Thrombosis in antithrombin-III-deficient persons. Report of a large kindred and literature review

Visual agnosia they could see, but were unable to recognise familiar objects or their use. Oral tendencies they would examine their surroundings with their mouths instead of their eyes. Hypermetamorphosis a desire to explore everything. Emotional changes emotion was dulled and facial movements and vocalisations were far less expressive. They lost fear where it would normally occur. Even after being attacked by a snake, they would casually approach it again. This was called 'placidity'. Hypersexuality a dramatic increase in overt sexual behaviour, including masturbation. They may even attempt copulation with inanimate objects.

Kluver Bucy syndrome.

The extensive use of wireless mobile phones and associated communication devices has led to increasing public concern about potential biological health-related effects of the exposure to electromagnetic fields (EMFs). EMFs emitted by a mobile phone have been suggested to influence neuronal functions in the brain and affect behavior. However, the affects and phenotype of EMFs exposure are unclear. We applied radiofrequency (RF) of 835 MHz at a specific absorption rate (SAR) of 4.0 W/kg for 5 hours/day for 4 and 12 weeks to clarify the biological effects on mouse brain. Interestingly, microarray data indicated that a variety of autophagic related genes showed fold-change within small range after 835 MHz RF exposure. qRT-PCR revealed significant up-regulation of the autophagic genes Atg5, LC3A and LC3B in the striatum and hypothalamus after a 12-week RF. In parallel, protein expression of LC3B-II was also increased in both brain regions. Autophagosomes were observed in the striatum and hypothalamus of RF-exposed mice, based on neuronal transmission electron microscopy. Taken together, the results indicate that RF exposure of the brain can induce autophagy in neuronal tissues, providing insight into the protective mechanism or adaptation to RF stress.

/pdf/induction-of-autophagy-in-the-striatum-and-hypothalamus-of-2v4myh7xnl.pdf

Induction of Autophagy in the Striatum and Hypothalamus of Mice after 835 MHz Radiofrequency Exposure.

We performed transurethral resections of the prostate in 100 patients under local anesthesia supplemented when appropriate by intravenous medication. In the first part of the study (40 patients) local anesthesia was infiltrated into the prostate transurethrally only, while in the second part (60 patients) infiltration was performed transurethrally and perineally. Prostate sizes ranged from 5 to 50 gm., and pain control was excellent in the majority of the patients, especially when perineal infiltration was added to the procedure. Of the patients 98 per cent said they would do it again, no patient required conversion to general anesthesia and there were no significant complications relating to the anesthesia. Local anesthesia with intravenous supplementation can be performed successfully in the majority of the patients with small to moderately sized prostate glands.

Transurethral Resection of the Prostate with Local Anesthesia in 100 Patients

Lymphatic Filariasis (LF) is a mosquito-transmitted parasitic disease caused by the filarial nematodes Wuchereria bancrofti, Brugia malayi and Brugia timori. In 1997, the 50th World Health Assembly approved a resolution calling for the elimination of LF as a public health problem (WHA50.29). This was deemed achievable with a regime of annual Mass Drug Administrations (MDAs) and, where appropriate, vector control for a minimum of four to six years. The Pacific counterpart was named the Pacific Programme to Eliminate Lymphatic Filariasis (PacELF). In the Pacific, countries which have reached the threshold of < 0.1% circulating filarial antigen (CFA) prevalence in children entered surveillance mode until 2012, whereas countries with persistent transmission planned further MDAs. Successful elimination of LF requires:

1) Accurate identification of residual foci of transmission (in countries with persistent transmission);

2) Comprehensive surveillance strategies to detect and combat potential resurgence (in countries entering surveillance mode); and,

3) Culturally appropriate education campaigns to encourage MDA compliance, as systematic non-compliers become reservoirs of infection.

It is crucial to apply sensitive diagnostic tools which are capable of identifying these areas of residual endemnicity or resurgence early. This phase of low prevalence poses particular challenges: “hot spots” may be scattered and ill-defined and the diagnostic tools measuring microfilaraemia (Mf) and CFA that were successful in the earlier phase of the programme may no longer be adequate because of issues with sensitivity, the requirement for larger sampling sizes, and lag phases before Mf or CFA are detectable in newly infected persons. The addition of antibody serology as a complementary diagnostic tool would provide an earlier warning system, since children born after the interruption of transmission would be antibody negative.

In order to incorporate serology into the LF programme, use of a standardised commercial assay must be used, such as the Filariasis Cellabs Enzyme-Linked Immunosorbent Assay (CELISA). Although the Filariasis CELISA has been manufactured since 2006, it is yet to be investigated for its potential use in large scale sampling. It was the aim of this research to determine:

1) The efficacy of the Filariasis CELISA antibody assay;

2) Its usefulness as a potential diagnostic tool for the inclusion into the LF programme; and,

3) Its role in future surveillance work.
This was achieved by validating the Filariasis CELISA for field applicability, assessing its efficacy for identifying areas of residual endemnicity, and investigating the spatial relationships between exposed and infected individuals. In addition, during the progression of the thesis, data became available concerning MDA compliance in Samoa. MDA compliance is also crucial for successful elimination of LF since systematic non-compliers remain as potential reservoirs of infection.

The Filariasis CELISA was easily applicable for field work using whole blood dried onto filter paper. Filter paper sampling had a sensitivity of 92% and a specificity of 77%, when compared to plasma samples. Five thousand four hundred and ninety-eight filter paper samples were assayed from four LF endemic South Pacific countries (Tuvalu, Tonga, Vanuatu, and Samoa). Antibody prevalence rates correlated with cessation of LF transmission in Tonga and Vanuatu, both of which have entered surveillance mode, and ongoing transmission in Samoa and Tuvalu. Most importantly, use of CFA prevalence in children alone, the current World Health Organization (WHO) recommendation, missed vital residual areas of endemic foci in Samoa, as observed by high antibody prevalence in children and Mf positive individuals. This observation required further investigation with an in-depth epidemiological study.

In Samoa, five villages were chosen for prevalence surveys, including Siufaga, which was originally believed to be LF-free. Results showed that the reservoir of infection was the older males and that there was a correlation between transmission (Mf/CFA positivity) and exposure in children. Crucially, ongoing transmission was occurring in Siufaga, as demonstrated by an overall CFA prevalence exceeding 1% and high antibody prevalence in children. CFA testing of children alone would not have identified Siufaga as an area of residual endemnicity.

Accurate identification of residual foci of transmission is challenging in areas where Aedes polynesiensis is endemic, such as Samoa, since no geographical clustering of infection has been demonstrated. Results from the aforementioned epidemiological study were spatially linked to household of residence (community based analyses) and/or primary school (school based analyses) of attendance. “Community based” analyses revealed significant spatial clusters of households with infected individuals and a relationship to antibody positive children when they were included in the spatial analysis. Similar results were observed for “school based” analyses. These promising findings are the first evidence of spatial clustering of LF in a day-biting Ae. polynesiensis endemic area. In addition, these results are the first evidence of dual clustering of Mf/CFA individuals with exposed children.

In Samoa, MDA non-compliance of infected individuals may contribute to persistent transmission. Exploring why these individuals are non-compliant is of paramount importance to the LF programme. Individuals testing positive for LF and children aged 7 – 10 years were asked to participate in a questionnaire designed to ascertain: 1) level of LF knowledge, (2) compliance, and (3) a number of risk factors. For the infected individuals, there was a significant association between MDA compliance and knowledge of LF and, for the children, this association also extended to use of mosquito protection. This exploratory study highlights the need for restructuring current educational campaigns, and their deliverance, to appropriately target children and the systematically non-compliant infected individuals. In addition, the study highlights the necessity to instigate qualitative studies to explore cultural and religious beliefs; a strong driver of compliance.

The overall findings fill critical gaps in knowledge for the elimination of LF namely:

1) Incorporation of antibody serology should be a priority because:

a. Certain areas of residual transmission will not be detected using Mf or CFA diagnostic testing alone; and,

b. Surveillance requires a diagnostic test capable of detecting resurgence early so that action can be timely.

2) In Samoa:

a. Identification of spatial clustering has a significant impact on the LF programme in terms of targeted treatment, re-introduction of vector control campaigns and aiding health personnel to locate potential Mf positive cases;

b. Previously declared “LF-free” villages may have residual transmission; and,

c. New health education campaigns are a necessity for targeting non-compliant individuals.

The addition of antibody serology into the repertoire of LF diagnostic tools holds huge promise for identifying areas of residual endemnicity and in future surveillance and control of LF.

Lymphatic filariasis elimination: residual endemnicity, spatial clustering and future surveillance using the new Filariasis CELISA diagnostic assay

Objective: This manuscript reviews the etiology, presentation and treatment options of hypersexuality. Methods: A MEDLINE search was conducted for English-language articles published over the past 35 years and was supplemented by a search of bibliographies of relevant articles [Compulsive Sexual Behavior, Sexual Addiction, altered sexual preference or Hypersexuality (hetero-, homo-, autosexual)]. Results: Hypersexuality is a change in types and increase in frequency of sexual behaviors. The etiology of hypersexuality is complex and involves a variety of physiological and psychological mechanisms. Frontal lobe dysfunction can lead to disinhibition of sexual behavior and hypersexual behavior. Temporal lobe abnormalities, which have been associated with hypersexuality, also seem to be involved in development of various fetishes, paraphilias, and pedophilia. This sexual behavior may also be the result of other neurologic disorders or a side effect of medications Conclusions: Hypersexuality can be idiopathic or the end result of many underlying disease processes. When the underlying cause may be treated, sexually disinhibited behavior is discontinued. Hypersexuality can cause behaviors in patients that are difficult to manage. But pharmacologic methods can successfully control hypersexual behaviors and paraphilias in most patient population.

https://print.ispub.com/api/0/ispub-article/7683

etiology, diagnosis & management ofHypersexuality: a review

Erectile dysfunction (ED) is frequently a symptom of underlying vascular disease. Vascular risk factors are the most common cause of erectile dysfunction. Endothelium of the penile vasculature plays an important role in the physiology of penile erection. Most patients presenting with vascular erectile dysfunction have a combination of trivascular disease, that being diabetes, hypertension and dyslipidemia, which may result in endothelial dysfunction. Other co-morbidities for vascular erectile dysfunction include smoking, sedentary life style, obstructive sleep apnea syndrome and obesity. When common vascular risk factors are absent, the critical role of a hypercoagulable state as contributing risk factor should be suspected. The inherited hypercoagulable syndromes primarily have an effect on veins, and only occasionally result in arterial thrombosis. The acquired hypercoagulable states which may cause endothelial dependent erectile dysfunction include antiphospholipid antibody syndrome, protein s, protein c and antithrombin III deficiencies, factor V Leiden and prothrombin gene mutation, hyperhomocysteinemia, dysfibrogenenmia and plasminogen deficiency. This paper reviews common hypercoagulable states that may result in endothelial dysfunction, and be an unsuspected cause of ED.

https://print.ispub.com/api/0/ispub-article/7404

Role and Management of Coagulopathies in Vascular Erectile Dysfunction

Purpose: We evaluated the feasibility, effectiveness, tolerance, and morbidity of transrectal ultrasound (TRUS) guided periprostatic infiltration with lidocaine / bupivacaine for provision of anesthesia during biopsy or minimally invasive surgery of the prostate. Methods: The study has two arms, with two groups per arm. The first arm, TRUS guided prostate biopsy, comprises patients with peri-prostatic block (n=10) and patients without such a block (n=10). The second arm, combined thermotherapy for symptomatic benign prostatic hyperplasia, had patients with transurethral lidocaine jelly and periprostatic block (n=10), and patients with transurethral jelly only (n=5). A mixture of equal volumes of 1% lidocaine and 0.25% bupivacaine, each with epinephrine (1:100,000 concentration ratio) was used. 5-10cc of the mixture was infiltrated at the base of the prostate, mid aspect and apex. No sedation, narcotic, or analgesic was required. All patients were monitored during their procedures. Pain control was assessed using a visual analog scale, a 10-point linear analog pain scale, and a global pain questionnaire. Results: Arm 1: Mean pain scores following peri-prostatic nerve block were significantly lower compared with control (2.1 ± 0.48 versus 8.2 ± 0.55, p<.0001). All patients in the infiltration group reported that they were satisfied with pain control, whereas only 5 control patients (50%) were satisfied. Arm 2: Mean pain scores of those following combined peri-prostatic infiltration and topical transurethral lidocaine jelly were significantly lower than transurethral lidocaine jelly only (2 ± 0.42 versus 7.2 ± 0.49, p=0.0004). All patients in the double block group reported that they were satisfied with their pain control, whereas only 3 control patients (60%) were satisfied. During the study no patient had any adverse effect. All procedures were performed in the outpatient setting. Conclusions: Peri-prostatic nerve block results in significant pain control during TRUS guided prostate biopsy and prostatic thermotherapy. The method is safe, convenient, does not require monitoring, and is well accepted by patients. For thermotherapy or other minimally invasive procedures, considerable cost is saved because of the absent need for anesthesia team support, recovery room facility and conscious sedation monitoring

/pdf/ultrasound-guided-peri-prostatic-neurovascular-infiltration-4d687vrih0.pdf

Ultrasound Guided Peri-Prostatic Neurovascular Infiltration for Biopsy and Minimally Invasive Prostate Surgery

Introduction: Patients who are unable to perform intermittent self-catheterization may undergo continent catheterizable stomas using the appendix (Mitrofanoff Appendico-vesicostomy). If the appendix is not available, the bowel is used to create a catherizable channel (Monti-Yang-Casale technique). Patients may develop shortening of the submucosal bladder tunnel with secondary leakage after being dry from the initial procedure. We have devised a novel technique for elongation of the submucosal intravesical tunnel in patients with secondary stomal leakage due to acquired shortening of the submucosal bladder tunnel. Methods: An in-situ bladder tube was created from the dome of the bladder with one end attached to bladder. A submucosal tunnel of adequate length (6: 1 ratio over 10F red rubber catheter) was created. The in situ bladder tube was rotated and brought through the tunnel to create flap valve mechanism. The intravesical end of the tube is anastomosed and the other end is attached to Monti-Yang-Casale tube, which is brought out as a catherizable stoma through the umbilicus. In the second patient, modification was used to create an in-situ tube from the posterolateral portion of the bladder, with urethral side attached to the bladder to prevent any rotation of the tube while placing it in the tunnel. Results:. We have used this technique in two patients. The first patient, who had Monti-Yang-Casale procedures, was fully continent after initial surgery and subsequently developed urinary leakage at the stoma. The second patient had a bladder tube combined with the Monti-Yang-Casale as the primary procedure. Both patients are totally continent following the new in-situ continent bladder tube procedure. Conclusions: Revision for incontinence may be surgically challenging and can lead to vascular compromise. The advantages of this technique are: (1) An in-situ continent bladder tube with can be added to the Monti-Yang-Casale procedure to correct recurrent urinary stomal leak. This technique preserves the stoma loop without handling of the bowel mesentery. (2) This method can also be used as a primary method when the Monti-Yang-Casale tunnel is not sufficiently long enough to cause continence, or compromised blood supply to the Monti-Yang-Casale catheterizable tube.

https://print.ispub.com/api/0/ispub-article/7157

In-situ Catheterizable Bladder Tube with Submucosal Tunneling CATHERIZABLE CHANNEL as Continent Mechanism for Urinary Diversion: A Technique

Acute scrotal pain is a common reason for emergency room visits in men of all ages, but especially in children and young adults. Differentiating those etiologies that require immediate surgical intervention from those that can be treated medically is often challenging. Excluding testicular torsion and avoiding unnecessary surgery although difficult in the past is easier now with advances in ultrasound and other diagnostic techniques. In this paper we suggest an anatomical approach to the acute scrotum by partitioning the contents of the scrotum and spermatic cord into distinct zones. It is postulated that this will facilitate physical and ultrasound exam making pre-surgical diagnosis more accurate. Zone I extends from the internal ring through the inguinal canal to the end of the spermatic cord. Zone II comprises the scrotum, subcutaneous tissues and the tunica vaginalis. Zone III encompasses the testicle with associated appendage and Zone IV includes the epididymis with its appendage. All pathological conditions affecting each zone and the resulting presentation of the acute scrotum are discussed.

https://print.ispub.com/api/0/ispub-article/10492

Anatomical Approach to Scrotal Emergencies: A New Paradigm for the Diagnosis and Treatment of the Acute Scrotum

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