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The aim of this study was to report surgical and functional outcomes in patients who underwent immediate penile fracture repair following location of the tunical tear with ultrasonography.Patients' clinical notes from September 2005 to October 2015 were reviewed. The inclusion criteria were the documented presence of an albugineal laceration at the preoperative ultrasonography and during surgical exploration. In total, 76 patients were enrolled in the study. The aetiology, presentation, imaging results, intraoperative findings, functional outcomes and complications of surgical repair were retrospectively extrapolated from the clinical notes. Patients were questioned about their erectile and urinary function 12 months after the traumatic event. Validated questionnaires were administered to enquire about sexual and urinary function. Finally, the accuracy of the ultrasound in detecting the site of the tunical defect was evaluated.The mean age was 39.5 years (range 21-72 years) and the median follow-up was 13 weeks. The aetiology of the fracture was sexual intercourse in 70 patients, the taqaandan manoeuvre in three and trauma while sleeping in three. The intraoperative findings showed a ventral and transverse tear in 93.5% of cases. Urethral injuries were evident in one-quarter of the patients. Ultrasonographic findings were confirmed intraoperatively in all patients. Worsening of the quality of erections was reported by 5% of patients, and 5.2% reported a penile curvature postoperatively.Penile fracture is a rare urological emergency and requires early surgical exploration and repair. Ultrasonography is a cheap and readily available investigation that allows confirmation of the diagnosis, and identification of the location of the tear and the associated urethral injury.

Background Treatment studies of depression in residential care are limited. Reports of predictors of response are rare. In the largest nursing home prospective antidepressant trial reported, we examined predictors of response. Methods This was a 12-week open-label study of mirtazapine orally disintegrating tablets performed in 30 US nursing homes. Subjects were men and women aged ≥70, with a Mini Mental State Exam (MMSE) score ≥10, who had a depressive disorder that required antidepressant treatment. Mirtazapine was started at 15 mg at bedtime, and adjusted to 15–45 mg/day. A 16-item Hamilton Depression Rating Scale was used to assess depression at baseline, weeks 2, 4, 8, and 12 or early termination. Results One hundred and twenty-four patients received at least one dose of study drug and of these, 119 had at least one post-drug assessment. Mean age was 82.9 years and 72% were female. Response rates at 12 weeks were 47% on the HAMD and 54% on the CGI. Age, sex, MMSE score, medical burden, history of prior depression, and baseline HAMD severity were not significantly associated with HAMD response (≥50% improvement) and in most cases correlations were trivial

The article describes a method of strip aerial triangulation using the Wild B8 plotter. The principal feature of the method is the transfer of exterior orientation of a camera by measurement of outer orientation parallel to successive airbases.

Objectifs Rapporter notre experience sur la chirurgie des meningiomes intracrâniens a Dakar . Methode Les auteurs rapportent une serie retrospective de 24 patients porteurs de meningiomes intracrâniens operes dans une unite neurochirurgicale differente de notre institution mere a Dakar . Le recrutement s'est fait de Janvier 2001 a Juillet 2004. L'evaluation diagnostique a repose essentiellement sur la tomodensitometrie cerebrale et l'anatomo-pathologie. Resultats Il s'agissait de 17 femmes et de 7 hommes. L'âge de nos patients variaient entre 21 et 77 ans avec un pic de frequence a 55 ans . Le syndrome d'hypertension intracrânienne et la comitialite ont ete les circonstances diagnostiques les plus frequentes avec un taux de 37%. La tomodensitometrie cerebrale a permis d'evoquer un diagnostic presomptif de nature. Concernant la topographie, les meningiomes de la convexite ont ete observes dans 50% des cas suivis par les meningiomes de la base (20%). L'evaluation de la qualite de l'exerese chirurgicale selon le grading de Simpson a retrouve 20% de grade I et 64% de grade II. L'insuffisance du plateau technique et le manque de competences en neuroanesthesie rendent compte de la mortalite post-operatoire de 12%. Conclusion Ce travail nous permet de proposer une strategie d'amelioration de la pratique neurochirurgicale tumorale en Afrique subsaharienne. Objective To report our experience of intracranial meningiomas surgery in Dakar. Method We analysed a population of 24 patients who underwent operation in a Neurosurgical unit different from our mother Institution. Brain CT scan has been done for every patient and histopathological confirmation has been reached for all patients. Results Regarding sex, we have 17 females for 7 males. The patient age was between 21 and 77 years old with a mean of 55.Intracranial hypertension and seizures were the main symptoms encountered with 37% for each. Our diagnostic evaluation is based on CT scan which showed 50% of convexity meningiomas and 20% basal one .By using Simpson grading to assess the quality of surgical resection ,we found 64% of grade II and only 20% of grade I.A 12% of postoperative death rate is related on the substandard medical set and the lack of neuroanesthesists. Conclusion We outlined a program to improve the neurosurgery practice in Sub-Saharan countries. Keywords : Afrique, meningiomes intracrâniens, neurochirurgie, Senegal, tumeurs, Africa, intracranial tumors, meningioma, neurosurgery, Senegal African Journal of Neurological Sciences Vol. 24 (1) 2005: pp. 45-554

Leptin is a peptide hormone secreted by adipocytes. It has been shown to modulate production and clearance of amyloid beta (Abeta) in rodent models. We sought to determine if serum leptin was associated with cognitive decline in the elderly. We studied 2871 well-functioning elders, aged 70-79, who were enrolled in a prospective study. Serum leptin concentrations were measured at baseline and analyzed by mean+/-1S.D. Clinically significantly cognitive decline over 4 years was defined as > or =5-point drop on the Modified Mini Mental State Exam (3MS). Compared to those in the lower leptin groups, elders in the high leptin group had less cognitive decline, 20.5% versus 24.7% (OR=0.79; 95% CI 0.61-1.02, p=0.07). After adjustment for demographic and clinical variables, including body mass index and total percent body fat, those in the high leptin group had significantly less likelihood of cognitive decline, OR=0.66 (95% CI 0.48-0.91). We conclude that in elderly individuals, higher serum leptin appears to protect against cognitive decline, independent of comorbidites and body fat.

ContextNeuropsychiatric symptoms of dementia are common and associated with poor outcomes for patients and caregivers. Although nonpharmacological interventions should be the first line of treatment, a wide variety of pharmacological agents are used in the management of neuropsychiatric symptoms; therefore, concise, current, evidence-based recommendations are needed.ObjectiveTo evaluate the efficacy of pharmacological agents used in the treatment of neuropsychiatric symptoms of dementia.Evidence AcquisitionA systematic review of English-language articles published from 1966 to July 2004 using MEDLINE, the Cochrane Database of Systematic Reviews, and a manual search of bibliographies was conducted. Inclusion criteria were double-blind, placebo-controlled, randomized controlled trials (RCTs) or meta-analyses of any drug therapy for patients with dementia that included neuropsychiatric outcomes. Trials reporting only depression outcomes were excluded. Data on the inclusion criteria, patients, methods, results, and quality of each study were independently abstracted. Twenty-nine articles met inclusion criteria.Evidence SynthesisFor typical antipsychotics, 2 meta-analyses and 2 RCTs were included. Generally, no difference among specific agents was found, efficacy was small at best, and adverse effects were common. Six RCTs with atypical antipsychotics were included; results showed modest, statistically significant efficacy of olanzapine and risperidone, with minimal adverse effects at lower doses. Atypical antipsychotics are associated with an increased risk of stroke. There have been no RCTs designed to directly compare the efficacy of typical and atypical antipsychotics. Five trials of antidepressants were included; results showed no efficacy for treating neuropsychiatric symptoms other than depression, with the exception of 1 study of citalopram. For mood stabilizers, 3 RCTs investigating valproate showed no efficacy. Two small RCTs of carbamazepine had conflicting results. Two meta-analyses and 6 RCTs of cholinesterase inhibitors generally showed small, although statistically significant, efficacy. Two RCTs of memantine also had conflicting results for treatment of neuropsychiatric symptoms.ConclusionsPharmacological therapies are not particularly effective for management of neuropsychiatric symptoms of dementia. Of the agents reviewed, the atypical antipsychotics risperidone and olanzapine currently have the best evidence for efficacy. However, the effects are modest and further complicated by an increased risk of stroke. Additional trials of cholinesterase inhibitors enrolling patients with high levels of neuropsychiatric symptoms may be warranted.

We examined the impact of medical comorbidities on length of stay and early readmissions in a sample of administrative records of 2396 acute psychiatric hospitalizations. The sample comprised all acute psychiatric admissions to Veterans hospitals from 1989 through 1992, for'which bipolar disorder, manic phase (ICD 296.4) was an active diagnosis. The most prevalent medical comorbidities were tested for association with length of stay and with readmission within 30, 90, or 180 days. We screened for associations using linear and logistic regressions, and then tested significant univariate associations separately using chi-square and t.tests. Mean length of stay was significantly longer in patients with a comorbid diagnosis of epilepsy (25.5 days vs. 19.2 days; p

Evaluations by families (of chronically mentally ill individuals) of mental health professionals and resources were solicited through a mail survey. The respondents, largely better educated, white, and female, indicated a generally high level of dissatisfaction. Emotional support, information, and aftercare resources were identified as particular areas of concern. The survey findings present a challenge to mental health professionals to reconsider the effects of chronic mental illness on the family and the needs of the non-ill family members.

SummarySignificant hyperlipemia was regularly encountered in rats with severe acute nephritis induced by anti-kidney serum.