Massive hemospermia: a new etiology and simplified treatment

Hemospermia is a common urologic symptom that is usually benign and self-limited, and required no clinical investigation. Massive hemospermia causing hematuria, with clot formation and occasional urinary retention, occurs in a subset of patients. Three patients are reported in whom cystourethroscopy demonstrated nonvaricose abnormal posterior urethral vessels. Treatment consisted of fulguration of the vessels. One patient was cured, 1 had no symptoms for 3 years and 1 improved slightly. Endoscopically, this is a safe simple outpatient surgical procedure that is recommended for massive hemospermia due to abnormal posterior urethral vessels.     

Program evaluation in the public interest: a new research methodology

For every social welfare or social control service program there are several parties, each with different interests: patients, clients, staff, management, and sponsors. Evaluation of such a program in the public interest must take the interests of these parties into account. To do so requires an untraditional methodology, that of a second-person, or communal, science, which is not above the conflict of parties and their interests in specifying the variables, staffing the research, balancing considerations of intrusion against those of bias, considering the action implications of the data, sequentially staging the research, or even publishing findings. This all makes evaluation in the public interest a highly political process often unlikely to be logically decisive about intervariable relationships, to yield generalizable results, or even to be completed.     

Altered passive eruption: an etiology of short clinical crowns

The gingival complex plays a vital role in the overall beauty of a smile. To predictably achieve a successful esthetic and functional result, the dentist must be able to precisely predict the treatment outcome based on biologic determinants. In this article, the biologic requirements for gingival health are discussed. In addition, a differential diagnosis for excess gingival display and treatment options for this condition are discussed.     

Mitral regurgitation: a new clinical perspective

Mitral regurgitation is a common valvular heart disease, particularly in the elderly population. The timing of surgical repair is controversial, but recent literature suggests a new clinical perspective on the management of this disease. Despite receiving medical treatment and having few initial symptoms, patients with mitral regurgitation due to flail leaflets have an excess mortality rate (6.3% per year) and high morbidity. Ten years after mitral regurgitation has been diagnosed, 90% of the patients have either died or undergone an operation. After surgical correction of mitral regurgitation, left ventricular dysfunction is a frequent complication and is the cause of excess heart failure and mortality. This complication is due to preoperative left ventricular dysfunction but is incompletely predictable with use of current methods. Conversely, considerable progress in surgery has resulted in an extremely low operative mortality rate (about 1% in patients younger than 75 years of age) and high feasibility of valve repair, even in patients with anterior leaflet prolapse. These facts have led to the new perspective that early surgical correction (before occurrence of overt symptoms or left ventricular dysfunction) should be considered when patients are diagnosed with severe mitral regurgitation.     

Microchemical analytical techniques of potential clinical interest

Microchemical techniques with the capability of single-cell analysis will become increasingly important in clinical laboratory practice. One of the current moves underway in this direction is determination of enzyme activities of cells by microscale spectrophotometry and spectrophotofluorometry for prenatal diagnosis of inherited enzyme deficiencies. Three less-common microanalytical techniques are considered here that are of potential interest in laboratory medicine. The first is dilatometry, which provides a means for enzyme or substrate assay involving measurement of the change in volume or density accompanying chemical reaction in solution. In this connection, the measurement of specific gravity itself to obtain certain chemical information is also of interest. The second of these techniques is the use of spectrophotometry to measure oxygen uptake for functional assays of cells. The third is the use of luminometry in a general system of analysis for determination of many important biochemical substances and activities. Each of these techniques can be used for microscale analysis without sacrifice of precision or accuracy; each is relatively simple, instrumentally ant technically, and could be automated.     

Reworded versus new interest items.

In revising the SVIB, 49 items were reworded and 101 items were replaced by new ones. The change in content between the original and reworded items was judged too slight to affect scoring of these items using current weights. The change in content between the original items and new items was judged too significant to allow these items to be scored on existing scales using current weights. To determine whether these judgments were correct, control and experimental groups responded to the items in a test-retest situation with a 3-day interval. 3 measures of stability agreed very well but not perfectly. An average of the 3 procedures indicated that 10 of the 49 reworded items should be classified as new instead of reworded. The criterion, stability of items, is a useful one in the selection of new items. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Anaphylaxis: clinical aspects, etiology and course in 118 patients

Systemic anaphylaxis is a potentially life-threatening clinical syndrome resulting from the release of biologically active substances such as histamine or prostaglandins upon a target organ. The aims of our study were to analyze clinical data, causative agents and follow-up in subjects with severe anaphylaxis. Of 5689 subjects who were referred from May 1994 through October 1996 to the allergy-immunology out-patient clinic of the University of Berne, 118 (2.1%; 68 females and 50 males; mean age 41 years) had experienced severe systemic anaphylaxis with hypotension, loss of consciousness or shock. 104 individuals (88.1%) showed accompanying dermal symptoms, 85 (72.0%) respiratory and 52 (44.1%) gastrointestinal signs. Causative agents were identified in 93.2% of these attacks; they included drugs (33.9%), insect stings (23.7%), foods (18.6%), exercise (8.5%), latex (7.6%), and immunotherapy (0.9%) with pollen extracts. A suspected cause could not be determined in 8 subjects. Atopy was present in 64 individuals (54%). Prior to the index anaphylaxis, 21 of 110 subjects (19.1%) with an identified cause had experienced more than one episode of anaphylaxis. Follow-up survey showed that 29 of these 110 individuals (26.4%) were accidentally reexposed to the causative agents. 19 of 24 patients (79.2%) used their emergency kits, while 5 were not equipped with. Only one severe systemic reaction occurred in a subject who intentionally reexposed himself to the identified cause of anaphylaxis. Besides cardiovascular symptoms, systemic anaphylaxis most often involves the skin and respiratory tract. Since prevention of anaphylaxis focuses upon avoidance of precipitating factors, all individuals with anaphylaxis should be referred to an allergologist for identification of the causative agents. The cause of anaphylaxis could be determined in the majority of patients with anaphylaxis. However, unexpected exposures are frequent. Thus, all patients who have had one or more episodes of anaphylaxis should carry an emergency kit for self-administration, and should be instructed in its use.     

Anejaculation: its etiology and pathogenesis, classification and clinical aspects

43 patients suffering from anejaculation were treated in 1983-1993 in the department of andrology of the N. A. Semashko Medical Institute urological clinic. Most commonly anejaculation is caused by prostatic and bladder neck surgery (25.6%), diabetes mellitus (18.6%) and presents as retrograde ejaculation, impaired sperm emission into the urethra, aspermatism (51.2, 27.9, 20.9% of patients, respectively). The leading pathogenetic factors are peripheral neuropathy, surgical injury to the bladder internal sphincter, psychosexual disorders. The authors propose classification and algorithm of the patients' examination to facilitate and enhance diagnosis. Special attention should be given to the presence or absence of orgasm, after-orgasm occurrence of spermatozoa in urine. Anejaculation treatment outcomes remain unsatisfactory. Good responses were achieved with selective adrenomimetic gutron, laser therapy and electrovibration. Prevention of anejaculation should be given more attention.     

Infectious diseases in athletes: new interest for an old problem

Interest in infectious disease among athletes has been greatly stimulated over the past decade by the development of modern automated systems that can enumerate specific elements of the immune system. Research has confirmed earlier clinical and animal studies in showing that either a single bout of exhausting exercise or persistent over-training can increase susceptibility to upper respiratory and other viral infections, although resistance to bacterial infections is apparently unaltered. Such findings do not seem a non-specific response to cooling and drying of the tracheal mucosa. Rather, heavy exercise has a depressant effect upon the T cell/interleukin/NK cell system which may persist for a week or more. In contrast, moderate training enhances immune defences. Given the negative impact of acute viral infections upon both competitive performance and morale, plus the occasional incident of sudden death associated with viral myocarditis, it is important that sports physicians minimize the incidence of viral infections in the athletes for whom they are responsible. Potential tactics include maintenance of immunization schedules, minimizing of exposure to infection, avoidance of over-training, maintenance of an adequate diet, and reduction of psychological and environmental stress. In top athletes, the regular monitoring of immune status may also be warranted, with the possible administration of immunoglobulins and prostaglandin inhibitors as required.     

"Integrated psychotherapy": a new clinical challenge

Integrated psychotherapy according to Barolin wants to be embedded in the general health system and regards the whole "bio-psychosocial entity of man" using psychical means, which can take psychotropic as well as somatotropic effect. It should come out of an isolated ivory tower and seek coordination with each and everyone dealing with the "human entity": medical (like medication, physiotherapy, etc.), nursing, social work, administration, etc. Psychotherapeutic "schools" should serve as a solid base of learning. Practical use however should go beyond schools: patient-centered instead of school-centered. Integrated psychotherapy should reach all persons who need it, within their somatogenic and psychogenic problems, especially the physical ill, up to accompaniment of the dying, especially in rehabilitation, including social environment, old-age groups. For this it needs social integration accepting economic responsibility (in the sense of "social ethics") plus evaluation. Hence, theory and practice of integrated psychotherapy find themselves linked to a higher human-ethical postulate, with a marked communicative component.     

Zonular function: a new hypothesis with clinical implications

Fifty-nine patients with mandibular fractures were treated making use of intravenous laser irradiation of the blood. Laser exposure had a marked antiinflammatory and analgesic effect, compensated for changes in disordered immunity status, and normalized red cell membrane structure and function as well as its energy supply.     

Multi-centre clinical respiratory research: a new approach?

BACKGROUND: Recruitment to clinical trials organised by the research committee of the British Thoracic Society (BTS) has declined. We suspected that this was due to increasing workloads for consultant physicians in the National Health Service (NHS). We investigated possible causes in study 1 and a possible solution in study 2. METHODS: Study 1--a questionnaire was sent to BTS members listing possible factors that might deter them from entering patients into trials. These were scored on a 0-5 scale. Study 2--we set up 13 panels of experts to cover all major fields of respiratory medicine. They were asked to design projects that would address the most important research questions that could be answered by multi-centre clinical trials. We sent 11 projects for scoring to consultant members of the BTS who were asked to score them on scientific merit and on their ability to contribute patients to the study. RESULTS: Study 1--of the 59% of consultants who responded, 77% said that competition with increasing demands on their time was the major reason for not participating. Study 2--40% of consultants returned project scores. Three projects were subsequently selected for grant application. CONCLUSIONS: Clinical research in the UK is under threat from increasing workloads on consultants. One solution to this problem is a national approach to commission major projects. The most important clinical research questions might then still be answered in the limited time available to consultants.     

Hirschsprung''s disease: a search for etiology

Expression of proliferating cell nuclear antigen (PCNA) as well as p53, bcl-2 and C-erb B-2 genes protein products on Reed-Sternberg/Hodgkin's (R-S/H) cells was analyzed by immunohistochemistry in 65 patients with Hodgkin's disease (HD). Their significance as markers of clinical malignancy and prognostic factors was evaluated. Positive reaction for PCNA was present in 57 cases (87.7%), for p53 in 42 (64.6%), for bcl-2 in 41 (63.1%), and for C-erb B-2 in 38 cases (58.5%) of HD. The high proliferate PCNA index and high expression of p53 and bcl-2 correlated with poor response to the treatment. Expression of both p53 and bcl-2 oncoproteins negatively influenced overall survival and disease free survival. Indexes of PCNA, p53 and bcl-2 were significantly higher in patients with advanced disease then in early clinical stages. In LP type of HD the lowest indexes of PCNA or bcl-2, and even lack of bcl-2 expression on R-S/H cells were observed. There was no correlation between expression of C-erb B-2 and response to the treatment, time of survival, clinical stage or histopathological types of HD. Statistical analysis let us to the conclusion, that indexes of PCNA, p53 and bcl-2 expression can be taken into consideration as a new prognostic factors in Hodgkin's disease. C-erb B-2 protein expression seems to be of no value for prognosis in HD.     

Toothache with a multifactorial etiology: a case report

A case report of orofacial pain originating from both dental and nondental conditions is presented. The spontaneous throbbing pain initiated from the left maxillary second premolar and spread throughout the entire upper part of the face to the frontoparietal area. Root canal treatment of the maxillary second premolar did not resolve the chief complaint. Magnetic resonance imaging examination revealed hypertrophy of the left inferior turbinate and soft tissue haziness in the left maxillary sinus floor. After antrostomy, submucosal turbinectomy, and endodontic treatment, the patient was free from pain. The final diagnosis of this case, in addition to pulpitis, was maxillary sinusitis with chronic rhinitis. The multiple factors associated with the etiology made the diagnosis difficult. The mechanism of referred pain from the maxillary sinus and paranasal mucosa to the maxillary teeth and face is discussed.     

Myocarditis. Epidemiology, etiology and clinical aspects

The term myocarditis covers a diversity of pathological conditions. Aetiologically, the best documented is acute infective myocarditis, predominantly caused by enteroviruses, particularly Coxsackie B. However, there are many possible sources of infection, and the management of immunosuppressed patients requires careful deliberation. Research into the pathogenesis of viral myocarditis has made formidable advances and provided detailed knowledge of the mechanisms responsible for myocardial damage. Microbiological techniques have yielded evidence of the involvement of Coxsackie viruses in the development of dilated cardiomyopathy. Nowadays, the term myocarditis has a strictly histopathological definition which is clinically applicable only in the few cases where endomyocardial biopsy is performed. The diagnosis, acute infective myocarditis, can usually be made with reasonable certainty on the basis of ECG findings and the serum concentrations of biochemical markers. Physical diagnostic procedures, particularly echocardiography, can provide useful supporting evidence. Prognosis is generally good in cases of acute infective myocarditis, whereas that in other forms of myocarditis varies from case to case. To date, antiviral agents have no established place in the treatment of viral myocarditis. Where diagnosis is based upon endomyocardial biopsy (e.g., in lymphocytic myocarditis), immunosuppressive therapy generally has no significant effect.