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We determined the clinical applicability, safety and efficacy of endoscopically injected glutaraldehyde cross-linked collagen for the treatment of efferent limb incompetence in the incontinent Indiana urinary reservoir.Six patients were diagnosed with incompetence of the efferent limb of the Indiana reservoir by video urodynamics. Glutaraldehyde cross-linked collagen was injected through the efferent limb at the level of the ileocecal valve. Outcome was assessed by evaluation of dryness and pouchograms.With a mean followup time of 26 months (range 6 to 36) after the last injection 5 of the 6 patients were cured. The remaining patient, although improved, had a small capacity and subsequently underwent ileal patch augmentation. No patient failed to improve. The mean volume of collagen was 16 ml. (range, 5 to 26). Reservoir volume increased from 150 to 400 ml.The use of glutaraldehyde cross-linked collagen in the treatment of the incontinent Indiana reservoir is safe and effective.

This study evaluated the hypothesis that the behavior problems that place children at risk for victimization by peers are associated with victimization primarily when children are also at social risk for victimization. Social risk was defined as lacking supportive friends or as being rejected by the peer group. Participants were 229 boys and girls in the 3rd through 7th grades (M age = 11 years 2 months). As predicted, behavior problems (internalizing problems, externalizing problems, and physical weakness) were more strongly related to victimization when children had few friends, had friends who were incapable of fulfilling a protective function (e.g., were physically weak), or were rejected by peers than when children had more friends, had friends capable of defending them, or were better liked by peers. Results illustrate the principle that individual risk variables depend on social context for expression.

The actual mechanism for risk of developing cancer in intestinal segments used for urinary diversion remains uncertain. The clinical and laboratory experiences are reviewed in this article. The pathogenesis is multifaceted, involving initiators and promoters of carcinogenesis. Molecular genetic technology may provide the key to decoding the mechanisms involved.

They're slow, they're hard-of-hearing, they don't get better--elderly patients can be a pain in the practice. Here's how to keep them away.

The clinical awareness of the various presentations of pheochromocytoma, along with newer monitoring and anesthetic techniques, has enabled early diagnosis and less fluctuation of blood pressure during operation. The use of meticulous surgical technique through the various incisions outlined in this article has made the excision of pheochromocytoma an expeditious operation and the accompanying hypertension surgically curable. Thus, pheochromocytoma is less likely to be a fatal lesion.

Myelin development has been studied in the neonatally hypothyroid rat brain by isolation and characterization of purified myelin preparations. The hormone deficiency results in a suppression of compact myelin formation and the persistence of a lighter possibly pro-myelin fraction. The appearance of myelin basic protein was markedly delayed in the hormone-deficient animals and this effect on the basic protein moiety may be responsible for the delayed myelinogenesis.

Ureteroscopy with the rigid instrument is now an integral part of the endourologic armamentarium for the management of patients with ureteral calculi. Our experience demonstrates that ureteroscopy can be a safe, efficacious, and less invasive modality. Morbidity will be lowered with proper patient selection, meticulous attention to technique, and use of the proper equipment. Prevention is the best way to avoid serious complications of ureteroscopy. The following guidelines are recommended: Ureteroscopy should be used primarily for patients with distal ureteral calculi. A guidewire should be in place at all times during ureteroscopy. Fragmentation devices should be available. No forceful manipulations should be undertaken during either introduction of the instrument or manipulation of the calculus. When access or manipulation is difficult, a stent should be placed in the ureter for ureteroscopy at a later date. When perforation occurs, a stent should be placed in the ureter and the injured dry unstented ureter complex avoided. Alternative endourologic modalities should be used when appropriate. When practicing urologists are aware of the indications, potentials, and limitations, ureteroscopy and other endourologic methods will permit safe successful treatment of most patients with ureteral calculi.

National Library of Medicine research, resource project, and resource improvement grant-related communication activity was measured and examined as an initial task in exploring information exchanges in health sciences librarianship. Grantees were generally found to be reporting results extensively in a variety of written formats and oral presentations. Ways to improve the transfer and utilization of research and development activity results are presented.