Faculty Bibliography

OBJECTIVE:To assess the feasibility of the menstrual cup for short-term management of urinary leakage among women with vesicovaginal fistula (VVF). METHODS:A repeated measures design compared volume of leakage with and without the cup via a 2-hr pad test among women with VVF seeking surgical repair at a health facility in Ghana. Subsequently a gynecological exam was administered to assess safety outcomes, followed by a questionnaire to assess acceptability and perceived efficacy. A paired t-test was used to analyze reduction of leakage in ml, and percent reduction was reported. Study limitations include observer bias while evaluating adverse outcomes and the possibility of social desirability bias during questionnaire administration that might overestimate the effect of the cup and women's acceptability. RESULTS:Of the 32 patients screened, 11 were eligible (100% consent rate). At baseline, mean (±SD) leakage in ml was 63.2 (±49.2) (95% CI: 30.2-96.3) over two hours, while the mean leakage over two hours of use of the cup was 16.8 (±16.5) (95% CI: 5.7-27.9). The mean difference of 46.4 (±52.1) ml with use of the cup (95% CI: 11.4-81.4) was statistically significant (p = 0.02). With the cup, women experienced an average 61.0% (±37.4) (95% CI: 35.9-86.2) leakage reduction, a difference 10/11 users (91.0%) perceived in reduced leakage. One participant, reporting four previous surgical attempts, experienced a 78.7% leakage reduction. Acceptability was high-women could easily insert (8/11), remove (8/11), and comfortably wear (11/11) the cup and most (10/11) would recommend it. No adverse effects attributable to the intervention were observed on exam, although some women perceived difficulties with insertion and removal. Data collection tools were appropriate with slight modification advised. CONCLUSION/CONCLUSIONS:A larger trial is warranted for a more robust evaluation of the menstrual cup for management of urinary leakage due to VVF among women who have not yet accessed surgery or for whom surgery was not successful.

Purpose To determine the maximum tolerated dose and safety of the epothilone, KOS-862, in patients with advanced solid tumors or lymphoma. Patients and Methods Patients were treated weekly for 3 out of 4 weeks (Schedule A) or 2 out of 3 weeks (Schedule B) with KOS-862 (16-120 mg/m(2)). Pharmacokinetic (PK) sampling was performed during cycles 1 and 2; pharmacodynamic (PD) assessment for microtubule bundle formation (MTBF) was performed after the 1st dose, only at or above 100 mg/m(2). Results Thirty-two patients were enrolled, and twenty-nine completed >/=1 cycle of therapy. Dose limiting toxicity [DLT] was observed at 120 mg/m(2). PK data were linear from 16 to 100 mg/m(2), with proportional increases in mean C(max) and AUC(tot) as a function of dose. Full PK analysis (mean +/- SD) at 100 mg/m(2) revealed the following: half-life (t ((1/2))) = 9.1 +/- 2.2 h; volume of distribution (V(z)) = 119 +/- 41 L/m(2); clearance (CL) = 9.3 +/- 3.2 L/h/m(2). MTBF (n = 9) was seen in 40% of PBMCs within 1 h and in 15% of PBMC at 24-hours post infusion at 100 mg/m(2). Tumor shrinkage (n = 2, lymphoma), stable disease >3 months (n = 5, renal, prostate, oropharynx, cholangiocarcinoma, and Hodgkin lymphoma), and tumor marker reductions (n = 1, colorectal cancer/CEA) were observed. Conclusion KOS-862 was well tolerated with manageable toxicity, favorable PK profile, and the suggestion of clinical activity. The maximum tolerated dose was determined to be 100 mg/m(2) weekly 3-on/1-off. MTBF can be demonstrated in PBMCs of patients exposed to KOS-862

The introduction of dual-energy computed tomography systems (ie, scanners that can simultaneously acquire images at different energies) has significant and unique applications for urologists. Imaging data from these scanners can be used to evaluate composition of urinary calculi and, by 'removing' iodine from an image, significantly decrease radiation dose to patients referred for hematuria. Further, the ability to create a virtual noncontrast image obviates the need for repeated scanning in patients with incidentally detected renal and adrenal masses. Finally, the ability to quantify the regional concentration of iodine in a renal neoplasm may provide a method to monitor effectiveness of therapy before size changes become apparent

Amyand's hernia is a rare presentation of an appendix within an inguinal hernia sac. It is commonly mistaken for an incarcerated or strangulated hernia. Prompt diagnosis requires awareness of this entity, as well as associated radiologic findings on computed tomography (CT) and ultrasound. Treatment includes antibiotics and surgical intervention involving appendectomy and hernia repair. We present a case of a premature infant who developed systemic symptoms after a circumcision and was eventually diagnosed with an Amyand's hernia with concurrent appendicitis

Our earlier studies showed that several ions inhibit the crystal growth of apatite and promote the formation of amorphous calcium phosphates (ACP). These ions include: magnesium (Mg), zinc (Zn), stannous (Sn), ferrous (Fe), carbonate (CO3), pyrophosphate (P2O7). The purpose of this study was to investigate the effect of combination of these ions (e.g., Mg & CO3, Mg & P2O7, Mg & Zn, etc) on the formation and stability of ACP. ACP compounds containing the different ions were prepared at 25 and 37 degrees C according to the method we previously described. Chemical stability was investigated by suspending the different ACP preparations in solutions with or without inhibitory ions. Thermal stability was determined by sintering the ACP at different temperatures. Dissolution properties were determined in acidic buffer. The ACP before and after chemical or thermal treatment were analyzed using X-ray diffraction, infrared spectroscopy, and thermogravimetry. Results showed synergistic effects of inhibitory ions on the formation of ACP. ACP materials, regardless of their composition, remained amorphous even after heat treatment at 400 degrees C. Transformation of ACP to other calcium phosphate phases depended on the pH and on the solution composition