Reflections on dentistry and dental problems under the Third Reich.

Victor Klemperer was a Professor of Romance Languages and Literature in Dresden during the 1920s and 1930s. He kept a diary and the entries for the period 1933 to 1945 have been examined for references relating to dentistry and dentists. These give an insight into an aspect of the social life of the period that appears to have been previously largely overlooked.

Impact of remote monitoring and supervision on resident training using new ACGME milestone criteria.

INTRODUCTION: The study objective was to determine the impact of remote monitoring and supervision (RMS) in integrated endourology suites (IES) on residents achieving endoscopic training milestones. MATERIALS AND METHODS: Twenty-one urology residents evaluated RMS in IES using a 25-question survey. IES provided audio-visual communication for faculty to supervise residents remotely. Questionnaire used a linear visual scale of 1-10 to assess acceptability (8 questions), impact on training (10 questions), supervision level (1 question), and pre- and post-training milestone self-assessments (6 questions). Improvements in Patient Care Milestone #7 (upper/lower tract endoscopic procedures) and Patient Care Milestone #9 (office-based procedures) were analyzed. RESULTS: Twenty-one urology residents (out of potential 23) evaluated RMS in IES using a 25-question survey (91.3% response rate). Overall RMS acceptability and satisfaction was high (mean score = 9.1/10) with a majority (95.2%) feeling comfortable being alone with the patient. Residents reported positively on the following parameters: autonomy without compromising safety (8.7), supervision level (8.6), achieving independence (8.4), education quality (8.3), learning rate (8.1), clinical decision-making (8.0), and reducing case numbers to achieve proficiency (7.6). Residents perceived no issues with under- or over-supervision, and a majority (76.2%) expressed that RMS should be standard of training in residency programs. Residents reported mean level increases of 2.5 and 2.8 (out of 5) in Patient Care Milestones for endoscopic procedures and office-based procedures, respectively (p < 0.0001). CONCLUSIONS: RMS in integrated endourology suites may enhance resident education and endoscopic training. The study demonstrated an increase in competency levels reported by residents trained using RMS.

Formalin disinfection of biopsy needle minimizes the risk of sepsis following prostate biopsy.

PURPOSE: We describe a simple and effective method to reduce the risk of infection after prostate biopsy. MATERIALS AND METHODS: A total of 1,642 consecutive prostate biopsy procedures during a 4-year period (2008 to 2012) were included in the study. Inclusion criteria consisted of pre-biopsy negative urine culture, bisacodyl enema and fluoroquinolone antibiotics (3 days). Formalin (10%) was used to disinfect the needle tip after each biopsy core. All patients were monitored for post-biopsy infection. The rate of infection was compared to that of a historical series of 990 procedures. Two ex vivo experiments were conducted to test the disinfectant effectiveness of formalin against fluoroquinolone resistant Escherichia coli, and another experiment was performed to quantitate formalin exposure. RESULTS: Post-biopsy clinical sepsis with positive urine and blood cultures (quinolone resistant E. coli) developed in 2 patients (0.122%). Both patients were hospitalized, treated with intravenous antibiotics and had a full recovery without long-term sequelae. Mild uncomplicated urinary infection developed in 3 additional patients (0.183%). All were treated with outpatient oral antibiotics and had a complete recovery. The overall rate of urinary infection and sepsis using formalin disinfection was approximately a third of that of a prior series (0.30% vs 0.80%, p=0.13). Ex vivo experiments showed a complete lack of growth of fluoroquinolone resistant E. coli on blood and MacConkey agars after exposure to formalin. The amount of formalin exposure was negligible and well within the safe parameters of the Environmental Protection Agency. CONCLUSIONS: Formalin disinfection of the biopsy needle after each prostate biopsy core is associated with a low incidence of urinary infection and sepsis. This technique is simple, effective and cost neutral.

A +20% adjustment in the computed tomography measured ureteral length is an accurate predictor of true ureteral length before ureteral stent placement.

PURPOSE: The correct length of a ureteral stent is important in minimizing postplacement discomfort and stent migration. We describe and validate a method to accurately measure the ureteral length. MATERIALS AND METHODS: The ureteral length in 48 patients undergoing ureteral stent placement for urolithiasis was measured by computed tomography (CT) (total thickness of axial slices between the ureteropelvic junction and ureterovesical junction) and adjusted up by 20%. The adjusted CT measurement of ureteral length was compared with direct intraoperative measurement using scatter plot and Pearson correlation coefficient. Correlation coefficients were also calculated between intraoperative ureteral length and various body habitus measurements such as the height, weight, and waist circumference. RESULTS: Median patient age was 62 years. The median stone diameter was 7.5 mm (1-20). The ratio of left- to right-sided stones was 2:1. The stone location was in the proximal ureter in 45.8%, distal ureter in 37.5%, kidney in 10.4%, and midureter in 6.3%. Symptoms included adnominal/flank pain (93.8%) followed by nausea/vomiting (39.6%) and gross hematuria (16.7%). Median creatinine was 1.4 (0.8-3.6 mg/dl) and median WBC was 8.6 (2.8-17.6). The median ureteral length was 25.8 cm (19.2-29.4) on the CT scan and 25.5 cm (19.0-29.0) on the intraoperative measurement (p=0.57). The Pearson correlation coefficient between the two measurements was 0.979. In contrast, the height, weight, and waist circumference correlated poorly with intraoperative ureteral length measurements (r=0.34, 0.19, and 0.40, respectively). CONCLUSION: CT-measured ureteral length adjusted up by 20% is a reliable method to accurately measure the true ureteral length. This method is superior to traditional indirect methods that rely on body habitus measurements.

Health-related quality of life results in pathologic stage C prostate cancer from a Southwest Oncology Group trial comparing radical prostatectomy alone with radical prostatectomy plus radiation therapy.

PURPOSE: To compare short- and long-term effects of adjuvant treatment versus observation after surgery on health-related quality of life (HRQL) of prostate cancer patients. PATIENTS AND METHODS: The Southwest Oncology Group (SWOG) intergroup trial compared radical prostatectomy (RP) plus observation versus RP plus adjuvant radiation therapy (RT). Two-hundred seventeen of 425 therapeutic trial patients were eligible and registered to the HRQL study. Patients completed the SWOG Quality of Life Questionnaire (emotional, physical, social, and role function; general symptom status; treatment/disease-specific symptoms; and global HRQL [GHRQL]) at baseline, 6 weeks, 6 months, and annually for 5 years. Prespecified outcomes were three genitourinary symptoms (bowel function tenderness, frequent urination, and erectile dysfunction [ED]) and measures of physical and emotional function. Adjustments were made for the baseline score. RESULTS: Patients receiving adjuvant RT reported worse bowel function (through approximately 2 years) and worse urinary function. There were no statistically significant differences for ED. GHRQL was initially worse for the RP+RT arm but improved over time and was better at the end of the period than the GHRQL reported for RP alone (treatment arm x time interaction, P = .0004). Symptom distress was significantly worse for the RP+RT arm compared with the RP alone arm, but the treatment arms did not differ with respect to other general measures of HRQL. CONCLUSION: The addition of RT to surgery resulted in more frequent urination, as well as early report of more bowel dysfunction, although bowel function differences disappeared over the 5-year period. The addition of RT did not negatively impact ED.

Similar age-specific PSA, complexed PSA, and percent cPSA levels among African-American and white men of southern Louisiana. Prostate-specific antigen.

OBJECTIVES: To determine the mean and median complexed prostate-specific antigen (cPSA) levels in a predominantly African-American population and to explore whether differences in cPSA exist between the races. Differences in total PSA (tPSA) levels between age-matched African-American and white men have been reported by several groups. Age-specific cPSA levels, however, have not been thoroughly evaluated and reported among African-American populations. METHODS: We prospectively evaluated the serum cPSA, tPSA, and percent cPSA levels by the Bayer Immuno 1 assay as a function of age among 1755 African-American and 630 white men in southern Louisiana presenting to a prostate cancer screening program. All men had a normal digital rectal examination or biopsy-proven benign pathologic findings. The intragroup and intergroup statistical analyses were carried out for each decade of age. RESULTS: The median cPSA level for African-American men aged 40 to 49, 50 to 59, and 60 to 69 years old was 0.45, 0.61, and 0.84 ng/mL, respectively. These did not differ significantly from those of age-matched white men. Also, no difference was found in the mean or median tPSA between the races. The percent cPSA values showed a trend for lower levels in African Americans. CONCLUSIONS: These findings suggest that no significant difference exists between cPSA or tPSA levels in African-American and white men without prostate cancer. Genetic and epigenetic factors distinct to this region may account for this observation and thus need further evaluation.