Long-term experience with controlled expansion cylinders in the AMS 700CX inflatable penile prosthesis and comparison with earlier versions of the Scott inflatable penile prosthesis

OBJECTIVEs. To determine complication and survival rates of the AMS 700CX penile prosthesis and to compare its reliability with earlier versions of the Scott inflatable penile prosthesis. METHODS: Retrospective chart review and telephone interviews were used. RESULTS: Actual 4-year survival of the AMS 700CX device was 85%, whereas earlier versions of the device had actual 4-year survival of 46% (p < 0.0001). The observed difference in prosthesis reliability could not be accounted for by differences in patient population, surgical technique, or incidence of infections. The most significant factor that contributed to improved prosthesis survival was the lack of cylinder complications (leaks and aneurysms). CONCLUSIONS: The controlled expansion cylinders of the AMS 700CX penile prosthesis are a significant advance in reliable, low-morbidity surgical therapy for impotence.     

Fitting a hand-glove prosthesis to enhance the reconstructed mutilated hand

We report a unique case of tubular polyclonal immunoglobulin G (IgG) deposition disease (PIDD) superimposed on diabetic nephropathy in an 84-year-old man presenting with subacute renal failure and proteinuria. The deposits were located exclusively between the tubular epithelial cells and the tubular basement membranes (TBMs) and stained intensely with antisera to IgG heavy chain and both kappa and lambda light chains. Electron microscopy revealed large predominantly extracellular electron-dense deposits with a distinctive curvilinear substructure. The associated light microscopic findings of tubular simplification with features of acute tubular necrosis implicate this tubulopathy as the cause of the acute renal failure. This appears to represent a unique entity that does not fit into any previously described category of renal tubular immune complex or immunoglobulin deposition disease.     

Hip abductor muscle activity in persons with a hip prosthesis while carrying loads in one hand

BACKGROUND AND PURPOSE: Carrying loads in one hand may result in the hip abductor (HA) muscles needing to generate large forces. For a person with a prosthetic hip, these forces may contribute to loosening of the implant. In this study, surface electromyography (EMG) was used to estimate the relative demands placed on the HA muscles as persons with a prosthetic hip carried loads in one hand. SUBJECTS: Twenty-five active subjects (9 female, 16 male) with a prosthetic hip participated. Subjects were aged 40 to 86 years (mean = 63.7, SD = 10.7). METHODS: Surface EMG data from the HA muscles (primarily the gluteus medius) were analyzed during mid-stance as subjects carried loads weighing 5%, 10%, and 15% of their body weight. Loads were carried in the hand opposite the side of the prosthetic hip (contralaterally held loads) or in the hand on the same side as the prosthetic hip (ipsilaterally held loads). RESULTS: Results showed that the contralaterally held loads produced greater HA muscle EMG activity levels than no-load walking. The ipsilaterally held loads produced lower HA muscle EMG activity levels than no-load walking. CONCLUSION AND DISCUSSION: These EMG data, in addition to calculations using a simple biomechanical model, suggest that persons should use caution or avoid carrying loads in the hand on the side contralateral to their prosthetic hip.     

Fifteen-year experience in axillofemoral bypass with externally supported knitted Dacron prosthesis in a Japanese hospital

Physicians and patients need convenient access to quality medical information. This study's goal was to place a medical resource on the World-Wide Web (WWW), allow access to it through a simple to use interface, and analyze the usage of such a resource. The Family Practice Handbook (TFPH) was digitized and placed onto the WWW. Usage data was obtained from June 1995-June 1996. 118,804 individuals accessed TFPH viewing 409,711 pages of information. A broad spectrum of topics was accessed. TFPH proved to be an extremely popular resource, servicing the broad information needs of an international audience. These preliminary findings suggest the future promise of Internet medical resources.     

Preliminary clinical experience with a new fluted humeral nail

The anterior jejunum from common vole naturally infected with Giardia microti (Kofoid et Christiansen, 1915) was examined by TEM and compared with the anterior jejunum from control (metronidazole-treated, Giardia-free) common voles (Pallas, 1778). Giardia microti infection resulted in significant diffuse shortening of microvilli and significant greater microvillous diameters. In addition, deformations of the microvilli were observed at the margin of the ventral disc. The microvilli attached to the lateral crest of the ventral disc were vesiculated with a disorganised filamentous core and contained whorled structures resembling "myelin-like figures". The findings are discussed in context of the Giardia-epithelial cell interaction.     

Developing sexual health software incorporating user feedback: a British experience

This article describes an interactive prototyping model for development of four computer software modules for British youth on sexual issues. An iterative cycle of development, user review and feedback, and subsequent modification and retesting was used with approximately 150 young adults, with particular attention to presentation style, screen design, usability, relevance of material, enjoyment, and learning. The software was designed to be realistically accommodated in school settings, to be used as a reference tool by students working alone or in a group teaching situation. Feedback from youth and adults attests to the feasibility of development, implementation, and instructional usefulness. Interactive prototyping proved essential in the face of skepticism from teachers concerning young people's information needs and acceptance of a computerized educational approach.     

A controlled study of quantitative feedback in married-couples brief group psychotherapy.

Investigated the impact of delayed, written feedback on the process and outcome of brief group psychotherapy for married couples using a 2-group, 2-stage design. 12 18–36 yr old heterosexual couples participated. Results show that (1) feedback variables showed more significant changes in expected directions than did the nonfeedback variables; (2) therapy plus feedback, in contrast to therapy alone, led to the assessment of greater behavioral change; (3) therapy plus feedback was a more effective tool than therapy alone for increasing the degree of congruence between self and peer ratings, and between self and therapist ratings. (28 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Teaching reading to disabled readers with language disorders: a controlled evaluation of synthetic speech feedback

In a long-term study two groups of language and reading impaired students (N = 15 + 15) were reading with the aid of segmented speech-feedback in a computerized program. One group received feedback that was simultaneously segmented visually and auditorily into syllables, the other received feedback by letter names. In both groups subjects were expected to synthesize segments into words and to compare their synthesis to whole word feed-back subsequently provided by the computer. They worked for half a lesson (approximately 20 minutes) a day for a total of 40 days. During this period the experiment groups progressed more in reading than a control group of age and reading-level-matched students (N = 35) who received traditional remedial instruction. The group in the syllable condition gained slightly more in non-word reading and in syllable segmentation than did the letter group. Differences in gains in reading abilities were not explained by differences in age, but to some extent by initial level of phoneme and syllable awareness. Future applications of the speech-feedback system are discussed.     

Four years' experience of valve replacement with the Bj?rk-Shiley tilting-disc prosthesis

105 valve replacements with the Bj?rk-Shiley tilting-disc prosthesis have been performed in 99 patients with an overall mortality of 12%. The hospital mortality for 73 single aortic valve replacements was 10%, for 24 single mitral valve replacements 13%, and for 5 double valve operations 20%. One late death (1%) occurred in a case with single aortic valve replacement. The follow-up period of the first patients with aortic valve replacement is 4 1/2 years, and that of those with mitral valve replacement over 2 1/2 years. The most common late complication in patients with mitral valve replacement was a paravalvular leak (19%), whereas in patients with aortic valve replacement slight haemolytic anaemia (4%) and late thromboembolism (3%) occurred most frequently. 84 of the 87 survivors showed manifest clinical improvement in their preoperative status and increased exercise tolerance.     

Ten years experience with cervicocapital prosthesis of the femur (author''s transl)]

A long-term survey (mean follow-up greater than 12 years) is presented of cord injury patients with reflux up to the kidney (grades 2 and 3). Of 39 patients 17 developed renal damage. There is no evidence that permanent urethral catheters protect kidneys from subsequent damage.     

Paroxetine: a review of clinical experience

The selective serotonin reuptake inhibitor paroxetine has been extensively studied and is now an established therapy for the treatment of depressive disorders. Paroxetine has demonstrated efficacy in major depression in both young and elderly patients, with an improved tolerability profile over conventional antidepressants. Paroxetine is effective across a continuum of anxiety and depressive disorders, including severe depression, depression with anxiety, comorbid depression and obsessive-compulsive disorder. The first agent of its class licensed for use in panic disorder, paroxetine has been shown to be effective in reducing the number of panic attacks and preventing relapse. A worldwide clinical database has established that paroxetine has a benign adverse event profile. Paroxetine therefore offers an effective and well tolerated treatment for a broad spectrum of psychiatric disorders.     

Efficacy of web-based personalized normative feedback: A two-year randomized controlled trial.

Objective: Web-based brief alcohol interventions have the potential to reach a large number of individuals at low cost; however, few controlled evaluations have been conducted to date. The present study was designed to evaluate the efficacy of gender-specific versus gender-nonspecific personalized normative feedback (PNF) with single versus biannual administration in a 2-year randomized controlled trial targeting a large sample of heavy-drinking college students. Method: Participants included 818 freshmen (57.6% women; 42% non-Caucasian) who reported 1 or more heavy-drinking episodes in the previous month at baseline. Participants were randomly assigned in a 2 (gender-specific vs. gender-nonspecific PNF) × 2 (single vs. biannual administration of PNF) + 1 (attention control) design. Assessments occurred every 6 months for a 2-year period. Results: Results from hierarchical generalized linear models provided modest effects on weekly drinking and alcohol-related problems but not on heavy episodic drinking. Relative to control, gender-specific biannual PNF was associated with reductions over time in weekly drinking (d = ?0.16, 95% CI [?0.02, ?0.31]), and this effect was partially mediated by changes in perceived norms. For women, but not men, gender-specific biannual PNF was associated with reductions over time in alcohol-related problems relative to control (d = ?0.29, 95% CI [?0.15, ?0.58]). Few other effects were evident. Conclusions: The present research provides modest support for the use of biannually administered web-based gender-specific PNF as an alternative to more costly indicated prevention strategies. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Is the randomized controlled trial overvalued as a basis for clinical decision-making? A review with comments

The randomized controlled trial (RCT) may have considerable limitations in clinical research. Lacking the possibility of blinding impairs the internal validity of the trials. The external validity is often impaired, as results of RCTs obtained in an ideal situation, may be difficult to generalize to a clinical routine situation. Pragmatic randomized trials move from ideal situations towards routine situations, and by modifying the design it is possible to reduce selection bias due to patient and physician preferences. Quasi-experimental studies have varying degrees of problems with internal validity but are necessary contributions to our knowledge of the effect of treatment in clinical routine situations. Limitations of the usefulness of RCTs as well as pragmatic and quasi-experimental studies in clinical research make it necessary to recognise that different methods complement one another. Research in development of RCTs and new methods in clinical research should be encouraged.     

Management of severe childhood hypertension with minoxidil: a controlled clinical study

The therapeutic efficacy of four antihypertensive regimens (minoxidil, propranolol, and hydrochlorothiazide; propranolol and hydrochlorothiazide; methyldopa and hydroch-orothiazide; and hydrochlorothiazide alone) was evaluated in one child with systolic hypertension and in eight children with systolic and diastolic hypertension. The mean blood pressure of 148/98+/-8/4 mm Hg observed during the hydrochlorothiazide control period fell to 142/88+/-8/4 mm Hg following methyldopa and hydrochlorothiazide, 141/85+/-6/2 mm Hg following propranolol and hydrochlorothiazide, and 128/74+/-4/2 mm Hg following minoxidil, propranolol, and hydrochlorothiazide. The only side effect directly associated with administration of minoxidil was hypertrichosis. The effectiveness of minoxidil in the present study suggests that this drug offers an important adjunct to current antihypertensive therapy in children.     

Naftifin--laboratory and clinical experience with a new antimycotic from the allylamine group

The authors evaluated the effectiveness of naftifin on a broad spectrum of 42 types of agents causing mycoses. Using the microdilution method, the authors assessed minimal inhibiting concentrations (MIC) of this antimycotic agent in 107 clinical isolates. Naftifin displayed a selective antifungal activity: excellent sensitivity was found in dermatophytes (MIC 90% = 0.39 mg.l-1), Aspergillae were medium sensitive (MIC = 0.09-12.5 mg.l-1). The majority of yeasts and filamentous fungi from the group of Zygomycetes was resistant to naftifin. The therapeutic results in 57 subjects with dermatomycoses corresponded to the results of in vitro tests of the antimycotic agent. Most successful as treatment of dermatophytoses at extra-intertriginous sites and treatment of pityriasis versicolor; manifestation of candidoses were not affected. The commercial preparation used--Fetimin cream--is considered by the authors a suitable alternative of hitherto used local antimycotics, in particular preparations from the azole series.     

A clinical, radiological and biomechanical study of the TARA hip prosthesis

We reviewed 60 patients with 72 TARA (total articular replacement arthroplasty) resurfacing hip prostheses. To analyse the behaviour of the femoral component a radiographic study was done and a two-dimensional finite element model was constructed. The stem of the femoral component plays a role in the load transfer mechanism. Stress shielding is seen in the proximal femur but depends on the interface conditions. When only the dome of the cup is assumed to be bonded to the bone, the stresses in the head increase dramatically and there is no more stress shielding. Five years after implantation radiographic signs of loosening of the femoral component were seen in 6.8% of the implants placed without notching in the femoral neck and in 28.6% of the components with notching (significant difference, P = 0.0005). Signs of loosening of the acetabular component were seen in 37.7% 5 years postoperatively. The cumulative survival rates of the femoral and acetabular components were 89.7% and 85.6% respectively 5 years after implantation. The overall clinical results are represented by an integration of the clinical results (Harris Hip Score System), the radiographic results and the survival analysis. This gave a success rate of only 72% 5 years after implantation.