Bulking agents: an analysis of 500 cases and review of the literature

Introduction and hypothesis: Stress urinary incontinence (SUI) is common, impacts women's quality of life, and generates high costs. Physiotherapy is the first-line therapy, and if it fails, suburethral slings are the gold standard in SUI surgery. Bulking agents injected periurethrally might be a beneficial alternative, but there is a paucity of data on bulking therapy. The aim of this study was to prospectively analyze the efficacy and safety of bulking agents in the setting of a tertiary referral center. Methods: In the last 13years, 514 elderly women with SUI were treated by injection therapy with either collagen (Contigen®), hyaluronic acid (Zuidex®), ethylene vinyl alcohol (Tegress®), or polyacrylamide hydrogel (Bulkamid®). Subjective and objective outcome was recorded at the 12-month postoperative appointment using the King's Health Questionnaire, visual analogue scale (VAS) describing their incontinence severity, standardized pad test, and urethral pressure profile. Results: Demographic data were equally distributed in all four groups of agents used. Sixty-one patients were lost to follow-up (10.6%). Statistically significant changes were found for maximum urethral closure pressure (MUCP), pad weight, and VAS before and after bulking for the four agents used. Pad test was negative in 73.2% of patients after bulking therapy. Subjective assessment showed improvements in general health and role limitations. The overall complication rate was low for all agents. Conclusions: This study shows improvement in incontinence after bulking therapy according to subjective and objective outcomes in an elderly population. In contrast to earlier reports, side effects due to injections were few and mild. We can advocate bulking therapy for treating SUI, as it is simple, safe, and shows both objective and subjective improvement and relie

Utilisation d’instruments de mesure avec des personnes ayant subi un accident vasculaire cérébral : une enquête par questionnaire auprès d’ergothérapeutes en Suisse romande

L’intérêt des instruments de mesure standardisés est reconnu en ergothérapie et plusieurs organisations professionnelles promeuvent leur utilisation. Les résultats d’études anglo-saxonnes montrent toutefois que les ergothérapeutes n’y ont pas tous recours dans leur pratique et que ceux qui en utilisent ne le font pas de manière fréquente. Les instruments de mesure étant développés et diffusés surtout en anglais, il est possible que les ergothérapeutes francophones en utilisent encore moins. Les objectifs de l’étude étaient : 1) de décrire les instruments de mesure standardisés utilisés auprès de personnes ayant eu un accident vasculaire cérébral par les ergothérapeutes en Suisse romande ; et 2) de décrire leur perception de facteurs facilitant ou entravant la sélection et l’utilisation d’instruments de mesure standardisés. Une enquête par questionnaire postal et en ligne a été menée. Soixante-sept ergothérapeutes y ont répondu. Quarante (60 %) participants ont indiqué utiliser des instruments de mesure standardisés et en ont cité 45 différents. Les versions utilisées sont à plus de 80 % en français et les participants indiquent ne pas savoir si ces dernières sont validées dans un tiers des cas. Enfin, les participants estiment que l’accès aux informations et aux instruments de mesure en français est mauvais. Les acteurs de la recherche et du développement de même que ceux de la formation devraient mettre en œuvre des stratégies permettant de faciliter la sélection et l’utilisation d’instruments de mesure par les ergothérapeutes francophones de Suisse

Bulking agents: an analysis of 500 cases and review of the literature

Stress urinary incontinence (SUI) is common, impacts women's quality of life, and generates high costs. Physiotherapy is the first-line therapy, and if it fails, suburethral slings are the gold standard in SUI surgery. Bulking agents injected periurethrally might be a beneficial alternative, but there is a paucity of data on bulking therapy. The aim of this study was to prospectively analyze the efficacy and safety of bulking agents in the setting of a tertiary referral center

High-resolution carbon dioxide concentration record 650,000800,000 years before present

Changes in past atmospheric carbon dioxide concentrations can be determined by measuring the composition of air trapped in ice cores from Antarctica. So far, the Antarctic Vostok and EPICA Dome C ice cores have provided a composite record of atmospheric carbon dioxide levels over the past 650,000 years. Here we present results of the lowest 200 m of the Dome C ice core, extending the record of atmospheric carbon dioxide concentration by two complete glacial cycles to 800,000 yr before present. From previously published data and the present work, we find that atmospheric carbon dioxide is strongly correlated with Antarctic temperature throughout eight glacial cycles but with significantly lower concentrations between 650,000 and 750,000 yr before present. Carbon dioxide levels are below 180 parts per million by volume (p.p.m.v.) for a period of 3,000 yr during Marine Isotope Stage 16, possibly reflecting more pronounced oceanic carbon storage. We report the lowest carbon dioxide concentration measured in an ice core, which extends the pre-industrial range of carbon dioxide concentrations during the late Quaternary by about 10 p.p.m.v. to 172–300 p.p.m.v

High-resolution carbon dioxide concentration records from the EPICA Dome C ice core (EDC99)

Changes in past atmospheric carbon dioxide concentrations can be determined by measuring the composition of air trapped in ice cores from Antarctica. So far, the Antarctic Vostok and EPICA Dome C ice cores have provided a composite record of atmospheric carbon dioxide levels over the past 650,000 years. Here we present results of the lowest 200 m of the Dome C ice core, extending the record of atmospheric carbon dioxide concentration by two complete glacial cycles to 800,000 yr before present. From previously published data and the present work, we find that atmospheric carbon dioxide is strongly correlated with Antarctic temperature throughout eight glacial cycles but with significantly lower concentrations between 650,000 and 750,000 yr before present. Carbon dioxide levels are below 180 parts per million by volume (p.p.m.v.) for a period of 3,000 yr during Marine Isotope Stage 16, possibly reflecting more pronounced oceanic carbon storage. We report the lowest carbon dioxide concentration measured in an ice core, which extends the pre-industrial range of carbon dioxide concentrations during the late Quaternary by about 10 p.p.m.v. to 172-300 p.p.m.v

Phase II study of amsacrine in solid tumors: a report of the EORTC early clinical trial-group

A total of 239 patients with advanced solid tumors were treated in this phase II trial. Amsacrine was administered as a single i.v. dose of 120 mg/m2 repeated at 21-day intervals. The initial dose was reduced to 90 mg/m2 in the case of extensive prior therapy. Some antitumor activity was detected in head and neck cancer but the drug appears to lack significant efficacy in epidermoid lung cancer as well as in carcinoma of the breast, melanoma, renal cell cancer, colorectal cancer and non-seminomatous testicular cancer. Leukopenia was the major toxic effect encountered in this trial and was similar at 90 and 120 mg/m2. © 1983.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

The role of Southern Ocean processes in orbital and millennial CO2 variations - a synthesis

Recent progress in the reconstruction of atmospheric CO2 records from Antarctic ice cores has allowed for the documentation of natural CO2 variations on orbital time scales over the last up to 800,000 years and for the resolution of millennial CO2 variations during the last glacial cycle in unprecedented detail. This has shown that atmospheric CO2 varied within natural bounds of approximately 170–300 ppmv but never reached recent CO2 concentrations caused by anthropogenic CO2 emissions. In addition, the natural atmospheric CO2 concentrations show an extraordinary correlation with Southern Ocean climate changes, pointing to a significant (direct or indirect) influence of climatic and environmental changes in the Southern Ocean region on atmospheric CO2 concentrations. Here, we compile recent ice core and marine sediment records of atmospheric CO2, temperature and environmental changes in the Southern Ocean region, as well as carbon cycle model experiments, in order to quantify the effect of potential Southern Ocean processes on atmospheric CO2 related to these orbital and millennial changes. This shows that physical and biological changes in the SO are able to explain substantial parts of the glacial/interglacial CO2 change, but that none of the single processes is able to explain this change by itself. In particular, changes in the Southern Ocean related to changes in the surface buoyancy flux, which in return is controlled by the waxing and waning of sea ice may favorably explain the high correlation of CO2 and Antarctic temperature on orbital and millennial time scales. In contrast, the changes of the position and strength of the westerly wind field were most likely too small to explain the observed changes in atmospheric CO2 or may even have increased atmospheric CO2 in the glacial. Also iron fertilization of the marine biota in the Southern Ocean contributes to a glacial drawdown of CO2 but turns out to be limited by other factors than the total dust input such as bioavailability of iron or macronutrient supply