Effect of freeze-thawing on the long-term stability of calcium levofolinate in 5% dextrose stored on polyolefin infusion bags.

BACKGROUND: Calcium levofolinate infusions could be prepared in advance by a centralized intravenous additive service (CIVAS) to improve safety and time management. OBJECTIVE: To investigate the effect of freezing, microwave thawing and long-term storage at 5 +/- 3 degrees C on the stability of calcium levofolinate in 5% dextrose solution. METHODS: Solutions of 250 mL of 5% dextrose in polyolefin bags (n = 5) containing approximately 400 mg of calcium levofolinate were prepared under aseptic conditions and frozen for 95 days at -20 degrees C. The solutions were then thawed using microwaves and stored at 5 +/- 3 degrees C for 1 month. The calcium levofolinate concentrations were measured by high performance liquid chromatography (HPLC). Visual inspection was performed and pH was measured periodically during the storage at 5 +/- 3 degrees C. Stability of the solution was defined as a concentration remaining superior to 90% of the initial concentration by regression analysis as recommended by the Food and Drug Administration (FDA). RESULTS: No colour change or precipitation in the solutions was observed. Calcium levofolinate infusions were stable when stored at 5 +/- 3 degrees C during 1 month after freeze-thaw treatment. Throughout this period, the lower confidence limit of the estimated regression line of concentration-time profile remained above 90% of the initial concentration. Slight change in pH values from 6.52 +/- 0.01 to 6.50 +/- 0.01 during storage time did not affect retention time on HPLC and has no clinical consequence, the solutions remaining in the acceptable range for perfusion (4

High dose chemotherapy and autologous stem cell transplantation in patients with multiple myeloma: the experience of a single haematological unit.

PURPOSE: To study the toxicity of high dose chemotherapy (HDCT) in multiple myeloma (MM) patients and its impact on event free survival (EFS) and overall survival (OS), and also the impact of thalidomide maintenance therapy on EFS and OS after HDCT. PATIENTS AND METHODS: From April 1999 to November 2006 37 patients (29 males, 8 females) out of a total of 38 scheduled were treated with HDCT and autologous peripheral stem cell transplantation (APSCT), as consolidation treatment after first- or second-line chemotherapy. Their median age was 55 years (range 38-71). HDCT regimen used was melphalan 200 mg/m(2). Following HDCT thalidomide 100 mg/day was administered as maintenance therapy to 28 patients in a random fashion. RESULTS: All patients tolerated well HDCT and APSCT. There was no treatment-related mortality. The median time interval for neutrophil recovery (>500/mm(3)) was 10 days (range 8-20), while the median time interval for platelets to recover to >20.000/mm(3) was 14 days (range 9-32). Twenty (54%) patients achieved complete response (CR), 15 (40%) partial response (PR), and 2 (6%) stable disease (SD). Before receiving thalidomide as maintenance treatment 12 (42%) patients were in CR, while all the others, except one who had progressive disease (PD), were in PR. CR correlated with better EFS and probably OS. Thalidomide maintenance treatment correlated with better EFS. CONCLUSION: In our series of patients HDCT appears to be a totally feasible, safe and without treatment-related mortality procedure, even in patients older than 60 years of age. It has a major impact in terms of CR achievement, which seems to strongly correlate with a prolonged EFS and OS. The use of thalidomide as a maintenance therapy induces a greater EFS which could possibly yield an improved OS.

Too close for comfort: accidental burn following subcutaneous mastectomy and immediate implant reconstruction.

We report a case of an accidental burn from a self-applied heat pack following subcutaneous mastectomy and implant reconstruction. Such patients are at increased risk of accidental burns not only due to loss of protective sensation, but also because of the thinner, less vascular overlying skin. We have changed our practice so that all patients undergoing breast reconstructive surgery are warned postoperatively to protect the skin from externally applied heat sources.

Pyogenic granuloma - the quest for optimum treatment: audit of treatment of 408 cases.

Pyogenic granuloma is a common, acquired, benign vascular lesion of skin and mucous membranes which may occasionally present intravascularly or subcutaneously. Pyogenic granuloma occur in all age groups and although they may eventually regress, removal of unsightly, bleeding or uncomfortably positioned lesions is usually sought before this takes place. This is a retrospective study of 408 cases of pyogenic granuloma that were analysed by the Stoke Mandeville Histopathology laboratory between 1994 and 2004. This study was carried out to review the sex, age and anatomic distribution of the lesions and to assess the most successful form of treatment on the basis of recurrence risk and other measures such as aesthetic result, acceptability and appropriateness of the procedure with respect to the patient. There was a slight male preponderance especially among children. The exception to this was lesions on mucous membranes, which were more common in women. Head and neck was the most common anatomical location, in particular the cheek and intraoral locations. Fewest recurrences were noted following excision and direct closure although all techniques investigated showed an acceptably low recurrence rate. Whatever technique is used it must yield material for histopathological analysis to ensure the exclusion of differential diagnoses.

Excessive verumontanum hyperplasia causing infertility.

Retrograde ejaculation is an uncommon cause of infertility in otherwise healthy men. We hereby report a previously undescribed verumontanum hyperplasia as a cause of retrograde ejaculation in a 32-year-old male that was successfully treated by transurethral resection.

Pheochromocytoma of the urinary bladder presenting only with macroscopic hematuria.

Pheochromocytoma of the bladder is an unusual tumor that typically presents with hypertensive crises related to micturition. We describe a case of bladder pheochromocytoma in a 42-year-old female in which macroscopic hematuria was the only alarming symptom. The diagnostic and operative issues of this type of tumor are discussed, along with the challenging treatment option of transurethral resection. Diagnosis, treatment and follow-up trends of this rare tumor are reviewed.

A descriptive assessment of the production and cost efficiency of general hospitals in Greece.

This paper focuses on the assessment of alternative aspects of the efficiency of 98 out of 126 hospitals of the Greek national health system. The analysis is directly concerned with the degree of utilisation of resources and the production efficiency of the general hospitals selected. For the measurement of the indices of efficiency, the internationally known method of Data Envelopment Analysis (modified to the particular characteristics of the Greek NHS) was used. The efficiency of Greek hospitals was assessed utilising two alternative conceptual models: one focusing on production and the other on cost efficiency. The results, in both cases, indicated the scope for substantial efficiency improvements. The analysis has sought to discuss the policy implications resulting from the current efficiency status of the hospitals with reference to issues of resource re-allocation and optimal scale size.

Burch colposuspension versus stamey endoscopic bladder neck suspension: a urodynamic appraisal.

A total of 51 consecutive female patients with genuine stress incontinence who underwent a Burch or Stamey operation were clinically and urodynamically evaluated preoperatively at least 8 months postoperatively. Our study group consisted of 27 women who underwent the Burch colposuspension and 24 who had the Stamey endoscopic bladder neck suspension. The urodynamic parameters which were studied pre- and postoperatively were the maximum flow rate (Qmax), the residual urine (Vres), the first sensation (FS), the bladder capacity (BC), the maximum vesical pressure (Pves max), the detrusor pressure at maximum flow (Pdet/Qmax), the functional urethral length (Lfun) and the maximum closure pressure (Pclos max). The successful results of the operations were 89% for Burch and 83% for the Stamey procedure. As for differing objective urodynamic findings, the Qmax, Pclos max, Vres and Lfun for both groups were the only parameters which showed statistically significant difference after surgery. The statistical comparison of the postoperative urodynamic parameters of the two operative techniques showed that Lfun, Pves max and Pclos max had difference in favor of Burch colposuspension. There were not statistical differences in the other studied parameters. In conclusion, according to the differentiation in the values of Pclos max, Lfun and Pves max, the Burch technique seems to result in a higher increase of patient's urethral resistance.

Prognostic factors for the operative correction of stress urinary incontinence.

Investigating the reliability of using some clinical and laboratory parameters as long-term prognostic factors in properly selected patients for stress urinary surgery could help in the prediction of the long-term result in each case. Toward this goal 51 women were examined prospectively, after they were assessed by clinical and laboratory exams with particular emphasis on urodynamic studies. Out of this group, 41 patients had genuine stress incontinence, and 10 had mixed stress incontinence. Twenty-seven women underwent Burch colposuspension while 24 had Stamey endoscopic bladder neck suspension. In all patients clinical and urodynamic evaluation was done with the same methodology before the operation, and after one month and six months, respectively. The study indicated that 73% of the incontinent women were cured. According to the "analysis of variance" and "correlation analysis" methods the factors which were found to influence the operative result were as follows: (1) Clinical factors including preoperative urgency, U.T.I. and previous gynaecological operations. These factors had negative prognostic value, while the grade of incontinence did not influence at all the outcome of surgery. (2) Urodynamic factors including preoperative residual urine, immediate operative first sensation of micturition, maximum urine flow rate, pre- and immediate postoperative bladder capacity and functional length. These factors influence the operative result negatively or positively according to the deviation from the normal values. Furthermore, the important immediate postoperative change of the urodynamic values was found to determine the result of the operation.

Appendicovesical fistula.

In this study, a case of appendicovesical fistula is introduced, a really uncommon complication of acute appendicitis. This special case joins the other 102 cases which have already been described in the international literature. Due to the mild and ambiguous symptomatology, the diagnosis of this kind of fistula is difficult to be confirmed, although a serious suspicion of a vesicointestinal communication does exist. Exploratory laparotomy is usually diagnostic and leads to decisive therapy. A brief review of this clinical entity is also included.

Evaluation of urodynamic parameters following Burch colposuspension.

Burch colposuspension is a very popular operation for the correction of genuine stress incontinence, due to its very good long-term results. The effect of the operation on the urodynamic parameters at the level of the bladder neck evaluated in this study, and correlated with clinical outcome. A total of 29 female patients with urinary stress incontinence who underwent a Burch colposuspension were clinically and urodynamically studied pre- and postoperatively. The urodynamic parameters chosen pre- and post-operatively were: maximum flow rate, residual urine, first sensation, bladder capacity, maximum detrusor pressure, detrusor pressure at maximum flow, functional urethral length and maximum closure pressure. Complete cure was obtained in 76% of the patients and improvement in 14%, the overall success rate being 90% for a mean follow-up of 18.4 months (range 8-27). Comparison of the pre- and postoperative urodynamic data revealed that the maximum urine flow rate, functional urethral length, maximum urethral closure pressure and residual urine were changed significantly after the operation. There were no statistical differences in the other parameters. All the urodynamic results that improved, however, only arrived at the lower limits of the values accepted as standard for normal individuals. This fact, however, did not prevent a good clinical result.

Stamey endoscopic vesical neck suspension in female urinary stress incontinence: results and changes in various urodynamic parameters.

A total of 32 female patients with urinary stress incontinence who underwent a Stamey endoscopic bladder neck suspension were clinically and urodynamically studied pre- and postoperatively. Complete cure was obtained in 78% of the patients and improvement in 6%, the overall success rate being 84% for a mean follow-up of 11.1 months (range 6-19). Complications occurred in 22% of the patients. Comparison of the pre- and postoperative urodynamic data revealed that the maximum urine flow rate, functional urethral length and maximum urethral closure pressure were changed significantly after operation. In addition, when studying the abdominal pressure transmission to the entire urethra during stress, there was a significant conversion of negative to positive pressure transmission after surgical repositioning of the urethra.

Distal blind-ending branch of Y ureteral duplication under surgical treatment.

A case of distal blind-ending branch of bifid ureter in a woman is presented. The complications caused by this anomaly have driven us to surgery, which was the only successful treatment for this patient.

Intravesical bacillus Calmette-Guérin administration in the prophylaxis of superficial bladder cancer.

A total of 68 patients received prophylactic/adjuvant intravesical Pasteur strain bacillus Calmette-Guérin (BCG) instillations following transurethral resection for superficial bladder carcinoma. An induction phase consisting of 6 weekly instillations was followed by a maintenance phase consisting of 1 instillation given every 3 months. A second 6-week course of BCG was administered to initial failure followed again by a quarterly maintenance therapy. The response rate for patients treated with one 6-week course was 56%, while complete response was achieved in 72% when both treatment courses were considered. Follow-up period lasted at least 2 years after each course of BCG. These results suggest that additional courses of BCG increase the prophylactic efficacy of intracavitary BCG. Regarding the purified protein derivative (PPD) skin test and granulomatous response in the bladder, it has been shown in the present study that, although favourable results occurred more frequently among patients with either PPD conversion from negative to positive or vesical granuloma formation, neither of these indices should be considered reliable prognostic indicators.

Cross-activation of the Rex proteins of HTLV-I and BLV and of the Rev protein of HIV-1 and nonreciprocal interactions with their RNA responsive elements.

The Rex regulatory proteins of human T-cell leukemia virus type I (HTLV-I) and bovine leukemia virus (BLV), and the Rev protein of human immunodeficiency virus type 1 (HIV-1), promote the cytoplasmic accumulation and translation of viral messenger mRNAs encoding structural proteins. Rev and Rex act through cis-acting elements on the viral RNA; these elements are named Rev- and Rex-responsive elements, or RRE and RXRE, respectively. We show that the Rex proteins of HTLV-I and BLV are interchangeable, but only the Rex protein of HTLV-I can substitute for Rev of HIV-1. Rex of HTLV-I and Rev of HIV-1 appear to act on RRE by similar mechanisms. Rev of HIV-1 does not act on the RXRE of HTLV-I or BLV. The nonreciprocal action of Rev and Rex suggests that these factors interact directly with the cis-acting RNA elements of the two viruses.

The rev (trs/art) protein of human immunodeficiency virus type 1 affects viral mRNA and protein expression via a cis-acting sequence in the env region.

The study of expression of several human immunodeficiency virus type 1 proviral mutants in human cells in the presence or absence of rev (trs/art) protein reveals that rev increases the levels of unspliced and env mRNA and the accumulated structural viral proteins. rev protein produced from appropriate expression vectors fully complements the rev-defective mutants. rev requires the presence of a specific cis-acting sequence for its function. This rev-responsive element sequence has been localized within a 520 base-pair fragment in the env region of human immunodeficiency virus type 1. gag and env expression is coordinately regulated by rev. Two independent cis-acting elements localized in the gag and env regions are responsible for the low levels of gag and env mRNA in the absence of rev. These elements are different than the rev-responsive element and act independent of each other.