Ureteric stent versus percutaneous nephrostomy for acute ureteral obstruction - clinical outcome and quality of life: a bi-center prospective study.

BACKGROUND: To compare quality of life (QoL) indices between ureteral stent (DJS) and nephrostomy tube (PCN) inserted in the setting of acute ureteral obstruction. METHODS: Prospective bi-centered study. Over the span of 2 years, 45 DJS and 30 PCN patients were recruited. Quality of life was assessed by 2 questionnaires, EuroQol EQ-5D and 'Tube symptoms' questionnaire, at 2 time points (at discharge after drainage and before definitive treatment). RESULTS: Patients' demographics and pre-drainage data were similar. There were no clinically significant differences in patient's recovery between the groups, including post procedural pain, defeverence, returning to baseline renal function, and septic shock complications. More DJS patients presented to the emergency room with complaints related to their procedure compared to PCN patients. At first, DJS patients complained more of urinary discomfort while PCN patients had worse symptoms relating to mobility and personal hygiene, with both groups achieving similar overall QoL score. At second time point, PCN patients' symptoms ameliorated while symptoms in the DJS group remained similar, translating to higher overall QoL score in the PCN group. CONCLUSIONS: The two techniques had a distinct and significantly different impact on quality of life. Over time, PCN patients' symptoms relieve and their QoL improve, while DJS patients' symptoms persist. Specific tube related symptoms, and their dynamics over time, should be a major determinant in choosing the appropriate drainage method, especially when definitive treatment is not imminent.

Reconsidering the connection between vitamin D levels and age-related macular degeneration.

PURPOSE: Recent evidence has suggested a correlation between reduced vitamin D levels and delayed angiogenesis and reduced inflammatory response, which are known to have a major role in the development and progression of age-related macular degeneration (AMD). DESIGN: Cross-sectional study. PARTICIPANTS: Members of the Maccabi Healthcare Services (MHS, one of the four largest Israeli Health Maintenance Organization) aged ≥60 years, whose vitamin D levels were taken as part of routine examinations between 2000 and 2008. METHODS: All data for this study were obtained from MHS databases that include medical information on 1.8 million subscribers. MAIN OUTCOME MEASURES: Serum 25-OH vitamin D levels. RESULTS: The total study population comprised of 1045 members diagnosed as having AMD, and 8124 as non-AMD, for whom there was information on vitamin D levels. The mean±SD level of 25-OH vitamin D was 24.1±9.41 ng/ml (range 0.8-120) for the AMD patients and 24.13±9.50 ng/ml (range 0.0-120) for the controls (P=ns). One-third (33.6%) of the AMD patients and 32.86% of the controls had a 25-OH vitamin D level <16 ng/ml, and the proportions of tests in which the 25-OH vitamin D level was >74 ng/ml were 0.19 and 0.14%, respectively (P=ns). CONCLUSIONS: No association was detected between vitamin D levels and the presence of AMD in this cross-sectional study. These results raise some doubt about an association between reduced vitamin D levels and the prevalence of AMD.

Characteristics and clinical significance of bacterial colonization of ureteral double-J stents in children.

OBJECTIVE: To determine the frequency, type of pathogen and clinical significance of bacterial colonization of double-J stents after pyeloplasty in children. PATIENTS AND METHODS: The medical files of 82 consecutive children (22 girls, 60 boys) who underwent pyeloplasty at a tertiary pediatric medical center in 2000-2007 were reviewed. Additional inclusion criteria were sterile urine preoperatively and placement of an indwelling double-J stent during surgery. Intravenous gentamicin was administered prior to pyeloplasty and stent removal; cephalexin was administered postoperatively until discharge. Children with a postoperative urinary tract infection (UTI) received full-dose antimicrobial treatment followed by prophylaxis until stent removal. RESULTS: Median patient age at surgery was 11 months (1 month-17.5 years). Forty-nine stents were inserted on the left side, 32 on the right, and one bilaterally. Cultures showed bacterial colonization in 58 cases (70.7%); 15 (25.8%) grew Staphylococcus (coagulase negative and positive). Eight children had febrile UTI postoperatively; in four the stent was colonized by Enterococci and in one by Proteus; three were sterile. There was no statistically significant association between positive stent culture and febrile UTI, patient age or sex, or stent laterality. The study was potentially limited by its observational design, small sample size, and the selective antibiotic treatment of patients with UTI which may have affected stent bacterial resistance. CONCLUSION: Bacterial colonization is not uncommon in double-J stents retained for several weeks after pyeloplasty, but is usually not clinically significant. Enterococcus is the most frequent pathogen.

First Report of the Parasitic Plant Orobanche aegyptiaca Infecting Olive.

Broomrapes (Orobanche spp.) are obligatory parasitic plants that infect the root system of vegetables and field crops worldwide resulting in severe damage. Five broomrape species are known as significant parasites of crops in Israel: O. aegyptiaca Pers., O. cernua Loefl., O. cumana Wallr., O. crenata Forssk., and O. ramose L. (1,2). Recently, O. aegyptiaca was found to parasitize roots of young olive trees (Olea europaea) in a 1-year-old plantation located in Esdraelon Valley, Israel (voucher specimens deposited in Newe-Ya'ar Weed Herbarium, Ramat Yishay, Israel). To our knowledge, this is the first time that a tree in general and olive in particular has been reported to serve as host for O. aegyptiaca. Washing the root system clearly verified connections between the parasite and olive roots. Cross sections of an attachment site confirmed the development of functional haustoria. Trees were planted in a field where tomatoes had been previously parasitized by O. aegyptiaca for several years. In April 2001, many O. aegyptiaca plants emerged under each olive tree in a total area of 0.3 ha. Additional emergence of O. aegyptiaca was observed until July 2001. The high level of Orobanche infection did not lead to visible damage in the trees. However, the mature parasite developed massive amounts of seeds, serving to increase the population of O. aegyptiaca in the field. References: (1) D. M. Joel and H. Eizenberg. Three Orobanche species newly found on crops in Israel. Phytoparasitica 30:187, 2002. (2) C. Parker and C. R. Riches. Parasitic Weeds of the World. CAB International, Wallingford, UK, 1993.