A Randomized Clinical Trial Of Lidocaine Jelly For Prevention Of Inadvertent Retrograde Stone Migration During Pneumatic Lithotripsy Of Ureteral Stone

UroToday – A frustrating effect of intracorporeal lithotripsy, especially with the pneumatic lithotripsy device, is retropulsion of the stone up the ureter and even into the kidney thereby making successful stone removal more difficult.

Several ancillary devices have been developed to reduce this problem, including ureteral baskets and balloon catheters. However, these devices tend to be expensive and not consistently reliable.

These clinicians reported on the simple instillation of 2-ml of 2% lidocaine jelly via a 5 French catheter during semi-rigid ureteroscopy, above the stone. The catheter is then replaced by the lithotripsy probe. Fifty patients were randomized at the time of their ureteroscopy and intracorporeal lithotripsy procedure with or without lidocaine jelly instillation. The two groups were similar in terms of their age, stone size and location. Stone or fragment retropulsion was observed in one (4%) of the study patients and seven (28%) of the control patients (p=0.002). The study group also had a significantly better stone free rate (96%) versus 72% (p=0.05, respectively) and efficiency quotient (92% versus 51%, p=0.002, respectively)

It would be interesting to see if a similar method could be developed for use with the flexible ureteroscope and replicate a similar prospective randomized study.

A.A Zehri, M. H. Ather, K. M. Siddiqui, M.N. Sulaiman
Journal of Urology 2008; 180: 966-968

Reported by UroToday Contributing Editor Elspeth M. McDougall, MD, FRCSC, MHPE

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Copyright © 2008 – UroToday

Pre-Activity Stretching May Hinder Athletic Performance, Unlv Study Finds

Contrary to the prevailing idea that stretching enhances athletic performance, a new study by UNLV kinesiology researchers found that certain stretching may actually reduce performance by decreasing leg power.

The study, which appears in the September 2008 issue of the Journal of Strength and Conditioning Research, investigated how two typical stretching techniques for the hamstrings and quadriceps muscles in the legs affected measures of strength and power in a group of male and female athletes.

Specifically, participants were asked to perform a vertical jump and seated knee flex on three occasions after a typical duration of basic static (holding) and ballistic (bouncing) stretches, or no stretching at all. While little or no difference was found in vertical jump and leg torque, power measures for the stretching groups were significantly reduced.

“Athletes typically include static stretching as a part of the warm-up, but the evidence is clear that this practice will decrease performance in sports that require explosive movements,” said UNLV kinesiology professor and study co-author Bill Holcomb, who directs the university’s Sports Injury Research Center. “Developing flexibility is important for reducing sports injury, but the time to stretch is after, not before, performance.”

Holcomb suggests that coaches limit stretch duration as a part of the warm up in most sports and refrain from pre-activity stretching altogether for sports that are reliant on maximum power. Instead, athletes should perform a whole-body warm-up activity followed by sport specific, or dynamic, stretching.

Power, calculated using a force-measuring device during the vertical jump testing, decreased between 2.4 and 3.4 percent after ballistic and static stretching. Vertical jump is commonly used in research as a predictor of power because the process of jumping requires a person to effectively generate force with their legs at rapid speed. Also, the hamstrings and quadriceps both function as major muscles used in jumping.

While the percentage of the power decrease may not warrant a change in warm up routine for recreational athletes, it is quite significant for competitive athletes participating in activities requiring maximum power, such as track and field and football, for example.

Participating in the study with Holcomb were UNLV Department of Kinesiology and Nutrition professors Mack Rubley and Mark Guadagnoli, and graduate kinesiology student Michelle Samuel. The study appeared in the September 2008 issue of the Journal of Strength and Conditioning Research and can be found online at: nsca-jscr.

UNLV is a doctoral-degree-granting institution of 28,000 students and 3,300 faculty and staff. Founded in 1957, the university offers more than 220 undergraduate, master’s and doctoral degree programs. UNLV is located on a 350-acre campus in dynamic Southern Nevada and is classified in the category of Research Universities (high research activity) by the Carnegie Foundation for the Advancement of Teaching.


Boca Raton Community Hospital First In Florida To Use New Device For Stroke Prevention In Atrial Fibrillation Patients

Boca Raton Community Hospital’s Christine E. Lynn Heart and Vascular Institute (LHVI) announced the first use in the state of Florida, and only the fourth use in the nation, of a recently FDA-approved device to exclude the left atrial appendage, a site associated with stroke in atrial fibrillation (afib) patients.

James Morris, MD and medical director of the Institute recently implanted what is known as the AtriClip™ into a 71-year-old male patient with atrial fibrillation who had been admitted to the hospital suffering from an intracranial bleed. The patient has since been discharged in good condition.

Patients with atrial fibrillation, or irregular heartbeat, have a five times higher risk of suffering a stroke than people who don’t have the condition, according to the Framingham Heart Study, which followed over 5,000 patients for more than 30 years.

Physicians believe this increased risk is associated with the failure of the left atrium to fully evacuate blood from the atrium during atrial fibrillation. The blood then pools in a cul-de-sac within the left atrium called the left atrial appendage (LAA). The LAA is a small pouch attached to the left atrium containing irregular interior surfaces called trabeculations. In patients with atrial fibrillation clots can form in these areas. These clots can then migrate through the circulatory system, block circulation to key structures in the body and lead to stroke.

“We believe over 90 percent of clots form in the left atrial appendage,” said Dr. Morris. “By occluding, or cutting off blood flow into the LAA, we can dramatically reduce the chance of stroke for patients with afib.”

Prior to the development of the AtriClip, surgeons used a stapler to remove the LAA, or sutured the appendage shut. Studies, however, showed that only about 40 percent of these procedures successfully closed the LAA.

With the AtriClip, surgeons place the device around the left atrial appendage using minimally invasive or “keyhole” techniques, which provide significant benefits to the patient over conventional open-heart procedures. The AtriClip is then closed and functions as a clamp to cut off the blood flow between the LAA and left atrium. The LAA is then reabsorbed by the body over a short period of time.

“The left atrial appendage is much like the body’s appendix. It performs no physiologic function. It is simply a reservoir, if you will, for the heart’s left atrium,” commented Dr. Morris. “Thus, the logic behind the AtriClip is quite elegant. If the LAA presents all risk but no reward to the afib patient, why not simply eliminate it.”

Another significant benefit of the AtriClip procedure is the potential for afib patients to not have to take anticoagulation medications such as Coumadin (warfarin sodium), long a mainstay therapy for this patient population. “If one takes out the repository where clots form, it stands to reason there could be a concomitant elimination of the use of anticoagulants and their significant side effects,” said Dr. Morris.

Dr. Morris was quick to emphasize that this benefit was limited to afib patients and not those using anticoagulant therapy for conditions like deep vein thrombosis or after angioplasty. “While we are very encouraged relative to the two-fold benefits of the AtriClip procedure, it is essential that the public knows the therapy is applicable only to patients with atrial fibrillation and high risk for stroke,” he said. “For that particular patient population, this is a tremendous advance in the care we can offer.”

Source: Boca Raton Community Hospital

View drug information on Warfarin Sodium tablets.

Testing Well Water Annually Recommended To Reduce Health Risks To Children

Private well water should be tested yearly, and in some cases more often, according to new guidance offered by the American Academy of Pediatrics (AAP). Researchers at the National Institute of Environmental Health Sciences (NIEHS), part of the National Institutes of Health, took a lead role in working with the AAP to develop these recommendations and draft a new AAP policy statement about the things parents should do if their children drink well water. The recommendations call for annual well testing, especially for nitrate and microorganisms such as coliform bacteria, which can indicate that sewage has contaminated the well. The recommendations point out circumstances when additional testing should occur, including testing when there is a new infant in the house or if the well is subjected to structural damage.

“Children are especially vulnerable to waterborne illnesses that may come from contaminated wells,” said Walter J. Rogan, M.D., an epidemiologist at NIEHS and lead author on the policy statement and technical report that appears in the June issue of Pediatrics. The new policy statement, “Drinking Water from Private Wells and Risks to Children,” offers recommendations for inspection, testing and remediation of wells providing drinking water for children.

“With few exceptions, well owners are responsible for their own wells,” said Rogan. Private wells are not subject to federal regulations and are only minimally regulated by states. With proper care, well water is safe; however, wells can become contaminated by chemicals or pathogenic organisms.

Nitrate, which comes from sewage or fertilizer, is the most common contaminant in wells. The presence of nitrates can be a problem particularly for infants under three months who can not metabolize nitrate. Water with a nitrate concentration of more than 1.0 milligrams per liter should not be used to prepare infant formula or given to a child younger than one year. The policy statement suggests using bottled water for infants when nitrate contamination is detected, or when the source of drinking water is not known.

The policy statement and accompanying technical report point out that water contamination is inherently local, and that families with wells need to keep in contact with state and local health experts to determine what should be tested in their community. For example, some parts of the country may have arsenic, radon, salt intrusion or agricultural runoff that may get into the water supply.

“As people move out of urban and suburban areas into areas that are not reached by municipal water supplies, it is more important than ever that people know who to contact in their local health department to get information about local groundwater conditions,” said N. Beth Ragan of NIEHS, who served as consultant on these reports. A compilation of state by state telephone and Web-based resources of local experts is included in the technical report. Approximately one-sixth of U.S. households now get their drinking water from private wells.

NIEHS Director Linda Birnbaum, Ph.D., says she is pleased that NIEHS researchers took the lead in writing this statement, and continue their longstanding liaisons with the American Academy of Pediatrics to develop state-of-the-science technical reports that can have a direct impact on public health.

“This statement will be extremely useful to many audiences – especially pediatricians,” Birnbaum said. “Pediatricians needed a one-stop shopping document that they can share with parents who have concerns about their children’s sources of drinking water.”

Reference(s): Rogan WJ, Brady MT, the Committee on Environmental Health and the Committee on Infectious Diseases. June, 2009. Technical Report. “Drinking Water from Private Wells and Risks to Children.” Pediatrics,123:6. DOI: 10.1542/peds2009-0751.

Committee on Environmental Health and Committee on Infectious Diseases. Policy Statement. “Drinking Water from Private Wells and Risks to Children.” Pediatrics,123:6. DOI: 10.1542/peds2009-0751.

Christine Bruske Flowers

NIH/National Institute of Environmental Health Sciences

Three Additional Alabama Deaths Linked To 2009 H1N1 Influenza

The Alabama Department of Public Health has been notified in the past week about the deaths
of three individuals: a man in his 60s from Talladega County, a woman in her 50s from Madison
County, and a female in her 70s from Jackson County. Specimens showed they tested positive
for 2009 H1N1 influenza.

Previous deaths of persons positive for H1N1 influenza have occurred this year in Bullock, Dale,
Houston, Jackson, Jefferson, Macon, Montgomery and Russell counties.

The continued widespread incidence of 2009 H1N1 influenza in Alabama and the 11 known
deaths in the state serve as reminder of the need for everyone to take steps to prevent
transmission of disease and to be immunized for both seasonal and H1N1 influenza when
vaccine becomes available.

Alabama Department of Public Health

Longitudinal Analysis Of Sexual Function Reported By Men In The Prostate Cancer Prevention Trial

UroToday- Analysis of patients on finasteride vs. placebo in the Prostate Cancer Prevention Trial (PCPT) suggests that the sexual dysfunction of men on finasteride is slight and limited in duration. The report of Carol Moinpour and colleagues appears in the Journal of the National Cancer Institute.

The PCPT was a 7 year blinded and randomized trial of finasteride 5mg per day vs. placebo to evaluate the efficacy of preventing prostate cancer (CaP). A 24.8% reduction in the prevalence of CaP among men taking finasteride was reported. In these studies participants completed questionnaires (the Sexual Problems Scale and the Sexual Activity Scale) and sexual toxicity ratings were complied by the research team. The participant reported measures were recorded at time of study enrollment, at randomization, at 6 months, and annually for 7 years. In addition, a Participant Lifestyles survey assessed the health behaviors of smoking status, physical activity, diet, and alcohol use.

Demographic and clinical variables were similar among the two treatment arms. A statistically significant increase in sexual dysfunction was found on the Sexual Activity Scale score with finasteride participants on average 3.21 points higher than those taking placebo at first assessment. This decreased to 2.11 points at the end of study. Following adjustment for covariates mean sexual dysfunction increased in both the finasteride and placebo arms at 6 months from baseline by 1.26 points per year. The cumulative increase was 8.2 points over the entire study period.

Overall, the effect of finasteride on sexual function was statistically significant but clinically minimal and it decreased with time. The authors conclude that patients should not hesitate to take finasteride for prostate cancer chemoprevention due to concerns over sexual dysfunction.

Moinpour CM, Darke AK, Donaldson GW, Thompson IM, Langley C, Ankerst DP, Patrick DL, Ware JE, Ganz PA, Shumaker SA, Lippman SM, Coltman CA

J Natl Cancer Inst. 99(13):1025-35, July 2007

Reported by UroToday Contributing Editor Christopher P. Evans, M.D.

UroToday – the only urology website with original content global urology key opinion leaders actively engaged in clinical practice.

To access the latest urology news releases from UroToday, go to:

Copyright © 2007 – UroToday
Reproduced for blog with permission of UroToday.

Survey Shows Need For Horse Safety Campaign

A recent UK HealthCare survey found that 60 percent of Kentucky horseback riding respondents did not wear any safety apparel the last time they went riding.

“Many riders who have been injured say that they feel that those injuries were preventable,” said Fernanda Camargo, DMV, Ph.D., equine extension professor at the University of Kentucky. “Wearing a helmet and paying attention to what your horse is communicating to you are two of the primary ways you can prevent injuries.”

Survey results also found that out of the 100 respondents, 31 have been injured at least once in the past three years from handling or riding a horse. However, out of those 31 injured respondents, 70 percent of them thought their injury could have been prevented.

“The survey conducted by this campaign showed that the majority of people who rode recently didn’t wear any protective gear, like a certified and properly fitted helmet,” explained Camargo. “One of the aims of this important campaign is reaching out to riders of all ages and abilities to educate them about how to stay safe riding and handling a horse. It can also serve as an important reminder to many of us who have years of experience but might become lax in our everyday behavior.”

The campaign’s website showcases booklets, produced in conjuction with dozens of participating equine organizations, featuring educational information on horse-transmitted diseases, horse-related injuries and general horse rider safety information. To visit the campaign website, share tips about experiences involving horse and rider safety, and read the blog, hosted by Camargo, go here.

By sharing your experiences online, you will be entered to win prizes, including general admission tickets to the 2010 Alltech FEI World Equestrian Games with final winners drawn on July 25, 2010.


University of Kentucky

Study: Link Between Air Pollution & Diabetes Risk

Right now, about 24 million Americans are living with diabetes.* but experts predict that number will double in the next 20 years. While doctors know diet and exercise can play a big role in the disease, a new study shows that your address could also be a major factor.

Even though his mother had diabetes, Joe Kessler didn’t know he was at risk. In fact, if it wasn’t for a routine check up, Joe may not have found out that he has diabetes, too.

“I was taking a physical and it was caught by accident just through the blood work. While I was glad it did, – I did not go to the doctor for that reason,” says Joe.

Since then, Joe has had to pay close attention to what he eats. Experts have known for some time that diabetes is linked to things like fatty and sugary foods. But now researchers at Ohio State University Medical Center have found a strong connection between diabetes, diet, and air pollution.

Doctor Sanjay Rajagopalan says air pollution not only affects your lungs, it also causes problems in other organs. His research team exposed mice to the same dirty air that many of us breathe every day.

“Every mouse that we exposed to high fat diet, along with exposure to inhaled particulates had marked worsening of diabetes,” says Dr. Rajagopalan.

The tests showed that air pollution caused inflammation, increased body fat and interferes with how the mice processed insulin, a hallmark of diabetes. And the effects were strongest when combined with poor diet. It’s not good news considering one in three Americans is obese, and one in six lives with poor air quality.**

“It’s interesting that the diabetic increases have been most notable in urbanized areas, where there’s been a high percentage of patients being exposed to bad air,” says Dr. Rajagopalan.

For years, Joe breathed bad air while working as a fabricator and welder. Today he’s an avid boater and doesn’t take a single breath of fresh air for granted.

There are steps you can take to protect yourself. Doctors say if you live in an area with poor air quality try to limit your exposure, especially during the worst conditions. And don’t be a couch potato, avoid fatty foods and get moderate exercise.

**Total Prevalence of Diabetes & Pre-diabetes, American Diabetes Association, retrieved January 2009 from diabetes/diabetes-statistics

**State of the Air 2008, American Lung Association, retrieved January 2009 from: lungusa


Ohio State University Medical Center

Cleviprex(TM) Reduces And Controls Acutely Elevated Blood Pressure In Elderly Patients, According To New Analysis From VELOCITY Trial

The Medicines Company (NASDAQ: MDCO) announced that its investigational agent, CleviprexTM (clevidipine butyrate) injectable emulsion was well tolerated in elderly patients and rapidly achieved and maintained blood pressure control in patients presenting to the emergency department or intensive care unit with acutely elevated blood pressure (n=27), according to a post-hoc analysis of the Phase 3 VELOCITY1 trial. VELOCITY was an open-label, single-arm, multi-center study in 126 emergency department patients presenting with acutely elevated blood pressure.

The analysis, which was presented at the annual meeting of the Society of Academic Emergency Medicine (SAEM), evaluated the safety and efficacy of Cleviprex in patients 65 years and older. Target blood pressure control was achieved with Cleviprex, administered by intravenous (IV) infusion, at a median of 5.8 minutes in these elderly patients and more than 96 percent of patients reached their target blood pressure range within 30 minutes. A continuous 18-hour infusion of Cleviprex was well-tolerated in the majority of elderly patients, with successful transition to oral therapy.

“Currently available options for the treatment of acutely elevated blood pressure are often not ideal for elderly patients due to contraindications with comorbidities,” said Charles Pollack, MD, Professor of Emergency Medicine, University of Pennsylvania. “The poor health of these elderly patients can make treatment in the hospital setting a real challenge.”

Most of the elderly patients in the analysis had end-organ damage at baseline with more than 20% suffering from existing renal disease (including dialysis dependent patients). While more than half of the patients in the analysis experienced an adverse event, most of the events were assessed as unrelated to Cleviprex.

“There is clearly a need in the marketplace for treatment alternatives for elderly patients with acute elevations of blood pressure,” said James Ferguson, M.D., Vice President, Global Medical, Surgical and Critical Care, The Medicines Company. “It is critical to carefully manage this high-risk patient group.”

The Risk of Acutely Elevated Blood Pressure

Acutely elevated blood pressure, or acute hypertension, is a life-threatening condition that can cause permanent damage to the brain, heart, kidneys and blood vessels. Each year, more than 3 million people are treated with intravenous antihypertensive drugs in U.S. hospitals for acute elevations of blood pressure. It is critical to rapidly manage and maintain optimal blood pressure to minimize risk of death and damage to vital organs.

About Cleviprex

Cleviprex is a novel investigational IV antihypertensive for the treatment of acutely elevated blood pressure, when the use of oral therapy is not feasible or desirable. Cleviprex has a rapid onset and offset of action and can be titrated for predictable blood pressure control. Unlike current antihypertensive treatments which are metabolized by the kidney or liver, Cleviprex is metabolized in the blood and does not accumulate in the body.

Six Phase III trials of Cleviprex met all of their primary endpoints. The most common adverse reactions seen with Cleviprex use were headache, sinus tachycardia, hypotension, nausea, polyuria, flushing, dizziness and vomiting.

About The Medicines Company

The Medicines Company (NASDAQ: MDCO) is focused on advancing the treatment of critical care patients through the delivery of innovative, cost-effective medicines to the worldwide hospital marketplace. The Company markets Angiomax® (bivalirudin) in the United States and other countries for use in patients undergoing coronary angioplasty, a procedure to clear restricted blood flow in arteries around the heart. The Company also has two products in late-stage development, CleviprexTM (clevidipine butyrate) injectable emulsion and cangrelor. The Company’s website is themedicinescompany.

Statements contained in this press release about The Medicines Company that are not purely historical, and all other statements that are not purely historical, may be deemed to be forward-looking statements for purposes of the safe harbor provisions under The Private Securities Litigation Reform Act of 1995. Without limiting the foregoing, the words “believes,” “anticipates” and “expects” and similar expressions are intended to identify forward-looking statements. These forward-looking statements involve known and unknown risks and uncertainties that may cause the Company’s actual results, levels of activity, performance or achievements to be materially different from those expressed or implied by these forward-looking statements. Important factors that may cause or contribute to such differences include whether the Company’s products will advance in the clinical trials process on a timely basis or at all, whether clinical trial results will warrant submission of applications for regulatory approval, whether the Company will be able to obtain regulatory approvals, whether physicians, patients and other key decision-makers will accept clinical trial results, and such other factors as are set forth in the risk factors detailed from time to time in the Company’s periodic reports and registration statements filed with the Securities and Exchange Commission including, without limitation, the risk factors detailed in the Company’s Quarterly Report on Form 10-Q filed on May 12, 2008, which are incorporated herein by reference. The Company specifically disclaims any obligation to update these forward-looking statements.

1 eValuation of the Effect of uLtrashOrt-Acting Clevidipine In the Treatment of patients with severe hYpertension

The Medicines Company

View drug information on Angiomax; Cleviprex.

Restless Leg Syndrome Linked With Erectile Dysfunction In Older Men

A study in the Jan. 1 issue of the journal Sleep shows that erectile dysfunction was more common in older men with restless leg syndrome (RLS) than in those without RLS, and the magnitude of this association increased with a higher frequency of RLS symptoms.

Results show that erectile dysfunction was 16 percent more likely in men with RLS symptoms that occur five to 14 times per month (odds ratio of 1.16) and 78 percent more likely in men whose RLS symptoms occur 15 or more times a month (OR=1.78). The associations were independent of age, body mass index, use of antidepressants, anxiety and other possible risk factors for RLS. Fifty-three percent of RLS patients and 40 percent of participants without RLS reported having erectile dysfunction, which was defined as a poor or very poor ability to have and maintain an erection sufficient for intercourse.

The results suggest it is likely that the two disorders share common mechanisms, said lead author Xiang Gao, MD, PhD, instructor at Harvard Medical School, associate epidemiologist at Brigham and Women’s Hospital and research scientist at the Harvard School of public health in Boston, Mass.

“The mechanisms underlying the association between RLS and erectile dysfunction could be caused by hypofunctioning of dopamine in the central nervous system, which is associated with both conditions,” said Gao.

Data were collected from 23,119 men who participated in the Health Professionals Follow-up study, a large ongoing U.S. cohort of male dentists, optometrists, osteopaths, podiatrists, pharmacists and veterinarians. Participants were between the ages of 56 and 91 years, with a mean age of 69 years. To reduce possible misclassification of RLS, participants with diabetes and arthritis were excluded.

Participants were questioned in 2002 about RLS diagnosis and severity based on the International RLS study group criteria. RLS was defined as having unpleasant leg sensations combined with restlessness and an urge to move; with symptoms appearing only at rest, improving with movement, worsening in the evening or at night compared with the morning, and occurring five or more times per month.

About four percent of participants had RLS (944 of 23,119 men), and about 41 percent (9,433 men) had erectile dysfunction. Men with RLS were older and were more likely to be Caucasian. The prevalence of erectile dysfunction also increased with age.

The authors noted that the association between RLS and erectile dysfunction also could be related in part to other sleep disorders that co-occur with RLS. For example, obstructive sleep apnea and sleep deprivation may decrease circulating testosterone levels.

They also pointed out that the cross-sectional design of the study did not allow for a determination of causality. Further epidemiological studies are needed to clarify the relationship between the RLS and erectile dysfunction and to explore the biological mechanisms underlying the association.

The study: “Restless Legs Syndrome and Erectile Dysfunction”

Source: Kelly Wagner

American Academy of Sleep Medicine