Partial migration of a maraena whitefish Coregonus maraena population from the River Elbe, Germany

The maraena whitefish Coregonus maraena is a threatened anadromous species in the North Sea, which in the past was decimated to near extinction. Since the late 1980s, several re-establishment programs have been implemented in rivers draining into the North Sea, but the scientific basis for sustainable conservation measures is often lacking, since little is known about the biology of this species. In this study, otolith microchemistry of fish ranging from 24.6 to 58.4 cm in total length (median 31.3 cm, SD 8.4 cm) was used to characterize the migration behavior of a reintroduced population of maraena whitefish from the River Elbe, Germany. Our analyses revealed the presence of 3 different migration patterns: (1) one-time migration into high-salinity habitat (North Sea) within the first year of life (29.6%), (2) multiple migrations between low- and high-salinity habitats starting in the first year of life (14.8%) and (3) permanent residency within low-salinity habitats, a pattern displayed by the majority (55.6%) of sampled individuals. Not only do these results reveal differential migration behavior, but they also indicate that permanent river residency is common in the River Elbe population of C. maraena. The role of the Elbe as both a feeding and a spawning habitat should thus be considered more explicitly in current conservation measures to support recovery of this species.

Estimating degradation-related settlement in two landfill-reclaimed soils by sand-salt analogues

Landfill reclaimed soil here refers to largely degraded materials excavated from old landfill sites, which after processing can be reinstated as more competent fill, thereby restoring the former landfill space. The success of the process depends on the presence of remaining degradable particles and their influence on settlement. Tests on salt-sand mixtures, from which the salt is removed, have been used to quantify the impact of particle loss on settlement. Where the amount of particle loss is small, say 10% by mass or less, settlements are small and apparently independent of lost particle size. A conceptual model is presented to explain this behaviour in terms of nestling particles and strong force chains. At higher percentages of lost particles, greater rates of settlement together with some sensitivity to particle size were observed. The conceptual model was then applied to two landfill reclaimed soils, the long-term settlements of which were found to be consistent with the conceptual model suggesting that knowledge of particle content and relative size are sufficient to estimate the influence of degradable particles in landfill reclaimed soils.

Chemical marking of European glass eels Anguilla anguilla with alizarin red S and in combination with strontium: in situ evaluation of short-term salinity effects on survival and efficient mass-marking

This study presents a new chemical double-marking technique for European glass eels Anguilla anguilla by combing alizarin red S (ARS) and strontium chloride hexahydrate (Sr). Marked eels (double marked with ARS and Sr, but also single marked with ARS) were exposed in situ to brackish water (15 g l^-1 artificial sea salt) for 14 days and did not exhibit increased mortalities compared with unmarked eels. Indeed, no mortality occurred in a marked group during the experiments. Moreover, an efficient mass-marking approach with low handling effort for both single ARS and double ARS-Sr techniques is described and was proven to be practicable for large-scale stocking programmes.

Anthropogenic spreading of anguillid herpesvirus 1 by stocking of infected farmed European eels, Anguilla anguilla (L.), in the Schlei fjord in northern Germany

The Schlei fjord in northern Germany is the recipient water of a comprehensive eel, Anguilla anguilla (L.), stocking programme. Since 2015, stocked eels become alizarin red S marked, but to date no control mechanism is implemented in this stock enhancement measure to prevent anthropogenic spreading of diseases. Consequentially, it was possible that farmed stocking cohorts of 2015 and 2016 (in total ca. 1040 kg) were subsequently tested positive for anguillid herpesvirus 1 (AngHV 1). For this study, 100 eels [total length (TL) 24.3-72.9 cm, age ca. 1-6 years] were caught in 2016 and investigated with regard to AngHV 1 infection, parasite load (Anguillicoloides crassus) and body conditions. 68% of the eels were found to be virus positive while larger specimens were more often infected. In addition, a fitted generalized linear model (area under the curve = 0.741) demonstrated that an increase in individual TL is accompanied with an increased risk of clinically relevant virus loads. Anguillicoloides crassus turned out to be an important stressor for eels, because parasite and virus load revealed a significant positive correlation. The results of this study evidently show the urgent need of a disease containment strategy for eel stocking programmes.

Psychological distress and adjustment to disease in patients before and after radical prostatectomy. Results of a prospective multi-centre study

The aim of this prospective multi-centre study was to evaluate the level of psychological distress (PD) and adjustment to disease in patients who underwent radical prostatectomy. Furthermore, the impact of urinary incontinence and erectile dysfunction on PD was assessed. Anxiety, depression and PD were evaluated using the Hospital Anxiety and Depression Scale in 329 prostate cancer patients before surgery as well as 3, 6 and 12 months after surgery. These results were compared with those of a male German general population reference group. Adjustment to disease was assessed using the Perceived Adjustment to Chronic Illness Scale. Patients reported low levels of PD at all points of assessment similar to population norms of age-matched German men. Persistent PD was seen in about 8% of the patients and 20% had PD at least two of the measurement points. Relevant predictors for PD after surgery were urinary symptoms and baseline PD. Adjustment to disease was highest before surgery and had significantly reduced at 3 and 6 months after surgery. In general, men are resilient to the experience of localised prostate cancer and adjust well psychologically after surgery. However, between 8% and 20% of patients could possibly benefit from mental health support.

Migration behaviour of twaite shad Alosa fallax assessed by otolith Sr:Ca and Ba:Ca profiles

Individual migration behaviour during the juvenile and adult life phase of the anadromous twaite shad Alosa fallax in the Elbe estuary was examined using otolith Sr:Ca and Ba:Ca profiles. Between hatching and the end of the first year of life, juveniles showed two migration patterns. Pattern one exhibited a single downstream migration from fresh water to the sea with no return into fresh water. In contrast, pattern two showed a first migration into the sea, then a return into fresh water and, finally, a second downstream migration into marine water. This first report of migration plasticity for A. fallax points to different exposure times to estuarine threats depending on the migration strategy. In adults, high Sr:Ca and low Ba:Ca in the majority of individuals confirmed prior reports of a primarily marine habitat use. Patterns reflecting spawning migrations were rarely observed on otoliths, possibly due to the short duration of visits to fresh water.

Understanding the Role of Device Level Interoperability in Promoting Health - Lessons Learned from the SmartPersonalHealth Project

To summarize lessons learned from the European Commission (EC) co-funded project SmartPersonalHealth, a project to promote a greater understanding of the value of interoperability among Personal Health Systems (PHS) and between them and other eHealth systems, in the landscape of continuity of care and across multi-cultural environments in Europe.

Key concepts in PHS interoperability, challenges, barriers and benefits were discussed with stakeholders (policy makers, regulators, procurers, healthcare providers, health professionals, patient representatives, industry, researchers) in three consultation workshops and a final conference. The results were synthesized in final report to the European Commission.

The survey and analysis presented, which are designed to set the scene on the key requirements of device level interoperability within a context of using sensors, signals and imaging informatics in healthcare, set out key interoperability standards for PHS as provided for in the Continua Health Alliance Guidelines and explores further the need for wider organisational and regulatory aspects of interoperability.

Achieving interoperability of eHealth systems is a complex process involving various actors and challenges far beyond technical and standardisation issues. For harnessing the key benefits of PHS, any interoperability scenario needs to account for value-based business cases for all stakeholders involved. It must foresee to enable seamless and consistent data and information flows by integrating and mixing devices used by patients/consumers at home, for remote monitoring, for home hospitalisation and/or within the hospital.

Understanding the role of device level interoperability in promoting health - lessons learned from the SmartPersonalHealth Project

OBJECTIVES

To summarize lessons learned from the European Commission (EC) co-funded project SmartPersonalHealth, a project to promote a greater understanding of the value of interoperability among Personal Health Systems (PHS) and between them and other eHealth systems, in the landscape of continuity of care and across multi-cultural environments in Europe.

METHODS

Key concepts in PHS interoperability, challenges, barriers and benefits were discussed with stakeholders (policy makers, regulators, procurers, healthcare providers, health professionals, patient representatives, industry, researchers) in three consultation workshops and a final conference. The results were synthesized in final report to the European Commission.

RESULTS

The survey and analysis presented, which are designed to set the scene on the key requirements of device level interoperability within a context of using sensors, signals and imaging informatics in healthcare, set out key interoperability standards for PHS as provided for in the Continua Health Alliance Guidelines and explores further the need for wider organisational and regulatory aspects of interoperability.

CONCLUSION

Achieving interoperability of eHealth systems is a complex process involving various actors and challenges far beyond technical and standardisation issues. For harnessing the key benefits of PHS, any interoperability scenario needs to account for value-based business cases for all stakeholders involved. It must foresee to enable seamless and consistent data and information flows by integrating and mixing devices used by patients/consumers at home, for remote monitoring, for home hospitalisation and/or within the hospital.

[Gallbladder polyps: prevalence and risk factors]

PURPOSE

The objective of the present study was to investigate the prevalence of gallbladder polyps and possible risk factors in a random population sample of an urban population.

MATERIAL AND METHODS

A total of 2099 subjects (1072 women, 1027 men; aged 19 - 65 years, mean age 42.1 (SD ± 12.8 years) were prospectively examined using ultrasound, a standardized questionnaire and laboratory studies.

RESULTS

Gallbladder polyps were identified in 6.1 % (128 / 2099) of all subjects (women: 6.1 % [63 / 1027]); men: 6.1 % [65 / 1072]). Solitary polyps were found in 52.4 % (65 / 124), two polyps in 16.1 % (20 / 124), three polyps in 6.5 % (8 / 124), several polyps in 22.6 % (28 / 124) and multiple polyps in 2.4 % (3 / 124) of subjects. The mean polyp diameter was 4.7 mm (SD ± 2.2; range 2 - 20 mm). The polyp diameter was ≤ 7 mm in 94.5 % of subjects. The polyps were described as pedunculate in 82.3 % (102 / 124). The polyps were broad-based in 11.3 % of subjects (14 / 124; men: 18 % women: 4.8 %). The polyps were homogeneously echogenic in 100 % of cases and with irregular contours in only one male subject. Multiple logistic regression failed to demonstrate an influence on the increased occurrence of gallbladder polyps for the risk factors of male sex, age, body-mass index (BMI), alcohol, nicotine or caffeine consumption or diabetes mellitus.

CONCLUSION

The prevalence of gallbladder polyps reported in the present study (6.1 %) is higher than figures previously published for populations in Germany or Europe. The majority of polyps were pedunculate and solitary. A typical risk factor profile for gallbladder polyps could not be identified in the present population sample.

Comparison of sonographically measured bowel wall vascularity, histology, and disease activity in Crohn's disease

The purposes of this study was to provide a retrospective comparison of semiquantitatively measured bowel wall vascularity by power Doppler sonography, endoscopic-histopathological biopsy findings, and disease activity in patients with confirmed Crohn's disease. Thirty-two out of 1,332 patients with histologically confirmed Crohn's disease (18 female, 14 male; mean age 38.8 years) met the inclusion criteria: ileocolonoscopy with biopsy and power Doppler sonographic determination of bowel wall vascularity with assessment of disease activity within a period of 5 days. Sonographic determination of bowel wall vascularity was based on a semiquantitative score. Endoscopic bowel wall biopsy specimens were assessed using a self-developed inflammation score and the disease activity was calculated using Crohn's disease activity index (CDAI). A significant association (p < 0.05) was shown for results of histology and bowel wall vascularity in the terminal ileum (kappa = 0.66; sensitivity 95%; specificity 69%). There was no observed association between CDAI and histology, although there was an association between CDAI and bowel wall vascularity (sensitivity 82%). Increased bowel wall vascularity in the terminal ileum measured by power Doppler ultrasound reflects inflammatory activity in histologically examined bowel wall. Power Doppler ultrasound may be able to monitor activity changes of the bowel wall determined by pharmaceutical treatment.

[Clinical pathways. Implementation in a urological department]

BACKGROUND

Clinical pathways are directions for standardised treatment processes for different diseases or procedures in a hospital. These pathways are developed within a team of several professions and are used as order and procedure sheets. Experiences with this element of quality management are limited in Germany.

METHODS

The development and the implementation process of 15 pathways in a urological department are described. A clinical pathway for female incontinence surgery (suburethral tape) is presented as an example. The effects of the pathways are evaluated on a routine basis.

RESULTS

Seventy-two percent of the patients were treated according to a clinical pathway. The advantages of clinical pathways are a better structuring and transparency of medical processes, a reduction of documentation, improvements in medical education and savings in time, hospital stay of the patients and costs. Expenses for pharmaceuticals were significantly reduced in connection with development of the pathways.

CONCLUSIONS

The implementation of clinical pathways is a complex but rewarding project. It can be expected that clinical pathways will be rapidly distributed in the near future and that they will contribute to improvements of health care quality.

Down syndrome and thyroid dysfunction: Should nutritional support be the first-line treatment?

Individuals with Down syndrome (DS) not only have increased risk of hypothyroidism, they also tend to develop a relatively novel mild form of neonatal hypothyroidism. One problem that may predispose those with trisomy 21 to hypothyroidism is the overexpression of the gene DYRK1A, which may have an affect on the thyroid. While thyroxine supplementation (such as Synthroid) is increasingly being advised for those with DS, this treatment may have both positive and negative effects. Nutritional support for hypothyroidism offers some of the same benefits as drug therapy but without the likely negative long-term effects. Early 20th century practitioners used bovine glandulars for those with DS children, which were believed to help support thyroid function. Some doctors in more recent times have also included iodine, L-tyrosine, selenium, and zinc. As nutrition for those with DS has been safely used by some practitioners for many decades, it is suggested that nutritional thyroid support, and not necessarily thyroxine, should be considered for use as a first line treatment for those with trisomy 21. This paper also hypothesizes that nutritional interventions begun prenatally by the mother, may possibly also be of benefit.

Might calcium disorders cause or contribute to myoclonic seizures in epileptics?

Although epilepsy is not rare, many epileptic conditions are considered to be idiopathic and the related seizures of unknown origin. It does appear that different types of seizures are caused by differing mechanisms. This paper discusses scattered case reports involving problems with calcium metabolism and the thyroid, and/or the parathyroid glands concurrent with seizures that support the position that calcium control mechanisms may have been involved in causing seizures in those patients. This paper hypothesizes that calcium levels can cause, or at least contribute to myoclonic (jerk) seizures, as well as to possibly infantile spasms. As these conditions are difficult to treat medically, this paper suggests that nutritional interventions, such as supplemental calcium, magnesium and/or vitamin D, might well be considered as an option as a first-line treatment in those with these types of epileptic disorders. The nutritional recommendations also would apply for those who have seizures concurrent with Down syndrome.

Evaluación de la función sexual femenina antes y después de un procedimiento para la corrección de la incontinencia urinaria de esfuerzo

The prevalence of urinary incontinence is around 20% of healthy middle-aged women. Incontinence causes a negative impact on the quality of life and sexuality. From August 2002 to January 2004, 30 patients (mean age 43 years) with stress urinary incontinence (59%), overactive bladder (15%) and mixed incontinence (26%) answered the ICIQ-SF(International Consultation on Incontinence Questionnarie-Short Form) and FSFI (Female Sexual Function Index) questionnaires before and after treatment for urinary incontinence. The follow-up ranged from 12 to 53 months. Mean ICIQ score was 17 and 7 before and after treatment respectivelly (p<0,001). Overactive bladder showed the worst scores in all domains. The patients who underwent surgery increased their scores of desire (p=0,02), satisfaction (p=0,05) and total score (p=0,02). Thirteen patients which ICIQ was zero increased: desire (p<0,01), satisfaction (p=0,05) and total score (p=0,01). Urinary incontinence significantly affects the quality of life. Therefore sexual evaluation in incontinence patients is recommended.

Serum HER2 extracellular domain in metastatic breast cancer patients treated with weekly trastuzumab and paclitaxel: association with HER2 status by immunohistochemistry and fluorescence in situ hybridization and with response rate

PURPOSE

We explored the relationship between circulating HER2 extracellular domain (ECD) and tissue HER2 status as determined by immunohistochemistry (IHC) and fluorescence in situ hybridization (FISH). We also examined its predictive value in a cohort of metastatic breast cancer patients treated with weekly trastuzumab and paclitaxel.

METHODS

Eligible patients had pre- and post-treatment stored serum specimens and were treated on a previously reported phase II trial. Retrospective analysis evaluated: the association between pretreatment serum HER2 ECD and tissue HER2 status by IHC and FISH; and the association between change in serum HER2 ECD after 12 weeks of therapy and response proportion.

RESULTS

Stored serum samples were available for 55/95 (58%) patients. Statistically significant associations were found between HER2 status as assessed by IHC and FISH, and baseline serum HER2 ECD level. Patients whose ECD normalized after 12 weeks of therapy had a higher response proportion compared with patients with persistently high ECD levels (68% versus 15%, P=0.005). A relative decline of over 55% from baseline HER2 ECD predicted response to therapy.

CONCLUSION

A statistically significant association was observed between pretreatment serum HER2 ECD and tissue HER2 status as assessed by IHC and FISH. A decrease in serum HER2 ECD level was a significant predictor of response to trastuzumab-based therapy.

An improved method for the automated enumeration of fluorescently labelled bacteria in human faeces

The study aimed to improve microscopy-based automated recognition of faecal bacterial cells labelled with 16S rRNA-targeted oligonucleotides and 4',6-diamidino-2-phenylindole (DAPI). Based on the software KS400 (Carl Zeiss Vision, Hallbergmoos, Germany), designed for automising microscopy-based image capture and image analysis, a routine was developed that affords the recognition of doubly stained bacteria and the rejection of artefacts. The accuracy of the automated enumeration was investigated by comparing the resulting data with those obtained by manual counting. The newly developed method was subsequently used to compare the total bacterial counts in human faecal samples using the domain specific probe Eub338 alone and a mixture of 5 domain-specific probes, respectively. Faecal samples from 90 healthy volunteers were analysed. The cell counts obtained with Eub338 were 10% lower than those obtained with the probe mixture. Since the cells detected with the probe mixture covered a wide range of signal intensities, a dynamic analysis routine was developed to effectively detect the whole range of bright to weak signals within the same image, while at the same time reliably rejecting artefacts.

Can cognitive deterioration associated with Down syndrome be reduced?

Individuals with Down syndrome have signs of possible brain damage prior to birth. In addition to slowed and reduced mental development, they are much more likely to have cognitive deterioration and develop dementia at an earlier age than individuals without Down syndrome. Some of the cognitive impairments are likely due to post-natal hydrogen peroxide-mediated oxidative stress caused by overexpression of the superoxide dismutase (SOD-1) gene, which is located on the triplicated 21st chromosome and known to be 50% overexpressed. However, some of this disability may also be due to early accumulation of advanced protein glycation end-products, which may play an adverse role in prenatal and postnatal brain development. This paper suggests that essential nutrients such as folate, vitamin B6, vitamin C, vitamin E, selenium, and zinc, as well as alpha-lipoic acid and carnosine may possibly be partially preventive. Acetyl-L-carnitine, aminoguanidine, cysteine, and N-acetylcysteine are also discussed, but have possible safety concerns for this population. This paper hypothesizes that nutritional factors begun prenatally, in early infancy, or later may prevent or delay the onset of dementia in the Down syndrome population. Further examination of these data may provide insights into nutritional, metabolic and pharmacological treatments for dementias of many kinds. As the Down syndrome population may be the largest identifiable group at increased risk for developing dementia, clinical research to verify the possible validity of the prophylactic use of anti-glycation nutrients should be performed. Such research might also help those with glycation complications associated with diabetes or Alzheimer's.

[The transobturator tape (TOT). A minimally-invasive procedure for the treatment of female urinary stress incontinence]

The transobturator tape, a new technique for the treatment of female urinary stress incontinence, was evaluated with a 1 year follow-up.A total of 124 patients were treated with a low elasticity polypropylene tape according to the technique described by Delorme. The operative procedure is described step by step. All patients were followed-up after 3, 6 and 12 months. No intra-operative complications were observed. After 12 months 88.7% of the patients were cured and an additional 6.4% showed improvement. The transobturator technique (from exterior to interior) is, given proven indications and an exact consideration of the instructions, a simple, safe and efficient surgical procedure for the treatment of female urinary stress incontinence. The technique avoids complications such as bladder, intestinal and vascular lesions. It is suitable for genuine incontinence and patients with recurrent stress incontinence.

Die radikale retropubische Prostatektomie?Goldstandard beim Prostatakarzinom?

Radical retropubic prostatectomy is still the most frequent surgical procedure for the treatment of localized prostate cancer. Improvements in the surgical techniques have contributed to significant reduction in operative time (median 69 min) and in rates of early and late complications. The surgical procedure and perioperative management are described, and results in 180 consecutive cases are presented. Severe postoperative complications did not occur. More than 95% of patients were completely dry within 6 months. Erectile function recovered in 71% of patients with bilateral preservation of the neurovascular bundles and in 34% of patients with unilateral nerve sparing. These results are in good agreement with data from the literature and confirm the outstanding role of the retropubic approach as the gold standard for radical prostatectomy, as well as the reproducibility of the result in community-based hospitals.

Synthesis, high-performance liquid chromatography-nuclear magnetic resonance characterization and pharmacokinetics in mice of CD271 glucuronide

Retinoic acid-glucuronides are known as retinoids with activity in acne therapy, limited placental transfer and reduced retinoid adverse effects. We synthesized the glucuronide of a novel retinoid, CD271 (adapalene), used for the treatment of moderate acne. The synthesis product ("CD271 glucuronide", CD271G) was purified by preparative HPLC. It undergoes in aqueous solution, like other glucuronides, rapid acyl-migration of the bound aglycone leading to position isomers. Thus characterization of purified CD271G could be only achieved by HPLC-NMR coupling. A subfraction ("CD271GB") consisting essentially of 2'- and 3'-CD271G was used for pharmacokinetic studies. After a single subcutaneous injection at a dosage of 30 mg/kg the substance showed considerable uptake and metabolism to CD271 indicating that CD271GB could serve as a prodrug for CD271.

Effects of fluoroquinolones on the locomotor activity in rats

During therapy with fluoroquinolones adverse CNS reactions such as dizziness, light-headedness, insomnia or sleepiness are observed in up to 20% of patients. Using a device developed at our institute for the simultaneous registration of the activity of rats housed in single cages, we have investigated the effects of trovafloxacin, fleroxacin or ofloxacin on the locomotor activity of juvenile and adult rats (11 per group) after oral administration of 600 mg/kg for 5 consecutive days. The effects were most pronounced after fleroxacin, which induced a reduction in activity to 36 +/- 9% (mean +/- SD) of the values measured in juvenile rats before treatment and to 60 +/- 21% (mean +/- SD) in adult rats. HPLC analysis of the plasma concentrations in juvenile rats showed that the concentrations of trovafloxacin were considerably lower than those of the other fluoroquinolones that had been studied previously in our laboratory: the peak concentration of trovafloxacin was 14 +/- 2.9 mg/l (mean +/- SD) after a single dose of 600 mg/kg in juvenile rats. Overall, we showed that the locomotor activities of juvenile and adult rats were significantly depressed during treatment with fluoroquinolones. The effects were more pronounced in juveniles. Monitoring of the locomotor activity of rats is a suitable approach to study CNS effects of fluoroquinolones in animals, but pharmacokinetics have to be taken into account.

Assessment of P450 induction in the marmoset monkey using targeted anti-peptide antibodies

The identity and expression of hepatic P450 enzymes in marmosets was investigated using a panel of anti-peptide antibodies originally targeted against human P450 enzymes. In immunoblotting, of 12 antibodies examined, 10 bound specifically to bands in marmoset liver microsomal fraction corresponding to P450 enzymes. It is proposed that these represent marmoset CYP1A1, CYP1A2, CYP2A, CYP2B, CYP2C forms (CYP2C-1 and CYP2C-2), CYP2D19, CYP3A21 and another CYP3A form (CYP3A-m). The antibodies, together with an anti-marmoset CYP2E1 antibody, were used to investigate the expression of 10 P450 enzymes in marmosets treated with P450-inducing chemicals. Treatment with phenobarbitone caused CYP2B, CYP2C-2 and CYP3A21 levels to increase, rifampicin caused increases in CYP2B and CYP2C-1 and a decrease in CYP3A21 levels, whereas dioxin caused CYP1A1 and CYP1A2 levels to increase and CYP2E1 levels to decrease. Clofibric acid did not induce any P450. P450 enzyme activities were assessed using 8 different substrates and increases were found after treatment with phenobarbitone, rifampicin, and dioxin. However, due to species differences in substrate selectivity, it proved difficult to ascribe these changes to individual P450 enzymes. Thus, the use of anti-peptide antibodies provides a more informative way of assessing the levels of specific P450 enzymes than enzyme activity measurements.

[Postobstructive polyuria in unilateral hydronephrosis. A case with 58 l/day]

Increased urinary outputs are common after release of bilateral ureteral or subvesical obstruction. However, polyuria is rare following unilateral obstruction. We report a case of excessive postobstructive diuresis of more than 58,000 ml per day (204 l in 10 days) after release of a left ureteral obstruction in a 56-year-old female, being the highest amounts reported in the literature. Polyuria was derived from the obstructed as well as from the normal contralateral kidney. The involved pathomechanism is complex and not completely understood. Treatment includes careful monitoring of the patient and replacement of fluid and electrolytes. In our case complete recovery of kidney function was observed after several days.

Idiopathic partial thrombosis of the corpus cavernosum

A case of spontaneous, partial, unilateral thrombosis of the corpus cavernosum is described. A 35-year-old white male presented with a painful mass in the perineum without priapism. Diagnostic evaluation with sonography and magnetic resonance imaging revealed a thrombosis in the left posterior corporal body. Treatment consisted of intravenous heparin followed by prophylactic acetylsalicylic acid. The thrombosis resolved spontaneously over several months without sequelae. Conservative management of this rare disease appears to be possible and safe.

Expression of adhesion receptors on rat limb bud cells and results of treatment with a thalidomide derivative

The expression of several adhesion surface receptors was studied on cells of early limb bud development of 58 Wistar rats treated orally with two daily doses of the thalidomide derivative EM12 (2 x 50 mg/kg body weight) from day 7 to 10 of pregnancy. EM12 is a more potent teratogen than thalidomide. Limb bud cells of 56 untreated animals served as controls. The studies revealed that the integrins CD11a, CD11b, CD18, CD49d, and CD61, as well as the additional adhesion receptors CD54, CD62L, and the transferrin receptor CD71 were expressed on day 11 of gestation to various degrees on these embryonic cells. In contrast to results of previous studies with a non-human primate (Callithrix jacchus) there was no down-regulation of any of these receptors on the surface of limb bud cells of the rat embryos after treatment with EM12. This result is in accordance with the lack of teratogenicity in this rodent species.

Incorporation of 1-[1-(13)C]Deoxy-D-xylulose in chamomile sesquiterpenes

Incorporation of synthetically prepared 1-[1-(13)C]deoxy-d-xylulose into chamomile sesquiterpenes has been achieved by injecting an aqueous solution into the anthodia of the plant. The analysis of labeling patterns and absolute (13)C abundances of the isolated sesquiterpenes bisabololoxide A (1), bisabololoxide B (2), and chamazulene (3) using quantitative (13)C NMR spectroscopy showed that 1-[1-(13)C]deoxy-d-xylulose was efficiently incorporated in all three isoprene building blocks of the sesquiterpenes. A significantly lower (13)C abundance of the labeled carbon atom in the biogenetically terminal isoprene unit confirms the mixed biosynthesis of this unit, involving both the mevalonic acid pathway and the methylerythritol phosphate pathway.

Involvement of the mevalonic acid pathway and the glyceraldehyde-pyruvate pathway in terpenoid biosynthesis of the liverworts Ricciocarpos natans and Conocephalum conicum

The incorporation of 13C-labeled glucose into borneol, bornyl acetate, the sesquiterpenes cubebanol and ricciocarpin A, phytol, and stigmasterol has been studied in axenic cultures of the liverworts Ricciocarpos natans and Conocephalum conicum. Quantitative 13C NMR spectroscopic analysis of the resulting labeling patterns showed that the isoprene building blocks of the sesquiterpenes and stigmasterol are built up via the mevalonic acid pathway, whereas the isoprene units of the monoterpenes and the diterpene phytol are exclusively derived from the glyceraldehyde-pyruvate pathway. These results indicate the involvement of both isopentenyl diphosphate biosynthetic pathways in different cellular compartments.

Identification of CYP2E1 in marmoset monkey

CYP2E1 is the main enzyme responsible for chlorzoxazone 6-hydroxylase activity in human liver. Here, it is shown that marmoset monkey liver microsomal fraction catalyses this reaction at a similar rate and with a similar Km to human liver and that the activity is increased 4-fold in marmosets treated with isoniazid, a known inducer of CYP2E1. This indicates that CYP2E1 is present in marmoset liver. However conversely, an anti-peptide antibody targeted against the C-terminus of human and cynomolgus monkey CYP2E1 (Val-Ile-Pro-Arg-Ser) failed to bind to marmoset monkey hepatic microsomal fraction. To investigate if there is a difference in the C-terminus of CYP2E1 in these species, this region of marmoset CYP2E1 was sequenced following amplification of marmoset liver cDNA with primers selected according to conserved regions identified in human and cynomolgus monkey CYP2E1. It was found that the deduced amino acid sequence of marmoset CYP2E1 in this region is very similar to human CYP2E1, but due to two base differences in the marmoset nucleic acid sequence, the C-terminus of marmoset CYP2E1 is extended by 2 amino acids, i.e. Val-Ile-Pro-Arg-Ser-Ser-Val. This difference is sufficient to prevent the binding of an antibody raised against the C-terminus of human CYP2E1. The expression of CYP2E1 in the marmoset was confirmed by raising an antibody against the deduced C-terminus of marmoset CYP2E1 (Pro-Arg-Ser-Ser-Val). In immunoblotting, this antibody bound to a single protein of 54 kDa in marmoset liver microsomal fraction. The intensity of the band was increased in isoniazid-treated marmosets, consistent with induction of CYP2E1. The antibody did not recognise human or cynomolgus monkey CYP2E1. This was expected since the immunising peptide sequence does not occur in these enzymes. The results demonstrate the presence of CYP2E1 in marmoset liver and illustrate the importance of the C-terminus for the production of specific antibodies against P450 enzymes.

Role of prostate-specific antigen velocity in prediction of final pathologic stage in men with localized prostate cancer

OBJECTIVES

Prostate-specific antigen (PSA) velocity prior to radical retropubic prostatectomy was evaluated to determine if men with a faster rate of rise in PSA have locally more extensive prostate cancer.

METHODS

Of 368 men who underwent radical retropubic prostatectomy, 82 had two to seven PSA measurements between 1.3 and 6.7 years before prostate biopsy for evaluation of PSA velocity. PSA velocity and the pretreatment parameters of PSA, Gleason score, and T stage were evaluated as predictive parameters of pathologic stage.

RESULTS

In men with pathologically organ-confined disease, PSA velocity was 1.12 ng/mL/yr; in non-organ-confined cases, it was 1.88 ng/mL/yr. There was a statistically significant relationship between a Gleason score of 7 and above and the pathologic extent of disease. There was no statistically significant relationship between T stage, the PSA at diagnosis, and PSA velocity with respect to final pathologic stage.

CONCLUSIONS

PSA velocity is not a strong predictor of pathologic stage in men with localized prostate cancer.

The area under the concentration-time curve of all-trans-retinoic acid is the most suitable pharmacokinetic correlate to the embryotoxicity of this retinoid in the rat

Earlier studies with etretinate and its metabolite acitretin suggested that area under the concentration-time curve (AUC) is the most suitable pharmacokinetic correlate to etretinate-induced teratogenesis. In an attempt to test this hypothesis with respect to the embryotoxic effects of all-trans-retinoic acid (all-trans-RA), we determined the embryotoxicity and plasma pharmacokinetics of all-trans-RA and its metabolites following administration of all-trans-RA to Wistar rats on Gestational Day (GD) 9, either subcutaneously (sc; dose levels 1, 3, or 5 mg/kg body mass) or orally (po; 5 mg/kg body mass). The 5 mg/kg dose of all-trans-RA was not embryotoxic when administered orally but led to high rates of embryolethality and skeletal defects following sc treatment. Determination of retinoids by HPLC showed that all-trans-RA reached similar maximum plasma concentrations (C(max)) after both dosing regimens, but its plasma AUC was ca. threefold higher after sc injection than po administration due to the slower uptake rate of the drug and its limited detoxification via beta-glucuronidation following sc injection. Furthermore, retinoid analysis in rat tissues (liver, kidney, duodenum, and jejunum), collected 1 hr after sc or po administration of 5 mg all-trans-RA/kg body mass on GD 9, confirmed that formation of all-trans-retinoyl-beta-glucuronide was much more extensive after po than after sc administration. Finally, linear regression analysis of either C(max). or AUC values of all-trans-RA in rat plasma and fetal abnormality rates showed that AUC values are better correlated with the embryotoxic outcome than C(max) [AUC-based correlation coefficient (r) > 0.90; C(max)-based r < 0.43]. Our findings establish the relevance of the AUC of all-trans-RA, and not its C(max), as the most appropriate pharmacokinetic marker of embryonic exposure and embryotoxic potency of all-trans-RA and stress the importance of the duration of exposure as a major determinant of embryotoxic outcome for retinoids.

Keratin 17 gene expression during the murine hair cycle

Keratin 17 (K17) expression is currently considered to be associated with hyperplastic or malignant growth of epithelial cells. The functions of this keratin in normal skin physiology and the regulation of its gene expression, however, are still unclear. As one possible approach to further explore K17 functions, we have studied the differential patterns of mouse K17 (MK17) transcription during the murine hair cycle by means of in situ hybridization, using a digoxigenin-labeled riboprobe. Cycling hair follicles in the skin of C57BL/6 mice were found to be the only skin structures expressing MK17 under physiologic conditions. MK17 transcripts were constantly observed throughout all hair cycle stages in the suprainfundibular outer root sheath (ORS). The MK17 expression was also evident in the isthmus part of the ORS, where it was expressed weakly and was spatially restricted during telogen, with an increase in early anagen and stable expression during mid- and late anagen, localizing to the zone of so-called trichilemmal keratinization. In addition, in early anagen, a group of epithelial cells in or next to the bulge region stained weakly for MK17. With progressing anagen development, MK17 expression in this region increased and was consistently localized to keratinocytes at the advancing front of the emerging epithelial hair bulb. In mid- and late anagen, this zone of MK17 expression spread along the proximal ORS, with a maximal level of expression in the innermost cell layer of the ORS. Overall, these findings provide data on the MK17 expression profile of normal murine skin and demonstrate hair-cycle-dependent regulation of MK17 expression.

2,3,7,8-tetrachlorodibenzo-p-dioxin (TCCD) affects keratin 1 and keratin 17 gene expression and differentially induces keratinization in hairless mouse skin

The environmental pollutant 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) causes chloracne in humans by mechanisms that are as yet poorly understood. Because TCDD is known to affect keratinocyte differentiation in vitro, we have studied TCDD-dependent morphologic changes and the expression of murine keratin 1 (MK1; differentiation associated) and keratin 17 (MK17; presumably hyperproliferation associated) in HRS/J hr/hr hairless mouse skin. TCDD (0.2 microg in acetone) applied topically to the dorsal skin caused epidermal acanthosis and hyperkeratosis of the dermal cysts as well as an involution of the utricles and the sebaceous glands. By means of in situ hybridization with digoxigenin-labeled riboprobes of sections from untreated and vehicle (control)-treated skin, we localized MK1 mRNA to the epidermal spinous cell compartment. MK17 transcripts were detected only in the derivatives of the hair follicle-utricle epithelium and dermal cysts. No spatial overlap was observed between MK1 and MK17 expression. After TCDD application, MK17 was newly expressed in the upper spinous cell layers of the interfollicular epidermis, although it was suppressed in the involuting utricles. In contrast, MK1 expression in the interfollicular epidermis was not affected by TCDD. Furthermore, MK1 expression was induced in the epithelium of the utricle remnants and in some dermal cysts. These data suggest that increased keratinization of the part of the follicular epithelium corresponding to the dermal cyst epithelium of hairless mice most probably explains the pathogenesis of TCDD-induced chloracne. The results demonstrate, furthermore, that TCDD can differentially affect keratinocyte differentiation in vivo as well as in vitro.

Avoiding complications of radical retropubic prostatectomy

During the past 15 years radical retropubic prostatectomy (RRP) has become the treatment of choice for localized prostate cancer. Before the 1980s the procedure was characterized by a significant number of intraoperative, postoperative and long-term complications. Since then the operation has evolved continuously, using the results from anatomical studies, and has resulted in a marked reduction in the morbidity and mortality associated with this procedure. The modern, anatomical approach to RRP emphasizes the principles of direct visualization and identification of the anatomical structures in the pelvis. Management of the dorsal vein complex and techniques for apical resection of the prostate, combined with improved understanding of the pelvic floor anatomy, have contributed to a reduced frequency of postoperative incontinence. The identification and localization of the "erectile nerves' (autonomic branches of the pelvic plexus to the corpora cavernosa) in the neurovascular bundles outside the prostatic capsule and Denonvilliers' fascia enables nerve-sparing surgery. In selected cases, sparing of the neurovascular bundles is possible to preserve sexual function without compromising cancer control as the principal goal of RRP.

Postnatal development and behaviour of Wistar rats after prenatal toluene exposure

Pregnant Wistar rats were treated with different concentrations of toluene by inhalation (300, 600, 1000 and 1200 ppm) from day 9 to day 21 of pregnancy for 6 h a day in a whole-body inhalation chamber (controls inhaled fresh air only). From day 22, rats were kept single-caged and were allowed to deliver. Besides a detailed evaluation of the physical development of the offspring we performed the following tests: forelimb-grasp reflex, righting reflex, cliff-drop aversion reflex, maintainance of balance on a rotating rod, measurement of locomotor activity and learning ability in a discrimination learning test. A toluene exposure of 1200 ppm resulted in a reduced body weight of rat dams and offspring and a higher mortality until weaning. The physical development (incisor eruption, eye opening and vaginal opening) was retarded in this group. There were no clear-cut and concentration-dependent differences in the development of reflexes, rota rod performance and locomotor activity between the offspring of animals exposed to toluene and the controls. Likewise, no effects were found on learning ability in the operant conditioning task. Compared to the controls there were no differences in mating, fertility and pregnancy indexes in the F1-generation. The tests performed have provided no evidence that toluene exposures < or = 1200 ppm induce adverse effects on the behaviour of rat offspring exposed during late embryonic and fetal development.

All-trans-retinoyl-beta-glucuronide is a potent teratogen in the mouse because of extensive metabolism to all-trans-retinoic acid

All-trans-retinoyl-beta-D-glucuronide (all-trans-RAG) is a water-soluble derivative of all-trans-retinoic acid (all-trans-RA) and has been characterized as an endogenous metabolite of vitamin A in rat bile and kidney. All-trans-RAG was previously demonstrated to be a major metabolite after application of all-trans-RA in several species (mouse, rat, rabbit, monkey); all-trans-RAG was described in these experiments to exhibit a very low placental transfer to the embryo. Because retinoid-like activity has been found after application of all-trans-RAG in vivo as well as in several in vitro systems, and because of its low placental transfer, this glycoconjugate appeared to be an interesting retinoid with possible therapeutic activity, but reduced teratogenicity. Here we investigated the teratogenic activity of all-trans-RAG in comparison to all-trans-RA in mice, and performed accompanying pharmacokinetic studies. Surprisingly, all-trans-RAG was more teratogenic than equimolar doses of all-trans-RA following subcutaneous application on day 11 of gestation in the mouse (20 mumol/kg body weight). Pharmacokinetic studies revealed that all-trans-RAG was extensively hydrolyzed to all-trans-RA and that the plasma area under the concentration-time curve (AUC) of all-trans-RA following all-trans-RAG application exceeded the plasma AUC value of all-trans-RA following application of all-trans-RA. Extensive hydrolysis of all-trans-RAG was also observed after intravenous application of this glycoconjugate. Transfer of all-trans-RAG to the embryo was low, but transfer was high to maternal organs such as the liver and kidney. These in vivo studies suggest that all-trans-RAG serves as a precursor of all-trans-RA by the intravenous and subcutaneous routes, and application of all-trans-RAG results in high and teratogenic in vivo exposure to all-trans-RA.

Venous dissection injuries during laparoscopic urological surgery

PURPOSE

The incidence of major venous dissection injuries during laparoscopic procedures is assessed and recommendations are made for management.

MATERIALS AND METHODS

We evaluated our experience with all major intra-abdominal injuries occurring during 274 consecutive laparoscopic procedures performed within a 4-year period. Five patients (1.7%) had a total of 6 major vascular injuries, including gonadal vein avulsion in 1 case, lumbar vein avulsion in 1 and a tear in the inferior vena cava in 4. Two patients sustained inferior vena caval injuries during nephrectomy because of adhesions from previous surgery and 1 of them had 2 venacavotomies.

RESULTS

All vascular injuries were venous and 5 of the 6 major vessel injuries were treated successfully endoscopically via intracorporeal suturing techniques. The injury requiring open repair was a gonadal vessel avulsion that occurred during retroperitoneal lymph node dissection early in our laparoscopic experience. Major vessel injuries were more likely to occur during complex laparoscopic procedures in patients who had undergone previous ipsilateral retroperitoneal surgery.

CONCLUSIONS

In select situations new techniques can allow for safe endoscopic control and repair of venous injuries during laparoscopic surgery.