Capacitive-based dilatometer cell constructed of fused quartz for measuring the thermal expansion of solids.

A dilatometer cell that can detect sub angstrom changes in the length of solid specimens in the temperature range 5 K

Growth hormone response to edrophonium in patients with Alzheimer's disease and normal control subjects.

The authors found that growth hormone (GH) response to edrophonium was no different in 12 Alzheimer's disease patients than in eight healthy elderly subjects. Previously reported differences could be due to differences in gender or baseline GH concentrations between patients and control subjects.

Clinical characteristics of Kraepelinian schizophrenia: replication and extension of previous findings.

OBJECTIVE: Subtypologies of schizophrenia based on cross-sectional criteria, such as the nomenclature of the DSMs, have not been successful in identifying valid diagnostic subgroups among patients with schizophrenia. A subtypology that uses criteria to classify individuals on the basis of longitudinal deficits in self-care may identify a more valid subgroup of schizophrenic patients. METHOD: This study describes the clinical characteristics of a group of schizophrenic patients identified on the basis of a longitudinal criterion: at least 5 years of continuous and complete dependence on others for obtaining and maintaining the basic necessities of life, including food, clothing, and shelter. RESULTS: Sixty-one "Kraepelinian" schizophrenic inpatients, when compared to 80 non-Kraepelinian schizophrenic inpatients who were similar in years of illness, age, and education, demonstrated more severe negative symptoms and more severe formal thought disorder; yet the severity of their delusions, hallucinations, and bizarre behavior did not differ significantly. None of the Kraepelinian patients and eight non-Kraepelinian patients met DSM-III-R criteria for schizoaffective disorder. CONCLUSIONS: Data from this replication study suggest that Kraepelinian schizophrenic patients, identified on the basis of a longitudinal course characterized by severe dysfunctions in self-care, may represent an alternative, and possibly more valid, method of subtyping schizophrenia.

BMY 14802, a sigma receptor ligand for the treatment of schizophrenia.

The theoretical role of sigma receptors in psychosis has led to the development of selective sigma receptor ligands as potential antipsychotic agents. BMY 14802 has its most potent binding at the sigma binding site, with some degree of serotonin subtype 1A and negligible dopamine receptor binding. It is atypical of standard neuroleptics in that it does not induce catalepsy in rats. It has been shown to have efficacy in animal models of psychosis. It was hypothesized that the drug would have antipsychotic effects in humans without producing the extrapyramidal side effects typical of standard neuroleptics. We report here the results of an uncontrolled, multicenter safety and efficacy study of patients with acute exacerbations of schizophrenia treated with BMY 14802. After 1 week of single-blind placebo treatment, 28 patients were treated with BMY 14802 (up to 3000 mg/day) for up to 4 weeks. There was no significant improvement in psychiatric symptoms, as measured by the total Brief Psychiatric Rating Scale scores or Clinical Global Improvement. There were no changes in involuntary movements, as measured by the Abnormal Involuntary Movement Scale, or in extrapyramidal symptoms as measured by the Simpson-Angus Scale.

Priapism: review of 34 cases.

One hundred ninety-seven cases of priapism have been recorded in the medical files of Charity Hospital Louisiana in New Orleans from 1938-1982. One hundred seventy-two adults and 25 children were registered in this series. Ninety-three per cent of the patients with priapism were black, and 86 patients of this group underwent 93 surgical procedures. The cases of 34 patients treated between July 1, 1981, and December 31, 1982, were thoroughly reviewed. Sixteen patients had a previous history of priapism. Average delay between onset of symptoms and presentation to the hospital for treatment was thirty hours. Sickle cell screens were obtained in 28 patients and were positive in 17. Twenty-nine patients were initially treated conservatively, with 17 priapisms eventually resolving, but the remaining 12 patients required surgical intervention. Overall, 50 per cent of the 34 patients had surgery. All of the surgical cases resolved satisfactorily with the Winter procedure. Complications with this procedure were uncommon, but postoperative bandaging was the chief cause of morbidity. Follow-up for at least six months revealed comparable sexual potency (80-83%) in either conservatively or surgically managed patients.

Glomus tumor of glans penis.

Glomus tumor is an infrequent skin lesion and a rare lesion on the male genitalia. This is the second reported case of this lesion on the penis.

External urinary diversion: pathologic circumstances and available technology.

A wide variety of uropathologic circumstances may necessitate intervention. All urologic interventions depend on two simple rules for success. The first is visualization (via direct-vision endoscopy or videovision endoscopy, usually in combination with external imaging via fluroscopy), as failure to visualize the area of pathology properly may compromise or doom the procedure. The second is adequate access to the urinary tract via the endoscope, which is ensured by wire, catheter, or other appropriate access device. Failure of proper access dooms interventional urologic, uroradiologic, and endourologic procedures to failure.

Gold-tip laser sleeve for a bare fiber.

A gold-tip laser sleeve for a bare laser fiber has been used for Nd:YAG laser irradiation of the prostate in both the canine model and a pilot clinical series. In the animal model, irradiation was undertaken using the Ablaser catheter through an open suprapubic cystotomy, and the procedure was monitored by video endoscopy via a perineal urethrostomy. Intraprostatic heating profiles were determined using real-time interstitial thermometry. As long as no carbonization occurred, irradiation with higher wattage resulted in higher intraprostatic temperatures. The "popcorn effect" caused a superficial temperature reduction but did not alter the ability of thermal conduction to heat deeper in the prostate. A small series of patients has been treated, with good results.

Shadow positioning technique: a method for postmortem identification.

Radiology is increasingly being used as a means of postmortem identification. We have devised a shadow positioning technique by which a postmortem radiograph of a skeletal part can exactly duplicate an antemortem radiograph, thus, faciliating identification by comparison of the antemortem and postmortem radiographs. The antemortem radiograph can be of any skeletal part and taken in any position.

The microbiology of raw, eviscerated chickens: a ten year comparison.

In 1979 a survey of selected chicken eviscerating plants was conducted to determine the levels of coliforms, Escherichia coli, and Salmonellae sp. on eviscerated chickens under current manufacturing practices. A comparison was made of the data from this survey and one conducted in 1969. The 1979 survey found that the chickens did not have a statistically significant reduced incidence of salmonella compared to chickens analyzed in 1969. Also, much of the bacterial contamination on a carcass at the end of the evisceration line was transient and was readily removed by the final spray washer. The addition of chlorine to chiller water did not appear to have an unusually beneficial effect on the microbiological quality of the chickens. In 1969, in the nine plants studied, the incidence of salmonella on chickens at the exit of the chillers was 20.5%. In 1979, in the nine plants studied, the incidence of salmonella on chickens at the exit of the chillers was 11.6%. In 1979 there was about a 45% reduction in the incidence of salmonella in eviscerated chickens in the nine plants studied compared to the incidence of salmonella in eviscerated chickens in 1969.

Partial colectomy required for resection of renal cell carcinoma: a case report and review of treatment options for locally advanced disease.

Because it is more commonly discovered as a result of an incidental finding on radiologic studies, renal cell carcinoma is being diagnosed at earlier stages. Patients still, however, present occasionally with locally advanced disease. Such a case is presented in a patient who required a partial colectomy at the time of radical nephrectomy to remove all of his disease. Also reviewed is the current state of treatment options available for renal cell carcinoma, including chemotherapy, radiation therapy, immunotherapy, and surgery. Despite advances in some of these areas, the mainstay of treatment for locally advanced renal cell carcinoma remains surgery.

Extracorporeal shock wave lithotripsy: an outpatient procedure.

At many centers circumstances have dictated that extracorporeal shock wave lithotripsy (ESWL*) be performed on an outpatient (that is same-day surgery or 1-day stay) basis. At our center, Louisiana Lithotripter, Inc., which is a privately owned ESWL unit located at Tulane University Hospital, we have had the opportunity to treat patients in the inpatient and outpatient setting since inception. Since our first ESWL treatment on December 18, 1985 we have treated more than 2,500 patients. Additionally, our unit was named an American Urological Association Training Center in October 1986, resulting in more than 200 urologist, nurse and technician trainee visits. The first 1,779 cases through December 31, 1988 have been thoroughly reviewed. The rate of outpatient ESWL has increased from 22% of the first 100 cases to more than 90% of the last 100. The cumulative over-all rate reached 70%. Currently, more than 95% of our cases are planned as same-day procedures. Safe and effective outpatient ESWL is able to be performed with first generation technology, paving the way for appropriate clinical application to newer technological modalities.

Ungated Medstone outpatient lithotripsy.

Ungated lithotripsy has raised the specter of possible cardiac arrhythmias. We reviewed ungated outpatient lithotripsy performed on 82 patients to evaluate the incidence of arrhythmias encountered and time saved. All patients were chosen in a random nonselected, prospective fashion. All treatments were performed on a mobile Medstone 1050 STS lithotriptor. The incidence of arrhythmias was 21%. All but 2 arryhthmias were benign and all reversed with gating. No arrhythmias occurred during treatment of right ureteral stones. In the left ureter only 1 patient had benign premature ventricular contractions during treatment. Arrhythmias occurred at 20 to 24 kv. in 20% of patients with right renal stones and 31% with left renal stones. All arrhythmias resolved with gating. No arrhythmias were encountered at an energy level of less than 20 kv. There was no evidence of electrocardiographic changes up to 1 hour after treatment. Pharmacological manipulation to maintain a heart rate of 100 may allow a treatment time of approximately 24 minutes. With ungating the rate may reach 120, allowing for a treatment time of approximately 20 minutes. In this series average ungated lithotripsy time was 36 minutes. In comparison, the average treatment time in 20 patients undergoing gated lithotripsy was 38.7 minutes. It is not clear from this study whether persistent ungated lithotripsy would have precipitated any life threatening arrhythmias since our practice has been to terminate the procedure and re-gate the shocks at the first sign of any persistent change in cardiac rhythm. Our data indicate that ungated lithotripsy with the Medstone device is safe when simple monitoring rules are followed.

An innovative approach to management of lower third ureteral calculi.

A total of 130 patients with symptomatic lower third ureteral calculi underwent 136 treatments by 43 accredited urologists. These treatments were performed at a fixed lithotripsy site and 16 mobile sites using the Medstone lithotriptor from December 1990 through January 1992. The average stone size was 8.16 x 5.14 mm. A total of 126 patients underwent a single treatment and 4 underwent multiple treatment sessions. Of the 126 patients undergoing monotherapy 10 (8%) were lost to followup, while 101 of the remaining 116 evaluable patients (87%) were stone-free with a single treatment. The 15 patients in this subgroup who were considered failures and the 4 patients who underwent multiple treatments had overall larger stone sizes. The preoperative stent placement rate was only 32%. The treatments were well tolerated by the patients. Our report confirms a high efficacy rate with the second generation bathless lithotriptor for management of lower third ureteral calculi. The importance of a stable and qualified technical team cannot be overemphasized.

The use of the Magnetip double-J ureteral stent in urological practice.

The Magnetip* double J type ureteral stent has been used in a wide variety of clinical urological settings. We reviewed the use of the stent in 50 patients. In 45 patients stents were placed in conjunction with extracorporeal shock wave lithotripsy, stone manipulation, obstruction due to pregnancy or malignancy, pyeloplasty and ureteroneocystostomy. In 83 per cent of the attempts the stent was placed successfully. Retrieval with the Magnetriever* was accomplished in 86 per cent of the cases (100 per cent in female and 76 per cent in male patients). Details of stent use are described.

Five-year retrospective, multi-institutional pooled analysis of cancer-related outcomes after cryosurgical ablation of the prostate.

OBJECTIVES: To define the potential role of cryosurgical ablation of the prostate (CSAP) as a treatment option for patients with localized prostate carcinoma (PCA), we performed a retrospective outcomes analysis of a large database of patients undergoing CSAP constructed from five institutions and compared this with matching outcomes from contemporary reports of patient outcomes after radiotherapy. METHODS: A total of 975 patients who underwent CSAP as primary therapy from January 1993 to January 1998 with sufficient outcomes data available were identified. Patients were stratified into three groups on the basis of their clinical features. Biochemical-free survival (BFS), post-CSAP biopsy results, and post-CSAP morbidities were calculated and recorded. RESULTS: The median follow-up for all patients was 24 months. The percentages of patients in the low, medium, and high-risk groups were 25%, 34%, and 41%, respectively. For prostate-specific antigen thresholds of less than 0.5 and less than 1.0 ng/mL, the 5-year actuarial BFS ranged from 36% to 61% and 45% to 76%, respectively, depending on the risk category. Overall, the positive biopsy rate was 18%. Morbidities included impotence in 93%, incontinence in 7.5%, rectourethral fistula in 0.5%, and transurethral resection of the prostate in 13% of patients (10% approved warming catheters versus 40% nonapproved). CONCLUSIONS: For each risk group, the 5-year BFS and positive biopsy rate after CSAP was comparable to matching outcomes reported after radiotherapy. Morbidities also seemed comparable, with impotence rates higher and rectal injury rates lower after CSAP than after radiotherapy. These data indicate that CSAP can be performed with low morbidity and can produce cancer-related results comparable to those reported for patients undergoing radiotherapy.