Do patients with low volume prostate cancer have prostate specific antigen recurrence following radical prostatectomy?

Aims:

The objective of this study was to determine the incidence of prostate specific antigen (PSA) relapse in patients with low volume prostate cancer following radical prostatectomy.

Methods:

Between 1993 and 2001, 50 of 717 patients had total tumour volumes of less than 0.5 cm3 following radical prostatectomy. Biochemical recurrence was defined as two consecutive values of serum PSA levels of 0.2 ng/ml or greater.

Results:

Median follow-up of the 50 patients was 58 months. In five of the 50 patients (10%), PSA recurrence was observed. All of these five cases had Gleason score of 3+3 (well and/or moderately differentiated), organ confined and surgical margin negative tumours. In three of the five cases, capsular incision resulted in benign glands extending into the surgical margin.

Conclusions:

Five of 50 cases had PSA failure. In three of the five patients, benign glands located in the margin could explain the “PSA recurrence”. However, in the other two patients, none of the pathological parameters correlated with measurable PSA levels. The explanation for their PSA failure is unclear.

Seasonal variation of reproductive performance, foetal development and progesterone concentrations of sheep in the subtropics

The aim of the present study was to investigate the effect of breeding season [late spring (LSP) vs winter (WIN)] on reproductive performances, foetal development and progesterone (P(4)) concentrations of sheep in the subtropics. Ewes of Farafra breed were exposed for mating in LSP (n = 79) and WIN (n = 45). Ultrasonographic examinations were performed at days 25, 45 and 75 of mating to estimate the pregnancy rate, incidence of twinning and percentage of foetal losses. Foetal growth rate was determined at 10-day interval, and blood samples were taken on days 0 (oestrus), 8, 18 of oestrous cycle and on days 30, 45, 60 and 90 of pregnancy for P(4) analysis. The results showed that pregnancy and lambing rates were greater (p < 0.01) for ewes mated in LSP (93.7% and 92.4%) than for those mated in WIN (75.6% and 71.1%), respectively. There was no effect of season on the incidence of twinning (overall 19.1%) or the frequency of foetal losses (overall 7.3%). Transient reduction of placental size, foetal growth and P(4) concentration was observed following LSP matings. In conclusion, pregnancy and lambing rates were higher following LSP matings. Summer heat stress of the late spring mated ewes transiently interferes with foetal growth and P(4) concentrations.

Ultrasonographic fetometry and determination of fetal sex in buffaloes (Bubalus bubalis)

The aim of the current study was to establish ultrasonic biometric threshold of different fetal parts in buffaloes and to evaluate the feasibility and accuracy of ultrasonic fetal sex determination. Serial ultrasonographic examinations were carried out on twelve pregnant buffalo-cows, during which fetal parts were measured, and fetal sex and presentation were determined. The obtained results revealed that embryo and amniotic vesicle (AV) were detected by the forth and fifth week of pregnancy, respectively. Organization was observed by the seventh week, while ossification was indicated between the eighth and 10th week. High correlations were found between different studied parameters and gestational age, where the highest correlation was found with the crown-rump length (CRL) and amniotic vesicle diameter (AVD) at the early-gestation; the biparietal diameter (BPD) at the mid-gestation; and the eyeball diameter (EBD) at the mid- and late-gestation. The results also revealed that the best window for fetal sexing was found between the 10th and 18th week of gestations, with an overall accuracy of 97.1%. The final polarity with all fetuses in anterior presentation was adopted by the 30th week. In conclusion, the overall data indicated the feasibility and value of ultrasonographic fetometry in buffaloes for evaluation of fetal development, estimation of gestational age and determination of fetal sex.

Validation of a soccer skill test for use with females

The aim of this study was to validate the Loughborough Soccer Passing Test (LSPT) for use with female players. Nineteen Premier Division (elite) and 16 Reserve team players (nonelite) volunteered for this study. The LSPT requires players to complete 16 passes against coloured target areas as fast and as accurately as possible. Participants completed an initial familiarisation trial followed by two main trials, each separated by at least one week. During both trials participants were given two practice efforts before recording the mean of the next two attempts as the performance score. All trials were performed inside a sports hall, using an indoor soccer ball, and following a standardised 10-min warm-up. The mean time taken (54.6 +/- 5.3 s vs. 61.6 +/- 6.5 s, p = 0.002), added penalty time (22.8 +/- 7.2 s vs. 35.9 +/- 11.5 s, p < 0.001) and overall performance time (77.4 +/- 11.6 s vs. 97.5 +/- 17.2 s, p < 0.001) were lower for elite players. Due to the lower agreement ratio, LSPT performance was more repeatable in the elite (x//1.39) relative to nonelite (x//1.45) group. In conclusion, the LSPT is a valid and reliable protocol to assess differences in soccer skill performance using female players.

Is formal training necessary for capsule endoscopy? The largest gastroenterology trainee study with controls

BACKGROUND

Little is known about the infrastructure to train gastroenterologists in capsule endoscopy. The level of capsule endoscopy exposure among trainees in the United Kingdom or Europe has also not been quantified.

AIMS AND METHODS

To assess the ability of 10 gastroenterology trainees with endoscopy experience to interpret 10 capsule endoscopy videos against five medical students, with an expert in capsule endoscopy as the gold standard. Parameters assessed included gastric emptying time, small bowel transit and the diagnosis made. A questionnaire survey assessed the level of capsule endoscopy exposure among United Kingdom trainees.

RESULTS

Trainees were better at determining the gastric emptying time (p=0.013) and more likely to record true positives compared to the students (p=0.037). They were also less likely to record false positives (p=0.005) and more likely to reach the correct diagnosis (p=0.001, OR 3.6, CI 1.8-7.4). Our survey found that, 65% of trainees had prior exposure to capsule endoscopy but only 13% had done capsule endoscopy reporting. Sixty seven percent felt capsule endoscopy should be incorporated into their training.

CONCLUSION

This study has shown that prior endoscopic experience enables trainees to interpret capsule endoscopy more accurately than medical students. However, there is a demand for focussed training which would enable trainees to reliably interpret pathology on capsule endoscopy.

Secondary prevention of fragility fractures by orthopaedic teams in the UK: a national survey

OBJECTIVE

To assess secondary prevention of fragility fractures by orthopaedic surgeons in the UK and study the effect of multidisciplinary approach in providing secondary prevention.

METHODS

A survey was conducted consisting of a postal questionnaire sent to 1000 UK orthopaedic surgeons. 750 valid responses were received.

RESULTS

The survey revealed poor compliance with existing guidelines. In the 60- to 80-year age group, the presence of a fracture liaison nurse made a significant difference in the prescription of vitamin D and calcium, providing weight bearing advice, fall risk assessment and dual energy x-ray absorptiometry (DEXA) scan requests. Orthogeriatric service made a significant difference in providing weight bearing advice and DEXA scan requests. In the above 80-year age group, fracture liaison nurses made a significant difference in provision of fall risk assessment and weight bearing advice. Orthogeriatric services made a significant difference in prescribing vitamin D and calcium, providing weight bearing advice and for DEXA scan requests.

CONCLUSION

The study re-emphasises the inadequate initiation of secondary preventive measures by orthopaedic units. It also highlights the importance of orthogeriatric and fracture liaison nurse services in improving compliance with existing guidelines.

Cooling the NGI - an approach to size a nebulised aerosol more accurately

The European Pharmaceutical Aerosol Group (EPAG) has undertaken investigations with the aim of developing robust methods for the droplet size analysis of nebuliser-produced aerosols in support of the proposed European Pharmacopeia general chapter 2.9.44 covering preparations for nebulisation. A multi-centre study was designed to investigate the effects of cooling the Next Generation pharmaceutical Impactor (NGI) before sample collection, as a means of reducing bias and variability caused by heat transfer-related evaporation. Droplets containing salbutamol were sized from 3 different nebulisers chosen to offer fundamentally different modes of aerosol generation: AeroNeb Go, a vibrating mesh nebuliser; PARI LC Plus, a breath-enhanced jet nebuliser; and MistyMax, a constant-output jet nebuliser. Each laboratory undertook determinations at ambient temperature, using an NGI pre-cooled in a refrigerator (5 degrees C for at least 90 min). The corresponding measurements were made using an ambient NGI as a benchmark. Salbutamol solution 5 mg/2 ml (Teva, Runcorn, UK) was used throughout the study. Analysis of individual and pooled results from 5 of the participants showed a similar trend insofar as the cooled NGI yielded a coarser nebulised aerosol than that obtained by the ambient NGI. Mass Median Aerodynamic Diameter (MMAD) was on average reduced by 9.5-21.9 % and the Fine Droplet Fraction < 5 microm (FDF) increased on average by 5.5-17.4 % for all the nebuliser designs when comparing ambient to cooled NGI. Despite the more laborious procedure of cooling the NGI, variability in data was generally similar to that obtained with the ambient NGI. We conclude that it is beneficial to cool the NGI when sizing nebulised aerosol. Furthermore, occasional findings during this study revealed a build-up of solute deposits within the interior of the NGI, and a more rigorous impactor cleaning/drying procedure is therefore recommended.

Psychiatric morbidity and social functioning among adults with borderline intelligence living in private households

BACKGROUND

Approximately one-eighth of the population will have DSM-IV borderline intelligence. Various mental disorders and social disability are associated with it.

METHOD

The paper uses data (secondary analysis) from a UK-wide cross-sectional survey of 8450 adults living in private households. Data were collected on psychiatric disorders, intellectual level, social functioning and service use.

RESULTS

In total, 12.3% of the sample had borderline intelligence. The prevalence of psychotic disorder was not significantly increased, but the group showed significant social disadvantage and increased rates of neurotic disorders, substance misuse and personality disorders when compared with their counterparts of normal intelligence. The borderline group was more likely to receive psychiatric medication, but not talking therapies. They appear to use significantly more services, including emergency services.

CONCLUSION

Adults with borderline intelligence are more likely to suffer from treatable mental disorders and an excess of substance misuse. Services should be aware of hidden morbidity in this group.

Assessment of the need to coat particle collection cups of the NGI to mitigate droplet bounce when evaluating nebuliser-produced droplets

The European Pharmaceutical Aerosol Group (EPAG) has been undertaking a series of investigations in support of developing robust methods for the droplet size analysis of nebuliser-produced aerosols for the proposed European Pharmacopoeia general chapter 2.9.44 covering preparations for nebulisation. The present two-centre study, which was designed to confirm whether or not coating the collection cups of the Next Generation pharmaceutical Impactor (NGI, the recommended impactor for the proposed monograph) is required, forms part of these investigations. The study evaluated NGI-measured aerodynamic droplet-size distributions of aerosols of a generic salbutamol solution for nebulisation generated by two different jet nebulisers. The results demonstrated that there was no indication of biased stage deposition when silicone oil was used to coat the impaction surfaces, as compared to uncoated surfaces. The conclusion was that there is no need to coat the NGI cups when nebulised products are investigated.

Obstructive lung disease in acute medical patients

OBJECTIVES

To determine the proportion of adult medical patients who have chronic obstructive pulmonary disease (COPD), using the Global initiative for Chronic Obstructive Lung Disease guidelines (GOLD), and its relation to vascular disease.

METHODS

This is a prospective cross-sectional study of adult patients admitted to acute medical wards. Interviewer administered questionnaire, anthropometric and spirometric measurements were done.

RESULTS

Spirometry was performed in 720 acute admissions [Mean (SD) age 50.0 (18.9) years, FEV1: 1.98 L (0.83), FEV1/FVC%: 75.1 (11.9)%; males 332 (46.1%), smokers 318 (44%); 43.2% had vascular disease]. Sixty-seven per cent of patients (480) had no airway disease including 35 (4.5%) with chronic cough and sputum with normal spirometry; 89 (12.4%) had asthma and 151 (20.9%) had COPD. Patients with COPD were significantly older [60.3 (16.6) years] than non-COPD patients [47.3 (18.5) years], p < 0.001 and had a greater number of pack years of smoking. A greater percentage of patients with COPD had vascular disease (52%) than the non-COPD patients (40.1%), p = 0.017). Multivariate analysis with vascular disease as outcome variable revealed relationships with older age (p < 0.001) and Indo-Trinidadian ethnicity (p = 0.015), but not with gender (p = 0.321) and smoking (p = 0.442). FEV1% as well as FEV1 showed a significant inverse relationship with vascular disease (p < 0.05).

CONCLUSIONS

The prevalence of COPD using GOLD guidelines in acute hospital admissions is 20.9%; 11.7% of admissions have chronic sputum or cough with normal spirometry. Vascular disease is more prevalent in those with COPD. Patients admitted to acute medical care with vascular disease may also have COPD.

Iodine status among pregnant women in Kuwait

Up to now, little has been known about iodine intake and the prevalence of iodine deficiency (ID), if any, in Kuwait. Urinary iodine excretion (UIE) and changes in thyroid function during pregnancy were thus evaluated.

METHODS

Urinary iodide level was measured in random urine samples collected from 326 pregnant women at different gestational trimesters. Blood samples were drawn for free T4 (FT4) and TSH level determination.

RESULTS

Median UIE levels fall within the normal range during all gestational trimesters i.e. >100 microg/l. However, if the new suggested recommendation for pregnant women <140 microg/l, is applied, median UIE values during trimesters 2 and 3 indicate ID. Mean serum TSH levels increased between trimesters 1 and 3 (p<0.05), whereas serum FT4 decreased between first and second trimesters (p<0.05), and this reduction continued at the third trimester. Furthermore, an increase in TSH levels for subjects with mild and moderate ID (Mi and Mo, respectively) were noticed (p<0.05) during the second trimester. However, FT4 levels dropped in subjects with Mi and Mo ID during the first trimester (p<0.05). In conclusion, these results suggest that 56.8% of pregnant women had median UIE level <145 microg/l, associated with high TSH and low FT4 levels.

CONCLUSION

Data obtained may indicate insufficient iodine intake among pregnant women in Kuwait.

Reoperative surgery on the aortic valve

The number of patients presenting for reoperative valve surgery is set to rise because of the increased longevity of the population. International trends indicate a shift towards the use of tissue valves in North America and Europe. In recent years, improved techniques have reduced the early mortality of these procedures, such that age, alone, is no longer an incremental risk factor. It is the co-morbidity which largely determines the fate of these patients. Percutaneous valve replacement is evolving and is likely to be a useful form of management especially in those with significant associated disease.