A novel single twist-drill access device for multimodal intracranial monitoring: a 5-year single-institution experience

BACKGROUND

Multimodal intracranial monitoring in the neurosurgical patient requires insertion of probes through multiple craniostomies.

OBJECTIVE

To report our 5-year experience with a novel device allowing multimodal monitoring though a single twist-drill hole.

METHODS

All devices (Hummingbird Synergy, Innerspace) were placed at the Kocher point between 2008 and 2013 at our institution. An independent clinical research nurse prospectively collected data on all bedside placements. Placement accuracy was graded on computed tomography scan as grade 1 (ipsilateral frontal horn or third ventricle), grade 2 (contralateral lateral ventricle), and grade 3 (anywhere else). Infection was monitored with serial cerebrospinal fluid samples.

RESULTS

Two hundred seventy-five devices (198 at bedside, 77 in operating room) were placed in patients with spontaneous subarachnoid hemorrhage (49%), traumatic brain injury (47%), and others (4%) for a median duration of 6 days. A junior (postgraduate year 1-2), midlevel (postgraduate year 3-4), or senior resident (postgraduate year 5-6) placed 39%, 32%, and 29% of the devices, respectively. Ninety-two percent of all devices placed were draining cerebrospinal fluid, ie, were grade 1 (75%) or 2 (17%). Placement accuracy did not vary with level of training. Complications included hemorrhage (10%) and infection (4%), with 1 patient requiring intraparenchymal hematoma evacuation and a second requiring abscess drainage. These rates were lower than reported in the literature for standard external ventricular drains.

CONCLUSION

Hummingbird Synergy is a novel single-port access device for multimodal intracranial monitoring that can be placed safely at the bedside or in the operating room with placement accuracy and has a complication profile similar to or better than that for standard external ventricular drains.

Comparison of parenchymal and ventricular intracranial pressure readings utilizing a novel multi-parameter intracranial access system

Introduction

Both ventricular and parenchymal devices are available for measurement of intracranial pressure (ICP). The Hummingbird^® Synergy Ventricular System is a novel device allowing multi-parametric neurological monitoring, including both ventricular and parenchymal ICP. The purpose of this study is to compare the congruence of the device’s ventricular and parenchymal ICP readings.

Methods

This single-center, quantitative, interventional study compared parenchymal and ventricular ICP readings from 35 patients with the Hummingbird^® System. If a difference of > ± 3 mmHg existed between an individual patient’s parenchymal and ventricular values, progressive intervention strategies were applied to correct identified issues.

Results

From a total of 2,259 observations, statistical analysis revealed congruence (within ±0-3 mmHg) of 93% of readings comparing parenchymal and ventricular ICP. Of the observations requiring intervention, 58% involved the parenchymal component, 30% involved the ventricular component, and 12% involved both components. Following prescribed interventions, 98% of readings became congruent (within ±0-3 mmHg). The adjusted mean difference between the two methods was -0.95 (95% CI: -0.97,-0.93) mmHg and all mean ICP readings fell between -2 and 2 mmHg.

Conclusion

The Hummingbird^® Synergy Ventricular System demonstrates congruence between ventricular and parenchymal ICP measurements within accepted parameters. Interventions required to realign parenchymal and ventricular readings serve as reminders to clinicians to be vigilant with catheter/cable connections and to maintain appropriate positioning of the ventricular drainage system. The results of this study support the recommendation to use the parenchymal ICP component for routine ICP monitoring, allowing dedication of the ventricular catheter to drainage of cerebrospinal fluid (CSF).

Does transurethral microwave thermotherapy (TUMT) affect emission of semen?

In the patient's choice of treatment for symptomatic BPH today, more importance has become attached to disturbances in sexual function as a side-effect. This study concerns analyses of semen after TUMT.

MATERIAL AND METHODS

TUMT was performed with Prostatron, Prostasoft 2.0. Fourteen men were able to provide semen specimens for this study. One sample was collected before and one three to seven months after TUMT. The analyses of semen included determinations of volume, sperm number, sperm morphology and secretory contribution of seminal vesicular and prostatic fluid.

RESULTS

One of the fourteen men could not provide a post-TUMT specimen, despite normal erection. One patient developed pain in the perineum/prostate region post-TUMT when ejaculating and showed azoospermia after the treatment. In analysing the whole group, no statistically significant differences were found between pre- and post-TUMT specimens, regarding semen emission (semen volume, total sperm number, total fructose and zinc) or sperm morphology.

Transurethral microwave thermotherapy for benign prostatic hyperplasia: clinical outcome after 4 years

PURPOSE

We describe long-term results of transurethral microwave thermotherapy. We determined pretreatment variables favorable for the outcome.

MATERIALS AND METHODS

We followed for 4 years 187 patients treated with Prostatron software 2.0.* Preoperative evaluations consisted of score, cystoscopy, transrectal ultrasonography, urine flow and residual volume measurements. Followup examinations with score and urodynamics were performed for 4 years after transurethral microwave thermotherapy. Kaplan-Meier plots and logistic regression were used for statistical analyses.

RESULTS

A decrease in the number of satisfied patients was noted from 62% at 1 year after transurethral microwave thermotherapy to 23% at 4 years. Initial decrease in score and increase in urine flow were followed by increase in score and decrease in flow at the 4-year followup of the 56 patients who had not received supplementary benign prostatic hyperplasia (BPH) treatment. The Kaplan-Meier analysis estimated the median time for need of supplementary BPH treatment to be 45 months. Pretreatment urine flow greater than 10 ml. per second and an irritative score less than 5 were the only factors related to a favorable outcome. Prostate volume or energy delivered to the prostate did not influence the result.

CONCLUSIONS

Four years after transurethral microwave thermotherapy 23% of the initially treated group were satisfied with the result. Two-thirds had received supplementary BPH treatment. Preoperatively less obstructed patients and those with low initial irritative scores responded more favorably to transurethral microwave thermotherapy treatment.

Transurethral microwave thermotherapy in symptomatic benign prostatic hyperplasia: a possible association between androgen status and treatment result?

BACKGROUND

Nothing is yet known of possible endocrine effects of transurethral microwave thermotherapy (TUMT) or of possible influence of endocrine status on the result of thermotherapy.

METHODS

Serum levels of testosterone (T), SHBG, estradiol, LH, and PSH were measured in 48 men with BPH before and 2-3 months after TUMT (Prostatron, Prostasoft 2.0; Technomed International, Lyon, France). Assessment of results was based on the patients' own estimations.

RESULTS

The treatment did not alter hormone levels. Patients who reported response after 12 months (n = 21) had significantly lower outset levels of calculated free testosterone (fT) than in the nonresponders (n = 27). In the patients aged < 70 years (n = 13), both the fT and T values were lower than in the nonresponders (n = 15). There was no age difference between responders and nonresponders.

CONCLUSIONS

TUMT did not influence hormone levels. These observations suggest that androgen status may influence the final result of treatment.

Effect of transurethral microwave thermotherapy. An evaluation with MR imaging

PURPOSE

To detect morphological changes in the prostate, as depicted with MR imaging, in order to clarify the effects of transurethral microwave thermotherapy (TUMT).

MATERIAL AND METHODS

Twenty patients with prostatism and a prostatic volume of 30-71 cm3 underwent MR examination before, the day after, and 6 months after treatment. TUMT was carried out with a Prostatron. A method to detect oedematous changes on heavily T2-weighted MR images was developed and used as an indicator of morphological changes.

RESULTS

The study showed some correlation (r=0.59) between the energy given at TUMT and an increased T2 signal. All patients with increased T2 signal except one were found among those who received the highest amount of energy to the prostate. Of 8 patients, 6 showed a symptomatic response to the treatment and 2 did not. There was a weak statistical correlation (r=0.41) between treatment response and increased T2 signal.

CONCLUSION

The study does not support the view that TUMT leads to significant necrosis in the prostate with loss of tissue and retraction. We theorize that the response to TUMT may be caused by a denervation of the prostate.

Transurethral microwave thermotherapy. A comparison between clinical outcome and morphologic effects assessed by urethrography

PURPOSE

To detect possible morphologic changes in the urethra in an attempt to clarify the effects of thermotherapy (TUMT).

MATERIAL AND METHODS

Eighteen patients with symptomatic disturbance in micturition and a prostatic volume of 14-133 cm3 underwent voiding cystourethrogram and retrograde urethrogram before and 6 and 12 months after treatment. TUMT treatment was carried out with a Prostatron unit.

RESULTS

No correlation was found between subjective improvement in symptoms and morphologic changes of the urethra. There were more responders among patients who received a high microwave effect.

CONCLUSION

We conclude that there is no evidence to support the view that TUMT leads to significant necrosis in the prostrate with loss of tissue and retraction. Our results support the view that TUMT causes denervation of the prostate.

Transurethral microwave thermotherapy of benign prostatic hyperplasia: do any pretreatment conditions predict the result?

OBJECTIVES

To investigate the long-term effect of transurethral microwave thermotherapy (TUMT) treatment and find possible predictors of a favourable outcome.

METHODS

Men with symptomatic benign prostatic hyperplasia (BPH) (n = 339) were examined before undergoing TUMT. The pretreatment evaluation included two or more of the following: cystoscopy, ultrasonic examination of the prostate, urine flow rate, residual urine volume and Madsen symptom score. The urodynamic measurements and Madsen score were repeated after 3, 6 and 12 months. Six different groups, based on pretreatment examinations or energy given during TUMT, were analysed.

RESULTS

The Madsen score was significantly reduced and the score reduction was similar in all groups. Residual urine did not change significantly and flow rate increased only marginally. At 12 months, 56% of the men were satisfied with the treatment result, 29% had received additional treatment because of insufficient relief symptoms, while the remaining 15% were not satisfied but decided not to undergo further treatment at present.

CONCLUSION

The reduction in the Madsen score remained stable during 1-year follow-up. None of the investigated pretreatment findings were predictive of a favourable treatment result. Since TUMT did not increase peak urinary flow significantly, men with BPH symptoms and unobstructed micturition appear to be the most suitable group for treatment. This group of men showed the same symptomatic improvement as the other investigated groups.

Adrenaline, cyclic AMP and potassium during general anaesthesia with and without epidural analgesia

Twenty patients undergoing abdominal surgery under general anaesthesia were studied to determine whether beta 2-adrenergic receptor sensitivity and adrenaline-induced hypokalaemia are related to preceding adrenergic stress. Half of the patients were given epidural analgesia with bupivacaine-adrenaline before starting surgery and then a booster dose after 60 min of surgery. The others were given only the epidural dose of bupivacaine-adrenaline at 60 min. Despite marked increases in the plasma adrenaline concentration after the intra-operative epidural dose, there was no decrease in the serum potassium concentration in either group. In the patients who received only the 60 min dose, the plasma adrenaline concentrations increased more, but the plasma level of cyclic AMP (a marker for beta 2-stimulation) increased similarly, which suggests that beta 2-adrenoceptor responsiveness was somewhat reduced. After the intraoperative bupivacaine-adrenaline, the T wave amplitude decreased, but neither U waves nor tachycardia developed. In conclusion, adrenergic stimulation during surgery does not decrease the serum potassium concentration, regardless of whether the surgical stress response has been modified by epidural analgesia. This lack of a hypokalaemic effect might be partly due to reduced responsiveness of beta 2-adrenoceptors to adrenaline.

The human renal 25-hydroxyvitamin D3-1 alpha-hydroxylase: properties studied by isotope-dilution mass spectrometry

The renal 25-hydroxyvitamin D3-1 alpha-hydroxylase activity has been measured in normal human kidney cortex, using a highly specific assay based on isotope-dilution mass spectrometry. The cortex was obtained from kidneys removed due to renal tumours. The subcellular distribution of 25-hydroxyvitamin D3-1 alpha-hydroxylase activity was studied. Enzyme activity was only observed in the mitochondrial fraction. Mitochondria from non-tumourous kidney cortex had a Vmax of 0.17 +/- 0.02 pmol min-1 mg-1 protein and the apparent Km was in the range of 14 mumol l-1. There was a tendency to a higher 25-hydroxyvitamin D3-1 alpha-hydroxylase activity in preparations from male kidney (0.21 +/- 0.03 pmol min-1 mg-1 protein) than female (0.12 +/- 0.02, P less than 0.05). A significant inverse correlation between serum phosphate and 25-hydroxyvitamin D3-1 alpha-hydroxylase activity was found. No correlation was observed between enzyme activity and serum levels of 1,25-dihydroxyvitamin D (total and free index), PTH, total calcium or ionized calcium. The results indicate that there is a sex difference in human 25-hydroxyvitamin D3-1 alpha-hydroxylase activity similar to the one observed in laboratory animals. Furthermore, the data support the hypothesis that serum phosphate is a major regulator of 1,25-dihydroxyvitamin D3 production in man.

Effects of orchidectomy and different modes of high dose estrogen treatment on circulating "free" and total 1,25-dihydroxyvitamin D in patients with prostatic cancer

Serum levels of total 1,25-dihydroxyvitamin D (1,25(OH)2D), vitamin D binding protein (DBP), sex hormone binding globulin (SHBG), testosterone, estradiol 17 beta (E2) and the "free" 1,25(OH)2D index were measured before and during treatment in prostatic cancer patients treated by orchidectomy (n = 15), with combined i.m. polyestradiol phosphate (PEP) + oral ethinyl estradiol (EE) (n = 10) and with i.m. PEP only for 3 months, followed by addition of oral EE (n = 9). Total concentrations of 1,25(OH)2D and DBP were unaffected by orchidectomy and treatment with i.m. PEP only, but were significantly elevated during treatment including oral EE. SHBG levels were unaffected by orchidectomy, slightly increased by i.m. PEP only and greatly increased by oral EE. The free 1,25(OH)2D index was slightly elevated by treatment including oral EE. Evidence was obtained that the increase in 1,25(OH)2D levels observed during oral estrogen treatment was secondary to the estrogen-augmented increase in DBP and not a result of an estrogen-stimulated synthesis of 1,25(OH)2D. Furthermore, the stimulatory effect of estrogen on DBP concentrations seemed to be dependent on the route of administration of the hormone.

Absorption of a pharmacological dose of vitamin D3 from two different lipid vehicles in man: comparison of peanut oil and a medium chain triglyceride

The absorption of a pharmacological dose of vitamin D3 from two different lipid vehicles, peanut oil, containing long chain fatty acids, and a medium chain triglyceride was compared. Serial measurements of the serum concentration of vitamin D3 after dosage were made. The serum levels of 25-hydroxyvitamin D3, the major circulating vitamin D3 metabolite, were also determined. The analytical methods used were based on HPLC. In the fasting state, the serum levels of vitamin D3 were significantly higher after administration in peanut oil than after administration in the medium chain triglyceride. When the vitamin D3 dose was ingested together with food no difference between the two formulations was observed. Only small inter-formulation differences in serum 25-hydroxyvitamin D3 levels were detected. The results indicate that the presence of long chain fatty acids facilitates the absorption of vitamin D3.

Changes in intravesical pressure during irrigating fluid absorption in transurethral prostatic surgery

Continuous recording of intravesical pressure (IVP) and incremental volumetric measurements of irrigating fluid absorption were performed during 37 transurethral resections of the prostate (TUR). Absorption which resulted in concomitant dilutional changes in peripheral blood, indicating intravascular absorption, was associated with prolongation of the time required to increase the IVP. There was an inverse relation between the change in maximum IVP and the rate of irrigating fluid absorption. Absorption that did not result in concomitant dilutional changes in peripheral blood, indicating extravascular absorption, was associated with similar changes in IVP parameters but the critical pressure for absorption was lower.

Effect of calcium intake on serum levels of 25-hydroxyvitamin D3

The effects of high calcium intake on vitamin D metabolism were investigated. To the normal diet of 14 healthy men, 2 g calcium were added daily for 6-7 weeks. The mean serum concentration of 25-hydroxyvitamin D3 increased from 73 +/- 7 to 94 +/- 6 nmol l-1 (P less than 0.05, Student's unpaired t-test; P less than 0.01, paired t-test) in the subjects receiving calcium, whereas there was only a minimal increase, from 67 +/- 5 to 71 +/- 4 nmol l-1 in a control group on a normal diet. At the end of the study the difference between the test group and the controls was highly significant (P less than 0.005). The calcium loading caused a statistically significant depression of the serum levels of 1,25-dihydroxyvitamin D. The results obtained are in agreement with previous studies in rats and indicate that calcium intake is of some importance for the serum level of 25-hydroxyvitamin D3. The findings are discussed in relation to our previous finding that there is a relationship between high 25-hydroxyvitamin D3 levels and hypercalciuria in renal-stone formers.

Irrigating fluid absorption and blood loss during transurethral resection of the prostate studied with a regular interval monitoring (RIM) method

A method for the study of physiological events during transurethral resection of the prostate (TUR) is described. Measurements of volumetric irrigating fluid balance, blood loss, central venous pressure (CVP) as well as blood haemoglobin and serum levels of sodium and glycine were performed at 10-min intervals. This regular interval monitoring (RIM) method offers the possibility to retrospectively correlate changes that occur during TUR at discrete time intervals. In 20 patients undergoing TUR, irrigating fluid absorption occurred throughout the procedure although the risk of having an absorption increased 30 min after surgery commenced. Increase of blood loss coincided with intravascular but not with extravascular absorptions. If there was a rapid massive intravascular absorption of about 500 ml/10 min, the CVP increased greater than 2 mmHg. The total intraoperative blood loss was not greater in patients with large absorption volumes. RIM will detect absorption greater than the urine excretion in any given period of time. If absorption occurs during a limited time of the TUR, RIM allows a partial correction for the urinary excretion in the volumetric fluid balance.

Factors influencing the osmolality and the concentrations of blood haemoglobin and electrolytes during transurethral resection of the prostate

Twenty patients undergoing transurethral resection of the prostate (TUR) were followed every 10 min intraoperatively as well as 1 and 2 h postoperatively with measurements of blood haemoglobin concentration (B-Hb), serum sodium (S-Na), serum potassium (S-K), serum osmolality (S-osmol), blood loss, central venous pressure and volumetric determination of the irrigating fluid absorption. Changes in B-Hb correlated well with the sum of acetated Ringer solution given and intravascular irrigating fluid absorption. A transient decrease in S-Na of 1-4 mmol/l followed absorptions less than 300 ml. With larger intravascular absorptions, three stages of dilutive changes in S-Na and B-Hb are described. Extravascular absorptions resulted in mild blood parameter changes at various times after their occurrence. Absorption of irrigating fluid was associated with an increase in S-K. S-osmol decreased in conjunction with some absorptions, although the irrigating fluid was isotonic. Postoperative analyses of blood parameters gave only limited information about intraoperative complications. The only consistent pattern was associated with intravascular irrigating fluid absorption.

Three commercial kits and one liquid-chromatographic method evaluated for determining 25-hydroxyvitamin D3 in serum

The accuracy of three commercial kit methods and one liquid-chromatographic (HPLC) method for determining 25-hydroxyvitamin D3 in serum was evaluated by using isotope dilution-mass spectrometry as a reference technique. The kit methods were based on radioimmunoassay and radioreceptor assay. Serum samples were analyzed from male and female volunteers, some of whom had been exposed to ultraviolet B light or given vitamin D3 orally. Results obtained with the three commercial kits were less accurate than those by HPLC. The agreement between the HPLC method and the comparison method was relatively good: r = 0.99; slope = 1.23; intercept = -2.9 micrograms/L. We conclude that methods based on HPLC should be preferred in routine clinical work and that the accuracy of the three commercial kits tested is not sufficient for their intended use.

Three commercial kits and one liquid-chromatographic method evaluated for determining 25-hydroxyvitamin D3 in serum

The accuracy of three commercial kit methods and one liquid-chromatographic (HPLC) method for determining 25-hydroxyvitamin D3 in serum was evaluated by using isotope dilution-mass spectrometry as a reference technique. The kit methods were based on radioimmunoassay and radioreceptor assay. Serum samples were analyzed from male and female volunteers, some of whom had been exposed to ultraviolet B light or given vitamin D3 orally. Results obtained with the three commercial kits were less accurate than those by HPLC. The agreement between the HPLC method and the comparison method was relatively good: r = 0.99; slope = 1.23; intercept = -2.9 micrograms/L. We conclude that methods based on HPLC should be preferred in routine clinical work and that the accuracy of the three commercial kits tested is not sufficient for their intended use.

On the regulatory importance of 1,25-dihydroxyvitamin D3 and dietary calcium on serum levels of 25-hydroxyvitamin D3 in rats

The serum level of 25-hydroxyvitamin D3 in rats was found to vary with the dietary intake of calcium. An increase in the dietary intake of calcium was found to be associated with an increase in the concentration of 25-hydroxyvitamin D3 and a decrease in the concentration of 1,25-dihydroxyvitamin D in serum. Intraperitoneal administration of 1,25-dihydroxyvitamin D3 was found to depress the serum concentration of 25-hydroxyvitamin D3 in rats on both medium and high calcium diets. These changes in the serum levels of 25-hydroxyvitamin D3 were not associated with statistically significant changes in the activity of mitochondrial vitamin D3 25-hydroxylase in the liver. Possible mechanisms for the regulation of the level of circulating 25-hydroxyvitamin D3 in serum are discussed.

Proposed criteria for identifying hyperabsorbers among normocalcaemic renal stone formers

Normocalcaemic male stone formers (n = 138), 31-51 years of age, were divided into a hypercalciuric group (n = 80), with calcium excretions exceeding 7.0 mmol/24 h, and a normocalciuric group (n = 58), with calcium excretions of 7.0 mmol/24 h or less. The hypercalciuric group of patients was further subdivided using two previously published methods for identifying hyperabsorbers--one based on fasting urinary calcium/creatinine ratios and renal threshold phosphate concentrations, Jongen and the other method based on an oral calcium load test, Pak et al. The first method identified 37 patients and the second method 12 patients as hyperabsorbers. However, of the latter 12 patients only 8 were identified as hyperabsorbers using the first method of classification. It is thus evident that the two methods used for subclassification may give surprisingly different results. In order to obtain better congruence, the consequences of changing the defining limits in the two different methods were investigated. On the basis of the results obtained a new model for identification of hyperabsorbers is presented and discussed. With these new selection criteria (TmPO4/GFR greater than or equal to 0.75, urinary fasting molar calcium/creatinine ratio less than 0.40, and an increase in urinary molar calcium/creatinine ratio after calcium load greater than or equal to 0.20), 27 of the hypercalciuric patients were identified as hyperabsorbers. This group included 23 of Jongen's 37 and all of Pak's 12 hyperabsorbers. No patient not identified as a hyperabsorber according to either Jongen's or Pak's method were found in this group. The suggested model for identifying hyperabsorbers seems to be practical at least in studies on the relation between hypercalciuria and metabolism of vitamin D3.

Studies on the relationship between vitamin D3 status and urinary excretion of calcium in healthy subjects: effects of increased levels of 25-hydroxyvitamin D3

The metabolic consequences of a rapid increase in vitamin D status in healthy subjects were investigated. Circulating levels of 25-hydroxyvitamin D3 were increased by 224% in 12 healthy men by giving oral vitamin D3 for 7 weeks and by 200% in 15 healthy women by UVB irradiation for 7 weeks. No statistically significant effects on the serum levels of calcium, phosphate, creatinine, urate, albumin, PTH, basal urinary excretion of calcium, fasting urinary excretion of cAMP, or urinary excretion of calcium after calcium load tests were observed with the unpaired t-test. With the paired t-test the small stimulatory effects (about 25%) on basal urinary excretion of calcium became statistically significant in both experiments. The ratio between calcium and creatinine in fasting urine was significantly elevated following UVB irradiation (from 0.11 +/- 0.02 to 0.21 +/- 0.04, p less than 0.025 unpaired t-test, p less than 0.02 paired t-test) but not after oral intake of vitamin D3. The level of 1,25-dihydroxyvitamin D in serum was not affected to a statistically significant degree by oral vitamin D3, whereas there was a slight decrease from 48 +/- 3 to 39 +/- 3 pmol/l following UVB irradiation. It is concluded that an increase in the concentration of 25-hydroxyvitamin D3 up to about 125 nmol/l has small and negligible effects on calcium homeostasis in healthy subjects. This finding is discussed in relation to our previous finding that hypercalciuric renal stone formers have elevated serum levels of 25-hydroxyvitamin D3 as compared with normocalciuric stone formers and healthy subjects.

25-Hydroxylase activity in subcellular fractions from human liver. Evidence for different rates of mitochondrial hydroxylation of vitamin D2 and D3

25-Hydroxylation of vitamin D2 and D3 was studied in subcellular fractions from human liver, using a technique based on isotope dilution-mass spectrometry. The mitochondrial fraction fortified with isocitrate catalysed 25-hydroxylation of vitamin D3 at a rate of about 10 pmol/mg protein X min. Under the same conditions, the rate of 25-hydroxylation of vitamin D2 was less than 2 pmol/mg protein X min. Crude microsomes fortified with NADPH catalysed 25-hydroxylation of vitamin D3 to a very low extent, and this activity was not linear with the amount of microsomal protein. A higher rate of conversion was obtained with a partially purified cytochrome P-450 fraction in the presence of NADPH-cytochrome P-450 reductase and NADPH. This fraction also catalysed 25-hydroxylation of 1 alpha-hydroxyvitamin D3 and 5 beta-cholestane-3 alpha, 7 alpha, 12 alpha-triol. 25-Hydroxylation of vitamin D2 could not be detected, neither with crude microsomes, nor with the microsomal cytochrome P-450 fraction. Since the assay for 25-hydroxyvitamin D2 was less sensitive than that for 25-hydroxyvitamin D3, these experiments do not rule out the presence of some 25-hydroxylase activity towards vitamin D2 in the microsomes. The results are discussed in relation to previous work in which a lower toxicity has been reported for vitamin D2 than for vitamin D3 in some mammalian species.

High circulating levels of 25-hydroxyvitamin D3 in renal stone formers with hyperabsorptive hypercalciuria

Normocalcaemic male stone formers, 31-51 years old (n = 108) on a free diet, were divided into a hypercalciuric group (n = 47) with calcium excretion rates higher than 8.0 mmol/24 h, a normocalciuric group (n = 32) with calcium excretion rates below 6.1 mmol/24 h and an intermediate group (n = 29). There were no statistically significant differences between the hypercalciuric and the normocalciuric groups with respect to serum levels of calcium, phosphate, creatinine, urate, ALAT, albumin, PTH, 1,25-dihydroxyvitamin D or urinary excretion of cAMP. The group of patients with high calcium excretion had significantly higher serum levels of 25-hydroxyvitamin D3 (75 +/- 4 nmol/l) than the group with low calcium excretion (57 +/- 4 nmol/l) (p less than 0.002), while the group of patients with intermediate calcium excretion had 25-hydroxyvitamin D3 levels between the other two groups (69 +/- 4 nmol/l). A highly accurate method based on isotope dilution-mass spectrometry was used to assay 25-hydroxyvitamin D3. Of the patients with hypercalciuria (n = 47), seven were classified as hyperabsorbers on the basis of calcium load tests. These patients were found to have even higher serum levels of 25-hydroxyvitamin D3 (108 +/- 10 nmol/l)--significantly higher than that of the hypercalciuric patients as a whole. The above study was carried out in March 1983. In September, the group of patients with high urinary calcium excretion also had significantly higher levels of 25-hydroxyvitamin D3 than the group of patients with low calcium excretion.(ABSTRACT TRUNCATED AT 250 WORDS)

Prostaglandin synthase catalyzed metabolic activation of p-phenetidine and acetaminophen by microsomes isolated from rabbit and human kidney

The metabolism of p-phenetidine in microsomes from rabbit kidney and the metabolism of acetaminophen and p-phenetidine in human kidney microsomes to protein binding metabolites were examined. Microsomal preparations from rabbit kidney medulla catalyzed the irreversible arachidonic acid-dependent binding of p-[14C]phenetidine to tissue protein. This was not observed in similar preparations from kidney cortex or if the microsomal protein was denatured. The Km (60 microM) of the binding reaction indicated that the enzymatic processes responsible for the binding have very high affinity for p-phenetidine. Indomethacin inhibited the binding to medullary microsomal protein whereas the inclusion of catalase and superoxide dismutase did not affect protein binding. Linolenic acid hydroperoxide was very effective in supporting binding whereas tertiary butylhydroperoxide and H2O2 were less effective. The binding in the presence of hydroperoxides was not sensitive to indomethacin or metyrapone. The binding ratio of 14C-ring to 14C-ethyl labeled p-phenetidine using rabbit kidney medulla microsomal protein was 2:1 suggesting that the binding species may be p-phenetidine quinone-imine and quinone-diimine dimers which have been shown previously to be products of the peroxidatic oxidation of p-phenetidine. The inclusion of reduced glutathione in incubations containing p-[14C] phenetidine, rabbit kidney medulla microsomes and arachidonic acid resulted in a decrease in radioactivity bound to protein and an increase in radioactivity in the aqueous phase after extraction. Thin-layer chromatography of the aqueous phase revealed the presence of reduced glutathione conjugates of the previously identified reactive dimers of p-phenetidine.(ABSTRACT TRUNCATED AT 250 WORDS)

Biosynthesis of prostaglandins in microsomes of human skeletal muscle and kidney

The capacity of human skeletal muscle, renal cortical and renal medullary microsomes to synthesize prostaglandins (PGs) from exogenous precursor was investigated. The microsomal fractions were incubated with [1-14C]-labelled arachidonate ([14C]-AA) in the absence and in the presence of reduced glutathione (GSH). [14C]-PGs formed in the incubates were extracted, separated by thin-layer chromatography and quantified using liquid scintillation spectrometry. [14C]-labelled PGE2, PGF2 alpha and 6-keto-PGF1 alpha were found to be the principal products of microsomal PG formation and appeared in similar relative quantities in the incubates of all three tissues studied. In some incubates of renal cortical and renal medullary microsomes formation of smaller relative amounts of [14C]-PGD2 and thromboxane B2 was also noted. In addition, formation of substantial amounts of a polar, not yet identified compound was frequently observed in all incubates. In the absence of GSH, [14C]-6-keto-PGF1 alpha was the main PG formed by microsomes of all of the three tissues. At the expense of 6-keto-PGF, the addition of GSH resulted in an almost 2-fold stimulation of [14C]-PGF2 alpha formation in the skeletal muscle and renal cortical incubates, whereas in the renal medullary incubates an increase in the relative amounts of [14C]-PGE2 was observed. The PG synthetic capacity was highest in the skeletal muscle and lowest in the renal cortical microsomes. The results demonstrate a considerable capacity of human skeletal muscle and of the renal cortex and renal medulla to synthesize prostacyclin. Furthermore, the data reveal GSH-dependent differences in the expression of PG biosynthesis in these tissues. The GSH-dependent differentiation of PG synthesis may reflect a mechanism of adaptation of local PG production to the physiological processes.

Chromosome and DNA cytometric study of a papillary carcinoma of the bladder with a high stemline and numerous double minutes

A papillary cancer of the bladder [WHO grade 3] was studied with chromosome and DNA analysis. A high frequency of mitoses was noted, and analysis of 151 metaphases revealed a dominating stemline in the pentaploid region. More than 95% of the cells contained double minutes (dm). Flow cytometry showed the dominant stemline to be in the hexaploid region, that is, about 20% above the numerical chromosome value. This difference is generally obtained when these two methods are compared and is not influenced by the presence of dm. Both methods have been complementary in the evaluation of this tumor.

Relation between hypercalciuria and vitamin D3-status in patients with urolithiasis

Patients with urolithiasis were divided into two groups, one (n = 38) with a urinary excretion of calcium exceeding 6.0 mmol/24 h and one (n = 32) with a calcium excretion lower than 6.1 mmol/24 h. The group of patients with a high urinary excretion of calcium had a significantly higher level of 25-hydroxy vitamin D3 (26.2 +/- 1.6 ng/ml) than had the group of patients with a normal urinary excretion of calcium (17.6 +/- 0.9 ng/ml) (p less than 0.001). A highly specific and accurate method, based on isotope dilution--mass spectrometry was used in the assay of 25-hydroxy vitamin D3. There was no over-all correlation between level of 25-hydroxy vitamin D3 and serum level of calcium (r = 0.1). The results are in accordance with the contention that the vitamin D3-status might be of some importance for the development of hypercalciuria in these patients.

Intravesical fat emulsion at computed tomography of bladder tumours

The value of using fat emulsion as an intravesical medium on examination of bladder tumours with computed tomography, based on a series of 46 patients, and the influence of recent transurethral resection on the bladder wall, are reported.

Clinical trial of a new antigonadotropic substance, 2,6-cis-diphenylhexamethylcyclotetrasiloxane, in cancer of the prostate. A pilot study

An organic siloxane compound, 2,6-cis-diphenylhexamethylcyclotetrasiloxane, (Cisobitan) has been shown to possess antigonadotropic properties. In this study it has been tried in prostatic cancer. 9 patients received the drug in the dose of 4-5 mg/kg body weight. General condition and subjective response, cytologic changes and semiquantitative scintigraphic changes of metastases were recorded, as well as common laboratory data. In this limited trial, Cisobitan was not adequate for tumour palliation. In a few instances subsequent oestrogen treatment was more effective. No side effects of Cisobitan were noted for periods up to 6 months. Further studies may be of value, perhaps using a higher dose.

Intravesical therapy with adriamycin in patients with superficial bladder tumors

An 80-mg dose of adriamycin was given intravesically once a month to 58 patients with superficial transitional cell tumor of the bladder. Complete cytological remission was achieved in all 11 patients with previously untreated, flat carcinoma in situ lesions. In 19 carcinoma in situ patients, who were previously treated by other means, cytological remission occurred in 74%. In T1 and T2 papillary tumor remission occurred in 65 and 20%, respectively. Minor local side effects were observed.

Conversion of arachidonic acid to prostaglandins in homogenates of human skeletal muscle and kidney

The capacity of human skeletal muscle and kidney homogenates to synthetize prostaglandins (PGs) from exogenous precursor was investigated. Low-speed supernatants of muscle as well as renal medullary and cortical homogenates were incubated with 14C-labelled arachidonic acid (14C-AA) prepared as a sodium salt. 14C-PGs in the incubates were extracted, separated with thin-layer chromatography (TLC) and quantified by radioscanning. In the skeletal muscle incubates 14C-AA was converted into 14C-PGs with a time-dependent yield, most effectively after 10--15 min incubation. Well-defined radiopeaks parallel to unlabelled standards of PGD2, PGE2, PGF2 alpha and 6-keto-PGF1 alpha were obtained in the chromatograms. PGE2 was the main PG formed, constituting over 50% of 14C-activity, whereas 6-keto-PGF1 alpha, PGD2 and PGF2 alpha were found in considerably lower proportions. In the renal medullary incubates, PGE2 likewise accounted for the largest part of 14C-PGs formed, but significant relative amounts of PGF2 alpha and PGD2 were also found. A minor peak, corresponding to 6-keto-PGF1 alpha and thus indicating formation of PGI2, was also obtained. In contrast to the medulla, no 14C-PGs could be found in the renal cortical incubates. The results demonstrate the existence of a considerable tissue specificity in the quantitative and qualitative expression of PG biosynthesis in man.

Priapism: surgical or medical treatment?

Two cases of priapism treated with fibrinolysin (streptokinase) are presented. Comparisons are made between medical and surgical treatment in the literature. It is concluded that fibrinolysin may be useful in some cases of early priapism, but should be chosen only after serious consideration of the circumstance that its use precludes early surgery.