Isotonic saline in elderly men: an open-labelled controlled infusion study of electrolyte balance, urine flow and kidney function

Isotonic saline is a widely-used infusion fluid, although the associated chloride load may cause metabolic acidosis and impair kidney function in young, healthy volunteers. We wished to examine whether these effects also occurred in the elderly, and conducted a crossover study in 13 men with a mean age of 73 years (range 66-84), who each received intravenous infusions of 1.5 l of Ringer's acetate and of isotonic saline. Isotonic saline induced mild changes in plasma sodium (mean +1.5 mmol.l(-1) ), plasma chloride (+3 mmol.l(-1) ) and standard bicarbonate (-2 mmol.l(-1) ). Three hours after starting the infusions, 68% of the Ringer's acetate and 30% of the infused saline had been excreted (p < 0.01). The glomerular filtration rate increased in response to both fluids, but more after the Ringer's acetate (p < 0.03). Pre-infusion fluid retention, as evidenced by high urinary osmolality (> 700 mOsmol.kg(-1) ) and/or creatinine (> 7 mmol.l(-1) ), was a strong factor governing the responses to both fluid loads.

Prostate-specific antigen (PSA), PSA density and age-adjusted PSA reference values in screening for prostate cancer--a study of a randomly selected population of 2,400 men

Prostate cancer screening with DRE, TRUS, and PSA testing was offered to 2,400 randomly selected men 55-70 years old. Among 1,782 examined, 65 (3.6%) men with prostate cancer were diagnosed. The PSA results were correlated to the diagnosis, the men's age, and the prostate volume. Least square regression analysis was used to calculate the 95% upper confidence intervals for PSA in each year of age in men without prostate cancer. The PPV was calculated for: (i) PSA > 4 ng/ml, (ii) PSAD > 0.15, (iii) PSAD > 0.20 and (iv) age-adjusted PSA reference values. A significant correlation was found between PSA and prostate volume, between PSA and age, and between the prostate volume and age. The calculated annual growth of the prostate was 1.6% and the annual increase in PSA was 2.4%. The age-adjusted upper PSA reference values for the three age categories studied (55-59, 60-64 and 65-70 years) were 5.2, 5.8, and 6.7 ng/ml, respectively. The PPVs for PSA > 4 ng/ml, PSAD > 0.15, PSAD > 0.20, and the age-adjusted PSA reference values were 17%, 14%, 22%, and 27%, respectively. Age-adjusted PSA or PSAD may increase the PPV compared to PSA > 4 ng/ml. The detection rate is, however, inadequate. A PSA cut-off at 4 ng/ml could therefore be maintained in men 55-70 years old. The median PSA values and median prostate volumes calculated for men with benign findings may serve as a reference in future studies.

Double-blind randomized study of symptoms associated with absorption of glycine 1.5% or mannitol 3% during transurethral resection of the prostate

PURPOSE

We studied which irrigating fluid, glycine 1.5% or mannitol 3%, is associated with the most favorable adverse effects profile when absorbed by the patient during transurethral resection of the prostate.

MATERIALS AND METHODS

Irrigating fluid bags containing mannitol 3% or glycine 1.5%, both with added ethanol 1% as an indicator of fluid absorption, were used in a randomized double-blind fashion during 394 transurethral prostatic resections. The incidence of 13 symptoms was studied in 52 patients (13%) who absorbed more than 500 ml. fluid.

RESULTS

The incidence of circulatory symptoms did not differ between the fluids but the risk of neurological symptoms, such as nausea, after transurethral prostatic resection was 4.8 times higher when glycine 1.5% was absorbed (p <0.04). An increase of 1,000 ml. in the volume of irrigant absorbed increased the overall risk for circulatory symptoms by a factor of 3.4 (p <0.03) and the risk of neurological symptoms by a factor of 4.4 (p <0.02).

CONCLUSIONS

Absorption of mannitol 3% during transurethral prostatic resection is associated with fewer neurological symptoms than glycine 1.5%.

Dihydrotestosterone and testosterone levels in men screened for prostate cancer: a study of a randomized population

OBJECTIVE

To investigate the possible relationship between serum levels of prostate specific antigen (PSA), dihydrotestosterone (DHT), testosterone, sexual-hormone binding globulin (SHBG) and tumour stage, grade and ploidy in 65 cases of prostate cancer diagnosed in a screening study compared to 130 controls from the same population.

PATIENTS, SUBJECTS AND METHODS

From a population of 26,602 men between the ages of 55 and 70 years, 2400 were selected randomly and invited to undergo screening for prostate cancer using a digital rectal examination, transrectal ultrasonography and PSA analysis. Among the 1782 attendees, 65 cases of prostate cancer were diagnosed. Each case was matched with two control subjects of similar age and prostate volume from the screening population. Frozen serum samples were analysed for PSA, DHT, testosterone and SHBG, and compared to the diagnosis and tumour stage, grade and ploidy. Comparisons between these variables, and multivariate and regression analyses were performed.

RESULTS

There were significant differences in PSA level with all variables except tumour ploidy. DHT levels were slightly lower in patients with prostate cancer but the difference was not statistically significant. There was a trend towards lower DHT values in more advanced tumours and the difference for T-stages was close to statistical significance (P = 0.059). Testosterone levels were lower in patients with cancer than in the control group, but the differences were not significant. There was no correlation between testosterone levels, tumour stage and ploidy, but the differences in testosterone level in tumours of a low grade of differentiation compared to those with intermediate and high grade was nearly significant (P = 0.058). The testosterone/DHT ratio tended to be higher in patients with more advanced tumours. SHBG levels were lower in patients with cancer than in controls but the differences were not statistically significant. There were no systematic variations of tumour stage, grade and ploidy. Multivariate analysis showed that if the PSA level was known, then DHT, testosterone or SHBG added no further information concerning diagnosis, stage, grade or ploidy. Regression analysis on T-stage, PSA level and DHT showed an inverse linear relationship between PSA and DHT for stage T-3 (P = 0.035), but there was no relationship between PSA and testosterone.

CONCLUSION

PSA was of value in discriminating between cases and controls and between various tumour stages and grades, but no statistically significant correlation was found for ploidy. If PSA level was known, no other variable added information in individual cases. Within a group, DHT levels tended to be lower among cases and in those with more advanced tumours. There was an inverse relationship between tumour volume, as defined by PSA level, and 5 alpha-reductase activity, as defined by DHT level, and the testosterone/DHT ratio. This trend was most obvious with T-stage. No systematic variation were found in the levels of testosterone or SHBG.

Cost-effectiveness analysis in early detection of prostate cancer: an evaluation of six screening strategies in a randomly selected population of 2,400 men

Based on the findings in an early detection study for prostate cancer [Gustafsson et al.: J Urol 148:1827-1831, 1992] using digital rectal examination (DRE), transrectal ultrasound (TRUS), and prostate-specific antigen (PSA), a cost-effectiveness analysis was performed based on 6 screening strategies, namely: 1) DRE of all individuals; 2) TRUS of all individuals; 3) DRE, TRUS, and PSA analysis followed by reexamination of individuals with PSAs > or = 7 ng/ml; 4) DRE of individuals with PSAs of > or = 4 ng/ml; 5) TRUS of individuals with PSAs of > or = 4 ng/ml; 6) DRE and PSA analysis followed by TRUS on individuals with PSAs > or = 4 ng/ml. The detection rates of prostate cancer using these 6 strategies were 2.4%, 3.3%, 3.6%, 2.0%, 2.6%, and 3.2%, respectively. Except for costs per detected cancer, costs were also calculated per detected small cancer (< or = 1.5 cm) and per detected cancer treated for cure. The cost calculations were based on total costs, i.e., direct plus indirect costs. When the 6 strategies were compared, taking into account the detection rate of cancers treated for cure and cost-effectiveness with respect to cancers treated for cure, strategies 1), 2), 3), and 4) were ruled out as less favorable than the remaining 2 strategies. TRUS of individuals with PSAs > or = 4 ng/ml (strategy 5) was the most cost-effective strategy and detected 80% of the cancers actually treated for cure. Screening with DRE and PSA analysis followed by TRUS of individuals with PSAs > or = 4 ng/ml (strategy 6) had a somewhat lower cost-effectiveness, but detected 90% of the cancers treated for cure.

Psychological reactions in men screened for prostate cancer

OBJECTIVE

To investigate the possible negative psychological impact of screening for prostate cancer with special focus on the impact of false positive and true positive test results.

SUBJECTS AND METHODS

As part of an early detection study for prostate cancer psychological and psychophysiological reactions to various phases of the diagnostic procedures were examined in 2400 randomly selected men divided into various groups. Their psychophysiological reactions were assessed by measurements of serum cortisol and their psychological reactions by questionnaires directed at determining emotional states and sleep disturbance. In a stratified sample of the population (100 men) measurements were made at the time of the screening examination and again 2 weeks later. In patients undergoing biopsy (307 men) measurements were made 2 weeks after screening, but before they were informed of the biopsy results, and again 4 and 16 weeks after screening.

RESULTS

Serum cortisol levels at the screening examination were higher than corresponding levels of a comparable sample of Swedish men during normal daily activity, indicating that an invitation to examination for prostate cancer per se might create emotional stress. Two weeks after the screening the elevated levels had decreased to normal. The highest cortisol levels were found in men who had undergone biopsy, immediately before they were informed of the results 2 weeks after screening. After they were informed, cortisol levels fell, regardless of the results of the biopsy. The patterns of emotional state and sleep disturbance were similar except that sleep disturbance was delayed.

CONCLUSION

In screening programmes for prostate cancer it is important to define clearly the high-risk groups to minimize the risk of adverse psychological reactions in those subjects with a low risk of having the disease. The results also emphasize the need to reduce the number of false positive results by choosing diagnostic tests of high specificity. The interval between a test and informing the subject of the results should be minimized to decrease the duration of the increased emotional stress.

Diagnostic methods in the detection of prostate cancer: a study of a randomly selected population of 2,400 men

We investigated the value of digital rectal examination, transrectal ultrasonography and prostatic specific antigen (PSA) analysis as aids in general clinical practice and in the early detection of prostate cancer. Of a randomly selected population of 2,400 men 55 to 70 years old who were offered examination with digital rectal examination, transrectal ultrasound and PSA analysis, 1,782 (74%) accepted and prostate cancer was detected in 65 (3.6%). When the transrectal ultrasound results were also considered the detection rate of digital rectal examination (2.3%) was increased by 50% and the number of stage T2A or less tumors was doubled. At reexamination due to markedly high PSA values (7 micrograms/l. or more) only a few additional cancers (5%) were detected. However, it is noteworthy that 80% of the detected cancers were found among the subgroup with abnormal PSA values (4 micrograms/l. or more) and comprising 17% of the study population, which suggests the possibility of selecting a risk group at mass screening. Moreover, the positive predictive value increased from 4% (when only digital rectal examination was positive) to 71% for the combination of positive digital rectal examination, positive transrectal ultrasound and an increased PSA concentration (that is 7 micrograms/l. or greater).

Prognostic significance of mucosal aneuploidy in stage Ta/T1 grade 3 carcinoma of the bladder

In a prospective series of 71 patients with newly detected grade 3, stages Ta and T1 bladder carcinoma tumor characteristics, including the results of deoxyribonucleic acid (DNA) analysis as well as morphological and DNA characteristics of the grossly normal urothelium, were investigated and related to progression-free survival. The mean duration of followup was 57 months, with a minimum of 24 months. Of the 71 patients 24 underwent primary cystectomy, and 47 were conservatively treated with transurethral resection alone, or followed by instillation therapy or irradiation therapy. Of the cystectomy and conservatively treated patients 2 (8%) and 16 (34%), respectively, died of bladder carcinoma. Among the 47 conservatively treated patients tumor progression could not be predicted by the initial characteristics of tumor stage, papillary or nonpapillary growth, tumor multiplicity, tumor size, existence of 1 or multiple aneuploid cell populations, S phase value, carcinoma in situ and atypia or aneuploidy in the mucosal biopsies. Neither was progression predicted by the recurrence rate during year 1 of observation. However, a change to or persistent mucosal aneuploidy and a change to or persistent morphological abnormality of the mucosa during year 1 of observation were predictive for tumor progression (p = 0.001 and 0.045, respectively). When compared in stepwise regression analysis (Cox's proportional hazard model), DNA aneuploidy in the mucosa at 12 months after diagnosis was a highly significant predictor, whereas morphology added no further prognostic information. Therefore, progression is related to gross chromosomal abnormalities of the mucosa. High risk patients can be identified by evaluation of the grossly normal mucosa, which should be done as part of the initial diagnosis and during followup in conservatively treated patients with stages Ta and T1, grade 3 bladder carcinoma.

Male and female sexual function and activity following ileal conduit urinary diversion

A group of 66 patients (40 males, 26 females) underwent an ileal conduit urinary diversion because of bladder cancer (44 patients) or incontinence/bladder dysfunction (22). They were questioned about pre- and post-operative sexual function and activity and it was found that 90% of the males (26/29) who were sexually active before surgery lost the ability to achieve erection following radical cystectomy. Although they were unable to achieve penile erection, 41% were able to experience orgasm by means of masturbation. Five of the 29 males received penile implants. Five of the 6 females treated by cystectomy, who were sexually active before the operation, reported either a decrease or cessation of sexual activity (i.e. coitus) post-operatively. The main problems were a decrease in sexual desire, dyspareunia and vaginal dryness. One women reported the inability to experience orgasm after surgery. Compared with women with bladder cancer, those with incontinence/bladder dysfunction were more likely to have an active sexual life after urostomy surgery. Seven females in this group, of whom 4 were sexually inactive before surgery, increased their sexual activity after the operation. For these women the conduit operation removed the need to use incontinence pads or indwelling catheters.

[A study on prostatic cancer. The patient can decide himself: medical or surgical treatment]

In a multicentre study, 101 consecutive patients with advanced prostate cancer were offered the choice of orchiectomy or treatment with an LHRH analogue. Together with the cancer diagnosis the patients were given verbal information about the treatment alternatives, and detailed written information to peruse at home. One week later the patients informed the attending physicians of their choice. Information as to the reasons for the patients' choice, and their views on their choice after the start of treatment were elicited by questionnaire. Of the 101 patients, 48 chose orchiectomy, and 48 treatment with an LHRH analogue, five patients being excluded owing to their inability to decide. Mean age was about 73 years in both treatment groups, and about two thirds of each group lived with a partner. The level of education was higher among those who chose medical treatment. The predominant reasons for the choice of treatment were as follows: Orchiectomy, simpler (31 per cent), troublesome having to have monthly injections (19 per cent), simple to perform (15 per cent); medical treatment, possibility of change in treatment (27 per cent), simpler (17 per cent), fear of surgery (15 per cent). Most patients in both groups had no difficulty deciding, chose quickly, felt sure about their choice, appreciated the opportunity of choosing, and had discussed their choice with their partners or intimates. Three months after the start of treatment, almost all patients were still satisfied with their choice, and had no wish to change their choice even if that were possible.(ABSTRACT TRUNCATED AT 250 WORDS)

Preventable sudden death in patients receiving angiotensin converting enzyme inhibitors and loop/potassium sparing diuretic combinations

Angiotensin-converting-enzyme inhibitors are frequently used in conjunction with diuretics in the treatment of congestive cardiac failure. We report two cases in which use of a proprietary combination diuretic containing a loop diuretic and potassium sparing agent with an angiotensin converting enzyme inhibitor was associated with hyperkalaemic cardiac arrest. Successful resuscitation from the arrest permitted elucidation of its mechanism. We believe that this outcome has not previously been reported, and emphasise the importance of electrolyte monitoring in patients receiving angiotensin converting enzyme inhibitors particularly if prescribed in addition to fixed combination proprietary diuretics.

Psychosocial adjustment and general state of health in patients with ileal conduit urinary diversion

The psychosocial adjustment and general state of health were investigated in 66 patients (40 males, 26 females) who had been subjected to an ileal conduit urinary diversion on account of bladder cancer (44 patients) or incontinence or bladder dysfunction (22 patients). Seventy per cent of the patients reported unchanged, overall, social activity (OSA) after the operation. Twenty per cent reported less and 10% more activity. Bladder-cancer patients were more likely to curtail their social activities compared with the patients with incontinence or bladder dysfunction. Appliance-related problems were mentioned by half of the patients who reported decreased OSA. One-third of the patients considered accidental leakage or fear of such leakage as the most negative aspect of surgery. Factors related to an altered body image were the most common negative aspect reported by females. Despite psychosocial problems, the majority of the patients (80%) considered their health to be good. Males, individuals working full-time and patients with unchanged OSA scored higher on a Health Index, i.e. considered themselves healthier than the rest of the patients.

Deoxyribonucleic acid profile and tumor progression in primary carcinoma in situ of the bladder: a study of 63 patients with grade 3 lesions

In 63 patients with primary grade 3 carcinoma in situ of the bladder flow cytometric deoxyribonucleic acid (DNA) analysis was performed at diagnosis and during an average followup of 63 months. The results of DNA measurements were related to disease progression, that is invasive tumor and/or metastatic disease. The DNA histograms were classified as diploid (2 patients) or aneuploid (61). A total of 3 categories of aneuploid tumors with different prognostic significance could be defined: 1) carcinoma in situ with 1 aneuploid cell population at diagnosis and with no change to multiple aneuploid cell populations throughout observation, 2) carcinoma in situ with 1 aneuploid cell population at diagnosis but with a later change to multiple aneuploid cell populations and 3) carcinoma in situ with multiple aneuploid cell populations already at diagnosis. At 5 years the progression-free survival for the 3 categories was 94%, 43% and 20%, respectively. Over-all, of the patients with multiple aneuploid cell populations (categories 2 and 3) 76% had progression, in contrast to 19% of those in category 1 (p less than 0.0005). In category 2 development of multiple aneuploid cell populations preceded progression in 8 of 11 progressive cases by an average of 20 months. Therefore, the occurrence of multiple aneuploid cell populations must be considered as a sign of high aggressiveness. We conclude that flow cytometric DNA analysis is a potent predictor of prognosis in cases of primary carcinoma in situ of the bladder.

Comparative histopathology and deoxyribonucleic acid flow cytometry of random mucosal biopsies in untreated bladder carcinoma

In a study of 290 patients with untreated carcinoma of the bladder, histopathological studies of random mucosal biopsies were compared with the results of deoxyribonucleic acid (DNA) flow cytometry. By histopathology the findings were classified as severe atypia corresponding to primary grade 3 carcinoma in situ, atypia not fulfilling the criteria for carcinoma in situ and no atypia. The DNA histograms were classified as diploid or aneuploid. Aneuploid cell populations in mucosal biopsies were found mainly in cases with aneuploid tumors of grade 3. Of the biopsies classified as concomitant carcinoma in situ 76% were aneuploid. In biopsies exhibiting less severe or no atypia aneuploidy was found in 41 and 10%, respectively. For these 3 morphological categories the distributions of the aneuploid cell populations were similar irrespective of the histopathological findings and they were also the same as that found in primary carcinoma in situ. We concluded that gross chromosomal aberrations may appear at an early stage of the tumor development and before changes recognizable by morphology. The similarity of the DNA profiles of the aneuploid cell populations, regardless of morphological findings, indicates that apart from gross chromosomal aberrations changes of the phenotype are necessary for the expression of morphological changes.

Digital rectal examination versus transrectal ultrasound in detection of prostate cancer. Preliminary results from a study of a randomly selected population

In a study of 2,400 randomly selected men (age 55-70 years) for early detection of prostate cancer the authors have compared the diagnostic value of digital rectal examination (DRE), transrectal ultrasound (TRUS) and prostate specific antigen (PSA). Altogether 62 prostate cancers were detected, corresponding to a detection rate of 3.5% but by use of DRE the detection rate was only 2.3%. The study showed that TRUS added significantly to the detection rate. If radical surgery is restricted to stages T1 and T2A, the combined use of DRE and TRUS detected twice as many cases fit for this treatment than DRE alone. The authors advocate randomized studies for evaluation of early radical treatment of prostate cancer. Before results of such studies have appeared they recommend methodological studies aimed at development and enhancement of the accuracy of the diagnostic tools.

Fine-needle aspiration biopsy with a new automatic fine-needle gun versus histological core in ultrasonically-guided transrectal biopsy for detection of prostate cancer

In connection with a health control study of 2,400 men for early detection of prostate cancer the authors have compared fine-needle aspiration biopsy using a new automatic fine-needle gun with histological cores obtained by the Biopty gun. Both procedures were ultrasonically guided. Prostate cancer was found in 62 patients and in 46 of these both biopsy methods were used on the same occasion. There was no essential difference in sensitivity between the two methods. The authors recommend fine-needle aspiration biopsy as the primary method but regard the histological core technique as a valuable supplement.

Conventional heparin and semisynthetic heparin analogue (SSHA) alteration of blood coagulation after embolic occlusion of human renal circulation

Blood coagulation and fibrinolytic variables were measured in a peripheral vein in a study of 21 consecutive patients before and after angio-embolization of renal carcinoma. The first ten patients received conventional heparin, 5000 IU twice daily, and the following eleven a semi-synthetic heparin analogue (SSHA), 50 mg twice daily, for 5 days. The first injection was given 2 hours before embolization and the last injection at least 12 hours before the last blood sampling. Both groups showed increased levels of FPA on day 5-7, indicating that the anticoagulant influence had ceased. F VII levels decreased only in the SSHA group from embolization to day 3, but were increased in both groups on day 5-7. Levels of thrombin-antithrombin complexes (TAT) were significantly increased in the heparin group 2 hours after embolization, indicating that thrombin activity had been formed. The corresponding TAT level in the SSHA group was not significantly increased. The differences could possibly indicate a different mechanism of action on blood coagulation of SSHA as compared with heparin, with involvement of extrinsic pathway and maybe by-passing antithrombin III inhibition.

The impact on work ability of ileal conduit urinary diversion

The purpose of the study was to investigate to what extent ileal conduit urinary diversion influenced patients' capacity to work. Sixty-sex urostomy patients were interviewed. Forty-seven of those were employed before surgery. Sixteen of 47 patients (34%) made permanent changes in their working conditions immediately after surgery, i.e. they did not resume work or they changed from full-time to part-time work. The working conditions changed in similar ways for another 15 patients who initially had been able to resume. Bladder cancer patients were more likely to work less than patients with incontinence/bladder dysfunction. Nineteen patients obtained disability pension either immediately after surgery or later. Eight of those considered stoma related problems, mainly leakage, as the main reason for inability to work. Diagnosis, gender, and type of work did not seem to affect the frequency of disability pension.

Urostomy appliances and stoma care routines. The relation to peristomal skin complications

The aim of the study was to describe types of appliances and stoma care routines and evaluate their relation to peristomal skin complications. Sixty-six patients with a cutaneous uretero-ileostomy were interviewed and the peristomal skin was assessed according to Classification of Peristomal Skin (CPS). The results show a conservatism regarding the types of appliance and the stoma care routines. More than half of the patients used the same product at follow-up as they were initially fitted with three to 14 years earlier. The routines adopted by the patients were often inadequate, resulting in skin complications. Continuous exposure of the skin to urine by creation of a too wide opening in the face-plate and infrequent changing of the appliance resulted in development of pseudoverrucose skin lesions.

Local status of the urinary stoma--the relation to peristomal skin complications

Sixty-six patients with uretero-ileostomy were investigated with special regards to local status of the urinary stoma, i.e. stomal site, length, size/shape, and peristomal skin. Each variable was defined. In reports from other centres there has been a lack of definitions making it difficult to compare results from different studies. One fifth of our patients had inadequately located stomas and 85% had stomas shorter than 1 cm. The peristomal skin status was assessed according to CPS, Classification of Peristomal Skin. Eight per cent of the patients exhibited severe erythematous/erosive lesions and one fifth pseudoverrucose lesions. The relation between skin lesions and local status of the urinary stoma was analyzed. Patients with inadequately located stomas were more likely to show severe erythematous/erosive lesions and there was a tendency towards patients with stomas shorter than 1 cm, more frequently exhibiting pseudoverrucose lesions.

Blood coagulation alterations after embolic occlusion of the renal circulation

Alterations in blood coagulation and fibrinolysis after embolic occlusion of renal adenocarcinoma were investigated in 11 patients. Peripheral vein blood was collected before, 2 hours after and on the first, third and fifth to seventh day after embolization. Five patients had renal vein blood sampling before and 2 hours after embolization. Increased levels of fibrinogen, plasminogen and antiplasmin were found on days 1-3. Antithrombin III showed a slight decrease between days 1 and 3 after embolization. All measured variables were lower in renal vein compared with simultaneous samples from peripheral vein. In renal vein samples, consumption of antiplasmin and antikallikrein was indicated. Fibrinopeptide A (FPA) was increased, with a mean maximum 2 hours after embolization. The findings seemed mainly to monitor acute phase reaction but also activation of blood coagulation and fibrinolysis. Embolization might be used as a human model of coagulation activation and acute phase reaction.

Intrapericardial bleomycin for the management of cardiac tamponade secondary to malignant pericardial effusion

A patient with malignant pericardial effusion with cardiac tamponade was treated by the instillation of intrapericardial bleomycin. The tumour deposits elsewhere in the body continued to progress and eventually killed the patient, but drainage and one dose of intrapericardial bleomycin prevented further episodes of pericardial effusion.

Comparative flow cytometric deoxyribonucleic acid studies on exophytic tumor and random mucosal biopsies in untreated carcinoma of the bladder

In 290 patients with untreated carcinoma of the bladder the deoxyribonucleic acid properties, as measured by flow cytometry, of 3 random mucosal biopsies were studied and compared to those of the exophytic tumors. Mucosal aneuploidy was found with few exceptions in aneuploid tumors only, and in a significantly lower frequency in aneuploid tumors of grade 2 than grade 3. The individual specificity of bladder tumors is emphasized by the observation that the level of ploidy was mostly the same in aneuploid mucosal biopsies as in the exophytic tumor. This is underlined further by the occurrence of cell populations of the same ploidy in different parts of the bladder mucosa. However, S-phase values of the concomitant intraurothelial lesions were significantly lower than those of the exophytic tumors. Therefore, we concluded that the process of evolution from malignantly transformed lesions, confined to the urothelium, to an exophytic or invasive tumor is dependent on a further elevated proliferation of the urothelial lesions.

Classification of peristomal skin changes in patients with urostomy

Peristomal skin lesions in patients with ileal conduit urinary diversion have been reported in frequencies ranging from none to occurrence in 100% of patients. In previous studies skin lesions often are referred to in unspecific terms, which has made it impossible to compare results with those of other studies. Thus a classification of peristomal skin (CPS) has been developed on the basis of macroscopic peristomal findings. It defines what can be accepted as ordinary findings, as well as two different types of skin lesions, erythematous-erosive and pseudoverrucous. Each of these is divided into two subgroups. Such a classification is a prerequisite for a meaningful comparison of the type, incidence, and severity of skin lesions in different groups; it also may allow a more reliable clinical evaluation of new ostomy appliances and skin care products. In addition, CPS may also facilitate communication among professionals who are responsible for the care of ostomy patients.

Haematological and biochemical observations during a 750 mile relay

During a marathon relay from John O'Groats to Lands End (JOGLE) various blood and urine parameters were measured in the runners. Samples of blood and urine were taken from each runner immediately prior to the event and on two occasions during it. Subsequently a three point plot was made for each parameter measured. No special diet was taken. Food and liquid refreshment was provided during the run, the first two days of which came from the organisers. The total distance covered was 870 miles and the time taken one hundred hours and thirty-two minutes. Although the results do not approach statistical significance a trend has been shown suggesting that even with the modern running shoe injury may still occur.

Hydrodynamics of micturition in stress-incontinent women. Comparisons of pressure and flow at different micturition volumes in stress-incontinent and continent women

The urethral flow, resistance and closure pressure and bladder pressures in 19 stress-incontinent but otherwise healthy women were compared with the same parameters in 19 healthy, continent women. The micturition studies were performed at three predetermined levels of bladder filling. The urethral closure pressure, the premicturition intravesical pressure and detrusor pressure at micturition were significantly lower in the stress-incontinent women than in the continent group. The intravesical opening pressure showed no intergroup difference. The urethral and bladder pressure measurements in the incontinent women indicated musculo-elastic tissue with greater compliance and less contractility than in normal women.

Direct transmural measurement of the detrusor pressure. A technique of detrusor pressure recording in micturition with intravesical and prevesical suprapubic catheters compared with recordings using a rectal balloon and rectal open-end catheters

A technique of suprapubic recording of intravesical and prevesical pressure is presented. We conclude that rapid intraabdominal pressure changes (cough) and slow and sustained pressure changes (long strain) are equally transmitted to the bladder and to the prevesical space. When intraabdominal pressure is increased, the prevesical route of recording gives more uniform values of intraabdominal pressure elevations than do recordings from the rectum via rectal balloon and rectal open-end catheters. In micturitions with an initial bladder volume of 400 ml the suprapubic prevesical catheter functions well and the pressure recorded is not significantly different when compared with rectal recordings of extravesical pressure. The advantages associated with the use of suprapubic catheters are that identical recording systems with open-end catheters are used for both intravesical and extravesical recordings and that detrusor pressure is recorded directly as the transmural pressure difference.

Clinical experiences of direct transmural measurement of the detrusor pressure

The clinical value of a technique using suprapubic catheters prevesically and intravesically for detrusor pressure recordings is analysed. The method has been used in 143 investigations including both males and females. The complication rate is low, 2.8%, and the advantages of a well defined measuring level and identical measuring systems for all pressure recordings are stressed. It is also concluded that there seems to be no risk of infection. For repeated investigations, such as when, for instance a second postoperative urodynamic check is wanted, this technique does not involve any drawbacks due to surgical trauma. The technique with two suprapubic catheters is well accepted by the patients and is preferred to rectal catheters by volunteers who have tried both types.

Hydrodynamics of micturition in healthy females: pressure and flow at different micturition volumes

A new urodynamic technique, in which detrusor and bladder pressures are recorded with suprapubic percutaneous catheters, was used for investigation of 19 healthy female volunteers to obtain urodynamic reference values. The investigation was made in parous as well as in nulliparous women of varying ages. Apart from a significantly elevated premicturition pressure in the elderly women, neither age nor parity seemed to change urodynamic parameters. Voidings with three different, defined bladder volumes in each volunteer indicated that flow increased with a larger volume up to a certain limit (400 ml) but further increase of volume did not raise the flow. All total bladder pressures, maximum detrusor pressures, and detrusor pressures at maximum flow at micturitions were independent of bladder volumes. Micturitions were made as detrusor micturitions as all volunteers were requested not to strain at voiding. It is considered that detrusor micturitions must be the best way to obtain comparable parameters from different urodynamic investigations.

Urodynamic effects of oral benzilonium bromide in healthy subjects

Benzilonium bromide (Ulcoban) has been tried in oral administration in 10 healthy volunteers, 5 of whom got the substance in a fast-release form and 5 in a combination of fast- and slow-release preparation. Serum concentration analyses show that the subject after 1 week of treatment has a certain amount of active substance in blood 12 h after the last administration. There is an increase in serum concentration during the morning hours after administration of another dose at least 1 h before breakfast. The serum concentration is higher when the fast-release form is used. We found in the urodynamic investigation, after 1 week of treatment, an effect on detrusor pressures and urinary flow. In micturitions with a large initial bladder volume, when the patient more easily can initiate a micturition, the difference is not statistically significant. When the initial bladder filling is small, it is more difficult to initiate a micturition, and at an initial bladder volume of 200 ml the difference between micturition with and without benzilonium bromide is more marked, especially in urinary flow and detrusor pressures where the differences are statistically significant.

Urodynamic effects of intravenous benzilonium bromide in healthy subjects

The urodynamic effects of benzilonium bromide (Ulcoban) were investigated. In 5 healthy subjects a decrease of the maximum detrusor pressure, maximum urinary flow and maximum intravesical pressure were recorded as well as in increase of the residual volume. A significant effect on pulse rate but no effect on systolic or diastolic blood pressure was found.

Von Garrelts' uroflowmeter. A technical evaluation

Von Garrelts' uroflowmeter, commercially available, was tested at different true flow rates and jet velocities. The impact geometry was varied. Results show that flow-rate recording with von Garrelts' uroflowmeter is little influenced by variations of these parameters, and the instrument can be recommended for scientific and routine clinical use.

Porphyria cutanea tarda, carcinoma of bronchus, rheumatoid arthritis, right hydronephrosis

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