[Urinary incontinence after radical prostatectomy]. / Harninkontinenz nach radikaler Prostatektomie.

Despite improved operative techniques the number of patients suffering from urinary incontinence after radical prostatectomy cannot be ignored. The recommended therapy after radical prostatectomy is initially to attempt conservative therapy during the first 6-12 months. If there is no improvement in the incontinence an operative procedure is recommended. An artificial sphincter which has been established over decades has good long-term results but is also beset by diverse problems. Recently diverse minimally invasive procedures have been introduced for therapy of male stress incontinence which are effective due to compression or have a functional therapeutic approach.

The terminology of skin disorders.

Accurate diagnosis of skin disorders is essential for primary care physicians; studies have shown that dermatologic diagnosis by primary care trainees and attending physicians could be improved. Careful attention to the history and a systematic approach to the physical examination are essential to our diagnostic skills. Thorough description of the history and physical findings are valuable for reference as the condition evolves and for communication when referral to a dermatologist is needed. This article reviews the lexicon of skin disorders, beginning with description of the component of skin affected, the primary lesion, the extent and distribution, the characteristics of the lesions, and secondary or special lesions. Careful description of skin color, moisture, turgor, texture, and temperature are emphasized, and definition of skin lesions follows.

Hormone replacement and breast cancer: implications of the Iowa Women's Health Study.

Amid conflicting reports about the link between hormone replacement therapy and breast cancer, the Iowa Women's Health Study gives grounds for cautious optimism. According to the study, women on hormone replacement therapy had a higher incidence of breast cancer, but the excess cancers were of a "favorable" histologic type. This paper discusses clinical decision-making in light of the study results.

Postoperative pulmonary complications: risk assessment, prevention, and treatment.

Patients with pre-existing pulmonary disease and certain other conditions are at increased risk of postoperative pulmonary complications. This article surveys how internists can identify high-risk patients clinically, use pulmonary function studies, use specific therapy to reduce risk, and manage postoperative complications.

Coagglutination for detection and serotyping of bacterial antigens: usefulness in acute pneumonias.

Staphylococcal coagglutination was evaluated for detection of Streptococcus pneumoniae and Haemophilus influenzae antigens in vitro and in the clinical setting of acute pneumonia. Coagglutination testing was performed with Phadebact reagents and with polyvalent and type-specific reagents for pneumococci prepared in the laboratory. Purified capsular antigens of 10 of 14 pneumococcal serotypes (included in the current pneumococcal vaccine formulation) were detected by coagglutination in the range of 0.5-62 ng/ml; serotype 6 was detected at 125 ng/ml, and serotypes 12, 23, and 25 were detected only at 500 ng/ml or more. Haemophilus influenzae type b antigen was detected at 100 ng/ml. Sputum, blood, and urine specimens of 36 consecutive patients admitted with pneumonia were evaluated prospectively by coagglutination. Nonspecific reactions were eliminated by pretreatment with ethylenediaminetetra-acetic acid and heating and with staphylococcal protein A. Eight of nine patients with sputum cultures positive for pneumococci had positive sputum coagglutination (sensitivity of 89%); 24 of 27 patients with cultures negative for pneumococci had negative sputum coagglutination (specificity of 89%). Serum or urine coagglutination was positive in five patients with pneumococcal pneumonia, including the only bacteremic case, the only fatality, and another patient who had a protracted clinical course. In conclusion, coagglutination is a simple, rapid, sensitive, and specific test for antigen detection in patients with acute pneumonia.

Rapid diagnosis of septic arthritis by coagglutination.

Pneumococcal capsular antigens were detected and serotyped by coagglutination in joint fluids and serum of a patient with septic arthritis within 1 h of obtaining the specimens. Pneumococcal antigens continued to be detected by coagglutination for 3 days, whereas cultures and Gram stains were negative after 1 day of antibiotic therapy.