Feasibility of outpatient daycase local anaesthestic Rezum™ without sedation.

BACKGROUND: Rezum™ is a relatively new bladder outflow obstruction (BOO) procedure that uses thermal energy through water vapour to cause necrosis of prostatic tissue. The standard delivery of this treatment is in an operating theatre under a general or spinal anaesthetic, or under local anaesthetic with sedation that requires patient monitoring. METHODS: We propose an outpatient daycase method of delivering Rezum™ under local anaesthetic without sedation, using a prostatic local anaesthetic block and cold local anaesthetic gel instillation into the urethra. RESULTS: Preliminary results of our first thirteen patients demonstrate the feasibility of this new technique, with a mean pain score of 2.1 out of 10 on a visual analogue scale, a successful trial without catheter in all 13 patients (one patient voided successfully on second trial), a reduction in mean International Prostate Symptom Score (IPSS) from 20.6 to 5.4, and improvement in maximum flow from 8.8 ml/s to 14.4 ml/s. The complications were minor (Clavien-Dindo less than III) and included a UTI, minor bleeding not requiring admission, and retrograde ejaculation. CONCLUSIONS: We demonstrate that an outpatient local anaesthetic daycase service without sedation is feasible. This can be delivered in a clinic setting, reduce waiting times for BOO surgery, and increase availability of operating theatre for other general anaesthetic urological procedures.

Suprascapular nerve injury during robot-assisted radical prostatectomy: a case report.

This case report aims to encourage teams to readjust the operating table during prolonged robotic cases, especially in those patients with a high body mass index. We present the case of a 59-year-old male who developed neuropathic pain involving the suprascapular nerve distribution following a prolonged robotic-assisted radical prostatectomy.

Dimensões da patela relacionadas à massa corporal do cão para emprego na confecção de prótese: estudo em cadáver / Patellar dimensions related to canine body mass for use in the manufacture of prosthesis: cadaver study

O objetivo deste trabalho foi mensurar as dimensões da patela de cadáveres caninos e avaliar sua relação com a massa corporal. Para a realização das medidas patelares, foram utilizados 70 cadáveres de cães adultos, com massa corpórea de 1 a 50kg, sem evidência clínica de afecção na articulação femorotibiopatelar. Com auxílio de um paquímetro, foram mensurados os comprimentos externo e interno, a largura externa no terço médio, a largura e a espessura internas nos terços proximal, médio e distal das patelas. Também foram mensuradas a largura nos terços proximal, médio e distal, a profundidade nos terços proximal, médio e distal do sulco troclear; essas medidas foram exclusivamente internas. Observou-se, de forma geral, forte correlação entre as medidas patelares e a massa corporal de cadáveres de cães. Nas condições deste estudo, pode-se concluir que o tamanho da patela varia segundo a massa corporal do cão e que essas medidas devem ser consideradas ao se planejar uma substituição protética.(AU)

The aim of this study was to measure the canine cadaver patellar dimensions and evaluate its relationship with body mass. 70 cadavers of adult dogs were used, with a body mass between 1 and 50kg, without clinical evidence of affection in the stifle joint. The external and internal lengths, external width in the middle third, width and thickness of the proximal, middle and distal thirds were measured using a pachymeter. The width was also measured in the proximal third, middle third and distal third, depth in the proximal third, middle third and distal third of the trochlear groove; these measurements were exclusively internal. A strong correlation was observed between the patellar dimension and body mass of canine cadavers. Under this study conditions, it is possible to conclude that the patellar size varies according to the canine body mass and these measures should be considered when planning a prosthetic replacement.(AU)

Obsessive-compulsive disorder in the elderly: A report from the International College of Obsessive-Compulsive Spectrum Disorders (ICOCS).

INTRODUCTION: Obsessive-compulsive disorder (OCD) is a highly disabling condition, with frequent early onset. Adult/adolescent OCD has been extensively investigated, but little is known about prevalence and clinical characterization of geriatric patients with OCD (G-OCD≥65years). The present study aimed to assess prevalence of G-OCD and associated socio-demographic and clinical correlates in a large international sample. METHODS: Data from 416 outpatients, participating in the ICOCS network, were assessed and categorized into 2 groups, age

New IR imaging modalities for cancer detection and for intra-cell chemical mapping with a sub-diffraction mid-IR s-SNOM.

We present two new modalities for generating chemical maps. Both are mid-IR based and aimed at the biomedical community, but they differ substantially in their technological readiness. The first, so-called "Digistain", is a technologically mature "locked down" way of acquiring diffraction-limited chemical images of human cancer biopsy tissue. Although it is less flexible than conventional methods of acquiring IR images, this is an intentional, and key, design feature. It allows it to be used, on a routine basis, by clinical personnel themselves. It is in the process of a full clinical evaluation and the philosophy behind the approach is discussed. The second modality is a very new, probe-based "s-SNOM", which we are developing in conjunction with a new family of tunable "Quantum Cascade Laser" (QCL) diode lasers. Although in its infancy, this instrument can already deliver ultra-detailed chemical images whose spatial resolutions beat the normal diffraction limit by a factor of ∼1000. This is easily enough to generate chemical maps of the insides of single cells for the first time, and a range of new possible scientific applications are explored.

Effect of exercise training on Ca2+ release units of left ventricular myocytes of spontaneously hypertensive rats

In cardiomyocytes, calcium (Ca2+) release units comprise clusters of intracellular Ca2+ release channels located on the sarcoplasmic reticulum, and hypertension is well established as a cause of defects in calcium release unit function. Our objective was to determine whether endurance exercise training could attenuate the deleterious effects of hypertension on calcium release unit components and Ca2+ sparks in left ventricular myocytes of spontaneously hypertensive rats. Male Wistar and spontaneously hypertensive rats (4 months of age) were divided into 4 groups: normotensive (NC) and hypertensive control (HC), and normotensive (NT) and hypertensive trained (HT) animals (7 rats per group). NC and HC rats were submitted to a low-intensity treadmill running protocol (5 days/week, 1 h/day, 0% grade, and 50-60% of maximal running speed) for 8 weeks. Gene expression of the ryanodine receptor type 2 (RyR2) and FK506 binding protein (FKBP12.6) increased (270%) and decreased (88%), respectively, in HC compared to NC rats. Endurance exercise training reversed these changes by reducing RyR2 (230%) and normalizing FKBP12.6 gene expression (112%). Hypertension also increased the frequency of Ca2+ sparks (HC=7.61±0.26 vs NC=4.79±0.19 per 100 µm/s) and decreased its amplitude (HC=0.260±0.08 vs NC=0.324±0.10 ΔF/F0), full width at half-maximum amplitude (HC=1.05±0.08 vs NC=1.26±0.01 µm), total duration (HC=11.51±0.12 vs NC=14.97±0.24 ms), time to peak (HC=4.84±0.06 vs NC=6.31±0.14 ms), and time constant of decay (HC=8.68±0.12 vs NC=10.21±0.22 ms). These changes were partially reversed in HT rats (frequency of Ca2+ sparks=6.26±0.19 µm/s, amplitude=0.282±0.10 ΔF/F0, full width at half-maximum amplitude=1.14±0.01 µm, total duration=13.34±0.17 ms, time to peak=5.43±0.08 ms, and time constant of decay=9.43±0.15 ms). Endurance exercise training attenuated the deleterious effects of hypertension on calcium release units of left ventricular myocytes.

Effect of exercise training on Ca²âº release units of left ventricular myocytes of spontaneously hypertensive rats.

In cardiomyocytes, calcium (Ca²âº) release units comprise clusters of intracellular Ca²âº release channels located on the sarcoplasmic reticulum, and hypertension is well established as a cause of defects in calcium release unit function. Our objective was to determine whether endurance exercise training could attenuate the deleterious effects of hypertension on calcium release unit components and Ca²âº sparks in left ventricular myocytes of spontaneously hypertensive rats. Male Wistar and spontaneously hypertensive rats (4 months of age) were divided into 4 groups: normotensive (NC) and hypertensive control (HC), and normotensive (NT) and hypertensive trained (HT) animals (7 rats per group). NC and HC rats were submitted to a low-intensity treadmill running protocol (5 days/week, 1 h/day, 0% grade, and 50-60% of maximal running speed) for 8 weeks. Gene expression of the ryanodine receptor type 2 (RyR2) and FK506 binding protein (FKBP12.6) increased (270%) and decreased (88%), respectively, in HC compared to NC rats. Endurance exercise training reversed these changes by reducing RyR2 (230%) and normalizing FKBP12.6 gene expression (112%). Hypertension also increased the frequency of Ca²âº sparks (HC=7.61 ± 0.26 vs NC=4.79 ± 0.19 per 100 µm/s) and decreased its amplitude (HC=0.260 ± 0.08 vs NC=0.324 ± 0.10 ΔF/F0), full width at half-maximum amplitude (HC=1.05 ± 0.08 vs NC=1.26 ± 0.01 µm), total duration (HC=11.51 ± 0.12 vs NC=14.97 ± 0.24 ms), time to peak (HC=4.84 ± 0.06 vs NC=6.31 ± 0.14 ms), and time constant of decay (HC=8.68 ± 0.12 vs NC=10.21 ± 0.22 ms). These changes were partially reversed in HT rats (frequency of Ca²âº sparks=6.26 ± 0.19 µm/s, amplitude=0.282 ± 0.10 ΔF/F0, full width at half-maximum amplitude=1.14 ± 0.01 µm, total duration=13.34 ± 0.17 ms, time to peak=5.43 ± 0.08 ms, and time constant of decay=9.43 ± 0.15 ms). Endurance exercise training attenuated the deleterious effects of hypertension on calcium release units of left ventricular myocytes.

Treatment choice for agoraphobic women: exposure or cognitive-behaviour therapy?

OBJECTIVES: The paper describes a treatment trial where exposure was compared with cognitive-behaviour therapy in the treatment of 39 female participants with a diagnosis of agoraphobia (DSM-111-R). The primary objective of the study was to see if cognitive therapy enhanced the effectiveness of exposure in the treatment of agoraphobia. DESIGN: Participants were randomly assigned to either exposure or cognitive-behaviour therapy. The two treatment groups were balanced for severity and duration of agoraphobia, presence of panic disorder, and age. METHODS: The exposure and the cognitive-behaviour therapy groups received the same amount of therapist-assisted exposure to feared situations but the participants in the cognitive-behaviour therapy group were, additionally, taught to identify and challenge negative automatic thoughts and dysfunctional assumptions. In the cognitive-behaviour therapy condition exposure was presented as an opportunity to identify and challenge negative thoughts. In the exposure condition, participants were given a behavioural rationale for doing exposure. Participants were seen individually for 10 sessions. Assessments were carried out before and after the treatment programme and, also, six months later. Assessments included self-reports of fear and avoidance, a behavioural test and questionnaire measures of relevant cognitions. Thirteen participants dropped out of treatment leaving 14 in the exposure condition and 12 in the cognitive-behaviour condition. Therapy sessions were taped and a sample of tapes was given to a judge who rated the quality of the cognitive-behaviour therapy. RESULTS: Substantial improvement was seen on virtually all measures irrespective of treatment condition both at the end of treatment and six months later. The cognitive-behaviour therapy group and the exposure group did not differ significantly at post-treatment or at six-month follow-up.

Stressor-induced alterations of the splenic plaque-forming cell response: strain differences and modification by propranolol.

The effects of stressor application on the splenic plaque-forming cell (PFC) response was assessed in two strains of mice: the BALB/cByJ strain, which is highly responsive to stressors; and the more hardy DBA/2J strain. Both strains exhibited a peak PFC response 120 h following administration of sheep red blood cells (SRBC; 5 x 106 cells). Stressor exposure reduced the immune response; however, the appearance of such an outcome was dependent upon the time at which the stressor was applied relative to SRBC inoculation. In DBA/2J mice, foot-shock applied either immediately after SRBC inoculation or at the time of the peak immune response (120 h) resulted in suppression of the PFC response. In BALB/cByJ mice, both stressor severities provoked an immunosuppression when applied 120 h after inoculation, but when applied 96 h after immunization only foot-shock reduced the PFC response. At other intervals, the stressors were without effect. Pretreatment with the beta-norepinephrine antagonist propranolol precluded the immunosuppression elicited by a stressor applied 96 h after inoculation, but did not affect the reduction of the PFC response elicited by a stressor applied 120 h after inoculation. It is suggested that several factors may contribute to stressor-provoked alterations of the immune response, and that the contribution of these factors vary over the course of an immune response being mounted.

Religion, ethnicity and obsessive-compulsive disorder.

Obsessive-compulsive disorder (OCD) is seen in many contrasting cultures but it is not known if the form of the disorder varies between these cultures. There have been anecdotal case reports where religion appeared to play a significant aetiological role in the disorder but the relationship between religion and OCD has not previously been systematically studied. This study was a retrospective, casenote study comparing the country of birth and religious affiliation of three groups of 50 patients. Its aim was to investigate the aetiological role played by religion in the development of OCD. The groups were patients with OCD from a specialist behavioural-cognitive unit, patients assessed in a specialist psycho-dynamic psychotherapy department and patients attending a general adult psychiatry outpatient department. More patients with OCD affiliated themselves with a religion as opposed to either of the other two groups. This difference disappeared when the type of religion was taken into account so that no conclusive relationship between OCD and religion could be identified. The findings do not diminish the importance of religion in the development of OCD in some individuals and suggest that future research in this area should include examination of the rigidity of upbringing and personal perception of the experience of strict rules or imposed religious practices.

The treatment of severe, chronic, resistant obsessive-compulsive disorder. An evaluation of an in-patient programme using behavioural psychotherapy in combination with other treatments.

This study examined 49 in-patients with obsessive-compulsive disorder who were treated over three years. The patients had failed to respond to previous treatment. Treatment consisted of in-patient exposure, occasionally combined with other interventions individually tailored to the patient's specific difficulties. This resulted in significant clinical improvements and an average 40% reduction in rituals in 31 (63.3%) of these chronic patients. These gains were maintained at an average 19-month follow-up. Checking rituals were more likely to be associated with good outcome. Women had a later onset of the disorder and a slight tendency to better prognosis. No other predictors of outcome were found.

Behavioural approaches to anxiety disorders.

Powerful behavioural treatments for many patients with anxiety disorders have been widely available since the 1970s. Despite this, the majority of such patients have continued to be treated with psychotrophic drugs. Recent litigation against the manufacturers of benzodiazepine drugs has made the public increasingly concerned about the prescription of anxiolytic agents. In parallel with the fall in popularity of drug treatment, advances have been made which increase the availability and applicability of behavioural treatments for these patients. This paper examines the impact of the development of self-exposure and cognitive methods on a number of common anxiety syndromes. Clinical examples of self-exposure are given to demonstrate the simplicity of the technique.

The metabolism of 1,6-dinitropyrene in rat hepatocytes.

This paper reports investigations using hepatocytes to study the metabolism and DNA binding of the environmental contaminant, 1,6-dinitropyrene. Since 1,6-dinitropyrene is not believed to be mutagenic per se, metabolites were synthesized and the metabolism of 1,6-dinitropyrene was subsequently studied in rat hepatocytes. The mode of activation of dinitropyrenes is reduction of one of the nitro groups. Nitroreduction has been shown previously to be oxygen sensitive and therefore the effect of oxygen on the metabolic pattern and DNA binding was investigated by comparing results from aerobic and anaerobic conditions. The binding of [14C]1,6-dinitropyrene equivalents to rat hepatocyte DNA was increased by 15% in the presence of oxygen. Although there was little difference in the rate of 1,6-dinitropyrene metabolism, with or without O2, there was a difference in the metabolic pattern. Under anaerobic conditions there was an increase in the level of the terminal reduction product 1-amino-6-nitropyrene.

Hysterical conversion and dissociation arising as a complication of behavioural psychotherapy treatment of obsessive-compulsive neurosis.

The case history of a patient with obsessive-compulsive disorder who developed hysterical conversion and dissociative symptoms during exposure treatment is described. The theoretical implications of this finding are discussed.

The stereoselectivity of 1,2-phenylethanediol and mandelic acid metabolism and disposition in the rat.

1. The steps involved in determining the chirality of the mandelic acid excreted by rats after administration of ethylbenzene and styrene were investigated by studying the fate of racemic, (R)- and (s)1,2-phenylethanediol, a precursor of mandelic acid. These investigations indicate the occurrence of two alternative routes of metabolism for 1,2-phenylethanediol, one involving retention of configuration and the other resulting in the loss of the chiral centre. 2. The stereoselectivity of the disposition of mandelic acid was investigated; rats were dosed with mandelic acid either as the racemate or as the individual enantiomers, G.1.c.-mass spectrometry and h.p.l.c. were used to determine the enantiomers of mandelic acid. 3. There were at least two routes by which mandelic acid could be metabolized and/or excreted; there is a stereoselective pathway in rat for (s)-mandelic acid, which gives rise to phenylglyoxylic acid. 4. The chiral inversion of (s)-mandelic acid to (R)-mandelic acid is reported; although this has been observed in bacteria it has not previously been observed in mammals. 5. The extent to which mandelic acid is metabolized to phenylglyoxylic acid is dependent on the enantiomeric composition of the mandelic acid administered. There is no evidence to indicate significant ketone-alcohol conversion, that is phenylglyoxylic acid is not significantly reduced to mandelic acid in vivo.

Acne excoriée--a case report of treatment using habit reversal.

Acne excoriée is a self-inflicted skin condition in which the sufferer has an urge to pick real or imagined acnieform lesions and which results in a worsening and spreading of the acne. The condition differs from most artefactual dermatoses as the patient usually spontaneously admits the self-inflicted nature of the condition. Although this condition is considered to be a neurotic manifestation of the patient, traditional psychiatric treatments have proved unsuccessful.