Electromotive administration of intravesical bethanechol and the clinical impact on acontractile detrusor management: introduction of a new test

PURPOSE

It is often difficult to determine the functional status of the detrusor muscle in patients with detrusor areflexia. We performed a clinical study to establish a test defining residual detrusor capacity in such patients.

MATERIALS AND METHODS

In phase 1, 5 controls with detrusor areflexia were tested with an intravesical instillation of 20 mg. bethanechol in 150 cc of sodium chloride 0.3% with and without 20 mA. of pulsed current applied via an electrode catheter through the saline. Cystometry simultaneously recorded intravesical pressure changes. In phase 2, 45 patients with detrusor areflexia were tested with electromotive administration of intravesical bethanechol. In phase 3, 25 mg. bethanechol given orally once daily were prescribed for 15 patients and voiding control was assessed after 6 weeks of therapy.

RESULTS

Neither bethanechol without current nor current through saline only led to increased intravesical pressure. However, we noted a mean pressure increase of 34 cm. water during the electromotive administration of bethanechol in 24 of 26 patients with areflexia and neurological disease compared to only 3 cm. water in 3 of 11 with a history of chronic bladder dilatation. Oral bethanechol restored spontaneous voiding in 9 of 11 patients who had had a positive response to the electromotive administration of bethanechol, whereas all 4 without a pressure increase during the electromotive administration of bethanechol did not void spontaneously.

CONCLUSIONS

Electromotive administration of intravesical bethanechol identifies patients with an atonic bladder and adequate residual detrusor muscle function who are candidates for restorative measures, such as oral bethanechol and intravesical electrostimulation. Those who do not respond to the electromotive administration of bethanechol do not benefit from oral bethanechol and are candidates for catheterization.

Disposable potentiometric enzyme sensor for direct determination of organophosphorus insecticides

A potentiometric disposable enzyme sensor for the direct and fast determination of organophosphorus (OP) insecticides was developed by using an organophosphorus hydrolase (OPH) immobilized on an ion-selective electrode. The disposable screen-printed transducer was based on double matrix membrane technology which allows easy mass production. The potentiometric device consisted of a H(+)-sensitive electrode with integrated Ag/AgCl reference electrode. The electrodes were prepared with N,N-dioctadecylmethylamine as H(+)-sensitive ionophore and pH calibration resulted in slopes of 55 mV decade-1 over a pH range from 11 to 6. OPH was isolated from recombinant Escherichia coli DH5 alpha and immobilized within poly(carbamoyl sulfonate) prepolymer on the surface of the H(+)-sensitive electrode without any further fixation membrane. OPH catalyzes the hydrolytic cleavage of OP compounds which releases protons in a concentration proportional to hydrolyzed substrate. Sensor performance was investigated with regard to enzyme load, concentration, pH and temperature of the measuring buffer using paraoxon as analyte. Best sensitivity and response time were obtained with sensors prepared with 250 U of OPH and measuring at 37 degrees C in 1.0 mM HEPES buffer, pH 9.3, containing 100 mM NaCl. The enzyme sensor exhibited a linear calibration range of 0.01-0.15 mM chlorpyrifos, 0.05-0.35 mM diazinon, 0.05-0.4 mM paraoxon and 0.007-0.05 mM parathion, respectively. For all these analytes response times to reach 95% of maximum change in potential did not exceed 5 min. Sensors stored under dry conditions at 4 degrees C still showed 60% of initial hydrolytic rate after 70 d. The sensors even when stored dry were ready for measurements after 5 min incubation in measuring buffer. A range of putative interfering substances did not influence sensor response, and suitability of measuring OPs in soil extracts was ascertained.

Analysis of ternary mixtures with a single dynamic microbial sensor and chemometrics using a nonlinear multivariate calibration

An amperometric biosensor based on immobilized bacterial cells of Alcaligenes eutrophus KT02 and an oxygen electrode was integrated in a flow-through system. Because microorganisms metabolize various organic analytes in a specific manner, the sensor shows for different pure analytes distinct time-dependent oxygen consumption rates that can be treated as characteristic patterns. This behavior is conserved also when the biosensor is exposed to a mixture of these organic analytes; the sensor with a particular type of microorganisms responds with a total signal. The respiration curves as time-dependent amplitudes were subdivided into several time channels. This procedure creates an additional data dimension and makes the single sensor "dynamic". Using multivariate calibration models with only one single biosensor, simultaneous quantitative analysis of ternary mixtures of acetate, L-lactate, and succinate was realized. A nonlinear algorithm that compensated for conceivable interactions of the analytes was superior to a partial least-squares algorithm. Each analyte was predicted more precisely by the nonlinear approach resulting in root-mean-square errors of prediction of 0.20 mg/L for acetate, 0.43 mg/L for L-lactate, and 0.73 mg/L for succinate.

Multimicrobial sensor using microstructured three-dimensional electrodes based on silicon technology

Two microbial strains with different substrate spectra were immobilized separately within a single biosensor chip featuring four individually addressable platinum electrodes. These were sputtered onto the inner surface of four isolated pyramidal cavities ("containments") micromachined on a silicon wafer. The biosensor chip was integrated into a flow-through system to measure the oxygen consumption of the immobilized microorganisms in the presence of assimilable analytes. As a model system, a yeast for the determination of biochemical oxygen demand (BOD) and a strain capable of degrading polycyclic aromatic hydrocarbons (PAH) were chosen. It was shown that the simple and mass-producible containment sensor exhibits good performance data: lower detection limit 0.1 mg/L naphthalene and 1 mg/L sensor-BOD; calibration range up to 30 mg/L; precision 3-6%; response time 2-3 min; service life up to 40 days; shelf life at 4 degrees C 6 months. The versatility of the multimicrobial sensor was demonstrated by measuring ordinary municipal wastewater samples as well as various aqueous samples contaminated with PAH. The concept of a multimicrobial sensor not only enlarges the substrate spectrum for sum parameters such as BOD but leads to additional information which allows for a more differentiated and immediate knowledge of sample composition. Using chemometrical data analysis, the multimicrobial sensor lays a foundation for developing an "electronic tongue".

Assay and importance of adhesive interaction between hamster (Mesocricetus auratus) oocyte-cumulus complexes and the oviductal epithelium

Adhesion between the oocyte-cumulus complex and infundibulum plays an important, but poorly understood, role in oocyte pick-up. The purposes of this study were to determine which components of the oocyte-cumulus complex and oviductal epithelium function in adhesion, to measure adhesion under physiological conditions, and to examine the effect of modulation of adhesion on oocyte-cumulus complex pick-up rate. Oocyte-cumulus complexes containing an expanded matrix were readily transported into the oviduct, while unexpanded complexes lacking an extracellular matrix were not picked up, indicating that the matrix is necessary for pick-up. Transmission electron microscopy revealed that during pick-up, adhesion occurred specifically between the ciliary crowns of the oviduct and the granules and filaments of the cumulus matrix. An assay was developed using vacuum from a low-flow peristaltic precision pump, modified for bi-directional flow, to measure the strength of adhesion between the oocyte-cumulus complex and the oviductal epithelium, and adhesion was measured during physiological conditions. The lectin wheat germ agglutinin and the polycation poly-L-lysine were then used to modulate adhesion, and the effects of increasing or decreasing adhesion on oocyte pick-up rate and ciliary beat frequency were examined. The data show that 1) the matrix of the oocyte-cumulus complex and the ciliary crowns of the oviduct function in adhesion during pick-up and that adhesion is necessary for pick-up, 2) adhesion can be assayed quantitatively and is very uniform among control infundibula, and 3) decreasing or increasing adhesion decreases oocyte pick-up rate and in some cases prevents pick-up without affecting ciliary beat frequency.

Containment sensors for the determination of L-lactate and glucose

This paper reports some new results on enzyme based silicon containment sensors. For the first time an L-lactate sensor in containment technology is presented. Through optimization of the buffer system the stability of the lactate sensor was enhanced and the linear response of over 10 mM was achieved. The glucose sensor has also been optimized for a large linear measurement range exceeding 30 mM. A two-enzyme chip with glucose and lactate sensor elements which were integrated on one silicon chip is presented. The response behaviour of the two-enzyme chip was very similar to the single chip behaviour. No cross-talking effects could be observed. A fabrication process for mass-production is described.

A disposable biosensor for urea determination in blood based on an ammonium-sensitive transducer

A potentiometric urea-sensitive biosensor using a NH4(+)-sensitive disposable electrode in double matrix membrane (DMM) technology as transducer is described. The ion-sensitive polymer matrix membrane was formed in the presence of an additional electrochemical inert filter paper matrix to improve the reproducibility in sensor production. The electrodes were prepared from one-side silver-coated filter paper, which is encapsulated for insulation by a heat-sealing film. A defined volume of the NH4(+)-sensitive polymer matrix membrane cocktail was deposited on this filter paper. To obtain the urea-biosensor a layer of urease was cast onto the ion-sensitive membrane. Poly (carbamoylsulfonate) hydrogel, produced from a hydrophilic polyurethane prepolymer blocked with bisulfite, served as immobilisation material. The disposable urea sensitive electrode was combined with a disposable Ag/AgCl reference electrode to obtain the disposable urea biosensor. The sensor responded rapidly and in a stable manner to changes in urea concentrations between 7.2 x 10(-5) and 2.1 x 10(-2)mol/l. The detection limit was 2 x 10(-5) mol/l urea and the slope in the linear range 52 mV/decade. By taking into consideration the influence of the interfering K(+)- and Na(+)-ions the sensor can be used for the determination of urea in human blood and serum samples (diluted or undiluted). A good correlation was found with the data obtained by the spectrophotometric routine method.

Wearable microdialysis system for continuous in vivo monitoring of glucose

We developed a new system to monitor glucose continuously in vivo. The miniaturised system is very easy to handle and was optimised to a resource-saving working modus. Sampling was performed by means of a biocompatible microdialysis needle probe inserted into the subcutaneous tissue. During glucose tolerance tests the results of our monitoring system were correlated with the glucose level of the venous blood stream. A comparison according to the procedure known as 'error grid analysis' provided an excellent correlation between the two completely independent analyses systems with the reference determination results. All values obtained with our systems were clinically correct or at least clinically acceptable.

T cell activation induced by novel gain-of-function mutants of Syk and ZAP-70

The Syk family tyrosine kinases play a crucial role in antigen receptor-mediated signal transduction, but their regulation and cellular targets remain incompletely defined. Following receptor engagement, phosphorylation of tyrosine residues within ZAP-70 and Syk is thought to control both kinase activity and recruitment of modulatory factors. We report here the characterization of novel mutants of ZAP-70 and Syk, in which conserved C-terminal tyrosine residues have been replaced by phenylalanines (ZAP YF-C, Syk YF-C). Both mutant kinases display a prominent gain-of-function phenotype in Jurkat T cells, as demonstrated by lymphokine promoter activation, tyrosine phosphorylation of potential targets in vivo, and elevated intracellular calcium mobilization. While the presence of p56-Lck was required for ZAP YF-C-induced signaling, Syk YF-C showed enhanced functional activity in Lck-deficient JCaM1 Jurkat cells. Our results implicate the C terminus of Syk family kinases as an important regulatory region modulating T cell activation.

Intravesical electromotive drug administration technique: preliminary results and side effects

PURPOSE

We performed intravesical electromotive drug administration (EMDA) for various bladder disorders during a 3-year period and assessed the technique, possible applications, complications and outcomes of this procedure.

MATERIALS AND METHODS

Intravesical EMDA was performed with local anesthetics for transurethral surgery and in combination with dexamethasone for the treatment of noninfectious chronic cystitis (interstitial/radiation cystitis), with mitomycin C for recurrence prophylaxis of high risk superficial bladder cancer and with oxybutynin/bethanechol for the hyperreflexive/acontractile detrusor. A standardized power source and electrode catheter were used for 215 treatments in 84 patients.

RESULTS

Transurethral bladder tumor resections were pain-free in 10 of 12 patients. Of the 25 patients with chronic noninfectious cystitis 15 were free of symptoms for a mean of 6.6 months, and there was a 73% increase in mean bladder capacity from 244 before to 421 cc after EMDA. Of the 16 patients with superficial bladder cancer 9 were free of recurrence for a mean of 14.1 months. In 10 of 14 patients with acontractile detrusors urodynamic examination showed detrusor contraction during EMDA of bethanechol. There were no contractions without electric current. EMDA of oxybutynin reduced detrusor hyperreflexia. A bladder ulcer was the single severe local complication and 4.6% of patients, mainly those with chronic cystitis, reported significant post-EMDA bladder/urethral pain. Minor side effects accounted for 23% of all treatments. No systemic side effects occurred.

CONCLUSIONS

Intravesical EMDA is effective and innocuous. The therapeutic concept combines the advantages of increased drug administration without systemic side effects.

Electromotive drug administration and hydrodistention for the treatment of interstitial cystitis

Thirteen patients with interstitial cystitis diagnosed by the NIH criteria were treated with intravesical electromotive administration of lidocaine and dexamethasone followed by cystodistention. After a mean follow-up of 10 (range 3-22) months, 8/13 (62%) of the patients reported complete resolution of bladder symptoms lasting an average 4.5 (range 0.75-17) months. Partial or short-term improvement of bladder symptoms was observed in three patients, while two patients reported aggravation of pain for several days after therapy. A significant increase in bladder capacity, to an average 166% of the pretreatment capacity, was observed in all patients. Whenever symptoms recurred after initially effective therapy, retreatments were performed with equal efficacy in 11 patients. This promising new therapeutic approach, performed on an outpatient basis, may become first-line treatment for patients with interstitial cystitis.

Identification of cigarette smoke components that alter functioning of hamster (Mesocricetus auratus) oviducts in vitro

Previous studies have shown that solutions of mainstream and sidestream cigarette smoke decrease both ciliary beat frequency and oocyte cumulus complex pick-up rate of hamster oviducts in vitro. The purpose of this study was to identify the component(s) in smoke that produces these effects. Chemicals reported to be ciliotoxic in other systems were tested on hamster infundibula at various concentrations to determine whether a dose-response inhibition of ciliary beat frequency occurred. In addition, the concentration of each test component was measured in mainstream and sidestream smoke solutions (whole, particulate, and gas phase). All test components (acrolein, formaldehyde, phenol, acetaldehyde, and potassium cyanide [KCN]) inhibited ciliary beat frequency in a dose-dependent manner. Inhibition of ciliary beat frequency was at least partially reversible for all test compounds except acrolein. The concentrations of acrolein, formaldehyde, and phenol that were required to inhibit beat frequency were at least 3-50 times higher than their corresponding concentrations in smoke solutions. In contrast, cyanide was present in all smoke solutions at concentrations sufficient to inhibit ciliary beat frequency. Cilia on the outer surface of the infundibulum function in picking up the oocyte cumulus complex. Oocyte cumulus complex pick-up rate was measured in vitro at KCN concentrations shown to inhibit ciliary beat frequency. Pick-up rate was likewise inhibited by KCN and remained significantly depressed after washout of KCN. These data show that cyanide is a potent inhibitor of both ciliary beat frequency and oocyte cumulus complex pick-up rate and that its concentration in smoke solutions is sufficiently high to explain the previously reported inhibition of these oviductal processes.

Cigarette smoke inhibits oocyte cumulus complex pick-up by the oviduct in vitro independent of ciliary beat frequency

The purpose of this study was to quantify the effects of acute exposure to mainstream (MS) and sidestream (SS) smoke solutions on oocyte cumulus complex pick-up rate in explants of hamster oviducts using a newly developed in vitro assay. Experiments were performed in handmade perfusion chambers using infundibula from hamster oviducts and oocyte cumulus complexes harvested from mature ovarian follicles. Oocyte cumulus complex pick-up rate was measured by placing a stained oocyte cumulus complex at the base of the infundibulum and recording the length of time needed for the complex to traverse a defined path to the ostium. Addition of either whole MS or SS smoke solutions to the perfusion chamber caused a dose dependent decrease in oocyte cumulus complex pick-up rate. Unexpectedly, upon washout of smoke solutions with control medium, oocyte cumulus complex pick-up rate continued to decline. The gas phase of MS smoke is more inhibitory than the particulate phase, while SS gas and particulate phases inhibit oocyte cumulus complex pick-up rate at equivalent doses. Ciliary beat frequency and oocyte cumulus complex pick-up rate were measured using the same infundibular explants to determine if smoke solutions decrease oocyte cumulus complex pick-up rate by inhibiting ciliary beat frequency. Ciliary beat frequency decreased in MS smoke solutions and recovered either partially or completely after washout of the smoke solutions. SS smoke solutions either produced no change in ciliary beat frequency or stimulated ciliary beat frequency. Oocyte cumulus complex pick-up rate decreased in both MS and SS smoke solutions and further declined during washout when ciliary beat frequency was equivalent to or higher than controls. These data show that oocyte cumulus complex pick-up rate and ciliary beat frequency can be uncoupled and that smoke solutions inhibit oocyte cumulus complex pick-up rate by affecting factors in addition to ciliary beat frequency. Possible reasons for the smoke induced decrease in oocyte cumulus complex pick-up rate are discussed. These results may explain the increased incidence of tubal infertility and ectopic pregnancy observed in women who smoke.

In vitro analysis of oocyte cumulus complex pickup rate in the hamster Mesocricetus auratus

In mammals, the oocyte and its surrounding cumulus cells constitute on oocyte cumulus complex (OCC). During ovulation, OCCs are extruded into the peritoneal or bursal cavity, depending on the species, and are then rapidly picked up by the fimbria on the outer surface of the oviductal infundibulum and transported to the ampulla, where fertilization occurs. We developed a method to measure OCC pickup rates quantitatively in vitro, and we used this method to evaluate the effects of viscosity and temperature on pickup rates. Hamster infundibula are placed in a holding pipette in a chamber modified to study OCC pickup. Ciliary beat frequencies (CBF) can be measured in the same preparation. Pickup rates vary depending on the pathway on which the OCC travels over the surface of the infundibulum; however, rates for a given pathway are very consistent. The average pickup rate at room temperature calculated from three different pathways/infundibulum was 55.2 +/- 10.6 microns/sec. Both rates between infundibula from the same female and rates among infundibula from different females were in most cases similar. Preparations preincubated in vitro for 2.75 hr produced rates similar to nonpreincubated samples, while longer preincubation resulted in decreased rates. Inclusion of Ficoll in culture medium to increase viscosity caused a concentration-dependent decrease in both OCC pickup rate and in CBF. However, a significant decrease in OCC pickup rate was only observed at viscosities higher than those found in bursal fluid. When trials were run at physiological temperature (36.4 degrees C) rather ambient temperature, rates increased to 136.7 +/- 29.9 (SD) microns/sec. Linear regression analysis demonstrated a strong positive correlation (r = 0.94) between OCC pickup rate and temperature. The OCC pickup rate assay can be used experimentally, and should be valuable in evaluating factors that affect rate and in studies dealing with the mechanism of OCC pickup.

Usefulness of color Doppler proximal isovelocity surface area method in quantitating valvular regurgitation

To define the clinical utility of the color Doppler proximal isovelocity surface area (PISA) method for estimating regurgitant stroke volume (SV), 160 regurgitant lesions were evaluated in 104 patients with mitral (MR), aortic (AR), and tricuspid (TR) regurgitation. Regurgitant SV by PISA was calculated as 2 pi R2 x V x (time-velocity integral/peak flow velocity), where R is the radius corresponding to the first blue-red interface velocity of the maximal PISA during the cardiac cycle. The time-velocity integral and peak flow velocity from the continuous-wave Doppler recording of the regurgitant jet were used to correct PISA for phasic variations in regurgitant flow. Fifteen lesions were excluded because of difficulty in tracing the continuous-wave Doppler regurgitant curve. Among 145 remaining regurgitant lesions, PISA was measurable in 50 (78%) of 64 cases of MR and 24 (69%) of 35 cases of TR but in only 12 (26%) of 46 cases of AR (p < 0.001). Regurgitant SV by PISA correlated modestly well with jet area/atrial area in all atrioventricular valve lesions (MR: r = 0.55; TR: r = 0.65; p < 0.001). However, the correlation improved if only central jets were considered (MR: r = 0.70; TR; r = 0.75; p < 0.001). These findings are not unexpected because jet area/atrial area underestimates the true severity of regurgitation in cases of eccentric (wall-impinging) jets. PISA was detected in all severe cases of regurgitation but in only 64% of cases of mild MR, 45% of cases of mild TR, and 6% of cases of mild AR (p < 0.01). The color Doppler PISA method is clinically useful in estimating regurgitant SV in MR and TR, including mild cases, but is less useful in AR.

Intravesical electromotive drug administration for the treatment of non-infectious chronic cystitis

Seventeen patients with non-infectious chronic cystitis (NICC) (9 with interstitial cystitis, 6 patients with radiation cystitis, 1 with chemocystitis and 1 with lupoid cystitis) were treated with electromotive administration of intravesical lidocaine and dexamethasone followed by hydrodistension of the bladder. Complete resolution of symptoms for an average of 7.5 months was observed in 11 patients (65%), partial improvement in 4 (23.5%). In this series no complications occurred. Electromotive drug administration (EMDA) and cystodistension were well tolerated by all patients. The treatment was performed on an outpatient basis, thus reducing therapeutic costs. The results presented demonstrate that the combination of EMDA and bladder hydrodistension is an effective first-line treatment for NICC patients.

Cigarette smoke inhalation affects the reproductive system of female hamsters

The purpose of this study was to determine if inhalation of mainstream (MS) or sidestream (SS) smoke affects the reproductive organs of female hamsters. Females inhaled smoke from one or two cigarettes twice per day for 30 d prior to mating using a smoking machine equipped for nose breathing. Serum cotinine levels were within the ranges found in active and passive humans smokers. On day 7 of pregnancy, the reproductive organs of controls and smokers were evaluated for the total number of corpora lutea (CL), the percentage of normal, pink, and small CL, the vascular area in the CL, the ultrastructure of the oviductal epithelium, the ratio of ciliated to secretory cells in the ampulla of the oviduct, the stretchability of the uterine horns, the percentage of implantation sites, and the percentage of touching implantation sites. All parameters, except the percentages of implantation sites and of small CL, were affected by exposure to smoke. To determine if the effects of smoking on the ovary and uterus could be reversed, females smoked for 30 d, remained in their cages without smoking for 30 d, and then were mated and evaluated on day 7 of pregnancy. In this reversal experiment, all ovarian and uterine parameters (except total CL) previously affected by smoking were normal in MS and SS females. These experimental observations show that components in both MS and SS smoke, when delivered at levels comparable to those human smokers receive, can affect the ovary, oviduct, and uterus.

Ciliary beat frequency of hamster oviducts is decreased in vitro by exposure to solutions of mainstream and sidestream cigarette smoke

Epidemiological data support a correlation between smoking and increased incidence of ectopic pregnancy, yet the causal mechanism responsible for this relationship is unknown. The purpose of this study was to examine the effect of solutions containing dissolved mainstream (MS) or sidestream (SS) cigarette smoke on ciliary beat frequencies (CBF) in explants of hamster oviducts. MS smoke is the puff inhaled by an active smoker, while SS smoke leaves the burning end of cigarette. SS smoke is inhaled by both active and passive smokers. Experiments were performed in handmade perfusion chambers using infundibula from hamster oviducts. After a short incubation in Earle's balanced salt solution containing HEPES buffer (EBSS-H), chambers were flushed with one of six types of smoke solution prepared in EBSS-H, and incubation continued 19 min. A second perfusion (washout) was then done using EBSS-H alone to determine whether effects induced by the smoke solutions could be reversed. CBF were determined at three times in both the smoke and washout solutions, and means were compared to values obtained in the initial EBSS-H incubation. All smoke solutions except the SS particulate solution inhibited CBF in a dose-dependent manner. Whole MS and whole SS smoke solution at the highest strength tested caused the greatest inhibition and in some cases completely stopped ciliary beating. Both single-strength and 0.1-strength MS gas phase solutions, which contained concentrations of nicotine in the range found in typical human smokers, produced about 50% inhibition of ciliary beating. Inhibition was generally seen within 2-12 min of adding smoke solutions.(ABSTRACT TRUNCATED AT 250 WORDS)

Analysis of ciliary beat frequencies in hamster oviducal explants

We have developed a simple direct method, requiring minimal manipulation, to measure beat frequencies of the cilia on the external surface of hamster oviducal infundibula in vitro. Two perfusion chambers (closed and open) were used; both can be hand-made in a few minutes and discarded after use. Ciliary beat frequencies were determined by measuring variations in light intensity with time in a single pixel positioned over a video image of the beating cilia. Data files were collected using Image 1 software and later transferred to PSI Plot or Lotus 123 spreadsheets for analysis by counting the number of brightness peaks recorded per second or by subjecting the data to Fourier transformation with or without smoothing. These methods of analysis gave similar results. To verify that Image 1 data files contain accurate representations of CBF, videotapes of beating cilia were made and subjected to frame-by-frame analysis. Image 1 interfaced with a standard video camera was found to collect reliable data over a beat frequency range of 0-15 cycles/sec. In some Fourier transforms, secondary peaks were observed and were shown to represent cilia beating at more than one frequency in a sampled region. Coefficients of variation for repeated measurements taken on the same region varied from 4.1% to 9.0%. Small but significant differences were found between beat frequencies at different regions of the same oviduct. When chambers were perfused discontinuously and measurements of beat frequency were made at least 5 min after each perfusion, no effect of perfusion on frequencies was observed. However, during continual perfusion of the open chamber, a slight but significant increase in beat frequency was observed after perfusion was initiated. Muscle contraction, which sometimes occurs in the open chamber, did not affect beat frequency measurements. Infundibula could be stored at 4 degrees C overnight without any negative effect on beat frequencies. Cold storage also reduced muscle contraction. Placement of a small coverslip on infundibula in the open chambers was also found to reduce muscle contraction and facilitate beat frequency measurements. Coverslipping did not affect beat frequencies. This method of beat frequency analysis will be valuable for analyzing factors that regulate or influence cilia in mammalian oviducts.

Intravesical application of oxybutynine: mode of action in controlling detrusor hyperreflexia. Preliminary results

Topical oxybutynine (Oxy) has been used successfully in neurogenic bladder patients who remained wet on oral anticholinergics or could not tolerate oral medication. However, little is known about the pharmacokinetics of intravesical Oxy. The aim of this study was to evaluate the resorption rate of intravesically given Oxy in the bladder in comparison with oral intake, and to find out which pharmacological properties of the drug are responsible for its effect when given intravesically. Our results indicate that peak plasma levels of intravesical Oxy appear later, are lower and stay longer compared to oral intake. Cystometries before, 20 min and 2 h after intravesical application of Oxy indicate that the main effect of intravesical Oxy on the detrusor is systemic due to its resorption. Our findings confirm the clinical experience that intravesical Oxy is well tolerated, very efficacious and better than oral medication.

Acute cocaine administration induces ventricular regional wall motion and ultrastructural abnormalities in an anesthetized rabbit model

Whether acute doses of cocaine can induce left ventricular (LV) regional wall motion abnormalities in animals with otherwise normal coronary arteries is unknown. We studied rabbits receiving constant cocaine infusions (group I: 0.025 to 1.5 mg/kg/min, n = 10), multiple cocaine boluses (group II: 3-5 mg/kg each bolus, n = 10), or saline (group III; n = 8). In group I rabbits, short-axis LV area and diameter increased by 15% to 40% at 60 minutes compared to baseline and to controls (p < 0.01), but percentage of global area fractional shortening was unchanged. Eight rabbits in each of groups I and II, but no controls, developed LV regional wall motion abnormalities as detected by echocardiography: 15 (7 hypokinesis and 8 akinesis or dyskinesis) in the anteroseptal and 2 (hypokinesis) in the posterior LV wall. Among rabbits showing LV wall motion abnormalities, anteroseptal fractional shortening and % area reduction averaged > 20% less (p = 0.03 for area reduction) at 30 minutes versus controls. Only 50% of group I or II rabbits with LV anteroseptal wall motion abnormalities had intraventricular conduction disturbances. Radioactive microsphere flow studies (n = 6) 1 minute after a 4 mg/kg cocaine bolus revealed an equivalent decrease (10% to 20%, average) in septal and LV free wall perfusion (p value not significant). Electron microscopy revealed myocardial cell contraction band necrosis in 3 and sarcoplasmic reticular edema in 7 of 10 cocaine rabbits (unrelated to dose). We conclude that acute cocaine administration in rabbits frequently produces LV anteroseptal wall motion abnormalities even in the absence of differentially decreased perfusion or intraventricular conduction disturbances and produces ultrastructural abnormalities of the myocytes. These findings suggest a direct, nonuniform effect of cocaine on the LV myocardium.

Glucose sensor in containment technology

A new transducer concept for miniaturized immobilized enzyme glucose sensors is presented. The enzyme containing membrane is anchored inside the microcontainment of a silicon chip together with the metal electrode. Containment based sensors are ideally suited for integration into microsystems. The fabrication process is planned as a full wafer process allowing transfer to low-cost mass-production with a narrow variability. The functionality of the containment concept is demonstrated by the fabrication of chips with single GOD-based amperometric glucose sensors which have been tested in glucose solution. The advantages of the containment technology are discussed.

Detection of genotoxic effects in human gastric and nasal mucosa cells isolated from biopsy samples

To assess genotoxic burdens from chemicals, it is necessary to relate observations in experimental animals to humans. The success of this extrapolation would be increased by including data on chemical activities in human tissues. Therefore, we have developed techniques to assess DNA damage in human gastric and nasal mucosa (GM, NM) cells. Biopsy samples were obtained during gastroscopy from macroscopically healthy tissue of the stomach or from healthy nasal epithelia during surgery. The specimens were incubated for 30-45 min at 37 degrees C with a digestive solution. We obtained 1.5-8 x 10(6) GM cells and 5-10 x 10(5) NM cells per donor, both with viabilities of 80-95%. The cells were incubated in vitro for 1 hr at 37 degrees C with the test compounds added in their appropriate solvents. In GM cells, we studied N-methyl-N'-nitro-N-nitrosoguanidine (MNNG), sodium dichromate (Na2Cr2O7), nickel sulphate (NiSO4), cadmium sulphate (CdSO4), and lindane. In NM cells, lindane was investigated. Each compound was assessed for DNA damaging activity in cells of at least three different human donor samples using the microgel single cell assay. Similar studies were performed with GM and NM cells obtained from Sprague-Dawley rats. We have found human GM cells to be more sensitive to the genotoxic activity of MNNG than rat GM cells (low effective concentration [LEC] = 0.16 and 0.625 micrograms/ml for human and rat, respectively). Human cells were also more sensitive to the cytotoxic/genotoxic activity of NiSO4 (LEC = 5 and 19 mumoles/ml for human and rat, respectively). CdSO4 was genotoxic in human GM cells (LEC = 0.03-0.125 mumoles/ml), whereas no dose-related genotoxicity was observed in rat GM at concentrations up to 0.5 mumoles/ml. In contrast, approximately equal responses regarding genotoxicity and cytotoxicity were observed in rat and human GM for Na2Cr2O7 (0.25-1 mumoles/ml). Lindane, however, was genotoxic in three out of four rat GM but not in human GM cells (0.5-1 mumoles/ml), whereas it was active in both rat and human NM cells. Together with other recently published in vivo findings, our results with lindane can be interpreted according to a parallelogram approach. In view of possible human exposure situations and the sensitivities of the two target tissues from both species, the data imply that lindane will pose a health risk to humans by inhalation but not by ingestion.

Antigenotoxic properties of lactic acid bacteria in vivo in the gastrointestinal tract of rats

In view of the high incidence of dietary-related tumors, one important research goal is to identify the participating genotoxic carcinogens and the nutritional factors that may counteract their activities. We therefore have further developed a method to assess DNA damage in tumor target tissues of the gastrointestinal tract. Subsequently the prevention of this inducible DNA damage by lactic acid bacteria and by milk products fermented with probiotics was studied as well. The microgel electrophoresis technique was applied to cells of the esophageal, gastric, duodenal, and colonic mucosa. Cells were grouped according to their degree of DNA damage, the simplest measure of which is to discriminate between those with damage (comets) and those without damage. When these cells were isolated from animals treated with a genotoxic carcinogen, N-methyl-N'-nitro-N-nitrosoguanidine (MNNG), and exposed to MNNG for 1-24 hours, it was possible to follow the course of genotoxicity throughout the gastrointestinal tract. After the animals were treated with the lactic acid bacteria under study, it was possible to detect antigenotoxic properties as well. The gavage of 10(10) viable Lactobacillus casei cells in 10 ml of 0.9% NaCl per kilogram body weight immediately before the oral administration of MNNG (5 mg/kg body wt) resulted in a reduction of induced DNA damage in gastric and colonic mucosa cells. A sequential treatment schedule was even more effective: when the animals were treated orally with lactic acid bacteria or yogurt (10 ml/kg body wt) in the morning followed by MNNG (7.5 mg/kg body wt) eight hours later and the colon cells were isolated 16 hours later, the percentages of cells remaining intact were distinctly higher in the combination groups (68 +/- 10 and 68 +/- 19 for L. casei and a "Bio" yogurt, respectively) than in the group receiving only MNNG (45 +/- 17). The effect of heating L. casei was studied and was found to yield less clear-cut effects in preventing genotoxicity. The method is an efficient tool to elucidate antigenotoxic properties of food components in vivo in those target tissues actually afflicted by dietary-related tumors.

The chances of a spina bifida patient becoming continent/socially dry by conservative therapy

One hundred and one patients with neurogenic lower urinary tract dysfunction due to myelomeningocele or sacral dysplasia, all older than 10 years of age, with a mean age of 15 years, and under regular urological control for many years were evaluated to discover if they had achieved urinary continence (dry day and night) or the status of socially dry (with dry intervals of more than 3 hours) with conservative means of treatment; or whether they remained incontinent or required operative procedures. The results were correlated with the urodynamic pattern of their detrusor-sphincter dysfunction and with the methods they used for bladder emptying. Special attention was paid to the effects of the various conservative treatment modalities nowadays available. The chances of becoming continent or at least socially dry by conservative therapy are best for patients with sphincter hyperreflexia provided that (1) the detrusor was already hypo- or areflexic, or detrusor hyperreflexia could be successfully controlled, and (2) that regular bladder emptying was achieved by clean intermittent (self) catheterisation. Twenty-four out of 45 patients in this group fulfilled these criteria: 18 are continent, 6 socially dry, a success rate of 54%. In patients with sphincter weakness the outlook is worse: in combination with detrusor hyperreflexia there is only a 16% chance, and in those with detrusor areflexia a 37% chance of becoming continent or socially dry, with the best results in wheelchair patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Percutaneous transrenal ureteral occlusion: indication and technique

Several techniques for achieving palliative ureteral occlusion in cases of underlying malignant diseases are known to exist. We performed nine ureteral occlusions on seven patients, using two different techniques (occlusion by detachable balloon and by "Harzmann Olive"). Initially, complete occlusion of all ureters was attained; in two cases a second occluding intervention had to be carried out after a period of 6 and 14 weeks. Six of seven patients enjoyed a marked improvement of their quality of life after occlusion. Complications were down to a minimum. In comparison with other techniques described in the literature, Harzmann's method seems to be the simplest, as well as the most fully developed one. It may also be recommended for patients in an advanced tumor stage.

[Special considerations in dental surgery procedures on organ transplantation patients]

In 150 patients 366 (95%) of 385 dental surgery procedures performed prior to organ transplantations were free of complications. In 6 patients circumscribed wound infections occurred, and 5 post-operative hemorrhages as well as 2 injection hematomas were observed. In the group of patients where dental surgery was performed after organ transplantation, all 123 procedures were free of complications. Treatment of transplantation patients in the dental office requires a profound understanding of the complex clinical problems these patients might present, a good coordination of the required measures and close cooperation between the transplantation center and the attending dentist. Special considerations of the treatment of organ transplantation patients and the indications for dental surgery are discussed.

Antiarrhythmic efficacy of Ethmozine (moricizine HCl) compared with disopyramide and propranolol

In the investigation of new antiarrhythmic drugs, comparative trials with clinically available antiarrhythmic agents provide a perspective from which to judge the new investigational agent. Two clinical investigations of moricizine HCl, each using a placebo-controlled, double-blind, crossover design, are summarized. In the first study, 18 patients with greater than or equal to 30 ventricular premature complexes (VPCs) per hour (mean 369 +/- 95) were given propranolol (120 mg daily) compared with moricizine HCl (816 +/- 103 mg daily). Propranolol suppressed 38% of VPCs in the study group, moricizine HCl, 81% of VPCs, and the combination of both drugs, 87%. Moricizine HCl was more effective than propranolol in suppressing VPCs at all individual levels greater than 70% (p less than 0.05, McNemar's test). The combination of moricizine HCl and propranolol was well tolerated. The second investigation used a placebo-controlled, double-blind, crossover design to compare the efficacy of disopyramide (600 mg daily) and moricizine HCl (800 mg daily) in 27 patients. Patients had greater than or equal to 40 VPCs/hr on a 24-hour ambulatory electrocardiogram. During moricizine HCl administration, the mean VPC frequency decreased from 524 to 151 VPCs/hr (71.2% reduction). In contrast, disopyramide reduced VPC frequency from 535 to 253 VPCs/hr (52.8% reduction) and demonstrated significantly greater side effects (p less than 0.05). Moricizine HCl was more effective than disopyramide in suppressing VPCs at all individual percent reduction levels greater than 70% (p less than 0.05, McNemar's test). Moricizine HCl was more effective in suppressing VPCs than either disopyramide or propranolol, with significantly fewer side effects.

[The body as the site of self and other perception--a contribution to the identity problem]

The author differentiates between two modes of perception, one is the "expressive" mode, stabilizing and aiming at constancy, the other is the "impressive" mode, penetrating the self and aiming at identification with the percept. The clinical relevance of the latter for the therapy of psychoses is demonstrated by five case studies. The "Leib" as the place of incidence of perception is viewed in its function for the interaction of physician and patient: above all psychotic border states induce forms of communication, which are remarkably close to the body and remain mostly unconscious, but might be the beginning and instigation of a whole of behaviour-(action) chains on the side of the therapist. For the purpose of a controlled handling of the instrument of therapeutic intervention it is necessary to bring to view precisely these processes occurring close to the body. The traditional idea of identity is embarrassing this process of perception.

Doppler echocardiographic assessment of left ventricular systolic and diastolic function in mild hypertension

Abnormalities in left ventricular (LV) wall thickness and mass have been demonstrated in patients with mild hypertension utilizing M-mode echocardiography. In addition, studies using radionuclide angiography have demonstrated abnormalities in early diastolic LV filling in asymptomatic hypertensive patients with normal ejection fraction and cardiac output. Recently, Doppler recordings of flow velocity in the ascending aorta and through the mitral valve have been shown to provide useful information about LV function. To determine whether flow abnormalities could be detected in patients with mild hypertension, we recorded Doppler aortic and mitral valve flow velocities in 21 men with mild hypertension. Casual systolic blood pressure was 147 +/- 18 mm Hg (mean +/- SD) and diastolic blood pressure was 96 +/- 9 mm Hg. LV mass (310 +/- 75 g) was elevated (i.e., above the 95% normal prediction interval) in 8 of 19 patients who underwent M-mode echocardiography; LV ejection fraction was normal in all patients (mean, 80%). As in previous studies in normal subjects, we found in these hypertensive patients an inverse correlation between age and both aortic peak flow velocity (r = -0.51, p less than 0.05) and transmitral early diastolic peak flow velocity (r = -0.44, p less than 0.05) and a positive relationship between age and mitral valve late diastolic peak flow velocity (r = 0.73, p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Relationship between age, body size, gender, and blood pressure and Doppler flow measurements in the aorta and pulmonary artery

Previous studies have demonstrated a relationship between both age and body surface area (BSA) and M-mode echocardiographic measurements of left ventricular, left atrial, and aortic root dimensions and left ventricular wall thickness. We evaluated the relationships between age, BSA, gender and blood pressure, and Doppler aortic and pulmonary artery (PA) flow velocity measurements in 97 adults, aged 21 to 78 years, without clinical evidence of cardiac disease. No significant relationship was found between gender or blood pressure and aortic or PA flow velocity measurements. Aortic peak flow velocity, flow velocity integral, and average acceleration decreased with increasing age (all p less than 0.001), whereas ejection time (corrected for heart rate) increased, and acceleration time did not change. In contrast, there was no relationship between age and Doppler PA flow velocity measurements. Although there was no relationship between BSA and Doppler aortic flow measurements, PA peak flow velocity and average acceleration increased, while acceleration time decreased with increasing BSA (all p less than 0.02). Decreases in aortic peak flow velocity and flow velocity integral may be partly related to known increases in aortic root diameter with aging. The relationship between PA flow velocity measurements and BSA is not readily explained.

Dependence of urine composition on the age and sex of healthy subjects

The lithogenic and inhibitory substances in the 24-h urine of 150 healthy females and 150 healthy males were recorded. These two groups were further subdivided into 6 different age-groups, with 25 in each group. The 24-h excretion in these various age-groups displayed considerable differences in some cases, particularly in the case of the pH value, and the Ca, Mg, citrate and phosphate excretion of the women, and the Ca, Mg, uric acid, Na and K excretion of the men. All the parameters measured with respect to the males displayed higher levels of excretion than those of the females.

Shear strength of brackets bonded to anterior and posterior teeth

A study was undertaken to determine the maximum shear strength of brackets bonded to anterior and posterior teeth. Brackets were bonded to two groups comprising 12 incisor and 12 molar teeth. After storage in water at 37 degrees C for 10 days, each bracket was tested to failure in a shear mode in a Instron machine. The mean value for the incisors was 164.3 +/- 35.1 kg/cm2 (16.1 +/- 3.4 MPa) and 115.7 +/- 41.1 kg/cm2 (11 +/- 4.0 MPa) for molars. These values, analyzed in a two-tailed test, were statistically different at the 0.01 level of confidence. It was concluded that differences in etching patterns do not necessarily affect shear bond strength and that the predominantly weak link in the bonding chain was at the bracket/resin interface. The lower values for molar teeth may relate to adaptation of the bracket and nonuniform resin thickness.

Effect of imaging view and sample volume location on evaluation of mitral flow velocity by pulsed Doppler echocardiography

Pulsed Doppler mitral flow velocity measurements have been used to evaluate left ventricular diastolic filling. In normal persons these measurements are affected by age and respiration, but not by gender, body surface area or normal blood pressure. Additional factors that may influence these measurements include the imaging view and sample volume location. In this study, the effects of imaging view and sample volume location were evaluated in 52 normal subjects, aged 21 to 78 years. Pulsed Doppler recordings were obtained from the apical 4-chamber and apical 2-chamber views with the sample volume located both in the left atrium and at the level of the mitral valve leaflet tips. Doppler measurements were slightly, but not significantly, higher (4% on average) for recordings obtained from the apical 4-chamber than from the 2-chamber view for peak flow velocity in both early and late diastole. However, apical 4-chamber recordings from a sample volume in the left atrium resulted in measurements significantly lower (p less than 0.05) for both early and late diastolic mitral peak flow velocity than those obtained near the mitral leaflet tips (peak flow velocity in early diastole = 43 +/- 12 vs 57 +/- 12 cm/s and peak flow velocity in late diastole = 36 +/- 7 vs 46 +/- 11 cm/s, respectively). The higher mitral peak flow velocity values recorded in early and late diastole near the mitral leaflet tips may be related to the smaller flow area at the mitral valve orifice compared with the left atrium.(ABSTRACT TRUNCATED AT 250 WORDS)

[Ecology of depression and sexuality in the climacteric and involution in the female]

The evaluation of psychiatric histories of 56 women from the age of 45 to 60 diagnosed as monopolar depressions demonstrates the incongruence of natural-scientific and interpreting (hermeneutic) competence. In 60% of the cases no details about the gynecological anamnesis could be found; in 36% informations about the sexual selfperception by the patients were available; these informations were not placed under a specific category of anamnesis but scattered throughout the text and left a exigency of interpretation. Gynecological pains in a wider sense appeared in half of the cases. These datas are put in the frame of a specific, socially preformed idea of female aging, which indeed gives place to the here studied depressive syndrome, but not to a suitable mode of expression according to age, sexual desire resp. female individuality. The term of "ideal motherliness", i.e. a motherliness without the obligation to produce children, is introduced here as a possible therapeutic and social criticism. The interdependence of sexual mode of expression on one side, which is granted or not granted from a certain age on, of psychiatric symptoms becoming relevant and a fitting niche on the other is called 'ecology' with regard to the said background and according to Bateson. So the dysfunctional stabilization of the patient is regarded as a reflexive kind of way.

[The origin of violence in psychiatry--a contribution to double-bind rage]

The discussion about Euthanasia newly has raised the question on the violent implications of interaction in psychiatry. Psychiatry is under obligation of the forces of order on one, of the wish to help on the other side. This double bind reflects an interactional feature of construction which the psychotic patient has to go through, but which he carries on too. The selfreduplicative construction of originally individual double bind-situations corresponds to the patient's conception of live, but evokes a specific, only perceptible at short notice, disintigrating "double-bind-Wut" in the involved therapist, which mainly is endangering the patient. The state of "double-bind-Wut" and the working up of this rage is determined by the primary process therefore directly unconscious. We investigate to what extent the "double-bind-Wut" is to make perceptible and thus to handle; by the means of casuistic microstructures we give reasons for the assumption that the desintrating power of "double-bind-Wut" might become a methodical paradigm of future research.