Impact of preoperative antiandrogen medication and nerve-sparing surgery on the outcome of radical prostatectomy.

OBJECTIVES: Radical prostatectomy in antiandrogen-medicated patients, as well as nerve-sparing surgery, has increased within recent years. We investigated the impact of antiandrogen medication on loss of blood and of nerve-sparing surgery on continence and potency. METHODS: A total of 401 men who underwent radical prostatectomy between January 1995 and September 1999 at our clinic were asked about antiandrogenic medication prior to radical prostatectomy and about daily life activities, overall satisfaction, voiding ability, and sexual activities. Consumption of erythrocyte concentrates and cryoprecipitated plasma was taken from the records. RESULTS: The average follow-up was 36 months. Seventy-two percent (n = 289) of our patients replied. Sixty-seven men (23%) who replied to our questionnaire had received antiandrogen medication prior to radical prostatectomy. In 53 (18%) of the men, the nerve-sparing technique was used. In antiandrogen-medicated patients, we observed a significantly elevated consumption of erythrocyte concentrates (antiandrogen-medicated 0.93, not antiandrogen-medicated 0.44; P = 0.013) and of cryoprecipitated plasma (antiandrogen-medicated 0.39, not antiandrogen-medicated 0.08; P = 0.010). Patients who underwent the nerve-sparing technique reported better results in daily life activities, general health status, International Prostate Symptom Score (IPSS), and continence. CONCLUSION: Our results point to a higher quality of life in patients who had undergone nerve-sparing surgery.

[CT-based assessment score after ventral spondylodesis for thoracolumbar spine fracture]. / CT-basierter Auswertungsscore nach ventraler Spondylodese bei thorakolumbalen Wirbelfrakturen.

BACKGROUND: Dorsoventral stabilization is a common procedure to treat thoracolumbar spine fractures. Especially in respect of the evaluation of alternative procedures to autogenous bone graft, a standardized evaluation score for ventral spondylodesis is necessary. PATIENTS AND METHODS: In a group of 44 patients a follow-up CT scan was evaluated with a standardized scoring system by four different independent evaluators (a trauma surgeon, an orthopedic surgeon, and two radiologists). The score is based on the morphologic classification of the region between graft and vertebral body. It allows a classification of the spondylodesis as sufficient, partial, and not sufficient. RESULTS: The statistical evaluation of the classification of the different evaluators shows very good interobserver agreement in monosegmental fusion and good agreement in bisegmental fusion. CONCLUSION: The demonstrated score is easy to handle, does not need special equipment for CT scans, and shows good interobserver agreement in the classification of spinal fusion after ventral spondylodesis for thoracolumbar spine fracture.

Low-cost data transfer from a questionnaire to standard software using a barcode pen.

Computer-aided transfer of questionnaire data simplifies the analysis of questionnaires. We present a solution based on an inexpensive barcode pen and its decoder, the software tool Barcode Wizard included in CorelDRAW, and a self-developed application written using Microsoft Visual Basic for Applications. The barcode may be provided on the questionnaire or on a transparency. Error correction is done by means of two different procedures. The present solution can be applied while looking over the completed questionnaire and thus allows time-saving, economic, and precise data transfer from the completed questionnaire directly into computer software.

[Simplified production of multimedia based radiological learning objects using the flash format]. / Vereinfachte Herstellung multimedialer radiologischer Lernobjekte mit dem Flash-Format.

PURPOSE: Evaluation of the applicability of the Flash Format for the production of radiological learning objects used in an e-learning environment. MATERIAL AND METHODS: Five exemplary learning objects with different didactic purposes referring to radiological diagnostics are presented. They have been intended for the use within the multimedia, internet-based e-learning environment LaMedica. Interactive learning objects were composed using the Flash 5.0 software (Macromedia, San Francisco, USA) on the basis of digital CT and MR images, digitized conventional radiographs and different graphical elements prepared as TIFF files or in a vector graphics format. RESULTS: After a short phase of initial skill adaptation training, a radiologist author was soon able to create independently all learning objects. The import of different types of images and graphical elements was carried out without complications. Despite manifold design options, handling of the program is easy due to clear arrangement and structure, thus enabling the creation of simple as well as complex learning objects that provided a high degree of attractiveness and interaction. Data volume and bandwidth demand for online use was significantly reduced by the Flash Format compression without a substantial loss of visual quality. CONCLUSION: The universally compatible Flash Format offers an opportunity for the simple production of radiological learning objects that fulfill all relevant needs of modern internet based e-learning environments, such as interactivity, employment of multimedia and convertibility.

[Quality of life following radical prostatectomy]. / Lebensqualität nach radikaler Prostatektomie.

PURPOSE: To investigate quality of life in prostate cancer patients after radical retropubic prostatectomy. MATERIALS AND METHODS: 401 men who underwent radical prostatectomy between January 1995 and September 1999 at our clinic were asked for information concerning daily life activities, overall satisfaction, voiding ability and sexual activity in standardized questionnaire. RESULTS: The average follow-up was 36 months, 72 % (n = 289) of our patients replied. In 53 (18%) of the men who replied to our questionnaire, the nerve-sparing technique had been used. At the time our patients were questioned, 202 (70%) did not use any pads, and 211 (73%) were satisfied or very satisfied with the outcome. Of these patients 98% would undergo a radical prostatectomy again. 13% (n = 37) of our patients reported limited satisfaction, 14% (n = 41) were not satisfied with their postoperative status. However, 69% of this latter group would nevertheless decide to have a radical prostatectomy again. Of the patients who underwent the nerve-sparing technique, 68% (n = 36) reported sufficient erections for sexual intercourse, four of them under medication with sildenafil. Patients who underwent the nerve-sparing technique reported better results in daily life activities, general health status, IPSS-score and continence. While age at the time of radical prostatectomy did not influence life quality, we found substantial correlation with the postoperative tumor stage. CONCLUSIONS: Our results underline the importance of early prostate cancer detection, not only regarding a lower recurrence rate, but also because of a better postoperative quality of life.

Genetic influence on blood pressure and lipid parameters in a sample of Polish twins.

We studied 76 healthy monozygotic (MZ) and same-sex dizygotic (DZ) twin pairs (mean age 35 +/- 8 years, body mass index, BMI, 23.6 +/- 3.9 kg/m2) to determine genetic and environmental contributions to systolic (SBP) and diastolic (DBP) blood pressure, heart rate (HR) and serum lipids [total cholesterol (TC), low-density lipoprotein cholesterol (LDL-chol), high-density lipoprotein cholesterol (HDL-chol) and triglycerides (TG)I. SBP, DBP and HR were measured clinically and by ambulatory blood pressure monitoring (ABPM). Parameters of the genetic models for age-, sex- and BMI-adjusted data were estimated by model fitting and path analysis technique using LISREL 8. We found significant genetic effect on SBP and DBP for both clinical and ABP measurements, ranging from 37% for night-time ambulatory DBP to 79% for daytime ambulatory SBP. Estimates of genetic effects were higher for daytime than night-time ABP values, and higher for ambulatory 24-h SBP than office SBP measurements, with the reverse true for DBP. Significant genetic effect on HR ranged from 59% for office measurements to 69% for 24-h mean values. In summary, we also found genetic effect on TC, LDL-chol and HDL-chol with estimates ranging from 36% to 64%, but not on TG. Furthermore, a shared environmental component for TG was found, estimated at 36%. We showed significant genetic effect on both office and ambulatory BP and HR, with stronger genetic effect on daytime than night-time BP. We also found genetic effect on TC and lipoprotein fractions, but no significant genetic effect on TG. Environmental factors influencing serum TG, such as alcohol consumption, may explain the apparent lack of genetic effect in this healthy, non-obese population.

N-acetyltransferase 2 phenotype in painters with bladder cancer and controls.

AIM: This study was designed to evaluate the impact of N-acetyltransferase 2 (NAT2, substrate: aromatic amines) in painters with bladder cancer and controls. BACKGROUND: Until the beginning of the 1960s, painters in Germany have used, among others, azo dyes based on carcinogenic aromatic amines. MATERIALS AND METHODS: Sixteen painters with bladder cancer and 26 healthy painters (controls) who were from the same area in Germany and in the same age group (+/-5 years) were recruited into the study. All subjects were phenotyped for NAT2 by the molar ratio of two caffeine metabolites in the urine which was determined by the high performance liquid chromatography (HPLC) method. The number of years working as a painter, age at first exposure to paints and the life-time smoking habits of subjects were noted. RESULTS: Fourteen cases and 23 controls had been exposed to paints before 1960. Age at first exposure to paint was 15.5 years (SD 5.3) in cases and 16.3 (SD 4.9) years in controls. Cases had worked 31.1 years (SD 15.0) and controls had worked 44.8 years (SD 7.2) as painters. Four cases and 7 controls were non-smokers. In this study, 88% of cases and 65% of controls were of the "slow" acetylation and phenotype, CONCLUSION: The result point to and impact of the slow acetylation status as an individual risk factor for bladder cancer in persons occupationally exposed to amounts of carcinogenic aromatic amines released from water-soluble azo dyes.

Cultures of exfoliated epithelial cells from different locations of the human urinary tract and the renal tubular system.

Exfoliated human urinary tract epithelial cells and renal tubular cells from urinary sediments of healthy adults, of urological patients and of internal patients were isolated and cultured. Cells started proliferating within 1 week after seeding a sediment. Proliferating cells formed colonies of different morphologies, designated as type-1 or type-2 cell colonies. Type-1 cell colonies showed irregular contours and spindle-like cells within the colonies. Subcultivation of type-1 cells for up to six passages was possible. Type-2 cell colonies showed smooth-edged contours and subcultivation was not possible. The epithelial character of type-1 cells was demonstrated by positive immunohistochemical staining for cytokeratin-7. In contrast to carbonic anhydrase-positive stained Madin Darby canine kidney cells (MDCK), which were used as positive controls for renal tubular cells, type-1 cells were carbonic anhydrase-negative on staining with the cobalt phosphate method. This indicates that type-1 cells were not of renal tubular origin. Type-2 cells were positively stained for carbonic anhydrase, indicating that type-2 cells were renal tubular cells. Type-2 cell colonies could be assigned to two subgroups with different cell forms. Colonies of cobblestone-like cells more often occurred than type-2 cell colonies with spindle-like cells, which are described in this study for the first time. Colonies with cobblestone-like cells formed domes (hemicysts), whereas spindle-like type-2 cell colonies did not. Cultures of urinary sediments from healthy adults, elderly multimorbid patients treated with furosemide, and urological patients with urolithiasis treated with sulfamethoxazole/trimethoprim and/or with a percutaneous nephrostomy catheter were compared. In 52% of all cultured sediments from healthy adults, in 30% of those from multimorbid patients, and in 75-80% of those from urological patients cells proliferated to colonies. The ratios of type-1 to type-2 cell colonies were 3.3:1 (healthy adults), 1.4:1 (urological patients with urolithiasis), and 1.8:1 (urological patients with urolithiasis, urine was directly collected from the renal pelvis with a percutaneous nephrostomy catheter). Successful cultures of the urinary sediments from these three groups revealed means of 3 or 4 colonies, 14 colonies, and 21 colonies, respectively. Differences in the number of colonies in relation to sex were observed only for the group of urological patients. It was shown that type-1 cells were urothelial cells, which did not show morphological differences due to their locations of origin within the urinary tract, whereas type-2 cells were probably renal tubular cells. These findings offer new aspects in the culturing of human urothelial or kidney epithelial cells with a method based on noninvasive collecting of specimens and requiring only minimal culture effort. The cultures obtained by this method can be used for in vitro studies in toxicological and clinical research.

Noninvasive diagnosis and treatment of a saddle pulmonary embolism. A case report in support of new trends in management of pulmonary embolism.

Transesophageal echocardiography and contrast-enhanced spiral CT of the chest helped to avoid a pulmonary angiography in an elderly patient with saddle pulmonary thromboembolism and allowed for direct evaluation of its resolution during treatment with subcutaneous low molecular weight heparin.

Plasma neuropeptide Y and catecholamines in women and men with essential hypertension.

Neuropeptide-Y (NPY) is a peptide proposed to modulate the effect of the sympathetic nervous system on blood pressure control and contribute to the development of essential hypertension. To assess the possible influence of gender on its role, we evaluated plasma NPY, noradrenaline (NA) and adrenaline (A) concentrations in men and women with essential hypertension. No difference in NPY concentration was found between genders, but NPY concentration was elevated in both hypertensive men and women. NA levels were similar in all investigated hyper- and normotensives, while A was increased only in hypertensive men. These results suggest various patterns of sympatho-adrenal activity in gender subgroups of patients with essential hypertension.

Transoesophageal echocardiography for definitive diagnosis of haemodynamically significant pulmonary embolism.

Transesophageal echocardiographic evaluation of right and left pulmonary arteries, up to the origin of their lobar branches, was prospectively performed with a single plane probe in 32 consecutive patients (18 M, 14 F, aged 55.5 +/- 14.6, from 32 to 80 years) with clinical or echocardiographic suspicion of pulmonary embolism, who met transthoracic echocardiographic criteria of right ventricular overload. Transoesophageal echocardiography showed unequivocal (20 patients) or suspected (three patients) intraluminar thrombi in 88.5% of 26 patients with haemodynamically significant acute or chronic pulmonary embolism, confirmed with reference methods. The sensitivity of the unequivocal transoesophageal echocardiographic diagnosis was 80% for acute and 73% for chronic haemodynamically significant pulmonary embolism. No false-positive results were found (specificity 100%). Additionally, in three cases, transoesophageal echocardiography disclosed the cause of the right ventricular overload revealing a previously undiagnosed atrial septal defect or Ebstein anomaly. Direct visualization of proximal pulmonary arterial thrombi by transoesophageal echocardiography emerges as a useful new method of prompt and definite diagnosis of haemodynamically important pulmonary embolism.

Continuous exposure to FG 7142: behavioural sensitisation is not accompanied by changes in benzodiazepine/GABA receptor coupling.

Chronic intermittent high-dose treatment with N-methyl-ß-carboline-3-carboxamide (FG 7142) leads to kindling accompanied by reduction in γ-aminobutyric acid (GABA) receptor function, whereas chronic continuous administration may result in behavioural effects in the opposite direction from those of acute FG 7142. In the present study, we have investigated the effects of continuous administration of low doses of FG 7142 on the response to an acute challenge dose of FG 7142 in an ethologically based model of anxiety. Rats treated continuously for 14 days with FG 7142 delivered by osmotic minipump at a rate of 1.2-1.5 mg/kg/day showed sensitisation to the anxiogenic effects of a challenge dose of FG 7142 (6 mg/kg), as measured in the elevated plus-maze. This was not accompanied by any change in benzodiazepine/GABA receptor coupling, as assessed by the 'GABA shift'. These results indicate that continuous low-dose treatment with FG 7142 can elicit sensitisation to the behavioural effects of FG 7142, but that this is unlikely to be mediated by changes in benzodiazepine/GABA receptor coupling.