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Introduction The first recorded use of a urethral catheter was in ancient Egypt, when papyrus reeds were used to artificially drain the bladder. Subsequently, a variety of other materials, including metals bronze, copper, silver and tin ; , and animal skins were used to produce primitive catheters. The first rubber catheters were produced in the 1800s, initially without, and later with, the provision of a balloon to aid in retaining the catheter in the bladder. Today, urinary catheters can be made from a number of materials, including latex, PVC and silicone. They are specifically designed for different uses; short and long-term indwelling catheters, and for intermittent self-catheterisation. There are a number of practical problems associated with urinary catheter use. These include discomfort and trauma on insertion, and the risks of urinary tract infection and catheter encrustation. Clearly, the degree of relevance of each of these issues varies with the situation in which the catheter is being used, but in all cases there has been considerable research into developing catheter technologies to combat each specific potential complication. This article summarises some of the difficulties encountered in the past, and examines some of the emerging technologies for dealing with catheter-related problems. Biocompatibility Modern urinary tract catheters are largely well tolerated, and this may almost be taken for granted. However, this was not always the case. Whilst, not surprisingly, early catheters may not have been particularly comfortable or compatible with human tissues, biocompatability has really only been addressed in recent years. It was during the 1980s that it was first recognised that biocompatibility was an important issue to consider, and at that time many cases of severe damage to the urethra following catheterisation with a latex catheter were reported. Interestingly, the cause in most instances was not actually latex, but a reaction to substances added to the latex at the time the catheter was manufactured.1 Following this discovery, the testing of new urinary catheters for biocompatibility assumed a new importance, and is now mandatory. A variety of tests may be performed to assess biocompatibility, including in vivo animal studies, and experiments involving the exposure of proposed new catheter materials to cultures of human urothelial cells.2 Biofilms and encrustation For indwelling catheters, be they urethral or suprapubic, encrustation may prove a significant problem. Encrustation is a complex process, in which crystalloid and colloid substances adhere to the surface of the catheter.3 It has been the focus of considerable study. Encrustation may happen whether the urine present is infected or sterile, and is thought to involve a number of steps, commencing with the adsorption of urinary proteins onto the surface of the catheter, with subsequent formation of a biofilm to which other materials, eg. bacteria, may adhere. A significant proportion of the studies with respect to encrustation and biofilm formation have been performed with ureteric stents, but some of their findings may also be applied to the development and use of long-term urinary catheters. It has been suggested that the actual protein content of biofilms may vary between encrusted and nonencrusted stents; 4 a finding that could well be extrapolated to urinary catheters, and may be of practical use in the search to find ways of reducing or entirely preventing encrustation from occurring. Once biofilm formation has commenced, the process currently is not able to be reversed, and if bacteria are present, and adherent to the catheter, the biofilm may protect the organism from the effect of antibiotic agents.5 Encrustation may also occur in sterile urine, and frequently these encrustations consist of calcium oxalate crystals. This process is less well understood than encrustation in the presence of infection. In an attempt to avoid the development of encrustation, various measures have been tried, including the use of long-acting antimicrobial coatings, and treatments designed to detach biofilms as they form. Currently however, these measures are far from perfected, and encrustation will remain a significant problem for indwelling catheters for the foreseeable future and prednisone.
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P148 LOW INVASIVE SURGICAL APPROACH IN THYROID SURGERY Chernyshev S.V., Komissarenko I.V., Shlyakhtych S.L., Shchupachinskaya L.O., Berezhnaya I.Yu Kiev City Center of Endocrine Surgery, Kiev, Ukraine A new low-invasive method of thyroid surgery without using special endoscopic instruments has been developed. Cutaneous access to the thyroid is carried out from an incision up to 2.5-3.0 cm, going along the natural fold of the neck Langerhans line ; in the lower part of nodding muscle. Tissular access is performed through fascial pockets of prethyroid muscles and middle jugular lymphatic collector. The thyroid lobe is removed beginning from the upper pole. The recurrent nerve and parathyroid glands are visualized. Using this method, 59 thyroid operations were performed: 8 thyroidectomies, 2 subtotal thyroidectomies, 49 hemithyroidectomies. In 7 cases unilateral approach was supplemented with a symmetric approach from the other side. Pathologically, 7 cases of papillary thyroid carcinoma, one case of follicular carcinoma, 3 cases of diffuse toxic goiter, 42 cases of benign thyroid nodular pathology have been diagnosed. The volume of a removed lobe with or without neoplasm was within the range 5.6 to 34.9 cm3. Ultrasound investigation and fine-needle aspiration biopsy were performed in preoperative period, and pathological study of frozen sections carried out during the operation. It should be stressed that, unlike endoscopic technique, using our method of surgery nodules were removed completely or in the form of two fragments, each of which contained a non-injured capsule. In postoperative period, transitory hypocalcemia was noted in one case, there were no cases of injury to recurrent laryngeal nerves. A 8-month postoperative follow-up period has not revealed any recurrences of thyroid pathology. Thus, this method allows to minimize the traumatic character of surgery without using expensive equipment, reduces the average duration of patients' treatment, ensures a high cosmetic effect, and allows a comprehensive study of tumor capsule for pathological diagnosis. P149 IMPAIRED QUALITY OF LIFE QoL ; IN UNTREATED HYPERTHYROIDISM MAINLY RELATES TO MENTAL FACTORS, WHILE PHYSICAL FACTORS PREDOMINATE IN UNTREATED HYPOTHYROIDISM Karmisholt J., Laurberg P. Dept. of Endocrinology and Medicine, Aalborg Hospital, Aarhus University Hospital, Denmark Background: Thyroid disease may lead to mental and physical alterations. Patients with untreated hyper- or hypothyroidism frequently experience impaired QoL. Whether the impaired QoL is due to mental or physical factors, is unknown. Aim: To investigate association between QoL and psychological and clinical symptoms in newly diagnosed hyper- and hypothyroid patients, and after one year of treatment. Methods: 12 hyperthyroid and 12 hypothyroid patients underwent investigation before and after treatment. QoL was investigated with SF-36, specific psychological symptoms with Hospital Anxiety and Depression Scale HADS ; and clinical symptoms with a hyperthyroid scale Klein-1988 ; and a hypothyroid scale Zulewski-1997 ; . SF-36 was reported as physical pcs ; and mental mcs ; composite scores, HADS as an anxiety HADA ; and a depression HADD ; score, clinical symptom scales as total scores Klein-score and Zulewski-score ; . The association between variables and QoL was examined in multivariate regression models. Results: Mean age SD ; , years: Hyperthyroid 57 11.1 ; , hypothyroid 53 13.3 ; . Female male ratio: hyperthyroid 10 2, hypothyroid 6 Mean values before after medical treatment, hyperthyroidism: TSH miu L ; : 0.01 1.4, T4 nmol L ; : 223 97, T3 nmol L ; : 6.4 1.9, Pcs: 43.1 47.0 p 0.19 ; , mcs: 45 54.1 p 0.007 ; , HADA: 8.4 5.5 p 0.02 ; , HADD: 6.2 4.0 p 0.07 ; , Klein-score: 13.1 6.5 p 0.002 ; . Hypothyroidism: TSH: 128.2 2.1, T4: 26.8 111, T3: 0.8 1.7, Pcs: 43.8 48.8 p 0.034 ; , Mcs: 49.4 54.0 p 0.092 ; , HADA: 5.0 3.7 p 0.03 ; , HADD: 3.8 2.1 p 0.09 ; , Zulewski-score: 4.4 2.2 p 0.003 ; . Baseline components of QoL which changed after treatment were: mcs in hyperthyroidism and pcs in hypothyroidism. In multivariate regression models HADA predicted mcs in hyperthyroidism p 0.048, r2 0.60 ; , and Zulewski-score predicted pcs in hypothyroidism p 0.038, r2 0.36 ; . Conclusion: Medical treatment of thyroid disease was associated with increase in some components of QoL. In hyperthyroidism, baseline anxiety level was associated to mental composite score, which increased after treatment. In hypothyroidism, baseline clinical symptom score was associated to physical composite score which increased after treatment. Impaired QoL in untreated hyperthyroidism mainly relates to mental factors, while physical factors predominate in hypothyroidism and prevacid and pepcid, for example, pepcid ac maximum strength.
White and 6% were black. Most patients 27 35 ; continued into the treatment withdrawal phase of the study. Two patients discontinued famotidine due to adverse events. Most patients improved during the initial treatment phase of the study. Results of the treatment withdrawal phase were difficult to interpret because of small numbers of patients. Of the 35 patients enrolled in the study, agitation was observed in 5 patients on famotidine that resolved when the medication was discontinued; agitation was not observed in patients on placebo see ADVERSE REACTIONS, Pediatric Patients ; . These studies suggest that a starting dose of 0.5 mg kg dose of famotidine oral suspension may be of benefit for the treatment of GERD for up to 4 weeks once daily in patients 3 months of age and twice daily in patients 3 months to 1 year of age; the safety and benefit of famotidine treatment beyond 4 weeks have not been established. Famotidine should be considered for the treatment of GERD only if conservative measures e.g., thickened feedings ; are used concurrently and if the potential benefit outweighs the risk. Pediatric Patients 1-16 years of age Use of PEPCID in pediatric patients 1-16 years of age is supported by evidence from adequate and well-controlled studies of PEPCID in adults, and by the following studies in pediatric patients: In published studies in small numbers of pediatric patients 1-15 years of age, clearance of famotidine was similar to that seen in adults. In pediatric patients 11-15 years of age, oral doses of 0.5 mg kg were associated with a mean area under the curve AUC ; similar to that seen in adults treated orally with 40 mg. Similarly, in pediatric patients 1-15 years of age, intravenous doses of 0.5 mg kg were associated with a mean AUC similar to that seen in adults treated intravenously with 40 mg. Limited published studies also suggest that the relationship between serum concentration and acid suppression is similar in pediatric patients 1-15 years of age as compared with adults. These studies suggest that the starting dose for pediatric patients 1-16 years of age is 0.25 mg kg intravenously injected over a period of not less than two minutes or as a 15-minute infusion ; q 12 h mg day. While published uncontrolled clinical studies suggest effectiveness of famotidine in the treatment of peptic ulcer, data in pediatric patients are insufficient to establish percent response with dose and duration of therapy. Therefore, treatment duration initially based on adult duration recommendations ; and dose should be individualized based on clinical response and or gastric pH determination and endoscopy. Published uncontrolled studies in pediatric patients have demonstrated gastric acid suppression with doses up to 0.5 mg kg intravenously q 12 h. Geriatric Use Of the 4, 966 subjects in clinical studies who were treated with famotidine, 488 subjects 9.8% ; were 65 and older, and 88 subjects 1.7% ; were greater than 75 years of age. No overall differences in safety or effectiveness were observed between these subjects and younger subjects. However, greater sensitivity of some older patients cannot be ruled out. No dosage adjustment is required based on age see CLINICAL PHARMACOLOGY IN ADULTS, Pharmacokinetics ; . This drug is known to be substantially excreted by the kidney, and the risk of toxic reactions to this drug may be greater in patients with impaired renal function. Because elderly patients are more likely to have decreased renal function, care should be taken in dose selection, and it may be useful to monitor renal function. Dosage adjustment in the case of moderate or severe renal impairment is necessary see PRECAUTIONS, Patients with Moderate or Severe Renal Insufficiency and DOSAGE AND ADMINISTRATION, Dosage Adjustment for Patients with Moderate or Severe Renal Insufficiency ; . ADVERSE REACTIONS The adverse reactions listed below have been reported during domestic and international clinical trials in approximately 2500 patients. In those controlled clinical trials in which PEPCID Tablets were compared to placebo, the incidence of adverse experiences in the group which received PEPCID Tablets, 40 mg at bedtime, was similar to that in the placebo group!
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