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Selected AbstractsManagement 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] Sex Differences in Salivary Cortisol Levels Following Naltrexone Administration,JOURNAL OF APPLIED BIOBEHAVIORAL RESEARCH, Issue 2 2000Laura Cousino Klein Effects of endogenous opioid peptide blockade by naltrexone on salivary Cortisol levels were examined in healthy men (n= 8) and women (n= 6). Participants received naltrexone (100 mg) during one laboratory session and a placebo pill during another session. Drug order was counterbalanced across participants. Saliva samples were collected 24 hr after each pill was administered. Among women, salivary Cortisol levels significantly increased following naltrexone administration compared with a placebo pill. Naltrexone administration did not alter salivary Cortisol levels in men. Results suggest sex differences in neuroendocrine sensitivity to opioid blockade, a finding that may hold significance with regard to the treatment of alcohol addiction with naltrexone. [source] Decreased portal flow volume increases the area of necrosis caused by radio frequency ablation in pigsLIVER INTERNATIONAL, Issue 3 2007Tsuyoshi Yoshimoto Abstract Background/aims: Although radio frequency ablation (RFA) has been widely accepted as an effective treatment for hepatocellular carcinoma (HCC), severe complications are not uncommon. Major complications seem to occur as a result of over-ablation beyond the intended area. As most patients with HCC have underlying cirrhosis, we speculated that decreased portal flow might cause the necrosis associated with RFA. To confirm this hypothesis, we examined the area of necrosis resulting from RFA under varying conditions of portal flow in a porcine model. Methods: RFA was performed using ultrasonographic guidance in anesthetized pigs. During the RFA procedure, portal flow was regulated by a balloon catheter, which was set in a portal trunk. The necrosis area was measured after sacrifice and was compared with the hyperechoic area that appeared during ablation. In another session, RFA was performed close to the hepatic vein and endothelial damage was examined. Results: The necrosis area caused by RFA was significantly larger when the portal flow volume was decreased by 50% or more. The hyperechoic lesion was always larger than the area of pathological necrosis regardless of portal flow volume. Under conditions of decreased portal flow, the vessel endothelium near the ablated area was more readily damaged. Conclusion: Decreased portal flow volume resulted in enlargement of the area of necrosis caused by RFA. Our results indicate that over-ablation could easily occur in patients with advanced cirrhosis, and that this could lead to major complications. Ultrasonographic guidance may be helpful for avoiding over-ablation. [source] ERP correlates of online monitoring of auditory feedback during vocalizationPSYCHOPHYSIOLOGY, Issue 6 2009Colin S. Hawco Abstract When speakers hear the fundamental frequency (F0) of their voice altered, they shift their F0 in the direction opposite the perturbation. The current study used ERPs to examine sensory processing of short feedback perturbations during an ongoing utterance. In one session, participants produced a vowel at an F0 of their own choosing. In another session, participants matched the F0 of a cue voice. An F0 perturbation of 0, 25, 50, 100, or 200 cents was introduced for 100 ms. A mismatch negativity (MMN) was observed. Differences between sessions were only found for 200-cent perturbations. Reduced compensation when speakers experienced the 200-cent perturbations suggests that this larger perturbation was perceived as externally generated. The presence of an MMN, and no earlier (N100) response suggests that the underlying sensory process used to identify and compensate for errors in mid-utterance may differ from feedback monitoring at utterance onset. [source] |