Correlation of opioid antinociception and hypothermia in dogs-An animal welfare refinement

The purpose of this study was to assess antinociception and correlation of antinociception and hypothermic effects after intravenous opioids in dogs. Nine healthy male Beagles were enrolled in the study. They were acclimated to a thermal nociceptive device, then received three IV treatments (saline, butorphanol 0.4 mg/kg and methadone 0.5 mg/kg) in a randomized complete block design. Rectal temperature and thermal withdrawals were assessed prior to and 0.5-6 h after drug administration. One dog was excluded due to lack of withdrawal to thermal stimuli. Rectal temperatures were not significantly different between treatments at time 0, but significantly decreased from 0.5 to 5 h for both opioids compared to saline. Withdrawals were significantly decreased, compared to saline, from 0.5 to 4 h for butorphanol and 0.5-5 h for methadone. A significant (p = .0005) and moderate (R2  = .43) correlation between antinociception and hypothermia occurred. Based on these data, intravenous butorphanol (0.4 mg/kg) and methadone (0.5 mg/kg) provided 4 and 5 h of antinociception, respectively. Opioid hypothermia can serve as an easy, noninvasive and humane manner for preclinical assessment of opioid antinociception in dogs prior to evaluation in clinical trials. This is a major refinement in animal welfare for assessing novel opioids, opioid doses and dose intervals in dogs.

Florfenicol urinary excretion and its potential for treating canine urinary tract infections

The canine urinary excretion of florfenicol was evaluated to explore its potential for treating urinary tract infections. Nine healthy male intact purpose-bred Beagles and four healthy client-owned dogs each received a single oral dose of florfenicol 20 mg/kg (300 mg/mL parenteral solution) with food. All voluntary urinations were collected for 12 h. Although florfenicol is reportedly bitter tasting, 7/9 Beagles and 4/4 client-owned dogs completely ingested the florfenicol and were enrolled; salivation (n = 1) and headshaking (n = 3) were observed. The last measured urine florfenicol concentrations were variable: Beagles (0.23-3.19 mcg/mL), Pug (3.01 mcg/mL) English Setter (21.29 mcg/mL), Greyhound (32.68 mcg/mL), and Standard Poodle (13.00 mcg/mL). Urine half-life was similar for the Beagles and the Pug, 0.75-1.39 h, whereas the half-life was 1.70-1.82 h for the English Setter, Greyhound, and Standard Poodle. Larger breed dogs exceeded 8 mcg/mL florfenicol (wild-type cutoff) in their urine at 12 h, whereas the Beagles and Pug had <8 mcg/mL; it is unclear if this is an individual, breed, or size difference. These data suggest oral florfenicol may need to be administered q6-12h for canine urinary tract infections, but further data are needed (more enrolled dogs, multiple-dose regimens) before considering clinical trials or breed-specific differences.

Abstract P5-13-03: Breast cancer risk assessment for underserved minority women in primary care: patient and provider perspectives

Background: Individualized breast cancer risk assessment can identify women at increased risk who are candidates for interventions with proven benefit, including chemoprevention, enhanced surveillance, genetic testing and risk-reducing surgery. Systematic risk assessment and prescription of individualized, risk-adapted cancer control recommendations provides a novel method for addressing cancer disparities in underserved minority women. Widespread dissemination of these approaches requires implementation in the primary care setting.

Purpose: to determine potential benefits and harms of a policy for routinely providing personalized breast cancer risk assessment for underserved minority women from the perspectives of patients and primary care providers (PCPs), and to explore ethical implications of breast cancer risk communication in this patient population.

Methods: African American and Hispanic women age 25–69 years without a history of breast cancer, presenting for a routine scheduled appointment with their primary provider at a Federally Qualified Health Center were invited to participate in a study on women's views about breast cancer risk. Breast cancer risk factor data was collected from all participants and individualized risk assessments were performed using three models (NCI BCRAT, Claus model and a pedigree assessment tool). PCPs discussed the results of the assessment with their patients and provided computer-generated, risk-adapted recommendations for screening and prevention that are based on national guidelines. Using a mixed methods approach, we collected quantitative survey data from participants at baseline (prior to receipt of risk information), immediately following the encounter with their PCP and two weeks later. We also used qualitative approaches in a subgroup of participants from each of three risk strata (general population risk, moderately-increased and high risk) including audio-recorded observational data from physician-patient interactions and in-depth interviews with patients and physicians in order to evaluate how women process risk information and make decisions regarding how to act on that information. Data collected broadly focused on the following topics: Interpretation and initial reaction to the personalized risk information provided by the PCPWhat it means to be “at (baseline, moderate, high) risk”Views on value of/potential benefits and harms of personalized risk informationLevel of trust in the informationPreferences regarding recommended surveillance strategies and risk reduction strategies (for moderate and high risk groups)Preferences regarding shared decision makingFuture plans/action steps based on personalized risk informationPerceptions of the manner that personalized risk information was presented to them by their PCP

Results: We are planning to enroll 480 participants for the quantitative survey portion and 48 participants for in-depth qualitative data collection, including audio-recorded patient-physician interactions and in-depth patient interviews, along with 8 in-depth provider interviews. Data collection is ongoing and results will be presented.

Acknowledgement: This research was supported by a grant from the National Cancer Institute (2P50CA106743)

Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P5-13-03.

Pilot study of dietary fat restriction and flaxseed supplementation in men with prostate cancer before surgery: exploring the effects on hormonal levels, prostate-specific antigen, and histopathologic features

OBJECTIVES

Dietary fat and fiber affect hormonal levels and may influence cancer progression. Flaxseed is a rich source of lignan and omega-3 fatty acids and may thwart prostate cancer. The potential effects of flaxseed may be enhanced with concomitant fat restriction. We undertook a pilot study to explore whether a flaxseed-supplemented, fat-restricted diet could affect the biomarkers of prostatic neoplasia.

METHODS

Twenty-five patients with prostate cancer who were awaiting prostatectomy were instructed on a low-fat (20% of kilocalories or less), flaxseed-supplemented (30 g/day) diet. The baseline and follow-up levels of prostate-specific antigen, testosterone, free androgen index, and total serum cholesterol were determined. The tumors of diet-treated patients were compared with those of historic cases (matched by age, race, prostate-specific antigen level at diagnosis, and biopsy Gleason sum) with respect to apoptosis (terminal deoxynucleotidyl transferase [TdT]-mediated dUTP-biotin nick end-labeling [TUNEL]) and proliferation (MIB-1).

RESULTS

The average duration on the diet was 34 days (range 21 to 77), during which time significant decreases were observed in total serum cholesterol (201 +/- 39 mg/dL to 174 +/- 42 mg/dL), total testosterone (422 +/- 122 ng/dL to 360 +/- 128 ng/dL), and free androgen index (36.3% +/- 18.9% to 29.3% +/- 16.8%) (all P <0.05). The baseline and follow-up levels of prostate-specific antigen were 8.1 +/- 5.2 ng/mL and 8.5 +/- 7.7 ng/mL, respectively, for the entire sample (P = 0.58); however, among men with Gleason sums of 6 or less (n = 19), the PSA values were 7.1 +/- 3.9 ng/mL and 6.4 +/- 4.1 ng/mL (P = 0.10). The mean proliferation index was 7.4 +/- 7.8 for the historic controls versus 5.0 +/- 4.9 for the diet-treated patients (P = 0.05). The distribution of the apoptotic indexes differed significantly (P = 0.01) between groups, with most historic controls exhibiting TUNEL categorical scores of 0; diet-treated patients largely exhibited scores of 1. Both the proliferation rate and apoptosis were significantly associated with the number of days on the diet (P = 0.049 and P = 0.017, respectively).

CONCLUSIONS

These pilot data suggest that a flaxseed-supplemented, fat-restricted diet may affect prostate cancer biology and associated biomarkers. Further study is needed to determine the benefit of this dietary regimen as either a complementary or preventive therapy.

Assessing treatment progress of individual patients using expected treatment response models

The dosage model provides a normative estimate of the overall pattern of patient improvement in psychotherapy. The phase model further specifies patterns of change in the domains of subjective well-being, symptom remediation, and functioning. The expected treatment response (ETR) approach uses patient characteristics to predict an expected path of progress for each patient. With repeated measures of mental health status, the treatment progress of an individual patient can be assessed against the patient's ETR to support decisions that would enhance the quality of a clinical service while it is being delivered.

Issues surrounding record keeping in district nursing practice

This article examines some aspects of nursing documentation following the publication of the document 'Guidelines for Records and Record Keeping' (UKCC, 1998). The importance of nursing documentation in patient care, in guiding practice and in providing information for members of the interprofessional healthcare team is highlighted. Record keeping forms an important part of the clinical governance initiative in terms of quality improvement and risk management. The issues surrounding the legal requirements of record keeping in district nursing practice are discussed. Suggestions are made for assessing the quality of nursing documentation by audit and research, in order to establish the suitability of using the present systems in the community setting.

Loss of p53 in benzene-induced thymic lymphomas in p53+/- mice: evidence of chromosomal recombination

The purpose of this study was to examine the role of chromosomal recombination in mediating p53 loss in benzene-induced thymic lymphomas in C57BL/6-Trp53 haploinsufficient (N5) mice (p53+/- mice). We characterized loss of heterozygosity (LOH) on chromosome 11 using seven microsatellite markers in 27 benzene-induced and 6 spontaneous thymic lymphomas. Eleven patterns of LOH were found between the induced and spontaneous tumors, with only one pattern being in common between the tumor groups. Nearly 90% (24 of 27) of benzene-induced tumors exhibited loss of the functional p53 allele locus, and 83% (20 of 24) of these tumors retained two copies of the disrupted p53 allele. The results indicate that benzene induces a high frequency of LOH on chromosome 11 in p53+/- mice, likely mediated by aberrant chromosomal recombination.

Early onset baldness and prostate cancer risk

Prostatic carcinoma is the leading cancer among American men, yet few risk factors have been established. Although increased androgen levels have long been associated with both prostatic carcinoma and baldness, to date no studies have shown an association between hair patterning and prostate cancer risk. A lack of standardized instruments to assess baldness or the assessment of hair patterning during uninformative periods of time may have precluded the ability of previous studies to detect an association. We hypothesized that baldness, specifically vertex baldness, should be assessed using standardized instruments and during early adulthood if an association with prostate cancer risk is to be found. To test this hypothesis, we included identical items related to hair patterning in surveys that were administered in two distinct prostate cancer case-control studies (Duke-based study, n = 149; 78 cases; 71 controls and community-based study, n = 130; 56 cases; 74 controls). In each, participants were provided with an illustration of the Hamilton Scale of Baldness and asked to select the diagrams that best represented their hair patterning at age 30 and again at age 40. From these data, the following five categories were created and compared: not bald (referent group); vertex bald early onset (by age 30); vertex bald later onset (by age 40); frontal bald early onset (by age 30); frontal bald later onset (by age 40); and frontal (at age 30) to vertex bald (at age 40). Separate analyses of the two studies are consistent and suggest an association between vertex baldness and prostate cancer [vertex bald early onset odds ratios, 2.44 [confidence interval (CI), 0.57-10.46)] and 2.11 (CI, 0.66-6.73), respectively; vertex bald later onset odds ratios, 2.10 (CI, 0.63-7.00) and 1.37 (CI, 0.47-4.06), respectively]. Although statistical significance was not achieved in either one of these studies, the concordance between the data suggests a need for future studies to determine whether early onset vertex baldness serves as a novel biomarker for prostate cancer and whether androgen production, metabolism, or receptor status differs among these men when compared to those who exhibit other types of hair patterning.

Anthropometric risk factors for prostate cancer

Cancer of the prostate is the leading cancer among American men, yet few risk factors are known. Anthropometry may help uncover potential risk factors for prostate cancer, since fat distribution, skeletal structure, and musculature may differ between men with this hormonally linked cancer and those without it. A case-control study was undertaken to determine whether anthropometric differences exist between prostate cancer cases and controls and whether such differences are associated with specific hormonal profiles. The study accrued 315 men stratified for race, age, and case/control status. Weight, height (sitting/standing), skinfold thicknesses (triceps, biceps, subscapular, suprailiac, thigh), circumferences (midarm, waist, hip, thigh), breadths (elbow, biacromial, biiliac), hormonal levels (total and free testosterone, dihydrotestosterone, sex hormone-binding globulin), bone density, and body composition were measured. Measures of upper body robustness [i.e., biacromial breadth-to-height ratio (p = 0.02) and biacromial (p = 0.05) and bideltoid (p = 0.04) breadths] were greater among controls. Strong negative associations were found uniformly between sex hormone-binding globulin levels and measures of body adiposity and musculature. Data show that prostate cancer cases exhibit a propensity toward a slight upper body skeleton, which may in itself serve as a risk factor or provide a benchmark of past nutritional and/or hormonal status and help elucidate the etiology of this disease.

Vesical endometriosis: report of two cases and review of the literature

Endometriosis is a common gynecologic disease in which endometrial tissue is deposited outside the normal confines of the uterine cavity. In rare instances, endometriosis involves the urinary tract, with the bladder the most frequent organ affected. Classic presenting symptoms include cyclic irritative voiding symptoms and suprapubic discomfort with or without hematuria. Both medical and surgical management have been advocated, but surgical extirpation is probably more efficacious. Two cases of endometriosis involving the the bladder are presented and contrasted in terms of pathophysiology. Contemporary management of this condition is reviewed, and guidelines for diagnosis and treatment are proposed.

Pheochromocytoma of urinary bladder: contemporary methods of diagnosis and treatment options

Two patients with vesical pheochromocytoma are presented with a review of the literature. Imaging modalities for localizing extra-adrenal pheochromocytomas are reviewed with an overview of the commonly accepted treatment options. Successful treatment of this lesion requires a high index of suspicion based upon the patient's symptom complex, allowing preoperative preparation prior to surgical manipulation.

Sclerosing lipogranulomatosis: a case report of scrotal injection of automobile transmission fluid and literature review of subcutaneous injection of oils

For nearly a century, physicians and laypersons have attempted to repair, reconstruct, and embellish the human body in numerous ways by injecting various oils beneath the skin. Soon after Gersuny's first reported subcutaneous injection of oil, the local and systemic complications became apparent. Despite this, the practice of oil injections continues. "Medical grade" silicone injection was investigated in the 1960s to 1980s with varied success and complications. While few physicians practice oil injection therapy, some laypersons continue to subject themselves or their clients to the risk of the disfiguring complications of sclerosing lipogranulomata. Accidental high-pressure injection injury of liquids, so-called grease gun injuries, continues to provide a therapeutic challenge for the hand surgeon. Our case of a man who injected automobile transmission fluid into his scrotum illustrates the classical course and proper management of sclerosing lipogranulomata. A subcutaneous inflammatory and fibrosing reaction occurred with regional lymphadenopathy. The need for complete excision of all involved tissue to treat the condition successfully is illustrated. This case also illustrates the tendency of patients to conceal from their doctors the history of self-injection of foreign bodies. In cases of self-injection, psychological counseling might certainly be appropriate.

Squamous cell carcinoma of the prostate: 2 cases of a rare malignancy and review of the literature

Primary squamous cell carcinoma of the prostate is an extremely uncommon malignancy, accounting for less than 1% of all prostatic cancers. We report on 2 patients with primary squamous cell carcinoma of the prostate: 1 with organ-confined disease and 1 with metastatic disease. Both patients presented with urinary obstructive symptoms and carcinoma was not suspected on digital rectal examination. Serum acid phosphatase and prostate specific antigen levels were normal. From a review of the literature and our 2 cases it is apparent that squamous cell carcinoma of the prostate is biologically more aggressive than adenocarcinoma.

Successful management of bilateral xanthogranulomatous pyelonephritis by bilateral partial nephrectomy

Bilateral xanthogranulomatous pyelonephritis is a rare condition with 7 previously reported cases, all of which required dialysis and/or resulted in death of the patient. We report a case in which bilateral partial nephrectomy was performed successfully for bilateral xanthogranulomatous pyelonephritis. The etiology, symptomatology, radiographic findings and treatment of this rare inflammatory condition are discussed with a brief review of the previously reported cases.

Accuracy in staging of renal cell carcinoma involving vena cava

Accurate preoperative staging of renal cell carcinoma is necessary to determine patient prognosis and surgical approach, particularly when tumor thrombus invades the vena cava. The pathologically-confirmed tumor stage was compared with the radiographic preoperative stage in 44 patients undergoing surgery for renal cell carcinoma invading the vena cava (T3cNxMx). Nine patients (20%) were upstaged as the result of extracapsular tumor extension. Twelve patients (27%) were upstaged due to unrecognized regional lymphadenopathy, and 1 patient was downstaged. Only 1 patient was upstaged as the result of unrecognized metastases. The level of tumor thrombus extension for surgical approach was accurately determined in all but 2 patients. Overall, 15 patients (34%) were upstaged as a result of pathologic studies, 28 patients (64%) were correctly staged, and 1 patient was downstaged. Radiographic staging of extracapsular tumor extension and regional lymphadenopathy is unreliable, but current radiographic techniques delineate the level of thrombus extension for surgical approach with high accuracy.

Spinal epidural abscess as a complication of Fournier's gangrene

Fournier's gangrene is a rare, multi-organism infection of the perineum. The disease is most often confined to the groin area with distant spread being extremely unusual. A ase of spinal epidural abscess as a complication of Fournier's gangrene is presented. The infection appears to have spread by the hematogenous route. The patient had several symptoms, including fever, which could have provided an early diagnostic clue. Multiple fever workups were negative, however, and the diagnosis was not made until quadriplegia developed. A lumbar puncture as part of the fever workup might have allowed for an earlier diagnosis and more prompt surgery.

Surgical management and prognosis of renal cell carcinoma invading the vena cava

A total of 44 patients with renal cell carcinoma and vena caval tumor thrombus underwent surgical resection. Of these patients 27 had primary tumor confined within Gerota's fascia, negative lymph nodes and no distant metastases (stage T3cN0M0). Patients who underwent extraction of a mobile tumor thrombus from the vena cava had a 69% 5-year survival rate (median 9.9 years) but patients with tumor thrombus directly invading the vena cava had a 26% 5-year survival rate (median 1.2 years), which improved to 57% (median 5.3 years) if the involved vena caval side wall was resected successfully. Of these patients 17 had renal cell carcinoma with vena caval thrombus as well as extrafascial extension, regional lymphadenopathy or distant metastases, and the 5-year survival rate was less than 18% in all groups (median survival less than 0.9 years). Prognosis was determined by the pathological stage of the renal cell carcinoma and by the presence or absence of vena caval side wall invasion but not by the level of tumor thrombus extension. Patients with incomplete resection of localized renal cell carcinoma with tumor thrombus do not survive any longer than those with extensive cancer, positive lymph nodes or distant metastases. However, when partial venacavectomy establishes negative surgical margins then survival markedly improves.

Oximetry in children recovering from deep hypothermia for cardiac surgery

Although pulse oximetry is a potentially useful diagnostic tool in the treatment of children after major open heart surgery, there are concerns regarding its reliability for measuring oxygen saturation (SaO2) in hypothermic or low perfusion states. To test pulse oximeter reliability in children under these conditions, our study compared 187 SaO2 pulse oximeter readings (Biox 3700) with simultaneous hemoximeter (OSM2, Radiometer) readings from 56 children rewarming after open heart surgery. Ages ranged from 4 months to 18 yr; temperatures ranged from 23.5 degrees to 38 degrees C (toe) and 31.3 degrees to 40.8 degrees C (core). The mean pulse oximeter SaO2 reading was 94.90% (SD 7.18, range 54% to 100%), mean hemoximeter reading was 96.07% (SD 7.06; minimum 54%; maximum 100%). The correlation between the readings was high (r = .88, p less than .005), and was not affected by low core temperature. When oximeter and cardiac monitor pulse rates coincided, the oximeter SaO2 value was within +/- 5% (p less than .05). We conclude that the Biox 3700 oximeter is reliable for noninvasive SaO2 monitoring in mild to moderately hypothermic children after open heart surgery, particularly when oximeter and cardiac heart rates coincide. Further studies are needed to confirm our findings in children with core temperatures less than 31.3 degrees C, and when other oximeters are used.

Force analysis of a laser beam incident on a fluid jet

For the purposes of investigating the use of a small perturbation to control the break up of a fluid jet, an analysis was performed which describes the force incident on a fluid jet due to radiation pressure. Two cases were addressed; one which considers only reflection, as occurs when the fluid is opaque, and one in which reflection and a subsequent transmission are considered, as when the fluid is semitransparent. The results show that in both cases, for a well focused laser beam, a finite force can be obtained which is not critically influenced by the location of the laser beam with respect to the fluid jet.

The ability to convert the 4 S glucocorticoid receptor to the 7-8 S form is dependent on both RNA and protein factors

The DEAE-cellulose-purified 4 S form of the rat liver glucocorticoid receptor can associate with cytosolic factors, as evidenced by an alteration of the sedimentation value of the 7-8 S form. On the basis of sedimentation profile, this form is indistinguishable from the activated, low-salt 7-8 S form isolated from rat liver cytosol. In addition, both the endogenous and reconstituted 7-8 S receptor can bind DNA as the 7-8 S form. In keeping with our reports that the endogenous form of the 7-8 S receptor is sensitive to RNAase digestion, treatment of the cytosol with RNAase prior to mixing with the 4 S receptor prevents the formation of the 7-8 S material. Moreover, warming the cytosol to 50 degrees C prior to mixing with the 4 S receptor also eliminates the ability to form the heavier material. Since RNA is heat-stable, this suggests that other factors may be involved. Treatment of the cytosol with N-ethylmaleimide, a reagent reported to be specific for sulfhydryl groups, also eliminates 7-8 S generating ability. These observations suggest that a protein may be a component of the 7-8 S generating material. This is substantiated by the observation that trypsin or chymotrypsin treatment of the cytosol mitigates the ability of the cytosol to form the 7-8 S material and results in the appearance of a form of the receptor that sediments at approximately 6 S. Protease treatment of partially purified material eliminates the 7-8 S generating activity entirely. We conclude that the 7-8 S form of the receptor can be reconstituted from the 4 S receptor via association with at least two other cytosolic factors, a protein and an RNA.

Studies with chymotrypsin and RNAase showing a heterooligomeric structure of the glucocorticoid receptor complex from rat liver which is stabilized by a low molecular weight factor

The glucocorticoid receptor from rat liver displays a differential sensitivity toward digestion by chymotrypsin and RNAase A that is dependent on its activation state. Unactivated (9-10 S) receptor is not digested by these enzymes, while activated 7-8 S receptor is. Chymotrypsin treatment yields an approx. 3 S form, while RNAase treatment yields a 4.9 S form that is distinct from the high-salt 4 S form. To firmly establish that the results are due to specific hydrolytic activities of the particular enzymes, we show that the chymotrypsin effect is inhibited by diisopropylfluorophosphate and not RNAasin, while the reverse is true for RNAase A. We further show that the differential sensitivity toward chymotrypsin is due to the association of a proteinase-resistant, heat-stable low molecular weight factor with the unactivated glucocorticoid receptor. When this factor is removed by warming, dialysis or molecular sieving of the receptor complex, the complex becomes sensitive to chymotrypsin. We also show that moderate chymotrypsin treatment yields a 6-7 S form of the receptor which is composed of, at least, RNA and the 4 S receptor. On the basis of these results, we propose that the 9-10 S receptor is composed of a low molecular weight stabilizing factor whose presence apparently alters the conformation of the complex such that the RNA and the RNA-binding site of the receptor are protected, a chymotrypsin-sensitive factor, RNA and the 4 S receptor itself.

Stabilization of glucocorticoid receptor association with RNA by a low molecular weight factor from rat liver cytosol

A small (Mr less than 500) anionic, heat-stable molecule has been identified in rat liver cytosol which prevents the RNase-induced decrease in the glucocorticoid receptor sedimentation properties which we described previously. This factor, which can be removed by dialysis, molecular exclusion chromatography, or ultrafiltration, functions as a true stabilizer of the RNA-glucocorticoid receptor association, and not as a RNase inhibitor. Preliminary characterization shows that the factor is not a protein, nucleic acid, or nucleotide, is not absorbed by activated dextran-charcoal, and is unaffected by extraction with organic solvents. This factor prevents activation of the glucocorticoid receptor by dilution. The relationship of this stabilization factor to a low molecular weight activation inhibitor described by others is discussed.

Acute renal failure in pregnancy associated with solitary kidney, congenital ureteropelvic junction obstruction, and renal cortical cyst

We have described a patient with acute renal insufficiency during pregnancy related to unilateral renal agenesis and congenital obstruction of the ureteropelvic junction. Optimism for a good outcome in both the mother and fetus seems justified if therapeutic measures in such cases can maintain renal homeostasis.

Penile prosthesis in Peyronie's disease

Many patients with Peyronie's disease suffer severe penile curvature, impotence, and respond poorly to conservative management. Sixteen patients with intractable Peyronie's disease had surgical incision of Peyronie's plaque and insertion of semi-rigid or inflatable penile implants. Patients had satisfactory results with elimination of curvature and resumption of coitus. Surgical procedures are indicated for impotent patients with Peyronie's disease who are unresponsive to conservative treatment.

Long-term results with the Kaufman prosthesis

Patients with incontinence after prostatectomy were examined for long-term results following implantation of a Kaufman prosthesis. These appears to be a dichotomy between patients who underwent implantations of the device after radical procedures versus those who had been operated upon for benign disease. Patients undergoing implantation of the prosthesis after an operation for malignant disease experienced a higher rate of complications and a lower over-all continence rate. Also, patients who underwent implantation of the Kaufman prosthesis in conjunction with the Small-Carrion prosthesis showed a 100 per cent failure rate. It appears from the data that the Kaufman prosthesis is not the long sought panacea.

Methylphenidate compared with behavioral self-control in attention deficit disorder: preliminary report

The effects of methylphenidate and behavioral self-control training on sustained attention were compared in 12 boys aged 6-9 years. Subjects were of low-average intelligence and had academic and behavioral problems including distractibility, short attention span, and impulsiveness. Treatment conditions (baseline, placebo, methylphenidate, and behavioral self-control training) were assigned according to a single-subject randomized blocks design. Attention was measured by the Children's Checking Test (CCT). Methylphenidate improved performance on the CCT and was superior to the other treatment conditions. Several children benefited from behavioral training, but statistical analysis of this change was nonsignificant. These results are consistent with and extend those of previous studies.

Identification of ureteroileal obstruction by retrograde loopography

Retrograde loopography in 106 patients (212 renal units) with ileal conduit urinary diversion was assessed to define the accuracy of this study in identifying ureteroileal obstruction. In 171 renal units (81%), the radiographic findings demonstrated by retrograde loopography correlated appropriately with the findings on excretory urography. However, in 41 renal units (19%) with absent ileoureteral reflux, there was no evidence of ureteroileal obstruction by excretory urography. This potential disparity between excretory urography and retrograde loopography has limited our use of the latter study for selected patients in whom the excretory urogram demonstrates (1) evidence of progressive upper tract deterioration, (2) anastomotic obstruction, or (3) patients with chronic renal failure or iodide sensitivity in whom the intravenous administration of contrast material may be contraindicated.

The primary megacystis syndrome

We discuss 7 cases of the primary megacystis syndrome to demonstrate that the syndrome is non-obstructive and non-neurogenic, and probably of psychogenic origin owing to learned dysfunctional voiding. The major complication is vesicoureteral reflux and initial therapy is aimed at its correction. Prolonged followup and retraining of voiding habits are necessary. Specific pharmacologic or biofeedback techniques are indicated should urodynamic abnormalities of function be evident.

Staging pelvic lymphadenectomy for carcinoma of the prostate risk versus benefit

A total of 125 patients underwent limited staging lymphadenectomy for adenocarcinoma of the prostate. Of these patients 19 per cent with clinical stage B1 disease, 52 per cent with clinical stage B2 disease and 59 per cent with clinical stages C disease had positive nodes. There was 1 death secondary to myocardial infarction and postoperative complications occurred in 7.2 per cent of the 125 patients. Limited staging pelvic node dissection provides information regarding nodal dissection similar to that identified after more extensive dissection and it can be accomplished with little morbidity.

Bilateral adrenal neuroblastoma

Bilateral adrenal neuroblastoma is extremely rare, with isolated case reports considered to represent metastatic spread rather than simultaneous occurrence. This patient was found to have synchronous, separate, and equal size neoplasms that morphologically and ultrastructurally are neuroblastoma. We believe that these findings represent the unusual occurrence of simultaneous primary adrenal neuroblastoma reflecting multicentric origin of this neoplasm.

Simultaneous open prostatectomy and inguinal herniorrhaphy

We report our results in 18 patients who had simultaneous open prostatectomy and inguinal herniorrhaphy between 1969 and 1976, and present our criteria for patient selection, operative technic, and postoperative results. The incidence of postoperative wound infection and recurrent hernia was 5.6% and 0 respectively, which compares favorably to results of herniorrhaphy and prostatectomy performed separately. The historic development of this procedure and the results of previously reported series are reviewed.

Complications of Small-Carrion penile prosthesis

Seventy-six patients with impotence have undergone insertion of the Small-Carrion penile prosthesis at Duke University Medical Center. Twenty patients experienced postoperative complications. Seven of these 20 patients lost one or both prostheses either by spontaneous extrusion or surgical removal. Although success with this procedure is well documented, complications may be significant when they occur and awareness of these problems is essential for proper management. The benefits of this procedure are reviewed, and reported complications and their management are discussed.

Management of vesicoureteral reflux

The retrospective analysis of 210 patients between 1 month and 17 years old with 314 primary vesicoureteral units with reflux was reviewed. Our results show that there was a direct correlation between the grade of reflux and the per cent of abnormal ureteral orifices. Medical management of low grade reflux produced successful results in 60 per cent of the cases. Operation was highly successful in grade I, II, and III reflux as opposed to grade IV. The distal tunnel (Glenn-Anderson) and Politano-Leadbetter procedures were equally effective in curing reflux. Postoperative urinary infection occurred equally in all grades and usually was confined to the bladder.

Technical considerations in distal tunnel ureteral reimplantation

The advantages of a distal tunnel ureteral reimplantation have been elaborated upon previously. This method offers simplicity of transvesical explosure, rapidity of execution, excellent visibility of the terminal ureteral segments, minimal dissection and trauma in the paravesical space, the opportunity to advance the ureteral orifices to a physiologic position on the trigone and minimal risk of angulation, kinking or obstruction of the terminal ureter. It is now recognized that this method, with the modifications discussed herein, has wide applicability in the management of vesicoureteral reflux of all varieties and etiologies.

The status of cardiovascular health knowledge among sixth, seventh, and eighth grade children

The goals of this study were to develop and standardize a test of cardiovascular health knowledge to determine its status among primary school children, to ascertain the rate at which cardiovascular health knowledge increases as compared to other subject areas, and to demonstrate the feasibility of the use of standardized achievement tests for assessing the results of health education curricula. The Iowa Cardiovascular Health Knowledge Test (ICVHT) was developed and administered in conjunction with a standardized educational testing program, the Iowa Test of Basic Skills (ITBS), to a stratified sample of 2,675 Iowa Students from grades six, seven, and eight. The average student in the sixth, seventh and eighth grades answered 37.9 +/- 0.4, 41.2 +/- 0.3, and 43.7 +/- 0.4 (SEM) percent of the items correctly. ICVHT scores increased minimally (less than 1 item/grade) as grade levels increased, but at a 75% slower rate than scores in other subjects tested. The results document a deficiency in cardiovascular health knowledge and provide a model for use in educational assessment programs in other health disciplines.

Surgical validation of angiographic studies of renal lesions

We reviewed 428 renal arteriograms done during a 5-year period to document the accuracy of angiography in the diagnosis of renal mass lesions and non-function. Subsequently, 198 kidneys (46%) were explored for treatment and diagnostic confirmation. Of the kidneys explored 87 (44%) were radiologically diagnosed as benign cysts. At exploration 6 diagnostic errors were proved, including 3 malignant and 3 benign lesions. The falsely negative malignancy rate was 3% in this category. The angiographic diagnosis of definite tumor was proved to be 100% accurate at operation. However, 3 tumors were benign, representing an 8% falsely positive diagnosis for malignancy. Of the kidneys explored 8% were angiographically diagnosed as being indeterminate. A variety of lesions were found, including 1 benign tumor, 1 malignant tumor and 5 inflammatory lesions. Two malignant lesions were found when exploring angiographically defined hydronephrosis. The remaining kidneys explored carried various diagnoses and were all proved to be correct surgically. Operative mortality was 0.5% but 9 kidneys with benign lesions were sacrificed owing to diagnostic indecision.