Eco-Concrete in High Temperatures

Concrete technology is becoming more and more sustainable and ecological following more extensive and focused research. The usage of industrial waste and by-products, such as steel ground granulated blast-furnace slag (GGBFS), mine tailing, fly ash, and recycled fibers, is a very important step toward a good transition of concrete into a "green" future and significant improvement in waste management in the world. However, there are also several known durability-related problems with some types of eco-concretes, including exposure to fire. The general mechanism occurring in fire and high-temperature scenarios is broadly known. There are many variables that weightily influence the performance of this material. This literature review has gathered information and results regarding more sustainable and fire-resistant binders, fire-resistant aggregates, and testing methods. Mixes that utilize industrial waste as a total or partial cement replacement have been consistently achieving favorable and frequently superior outcomes when compared to conventional ordinary Portland cement (OPC)-based mixes, especially at a temperature exposure up to 400 °C. However, the primary emphasis is placed on examining the impact of the matrix components, with less attention given to other factors such as sample treatment during and following exposure to high temperatures. Furthermore, there is a shortage of established standards that could be utilized in small-scale testing.

Interpretable Machine Learning for Prediction of Post-Fire Self-Healing of Concrete

Developing accurate and interpretable models to forecast concrete's self-healing behavior is of interest to material engineers, scientists, and civil engineering contractors. Machine learning (ML) and artificial intelligence are powerful tools that allow constructing high-precision predictions, yet often considered "black box" methods due to their complexity. Those approaches are commonly used for the modeling of mechanical properties of concrete with exceptional accuracy; however, there are few studies dealing with the application of ML for the self-healing of cementitious materials. This paper proposes a pioneering study on the utilization of ML for predicting post-fire self-healing of concrete. A large database is constructed based on the literature studies. Twelve input variables are analyzed: w/c, age of concrete, amount of cement, fine aggregate, coarse aggregate, peak loading temperature, duration of peak loading temperature, cooling regime, duration of cooling, curing regime, duration of curing, and specimen volume. The output of the model is the compressive strength recovery, being one of the self-healing efficiency indicators. Four ML methods are optimized and compared based on their performance error: Support Vector Machines (SVM), Regression Trees (RT), Artificial Neural Networks (ANN), and Ensemble of Regression Trees (ET). Monte Carlo analysis is conducted to verify the stability of the selected model. All ML approaches demonstrate satisfying precision, twice as good as linear regression. The ET model is found to be the most optimal with the highest prediction accuracy and sufficient robustness. Model interpretation is performed using Partial Dependence Plots and Individual Conditional Expectation Plots. Temperature, curing regime, and amounts of aggregates are identified as the most significant predictors.

Hybrid Interfacial Transition Zone between Wet-On-Wet Casted Concrete-Microstructure and Mechanical Properties

The manufacture of elements containing two types of concrete allows for the minimization of the amount of Portland cement by matching the properties of concrete with local structural and durability requirements. The most common production method of the hybrid element is wet-on-hard and wet-on-wet. Casting wet-on-dry is the most common approach while casting wet-on-wet has been used mostly for concrete overlays and screeds. The study focuses on the wet-on-wet method but is applied in the production of vertical and horizontal elements. Bond-behavior and micro properties of the wet-on-wet casting interface of ultra-high-performance concrete (UHPC)-normal strength concretes are investigated. The obtained results indicate the formation of a hybrid interfacial transition zone between the two types of casted concrete. The binder matrix located in this zone appeared to combine properties of both used concrete. Porosity, phase composition, and presumably also strength, changed gradually. Furthermore, despite significant differences in shrinkage, no microcracking or delamination was observed in that zone. The ultimate flexural and compressive strength of the produced elements were either equal to the stronger concrete or were higher than the weaker of the used concrete.

Priapism of the glans and corpus spongiosum: Report of two cases with angiography

Priapism, whether of the arterial or veno-occlusive type, mainly affects the cavernous bodies, leaving the low-pressure system in glans and corpus spongiosum soft without urethral compression. In the present 2 case reports, the pathologically increased pressure primarily affected the corpus spongiosum. One had arterial priapism following penile revascularization and the other veno-occlusive priapism due to thrombosis of the internal pelvic veins. Both had ulcerations of the glans and urinary retention requiring suprapubic catheterization. Arteriography revealed the disease mechanism in both, and led to embolization in 1.

Treatment of full thickness focal cartilage lesions with a metallic resurfacing implant in a sheep animal model, 1 year evaluation

BACKGROUND

Full depth focal cartilage lesions do not heal spontaneously and while some of these lesions are asymptomatic they might progress to osteoarthritis. Treatment for these lesions is warranted and the gold standard treatment at younger age remains biological healing by cell stimulation. In the middle-age patient the success rate of biologic treatment varies, hence the surge of non-biological alternatives. Our objective was to evaluate the efficacy and safety of a metallic implant for treatment of these lesions with respect to the long-term panarticular cartilage homeostasis.

METHODS

The medial femoral condyle of 16 sheep was operated unilaterally. A metallic implant was inserted in the weight-bearing surface at an aimed height of 0.5 mm recessed. Euthanasia was performed at 6 or 12 months. Implant height and tilt was analyzed using a laser-scanning device. Damage to cartilage surfaces was evaluated macroscopically and microscopically according to the Osteoarthritis Research Society International (OARSI) recommendations.

RESULTS

Thirteen sheep were available for evaluation and showed a varying degree of cartilage damage linearly increasing with age. Cartilage damage of the medial tibial plateau opposing the implant was increased compared to the non-operated knee by 1.77 units (p = 0.041; 95% CI: 0.08, 3.45) on a 0-27 unit scale. Remaining joint compartments were unaffected. Implant position averaged 0.54 recessed (95% CI: 0.41, 0.67).

CONCLUSIONS

Our results showed a consistent and accurate placement of these implants at a defined zone. At this position cartilage wear of opposing and surrounding joint cartilage is limited. Thus expanded animal and human studies are motivated.

Severe postprostatectomy incontinence: Is there an association between preoperative urodynamic findings and outcome of incontinence surgery?

OBJECTIVE

This study investigated urodynamic findings in prostate cancer patients with self-reported persistent severe postprostatectomy urinary incontinence (PPI) as well as the outcome of incontinence surgery. The main aim was to evaluate the ability of preoperative urodynamic dysfunctions to predict the outcome of incontinence surgery. The hypothesis was that preoperative bladder dysfunction was predictive of an unsuccessful surgical outcome.

MATERIALS AND METHODS

Based on patient-reported adverse effects after radical prostatectomy (RP) in 2005-2009, 94 men with persistent severe PPI were invited in 2011 to a clinical examination including urodynamics. When indicated, surgery for PPI was offered, and by January 2014, 46 patients had been operated on with either an artificial urinary sphincter or a sling. The outcome of PPI surgery was evaluated with a follow-up questionnaire. Successful outcome was defined in two ways: patient-reported satisfaction and using one or fewer pads/day.

RESULTS

Of the 94 men with severe PPI more than 12 months after RP, 76 patients (81% response rate) met for clinical examination. Among them, 99% had intrinsic sphincter deficiency, in 67% coexisting with urodynamic bladder dysfunction. The presence of preoperative bladder dysfunction was not predictive of the outcome of PPI surgery. Preoperative use of fewer pads, less severe PPI, and a longer interval between RP and PPI surgery were associated with the successful outcome of one or fewer pads/day. Longer duration from RP to PPI surgery was the only preoperative factor associated with the successful outcome of satisfaction.

CONCLUSIONS

The hypothesis was not supported as the presence of preoperative urodynamic bladder dysfunction was not predictive of the outcome of PPI surgery in this study.

How should continence and incontinence after radical prostatectomy be evaluated? A prospective study of patient ratings and changes with time

PURPOSE

We examined prevalence rates, and changes in continence and incontinence before and after radical prostatectomy for prostate cancer by comparing different definitions. We also studied the descriptive validity of the grading system of Ellison et al for post-prostatectomy incontinence and baseline predictors of post-prostatectomy incontinence at 12 months.

MATERIALS AND METHODS

This national prospective study included 844 patients treated with radical prostatectomy between 2005 and 2009. Adverse effects, including urinary dysfunction and bother, were reported by 735 patients (88%) using the EPIC-50 and UCLA-PCI validated questionnaires at baseline and 12-month followup. Linear regression analysis was done to examine baseline predictors and the degree of post-prostatectomy incontinence at followup.

RESULTS

At 12 months after radical prostatectomy 74% of patients reported post-prostatectomy incontinence, of whom 40% used pads daily, 34% reported occasional dribbling without pads and 26% had total urinary control. When defined as total incontinence/no urinary control, severe post-prostatectomy incontinence was reported by 3% of the men but 25% had severe post-prostatectomy incontinence according to the stratification of Ellison et al. Of patients with preoperative incontinence 14% improved postoperatively. Predictors of post-prostatectomy incontinence were age 65 years or greater, not working, sexual dysfunction and incontinence preoperatively. The latter 2 remained the strongest predictors on multivariate analysis. Prostate cancer related variables were not associated with post-prostatectomy incontinence.

CONCLUSIONS

The prevalence of post-prostatectomy incontinence varied considerably according to the definition applied. In our opinion incontinence may be reported as any leakage and not only as pad use with grading done on a symptom scale. Preoperative sexual dysfunction and urinary incontinence were the strongest predictors of post-prostatectomy incontinence at 12-month followup.

Evaluation of patients after treatment of arterial priapism with selective micro-embolization

OBJECTIVE

Arterial (high-flow) priapism is characterized by a prolonged non-painful erection without sexual arousal as a result of unregulated inflow of blood to the corpus cavernosum. Treatment is based on decreasing this elevated inflow, primarily by means of selective arteriography and embolization. The aim of this study was to evaluate the treatment of patients with arterial priapism.

MATERIAL AND METHODS

In the period between 1990 and 2004, 10 patients with arterial priapism were admitted to our department. The mean age when priapism developed was 32 years (range 11-62 years). Eight patients were treated with selective embolization, one was operated on and one refused treatment. Nine patients completed a standardized questionnaire which included the International Index of Erectile Function (IIEF-5). The mean follow-up time after treatment was 70 months.

RESULTS

All patients treated with selective embolization achieved reduced tumescence. Six out of eight patients had an improved IIEF-5 score after treatment. In nine men, the etiology of the arterial priapism was perineal trauma. In one case, an anomaly with an accessory artery to the corpus cavernosum was diagnosed, which required surgery, and in one case recurrence of the priapism necessitated a second embolization.

CONCLUSIONS

Selective embolization results in reduced tumescence and an improvement in erectile function in patients with arterial priapism. Trauma to the perineum was the main etiology in this study.

[Treatment of erectile dysfunction with penile implants]

BACKGROUND

Penile implants are the final step in the treatment of erectile dysfunction. The aim of this study was to evaluate patients treated with penile implants in our department.

MATERIAL AND METHODS

From 1990 to 2002, 37 men with erectile dysfunction were treated with a three-component penile implant (AMS 700). In 2 patients the implant was removed; 2 patients were dead at the time of the study. The remaining group (n = 33) received a questionnaire concerning their penile implants, of whom 27 (82 %) responded. Mean observation time after surgery was 6 years. Mean age at surgery was 50 (27 - 68 years).

RESULTS

Diabetes mellitus, trauma and venous insufficiency were the main reasons (68 %) for dysfunction in this patient group. Five patients had perioperative or early postoperative complications. Nineteen (51 %) were re-operated mainly because of dislocation (n = 5), perforation (n = 4) or mechanical failure (n = 4) of the implant. Twenty (74 %) patients were satisfied after surgery. There was no significant improvement in libido or in the relationship with partners.

INTERPRETATION

Three out of four patients were pleased to have the penile implantation done despite the high reoperation rate.

Pharmacotherapy for Erectile Dysfunction

INTRODUCTION

Advances in understanding of the biochemistry and physiology of penile erection have led to breakthroughs in pharmacotherapy of erectile dysfunction.

AIM

To provide recommendations/guidelines concerning state-of-the-art knowledge for the putative molecular and cellular mechanisms of action of centrally and peripherally acting drugs currently utilized in pharmacotherapy of erectile dysfunction.

METHODS

An international consultation in collaboration with the major urology and sexual medicine associations assembled over 200 multidisciplinary experts from 60 countries into 17 committees. Committee members established specific objectives and scopes for various male and female sexual medicine topics. The recommendations concerning state-of-the-art knowledge in the respective sexual medicine topic represent the opinion of experts from five continents developed in a process over a two-year period. Concerning the Pharmacotherapy for Erectile Dysfunction Committee there were 25 experts from 10 countries.

MAIN OUTCOME MEASURE

Expert opinion was based on grading of evidence-based medical literature, widespread internal committee discussion, public presentation and debate.

RESULTS

Selective and potent oral PDE5 inhibitors have significantly more affinity than cGMP and form broader molecular interactions with multiple amino acids, thereby blocking access to cGMP in the catalytic sites of the PDE5 enzyme. PDE5 inhibitors, which vary as to biochemical potency, selectivity and pharmacokinetics, lead to cGMP elevation and relaxation facilitation of penile corpus cavernosum smooth muscle cells following sexual stimulation. Various centrally acting drugs influence sexual behaviour. In particular, the dopaminergic substance apomorphine is a central enhancer that acts in the paraventricular nucleus of the hypothalamus as a dopamine (D2) receptor agonist, induces and increases penile erection responses via disinhibition, following sexual stimulation.

CONCLUSIONS

There is a need for more research in the pharmacotherapeutic development of central and peripheral agents for safe and effective erectile dysfunction treatment.

[Expandable penile implants in patients with erectile dysfunction]

Modern medical treatment can restore normal sexual function in the majority of men with erectile dysfunction, but some men will not obtain an erection sufficient for sexual intercourse. In some of these men, with a strong desire to have an active sexual life including intercourse, it is possible to restore the function by the use of a penile implant. We describe the indications, the surgical procedure and the results with an expandable penile implant.

Priapism of the glans and corpus spongiosum. Report of two cases with angiography

Priapism, whether of the arterial or veno-occlusive type, mainly affects the cavernous bodies, leaving the low-pressure system in glans and corpus spongiosum soft without urethral compression. In the present 2 case reports, the pathologically increased pressure primarily affected the corpus spongiosum. One had arterial priapism following penile revascularization and the other veno-occlusive priapism due to thrombosis of the internal pelvic veins. Both had ulcerations of the glans and urinary retention requiring suprapubic catheterization. Arteriography revealed the disease mechanism in both, and led to embolization in 1.

Sacral neuromodulation in Norway: clinical experience of the first three years

We present our first three years' experience of sacral neromodulation as first line therapy in patients with a non-neurogenic refractory urge incontinence. In 53 patients, 45 women and 8 men with a mean age of 54 years (range 17-76 years), tested by subacute percutan nerve evaluation, 19 patients were declared as responders according to our programme. Fourteen patients, twelve women and two men with a mean age of 47 years (range 33-73 years), agreed to implantation of a neuroprosthesis (Medtronic Interstim Model 3031), which was placed in a subcutaneous buttock pocket in 12 patients. In the first two patients, the device was implanted subcutaneously corresponding to the lower quadrants of the abdominal wall. In two patients, the lead was repositioned from S:4 to S:3 six to twelve months after the primary implantation. In one woman with sensory urgency, the neuroprosthesis was removed six months after it was implanted because of failure. The patients were followed every six months using voiding diary, uroflowmetry, residual urine and cystometry. Eight patients reported total continence, and five declared >50% improvement. One woman has chronic bacteriuria and intermittently symptomatic urinary tract infection, which reduce the response to the chronic sacral nerve stimulation. Because of residual urine, four women are following an individual self-catheterisation programme. In conclusion, we have documented that sacral neuromodulation is an effective and safe procedure in patients with refractory urge incontinence depending on detrusor overactivity. We confirm the clinical results reported by other centres with long experience of sacral neuromodulation.

The clinical value of dynamic magnetic resonance imaging in normal and incontinent women--a preliminary study on micturition

In this preliminary study in nine volunteers and nine women with genuine stress incontinence (GSI) dynamic magnetic resonance imaging (MRI) was used to study the voiding phase in the sitting position after physiological filling of the bladder by urine. The MRI technique has been documented as being useful for this purpose, but in this small group of women it was not possible to determine any specific difference in the voiding pattern between the volunteers and the G

Clinical trial designs: is it possible to have a unified approach and common end points?

The accelerating development during the last 5 y of new compounds for the medical treatment of erectile dysfunction (ED) demands standardized high-quality protocols for evaluation of the therapeutic effect of these treatments. Outcome analyses have to rely on prospective, placebo-controlled trials within predefined populations, where the results are based on good biostatistics, self-administered questionnaires that include partner assessments, quality-of-life measures, and treatment satisfaction. Currently, we have access to different drug application procedures for clinical use in the treatment of ED, and soon we will have new competitive analogues for optional oral treatment. From a wider perspective, we will naturally see second- and third-generation compounds and drugs related to different effector mechanisms. In many subpopulations, ED has a close relation to specific comorbidities, such as cardiovascular diseases and diabetes. Regarding these aspects, the baseline for all clinical trials should be unified and structured not only to evaluate the clinical outcome assessment (subjective and objective) and adverse events as end points, but also to relate the defined therapeutic response to good current clinical practice.

Hydrophilic versus non-coated catheters for intermittent catheterization

Since Lapides reintroduced clean intermittent catheterization (CIC) in 1972, this procedure has been used routinely in individualized programmes for bladder evacuation in various bladder disorders. It has been suggested that in clinical practice hydrophilic catheters are preferable to non-coated catheters. In reviewing the literature on CIC, many of the reports were found to rely on data from non-randomized retrospective studies. In some recent prospective studies, involving a limited number of patients, hydrophilic and non-coated catheters have been evaluated and compared, especially with regard to bacteriuria and urethral irritation. The available data indicate that using hydrophilic catheters for CIC may induce lower rates of bacteriuria and long-term urethral complications such as urethral strictures. However, to reach a reliable conclusion about the supposed advantage of the hydrophilic catheters, there is a need for a prospective, randomized long-term multicentre study. It is important in such a study to define patient characteristics including age, gender, diagnosis of bladder dysfunction, reason for CIC, physical and mental handicap, manual dexterity and previous treatments. Effect parameters should include number of catheterizations, urinary tract infection, early and long-term urethral complications, patient satisfaction, preferences and dropout rates. It is obligatory to include factors such as cost-benefit and cost-effectiveness.

Repeated pressure-flow studies in the evaluation of bladder outlet obstruction due to benign prostatic enlargement. Finasteride Urodynamics Study Group

Test-retest reliability of repeated voids in pressure-flow studies and the influence on maximum flow rate (Q(max)pQ), detrusor pressure at maximum flow rate (p(det)Qmax), voided volume, and residual urine were studied. Also the agreement in interpretation of pressure-flow tracings between investigators and a single blinded central reader acting as a quality control center (QCC) were assessed. In addition, correlations between p(det)Qmax and patient age, International Prostate Symptom Score (IPSS), free maximum flow rate (Qmax), and prostate volume were calculated. Using suprapubic pressure recording, 216 men with lower urinary tract symptoms (LUTS) due to benign prostatic enlargement (BPE) were investigated in 11 centers. In each pressure-flow study, three sequential voids were performed, and quality controlled recordings were analyzed for Q(max)pQ and p(det)Qmax by the QCC. Trans rectal ultrasound was used to measure the prostate volume. Mean Q(max)pQ did not change, but p(det)Qmax decreased significantly in the second and third sequential voids. Using the Abrams-Griffiths nomogram definition of obstruction, 125 patients (67%) were classified as obstructed from the first void, but only 111 patients (59%) from the third void. The agreement between the investigator assessment and that of a single blinded reader was good. There was no significant correlation between p(det)Qmax and patient age, IPSS, and Qmax, whereas a modest correlation was found between p(det)Qmax and prostate volume. In summary, there was no significant change in Q(max)pQ, but p(det)Qmax decreased for the three consecutive voids, which can be explained by a decrease in outlet resistance. The agreement between the investigator and QCC interpretations shows the value of a standardized technique, supporting the feasibility of multicenter urodynamic studies. There is a modest, but statistically significant, correlation between detrusor pressure and prostate size, supporting the hypothesis that prostate size is a contributing factor in symptomatic BPH.

Hypertension and pseudoaneurism on the renal artery following retrograde endopyelotomy (Acucise)

Acucise endopyelotomy has gained widespread use in the treatment of ureteropelvic junction obstruction. Acute postoperative bleeding is a well-known complication. We report one case with a delayed postoperative formation of pseudoaneurism, and one case which developed arterial hypertension postoperatively.

Interstitial laser coagulation in patients with lower urinary tract symptoms from benign prostatic obstruction: treatment under sedoanalgesia with pressure-flow evaluation

OBJECTIVES

To evaluate the effects on lower urinary tract symptoms and pressure-flow variables after interstitial laser coagulation (ILC) of the prostate using the Indigo diode laser system (Indigo, Palo Alto, USA).

PATIENTS AND METHODS

Forty-nine men (median age 68 years, range 52-80) were assessed using symptom scores and voiding variables before and at 3 and 12 months after ILC. A subset of 26 men (median age 68 years, range 63-72) underwent pressure-flow measurements before and at 6 months after ILC. All treatments were performed in the outpatient department using sedoanalgesia.

RESULTS

The International Prostate Symptom Score decreased from 22 to 11 at 12 months after ILC. The peak urinary flow (Qmax ) was 8.6 mL/s at baseline and increased to 9.9 mL/s at 12 months. Residual urine volumes were unchanged. The median duration of urinary retention after ILC was 3 days. From pressure-flow recordings, 17 patients were categorized as obstructed and seven as equivocally obstructed before ILC (using the International Continence Society definition). Their Qmax increased from 7.7 to 9.0 mL/s after 6 months, the detrusor pressure at Qmax decreased from 68 to 51 cmH2O and the Abrams-Griffiths number decreased from 54 to 29 (P<0.01). Patients with moderate to equivocal obstruction had a greater relief of symptoms than those who were clearly obstructed. Patients with prostate volumes of >40 mL had a greater decrease in the Abrams-Griffiths number than had patients with smaller prostates. Postoperative perineal pain was reported by 72% of patients; the pain subsided after 1-2 weeks. The re-treatment rate was 15% within the first year.

CONCLUSION

Treatment with ILC produced substantial effects on symptoms and moderate to small changes in urodynamic variables. Patients with moderate or equivocal bladder outlet obstruction or large prostates seem to be the best candidates for this treatment. However, treatment was followed by perineal pain for 1-2 weeks in most cases. A long-term follow-up is necessary to determine the role of ILC.

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.

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.

Association of the aggrecan keratan sulfate-rich region with collagen in bovine articular cartilage

Aggrecan, the predominant large proteoglycan of cartilage, is a multidomain macromolecule with each domain contributing specific functional properties. One of the domains contains the majority of the keratan sulfate (KS) chain substituents and a protein segment with a proline-rich hexapeptide repeat sequence. The function of this domain is unknown but the primary structure suggests a potential for binding to collagen fibrils. We have examined binding of aggrecan fragments encompassing the KS-rich region in a solid-phase assay. A moderate affinity (apparent Kd = 1.1 microM) for isolated collagen II, as well as collagen I, was demonstrated. Enzymatic digestion of the KS chains did not alter the capacity of the peptide to bind to collagen, whereas cleavage of the protein core abolished the interaction. The distribution of the aggrecan KS-rich region in bovine tarsometatarsal joint cartilage was investigated using immunoelectron microscopy. Immunoreactivity was relatively low in the superficial zone and higher in the intermediate and deep zones of the uncalcified cartilage. Within the pericellular and territorial matrix compartments the epitopes representing the aggrecan KS-rich region were detected preferentially near or at collagen fibrils. Along the fibrils, epitope reactivity was non-randomly distributed, showing preference for the gap region within the D-period. Our data suggest that collagen fibrils interact with the KS-rich regions of several aggrecan monomers aligned within a proteoglycan aggregate. The fibril could therefore serve as a backbone in at least some of the aggrecan complexes.

Management of benign prostatic hyperplasia in Scandinavia. A hospital questionnaire on pretreatment evaluation and treatment. The Scandinavian Urologic Association Subcommittee on Benign Prostatic Hyperplasia

In order to describe the present status in Scandinavia of evaluation and treatment of patients presenting with symptomatic benign prostatic hyperplasia (BPH), a questionnaire was mailed to 261 relevant hospitals. In total 76% of the departments answered. Several differences between hospital types in each country were revealed, as well as differences between countries. Generally, symptom scores and urodynamics were used more often in university hospitals as compared to other types of hospitals. Symptom scores were most popular in Denmark and Sweden, while uroflowmetry generally was employed in Denmark and Finland, but less frequently in Sweden and Norway. The highest frequency of prostatic surgery was noted in Denmark. Watchful waiting accounted for the handling of 30% of the BPH patients in Finland and Sweden, in contrast to only 15% in Denmark.

Posterior sagittal resection for rectal aganglionosis: preliminary results of a new approach

BACKGROUND

There is no general agreement about how patients who have short-segment Hirschsprung's disease should be treated.

METHODS

Ten patients with Hirschsprung's disease, seven with rectal and three with rectosigmoidal aganglionosis, were operated on through a posterior sagittal incision. In nine patients, a primary rectal resection and coloanal anastomosis was performed. In one patient, a longitudinal posterior myectomy of the rectum was performed as a primary procedure, but the procedure was eventually converted to a rectal resection and coloanal anastomosis through the same incision.

RESULTS

One early and one late anastomotic complication occurred. Both were successfully treated with a temporary fecal diversion (left-sided colostomy for 6 to 8 weeks). The functional results as evaluated with anorectal manometry were similar to a group of Hirschsprung's patients treated with transabdominal pull-through resection and coloanal anastomosis.

CONCLUSION

This approach might prove to be a useful alternative both to the transabdominal resection and the posterior longitudinal rectal myectomy in Hirschsprung's disease with rectal aganglionosis.

[Interstitial laser coagulation in the treatment of benign prostatic hyperplasia. Preliminary results]

51 patients aged 68 (range 52-81) years with lower urinary tract symptoms compatible with obstruction from benign prostatic hyperplasia were treated with interstitial laser coagulation (ILC). Postoperative urinary retention lasting less than one week was seen in the majority of cases. All patients were followed up for three months and ten cases had further follow-up after one year. Three months after treatment the international prostate symptom score decreased from 23.3 +/- 0.7 to 8.9 +/- 0.8 and was 10.2 +/- 2.1 after one year. Peak urinary flow increased concomitantly from 8.3 +/- 0.4 to 12.2 +/- 0.7 at three months and was 11.5 +/- 1.4 ml/sec after one year. Three patients received other, additional treatment because the ILC-treatment failed. In conclusion, interstitial laser coagulation had marked effects on symptoms, whereas the effects on objective parameters were less pronounced in this selected group of patients. However, more extensive follow-up, is essential for further evaluation of this new treatment procedure.

Colorectal resection and anal anastomosis with an intraluminal stapler in Hirschsprung's disease

Twenty patients aged 5 months - 4 years (mean 14 months) with Hirschsprung's disease were operated upon. In all cases a pull-through resection and stapled circular coloanal anastomosis was performed, in 11 with a single-stapling technique and in 9 with double-stapling. Isopaque rectography 4 - 10 days postoperatively showed an intact anastomosis in all 20 patients, i. e., there were no clinical or subclinical leaks. On palpation 4 - 6 weeks postoperatively, there were signs of stenosis in 4 patients. However, no. 9 - 11 Hegar dilators passed easily and there was no residual stenosis at follow-up 3 months after surgery. The technique can be recommended in children over 6 months of age.

[Benign prostatic hyperplasia. Shared care between urologists and general practitioners]

Clinical treatment of benign prostatic hyperplasia has been considered to be a task for the urologist alone. The urologist has been the only person capable of providing relief from the urethral obstruction through open and transurethral surgery. In recent years, knowledge about the physiology and pharmacology of the lower urinary tract and about the normal development of the condition has increased considerably. This has led to the development of new pharmacological drugs with positive effects on the symptoms caused by the obstructing hyperplastic prostate gland. The general practitioner now has a means of caring for patients with benign prostatic hyperplasia as long as the obstruction is not too pronounced and the symptoms are mild or moderate. Provided that urinalysis and creatinine level are normal, and there is no suspicion of malignancy, medical treatment can be considered. In cases with mild or moderate symptoms without suspicion of serious obstruction, even expectancy ("watchful waiting") may be preferred. When there is doubt about the diagnosis or when the effect of treatment is not as expected, the patient should be referred to a urologist. Benign prostatic hyperplasia is a condition where the care can suitably be shared between urologist and general practitioner.

Potassium channel openers for treatment of bladder hyperactivity

The potassium (K+) channel openers induce hyperpolarization by ATP-sensitive K+ channels. This group of compounds has been demonstrated to effectively relax the human detrusor and reduce bladder hyperactivity in obstructed rats. In patients with overactive bladders, oral administration and intravenous infusion of different K+ channel openers were without significant effect on urodynamic variables. In conscious dogs, a new K+ channel opener was found to increase bladder compliance with reduced micturition frequency. K+ channel openers have an interesting potential for the treatment of bladder hyperactivity, but development of new selective compounds with further clinical experience are demanded.

Ultrastructural changes in primary guinea pig osteoarthritis with special reference to collagen

Collagen fibril distribution and surface and volume densities in proximal tibial articular cartilage were measured in 6- and 12-month-old Dunkin-Hartley guinea pigs developing primary osteoarthritis. At 12 months, gross fibrillation and ulceration of the articular cartilage were observed on the medial but not on the lateral condyle. Collagen volume density decreased with age in the interterritorial compartments in the superficial zone, medially by 16% and laterally by 8%. In the upper radial zone, collagen volume density decreased interterritorially by 10% on the medial condyle only. Despite gross osteoarthritic changes, only moderate and predominantly focal ultrastructural collagen changes were observed. Thus neither gross network disruption nor fibril thickening seems to be a general feature in early guinea pig osteoarthritis.

Detubularized right colonic reservoir with intussuscepted ileal nipple valve or stapled ileal ("Lundiana") outlet. Clinical and urodynamic results in a prospective randomized study

In a prospective randomized study, patients undergoing cystectomy and continent urinary diversion by means of a detubularized right colonic reservoir were randomized to one of two types of outlet: either an intussuscepted ileal nipple valve (n = 15) or a stapled ileal ("Lundiana") outlet (n = 15). There were no early complications from the reconstruction. Subsequently, one ileal nipple outlet required revision because of progressive catheterization difficulties. In the Lundiana group, perforation of the reservoir occurred in one case and a narrow stomal opening was revised in local anesthesia in two cases. Urodynamic assessment revealed similar pressures at rest for the two outlets. At stress (concomitant with reservoir contraction), there was a distinct increase in outlet pressure in the nipple valves, but this was rarely encountered in the Lundiana group. Questionnaires showed episodes of urinary leakage to be more common in the Lundiana group, whereas the reverse applied to catheterization difficulties. In both groups, however, the great majority of patients were satisfied or very satisfied with the function of the urinary tract.

Pituitary adenylate cyclase-activating polypeptide, helospectin, and vasoactive intestinal polypeptide in human corpus cavernosum

1. The distribution and effects of pituitary adenylate cyclase-activating polypeptide (PACAP-27 and -38), helospectin (Hel-1 and Hel-2), and vasoactive intestinal polypeptide (VIP), were investigated in isolated preparations of human corpus cavernosum (CC). 2. Immunohistochemistry revealed coinciding profiles of nerve structures that showed immunoreactivities for VIP and PACAP, and VIP and Hel. Confocal microscopy showed the co-existence of VIP- and PACAP-immunoreactivities, and VIP- and Hel-immunoreactivities in most (90%) varicose nerve structures. 3. As determined by radioimmunoassay, the amounts of VIP, PACAP-27, and PACAP-38 in the preparations were 61.7 +/- 11.6, 0.1 +/- 0.05, and 3.7 +/- 0.5 pmol g-1 wet weight of tissue (pmol g-1 wet wt.), respectively. In tissue from patients with diabetes, the content of VIP was lower (13.7 +/- 0.5 pmol g-1 wet wt.), whereas that of PACAP (-27 and -38) was unchanged. 4. Cyclic nucleotide levels were determined in preparations exposed to PACAP-27, PACAP-38, Hel-1, Hel-2, and VIP. All the peptides, but Hel-2, significantly increased the concentrations of cyclic AMP, whereas the levels of cyclic GMP were unchanged. 5. The peptides concentration-dependently relaxed noradrenaline-contracted preparations. The order of potency was VIP > PACAP 27 > Hel-1 > Hel-2 > PACAP-38. 6. Hel-1, VIP and PACAP-27 effectively counteracted electrically induced contractions. At 10(-6) M, the highest peptide concentration used, the inhibitory effects obtained reached 96 +/- 3%, 87 +/- 6%, and 80 +/- 3%, respectively. 7. The results suggest that PACAP and Hel-1 are co-localized with VIP in nerve structures within the human cavernous tissue, and that the peptides are effective relaxants of CC preparations in vitro. The role of the investigated peptides for penile erection remains to be established.

Estrogen receptors in the human male bladder, prostatic urethra, and prostate. An immunohistochemical and biochemical study

The distribution and quantity of estrogen receptors (ERs) in the human male bladder, prostatic urethra and the prostate were studied in eight males with recurrent papillomas of the bladder or monosymptomatic hematuria (median age 61 years), 14 men undergoing transurethral resection due to benign prostatic hyperplasia (median age 70 years), and nine men undergoing cystectomy due to malignant tumour of the bladder (median age 70 years). In the first group of patients, biopsies for immunohistochemical examination were obtained from the bladder vault, bottom, both side-walls, the trigone area, and the mid-portion of the prostatic urethra, and in the second group from three locations of the prostatic urethra (bladder neck, mid-portion and veramontanum). In the third group, tissue specimens were taken from the vault of the bladder, prostatic urethra, and the prostate, for immunohistochemical as well as biochemical analysis. In the first group, ERs were found in three out of eight specimens of the prostatic urethra, and in one of these, ERs were confined to periurethral glands. ERs could not be demonstrated in any of the bladder-biopsies. In the second group, ERs were not found in the bladder neck, but were seen in four preparations from the veramontanum and in two from the midportion of the urethra. ERs were located in the urothelium and periurethral glands. In the third group, ERs were seen immunohistochemically in the prostatic urethra (two cases) and the prostatic stromal tissue (two cases). ERs could be demonstrated in the bladder neither by immunohistochemistry nor biochemically.(ABSTRACT TRUNCATED AT 250 WORDS)

Angiotensin I is converted to angiotensin II by a serine protease in human detrusor smooth muscle

The aim of the present study was to investigate whether a pathway for conversion of angiotensin I (ANG I) to angiotensin II (ANG II) other than that via angiotensin-converting enzyme (ACE) is present in the smooth muscle of the human detrusor. Isolated detrusor strips from 11 patients were contracted by ANG I (1 microM) in the absence or presence of enalaprilat (10 microM), soybean trypsin inhibitor (STI, 200 micrograms/ml), or both. The metabolic activity in detrusor membranes from four patients was studied separately using Hip-Gly-Gly or ANG I as a substrate, with or without various protease inhibitors. The contractile response to ANG I (1 microM) was depressed by enalaprilat from 66 +/- 22 (mean +/- SD) to 39 +/- 13% of the K+ (124 mM)-induced response (P < 0.01, n = 11), and the combination of enalaprilat and STI resulted in a further reduction in contractile amplitude to 25 +/- 14% (P < 0.01 vs. K+, and P < 0.05 vs. enalaprilat alone) and a significantly slower developing contraction with a time to peak of 3.7 +/- 1.7 vs. 1.1 +/- 0.3 min for ANG I alone (P < 0.01). In detrusor membranes, a low ACE activity, inhibitable by captopril, was demonstrated by the formation of hippuric acid (0.70 nmol.min-1.mg protein-1) from the synthetic ACE substrate, Hip-Gly-Gly. However, the conversion of ANG I (166 nmol.min-1.mg protein-1) to ANG II was not affected by ACE inhibition, while serine protease inhibitors, e.g., STI and chymostatin, completely prevented ANG II formation.(ABSTRACT TRUNCATED AT 250 WORDS)

Effects of nicorandil on human isolated corpus cavernosum and cavernous artery

Nitric oxide (NO) released from nonadrenergic-noncholinergic (NANC) nerves seems to be a principal mediator of the relaxation of penile erectile tissue necessary for erection, and drugs acting by release of NO have been shown to produce erection when injected intracorporeally into impotent patients. By producing hyperpolarization, K+ channel openers are effective in relaxing isolated penile erectile tissue from rabbit and man, and can produce tumescence and erection when injected intracorporeally into animals. Nicorandil is classified as a K+ channel opener, but it also acts as a donor of NO. In the present study, the effects of nicorandil on isolated preparations from human corpus cavernosum (CC) and deep cavernous artery (Acc) were compared with those of cromakalim (K+ channel opener) and SIN-1 (NO donor). Nicorandil produced a concentration-dependent relaxation of CC and Acc preparations. The relaxations obtained at the highest nicorandil concentration used (10(-4) M.) were 75 +/- 3% and 66 +/- 4% in CC preparations contracted by noradrenaline and endothelin-1, respectively. The corresponding effects in Acc preparations were 70 +/- 14% and 73 +/- 5%. Glibenclamide (blocking ATP-dependent K+ channels) significantly reduced the nicorandil-induced relaxation in CC, but not in Acc. Methylene blue (believed to block soluble guanylate cyclase) reduced nicorandil's relaxant effect in CC, although statistical significance was not obtained. NG-nitro-L-arginine 10(-4) M. (NO synthase inhibitor) did not significantly influence the effect of nicorandil on precontracted preparations in either tissue. In CC preparations contracted by electrical field stimulation, nicorandil and cromakalim concentration dependently inhibited the responses. This effect was significantly counteracted by glibenclamide. It is concluded that nicorandil is effective in relaxing human CC chiefly by its K+ channel opening action, and to some extent by its ability to release NO. For nicorandil's relaxing effect on Acc, ATP dependent K+ channels seem to be of limited importance. If effective in impotent patients, the drug may represent a new, interesting approach to the treatment of erectile dysfunction.

Fibromodulin distribution and association with collagen

Fibromodulin, an acidic 59-kDa proteoglycan, binds to collagen and inhibits collagen fibril formation in vitro. To determine whether fibromodulin is also bound to collagen in vivo, we used immunocytochemical methods to study the spatial relation of the proteoglycan to collagen fibrils in cartilage and tendon. We also studied the quantitative distribution of fibromodulin among compartments in articular cartilage at the ultrastructural level. Fibromodulin was identified with polyclonal antibodies raised in rabbits, and immunoreactivity was detected with protein-A gold. As the major proportion of fibromodulin immunoreactivity was localized along the periphery of the collagen fibrils, the relationship to the banding pattern of the collagen fibrils was mapped. The proteoglycan showed a non-random distribution, with preference to the gap region, axially within the D-period. Reactivity differed among the tissue compartments, with the lowest degree of labelling pericellularly, increasing with distance from the cell, the highest levels being observed in the interterritorial matrix. Labelling density was highest at the articular surface, gradually decreasing towards the cartilage-bone junction. The correlation between collagen fibril diameter and fibromodulin concentration also varied among compartments. Thus, the ratio of fibromodulin to collagen surface density was highest at the surface of the joint cartilage, exhibiting a gradient with higher values in the territorial matrix, decreasing towards the cell in all layers. These findings indicate that fibromodulin represents a factor used by chondrocytes to regulate assembly and function of collagen fibrils.