Comparison of quality of urinary bladder filling in CT urography with different doses of furosemide in the work-up of patients with macroscopic hematuria.

INTRODUCTION: The protocol for preparation of computed tomography urography (CTU) examinations at our hospital was changed in 2013 to improve the quality of urinary bladder filling in the excretory phase. The aim of this study was to evaluate the quality of urinary bladder filling on CTU after different doses of furosemide were administered to patients with macroscopic hematuria. METHODS: The cohort was 215 patients who underwent elective CTU due to macroscopic hematuria between 2014 and 2018. 5 mg furosemide were administrated to 100 patients, 2.5 mg to 100 patients and 0 mg to 15 patients. Contrast medium layered bladders were excluded, leaving 193 patients: 92, 89 and 12 in each group. Urinary bladder volume was calculated in corticomedullary (CMP) and excretory phase (EP). Bladder distension was classified as satisfactory or not. Attenuation of bladder content in EP was noted. RESULTS: Average volume in EP was 370 ± 224 ml (28-1052) after 5 mg furosemide, 274 ± 120 ml (43-628) after 2.5 mg and 180 ± 104 ml (53-351) after 0 mg. 85% of the bladders were satisfactory distended after 5 mg, 80% after 2.5 mg and 58% after 0 mg. Average attenuation was 266 ± 89 HU (103-524) after 5 mg, 362 ± 156 HU (118-948) after 2.5 mg and 761 ± 331 HU (347-1206) after 0 mg. The differences in volume and attenuation were significant. CONCLUSION: 5 mg furosemide is preferred rather than 2.5 mg in preparation for CTU examinations of patients with macroscopic hematuria. There was no difference between the doses concerning rate of satisfactory bladder distension, but the higher dose resulted in larger bladder volume and more suitable attenuation of bladder content. IMPLICATIONS FOR PRACTICE: Development of CTU-image quality could improve bladder cancer diagnostics.

Methodological aspects on immunohistochemistry in dermatology with special reference to neuronal markers.

In an attempt to optimize the immunohistochemical procedure for visualizing neuronal markers, such as neuropeptides, in the human skin, different alternatives in all steps of the process were compared. We have studied the influence of type of immunohistochemical method, the biopsy technique, including the size of the punch biopsy, anaesthesia, the choice of fixative and the time of fixation, the storage process, the sectioning parameters, incubation procedure, the type of fluorophore-conjugated antibody and its dilution, mounting and storage, and, finally, microscopical examination. The following procedure was found to give the best result: punch biopsies of 3 mm, taken under local anaesthesia using lidocaine injected into the dermis-subcutis at the place of biopsy; fixation by a buffered 10% formalin solution containing 14% of saturated picric acid for 2 h at 4 degrees C; storage in 10% sucrose buffer for at least 24 h up to 1 month at 4 degrees C or deep-frozen to -70 degrees C for 2 months (with only a minor structural deterioration); cryostat sectioning of the biopsies with a section thickness of 14 microns and with the cutting edge perpendicular to the skin surface; rhodamine (TRITC)-conjugated, instead of fluorescein-isothiocyanate (FITC)-conjugated, secondary antiserum, since it gives a lower background fluorescence; and for the incubation and mounting procedures, our standard laboratory routines were applied. The result is an optimal indirect immunofluorescence technique, to be applied in dermatology. We also found that biopsies taken under local anaesthesia with chloroethyl spray lost almost all immunofluorescence for several neuronal markers in the epidermis-upper dermis.

Evidence for gamma-melanocyte stimulating hormone containing nerves and neutrophilic granulocytes in the human skin by indirect immunofluorescence.

gamma-melanocyte stimulating hormone (gamma-MSH)-like immunoreactivity has been found by indirect immunofluorescence in nerve fibers and terminals as well as in neutrophilic granulocytes of normal human skin. A preferential localization to sensory nerves was seen; abundant nerve fibers displaying gamma-MSH immunoreactivity were observed as free nerve endings in the basal layer of the epidermis and in the upper dermis, close to the Merkel cells, in Meissner's corpuscles, around the external root sheath of the lower part of the hair follicles, and in nerve bundles of the deeper parts of the dermis. Very few fibers were seen to be associated with sweat glands and most blood vessels, although arterioles were densely innervated. Thus, gamma-MSH should be considered for possible role as a sensory or axon-reflex chemical messenger. Furthermore, the presence of gamma-MSH in neutrophilic granulocytes raises the possibility that gamma-MSH may play a role in the genesis of post-inflammatory hyperpigmentation, nevi, and melanomas.

Therapy of colorectal carcinoma with monoclonal antibodies (MAb17-1A) alone and in combination with granulocyte monocyte-colony stimulating factor (GM-CSF).

A mouse monoclonal antibody (MAb17-1A) (IgG2A) against colorectal carcinoma cells was used to treat patients with metastatic disease. Major direct effector functions of MAb seem to be ADCC (antibody dependent cellular cytotoxicity), CDC (complement dependent cytolysis) and apoptosis ('programmed cell death'). Thus, a high tumor cell saturation of the MAb should be achieved. Increasing doses of MAb to the patients increased the total area under the concentration curve and thus the exposure of tumor cells to MAb. However, the response rate (with complete + partial + minor response + stable disease defined as response) was not augmented. In total, 10/52 (19%) patients responded and in fact lower doses (less than 2 g) might induce a higher response frequency (9/52) than higher doses (greater than 2 g) (1/52). During treatment, the numbers of cytotoxic cells (lymphocytes and monocytes) increases in the tumor lesion and complement components were deposited. As ADCC may be important, effector mechanism attempts were made to augment the cytolytic capability of the effector cells by simultaneously giving the patients GM-CSF. The combination of MAb17-1A + GM-CSF augmented the ADCC activity of blood mononuclear cells and a heavy infiltration of monocytes could be noted in the tumor. Out of 15 available patients 6 (40%) showed a response.

Occupational lifting by nursing aides and warehouse workers.

Nursing aides (18 women and six men) at one traditional and one modern geriatric ward, and warehouse workers (16 men) at two different types of warehouse departments were studied during occupational work. The vertical load during manual handling was measured using strain gauges built into wooden shoes. The warehouse workers performed four times as many lifts as the nursing aides and transferred five times as great a mass per unit time. Less than 25% of the lifts were carried out with the load evenly distributed on both feet during both the upward lift and lowering. In the warehouses the lifts were short, while the nursing aides were exposed both to lifts of longer duration and to carrying, as well as a greater frequency of unexpected, sudden and high peak load. The heart rate and oxygen uptake values recorded were relatively low, and both groups utilized approximately 25% of their maximum aerobic power. According to official occupational injury statistics, both warehouse workers and nursing aides belong to risk groups with a high frequency of reported back injuries. However, more injuries are reported by nursing aides than by warehouse workers. Greater muscle strength in male workers may partly explain this difference. Qualitative differences in the design of the lifting work, with more lifts of long duration in awkward work postures, more carrying, more exertion of horizontal forces and a greater frequency of unexpected rapid lifts in the nursing aides may also contribute to the differences in risk of injury between these occupational groups. Considerable differences were found between the two hospital wards as regards lifting frequency, force, duration and the proportion of lifts with an even distribution of load on both feet during upward lift. The lifting work was approximately 50% less in the modern ward, which has easily maneuvered electric overhead hoists, spacious premises and better work organization than in the traditional ward, even though the patient handling needs were equivalent. In the warehouse department at which the wares were stored with easy access, the frequency of lifts with an even distribution of load on both feet was approximately 25%, compared to 7% in the other warehouse department. In conclusion, evaluations of occupational lifting work should include a quantitative assessment of the duration and load distribution of lifting, as well as of postures. Workstation design, technical aids and work organization have a profound effect on the lifting work load even in jobs with equal manual handling demands.

An experimental evaluation of psychophysical criteria for repetitive lifting work.

Two experiments were performed to test the reliability and validity of psychophysically determined maximum acceptable workloads for setting lifting standards. The perceived workload in a repetitive diagonal lifting task was found to be a positively accelerated function of the weight lifted and of the work pace respectively. A twofold increase in objective workload resulted in a four- to fivefold increase in perceived workload. This relation was independent of previous occupational experience of lifting work. The psychophysically assessed maximum acceptable workloads for this type of lifting task appeared to be satisfactorily reproducible when subjects had to adjust work pace or when they were left free to adjust both the weight and the work pace. However, the results raised several questions concerning the applicability of the psychophysical assessment of maximum acceptable lifting work. Slight changes in the instructions given to the subjects had a definite effect on the selection of workloads. Furthermore, the workloads selected by subjects with previous occupational experience of lifting work - i e, warehouse workers - were systematically lower than those selected by subjects without such previous experience - i e, office employees. At the same time, the warehouse workers rated perceived exertion higher than the office employees, indicating that previous occupational experience of lifting work enhanced the subjective assessment of physical effort. There were no consistent relations between the workloads found acceptable by the subjects and their physical characteristics and performance capacity.

Cytogenetic analysis of structural rearrangements in three varieties of common wheat, Triticum aestivum.

The winter wheat varieties 'Starke' and 'Cappelle Desprez' and the spring wheat 'Chinese Spring' were analysed for structural chromosome rearrangements that resulted in the formation of multivalents in F1 hybrids. The analyses were carried out using hybrids involving euploids, monosomic and ditelosomic stocks, and double-monotelodisomic constructs. The study confirmed that 'Cappelle Desprez' differs from 'Chinese Spring' in a reciprocal translocation between chromosomes 5B and 7B (Riley et al. 1967); a translocation involving chromosomes 3B and 3D could not be verified. Furthermore, the analysis showed that 'Starke' differs from 'Chinese Spring' in a reciprocal translocation between chromosomes 7A and 7D. Both translocations have a coefficient of multivalent realisation of about 0.84. Further multivalents in euploid 'Starke', in euploid and some aneuploid stocks of 'Cappelle Desprez', and in euploid as well as various types of aneuploid hybrids between all three varieties could nearly all be explained hypothesizing that chromosome 2B of both 'Starke' and 'Cappelle Desprez' is a duplication-deficiency chromosome. In the hypothesis a part of the long arm of 2B is missing and replaced by a duplicated part of the long arm of chromosome 2D. The multivalents of this rearrangement showed an average coefficient of realisation of about 0.09.

Effects of work in cold stores on man.

A work physiological study was conducted during three different types of work in cold stores, i.e., at dairies and in the cutting and packaging of meat. Peripheral cooling, especially of the fingers and hands, was noted in all the subjects. The work load was relatively light for the packers but varied considerably in the dairy work. In both dairy and packaging work, clothing was unsatisfactory in terms of thermal insulation and flexibility. The butchers were subjected to less cooling, as a result of a relatively intense but even work rate and clothing adapted to the work. The subjects were very capable of perceiving temperature changes in the peripheral parts of their bodies. Individual variations were considerable, especially with respect to cooling and the perception of temperature and discomfort.