Investigation of phthalate release from tracheal tubes.

Phthalates are chemicals used extensively in the manufacture of plastics for their desirable physical characteristics. In addition to enhancing the performance of plastics, phthalates have a number of undesirable effects, principally endocrine disruptor effects, that may have adverse effects on reproductive development and functioning. As a result, they have been banned from the manufacture of children's toys. Despite this, they continue to be used in the manufacture of medical devices, including anaesthetic equipment. This study aimed to assess phthalate release from five brands of tracheal tube. Using gas chromatography-mass spectrometry, we analysed phthalate concentrations from samples of ultra pure water in which tracheal tubes had been submerged. Phthalate concentration increased from 6.7 to 149 µg.l(-1) over a period of 4.8 days. Phthalate release from anaesthetic equipment has not previously been documented over short time periods and raises the possibility of iatrogenic endocrine disruption with routine anaesthesia.

Understanding federal medical device statutes and their application to various penile prostheses.

Medical devices have become an important component of our professional armamentarium. This paper exposes the practitioner to the Food and Drug Administration and its control over medical devices. Specifically, the 1976 amendment to the Food and Drug Administration Acts is described, along with the subsequent federal laws. Because of all the new technology available, physicians should be aware of the applicable laws and regulations. In addition, a review of the penile prosthesis includes its history and evolution, as well as the entire product line available for use. Attention is directed to the problems that have arisen from malfunctioning components.

Long-term experience utilizing a new balloon expandable prostatic endoprosthesis: the Titan stent. North American Titan Stent Study Group.

OBJECTIVES: To determine the long-term safety and efficacy of the Titan endoprosthesis as a therapeutic alternative in the management of men with bladder outlet obstruction. METHODS: One hundred forty-four patients (mean age, 73.5 years +/- 4.2) had placement of the Titan stent. The stents were inserted under direct vision and expanded to 33 F using a balloon catheter. Of the 144 patients, 59 (41%) were in urinary retention and 85 (59%) presented with moderate to severe symptoms of prostatism. Patients were assessed at baseline and in follow-up at 1, 3, 6, 12, 18, and 24 months. Parameters of evaluation included the Madsen-Iversen symptom questionnaire, peak flow rate (Qmax), postvoid residual urine volume (PVR), and incidence of adverse events. RESULTS: At 24 months, for the retention cohort, symptoms, Qmax, and PVR were 5.21 +/- 0.81, 11.34 +/- 1.12 mL/s, and 31.00 +/- 12.8 mL, respectively (P < 0.002). For patients with symptoms of bladder outlet obstruction, the results were as follows at 24 months: (1) symptoms decreased from 15.89 +/- 0.47 to 9.33 +/- 0.86 (P < 0.001); (2) Qmax increased from 8.59 +/- 0.41 mL/s to 11.43 +/- 1.12 mL/s (P < 0.001); and (3) PVR decreased from 116.94 +/- 19.95 mL to 74.4 +/- 36.2 mL (P < 0.03). There were minimal complications; stents were removed from 28 patients (19%) because of migration, 10 of which were placed by one investigator. CONCLUSIONS: When properly placed, the Titan stent was an effective therapeutic alternative to prostatectomy or long-term catheterization in high-risk obstructed patients or those in urinary retention.

Lesch-Nyhan syndrome.

Three cases of severe involvement of the kidney with calculi in patients with the Lesch-Nyhan syndrome are presented. Two patients have radiolucent uric acid calculi. The biochemistry and pathology of the Lesch-Nyhan syndrome is discussed. Mechanisms in one family is traced over five generations. Although this syndrome is rare, the possibility of its existence must be entertained in patients with retardation and arthritis.

Too bad for you, Humpty Dumpty.

PIP: The average age of men who have vasovasostomies (reversal of vasectomies) is 36, with the average interval from vasectomy to vasovasostomy being 7.6 years. The postvasovasostomy semen analysis shows uniform results in that the count is usually on the lower side (30 million), the motility is markedly reduced, and the morphology is abnormal in at least 50%. The quality of semen is usually sufficient to effect conception. A technically good result can produce a high sperm count, with good motility and morphology, but be functionally unsuccessful in that no pregnancy occurs. National statistics (U. S.) suggest a 75% successful sperm count, with a 40-60% rate of conception. The author's method of vasovasostomy is described. The operation usually takes about 2 hours. After a mid-line scrotal incision, each vas has its scar dissected out and the proximal and distal vas are isolated. Care should be taken not to strip the blood supply of the vas so as to not necrose it. Usually a creamy effluent comes from the proximal vas, which has dead and disintegrating sperm. 3.5x magnifying loupes and 8-0 opthalmic black braided silk are used. 2 sutures are taken 180 degrees apart directly through the muscularis and the lumen to exactly approximate both proximal and distal lumens. At least 6 more 8-0 sutures are taken circumferentially through the muscularis of the vas. No intralumental splints are used. The skin is then closed with 1 subcuticular suture of 4-0 dexon. It may take 5 months to a year for the patient's sperm count to enable him to impregnate his partner.^ieng

Allergic prostatosis.

The first case of prostatic eosinophilic infiltration treated with antihistaminic therapy is reported. Histological specimens before and after treatment are included.

Lower-esophageal webs.

A case of a true lower-esophageal web is reported. The web was not visualized on radiological examination, but was visualized and removed by endoscopy. The purpose of this report is to point out that true lower-esophageal webs are different from lower-esophageal rings. Lower-esophageal webs occur much less frequently than lower-esophageal rings but must be included in the differential diagnosis of dysphagia.