ABSTRACT
Urinary diversion following radical cystectomy and neoadjuvant chemotherapy is the gold standard for the management of muscle-invasive bladder cancer. Urinary diversions are at an increased risk of urolithiasis as a result of various factors. Traditional surgical intervention has included open cystolithotomy which has given way to minimally invasive techniques as of late. We describe a case of a robotic-assisted cystolithotomy from a neobladder in a 54-year-old female patient with muscle-invasive bladder cancer. This is the first description of a robotic-assisted removal of a stone in an orthotopic neobladder. This approach has many advantages, especially in the removal of larger stones. Further study is needed to investigate the efficacy and success of this approach.
ABSTRACT
In a review summary on page 450, Pasmans and others discuss the future of keeping reptiles and amphibians as pets. Here, Clifford Warwick and others discuss the animal welfare and public health implications of exotic pet business.
Subject(s)
Amphibians , Animal Welfare , Animals, Exotic , Public Health , Reptiles , Animals , Commerce , ForecastingABSTRACT
BACKGROUND: Late effects (LEs) after cancer treatment are increasing. After childhood cancer, substantial risks include physical, psychological and social LE and vary with age. Teenagers and young adults (TYA) present with particular cancers; their risk of LE may relate to cancer site, treatment or their age itself. The LEs after TYA-onset cancers are described in relation to age at diagnosis of primary tumour. PATIENTS AND METHODS: Data were extracted from Medline English language articles, 1999-2009. Keywords were late effect/s, late toxicity and survivor and the frequent TYA cancer sites. Only those articles that reported the relation between LEs risks with age at diagnosis were included. RESULTS: The majority of known LEs are described after TYA cancer. No study primarily aimed to relate TYA age to LEs. Many studies did not report LE by age. TYA-specific risks are seen in cardiac toxicity, second malignancies, pulmonary complications and psychosocial difficulties when compared with older or younger cancer survivors. CONCLUSIONS: TYA age brings specific LE risks after cancer. Prospective population-based collection of LE data after TYA cancer will inform the development of appropriate services to effectively manage LE.
Subject(s)
Neoplasms, Second Primary/epidemiology , Neoplasms/therapy , Survivors , Adolescent , Age Factors , Antineoplastic Agents/adverse effects , Cardiovascular Diseases/epidemiology , Cardiovascular Diseases/etiology , Humans , Infertility/etiology , Kidney Diseases/epidemiology , Kidney Diseases/etiology , Lung Diseases/epidemiology , Lung Diseases/etiology , Metabolic Diseases/epidemiology , Metabolic Diseases/etiology , Neoplasms/psychology , Neoplasms, Second Primary/etiology , Radiotherapy/adverse effects , Risk Factors , Survivors/psychology , Young AdultSubject(s)
Microcomputers , Prostheses and Implants/veterinary , Turtles , Animals , Equipment DesignSubject(s)
Animal Welfare , Computers , Prostheses and Implants/veterinary , Turtles , Animals , Conservation of Natural ResourcesABSTRACT
To assess the impact of a field-transmitted electrocardiogram (ECG) on patients with possible acute myocardial infarction, randomized and open trials were performed with a portable electrocardiographic system coupled with a cellular phone programmed to automatically transmit ECGs to the base hospital. Consecutive patients served by the 6 units of the Salt Lake City Emergency Rescue System were studied; 71 patients were randomized to in-field ECG (n = 34) versus no ECG (n = 37). Time on scene was 16.4 +/- 9.7 minutes for the ECG group versus 16.1 +/- 7.0 minutes for the non ECG group (difference not significant). Time of transport averaged 18.2 +/- 9.9 and 17.6 +/- 13.1 minutes, respectively (difference not significant). Six of 34 patients with in-field ECG showed acute myocardial infarction, qualified for and received thrombolytic therapy at 48 +/- 12 minutes after hospital arrival (range 30 to 60) compared with 103 +/- 44 minutes (p less than 0.01) for 51 historical control patients and 68 +/- 29 minutes for 6 concurrent control patients without in-field ECG. Thus, in-field ECG causes negligible delays in paramedic time, leads to significant decreases in time to in-hospital thrombolysis and may make in-field therapy feasible. In-field ECG may be an important addition to reperfusion strategies.
Subject(s)
Electrocardiography , Emergency Medical Services , Modems , Myocardial Infarction/drug therapy , Thrombolytic Therapy , Allied Health Personnel , Humans , Myocardial Infarction/diagnosis , Time FactorsABSTRACT
Microcolumns prepared in the authors' laboratory, two commercial microchromatography kits, and electrophoresis with elution were compared for Hb A2 quantitation. Day-to-day imprecision of microchromatographic methods was similar (CV 4.7--6.6%) and somewhat less than electrophoresis with elution (CV 8.0--9.1%). Both commercial kits showed variable imprecision in different lots; one lot of Kit B gave erratic results due to resin leakage. From 49 patient specimens, Kit A microcolumns and those of the authors identified the same 14 patients with an elevated percentage of Hb A2 and showed good correlation (P = 0.90), although Kit A showed constant bias toward higher values. Electrophoresis with elution resulted in a false-positive and a false-negative value, did not correlate well with microcolumns (P = 0.78 and 0.76), and showed proportional bias toward lower values for an elevated percentage of Hb A2. Commercial kits were convenient, relatively quick, and cost-effective. Frozen, stabilized hemolysates performed well for quality control.
Subject(s)
Blood Protein Electrophoresis , Chromatography, DEAE-Cellulose , Hemoglobin A2/analysis , Hemoglobin A/analysis , Costs and Cost Analysis , Time FactorsABSTRACT
Carriers of hemoglobin Providence have three types of beta chain in their hemolysates. The two abnormal chains have asparagine (Providence N, Prov N) or aspartic acid (Providence D) at position beta 82, instead of lysine. In vitro, only two beta chains are synthesized by reticulocytes of carriers, betaA and betaProv N. In vivo studies showed that the specific activity of Providence N was initially 10-fold higher than that of Providence D; the specific activities of the two labeled hemoglobins were approximately equal 5 wk after injection of isotope. Oxygen affinity of carriers' blood was somewhat increased, but they were not polycythemic. The affinity of the purified hemoglobins Providence was decreased. Addition of 2, 3 diphosphoglycerate had little effect on the affinity of either hemoglobin component, and addition of inositol hexaphosphate produced no change in the affinity of Providence D. These studies demonstrate that Providence N is deamidated to Providence D during the life span of the erythrocyte, and suggest this finding may represent only an easily observed prototype of posttranslational modification of proteins in general. Despite and abnormal P50 of the blood, oxygen transport is probably normal in carriers of the abnormal hemoglobins.
