[Estimation of the optimal tube length : Systematic review article on published formulae for infants and children]. / Abschätzung der optimalen Tubuslänge : Systematische Übersichtsarbeit zu publizierten Formeln bei Säuglingen und Kindern.

BACKGROUND: The correct placement of an endotracheal tube in children is essential as incorrect placement following unilateral ventilation and tube displacement may lead to far-reaching consequences, such as volutrauma and hypoxia, respectively. Different formulae referring to the correct placement of nasotracheal and orotracheal tubes have been published with reference to body weight and age. OBJECTIVE: The aim of the present review article was to identify and compare the published formulae for estimating correct endotracheal tube placement in children with their advantages and disadvantages. MATERIAL AND METHODS: A search in Medline and PubMed was performed to identify published formulae. Formulae for insertion depth in orotracheal and also nasotracheal intubation are discussed. The published formulae for newborns and infants are presented separately. The keywords "paediatric"/"pediatric", "anaesthesia"/"anesthesia", "anaesthesiology"/"anesthesiology", "endotracheal tube", "placement", "position", "length", "depth" and "insertion" were used to identify the formulae. RESULTS: A total of 806 publications were found, 16 publications were identified as being relevant and 13 different formulae were identified. In the age group from 1 to 16 years old a total of 7 formulae (6 age-based formulae and one based on weight) and for newborns and infants a total of 6 formulae (4 formulae based on body weight, 1 formula based on body length and 1 formula based on gestational age) were found. All publications were subsequently assessed and classified independently by a specialist physician in anesthesiology and a specialist physician in pediatrics. CONCLUSION: The published formulae were comparatively simply to apply but had notable limitations. Correlating the position of the endotracheal tubes with chest x-rays, the concordance analysis showed that for the age-based formulae using orotracheal as well as nasotracheal intubation and in both age groups, an accordance could only be achieved in a maximum of 81%. In the presence of a lack of alternative possibilities, only one formula based on the gestational age seemed to have an impact on estimation of correct endotracheal tube depth placement in newborns and infants. Therefore, a generally valid formula cannot be recommended without verification by auscultation or chest x-ray.

A study of human papillomavirus on vaginally inserted sex toys, before and after cleaning, among women who have sex with women and men.

OBJECTIVES: The objective of the study was to determine the potential of human papillomavirus (HPV) transmission via shared sex toys, and determine whether cleaning practices implemented by the study participants were effective. METHODS: Vibrator 1 was composed of thermoplastic elastomer. Vibrator 2 was composed of silicone. Twelve women, recruited from a university, used each vibrator on separate occasions and provided self-collected vaginal and vibrator samples (obtained from the vibrator shaft and handle), collected immediately after use, immediately after cleaning with a commercially available cleaner, and 24 h after cleaning. Vaginal and vibrator samples were assessed for HPV DNA by the Roche Linear Array HPV Genotyping Test. RESULTS: HPV was detected in the vaginal samples of 9/12 (75%) women. Vibrator 1 shaft swabs were HPV positive before cleaning in 89% (8/9), immediately after cleaning in 56% (5/9), and 24 h after cleaning in 40% (2/5) of those that were HPV positive immediately after cleaning. Vibrator 2 shaft swabs were HPV positive before cleaning in 67% (6/9), immediately after cleaning in 44% (4/9), and 24 h after cleaning in none. CONCLUSIONS: HPV was detected on at least one vibrator immediately after use in the women with vaginal HPV. This supports the potential for HPV transmission via shared sex toy use, and is additionally supported by continued detection of HPV up to 24 h after standard cleaning. The data add to understanding of the range of sexual behaviours associated with HPV transmission, and the need for evidence-based recommendations for sex toy cleaning.

USA study of sex toy use by HIV-positive men who have sex with other men: implications for sexual health.

HIV/AIDS disproportionately impacts men who have sex with men (MSM) in the USA. Most existing literature on MSM with HIV focuses on transmission risk, but does not acknowledge health-promoting sexual behaviours men may undertake. This study examined sex toy use within this population to describe the extent to which using toys is incorporated into their sexual repertoires as a risk reduction practice. Data regarding sociodemographics, sexual/health-related behaviours and sex toy use were collected from 2275 MSM using an online survey. Most participants reported being sexually active (88.5%), and the majority (70.2%) of participants reported sex toy use within the previous year. Sex toy users were more likely to be white, in sexual relationships with others, and reported higher levels of sexual satisfaction. Given that sex toy use is common among this population, room for discussion exists about sex toys as tools to enhance pleasure and reduce HIV/sexually transmitted infection (STI) transmission.

A novel A121T mutation in human cationic trypsinogen associated with hereditary pancreatitis: functional data indicating a loss-of-function mutation influencing the R122 trypsin cleavage site.

BACKGROUND: The understanding of genetic risk factors for chronic pancreatitis increased in the last decade with the discovery of mutations in the cationic trypsinogen gene (PRSS1). The first mutation was detected at the R122 autocleavage site of the protein (R122H) and subsequently two other mutations in this region, R122C and V123M, were described that resulted in a similar phenotype of hereditary pancreatitis. This study reports a novel A121T mutation within this region and characterises the resulting molecular properties at the autocleavage site. METHODS: Blood samples of a PRSS1 A121T carrier family were analysed for PRSS1 mutations using melting point curve analysis, restriction endonucleases and DNA sequencing. Conformation dependent properties of the mutated sequence were analysed by molecular modelling. The autodegradation kinetic of the mutated trypsin sequence was measured by a novel fluorescence resonance energy transfer (FRET) assay using designed 11 amino acid peptides from PRSS1 aa 118-aa 127 containing the trypsin cleavage site at aa 122 coupled to a Dabcyl/EDANS FRET system. The kinetic of tryptic peptide cleavage was measured in a fluorescence enzyme linked immunosorbent assay (ELISA) reader. RESULTS: DNA sequencing revealed a novel G to A transition at position 133279 of the published genomic sequence (#U66061 GenBank). The mutation results in an amino acid substitution of alanine by threonine at position 121 (A121T) of the cationic trypsinogen. Four additional mutation carriers could be identified among the relatives while only the first patient developed chronic pancreatitis. Molecular modelling of PRSS1 A121T revealed a change in the bond pattern between the R122 region and the calcium binding loop, whereas FRET assays showed an increased trypsin cleavage rate with a reaction kinetic elevated by more than 80%. CONCLUSION: The novel PRSS1 A121T mutation highlights the surface exposed region PRSS1 A121-R122-V123 as a hotspot for hereditary pancreatitis associated trypsinogen mutations. Molecular modelling and FRET assays provide evidence for an A121T mutation dependent increase in susceptibility to trypsin digestion at the R122 cleavage site suggesting an enhanced autodegradation and a loss-of-function at the autocleavage site.

[Clinical symptomatology and histopathological changes in Peyronie's disease: a comparative analysis]. / Induratio penis plastica: Vergleich der klinischen Symptomatik und der Plaque-Histopathologie.

PURPOSE: Our understanding of the etiology of Peyronie's disease (IPP) as well as the diagnostic and therapeutic approach is suboptimal. In order to improve this situation, we conducted a comparative retrospective analysis between the clinical symptoms of 50 patients with IPP and their histopathological results after radical plaque excision. PATIENTS AND METHODS: From 106 patients with IPP who consulted our clinic between 2002 and 2004, fifty were selected after clinical examination (sonography, Doppler sonography, DICC cavernosometry, X-ray) for surgery. The median age was 57.2 years. The plaque material was examined qualitatively and semi-quantitatively. Perivascular infiltrations and the type of the cells have been investigated immunhistochemically, and the structure of collagen was analysed by polarisation microscopy. RESULTS: In all 50 plaques, the tunica albuginea was fibrotic. In 41 cases the corpora cavernosa were infiltrated too. In 22 patients, the cavernosogram revealed venous leakage from the penile shaft. 32 plaques showed inflammatory infiltrations, 21 pathological vessels and 16 osseous metaplasia. In 13 plaques the fibrosis was stable and areactive. Mostly patients with metaplastic plaques or atypical vessels suffered from pain and erectile dysfunction. The results 6 months after plaque resection were best in painless patients who had that were plaques well marked off from the surrounding tissue (n = 13). Patients with aggressive fibroses of the corpora cavernosa (n = 5) and venous leakages from the penile shaft (n = 10) showed the worst results. CONCLUSION: A preoperative biopsy of IPP plaques could improve the quality of therapeutic decision. Painless patients with well marked and detectable plaques are suitable candidates for surgery. An operation is not the first-line option for patients with aggressive fibroses, venous leakages and painful indurations with fuzzy demarkation.

Mutational and expression analysis of CDK1, cyclinA2 and cyclinB1 in epilepsy-associated glioneuronal lesions.

Gangliogliomas and focal cortical dysplasias (FCDs) constitute glioneuronal lesions, which are frequently encountered in biopsy specimens of patients with pharmacoresistant focal epilepsy and relate to impaired differentiation and migration of neural precursors. However, their molecular pathogenesis and relationship are still largely enigmatic. Recent data suggest several components of the insulin-pathway, including TSC1 and TSC2 mutated in tuberous sclerosis complex (TSC), to be altered in gangliogliomas and FCD with Taylor type balloon cells (FCD(IIb)). The proteins tuberin (TSC2) and hamartin (TSC1) constitute a tumour suppressor mechanism involved in cell-cycle control. Hamartin and/or tuberin were reported to colocalize and/or interact with CDK1, cyclinB1 and cyclinA2 that are critically involved in cell-size and cell-growth control. Here, we have carried out mutational and expression analyses of CDK1, cyclinB1 and cyclinA2 in gangliogliomas and FCD(IIb). Mutational screening was performed by single-strand conformation polymorphism analysis in gangliogliomas (n = 20), FCD(IIb) (n = 35) and controls. CyclinB1 revealed a polymorphism (G to A, cDNA Position 966, GenBank: NM_031966) in exon 7 with similar frequencies in FCD(IIb), gangliogliomas and control specimens (FCD n = 9/35; gangliogliomas n = 5/20; control n = 20/100). We used real-time reverse transcription polymerase chain reaction to determine expression levels of CDK1, cyclinB1 and cyclinA2 in 10 FCD(IIb) and nine gangliogliomas compared with unaffected adjacent control tissue of the same patients. We observed significantly lower expression of CDK1 and cyclinA2 in FCD(IIb) vs. controls whereas no significant expression differences were present for CDK1, cyclinB1 and cyclinA2 in gangliogliomas. Our data strongly argue against mutational events of CDK1, cyclinB1 and cyclinA2 to play a role in gangliogliomas or FCD(IIb). However, a potential functional significance of lower expression for the cell-size and cell-cycle regulators CDK1 and cyclinA2 in FCD(IIb) composed of large dysplastic neurones and balloon cells needs to be further resolved.

[Sealing of percutaneous nephrolithotomy access after complete stone removal with a hemostyptic gelatin powder (Spongostan)]. / Die Verklebung des perkutanen Arbeitskanales nach kompletter Steinsanierung mit einem Gelatine-Matrix-Hämostypticum (Spongostan).

PURPOSES: Parallel to the pilot project of Lee et al. which was published in February 2004, we also considered the possibility to seal the percutaneous nephrolithotomy (PCNL) access after complete stone removal via the local amplatz sheath. We started our project with the aims of increasing postoperative patient comfort, minimizing the risk of bleeding, and reducing postoperative cost and length of the hospital stay by performing this minimally invasive technique in 7 patients with medium stone burden. MATERIALS AND METHODS: All patients were treated by removing stones via a working channel passing through the lower pole calix. After complete stone removal a hemostyptic gelatin powder (Spongostan, Johnson & Johnson) was prepared to a doughy paste, some drops of contrast medium were added and the whole material was introduced through the amplatz sheath into the working channel under imaging control. Imaging-controlled insertion of the doughy gelatin clot through the amplatz sheath into the parenchymal part of the channel alone resulted in immediate hemostasis in all patients. The amplatz sheath was retracted over a 28 Fr. rectal tube which was used to push the gelatin forward. There was no need for an additional tamponade of the renal fat capsule or the abdominal wall. After 2 minutes when no channel bleeding was apparent, the skin sutures were placed. RESULTS: Bleeding of the nephrostomy tract did not occur in any of the 7 patients. Average operating time was 50 minutes which was not significantly reduced by performing the new procedure. However, the hospital stay was reduced by 2 days. Two of the patients showed a single fever episode during the second postoperative evening. All patients presented with steady postoperative laboratory values without evidence of bleeding. Free urinary flow from the collecting system was controlled by means of ultrasound and urography. CONCLUSIONS: Similar to the recent usage of FloSeal/Baxter reported by Lee et al. we can confirm very reliable and immediate hemostasis using a pasty preparation of Spongostan (Johnson and Johnson) gelatin powder which was classified as being less toxic by the FDA in 2003 due to the lack of glutaraldehyde and bovine thrombin. Therefore, tubeless PCNL can be used for complete percutaneous clearance of stones without bleeding.

[Implantation of the AMS 800 artificial sphincter system in a woman via a paraurethral access]. / Implantation des artifiziellen Sphinktersystems AMS 800 bei der Frau über einen paraurethralen Zugang.

The procedure described demonstrates the feasibility of reliable implantation of an artificial sphincter system in female patients via a paraurethral access between the urethral orifice and the clitoris following radical cystectomy with continent, orthotopic urinary diversion and postoperatively developed urinary stress-incontinence. The technique presented avoids the more invasive transperitoneal or transvaginal approaches which jeopardize the neobladder-neck and increase the risk for infections or fistulas.

[Acute heart arrest during urologic routine interventions in 2 cases. Interdisciplinary crisis management assures tumor-free survival despite fulminant lung embolism with acute heart arrest during thoraco-abdominal tumor nephrectomy and radical cystoprostatovesiculectomy]. / Akuter Herzstillstand während urologischer Routineeingriffe in 2 Fällen. Interdisziplinäres Krisenmanagement sichert tumorfreies Uberleben trotz fulminanter Lungenembolie mit akutem Herzstillstand während einer thorakoabdominalen Tumornephrektomie und einer radikalen Zystoprostatovesikulektomie.

Intraoperative pulmonary embolism with acute cardiac arrest can successfully be managed by immediate open cardiac massage followed by rt-PA injection, an inter-disciplinary approach is mandatory. The scheduled tumor nephrectomy was performed 6 weeks after the initial event. The tumor was embolised with intravascular coils placed in a supraselective manner by the radiologist. During the secondary procedure it was found to be necrotic. In the second case the event occurred at the end of a radical cystectomy. Instead of an ileal conduit cutaneous ureterostomies were used for urinary drainage after cardiac output had been restored and rt-PA had been administered.