Cumulative summation (CUSUM) charts in the monitoring of hypospadias outcomes: a tool for quality improvement initiative.

OBJECTIVE: Cumulative summation (CUSUM) charting is a statistical tool that allows an individual surgeon or surgical department to monitor any binary outcome and rapidly detect when complications are outside the acceptable limits. We applied CUSUM statistical analysis to hypospadias repair to utilize the results in our own quality Improvement process. MATERIALS AND METHODS: An institutional review board-approved retrospective review of all patients who underwent hypospadias repair by a single fellowship trained pediatric urologist at a single institution between September 2004 to July 2009 was performed. To graphically represent the complication rates and to assess for unacceptable rates, the use of CUSUM control charting was employed. RESULTS: In our retrospective review, there were a total of 184 patients who underwent a total of 203 surgeries. Using CUSUM analysis, our incidence of major complications was within acceptable limits until approximately the first 150 operations had been performed, at which time the complication rate fell below the lower limit, indicating performance exceeded expectations. CONCLUSION: CUSUM statistical charting was successfully applied to the retrospective monitoring of hypospadias outcomes at our institution. This is the first known publication in which CUSUM charts were used to evaluate complications of hypospadias repair.

Precautions and complications in the use of the urolume wallstent.

The Urolume Wallstent was first used to treat urethral strictures in 1987. Its place in the treatment of urethral strictures is now well established and we have used it successfully in over 100 patients. Recent interest in alternative methods of treating benign prostatic hyperplasia (BPH) has led to the use of this and other stents in patients with symptomatic BPH who are a poor surgical risk. Over 270 patients have been treated by us with the Urolume Wallstent with satisfactory results. More recently we have also used this stent as an alternative to transurethral resection of the prostate in fat patients. Although the Urolume Wallstent is easy to use and clinically effective, complications can arise if proper care is not taken during its insertion. As the stent has become more widely used more problems and difficulties have been experienced. We discuss these and describe the precautions which should be taken in the use of this device in order to achieve the best results.

Renal adenocarcinoma in young adults.

Renal adenocarcinoma is rare in young people. The prognosis of the condition would appear to be better in young people justifying a radical treatment rationale even in cases of advanced disease. This report describes a series of patients under the age of 30 with renal adenocarcinoma and a review of the literature. The possible mechanisms for the apparent improved survival of patients in this age group is discussed.

New intra-ureteral stent for use during reconstructive surgery.

This paper describes a stent which has been specifically designed to facilitate the identification of the ureters during lower urinary tract reconstruction. It has semi-rigid limbs which allow easy ureteric identification and a soft central portion which lies across the trigone without traumatising the ureteric orifices.

Age-related decrease in omega conotoxin binding to rat cardiac synaptosomes.

A cardiac synaptosomal preparation developed by this laboratory was used to study neuronal calcium channels in aging rat heart. Ca2+ channels were quantified by measuring binding of iodinated omega conotoxin, which is reported to specifically block neuronal Ca2+ channels. We determined the binding of [125I]-omega conotoxin GVIA to a synaptosomal preparation from the hearts of 6- and 24-month-old male Fisher 344 rats. The maximum number of binding sites (Bmax +/- SD, fmol/mg protein) is lower in preparations from 24-month (2.2 +/- 0.6) than from 6-month (3.4 +/- 0.7)-old rats. This decrease in number of binding sites suggests an age-related reduction in the number of neuronal calcium channels. Since calcium is essential for exocytotic release of norepinephrine and is made available intracellularly through neuronal calcium channels, the reduction in neuronal calcium channel number may explain, in part, our previous observations of diminished release of norepinephrine in senescent hearts.

Neuroleptic malignant syndrome.

Neuroleptic malignant syndrome may occur in patients taking neuroleptics and other psychotropic drugs. The syndrome is characterized by hyperthermia, muscular rigidity, altered consciousness and autonomic instability. Cerebrospinal fluid examination is normal. Treatment includes intensive supportive measures and the use of dantrolene or bromocriptine, or both.