Egress of air through minitracheostomy tube: a dilemma about its position.
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Adult↗
Biomedical subjects
R Sikora
Publications and source records attributed to R Sikora.
Immunoglobulin E antibody against environmental allergens in subjects with trimellitic anhydride-induced asthma.
The purpose of this study was to assess the relationship between atopy and the development of occupational asthma as a consequence of exposure to trimellitic anhydride (TMA). A case-control study was performed, which comprised 16 employees identified as having TMA-induced asthma and 44 similarly exposed controls. Specific immunoglobulin E measurements in response to cat, dust mite, ryegrass, and ragweed antigens were performed. Fifty-six percent of cases and 29% of controls were found to be atopic (P = 0.098). We demonstrated that there was a trend toward employees with TMA asthma being more atopic than those without TMA asthma. Atopy as an assessment of risk for the development of TMA asthma is unlikely to be useful, although further investigation may be warranted.
Adult↗
Comparison of domestic violence screening methods: a pilot study.
STUDY OBJECTIVE: Previous studies have indicated a number of barriers to screening for domestic violence (DV) in an emergency department setting. These barriers result in inconsistencies which determine who is screened as well as the content and quality of the information obtained, and if uncontrolled they are likely to affect measurements of DV incidence in ED populations. The objectives of this project were to design a screening tool that circumvented these barriers and sources of error; to assess whether such an alternative method of screening for DV was acceptable to our patients; and to determine whether the alternative and traditional methods of screening for DV would yield comparable results. Our hypotheses were that the alternative screening tool would be acceptable to our patients and that no significant differences would be found between the two methods. METHODS: The study took place in a rural, university-affiliated ED with approximately 36,000 annual patient visits. The study population consisted of 186 women older than 18 years of age who were treated by one designated physician. Approximately half of these subjects were screened for DV in a face-to-face interview. The other half listened to a tape-recorded questionnaire and recorded their responses on a coded answer sheet. RESULTS: There were 175 completed screenings. The average age of all respondents was 34 years, and 90 (51%) indicated a cumulative lifetime experience of DV of some sort. Overall, 3% of the respondents indicated they were in the ED for injuries received as a result of DV. No significant differences were found between the two methods of screening for DV on any measurement, including refusals. No problems hearing the tape or understanding the instructions were reported. CONCLUSION: These results indicate that the alternative method of employing a recorded questionnaire was no less effective than the best efforts of a designated and conscientious physician. As a means of quickly assessing the prevalence of DV in an ED setting, we find much to recommend such an approach.
Adolescent↗
[Value of registering nocturnal REM phase related erections in diagnosis of erectile impotence].
A recently published field study from Boston, USA, showed an incidence of complete erectile dysfunction of 9.6% in 1290 men between 40 to 70 years. The invasive diagnostic schedule based on intracavernous pharmacon injection since 1982, continues to be dependent on the individual adrenergic tonus of the patient influenced by stress and fear. False-positive results are often found and consequently lead to strictly somatic therapeutic approaches like microsurgical vascular procedures or prosthetic implants. Computerized registration of nocturnal REM-phase correlated erections (NPTR-measurements) enables the examiner to evaluate the principal erectile capacity of intracavernous erectile tissue independently from psychic disturbances, if well standardized evaluation criteria are used.
Diagnosis, Differential↗
Hypertension and tachycardia during adrenal manipulation.
The purpose of this report is to draw attention to haemodynamic changes during intraoperative adrenal gland manipulation. Severe hypertension, ventricular tachycardia and subendocardial ischaemia occurred during the manipulation of adrenal gland in a patient who underwent live related donor nephrectomy. The patient responded well to intravenous lidocaine. Plasma norepinephrine concentration was elevated at the time of event. Further investigations after surgery excluded the possibility of phaeochromocytoma. In two years follow-up patient remains well. Suspicion for the cause of the event remains the excessive release of catecholamines with manipulation of a normal adrenal gland. The presence of halothane might have contributed to the arrythmia.
Adrenal Glands↗
Objective measurement of the effectiveness, therapeutic success and dynamic mechanisms of the vacuum device.
OBJECTIVES: To determine the efficacy and possible beneficial effects of the Catalyst vacuum device (VD) in the treatment of impotence, the ischaemic state of the penis after application of a constriction ring and the origin of the blood in the corpus cavernosum after application of the VD. PATIENTS AND METHODS: Thirty men (mean age 62 years; range 46-76) suffering from erectile dysfunction were selected for the trial after using the VD for 2 weeks at home. Changes in penile tumescence and rigidity before, during and after the VD were assessed using the Rigiscan monitor. Blood gas analysis (BGA) was performed in selected patients whilst using the VD, allowing calculation of the proportional contribution of venous and arterial blood to the increase in penile volume. The efficacy of the VD was also assessed by questionnaires completed before treatment and at the 6 month follow-up. RESULTS: Four patients were lost to follow-up but the 26 impotent men who used the VD for 6 months were able to have sexual intercourse after using the VD. The average rigidity measured at the base and tip of the penis after application of the VD was > 80%. The duration and extent of nocturnal penile tumescence and rigidity at the start and the end of the study improved, although only one variable increased significantly. Patients reporting spontaneous morning erections showed significant improvements in total erection-time, erection-phase and plateau-phase duration, effective rigidity and tumescence increase. BGA determined 30 min after applying a constriction ring showed ischaemia of the penile blood and the mean contribution of arterial and venous blood to penile blood volume was by 58 and 42%, respectively. CONCLUSION: The efficacy of the Catalyst vacuum device was objectively determined and the quality of the nocturnal erections improved in some patients. After application of a constriction ring an ischaemia of the penis developed. In contrast to previous reports, the increased penis volume during the application of the VD is caused not only by arterial inflow but also by venous backflow.
Aged↗
Measurement of BBN-induced alterations in rat urothelium by electron microscopic X-ray microanalysis.
The aim of this study was to analyse N-butyl-n-butanol-4-nitrosamine (BBN)-induced alterations of the urothelium in rats concerning its content of phosphorus, sulphur, chlorine, potassium and calcium using electron microscopic X-ray microanalysis (REM analysis). The following histopathological findings of the bladder mucosa were discovered after exposure to BBN: normal urothelium (n = 36); focal epithelial proliferations (n = 12) following 6-12 week's exposure; epithelial hyperplasia (n = 8) after urothelial carcinoma (n = 4) following 12 weeks' exposure. The observed phosphorus/sulphur and phosphorus/calcium ratios based on REM analysis did not show any statistical correlation with the morphological changes classified by light microscopy. Our data do not support the hypothesis raised by other investigators that an increase in phosphorus content or phosphorus/sulphur or phosphorus/calcium ratio could indicate early neoplastic transformations of urothelial cells as "tumor markers".
Animals↗
Intracavernosal kinetics of eicosanoids and endothelin during erection. Data from human and animal studies on intrapenile and systemic prostaglandins.
The release of mediator substances of the arachidonic acid cascade is closely related to the functional state of the endothelium. A significant lower prostacyclin/thromboxane A2 ratio in penile plasma of organogenic impotent patients in comparison to patients with psychogenic erectile dysfunction has been described in the literature. We observed the time-related liberation of prostacyclin, thromboxane A2 and the vasoactive peptide endothelin for 16 minutes of a drug-induced erection. We compared kinetics of patients with penile deviation and transsexualism, to patients suffering from severe organogenic impotence. We assessed the usefulness of the prostacyclin-to-thromboxane A2 ratio as a possible indicator of corporal degeneration. An animal model has been created to observe differences between rabbits under 100 days of standard diet alimentation, rabbits under cholesterol enriched diet and rabbits with hereditary hyperlipidemia type II A. Hyperlipidemia is suspected to be one possible factor causing organogenic impotence. Enzyme-immuno-assays were used for the determination of all substances. The systemic prostacyclin-to-thromboxane A2 ratio differed significantly between control rabbits and rabbits with hyperlipidemia. Prostacyclin, thromboxane A2 and endothelin in corpus cavernosum plasma showed a typical profile during spontaneous and drug-induced erection. A significant difference between groups of patients suffering from organogenic or psychogenic impotence could not be found. The value of the determination of the studied substances in differential diagnosis seems to be dubious.
Alprostadil↗
Criteria for examiner-independent nocturnal penile tumescence and rigidity monitoring (NPTR): correlations to invasive diagnostic methods.
78 patients (pts.) with erectile dysfunction (ED) underwent conventional diagnostic evaluation including NPTR monitoring with the Rigiscan, intracavernous drug testing, dynamic cavernosometry, doppler evaluation, pharmaco-angiography and neurologic tests. Only erections of the best rigidity recorded over three nights served for classification into three classes of rigidity. Patients with neurogenic impotence showed significantly poorer and fewer erectile events per hour than vasculogenic impotent men. Patients with arteriogenic ED had better erections than patients with venogenic or mixed arterio-venogenic ED. Severity of organic ED during conventional diagnostic work-up correlated to loss of rigidity during NPTR recordings, but no differential diagnosis between arteriogenic, venogenic or neurogenic impotence could be made with NPTR data alone. The presented criteria for NPTR evaluation permit a time-saving, examiner-independent analysis.
Adult↗
[Angiography of the a. pudenda and its branches in erectile dysfunction. A modified angiographic technic and optimized use of vasodilator substances].
A new simplified technique for evaluating the internal pudendal artery and the penile vessels is described using a new catheter configuration with a very short 90 degrees-angled tip. In 30 consecutive patients, a superselective catheterisation of the internal pudendal artery was achieved in 93%. To improve visualisation of the penile arteries, the selective intraarterial application of 0.2 mg nitroglycerin in addition to the mandatory intracavernous injection of papaverin or prostaglandin E1 has proved to be of value. Examination of the blood blow velocity in the dorsal penile artery with Doppler ultrasound 2 minutes after intra-arterial application of 0.2 mg nitroclyerin showed a mean elevation of the Doppler amplitude by the factor 2.4 (range 0.4-9). With regard to the maximal increase of the blood velocity (range 1-6 minutes), a high interindividual difference was observed.
Arteries↗
[Reflectory stimulation of the pudendal nerve in dynamic pharmaco-cavernosometry].
A prospective study was performed in 20 patients to assess the impact of vibratory glans stimulation on the course and results of dynamic pharmaco-cavernosography and cavernosometry. An intracorporeal pressure rise was achieved with lower amounts of saline when stimulation was applied and in some cases could not be provoked by saline infusion without glans stimulation. False-positive diagnoses of diffuse venous leakage could thus be eliminated. The data presented in this paper confirm the need for stimulation of the pudendal reflex arch to achieve physiological conditions. The simplicity of the procedure and the minimal time requirement suggest its clinical routine application of vibratory glans stimulation during cavernosography and cavernosometry.
Erectile Dysfunction↗
[Imaging of penile vascular anastomoses using color-coded Doppler ultrasound: comparison with CW Doppler ultrasound and clinical aspects].
In fourteen patients undergoing surgical revascularization (11 with Hauri's, three with Virag's anastomosis) because of erectile dysfunction, the patency of vascular anastomosis was evaluated and visualized by color-coded-Doppler sonography (CCDS). Results were compared with continuous-wave Doppler (CWD) and clinical data. CCDS proved to be superior to CWD with regard to assessment of flow in the penile vessels and to applicability. Strength and direction of flow can be judged visually. Therefore, the nature of the imaged vessel (artery or vein, deep or dorsal artery) can be differentiated. There is a good correlation of CCDS and CWD in their evaluation of the patency of the anastomosis. CCDS showed higher accuracy in detecting deep cavernosal arteries.
Adult↗
[Microsurgical treatment for erectile impotence].
Using strict selection criteria, peripheral microsurgical revascularization was performed in 23 of 180 patients with erectile dysfunction (seen between February 1987 and December 1988). Average age of the 23 men was 51.8 (44-59) years. In 14 patients, the epigastric artery was transposed end-to-side to a side-to-side anastomosis between the dorsal artery and vein of the penis, while in two a piece of inferior epigastric vein was interposed. In the other seven patients an end-to-side anastomosis was constructed between the inferior epigastric artery and the deep dorsal vein of the penis. After three months, 19 of 20 patients who were followed-up had regular intercourse without intracavernous administration of drugs, after six months 15 of 17, after one year 11 of 14. In two patients irreversible thromboses of the anastomoses occurred when anticoagulant administration, required postoperatively, had been discontinued. The results indicate that with careful selection microsurgical treatment can achieve good results.
Anastomosis, Surgical↗
The value of magnetic resonance imaging at 1.5 T in the evaluation of the scrotal content.
50 patients with a broad variety of scrotal disorders were evaluated in form of a prospective study by high-resolution scrotal sonography and magnetic resonance imaging at 1.5 T with high-resolution surface coils. Basic anatomic correlations to normal structures of the scrotum were studied in 4 fresh cadaver testicles without pathology. Magnetic resonance imaging is sensitive and specific, but time-consuming and expensive.
Genital Diseases, Male↗
[Selective microsurgical therapy in vascular-induced erectile impotence].
Patients with erectile dysfunction should be subjected to a complex and complete diagnostic procedure, including selective pharmaco-phalloangiography and dynamic pharmacocavernosonography only when SKAT has failed and after the exclusion of neurological disorders. Patients being offered these invasive procedures should be highly motivated and willing to undergo surgical correction of the vascular origin of their erectile impotence. If peripheral vascular occlusive disease is found affecting the pelvic arteries, the best operative technique must be selected. In our opinion, this decision should be made intraoperatively after visualization of the dissected dorsal penile vessels. Use of the Doppler probe can be extremely helpful during the operation. Intraoperative findings on the degree of arteriosclerosis and arterial flow can differ from those allowed by preoperative diagnostic procedures. Penile erectile function was restored in seven of nine patients after penile revascularization performed under microsurgical conditions. We used the operative methods described by Virag and Hauri, applying our own modification of the Hauri procedure in two patients. With careful selection of patients and methods it should be possible to resolve individual patients' problems with peripheral occlusion, even though the exact hemodynamic pathology remains obscure.
Adult↗
The contingent negative variation during a memory retrieval task.
Evoked potentials were recorded from the human scalp during performance of a memory retrieval task modeled after a paradigm originated by Sternberg (1966). Subjects were required to decide whether a probe digit was contained in a series of one to four target digits presented a few seconds before. The amplitude of the contingent negative variation (CNV) preceding the probe digit and the speed of CNV resolution after the probe varied as a function of target set size. CNV amplitude was greatest when the set size was one. The smaller the set size, the more positive the evoked potential 300 msec after the probe, regardless of whether a motor response was required.
Adult↗
[A case of renal lesion in secondary recurrent syphilis].
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Adult↗