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[Prevalence of nosocomial urinary infection. Alternatives to bladder catheterization].

BACKGROUND: The detection of a high percentage of nosocomial urinary infection (NUI) associated with vesical catheterization (VC) and the frequent use of VC in patients with urinary incontinence, led us to implant a prevention programme which included the introduction of absorbent diapers as a alternative to vesical catheterization in incontinent patients. MATERIAL AND METHODS: After actualization and introduction of VC preventive measures and the introduction of absorbent diapers, regular determinations were made of the prevalence of NUI with analysis of the variations using the chi 2 test for trends. The prevalence of urinary incontinence and the efficacy of the diapers were also measured. RESULTS: The prevalence of NUI associated with VC showed a significant decrease, from 27.5% to 3% (p = 0.004). Between 6% and 11% of the patients admitted to the medical service had urinary incontinence. After introduction of the diapers as part of health care assistance programme, the use of VC in patients with urinary incontinence is rare. CONCLUSIONS: 1) The prevention programme allowed a significant reduction in the prevalence of NUI associated with VC. 2) The use of absorbent diapers to care for patients with urinary incontinence probably contributed to reducing the prevalence of NUI. It was well accepted by the nursing staff and iatrogeny associated with their use was scarce.

Aged↗

Skin surface application of ketocaine to provide local anaesthesia for cutting split skin grafts.

Astra 2337 ketocaine-soaked pads applied to the skin surface produced analgesia adequate for split skin graft cutting 85 out of 86 patients. In 86 per cent, the analgesia was completely satisfactory; a few had some discomfort or pain but all could tolerate this. Application for 1 hour is time enough, but the effect lasts for at least 8 hours and probably longer. Apart from occasional redness and oedema of the skin, no adverse effects wer noted and the blood levels of absorbed ketocaine were far below the toxic level. This simple effective technique is of great value, particularly in such cases as burns who require multiple grafting operations and in whom repeated general anaesthetics can have such adverse effect.

Anesthesia, Local↗

An experimental study of the antileprosy activity of a series of thioamides in the mouse.

A series of substituted thioamides have been studied to establish whether their structure-activity pattern against Mycobacterium leprae is similar to that displayed against M. tuberculosis. Antileprosy activity was evaluated in the mouse foot pad using both the kinetic and continuous methods. Ethionamide and prothionamide were found to be the most active compounds and to be of approximately equal potency. Thioisonicotinamide was about five times less active. 2-t-Butyl-thioisonicotinamide, 2-dimethylamino-thioisonicotinamide, and pyrazine carbonic thioamide were inactive at the dosages tested. High-pressure liquid chromatographic methods were devised to study the potential influence of pharmacological factors on their in vivo activity. Fecal measurements suggested that all of the thioamides were well absorbed when fed in the diet. After intravenous administration, all of the thioamides were rapidly eliminated from the mouse. The differences in their elimination rates probably played only a minor role in affecting their relative antileprosy activities. It was concluded that the structural requirements for antileprosy and antituberculosis activity of the thioamides are probably similar.

Amides↗

In vitro transmission and attenuation of impact vibrations in the distal forelimb.

An in vitro model was developed and validated in vivo to quantify the attenuation of impact vibrations, transmitted through the lower equine forelimb and to assess the effects of horseshoeing on this attenuation. The transsected forelimbs of 13 horses were equipped with custom-made hollow bone screws in the 4 distal bones, on each of which a tri-axial accelerometer could be mounted. The limbs were then preloaded while the impact was simulated by dropping a weight on the steel plate on which the hoof was resting. At the hoof wall, the distal, middle and proximal phalanx and at the metacarpal bone, the shock waves resulting from this impact were quantified. To assess the damping effects of shoeing, measurements were performed with unshod hooves, hooves shod with a normal flat shoe and hooves shod with an equisoft pad and a silicone packing between hoof and pad. The in vitro model was validated by performing in vivo measurements using one horse, and subjecting the limb of this horse to the same in vitro measurements after death. Approximately 67% of the damping of impact vibrations took place at the interface between the hoof wall and the distal phalanx. The attenuation of impact vibrations at the distal and proximal interphalangeal joints was considerably less (both 6%), while at the metacarpophalangeal joint 9% of the amplitude of that at the hoof wall was absorbed, leaving approximately 13% of the initial amplitude at the hoof wall detectable at the metacarpus. Compared to unshod hooves the amplitude at the hoof wall is 15% higher in shod hooves. No differences could be observed between shoe types. At the level of the first phalanx and metacarpus the difference between shod and unshod vanished; it was therefore concluded that, although shoeing might influence the amplitude of impact vibrations at the hoof wall, the effect of shoeing on the amplitude at the level of the metacarpophalangeal joint is minimal.

Animals↗

Potential chlorpyrifos exposure to residents following standard crack and crevice treatment.

Multipathway exposures were evaluated for residents of houses over a 10-day period following a crack and crevice application of a chlorpyrifos-based formulation. Three multiroom houses with two adults each were treated. Air concentration, total deposition, and dislodgeable residues on horizontal surfaces were measured to assess potential respiratory, oral, and dermal exposures, respectively, in treated and untreated high activity rooms. In addition, urine samples collected from the adults were analyzed for the primary metabolite of chlorpyrifos, 3,5,6-trichloropyridinol, to determine absorbed dose. The maximum chlorpyrifos air concentration observed was 2.3 microgram/m3, with air concentrations generally decreasing to levels ranging from 0.1 to 0.3 microgram/m3 within 10 days. Carpet dislodgeable residues, used to evaluate the amount of residues potentially transferred upon contact, were less than the analytical method limit of quantitation (1.6 microgram/m2). Hard plastic balls placed in the homes on the day before application contained no detectable dislodgeable residues (<6.5 microgram/m2). Ten-day cumulative nontarget residues deposited on surfaces, as determined by deposition pads, were less than 2.3 microgram/100 cm2. Deposition samples from all living area floors collected 2 hr after application contained less than 9.9 microgram/100 cm2. Therefore, contact with household surfaces and subsequent hand-to-mouth activity are not expected to significantly contribute to overall exposure. Estimated exposures to children, based on the passive dosimetry measurements, ranged from 0.26 to 2.1% of the no observed effect level for plasma cholinesterase depression. In addition, potential exposures to the adult residents, as indicated by the urinary 3,5,6-TCP biomonitoring, did not increase as a result of the application.

Adult↗

Bowel perforation during percutaneous renal surgery.

INTRODUCTION: We report the case of a 74 years old patient presenting bowel lesion in a percutaneous renal surgery to extract a 2.5cm diameter stone. CASE REPORT: The access to percutaneous nephrostolithotomy was performed between the 11th and 12th left ribs at the posterior axillary line. An abdominal transversal pad was placed and a guide was passed down the ureter with no difficulty. Surgical time was of approximately 40 minutes. Antegrade pielography performed at the end of the procedure was normal. In the first post-operative day, the patient presented severe pain and abdominal defense. An additional descendent pielography was performed gently pulling the nephrostomy catheter, thus contrasting the bowel. The patient underwent an exploratory laparotomy where lacerations in left colon external wall and a bowel transfixing lesion were found. Non-absorbable sutures in two layers were performed. The patient presented a good progress with no occurrences during post-operative period, and was discharged in one week.

Journal Article↗

[Arthroscopic stabilization of the fractured intercondylar eminence].

PURPOSE OF THE STUDY: The authors present the results of arthroscopic reduction of a displaced fracture of the intercondylar eminence and stabilization of the fracture with a tension band wire and absorbable, double PDS sutures. MATERIAL: In the years 1998 to 2002, a fracture of the intercondylar eminence was arthroscopically diagnosed in 34 patients, 21 women and 13 men in the age range of 17 to 46 years. Five patients had type I fracture, 13 had type II fracture and 16 had type III fracture, as classified by the Meyers and McKeever system. Arthroscopic stabilization was used for all type II and type III fractures in a total of 29 patients. Double PDS sutures no. 1 were always applied. One double PDS loop was used in eight patients and, in the rest, two or three double PDS loops were employed. METHODS: PDS no. 1 sutures were inserted, by means of wire loops, through bone tunnels. These were drilled with 2-mm Kirschner's wires, using an anterior cruciate ligament (ACL) reamer, medial to the tibial tuberosity. Double PDS sutures were applied to the distal portion of the ACL, which permits good stabilization even in comminuted fractures of the eminence. The strength of a double PDS loop is sufficient and facilitates speedy recovery. Before terminating surgery it is necessary to check joint mobility and fixation stability. Only good stability allows for early mobilization of the joint. The postoperative treatment involved immobilization of the knee joint with a rigid brace in a semi-flexed position at 20 degrees for 6 weeks. However, from the second postoperative day, the brace was removed during targeted rehabilitation. Exercise on a continuous passive motion device, strengthening of the thigh muscles, patellar mobilization, walking with the use of crutches, while wearing the brace, with partial weight bearing until pain were practised. A treadmill without loading was used from the fifth postoperative week. RESULTS: Twenty-nine patients in whom stabilization with PDS sutures was used were evaluated. Of them 26 were completely free from any complaints and fully healed, always without findings of displacement on X-ray. In one patient, a fragment of the comminuted fracture was loosened and interfered with full extension. It was removed by arthroscopy and full recovery without consequences ensued. One patient underwent repeat surgery for hematoma in the wound; after wound healing and rehabilitation, he achieved a full range of motion. One patient showed signs of fibrosis of Hoffa's fat pad. All patients returned to the style of life as before injury. At follow-up of 1 to 4 years, Lysholm scores were excellent in 23 patients, very good in four patients, satisfactory in one patient (repeat surgery) and one patient was not examined. DISCUSSION: Fracture of the intercondylar eminence is caused by a mechanism similar to that causing rupture of the anterior cruciate ligament but, in addition, the margin of the intercondylar fossa is pressed against the eminence which breaks off. Displaced fractures (types II and III according to the Meyers and McKeever classification) are indicated for surgical stabilization. Fixation of the fractured eminence by means of absorbable material is sufficient, and insertion of metal material and its subsequent removal thus can be avoided. Arthroscopic inspection permits exact reduction; this procedure is minimally invasive. CONCLUSIONS: Arthroscopic stabilization of a fractured eminence by means of PDS sutures is a gentle surgical procedure that provides good mechanical support, facilitates early rehabilitation and achieves good outcomes. The use of absorbable sutures allows us to avoid further surgery in order to remove fixation material.

Adolescent↗

The external urethral barrier for stress incontinence: a multicenter trial of safety and efficacy. Miniguard Investigators Group.

OBJECTIVE: To assess the efficacy and safety of an external urethral barrier for the management of mild to moderate stress urinary incontinence in adult women. METHODS: Four hundred eleven women with the symptom of stress urinary incontinence in 12 United States centers participated. Additional inclusion and exclusion criteria were applied before protocol device use, and ultimately 390 subjects began device use. Outcome measures for efficacy and safety were assessed. Efficacy was evaluated by the number of leakage episodes using a voiding diary, subjective urinary leakage severity, incontinence impact scores, and pad testing. Safety was evaluated by symptom assessment, urinalysis, urine culture, measurement of postvoid residual urine volume, vulvar cytology, vaginal culture, and (n = 81) cystometric testing. RESULTS: Efficacy was indicated by statistically significant reductions in the number of leakage episodes, subjective leakage severity scores, incontinence impact scores, and pad-test loss during device use. The data also indicated that the device was safe, as evidenced by the lack of statistically significant changes in the percentage of subjects with urinary tract infections during device use or in postvoid residual urine volume and cystometric indices. Symptoms of vulvar irritation or lower urinary tract discomfort occurred in a small percentage of subjects but were generally transient, and only three women discontinued using the device. CONCLUSION: The external urethral barrier appears to be a safe nonsurgical alternative to absorbent products for the management of mild to moderate stress urinary incontinence in adult women.

Adolescent↗

Assessment of human exposure to pesticides in greenhouses and effectiveness of personal protective devices.

The exposure to pesticides in a group of workers growing vegetables in greenhouses in farms near Rimini in Italy was evaluated. The pesticides used were organophosphorus compounds, organochlorine compounds, carbamates, pyrethroids, amide and anilide derivatives. Measurements were carried out in seven greenhouses randomly selected. The environment was free of atmospheric agents which could have influenced the pesticide concentrations in the indoor air. Two types of chemical sampling were performed: environmental and personal. The latter was done in the liquid for washing hands and by means of pads applied directly to the worker's skin and to the clothes. The aim of the determination of airborne pesticide concentrations was to evaluate mean environmental exposure to pesticides in the sprayed areas. The sampling went on from a fixed point during the entire spraying period. The aim of individual sampling was to determine the active ingredients as contaminants. The values obtained showed a risk of exposure for the greenhouse personnel working without using personal protective devices (masks, gloves and waterproof clothes), considering that pesticides could be absorbed through the skin in between the spraying intervals.

Agricultural Workers' Diseases↗

Are washable absorbents effective at containing urinary incontinence?

This article describes a pilot study to evaluate washable (or reusable) absorbent garments for adults with moderate to heavy urinary incontinence. The article will describe: The study process; How the individual products performed and how the washable and disposable products compared; How nurses can enable their patients to use washable products appropriately.

Adult↗

Energy values and energy balance in rats fed on supplements of guar gum or cellulose.

In five experiments where guar gum (GG) or Solka-floc cellulose (SF) supplemented a semi-synthetic diet (100 g/kg) for male Wistar rats at 21 degrees, it was found that GG acutely depressed both ad lib. and meal-fed food intakes by 40-50%. The effect was temporary, with the GG having no effects on food intake in the longer term. Dietary energy balance over 28 d with animals fed on equal amounts of a basal ration showed partial digestible energy values, calculated from the intake and faecal loss of energy, for the supplements which averaged 0 kJ/g SF and 10 kJ/g GG, so that GG contributed substantial amounts of absorbable energy. Despite this additional energy from GG, there was very often no additional gain of body fat. Rather, in some experiments, fat deposition was actually decreased by supplementation with GG. GG is inferred to have a putative thermogenic effect which is often greater than the energy it supplies. This effect occurred to a greater extent in circumstances associated with a higher 'energy status', indicated by higher efficiencies of conversion of gross dietary energy to retained body energy, higher fat:lean tissue deposition ratios and the occurrence of larger deposits at the epididymal fat pad site. There was some evidence that deposition at this site was more extensively affected by GG than deposition of fat in the body as a whole. Possible implications of the present findings are discussed.

Animals↗

[Radiolysis of acrinol in radio-sterilization of acrinol pharmaceuticals].

Acrinol in dry solid state after gamma irradiation with 80 kGy (8 Mrad) undergoes 8% decomposition, with G(-M)=30, and in wet solid state (10% moisture content) undergoes 15% decomposition, with G(-M)=56, as shown by absorbed spectrometric measurement. From these results, it is estimated that the irradiation dose of 25 kGy (2.5 Mrad) prefered by many countries as sterilization dose will achieve the radiolysis rate of 2.8% or 4.7% for dry solid state or wet solid state acrinol, respectively. The stickiness power of plaster tape made of raw rubber and polyterpene resin don't decrease with irradiation dose of less than 40 kGy (4 Mrad). Then, the radio-sterilization on the dose of 25 kGy (2.5 Mrad) may be applied to solid pharmaceuticals such as commercial rubber adhesive plaster with acrinol pad. Besides, acrinol in 0.1% aqueous solution after irradiation of 10 kGy (1 Mrad) at room temperature undergoes 20% decomposition, with G(-M)=0.5. The radiolysis rate in this state is estimated 45% with the dose of 25 kGy (2.5 Mrad). Then, the radio-sterilization with this dose must not be applied to liquid pharmaceuticals such as 0.1% acrinol aqueous solution. While, it was reported by Hosobuchi and Sato that the antimicrobial effect of irradiated acrinol to Staphlococcus aureus increased with irradiation dose. Then, it is expectable that some materials with antimicrobial activity are prodused by gamma irradiation.

Acridines↗

Pharmacokinetics of multiple-dose oral cilostazol in middle-age and elderly men and women.

Cilostazol is being developed for the treatment of intermittent claudication due to peripheral arterial disease (PAD). This study was conducted to investigate the effects of age and gender on the pharmacokinetics of cilostazol after multiple-dose administration. It was an open label, multiple-dose study of cilostazol administered to male and female subjects 50 years of age and older at a dose of 100 mg (oral tablet) twice daily for 7 days. Equal numbers of healthy male and female (7 per group), nonsmoking subjects stratified into age groups of 50 to 59 years, 60 to 69 years, and 70 years or older were enrolled. Serial plasma samples were obtained. Data were analyzed by model-independent methods. Cilostazol was absorbed at a moderate rate, with peak plasma concentrations occurring at an overall mean of 2.4 hours after administration. Cilostazol is extensively bound (95%), primarily to albumin. A trend toward increasing cilostazol free fraction with age was observed in the male subjects, which was explained by a decrease in plasma albumin concentration with age. Differences in plasma protein binding between age and gender groups (less than 15%) are not expected to have any clinical significance. Plasma cilostazol concentrations reached steady state by day 4. The pharmacokinetic characteristics of cilostazol were not affected by age or gender.

Administration, Oral↗

Estimation of individual dermal and respiratory uptake of polycyclic aromatic hydrocarbons in 12 coke oven workers.

Twelve workers from a coke plant in The Netherlands participated in an intensive skin monitoring programme combined with personal air sampling and biological monitoring during five consecutive eight hour workshifts. The purpose of the study was to make a quantitative assessment of both the dermal and respiratory intake of polycyclic aromatic hydrocarbons (PAHs). Pyrene was used as a marker compound for both dermal and respiratory exposure to PAHs. The biological measure for the internal exposure to PAHs was urinary 1-OH-pyrene concentration. Measurements on exposure pads at six skin sites showed that mean total skin contamination of the 12 workers ranged between 21 and 166 micrograms pyrene a day. The dermal uptake of pyrene ranged between 4 and 34 micrograms/day, which was about 20% of the pyrene contamination on skin. The mean concentration of total pyrene in the breathing zone air of the 12 coke oven workers ranged from 0.1 to 5.4 micrograms/m3. The mean respiratory uptake of pyrene varied between 0.5 and 32.2 micrograms/day. Based on the estimates of the dermal and respiratory pyrene uptake it is concluded that an average 75% (range 28%-95%, n = 12) of the total absorbed amount of pyrene enters the body through the skin. Because of the difference in the pyrene:benzo(a)pyrene ratio between the air samples and the skin contamination samples, the dermal uptake of benzo(a)pyrene was also estimated. This was about 51% of the total absorbed amount (range 8%-92%, n = 12). The total excreted amount of urinary 1-OH-pyrene as a result of exposure to PAHs during the five consecutive workshifts varied between 36 and 239 nmol. A multiple regression model of the mass balance between pyrene dose (both dermal and respiratory) and 1-OH-pyrene excretion confirmed the relevance of the dermal exposure route. The variation in urinary 1-OH-pyrene excretion was determined more by the dermal pyrene dose than by the respiratory dose. The model showed an estimate of the percentage of the absorbed amount of pyrene that is metabolised and excreted as 1-OH-pyrene in urine. For the 12 workers this percentage varied between 13% and 49% depending on smoking habits and consumption of alcohol. The results of this study indicate that among coke oven workers, the skin is the main route of uptake of PAHs. Preventive measures to reduce exposure to PAHs should be focused more on the reduction of dermal contamination by PAHs than on the reduction of inhaled dose.

Adult↗

Identification of gases responsible for the odour of human flatus and evaluation of a device purported to reduce this odour.

BACKGROUND/AIMS: While the social significance of flatus derives mainly from its odour, previous studies have focused on the non-odoriferous components of rectal gas. The aims of the present study were to determine the role of sulphur-containing gases in flatus odour and test the efficacy of a device purported to reduce this odour. METHODS: Flatus was quantitatively collected via rectal tube from 16 healthy subjects who ingested pinto beans and lactulose to enhance flatus output. The concentrations of sulphur-containing gases in each passage were correlated with odour intensity assessed by two judges. Odour intensity was also determined after treatment of flatus samples with zinc acetate, which binds sulphydryl compounds (hydrogen sulphide and methanethiol), or activated charcoal. Utilising gastight Mylar pantaloons, the ability of a charcoal lined cushion to adsorb sulphur-containing gases instilled at the anus of eight subjects was assessed. RESULTS: The main sulphur-containing flatus component was hydrogen sulphide (1.06 (0.2) mumol/l), followed by methanethiol (0.21 (0.04) mumol/l) and dimethyl sulphide (0.08 (0.01) mumol/l) (means (SEM)). Malodour significantly correlated with hydrogen sulphide concentration (p < or = 0.001). Zinc acetate reduced sulphur gas content but did not totally eliminate odour, while activated charcoal removed virtually all odour. The cushion absorbed more than 90% of the sulphur gases. CONCLUSION: Sulphur-containing gases are the major, but not the only, malodorous components of human flatus. The charcoal lined cushion effectively limits the escape of these sulphur-containing gases into the environment.

Adolescent↗

The foot as a shock absorber.

A mathematical analysis of the deformation of the foot is developed to determine the role that stretch of ligaments and tendons plays in absorbing shock following impact. Our analysis is based on an anatomical biomechanical model that includes each of the bones of the foot. We calculate the time course of the deflection of the joints and the elongation of the ligaments and tendons and determine the ground reaction force acting on the heel. Quasi-linear viscoelastic theory is used for soft tissue constitutive relationships. With biomechanical data selected from the literature, we obtain a vertical force impact peak of 8000 N, occurring at 16 ms following heel strike. This is of higher magnitude and shorter duration than is found experimentally, as is to be expected, since we did not include the heel pad in our model and we assumed that the impact surface was ideally rigid.

Biomechanical Phenomena↗

Possible role of triacylglycerol-rich lipoproteins in the down-regulation of adipose obese mRNA expression in rats re-fed a high-fat diet.

The large amount of absorbed dietary lipid after feeding a high-fat diet is mainly transported as triacylglycerol (TG)-rich lipoproteins (TRL) in the post-prandial blood and is subsequently distributed to peripheral tissues including adipose and muscle tissues. An in vivo and an in vitro study were conducted to investigate the possible role of post-prandial TRL after high fat feeding in the regulation of obese (ob) gene expression. Adult male Wistar rats were fasted for 48 h and re-fed either a fat-free/high-carbohydrate diet or a high-fat diet for 2, 4, or 8 h and plasma glucose, insulin, TG, and leptin as well as ob mRNA expression in epididymal fat pads were examined. Rats re-fed the high-fat diet had significantly higher plasma TG (p < 0.05) and lower plasma leptin and adipose ob mRNA (p < 0.05) than those fed the fat-free/high-carbohydrate diet; however, plasma glucose and insulin concentrations were not significantly different between the two groups. Plasma lipid analysis found large amount of TRL in rats fed with high-fat diet; however, only very small amount of the TRL was found in rats fed with fat-free/high-carbohydrate diet. We speculated that TRL might involve in regulation of ob gene expression. To further examine the regulation of TRL on ob mRNA expression, differentiated 3T3-L1 adipocytes were treated with TRL collected from rats fed 5 ml soybean oil by gastric intubations. TRL down-regulated ob mRNA not only in a dose and time dependent manner but also in the presence of insulin in 3T3-L1 adipocytes. These results suggest a possible role of TRL in the down-regulation of adipose ob mRNA expression and may account, at least in part, for the previous observations that short-term high fat feeding resulted in lower plasma leptin.

3T3-L1 Cells↗

Portal absorption of 15N and amino nitrogen in the growing pig after ingestion of labelled milk, yogurt or heat-treated yogurt.

The aim of this experiment was to study 15N and amino-nitrogen (AN) portal absorption in the growing pig after ingestion of uniformly (0.2509 APE) labelled 15N milk (M), yogurt ingested just after manufacturing (Y0), yogurt stored for 21 d at 4 degrees C (Y21) and heat-treated yogurt (HY). The highest porto-arterial differences (PAD) in 15N and AN were found in the period between 30 min and 90 min after ingestion. The absorption of nitrogen from M and HY mainly occurred during the 0-120 min time period (about 70% for M and 67% for HY). For Y0 and Y21, a larger displayed absorption period over the 0-240 min time period was observed. Y0 and Y21 presented a quite similar portal absorption profile. The 15N absorption rate was close to 80% for each studied milk product, suggesting that under our experimental conditions, dairy products (M, Y0, Y21 and HY) deliver nearly the same amounts of nitrogen to the organism. AN absorption rates were around 78% with a higher variability between the milk products. These results also indicate that most of the proteins were absorbed within the 240 min postprandial period.

Animals↗