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Nivash Selvaraj, Mathisekaran Thangarasu, Sanjay Jayaprakash, Deepak Raghavan, Rajesh Paul Department of Urology, Apollo Main Hospital, Chennai, Tamil Nadu, IndiaCorrespondence: Nivash SelvarajDepartment of Urology, Apollo Main Hospital, Chennai 600006, Tamil Nadu, IndiaEmail nivi5407@gmail.comPurpose: Bladder neck contracture is an annoying problem for patients as well as urologists. Recurrence still remains a common problem associated with significant morbidity. This study evaluated the efficacy and side effects of mitomycin C (MMC) which has anti-fibroblast as well as anti-collagen properties in the deterrence of bladder neck contracture (BNC) recurrence after transurethral bladder neck resection (TUBNR).Materials and Methods: Ten patients between March 2017 and April 2018 with extremely persistent BNCs who underwent multiple failed endoscopic procedures (≥ 3 times) were evaluated by using International Prostate Symptom Score (IPPS), uroflowmetry, quality of life (QOL) and post void residual urine (PVR) preoperatively. All patients underwent transurethral bladder neck resection (TUBNR) followed by ten-point intraoperative MMC injection, not exceeding a total dose of 2 mg (0.2 mg/mL), which was given circumferentially at the resected site, using Williams cystoscopic needle. Patients were reviewed at 3 months, 6 months, 1 year and 2 years postoperatively.Results: The procedure was done on a day care basis. The recurrence period prior to our treatment was 3.2 ± 1.3 months. The follow-up was for 24 months. Overall 80% (8 of 10) of patients demonstrated resolution of BNCs as well as sufficient flow rate which was evaluated by uroflowmetry, PVR, IPPS and QoL postoperatively. One patient had detrusor underactivity. Relapse was seen in two patients. None of the patients experienced any significant adverse effects related to MMC.Conclusion: Intraoperative ten-site injection of MMC after TUBNR can be regarded as a safe and efficient technique with no serious adverse event.Keywords: bladder neck contracture, mitomycin c, scar modulators, transurethral resection of prostate, Williams cystoscopic needle

Devanathan Raghavan,1 John A Howington,2 Duan Broughton,1 Cortney E Henderson,1 Jeffrey W Clymer1 1Preclinical Research, Ethicon Endo-Surgery, Cincinnati, OH, USA; 2NorthShore University HealthSystem, Chicago, IL, USA Abstract: Ultrasonic cutting and coagulating devices have been used successfully in thoracic applications such as pulmonary resection or artery harvesting, but few studies have evaluated their use in sealing pulmonary vessels. In this study we compared two commercially available devices, Harmonic Ace+ (HAR, Ethicon Endo-Surgery, Inc., Cincinnati OH, USA) and SonoSurg (SS, Olympus America, Center Valley, PA, USA), in a canine preclinical model. There were three sections to the study: acute, survival, and ex vivo (burst pressure). Hemostasis of sealed pulmonary arteries and veins was assessed for the initial application and during a simulated hypertensive crisis, both immediately after vessel sealing and after a survival period of 30 days. Other intraoperative measures were also evaluated, including transection time, tissue sticking, tissue tags, and char on the seal. Histological evaluation was performed both after initial sealing and after the survival period. Burst pressure of sealed vessels was measured ex vivo. For both devices, hemostasis was excellent, including those measurements made under simulated hypertensive crisis. There were no differences in any of the intraoperative measures or thermal damage evaluated histologically. Wound healing was normal. The burst pressures for ex vivo vessels sealed by HAR (median 619.2 mmHg) were significantly higher than those of SS (350.3 mmHg, P = 0.022). Both devices displayed acceptable characteristics in sealing canine pulmonary arteries and veins. The only difference observed was that HAR produced burst pressures 76.8% greater than SS, which may lead to a lower percentage of failures in the region of physiological interest. Use of ultrasonic devices in thoracic applications provides a high rate of initial hemostasis, supraphysiological burst pressures, and durable seals that heal normally. Keywords: ultrasonic sealing, thoracic, pulmonary vessels, burst pressure, hemostasis

Aspergillus niger, a fungus, is adapted to polyethylene for a study of the latter's biodegradation. As time passes, biotic and sterile treatments differ in results. Calorimetric measurements show that auto-oxidation, formation of carbonyl groups and water diffusion occur, leading to inevitable biodegradation. Since there is an observed decrease in amorphocity, microogranisms can metabolize the sample, increasing its crystallinity. A significant factor in this process is sucrose, an external substrate. The analysis utilized a Differential Scanning Calorimeter and a Fourier Transform Infrared spectrometer.

Cyclical vomiting syndrome (CVS) is an idiopathic functional disorder characterized by recurrent episodes of nausea and vomiting separated by symptom-free intervals. Even though initially described in children, it is seen in all age groups. Exact etiology is not known. Various physical, infectious, and psychosocial stressors have been implicated for CVS. High incidence of psychiatric comorbidities such as panic attacks, anxiety disorder, and depression is seen in CVS. Most children outgrow CVS with time though some may transition to migraine or continue to have CVS as adults. Frequent misdiagnosis, delay in diagnosis, or inadequate treatment often lead to years of recurrent vomiting. This case report highlights the importance of the management of CVS by a multidisciplinary team including a psychiatrist in addressing the various physical and psychological factors effectively and that would result in faster and prolonged recovery. [ABSTRACT FROM AUTHOR]

Throughout the world there are problems recruiting ethnic minority patients into cancer clinical trials. A major barrier to trial entry may be distrust of research and the medical system. This may be compounded by the regulatory framework governing research with an emphasis on written consent, closed questions and consent documentation, as well as fiscal issues. The Leicester UK experience is that trial accrual is better if British South Asian patients are approached by a senior doctor rather than someone of perceived lesser hierarchical status and a greater partnership between the hospital and General Practitioner may increase trial participation of this particular ethnic minority. In Los Angeles, USA, trial recruitment was improved by a greater utilisation of Hispanic staff and a Spanish language-based education programme. Involvement of community leaders is essential. While adhering to national, legal and ethnical standards, information sheets and consent, it helps if forms can be tailored towards the local ethnic minority population. Written translations are often of limited value in the recruitment of patients with no or limited knowledge of English. In some cultural settings, tape-recorded verbal consent (following approval presentations) may be an acceptable substitute for written consent, and appropriate legislative changes should be considered to facilitate this option. Approaches should be tailored to specific minority populations, taking consideration of their unique characteristics and with input from their community leadership. [ABSTRACT FROM AUTHOR]