Rapid and complete decompression of chronic urinary retention: a safe and effective practice

We carried out a prospective study of consecutive patients who presented with chronic urinary retention over a period of 2 years in order to determine the safety and effectiveness of rapid and complete decompression of chronic urinary retention. A total of 22 patients met the inclusion criteria. Although slow decompression is thought to reduce complications, it harbours the disadvantages of impracticability, time and labour demands and an increased risk of infection. Post-obstructive diuresis, haematuria and hypotension are relatively frequent in rapid and complete decompression of chronic urinary retention. However, they are mild, transient and clinically insignificant. Rapid and complete decompression of the chronically obstructed urinary bladder not only saves time, it is safe and effective and should be adopted as the standard practice.

Assessing lexicon: validation and developmental data of the Picture Naming Game (PiNG), a new picture naming task for toddlers

BACKGROUND

Understanding lexical abilities in infants and toddlers is important, yet no single tool can be used.

AIMS

To perform a validation of a new tool (known as the Picture Naming Game, or 'PiNG') for assessing lexical comprehension and production in toddlers and to obtain developmental trends for Italian children.

METHODS & PROCEDURES

PiNG consists of four subtests: Noun Comprehension (NC), Noun Production (NP), Predicate Comprehension (PC) and Predicate Production (PP), each containing 20 lexical targets. It was administered to 388 children with typical development aged 19-37 months. The short form of the Italian version of the MacArthur-Bates Communicative Development Inventories (MB-CDI), previously completed by parents of participants, was used for the validation of PiNG.

OUTCOMES & RESULTS

For the validation study, reliability, internal consistency and concurrent validity were analysed. The reliability was optimal for NC, NP and PP, and satisfactory for PC. Split-half analysis showed a fair internal consistency for all of the subtests. Concurrent validity was verified through the correlation with MB-CDI using Pearson's correlation coefficient, which was significant even after having controlled for age. To describe the developmental trends, data are provided for 1-month age intervals. The comprehension subtests showed a rapid increase at younger ages, with children reaching a plateau slightly earlier for the NC (at 30 months versus 33 months for the PC). The increase in the production subtests was gradual; PP appeared to be the most difficult subtest, administrable starting at the age of 24 months. When we analysed, as potential confounders for developmental trends, gender, parents' educational level, and the way in which the subtests were administered, no differences were found, except for a better performance for girls in the NP subtest.

CONCLUSIONS & IMPLICATIONS

Overall, the results suggest that PiNG is suitable for children in the age range considered to evaluate language abilities. It can be used together with other tools with clinical and theoretical objectives also to describe lexical abilities in atypical populations, such as children with cognitive and/or language impairment, as well as with late-talking children. Finally, the four subtests can be administered separately or combined, which provides flexibility in clinical use, in that the individual child's linguistic and/or cognitive characteristics and level can be taken into consideration.

Factors influencing choice of surgical route of repair of genitourinary fistula, and the influence of route of repair on surgical outcomes: findings from a prospective cohort study

OBJECTIVE

The abdominal route of genitourinary fistula repair may be associated with longer term hospitalisation, hospital-associated infection and increased resource requirements. We examined: (1) the factors influencing the route of repair; (2) the influence of the route of repair on fistula closure 3 months following surgery; and (3) whether the influence of the route of repair on repair outcome varied by whether or not women met the published indications for abdominal repair.

DESIGN

Prospective cohort study.

SETTING

Eleven health facilities in sub-Saharan Africa and Asia.

POPULATION

The 1274 women with genitourinary fistula presenting for surgical repair services.

METHODS

Risk ratios (RRs) and 95% confidence intervals (95% CIs) were generated using log-binomial and Poisson (log-link) regression. Multivariable regression and propensity score matching were employed to adjust for confounding.

MAIN OUTCOME MEASURES

Abdominal route of repair and fistula closure at 3 months following fistula repair surgery.

RESULTS

Published indications for abdominal route of repair (extensive scarring or tissue loss, genital infibulation, ureteric involvement, trigonal, supratrigonal, vesico-uterine or intracervical location or other abdominal pathology) predicted the abdominal route [adjusted risk ratio (ARR), 15.56; 95% CI, 2.12-114.00]. A vaginal route of repair was associated with increased risk of failed closure (ARR, 1.41; 95% CI, 1.05-1.88); stratified analyses suggested elevated risk among women meeting indications for the abdominal route.

CONCLUSIONS

Additional studies powered to test effect modification hypotheses are warranted to confirm whether the abdominal route of repair is beneficial for certain women.

Laparoscopic management of small bowel obstruction with associated intestinal ischemia

Obstruction is the most common surgical disorder of the small bowel. Complete small bowel obstruction (SBO) is usually treated surgically because bowel strangulation cannot be excluded with certainty. Acute SBO has been previously considered a relative contraindication for laparoscopic management especially due to the laparotomy conversion rate. We present a case of SBO for which laparoscopic management resulted in earlier return of bowel function, shorter hospital stay, faster overall recovery, and decreased morbidity when compared to laparotomy.

Unusual giant prostatic urethral calculus

Giant vesico-prostatic urethral calculus is uncommon. Urethral stones rarely form primarily in the urethra, and they are usually associated with urethral strictures, posterior urethral valve or diverticula. We report a case of a 32-year-old man with giant vesico-prostatic (collar-stud) urethral stone presenting with sepsis and bladder outlet obstruction. The clinical presentation, management, and outcome of the giant prostatic urethral calculus are reviewed.

Systematic review: kidney transplantation compared with dialysis in clinically relevant outcomes

Individual studies indicate that kidney transplantation is associated with lower mortality and improved quality of life compared with chronic dialysis treatment. We did a systematic review to summarize the benefits of transplantation, aiming to identify characteristics associated with especially large or small relative benefit. Results were not pooled because of expected diversity inherent to observational studies. Risk of bias was assessed using the Downs and Black checklist and items related to time-to-event analysis techniques. MEDLINE and EMBASE were searched up to February 2010. Cohort studies comparing adult chronic dialysis patients with kidney transplantation recipients for clinical outcomes were selected. We identified 110 eligible studies with a total of 1 922 300 participants. Most studies found significantly lower mortality associated with transplantation, and the relative magnitude of the benefit seemed to increase over time (p < 0.001). Most studies also found that the risk of cardiovascular events was significantly reduced among transplant recipients. Quality of life was significantly and substantially better among transplant recipients. Despite increases in the age and comorbidity of contemporary transplant recipients, the relative benefits of transplantation seem to be increasing over time. These findings validate current attempts to increase the number of people worldwide that benefit from kidney transplantation.

Systematic review: kidney transplantation compared with dialysis in clinically relevant outcomes

Individual studies indicate that kidney transplantation is associated with lower mortality and improved quality of life compared with chronic dialysis treatment. We did a systematic review to summarize the benefits of transplantation, aiming to identify characteristics associated with especially large or small relative benefit. Results were not pooled because of expected diversity inherent to observational studies. Risk of bias was assessed using the Downs and Black checklist and items related to time-to-event analysis techniques. MEDLINE and EMBASE were searched up to February 2010. Cohort studies comparing adult chronic dialysis patients with kidney transplantation recipients for clinical outcomes were selected. We identified 110 eligible studies with a total of 1 922 300 participants. Most studies found significantly lower mortality associated with transplantation, and the relative magnitude of the benefit seemed to increase over time (p < 0.001). Most studies also found that the risk of cardiovascular events was significantly reduced among transplant recipients. Quality of life was significantly and substantially better among transplant recipients. Despite increases in the age and comorbidity of contemporary transplant recipients, the relative benefits of transplantation seem to be increasing over time. These findings validate current attempts to increase the number of people worldwide that benefit from kidney transplantation.

Epidemiological and aetiological factors of male infertility in northern Nigeria

OBJECTIVE

To evaluate some epidemiologic and aetiologic factors for male infertility in our patients.

METHOD

All male patients who presented with infertility in urology clinic of the department of surgery between 1991and2005 were retrospectively reviewed. Epidemiologic and aetiological factors of male infertility were studied.

RESULT

There were 537 patients; age ranged 18 to 56 years with a mean of 34 +/- 9.0 SD years. Primary infertility was seen in 515 (96%) patients. About 70% were infertile for 2 to 6 years. Primary testicular insufficiency was seen in 260 patients (48.7%) mainly resulting from genitourinary tract infection. Azoospermia resulting from testicular pathology was seen in 18 (3.4%) and obstruction to the vas or epididymis was seen 75 (14.0%) patients. Two hundred and fourteen (45%) patients had oligospermia resulting from testicular insufficiency while 61 (11.4%) had oligospermia due obstruction.

CONCLUSION

Infertility resulted mainly from preventable causes. This can be prevented by prompt and adequate treatment of genitourinary infection, testicular maldescent and testicular torsion.

Isolation and evaluation of novel adeno-associated virus sequences from porcine tissues

High antigenic compatibility and low toxicity is associated with xenograft transplantation of porcine tissues in immunodeficient human recipients. We hypothesized that adeno-associated viruses (AAVs) of porcine origin could be highly compatible to human tissues and thus of good efficiency and low toxicity for in vivo gene transfer. Porcine tissues were screened by PCR for the presence of AAV using primers designed to bind conserved regions and amplify variable regions of an alignment of several AAV sequences available on GenBank. We isolated new AAV capsid sequences from porcine tissues and successfully generated a recombinant AAV2/po1 vector by transfection. The AAV2/po1 vector was not cross-neutralized by antisera generated against all other commonly used AAVs (serotype 1, 2, 3, 4, 5, 7 and 8) indicating a distinct antigenic profile. Preexisting immunity to AAVpo1 could not be detected in the human sera evaluated. In mice, AAV2/po1 particles expressing beta-galactosidase or green fluorescent protein demonstrated high transduction efficiency in muscle fibers and the retina after intramuscular or intraocular administration. Biodistribution experiments following systemic administration showed efficient gene transfer exclusively in muscle fibers. Novel AAVs derived from porcine tissues may contribute to the generation of new preventive or curative clinical modalities acceptable for human use.