Evaluation of a "walk-through" ladder top design during ladder-roof transitioning tasks.

This study evaluated the effect of an extension ladder "walk-through" top design on kinetic and kinematic behaviors and the outward destabilizing forces induced on the ladder during transitioning at elevation. Thirty-two male participants performed stepping tasks between a ladder top and a roof at simulated elevation in a surround-screen virtual-reality system. The experimental conditions included a "walk-through" and a standard ladder top section supported on flat and sloped roof surfaces. Three force platforms were placed under the ladder section and in the roof to measure propulsion forces during transitions. A motion measurement system was used to record trunk kinematics. The frictional demand at the virtual ladder base was also calculated. The results indicate that under optimal ladder setup (angle 75.5 °), the frictional demand at the ladder base remains relatively small for all experimental conditions. Also, the "walk through" ladder top eased the ladder-to-roof transitions but not the roof-to-ladder transitions.

ENDOVASCULAR TREATMENT OF AN ANEURYSM OF THE SPLENIC ARTERY.

Aneurysms of the splenic artery account for about 60% of all aneurysms of visceral arteries. Most of them are asymptomatic until rupture and are discovered accidentally, usually after an imaging study. The treatment is surgical or endovascular depending on the type, location and size. We present a case of a patient with an asymptomatic, accidentally found aneurysm of the splenic artery which we successfully treated with a covered stent. The control CT-angiography on 6th month showed patent stent and totally occluded aneurysm. It is very important in cases of acute abdomen and hemorrhagic shock to think of a ruptured aneurysm. In these cases the treatment of choice is endovascular as it is mini-invasive and organ-saving.

Research to improve extension ladder angular positioning.

A leading cause for extension ladder fall incidents is a slide-out event usually related to suboptimal ladder inclination. An improved ladder positioning method or procedure could reduce the risk of ladder stability failure and the related fall injury. The objective of the study was to comparatively evaluate the effectiveness of a multimodal angle indicator with other existing methods for extension ladder angular positioning. Twenty experienced and 20 inexperienced ladder users participated in the study. Four ladder positioning methods were tested in a controlled laboratory environment with 4.88 m (16 ft) and 7.32 m (24 ft) ladders in extended and retracted positions. The positioning methods included a no-instruction method, the current standard anthropometric method, and two instrumental methods - a bubble level indicator, and a multimodal indicator providing direct feedback with visual and sound signals. Performance measures included positioning angle and time. The results indicated that the anthropometric method was effective in improving the extension ladder positioning angle (p < 0.001); however, it was associated with considerable variability and required 50% more time than no-instruction. The bubble level indicator was an accurate positioning method (with very low variability), but required more than double the time of the no-instruction method (p < 0.001). The multimodal indicator improved the ladder angle setting as compared to the no-instruction and anthropometry methods (p < 0.001) and required the least time for ladder positioning among the tested methods (p < 0.001). An indicator with direct multimodal feedback is a viable approach for quick and accurate ladder positioning. The main advantage of the new multimodal method is that it provides continuous feedback on the angle of the device and hence does not require repositioning of the ladder. Furthermore, this indicator can be a valuable tool for training ladder users to correctly apply the current ANSI A14 standard anthropometric method in ladder angular positioning. The multimodal indicator concept has been further developed to become a hand-held tool in the form of a smart phone application.

[A multicenter comparative observation on the effectiveness and the rapidness of the effect of Cystostop Rapid versus antibiotic therapy in patients with uncomplicated cystitis].

UNLABELLED: The currently available treatment for uncomplicated urinary tract infections includes only antibiotics and chemotherapeutic agents. Experience in the management of acute uncomplicated infections using non-antibiotic products is very limited. The aim of this observation was to study to what extent the response to Cystostop Rapid would be more rapid and more effective compared to antibiotic therapy in patients with acute uncomplicated urinary bladder infections. The secondary objective was to determine the time to improvement of cystitis symptoms following the start of treatment, as well as the duration of patients' disablement. A total of 158 female subjects were included, assessed microbiologically, and evaluated for incidence and severity of symptoms, before the start of treatment and after completion of treatment. A visual analogue scale was used for patient self-assessment of the severity of symptoms, the improvement of symptoms, as well as the time to improvement of symptoms. RESULTS: 158 females, eligible according to the inclusion criteria of the study, were allocated to one of the two groups according to time of enrollment: Group A included 86 subjects: assigned to Cystostop Rapid for 3 days and administered according to the manufacturer's recommended regimen; and Group B included 72 women: assigned to ciprofloxacin 500 mg twice daily for 3 days according to the Product Registration File with the BDA. The clinical and microbiological effectiveness of Cystostop Rapid was comparable to that of ciprofloxacin, providing a two-fold more rapid improvement of cystitis symptoms, at a mean time to improvement of 24 hours (p < 0.02) versus 46 hours for ciprofloxacin. Clinical improvement within 48 hours of Cystostop Rapid regimen occurred in 97% (p < 0.02) of patients, vs. 65.3% of patients on ciprofloxacin. Improvement of symptoms within 12 hours was reported in 36% of patients on Cystostop Rapid vs. 5.5% of patients in the ciprofloxacin group (p < 0.02). No adverse events or intolerability to the therapy were reported throughout the course of the study.

Postural stability effects of random vibration at the feet of construction workers in simulated elevation.

The risk of falls from height on a construction site increases under conditions which degrade workers' postural control. At elevation, workers depend heavily on sensory information from their feet to maintain balance. The study tested two hypotheses: "sensory enhancement"--sub-sensory (undetectable) random mechanical vibrations at the plantar surface of the feet can improve worker's balance at elevation; and "sensory suppression"--supra-sensory (detectable) random mechanical vibrations can have a degrading effect on balance in the same experimental settings. Six young (age 20-35) and six aging (age 45-60) construction workers were tested while standing in standard and semi-tandem postures on instrumented gel insoles. The insoles applied sub- or supra-sensory levels of random mechanical vibrations to the feet. The tests were conducted in a surround-screen virtual reality system, which simulated a narrow plank at elevation on a construction site. Upper body kinematics was assessed with a motion-measurement system. Postural stability effects were evaluated by conventional and statistical mechanics sway measures, as well as trunk angular displacement parameters. Analysis of variance did not confirm the "sensory enhancement" hypothesis, but provided evidence for the "sensory suppression" hypothesis. The supra-sensory vibration had a destabilizing effect, which was considerably stronger in the semi-tandem posture and affected most of the sway variables. Sensory suppression associated with elevated vibration levels on a construction site may increase the danger of losing balance. Construction workers at elevation, e.g., on a beam or narrow plank might be at increased risk of fall if they can detect vibrations under their feet. To reduce the possibility of losing balance, mechanical vibration to supporting structures used as walking/working surfaces should be minimized when performing construction tasks at elevation.

[Retro and extraperitoneoscopic operations in urology--initial experience].

Retroperitoneoscopic approach is gradually becoming the method of choice in many urologic diseases. In this article we analyse and present the first cases of urological retroperitoneoscopic operations performed in the Department of Urology of the University Hospital "Akeksandrovska". For the period from May 2006 to March 2009 35 extra- and retroperitoneoscopic operations were performed. A 26 retroperitoneoscopic decortications (unroofing) of renal cysts with different localization were performed. 5 pieloplasties without interruption of pieloureteral segment (3 by Fenger method. 2 cases with Y-V pyeloplasty), 2 ureterolithotomies, 1 pyelolithotomy and one radical extraperitoneoscopic prostatectomy. The mean operative time in retro-peritoneoscopscopic decortications of renal cysts was 49.62 minutes (15 to 95 minutes), and in pyeloplasties, ureterolithotomies and pyelolithotomies, mean operative time was 88.00 minutes (65 to 150 minutes). The average pararenal drainage secretion was 138 ml for 24 hours (from 50 ml to 150 ml. The average blood loss was 86 ml (from 50 ml to 120 ml). In one case conversion was required because of technical problems and little experience of the team. Postoperatively in 5 cases (13.51%) we observed subcutaneous emphysema. The benefits of retro-extraperitoneoscopic urological operations are associated with lower morbidity, short stay in hospital, shorter recovery period and less pronounced pain syndrome.

[Local recurrence of the renal cell carcinoma in renal fossa after complete radical nephrectomy. What are the risk factors?].

The local recurrence of the renal cell carcinoma in renal fossa after complete radical nephrectomy is uncommon. According to the latest articles related to this issue it ranges between 2% and 4%. For the period of 1999-2005 we evaluated 11 patients who underwent surgery for isolated renal cell carcinoma recurrence, all of them without clinical presence of distal metastases. 9 of the patients were operated for their first time in our department, and only two in other hospitals. These 9 patients represent 1.41% of the whole number of radical nephrectomies for RCC (637) which took place in our department for the same period of time. The tumor stage of the primary tumor varied from T1 to T3a. In addition lymph node dissection was performed on 7 of the patients. The average time for developing clinically significant fossa recurrence was 18 months. The current article has the purpose to present newer the data for the factors, which may be directly related to the risk of developing local recurrence in the renal fossa after complete radical nephrectomy--the initial tumor stage of the RCC, the relationship between the primary tumor and the histological type of the recurrent masses.

[Could the transrectal prostate biopsy predict the rate of positive lymph nodes in prostate cancer patients?].

Since 1989, when Hodge and al. demonstrated transrectal ultrasound guided prostate biopsy, it has become a "gold standard" for the diagnosis of prostate cancer. According to the experience gained in the period 1999-2003 in the Department of Urology-Medical University, Sofia, in a prospective follow-up of 20 prostate cancer patients, we found relationship between the positive tru-cut biopsy cores and the rate of positive lymph nodes.

[Operative method of pyeloplasty: X-pyeloplasty].

The classic operative methods are still topical. Applying some new operative techniques makes the medical science more complete and thus help better treatment of the variety of diseases encountered in medical practice. In this article the authors present brand - new operative method of pieloplasty, named by them X-pieloplasty.

[Biliurolithiasis - a classification of a disease with complex characteristics].

The development of the medicine itself, meets the current question of the common, interdisciplinary method of approach in the treatment of a series of diseases, such as biliurolithiasis. The attempt to make a classification is basic for making an optimal method of treatment of the biliurolithiasis. The biliurolithiasis is a disease influencing some new strategies of treatment in the combined efforts of the urologist and the surgeons both.

[The echography as a method for measuring the calculus volume].

The method of echography is one of the basic diagnostic methods used in medicine. It's application is of a great importance for the clinical estimation of the cases of kidney stone disease. The authors put a stress on the use of the echography as a method of a brand-new conception aiming to get a vision of the kidney stone as a geometric figure, based on a mathematical principle.

[Methods optimizing the efficiency of the extracorporeal shockwave lithotripsy (ESWL)].

The medicine science is in a progressive mode. One of the ever discussed problems is the stone kidney disease and the optimizing methods of its treatment. In this article the authors announced a new method of applying jelly, thus improving the efficiency of the Extracorporeal Shockwave Lithotripsy (ESWL).

[A case of penis self-injection of liquid paraffin--operative treatment and results]. / Sluchai na avtoinzhektirane na techen parafin v penisa--operativno lechenie i rezultati.

The authors describe a rare clinical case named penis "paraffinoma" or "lipogranuloma". This problem has been discussed in only 6 scientific reports and articles during the period 1996-2002 [1, 2, 4, 5, 6]. Jh. Jeong et al. (1996) operated 13 patients with penis paraffinoma and concluded that the plastic and reconstructive procedures are safe and without any complications.

Height, surface firmness, and visual reference effects on balance control.

OBJECTIVES: To investigate the effects of height, surface firmness, and visual reference on standing balance in construction workers. DESIGN: Controlled laboratory study with balanced repeated measures. PARTICIPANTS: Twenty four construction workers. SETTING: Test subjects performed standing tasks at ground level as well as at 3 m and 9 m high balconies on firm or deformable surfaces with close visual references included or excluded from their visual field. METHODS: Standing balance was determined from center of pressure as measured by a force platform. Dependent variables were root mean square of sway in medial-lateral and anterior-posterior directions, area of sway, and velocity of sway. RESULTS: Heights without close visual references significantly increased all sway parameters. The effect of height in conditions without close visual references increased dramatically on deformable surfaces. CONCLUSIONS: Elevated work environments and deformable work surfaces negatively affect balance and may be associated with increased risk of fall incidents. Appropriate close visual references increase the ability to maintain balance.

Serum cystatin C in renal transplant patients.

Assessment of renal function in clinical medicine is of great importance especially in patients with renal transplants. Cystatin C has the characteristics of an ideal marker to assess renal glomerular filtration rate. Forty patients with renal transplants under steady-state post-transplant conditions were included in the study. Steady-state was defined as lack of acute rejection periods during the last 6 months and stable cyclosporin A medication during the past 4 weeks. Gender was balanced with 20 male and 20 female patients, the mean age was 51+/-14 years, time since transplantation was 5+/-3.5 years. Fifteen percent of the patients suffered from diabetes mellitus. Immunosuppression consisted of cyclosporin A, imuran, and prednisolon. To assess renal function cystatin C, creatinine clearance, serum creatinine, and serum beta2-microglobulin were tested. Creatinine was analysed in serum and urine to calculate the creatinine clearance related to 1.73 m(2) body surface. Cystatin C and beta2-microglobulin were determined by using a particle-enhanced turbidimetric assay. Cystatin C correlated best with creatinine clearance (r=0.66), beta2-microglobulin (0.57), and serum creatinine (0.56). The diagnostic accuracy of cystatin C was significantly better than serum creatinine (p<0.05), but did not differ significantly from creatinine clearance (p=0.73), and beta2-microglobulin (p=0.46). Our data show that patients with renal transplants, cystatin C has a similar diagnostic value as creatinine clearance. However, it is superior to serum determination of creatinine and beta2-microglobulin. Cystatin C allows for rapid and accurate assessment of renal function in patients with renal transplants and is clearly superior to the commonly used serum creatinine.

Preventing falls from roofs: a critical review.

Work-related falls from roofs remain a significant problem for workers in the construction industry. Knowledge about the main causative or initiating factors leading to fall incidents is desperately needed for fall prevention intervention. From biomechanical and psychophysiological perspectives the majority of occupational falls, including falls from roofs, can be regarded as loss-of-balance incidents. The primary objective of this paper is to summarize the current knowledge from multiple fields about factors that are related to the control of balance during roofing work. An extensive literature review identified a number of environmental, task-related and personal factors that degrade the control of balance and could be associated with the initiation of falls from roofs. These factors include visual exposure to elevation; unstable visual cues and inadequate visual information in the work environment; 'confined' and inclined support surfaces; unexpected changes in roof surface properties; load handling; physical exertion; fatigue; task complexity that diverts workers' attention; individual differences; work experience and training; and personal protective equipment. Current measures to reduce falls from roofs focus mainly on fall protection procedures, such as the use of covers, guardrails, safety nets, and personal fall-arrest systems, or the application of warning-line systems, safety monitoring systems, and fall protection plans. In many instances, these procedures are not practical for the industry and current regulations allow the use of alternative means of fall protection, such as slide guards. Future research on preventing falls from roofs should consider the main effects and interactions of the environmental, task-related and personal factors that affect the balance control of workers. Research-supported improvements in the visual and physical characteristics of the roof work environment, the construction materials and methods, and work procedures and practices may result in improved workers' balance control as well as overall safety performance, and would ultimately reduce incidents of falling from a roof.

[A modification of Freyer's typical prostatectomy]. / Modifikatsiia na tipichniia metod na Freyer za adenomektomiia.

Adenomectomy in its present-day modality has a millennium-long history. Chronologically, its development, justly or not, is marked by a great number of names among which it is worth noting Sir Peter Freyer (London) and his paper published in 1901, dealing with the radical treatment of the hypertrophied prostate by urinary bladder exposure. E. Fuller (USA) claims that the first practical implementation of the method six years previously is credited to him. Since then, there are no different opinions on the need of total gland enucleation, with some differences remaining in terms of operative access and hemostasis. Over the period 1998-1999, thirty-two adenotomies are performed according to Freyer's original method in the Department of Urology--University Hospital "Alexandrovska". An indwelling catheter with inflated balloon is inserted into the prostate bed for hemostasis without using packs or placing sutures. The obtained results are estimated as good.

[Problems relating to vascular reconstruction in renal transplantation from a living donor]. / Problemi na s'dovite rekonstruktsii pri b'brechni transplantatsii ot zhiv donor.

We discuss vascular surgical problems in 59 kidney transplantations using alive donors. From April 96 till May 99 we harvested 59 kidneys from relatives (44 women and 15 men), mean age 54.33 years. Those kidneys were transplanted to 37 men (mean age 55.71 years), and 22 women (mean age 36.85 years). Preoperative dialysis was performed for a period of 5.015 years (mean). Thirty eight of the kidneys are right, and 21 of them are left. Six kidneys have two renal veins (10.16%), and 5 of them have two renal arteries (8.47%). We prefer end-to-end anastomosis between the donor renal artery and the recipient hypogastric artery. It ensures best regional hemodynamics, long-term patency and best positioning of the kidney avoiding vascular compression. The venous anastomosis is performed end-to-side to the iliac vein of the recipient. In 7 cases of short renal artery of the donor kidney greater saphenous vein is used as arterial conduit to ensure tension-free anastomoses. Only 1 patient (1.74%) of 59 cases (71 venous anastomoses) suffered thrombosis of the iliac vein, which caused kidney rupture. We had 5 cases of postoperative bleeding (8.47%), three of them were from the kidney hilus, and two from exposure sites. After reexploration all of them have normal function. Vascular anomalies and/or vascular disease do not preclude the procedure. Atraumatic harvesting of the kidney is critical.

[Live-donor kidney transplantations. The problems of vascular reconstructions]. / Bubrechni transplantatsii ot zhiv donor. Problemi na sudovite rekonstruktsii.

The aim of the study was to evaluate the vascular surgery problems in 59 kidney transplantations from live donor, performed by the team for kidney transplantations (vascular surgeons and urologists) of Medical University--Sofia, for the period from April 1996 to May 1999. Nephrectomy was performed on 59 relatives (44 female and 15 males)--54.33 years average age. Donor kidneys were transplanted to 37 males (55.71 years average age) and 22 females (36.85 years average age). The average duration of hemodialysis prior to transplantation was 60.18 months (5.015 years). Most of donor kidneys were right--38, while only 21 were left. In six kidneys duplex renal veins were presented (10.16%), while in other 7 cases (11.76%) there were duplex renal arteries. We preferred termino-terminal anastomoses of donor renal artery to the hypogastric artery of the recipient, which provides not only better regional hemodynamics guaranteeing long term patency of the anastomoses, but presents optimal positioning of new kidney to the retroperitoneal space of recipient avoiding external compression of renal vessels. The standard performance of venous anastomoses was termino-lateral to the iliac vein of the recipient. In 7 cases, saphenous vein graft was used to replace or prolong the donor arteries or veins. Postoperative results of live donor kidney transplantation were successful in all cases, except one case (1.74% of 71 venous anastomoses) with late deep venous thrombosis of recipient's iliac vein resulting in kidney rupture and unavoidable nephrectomy. There were also 5 cases of haemorrhage (8.47%): in 3 of them from the renal hilus and in 2--profuse bleeding from the operative approach, all successfully treated after reoperation. Our satisfactory results in live donor kidney transplantation prove this method as a method of choice in certain cases of chronic renal insufficiency, especially in lack of cadaver kidneys. Contemporary vascular surgery disposes of various techniques that makes possible transplantation even in cases with serious anomalies of renal vessels. The atraumatic nephrectomy of donor kidney remains one of the main factors contributing to the successful outcome of kidney transplantation.

[Echinococcus of the kidney]. / Ekhinokok na bubreka.

Echinococcus of the kidney is a rare form of hydatid disease, and accounts for 2 to 3 per cent of all echinococcoses. Over a ten-year period (1987-1996), eight patients with age ranging from 30 to 61 years are diagnosed and treated. Five of them (62.5 per cent) are discovered in the last two years. In seven instances (87.5 per cent) the diagnosis is made preoperatively on the ground of laboratory examinations; serological tests--intradermal test of Casoni and complement fixation after Ghedini-Weinberg, echographic and roentgenological methods. In two patients (33.3 per cent) scoleces and Echinococcus fragments are discovered in the urine. The serological tests are positive in five cases (62.5 per cent). All patients undergo operation, with nephrectomy performed in five (62.5 per cent), and capsula adiposa renis--in three (37.5 per cent). So far, no relapse of the disease is recorded.