Vesico-urethral anastomosis (VUA) evaluation of short- and long-term outcome after robot-assisted laparoscopic radical prostatectomy (RARP): selective cystogram to improve outcome.

The role of a cystogram to assess the vesico-urethral anastomosis (VUA) after robot-assisted laparoscopic radical prostatectomy (RARP) has been debated. Early catheter removal without cystogram was reported to be associated with a trend towards an increased risk of acute urinary retention (AUR). In two cohorts we studied the effects of VUA leakage on cystogram and functional outcome after RARP. Cohort A contained 1390 consecutive men that routinely underwent a cystogram after RARP. Transurethral catheter (TUC) was removed in the absence of VUA leakage or minimal leakage on subsequent repeat cystogram. Outcome was compared to a group of 120 men that underwent cystography 7-10 days after RARP but had the TUC removed independent of cystography findings (cohort B). Outcome was assessed by early clinical follow-up and quality of life (QOL) questionnaires at 6 months. Men in cohort B had an increased risk of AUR and 6 months voiding complaints when compared to cohort A. The incidence of AUR and voiding complaints was associated with grade 2-3 leakage on cystography in cohort B but not in cohort A. Grade 2-3 leakage on cystogram was more likely in men with larger prostates larger and preoperative voiding complaints. Selective cystogram in men with larger prostates and preoperative lower urinary tract symptoms (LUTS) may prevent early AUR and voiding complaints after RARP when prolonged TUC use is applied.

[Schimke's immuno-osseous dysplasia as an explanation for the rare combination of disproportionately short stature and the nephrotic syndrome]. / Immuno-ossale dysplasie van Schimke als zeldzame oorzaak van de combinatie van kleine lichaamslengte en nefrotisch syndroom.

A 10-year-old Turkish boy with consanguineous parents was presented with a disproportionately short stature and a nephrotic syndrome. The mild form of Schimke's immuno-osseous dysplasia was diagnosed as the common cause. This rare, autosomal recessive osteochondrodysplasia is characterised by spondyloepiphyseal dysplasia, facial dysmorphism, T-cell immunodeficiency and progressive renal failure due to focal segmental glomerulosclerosis. In Schimke's immuno-osseous dysplasia, a severe early-onset form and a milder later-onset form can be distinguished on the basis of the clinical course. The patient was treated by fluid and salt restriction, enalapril and later also losartan, which led to a decrease in the proteinuria and an increase in serum albumin concentration. Two years later, the renal function was still normal.

Assessment of the microbiological safety of enteral feeds when used with a prolonged feeding time.

The microbiological risks of using a ready-to-use 1-litre enteral feeding system (Nutrison Steriflo) in a centre for burn patients were assessed. Such a system will have a relatively long hanging time (> 8 h). This could possibly lead to increased microbiological risks, because if the feed has been contaminated during use, microbes have a longer time available to multiply to high numbers. Multiplication will be relatively rapid due to the temperature conditions in the ward. A study was therefore carried out in which the microbiological quality of enteral formulae remaining in the bottle and giving set at the end of feeding burn patients (n = 5) was determined. From the 80 samples harvested from bottles and giving sets, microbiological analyses at all sampling points were performed in 54. It was shown that the microbiological quality of formulae in bottle and giving set remained good (colony count < 1 per ml), apart from in three exceptional cases. Fifty-one samples remained sterile throughout the feeding period. The results clearly show that the well-developed design of the system, combined with adherence to hygienic procedures by the nursing staff, make it possible to feed burn patients in a microbiologically safe way, even when a relatively long hanging time is used.

Effect of antihypertensive drugs on insulin absorption.

OBJECTIVE: To examine the effects of antihypertensive drugs on the absorption of subcutaneously injected insulin. RESEARCH DESIGN AND METHODS: Eleven healthy volunteers (group 1) were given 1 mg/kg body wt propranolol three times a day during 48 h and a single dose on the morning of investigation. Seven other healthy volunteers (group 2) were given 10 mg nifedipine 30 min before subcutaneous injection of 10 U 125I-labeled soluble insulin. Absorption was measured by counting radioactivity externally. In both groups, control experiments were conducted under the same conditions without administration of propranolol or nifedipine. RESULTS: Propranolol usage was associated with higher mean percentages of remaining activity (P less than 0.05 by analysis of variance [ANOVA]) than in the control experiment. In the nifedipine experiment, mean percentages were significantly lower compared with the control experiment (P less than 0.02 by ANOVA). The mean decline in activity of all 30-min periods was 6.8 +/- 3.5 vs. 3.6 +/- 3.7% for control versus propranolol (group 1) (P less than 0.05) and 6.3 +/- 1.8 vs. 9.6 +/- 3.2% for control versus nifedipine (group 2) (NS). CONCLUSIONS: Antihypertensive drugs can influence insulin absorption. Propranolol (a peripheral vasoconstrictor) decreases insulin absorption, whereas nifedipine (a vasodilatator) increases insulin absorption.