Is Onabotulinum Toxin-A Combined Injection in the Bowel Patch and the Bladder Remnant a Safe Alternative to Bladder Re-Augmentation?

OBJECTIVE

To assess both the safety and efficacy, in terms of symptomatic improvement, of botulinum toxin injections distributed in the bowel patch and the bladder remnant of failed augmented bladders.

MATERIALS AND METHODS

A retrospective study was performed on patients with augmented bladders who had presented with clinical and/or urodynamic failure and had received an onabotulinum¹ toxin-A (BTX-A) injection at both the bowel and the bladder level due to refractoriness to oral treatment. The primary variable tested was safety, which was assessed by analysing the adverse effects according to the Clavien-Dindo classification. Subjective improvement was assessed by means of the Treatment Benefit Scale (TBS) as a secondary variable.

RESULTS

Eight patients who underwent a total of 23 procedures were analysed. The mean age at first injection was 23 years. The mean interval between bladder augmentation and first BTX-A injection was 65.11 months. The mean interval between BTX-A injections was 11.6 months. No adverse effects due to systemic absorption were recorded. The only postoperative complication was an afebrile urinary infection (Clavien-Dindo 2) in 2 out of 23 procedures (8.7%). Eighty-six percent (19/22) of the procedures yielded a symptomatic benefit (TBS 1 and 2).

CONCLUSION

Injection of onabotulinum toxin-A in both the bowel patch and the bladder remnant appears to be a safe and efficient technique for the symptomatic treatment of patients with bladder augmentation who have shown clinical and/or urodynamic failure in response to a conservative treatment. This procedure allows bladder re-augmentation to be delayed or even avoided.

Association between chronic lymphocytic thyroiditis and papillary thyroid carcinoma: A retrospective study in surgical specimens

INTRODUCTION

The hypothesis of an association between papillary thyroid carcinoma (PTC) and chronic lymphocytic thyroiditis (CLT) continues to generate debate. Retrospective studies suggest that there is a greater probability of diagnosing a PTC in surgical specimens with CLT; however, prospective studies suggest that there is no true increase in risk.

METHODS

An analytical, cross-section measurement and retrospective study was carried out considering gender, age and diagnosis of CLT and PTC in surgical specimens. A binary logistic regression model was proposed to predict the probability of carrying out the diagnosis of PTC based on the diagnosis of CLT, gender and age.

RESULTS

The study population consisted of 1136 patients, 1047 (92.2%) women and 89 (7.8%) men, with an average age of 47.5±14.3 years. The prevalence of CLT and PTC was 14.9% and 16.1% respectively. Coexistence between PTC and CLT was found in 44 patients, corresponding to 3.9% of the population. Our logistic regression model suggests that the probability of diagnosing PTC in surgical specimens of male patients under 40 years old and with CLT is 53.8%.

CONCLUSIONS

We suggest that there is a greater probability of diagnosing PTC in surgical specimens with confirmatory histological data for CLT; in addition, in males under 40 years old this probability increases.

Presence of heat shock protein in chronic periapical pathology of pulpal origin

In order to establish whether tissues damaged by Chronic Periapical Pathology (CPP) of endodontic origin produced heat shock protein (HSP) capable of attracting reactive lymphocytes, paraffin sections of samples from the oral cavity of 10 patients with CPP were incubated with commercially available anti-HSP monoclonal antibodies. Antibodies were evidenced employing the alkaline phosphatase immunoenzymatic method (DAKO). HSP was found in the lamina propria infiltrated by lymphocytes, in six of the ten samples. These results suggest that HSP may be one of the lymphocyte recruiting factors in the damaged area and opens new possibilities for further research.

Study on gutta-percha points using scanning electron microscopy and analysis with electron microprobe

A comparative study of the apical morphology and contour was performed with the scanning electron microscope at 45x, 70x and 300x, while the chemical composition of eight gutta-percha point brands was surveyed with an EDAX 9100 electron microprobe. They were classified according to their apical morphology as conical (25%) and truncate (75%), based on their contour as regular (50%) and irregular (50%) and according to their surface as without defects (50%) and with defects (50%). The analysis of inorganic compounds revealed the presence of varying proportions of Zn, Ba, Si, Mg. Ca, P, Cl and Al, possibly implying that the presence of Ba and Al could interfere with postendodontic repair or at least irritate the periapical area if inadvertently overfilled.

[Paget disease of the bone: differential diagnosis of osteolytic lesions. Report of one case]

We report a 48 years old female with Paget's disease of the bone who consulted for leg pain. After exhaustive examination a magnetic nuclear resonance revealed a 7 mm intradural schwannoma that was resected without improvement. Four years later, with generalized, progressive bone pains, several osteolytic rib lesions were detected. A bone scintigraphy showed extensive areas of hyperfixation of Tc99 DPM. Biochemical tests were normal with exception of very high serum alkaline phosphatases. Looking for some neoplastic disease, a breast nodule was detected by mammography. Biopsy demonstrated benign disease. Finally, a rib lesion biopsy disclosed diagnosis of Paget's disease of the bone. Treatment with calcitonin, etidronate and vitamin D resulted in partial clinical improvement, reduction of abnormal isotope hyperfixation in bone scintigraphy and of serum alkaline phosphatase levels.

The inhibitory effects on sexual behavior and ambulatory activity of the mixed GABAA/GABAB agonist progabide are differentially blocked by GABA receptor antagonists

Progabide inhibited male rat sexual behavior at a dose of 200 mg/kg. This dose had only modest effects on ambulatory activity and no effect at all on motor coordination as evaluated by a rotarod test. The GABAA antagonist bicuculline, at a dose of 1 mg/kg, blocked the effects of progabide on sex behavior. In contrast, the GABAB antagonist CGP 35348, at doses of 50 and 100 mg/kg, was ineffective. These doses have previously been shown to block the actions of baclofen on sexual behavior. It was concluded that the GABAA but not the GABAB receptor is important for the inhibitory effects of progabide on that behavior. The actions of progabide on ambulatory activity were not blocked by bicuculline or CGP 35348 at any of the doses used (up to 2 and 200 mg/kg, respectively). Even the combination of both antagonists was ineffective. This suggests that the motor effects of progabide are mediated by either a non-GABAergic receptor or by a subtype of the GABAA or the GABAB receptor that is not sensitive to the antagonists. Present results show that the effects of progabide on motor functions depend on mechanisms different from those involved in its effects on sexual behavior. They further suggest that the GABAA receptor may be important for drug actions on male sexual behavior.

Embolization of the mesenteric arteries: surgical treatment in twenty-three consecutive cases

Twenty-three patients with acute embolization of the superior mesenteric artery are presented. Twenty-one of them presented with sudden abdominal pain but no other remarkable physical findings. One had diffuse abdominal pain while one did not have any abdominal pain. Twenty-two patients underwent direct surgical revascularization and one patient refused operation. The total mortality in this series was 27%. Eighteen patients underwent revascularization without resection and 15 of them (83%) survived. Early diagnosis is the key to improved results in acute mesenteric ischemia. It relies on the aggressive utilization of arteriography to identify patients with superior mesenteric artery embolization before intestinal infarction takes place.