Real-world outcomes following third or subsequent lines of therapy: A Danish population-based study on 189 patients with relapsed/refractory large B-cell lymphomas

Outcome data of patients with relapsed/refractory (R/R) diffuse large B-cell lymphoma (DLBCL) beyond the second line are scarce outside of clinical trials. Novel therapies in the R/R setting have been approved based on single-arm trials, but results need to be contextualized by real-world outcomes. Medical records from 3753 Danish adults diagnosed with DLBCL were reviewed. Patients previously treated with rituximab and anthracycline-based chemotherapy who received the third or later line (3 L+) of treatment after 1 January 2015, were included. Only 189 patients with a median age of 71 years were eligible. The median time since the last line of therapy was 6 months. Patients were treated with either best supportive care (22%), platinum-based salvage therapy (13%), low-intensity chemotherapy (22%), in clinical trial (14%) or various combination treatments (32%). The 2-year OS-/PFS estimates were 25% and 12% for all patients and 49% and 17% for those treated with platinum-based salvage therapy. Age ≥70, CNS involvement, elevated LDH and ECOG ≥2 predicted poor outcomes, and patients with 0-1 of these risk factors had a 2-year OS estimate of 65%. Only a very small fraction of DLBCL patients received third-line treatment and were eligible for inclusion. Outcomes were generally poor, but better in intensively treated, fit young patients with limited disease.

Pelvic insufficiency fractures frequently occur following preoperative chemo-radiotherapy for rectal cancer - a nationwide MRI study

AIM

The aim of this prospective case-control study was to evaluate the rate of pelvic insufficiency fractures (PIFs) in Denmark using MRI at the 3-year follow-up. All patients had rectal cancer and had undergone surgery with or without preoperative chemo-radiotherapy (CRT).

METHOD

Patients registered with primary rectal cancer in the Danish Colorectal Cancer Group database, who underwent rectal cancer resection from April 2011 through August 2012, were invited to participate in a national MRI study aiming to detect local recurrence and evaluate quality of the surgical treatment. Pelvic MRI including bone-specific sequences 3 years after treatment was obtained. The primary outcome was the rate of PIFs; secondary outcome was risk factors of PIFs evaluated in multivariate analysis.

RESULTS

During the study period, 890 patients underwent rectal cancer surgery. Of these, 403 patients were included in the MRI study and had a 3-year follow-up MRI. PIFs were detected in 49 (12.2%; 95% CI 9.0-15.4) patients by MRI. PIFs were detected in 39 patients (33.6%; 95% CI 24.9-42.3) treated with preoperative CRT compared to 10 (3.5%; 95% CI 1.3-5.6) non-irradiated patients (P < 0.001). In a multivariate analysis female gender (OR = 3.52; 95% CI 1.7-7.5), age above 65 years (OR = 3.20; 95% CI 1.5-6.9) and preoperative CRT (OR = 14.20; 95% CI 6.1-33.1) were significant risk factors for PIFs.

CONCLUSION

Preoperative CRT in the treatment of rectal cancer was associated with a 14-fold higher risk of PIFs after 3 years, whereas female gender and age above 65 years each tripled the risk of PIFs.

Persistent infections with infectious pancreatic necrosis virus (IPNV) of different virulence in Atlantic salmon, Salmo salar L

Infectious pancreatic necrosis virus (IPNV) is a prevalent pathogen in fish worldwide. The virus causes substantial mortality in Atlantic salmon juveniles and smolts when transferred to sea water and persistent infection in surviving fish after disease outbreaks. Here, we have investigated the occurrence of the virus as well as the innate immune marker Mx in the head kidney (HK) of Atlantic salmon throughout an experimental challenge covering both a fresh and a seawater phase. The fish were challenged with a high (HV) and low virulence (LV) IPNV. Both isolates caused mortality due to reactivation of the virus after transfer to sea water. In the freshwater phase, higher levels of virus transcripts were detected in the HK of fish infected with LV IPNV compared to HV, suggesting that the HV isolate is able to limit its own replication to a level where the innate immune system is not alerted. Further, ex vivoHK leucocytes derived from fish infected with the two isolates were stimulated with CpG DNA. Significantly, higher IFN levels were found in the LV compared to the HV group in the freshwater phase. This suggests that the viruses attenuate the antiviral host immune response at different levels which may contribute to the observed differences in disease outcome.

Immunostimulatory CpG oligodeoxynucleotides stimulate expression of IL-1beta and interferon-like cytokines in rainbow trout macrophages via a chloroquine-sensitive mechanism

Synthetic oligodeoxynucleotides (ODNs) containing unmethylated CpG motifs are known to stimulate immune responses and are potent adjuvants in higher vertebrates, but so far the effects in fish are poorly described. We here report that CpG ODNs induce IL-1beta expression and production of interferon-like cytokines in rainbow trout head-kidney macrophages, whereas ODNs with an inverted motif (GpC) have a much less stimulatory effect. We further demonstrate that endosomal maturation is essential for CpG signalling, as chloroquine, a compound known to block endosomal acidification, inhibits cytokine expression in the macrophages.

CpG oligodeoxynucleotides and plasmid DNA stimulate Atlantic salmon (Salmo salar L.) leucocytes to produce supernatants with antiviral activity

Unmethylated CpG dinucleotides are more frequent in the genomes of bacteria and viruses than of vertebrates. We report herein that plasmid DNA and synthetic oliogodeoxynucleotides (ODNs) containing unmethylated CpG induce production of antiviral cytokine activity in Atlantic salmon leucocytes, whereas ODNs with an inverted motif (GpC) or with methylated cytosines have nearly no stimulatory effect. The adherent cell population, representing mainly macrophages, is directly activated by CpG-ODN, while the effect on the non-adherent population is weak. Since the peak antiviral activity in ODN-stimulated leucocytes is seen after 48h, this might indicate that the unmethylated DNA stimulates the adherent cells to produce co-stimulatory molecules, which in turn stimulates production of antiviral cytokines in the non-adherent cell population. The potent immune activation by CpG ODNs points to possible new applications as adjuvant in fish vaccines.

Home uroflowmetry by means of the Da Capo home uroflowmeter

OBJECTIVE

The Da Capo home flowmeter was tested versus the Urodyn 1000 flowmeter. The two flowmeters are based on different principles. The Da Capo is a portable, battery powered flowmeter designed to record all voidings during a period of time (e.g. 24 h) for a single patient.

METHODS

The flowmeters were tested with regard to accuracy of measurement of the voided volume and maximum flow (Qmax). Further, the Da Capo was tested by 10 healthy male volunteers, median age 47 years, range 21-57.

RESULTS

Both flowmeters were very accurate measuring Qmax and voided volume. A few artifacts arose, i.e. extremely high Qmax values were recorded. All test persons found the flowmeter easy to handle.

CONCLUSION

The weight transducer based Da Capo home flowmeter proved as accurate as the stationary flowmeters. It is easy to handle and it provides all-day monitoring of uroflow and voided volume.

Serum amyloid A transcription in Atlantic salmon (Salmo salar L.) hepatocytes is enhanced by stimulation with macrophage factors, recombinant human IL-1 beta, IL-6 and TNF alpha or bacterial lipopolysaccharide

Serum amyloid A (A-SAA) has previously been reported to be an acute-phase protein in salmonids. Hepatocytes represent a major source of A-SAA in salmonids, but nothing is known about hepatocyte SAA synthesis in fish. In the present work, the expression of A-SAA transcripts in primary cultures of Atlantic salmon hepatocytes in response to macrophage derived cytokines, human recombinant cytokines and bacterial lipopolysaccharide (LPS) was studied by Northern blot analysis. The macrophage supernatants were prepared by stimulating Atlantic salmon head kidney macrophages with LPS, yeast glucan or a leukocyte derived macrophage activating factor (MAF). The supernatants from glucan- or MAF-stimulated macrophages had no effect on A-SAA expression of the hepatocytes, while supernatants from LPS-stimulated macrophages gave about a 2-fold increase in expression. The combination of either glucan and MAF, or LPS and MAF were more effective and these supernatants gave a 3.4- and 5.2-fold increase in A-SAA expression, respectively. The hepatocytes were also treated with the human recombinant cytokines TNFalpha, IL-1beta and IL-6, alone or in combination. The A-SAA response to each of them alone was modest, but TNFalpha and IL-6 or IL-1beta and IL-6 in combination gave a higher response than each cytokine alone. These data suggest that the expression of A-SAA by hepatocytes from Atlantic salmon is induced by cytokine-like molecules. Interestingly, hepatocytes treated directly with LPS gave a more than 10-fold increase in SAA mRNA expression, but it is not known if this is a direct effect of LPS on the hepatocytes or if it is mediated by other contaminating cell types.

Is bladder outlet obstruction normal in elderly men without lower urinary tract symptoms?

The aim of the present study was to correlate basic voiding parameters, including uroflowmetry, symptom score, and residual urine volume with the results of pressure-flow studies applying the Abrams/Griffith nomogram, in a series of urologically asymptomatic elderly men. Twenty-nine consecutive male volunteers (median age, 66 years) without past or present urological complaints participated. Fifteen (52%) of the 29 subjectively normal men proved to have bladder outlet obstruction (BOO). Qmax <10 mL/s had a positive predictive value of 100% in diagnosing obstruction, whereas the predictive information of higher flow rates proved very modest. No significant difference existed between obstructed and unobstructed persons at any cutoff value concerning symptom score. The sensitivity as well as the positive predictive value of a residual urine volume >50 mL was zero. It is concluded that a surprisingly high prevalence of BOO in asymptomatic elderly men was demonstrated and that the correlation between pressure flow investigations and alternative diagnostic tests, i.e., flow rate, symptom score, and residual volume was weak in this group of men. It is suggested that a possible explanation for the high frequency of BOO observed in the evaluated asymptomatic men could be that the values defining obstruction have been set too low. Neurourol. Urodynam. 18:545-552, 1999.

Uroflow in women: an overview and suggestions for the future

The literature on uroflowmetry in women is presented and evaluated. Uroflowmeters are described and found generally sufficiently accurate, although the errors arising from electronic evaluation may invalidate the test. Six flow curve patterns are proposed in accordance with described pathological conditions. From the literature it is summarized that the normal Qmax is 20-36 ml/s. Qmax is linearly correlated to the voided volume, increasing by 5.6 ml/s/100 ml. Pregnancy, age and menstrual cycle do not influence Qmax. Several pathological conditions have been associated with specific flow curve patterns. These conditions are described and associations with the proposed flow definitions made.

[Waiting lists for men with benign urinary disorders]

This paper reflects the problems in having a large non-specific waiting-list. One hundred and twenty-eight patients were on a waiting-list under the main diagnosis of prostatism. This diagnosis revealed seven patients with cancer in the urinary tract system. Only two-thirds of the patients on the waiting-list were interested in further examination and treatment. This paper emphasizes the need for a more specific referral, when dealing with symptoms from the lower urinary tract system.

Uroflowmetry

Uroflowmetry is a widely used noninvasive screening modality for patients who present with symptoms of lower urinary dysfunction. However, it should be recognized that uroflowmetry represents the compound effect of bladder and urethral function because it may easily be misinterpreted. In elderly men with "prostatism", uroflowmetry is often sufficient to indicate treatment, while the value in women is less prominent. In pediatrics, more sophisticated urodynamic testing is crucial.

Yeast beta-glucan stimulates respiratory burst activity of Atlantic salmon (Salmo salar L.) macrophages

Previous studies have shown that head kidney macrophages isolated from glucan injected rainbow trout (Oncorhychus mykiss) and Atlantic salmon (Salmo salar L.) have increased ability to kill Aeromonas salmonicida. The present work was aimed at investigating the in vitro effects of glucan on the respiratory burst and bactericidal potential of Atlantic salmon head kidney macrophages. Salmon macrophages were incubated for 1-7 days with various concentrations of yeast beta-glucan (MacroGard) and tested for respiratory burst activity by the reduction of nitroblue-tetrazolium (NBT) after exposure to phorbol myristate acetate (PMA) or opsonized zymosan. The macrophages showed a marked increase in respiratory burst activity 4 to 7 days after addition of glucan. Macrophages treated with 0.1-1 microgram mL-1 gave a maximum respiratory burst response, whereas 10 micrograms mL-1 had no effect and 50 micrograms mL-1 was inhibitory. The glucan also triggered respiratory burst activity directly, but this occurred only at relative high concentrations with a maximal effect at > or = 200 micrograms mL-1. The validity of using the NBT-assay as a measure of respiratory burst activity was confirmed by using inhibitors of O2- production (superoxide dismutase, trifluoperazine and diphenylene iodonium). Despite the stimulatory effect of glucan on the respiratory burst activity of salmon macrophages, these cells did not show increased bactericidal activity against the avirulent and virulent strain of A. salmonicida. Upregulation of burst activity alone is thus apparently not sufficient to enhance bactericidal activity against this pathogen by Atlantic salmon macrophages.

Long-term probability of prostatism vs general morbidity and mortality. Prospectively obtained data in a randomly selected cohort aged > 50 years

In a 7-year study of 178 randomly selected healthy men older than 50, data were respectively obtained concerning treatment for benign prostatic hypertrophy (BPH) and overall morbidity and mortality. Plain symptom scores were calculated in all cases and urinary voiding was recorded in 112. The maximum flow rate was read and the pattern of flow curve determined. Log rank test and survival curves were used in evaluation of results. The general risk of death or disease overshadowing BPH greatly exceeded the probability of surgery for prostatism. The only factor predicting need for prostatectomy was a symptom score higher than 6 points. If the symptom score is low and indications for treatment are otherwise, relative, an expectant attitude to surgery for BPH is advocated.

Longitudinal observations on normal and abnormal voiding in men over the age of 50 years

A cohort of 200 men over the age of 50 years was selected at random. Initially 112 men participated. After 5 years 61 were participating, and 2 years later 34 men still had no voiding problems, while 19 had had treatment for prostatism. A history was obtained and all 112 had symptom analysis and uroflow examination. The uroflow variables Qmax, Qave, Qmax-time, Q "corrected", volume and the ratio Qmax/Qmax-time were recorded together with the symptom score and subjective evaluation. After 5 and 7 years all primary data were reviewed in the 61 and 34 men respectively, while a full history was obtained in the rest. The 3 sets of data were evaluated separately as 3 cross-sectional investigations and as paired data sets by means of non-parametrical statistical analysis. Comparing the 3 sets of data longitudinally, significant differences were found in Qmax, Qave, Qcor and Acc. A correlation analysis showed that Qmax, Qave, Q "corrected" and volume decreases significantly with advancing age in asymptomatic men, while no correlation with age was found in the 19 treated men. On the basis of the 93 men, untreated for 7 years, nomograms of Qmax, Volume and Acc were constructed using 2.5, 25, 50, 75 and 97.5% percentiles in 5-year groups. Likewise, a nomogram on symptom score was constructed on the basis of the 82 men, asymptomatic and untreated for 7 years. In conclusion, uroflow in subjectively normal men over the age of 50 years shows increasing abnormality with advancing age. At the same time elderly men tolerate a considerable amount of symptoms of infravesical obstruction. The severity of symptoms increased with advancing age, but differently in persons likely and not likely to need operation.

Mechanical versus visual evaluation of urinary flow curves and patterns

Flow curves from 100 consecutive patients were obtained using the Urodyn 1000 mictiograph. Four observers evaluated the flow curves blindly, i.e. without access to the mechanically estimated values. Further, the flow curve pattern was decided upon in each case. The 4 observers agreed very meticulously in the evaluation while they disagreed with the mechanically obtained results. The visually read values were significantly lower than the mechanically determined ones. At the same time the difference in Qmax was most pronounced in abnormal curves. In conclusion the mechanical evaluation of uroflow curves may be misleading and should not replace the visual evaluation.

Age-related variation in urinary flow variables and flow curve patterns in elderly males

A group of randomly selected males, over 50 years of age, was examined with regard to history and urinary flow rate. Originally, the group had comprised 93 men without voiding problems, 15 who, although suffering from voiding problems, had not yet contacted their doctor, and 4 who had contacted their doctor because of voiding problems. Five years later the data were re-examined and 61 men were fully investigated again; in the remaining 51 patients only the history was updated. The 2 sets of data were evaluated separately as 2 cross-sectional investigations and as paired data sets by means of non-parametric statistical analysis. All uroflow variables were considered, i.e. Qmax, Qave, Qmax-time, Q "corrected", volume and the ratio Qmax/Qmax-time. In addition, the flow curve configuration was classified as normal or abnormal. When compared as 2 cross-sectional investigations, the latter confirmed the results of the first. Qmax, Qave, Q "corrected" and volume decreased with advancing age, but no correlation could be demonstrated between Qmax-time and age. The flow curve pattern altered, so that a normal flow curve was seldom seem at an advanced age. Uroflow variables tended towards the abnormal with advancing years and symptoms increased concurrently. These changes were largely accepted by the elderly males. Thus the decision to operate for benign prostatic hyperplasia should be based on both history and urinary flow.

Tooth and bone development in a Danish medieval mandible with unilateral absence of the mandibular canal

A Danish anthropological collection of medieval human skeletons excavated in 1986 involves a mandible (No. 212) from an adult female born without the lower alveolar nerve and mandibular canal. It is believed that the defect has resulted in lack of tooth development on the affected side and that the mylohyoid nerve has partially compensated for this defect by development of teeth in localized areas. The defective mandibular dentition has caused a compensatory development of the alveolar process in the maxilla. The missing occlusal support has altered muscular traction on the mandible. This has caused an alteration in mandibular shape. Whether the asymmetric development of the mandible is caused by muscular dysfunction, by failure in angular growth apposition, or by a combination of these factors is discussed. The case presents valuable data in the ongoing discussion about the interaction between nerve tissue and tooth formation and about the interaction between occlusion, jaw morphology, and muscular traction. The study shows how archeological material in an interdisciplinary cooperation between archeological, embryological and orthodontic research can contribute to the clarification of current biological problems.

Crossed immunoelectrophoretic analysis of Mycobacterium paratuberculosis

Antigenic analysis of M. paratuberculosis revealed extensive cross-reactivity with M. avium; however, the number of cross-reactive antigens found was dependent on the strain of M. avium tested. One antigen was shown to be the common antigen while another appeared to be iron-regulated in its production. A commercial polyclonal antibody to M. paratuberculosis produced a CIE precipitin pattern comparable to that of the antibody produced for the present study. An antigen designated no. 6 was consistently precipitated by sera from cattle infected with M. paratuberculosis. This antigen exhibited complete cross-reaction with M. avium and partial cross-reaction with M. phlei. Among three commercially available complement fixation (CF) antigen that could be precipitated by M. paratuberculosis antibodies. A commercial antigen for use in an agar gel immunodiffusion test for Johne's disease diagnosis produced 12 precipitins with the M. paratuberculosis antibody, one of which was identical with antigen 6.

Renal pelvic calculi and neoplasm. New indication for treatment of asymptomatic renal pelvic calculi?

Metaplasia of the renal pelvis caused by chronic irritation, calculi, infection is a reversible pre-malignant condition. The application of ESWL on renal calculi as a safe treatment in relation to metaplasia is discussed and a case history is presented.

Intestinal and pulmonary mycotic lymphadenitis in cattle

Among 4877 slaughtered cattle with tuberculosis-like lesions in lymph nodes, 94 cases (1.9 per cent) revealed fungal hyphae on histopathological examination. The survey period was 12 years and most of the affected animals (greater than 77 per cent) were beef cattle. Affected nodes were mesenteric in 84 cases (89.4 per cent), mediastinal and/or bronchial in seven cases (7.4 per cent), and in three cases (3.2 per cent), both mesenteric and mediastinal nodes were affected. The incidence of mycotic lymphadenitis was unrelated to year of study or season. Eighty-two of the cases were re-examined histologically and immunohistochemically. All lesions were granulomatous in nature and, in 26 cases, eosinophilic asteroid bodies (rosette formation) around hyphae were found. In 75 cases, immunofluorescence staining identified the agent as a zygomycete, probably Absidia corymbifera and, in one case, there was a concurrent infection with a Candida species. In seven cases that did not react with the antibodies employed, a diagnosis of zygomycosis was suggested on the basis of hyphal morphology. Hyphae of Aspergillus spp. were not found in any of the lesions. A concurrent fungal and mycobacterial infection (M. avium) was diagnosed in one case. Thus, zygomycetes are the main cause of macroscopically apparent mycotic lymphadenitis, a sporadic disease most probably caused by feeding with mouldy food stuffs.

Significance of predominantly irritative symptomatology before a prostatic operation

The prognostic value of an excess of preoperative irritative symptoms of prostatism was evaluated. The prospective study included 139 men treated for benign prostatic hyperplasia who were evaluated by symptom analysis, uroflowmetry, water cystometry and pressure-flow study preoperatively and 6 months postoperatively. The criterion for evaluation of postoperative success or failure was the subjective evaluation of the patient at 6 months. None of the single preoperative symptoms of prostatism predicted an eventual postoperative failure, nor did the preoperative predominance of irritative symptoms or the combination of irritative symptoms and detrusor instability attain prognostic significance.

Pulmonary mycosis in farmed deer: allergic zygomycosis and invasive aspergillosis

During 1988, pulmonary mycosis was diagnosed in four of 116 farmed deer examined on suspicion of tuberculosis. The histopathology showed allergic bronchopulmonary mycosis in a red deer (Cervus elaphus) and the agent was identified as a zygomycete, probably Absidia corymbifera, by immunofluorescence staining. Three fallow deer (Dama dama) had invasive necrotizing mycotic pneumonia and progressive exudative mycotic alveolitis caused by Aspergillus fumigatus. In the red deer, weakness due to paratuberculosis had probably promoted the mycotic infection. The three fallow deer were bred on another farm, where predisposing factors included mouldy straw and incorrect management.

Trepanation as a therapeutic measure in ancient (pre-Inka) Peru

Three cases of probably therapeutically intended trepanations of cranial fractures in ancient Peru are presented and discussed.

Urodynamics in prostatism. I. Prognostic value of uroflowmetry

A prospective study was undertaken to examine the prognostic value for the symptomatic outcome of prostatic surgery of preoperative urodynamic testing in patients with prostatism. The study design included selection of patients for prostatic surgery by means of classic non-urodynamic urologic investigations such as history, residual urine, serum creatinine, cystoscopy and possibly intravenous urography. In addition an extensive urodynamic work-up (uroflowmetry, cystometry and pressure-flow study with stop-test) was included. The results of the urodynamic studies were unknown to the surgeon selecting the patients for operation. This evaluation was repeated 6 months postoperatively. Totally 139 patients entered the study. The patients were classified according to the preoperative maximum flow rate (Qmax) and in spite of preoperative differences in uroflow, pressure-flow variables and symptom scores, no differences of clinical significance were noted postoperatively among the groups. However, the high-flow group (preoperative Qmax greater than or equal to 15 ml/sec) had a statistically significant lower success rate as judged by the patients subjective evaluation of the outcome of surgery. An analysis of diagnostic sensitivity and specificity indicated Qmax = 15 ml/sec as a relevant cut-off value regarding preoperative identification of patients at risk of a less favourable outcome of surgery. This group of patients was characterized by a higher incidence of persistent uninhibited detrusor contractions at follow-up and a lower incidence of preoperative infravesical obstruction. In conclusion we recommend uroflowmetry in the preoperative evaluation of patients with prostatism.

Uroflowmetry in asymptomatic elderly males

Uroflowmetry is important in the evaluation of prostatism. We have investigated 93 men, selected at random from the National Register, who had no subjective voiding problems but who fell within the appropriate age range. The sample was representative of the male metropolitan population. Uroflowmetry was carried out and the data are presented graphically in nomograms where the Q max/volume, Q average/volume and Q max time/volume relations are given. Flow variables were evaluated to delineate possible correlations to age. It was found that the median Q max decreased from 18.5 ml/s at the age of 50 years to 6.5 ml/s at 80 years. Only one-third of the group had a Q max exceeding 15 ml/s. The median voided volume was 208 ml. Half of the subjects voided less than 200 ml and one-third less than 150 ml.

Malignant melanoma of the uvea in the dog

A case of canine uveal malignant melanoma with widespread metastases in a Golden Retriever is presented. In addition all cases of canine ocular neoplasms submitted to the Eye Pathology Institute (EPI) between 1960 and 1985 were reviewed. Intraocular malignant melanoma constituted about 25 percent of the submissions.

Some clinical aspects of uroflowmetry in elderly males. A population survey

A random sample of 200 males aged 50 years or more was selected from the National Register in order to investigate various aspects of spontaneous uroflowmetry and to estimate the frequency of prostatism and symptoms of lower urinary tract dysfunction. All in all the data from 112 persons were analysed. The prevalence of prostatism was found to be 17% (95% confidence limits 11-26%), while 88% (95% confidence limits 83-95%) experienced various degrees of symptoms. Only few associations between single symptoms and uroflowmetry variables were demonstrated. However, statistically significant correlations were revealed between obstructive and total symptom scores on one hand and maximum and average flow rates on the other hand. As the correlations were modest and a considerable overlap of uroflow variables in persons with and without prostatism were proved, the diagnostic specificity and sensitivity of maximum flow rate as well as other uroflow variables were low in the screening for prostatism. In conclusion uroflowmetry appears inefficient to confirm a clinical impression of prostatism.

Reproducibility of uroflowmetry variables in elderly males

In the evaluation of prostatism urodynamics and especially uroflowmetry has received widespread attention. Review of the literature, however, revealed little information on the consistency of flow variables. Therefore eleven male volunteers above fifty years of age were asked to void five times during a short period of time. Each subject was found to reproduce his own flow curve fairly well. Statistical analysis of various flow variables, i.a. Q1s, Qmax, volume-corrected Qmax, Qmax time, Qave and volume voided, demonstrated a high degree of reproducibility. In conclusion a single flow curve is sufficient for clinical routine on the assumption that the patient declares the voiding to be typical.

Imported canine visceral leishmaniasis in Denmark

The first case of imported visceral leishmaniasis in the dog in Denmark, and probably in Scandinavia, is described. The dog, a 5-year-old female wire-haired bird dog, became ill about 21 months after it had returned from a year's stay in Spain (Malaga). The clinical signs were fever, lameness, enlargement of the popliteal lymph nodes and weight loss. A tentative clinical diagnosis of leukaemia was discarded after the microscopic recognition of Leishmania organisms in a biopsy from a popliteal lymph node (Fig. 1). The diagnosis was confirmed by the demonstration of the kinetoplast in the organisms by electron microscopy (Fig. 3 a-b). The organisms measured about 2 micron in diameter indicating that the species in question was Leishmania donovani infantum, which is indigenous to Spain and other Mediterranian countries. The dog was killed, and Leishmania were found in sections of mesenteric and popliteal lymph nodes, spleen, liver, lung and kidneys. The most interesting histologic features were interstitial nephritis, dominated by numerous plasma cells and membranous glomerulonephritis (Fig. 2). It is suggested that the glomerulonephritis is immune complex-mediated as it is in human visceral leishmaniasis. The risk of bringing dogs in and out of the Mediterranean region is stressed, and veterinarians are advised to have leishmaniasis in mind when they are confronted with dogs taken ill with non-specific symptoms after a stay in that part of the world, even if as much as two years have elapsed between the return and the onset of clinical signs.

An improved medium for culture of Mycobacterium paratuberculosis from bovine faeces

Löwenstein-Jensen medium with mycobactin, cyclo-heximide, penicillin, and chloramphenicol, and enriched with sodium pyruvate, was compared with an ordinary L.-J. medium with mycobactin. Faeces samples from cattle experimentally infected with M. paratuberculosis were cultured on both media. The improved medium gave 11 % more positive cultures and 90 % more colonies. Of the positive cultures 97 % showed detectable growth after 8 weeks of incubation, and the contamination rate was reduced to 0.4 %. By culture of faeces samples from naturally infected cattle the improved medium identified 23.2 % more infected animals than the basic medium, mostly due to a reduction of the contamination rate to about 3 %.

Experimental infection with Mycobacterium avium, serotype 2, in pigs. 5. The immunizing effect of BCG vaccine against M. avium infection

The immunizing effect of BCG vaccination against infection with M. avium was evaluated in pigs on the basis of clinical and pathological findings and numbers of acid-fast organisms in the tissues.

In experiments with small and large challenge doses i.v. (10⁻² and 5 mg) the vaccinated animals were found to be partially protected. As compared to non-vaccinates, a reduction of viable organisms was found in vaccinates examined 28-31 or 70-73 days after challenge (Table 4), and fewer positive tissues were found in vaccinates than in non-vaccinates (Table 3). The most obvious results were seen in the experiment with a challenge dose of 10⁻² mg i.V., where the number of organisms was consistently smaller in vaccinates than in non-vaccinates (Table 4). In contact infection experiments, the observations in both vaccinated and non-vaccinated pigs were limited and the results difficult to evaluate. There seemed to be a protection, as judged by histopathological and cultural findings. kw|Keywords|k]Mycobacterium avium, Serotype 2; k]BCG vaccination; k]challenge, intravenous, oral; k]pigs

Experimental infection with Mycobacterium avium, serotype 2, in pigs. 4. Contact infection from orally inoculated pigs

In 3 experiments, 13 pigs were inoculated orally with 0.5 mg Mycobacterium avium daily for 5 days (1 mg = 32–68×10⁶ viable units). Five to 8 days after inoculation, 16 non-inoculated pigs were added to the inoculated pigs.

Cultures from faeces showed excretion of M. avium from all the inoculated pigs for some time within the period 16 to 65 days after the last inoculation; the greatest numbers of organisms (62000 per 100 g faeces) were found at about the middle of the excretion period (Table 2). Two of the contact pigs were found to excrete M. avium in small numbers, 1 at 15, the other at 37 and 44 days after contact.

All the inoculated pigs and 13 of the contact pigs showed positive intradermal tuberculin reactions. Post-mortem examination showed tuberculous lesions in all the inoculated pigs (Table 3). M. avium was transmitted to 15 of 16 pigs by contact. Five of these pigs showed gross lesions, 10 of them microscopic lesions only; in 9 of them the infection was proved by culture.

Experimental infection with Mycobacterium avium, serotype 2, in pigs. 3. Oral infection with small doses of M. avium

Pigs were inoculated orally with Mycobacterium avium in doses ranging from 15.6 × 10² to 15.6 × 10⁶ viable units daily for 15 days (Table 1). The animals were necropsied 31–32 days after the last inoculation.

Pigs given doses of 15.6 × 10⁶ and 15.6 × 10⁵ viable units showed delayed hypersensitivity to avian tuberculin 24 days after the last inoculation (Table 2). The pig inoculated with 15.6 × 10⁶ viable units showed macro- and/or microscopic lesions of the intestines and the liver, and of the mandibular, mesenteric and hepatic lymph nodes. Cultures showed growth of M. avium from the same tissues and from the spleen and the left tracheobronchial lymph node. The pig inoculated with 15.6 × 10⁵ viable units showed a pronounced granulomatous infiltration in the tonsils and the mesenteric lymph nodes. Growth of M. avium was obtained from the tonsils, the intestinal mucosa (Peyer patch) and the mandibular and mesenteric lymph nodes. Viable unit counts were high in the tonsils and in the mesenteric lymph nodes (Tables 3 and 4).

Lower doses gave rise to a minimal tissue reaction and/or very low viable unit counts, and are not considered to be capable of producing a progressive tuberculosis.