Prostate cryotherapy: practicalities and applications from the Calgary experience.
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Aged↗
Biomedical subjects
D Wiseman
Publications and source records attributed to D Wiseman.
Barrier agents for preventing adhesions after surgery for subfertility.
BACKGROUND: Pelvic adhesions can be the result of inflamation, endometriosis or surgical trauma. Prevention of postoperative adhesions (either new or reoccurance) has been postulated by using barriers to prevent two surfaces being in contact. When pelvic surgery is being undertaken strategies to reduce pelvic adhesions occurring may be undertaken and these include barrier agents which are placed between the pelvic structures. Two synthetic barriers with differential characteristics are commercially available: oxidised regenerated cellulose (Interceed) and polytetrafluoroethylene (PTFC) (GoreTex). OBJECTIVES: The objective of this review was to assess the effect of mechanical barriers (materials interposed between pelvic structures to prevent adherence of serosal surfaces) used during pelvic surgery in women of reproductive age on pregnancy rates, pelvic pain, or postoperative adhesion reformation. SEARCH STRATEGY: The Cochrane Menstrual Disorders and Subfertility Group specialised register of controlled clinical trials was undertaken. In addition, companies were contacted for unpublished trials. SELECTION CRITERIA: Randomised controlled trials or controlled clinical trials of barriers versus no treatment or other barriers in women undergoing fertility preserving pelvic surgery. DATA COLLECTION AND ANALYSIS: Reviewers assessed eligibility and trial quality. MAIN RESULTS: 15 randomised controlled trials were included. Five trials randomised patients while the remainder randomised pelvic organs. Laparoscopy was the primary surgical technique in six trials while the remaining trials were laparotomy. Indications for surgery included myomectomy (five trials), ovarian surgery (four trials), pelvic adhesions (six trials), endometriosis (two trials) and mixed (one trial). Thirteen trials assessed Interceed versus no treatment, two assessed Interceed versus Gore-Tex, one trial assessed Gore-Tex versus no treatment, and one trial assessed Seprafilm versus no treatment. No study reported pregnancy or reduction in pain as an outcome. The use of Interceed in women was associated with reduced incidence of pelvic adhesion formation, both new formation and re-formation following laparoscopic surgery and after laparotomy. Gore-Tex was more effective than no barrier or Interceed in preventing adhesion formation. There was limited evidence that Seprafilm was effective in preventing adhesion formation in women following myomectomy. REVIEWER'S CONCLUSIONS: The absorbable adhesion barrier Interceed reduces the incidence of adhesion formation, both new formation and re-formation, at laparoscopy and laparotomy, but there are insufficient data to support its use to improve pregnancy rates. Gore-Tex may be superior to Interceed in preventing adhesion formation but its usefulness is limited by the need for suturing and later removal. There was no evidence of effectiveness of Seprafilm in preventing adhesion formation.
Cellulose, Oxidized↗
Transrectal ultrasound-guided biopsy of the prostate: relation between ASA use and bleeding complications.
OBJECTIVE: To determine the relation between ASA ingestion and the incidence of bleeding complications after transrectal ultrasound (TRUS)-guided biopsy of the prostate. METHODS: Overall, 1810 patients with suspected prostate disease were followed after biopsy. ASA use was determined before the procedure. A TRUS-guided sextant biopsy was performed and patients were contacted immediately and by follow-up telephone call to determine whether there were any immediate or delayed bleeding complications. RESULTS: Overall, 46 subjects (2.5%) had bleeding complications. Of the 54 subjects reporting current use of ASA, 2 (3.7%) had such complications. This difference was not significant. CONCLUSION: There was no evidence of an association between the use of ASA and postbiopsy bleeding complications.
Adult↗
Prostatic cryosurgery: use of MR imaging in evaluation of success and technical modifications.
PURPOSE: To evaluate the usefulness of contrast material-enhanced magnetic resonance (MR) imaging in objective assessment of prostatic cryosurgery and the role of MR imaging in the modification of prostatic cryosurgical technique. MATERIALS AND METHODS: Thirty-eight consecutive patients with localized (T1-3, N0, M0) prostatic adenocarcinoma treated with prostatic cryosurgery underwent MR imaging without contrast enhancement before cryosurgery and unenhanced and gadolinium-enhanced MR imaging within 1-3 weeks after cryosurgery. The first 20 patients also underwent MR imaging at 3 months after cryosurgery. MR imaging findings were correlated with those from transrectal ultrasound-directed prostatic staging biopsy. RESULTS: Cryonecrotic prostate was identified as avascular regions characterized by absolute signal void on contrast-enhanced images. With progressive modification of cryosurgical technique, complete cryoablation of the prostate was achieved in the latter nine of the 38 patients. When cryoablation was considered complete according to MR imaging criteria, findings invariably correlated with those at biopsy, with no residual prostate tissue or tumor. CONCLUSION: Gadolinium-enhanced MR imaging of the prostate after cryosurgery provides a highly accurate means of monitoring success. Objective MR imaging findings allow modifications to the technology and technique, resulting in optimal therapeutic results with prostatic cryosurgery.
Adenocarcinoma↗
Characterisation of cytosolic phospholipase A2 as mediator of the enhanced arachidonic acid release from dimethyl sulphoxide differentiated U937 cells.
Studies were performed to characterise the phospholipase A2 (PLA2) responsible for the greatly increased capacity to release arachidonic acid (AA) of dimethyl sulphoxide (DMSO) differentiated U937 monocytic cells compared to undifferentiated cells (18-fold increase in response to Ca2+ ionophore A23187). Cytosolic PLA2 (cPLA2) activity could be measured in homogenates of differentiated cells, and the highly selective cPLA2 inhibitor arachidonic acid trifluoromethyl ketone reduced A23187 induced [3H]AA release from pre-labelled cells by at least 80%, with an IC50 (12.7 +/- 1.4 microM) not significantly different from that for inhibiting authentic cPLA2 (9.3 +/- 2.0 microM). On the other hand, type II PLA2 activity was not detected in cell homogenates, and [3H]AA release was not inhibited by heparin (1 mg/mL), which binds secreted type II PLA2 and reduces its ability to degrade membrane phospholipids. Stimulation of intact cells with A23187 plus phorbol myristate acetate (PMA) under conditions that released [3H]AA did not increase cPLA2 activity of the cell homogenate, and there was little difference between DMSO differentiated and undifferentiated cells in cPLA2 protein content, cPLA2 specific activity of homogenates, or distribution of cPLA2 between membrane and cytosol in the resting cell. Following stimulation with A23187 plus PMA, no increase in [33P] labelling of cPLA2 immunoprecipitates was seen in cells pre-labelled with [33P] orthophosphate, nor a change in electrophoretic mobility of cPLA2. It was concluded that cPLA2 releases the bulk of AA from stimulated, DMSO differentiated U937 cells. The failure to observe increased cPLA2 specific activity following cellular stimulation could be explained by increased [3H]AA release requiring the activation of only a small proportion of the cell pool of cPLA2 or, alternatively, by increased release reflecting greater Ca(2+)-dependent association of cPLA2 with membrane substrate rather than increased specific activity per se. There was no evidence that any such increased membrane association resulted from cPLA2 phosphorylation. The relative inability of undifferentiated cells to release AA was not due to the absence of cPLA2 or an altered distribution between membrane and cytosol, but suggested the presence of a repressor mechanism that prevents elevated Ca2+ from functionally activating the enzyme intracellularly.
Arachidonic Acid↗
Dose effects and predictors of outcome in a randomized trial of transdermal nicotine patches in general practice.
The transdermal nicotine patch has proved an effective aid to smoking cessation. The ease of securing good compliance gives it a potential advantage over nicotine gum as an adjunct to brief advice and support in primary care settings where the major public health impact is obtained. In a preliminary report of half the sample of a randomized placebo controlled trial, we showed the patch to be effective in a general practice setting. We report here the definitive results of the full sample, including dose effects, predictors of outcome and other issues of theoretical and practical interest. A total of 1200 heavy smokers (> or = 15 per day), attending 30 general practices in 15 English counties received brief GP advice, a booklet and 16 hours per day patch treatment for 18 weeks. Dose increase and abrupt vs. gradual reduction of patch dosage were also randomized and follow-ups conducted at 1, 3, 6, 12, 26 and 52 weeks. Outcome was measured by self-reported complete abstinence from week 3 to 52 with biochemical validation at all follow-up points. Nicotine patch treatment doubled the rate of continuous abstinence up to 1 year (nicotine 9.6%, placebo 4.8%, p < 0.01); it most likely worked by reducing withdrawal symptoms. It enhanced cessation during the first week and reduced relapse during the second week. The dose increase after week 1 produced no sustained increase in cessation. Gradual reduction was no better at preventing relapse than abrupt withdrawal of patches after week 12. Whether relapse would have increased by ending treatment at some point between weeks 3 and 12 was not tested. Although pre-treatment dependence on cigarettes was prognostic of failure, the patches were equally helpful to both highly and less dependent smokers. Patches were particularly helpful to smokers with pre-treatment subclinical dysthymic symptoms. All but one of the 96 subjects eventually achieving long-term abstinence in the study quit during the first week of cessation.
Administration, Cutaneous↗
CT of the liver after cryotherapy of hepatic metastases: imaging findings.
Cryotherapy is the in situ destruction of abnormal tissue using subzero temperatures (Fig. 1). Recent studies have demonstrated the technical feasibility, safety, and effectiveness of hepatic cryotherapy in the treatment of liver tumors [1, 2]. Such treatment can be precisely focused on the tumor, thereby preserving surrounding normal tissue. In addition, because major vessels with flowing blood are protected from cryoablation, tumors adjacent to these vessels can be treated without sacrificing vasculature. Hepatic cryoablation is therefore particularly suitable for patients who do not qualify for surgical resection because of multiple metastases involving both lobes of the liver, or because of lesions close to major blood vessels. After the procedure, CT during arterioportography is of little value in distinguishing cryolesion from malignant tumor (Fig. 2), and CT with IV contrast enhancement is recommended for follow-up. It is important to distinguish CT findings of successful and unsuccessful treatment, treatment complications such as abscess and cholestasis, and recurrent tumor. The purpose of this essay is to illustrate the findings on CT with IV contrast enhancement in various situations, emphasizing features that are useful in making accurate differential diagnosis.
Aged↗
A new laboratory method for altering positive affect.
This paper reports the development with 95 undergraduates of a new method for altering Positive Affect in the laboratory. The method consists of assigning persons to complete a boring task for a specific amount of time and shortly after beginning the task, informing them that the assigned time period has either been increased or reduced. The advantages of this method are that it is effective, relatively free of demand characteristics, ethical, fast to administer, and parallels "real world" experiences. In addition, this procedure seems to circumvent limitations of other mood-induction procedures.
Adult↗
Evidence for an absence of deleterious effects of ultrasound on human oocytes.
Animal and human data would suggest that ultrasound causes deleterious effects to oocytes during meiosis. We directly compared the fertilization rate and embryonic development following in vitro fertilization and embryo transfer of those oocytes exposed to ultrasound and those not exposed in the same patient. In 39 unscreened patients a combination of laparoscopy and ultrasound was used for oocyte recovery. Laparoscopy was performed first on the most accessible ovary (usually the right) and at least one oocyte was obtained. Ultrasound-guided oocyte recovery was successful in the other inaccessible ovary. To assess how oocytes obtained by ultrasound or laparoscopy related to the pregnancy rate, two groups of patients were evaluated in whom the embryos transferred either had been exposed to ultrasound or had not been. The fertilization and the embryo cleavage rates were not significantly different between the ultrasound-exposed and the unexposed groups. The pregnancy rate was also not significantly different [9 of 49 (18.4%) for ultrasound exposed versus 14 of 74 (18.9%) for unexposed]. There was one early spontaneous abortion in each group. Further analysis of a group of 40 patients, in whom the oocytes were exposed to ultrasound in situ, after the endogenous luteinizing hormone (LH) surge had begun 1-27 hr earlier, revealed that 6 became pregnant (15%). This preliminary study suggests that exposure of human oocytes to ultrasonic waves, either during the different phases of meiosis or after the completion of meiosis, did not significantly influence the developmental potential of the in vitro fertilized embryos.
Chorionic Gonadotropin↗
Teacher awareness program on child abuse: a randomized controlled trial.
Teachers have a significant role in preventing, detecting and reporting child abuse and neglect. They are hindered in fulfilling this role by a serious lack of knowledge of the law, of school board policies, and of maltreatment. A comprehensive professional development workshop was developed and presented to elementary school teachers. The package was evaluated by means of a randomized controlled trial. The workshop proved to be effective in increasing and maintaining knowledge.
Awareness↗
"Ultrasound rescue": a successful alternative form of oocyte recovery in patients with periovarian adhesions.
Oocyte recoveries for in vitro fertilization/embryo transfer were performed in 82 cycles in 73 women. The status of the ovaries was unknown. Laparoscopy was performed and oocytes from accessible follicles aspirated. The remaining follicles were aspirated ultrasonographically. The recovery rates for laparoscopy of accessible follicles and for ultrasonographic recovery from laparoscopically inaccessible follicles were identical. In 26 patients laparoscopy only was performed. One or more oocytes was obtained in 92% of patients. In 56 cycles when laparoscopy was followed by ultrasound, one or more oocytes were recovered in 95% of patients; in 12 of these patients, three of whom achieved pregnancy, the only oocytes were recovered by the ultrasonographic means after laparoscopy had failed. This method provided an alternative to screening laparoscopy and indicated that cycles of controlled hyperstimulation could be performed with a satisfactory expectation of oocyte recovery in women in whom the state of the pelvis was unknown.
Clomiphene↗
Angiogenic factor in ocular fluid.
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Angiogenesis Inducing Agents↗
Initial experience with in vitro fertilization and embryo transfer at the University of Calgary/Foothills Hospital.
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Alberta↗
The prediction of ovulation: a comparison of the basal body temperature graph, cervical mucus score, and real-time pelvic ultrasonography.
Ninety-five menstrual cycles were studied in 20 women undergoing donor artificial insemination (AID). In 49 cycles basal body temperature (BBT) changes were charted daily and both daily cervical mucus scoring (modified Insler score) and daily realtime ultrasonography (USS) were performed from day 11 to ovulation. AID was performed only on the day of follicular rupture. A control group, not subjected to USS, were inseminated two to three times per cycle over 46 cycles in the periovulatory period. The Insler score was found to be a reliable indicator of follicular development and rupture. The BBT was found to be less reliable than the Insler score or USS. While USS may be used to confirm follicular development, the Insler score is reliable and less costly.
Body Temperature↗
The effects of ovarian adhesive disease upon follicular development in cycles of controlled stimulation for in vitro fertilization.
This study was designed to determine the effect of periovarian adhesive disease upon follicular development. Forty-one clomiphene citrate/human menopausal gonadotropin/human chorionic gonadotropin-stimulated cycles for in vitro fertilization and embryo transfer were studied. Each patient was assessed ultrasonographically before laparoscopic oocyte recovery. The number of follicles in each ovary greater than 1.2 cm was counted. By laparoscopy it was possible to determine the degree of periovarian adhesive disease. Sixteen patients had bilateral adhesion-free (AF) ovaries, 12 had bilateral adherent (A) ovaries, and 13 had one AF and one A ovary. In the 13 patients with one ovary AF and the other A, the mean number of follicles +/- 1 standard deviation (SD) was 3.4 +/- 1.4 and 1.2 +/- 1.1 (P less than 0.001), respectively. A total of 116 follicles was noted in 45 AF ovaries (mean +/- 1 SD, 2.6 +/- 1.3) and 59 follicles in 37 A ovaries (mean +/- 1 SD, 1.6 +/- 1) (P less than 0.001). From these data it was concluded that the presence of periovarian adhesive disease inhibits folliculogenesis by a yet undetermined mechanism.
Clomiphene↗
Human parvovirus infection and aplastic crisis in hereditary spherocytosis.
This report records an episode of parvovirus-induced bone-marrow aplasia in a child with hereditary spherocytosis and arising during a local outbreak of erythema infectiosum (fifth disease or 'slapped-cheek syndrome'). Inapparent infection was found in two haematologically normal family contacts.
Anemia, Aplastic↗
The effect of chloroquine on macromolecule synthesis and oxygen uptake in Escherichia coli [proceedings].
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Bacterial Proteins↗
Measurement of formaldehyde concentrations in a subatmospheric steam-formaldehyde autoclave.
A method has been developed for measuring formaldehyde concentrations in a subatmospheric steam-formaldehyde autoclave. Data obtained using this method indicate that the concentration of formaldehyde in the chamber atmosphere is not homogeneous and that it decreases rapidly with time. The penetration of formaldehyde vapour into narrow tubes has also been investigated and was shown to be dependent on the length-to-bore ratio of the tubes. The formaldehyde concentration within the tubes could be increased by using a lower vacuum in the air removal stage at the beginning of the cycle.
Formaldehyde↗