Inhibition of carrageenan-induced spinal c-Fos activation by systemically administered c-fos antisense oligodeoxynucleotides may be facilitated by local opening of the blood-spinal cord barrier

Proto-oncogenes of the fos and jun family are rapidly expressed in the central nervous system following various stimuli. Proto-oncogene encoded nuclear proteins such as c-Fos or c-Jun act as transcription factors that may link neuronal excitation to changes in target gene expression. However, the precise in vivo functions of proto-oncogenes in neuroplasticity are still poorly understood. In the present study the effect of systemically administered c-fos antisense oligodeoxynucleotides (ODNs) on c-Fos and dynorphin protein levels in rat L4 spinal cord has been investigated by immunohistochemistry during carrageenan-induced hindpaw inflammation. Continuous infusion of terminal-phosphorothioated c-fos antisense ODNs by subcutaneously implanted miniosmotic pumps for 3 days sequence-specifically suppressed c-Fos protein expression in dorsal horn neurons by about 50%, while the increase in c-Jun immunopositive nuclei was not affected. Digital image analysis revealed a concomitant decrease in spinal dynorphin immunoreactivity. Moreover, 48 hr after carrageenan injection into one hindpaw plasma protein extravasation was observed in numerous blood vessels in the ipsilateral dorsal horn using intravenously administered Evans Blue. Our results provide further evidence that c-Fos may contribute to the regulation of spinal dynorphin gene expression following noxious stimulation. The local increase in blood-spinal cord barrier permeability during sustained peripheral inflammation may permit penetration of hydrophilic antisense ODNs into the central nervous system.

Signalling pathways: a common theme in plants and animals?

The unexpected notion that disease resistance mechanisms may use similar regulatory pathways to developmental processes has emerged from recent advances in understanding signal transduction pathways in insects, mammals and plants.

[High-energy extracorporeal shock-wave therapy (ESWT) in the treatment of pseudarthrosis]

PROBLEM

The success rate of high-energy extracorporal shock wave therapy in the treatment of non-unions in comparison to the "golden standard" surgery is still unclear.

METHOD

In a prospective study, 3000 impulses with an energy density of 0.6 mJ/mm2 were applied with an experimental device to the pseudarthrosis in 52 patients.

RESULTS

The mean duration of pseudarthrosis was 13 months. A mean of 2.5 surgical interventions had already been performed. Bony union was achieved in 52% of our patients after an average of 3.3 months. Failures especially were found in the atrophic type of pseudarthrosis as well as in congenital bone disorders like fibrous dysplasia or osteogenesis imperfecta. No serious complications were observed.

CONCLUSIONS

Even after numerous surgical interventions high-energy extracorporal shock wave therapy as a noninvasive method for the treatment of bony non-unions showed a fair success rate. A higher success rate can be expected by strict selection criteria.

[Radiation exposure in digital micturition cystourethrography in children. How much exposure by fluoroscopy?]

OBJECTIVE

Determination of the proportion of the dose-area product caused by fluoroscopy at voiding cystourethrography in children, using digital image intensifier technology.

PATIENTS AND METHODS

Using computer-assisted dosimetry, we determined the dose-area product and the respective proportions of the dose-area product caused by fluoroscopy and radiography as well as the number of radiographs taken at a given examination of 40 children (8 children less than 2 years old, 15 children between 2 and 6 years old and 17 children between 6 and 15 years old).

RESULTS

The computer software program correctly differentiated between fluoroscopy and radiography in 80% of cases. Incorrect results were primarily observed in newborns and young children. The total radiation dose ranged in relation to patient age from 22 to 651 cGy x cm2. Fluoroscopy was responsible for an average 78% of the applied radiation dose.

CONCLUSION

Computer-assisted dosimetry is useful in determining the proportion of the dose-area product caused by fluoroscopy in older children undergoing voiding cystourethrography. When image intensifier technology is used, this accounts for more than 75% of the total radiation dose. The method is not suitable for use in small children.

[Extracorporeal shock-wave therapy. Experimental basis, clinical application]

The purpose of our studies was to investigate experimentally the dose-dependent effects of extracorporeal shock waves on tendon and bone and to unveil therapeutic possibilities in tendinopathies and pseudarthroses. In animal experiments, both positive and negative influences were exerted by shock waves, depending on the initial situation and on the power of the applied shock waves. In prospective clinical trials positive effects were found in the treatment of persistent tennis elbow, plantar fasciitis, calcifying tendinitis, and pseudarthrosis. Our data show that extracorporeal shock waves may provide analgesic, resorptive and osteo-inductive reactions with nearly no side effects. However, the high cost of apparatus and staff prevents a routine application. Extracorporeal shock waves thus remain a last alternative before the indication is made for an operative procedure.

Nephroblastoma - Wilms’ tumour in adults. Review of 10 cases

Nephroblastoma (Wilms’ tumour) is very rarely found in adult patients. We report on 10 cases to demonstrate the diagnostic and therapeutic problems. In the case of flank pain, large tumour mass, fast tumour growth and young age, the possibility of Wilms’ tumour should be taken into consideration even in adult patients. The chances for successful treatment by primary surgery with adjuvant therapy are favourable for the lower stages I and II. All our patients presenting with tumour stages I and II have survived and have been disease free for 68 months now. One of the patients with Wilms’ tumour stage III died 8 months postoperatively while another one has been disease-free for 120 months now. In the advanced stage IV, no patient survived. In cases of inoperable large tumours in adults, the possibility of primary chemotherapy should be considered under certain circumstances. Rapid tumour regression may confirm diagnosis and will enable salvage operation in some cases.

[Infectious spondylitis. A retrospective evaluation of MRI markers]

AIM AND METHODS

The aim of the present study was to evaluate the MRI criteria of infectious spondylitis (spondylodiscitis). The MR images of 23 patients suffering from spondylodisitis (78% unspecific, 22% specific) were retrospectively analyzed.

RESULTS

The height of the intervertebral discs involved was normal in 40%, reduced in 43% and increased in 17% of the cases. The most common findings can be summarized in an MR triad: 1) The vertebral bodies involved are hypointense in T1-weighted images (100%) with a lack of delineation of the intervertebral discs (53%). 2) The injection of Gd-DTPA yields an enhancement of the vertebral bodies involved and intervertebral discs (95% and 74% respectively). 3) The vertebral bodies and intervertebral discs are hyperintense in T2-weighted sequences (76% and 90% respectively). When present, a paravertebral or intraspinal extension of the infection was isointense compared with the adjacent involved vertebral body in the majority of the patients. A differentiation between unspecific and specific etiology based on the MR images was not possible.

CONCLUSIONS

The vertebral bodies affected were usually hypointense in T1-W with enhancement after the administration of Gd-DTPA and hyperintense in T2-W. The discs involved were usually hyperintense in T2-W and demonstrated an inhomogeneous enhancement.

Mechanical thrombectomy of embolic occlusion in both the profunda femoris and superficial femoral arteries in critical limb ischaemia

We report our preliminary experience using the Amplatz device for percutaneous thromboembolectomy in acute occlusion in both the profunda femoris artery (PFA) and superficial femoral artery (SFA) in four patients (mean age 78.5 years). All patients suffered from acute lower limb ischaemia, Fontaine Grade 3, due to cardiac embolization. Estimated occlusion times range from 3 h to 3 days. All four patients were treated successfully. Device activation time for both the PFA and the SFA was 85 s +/- 15 s. Total procedure time was 25 min +/- 10 min. There was no need for adjunctive procedures or intensive care monitoring. We conclude that the Amplatz device is a very effective and safe procedure for the quick restoration of vascular patency in cases of simultaneous embolically occluded PFA and SFA.

[Presentation of a new self-expanding vascular spiral stent]

The technical details as well as first clinical results of a newly developed Nitinol stent are presented. The spiral-shaped Nitinol stent was implanted in two patients with complicated peripheral arterial obstruction after bypass surgery. Stent implantation was very exact and technically simple using a special implantation catheter. While one patient is free of symptoms three months after stent implantation, an early obstruction was observed in the other patient one day after the interventional procedure. The specific spiral design allows a simple percutaneous extraction of the stent. A cross-over use of the stent seems principally possible, but limited due to the length of the implantation catheter of 70 cm. Prospective clinical studies are, however, warranted.

[The diuresis urogram in patients with a bladder replacement]

PURPOSE

To differentiate between urodynamically relevant obstruction and functionally unimportant dilation of the upper urinary tract in patients with neobladder using a modified furosemide urogram.

METHOD

An excretory urogram with furosemide loading was carried out in 19 patients with neobladder and sonographically and urographically confirmed dilation of the upper urinary tract. Once strong contrasting of the renal pelves and calyces has been achieved, 20 mg of furosemide were applied and late radiographs were obtained at 15 min and 30 min, respectively. An obstruction was defined as increasing dilation of the renal pelves and calices during forced diuresis and lack of washout effect of the contrast medium.

RESULTS

In 32 cases, the renoureteral unit (RUU) was dilated on ultrasound. Of these, 25 RUU's showed good emptiness of contrast medium upon stimulation of diuresis, six RUU's returned a borderline findings, while one RUU was found to exhibit a decompensated anastomotic stenosis, which was dilated. Two further patients with borderline findings were later treated surgically due to their pain symptoms. No patient required further preoperative diagnostic procedures.

CONCLUSIONS

The modified furosemide urogram represents a cost-effective diagnostic orientation strategy in patients with neobladder and dilated renal pelves and calyces and is both well-tolerated by patients and meets with broad acceptance from the urologic staff.

Decreased heterogeneity of capillary plasma flow in the rat whisker-barrel cortex during functional hyperemia

The pattern of capillary plasma perfusion was investigated in the rat brain during functional activation. Functional hyperemia was induced in the left whisker-barrel cortex by deflection of the right mystacial vibrissae for 2 min at frequencies of 1-7 Hz. Rats were decapitated under anesthesia 3-4 s after i.v. bolus injection of Evans blue dye. The steep increase of the arterial dye concentration ensures that divergent capillary plasma transit times result in unequal intracapillary dye concentrations. Plasma perfusion heterogeneity was determined from the coefficient of variation (CV) of Evans blue concentrations measured in numerous single capillaries of the whisker-barrel cortex. Functional hyperemia was quantified from measurements of CBF using the [14C]-iodoantipyrine technique in a second experimental group. CBF in the left whisker-barrel cortex increased with the stimulation frequency and was maximal at 5 Hz compared to the right side. Conversely, plasma perfusion heterogeneity decreased with stimulation frequency in a reciprocal way, being minimal at 5 Hz. Results indicate a decrease in the microcirculatory flow heterogeneity during functional hyperemia in the brain.

Endovascular stenting in patients with Iliac compression syndrome. Experience in three cases

The authors report their experience in the percutaneous treatment of the iliac compression syndrome in three women (20-53 years old) with acute iliofemoral deep venous thrombosis; in one case, there was an additional thrombus in the inferior caval vein. They were treated by percutaneous implantation of Palmaz stents in the left common iliac vein 1 day after surgical thrombectomy and construction of an arterial venous fistula. All patients showed marked improvement, as determined from venograms obtained immediately after stent implantation. The arteriovenous fistulae were closed 3 months later. At 6 months follow-up, the median clinical and color-coded duplex ultrasound indicates that all stents are patent and all patients are free of symptoms.

Alveolar echinococcosis of the liver: percutaneous stent therapy in Budd-Chiari syndrome

BACKGROUND AND AIMS

Infiltration of the hepatic veins in the alveolar echinococcosis can lead to the development of the Budd-Chiari syndrome. The medical and surgical treatment of this condition is generally unsatisfactory. The results of successful interventional treatment with percutaneous stent implantation in the hepatic veins are reported.

METHODS

Using a transjugular approach, metal mesh stents (Boston Scientific, Medi-Tech Accuflex 8/60 mm) were placed in the median and left hepatic veins of a 53 year old woman. After the intervention, oral chemotherapy with albendazole (2 x 400 mg/day) was continued, but no anticoagulants were given.

RESULTS

Stent placement was performed without complications. The clinical picture improved rapidly: normalisation of portal blood flow was confirmed by Doppler ultrasound and there was improvement of liver function, reduction of oesophageal varices, and disappearance of ascites. A follow-up examination at 15 months showed no evidence of stent occlusion.

CONCLUSIONS

Treatment of portal hypertension in alveolar echinococcosis of the liver is problematic. In selected patients with portal hypertension secondary to hepatic vein stenoses but no cirrhosis, percutaneous stent placement in the hepatic veins represents a promising treatment alternative.

Standardized hair photography

BACKGROUND

Photographs currently published or used clinically in hair restorative surgery vary greatly in positioning, lighting, posing, and technique.

OBJECTIVE

The purpose of this work is to aid in standardizing these variables and to review the necessary equipment and techniques required to achieve these goals.

METHODS

Nine standardized views are shown. Also addressed is hairline depiction taking into account variable hair styles.

CONCLUSION

Standardization is achieved with consistent reproduction of patient photographs in hair restoration.

Experimental intracerebral hemorrhage: description of a double injection model in rats

For experimental purposes, the most common technique of producing an intracerebral hematoma in rats is the injection of unclotted autologous blood. All modifications of this model share the problem that size and extension of the hematoma are not reproducible, because the injected blood either ruptures into the ventricular system or it extends to the subarachnoid or subdural space. Therefore a double injection model of experimental intracerebral hemorrhage in rats has been developed using 19 male Sprague-Dawley rats. After inducing anesthesia a cannula was stereotactically placed into the caudate nucleus and an intracerebral hematoma was produced with the double injection method in which first a small amount of fresh autologous blood is injected which is allowed to clot (preclotting) in order to block the way back along the needle track; the actual hematoma is produced in a second step of the injection. The clot volume was measured on stained serial sections. A total injection volume of 50 microliters of autologous blood produced intracerebral hematomas of 41.1 +/- 10.0 microliters and of similar shapes. The double injection method allows to generate reproducible hematomas in rats. This new model of intracerebral hemorrhage will allow further investigation of fibrinolytic and cytoprotective therapies.

Psychopathology in offspring of mothers with borderline personality disorder: a pilot study

OBJECTIVE

Children of mothers with borderline personality disorder (BPD) were hypothesized to be at greater risk for psychopathology, particularly impulse spectrum disorders, than children of mothers with other personality disorders.

METHOD

Twenty-one index children were compared with 23 children of mothers with a nonborderline personality disorder. Diagnoses were obtained using the Kiddie Schedule for Affective Disorders and Schizophrenia-Episodic Version (KSADS-E) and the Child Diagnostic Interview for BPD (CDIB), and functioning was rated with the Child Global Assessment Schedule (CGAS). Physical, sexual, and verbal abuse, as well as family violence and placements, were also assessed.

RESULTS

The children of the borderline mothers, as compared with controls, had more psychiatric diagnoses, more impulse control disorders, a higher frequency of child BPD, and lower CGAS scores. There were no differences between the groups for trauma.

CONCLUSION

The offspring of borderline mothers are at high risk for psychopathology.

[Therapeutic interventions in benign bile duct strictures]

Surgical treatment of benign bile duct strictures continues to be associated with significant lethality. Thus, radiological interventions become increasingly important. A total of 32 patients were treated. Their bile duct strictures had different origins. We performed percutaneous transhepatic cholangiographies in 32 patients, cholangioscopies in 7, and biopsies in 2 patients. Therapeutic interventions included percutaneous transhepatic drainages in 30 patients, laser lithotripsies in 5, and dilatations in 8 patients. As a total, 36 stents (mostly Palmaz stents) were implanted in 27 patients. Acuflex stents were implanted in 2 of these patients and were extracted after successful clearance of the bile ducts following stone fragmentation. No severe complications were observed. Five out of 8 dilatations were unsuccessful, so that stents were implanted. Five patients died. Three stent occlusions and 1 spontaneous stent migration occurred after an average of 29 months; the latter could be treated by means of radiological procedures. The remaining patients are living symptom-free, on average, since 18.6 months.

[Superselective embolization of tumor nodes in solitary kidney in inoperable patients]

PURPOSE

Evaluation of superselective embolisation of renal tumours in inoperable patients with solitary kidneys.

METHODS AND PATIENTS

Eight inoperable patients with solitary kidneys bearing tumour nodules underwent 1-3 superselective embolisation procedures with ethibloc (5x) or polyvinyl alcohol (1x). Renal function was monitored with creatinine levels. Tumour size was controlled every three months by means of sonography.

RESULTS

Technical success rate was 100%. In 3/3 patients haematuria could be stopped. Post-embolisation renal function was unchanged in 6 patients and deteriorated in two patients; creatinine level rose to a maximum of 2.2 mg%. We observed no other side effects. Seven of eight patients died during a median follow-up period of 9.3 months (4-18 months); in two cases they died due to their underlying malignant disease. One patient had local tumour progress.

CONCLUSIONS

Superselective embolisation of renal tumours in patients with solitary kidneys may be a helpful, well-tolerated therapeutic option in inoperable, symptomatic patients.

CT-guided intraarterial chemotherapy in locally advanced tumors

In a retrospective study, 123 patients with tumors (the majority were recurrent pelvic or breast neoplasms) underwent 376 cycles of intraarterial chemotherapy. Contrast material-enhanced computed tomography was performed to check the position of the catheter during 221 cycles. On the basis of findings, the catheter was repositioned 46 (20.8%) times because of weak contrast enhancement in the tumor region (n=24[10.9%]), involvement of neighboring healthy tissue (n=15[6.8%]), or both (n=7[3.2%]).

Parallel changes of blood flow and heterogeneity of capillary plasma perfusion in rat brains during hypocapnia

Plasma perfusion patterns were investigated in brain capillaries during decreased cerebral blood flow induced by hyperventilation. Anesthetized rats were decapitated 3-4 s after being given an intravenous bolus injection of Evans blue dye. the measured steep increase of the arterial dye concentration at this moment ensures that different capillary plasma transit times are reflected in different intracapillary dye concentrations. The observed heterogeneity of capillary plasma transit time was expressed as the coefficient of variation (means +/- SD) of the intracapillary dye concentrations. For comparison, cerebral blood flow was determined at comparable PCO2 values in a second experimental group. At arterial PCO2 values between 40 and 25 mmHg, the cerebral blood flow and the coefficient of variation of the intracapillary dye concentration decreased with decreasing PCO2, whereas at PCO2 values <25 mmHg cerebral blood flow and coefficient of variation did not correlate with the arterial PCO2. However, it cannot be excluded that the coefficient of variation of the intracapillary dye concentration increases between 25 and 14 mmHg and decreases between 14 and 10 mmHg. It is concluded that the reduction of cerebral blood flow measured during moderate hypocapnia is paralleled by a decreased heterogeneity of the brain capillary perfusion. During severe hypocapnia this relationship is lost, indicating a potential disturbance of the cerebral microcirculation.

[Percutaneous dynamic atherectomy with the aid of 12-F and 14-F transluminal atherectomy catheters (TEC): initial results]

OBJECTIVE

The presented study reports on the first experience with the large diameter 12 F and 14 F TEC system for percutaneous dynamic atherectomy of peripheral vascular obstructions.

METHODS AND PATIENTS

The 12 F and 14 F TEC-extraction catheter was used to recanalize peripheral vascular obstructions in 4 patients. The extracted material was continuously aspirated during the procedure. Three patients with intermittent claudication suffered from chronic arterial occlusion (two cases) or from stenosis of an implanted stent (one case) in the region of the superficial femoral artery. In another patient with long-term dialysis history an insufficient collier shunt was treated by atherectomy.

RESULTS

Complete vascular recanalisation was achieved in all cases. Supplementary intervention was not necessary. There were no complications.

CONCLUSION

Atherectomy with the large diameter 12 F and 14 F TEC allows a safe and complete recanalisation of complex peripheral vascular occlusions. Further studies must show whether the enlarged vascular intrusion is justified by more favourable results.

Postnatal distribution of Glut1 glucose transporter and relative capillary density in blood-brain barrier structures and circumventricular organs during development

In the adult brain, Glut1 is associated with capillaries that form a tight barrier whereas Glut1 is lacking in capillaries with non-barrier properties, i.e. the circumventricular organs. In the present study the postnatal developmental changes of brain capillaries and Glut1 were compared in different tight and non-barrier structures. Rats were investigated at birth, 5th postnatal day (P5), P10, P15, P20, P30 and at the age of one year. Antibody stains of brain capillaries (fibronectin) and of Glut1 were visualized by fluorescent microscopy in identical brain cryosections. All brain capillaries of structures that have a tight barrier in adult animals showed the existence of Glut1 during postnatal development. Most non-barrier structures lacked Glut1 in their capillary endothelium after birth although Glut1 was found in the area postrema and subfornical organ at P0 and disappeared thereafter. The relative capillary density in tight barrier structures of the gray matter was more than doubled from birth to P20 with minor changes later. In contrast white matter structures missed any significant increase during development. It is concluded that Glut1, as an indicator of barrier properties, is existing in all blood-brain barrier structures at birth already. The capillary densities observed in different brain structures at birth are not related to the values found in adult animals.

[Thrombectomy using a high-speed rotatable catheter--initial results]

Evaluation of the Amplatz rotational catheter for the recanalisation of acute thrombotic occlusions in various vascular regions. The Amplatz air-driven rotational catheter was used in 5 patients with acute vessel occlusion in various vascular regions: superficial and profundal femoral artery respectively and popliteal artery with tibiofibular trunk (case 1 and 2), a Collier-Shunt (case 3), the left main pulmonary artery (case 4) and the portal vein after TIPS procedure (case 5). A complete or partial recanalisation was achieved in all cases. Time accounted for recanalisation was between 40 and 90 seconds. No adjunctive intervention was necessary. No complications occurred. The Amplatz thrombectomy device allows a fast, safe and effective mechanical thrombectomy of peripheral arteries and haemodialysis shunts. Partial recanalisation of large caliber vessels is also possible.

[Quality control after pelvic injuries with a scoring system]

Quality control after treatment of pelvic injuries is often poor because many criteria of assessment lack objectivity. In order to attain improved comparability of results, we present a scoring system including subjective as well as functional and radiological criteria. The assessment is based on a calculation according to the importance of the criteria. The total score supplies the final result with a breakdown into excellent, good, fair and poor. 33 patients with type B and C injuries (Tile) underwent evaluation with this scoring system. We found 15 excellent, 10 good, 2 fair and 6 poor results. The score showed that patients' most frequent handicap was pain (median 60% of maximum score). Hip mobility was hardly affected, and from the radiological point of view it appeared that alterations of pelvic symmetry and symphysis were most common. Our proposal is to apply this scoring system on a wide basis, because only with a great number of patients can the effectiveness of the score be tested and different ways of treatment assessed with regard to early and late results. Our system could be a useful contribution to sufficient quality control, particularly after such complex and severe injuries.

Elastofibroma and pre-elastofibroma--a biopsy and autopsy study

Two biopsy cases of elastofibroma--one unilateral and one bilateral--are described. A study of 100 autopsies revealed 13 elderly patients with elastofibroma. Males (n = 10; 16.9%) were more affected than females (n = 3; 7.3%). Pre-elastofibroma-like morphological changes (e.g. few or many degenerated elastic fibres) were observed in 81% of the autopsies. Minor pre-elastofibroma-like changes were seen in males and major changes predominantly in females. In addition to physiological ageing as yet unknown factors, rather than abnormal elastogenesis or degeneration, seem to be involved in this pseudotumour.

Wilms' tumor in adults. Review of 10 cases

A nephroblastoma (Wilms' tumor) is very rarely found in adult patients. We report on 10 cases to demonstrate the diagnostic and therapeutic problems. In case of flank pain, large tumor mass, fast tumor growth, and young age, the possibility of a Wilms' tumor should be taken into consideration even in adult patients. The chances for a successful treatment by primary surgery with adjuvant therapy are favorable for the lower stages I and II. All our patients presenting with tumor stages I and II have survived and are free of disease since 68 months at the time of the study. One of 2 patients with a Wilms' tumor stage III died 8 months postoperatively, while the other is free of disease since 120 months. In the advanced stage IV no patient survived. In cases of inoperable large tumors in adults, the possibility of primary chemotherapy should be considered under certain circumstances. Rapid tumor regression may confirm the diagnosis and will enable salvage operation in some cases.

Stromal nodules in benign prostatic hyperplasia

OBJECTIVE

Stromal nodules from benign prostatic hyperplasia (BPH; n = 375 from autopsy, n = 100 from biopsy specimens) were investigated with regard to cytoskeletal components, topography, vascularization, leukocytic infiltrates, and proliferative activity.

METHODS

The nature of stromal nodules was studied by histopathology and immunohistochemistry, using antibodies against alpha-actin, desmin, myosin, vimentin, BMA-120, factor VIII, CD3, CD4, CD20, CD34, CD45RO, CD68, PCNA, and MiB1.

RESULTS

The findings lead to an extended classification of stromal nodules in BPH: immature mesenchymal (IM; 8.8%), fibroblastic (FB; 65.2), fibromuscular (FM; 21.6), and smooth muscular (SM; 4.4%). The different types occurred in all age decades in a similar distribution (FB > FM > IM > SM). Topographical studies (modified zonal subdivision of McNeal) revealed stromal nodules predominantly in the transitional zone (n = 286), less in the central zone (n = 78), occasionally in the peripheral zone (n = 11), and predominantly in the periurethral (n = 287) and less in the intermediate (n = 84) and subcapsular (n = 4) regions. The different types of nodules presented a distinct vascular pattern. FB, FM, and SM nodules showed significantly increased diffuse infiltrates of T lymphocytes-mainly T helper cells (mean 73%)-and an increase of B lymphocytes. Proliferative activity in the nodules was not observed. Stromal nodules were not observed in normal nonhyperplastic prostates; they only occurred in combination with hyperplastic nodular glandular proliferates.

CONCLUSIONS

The findings are suggestive of a maturational sequence of stromal nodules in BPH and of a possible significance of immunocompetent cells in the development of stromal nodules and further suggest that both stroma and epithelium of the prostate respond with nodular hyperplasia to the stimulus, which causes BPH.

[Experiences with an alternative distension medium in oral contrast imaging of the small intestine]

PURPOSE

The image quality of oral small bowel imaging is often poor on account of the small bowel enema. A new contrast medium should increase the image quality due to better compliance of patient because of the better taste of substance. The loading of patient with radiation or time should not increase.

METHODS AND PATIENTS

We investigated prospectively 40 patients, randomized in two groups of 20 patients each. Two different substances were used as contrast medium: barium-methylcellulose and Barium-Mucofalk, respectively. The quality of the double contrast, profile of the mucosa, duration of radiation, duration of examination, dose-area product, and taste of the substance were judged for significance.

RESULTS

The taste of the new contrast medium was judged to be better: twice as often as "good" and five times less often as "bad", the difference was not significant due to the small number of patients. There is no significant difference in the other criterias.

CONCLUSION

Mucofalk is an alternative contrast medium for oral small bowel radiology in cases of difficult placement of the tube for enema. The quality of double contrast and visualization of the profile of mucosa are the same while the taste is better.

[Clinical relevance of mammography in men]

PURPOSE

During a period of four years 104 mammograms were performed in 89 men. Mastectomies were carried out on 23 men (group 1). 66 patients (group 2) were followed up clinically and in 15 patients serial mammograms were obtained.

MATERIAL AND METHOD

In group 1 there were 5 patients with bilateral gynaecomastia, 9 with unilateral gynaecomastia and two with pseudogynaecomastia and there were 7 patients with malignancies. In group 2 there were 46 patients with bilateral gynaecomastia and 10 patients with unilateral gynaecomastia. Pseudogynaecomastia was found in 25 patients. There were 7 malignancies, of which 5 had been suspected clinically and one had been diagnosed as gynaecomastia by mammography. Two carcinomas in situ were missed clinically and also by mammography.

CONCLUSION

When malignancy is not suspected on clinical grounds the first examination should be sonography, mammography being reserved for cases of doubt. Where, however, malignancy is suspected, and for follow-up, mammography retains its primary position.

Low pretreatment gallbladder stone densities at computed tomography predict rapid stone clearance following extracorporeal shock wave lithotripsy

The importance of routine computer tomographic (CT) stone analysis in optimizing the therapeutic outcome after extracorporeal shock wave lithotripsy (ESWL) remains controversial. The aim of the present prospective study was to seek a correlation between CT findings and stone clearance rates after ESWL in 159 patients. One hundred fifty-nine symptomatic patients (116 females, 43 males) with solitary radiolucent gallbladder stones underwent CT for stone analysis before lithotripsy. In Group I (<50 HU, n=104), stone clearance was achieved in 55.8% of patients within 6.11+/- 6.95 months; in Group II (51-100 HU, n = 28), in 50.0% of patients within 11.2 +/- 10.3 months; in Group III (>100 HU, n = 27) in 29.7% of patients within 9.60 +/- 6.96 months. The mean follow-up period was 17.9 +/- 10.0 months. Patients in Group I showed a significantly higher rate of stone clearance than those in Groups II and III (p < 0.001) as well as a significantly shorter time for the achievement of total stone clearance than either of the other groups (p < 0.001). The authors conclude that CT stone analysis provides a more accurate method of selecting patients suitable for ESWL and may be of importance in predicting the expected length of time for achieving complete stone clearance.

Autoradiographic analysis of the regional distribution of Glut3 glucose transporters in the rat brain

Glut3 is a glucose transporter protein which facilitates the transport of glucose across the neuronal membranes. The local distribution of Glut3 in the brain is not well known. The present study had the aim to verify the local distribution of Glut3 in the brain and to compare it with the local glucose utilization. A polyclonal antibody directed against the C-terminal peptide sequence of Glut3 was applied to cryosections of rat brains. A secondary antibody was added which had been coupled to 35S. Using autoradiography and radioactive standards, 17 cerebral structures were investigated. The results show moderate differences of Glut3 density in the structures investigated ranging from -23% to +41% of the mean density. The pineal gland was an exception with a density 66% lower than mean. Local cerebral glucose utilization (LCGU) was analyzed in identical brain structures by application of the quantitative autoradiographic 2-deoxyglucose method to conscious rats. The range of LCGU was from -59% to +55% of the mean. No correlation was found between the moderately heterogeneous Glut3 transporter density and the strongly heterogeneous local cerebral glucose utilization. The results show that the local density of Glut3 glucose transporter protein does not reflect the local level of glucose utilization in the brain.

[Results of catheter embolization of renal cell carcinoma]

PURPOSE

We pointed out the value of catheter embolisation of kidney tumours.

METHODS AND PATIENTS

We treated 42 patients with kidney tumours. For peripheral embolisation we placed Histoacryl or Ethibloc into the kidney artery via a transfemoral catheter. 33 patients had haematuria. 8 patients were lost for follow up. 26 patients were treated by embolisation alone and 8 patients were treated before nephrectomy.

RESULTS

Haematuria was stopped in 98% and never reoccurred. The intraoperative blood-loss was 600 ml on average. 55% of patients treated by embolisation alone died within the first year. 51% of patients suffered from a slight postinfarction syndrome. One patient died of sepsis and one had pulmonary insufficiency due to AV shunt and pulmonary embolism.

CONCLUSIONS

Peripheral embolisation of kidney tumours can be used successfully and is minimal invasive, in case of haematuria and pain. The perioperative risk is reduced due to limited blood loss.

[Radiation exposure during digital hysterosalpingography: how much is due to fluoroscopy?]

PURPOSE

To determine the proportion of radiation exposure from fluoroscopy during the performance of hysterosalpingography, using a digital image intensifier.

MATERIAL AND METHOD

20 women with primary or secondary sterility were examined. The total radiation dose was measured and the proportion due to fluoroscopy was determined. The use of a computer programme permitted accurate differentiation of the dose obtained by fluoroscopy and radiography. Total mean radiation dose was 256 cGy x cm2; fluoroscopy contributed 187 cGy x cm2. On average, fluoroscopy contributed 69% of total radiation dose.

CONCLUSION

During hysterosalpingography with a digital image intensifier, fluoroscopy should be as brief as possible since it contributes most of the radiation dose.

Regional congruence and divergence of glucose transporters (GLUT1) and capillaries in rat brains

The association of glucose transporters (GLUT1) and brain capillaries was tested in different brain structures of rats by a direct comparison of the topologies of capillaries and GLUT1 in identical brain sections. Antibody staining of capillaries (fibronectin) and GLUT1 were made visible by fluorescence microscopy. The results showed differences between brain structures containing a tight and a leaky blood-brain barrier. All capillaries of brain structures with a tight blood-brain barrier showed congruent staining of GLUT1 and capillary morphology. The circumventricular organs that are known to have leaky barrier capillaries were stained by fibronectin antibodies but not by GLUT1 antibodies. Ependymal cells showed moderate staining by GLUT1 antibodies both in areas with tight and leaky barriers. The subcommissural organ appeared to be unique showing neither capillary nor GLUT1 stain. It is concluded that glucose transporters (GLUT1) exist in all brain capillaries of blood-brain barrier structures, whereas they are absent in leaky barrier structures. Moderate amounts of glucose transporter (GLUT1) can also be detected in ependymal cells.

[First clinical experience with a new nitinol stent in the biliary system]

PURPOSE

To evaluate the clinical usefulness of a new nitinol biliary stent (Memotherm) in patients with malignant biliary obstruction. 32 self expanding nitinol stents were applied in 17 patients. The following parameters were investigated: Difficulty of placement, lateral stability and patency over an observation time between 3 weeks and 11 months.

RESULTS

In 29/32 stent application could be performed with high precision. In 3/32 we observed a displacement about 1 cm--according to the optimal stent position. Stent shortening was about 5 mm in 31/32 stents, secondary shortening only occurred in one patient with primarily distracted stent design. Lateral stability was sufficient in 21/25 stenoses with the consequence that dilatation was only performed in 4 cases. Average stent patency was 4.8 months, the average survival 5.1 months. Because of his special design, this stent may not be used for a stenosis with angulation higher than 90 degrees.

CONCLUSION

Basing on a small calibre introducing system, easy placement, predictable minimal shortening and good lateral stability, the Memotherm seems an interesting alternative to other metal stents.

[Alveolar echinococcosis of the liver--computerized tomography findings]

In order to ascertain the typical computed tomographic findings of hepatic alveolar echinococcosis, 24 computed tomograms of 19 patients were evaluated. The liver was involved in all cases whereas the diaphragma was infiltrated in 32%, and the retroperitoneal area in 42%. The right liver lobe was affected in 65%. Both before and after intravenous bolus contrast medium administration, the lesions were mainly inhomogeneous and of low density; a masking of the lesions due to the contrast medium administration was not observed; the enhancement pattern was irregular. Calcifications were detected in 96% of the cases, cystic structures in 50%, and cholestasis in 54%. On the basis of the crucial finding of calcifications in combination with the other typical observations, CT seems to be very suitable for the evaluation of hepatic alveolar echinococcosis.

Predicting vertebral deformity using bone densitometry at various skeletal sites and calcaneus ultrasound

We investigated the usefulness of bone density measurements from multiple skeletal sites and calcaneus ultrasound for evaluating the probability of vertebral deformation. Bone mineral density (BMD) was measured at the second metacarpal and middle phalanges using radiographic absorptiometry of hand radiographs, and at the lumbar spine using dual-energy x-ray absorptiometry. Distal radius and proximal radius were measured using single-energy x-ray absorptiometry (SXA), expressed as bone mineral content (BMC, grams per centimeter), and as BMD (grams per square centimeter). The calcaneus was measured using both SXA (BMD) and broadband ultrasound attenuation (BUA). Among the women in this study (mean age 74, SD = 5), 84 women developed new vertebral deformations (57 cases with one and 27 cases with two or more deformations), which were identified on serial radiographs during an average of 9 years prior to the measurements of bone density. Logistic regression analysis was used to calculate odds ratios for risk of deformation corresponding to a 1-SD difference in density or ultrasound, adjusted for age. All bone measurements were significantly associated with vertebral deformation, with odds ratios (95% confidence intervals) ranging from 1.40 (1.10, 1.78) for proximal radius BMD to 1.88 (1.45, 2.44) for calcaneus BMD measurements. Measurements of calcaneal BUA, calcaneal BMD, and hand BMD generally remained significant when included simultaneously with another measurement in the same model, suggesting that spine or radius BMD may not provide much additional information about risk of deformation. It appears that all of the measurements of bone density and ultrasound provide useful information regarding the probability of deformation. These findings await confirmation in a prospective study.

A comparison of the families of mothers with borderline and nonborderline personality disorders

The purpose of this study was to evaluate the families of procreation of mothers with borderline personality disorder (BPD) on measures of family stability, family satisfaction, and family environment. Families of nine BPD mothers were compared with families of 14 mothers with other personality disorders using a semi-structured interview to evaluate family history, the Family Environment Scale (FES), and the Family Satisfaction Scale (FSS). Families of procreation of BPD mothers were more unstable than comparison group families. FES scores of BPD mothers were significantly lower than controls in cohesion and organization, but not in conflict. Instability and low family cohesion are common in families of BPD mothers, and may place their children at increased risk for development of psychopathology.

[Severity scores underestimate the seriousness of acute renal failure after emergency surgery]

OBJECTIVES

The predictive value of APACHE II and SAPS severity scores were evaluated in a group of patients with acute renal failure admitted in ICU after emergency surgery. The criteria of poor prognosis identified in the 24 hours following admission were also evaluated.

STUDY DESIGN

Open prospective study.

PATIENTS AND METHODS

During 22 months, we included every patient admitted in ICU after emergency surgery with a serum creatinine concentration > or = 130 mumol.L-1. Clinical and biological parameters were collected in the first 24 hours following admission and the severity scores were calculated. Prediction of hospital outcome, based on APACHE II score, was calculated. The standard mortality ratio (observed mortality/predicted mortality) was calculated. Accuracy of SAPS and APACHE II score was compared using ROC curves and comparison of the areas under the curves.

RESULTS

Death in ICU occurred in 44% of the patients while hospital mortality was 51%. The standard mortality ratio for APACHE II score was 1.35. The areas under the curves for SAPS and APACHE II scores were not statistically different. The criteria of poor prognosis, identified in the first 24 hours following admission, were cardiovascular failure, oliguria and sepsis.

CONCLUSION

Conventional severity scores are inaccurate for prediction of mortality in patients with acute renal failure following emergency surgery.

Patterns of capillary plasma perfusion in brains in conscious rats during normocapnia and hypercapnia

The present study aimed to investigate the distribution pattern of plasma flow velocities in brain capillaries. We tested the hypothesis that plasma flow velocities are heterogeneous in the brain capillaries of normocapnic conscious rats and become more homogeneous during increased cerebral blood flow induced by hypercapnia. We developed a method that makes it possible to detect the distribution pattern of plasma flow velocities from the intravascular dye concentrations measured in different capillaries. Evans blue was injected intravenously as a bolus, and 3 to 4 seconds later the rats were decapitated. During this period, a steep increase in arterial dye concentration was verified by frequent arterial blood sampling. Under such conditions, divergent plasma flow velocities in different capillaries yield unequal intravascular dye concentrations. Dye concentrations were measured in several hundred capillaries of brain cryosections using quantitative fluorescence microscopy based on calibration curves obtained from anesthetized rats. The results show a high degree of variation in the intravascular dye concentration during normocapnia. During increasing stages of hypercapnia, the variation was gradually reduced. The coefficient of variation (SD/mean-100) of intracapillary dye concentration decreased from 76% at normocapnia to 22% at extreme hypercapnia (PCO2 of 87 mm Hg), thus showing an inverse correlation with arterial PCO2 (r = .97). The heterogeneity of intravascular dye concentrations observed in the present experiments indicates heterogeneous velocities of plasma perfusion in different brain capillaries during normocapnia and a more homogeneous distribution pattern during hypercapnic hyperemia.