Patient education with or without manual therapy compared to a control group in patients with osteoarthritis of the hip. A proof-of-principle three-arm parallel group randomized clinical trial.

OBJECTIVE: To investigate the effectiveness of a patient education (PE) program with or without the added effect of manual therapy (MT) compared to a minimal control intervention (MCI). METHODS: In a single-center university hospital setting, a total of 118 patients with clinical and radiographic unilateral hip osteoarthritis (OA) from primary care were randomized into one of three groups: PE, PE plus MT or MCI. The PE was taught by a physiotherapist involving five sessions. The MT was delivered by a chiropractor involving 12 sessions and the MCI included a home stretching program. Primary outcome was self-reported pain severity on an 11-box numeric rating scale (NRS) immediately following a 6-week intervention period. Patients were followed for 1 year. RESULTS: Primary analysis included 111 patients (94%). In the combined group (PE + MT), a clinically relevant reduction in pain severity compared to the MCI of 1.90 points (95% confidence interval (CI) 0.9-2.9) was achieved. Effect size (Cohen's d) for the PE + MT minus the MCI was 0.92 (95% CI 0.41-1.42). Number needed to treat for PE + MT was 3 (95% CI 2-7). No difference was found between the PE and MCI groups, with mean difference 0.0 (95% CI -1.0 to 1.0). At 12 months, not including patients receiving hip surgery the statistically significant difference favoring PE + MT was maintained. CONCLUSIONS: For primary care patients with OA of the hip, a combined intervention of MT and PE was more effective than a MCI. PE alone was not superior to the MCI. TRIAL REGISTRATION: clinicaltrials.govNCT01039337.

Laparoscopy for the impalpable testes: experience with 80 intra-abdominal testes.

OBJECTIVE: To evaluate two-stage laparoscopic Fowler-Stephens (FS) orchidopexy for intra-abdominal testes. MATERIALS AND METHODS: A retrospective analysis was performed of the clinical findings, interventions and outcomes in 111 boys undergoing laparoscopy for 132 impalpable testes. RESULTS: The median age was 5.7 years (1.1-14.6 years). Twenty-seven testes were absent. Eighty testes were intra-abdominal, of which 10 were removed laparoscopically due to anatomical anomalies (4), short spermatic cord (5) or atresia (1). Twenty-five testes were located in the groin. Laparoscopic FS procedure was performed for 65 intra-abdominal testes: 60 two-stage operations and five where the testes were removed during FS second stage due to short vas or testicular atrophy. Outcome was successful in 80%. One-stage laparoscopic orchidopexy without vessel division was performed in five intra-abdominal testes with satisfactory results in three. In general, the success rate is higher in boys with bilateral intra-abdominal testes, probably due to younger age at operation. CONCLUSIONS: At our centre two-stage laparoscopic Fowler-Stephens orchidopexy for intra-abdominal testes showed results comparable to most other studies, but less satisfactory than a couple of recent studies. The median age at referral was higher than recommended. Operation at an earlier age may further improve the results.

Isolated photons in deep inelastic scattering.

Photon radiation at large transverse momenta at colliders is a detailed probe of hard interaction dynamics. The isolated photon production cross section in deep inelastic scattering was measured recently by the ZEUS experiment, and found to be considerably larger than theoretical predictions obtained with widely used event generators. To investigate this discrepancy, we perform a dedicated parton-level calculation of this observable, including contributions from fragmentation and large-angle radiation. Our results are in good agreement with all aspects of the experimental measurement.

Darbepoetin alfa administered every 3 weeks alleviates anaemia in patients with solid tumours receiving chemotherapy; results of a double-blind, placebo-controlled, randomised study.

This dose-finding, placebo-controlled study evaluated the safety and efficacy of darbepoetin alfa administered every 3 weeks (Q3W) to anaemic patients receiving chemotherapy. In part A, patients (haemoglobin 50% of patients achieving a haematopoietic response. Administration of darbepoetin alfa Q3W has a tolerable safety profile and effectively ameliorates anaemia due to chemotherapy.

Characteristics and risk factors of infections after glaucoma filtering surgery.

PURPOSE: To define characteristics and potential risk factors of endophthalmitis and blebitis after glaucoma filtering surgery in adults. METHODS: A chart review of all cases of endophthalmitis or blebitis treated at the Duke University Eye Center for 6 years (January 1993 to December 1998) was performed to identify patients with a history of incisional glaucoma surgery. RESULTS: Twenty patients were identified. The filtering bleb was located superiorly in all patients. Blebitis but not endophthalmitis developed in 3 (15%) of 20 patients, and all had visual outcomes of at least 20/25. Endophthalmitis (blebitis and vitritis) occurred in 17 (85%) of 20 patients. Cases of blebitis were treated with topical antibiotics. All cases of endophthalmitis were treated with intravitreal antibiotics, and 3 (18%) of 17 patients also underwent immediate vitrectomy. Initial visual acuity was less than hand motions in 5 (29%) of 17. Final visual acuity was less than 20/200 in only one case of endophthalmitis. In 15 (75%) of 20 patients, the bleb was noted to be thin, avascular, or both. On presentation, 11 (55%) of 20 blebs had Seidel-positive leaks with hypotony. A history of recurrent bleb leaks was documented in 7 (33%) of 20 patients. Pseudophakia was present in 13 (65%) of 20 eyes, and 7 (35%) of 20 had undergone combined cataract and filtering surgery. A prodrome, such as a browache, headache, or external eye inflammation or infection, was documented in previous physician visits in 7 (35%) of 20 patients. No cases occurred in eyes with glaucoma implants. CONCLUSIONS: Patients in whom endophthalmitis develops after trabeculectomy do poorly, even with aggressive medical and surgical intervention. As expected, several patients had thin, avascular, leaking blebs. In addition, hypotony, recurrent bleb leaks, pseudophakia, and more than one filtering surgery may also be associated with blebitis or endophthalmitis after glaucoma filtering surgery. In a surprising number of patients, prodromal signs or symptoms were documented by ophthalmologists days or weeks before the diagnosis of blebitis or endophthalmitis was made.

Cellular effects of heparin on the production and release of tissue factor pathway inhibitor in human endothelial cells in culture.

Tissue factor pathway inhibitor (TFPI), the major downregulator of procoagulant activity of the tissue factor-factor VIIa complex (TF. FVIIa), is synthesized and constitutively secreted by endothelial cells (ECs). Here we describe the in vitro effects of heparin on the cellular localization, gene expression, and release of TFPI in human ECs in culture. Both unfractionated heparin (UFH) and low-molecular-weight heparin (LMWH; Fragmin) time-dependently induced a significant enhanced secretion of TFPI, paralleled by a redistribution and increase of TFPI on the cell surface and a decrease of intracellular TFPI. Immunogold electron microscopy showed the presence of clusters of TFPI, both on the plasmalemma proper and within cell-surface opened caveolae/enlarged caveolar profiles. Activation of FX by TF. FVIIa on ECs treated with endotoxin was inhibited by both heparins but to a higher extent by LMWH. Inhibition of protein synthesis by cycloheximide did not reduce the release of TFPI induced by heparin. Long-term incubation (48 hours) resulted in a time-dependent enhanced production of TFPI. After the first 4 to 8 hours, depletion of intracellular TFPI was observed, more significantly with UFH. Northern blot analysis of TFPI mRNA also showed a decrease of the 1.4-kb transcript after 4 hours of incubation with UFH, followed by recovery and an increase over the control level after 24 hours. Incubation of ECs with phorbol ester (PMA) significantly enhanced the secretion of TFPI and increased its activity on the cell surface, probably by preventing invagination of caveolae. Heparin-stimulated release of TFPI decreased significantly in the presence of PMA to a level that was 2. 4 times lower than the expected additive value for PMA and UFH separately. Pretreatment of ECs with PMA suppressed a subsequent response to heparin. Altogether, our results suggest that the heparin-induced release of TFPI might involve a more specific mechanism(s) than the previously hypothesized simple displacement of TFPI from the cell surface glycocalyx. We assume that the increased secretion and redistribution of cellular TFPI induced by heparins in ECs in culture can play an important role in the modulation of the anticoagulant properties of the endothelium.

Clearance and renal extraction of technetium-99m-L,L-ethylenedicysteine, I-131-ortho-iodohippurate and I-125-iothalamate in pigs.

99mTc-L,L-ethylenedicysteine (99mTc-EC) has been proposed as a 99mTc-labelled alternative to radio-iodinated ortho-iodohippurate (OIH) for renal imaging and evaluation of renal function. The kinetics of this new renal function agent were studied by a single-injection plasma clearance technique in pigs. 99mTc-EC, 131I-OIH and 125I-iothalamate were injected and the plasma concentration of the three tracers was followed for 240 min. Renal, hepatic and total plasma clearance were calculated. There was no difference between the renal plasma clearance of 99mTc-EC and 131I-OIH (175 +/- 9 versus 178 +/- 8 ml min-1, P = 0.43), whereas the difference between the total plasma clearance of 99mTc-EC and 131I-OIH was highly significant (268 +/- 16 versus 185 +/- 9 ml min-1, P = 0.0001). 99mTc-EC had a significant hepatic clearance of 83 +/- 10 ml min-1 whereas the hepatic clearance of 131I-OIH was negligible. Renal plasma extraction of both 99mTc-EC and 131I-OIH decreased significantly between 2 and 240 min post-injection from 0.85 to 0.45% for 99mTc-EC and from 0.93 to 0.57% for 131I-OIH. Red blood cell binding of 99mTc-EC and 131I-OIH was 6.1% and 20%, respectively. The protein binding of 99mTc-EC and 131I-OIH was 32% for both tracers. We conclude that 99mTc-EC is not a suitable tracer for measuring renal function by the single-injection plasma clearance technique in pigs. This is due to a decreasing renal extraction and a significant hepatic clearance.

[Follow-up of non-negative cervical cytological smears in the county of Funen]. / Opfølgning af ikkenegative cervixcytologiske prøver i Fyns Amt.

The outcome of screening for cervical cancer in the county of Funen was evaluated in two sequential periods (1.7.-31.12.1989 and 1.7.-31.12.1992), comprising 17,493 and 18,135 respectively. About 10.5% of the screened women had a define non-negative smear. From the first and the second period 80% and 85.1% of the non-negative smears respectively were followed up within six months. The follow-up of positive smears was 96% in both periods. Four point nine percent and 3.3% respectively of the non-negative smears were not followed up within 18 months. No women were actually lost in the screening system, unless they renounced further follow-up themselves. The follow-up was improved from the first to the second period, presumably as a result of a better general acquaintance with the screening procedures. The study indicates that reorganization of a screening programme requires both time and adjustment. Moreover, it is important that a successful screening programme frequently adjusts its procedures.

[Evaluation of blood loss and absorption of irrigating fluid in transurethral resection of the prostate]. / Evaluering af blodtab og absorption af skyllevaeske ved transuretal resektion af prostata. En spørgeskemaundersøogelse.

A questionnaire was sent to all Danish departments performing transurethral resection of the prostate (TUR-P) concerning the use of irrigating fluids and methods to estimate peroperative blood loss and absorption of irrigating fluid. Fifty-six of 60 departments used glycine as an irrigant. Seventeen percent of the departments measured blood loss peroperatively (HemoCue). Only two departments (3%) measured absorption of irrigating fluid quantitatively by the expired breath ethanol method. The other departments estimated blood loss and absorption of irrigant from the colour of the irrigating fluid. From studies of the literature we suggest the use of sorbitol/mannitol as irrigating fluid instead of glycine, as this may have fewer adverse effects, and we recommend quantitative measurements of blood loss and absorption of irrigating fluid to minimise the potentially dangerous consequences of TUR-P.

Comparison of astigmatism after penetrating keratoplasty by experienced cornea surgeons and cornea fellows.

PURPOSE: We compared surgically induced astigmatism after penetrating keratoplasty performed by supervised cornea fellows and experienced cornea surgeons. METHODS: Data were collected by retrospective chart review of 166 cases (166 eyes) of penetrating keratoplasty: 63 performed by two cornea surgeons and 103 by four cornea fellows. Astigmatism was calculated using scalar and vector methods. Vector analysis was performed on 109 of 166 eyes. Two techniques were compared: intraoperative keratometry and suture adjustment and the torque-antitorque running suture technique with no intraoperative keratometry or suture adjustment. RESULTS: Mean surgically induced scalar astigmatism changed from preoperative astigmatism by 3.27 diopters (fellows) and 2.94 diopters (attending surgeons). In 109 cases, surgically induced vector cylinder changed from peroperative astigmatism by 4.21 diopters at 98 degrees (fellows) and 4.25 diopters at 114 degrees (surgeons). Surgically induced vector astigmatism changed from preoperative astigmatism by 4.67 diopters at 93 degrees in the first 6 months (fellows) and by 3.79 diopters at 103 degrees in the second 6 months. Analysis of x-axis and y-axis components of the surgically induced vector cylinder showed that the majority of the astigmatism was induced in the y-axis and that this difference was significant (P < .001) in all comparisons, independent of technique or surgeon group. CONCLUSIONS: Penetrating keratoplasty performed by supervised cornea fellows resulted in similar rates of surgically induced vector astigmatism, surface asymmetry, and surface regularity as that by experienced surgeons. Fellows induced significantly more with-the-rule astigmatism, but this tendency decreased with further training. Penetrating keratoplasty astigmatic outcomes were not significantly different whether or not intraopertive keratometry and suture adjustment were utilized. This study supports the concept that increased experience with corneal transplantation improves the outcome of penetrating keratoplasty by using the criterion of postoperative astigmatism as a measures.

Assembling medical devices: the essential steps for success.

Designers of complex medical devices face many challenges in taking a product from prototype to mass production. There are numerous obstacles that can bring a project to a standstill and at the same time take it considerably over budget. This article will examine some of the engineering issues related to medical device assembly, such as the management of the project, choice of component and assembly system suppliers, and quality.

Renal functional reserve in pigs: renal haemodynamics, renal tubular function and salt and water homeostatic hormones during amino acid and dopamine stimulation.

The purpose of the study was to evaluate renal functional reserve [RFR is the difference between glomerular filtration rate (GFR) at rest and maximal GFR after stimulation] in a controlled study in normal pigs. Our basic hypothesis was that a decreased RFR may be used as an early indicator of renal deterioration, i.e. a test to disclose significant obstruction as opposed to simple dilatation in hydronephrosis. During various forms of stimulation (amino acids, captopril and dopamine), we measured changes in GFR, renal plasma flow (RPF), tubular reabsorption of sodium and water, net uptake from plasma to the kidney of three salt and water homeostatic hormones (angiotensin II, aldosterone and atrial natriuretic peptide) and of glucagon, which is thought to play a key role as mediator of the GFR increase during amino acid infusion. We found the largest GFR increase during combined infusion of amino acids and dopamine (+13%), but compared with a non-stimulated control group, the GFR increase was statistically non-significant. RPF increased by 57% during stimulation with amino acids plus dopamine (P < 0.001), while tubular reabsorption of sodium and water, and renal uptake of angiotensin II, aldosterone and atrial natriuretic peptide showed no significant differences between control and stimulation groups. The renal uptake of glucagon increased significantly during amino acid stimulation with no concomitant GFR increase. We conclude that in this experimental, non-obstructed model, RFR is a very insensitive measure, which cannot be used to discriminate between obstruction and simple dilatation in hydronephrosis. Further, our study does not support the hypothesis that glucagon is involved in GFR changes after amino acids.

[Anderson-Hynes pyeloplasty in hydronephrosis]. / Anderson-Hynes-pyeloplastik ved hydronefrose.

The purpose of the study was to evaluate pyeloplasty a.m. Anderson-Hynes in the treatment of hydronephrosis in a large series of patients. In 175 patients, consecutively operated for ureteropelvic junction obstruction, we found 24 (14%) with minor postoperative complications, mostly urinary tract infection. Six patients (3%) were reoperated because of continued pain and obstructed drainage postoperatively. There was a small, but statistically significant increase in renal functional share on the operated side. We found a highly significant correlation between postoperative changes in total GFR and single kidney GFR on the operated side, which suggests a real improvement in renal function, rather than a simple reallocation of function between the two kidneys. We conclude that newer treatment modalities known as "minimally invasive surgery" must give comparably good results in order to be an acceptable alternative to traditional dismembered pyeloplasty.

Use of fluoxetine for the treatment of stereotypical pacing behavior in a captive polar bear.

Stereotypical behaviors are common in captive animals, particularly captive polar bears. Effects of oral administration of fluoxetine on chronic stereotypical and typical behaviors in a captive polar bear were monitored. Fluoxetine treatment terminated stereotypic pacing behavior, facial tic, and huffing/coughing activity. The expression of typical polar bear behaviors was not affected by fluoxetine treatment, although the proportion of time spent engaged in typical behaviors changed during the course of the observation period. Response of the bear to fluoxetine treatment indicated that pharmacologic manipulation of the serotonergic system can safely eliminate stereotypical behaviors in captive polar bears.