Reaction time does not predict surgical skill.
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Adult↗
Biomedical subjects
J Shah
Publications and source records attributed to J Shah.
Isolated solitary vertebral body tuberculosis--study of seven cases.
AIM: To describe the magnetic resonance imaging (MRI) findings in isolated solitary vertebral body tuberculosis. Also to emphasize tuberculosis as an important entity, besides neoplasms, in the differential diagnosis of pathologies involving a single vertebral body. MATERIAL AND METHODS: The clinical and imaging features of seven patients (four men and three women; age range 18-60 years), with proved solitary vertebral body tuberculosis were retrospectively studied. RESULTS: Isolated solitary vertebral body tuberculosis is seen in only 1.69% of the total proven cases of spine tuberculosis seen in our institute between 1993 and 2002. All patients presented with constitutional symptoms and localized pain and tenderness. MRI showed decreased signal intensity on T1-weighted images and increased signal intensity on T2-weighted images. Cortical break was seen in three patients of whom epidural and pre-vertebral extensions were seen in one each. CONCLUSIONS: Although tuberculosis affecting a solitary vertebral body is rare it should be considered as an important differential diagnosis, besides neoplasms. In these cases MRI serves as the best imaging technique available for diagnosis. However, confirmation can only be made on histopathology or culture of the specimen.
Adolescent↗
Urology in perspective.
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Education, Medical↗
Prevention of postoperative nausea and vomiting after spinal morphine for Caesarean section: comparison of cyclizine, dexamethasone and placebo.
BACKGROUND: Low-dose intrathecal (spinal) morphine (0.1-0.2 mg) for Caesarean section delivers excellent postoperative analgesia but is associated with significant nausea and vomiting. We compared the antiemetic efficacy of cyclizine, dexamethasone, and placebo in this clinical setting. METHODS: Ninety-nine women undergoing elective Caesarean section under spinal anaesthesia were allocated randomly, in a double-blind study design, to receive either cyclizine 50 mg, dexamethasone 8 mg, or placebo as a single-dose infusion in saline 0.9%, 100 ml on completion of surgery. Spinal anaesthesia consisted of: hyperbaric bupivacaine 0.5%, 2.0 ml; fentanyl 10 micro g; and spinal morphine 0.2 mg. The primary outcome measure was the incidence of nausea. RESULTS: The incidence of nausea was significantly less in patients receiving cyclizine compared with dexamethasone and placebo (33 vs 60 and 67%, respectively, P<0.05). Severity of nausea and number of vomiting episodes were also less at 3-6 h in cyclizine patients. Overall satisfaction with postoperative care at 24 h, expressed on a 100 mm visual analogue scale, was greater in cyclizine [78 (28)] than either dexamethasone [58 (31), P=0.03] or placebo [51 (28), P=0.008]. CONCLUSION: We conclude that following spinal morphine 0.2 mg and fentanyl 10 micro g analgesia for Caesarean section, cyclizine 50 mg i.v. reduces the incidence of nausea compared with dexamethasone 8 mg i.v. or placebo. It also lessens the severity of nausea and vomiting, and increases maternal satisfaction in the early postoperative period.
Adult↗
A rare complication of a prostatic stent.
We describe a case in which an elderly man with deteriorating lower urinary tract symptoms had problems with an indwelling prostatic stent. We discuss the merits of prostatic stents and recommend indications for their use.
Aged↗
Validation of a web-based training tool for lumbar puncture.
WebSET is an Internet based educational tool that can be used on any standard personal computer. It has been developed by a European collaboration and integrates high quality courseware, self-assessment exercises, video clips and VR simulation. This pilot study was carried out to validate the lumbar puncture (LP) module in training. Subjects who had never performed an LP participated in the study. The subjects were randomized into 2 groups: 1) underwent training and 2) control group. Both groups performed a pre-test and post-test LP on a synthetic mannequin. There was a significant improvement in the training group in terms of performance assessment as compared to the control group. This study showed that there was a significant improvement in the performance of the procedure and in procedural knowledge after training with WebSET.
Computer Simulation↗
Undergraduate urology: a survey of current provisions and guidelines for a core curriculum.
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Curriculum↗
Male genital tract injuries after contemporary inguinal hernia repair.
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Genitalia, Male↗
Erectile dysfunction through the ages.
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Aphrodisiacs↗
Can shoe size predict penile length?
OBJECTIVE: To establish if the 'myth' about whether the size of a man's penis can be estimated from his shoe size has any basis, in fact. SUBJECTS AND METHODS: Two urologists measured the stretched penile length of 104 men in a prospective study and related this to their shoe size. RESULTS: The median stretched penile length for the sampled population was 13 cm and the median UK shoe size was 9 (European 43). There was no statistically significant correlation between shoe size and stretched penile length. CONCLUSION: The supposed association of penile length and shoe size has no scientific basis.
Adolescent↗
Validation of a flexible cystoscopy course.
OBJECTIVE: To examine the instructional effectiveness of a course for nurses wishing to learn flexible cystoscopy, using a virtual reality flexible cystoscopy simulator to measure the outcome. SUBJECTS AND METHODS: Fourteen urology nurse practitioners with no previous experience of cystoscopy were taught the basic techniques of flexible cystoscopy. They then had supervised group instruction during which they practised flexible cystoscopy on an inanimate latex model, and were taught how to handle the cystoscope, followed by unsupervised practice, including use of the virtual reality (VR) simulator (URO Mentor, Simbionix, Israel). They then undertook a cystoscopy task on the simulator; within the bladder there were 10 flags (numbered 1-10) at key positions. By visualizing and photographing each of the flags the subject would have visualized the entire bladder mucosa. The number of flags seen was thus used as a measure of how much of the bladder mucosa was examined. The VR simulator also measured the total procedure time. After a day of training the subjects were reassessed and the changes in performance evaluated. Subjects were also asked their opinion of the use of VR for flexible cystoscopy. RESULTS: The median (range) time to complete the procedure before the course was 3.33 (2-5.5) min and the number of flags seen 7 (6-9). After the course, the median time decreased to 2.85 (1.5-4.42) min and the number of flags seen increased to 8 (6-9). The change in time was significant (P = 0.03) but the difference in the number of flags was not (P = 0.12). All 14 subjects enjoyed the use of VR for learning flexible cystoscopy; they all reported that they were more confident in handling a flexible cystoscope and in undertaking flexible cystoscopy. CONCLUSION: The virtual reality simulator was an effecctive tool for teaching flexible cystoscopy.
Adult↗
Virtual reality flexible cystoscopy: a validation study.
OBJECTIVES: To validate a flexible cystoscopy simulator by determining if it could differentiate between expert and novice cystoscopists. SUBJECTS AND METHODS: Seventeen subjects (10 novices with no previous endoscopic experience and seven urologists who had all carried out > 1000 flexible cystoscopies each) were asked to undertake a flexible cystoscopy task on the URO Mentor (Simbionix, Israel) virtual reality (VR) machine. In the task used the bladder mucosa has 10 flags (numbered 1-10) at key positions in the bladder; by visualizing each of the 10 flags and photographing them the subject will have indirectly visualized the entire mucosa. Subjects were asked to carry out the task 10 times, to allow their rate of acquisition of skill to be assessed. The total time taken for the task and the number of flags visualized were used as measures of performance. RESULTS: The experienced urologists were significantly better at flexible cystoscopy than the medical students on the first trial for the mean number of flags seen (9.57 vs 8.0, P = 0.01) and the mean time to complete the task (2.33 vs 4.89 min, P = 0.03). At the 10th trial there was still a significant difference for the time taken, between the medical students and the urologists (2.33 vs 0.81 min, P = 0.01) but not for the number of flags seen (9.2 vs 9.6, P = 0.46). The medical students improved between the first and the 10th attempt, being significantly quicker for trial 10 than trial 1 (P = 0.005). However, although the medical students appeared to see more flags (8.0 vs 9.2) this was not significant (P = 0.05). The urologists did not differ in the number of flags visualized between the first and 10th trial, although they were significantly quicker in completing the task (P = 0.02). The urologists were significantly faster in trial 2 than trial 1, but no faster thereafter (P = 0.04). CONCLUSIONS: Using the URO Mentor simulator, it was possible to assess the level of experience of flexible cystoscopy, and therefore the system has construct validity. As in the real situation there is a period of learning during which the subject becomes familiar with the computer/machine/human interface, the task and the handling of the instruments. These results support the view that there is a role for VR simulators in urological training.
Clinical Competence↗
Increased first-trimester nuchal translucency as a prenatal manifestation of salt-wasting congenital adrenal hyperplasia.
Congenital adrenal hyperplasia (CAH) is an autosomal recessive disorder that results from a deficiency in one or other of the five enzymes of cortisol biosynthesis. The most common form of CAH is 21-hydroxylase deficiency (21-OHD) and this may be manifest clinically in the neonatal period as a life threatening salt-wasting condition along side genital ambiguity. Prenatal diagnosis is available for CAH, however, there is poor correlation between the specific genotype and the phenotypic expression of the condition. We report two cases of severe salt-wasting CAH in one family that presented in both pregnancies with increased nuchal translucency (NT) in the first trimester. This is the first report of the association, between increased NT and CAH 21-OHD.
Adrenal Hyperplasia, Congenital↗
Rectal salami.
We present the case of a 63-year-old man who had inserted a salami into his anal canal for sexual stimulation--the commonest reason for inserting foreign bodies--and who subsequently required a laparotomy for its removal. This common surgical problem requires a thorough medical history, an examination and the use of radiographs for management. Current techniques for removal of such objects are discussed.
Foreign Bodies↗
A fatty acid desaturase modulates the activation of defense signaling pathways in plants.
Salicylic acid (SA) plays an important role in activating various plant defense responses, including expression of the pathogenesis-related (PR) genes and systemic acquired resistance. A critical positive regulator of the SA signaling pathway in Arabidopsis is encoded by the NPR1 gene. However, there is growing evidence that NPR1-independent pathways can also activate PR expression and disease resistance. To elucidate the components associated with NPR1-independent defense signaling, we isolated a suppressor of the npr1-5 allele, designated ssi2. The recessive ssi2 mutation confers constitutive PR gene expression, spontaneous lesion formation, and enhanced resistance to Peronospora parasitica. In contrast, a subset of defense responses regulated by the jasmonic acid (JA) signaling pathway, including expression of the defensin gene PDF1.2 and resistance to Botrytis cinerea, is impaired in ssi2 plants. With the use of a map-based approach, the SSI2 gene was cloned and shown to encode a stearoyl-ACP desaturase (S-ACP DES). S-ACP DES is an archetypical member of a family of soluble fatty acid (FA) desaturases; these enzymes play an important role in regulating the overall level of desaturated FAs in the cell. The activity of mutant S-ACP DES enzyme was reduced 10-fold, resulting in elevation of the 18:0 FA content in ssi2 plants. Because reduced S-ACP DES activity leads to the induction of certain defense responses and the inhibition of others, we propose that a FA-derived signal modulates crosstalk between different defense signaling pathways.
Amino Acid Sequence↗
Volumetric MRI, pathological, and neuropsychological progression in hippocampal sclerosis.
OBJECTIVE: To examine the relationships between age at onset and duration of seizure disorder with severity of hippocampal sclerosis (HS) and cognitive functioning in patients with HS and unilateral temporal lobe epilepsy. METHODS: Twenty-six subjects had left temporal lobe seizure onset; 20 had right temporal onset. Measures were age at seizure onset, duration of seizure disorder divided by age (seizure duration), history of febrile convulsion (FC), ratio of the smaller hippocampal volume to the larger (HF) as determined by volumetric MRI, and pathologic HS grade. RESULTS: Results showed that pathologic HS grade and HF were positively related to seizure duration, and negatively related to seizure onset. When subjects were divided into onset prior to age 10 versus later, subjects with earlier onset had higher mean pathologic HS grade and smaller (more asymmetric) mean HF. When subjects were divided into seizure duration <0.5 (i.e., less than half current lifetime) vs greater, subjects with seizure duration > or =0.5 had higher mean pathologic HS grade and lower mean HF. There was also evidence for earlier age at seizure onset and longer seizure duration being associated with worse performance on neuropsychological measures. FC was not related to either seizure duration or age at seizure onset, but patients with a history of FC showed higher pathologic HS grade and lower HF. A history of FC was not related to cognitive functioning. CONCLUSIONS: Unilateral HS patients with earlier seizure onset and longer duration of epilepsy have more severe HS and greater hippocampal volume asymmetry. This suggests that HS may be a progressive disorder with risk for cognitive dysfunction.
Adolescent↗
Relationship of flumazenil and glucose PET abnormalities to neocortical epilepsy surgery outcome.
BACKGROUND: Cortical areas showing abnormal glucose metabolism and [(11)C]flumazenil (FMZ) binding are commonly seen on PET scans of patients with intractable partial epilepsy, but it is unclear whether these must be totally resected to achieve seizure control. OBJECTIVE: To analyze whether the extent of cortex showing 2-deoxy-2-[(18)F]fluoro-D-glucose (FDG) or FMZ PET abnormalities correlates with the outcome of resective epilepsy surgery. METHODS: Cortical FDG and FMZ PET abnormalities in 15 young patients (mean age, 12.2 +/- 7.0 years) with intractable partial epilepsy of neocortical origin were marked as regions with abnormal asymmetry using an objective semiautomated software package. These marked regions were then projected and measured on the brain surface reconstructed from the coregistered high-resolution MRI. Following cortical resection, the size of nonresected cortex with preoperative PET abnormalities was also measured (calculated separately for marked areas in the lobe of seizure onset as defined by long-term video EEG monitoring, and in remote cortical areas). Extent of preoperative PET abnormalities and postoperative nonresected cortex abnormalities on PET were correlated with outcome scores. RESULTS: Large preoperative FMZ PET abnormalities were associated with poor outcome (r = 0.57; p = 0.025). Larger areas of nonresected cortex with preoperative FMZ PET abnormalities in the lobe of seizure onset were also associated with worse outcome in the whole group (r = 0.66; p = 0.007) as well as in patients with extratemporal resection (r = 0.73; p = 0.007), and in those with no lesion on MRI (r = 0.60; p = 0.049). Patients with seizure-free outcome had significantly smaller nonresected cortex with preoperative FMZ PET abnormalities than those who continued to have seizures (p = 0.022). No significant correlations between nonresected FDG PET abnormalities and surgical outcome were found. CONCLUSIONS: Extensive cortical abnormalities on FMZ PET predict poor outcome in neocortical epilepsy surgery. Resection of FMZ abnormalities in the lobe of seizure onset is associated with excellent outcome even in the absence of a structural lesion. In contrast, although FDG PET abnormalities regionalized the epileptogenic area, their size was not related to the extent of epileptogenic tissue to be removed.
Adolescent↗