Cardiovascular Benefits of Testosterone Replacement Therapy in the Andropausal Male

Androgen deficiency has been receiving a lot of attention as an evolving health concern in the in-dustrialized world. With population aging, hypogonadism has become a challenging medical problem confronting practicing physicians. The importance of this increasingly prevalent disease arises from its potentially debilitating and serious consequences, such as atherosclerosis, diabetes mellitus, metabolic disorders, muscular weakness, psychiatric illness, sexual dysfunction and vascular inflammation. When left untreated, testosterone deficiency is associated with increased cardiovascular mortality.

Antibiotic Bone Cement and Ultraviolet Light Use in Total Knee Arthroplasty

Objective: The purpose of this study was to determine usefulness of antibiotic bone cement and UV light in primary Total Knee Arthroplasty (TKA). Patients and Methods: Between 1986 and 2008, 3105 TKAs were performed using 750 mg of cefuroxime per bag of cement (Group 1), 7537 using cefuroxime and UV light (Group 2), and 4573 using UV light and gentamicin premixed (Group 3). Results: The primary infection rate was 0.57% (87 acute postoperative infections). Of these, 27 (0.9%) were in Group 1, 44 (0.6%) were in Group 2, and 16 (0.35%) were in Group 3 (p = 0.0013). Kaplan-Meier survival in Groups 1 - 3 for reoperation for aseptic loosening of any component at 5 years was 0.9908, 0.9927, and 0.9959, respectively (p = 0.1315). Conclusion: Despite potential concerns mentioned in the literature, these results continue to support the use of antibiotic bone cement and UV lights during TKA.

Coronary Flow Reserve Assessment of Orbital Atherectomy: An Observational Pilot Study

The aim of this prospective observational pilot study was to observe the impact of orbital atherectomy (OA) on the coronary microcirculation via coronary flow reserve (CFR) measurements. Fifteen subjects who had successful OA and stent placement with no procedural complication were enrolled at 3 hospitals in the U.S. Baseline and hyperemic velocities were 16 ± 5.2 and 36 ± 14 cm/sec, respectively. The average CFR post-procedure was within the normal range at 2.23 ± 0.33. The observation of normal CFR following OA may be attributed to the orbital action of the device that allows for continuous flow during treatment, minimizing a bolus embolization effect which can impact microvascular function.

Ischemic colitis masquerading as colonic tumor:Case report with review of literature

Ischemic colitis can mimic a carcinoma on computed tomographic (CT) imaging or endoscopic examination. A coexisting colonic carcinoma or another potentially obstructing lesion has also been described in 20% of the cases of ischemic colitis. CT scan can differentiate it from colon cancer in 75% of cases. However, colonoscopy is the preferred method for diagnosing ischemic colitis as it allows for direct visualization with tissue sampling. Varied presentations of ischemic colitis have been described as an ulcerated or submucosal mass or as a narrowed segment of colon with ulcerated mucosa on colonoscopy. Awareness and early recognition of such varied presentations of a common condition is necessary to differentiate from a colonic carcinoma, and to avoid unnecessary surgery and related complications.

Accuracy of colon tumor localization:Computed tomography scanning as a complement to colonoscopy

AIM:To determine the utility of computed tomography(CT) scanning in localizing colon tumors.METHODS:At a single tertiary care teaching hospital,a retrospective chart review was conducted on patients who underwent surgery for colon malignancies between January 2004 and May 2006.One hundred and four charts containing all of the following data were reviewed:preop erative colonoscopy report,preoperative CT report,surgical operative report,tumor pathology report.The colon was divided into five segments from the cecum to the sigmoid and the location of the lesions was categorized into one of these areas.The tumor location was considered "erroneous" if its location determined during surgery differed from the location determined by colonoscopy or CT.RESULTS:Over all,tumor location was accurately determined via colonoscopy in 83/104 cases(79.8%) and erroneously in 21/104(20.2%) of cases.CT scan accurately localized colon tumors in 52/104(50.0%) of cases,incorrectly localized tumors in 18/104(17.3%) of cases,and did not detect known tumors in 34/104(32.7%) of cases.Of the 21 tumors erroneously located by colonoscopy,11(52.4%) were accurately localized by CT scan.The average tumor size for all patients in this study was 5.72(+/-3.11) cm.The average size of tumors properly located by colonoscopy and CT was 5.39(+/-3.34) cm and 6.79(+/-3.48) cm,respectively.The average size of the tumors not detected by CT was 3.98(+/-1.75) cm.CONCLUSION:CT scanning may be used in concert with colonoscopy to help localize colon tumors.

Misdiagnosis of tuberculosis and the clinical relevance of nontuberculous mycobacteria in Zambia

Objective:To determine the accuracy of TB diagnosis of TB in Zambia in the era of increasing HIV prevalence.Methods:Sputum of the clinically diagnosed TB cases was additionally subjected to liquid culture and molecular identification.This study distinguished between TB cases confirmed by positive Mycobacterium tuberculosis(M.tuberculosis) cultures and mycobacterial disease caused by non-tuberculous mycobacteria(NTM).Results:Only 49% of the 173 presumptively diagnosed TB cases was M.tuberculosis cultured,while in 13% (22) cases,a combination of M.tuberculosis and NTM was found.In 18% of the patients only NTM were cultured.In 28% ,no mycobacteria was cultivable.HIV positive status was correlated with the isolation of NTM(P【0.05).Conclusions:The diagnosis of tuberculosis based on symptoms, sputum smear and/or chest X-ray leads to significant numbers of false-positive TB cases in Zambia,most likely due to the increased prevalence of HIV.The role of NTM in tuberculosislike disease also seems relevant to the false diagnosis of TB in Zambia.

Gut microbiota interactions with anti-diabetic medications and pathogenesis of type 2 diabetes mellitus

Microorganisms including bacteria,viruses,protozoa,and fungi living in the gastrointestinal tract are collectively known as the gut microbiota.Dysbiosis is the imbalance in microbial composition on or inside the body relative to healthy state.Altered Firmicutes to Bacteroidetes ratio and decreased abundance of Akkermansia muciniphila are the predominant gut dysbiosis associated with the pathogenesis of type 2 diabetes mellitus(T2DM)and metabolic syndrome.Pathophysiological mechanisms linking gut dysbiosis,and metabolic diseases and their complications include altered metabolism of short-chain fatty acids and bile acids,interaction with gut hormones,increased gut microbial metabolite trimethylamine-N-oxide,bacterial translocation/Leaky gut syndrome,and endotoxin production such as lipopolysaccharides.The association between the gut microbiota and glycemic agents,however,is much less understood and is the growing focus of research and conversation.Recent studies suggest that the gut microbiota and anti-diabetic medications are interdependent on each other,meaning that while anti-diabetic medications alter the gut microbiota,the gut microbiota also alters the efficacy of anti-diabetic medications.With increasing evidence regarding the significance of gut microbiota,it is imperative to review the role of gut microbiota in the pathogenesis of T2DM.This review also discusses the interaction between gut microbiota and the various medications used in the treatment of T2DM.

子宫骶骨韧带阴道穹隆悬吊术:5年结局

OBJECTIVE: To evaluate the five-year anatomic and functional outcomes of the high uterosacral vaginal vault suspension. METHODS: One hundred ten patients with advanced symptomatic uterovaginal or posthysterectomy prolapse treated between January 1997 and January 2000 were identified and 72 (65% ) consented to participate in this study. Anatomic outcomes were obtained by Pelvic Organ Prolapse Quantification. Functional results were obtained subjectively and with quality of life questionnaires, including the short-form Incontinence Impact Questionnaire (IIQ) and Urogenital Distress Inventory (UDI), and Female Sexual Function Index. RESULTS: The mean follow-up period was 5.1 years (range 3.5- 7.5 years). Vaginal hysterectomy (37.5% ), anterior colporrhaphy (58.3% ), posterior colporrhaphy (87.5% ), and suburethral slings (31.9% ) were performed as indicated. Surgical failure (symptomatic recurrent prolapse of stage 2 or greater in one or more segments) was 11 of 72 (15.3% ). Two patients (2.8% ) had recurrence of apical prolapse of stage 2 or greater. For those sexually active preoperatively and postoperatively (n=34), mean postoperative Female Sexual Function Index scores for arousal, lubrication, orgasm, satisfaction, and pain were normal, whereas the desire score was abnormal (mean= 3.2). However, 94% (n=29) were currently satisfied with their sexual activity. Postoperative IIQ/UDI scores were significantly improved in all three domains (irritative, P= .01; obstructive, P < .001; stress, P=.03) and overall (IIQ- 7, P < .001; UDI, P < .001) compared with preoperatively. Bowel dysfunction occurred 33.3% preoperatively compared with 27.8% postoperatively (P=.24). CONCLUSION: Uterosacral ligament vaginal vault fixation seems to be a durable procedure for vaginal repair of enterocele and vaginal vault prolapse. Lower urinary tract, bowel, and sexual function may be maintained or improved.

Toxicity of abdominal fat

Abdominal fat or truncal obesity consists of both subcutaneous and visceral fat. It has been found that visceral fat is more metabolically active than subcutaneous fat. The low-level inflammation linked with abdominal fat is associated with insulin resistance and with increases in the release of inflammatory adipokines and cytokines. As a result of these changes, abdominal fat can cause a variety of health conditions. In this review, we focus on the adverse effects of abdominal fat on the body and how it can lead to the development of cardiovascular disease, hypertension, type 2 diabetes mellitus, hyperlipidemia, stroke and cancer. Additionally, we discuss how abdominal fat can be reduced as a result from correction of hormonal deficiencies.

女性间质性膀胱炎或膀胱疼痛综合征的治疗

间质性膀胱炎或膀胱疼痛综合征是一组主要表现为尿频、尿急的慢性综合征，伴有膀胱充盈时疼痛加重的盆腔痛，患者常有疲乏感。。与细菌感染引起的膀胱炎不同，间质性膀胱炎在无尿道感染或其他明显的病理改变的情况下，也可以出现症状。间质性膀胱炎盆腔痛的程度可从腹部压痛到剧痛不等。由于这些难解的不确定因素存在，所以有关于间质性膀胱炎定义、病因学和最佳治疗方法的争论颇多。