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P-0418 THE LUE PROCEDURE AS A SALVAGE FOLLOWING A NESBIT PROCEDURE A. Muneer, J. Kalsi, S. Minhas, P. Kumar & D.J. Ralph London ; Introduction: Residual penile deformity following a Nesbit procedure for Peyronie's disease can be a difficult problem to manage. A surgical option to correct this is to perform a Lue procedure. The aim of this study was to analyse the outcomes of performing a Lue procedure in patients with Peyronie's disease who have already undergone a Nesbit procedure and subsequently present with residual penile deformity. Patients and Methods: Over a five year period, fifteen patients mean age 52 years, range 33-66 years ; presented to our department with residual penile deformity following a Nesbit procedure. All the patients had painless and stable Peyronie's disease and underwent the Lue procedure using plaque incision and venous grafts from the long saphenous vein or Tutoplast. The outcomes were assessed using a set criterion which recorded the degree of penile shortening, quality of erections and penile angulation. Results: Pre-operatively, the mean angle of deformity was 50 range 10-90 ; . The mean follow up was 10 months. Two patients reported post operative penile shortening and one patient reported a new onset of erectile dysfunction. 73% of patients had a straight penis. Overall, 93% of patients reported either an excellent or satisfactory result following the Lue procedure. Conclusions: Our results indicate that the Lue procedure is a highly effective salvage procedure to correct residual penile deformity following a failed Nesbit procedure in patients with Peyronie's disease, for example, medicines. The primary factor hindering the use of barcode technology in clinical quality improvement was the pharmaceutical industry's unwillingness to adopt a universal barcode standard for all medications.35 This left the task of barcoding pharmaceutical products at the unit-dose level to the hospital. Pioneering institutions could outsource the repackaging process or set up assembly linelike processes in their own pharmacies. Early adopters feared the possibility of introducing new sources of error. Managing the infrastructure changes was also challenging, as so was budgeting for repackaging equipment and additional staff to develop and administer quality control processes necessary to accommodate the technology!

ABSTRACT 53 IMPROVED SURVIVAL IN CARDIOGENIC SHOCK AFTER MYOCARDIAL INFARCTION WITH VENTRICULAR ASSIST DEVICE VAD ; SUPPORT. John W. C. Entwistle III M.D., Ph.D., Paul B. Bolno M.D., Elena Holmes N.P., Louis E. Samuels M.D. Cardiogenic shock after acute myocardial infarction is associated with a very high mortality rate. To improve survival in these patients, we have provided mechanical cardiac support using the Abiomed BVS 5000 to 15 patients average age 58.5 years ; in cardiogenic shock after myocardial infarction who were failing medical management, and in whom death appeared to be imminent. Ten patients were suffering primarily from left ventricular dysfunction and were supported with a left ventricular assist device LVAD ; . Eight of these patients were weaned from device support, and 6 survived. In contrast, 5 patients presented with biventricular failure or combined pulmonary and left ventricular failure, and were supported with bi-ventricular VADs BiVAD ; n 4 ; or LVAD with extracorporeal membrane oxygenation ECMO ; n 1 ; . None of these patients could be weaned from device support. Two BiVAD patients underwent cardiac transplantation, and only one survived. Thus, in the presence of left ventricular failure producing cardiogenic shock after myocardial infarction, LVAD support can produce a 60% survival rate in those patients who are failing medical management. However, in patients requiring bi-ventricular support or ECMO after myocardial infarction, BiVAD support may be used to stabilize the patient until transplantation, but the overall prognosis remains poor, for example, pharmacist. We wish to acknowledge the Arthritis Research Campaign, the National Association for the Relief of Paget's Disease, Proctor & Gamble Pharmaceuticals and Aventis Pharma for grant support. The Health Services Research Unit is funded by the Chief Scientist Office of the Scottish Executive Department of Health. The views expressed are those of the authors and not necessarily those of the funding body. S.H.R. acts as a consultant for Proctor & Gamble, Aventis Pharma and Novartis, which are pharmaceutical companies that manufacture drugs used in the treatment of Paget's disease. S.H.R. and A.L.L. have received funding from the Arthritis Research Campaign, the National Association for the Relief of Paget's Disease, Proctor & Gamble Pharmaceuticals and Aventis Pharma for the PRISM trial of treatment strategies in PDB.
1. National Asthma Education and Prevention Program. Expert Panel Report: Guidelines for the Diagnosis and Management of Asthma: Update on Selected Topics, 2002. Bethesda, Md: National Heart, Lung, and Blood Institute, National Institutes of Health, Public Health Service, US Dept of Health and Human Services; 2003. Available at: : nhlbi.nih.gov guidelines asthma . Accessed February 26, 2005. 2. Fuhlbrigge AL, Adams RJ, Guilbert TW, et al. The burden of asthma in the United States: level and distribution are dependent on interpretation of the national asthma education and prevention program guidelines. J Respir Crit Care Med. 2002; 166: 1044-1049. Lieu TA, Quesenberry CP, Sorel ME, Mendoza GR, Leong AB. Computer-based models to identify high-risk children with asthma. J Respir Crit Care Med. 1998; 157 pt 1 ; : 1173-1180. 4. Greineder DK, Loane KC, Parks P. A randomized controlled trial of a pediatric asthma outreach program. J Allergy Clin Immunol. 1999; 103 pt 1 ; : 436-440. 5. Glauber JH. Does the HEDIS asthma measure go far enough? J Manag Care. 2001; 7: 575-579. Finkelstein JA, Lozano P, Streiff KA, et al; Patient Outcomes Research Team. Clinical effectiveness research in managed-care systems: lessons from the Pediatric Asthma Care PORT. Health Serv Res. 2002; 37: 775-789. Fuhlbrigge A, Carey VJ, Adams RJ, et al. Evaluation of asthma prescription measures of health system performance based on emergency department utilization. Med Care. 2004; 42: 465-471. Kerr EA, Mittman BS, Hays RD, Siu AL, Leake B, Brook RH. Managed care and capitation in California: how do physicians at financial risk control their own utilization? Ann Intern Med. 1995; 123: 500-504. Adams RJ, Fuhlbrigge A, Finkelstein JA, et al. Use of inhaled anti-inflammatory medication in children with asthma in managed care settings. Arch Pediatr Adolesc Med. 2001; 155: 501-507. Aveyard P. Assessing the performance of general practices caring for patients with asthma. Br J Gen Pract. 1997; 47: 423-426. Glauber JH, Fuhlbrigge AL. Stratifying asthma populations by medication use: how you count counts. Ann Allergy Asthma Immunol. 2002; 88: 451-456. Hirschhorn LR, Trnka Y, Onderdonk A, Lee ML, Platt R. Epidemiology of community-acquired Clostridium difficileassociated diarrhea. J Infect Dis. 1994; 169: 127-133. Calhoun WJ, Sutton LB, Emmett A, Dorinsky PM. Asthma variability in patients previously treated with 2-agonists alone. J Allergy Clin Immunol. 2003; 112: 1088-1094. Zhang J, Yu C, Holgate ST, Reiss TF. Variability and lack of predictive ability of asthma end-points in clinical trials. Eur Respir J. 2002; 20: 1102-1109. Monheit AC. Persistence in health expenditures in the short run: prevalence and consequences. Med Care. 2003; 41 suppl ; : III53-III64. 16. Stempel DA, McLaughlin TP, Pendergraft TB, Stanford RH, Fuhlbrigge AL. Patterns of asthma control: A 3-year analysis of patient claims. J Allergy Clin Immunol. In press. 17. Newhouse JP. Risk adjustment: where are we now? Inquiry. 1998; 35: 122-131. Welch WP. Regression toward the mean in medical care costs: implications for biased selection in health maintenance organizations. Med Care. 1985; 23: 12341241. Dudley RA, Medlin CA, Hammann LB, et al. The best of both worlds? potential of hybrid prospective concurrent risk adjustment. Med Care. 2003; 41: 56-69. Sales AE, Liu CF, Sloan KL, et al. Predicting costs of care using a pharmacybased measure risk adjustment in a veteran population. Med Care. 2003; 41: 753-760 and ethambutol. 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Insufficient evidence to decide between them at present. The lack of informative RCTs for the most widely used treatments for atopic eczema i.e. emollients and bath additives ; is striking. This is particularly so when a recent detailed economic study in Nottingham suggested that the emollient and bath oils accounted for 81% of total NHS prescribing costs for children with atopic eczema in the community.412 In addition to the `pull' of the Pharmaceutical Industry's agenda, lack of public investment into researching the treatment of atopic eczema has been another factor leading to the unbalanced coverage of the tree of RCTs in atopic eczema. We did not identify one RCT of atopic eczema supported by the UK Medical Research Council in our search. Clinical trials are expensive and time consuming to run, and it is a credit to some working in the NHS that they have managed to carry out well-designed large independent RCTs in their own time.243 It is also possible that some of the obvious gaps in researching atopic eczema treatment have not been addressed simply because researchers working in relative isolation have not asked the right questions, or because the more practical questions concerning comparison of several commonly used treatments are too difficult or are perceived as less interesting to researchers than testing a `new' drug. Despite the authors' familiarity with the subject area, some genuine surprises occurred as a result of the review, such as the finding of two RCTs that suggest cotton clothing is no better than soft synthetic fibres, identifying a well-conducted RCT on bioresonance that did not show any benefit, and finding out that there is no good RCT evidence to support the use of topical antibiotic corticosteroid combinations. On the positive side, there were some RCTs indicating a potentially useful benefit of psychological and various non-pharmacological approaches. It was also interesting to locate five RCTs that suggested there was little, if any, advantage in using topical corticosteroids twice as opposed to once daily as this might have clear benefits to patients in terms of convenience of fewer adverse effects, as well as offering potentially very large cost savings to the NHS if adopted on a national scale.
This retrospective survey was conducted in six major hospitals 4 in Metro Manila, 1 in Metro Cebu, 1 in Davao ; with at least 200-bed capacity, officially listed under the Philippine Hospital Association and hospitals that provide individual executivecheck-uppackages. The hospitals were sent formal letter addressed to the Medical Director or hospital administrator explaining the purpose of the study and requesting for access to the hospital records. Once consent was given, a hospital coordinator was chosen from the hospital staff for each of the recruited hospital. The hospital coordinator facilitated the retrieval of charts, data collection and coordination of the study activities. The following hospital data were gathered: the total number of hospital admissions for the year 2001, and the number of executive check and vepesid.

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Figure 3.4. BPH Impact Index BII ; score improvements for medical therapies by duration of follow-up. Missing bars indicate that data were not available.

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Surgeons to suggest sleeve gastrectomy or Lap Band as a simpler safer alternative for these patients. The aim of this study was to evaluate the safety and efficacy of LRYGBP in this cohort when performed in an experienced bariatric center. Methods: A retrospective review of prospectively collected data on all patients undergoing primary LRYGBP at our center from May, 1999 to November, 2005 was performed. Patients weighing at least 400 lbs were compared to those 400lbs. with respect to age, BMI, conversion rate, % excess weight loss EWL ; , complications and mortality. Results: Of 2920 patients undergoing primary RYGBP, 134 4.5% ; weighed at least 400 lbs. with mean weight of 440 lbs 400-602 ; , mean BMI of 64 48-85 ; , mean age of 39 and 69% were male. Laparoscopy was attempted in 131 of whom 11 8% ; required conversion. There were no 30-day mortalities or pouch leaks but 5 3.7% ; required additional surgery. Of patients followed 1 yr, mean EWL was 61% and 87% lost at least 50% EWL. In contrast, patients weighing 400 were predominantly female 87% ; , had a lower conversion rate 2.1% P .01 ; , higher mean EWL 76%, but a 0.14% thirty day mortality. Conclusion: Although patients 400lbs. had a significantly higher conversion rate and lower %EWL, LRYGBP was equally safe and produced significant weight loss in both cohorts. LRYGBP, therefore, should remain the bench mark for even patients over 400 lbs. P6. PSYCHOLOGICAL CONCERNS FOR MALES SEEKING BARIATRIC SURGERY. Heidi Cherwony, PsyD, Robert T. Marema, MD, Cynthia K. Buffington, PhD, U.S. Bariatric, Ft. Lauderdale, FL Background: Society is believed to discriminate less against obese males than females. The purpose of our study was to determine the influence of gender on the psychological status of individuals with the most serious stage of obesity, morbid obesity. Methods: The population included 169 morbidly obese MO ; individuals who underwent a psychological evaluation for bariatric surgery candidacy. Psychological status of the study population was assessed by a clinical interview and by scores obtained on the Minnesota Multiphasic Personality Inventory-2, Millon Behavioral Medical Diagnostic, and the Beck Depression Inventory-II. Results: While MO male and female study participants did not differ p 0.05 ; with regard to current age or age of obesity onset, body size was significantly p 0.02 ; higher among the males. There were also no significant p 0.05 ; gender differences in life stresses, coping skills, eating behavior, exercise, and social support. However, males, as compared to females scored significantly p 0.01 ; higher on scales that assess addictive behavior and tendency toward alcoholism. Furthermore, the MO males were more likely to report depression and health problems than females and were more guarded, confrontational, forceful, and pessimistic. In addition, males scored higher on cognitive dysfunction scales and were less spiritual p 0.01 ; . Although males tended to have more psychological issues in association with their obesity than females, the data show that males were more reluctant to seek psychological help. Conclusion: MO males present preoperatively with a number of psychological issues for which they are reluctant to seek treatment. These issues need to be recognized and addressed. P7. OBESITY, PSYCHOLOGICAL TESTING AND SUBSTANCE ABUSE. Edward H. Livingston, MD, UT Southwestern, Dallas, TX. Background: The National Epidemiologic Survey on Alcohol and Related Conditions NESARC ; is a population representative survey of psychological and substance abuse characteristics of the U.S. population. This survey contains detailed information from standardized psychological tests for 43, 093 individuals of whom 1, 159 are morbidly obese. Although it is commonly accepted that there is a relationship between obesity and psychological disorders the ability to demonstrate this on standardized tests has been limited. Methods: The NESARC was obtained from the National Institute on Alcohol Abuse and Alcoholism. Body mass indices were calculated from respondent self-reported height and weight information. The prevalance of substance abuse, psychological disorders and SF-12 scores were compared as a function of body size Results: Individual domain scores for the SF-12 physical and mental disability etc. ; fell inversely as body weight increased. Personality, Conduct, Antisocial and Obsessive-Compulsive disorder increase with body weight. Substance abuse for alcohol, smoking and marijuana decreased with increasing body weight, for instance, prednisone. 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0.092 ; . Difference was found only in the two patients with pronounced hippocampal atrophy 1.5 versus 1.7 in Patient 2, and 2.5 versus 2.8 in Patient 6 ; . In relation to controls, patients had a reduced BP also in the ipsilateral anterior cingulate p 0.002 ; , the ipsilateral insular cortex p 0.015 ; , the ipsilateral temporal neocortex p 0.029 ; , the contralateral hippocampus p 0.025 ; , and the raphe nuclei p 0.016 ; . Reduction in ipsilateral cingulate was detected in five of the patients, and in the ipsilateral insular cortex in five. One patient had reduced BP in the ipsilateral inferior temporal gyrus, and one bilaterally in the orbitofrontal cortex in addition to the cingulate and insular reductions see table 1, figure 3B ; . Although the mean values were reduced in the contralateral mesial temporal lobe, none of the patients showed values below the 95% CI in this region. Patients and controls had similar values in all other VOI see table 3 ; . The mean arterial concentration of [11C]WAY 100 635 did not differ between the two groups 35 18% [patients] and 39 19% [controls] at 4 minutes after bolus injection, and 7 2% [patients] and 8 4% [controls] at 20 minutes after injection ; . The metabolic ratios. According to the clinical consensus the epileptogenic temporal lobe was identified by temporal lobe hypometabolism in 5 of the 11 [18F]FDGPET investigated patients. In a subsequent detailed analysis, using the same VOI as for 5-HT1A receptor BP, the hypometabolic area included the contralateral hippocampus in two patients, the ipsilateral orbitofrontal cortex in one, and the ipsilateral cingulate in another. The group comparison showed difference only in the temporal neocortex p 0.019, the variance was high in the hippocampal VOI ; and the insular VOI p 0.005 ; , ipsilaterally to the epileptogenic region, with lower values in the patients table 4.
TABLE 30 Health state utility values according to site of fracture for women243 Fracture type Spine clinical ; Hip Forearm Humerus Pelvis Other femoral Tibia Clavicle, scapula and sternum Ribs Utility in 1st year following fracture 0.626 0.792 0.977 Utility in 2nd year following fracture 0.909 0.813 0.999, for example, enalapril maleate.

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