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Victoria, Canada

Fuoco M.,Queens University | Cox L.,Victoria General Hospital | Kinahan T.,UBC Kelowna General Hospital
Canadian Urological Association Journal | Year: 2015

Traumatic self-amputation of the penis by a psychotic patient is rare. Microvascular replantation is the favored management approach. There are no known cases of self-amputation followed by ingestion of the stump and subsequent replantation. A 51-yearold patient with paranoid schizophrenia presented 2 hours following penile amputation. He had swallowed the excised portion, which was endoscopically retrieved from the stomach in the emergency department. Successful reattachment was achieved including microvascular repair of the dorsal penile arteries without cavernosal arterial anastamoses. A Winter's shunt was performed to improve venous circulation. The patient has been followed for 3 years from the date of repair. He has adequate erection for intercourse and good urinary function, but has experienced sensory loss over the dorsal aspect and glans and urethral stricture dilation. This is the first report of replantation following ingestion of an amputated penis. © 2015 Canadian Urological Association. Source


Dennie J.,Victoria General Hospital | Pillay S.,National Womens Hospital | Watson D.,Womens and Childrens Health Institute | Grover S.,Royal Childrens Hospital
Fertility and Sterility | Year: 2010

Objective: To describe a novel technique for the acute management of a transverse vaginal septum with hematocolpos. Design: Retrospective case series. Setting: Secondary- and tertiary-care centers in Australia and New Zealand. Patient(s): Three patients with a transverse vaginal septum presenting with pain and a hematocolpos. Intervention(s): Laparoscopic drainage of the hematocolpos. Main Outcome Measure(s): Pain relief until definitive resection of the transverse vaginal septum. Result(s): All patients were free of pain after the procedure. Two patients had a second laparoscopic procedure to drain the hematocolpos which had reaccumulated while awaiting definitive surgery. All three patients have undergone resection of the septum. Conclusion(s): Laparoscopic drainage provides a novel approach to the acute management of a transverse vaginal septum, providing pain relief without compromising the success of definitive surgery which can be performed at a later date. Copyright © 2010 American Society for Reproductive Medicine, Published by Elsevier Inc. Source


Lynch T.,Public Health Agency of Canada | Chong P.,Public Health Agency of Canada | Zhang J.,Public Health Agency of Canada | Hizon R.,Public Health Agency of Canada | And 8 more authors.
PLoS ONE | Year: 2013

Background: Clostridium difficile are Gram-positive, spore forming anaerobic bacteria that are the leading cause of healthcare-associated diarrhea, usually associated with antibiotic usage. Metronidazole is currently the first-line treatment for mild to moderate C. difficile diarrhea however recurrence occurs at rates of 15-35%. There are few reports of C. difficile metronidazole resistance in the literature, and when observed, the phenotype has been transient and lost after storage or exposure of the bacteria to freeze/thaw cycles. Owing to the unstable nature of the resistance phenotype in the laboratory, clinical significance and understanding of the resistance mechanisms is lacking. Methodology/Principal Findings: Genotypic and phenotypic characterization was performed on a metronidazole resistant clinical isolate of C. difficile. Whole-genome sequencing was used to identify potential genetic contributions to the phenotypic variation observed with molecular and bacteriological techniques. Phenotypic observations of the metronidazole resistant strain revealed aberrant growth in broth and elongated cell morphology relative to a metronidazole-susceptible, wild type NAP1 strain. Comparative genomic analysis revealed single nucleotide polymorphism (SNP) level variation within genes affecting core metabolic pathways such as electron transport, iron utilization and energy production. Conclusions/Significance: This is the first characterization of stable, metronidazole resistance in a C. difficile isolate. The study provides an in-depth genomic and phenotypic analysis of this strain and provides a foundation for future studies to elucidate mechanisms conferring metronidazole resistance in C. difficile that have not been previously described. © 2013 Lynch et al. Source


Curran S.,Health Elements | Brotto L.A.,University of British Columbia | Fisher H.,Health Elements | Knudson G.,University of British Columbia | Cohen T.,Victoria General Hospital
Journal of Sexual Medicine | Year: 2010

Introduction: Provoked vestibulodynia (PVD) is a distressing genital pain condition affecting 12% of women. Treatment modalities vary and although vestibulectomy has the highest efficacy rates, it is usually not a first-line option. Acupuncture has a long history in the traditional Chinese medicine (TCM) system and operates on the premise that pain results from the blockage or imbalance of important channels. The main principle of treatment is to move Qi and blood to cease genital pain. Aim.: To explore effect sizes and feasibility in a pilot study of acupuncture for women with PVD. Methods.: Eight women with PVD (mean age 30 years) underwent 10 1-hour acupuncture sessions. Specific placement of the needles depended on the woman's individual TCM diagnosis. TCM practitioners made qualitative notes on participants' feedback after each session. Main Outcome Measures.: Self-reported pain (investigator-developed), pain-associated cognitions (Pain Catastrophizing Scale [PCS], Pain Vigilance and Awareness Questionnaire), and sexual response (Female Sexual Function Index) were measured before and after treatment sessions 5 and 10. Qualitative analyses of TCM practitioner notes were performed along with one in-depth case report on the experience of a participant. Results.: A repeated measures analysis of variance revealed significant decreases in pain with manual genital stimulation and helplessness on the PCS. An examination of effect sizes also revealed strong (though nonsignificant) effects for improved ability to have intercourse and sexual desire. Qualitative analyses were overall more positive and revealed an improvement in perceived sexual health, reduced pain, and improved mental well-being in the majority of participants. Conclusions.: Effect sizes and qualitative analyses of practitioner-initiated interviews showed overall positive effects of acupuncture, but there were statistically significant improvements only in pain with manual genital stimulation and helplessness. These findings require replication in a larger, controlled trial before any definitive conclusions on the efficacy of acupuncture for PVD can be made. © 2009 International Society for Sexual Medicine. Source


Paquette V.,Oak Street Health | Culley C.,Royal Jubilee Hospital | Greanya E.D.,Victoria General Hospital | Greanya E.D.,University of British Columbia | And 2 more authors.
Seizure | Year: 2015

Purpose To review the evidence for efficacy and safety of lacosamide in adult patients with refractory epilepsy and refractory status epilepticus (RSE). Methods A systematic literature search of MEDLINE, PubMed, EMBASE, IPA, Google and Google Scholar (through October 2014) was performed. Results Fourteen studies assessing lacosamide in 3509 refractory epilepsy patients were included. In 3 RCTs, more patients had at least 50% reduction in seizure frequency with lacosamide compared to placebo with 38.3-41.1%, 38.1-41.2%, and 18.3-25.8%, in the 400 mg/day, 600 mg/day, and placebo groups, respectively. In non-comparative trials, 18-69% of patients achieved at least 50% reduction in seizure frequency, and 1.7-26.2% achieved seizure freedom. Non-responders were documented in two trials, with 26.2-34% having no response. Thirteen studies assessing lacosamide in 390 RSE patients were included. When assessing lacosamide's ability to terminate RSE, one comparative cohort study found no improvement in SE duration or seizure control with addition of lacosamide. Another study documented no difference compared to use of phenytoin. Eleven descriptive studies using lacosamide as add-on RSE therapy revealed seizure termination rates of 0-100% (median 64.7%). In all patients receiving lacosamide, dizziness (21.8%), vision disturbances (10.4%), drowsiness (7.4%), headache (7.0%), nausea (6.5%), and coordination problems (5.8%) were the most common adverse effects. Conclusion Based on evidence to date, adjunctive lacosamide is a treatment option to reduce seizure frequency in patients with refractory epilepsy and terminate seizures in patients with RSE. The safety information summary can be used to advise patients of potential adverse effects. © 2014 British Epilepsy Association. Source

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