Obstruction Score Research Articles

Ceftazidime improves hemodynamics and oxygenation in ovine smoke inhalation injury and septic shock

To investigate ceftazidime in acute lung injury (ALI) and sepsis. Prospective, randomized, controlled animal study in an investigational ICU at a university hospital. Eighteen female Merino sheep were prepared for chronic study and subjected to smoke inhalation and septic challenge according to an established protocol. Whereas global hemodynamics and oxygenation remained stable in sham animals (no injury, no treatment), the injury contributed to a hypotensive-hyperdynamic circulation in the control group (smoke inhalation and sepsis, no treatment), as indicated by a significant increase in cardiac index) and heart rate and a drop in mean arterial pressure. Treatment with ceftazidime (smoke inhalation and sepsis, treatment group) stabilized cardiac index and heart rate and attenuated the decrease in mean arterial pressure. The deterioration in PaO2/FiO2 ratio and pulmonary shunt fraction (Qs/Qt) was significantly delayed and blunted by ceftazidime. At 24 h after injury a significant increase in airway obstruction scores of bronchi and bronchioles in both injured groups was observed. Ceftazidime significantly reduced airway obstruction vs. control animals. Whereas plasma nitrate/nitrite levels increased similarly in the two injured groups, lung 3-nitrotyrosine content remained at the baseline level in the ceftazidime group. In ovine lung injury ceftazidime improves global hemodynamics and oxygenation not only by bacterial clearance but also via reduction in toxic nitrogen species such as 3-nitrotyrosine. Therefore ceftazidime appears as a clinically relevant adjunct in the common setting of sepsis-associated lung injury.

Patient Satisfaction Survey of Outpatient-Based Topical Local Anesthetic KTP Laser Inferior Turbinectomy: A Prospective Study

The aim of this study was to determine patient satisfaction and feasibility of performing KTP laser inferior turbinectomy under topical anesthetic/decongestant spray. A prospective survey study was performed in the Outpatients' Department of a District General Hospital. Thirty-nine consecutive patients suffering from allergic or nonallergic vasomotor rhinitis were prospectively entered into the study. Preoperative details were gathered including current nasal obstruction score as indicated on a visual analog score (VAS). Lidocaine hydrochloride 5% w/v and phenylephrine hydrochloride 0.5% w/v was applied via topical spray to anesthetize and decongest the nose. The inferior turbinates (ITs) were reduced by parallel mucosal cuts using the KTP laser. Intraoperative details were recorded included pain experienced and bleeding. We studied the subjective clinical effectiveness and patient satisfaction. All patients were followed up at standard intervals by telephone over a 6-month period. At each interval, current nasal obstruction, pain, bleeding, and crusting on VAS were collected. Morbidity was determined in terms of return to work, return to hospital, or recurrence of symptoms. At the end of 6 months all patients were asked if they would have the procedure repeated again and/or recommend it to a friend. Reduction of ITs under topical anesthesia was acceptable to 83% of all patients. Eighty-seven percent of all patients felt they would recommend the procedure and mode of anesthesia to a friend. Our patients obtained the maximum subjective benefit at 6 weeks postoperatively. A significant improvement in nasal obstruction was achieved. There was subjective improvement in associated symptoms including hyposmia/anosmia, rhinorrhea, and sneezing. Only 28% of all patients required medication again to aid symptom control. Postoperative bleeding was insignificant. The return to a ward or clinic was minimal and 82% of all employed patients were back at work within a week. Our study showed that KTP laser inferior turbinectomy is suitable to be performed in the outpatient department under topical anesthetic/decongestant spray and provides excellent relief for nasal obstruction and high patient compliance and satisfaction.

Role of pre-infarction angina and inflammatory status in the extent of microvascular obstruction detected by MRI in myocardial infarction patients treated by PCI

Background, objectives The extent of microvascular obstruction (MVO) during myocardial infarction referred to as the “no-reflow phenomenon”, may determine myocardial damage. Our study aimed to investigate the incidence and the influencing factors of MVO in patients with ST-elevation myocardial infarction (STEMI) treated by primary percutaneous intervention (PCI). Patients, methods Using contrast-enhanced MRI, microvascular obstruction was defined as early hypoenhancement. Contrast defects were scored from 0 (no hypoenhancement) to 3 (strong hypoenhancement). 50 patients (56 ± 11 years) with STEMI underwent PCI. Contrast-enhanced MRI (6 ± 2 days after STEMI) and biochemical parameters were evaluated. Results Microvascular obstruction (score 1 to 3) was observed in 90% of the patients and major microvascular obstruction (score 2–3) in 54%. In univariate analysis, leukocytes and CRP levels were associated with MVO, whereas pre-infarction angina and prior medication by aspirin or calcium channel antagonist appeared protective. Microvascular obstruction intensity positively correlated with baseline inflammation status assessed by C-reactive protein and leukocytes (rho = 0.43 and rho = 0.44; p = 0.003), the peak of CK (rho = 0.56; p = 0.01) or Troponin I (rho = 0.59; p = 0.01) and negatively correlated with LVEF (rho = − 0.44; p = 0.002). Multivariate analysis identified the absence of pre-infarction angina as the only independent predictor for microvascular obstruction (odds ratio, 8.35, 95% confidence interval 1.27–54.71; p = 0.027). Conclusion MRI-detected microvascular obstruction has a high incidence in patients with STEMI treated by primary PCI and determines post-MI LVEF even in patients with post PCI TIMI 3 flow score. Pre-infarction angina appears to be an independent determinant of the extent of MVO detected by MRI.

Mortality and Functional Performance in Severe Emphysema after Lung Volume Reduction or Transplant

The purpose of this endeavor is to compare the morbidity, mortality and costs of LVRS versus transplantation in severe emphysema. This was a retrospective review of severe emphysema patients who received LVRS (n = 70) from 1994–1999, or transplant (n = 87) from 1994–2004. Change in functional status was calculated by the change in modified BODE (mBODE) score. Financial data included physician, hospital and medication costs. Preoperatively, there was no significant difference between the transplant and LVRS groups (mean ± SD) in age (57.7 ± 5.7 vs. 59.1 ± 8.3 years), BMI, Borg dyspnea score, 6-minute walk distance or mBODE (10.4 ± 2.6 vs. 9.6 ± 2.7, p = 0.4). Preoperatively, FEV1% (23.6 ± 8.5 vs. 31.9 ± 17.7, p = 0.008) was significantly lower in the transplant group. One year post-operatively, transplantation patients had a significantly greater improvement in mBODE (−5.7 vs. −2.0, p = 0.0004), FEV1% (43.4 vs. 2.2%, p = 0.0004) and Borg score (−3.0 vs. −1.4, p = 0.04). Transplantation patients had lower long-term survival compared to LVRS patients (p = 0.01). The only variable that affected survival was type of surgery favoring LVRS (hazard ratio 1.7, 95% confidence limits 1.05–2.77). During a mean follow-up of 2.4 ± 2.5 years after transplant and 5.0 ± 3.1 years after LVRS, transplantation mean total costs were greater ($381,732 vs. $140,637, p < 0.0001). Transplantation patients spent more time in the hospital (74.3 ± 81.3 vs. 39.5 ± 66.7 days, p = 0.009) and had more outpatient visits (29.9 ± 28.8 vs. 12.3 ± 12.6 visits, p < 0.0001). In patients who survive over 1 year, transplantation provides a higher level of functional status and a greater improvement in airflow obstruction, dyspnea, exercise tolerance, and mBODE score, but costs more and carries greater mortality.

Endobronchial brachytherapy for symptom palliation in non-small cell lung cancer—Analysis of symptom response, endoscopic improvement and quality of life

Endobronchial brachytherapy (EBBT) is a useful modality for the palliation of endobronchial symptoms in advanced non-small cell lung cancer (NSCLC). We report our experience with a special emphasis on duration of symptom palliation and the impact on quality of life (QOL). The records of 95 previously untreated patients with locally advanced NSCLC were treated with palliative radiation using EBBT with or without palliative external radiation (XRT) were analysed. Eighty patients received EBBT and palliative XRT. EBBT was delivered in two sessions of EBBT 8Gy each or a single session of 10Gy. Fifteen patients received EBBT alone to 15Gy in a single session. Symptomatic response rates, duration of symptom palliation, obstruction scores and complications were assessed and compared. Quality of life outcomes, measured using the EORTC QLQ C30 and LC13 questionnaires, were analysed. The overall symptomatic response rates were 93% for dyspnea, 81% for cough, 97% for haemoptysis and 91% for obstructive pneumonia. The median time to symptom relapse was 4-8 months for all symptoms, and the median time to symptom progression was 6-11 months. Quality of life showed significant improvement in symptom scores, functional scales and overall QOL. Complication rates were low. Only one patient died of fatal haemoptysis. EBBT is thus a safe and effective palliative tool in advanced non-small cell lung cancer, with a relatively long duration of symptom palliation and a considerable improvement in the quality of life. There is significant reduction of endobronchial obstruction.

Validation of the short forms of the incontinence impact questionnaire (IIQ‐7) and the urogenital distress inventory (UDI‐6) in a Turkish population

To validate the Turkish versions of the IIQ-7 and UDI-6 for use in Turkish-speaking populations. After establishing the test-retest reliability and internal consistency in a pilot study, 302 patients were enrolled in the study and general and subscale scores of the questionnaires were calculated. All participants underwent an urodynamic assessment. Both instruments showed a high internal consistency (Cronbach's alpha for the IIQ-7 and UDI-6 was 0.87 and 0.74, respectively) and test-retest reliability (Spearman's rho was 0.99 for both of the scales (P < 0.001). 55.6% of the participants showed urodynamic abnormality and/or leakage. 39.7% had urodynamic stress incontinence (USI) and 15.9% had detrussor overactivity (DOA) +/- USI. The mean scores of each IIQ-7 and UDI-6 were significantly higher in the USI, and DOA +/- USI groups compared with normal women. Women with DOA +/- USI scored highest in the IIQ-7 and UDI-6. The irritative subscale scores of the 1st and 2nd items of the UDI-6 were significantly higher in the DOA +/- USI group. The stress subscale scores of 3rd and 4th items of UDI-6 were significantly higher in the USI group. Women with postvoid residual (PVR) urine values greater than 50 ml had significantly higher obstructive subscale scores compared to the ones who had less residual volumes. The Turkish translated versions of the IIQ-7 and UDI-6 are reliable, consistent and valid instruments for assessing symptom severity and the impact on QOL in Turkish speaking women with urinary incontinence.

Bowel symptoms in women planning surgery for pelvic organ prolapse

The objective of the study was to measure associations between bowel symptoms and prolapse. Baseline data were analyzed from 322 women in the Colpopexy And Urinary Reduction Efforts trial of sacrocolpopexy with or without Burch colposuspension. Women completed the Colorectal-Anal Distress Inventory and Colorectal-Anal Impact Questionnaire and underwent Pelvic Organ Prolapse Quantification. Associations between symptoms and questionnaire scores and Pelvic Organ Prolapse Quantification measures were assessed. Mean age was 61 +/- 10 years. Pelvic Organ Prolapse Quantification stages were II (14%), III (67%), and IV (19%). Colorectal-Anal Distress Inventory symptoms did not increase with prolapse stage. Colorectal-Anal Distress Inventory obstructive subscale scores were higher in stage II women (median 29 [interquartile range 8,92] versus 17 [0,33] and 25 [0,38] for stages III and IV, respectively; adjusted P = .01). The few statistically significant correlations between symptoms and vaginal descent were negative and weak (less than 0.2). Bowel symptoms and questionnaire scores do not increase with prolapse stage in women presenting for sacrocolpopexy.

AIRWAY OBSTRUCTION AND LUNG HISTOPATHOLOGY IN SHEEP WITH SMOKE INHALATION ALONE AND IN COMBINATION WITH BACTERIAL CHALLENGE

Airway obstruction can be life threatening in burn patients and may contribute to pneumonia and barotrauma. A further increase in morbidity and mortality of burn patients occurs with sepsis. The purpose of this study is describe the histopathology of animals with smoke inhalation and bronchial bacterial challenge and to test the hypothesis that inhalation injury and bacterial airway challenge will increase the degree of airway obstruction compared to sheep with inhalation injury alone. Method: Sheep with inhalation injury by cooled cotton smoke (n = 6) and combined inhalation injury and airway challenge with pseudomonas aeruginosa, (5 × 1011 cfu), (n = 7) were studied for 24 hours. Sham, uninjured animals served as controls (n = 7). At sacrifice, lung tissue was systematically sampled for histopathology and assessment of airway obstruction was preformed on masked slides. Results: Bronchial obstruction was significantly greater in the smoke only and smoke plus bacterial challenge groups compared to sham animals, p < 0.05. Mean bronchial obstruction scores were 6.7 ± 2.9, 27.1 ± 16.9 and 36.2 ± 17.4 for sham, smoke only and smoke + bacteria animals, respectively. Comparison in the degree of bronchiolar obstruction showed no difference between the sham and the smoke only group, but animals receiving smoke plus bacteria showed an approximately 5-fold increase in mean bronchiolar obstruction that was significantly greater than the smoke only group (p < 0.05). Parenchymal tissue from the smoke only group showed virtually no difference compared to sham. In the smoke plus bacterial challenge group, the parenchyma showed extensive alveolar edema with neutrophils and many bronchioles collapsed or filled with edema fluid or neutrophils. Conclusions: Smoke plus bacterial challenge produces much greater levels of airway obstruction and much more extensive parenchymal injury as compared to the sham or smoke only animals.

Continuous nebulized albuterol attenuates acute lung injury in an ovine model of combined burn and smoke inhalation*

Albuterol, due to its bronchodilatory and anti-inflammatory effects, is given via continuous nebulization in children with severe asthma. Combined burn and smoke inhalation injury frequently results in acute lung injury due to a combination of airway obstruction and inflammation. We hypothesized that albuterol administered via continuous nebulization would mitigate acute lung injury after smoke inhalation injury and burn. Randomized prospective animal model. Twenty adult female sheep (mean weight, 33.1+/-0.9 kg). Adult ewes were subjected to a 40% body surface area third-degree flame burn and smoke inhalation injury after tracheostomy. Sheep were allocated to a) sham group, b) saline continuous nebulization group, c) 20 mg of albuterol continuous nebulization group, or d) 40 mg of albuterol continuous nebulization group (n=5 animals per group). All groups received intravenous lactated Ringer's solution at 4 mL.kg-1.%burn(-1).24 hrs-1 for resuscitation and were equally mechanically ventilated throughout the 48-hr study period. Pulmonary and cardiac function, lung lymph flow, bronchial obstruction score, and wet/dry lung weights were recorded. Compared with saline and control groups, the albuterol groups had lower pause and peak inspiratory pressures, decreased pulmonary transvascular fluid flux, a significantly higher Pao2/Fio2 ratio, and decreased shunt fraction at 48 hrs postinjury. The wet-to-dry lung weight ratio and bronchial obstruction scores were lower for sheep receiving albuterol. Continuous nebulization of albuterol improves pulmonary function via improved airway clearance and decreased fluid flux in a combined burn/smoke inhalation injury model.

Six‐minute walk test in children and adolescents with cystic fibrosis

The 6-min walk test is a simple, rapid, and low-cost method that determines tolerance to exercise. We examined the reproducibility of the 6-min walk test in 16 children with cystic fibrosis (11 female, 5 male; age range, 11.0 +/- 1.9 years). We related the distance walked and the work performed (distance walked x body weight) with nutritional (body mass index and respiratory muscle strength) and clinical (degree of bronchial obstruction and Shwachman score) status. Patients were asked to walk as far as possible upon verbal command on two occasions. There was no statistical difference between distances walked (582.3 +/- 60 and 598.2 +/- 56.8 m, P = 0.31), heart rate, respiratory rate, pulse oxygen saturation, arterial blood pressure, dyspnea, and percentage of maximal heart rate for age in the two tests. Distance walked correlated (Pearson) with maximal expiratory pressure (98.6 +/- 28.1 cmH2O, r = 0.60, P < 0.01), maximal heart rate (157.9 +/- 10.1 bpm, r = 0.59, P < 0.02), Borg dyspnea scale (1.7 +/- 2.4, r = 0.55, P < 0.03), and double product (blood pressure x heart rate; r = 0.59, P < 0.02). The product of distance walked and body weight (work) correlated (Pearson) with height (r = 0.83, P = 0.000), maximal expiratory pressure (r = 0.64, P < 0.01), systolic blood pressure (r = 0.56, P < 0.02), and diastolic blood pressure (r = 0.55, P < 0.03). We conclude that the 6-min walk test is reproducible and easy to perform in children and adolescents with cystic fibrosis. The distance walked was related to the clinical variables studied. Work in the 6-min walk test may be an additional parameter in the determination of physical capacity.

Efficacy and safety of tamsulosin for benign prostatic hyperplasia: clinical experience in the primary care setting

ABSTRACTObjective: This study evaluated the efficacy and safety of the α1A/α1D subtype-selective blocker tamsulosin for the increasingly common treatment of benign prostatic hyperplasia (BPH) in the primary care setting.Methods: A total of 493 men (age ≥ 45 years), 99.6% of whom had moderate or severe BPH at baseline, were given tamsulosin 0.4 mg/day in a multicenter, open-label study conducted over 45 days by 42 primary care physicians and two urologists.Results: Mean American Urological Association (AUA) Symptom Score decreased by 7.5 from a baseline of 20.0 on day 4, representing a 37.5% improvement over baseline ( p < 0.001). AUA Obstructive and Irritative Scores declined significantly by day 4 (–4.7 and –2.7, respectively), as did AUA Bother Score (–5.4, p < 0.001) and mean BPH Impact Score (–2.5, p < 0.001). The Investigator's Global Assessment showed slight or greater improvement in 77.2% of patients (13.7% markedly improved). Effects were maintained from day 4 through day 45.Conclusions: Overall, patients treated with tamsulosin in a primary care setting experienced rapid, significant improvement in their signs and symptoms of BPH, based upon the change in the AUA Symptom Score. Tamsulosin was well tolerated; no new safety concerns were observed. Tamsulosin was not associated with significant effects on blood pressure or first-dose hypotension.

The Association Between Lower Urinary Tract Symptoms and Renal Function in Men: A Cross-Sectional and 5-Year Longitudinal Analysis

We assessed the association between LUTS and renal function in men in a cross-sectional and a longitudinal study. Men participating in health investigation in Vienna entered this study. In the cross-sectional analysis a consecutive series of men were studied and in the longitudinal analysis men were reevaluated after 5 years. LUTS were assessed by I-PSS and renal function was evaluated by GFR, as calculated by the Cockcroft-Gault equation. A total of 2.469 men with a mean age of 47.1 years (range 30 to 80) entered the cross-sectional study and 439 with a mean age of 51.7 years (range 45 to 79) could be assessed in longitudinal analysis. In the cross-sectional study there was no association between the degree of LUTS and GFR during 5 life decades (p = 0.55). An identical pattern was observed for irritative and obstructive scores. In the longitudinal cohort mean GFR +/- SD decreased from 84.3 +/- 20.2 ml per minute at baseline to 79.2 +/- 18.7 ml per minute after 5 years (-6.0%, p <0.0001). The mean decrease in GFR after 5 years was 4.5 ml per minute (-5.4%) in men without/mild LUTS (I-PSS 7 or less at ages 55.4 +/- 11.0 years), 3.9 ml per minute (-4.9%) in those with moderate LUTS (I-PSS 8 to 20 at ages 61.3 +/- 11.6 years) and 4.2 ml per minute (-5.2%) in those with severe LUTS (I-PSS greater than 20 at ages 64.3 +/- 7.4 years). On linear regression analysis in the 2 study cohorts neither I-PSS, nor obstructive or irritative score affected GFR (p >0.05). The only determinants for GFR less than 90 ml per minute were age (p <0.0001) and hypertension (p <0.0001). LUTS do not represent an independent risk factor for impaired renal function in men.

Intranasal Phototherapy is an Effective Treatment in Allergic Rhinitis

RATIONALE: We have recently found that intranasal phototherapy using a combination of low dose UVB, UVA and visible light (mUV/VIS) improves allergic rhinitis. The aim of the present study was to provide further data on the efficacy of rhinophototherapy and to study the mechanism of action of mUV/VIS light.METHODS: In an open study, intranasal phototherapy was performed in 70 patients with ragweed-induced allergic rhinitis. Each intranasal cavity was irradiated 3 times a week for 2 weeks, using gradually increasing doses of mUV/VIS. Evaluation was based on clinical symptom scores. The effect of mUV/VIS light on T cell, eosinophil and basophil apoptosis was also evaluated in vitro using cell cultures.RESULTS: Intranasal phototherapy significantly decreased scores for sneezing (p < 0.001), rhinorrhea (p < 0.001), nasal itching (p < 0.001), nasal obstruction (p < 0.001) and total nasal score (p < 0.001). In the overall efficacy assessment 90% of the patients found that phototherapy significantly inhibited the clinical symptoms. Rhinophototherapy was tolerated well, the only side effect was dryness of the nasal mucosa, which was controlled with emollients. mUV/VIS irradiation induced a dose-dependent increase in apoptosis of memory T cells, naive T cells, eosinophils but not basophils.CONCLUSIONS: These data support that intranasal phototherapy is effective for the treatment of allergic rhinitis and the mechanism of action is at least partly attributed to apoptosis induction of cells with important role in the pathogenesis of the disease. RATIONALE: We have recently found that intranasal phototherapy using a combination of low dose UVB, UVA and visible light (mUV/VIS) improves allergic rhinitis. The aim of the present study was to provide further data on the efficacy of rhinophototherapy and to study the mechanism of action of mUV/VIS light. METHODS: In an open study, intranasal phototherapy was performed in 70 patients with ragweed-induced allergic rhinitis. Each intranasal cavity was irradiated 3 times a week for 2 weeks, using gradually increasing doses of mUV/VIS. Evaluation was based on clinical symptom scores. The effect of mUV/VIS light on T cell, eosinophil and basophil apoptosis was also evaluated in vitro using cell cultures. RESULTS: Intranasal phototherapy significantly decreased scores for sneezing (p < 0.001), rhinorrhea (p < 0.001), nasal itching (p < 0.001), nasal obstruction (p < 0.001) and total nasal score (p < 0.001). In the overall efficacy assessment 90% of the patients found that phototherapy significantly inhibited the clinical symptoms. Rhinophototherapy was tolerated well, the only side effect was dryness of the nasal mucosa, which was controlled with emollients. mUV/VIS irradiation induced a dose-dependent increase in apoptosis of memory T cells, naive T cells, eosinophils but not basophils. CONCLUSIONS: These data support that intranasal phototherapy is effective for the treatment of allergic rhinitis and the mechanism of action is at least partly attributed to apoptosis induction of cells with important role in the pathogenesis of the disease.

A Randomized Controlled Trial of Mometasone Furoate Nasal Spray for the Treatment of Nasal Polyposis

To evaluate the efficacy and safety of mometasone furoate nasal spray (NS) for the treatment of nasal polyposis. Randomized, double-blind, placebo-controlled, parallel-group, multicenter study. A total of 24 centers in 17 countries. A total of 310 subjects 18 years or older with bilateral nasal polyps. (1) A 200-microg dose of mometasone furoate NS in the morning and matching placebo in the evening; (2) 200-microg doses of mometasone furoate NS in the morning and evening; or (3) matching placebo in the morning and evening. All 3 regimens were administered as a nasal spray for 4 months. Primary end points were change from baseline to last assessment in physician-assessed bilateral polyp grade and change from baseline in subject-assessed congestion and/or obstruction score averaged over the first month of treatment. Analysis of variance was used for all efficacy end points except for change in bilateral polyp grade, for which baseline polyp grade was added as a covariate to the analysis of variance model to account for any between-group baseline differences in this variable. Mometasone furoate NS doses of 200 microg administered once or twice daily produced greater reductions in bilateral polyp grade at the end point than placebo, with differences reaching statistical significance with twice-daily dosing (P = .04). Over 1 month, both mometasone furoate NS regimens produced statistically superior improvements from baseline in congestion and/or obstruction score vs placebo (P = .01 for once-daily dosing; P<.001 for twice-daily dosing). The drug was well tolerated. Mometasone furoate NS is an effective and well-tolerated treatment for bilateral nasal polyposis in adults, reducing nasal polyp size and symptoms of nasal congestion and/or obstruction.

Optimization of dose and fractionation of endobronchial brachytherapy with or without external radiation in the palliative management of non-small cell lung cancer: A prospective randomized study

Endobronchial brachytherapy (EBBT) is an established modality for the palliation in advanced non-small cell lung cancer. We compared three different schedules using EBBT with or without external radiation (XRT) in this setting. Forty-five patients were randomized to three treatment arms. Arm A received XRT to a dose of 30 Gy/10 fr/2 weeks and two sessions of EBBT 8 Gy each. Arm B received the same XRT and a single session of EBBT 10 Gy at 1 cm. Arm C received only a single fraction of brachytherapy to a dose of 15 Gy at 1 cm without XRT. Symptomatic response rates, duration of symptom palliation, obstruction scores, quality of life outcomes and complications were assessed and compared. The overall symptomatic response rates were 91% for dyspnea, 84% for cough, 94% for hemoptysis and 83% for obstructive pneumonia. There was no significant difference between the arms. The median time to symptom relapse was 4-8 months for all symptoms and the median time to symptom progression was 6-11 months. The results were comparable between groups except for hemoptysis, where a shorter palliation was seen in Arm C that achieved statistical significance (P < 0.01). Quality of life showed significant improvement, with maximum benefit in Arm A. Complication rates were low. Only one patient died of fatal hemoptysis. EBBT is thus a safe and effective palliative tool in advanced non-small cell lung cancer, either alone or in conjunction with XRT. The difference between the treatment arms were not statistically significant in most categories, but patients treated with XRT and two endobronchial sessions of 8 Gy had the most consistent benefit in terms of all the parameters studied.

Uroflowmetry, trans rectal ultra sonography and power doppler to develop a less invasive bladder outlet obstruction score in benign prostatic hyperplasia: A prospective analysis

<b>OBJECTIVE</b> : To evaluate the ability of transrectal power doppler sonography (TRPDS) in combination with conventional grey scale transrectal<b> </b> ultrasonography (TRUS), uroflowmetry and clinical parameters, to predict bladder outlet obstruction (BOO) in benign prostatic hyperplasia (BPH).<b> MATERIALS AND METHODS</b> : Sixty-nine male patients with more than 50 years of age, presenting with lower urinary tract symptoms were evaluated prospectively for BOO secondary to BPH. TRUS was done to estimate prostate volume (PV), transition zone volume (TZV), median lobe projection in the bladder (ML) and bladder wall thickness (BWT). TRPDS was done to measure resistive index (RI) of transition zone vessels. All patients also underwent PFS and depending upon its results, the patients were divided into Group 1 [Abram-Griffiths (AG) number < 40] and Group 2 (AG number >40). Mean values of TRUS and TRPDS parameters and uroflowmetry in the two groups were compared to identify predictive factors for BOO.<b> RESULTS</b> : Demographic profile of Group 1 (n= 42) was similar to that of Group 2 (n= 27). Significant independent factors for prediction of BOO were maximum flow rate, resistive index of transition zone, median lobe projection into the bladder and post void residue. BOO scoring system was developed based on these 4 factors, which showed a specificity of 77.8% and a sensitivity of 85.7%, with an overall predictive value of 82.6%. <b> CONCLUSIONS</b> : Transrectal power doppler ultrasonography (resistive index) in combination with uroflowmetry, median lobe projection in bladder and post void residue measurement can predict BOO with a high specificity and sensitivity.

Efficacy of a Leukotriene Receptor Antagonist in the Treatment of Perennial Allergic Rhinitis

The objectives of this study were to investigate the efficacy of leukotriene receptor antagonists in the treatment of perennial allergic rhinitis. The study was designed as a randomized, 14-day treatment to compare the efficacy of zafirlukast, loratadine, and the combination of loratadine and pseudoephedrine in the treatment of perennial allergic rhinitis. Rhinitis symptom scores, acoustic rhinometry, and rhinomanometry were used to evaluate the efficacy. The results showed that after a 14-day treatment period, patients in all treatment groups had a lower mean score for the symptoms of rhinorrhea, nasal itching, and nasal obstruction (p < .05). Patients who took zafirlukast did not report a significant decrease in sneezing score (p = .1456), but the decrease in nasal obstruction score was more pronounced than in those who took loratadine or loratadine- pseudoephedrine (p = .014). However, the results of acoustic rhinometry and rhinomanometry did not have a significant difference among the three groups (p > .05). The study concluded that zafirlukast seemed to have a better effect on relieving the symptom of nasal obstruction in patients with perennial allergic rhinitis, but the actual mechanism needs further investigation.

Passive smoking, allergic rhinitis and nasal obstruction in children

Allergic rhinitis is a common cause of nasal obstruction in childhood. This prospective study looked at the effect of passive smoking on nasal obstruction in children with and without allergic rhinitis. Eighty-one children took part. Each child was asked to score his or her degree of nasal obstruction on a visual analogue scale. Exposure to passive smoking was determined subjectively using a parental questionnaire, and objectively by measuring the urinary cotinine/creatinine ratio. Results were tabulated using Microsoft Excel and analysed with SPSS statistical software. Nasal obstruction was significantly worse in children with a positive history of allergic rhinitis (p < 0.05). There was also a trend towards a higher nasal obstruction score in children without allergic rhinitis exposed to passive smoking compared to those who were not so exposed. As would be expected, nasal obstruction is worse in children with allergic rhinitis than in those without. Passive smoking tends to increase the symptom of nasal obstruction in children without allergic rhinitis.

Effectiveness of Urethral Injection of Botulinum A Toxin in the Treatment of Voiding Dysfunction after Radical Hysterectomy

Objective: After radical hysterectomy for cervical cancer patients may have difficulty in urination due to detrusor underactivity and a non-relaxing urethral sphincter. This study evaluated the effectiveness of urethral injection of botulinum A toxin in treating voiding dysfunction in these patients. Methods: Thirty patients with difficult urination after radical hysterectomy due to cervical cancer were enrolled to receive urethral injection of 100 units of botulinum A toxin (n = 20) or medical treatment as controls (n = 10). The clinical results and urodynamic parameters at baseline and after treatment were compared in the study group, and the quality of life (QOL) index was compared between the study and control groups. Results: After urethral injection of botulinum A toxin, 8 patients had excellent results (40%) and 8 had improved results (40%) in the study group. Both voiding pressure (115.2 ± 63.7 vs. 90.2 ± 49.5 ml, p = 0.025) and post-void residual volume (330.9 ± 124.9 vs. 183.9 ± 183.4 ml, p = 0.011) improved significantly after treatment. The obstructive symptom score was significantly reduced (17.5 ± 4.7 vs. 5.7 ± 2.3 points, p = 0.000) and the QOL index also improved (4.5 ± 2.7 vs. 2.3 ± 2.3 points, p = 0.000) after treatment. The success rate was 80% in the study group. There were no significant changes in obstructive symptom scores or the QOL index in the control group. The maximal effect appeared about 1 week after treatment. The duration of the therapeutic effect ranged from 3 to 9 months. Mild stress urinary incontinence and nocturnal enuresis were noted in 7 patients (35%). Conclusion: Urethral injection of botulinum A toxin can be effectively used to treat patients with detrusor underactivity and non-relaxing urethral sphincter after radical hysterectomy with few adverse effects.

Vaginal Wall Descensus and Pelvic Floor Symptoms in Older Women

To understand the clinical significance of early pelvic organ prolapse in older women, we studied associations between vaginal descensus and pelvic floor symptoms. In this cross-sectional study, 270 women enrolled at one site of the Women's Health Initiative clinical trial completed a questionnaire modified from the Pelvic Floor Distress Inventory on pelvic floor symptoms and underwent a Pelvic Organ Prolapse Quantification (POP-Q) examination. We tested associations between symptoms (individual and grouped) with anterior, posterior, uterine, and maximum vaginal descensus. Mean age was 68 years. Ninety-six percent had POP-Q stages I or II. Only obstructive urinary symptoms and feeling a bulge were associated with vaginal descensus. Obstructive urinary symptom scores increased as anterior (P = .04), posterior (P < .01), and maximal (P = .01) vaginal descensus increased. Urinary incontinence or bowel symptoms were not associated with descensus of any vaginal compartment. ''See or feel a bulge,'' reported by 11 women (4%), was associated with descensus in all compartments (P < or = .04 for all) and with prolapse at or beyond the hymen (P < .001). This symptom was specific (100%), but not sensitive (16%) for prolapse, defined as descensus at or beyond the hymen. Vaginal support defects in older women are associated with obstructive urinary symptoms and the symptom of seeing or feeling a bulge. However, symptoms are not useful in discriminating between women with and without milder vaginal wall descensus. Based on these results, we suggest that other etiologies for bothersome bladder or bowel complaints be considered before performing surgery for early pelvic organ prolapse.