Perineal ultrasound evaluation of urethral mobility after the TVT-O procedure

AIMS

The aim of study was to assess, by means of perineal ultrasound (US), women treated with the trans-obturator suburethral sling procedure for urinary stress incontinence (USI).

METHODS

Twelve women with USI and urethral hypermobility were enrolled. Static and dynamic perineal US of urethral mobility was performed before and after tension-free vaginal tape opturator (TVT-O) procedure: US parameters evaluated were pubis-urethra distance and inclination angle of the urethral axis.

RESULTS

The Valsalva stress US evaluation showed a return to normal range of the pubic urethral distance in all cases (p = 0.0001); also a correction of the angle of inclination of the urethral axis occurred in all patients (p < 0.0001).

CONCLUSIONS

Our results propose the use of perineal US for patients with USI as an additional diagnostic tool and a means for postsurgical follow-up.

Clinical, electrocardiographic, and biochemical data for immediate risk stratification in acute coronary syndromes

The recent evolution in therapeutic options for acute coronary syndromes (ACS) mandates early risk stratification in order to select the appropriate treatment strategy for individual patients. Simple clinical data derived from the patient's medical history and physical examination, a standard twelve-lead electrocardiogram (ECG), and determinations of biochemical markers of myocardial damage can be obtained in the emergency room and serve as a guide for deciding appropriate medical management and optimal use of available resources. Even the most important classification of the ACS is based upon a simple and dichotomous description of the ECG, where the presence of ST-segment elevation mandates an immediate attempt to restore coronary perfusion (either pharmacologically or mechanically), whereas its absence suggests pharmacological stabilization before further evaluation. Across the whole spectrum of ACS, clinical history data (such as older age, previous coronary events, and diabetes) and clinical variables (such as higher heart rate, lower blood pressure, and higher Killip class) are the most powerful prognostic determinants at multivariate analyses derived from large databases. The ECG adds significant and independent prognostic information using the analysis of qualitative (direction of ST-segment shift, associated T-wave inversion, and presence of conduction disturbances) and quantitative (number of leads involved, amount of ST- segment shifts, duration of QRS) characteristics. Biochemical markers of myocardial damage have also been identified as independent predictors of events. In addition, retrospective analyses of clinical trials have suggested that biochemical markers might serve as a guide to select pharmacological therapy. However, how to best combine electrocardiographic and biochemical data for immediate risk stratification remains to be further elucidated.

Efficacy of Bacillus thuringiensis israelensis, Bacillus sphaericus and temephos for managing Anopheles larvae in Eritrea

We evaluated the larvicidal activity of the granular formulation of Bacillus thuringiensis israelensis (Bti) serotype H-14 (Vectobac G, 200 ITU/mg) and Bacillus sphaericus (Bsph) serotype H5a5b (Vectolex CG, 670 Bs ITU/mg) against Anopheles arabiensis and other mosquitoes in breeding habitats in 3 sites, Gash-Barka, Anseba, and Debub zones, in Eritrea. The primary objective was to determine the optimal application rate and duration of effect for Bti and Bsph in representative larval habitats as compared with the organophosphate temephos. The biolarvicides were tested at 100% (high) and 50% (low) of the maximum recommended application rate. Temephos was applied at a rate of 100 ml/ha. At least 4 replicate experiments with Vectobac G (5.6 and 11.2 kg/ha), Vectolex CG (11.2 and 22.4 kg/ha) were conducted in each study site. All 3 larvicides caused significant mortality of the main malaria vector species, An. arabiensis, and other mosquito species (Anopheles cinereus, Anopheles pretoriensis, Culex quinquefasciatus). The larvicidal activity for Bti and Bsph was variable depending upon breeding habitat, mosquito species, and general ecology of the area. Both biopesticides had a similar duration of activity (2-3 wk) and were generally as effective as temephos for these time periods. In some cases, the high and low application rates for Bti and Bsph produced equivalent control over 2-3 wk. The 2 Bacillus biopesticides were less effective in habitats with high algal content and in fast flowing streams primarily because of the inability to penetrate algal mats and dilution effect, respectively. The results show that application of the 2 biolarvicides bimonthly to streambed pools, rain pools, and similar habitats would maintain control of the anopheline mosquito population.

Ocular surface changes induced by topical application of latanoprost and timolol: a short-term study in glaucomatous patients with and without allergic conjunctivitis

BACKGROUND

This study evaluated the conjunctival effects of latanoprost and timolol, both of which contain benzalkonium chloride, in patients with primary open-angle glaucoma (POAG), with and without a history of allergic conjunctivitis (AC).

METHODS

Two groups of 25 patients with and without a positive history for AC were studied. After a 21-day wash-out period patients were randomized to 14 days treatment with latanoprost or with timolol, in a cross-over fashion. The following parameters were evaluated on days 0 and 14: number of white blood cells, ferning test, conjunctival impression cytology, subjective symptoms, and objective ocular changes.

RESULTS

Latanoprost caused: (a) an increase in eosinophils in both groups and reduction in lymphocytes only in the group with a history of AC; (b) alterations in ferning test and impression cytology only in AC patients; and (c) development of subjective symptoms and objective signs only in non-AC glaucomatous subjects. Timolol therapy was responsible only for the occurrence of subjective symptoms and objective signs in non-AC patients.

CONCLUSION

Latanoprost treatment induces ocular surface changes which are more evident in POAG patients who are also affected by AC. These findings are probably related to the very high latanoprost concentration of benzalkonium chloride and to its bedtime administration, which further amplifies the toxicity.

Home care. An emerging solution to the healthcare crisis

As the nation's policy makers and healthcare professionals have wrestled with changing the fundamental way that medical care is delivered in this country, they have considered many options. Home care is one option that should be considered seriously. It is one of the fastest growing segments of the U.S. healthcare system because it's cost-effective, improves patients' quality of life, and can efficiently treat patients with a broad range of medical conditions.

Assessment of left internal mammary artery grafts using dipyridamole Doppler echocardiography

Color Doppler echocardiography of the left mammary artery was combined with dipyridamole testing in order to assess the presence of significant (>70%) graft stenosis in 87 patients with a mammary artery graft to the left anterior descending coronary artery presenting with chest pain. Occluded grafts are detected by absent diastolic flow velocities at baseline, whereas the response of the diastolic flow velocity to dipyridamole distinguishes patients with critical versus noncritical stenosis of a patent graft.

Measurement of mitral valve area in mitral stenosis: four echocardiographic methods compared with direct measurement of anatomic orifices

OBJECTIVES

This study sought to compare the mitral valve areas of patients with rheumatic mitral valve stenoses as determined by means of four echocardiographic and Doppler methods with those obtained by direct anatomic measurements.

BACKGROUND

There has been no systemic comparison between Doppler-determined valve areas and the true anatomic orifice in a single cohort.

METHODS

In 30 patients with mitral stenosis, the mitral valve areas determined by two-dimensional echocardiographic planimetry, pressure half-time, flow convergence region and flow area were compared with the values directly measured on the corresponding excised specimen by means of a custom-built sizer.

RESULTS

The correlation coefficient was r = 0.95 (SE 0.06, p < 0.0001) for two-dimensional planimetry; r = 0.80 (SE 0.09, p < 0.0001) for pressure half-time; r = 0.87 (SE 0.09, p < 0.0001) for flow convergence region; and r = 0.54 (SD 0.1, p < 0.002) for flow area. Two-dimensional echocardiographic planimetry, pressure half-time, flow convergence region and flow area overestimated the actual anatomic orifice by > 0.3 cm2 in 2, 1, 6 and 0 patients, respectively, and underestimated it by > 0.3 cm2 in 0, 4, 1 and 8 patients, respectively.

CONCLUSIONS

Mitral valve areas determined by two-dimensional planimetry, pressure half-time and proximal flow convergence region reliably correlated with size of the anatomic orifice. The flow area method provided a less reliable correlation.

Effect of treatment duration on plasma levels of clozapine and N-desmethylclozapine in men and women

Plasma levels of clozapine and its major metabolites, N-desmethylclozapine and clozapine-N-oxide, were measured in 18 schizophrenic patients at different times (4, 6 and 24 weeks) during the course of treatment with multiple doses of the drug, by using high performance liquid chromatography (HPLC) with UV detection. Plasma levels of clozapine and N-desmethylclozapine were significantly higher in females than in males after 4 and 6 weeks, but not after 24 weeks, of treatment. No sex difference was found at any time with respect to plasma levels of clozapine-N-oxide.

Transthoracic 2D echo color Doppler assessment of internal mammary artery to left anterior descending coronary artery graft

For noninvasive evaluation of anatomy and flow characteristics of internal mammary artery graft (IMA-graft), 2D echo-Color-Doppler (CDE) was performed in 60 patients (54 M, 6 F, mean age 54.1 +/- 6.9 y), who underwent coronary angiography 20.1 +/- 13 months after a coronary artery bypass graft (CABG). CDE was performed, using an echocardiographic unit equipped with a 5 MHz linear transducer. In all patients, measurements of IMA-graft diameter (mm), and peak systolic and diastolic flow velocity (cm/sec) were obtained at baseline and also in 16 patients after dipyridamole infusion (0.54 mg/Kg/min) and in 10 patients after sublingual nitroglycerin (NTG) (0.4 mg). Angiography showed the IMA-graft patency in 58/60 patients (96.8%). A typical biphasic flow was displayed by CDE in 49/58 patients (84.4%) with angiographic patency. Dipyridamole infusion increased both IMA-graft diameter and peak diastolic flow velocity (PDFV) from 2.28 +/- 0.51mm to 2.9 +/- 0.42mm and from 19.4 +/- 6.2 cm/sec to 93.9 +/- 29 cm/sec, respectively (p < 0.0001). No significant modifications of peak systolic flow velocity (PSFV) were observed. NTG increased PDFV from 29.11 +/- 8 cm/sec to 41.88 +/- 7.20 cm/sec (p < 0.005), while diameter and PSFV showed no statistically significant modifications. CDE is a useful diagnostic tool for noninvasive evaluation of IMA-graft patency both early after surgery and during long-term follow-up. CDE pharmacological stress improves the sensibility of the technique and it can provide indirect information about pathophysiology of recipient coronary vessel.

[Multiplane transesophageal echocardiography. The experience with 250 patients]

BACKGROUND AND OBJECTIVES

Multiplane transesophageal echocardiography provides countless tomographic planes through an angle of 180 degrees, thus overcoming the restriction encountered even with biplane transesophageal echocardiography. However, the incremental diagnostic value and clinical usefulness of this technique over biplane transesophageal echocardiography has not been extensively studied.

STUDY POPULATION AND METHODS

In order to evaluate its advantages over biplane imaging, 250 patients (129 male, 121 females) aged 14-86 years, underwent multiplane transesophageal echocardiography. Indications for the study were the following: source of embolism in 83 patients, suspected prosthetic dysfunction in 58 patients, valvular disease in 46 patients, congenital heart disease in 30 patients, aortic disease in 17 patients, intra- or paracardiac masses in 11 patients, and other reasons in 5. All the patients underwent an initial comprehensive diagnostic assessment using only the transverse (0 degree) and longitudinal (90 degrees) plane as the biplane imaging technique. "Off-axis" tomographic sections through the full 0 degree to 180 degrees angle were subsequently obtained by means of the gradual electrical rotation of the transducer. The echocardiographic information obtained by rotating the transducer was then compared to that obtained by biplane imaging to determine whether the additional information provided by "off-axis" sections a) carried diagnostic data; b) were to be considered useful but not diagnostic; or c) irrelevant.

RESULTS

Additional diagnostic information was obtained in 24 out of the 250 patients (9.6%), including the source of embolism in 9 patients, mitral insufficiency in 6 patients, bicuspid aorta in 2 patients, aortic endocarditis in 2 patients, mitral prosthetic dysfunction in 4 patients and complex congenital heart disease in 1 patient. Additional useful but non-diagnostic information was obtained in 162 patients (64.8%). These data mainly allowed a more comprehensive assessment of the cardiac abnormality, enhancing confidence in the transesophageal diagnosis. Finally, data considered to be irrelevant were found in 64 patients (25.6%).

CONCLUSIONS

The present study indicates that the wide range of tomographic planes provided by multiplane transesophageal echocardiography allows a more comprehensive evaluation of cardiac diseases and makes an accurate diagnosis possible in a significant number of cases.

The human pineal gland responds to stress-induced sympathetic activation in the second half of the dark phase: preliminary evidence

Previous reports by our group and by others showed that the human pineal gland is unresponsive to stress-induced systemic sympathetic activation either during the day or 3 hrs after the beginning of darkness. In the present study, we investigated whether a longer period of dark exposure is required to demonstrate a stimulatory effect of stress-induced sympathetic activation on the human pineal gland. For this purpose, plasma melatonin levels were measured in six healthy men (aged 25-34 yrs) both in resting condition and before and after a physical exercise performed between 02.40 and 03.00 h, 30 min after exposure to bright light (2000 lux). Light exposure lasted from 02.10 h up to 04.00 h. The exercise consisted in bicycling on a bicycle ergometer at 50% of the personal maximum work capacity (MWC) for 10 min, followed by another 10 min of bicycling at 80% of the MWC. In the same subjects, plasma melatonin levels were measured also without exposure to light and with no exercise (control dark condition). The results showed that physical exercise, although inducing a rapid and short-term general sympathetic activation (as shown by significant changes in cardiovascular parameters) was able to increase light-depressed plasma melatonin levels only 5 hrs after the end of the stress (p < 0.0001, group X time interaction, two-way ANOVA with repeated measures). These findings suggest that the human pineal gland is responsive to systemic sympathetic activation induced by physical stress in the second half of the dark phase.

Long-term effects of befunolol on the corneal endothelium and the consensual ophthalmotonic reaction

In a double-blind study, 30 patients with ocular hypertension were randomly assigned to receive one drop of 0.5% befunolol or placebo (the drug vehicle) in each eye twice daily for 120 days. The befunolol used contained no preservatives. Before and after treatment the number and shape of the endothelial cells of the five corneal sectors were evaluated. After 120 days of twice-daily application of befunolol or placebo, no changes in the shape or density of the corneal cells were found in any patient. No differences in the patients receiving befunolol or placebo were noted. The consensual ophthalmotonic reaction was studied in 15 of the patients before and after befunolol administration. A significant decrease in intraocular pressure was noted at 30 minutes and at 1, 2, 3, 4, 5, and 6 hours after befunolol. Intraocular pressure also decreased significantly at 1 to 4 hours after placebo, and then returned to pretreatment levels at 6 hours.

Topically applied levobunolol does not cause changes in the corneal endothelium

The corneal endothelium was examined in ten patients suffering from ocular hypertension before, during and after four months of topical levobunolol treatment. The untreated fellow eye served as a control. The number of endothelial cells, determined with a McIntyre eyepiece and an Eisner's contact lens, was not affected by levobunolol therapy. In addition, the morphology of the cell did not appear to be affected by the drug.

Trabeculectomy and extracapsular cataract extraction with posterior chamber lens implantation: a long term study

Extracapsular cataract extraction with posterior chamber lens implantation and trabeculectomy was performed on 15 cataractous eyes in 15 patients: 5 were affected with chronic closed angle glaucoma and 10 with primary open angle glaucoma. This procedure offers the intraocular pressure control expected after trabeculectomy and, at the same time, gives the patients all visual benefits that cataract extraction with intraocular lens implantation warrants, without the introduction of new complications.