Tuesday, August 28, 2012

French catheter scale

The French scale or French gauge system is commonly used to measure the size of a catheter. It is most often abbreviated as Fr, but can often abbreviated as Fg, FR or F. It may also be abbreviated as CH or Ch (for Charrière, its inventor) in French speaking countries.
A catheter of 1 French has a diameter of ⅓ mm, and therefore the diameter of a round catheter in millimeters can be determined by dividing the French size by 3:
D (mm) = Fr/3
Fr = D (mm) × 3
For example, if the French size is 9, the diameter is 3 mm.
An increasing French size corresponds to a larger diameter catheter. This is contrary to needle-gauge size, where an increasing gauge corresponds to a smaller diameter catheter.
The french size is a measure of external diameter of the catheter (not internal drainage channel). So, if a 2 way catheter of eg. 20 Fr is compared to a 20 Fr 3 way catheter then they both have same external diameter but 2 way catheter will contain larger drainage channel than 3 way. 3 way catheters accommodate an extra channel for irrigation in the similar external diameter.
The French gauge was devised by Joseph-Frédéric-Benoît Charrière, a 19th-century Parisian maker of surgical instruments, who defined the "diameter times 3" relationship. 


Researchers develop sutures that monitor wounds and deliver heat to help speed up healing.

A stitch in time might save a little more than nine now that researchers have successfully developed electronic sutures that monitor wounds and help speed up the healing process.
Invented by John Rogers, a professor of materials science and engineering at the University of Illinois at Urbana-Champaign, the smart stitches contain ultrathin silicon sensors that can be blended with polymer or silk strips thin enough to thread through needles. In animal tests, Rogers and his team were able to lace the sutures through skin and knot them without damaging the sensors.
Because elevated temperatures can indicate infection, the sutures monitor temperature at the wound site. The stitches can also deliver heat, which can aid healing.
This is the old-fashioned way to do a suture: Now, electronic sutures can monitor wounds and help speed up the healing process. 

However, Rogers envisions that they could also be used to deliver medicine.
"Ultimately, the most value would be when you can release drugs from them in a programmed way," he said, according to Technology Review.
Doing so would mean coating the electronic sutures with drug-infused polymers that can release chemicals when prompted by heat or an electrical pulse.
The team built two kinds of sensors: A silicon diode that changes its current output according to temperature and a platinum nanomembrane resistor that alters its resistance to temperature. The sutures' micro-heaters, made of gold filaments, produce heat when an electric current passes through them.

Varicocele Surgery Increases Testosterone Levels in Men

    from Medscape
  • The investigators conducted a search of the literature using the Medline/PUBMED database up to May 31, 2011. They also searched cross-references from eligible articles.
  • Included were studies describing patients who underwent varicocelectomy for unilateral or bilateral varicocele, with at least 2 testosterone evaluations (before and after the procedure) and follow-up of 1 month or longer.
  • The testosterone levels had to be measured using the same laboratory method, such as radioimmunoassay.
  • The primary outcome was the difference in testosterone level before and after the surgical procedure.
  • Studies could be randomized controlled trials, observational studies, and comparative studies.
  • 2 reviewers independently assessed the selected studies and tabulated extracted data to pool for the meta-analysis.
  • Of 125 potentially relevant studies, 9 were included for this analysis.
  • The 9 studies involved 814 patients who underwent varicocelectomy and follow-up for at least 3 months.
  • Each study had between 12 and 325 patients, with a mean age of 31.4 years.
  • Surgical procedures performed included inguinal or subinguinal varicocelectomy and sclerotherapy.
  • Diagnosis was by physical palpation of a varicocele before the procedure.
  • All men had serum testosterone levels measured before and after the procedure.
  • Mean serum testosterone levels were increased by a mean of 97.48 ng/dL (95% confidence interval, 43.73 - 151.22; P = .0004) from before to after the procedure.
  • The authors concluded that the procedure of varicocelectomy increases testosterone levels and may thus have benefits for male infertility.

Sunday, August 26, 2012

Holy Prepuce

The Holy Prepuce, or Holy Foreskin (Latin præputium or prepucium) is one of several relics attributed to Jesus, a product of the circumcision of Jesus.
At various points in history, a number of churches in Europe have claimed to possess Jesus' foreskin, sometimes at the same time. Various miraculous powers have been ascribed to it.

History and rival claims

All Jewish boys are required by Jewish religious law to be circumcised on the eighth day following their birth; the Feast of the Circumcision of Christ, still celebrated by many churches around the world, accordingly falls on January 1. Luke 2:21 (King James Version), reads: "And when eight days were accomplished for the circumcising of the child, his name was called JESUS, which was so named of the angel before he was conceived in the womb.The first reference to the survival of Christ's severed foreskin comes in the second chapter of the apocryphal Arabic Infancy Gospelwhich contains the following story:
1.   And when the time of his circumcision was come, namely, the eighth day, on which the law commanded the child to be circumcised, they circumcised him in a cave.
2.   And the old Hebrew woman took the foreskin (others say she took the navel-string), and preserved it in an alabaster-box of old oil of spikenard.
3.   And she had a son who was a druggist, to whom she said, "Take heed thou sell not this alabaster box of spikenard-ointment, although thou shouldst be offered three hundred pence for it."
4.   Now this is that alabaster-box which Mary the sinner procured, and poured forth the ointment out of it upon the head and feet of our Lord Jesus Christ, and wiped it off with the hairs of her head.

Foreskin relics began appearing in Europe during the Middle Ages. The earliest recorded sighting came on December 25, 800, when Charlemagne gave it to Pope Leo III when the latter crowned the former Emperor. Charlemagne claimed that it had been brought to him by an angel while he prayed at theHoly Sepulchre, although a more prosaic report says it was a wedding gift from the Byzantine Empress Irene. The Pope placed it into the Sanctum sanctorum in the Lateran basilica in Rome with other relics. Its authenticity was later considered to be confirmed by a vision of Saint Bridget of Sweden.The foreskin was then looted during the Sack of Rome in 1527. The German soldier who stole it was captured in the village of Calcata, 47 km north of Rome, later the same year. Thrown into prison, he hid the jeweled reliquary in his cell, where it remained until its rediscovery in 1557. Many miracles (freak storms and perfumed fog overwhelming the village) are claimed to have followed.[5] Housed in Calcata, it was venerated from that time onwards, with the Church approving the authenticity by offering a ten-year indulgence to pilgrims. Pilgrims, nuns and monks flocked to the church. "Calcata was a must-see destination on the pilgrimage map." The foreskin was reported stolen by a local priest in 1983.
According to the author David Farley, "Depending on what you read, there were eight, twelve, fourteen, or even 18 different holy foreskins in various European towns during the Middle Ages."[6] In addition to the Holy Foreskin of Rome (later Calcata), other claimants included the Cathedral of Le Puy-en-Velay, Santiago de Compostela, the city of Antwerp, Coulombs in the diocese of Chartres, France as well as Chartres itself, and churches inBesançon, Newport, Metz, Hildesheim, Charroux, Conques, Langres, Fécamp, Stoke-on-Trent , Calcata, and two inAuvergne.[6]
One of the most famous prepuces arrived in Antwerp in the Brabant in 1100 as a gift from king Baldwin I of Jerusalem, who purchased it in Palestine in the course of the first crusade. This prepuce became famous when the bishop of Cambray, during the celebration of the Mass, saw three drops of blood blotting the linens of the altar. A special chapel was constructed and processions organised in honour of the miraculous relic, which became the goal of pilgrimages. In 1426 a brotherhood was founded in the cathedral "van der heiliger Besnidenissen ons liefs Heeren Jhesu Cristi in onser liever Vrouwen Kercke t' Antwerpen"; its 24 members were all abbots and prominent laymen. The relic disappeared in 1566, but the chapel still exists, decorated by two stained glasswindows donated by king Henry VII of England and his wife Elizabeth of York in 1503.
The abbey of Charroux claimed the Holy Foreskin was presented to the monks by Charlemagne. In the early 12th century, it was taken in procession to Rome where it was presented before Pope Innocent III, who was asked to rule on its authenticity. The Pope declined the opportunity. At some point, however, the relic went missing, and remained lost until 1856 when a workman repairing the abbey claimed to have found a reliquary hidden inside a wall, containing the missing foreskin. The rediscovery, however, led to a theological clash with the established Holy Prepuce of Calcata, which had been officially venerated by the Church for hundreds of years; in 1900, the Roman Catholic Church resolved the dilemma by ruling that anyone thenceforward writing or speaking of the Holy Prepuce would be excommunicated.[5] In 1954, after much debate, the punishment was changed to the harsher degree of excommunication, vitandi (shunned) and the Second Vatican Council later removed the Day of the Holy Circumcision from the Latin church calendar, although Eastern Catholics and Traditional Roman Catholics still celebrate the Feast of the Circumcision of Our Lord on January 1.

[edit]Modern practices

Most of the Holy Prepuces were lost or destroyed during the Reformation and the French Revolution.[5]
The Holy Prepuce of Calcata is worthy of special mention, as the reliquary containing the Holy Foreskin was paraded through the streets of this Italian village as recently as 1983 on the Feast of the Circumcision, which was formerly marked by the Roman Catholic Church around the world on January 1 each year. The practice ended, however, when thieves stole the jewel-encrusted case, contents and all.[5] Following this theft, it is unclear whether any of the purported Holy Prepuces still exist. In a 1997 television documentary for Channel 4, British journalist Miles Kington travelled to Italy in search of the Holy Foreskin, but was unable to find any remaining example.

[edit]Historical allusions and references to the Holy Prepuce

Voltaire, in A Treatise of Toleration (1763), ironically referred to veneration of the Holy Foreskin as being one of a number of superstitions that were "much more reasonable... than to detest and persecute your brother".[8]
Umberto Eco, in his book Baudolino, has the young Baudolino invent a story about seeing the holy foreskin and navel in Rome to the company of Frederick Barbarossa.
In July 2009, Penguin/Gotham Books published An Irreverent Curiosity: In Search of the Church's Strangest Relic in Italy's Oddest Town, American writer David Farley's account of trying to locate the Holy Foreskin of Calcata.
In Chuck Palahniuk's book Choke, the main character is told that he was cloned from Jesus' foreskin.

dialysis basics presentation

dialysis basics presentation

by Dr. Nirvan Mukerji


Monday, August 20, 2012

Wednesday, August 15, 2012

Diuresis Renography for Differentiation of Upper Urinary Tract Dilatation From Obstruction F+20 and F-15 Methods

Introduction: The aim of this study was to evaluate diuresis renography with an intravenous injection of furosemide 20 minutes after administering the radiopharmaceutical (F+20 protocol) or 15 minutes before (F-15 protocol) in patients with upper urinary tract dilatation.
Materials and Methods: Twenty-one patients with pyelocaliceal system dilatation, but not ureteral dilatation, on ultrasonography were evaluated. The patients underwent diuresis renography using the F+20 and F-15 protocols. Renal scan findings and kidney split function were recorded. Then, the patients underwent surgical or conservative treatment according to their clinical conditions and imaging results. Follow-up was done 3 and 6 months postoperatively by physical examination, intravenous urography, and diuresis renography.
Results: Eleven patients (52.4%) had complete obstruction in both protocols of renography, and 5 (23.8%) had an equivocal result in the F+20 and an obstructive pattern in the F-15. These patients underwent surgical operation. In 3 patients (14.3%), both protocols demonstrated a normal urinary tract. In 2 patients (9.5%), a nonobstructive response in the F+20 and an equivocal result in the F-15 were seen. One of them underwent surgical operation because of impaired kidney function during the follow-up and 1 was treated conservatively. Overall, obstruction was found in 16 out of 21 patients (76.2%) by the F-15 protocol, while it was found in 11 (52.4%) by the F+20 protocol (P = .01). The mean kidney split function was 55.15% ± 7.82% and 54.81% ± 6.87% in F+20 and F-15 protocols, respectively (P = .45).
Conclusion: Using the F-15 protocol may reduce the equivocal results of the F+20 for diuresis renography.
Urol J (Tehran). 2007;4:36-40. www.uj.unrc.ir

Tuesday, August 14, 2012

Urinary Risk Factors for Bladder Cancer

Monday, August 6, 2012



Purpose: We evaluated pain tolerability and the preliminary results of percutaneous tibial nerve stimulation (PTNS) in children with unresponsive lower urinary tract symptoms (LUTS).

Materials and Methods: A total of 23 children 4 to 17 years old with LUTS refractory to conventional treatment underwent PTNS at 12, 30-minute weekly sessions. Ten patients had idiopathic overactive bladder, 7 were in nonneurogenic urinary retention and 6 had neuropathic bladder. Ten children were carefully evaluated for pain during needle insertion and electrical stimulation using certain scoring systems, namely the faces pain rating scale, Children’s Hospital of Eastern Ontario pain scale, visual analogue scale and Questionario Italiano del Dolore.
Evaluation was done at the first, sixth and last sessions. An anxiety-depression test was administered. All 23 children underwent clinical and urodynamic evaluation before and after treatment.

Results: All except 1 patient completed treatment. An anxious-depressive trait was found in 7 of 10 children/parents on anxiety-depression testing. Regarding pain, the faces pain rating scale never showed the severe pain face, the Children’s Hospital of Eastern Ontario scale showed signs of pain at the beginning of each stimulation but not at the end, and the visual analog scale generally showed a low score with a further decrease during the first (p _ 0.05), sixth (p _ 0.03) and twelfth (p _ 0.02) sessions. The Questionario Italiano del Dolore score was significantly related to the affective component of pain (p _ 0.002) and it decreased between the first and last sessions. The 10 children with overactive bladder had symptom improvement in 80%, incontinence was cured in 5 of 9 and urodynamics showed normalization of cystometric bladder capacity in 62.5% with no more unstable contractions in those who became continent. Symptoms improved in 71% of the children in urinary retention. One of 3 and 4 of 7 patients had incontinence and post-void residual urine cured, respectively. Urodynamics showed an improved detrusor pressure at maximum flow (p _ 0.009) and flow rate (p _ 0.005). Symptoms and urodynamics did not significantly change in the neuropathic bladder group.

Conclusions: PTNS is safe, minimally painful and feasible in children. It seems helpful for treating refractive nonneurogenic LUTS.

Saturday, August 4, 2012

Androgen Insensitivity Syndrome (AIS)

Androgen Insensitivity Syndrome (AIS)

Quigley scale for androgen insensitivity syndrome

a nice presentation hope u like it

Renal Tubular Disorders – Management

Renal Tubular Disorders – Management

a nice presentation from the net

Thursday, August 2, 2012

Prostatitis: a concise review

Prostatitis: a concise review

Bacterial and non-bacterial etiologies

Prostatitis affects up to 50% of men at some point in their lives. Affects men of all ages 
About 8% of all urology visits in United States related to prostatitis 
Only about 6-8% of men with prostatitis will have bacterial prostatitis 

Pathophys: NIH classification and definitions of prostatitis:
I. Acute bacterial prostatitis.
II. Chronic bacterial prostatitis: recurrent infection.
III. Chronic abacterial prostatitis/chronic pelvic pain syndrome: no demonstrable infection
IIIA. Inflammatory chronic pelvic pain syndrome: wbc present in semen/expressed prostatic secretions or voided bladder urine (VB3).
IIIB. Noninflammatory chronic pelvic pain syndrome: no wbc noted in semen/expressed prostatic secretions or VB3.
IV. Asymptomatic inflammatory prostatitis: detected by prostate bx or presence of wbcs in prostatic secretions during evaluation for other disorders.  

Organisms isolated in acute and chronic bacterial prostatitis are same as those causing UTI
E. coli accounts for 80% of prostatic infections; 
Other gram-negative organisms (Pseudomonas aeruginosa, Serratia, Klebsiella proteus) account for 10-15% of infections. 
Enterococci identified in 5-10% cases of prostatitis 
Role of Chlamydia trachomatis in prostatitis is controversial. 

Etiology of acute bacterial prostatitis is often due to reflux of infected urine into prostatic ducts that drain into posterior urethra
Inflammation and edema may lead to occlusion of these ducts, trapping bacteria within, leading to chronic bacterial prostatitis 
Intraprostatic urinary reflux, causing a “chemical” prostatitis, may play a role in etiology of nonbacterial prostatitis  

Urinary frequency and urgency, dysuria, malaise, pain in perineum, groin, testes, back, suprapubic area

Fever/chills if acute bacterial, decreased urine flow rate, nocturia; tender, boggy, or firm prostate on DRE

Differential diagnosis
Distal ureteral calculus, Müllerian remnant, urethral stricture, BPH, seminal vesicle cyst, prostatic cyst, IC, bladder cancer, urachal remnant, hernia, ejaculatory duct cyst, depression/stress, spinal stenosis, mesenteric cyst, fibromyalgia


Meares-Stamey test (4 glass test) is gold standard for diagnosis of bacterial prostatitis. After cleansing and retraction of foreskin, pt voids first 10 mL into sterile container (VB1), then collects midstream 5-10 mL (VB2), then prostatic massage performed, collect expressed prostatic secretions and review under microscope and collect first 10 mL of urine after massage (VB3). 
Modification of Nickels allows for simple testing with 91% sens and specif compared to Meares-Stamey technique.
Modified Nickels technique: Collect midstream urine and perform prostatic massage, then collect postmassage urine and perform UA, C&S on both. 
Future studies include immunologic techniques to allow for ab screening of the expressed prostatic secretions or VB3 specimen for common prostatic pathogens and molecular biologic techniques using PCR to id bacterial gene products  

Bladder scanner PVR to ensure complete bladder emptying. Uroflow helpful in pts with voiding complaints.
Cystoscopy not indicated in most pts.
Videourodynamics in pts with nonbacterial chronic prostatitis may demonstrate spastic dysfunction of bladder neck and prostatic urethra


Acute bacterial prostatitis with abx; typically fluoroquinolones for 6-12 wk. TMP/SMX may be used.

Chronic bacterial prostatitis rx with abx for extended periods; in pts with frequent recurrent infections long-term prophylactic abx may be employed. 

Chronic nonbacterial prostatitis may be treated as follows:
Category IIIA: Trial of broad-spectrum abx, alpha-blocker therapy, anti-inflammatory agents, finasteride or other 5-alpha reductase inhibitor if enlarged prostate, prostatic massage (2-3 ×/wk), supportive therapy (counseling), transurethral microwave therapy or phytotherapy.
Category IIIB: Alpha-blocker therapy, muscle relaxant, analgesics, biofeedback, relaxation exercises, supportive therapy (counseling).

Other Therapies: Sitz baths; avoidance of spices, caffeine, and alcohol. Biofeedback has encouraging results in pts with noninflammatory chronic pelvic pain syndrome

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