Chirped fiber Bragg grating detonation velocity sensing.

An all optical-fiber-based approach to measuring high explosive detonation front position and velocity is described. By measuring total light return using an incoherent light source reflected from a linearly chirped fiber Bragg grating sensor in contact with the explosive, dynamic mapping of the detonation front position and velocity versus time is obtained. We demonstrate two calibration procedures and provide several examples of detonation front measurements: PBX 9502 cylindrical rate stick, radial detonation front in PBX 9501, and PBX 9501 detonation along curved meridian line. In the cylindrical rate stick measurement, excellent agreement with complementary diagnostics (electrical pins and streak camera imaging) is achieved, demonstrating accuracy in the detonation front velocity to below the 0.3% level when compared to the results from the pin data. Finally, an estimate on the linear spatial and temporal resolution of the system shows that sub-mm and sub-µs levels are attainable with proper consideration of the recording speed, detection sensitivity, spectrum, and chirp properties of the grating.

Multidrug-resistant NDM-1 Klebsiella outbreak and infection control in endoscopic urology.

UNLABELLED: What's known on the subject? and What does the study add? Since the first case of multidrug-resistant New Delhi metallo-ß-lactamase (NDM-1) Klebsiella and Escherichia coli UTI in January 2008, there have been more reports of cases worldwide. Urology is a specialty uniquely vulnerable to these organisms because the NDM-1 carriers tend to be the common UTI-causing organisms. Further, the nature of the procedures involved in endoscopy in the urinary tract confers the potential for direct exposure and transmission of the organisms that commonly cause UTI. Although decontamination by sterilization of urological endoscopes and surgical instruments is well established in the operating theatre suite, there were no national standardized guidelines for infection control measures with respect to the video camera head in endoscopic urology in the UK. This paper reports the first UK outbreak of NDM-1 Klebsiella UTI, for which the common source of infection was rapidly traced to the endoscopic camera head in the urology theatre, where single-use sterile disposable plastic camera sheaths were not routinely used and the camera head was regularly cleaned with detergent wipes. We found that infection control practices vary across UK urology units. In the context of infection control, we highlight a need for standardized practice in the use of camera sheaths and in the decontamination process for endoscopic video camera heads. Either sterilization or use of single-use sterile disposable plastic camera sheaths with regular cleaning of the camera head using approved disinfectant for all endoscopy work is recommended. OBJECTIVES: • To report the first UK outbreak of NDM-1 Klebsiella, for which the common source of infection was rapidly traced to the endoscopic camera head in the urology theatre, where camera sheathing was not routinely used and the camera head was regularly cleaned with detergent wipes. • To survey the use of camera sheath and infection control practices in endoscopy in urology in the UK. PATIENTS AND METHODS: • A structured questionnaire was conducted via telephone interview with urological theatre sisters/charge nurses from all urological units across the UK. • Data on the use of camera sheath, cleaning practices, type of disinfectant used and choice of prophylactic antibiotics were obtained. RESULTS: • Out of 206 NHS urology units, 158 (77%) units across the UK were surveyed. Forty-one (25.9%) do not use camera sheaths, 16 (10.1%) were used dependent on the consultant's preference, and the remaining 101 (63.9%) routinely used camera sheath. • Twenty-one (13.3%) units clean the camera head only at the end of the operating list and the remainder clean after every case. • The choice of cleaning agent/disinfectant used varied considerably. They are broadly categorised as alcoholic wipes 90 (57%), detergent wipes 46 (29.1%) and soapy water 21 (13.3%). • The choice of prophylactic antibiotic includes gentamicin alone (96.3%), augmentin alone (1.4%), gentamicin/amoxicillin (0.7%) and cefuroxime alone (0.7%). CONCLUSIONS: • In the context of infection control, we highlight the need for a standardized practice in the use of camera sheaths and the process of decontamination of the endoscopic camera head. • Either sterilization or use of single-use sterile disposable plastic camera sheath with regular cleaning of the camera head using approved disinfectant for all endoscopy work is recommended.

Local anesthetic and steroidal prostatic injection for chronic pelvic pain syndrome: an effective last resort?

OBJECTIVE: the chronic pelvic pain syndrome is a severely debilitating and protracted condition for patients and a challenging condition for clinicians to treat. We report our experience with an adjunctive treatment in four patients using peri- and intra-prostatic injection of Levobupivicaine and Methylprednisolone combination via a transperineal approach under general anaesthesia. METHODS: a retrospective observational report. RESULTS: all patients had found little or no relief of their perineal/pelvic pain with the use of antimicrobials, alpha blockers, anti-inflammatories, anticholinergics, Elmiron or with TURP. In all cases, the use of prostatic injection treatment has resulted in a complete eradication of perineal pain and significant improvement to quality of life for at least a period of time. DISCUSSION: we suggest prostatic injection treatment as a last resort therapy in relieving pain. Our report provides a basis for a larger randomised controlled study with longer term follow-up to evaluate its efficacy and durability.

Radical exenteration surgery is curative in locally advance mucinous prostatic adenocarcinoma involving bladder and rectum.

The management of mucinous prostatic adenocarcinoma include hormonal treatment, radiotherapy and radical prostatectomy with variable long-term outcome. We report a 59 year old man with advanced mucinous prostatic adenocarcinoma involving almost the entire bladder and had failed treatment with hormonal and radiotherapy, but subsequently underwent radical pelvic exenteration surgery that resulted in long-term cure. He remains alive, his PSA remains undetectable and his surveillance CT scans did not show any evidence of recurrence after 11 years post-surgery. The favourable outcome of radical surgery suggests that radical surgery should be considered, especially in cases with failed initial treatments.