436 POSTOPERATIVE SYSTOLIC HYPOTENSION IN FRACTURED NECK OF FEMUR PATIENTS

Introduction

Secondary analysis of outcomes after 11,085 hip fracture operations from the prospective UK Anaesthesia Sprint Audit of Practice (ASAP 2) found an association between reduced intraoperative systolic arterial pressure (SAP) and postoperative mortality at five and 30 days. We sought to determine the incidence of hypotension in the postoperative period, rather than just intraoperatively, in a small sample of patients with fractured neck of femur.

Method

We performed a retrospective review of the notes, electronic vital signs and electronic general practice records from 40 patients with fractured neck of femur. We identified the latest SAP performed at their general practice (if done within one year before admission). We noted the pre-operative baseline SAP reading from the ward as well as the lowest SAP during several time periods: the pre-operative period; the fracture surgery; the recovery room; and during each 24-h period postoperatively until the fifth postoperative day.

Results

A SAP recording from general practice within the previous year was only accessible in 21 (53%) of patients, but where it was accessible, it was within 20% of the immediate preoperative SAP in 14 (66%) of patients. The incidence of relative hypotension (< 80% preoperative SAP) was 54% in the operating theatre, 41% in the recovery room, 65% on the ward during the remainder of the first postoperative 24 h, 55% during postoperative day 2, 53% during day 3, 33% during day 4 and 41% during day 5.

Conclusions

Postoperative hypotension was common in our sample. In our analysis, the highest incidence was on the ward during the first 24 hours postoperatively. However, 41% of patients still had hypotension 5 days postoperatively.

Efficacy and safety of liraglutide 3.0 mg for weight management are similar across races: subgroup analysis across the SCALE and phase II randomized trials

The efficacy and safety of liraglutide 3.0 mg versus placebo, as adjunct to diet and exercise, was evaluated in racial subgroups. This post hoc analysis of pooled data from five double-blind randomized, placebo-controlled trials was conducted in 5325 adults with either a body mass index (BMI) ≥27 kg/m(2) plus ≥1 comorbidity or a BMI ≥30 kg/m(2). Statistical interaction tests evaluated possible treatment effect differences between racial subgroups: white (4496, 84.4%), black/African-American (550, 10.3%), Asian (168, 3.2%) and other (111, 2.1%). Effects of liraglutide 3.0 mg on weight loss, associated metabolic effects and safety profile were generally consistent across racial subgroups. All achieved statistically significant mean weight loss at end-of-treatment with liraglutide 3.0 mg versus placebo: white 7.7% versus 2.3%, black/African-American 6.3% versus 1.4%, Asian 6.3% versus 2.5%, other 7.3% versus 0.49%. Treatment effects on weight and cardiovascular risk markers generally showed no dependence on race (interaction test p > 0.05). Adverse events were similar across racial subgroups.

Recurrent activating mutations of CD28 in peripheral T-cell lymphomas

Peripheral T-cell lymphomas (PTCLs) comprise a heterogeneous group of mature T-cell neoplasms with a poor prognosis. Recently, mutations in TET2 and other epigenetic modifiers as well as RHOA have been identified in these diseases, particularly in angioimmunoblastic T-cell lymphoma (AITL). CD28 is the major co-stimulatory receptor in T cells which, upon binding ligand, induces sustained T-cell proliferation and cytokine production when combined with T-cell receptor stimulation. We have identified recurrent mutations in CD28 in PTCLs. Two residues-D124 and T195-were recurrently mutated in 11.3% of cases of AITL and in one case of PTCL, not otherwise specified (PTCL-NOS). Surface plasmon resonance analysis of mutations at these residues with predicted differential partner interactions showed increased affinity for ligand CD86 (residue D124) and increased affinity for intracellular adaptor proteins GRB2 and GADS/GRAP2 (residue T195). Molecular modeling studies on each of these mutations suggested how these mutants result in increased affinities. We found increased transcription of the CD28-responsive genes CD226 and TNFA in cells expressing the T195P mutant in response to CD3 and CD86 co-stimulation and increased downstream activation of NF-κB by both D124V and T195P mutants, suggesting a potential therapeutic target in CD28-mutated PTCLs.

Examining the connectivity between different cellular processes in the Barrett tissue microenvironment

In Barrett associated tumorigenesis, oxidative phosphorylation and glycolysis are reprogrammed early in the disease sequence and act mutually to promote disease progression. However, the link between energy metabolism and its connection with other central cellular processes within the Barrett microenvironment is unknown. The aim of this study was to examine the relationship between metabolism (ATP5B/GAPDH), hypoxia (HIF1α), inflammation (IL1β/SERPINA3), p53 and obesity status using in-vivo and ex-vivo models of Barrett oesophagus. At the protein level, ATP5B (r = 0.71, P < 0.0001) and p53 (r = 0.455, P = 0.015) were found to be strongly associated with hypoxia. In addition, levels of ATP5B (r = 0.53, P = 0.0031) and GAPDH (r = -0.39, P = 0.0357) were positively associated with p53 expression. Moreover, we demonstrate that ATP5B (r = 0.8, P < 0.0001) and GAPDH (r = 0.43, P = 0.022) were positively associated with IL1β expression. Interestingly, obesity was negatively associated with oxidative phosphorylation (r = -0.6016, P = 0.0177) but positively associated with glycolysis (r = 0.743, P = 0.0015). Comparable correlations were exhibited in the ex-vivo explant tissue between metabolism, p53, hypoxia, inflammation and angiogenesis (P < 0.05). We have shown that metabolism is closely linked with many cellular processes in the Barrett tissue microenvironment.

Structure and function of CrACA1, the major PM-type Ca2+-ATPase, expressed at the peak of the gravity-directed trans-cell calcium current in spores of the fern Ceratopteris richardii

Spores of the fern Ceratopteris richardii have proven to be a valuable single-cell system for studying gravity responses. The earliest cellular change directed by gravity in these cells is a trans-cell calcium current, which peaks near 10 h after the spores are induced to germinate. This current is needed for gravity-directed axis alignment, and its peak is coincident with the time period when gravity polarises the direction of subsequent nuclear migration and rhizoid growth. Transcriptomic analysis of genes expressed at the 10-h time point revealed several that encode proteins likely to be key components that either drive the current or regulate it. Notable among these is a plasma membrane (PM)-type Ca(2+) ATPase, CrACA1, whose activity pumping Ca(2+) out of cells is regulated by gravity. This report provides an initial characterisation of the structure and expression of this protein, and demonstrates its heterologous function complementing the K616 mutant of yeast, which is deficient in PM-type Ca(2+) pump activity. Gravity-induced changes in the trans-cell Ca(2+) current occur within seconds, a result consistent with the hypothesis that the force of gravity can rapidly alter the post-translational state of the channels and pumps that drive this current across spore cells. This report identifies a transporter likely to be a key driver of the current, CrACA1, and characterises the role of this protein in early germination and gravity-driven polarity fixation through analysis of expression levels, functional complementation and pharmacological treatments. These data, along with newly available transcriptomic data obtained at the 10-h time point, indicate that CrACA1 is present, functional and likely a major contributing component of the trans-cell Ca(2+) efflux. CrACA1 is not necessary for polar axis alignment, but pharmacological perturbations of it disrupt rhizoid development. These data support and help refine the post-translational modification model for gravity responses.

The lumbar supraspinous ligament demonstrates increased material stiffness and strength on its ventral aspect

The present work represents the first reported quantified anisotropic, inhomogeneous material constitutive data for the human supraspinous ligament (SSL). Multi-axial material data from 30 human cadaveric SSL samples was collected from distinct locations (dorsal, midsection, and ventral). A structurally motivated strain-energy based continuum model was employed to characterize anisotropic constitutive parameters for each sample. The anisotropic constitutive response correlated well with the reported experimental data (R2>0.97). Results show that in the lumbar spine both the material stiffness and stress at failure were significantly higher in the ventral region of the SSL as compared with the dorsal region (p<0.05). In the along fiber direction a higher stiffness and stress at failure were observed when compared to the transverse direction. These results indicate that modeling spinal ligaments using the hyperelastic line elements that have typically been used may be insufficient to capture their complex material response.

p53 overexpression in Ewing's sarcoma/primitive neuroectodermal tumour is an uncommon event

Aim-To determine the presence of p53 overexpression in Ewing's sarcoma/primitive neuroectodermal tumours (ETs) and to assess whether p53 accumulation has any prognostic value.Methods-From a prospectively compiled database of 76 patients with ETs, suitable tumour tissue was available for 38. The monoclonal antibody pAb1801 was used to detect p53 nuclear protein overexpression. Results-Nuclear staining was detected in the tumours of three (8%) of the 38 patients. Where tumours stained positively, over 10% of the tumour nuclei were postively stained. All three patients whose tumours overexpressed p53 died and in a relatively short time compared with the patients who did not overexpress p53 (mean 3.7 months compared with a mean of 38.7 months in the p53 negative group).Conclusion-Overexpression of p53 in ETs is an uncommon event. Overexpression of p53 has repeatedly been shown to correlate closely with p53 point missense mutations and therefore this oncogenic event appears not to be of primary pathogenic importance in ETs. There is a tentative indication that those uncommon ETs in which p53 overexpression can be detected may be-have more aggressively.

Study of a Swiss dopa-responsive dystonia family with a deletion in GCH1: redefining DYT14 as DYT5

OBJECTIVE

To report the study of a multigenerational Swiss family with dopa-responsive dystonia (DRD).

METHODS

Clinical investigation was made of available family members, including historical and chart reviews. Subject examinations were video recorded. Genetic analysis included a genome-wide linkage study with microsatellite markers (STR), GTP cyclohydrolase I (GCH1) gene sequencing, and dosage analysis.

RESULTS

We evaluated 32 individuals, of whom 6 were clinically diagnosed with DRD, with childhood-onset progressive foot dystonia, later generalizing, followed by parkinsonism in the two older patients. The response to levodopa was very good. Two additional patients had late onset dopa-responsive parkinsonism. Three other subjects had DRD symptoms on historical grounds. We found suggestive linkage to the previously reported DYT14 locus, which excluded GCH1. However, further study with more stringent criteria for disease status attribution showed linkage to a larger region, which included GCH1. No mutation was found in GCH1 by gene sequencing but dosage methods identified a novel heterozygous deletion of exons 3 to 6 of GCH1. The mutation was found in seven subjects. One of the patients with dystonia represented a phenocopy.

CONCLUSIONS

This study rules out the previously reported DYT14 locus as a cause of disease, as a novel multiexonic deletion was identified in GCH1. This work highlights the necessity of an accurate clinical diagnosis in linkage studies as well as the need for appropriate allele frequencies, penetrance, and phenocopy estimates. Comprehensive sequencing and dosage analysis of known genes is recommended prior to genome-wide linkage analysis.

Progranulin mutations and amyotrophic lateral sclerosis or amyotrophic lateral sclerosis-frontotemporal dementia phenotypes

OBJECTIVE

Mutations in the progranulin (PGRN) gene were recently described as the cause of ubiquitin positive frontotemporal dementia (FTD). Clinical and pathological overlap between amyotrophic lateral sclerosis (ALS) and FTD prompted us to screen PGRN in patients with ALS and ALS-FTD.

METHODS

The PGRN gene was sequenced in 272 cases of sporadic ALS, 40 cases of familial ALS and in 49 patients with ALS-FTD.

RESULTS

Missense changes were identified in an ALS-FTD patient (p.S120Y) and in a single case of limb onset sporadic ALS (p.T182M), although the pathogenicity of these variants remains unclear.

CONCLUSION

PGRN mutations are not a common cause of ALS phenotypes.

The natural history of lower urinary tract dysfunction in men: the influence of detrusor underactivity on the outcome after transurethral resection of the prostate with a minimum 10-year urodynamic follow-up

OBJECTIVES

To assess the long-term outcome of the efficacy of transurethral resection of the prostate (TURP) in men with detrusor underactivity (DUA), a cause of lower urinary tract symptoms (LUTS) in a significant minority of men.

PATIENTS AND METHODS

Neurologically intact men with LUTS, who were investigated in our department between 1972 and 1986, diagnosed with DUA and who underwent surgical intervention, were invited for a repeat symptomatic and urodynamic assessment. Identical methods were used, allowing direct comparison of the results.

RESULTS

In all, 224 men were initially diagnosed with DUA; 87 (39%) of these died in the interim and 22 followed had a TURP, with a mean follow-up since surgery of 11.3 years. There were no significantly sustained reductions in any symptoms. There was a small but significant reduction of questionable clinical significance in the bladder outlet obstruction index, but this did not translate into an improved flow rate. Comparison with 58 age-matched patients with DUA who remained untreated showed no significant advantage of surgical intervention in the long-term; on the contrary, there was more chronic retention in those who had had surgery.

CONCLUSIONS

There are no long-term symptomatic or urodynamic gains from TURP in men shown to have DUA. The results of TURP in men with DUA are important, as urologists who surgically treat patients based on the symptoms and uroflowmetry alone will do so in a significant minority of men with DUA. These results strengthen the argument for a routine preoperative urodynamic assessment.

Hydrophilicity of 3-D biomaterials: the Washburn equation

Characterisation and quantification of the surface energy of biomaterials used as tissue engineering scaffolds is important, but many of the techniques available to examine these properties are only applicable to smooth flat samples, not porous materials. This paper describes the application of the Washburn equation to measure the surface energy of a range of porous polyether polyurethane scaffolds with three test liquids; n-Hexane was used to measure a material constant, whilst ethanol and xylene were used to measure contact angles. The results show that the Washburn equation is not applicable in its current form, reasons for this could be that the voids in the materials are too wide for effective capillarity; absorption of the solvents into the polymer matrix may further complicate the measured imbibition profile. Another possible reason is the differences between the sizes of the interconnecting pores in scaffolds with varying void sizes; this could affect the capillary effect of the test liquids through the material. The repeatability of the results and the similar patterns observed with the different liquids suggest that if these issues could be quantified and incorporated into the Washburn equation, it may be possible to generate useful results for similar materials.

Zinc-responsive dermatosis in dogs: 41 cases and literature review

Forty-one cases of zinc-responsive dermatosis in the dog are described. The Siberian husky was the predominant breed affected. Periocular crusts were the most common clinical sign and parakeratosis was noted in the skin biopsy specimens of all dogs. Treatment with oral zinc ameliorated the clinical signs in most dogs, but cases necessitating other treatments such as parenteral zinc or retinoids are reported. The authors recommend a starting dose of 2-3 mg kg-1 elemental zinc per day in the treatment of this disorder.

Immunoassay for detection of cocaine/metabolites in oral fluids

There is growing interest in the use of alternate biological fluids for drug testing. An advantage of oral fluids is that collection can be made from individuals under direct observation without undue embarrassment or invasion of privacy. This study evaluated the STC Cocaine Metabolite MICRO-PLATE EIA for use in detection of cocaine and metabolites in oral fluids. Intra- and interassay precision of the EIA was < 10%. The EIA was cross-reactive to benzoylecgonine (100%), cocaine (> 12.9%), and cocaethylene (13.8%), but did not demonstrate detectable cross-reactivity with other commonly encountered medicants. Evaluation of a series of potential adulterants of oral fluids indicated that common household chemicals and foodstuffs did not alter the outcome of EIA testing for cocaine metabolite. Analysis by EIA and by gas chromatography-mass spectrometry (GC-MS) of oral fluids and urine specimens collected from current drug users in treatment programs and subjects participating in research studies involving controlled dosing of cocaine provided assessment of the clinical sensitivity and specificity of the STC Cocaine Metabolite EIA. Analysis of the data by means of receiver operating characteristic (ROC) plot indicated that the optimal cutoff concentration for the oral fluids EIA was 10 ng/mL. In comparison to GC-MS (10-ng/mL combined cutoff concentration for cocaine and benzoyleogonine), the EIA (10-ng/mL cutoff concentration) demonstrated a sensitivity, specificity, and accuracy of 95%, 82%, and 88%, respectively. The oral fluids EIA was slightly less sensitive than the urine EIA (300-ng/mL cutoff concentration) for the detection of cocaine metabolite with a sensitivity, specificity, and accuracy of 73%, 85%, and 88%, respectively. Overall, testing of oral fluids for cocaine metabolite with the STC Cocaine Metabolite MICRO-PLATE EIA appears to offer a viable alternative to urine for detection of recent cocaine use.

Clinical efficacy of selamectin for the control of fleas on dogs and cats

The topical endectocide selamectin (Revolution, Pfizer Animal Health) was evaluated in seven veterinary dermatology specialty clinics for its ability to control fleas on 75 dogs and 46 cats from single- and multiple-animal households. All animals were treated on days 0, 30, and 60 with a minimum unit dose of 6 mg/kg of selamectin(h) applied to the skin in a single spot at the base of the neck in front of the scapulae. The product was applied according to label instructions, and the use of other topical or environmental flea control products was prohibited during the study. Efficacy was assessed by percentage reductions in geometric mean flea comb counts. The reductions in flea numbers for dogs and cats combined were 90.6%, 97.0%, and 98.0% on days 30, 60, and 90, respectively, compared with day 0. This study demonstrates that selamectin, applied at 30-day intervals to dogs and cats, effectively controls flea infestations without other flea control products in single- and multiple-animal households.

Role of atrial natriuretic peptide in nocturnal polyuria in elderly males

OBJECTIVES

To demonstrate nocturnal polyuria objectively and to assess the role of atrial natriuretic peptide (ANP) in healthy elderly males with and without nocturnal polyuria (NP).

PATIENTS AND METHODS

31 healthy elderly men known to have NP (passing more than 33% of their 24-hour urine output during an 8-hour period overnight) and 12 controls without NP were invited to take part in the study. Blood and urine samples were collected at 4-hourly intervals in order to measure urine output, serum and urine electrolytes and osmolality as well as serum cortisol, renin, aldosterone, arginine vasopressin (AVP) and ANP.

RESULTS

26 men with NP and 8 controls agreed to take part in the study. Subjects with NP were found to have a diuresis and natriuresis as well as a significant increase in ANP overnight compared to the control group. There was no difference in the other parameters between the 3 groups, with the exception of aldosterone and AVP.

CONCLUSIONS

This study has shown a group of subjects with increased natriuresis and diuresis overnight, associated with an increase in ANP. It is possible that subclinical cardiac failure causes an increase in ANP therefore causing nocturnal urinary symptoms and this theory needs further exploration.

Continued improvement in pressure-flow parameters in men receiving finasteride for 2 years. Finasteride Urodynamics Study Group

OBJECTIVES

To assess the long-term effects of finasteride on pressure-flow parameters in men with urodynamically documented bladder outflow obstruction (BOO).

METHODS

One hundred twenty-one men with benign prostatic enlargement (BPE) and lower urinary tract symptoms (LUTS) underwent a pressure-flow study (PFS) at 1 of 11 clinical centers. The PFS technique was standardized, and all tracings were read by a single reader unaware of the treatment group. Patients who were obstructed according to a modified Abrams-Griffiths nomogram were randomized to 5 mg finasteride (n = 81) or placebo (n = 40) for 12 months; all patients continuing into an open extension received finasteride during the second 12 months of therapy. Results of the initial 12-month study demonstrated the benefit of finasteride treatment on PFS parameters. To examine the continuing effects over time, an analysis of the data from 54 patients who completed 24 months of treatment with finasteride is provided.

RESULTS

Detrusor pressure at maximum flow (PdetQmax) continued to decrease during the second 12 months of therapy (decreases of 5.3 and 11.7 cm H2O at months 12 and 24, respectively). The percentage of patients obstructed by Abrams-Griffiths classification decreased from 76.2% at baseline to 66.7% at month 12 and 59.6% at month 24. An intention-to-treat analysis yielded similar results.

CONCLUSIONS

Finasteride improves urodynamic measures of obstruction in men with BPE and LUTS, with continued improvement during the second 12 months of therapy.

Desmopressin in the treatment of nocturnal polyuria in the male

OBJECTIVES

To assess whether desmopressin (1-desamino 8-d-arginine vasopressin) is safe and effective in the treatment of nocturnal polyuria in elderly men.

PATIENTS AND METHODS

Twenty men (age 52-80 years) complaining of nocturia were found to have nocturnal polyuria, determined from frequency-volume charts and defined as the production of >33% of the 24 h urine volume overnight, averaged over a 1-week period. In a double-blind study of cross-over design, a 1-week placebo run-in period was followed by two 2-week periods of placebo or 20 microg intranasal desmopressin, and ended with an open 2-week treatment period with 40 microg desmopressin.

RESULTS

Desmopressin caused a significant reduction in nocturnal urine volume and the percentage of urine passed at night, but the reduction in nocturnal frequency was only significant during treatment with 40 microg desmopressin. Four patients on desmopressin experienced side-effects, three of which were thought to be due to fluid retention.

CONCLUSION

Desmopressin is an effective treatment for nocturnal polyuria in some elderly men. However, it can cause fluid retention and should not be given to patients with cardiac failure. Those undergoing treatment must be closely monitored.

Stenting of the right internal mammary artery graft and right coronary artery via a femoral approach

We describe a case of balloon angioplasty and stenting of the right internal mammary artery (RIMA) graft anastomosis and the native right coronary artery through an in situ RIMA graft using two Bard XT stents (USCI Division of C.R. Bard, Inc., Billerica, Massachusetts). This case illustrates the feasibility of transluminal angioplasty and stenting of RIMA grafts and the native coronary artery using a femoral artery approach.

Improvement of pressure flow parameters with finasteride is greater in men with large prostates. Finasteride Urodynamics Study Group

PURPOSE

We assess the effect of finasteride, a 5alpha-reductase inhibitor, on objective voiding parameters in men with lower urinary tract symptoms and benign prostatic enlargement on digital rectal examination (known as clinical benign prostatic enlargement) in a double-blind placebo controlled multicenter study using strict standard pressure flow study techniques.

MATERIALS AND METHODS

A modification of the Abrams-Griffiths nomogram was used by 1 reader to ensure that all patients met objective criteria for bladder outlet obstruction at baseline. After performing a pressure flow study patients with obstruction were randomized 2:1 to receive 5 mg. finasteride (81) or placebo (40) daily. A second pressure flow study was performed at month 12. At baseline and month 12 free urinary flow studies and transrectal ultrasound were performed, and International Prostate Symptom Score questionnaires were completed. Patients were treated between May 1994 and July 1996.

RESULTS

Finasteride caused a significant decrease (-8.1 cm. water) in detrusor pressure at maximum flow (p <0.05 versus placebo p = 0.02), increase (+1.1 ml. per second) in maximum flow rate (p <0.05 versus placebo p = 0.02) and decrease (-22.8%) in prostate volume (p <0.05 versus placebo p <0.001). Men with prostates larger than 40 cc had greater improvement in detrusor pressure at maximum flow (between group difference -14.5 cm. water, 95% confidence interval -26.2 to -2.6, p = 0.02) and maximum flow rate (mean treatment effect +1.6 ml. per second, 95% confidence interval -0.2 to 3.0, p = 0.02) compared to those with prostates 40 cc or less (between group differences not significant).

CONCLUSIONS

Finasteride treatment resulted in improvements in urodynamic parameters, which were greater in men with large prostates.

Early experience with the Bard XT stent

The Bard XT stent is a new generation balloon expandable intracoronary stent. It has several unique design advantages. Between October 1996 and November 1997, 127 Bard XT stents of various length were deployed in 93 patients with 109 lesions. According to the American College of Cardiology (ACC) and American Heart Association (AHA) classifications 7 lesions were type A, 38 were type B1, 43 were type B2 and 21 were type C [Ellis et al.: Circulation 82:1193-1202, 1990]. Stent delivery was successful in 98% of attempts. Angiographic success was achieved in 98% of 109 lesions. Procedural success was achieved in 94% of 93 patients. Minimal luminal diameter (MLD) increased from 0.91+/-0.34 mm to 3.03+/-0.44 mm and percentage diameter stenosis reduced from 69.1+/-11.07 to 9.96+/-6.81. Complications occurred in four patients. One patient had intracranial hemorrhage, one patient had subacute thrombosis and two patients died postprocedure. Patients were followed for a period of 1 to 14 months (average 7+/-4 months) for major cardiac events and clinical restenosis. The Bard XT stent is a user-friendly device which provided excellent angiographic results and short-term clinical outcome in selected cases. Further study is required to evaluate effects on restenosis.

Angiographic follow-up and clinical experience with the flexible Tantalum Cordis stent

The Cordis stent is a flexible, highly radioopaque intracoronary stent engineered from a single Tantalum filament folded into a sinusoidal helical coil. It is premounted on a semicompliant balloon expandable stent delivery system. From September 1995-March 1996, 147 Cordis stents were deployed in 105 patients (aged 58+/-12 yr, 71% male). Clinical indications for stenting were unstable angina in 59 (55%), stable angina in 41 (38%), and acute myocardial infarction in 7 (7%). The target vessel was the right coronary artery in 45%, the left anterior descending in 31%, and the circumflex artery in 22%. One stent was deployed in a vein graft, and one stent was deployed in a left internal mammary artery graft. Stent deployment was achieved in all but one patient. Acute in-stent thrombosis occurred in 3 patients (2.9%). Two of these patients required urgent coronary artery bypass surgery. Subacute stent thrombosis occurred in 2 patients (1.9%). Minimum lumen diameter increased from 0.70+/-0.41 mm to 3.50+/-0.60 mm following stent placement. All patients received aspirin. Eighty-one patients (77%) received ticlopidine, and 4 patients (4%) received warfarin therapy. The mean hospital stay was 3.4+/-2.3 days. Six-month follow-up angiography was performed on 50 out of 55 eligible patients at one of the two institutions involved in this study. Computer-assisted quantitative coronary angiography defined a restenosis rate of 26%. Repeat revascularization was required in 8 patients (14.5%) at 6-mo follow-up. The Tantalum Cordis intracoronary stent is an effective and safe means of treating coronary lesions, even in patients with unstable ischemic syndromes. Acute and subacute rates of in-stent thrombosis were acceptable, and the long-term angiographic restenosis rates and need for repeat revascularization were favorable.

A novel therapy for nocturnal polyuria: a double-blind randomized trial of frusemide against placebo

OBJECTIVE

To report a randomized, double-blind, placebo-controlled trial of an afternoon dose of the diuretic frusemide, used to establish an early evening diuresis and so diminish nocturnal voiding frequency and voided volume in elderly men presenting with lower urinary tract symptoms (LUTS).

PATIENTS AND METHODS

After a 2-week placebo run-in period, 49 men aged > 50 years were randomized to receive 40 mg of frusemide or placebo, taken 6 h before their usual bedtime. Day and night-time frequency and voided volume during the run-in and treatment periods were compared between the placebo and frusemide groups.

RESULTS

In the 43 men completing the study, there was a significant reduction in night-time frequency (-0.5 and 0) and percentage night-time voided volume (-18% and 0%) in those taking frusemide compared with placebo. Of patients on active treatment, seven of 19 had a reduction in night-time frequency of > or = 1, compared with only one of 20 on placebo, and 14 of 21 felt that frusemide had helped their nocturia, compared with only five of 22 on placebo.

CONCLUSION

Men with LUTS whose most prominent symptom is nocturia should complete a frequency-volume chart. In those with nocturnal polyuria, 40 mg of frusemide resulted in a significant reduction in night-time frequency and percentage voided volume.

Serum and skin IgA concentrations in normal and atopic dogs

OBJECTIVE

To compare serum and skin surface IgA concentrations from atopic and normal dogs.

PROCEDURE

IgA concentrations in sera and skin washings of 20 clinically normal dogs that had no history of pruritus or skin disease were compared to those obtained in 20 dogs with a diagnosis of atopy determined by history, clinical examination and positive intradermal skin test.

RESULTS

There was no significantly difference in the mean serum IgA concentration in normal dogs (252 +/- 187 mg/L) versus atopic animals (314 +/- 327). When skin washings from all sites in both groups were compared, atopic dogs had significantly greater concentrations of IgA in their skin washings than normal dogs as evaluated by an enzyme-linked immunoassay (P < 0.001). However, there was no significant difference between the individual sites of the skin washings of atopic and normal dogs.

CONCLUSION

IgA concentrations of skin washings in atopic dogs were greater than in normal dogs. Further investigations need to determine if the greater concentrations were caused by nonspecific inflammation or by secretion of allergen-specific IgA onto the skin surface.

P-glycoprotein is expressed in the mineralizing regions of the skeleton

Using oligonucleotide primers specific for the human MDR 1 gene, we were able to identify a specific amplicon using RT-PCR from total bovine growth plate chondrocyte RNA. The identification of MDR mRNA in growth plate chondrocytes led us to examine the precise distribution of MDR P-glycoprotein in bone and cartilage. We applied two monoclonal antibodies (C219 and C494) to human fetal, neonatal, and childhood growth plates and bone. In growth plates, P-glycoprotein was detected at high levels in a perilacunar distribution in the calcifying zone and at lower levels in hypertrophic, but not proliferative or reserve zone, chondrocytes. P-glycoprotein was also observed in perichondrial chondrocytes, in perivascular chondrocytes and matrix in the fetal cartilage anlage, and in osteoblasts and the surface osteoid matrix of newly formed bone trabeculae in the primary spongiosa. The recently described chloride channel of P-glycoprotein suggests a potential role of P-glycoprotein in growth plate chondrocyte hypertrophy.

Urodynamics and laser prostatectomy

A total of 81 patients with symptomatic bladder-outlet obstruction (BOO) due to benign prostatic hyperplasia (BPH) underwent visual laser ablation of the prostate (VLAP) using a right-angled firing neodynium: YAG laser. The mean pre-operative prostatic volume was 48.5 ml. All patients were discharged on the 1st post-operative day with an indwelling catheter. Two patients underwent a transurethral prostatectomy (TURP) after failing a trial without catheter on two occasions. Of the remaining 79 patients, 75 were evaluated 6 months post-operatively. Mean symptom scores (I-PSS) decreased from 20.9 to 5.8, the mean maximal urinary flow rate increased from 7.9 to 16.4 ml/s and the mean residual volume decreased from 88.1 to 15.6 ml. Several different methods of evaluating BOO from pressure-flow measurements were used and all showed improvement. All the above-mentioned parameters showed a highly significant improvement (P < 0.01) at 6 months.

Thoracoscopy for spontaneous pneumothorax

Video-assisted thoracic surgical approaches appear to be viable alternatives to thoracotomy when surgical management of spontaneous pneumothorax is required. Apical bullae of the lung can be resected, and pleural abrasion can be accomplished with minimal postoperative morbidity and usually a shorter postoperative stay in hospital. Fifteen patients with primary (n = 9) and secondary (n = 6) spontaneous pneumothoraces have recently been treated by our group with the video-assisted thoracic surgical approach. Secondary pneumothoraces in the 6 patients were a result of cystic fibrosis (n = 2) and chronic obstructive pulmonary disease (n = 2), iatrogenic (n = 1), and post heart-lung transplantation (n = 1). All were treated by endoscopic stapled resection of bullous disease and pleural abrasion. There were no deaths. In 2 patients with secondary spontaneous pneumothorax, recurrent pneumothoraces developed eventually requiring thoracotomy for direct surgical management.