaluate recommendations regarding follow-up urologic examinations in persons with SCI in order to provide the most cost-effective program while maintaining optimum patient care.

The effect of physical activity and fitness on specific antibody production in college students.

BACKGROUND: The purpose of this study was to determine the effect of moderate physical activity/fitness on the immune response to a defined antigen, in particular, the hemagglutinin-inhibition response to the H1 (A/Texas/36/91) and H3 (A/Johannesburg/33/94) components of the 1995-96 Influenza virus vaccine. METHODS: Sixty-seven volunteers 18-30 years of age (mean 21.1 + 2.3) participated in the study. Physical activity was assessed using the Stanford 7-Day Recall Questionnaire, physical fitness (VO2max) was predicted based on graded submaximal cycle ergometry. Participants were divided into six groups (lower-active/fit, moderate active/fit, and higher active/fit), based on their scores on the 7-Day Recall Questionnaire or predicted VO2max, respectively. Plasma samples were collected prior to, one, two, four, and six weeks post vaccination. A total of four separate repeated measures ANOVA were utilized to evaluate the effect of physical fitness and physical activity on the immune response to the H1 and H3 components of the vaccine. RESULTS: As expected, for both antigens, titers significantly increased after vaccination, with the highest titers found on week four (H1) and week six (H3), respectively. However, for both antigens, there was no difference between groups and no significant interaction. CONCLUSIONS: The results of this study showed no significant effect of physical fitness or physical activity on the production of specific antibody in the range of physical fitness and physical activity found within this group of college students.

New trends in urologic management of spinal cord injured patients.

We have attempted to address some of the current issues and new trends in the urologic management of SCI patients. Although tremendous progress has been made with these patients, resulting in a significant lowering of renal morbidity and mortality, there is still room for improvement. Newer methods of bladder management and refinements of older techniques are being sought. Progress in treating urinary infections should occur through development of new antibacterials and through improved understanding of host-bacterial interactions. Research into these problems and the general management of the neurologic dysfunction in SCI offers the hope of an even brighter future for these severely disabled patients.

Complications of intracavernous injections and penile prostheses in spinal cord injured men.

Erectile dysfunction is a common complication in men who have had spinal cord injury (SCI). This retrospective study focuses on the complications encountered at our institution with both penile prostheses and intracavernous injections in men with SCI. Seventy-two men with SCI were treated with intracavernous injections for erectile dysfunction, and 30 penile prostheses were implanted in 19 men with SCI. Twenty-two of the 72 patients in the intracavernous injection program had adverse effects; none were severe. Prolonged erections lasting four to six hours and ecchymosis were the most common complications. No complication required discontinuation of treatment. There were 23 inflatable prostheses and seven semirigid rods. Mechanical failures occurred in 15 instances, infection occurred in nine, and late erosion occurred in three. Although multiple revisions and replacements were necessary, 14 of the 19 patients had satisfactorily functioning implants at their last outpatient visit. Patients were selected carefully for penile implant placement and yet significant complications and expense were incurred to obtain satisfactory results. Although follow-up has been relatively short, the intracavernous injections of vasoactive medications appear to be a more attractive initial means of treating the erectile dysfunction in men with SCI. The complications are relatively minor and the incidence of prolonged erections has decreased with increased experience. Furthermore, the cost of treatment will be considerably less than that with implant surgery, particularly in view of the high drop-out rate. Although improved implants have decreased the occurrences of mechanical failure, it seems likely that infection and extrusion will continue to be significant problems among men with SCI.

Intracavernous pharmacotherapy for management of erectile dysfunction in spinal cord injury.

Sexual dysfunction due to inadequate or poorly sustained erections is a common problem among patients with spinal cord injury (SCI). While penile prostheses have provided adequate treatment for many patients, the complication rate in spinal cord injured patients remains high and they have not received widespread acceptance among SCI patients or the physicians treating them. Recently, intracavernous injections of vasoactive medications have proved beneficial for treating patients with erectile dysfunction. In the current study, we evaluated 40 SCI patients and 116 patients with vascular based impotence who had been followed for a minimum of 1 month while utilising intracavernous injections of phentolamine and papaverine. SCI patients with neurogenic based erectile dysfunction are significantly different from vascular impaired patients. SCI patients are younger and have been impotent for a longer period of time when treatment is sought. Furthermore, the dose of medication required is significantly less for SCI patients. The time of erection is longer and the quality of erection is better in neurogenic based impotence. Results with this treatment in SCI appear to be quite good with short term followup and long term evaluation of this methodology in SCI appears warranted.

Practical uses of a quantitative renal scintillation camera study.

A quantitative renal scintillation camera study has been described for the evaluation of total renal function and the split function of the two kidneys by a noninvasive technic. It requires no patient preparation, is not affected by bowel gas, and no allergic reactions have been reported. Six cases are reported to illustrate its usefulness with renal tumors, neurogenic bladders, pyelonephritis, nephrolithiasis, congenital anomalies, and renal insufficiency.