[Massive incrustation of a plastic urethral prosthesis after implantation for 5 months]

A male aged 73 years in poor cardio-pulmonary condition and with urinary retention due to prostatic infravesical obstruction was treated with implantation of a new type of plastic urethral catheter. Prostatectomy was planned after improvement in the cardio-pulmonary condition. This period was prolonged and, five months after implantation of the urethral catheter, massive incrustation in the proximal intravesical part had formed. The catheter was found to be firmly embedded in the prostatic part of the urethra and cystotomy proved necessary to remove it.

Tensile and compressive properties of cancellous bone

The relationship between the mechanical properties of trabecular bone in tension and compression was investigated by non-destructive testing of the same specimens in tension and compression, followed by random allocation to a destructive test in either tension or compression. There was no difference between Young's modulus in tension and compression, and there was a strong positive correlation between the values (R = 0.97). Strength, ultimate strain and work to failure was significantly higher in tensile testing than in compressive testing.

GH-replacement therapy in adults

Growth hormone (GH) deficiency in adults, whether GH deficient since childhood or patients rendered GH deficient in adult life, is associated with psychosocial maladjustment, reduced muscle strength and reduced exercise capacity. Body composition is significantly altered with increased fat and decreased muscle volume as compared to healthy subjects. Kidney function is subnormal, and so is sweat secretion. Epidemiological data suggest premature mortality due to cardiovascular disease in hypopituitary patients. Short-term GH treatment trials have shown improved psychosocial performance, normalization of body composition, increased muscle strength, improved exercise capacity, increased cardiac performance and increase in bone mineral mass as well as in serum markers of bone turnover, and normalization of kidney function. Thus GH replacement therapy in GH-deficient adults exhibits potential long-term beneficial effects. A number of important questions has to be addressed before long-term GH replacement therapy in GH-deficient adults can be considered on a routine basis.

Reduction in sella turcica volume. An effect of long-term treatment with the somatostatin analogue, SMS 201-995, in acromegalic patients

Ten patients with acromegaly were treated with the long-acting somatostatin analogue, Sandostatin (SMS 201-995, octreotide) for more than one year. Computerized tomography was performed before and on 4 different occasions during the treatment. Sella turcica volumes were calculated in nine patients and showed a gradual decrease in all, averaging 32% +/- 14.6%, P less than 0.001 at the end of the study, which is probably indicative of a simultaneous reduction in adenoma size.

Effects of neuropeptide Y on regulation of blood flow rate in canine myocardium

The effect of neuropeptide Y (NPY) on tension development was examined in isolated canine coronary arteries, and the effects on local myocardial blood flow rate were studied in open-chest anesthetized dogs by the local 133Xe washout technique. By immunohistochemistry, numerous NPY-like immunoreactive nerve fibers were identified in the adventitia of canine coronary arteries. NPY (10(-9)-10(-6) M) supplied to isolated epicardial segments of the left anterior descending coronary artery induced a modest vasoconstriction, with a maximum tension of 0.95 mN, that was only 6.9% of the response to K+. In contrast, intracoronary NPY (0.01-10 micrograms) induced a considerable degree of vasoconstriction; the reduction of blood flow rate was dose related, with a maximum reduction to 52% of control values. The effect of intracoronary NPY (1 microgram) on maximally relaxed arterioles elicited by 30 s of ischemia was studied in separate experiments during reactive hyperemia. NPY induced a decrease in maximum blood flow during reactive hyperemia (166.6 vs. 214.6% of preocclusive blood flow rate, mean values; P = 0.05), an increase in the cumulative excess blood flow (61.0 vs. 35.3 ml/100 g; P = 0.02), and an increase in the duration of reactive hyperemia compared with control values (66 vs. 41 s; P = 0.02). Thus we conclude that in the heart NPY is a potent vasoconstrictor that seems to act preferentially on smaller intramyocardial arterioles. Furthermore, NPY inhibits vascular relaxation of myocardial resistance vessels after ischemia, suggesting that this peptide may participate in the regulation of myocardial blood flow not only during physiological conditions but also after ischemia.

Novel islet, duct, and acinar cell markers defined by monoclonal autoantibodies from prediabetic BB rats

Novel islet cell, duct cell, and acinar cell markers have been identified by monoclonal autoantibodies (Maab) derived from prediabetic BB rats. Spleen cells from two rats that both developed diabetes after splenectomy were fused with mouse myeloma cells. A cellular immunoradiometric assay for differential reactivity toward the surface of two closely related, insulin- and non-insulin-producing rat islet tumor cell lines was used to select and clone several IgM-producing hybridomas. The supernatants were finally characterized by two-color immunofluorescence with islet hormone antisera on frozen sections of human, monkey, and rat pancreas. Maab EB52 stained PP cells, but also few A cells on rat pancreas. Maab CA812 identified a subpopulation of islet D cells on rat, human and monkey pancreas. Although the CA812-reactive antigen and somatostatin were coexpressed in most D cells in adult rat pancreas, only a few islet D cells were stained in the newborn pancreas. The CA812-reactive antigen was not detected in somatostatin-producing cells in the duct epithelium. Maab H37 and IF5 selectively stained acinar cells in rat, human, and monkey pancreas, whereas Maab DA39 identified the rat ductal epithelium including the scattered endocrine cells of the ducts. In summary, B lymphocytes producing autoantibodies to pancreatic endocrine, exocrine, and ductal markers are present in prediabetic BB rats and can be detected by use of transformed pluripotent islet cells as target. Such B lymphocytes can be immortalized to produce monoclonal antibodies to study their role in insulin-dependent diabetes mellitus pathogenesis and to clarify the development of the pancreas.

[Thrombocyte concentrate infusions--a study of the frequency of contamination and its clinical significance]

Three hundred and twenty-four samples from platelet concentrate bags were examined for bacterial contamination. Blood cultures were made when platelet transfusion was followed by pyrexia to examine the frequency of platelet transfusion-induced septicemia. 6.5% of samples showed bacterial growth, mostly ordinary skin flora, but other bacteria were also demonstrated. Pyrexia followed 14% of the transfusion episodes, and in 58% of the febrile episodes this was associated with bacterial contamination of the bag. In one episode of post-transfusion pyrexia the same bacteria were found in cultures from both bag and blood. The case is presented here. Sources of bacterial contamination of platelet preparations are discussed. The use of platelet concentrates in treatment of thrombocytopenic patients is so important that the demonstrated rate of contamination does not alter the indication for platelet transfusion. Nevertheless, when platelet transfusion is followed by pyrexia, cultures from the bag and patient's blood should be performed to establish etiology and relevant antibiotic treatment.

Effects of growth hormone on body composition in adults

GH replacement therapy in GH-deficient adults has recently been shown to increase (normalize) muscle volume and decrease adipose tissue volume as measured by means of CT scan and skinfold thickness. Also in adults with acquired GH deficiency in adulthood, GH replacement has been shown to significantly influence body composition with an increase in lean body mass and a reduction in skinfold thickness. Preliminary results from an open long-term trial indicate that 12 months of GH substitution result in a further normalization of the muscle/fat ratio. The fluid-retaining effect, with a significant increase in extracellular-fluid volume demonstrated during GH administration to normal subjects, seems to be of little clinical importance if a replacement dose around 2 IU/m2/day is chosen for young GH-deficient adults. Long-term trials are needed to finally establish the indication of GH replacement therapy in GH-deficient adults.

[Petroleum burns--toxic contact dermatitis]

A great proportion of older housing facilities in Copenhagen are occupied by elderly individuals whose flats are heated by petroleum stoves. These individuals have frequently reduced mobility and may risk falling while filling their stoves. They may thus be exposed to the effect of the toxic fluid on the skin. The clinical pictures in two cases are described.

Peptide histidine methionine and vasoactive intestinal peptide: occurrence and relaxant effect in the human female reproductive tract

The occurrence of the neuropeptides peptide histidine methionine (PHM) and vasoactive intestinal peptide (VIP) in the human female genital tract was studied by means of immunochemistry and radioimmunoassay in combination with gel chromatography. In addition, the effect of PHM and VIP on smooth muscle activity was investigated in vitro. The regional distribution of PHM as determined by radioimmunoassay correlated with that of VIP. This finding agreed with the immunohistochemical data, which, in addition, provided evidence for colocalization of the two peptides in nerve fibers. These fibers were most abundant in the vagina and the uterine cervix, where they seemed to innervate blood vessels, smooth muscle, and epithelial cells. The concentrations of immunoreactive PHM and VIP were found to be similar in all areas except in the vagina, where the PHM concentration was fourfold that of VIP. Gel chromatography of vaginal extract revealed a high concentration of a C-terminally extended form of PHM, suggesting differential processing pathways of the VIP precursor. Both PHM and VIP inhibited, in a dose-dependent manner, the smooth muscle activity in strips from the Fallopian tube and the myometrium. Administered in combination, PHM and VIP had an additive effect and displayed the same efficacy as VIP alone, indicating that the peptides act via a common receptor.

[Increased episcleral venous pressure in uveal effusion]

This paper reports on two patients with bilateral, spontaneous choroidal and retinal detachment. One patient had scleritis, while in the other no underlying eye disease was found. No signs of orbital venous congestion were detected. Although the pathogenesis of this disease is not fully known, the findings of (1) dilated episcleral veins and (2) elevated episcleral venous pressure suggest an obstruction of venous outflow from the uveal tract. The authors believe that these two findings may have been caused by shunting of venous blood anteriorly from the uveal tract into the episcleral veins due to partial obstruction of the vortex veins.

Beneficial effects of growth hormone treatment in GH-deficient adults

A double-blind, placebo-controlled, crossover study on the effects of 4 months' growth hormone (GH) treatment was carried out in 22 GH-deficient adults (8 women, 14 men; mean [SEM] age 23.8 [1.2] years). 1 patient was withdrawn because of oedema. Mean total body weight of the other 21 did not change, whereas mean muscle volume of the thigh, estimated by computerised tomography (CT), was significantly higher after GH than after placebo (70.0 [3.7] vs 66.3 [3.1] ml/0.8 cm cross-sectional slice). The mean adipose tissue volume of the thigh and subscapular skinfold thickness fell significantly during GH treatment. Growth hormone caused a small increase in the isometric strength of the quadriceps muscles and a significant rise in exercise capacity (60.8 [7.2] vs 54.2 [6.6] kJ). The heart rate both at rest and after maximum exercise was low during the placebo period and increased significantly during GH treatment. Blood pressure and echocardiographic wall mass of the left ventricle did not change during the study. Growth hormone increased both mean glomerular filtration rate and renal plasma flow from a subnormal level on placebo to a level comparable with that of an age-matched control group. The filtration fraction did not change. Urinary albumin excretion was in the low normal range and was not affected by GH treatment. Finally, GH treatment normalised mean circulating levels of insulin-like growth factor 1 (IGF-1), which were low after the placebo period (96 [9] micrograms/l placebo; 224 [28] micrograms/l GH). These findings suggest that GH, in a conventional replacement dose, has several potentially beneficial effects in GH-deficient adults and therefore encourage future long-term trials.

[Massive feto-maternal hemorrhage. Diagnosis, quantitation, etiology and (para-clinical findings)]

Massive feto-maternal haemorrhage occurs with a frequency of approximately 1 out of 1,000 deliveries and involves a considerable risk for intrauterine/perinatal morbidity and mortality. Three cases of massive feto-maternal haemorrhage are described. Methods of diagnosis and quantitation are reviewed. The etiological conditions are briefly mentioned and clinical and paraclinical aspects in the fetus/infant and also the mother are reviewed. Investigation for feto-maternal haemorrhage should be undertaken in all cases of unexplained stillbirth and perinatal death and in all cases with hypovolaemic shock or non-haemolytic anaemia in neonates. In addition, investigation should be undertaken in selected cases with deterioration of fetal condition after eg trauma to the uterus, external version and amniocentesis, particularly in cases with massive vaginal haemorrhage and/or aspiration of haemorrhagic amniotic fluid. In these latter cases, it may also be of value to carry out Kleihauer's test on aspirate from the vagina and/or amniotic fluid with the object of determining whether the haemorrhage is of fetal or maternal origin.

Fluoride uptake into demineralized primary enamel from fluoride-impregnated dental floss in vitro

Fluoridated mouthrinses are not advised for preschool children who may swallow much of the agent. An alternate method of delivering topical fluoride to the interproximal tooth surfaces in these young patients may be fluoridated dental floss. The purpose of this study was to determine the fluoride levels of demineralized primary enamel both before and after the use of a commercially available dental floss impregnated with commercially available fluoride-containing products. The results showed that demineralized primary tooth surfaces treated with fluoride-impregnated dental floss exhibited significantly higher fluoride levels than those surfaces treated by immersion in a fluoridated mouthrinse or deionized water.

Density changes at the proximal tibia after medial meniscectomy

Trabecular bone density changes at the proximal tibia were studied after total and partial meniscectomy using quantitative computerized tomography. Thirty-seven medially meniscectomized patients (5- and 10-year follow-up) and 10 control persons were included. In the partially and the totally meniscectomized knees, the area of maximal density in the medial tibial condyle was displaced approximately 4 mm in a posteromedial direction relative to the position in the intact knees. In both partially and totally meniscectomized knees, the density in the region of tibiofemoral contact in the medial tibial condyle was higher compared with the density in the same region in the contralateral intact knees. This difference was of the same order in the 5- and 10-year follow-up groups. The density difference between the meniscectomized and the intact knees in the region of tibiofemoral contact in the medial condyle was significantly higher in totally than in partially meniscectomized patients. It is concluded that not only total but also partial medial meniscectomy is followed by density changes, occurring within the first 5 years after meniscectomy. The results emphasize the importance of the utmost conservatism in surgery on the meniscus.

The predictive value of quantitative computed tomography for vertebral body compressive strength and ash density

Whole lumbar vertebral sections (L2 and L3) were obtained from 30 elderly individuals aged 43-95 years, mean 81 years (13 females, 17 males). None of the subjects had had malignant diseases. Quantitative computed tomography (QCT) was performed on an EMI 7070 scanner. One 8 mm slice parallel to the end-plates was obtained from the center of each vertebral body. The trabecular bone mass in each slice was outlined interactively by means of a tracer-ball. A CT-histogram was recorded inside this area, and average CT-values were expressed in Hounsfield Units (HU). The whole vertebral body (L2) was compressed in a materials testing machine. From the central part of L3, vertical cylindrical pure trabecular bone specimens were obtained. The biomechanical competence of these specimens was also assessed by means of a materials testing machine. Finally, all bone specimens were incinerated for determination of apparent ash-density. Highly significant positive correlations were found between average CT-values and (a) stress values of the trabecular bone (r = 0.81, p less than 0.001) and (b) ash-density of the pure trabecular bone (r = 0.81, p less than 0.001). Furthermore, a significant positive correlation was found between CT-values and (a) total vertebral body load (r = 0.72, p less than 0.001), (b) total vertebral body stress (load/cross-sectional area) (r = 0.55, p less than 0.001) and (c) ash-density of the whole vertebral body (r = 0.76, p less than 0.001). It is concluded that quantitative computed tomography gives valid predictions of both vertebral trabecular bone mass and mechanical competence.(ABSTRACT TRUNCATED AT 250 WORDS)

Regulatory peptides in the mammalian urogenital system

By immunocytochemistry a number of the gut/brain peptides have been demonstrated in nerve fibers of the mammalian urogenital tract. These peptides are localized to large vesicles in nerve terminals of afferent fibers or efferent nerves innervating blood vessels, non-vascular smooth muscle, lining epithelium and glands. There is evidence that some neuropeptides (VIP, NPY) participate in the local non-cholinergic, non-adrenergic nervous control of smooth muscle activity and blood flow, while other peptides (substance P, CGRP) seem to be sensory transmitters. It is likely that impaired function of the peptidergic nerves is involved in sexual dysfunction such as male impotence.