Physician-generated cost containment in transurethral prostatectomy

Cost containment need not be imposed on physicians by government, insurance companies and hospital administrators. Decreases in hospital cost can be achieved voluntarily by physicians without sacrificing quality of care, especially for common procedures with relatively homogeneous patient populations, such as transurethral prostatectomy. Variations in existing practice were identified and shared, and optimal scientific practice was discussed at 5 meetings of the division of urology during a 16-month period. Strict guidelines were not developed; surgeons were encouraged to apply cost-related knowledge individually. Resource use was measured before, during and after the intervention. A total of 356 transurethral prostatectomies was studied. There were significant decreases in preoperative and postoperative length of stay, specific ordering practices and total hospital charges. University faculty differed from community urologists and individual surgeons varied considerably. Suggestions for scientific cost management in prostatectomy are presented.

An examination of O-2-isocephems as orally absorbable antibiotics

The synthesis and structure-activity relationships of a series of orally absorbed O-2-isocephems are described. These compounds possessed a D-[(p-hydroxyphenyl)glycyl]amino substituent at the 7-position while the substituent at the 3-position was varied. Relative to the analogous cephems, the O-2-isocephems exhibited comparable to better activity against Gram-positive organisms. Against Gram-negative organisms, their activity was variable but did indicate a lower beta-lactamase stability. Following oral administration, the O-2-isocephems generally exhibited longer half-lives but lower Cmax's and urinary recoveries.

Infectious complications of penile prosthesis surgery

Penile prosthetic surgery has become an increasingly common procedure. However, infection of the prosthesis remains a significant complication that almost always results in loss of the device. We present our 10-year experience with 9 infected prostheses among 417 total penile implants, for an over-all incidence of infectious complications of 2.2 per cent. A strict, broad-spectrum antibiotic schedule was adhered to rigidly by all patients, beginning preoperatively and continuing for a total of 10 days of perioperative coverage. Staphylococcus species were cultured in 56 per cent of the infected patients and in 100 per cent of the patients with positive cultures. Spinal cord injury patients showed a particular predisposition to prosthetic infection, with a 15 per cent incidence of infectious complications. Two other patients became infected after dental procedures and the need for routine antibiotic prophylaxis in the penile prosthesis patient is emphasized. Urinary tract instrumentation at the time of prosthetic implantation, whether planned or incidental, also appears to add a potentially avoidable risk for subsequent infection.

Fructose-2,6-bisphosphatase and 6-phosphofructo-2-kinase are separable in yeast

Fructose-2,6-bisphosphatase was purified from yeast and separated from 6-phosphofructo-2-kinase and alkaline phosphatase. The enzyme released Pi from the 2-position of fructose 2,6-bisphosphate and formed fructose 6-phosphate in stoichiometric amounts. The enzyme displays hyperbolic kinetics towards fructose 2,6-bisphosphate, with a Km value of 0.3 microM. It is strongly inhibited by fructose 6-phosphate. The inhibition is counteracted by L-glycerol 3-phosphate. Phosphorylation of the enzyme by cyclic-AMP-dependent protein kinase causes inactivation, which is reversible by the action of protein phosphatase 2A.

Positron emission tomography studies of basal ganglia and somatosensory cortex neuroleptic drug effects: differences between normal controls and schizophrenic patients

Glucose metabolic rate in the basal ganglia, thalamus, and somatosensory cortex was examined in eight patients with schizophrenia before and after receiving neuroleptic medication. Basal ganglia metabolic rates were increased with medication: more on the right than on the left and more in putamen than caudate. The cortical anteroposterior ratio, an index of relative hypofrontality, was not affected by neuroleptics. The brain areas that were found to be altered by neuroleptics were selected for comparison between off-medication schizophrenics and controls. Metabolic rates in the basal ganglia tended to be low in patients with schizophrenia in comparison to 24 age- and sex-matched controls.

Vasectomy and vasovasostomy have no effect on seminal plasma zinc concentrations

Mean zinc concentrations were determined for human seminal plasma obtained from 110 nonvasectomized men (139 micrograms. per ml.), 43 recently vasectomized men (144 micrograms. per ml.), 25 long-term vasectomized men (139 micrograms. per ml.) and 25 men who had undergone vasovasostomy (129 micrograms. per ml.). The results indicate that there is no significant short-term or long-term effect of these surgical procedures on prostatic secretory function as measured by seminal plasma zinc concentration.

Cervical meningeal histiocytosis demonstrated by magnetic resonance imaging

Involvement of the central nervous system by histiocytosis X is usually restricted to the parasellar region. A rare case of histiocytosis X involving the cervical meninges in a 12-month-old boy is demonstrated and the magnetic resonance features of this tumor are described.

[Prospective study of the work of the practising pediatrician]

In this supplementum a prospective study on the activity of the pediatrician in private practice is reported. The study was carried out with the collaboration of 39 pediatricians in the area of Zurich between 1980 and 1982.

Internal urethrotomy in girls and its impact on the urethral intrinsic and extrinsic continence mechanisms

The cause of incontinence in a group of 11 girls (mean age 18 +/- 3 years) who had undergone internal urethrotomy during childhood was assessed. Urodynamic methods were used to characterize the detrusor, and urethral profiles were performed to identify the impact of the operation on the extrinsic and intrinsic mechanisms of urethral closure. The results show that 4 of 11 patients demonstrated detrusor instability associated with a high voiding flow rate. The average resting urethral closure pressure in all patients showed significant reduction in maximum closure pressure (62 +/- 32 cm. water) when compared to normal age-matched controls. Transmission pressures to coughing demonstrated a high percentage of transmission to the distal and mid urethra (180 +/- 20 per cent). It was concluded that the intrinsic mechanism of urethral continence as measured by the resting urethral pressure profile was compromised by the urethrotomy. However, the extrinsic mechanisms as measured by the transmission values was not affected. On the basis of these findings it is argued that internal urethrotomy compromises the closure mechanisms intrinsic to the urethra. Continence in these patients most likely is maintained by the action of extrinsic factors transmitting high closure pressures at the distal third of the urethra. Finally, it is postulated that urethrotomy patients are at increased risk for stress incontinence at an early age.

Hemorrhoids or rectal varices: defining the cause of massive rectal hemorrhage in patients with portal hypertension

Identifying the source of lower gastrointestinal hemorrhage in patients with chronic liver disease and portal hypertension can be challenging. We present 2 cases of hemorrhage from rectal varices and a discussion on the differences between simple hemorrhoids and rectal varices. Evaluation of rectal bleeding in patients with portal hypertension is discussed and possible therapeutic options are described.

Frontal cortex and basal ganglia metabolic rates assessed by positron emission tomography with [18F]2-deoxyglucose in affective illness

Twenty affective disorder patients (16 bipolar and 4 unipolar) and 24 normal controls received scans with positron emission tomography (PET) using [18F]2-deoxyglucose (FDG) as a tracer. Subjects received a series of brief electrical stimuli to their right arms during FDG uptake. Patients with bipolar affective illness had significantly lower frontal to occipital glucose metabolic rate ratios (relative hypofrontality) and significantly lower metabolic rates in their basal ganglia in comparison to whole slice metabolism than normal controls. Patients with unipolar illness showed significantly higher frontal to occipital ratios, and also showed relatively decreased metabolism in the basal ganglia. All results in unipolar patients should be considered exploratory due to the small number of patients. Clinical depression ratings correlated negatively with whole slice metabolic rate.

Positron emission tomography in schizophrenic patients with and without neuroleptic medication

Positron emission tomography using [18F]2-fluoro-2-deoxy-D-glucose was performed in nine chronic schizophrenic patients both when medication-free and when medicated with neuroleptics. Total brain cortex, temporal cortex, and basal ganglia glucose use was significantly increased with medication; however, there was no change in anterior/posterior metabolic gradients.

Alternative statistical models for the examination of clinical positron emission tomography/fluorodeoxyglucose data

This article describes a method for partitioning metabolic variability found in positron emission tomography/[18F]fluorodeoxyglucose studies. For the 15 subjects examined, 74.8% of the total metabolic variability could be ascribed to individual differences in global metabolic rate, whereas 15.8% of the total variability was consistent regional variation or pattern across subjects. Subsequently, the method of Q-component analysis is described for the identification of strong- and weak-pattern subjects. In addition, a standardization procedure that amplifies the observed pattern by removing systematic individual differences is described. Finally, the implications of these findings and methods for future and clinical studies are discussed.

The statistical interaction of cerebral specialization and integration in the interpretation of dynamic brain images

Two constructs of brain function, namely cerebral specialization and integration, have been examined in the analysis of blood flow and metabolic function resulting from dynamic imaging procedures. The purpose of the current paper is to illustrate the interaction of these two constructs at the statistical level. Because of the statistical interaction, it is argued that the currently accepted statistical evidence for cerebral specialization is, in fact, partially a function of the degree of regional cerebral integration. Therefore, found asymmetries of flow or rate may be solely a function of cerebral integration. These points are discussed with respect to developing a better understanding of stimulus/brain/behavior relations.

Clinical correlates of decreased anteroposterior metabolic gradients in positron emission tomography (PET) of schizophrenic patients

The finding in schizophrenic patients of a reversal of the normal frontal to posterior pattern of brain metabolic activity with positron emission tomography (PET) is of interest, but its relevance to psychopathology is unknown. Using PET, the authors studied 21 patients with chronic schizophrenia and 21 age- and sex-matched control subjects. Although eight of the 21 patients and only one of the control subjects showed a relatively lower anteroposterior metabolic gradient, no clinical correlates of this finding were noted. In addition, cerebral atrophy, as determined by CAT scan, was not associated with this aberrant metabolic pattern.

Hydrocele following internal spermatic vein ligation: a retrospective study and review of the literature

We reviewed 82 consecutive infertile men with varicoceles and 1 teenage boy with a painful varicocele, all of whom underwent a total of 111 internal spermatic vein ligations (55 unilateral and 28 bilateral) by the suprainguinal approach (Palomo method). Of these patients 3 who underwent unilateral and 3 bilateral internal spermatic vein ligations subsequently suffered a total of 8 hydroceles after an average postoperative interval of 18.2 months. The protein concentration of the hydrocele fluid in the 2 most recent patients was consistent with lymphatic obstruction.

The Genain Quadruplets: electrophysiological, positron emission, and X-ray tomographic studies

Four 51-year-old monozygotic quadruplets concordant for schizophrenia, originally studied at the National Institute of Mental Health 25 years ago, were restudied with topographic electroencephalography (EEG), evoked potentials (EPs), computed tomography (CT scans), polysomnographic sleep recordings, and positron emission tomography (PET) with 18F-2-deoxyglucose. EEG and EP findings were consistent with those from other groups of patients with schizophrenia and showed great similarity within the quadruplets. CT scans revealed uniformly small lateral ventricles. PET scans replicated earlier findings of relatively low glucose use in the frontal lobes but did not show strong familial concordance.

Correlational methods for determining regional coupling of cerebral glucose metabolism: a pilot study

The current study presents an alternate method of analyzing PET data by means of a correlational approach. Correlational or coupling patterns of regional cerebral glucose metabolism were found for normal subjects and patients with schizophrenia under electric shock stimulation. At two levels (91 mm and 78 mm) significant differences were found between the coupling patterns of normal subjects and patients with schizophrenia. For the normals, the obtained correlational maps were consistent with the sensory input. However, such patterns were not found for the patients with schizophrenia. Therefore it is suggested that the outlined analysis procedure may complement the standard approach of comparing the mean metabolic rates.