408Albuminuria as a predictor of incident ischemic stroke and myocardial infarction in patients with type 2 diabetes but without cardiovascular disease: A Danish cohort study

Background

Risk stratification in patients with type 2 diabetes continues to be an important priority in the management of diabetes-related morbidity and mortality. International guidelines generally recognize patients with diabetes and cardiovascular disease as high-risk patients. Risk stratification is, however, more uncertain in diabetes patients without cardiovascular disease. Micro- and macroalbuminuria have previously been identified as predictors of cardiovascular events and mortality in general cohorts of diabetes patients. However, less is known about the predictive value of albuminuria in patients with diabetes but without established cardiovascular disease.

Purpose

We aimed to examine the association between albuminuria level and the risk of ischemic stroke, myocardial infarction, and all-cause mortality in patients with type 2 diabetes and without a diagnosis of cardiovascular disease.

Methods

We linked Danish nationwide registries to identify patients with type 2 diabetes and without cardiovascular disease from May 2005 through June 2015. Based on two consecutive measurements of the urinary albumin excretion rate or albumin-to-creatinine ratio patients were stratified in categories of normoalbuminuria, microalbuminuria, and macroalbuminuria. Patients were followed for the outcomes ischemic stroke, myocardial infarction, and all-cause mortality until December 31, 2015. Five-year risk of outcomes were presented as cumulative incidence functions (with death as a competing event). Associations between albuminuria level and incidence of ischemic stroke, myocardial infarction, and all-cause mortality were evaluated with Cox proportional hazard regression adjusted for cardiovascular risk factors.

Results

The study population included 78,841 patients with type 2 diabetes (44.7% females, mean age 63.2). When comparing patients with microalbuminuria to patients with normoalbuminuria in an age- and sex-adjusted analysis, we found hazard ratios (HRs) of 1.45 (95% CI: 1.24–1.69), 1.45 (95% CI: 1.24–1.70), and 1.50 (95% CI: 1.39–1.61) for ischemic stroke, myocardial infarction, and all-cause mortality, respectively. Furthermore, macroalbuminuria was associated with HRs of 2.05 (95% CI: 1.70–2.48), 2.25 (95% CI: 1.86–2.71), and 2.03 (95% CI: 1.85–2.23) for ischemic stroke, myocardial infarction, and all-cause mortality, respectively. Similar results were found after adjusting for cardiovascular risk factors.

Conclusions

In this nationwide cohort study of patients with type 2 diabetes but without cardiovascular disease, patients with micro- and macroalbuminuria had a higher risk of incident ischemic stroke, myocardial infarction, and all-cause mortality. This finding supports that patients with micro- or macroalbuminuria should be screened regularly and followed closely in clinical practice. Moreover, these findings suggest that patients with type 2 diabetes and micro- or macroalbuminuria may benefit from intensive vascular risk reduction.

Short-term impact of HbA1c on morbidity and all-cause mortality in people with type 2 diabetes: a Danish population-based observational study

AIMS/HYPOTHESIS

In a population-based setting, we investigated whether diabetes-related morbidity and all-cause mortality within 2 years of HbA(1c) measurement were associated with that HbA(1c) level in individuals with type 2 diabetes. The main objective was to compare outcomes in those with HbA(1c) ≥ and <7% (53 mmol/mol).

METHODS

Individuals with type 2 diabetes from Aarhus County, Denmark, were identified from public data files in a 3 year period (2001-2003). Stratifying the 17,760 individuals by HbA(1c), we estimated HRs for diabetes-related morbidities and all-cause mortality using Cox regression. Results were also stratified by treatment modality.

RESULTS

In total, 1,805 individuals experienced at least one diabetes-related morbidity and 1,859 individuals died. In general, the HRs in adjusted analyses of diabetes-related morbidity and mortality were increased for HbA(1c) ≥ 7% (53 mmol/mol): morbidity, HR 1.48 (95% CI 1.34, 1.63); and mortality, HR 1.26 (95% CI 1.15, 1.39). On grouping individuals according to HbA(1c) <5% (31 mmol/mol), 5.0-5.9% (31-41 mmol/mol), 6.0-6.9% (42-52 mmol/mol), 7.0-7.9% (53-63 mmol/mol), 8.0-8.9% (64-74 mmol/mol) and ≥ 9% (75 mmol/mol), the HRs for mortality formed a U shape, with HbA(1c) 6.0-6.9% (42-52 mmol/mol) at the lowest point. For diabetes-related morbidity, a dose-response pattern appeared (lowest for HbA(1c) < 5% [31 mmol/mol]). Patterns of HR differed with treatment modality.

CONCLUSIONS/INTERPRETATION

An HbA(1c) level ≥ 7% (53 mmol/mol) was associated with increased morbidity and mortality. Both high and very low levels of HbA(1c) were associated with increased mortality. A dose-response pattern appeared for morbidity. The impact of HbA(1c) level on morbidity and mortality depended on treatment modality.

Improved quality of Type 2 diabetes care following electronic feedback of treatment status to general practitioners: a cluster randomized controlled trial

AIMS

To evaluate the effect of an electronic feedback system to general practitioners on quality of Type 2 diabetes care.

METHODS

  A cluster randomized, controlled trial with 15 months follow-up. Eighty-six general practices (158 general practitioners) in a Danish county caring for 2458 people 40-70 years old with Type 2 diabetes were randomized to receive or not to receive electronic feedback on quality of care. People with Type 2 diabetes were identified using a validated algorithm. Primary end-points were processes of care according to guidelines on prescriptions redeemed for Type 2 diabetes treatments, measuring of glycated haemoglobin and cholesterol and visits to ophthalmologists. Secondary end-points were changes in level of glycated haemoglobin and serum cholesterol. Data were analysed using generalized linear models accounting for clustering at practice level.

RESULTS

During follow-up, people with Type 2 diabetes in the intervention group more often redeemed recommended prescriptions than people in the control group, respectively, as follows: oral antidiabetic treatment (32.8 vs. 12.0%, P =0.002), insulin treatment (33.8 vs. 12.4%, P < 0.001), lipid-lowering medication (38.3 vs. 18.6%, 0.004) and blood pressure medication (27.6 vs. 16.3%, P = 0.026). There were no differences in mean glycated haemoglobin and serum cholesterol between the two groups.

CONCLUSIONS

Electronic feedback to general practitioners on the quality of Type 2 diabetes care resulted in significantly improved quality regarding processes of care according to guidelines. It was not possible to demonstrate any effect on secondary end-point measures within the follow-up period. Electronic feedback on quality of diabetes care can be effective in improving adherence to treatment according to evidence-based guidelines.

Volume changes in polycystic kidneys during chronic dialysis and after renal transplantation

Renal volume was determined by repeated CT scanning in 26 patients with adult polycystic kidney disease after institution of replacement therapy for terminal renal failure. Thirteen patients, treated for an average period of 6.7 years (SD 3.4, range 1.1-13.7), had a functioning necrokidney graft at the close of the study and had been grafted for 80.8% (SD 18) of the total treatment time. They showed a reduction of renal volume averaging 1.07% (SD 0.89) per month. Thirteen patients, treated for an average period of 5.7 years (SD 3.3, range 1.2-12.2), were on dialysis at the close of the study. Four had been on dialysis only, 9 had carried one or more (rejected) necrokidney grafts for 22.8% (SD 25) of the total treatment time. Three of them showed a significant increase in renal volume, whereas ten showed a decrease. The average change of renal volume in the entire group was -0.28% (SD 1.36) per month, significantly smaller than in the transplanted patients (p less than 0.01). It is concluded that polycystic kidneys shrink after successful grafting, whereas volume changes vary on dialysis treatment.

The Danish National Diabetes Register: trends in incidence, prevalence and mortality

AIMS/HYPOTHESIS

The aim of the study was to describe trends in the incidence rate, prevalence and mortality rate for diabetes in Denmark.

METHODS

Healthcare registers at the National Board of Health were used to compile a register of diabetic patients in the Danish population (5.4 million people). Age- and sex-specific prevalence, incidence rates, mortality rates and standardised mortality ratios relative to the non-diabetic part of the population were calculated.

RESULTS

The register contains records for about 360,000 persons with diabetes; 230,000 were alive at 1 January 2007, corresponding to an overall prevalence of 4.2%. The prevalence increased by 6% per year. In 2004 the incidence rates were 1.8 per 100,000 at age 40 years and 10.0 per 100,000 at age 70 years. The incidence rate increased 5% per year before 2004 and then stabilised. The mortality rate in the diabetic population decreased 4% per year, compared with 2% per year in the non-diabetic part of the population. The mortality rate decreased 40% during the first 3 years after inclusion in the register. The standardised mortality ratio decreased with age, from 4.0 at age 50 years to 2.5 at age 70 years and just under 2 at age 85 years, identically for men and women. The standardised mortality ratio decreased 1% per calendar year. The lifetime risk of diabetes was 30%.

CONCLUSIONS/INTERPRETATION

The prevalence of diabetes in Denmark rose in 1995-2006, but the mortality rate in diabetic patients decreased faster than that of the non-diabetic population. The mortality rate decreased markedly just after inclusion in the register. Incidence rates have shown a tendency to decrease during the last few years, but this finding should be viewed with caution.

The effect of penile vibratory stimulation on male fertility potential, spasticity and neurogenic detrusor overactivity in spinal cord lesioned individuals

PURPOSE

Present the possibility for treatment of male infertility, spasticity, and neurogenic detrusor overactivity in spinal cord lesioned (SCL) individuals with penile vibratory stimulation (PVS).

METHOD

Obtaining reflex-ejaculation by PVS, by using a vibrator developed for this purpose. The stimulation was performed with a vibrating disc of hard plastic placed against the frenulum of the penis (amplitude > or = 2.5 mm). The vibration continued until antegrade ejaculation or for a maximum of 3 minutes followed by a pause of 1 minute before the cycle was repeated, maximally 4 times.

RESULTS

>80% SCL men are able to obtain ejaculation with PVS. Pregnancy rates obtained with home PVS and intra-vaginal insemination was 22-62% (4 studies), and with PVS or electroejaculation and intrauterine insemination/in-vitro fertilization/intracytoplasmatic sperm injection 39-64% (9 studies). PVS was demonstrated to decrease spasticity significantly when measured by the modified Ashworth scale. In addition, a decrease of the number of spontaneous EMG events which probably indicate spasms was observed. Increase in bladder capacity at leakpoint following 4 weeks of frequent ejaculation with PVS treatment was likewise demonstrated.

CONCLUSION

PVS has proved its importance for SCL male fertility, in the years to come its place in treatment of spasticity and neurogenic detrusor overactivity has to be established.

Quantitative analysis of retinopathy in type 2 diabetes: identification of prognostic parameters for developing visual loss secondary to diabetic maculopathy

PURPOSE

To describe whether quantitative assessment of early changes in the morphology of retinopathy lesions can predict development of vision-threatening diabetic maculopathy.

METHODS

We used a nested case-control study, and we studied 11 type 2 diabetes patients who had developed visual loss secondary to diabetic maculopathy. For each diabetes patient, we also studied three matched control patients who had been followed for a comparable period of time without developing visual loss. Fundus photographs describing the early development of retinopathy were digitized and subjected to a full manual quantitative grading on a computer monitor. Differences in the early development of retinal morphology were compared between the two groups. The outcome parameters were changes in the number and area of haemorrhages and exudates in different regions of the fundus, and the weighted distance of these lesions from the fovea and the optic disc.

RESULTS

In patients who developed visual loss secondary to diabetic maculopathy there was significant early progression in the total area and number of haemorrhages and exudates. The haemorrhages had progressed in all retinal areas except the area around the optic disc and the temporal vascular arcades. The exudates had progressed temporally from the fovea and in the retinal periphery.

CONCLUSIONS

The results suggest that a quantitative description of the regional development of early diabetic retinopathy may help in identifying patients who will later develop vision-threatening maculopathy.

Bladder emptying over a period of 10–45 years after a traumatic spinal cord injury

STUDY DESIGN

Epidemiological follow-up study.

OBJECTIVE

To examine the bladder-emptying methods at least 10 years after a traumatic spinal cord injury (SCI).

SETTING

Clinic for Para- and Tetraplegia and Department of Urology, Rigshospitalet, Copenhagen University Hospital, Denmark.

METHODS

Retrospective data collection from patient records and data collected with a follow-up questionnaire. The response rate was 84.6% corresponding to 236 SCI individuals, injured in 1956-1990. There were 82/18% male/female patients and 47/53% tetraplegic/paraplegic. Age at the time of follow-up was 50.5 years in mean (range 28-84). Years from time of injury were 24.1 years in mean (range 10-45).

RESULTS

The use of clean intermittent catheterisation (CIC) rose from 11% at the initial discharge to 36% at the time of follow-up. The use of suprapubic tapping fell from 57 to 31% in the same period, while the use of Crede manoeuvre rose from 5 to 19%. During follow-up, 46% changed bladder-emptying method. The results showed the following trends in change of method: a high proportion of discontinuation in normal bladder emptying, suprapubic tapping and abdominal pressure and a high proportion of continuation when using CIC. 28% found their bladder-emptying method to be a problem; of these 58% were tetraplegic. Of the participants using CIC, 92% reported using hydrophilic-coated catheters.

CONCLUSIONS

Changing of bladder-emptying method among SCI individuals over time is common. CIC alone or in combination with another bladder-emptying method is the most frequently used method of bladder emptying.

SPONSORSHIP

The study was carried out as part of the primary author's PhD-study, which was financed by Medicon Valley Academy and Coloplast A/S.

Elevated plasma levels of vascular endothelial growth factor and plasminogen activator inhibitor-1 decrease during improvement of psoriasis

OBJECTIVE AND DESIGN

An evaluation of angiogenesis related molecules during open treatment of psoriasis.

MATERIALS AND SUBJECTS

Plasma samples and skin biopsies from 16 patients with psoriasis and plasma samples from 13 healthy controls.

TREATMENT

Ranitidine 300 mg orally twice daily for 6 months.

METHODS

Vascular endothelial growth factor (VEGF) and plasminogen activator inhibitor-1 (PAI-1) were determined by ELISA methods in plasma collected from the patients before treatment and after 1, 3 and 6 months. Vessel counts were performed in biopsies from affected skin areas taken before treatment and after 3 and 6 months. The results were compared to simultaneous PASI scores.

RESULTS

Pre-treatment plasma levels of VEGF and PAI-1 were significantly elevated in patients compared with levels in healthy persons (p = 0.02 and p = 0.04, respectively). The plasma levels decreased significantly during treatment (p = 0.03 and p = 0.01, respectively), and the decrease in combined levels correlated with the decrease in PASI score. However, the vessel density in affected skin did not change during treatment.

CONCLUSIONS

Increased pre-treatment levels of VEGF and PAI-1 and decrease during improvement of the disease suggest that the two molecules may play a role in pathogenesis of psoriasis.

HbAlc in an unselected population of 4438 people with type 2 diabetes in a Danish county

OBJECTIVE

To describe the use and level of HbA1c in a large unselected Type 2 diabetic population in Denmark. In addition, to describe the characteristics of the patients and the general practitioners in relation to the monitoring of HbA1c.

DESIGN

Data were collected from public data files for the period January 1993 to December 1997.

SETTING

The County of Vejle with a background population of 342,597 citizens, 303,250 of whom were listed with participating general practitioners.

PATIENTS

The Type 2 diabetic population alive and resident in the county on 1 January 1997.

RESULTS

In a population of 4438 Type 2 diabetics, 73% had a minimum of one annual HbA1c measurement in 1997. No HbA1c measurement was associated with a long history of diabetes, diet treatment or old age. Poor glycaemic regulation was found in 65% of the Type 2 diabetics in 1997. Poor glycaemic regulation was associated with tablet or insulin treatment, age under 70 years and long history of diabetes. The interpractice variation was huge.

CONCLUSION

The quality of HbA1c monitoring of Type 2 diabetics needs to be improved. Possibilities for improvement seem to be present.

Use and validation of public data files for identification of the diabetic population in a Danish county

INTRODUCTION

This study aims to describe the process of identifying people known to have diabetes through public data files, to validate this method, and to describe models for optimization of such identification processes.

PATIENTS AND METHODS

In a study population of 303,250 citizens, the diabetics were identified by combining information from public data files with information from general practitioners. Data validity was checked by comparing the results of data searches in public data files against information from general practitioners and a random sample of diabetics. Two models were defined to optimize the use of public data files for identification of diabetics. In model A the minimum number of parameters needed to obtain a sensitivity as high as possible was identified. In model B the optimal combination of parameters needed to obtain a high positive predictive value combined with a high sensitivity was identified.

RESULTS

A total of 5449 diabetics were identified. Of those 4438 (81%) were classified as Type 2 diabetics and 1011 (19%) were classified as Type 1 diabetics. The data validation revealed that one person was misclassified as a diabetic and 93 persons were misclassified as non-diabetics. In model A the identification parameters included: "prescription", "HbA1c", "chiropodist service" and "glucose service". In model B the optimal combination of parameters was identified as: minimum two HbA1c measurements, minimum one visit to a chiropodist, minimum one prescription or minimum one abnormal HbA1c during one year.

CONCLUSION

Public data files are suitable for identification of both Type 1 and Type 2 diabetics. Models have been developed to identify diabetics and to promote the possibilities of long-term follow-up and quality assessment in an unselected diabetic population in a region.

Cerebral activation during micturition in normal men

Specific cerebral lesions have shown the crucial role of the brain in the control of micturition. The precise identification of the anatomical cerebral structures involved in micturition can contribute to a better understanding of the control of micturition and the development of therapeutic models. Various neuropathological and animal studies have referred to the medulla oblongata, pons, limbic system, superior frontal lobe and premotor cortical regions as areas implicated in micturition control. The aim of this study was to investigate whether the activity of these areas during micturition can be confirmed by PET in normal men. The distribution of the regional cerebral blood flow after bolus injection of (15)O water was used as an indirect measure of cerebral activation. PET scans were performed during the following three conditions: (i) at rest with the bladder empty; (ii) during simulated micturition after instillation of isotonic saline into the urinary bladder; and (iii) the withholding of urine (saline). Normal micturition using this model was achieved in eight out of 12 right-handed normal subjects. The changes in bladder contraction, bladder pressure and intra-abdominal pressure were monitored on-line during the whole scanning session by a cystometry device. The images were analysed using statistical parametric mapping at a significance threshold of P < 0.05 with correction for multiple independent comparisons. Micturition versus rest was associated with bilateral activation of areas close to the postcentral gyrus, inferior frontal gyrus, globus pallidus, cortex cerebelli, vermis and midbrain. On the left side, activation of the middle frontal gyrus, superior frontal gyrus, superior precentral gyrus, thalamus and the caudal part of the anterior cingulate gyrus was seen, while on the right side we found activation in the supramarginal gyrus, mesencephalon and insula. When the threshold value was lowered to P < 0.001 (Z > 3.09) without correction for multiple comparisons, we found additional activation in the medial pontine tegmentum, mesencephalon, right thalamus, right middle frontal gyrus and left insula. When urine- withholding was compared with rest, the left insula showed a tendency to activate. We conclude from this study, in which urinary bladder contraction was verified cystometrically, that the onset and maintenance of micturition in normal men is associated with a vast network of cortical and subcortical regions, confirming observations from clinical and animal studies.

False iliac artery aneurysm following renal transplantation

We report a very rare case of a false iliac artery aneurysm following renal transplantation. The patient was a 51-year-old women who presented with a painful 10 x 10 cm pulsating mass in her left iliac fossa. The patient had received a second cadaveric renal transplantation 5 years previously. The graft never functioned and transplant nephrectomy was performed 2 weeks later. A CT-scanning showed a 10 x 10 cm large aneurysm arising from the left external iliac artery. At operation a large false aneurysm was identified arising from the original transplant anastomotic site. Due to the extent of the aneurysms, a Gortex graft was inserted between the external iliac artery and the common femoral artery. The patient made an uneventful post-operative recovery.

Effect of repeated ejaculation on semen quality in spinal cord injured men

PURPOSE

We evaluate the effect of repeated ejaculations on semen quality in spinal cord injured men.

MATERIALS AND METHODS

The study included 19 spinal cord injured men with anejaculation. Semen was obtained by penile vibratory stimulation in the clinic and patients were instructed in the technique. Optimized vibration parameters were used (2.5 mm. amplitude at 100 Hz.). Penile vibratory stimulation was performed at least once a week for 12 months. Semen quality was examined at baseline and every 3 months during the 1-year study period. Hormonal assays were also performed at each visit. In 9 patients unilateral testicular biopsy was done at baseline and at the end of the 12 months.

RESULTS

Normal sperm counts and low motility were seen at baseline. No semen parameter significantly changed during the 12 months of repeated ejaculation. All hormonal assays during the entire study were within normal range and no significant change was observed. Of the 9 biopsies 6 (67%) showed normal spermatogenesis at baseline and no convincing qualitative changes in testicular histology were seen after repeated ejaculation.

CONCLUSIONS

Repeated ejaculation in spinal cord injured men does not change the typically poor semen quality. Therefore, stagnation in the seminal ducts due to infrequent ejaculation is not the etiology of the poor semen quality in these patients.

[Quality assessment of diabetes care in a large general practice. Identification and biomedical status]

The aims of this study were to describe the diabetic population and to evaluate the routine diabetic care in one general practice. All patients with recognized diabetes were included. Information was collected from each patient's record and from patients' and doctors' questionnaire. One hundred an fourty (1.8%) of the patients had recognized diabetes and 81% of these diabetes had non-insulin-dependent diabetes (NIDDM). According to the records, HbA1c had been monitored in 85% of the NIDDM patients in the preceding year and in 76% of the IDDM patients. The corresponding figures for albuminuria were 84% vs. 76%, for S-creatinine 74% vs. 81%, for S-cholesterol 37% vs. 24%, for weight 47% vs. 43%, for blood pressure 60% vs. 48%, for foot care 67% vs. 62% and for eye examination 76% vs. 75%. International targets for good control were obtained for HbA1c in 42% of cases, for weight in 23%, for blood pressure in 30% and for S-cholesterol in 40% at the last control. The results of the study indicate that there is a continuous demand for quality monitoring and improvement of diabetic care in general practice.

Seminal plasma PSA in spinal cord injured men: a preliminary report

OBJECTIVE

The aim of the study was to evaluate the impact of spinal cord injury on seminal plasma PSA concentration.

MATERIAL

Semen obtained from normal controls (n = 20) and patients (n = 16) with spinal cord injury.

RESULTS

The concentration of prostate specific antigen in seminal plasma depended on the level of spinal cord injury, with significantly lower concentrations in patients with spinal cord lesions below T7 compared to both normal age-matched controls (P = 0.007) and patients with spinal cord injuries at or above T7 (P = 0.017).

CONCLUSIONS

The results add to the previously reported observations of the possible impact of neurogenic stimulation on prostate activity. More studies of neurogenic stimulation in prostate growth and development are warranted to further elucidate the possible impact of neurogenic factors in the development of prostatic diseases.

Studies on mast cells and histamine release in psoriasis: the effect of ranitidine

The purpose of this study was to investigate histamine and skin mast cells in psoriasis before and during 6 months of treatment with high-dose ranitidine. Sixteen psoriasis patients, presenting a mean PASI score of 15.4, were compared with 13 age- and sex-matched healthy controls. Resting extracellular skin levels of histamine and histamine release to mast cell secretagogues, as measured by the microdialysis technique, were increased in involved psoriasis skin compared to normal skin in the controls. Plasma histamine, but not basophil histamine release, was significantly increased in the patients. Mast cells and lymphocytes were significantly increased in numbers in involved versus non-involved skin in the patients, the lymphocytes being predominantly T-lymphocytes expressing HLA-DR activation. During 6 months of ranitidine treatment, mean PASI score of 15.4 decreased to 5.8. The lymphocyte infiltration, but not mast cell numbers, was significantly reduced during treatment, and histamine release to mast cell secretagogues was normalized. These observations suggest that skin mast cells in active psoriasis are functionally hyperreactive. The biochemical findings together with the clinical effect of ranitidine indicate that histamine may be involved in the pathophysiology of psoriasis.

Pregnancy after assisted ejaculation procedures in men with spinal cord injury

OBJECTIVE

To present the results of fertility treatment in 28 men with spinal cord injury (SCI) and their partners.

DESIGN

Retrospective analysis.

SETTING

University hospital outpatient clinic and home.

PATIENTS

Twenty-eight anejaculatory men with SCI and their partners seeking treatment for infertility.

INTERVENTION

Penile vibratory stimulation and electroejaculation as semen retrieval methods. Assisted reproductive techniques used: vaginal self-insemination at home, intrauterine insemination, in vitro fertilization with or without intracytoplasmic sperm injection.

MAIN OUTCOME MEASURES

Ejaculation rate; sperm count and motility; pregnancy rates.

RESULTS

All of the men were able to ejaculate either by penile vibratory stimulation (79%) or electroejaculation (21%). Median total sperm count was 65 million (range, 0.1 to 480) with a median motility of 13% (range, 1% to 60%). Overall, 9 of 28 couples (32%) achieved 10 pregnancies (4 self-insemination, 3 intrauterine insemination, 1 in vitro fertilization, and 2 intracytoplasmic sperm injection).

CONCLUSIONS

An ejaculation rate of 100% was achieved using penile vibratory stimulation as a first treatment option with electroejaculation as a second option. Motivated couples with adequate semen quality may be offered penile vibratory stimulation combined with self-insemination at home. Together with intrauterine insemination or fertilization techniques used in vitro, the pregnancy rate per treatment cycle for SCI couples may approach that of natural procreation in healthy and fertile couples.

[Clinical effect of ranitidine in psoriasis. An open prospective study]

We report the results of an open, prospective study of 20 patients with moderate to severe psoriasis (median PASI score: 15.7) treated with oral ranitidine 300 mg twice daily for six months. No other medication was allowed during the study period. The median PASI score was reduced to 14.5, 9.1 and 5.7 after one, three and six months of treatment, respectively (p < 0.00001). A mild to moderate worsening was observed in 15 patients within the first month of treatment, but this was not followed by exclusion from the study, and long-term treatment improved disease status in most patients. Eight patients continued therapy with ranitidine 300 mg twice daily after the study was completed. None of these patients relapsed during a follow-up period of 12-18 months. The results of the present study suggest that ranitidine may be beneficial in the treatment of some patients with psoriasis.

Quality of semen obtained by penile vibratory stimulation in men with spinal cord injuries: observations and predictors

OBJECTIVES

To study the semen quality and to examine prognostic factors that may affect semen quality in men with spinal cord injuries (SCI) who respond to penile vibratory stimulation (PVS).

METHODS

Fifty-one PVS responders were prospectively examined. Penile vibratory stimulation was induced with optimized vibration parameters. Semen quality was characterized by semen analysis. The gel agglutination test for the presence of antisperm antibodies and serum hormone assays were performed. Characteristics of the spinal lesions, type of bladder management, and hormone assays were compared to semen quality and incidence of azoospermia or total lack of motility.

RESULTS

The mean semen parameters were: volume-1.9 mL (range 0.2 to 7.0); total sperm-457 million (range 0 to 10,900); motility-12.6% (range 0% to 55%); total motile sperm-39.3 million (range 0 to 401); normal morphology-50.1% (range 0% to 90%). Better sperm motility was seen in men with cervical lesions versus those with thoracic lesions (16% versus 7%) and incomplete versus complete lesions (19% versus 10%). There was a higher incidence of azoospermic specimens in men with thoracic lesions versus cervical level (26% versus 3%) and a lower incidence of finding any motile sperm in the specimen (47% versus 81%). Men voiding without catheters had a lower incidence of azoospermia (3% versus 28%). Abnormalities of hormone and antibody tests were rare.

CONCLUSIONS

Better sperm specimens from PVS of men with SCI may be expected from men with higher neurologic level, incomplete lesions, and those voiding without the use of a catheter. Hormonal abnormalities and immunologic causes do not explain the poor sperm quality seen in men with SCI.

[Evaluation and treatment of patients with kidney calculi]

Renal stone disease is a common disorder causing much discomfort and high rates of sick-leave. Surgical treatment has improved dramatically with extracorporeal shock wave lithotripsy, but the recurrence rate is high, and it would be desirable to be able to offer the patients effective steps in prevention of further stone formation. The biochemical abnormalities associated with stone formation are complex and not fully elucidated. It should, however, be possible to reduce the recurrence rate with a relatively simple programme for investigation of the patients. The pathogenesis of renal stones is, therefore, reviewed with reference to a plan for the practical approach to the prevention and management of nephrolithiasis, that has recently been recommended by The National Kidney Foundation, USA.

Pressure-to-cross-sectional area relationships in the proximal urethra of men with bladder outlet obstruction

PURPOSE

Related values of pressure and cross-sectional area in the proximal urethra were measured in patients with bladder outlet obstruction. Urethral opening pressure and elastance (the inverse of compliance) were estimated.

MATERIALS AND METHODS

We studied 15 men with standard urodynamic examinations. The pressure-to-cross-sectional area relationship in the prostatic urethra was determined using a special probe.

RESULTS

Elastance varied significantly along the studied portion of the urethra, with higher values found in the sphincter area. The estimated urethral opening pressure appeared high compared to that in unobstructed cases and without variation along the prostatic urethra.

CONCLUSIONS

The most important effect of prostatic obstruction appears to be the increased urethral opening pressure.

Systemic high-dose ranitidine in the treatment of psoriasis: an open prospective clinical trial

We report the results of an open, prospective study on the efficacy of systemic ranitidine in the treatment of psoriasis. Twenty patients suffering from moderate to severe psoriasis were included in the study. The median pretreatment PASI score was 15.7 (range 6.0-24.7). The patients were treated with oral ranitidine 300 mg twice a day for 6 months; no other medication was allowed during the study period. Eighteen patients completed the study. The median PASI score was reduced from 15.7 to 14.5, 9.1 and 5.7, after 1, 3 and 6 months of treatment, respectively (P < 0.00001). A significant reduction in PASI score was evident at 3 months of treatment. A mild to moderate deterioration occurred in 15 patients within the first month of treatment, but this was followed by improvement during prolonged treatment in most patients. No other clinical and/or biochemical side-effects were observed. Eight patients continued therapy with ranitidine after the study was completed, and none of these patients relapsed during a follow-up period of 12-18 months. The results of the present study suggest that ranitidine may be a beneficial and safe treatment for psoriasis. In addition, high-dose, long-term ranitidine treatment appears to be free from severe adverse effects.

Nocturnal temperature and subcutaneous blood flow in humans

The aim of this study was to investigate the possible relationship between variations in local skin and body temperatures, and a subcutaneous hyperaemia response during sleep in humans. Nocturnal subcutaneous blood flow (SBF) was measured in the lower legs of 9 subjects for 8-12 h under outpatient conditions. The core temperature was measured by a tympanic membrane temperature sensor, and the local skin temperature was measured by a skin temperature sensor. The 133Xe wash-out technique with portable CdTe(Cl) detectors was used for measurement of the SBF. The SBF increased significantly (P < 0.0001) after 1 h sleep, with the hyperaemia persisting for 2 h. During the hyperaemic phase, the local skin temperature increased significantly (P < 0.0001) and then decreased again in the post-hyperaemic phase (P < 0.01). The core temperature decreased significantly during the measurement period (P < 0.01). Separate ordinary linear regression analyses revealed no significant correlations between the measured temperature parameters and the blood flow levels during sleep. The results indicate no governing role of the local skin or body temperatures on the local SBF. The local skin temperature increased significantly secondary to the nocturnal subcutaneous hyperaemia (i.e. active vasodilatation), which is believed to be involved in a thermoregulatory effector mechanism.

Tissue culture supernatants from human islets of Langerhans activate the oxidative burst response of human monocytes in vitro

Macrophages play a major role in the pathogenesis of insulin-dependent diabetes mellitus in animals. These cells are the first to invade the pancreas and macrophage-eradicating treatments reduce the incidence of the disease. In humans, however, their role is less clear. In this study we investigated the hypothesis that the pancreatic environment per se could activate macrophages. Tissue culture supernatants from human islets of Langerhans were tested for chemotactic activity and oxidative burst response in monocytes isolated from healthy adults. Preincubation with the supernatants enhanced the oxidative burst response evoked by fMLP (up to 379%) and opsonized zymosan (up to 173%). The activity decreased by dilution and was no longer detectable at 1:16. No increased activity was seen in supernatants from a number of other human endocrine and non-endocrine primary cells, suggesting a factor specific for islet tissue. The increased oxidative burst response could partially be eliminated by heat- and proteinase K treatment, suggesting that the activity could be of polypeptide nature. The factor could not be absorbed by polyvalent rabbit antibodies directed towards a variety of cytokines not by a mixture of high-titer anti-cytokine antibodies. It is possible that islet factors could also promote such monocyte activation in vivo in monocytes attracted to the islets of Langerhans by other means. This could contribute to the development of insulin-dependent diabetes in humans.

Flavoxate treatment of micturition disorders accompanying benign prostatic hypertrophy: a double-blind placebo-controlled multicenter investigation

To investigate the effect of flavoxate (Urispadol) treatment on patients with symptomatic benign prostatic hypertrophy (BPH), with the main weight on the irritative symptoms, a randomized, double-blind, parallel-group, placebo-controlled and multicenter investigation was carried out. Seventy patients entered the study, 37 were allocated to flavoxate treatment on a daily dose of 1,200 mg (400 mg t.i.d.) for 12 weeks, and 33 patients were allocated to placebo treatment. In spite of a sufficient power, the study did not discriminate the two treatment groups in a statistically significant way (p > 0.05), when considering the main endpoints: the irritative symptom score and the global patient evaluation. Conservative treatment of micturition disorders accompanying BPH with flavoxate in doses of 1,200 mg/day cannot be recommended for clinical use.

Pressure/cross-sectional area relations in the proximal urethra of healthy males. Part 2: Power generation during voluntary contraction

The power generation in the proximal urethra during voluntary squeezing was studied in 30 healthy male volunteers aged 23-85 years. Measurements were performed at 5-mm intervals from the bladder neck and beyond the region of high pressure, and the maximum power generation during contraction was calculated at each measurement location. All subjects were further evaluated by means of symptom score, prostatic volume determined by rectal ultrasound, urethral pressure profile, cystometry, and pressure flow. There was a significant variation in power generation along the urethra, with minimum values in the prostatic segments and an approximately 5-fold increase in the high pressure zone. Power generation remained high in the urethral segment distal to the high pressure zone. No correlation between age and power generation could be demonstrated in any part of the urethra. The technique employed does not allow for a differentiation of the individual muscles involved, however, it is suggested that the pelvic floor dominates above the level of the perineal membrane, whereas the striated muscles of the penis may influence the proximal part of the spongious urethra. Physiologically, the contractile capability of the male urethra is probably important for the continence function, as well as it may be of significance for the normal ejaculatory function.

Pressure/cross-sectional area relations in the proximal urethra of healthy males. Part 1: Elastance and estimated pressure in the uninstrumented urethra

The pressure/cross-sectional area relation in the resting urethra during the storage phase was studied in 31 healthy male volunteers aged 23-85 years. Measurements were performed at 5-mm intervals from the bladder neck and beyond the region of high pressure, and the elastance and estimated pressure in the uninstrumented urethra (Po) were calculated at each measurement location. All subjects were further evaluated by means of symptom score, prostatic volume determined by rectal ultrasound, urethral pressure profile, cystometry, and pressure flow. The elastance and Po both varied along the urethra, with significantly higher values of both parameters in the sphincteric region as compared to the prostatic area. A significant positive correlation was found between Po and age in the prostatic parts of the urethra, whereas no correlation could be demonstrated between elastance and age in any part of the urethra. These results indicate that the prostatic parts of the urethra are readily distensible at modest intraluminal pressures as compared to the sphincteric segment, and that the intraluminal pressure required to obtain a given distension of this segment of the urethra seems to increase with age. It is suggested that the technique may prove of value in the elucidation of pathophysiological mechanisms related to benign prostatic hyperplasia, and that the technique may bring new insight into the mode of action of various treatment modalities for this disease.

Ejaculation induced by penile vibratory stimulation in men with spinal cord injuries. The importance of the vibratory amplitude

A total of 66 men with a spinal cord injury (SCI) and ejaculatory dysfunction were included in two different but comparable study populations I (n = 25) and II (n = 41). The level of lesion ranged from C2 to L1 (44 complete). Penile vibratory stimulation (PVS) to induce ejaculation was performed with two different types of vibrators in population I and considerably different ejaculation rates (antegrade+retrograde) occurred depending on the vibrator used. Our experience suggested discrepancies between the manufacturers' specifications and the actual vibrator outputs concerning frequencies and peak-to-peak amplitudes. Retrospectively performed determinations revealed that the manufacturers' specifications regarding the frequencies were accurate whereas the peak-to-peak amplitudes were inaccurate. With a frequency of 100 Hz and determined peak-to-peak amplitudes of 1 mm and 2.5 mm, ejaculation rates of 32% and 96%, respectively, were obtained in population I. This indicates that an adequate peak-to-peak amplitude is essential to exceed an 'ejaculatory threshold' in the majority of SCI men. Furthermore, an ejaculation rate of 83% obtained in a subsequent prospective study of 41 SCI men (population II) verified that a frequency of 100 Hz and a peak-to-peak amplitude of 2.5 mm seems to approach the ideal vibrator output. The ejaculation responses obtained by JS (first author) were reproduced when the PVS was performed by the patient or his partner, indicating that the vibrator output is more important than PVS experience. No major adverse reactions due to autonomic dysreflexia were observed. The lowest level of SCI where antegrade or retrograde ejaculation occurred was T9 and L1, respectively. No absolute predictors for ejaculatory success or failure in relation to patient age, years since lesion, completeness of SCI, urinary bladder management method, hip flexion and bulbocavernous reflexes were observed. Therefore, most SCI men with ejaculatory dysfunction should be considered candidates for PVS.

Ureteroscopic management of transitional cell tumors

Eighty-nine ureteroscopies, comprising 102 renal units, were performed on 31 patients for diagnosis, treatment or follow-up of transitional cell tumors of the upper urinary tract. The indications were hematuria or filling defect (29 endoscopies), treatment of tumor (19) and follow-up (41), i.e. 33, 21 and 48 renal units. Ureteroscopy (including 2 peroperative) was satisfactorily completed in 93 units. Tumor was suspected or diagnosed in 57 units, but later disproved in 11. Two tumors were overlooked at endoscopy. Surgery was performed in 21 cases (bilateral in 3), with indications based on ureteroscopic findings in 58%. Electroresection, laser photocoagulation or fulguration was done on ten units (average treatment sessions 2.6). Inadequate ureteroscopic treatment led to surgery in two of these units, but in seven open surgery was avoided (follow-up 6-47, mean 25 months). One old patient had no further treatment. Follow-up ureteroscopy was planned for 48 units and completed in 42. Complications occurred after 11 of 89 endoscopies. Ureteroscopic management of upper-tract urothelial tumors can be satisfactory, with long freedom from recurrence.

The dynamic pressure response to rapid dilatation of the resting urethra in healthy women: an in vivo evaluation of visco-elastic properties

The urethral pressure response to a sudden forced dilatation was studied at the bladder neck, in the high-pressure zone and in the distal urethra in ten healthy female volunteers. The pressure response was fitted with a double exponential function of the form Pt = Pequ + P alpha e-t/tau alpha + P beta e-t/tau beta, where Pequ, P alpha and P beta are constants, and tau alpha and tau beta are time constants; this equation has previously been demonstrated to describe the pressure decay following dilatation. On the basis of a theoretical model the elastic and viscous constants for the urethral tissues were computed. The results showed significant differences along the urethra, with the high-pressure zone showing the highest maximum and equilibrium pressures, fastest pressure decay and highest elastic coefficient. The pressure response represents an integrated stress response from the surrounding structures, which reflects the visco-elastic properties of the tissues involved. The findings seem therefore to correlate well with the anatomical findings, which have shown a high fibre density of the horseshoe-shaped rhabdosphincter in the mid-portion of the urethra. The method permits a detailed assessment of static and dynamic urethral responses to dilatation which can be applied as an experimental simulation of urine ingression, and is therefore presumed to be of value in the evaluation of normal and pathological urethral sphincter function.

[Recruitment of patients for clinical trials on psoriasis. A review of recent dermatological literature]

Reports of 62 psoriasis clinical trials listed in the Cumulated Index Medicus during 1988 and 1989, and published only in leading dermatological journals, were evaluated with respect to different elements of research methodology concerned with the recruitment of patients. The evaluation included items such as eligibility criteria, the sampling process, ethical considerations, and sample size calculation. Major weaknesses in the description of all aspects of the recruitment procedure were demonstrated. For example, a quantitative disease activity criterion at entry was mentioned in 15% of the studies, consecutive patients were included in 5% of the trials, approval from an ethics committee and informed consent of patients was mentioned in 16% of the studies and a pre-study sample size calculation was not mentioned in any of the trials.

A technique for measurement of related values of pressure and cross-sectional area in the male urethra

A probe for measurement of related values of cross-sectional area and pressure in the male urethra was constructed. The probe allows induction of variable pressures or fluid volumes in a distensible balloon located in the urethra and simultaneous recording of related values of cross-sectional area and pressure. Cross-sectional area is measured in the range of 11-102 mm2 using the field-gradient principle. Pressure is measured in the range of 0-250 cmH2O using tip transducers. The time constant for cross-sectional area measurement is 0.02 s and that for pressure measurement, 0.007 s. The pressures required to reach the maximal and minimal cross-sectional areas of the balloon are 2.8 and -2.4 cmH2O, respectively. The shape of the probe after its placement in the urethra was studied by transrectal ultrasound in five volunteers. The results showed that the measurement error caused by the slope of the balloon walls or the forced bending of the catheter did not exceed 5%. The method enables a description of the biomechanical properties of the male urethra at rest in terms of estimated pressure at zero cross-sectional area, elastance, and stress-relaxation and at voluntary contraction in terms of work and power as evaluated at well-defined anatomical locations.

Lack of effect of peripheral nervous blockade on nocturnal fluctuations in lower-leg subcutaneous blood flow in man

1. The local subcutaneous adipose tissue blood flow was measured simultaneously in the right and left lower legs of 10 normal human subjects under out-patient nocturnal conditions. The 133Xe-wash-out technique, portable CdTe(Cl) detectors and a portable data-storage unit were used for the measurement of blood flow. 2. The purpose of the study was to unveil the possible role of centrally controlled nerve fibres to the measurement area as mediators of a previously described nocturnal subcutaneous hyperaemia of 2 h duration. Therefore, before the sleeping period, a local nervous blockade was applied immediately proximal to the isotope depot on the right lower leg by the injection of approximately 15 ml of bupivacaine (5 mg/ml) subcutaneously. 3. Control experiments revealed blockade of the baroreceptor vasoconstrictor reflex activity 4 h after application of the local nervous blockade in three subjects examined. 4. Identical nocturnal isotope-wash-out curves were recorded from the two legs. Subcutaneous blood flow was found to increase significantly (P < 0.0001) after approximately 1 h of sleep and the hyperaemia persisted for 2 h. 5. A significant positive correlation was detected between the latency periods from going to bed until the onset of the hyperaemia in the right and left lower legs (P < 0.001, r = 0.95). 6. No significant difference could be detected between the relative blood flow increase during the hyperaemic phase in the right and left lower legs (P = 0.83). 7. It is concluded that the present data seem to rule out a central nervous factor(s) as the eliciting mechanism of the nocturnal subcutaneous hyperaemia.(ABSTRACT TRUNCATED AT 250 WORDS)

[Ejaculation induced by electrostimulation in men with spinal cord injuries]

Five men (aged 29-43 years) with ejaculatory dysfunction and spinal cord injuries for 10-41 years and level of complete lesions from C6 to T10 underwent electrostimulation. Antegrade ejaculate was obtained in all five participants and simultaneous retrograde ejaculation in four. In general, the total number of spermatozoa was greatest in the retrograde ejaculates and highly variable between the subjects both in the antegrade (0.2-5330 mill.) and in the retrograde ejaculates (0.4-5690 mill.). The percentage of immobile and morphologically abnormal spermatozoa was increased compared with normal values. In connection with the electrostimulation procedures no cases of autonomous hyperreflexia or rectal mucosal injury were observed.

The dynamic urethral sphincter function in healthy females assessed by rapid dilatations in the resting state: evaluation of reproducibility

Recording the pressure response to rapid dilatations enables one to assess urethral sphincter function. The rapid dilatations of the urethra experimentally simulate the ingression of urine. A method that enables standardized dilatations of 2-mm long urethral segments was urine (USED).A method that enables standardized dilatations of 2-mm long urethral segments was used, and the subsequent pressure response was measured. The reproducibility of the urethral pressure response to rapid and standardized dilatations was evaluated by repeating the measurements after 1 week in 10 healthy females. The pressure response showed an acceptable reproducibility. The urethral pressure increase as a response to dilatation is considered to rely on stretching of intra- and periurethral fibers. Calculations of strain (change in length divided by the original length) of circularly arranged fibers when the urethra is dilated indicate that the tension (and pressure) bearing layers must be located outside a circular zone with a radius of 4 mm perpendicular to the longitudinal axis of the urethra.

A retrospective evaluation of 691 ureteroscopies: indications, procedures, success rate and complications

In the period of 1983-1990, a total of 691 ureteroscopies were performed in 480 patients. The main indications for ureteroscopy were stones, stenoses or making a diagnosis. In one third of the cases, pathology was suspected in the renal pelvis or at the ureteropelvic junction, in one third in the distal third of the ureter, and in the remaining cases, in either the upper or the middle part of the ureter. The most frequent ureteroscopic procedures were diagnostic examination or surveillance and procedures involving treatment of stones. In the 1st attempt, the ureteroscope was introduced to the suspected pathology in 79.9% of all cases, and the main objective was achieved in 76.6%. The success of stone manipulation has increased from 74% in the 1st to 92% in the last part of the period. More than half the procedures involving a ureteral stenosis were not completed satisfactorily. The location of suspected pathology did not influence the results. Complications occurred in 23% of the ureteroscopies, and the relative number of major complications decreased continuously. We conclude that ureteroscopy is appropriate at any location of pathology and that efforts must be made to minimize both major and minor complications.

Microdialysis of the interstitial water space in human skin in vivo: quantitative measurement of cutaneous glucose concentrations

The purpose of this study was to evaluate the usefulness of a microdialysis technique for measurement of substances in the interstitial water space in intact human skin. Glucose was selected to validate the method. The cutaneous glucose concentration was measured by microdialysis and compared to that in venous blood. Single dialysis fibers (length 20 mm, 2,000 Da molecular weight cutoff) were glued to nylon tubings and inserted in forearm skin by means of a fine needle. Dialysis fibers were inserted in duplicate. Seven subjects were investigated after an overnight fast. Intradermal position of the dialysis probes was established by C-mode ultrasound scanning. The implantation trauma lasted 90-135 min as measured by laser Doppler flowmetry. Each dialysis fiber was calibrated in vivo by perfusing it with four to five different glucose concentrations. The perfusion rate was 3 microliters/min. Regression analysis of the calibration curves yielded the relative in vivo recovery of glucose. The skin glucose concentration was calculated as that particular perfusate glucose concentration that resulted in no net glucose transport across the dialysis membrane. Correlation coefficient of the regression lines was 0.93 +/- 0.03 (mean +/- SEM). After the injection trauma had vanished, recovery was 20.5 +/- 0.7%. Coefficient of variation (CV) on recovery was 10.9%. The cutaneous glucose concentration was 99.1 +/- 1.8% of the glucose concentration in venous plasma water (CV 4.1%). These findings suggest that the microdialysis technique accurately and precisely can reflect biochemical events in the interstitial water space in human skin in vivo.

Subdermal penetration of topically applied clobetasol propionate in ointment base through intact human skin: lack of effect on subcutaneous adipose tissue blood flow

Some data have demonstrated a substantial subdermal accumulation of topically applied drugs in animals. The aim of this study was to evaluate a possible effect of epicutaneously applied clobetasol propionate on blood flow in human subcutaneous adipose tissue. Nine healthy subjects were studied. The 133Xenon wash-out method was used for the measurement of subcutaneous blood flow. Resting blood flow and the local blood flow regulatory mechanisms, autoregulation of blood flow and the veno-arteriolar reflex, were assessed prior to treatment and were measured following 24, 48 and 72 h of treatment. The results demonstrated no effect of clobetasol propionate on resting subcutaneous blood flow or the local regulatory mechanisms.

Diurnal variations in lower leg subcutaneous blood flow rate in patients with chronic venous leg ulcers

The blood flow rate in subcutaneous adipose tissue was measured on the lower legs of 11 patients with chronic lower-leg venous insufficiency and ulceration and in eight age-matched control subjects for 12-20 h, under ambulatory conditions, using the 133Xe wash-out technique with portable Cadmium telluride (CdTe(Cl)) detectors. In both groups, the change from an upright to a supine position at the beginning of the night period elicited an instantaneous increment in the blood flow rate of 30-40% with a decrease in the central and local postural sympathetic vasoconstrictor activity. After approximately 1 h of sleep, a considerable increase in blood flow rate was seen in both patient and control groups which persisted for nearly 100 min. In the patient group, the mean increase was 137% compared to a mean increase of 68% in the control group (P less than 0.01). The blood flow then returned to the same level as at the beginning of the night and remained stable until the subjects woke in the morning. The differences between this nocturnal hyperaemic phase and the adjacent phases were highly significant in both groups (P less than 0.0001 and P less than 0.005, respectively). The blood flow levels measured on the second day were of the same magnitude as those registered on the first day. The mean values of the wash-out rate constants (k) of the two groups were of the same magnitude in all phases of subcutaneous blood flow level, except in the hyperaemic phase, where it was significantly higher in the patient group (P less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Scabies and Pyoderma in Lilongwe, Malawi. Prevalence and seasonal fluctuation

From January 1988 to June 1989, data were collected daily on the patients who were seen at the Dermatology Clinic attached to the Kamuzu Central Hospital, Lilongwe, Malawi. Cases were diagnosed and patients were treated under the supervision of a dermatologist. A total of 34,002 patients were seen during the study period. Of these patients, 15,526 (45.7%) were children and 18,476 (54.3%) were adults. The prevalence of scabies was 40.4% in children and 31.6% in adults, whereas the prevalence of impetigo/bacterial skin infections was 26% in children and 10.4% in adults. Based on data accumulated for periods of 1 month, the incidence rate of scabies was highest during the cold, dry season (May-November) and the incidence rate of skin infection was highest during the hot, rainy season (December-April). Since the patients who were studied lived predominantly in rural settings, an explanation for the higher incidence rate of scabies during the cold season could be close body contact resulting from the overcrowding within the houses. The reason for the increase in the incidence rate of pyoderma during the rainy season might be linked to deficiencies in hygienic precautions. A community-based intervention strategy with children as its target population is proposed to combat these diseases.

[The significance of brain death as a criterion for renal transplantation. Status after 9 months]

The effect of introduction of the brain-death criterion in Denmark on the course of cadaver kidney transplantation was evaluated by comparing the course of 31 consecutive patients transplanted after introduction of brain-death criterion with the course of a similar consecutive group of patients transplanted just before the new death criterion. The consequences of the new death criterion were significantly earlier onset of graft function, diminished need for posttransplant dialyses, reduced need for immunosuppressive treatment with Minnesota-antilymphocytglobulin and briefer hospital stays. The easier postoperative course had great psychological effects for the patients and the staff, and the cost of each transplantation was estimated to be reduced by at least 50,000 DKr per patient (approximately 5,000 pounds).

Method for evaluation of the urethral closure mechanism in women during standardised changes of cross-sectional area

A method for evaluation of the closure mechanism in the female urethra during forced opening has been developed and tested. The cross-sectional area (CA) of the tube and the intraluminal pressure were measured simultaneously by a specially designed balloon catheter. The method enables induction of standardised changes of CA at different rates. Applied in the female urethra the induction results in a distinct pressure response which increases with increasing rate of change of CA as well as size of the induction. The inflation of the balloon simulates a forced opening of the urethra and hence leakage. Obviously, urinary incontinence takes place at forced opening of the urethra. Accordingly, this novel method can give important information on the pathophysiology of stress urinary incontinence in particular and the physiology of sphincter functions in general.