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Selected AbstractsUsefulness of skin testing in cutaneous drug eruptions in routine practiceCONTACT DERMATITIS, Issue 3 2009Tatiana Tchen Background: Cutaneous drug eruptions are common side-effects. The imputation score combining intrinsic (chronology, clinical and paraclinical signs) and extrinsic criteria used in Pharmacovigilance Centres is insufficient alone to identify with certainty a responsible drug. Objective: To evaluate the imputation score before and after performing skin testing in patients with cutaneous drug eruptions. Patients/Methods: A single-centre retrospective study was performed on 339 patients tested between 2001,2006. Imputation scores were calculated before and after skin tests for each cutaneous drug eruption according to the clinical type of skin eruption and the type of drug. Results: Among 121 patients meeting inclusion criteria, 46% showed an increase of the imputation score as shown by 25/41 cases of maculo-papular exanthema, 4/11 cases of acute generalized exanthematous pustulosis and 17/41 cases of urticaria/anaphylaxis. The imputation score increased in 25/70 cases of the tested antibiotic drugs, in 14/56 cases of cardiovascular drugs, and it increased in 19 patients (34%) with I1 or I2 imputation scores before skin testing and in 29 (52%) with an I3 imputation score before skin testing. Conclusions: Drug skin testing appeared useful in investigating cutaneous drug eruptions in routine practice, including not only drugs with a high imputation score (I3) but also those with a lower score (I1, I2). Drug skin testing should lead to oral rechallenge of drugs with negative tests in order to determine which drugs may be used safely. [source] A low-dimensional physically based model of hydrologic control of shallow landsliding on complex hillslopesEARTH SURFACE PROCESSES AND LANDFORMS, Issue 13 2008Ali Talebi Abstract Hillslopes have complex three-dimensional shapes that are characterized by their plan shape, profile curvature of surface and bedrock, and soil depth. To investigate the stability of complex hillslopes (with different slope curvatures and plan shapes), we combine the hillslope-storage Boussinesq (HSB) model with the infinite slope stability method. The HSB model is based on the continuity and Darcy equations expressed in terms of storage along the hillslope. Solutions of the HSB equation account explicitly for plan shape by introducing the hillslope width function and for profile curvature through the bedrock slope angle and the hillslope soil depth function. The presented model is composed of three parts: a topography model conceptualizing three-dimensional soil mantled landscapes, a dynamic hydrology model for shallow subsurface flow and water table depth (HSB model) and an infinite slope stability method based on the Mohr,Coulomb failure law. The resulting hillslope-storage Boussinesq stability model (HSB-SM) is able to simulate rain-induced shallow landsliding on hillslopes with non-constant bedrock slope and non-parallel plan shape. We apply the model to nine characteristic hillslope types with three different profile curvatures (concave, straight, convex) and three different plan shapes (convergent, parallel, divergent). In the presented model, the unsaturated storage has been calculated based on the unit head gradient assumption. To relax this assumption and to investigate the effect of neglecting the variations of unsaturated storage on the assessment of slope stability in the transient case, we also combine a coupled model of saturated and unsaturated storage and the infinite slope stability method. The results show that the variations of the unsaturated zone storage do not play a critical role in hillslope stability. Therefore, it can be concluded that the presented dynamic slope stability model (HSB-SM) can be used safely for slope stability analysis on complex hillslopes. Our results show that after a certain period of rainfall the convergent hillslopes with concave and straight profiles become unstable more quickly than others, whilst divergent convex hillslopes remain stable (even after intense rainfall). In addition, the relation between subsurface flow and hillslope stability has been investigated. Our analyses show that the minimum safety factor (FS) occurs when the rate of subsurface flow is a maximum. In fact, by increasing the subsurface flow, stability decreases for all hillslope shapes. Copyright © 2008 John Wiley & Sons, Ltd. [source] Routine use of Xeomin® in patients previously treated with Botox®: long term resultsEUROPEAN JOURNAL OF NEUROLOGY, Issue 2009D. Dressler Background and purpose:, Based upon large and carefully performed studies Xeomin® was first registered in 2005. However, its real potential can only be assessed, when it is used outside of study design restrictions, in an independent setting, in off-label indications and during continued use. Methods and results:, Two hundred and sixty-three patients (91 with dystonia, 84 with spasticity, 17 with hemifacial spasm and re-innervation synkinesias, 64 with hyperhidrosis, 7 with hypersalivation), who were previously treated with Botox® for at least 1 year under stable conditions, were converted in a blinded fashion to Xeomin® using a 1:1 conversion ratio and identical treatment parameters. Therapeutic outcome and adverse effects were monitored by neurological examination and structuralised interviews. In 223 patients (all except those with axillary hyperhidrosis) Xeomin® was used continuously throughout a 3 year period. Altogether 1050 injection series were performed. Patients with dystonia received 261.5 ± 141.0 MU Botox®/Xeomin®, patients with spasticity 450.5 ± 177.1 MU, patients with hemifacial spasm and reinnervation synkinesias 44.7 ± 19.5 MU and patients with hyperhidrosis 286.9 ± 141.6 MU. The maximum botulinum toxin dose applied was 840 MU. There were no subjective or objective differences between Botox® and Xeomin® treatments with respect to onset latency, maximum and duration of their therapeutic effects and their adverse effect profiles. Long-term use did not reveal additional safety relevant aspects. None of the patients lost therapeutic efficacy during the observation period. Conclusions:, Xeomin® can be used safely in doses of up to 840 MU. Even when applied in high doses it did not produce secondary therapy failure. There were no diffusion differences between Botox® and Xeomin®. Using a conversion ratio of 1:1 Xeomin® and Botox® can easily be exchanged in a continued treatment. [source] Low-flow anaesthesia at a fixed flow rateACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 10 2009A. CHERIAN Aims and Objectives: This study attempts to assess the safety of low-flow anaesthesia (LFA) at fixed flow rates with particular reference to the incidence of a decline in FiO2 below safe levels of 0.3 and to determine whether LFA can be used safely in the absence of an FiO2 monitor. Methods: A total of 100 patients undergoing procedures under general anaesthesia at fresh gas flows of 300 ml/min of O2 and 300 ml/min of N2O were monitored while maintaining the dial setting of isoflurane at 1.5% for 2 h. The changes in gas composition were analysed and even a single recording of FiO2 of <0.3 was considered sufficient to render the technique unsafe in the absence of gas monitors. Results: The lowest recorded value of FiO2 was 31% (v/v%). There was no incidence of adverse events necessitating the conversion from low flows to conventional flows. Conclusions: We conclude that low flows of 300 ml/min of N2O and 300 ml/min of oxygen can be used safely for a period of 2 h without the use of monitors for gas analysis of oxygen and agent in adult patients weighing between 40 and 75 kgs. [source] Dronedarone: A New Treatment for Atrial FibrillationJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 11 2008JAMES C. LAUGHLIN M.D. Dronedarone is a benzofuran derivative pharmacologically related to amiodarone but without the iodine moiety. It is designed for the treatment of atrial fibrillation and atrial flutter. Historically, amiodarone has proved most effective in maintaining sinus rhythm and has been used safely in patients with advanced heart failure. However, its use has been limited by cumulative and often irreversible organ toxicity, especially in younger patients. Dronedarone was developed in an effort to provide equivalent efficacy and safety with less toxicity. Dronedarone has proved efficacious without toxic or proarrhythmic effects and has minimal side effects, but remaining concerns exist regarding its use in patients with advanced heart failure. [source] The Effect of Antihistamine Cetirizine on Ventricular Repolarization in Congenital Long QT SyndromeJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 7 2007ANNA-MARI HEKKALA M.D. Introduction: Many drugs are known to block cardiac potassium channels, thus prolonging QT interval and predisposing to malignant arrhythmias. Patients with congenital long QT syndrome are particularly vulnerable, but usually electrophysiological effects of drugs have not been assessed in these patients at risk. Methods: Fifteen asymptomatic patients with type 1 (LQT1), 15 patients with type 2 (LQT2) long QT syndrome, and 15 healthy volunteers took a placebo and cetirizine 10 mg. In addition, healthy volunteers took cetirizine 50 mg. The study was single-blinded and randomized. Exercise tests were performed during stable plasma concentrations. The electrocardiogram was recorded with a body surface potential mapping system (BSPM). Data were analyzed with an automated analyze program. QT intervals to the T wave apex and T wave end and their difference (Tp-e) were determined at rest and at specified heart rates during and after exercise. Results: Cetirizine did not lengthen the QT intervals at rest or during exercise and recovery in any group. It shortened Tp-e at rest in LQT1 and LQT2 patients and during exercise test in LQT1 patients, thus slightly decreasing electrocardiographic transmural dispersion of repolarization. Conclusions: Cetirizine does not adversely modify ventricular repolarization in types 1 and 2 long QT syndrome, suggesting that it might be used safely in these long QT syndrome patients. [source] Image-guided and -monitored renal artery stenting using only MRIJOURNAL OF MAGNETIC RESONANCE IMAGING, Issue 5 2006Daniel R. Elgort PhD Abstract Purpose To demonstrate the ability of a unique interventional MR system to be used safely and effectively as the only imaging modality for all phases of MR-guided stent-supported angioplasty. Materials and Methods An experimental disease model of renal stenosis was created in six pigs. An interventional MR system, which employed previously reported tools for real-time catheter tracking with automated scan-plane positioning, adaptive image parameters, and radial true,FISP imaging with steady-state precession (True-FISP) imaging coupled with a high-speed reconstruction technique, was then used to guide all phases of the intervention, including: guidewire and catheter insertion, stent deployment, and confirmation of therapeutic success. Pre- and postprocedural X-ray imaging was used as a gold standard to validate the experimental results. Results All of the stent-supported angioplasty interventions were a technical success and were performed without complications. The average postoperative residual stenosis was 14.9%. The image guidance enabled the stents to be deployed with an accuracy of 0.98 ± 0.69 mm. Additionally, using this interventional MRI system to guide renal artery stenting significantly reduces the procedure time, as compared to using X-ray fluoroscopy. Conclusion This study has clearly demonstrated the first successful treatment of renal artery stenting in an experimental animal model solely under MRI guidance and monitoring. J. Magn. Reson. Imaging 2006. © 2006 Wiley-Liss, Inc. [source] Cytotoxicity evaluation of enzyme inhibitors and absorption enhancers in Caco-2 cells for oral delivery of salmon calcitoninJOURNAL OF PHARMACEUTICAL SCIENCES, Issue 4 2004Rakhi B. Shah Abstract The usefulness of enzyme inhibitors and absorption enhancers with least mucosal cell cytotoxicity was evaluated on Caco-2 cell monolayers. The temporal cytotoxicity of several protease inhibitors at 500 ,g/mL (e.g., turkey and chicken ovomucoids, aprotinin, and Protease Inhibitor Cocktail) and absorption enhancers [e.g., cholate (3%), glycocholate (3%), glycosursodeoxycholate (3%), ethylenediaminetetraacetic acid (EDTA, 0.1%), hydroxypropyl-,-cyclodextrin (HP-,-CD, 5%), hydroxypropyl-,-cylcodextrin (HP-,-CD, 5%), ,-cylcodextrin (,-CD, 5%), tetradecyl-,- D -maltoside (0.25%), octylglucoside (0.25%), citric acid (10%), glycyrrhetinic acid (0.34 mM), and Tween-80® (0.1%)] was measured by monitoring their effect on Caco-2 cell viability. Cell viability was measured by mannitol permeability measurements, transepithelial electrical resistance (TEER) measurements, DNA-propidium iodide staining assay, and WST-1 assay (tetrazolium salt based assay). Sodium dodecyl sulfate (0.1%), a potent surfactant, was used as a positive control. Chicken and turkey ovomucoids were nontoxic to cells as evaluated by all the methods used. Aprotinin decreased the TEER, whereas plasma membrane damage was seen with Protease Inhibitor Cocktail after a 24-h period. With respect to the absorption enhancers, the toxicity increased directly as a result of an increase in the time of incubation. The enhancers EDTA and HP-,-CD can be used safely for a short period of time, whereas glycosursodeoxycholate, glycyrrhetinic acid, octylglucoside, HP-,-CD, and ,-CD can be used for a longer period. © 2004 Wiley-Liss, Inc. and the American Pharmacists Association J Pharm Sci 93: 1070,1082, 2004 [source] Topological resonance energy, bond resonance energy, and circuit resonance energyJOURNAL OF PHYSICAL ORGANIC CHEMISTRY, Issue 1 2008Jun-ichi Aihara Abstract Circuit resonance energy (CRE) is a key quantity that links energetic and magnetic criteria of aromaticity for a polycyclic ,-system. Topological resonance energy (TRE) correlates well with the sum of CREs for an entire ,-system. We found that bond resonance energy (BRE), so far defined to estimate the degree of kinetic stability for a polycyclic ,-system, also correlates very well with the corresponding quantity defined with CREs. These findings justify the view that graph-theoretical quantities, such as TRE and BRE, can be used safely even though they rely on unrealistic reference structures. Copyright © 2007 John Wiley & Sons, Ltd. [source] Clinical Evaluation of Gemcitabine in Dogs with Spontaneously Occurring MalignanciesJOURNAL OF VETERINARY INTERNAL MEDICINE, Issue 1 2005Carrie E. Kosarek We conducted a clinical evaluation of gemcitabine in 19 dogs with spontaneously occurring malignancies. The principal objectives of this study were to characterize toxicity and seek preliminary evidence of antitumor activity of gemcitabine administered every 2 weeks (biweekly) as a 30-minute IV infusion. A total of 64 doses, ranging from 300 mg/m2 to 675 mg/m2, were administered during the initial 8-week evaluation period, and an additional 131 doses were administered during the extended evaluation period. The total cumulative dose for the 10 dogs receiving gemcitabine in the extended evaluation period ranged from 1,500 mg/m2 to 24,300 mg/m2. Clinical evidence of toxicity was minimal. Cumulative myelosuppression was not apparent. Unexplained retinal hemorrhages occurred in 1 dog. No complete or partial remissions were observed during the initial evaluation period; however, objective responses were observed in 2 dogs during the extended evaluation period. Gemcitabine is a promising new chemotherapeutic agent that can be used safely in dogs with cancer. Biweekly administration of doses of 675 mg/m2 IV results in minimal and acceptable toxicity. [source] Clinical Evaluation of Methoximorpholino-Doxorubicin (FCE 23762) in Dogs with Spontaneous MalignanciesJOURNAL OF VETERINARY INTERNAL MEDICINE, Issue 1 2000Sarah E. Sheafor We conducted a clinical evaluation of FCE 23762, a methoxymorpholino analog of doxorubicin, in 48 dogs with metastatic, nonresectable, or chemotherapy-resistant spontaneous malignancies at an initial dosage of 50,60 ,g/kg IV every 3 weeks. Clinical evidence of toxicity was minimal; 6 dogs developed grades I, II, and III hematologic toxicities after the 1st treatment, and 1 dog developed grade II gastrointestinal toxicity. One dog became pancytopenic 4 months after discontinuation of FCE 23762. No other adverse effects were noted. Partial or complete remissions were observed in 32% of the dogs. Responses were observed both in previously untreated dogs and in those that had received prior chemotherapy, including doxorubicin. FCE 23762 is a promising new antineoplastic agent that can be used safely in dogs with cancer; doses higher than those used in this study may be used eventually in practice. [source] Retreatment with interferon and ribavirin vs interferon alone according to viraemia in interferon responder-relapser hepatitis C patients: a prospective multicentre randomized controlled studyJOURNAL OF VIRAL HEPATITIS, Issue 3 2003I. Portal Summary., Low pretreatment viral load has consistently been shown to be an independent predictor of sustained response (SR) in patients with chronic hepatitis C infection. We assessed the efficacy of interferon (IFN) plus ribavirin vs IFN alone in low viraemic patients (<2 millions copies/mL) who had relapsed to a previous course of IFN and the efficacy of 24 vs 48 week combination therapy in high viraemic patients. Two hundred and ninety-seven patients were randomly assigned to one of the four regimens after stratification on pretreatment viral load. All patients received IFN- ,2b (6 million units thrice weekly for 24 weeks and 3 million units thrice weekly for 24 weeks). Patients with low viraemia received either IFN- ,2b alone for 48 weeks (R1: 42 patients) or IFN- ,2b plus ribavirin (600 mg/day) for 24 weeks and IFN- ,2b alone for the next 24 weeks (R2: 48 patients). Patients with high viral load received either IFN- ,2b plus ribavirin for 24 weeks and then IFN- ,2b alone for the next 24 weeks (R3: 104 patients) or IFN- ,2b plus ribavirin for 48 weeks (R4: 103 patients). In low viraemic patients the rate of SR was 37.7% in group R1 and 59.6% in group R2 (P < 0.05). In high viraemic patients, the rate of SR was 44.7% in group R3 and 51.4% in group R4 (P: NS). Thirty-one patients discontinued treatment (10.4%) without difference regarding treatment regimen. In the regimen using ribavirin we found no difference in terms of SR between patients receiving a dose of ribavirin below 10.6 mg/kg/day (55%) or over 10.6 mg/kg/day (58%). Histological improvement occurred in 70.2% of patients regardless of the regimen. Logistic regression showed that genotype 2 and 3, Knodell score <6 and alanine aminotransferase pretreatment level >3 × upper limit of normal were significantly and independently correlated with SR. In low viraemic patients who relapsed to a previous IFN treatment, combination therapy using high-dose IFN and low-dose ribavirin is better than high-dose IFN alone. In high viraemic patients there was no benefit in increasing the duration of combination therapy from 24 to 48 weeks. In this study, it was found that low dose of ribavirin can be used safely and there is no effect of ribavirin dose on SR. [source] Review article: practical management of inflammatory bowel disease patients taking immunomodulatorsALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 1 2005C. A. SIEGEL Summary Azathioprine, mercaptopurine, methotrexate, ciclosporin and tacrolimus all have their respective niches in the treatment of inflammatory bowel disease. These immunomodulators are potent and effective medications; however, they potentially have serious toxicity. To maximize benefit and minimize risk, clinicians must understand the mechanism of action, appropriate indications, range of toxicity and proper dosing of these medications. Furthermore, once initiating therapy, patients need to be monitored appropriately for evidence of efficacy and toxicity. This review includes the rationale behind recommendations for the management and monitoring of patients using immunomodulators. For the purine antagonists , azathioprine and mercaptopurine , the evidence for utility of thiopurine methyltransferase testing and mercaptopurine metabolite monitoring is addressed. The roles of liver biopsy and screening for methylenetetrahydrofolate reductase mutations in patients taking methotrexate are reviewed. With appropriate monitoring, the calcineurin inhibitors , ciclosporin and tacrolimus , can be used safely and effectively. Immunomodulators are important agents for the treatment of Crohn's disease and ulcerative colitis, and prescribing clinicians should be comfortable recognizing both their value and their limitations. [source] Extended right liver grafts obtained by an ex situ split can be used safely for primary and secondary transplantation with acceptable biliary morbidityLIVER TRANSPLANTATION, Issue 7 2009Atsushi Takebe Split liver transplantation (SLT) is clearly beneficial for pediatric recipients. However, the increased risk of biliary complications in adult recipients of SLT in comparison with whole liver transplantation (WLT) remains controversial. The objective of this study was to investigate the incidence and clinical outcome of biliary complications in an SLT group using split extended right grafts (ERGs) after ex situ splitting in comparison with WLT in adults. The retrospectively collected data for 80 consecutive liver transplants using ERGs after ex situ splitting between 1998 and 2007 were compared with the data for 80 liver transplants using whole liver grafts in a matched-pair analysis paired by the donor age, recipient age, indications, Model for End-Stage Liver Disease score, and high-urgency status. The cold ischemic time was significantly longer in the SLT group (P = 0.006). As expected, bile leakage from the transected surface occurred only in the SLT group (15%) without any mortality or graft loss. The incidence of all other early or late biliary complications (eg, anastomotic leakage and stenosis) was not different between SLT and WLT. The 1- and 5-year patient and graft survival rates showed no statistical difference between SLT and WLT [83.2% and 82.0% versus 88.5% and 79.8% (P = 0.92) and 70.8% and 67.5% versus 83.6% and 70.0% (P = 0.16), respectively]. In conclusion, ERGs can be used safely without any increased mortality and with acceptable morbidity, and they should also be considered for retransplantation. The significantly longer cold ischemic time in the SLT group indicates the potential for improved results and should thus be considered in the design of allocation policies. Liver Transpl 15:730,737, 2009. © 2009 AASLD. [source] Phytochemical Research Using Accelerator Mass SpectrometryNUTRITION REVIEWS, Issue 10 2004Le T. Vuong PhD Vegetables and fruits provide an array of microchemicals in the form of vitamins and secondary metabolites (phytochemicals) that may lower the risk of chronic disease. Tracing these phytochemicals at physiologic concentrations has been hindered by a lack of quantitative sensitivity for chemically equivalent tracers that could be used safely in healthy people. Accelerator mass spectrometry is a relatively new technique that provides the necessary sensitivity (in attomoles) and measurement precision (<3%) towards 14Clabeled phytochemicals for detailed kinetic studies in humans at dietary levels. [source] Visual and brainstem auditory evoked potentials in children with headachePEDIATRICS INTERNATIONAL, Issue 5 2008Bulent Unay Abstract Background: Headache is a common problem in the pediatric population. The purpose of the present study was to evaluate visual evoked potentials (VEP) and brainstem auditory evoked potentials (BAEP) in children with headache. Methods: Thirty-seven children fulfilling the International Headache Society Criteria for a diagnosis of migraine, 35 children with tension-type headache and 40 healthy children (control group) were enrolled in the study. Results: The mean age of patients and controls was 10.4 years. P100 latency and amplitudes of migraine patients were significantly higher than children with tension-type headache and control subjects. Children with tension-type headache also had higher P100 latency and amplitude values than control subjects but there was no statistical difference. BAEP responses were similar between all groups. Conclusion: Measurement of VEP latency and amplitude is a valuable and reliable test for the diagnosis of migraine and can be used safely in childhood. [source] Public safety aspects of pyrethroid insecticides used in West Nile virus-carrying mosquito control,PEST MANAGEMENT SCIENCE (FORMERLY: PESTICIDE SCIENCE), Issue 7 2007Derek W Gammon Abstract West Nile virus is becoming increasingly prevalent in the USA, causing fever, encephalitis, meningitis and many fatalities. Spread of the disease is reduced by controlling the mosquito vectors by a variety of means, including the use of pyrethroid insecticides, which are currently under scrutiny for potential carcinogenic effects in humans. Pyrethrins and resmethrin, a pyrethroid, have been shown to cause tumours in rat and mouse models respectively. However, the tumours appear to be caused by liver enzyme induction and hypertrophy rather than genotoxicity, and the results are therefore unlikely to be applicable to humans. Nonetheless, for resmethrin, the US Environmental Protection Agency (EPA) has concluded that there is a likely risk of carcinogenicity in humans, requiring the manufacturers to provide more detailed data to prove that it can be used safely in vector control. Reproductive toxicity of resmethrin in the rat is also discussed. Copyright © 2007 Society of Chemical Industry [source] New Enhancements of the Scrotal One-Incision Technique for Placement of Artificial Urinary Sphincter Allow Proximal Cuff PlacementTHE JOURNAL OF SEXUAL MEDICINE, Issue 10 2010Steven K. Wilson MD ABSTRACT Introduction., Urinary incontinence impairs sexual functioning and sexual satisfaction. Traditional artificial urinary sphincter (AUS) implantation requires perineal incision for cuff placement and a second inguinal incision for reservoir and pump placement. We believed AUS could be placed easier and quicker through one scrotal incision. Aim., In an effort to effect more proximal placement of the cuff while keeping the advantages of the one scrotal incision technique, we report enhancements to the original surgical technique. Methods., Thirty patients have been operated upon using the enhanced technique. A modification of the SKW retractor system (AMS) facilitates deep bulbar exposure. Twenty patients were first time implantations and 10 were revisions with five of the revisions having had the original AUS placed by traditional two-incision technique. Two of the first time AUS patients received an inflatable penile prosthesis through the same incision. Main Outcome Measures., We evaluated site of cuff placement, sizes of cuffs used, postoperative continence status. Results., All of the virgin AUS required dissection of the bulbocavernosus muscle prior to cuff placement. In scrotally placed revisions, replacement cuffs were situated considerably proximal (4.5,7.5 cm) to the original cuff site. The perineal placed revisions were accomplished through a scrotal incision with replacement of two cuffs in the same site and the three other patients immediately distal. No intraoperative complications were seen. One patient developed scrotal hematoma requiring drainage. Only 15 patients are available for follow-up and all are socially continent (one pad or less). Conclusions., Transscrotal approach is used safely and efficiently for penile implants and AUS implantation. The new enhancements to the one-scrotal incision technique allow more proximal cuff placement as evidenced by the bulbocavernosus muscle dissection and use of larger cuffs. Continence rate is similar to rates achieved with perineal placement of cuff found in the literature. Wilson SK, Aliotta PJ, Salem EA, and Mulcahy JJ. New enhancements of the scrotal one incision technique for placement of artificial urinary sphincter allow proximal cuff placement. J Sex Med 2010;7:3510,3515. [source] Efficacy of tricaine methanesulphonate and clove oil as anaesthetics for juvenile cobia Rachycentron canadumAQUACULTURE RESEARCH, Issue 7 2009Mariel Gullian Abstract Six experiments were designed to determine the optimal anaesthetic dosage of tricaine methanesulphonate (TMS) and clove oil that could be used safely on juvenile cobia Rachycentron canadum of two sizes [G1=4.9±0.8 g; G2=13.9±3.1 g]. We documented the stage of anaesthesia and the acute toxicity as 96 h LC50 (lethal concentration 50% population) at various exposure times of the two anaesthetics. At 10 min induction time, the TMS 96 h LC50 was 93.9 mg L,1 in G1 and 97.0 mg L,1 in G2. Compared with clove oil, the 96 h LC50 was 60.0 mg L,1 in G1 and 69.8 mg L,1 in G2. The difference between the two groups (G1, G2) did not influence anaesthesia safety (P>0.05). Rachycentron canadum achieved stage 3 anaesthesia more rapidly at a lower clove oil concentration level (40 mg L,1, 10 min) than TMS (60 mg L,1, 10 min), but the recovery period of clove oil, was significantly longer. Clove oil was the most effective in reducing the short-term stress induced by routine biometry (20 mg L,1, 10 min) and also by transporting (1 mg L,1, 8 h). Whereas, for long-term exposure, 40 mg L,1 TMS was found to be safe. [source] Management of recurrent anastomotic stenosis following radical prostatectomy using holmium laser and steroid injectionBJU INTERNATIONAL, Issue 7 2008Ehab Eltahawy OBJECTIVE To present our experience with the management of recurrent and resistant anastomotic stenosis following radical prostatectomy (RP) using transurethral laser incision of the stenotic area and injection of steroids. PATIENTS AND METHODS Between January 1999 and April 2006, we evaluated 24 patients with anastomotic stenosis that would not allow the passage of the flexible cystoscope (17 F). Using the paediatric 7.5 F Olympus scope and a 550-µm fibre holmium laser, deep incisions were cut at the 3 and 9 o'clock positions at the bladder neck, and then triamcinolone was injected at the incision sites. Another session was then scheduled for office cystoscopy 6 weeks later, and if that showed evidence of annularity, another incision was made, as described above. RESULTS All 24 patients had RP for localized disease, 21 were retropubic and two were perineal, and one laparoscopic. Five patients had adjuvant radiotherapy. The mean patient age was 64 years. Nineteen (79%) patients had previous attempts to open the bladder neck: eight patients had dilatation, eight patients had internal urethrotomy, five patients underwent transurethral resection of the bladder neck, and six patients had open surgical intervention. The procedure was done once in 17 patients, and twice in seven patients. After a mean (range) follow up of 24 (6,72) months, 19 patients (83%) had a well-healed and widely patent bladder neck. Of the 24 patients, 17 had urinary incontinence (UI) associated with the bladder neck contracture. An artificial urinary sphincter was implanted in 11 patients, three of which had to be explanted for malfunction in two, and erosion in one. CONCLUSION Holmium laser bladder neck incision and steroid injection for anastomotic stenosis after RP had a success rate of 83% in this small series. It can be used safely as a primary treatment, or in some cases, for resistant and recurrent stenosis. It appears that insertion of an artificial sphincter can be done in patients with UI when the bladder neck remains patent for at least 8 weeks. [source] | ||||||||||||||||