[Amifostine as protective agent in cisplatin-based chemotherapy of advanced bladder cancer]. / Renale Protektion unter MVEC-Polychemotherapie beim fortgeschrittenen Urothelkarzinom der Harnblase durch Amifostin.

Amifostine is an organic thiophsophate which protects normal cells from the effects of chemotherapy with reduced nadir and duration of cyclophosphamide induced neutropenia, reduced cisplatin derived renal and neurological complications being described. However, no data are available for urological malignancies treated with cisplatin-based chemotherapy. Aim of the study was to assess the efficacy of pretreatment with amifostine in terms of prevention of renal, hematopoietic and neurologic toxicity. 17 patients (mean age: 62.6 [45-74]) with advanced transitional cell carcinoma of the urinary bladder received inductive or adjuvant cisplatin based chemotherapy (1-6 cycles) with a cisplatin dose of 70 mg/m(2). Amifostine (740-910 mg/m(2)) was administered intravenously 30 minutes prior to chemotherapy. For all patients creatinine clearance, serum creatinine and electrolytes including magnesium, and blood cell count were determined prior to and after each cycle. A group of 12 patients (mean age: 61.9 [51-67]) did undergo MVEC chemotherapy (1-4 cycles) without receiving amifostine and served as control group. Amifostine was well tolerated and only 1 patient suffered from gastrointestinal discomfort, blood pressure remained unchanged in all patients. Amifostine prevented a significant reduction of creatinine clearance even in the 2 patients with known renal insufficiency: mean creatinine clearance was 125 +/- 20 ml/min prior to and 115 +/- 25 ml/min after chemotherapy. In the control group, however, creatinine clearance dropped from 121 +/- 30 ml/min to 85 +/- 20 ml/min after completion of MVEC chemotherapy. Serum creatinine levels did not increase significantly (1.1 mg/dl prior to and 1.2 mg/dl after chemotherapy), magnesium levels did not decrease significantly and normalized at the end of chemotherapy. Significant neutropenia and thrombocytopenia developed in 29 % and 12 % of the patients in the amifostine group and in 67 % and 33 % of the patients in the control group. Amifostine was shown to have a protective effect against cisplatin induced nephrotoxicity in the elderly patient undergoing systemic chemotherapy. Based on our data amifostine should be applied in the supportive management to prevent chemotherapy induced complications.

Anatomical interrelationships of the medial preoptic area and other brain regions activated following male sexual behavior: a combined fos and tract-tracing study.

The medial preoptic nucleus (MPN) is an essential site for the regulation of male sexual behavior. Previous studies using c-fos as a marker for neural activation have shown that copulation increased c-fos expression in the MPN. Neural activation was also present in brain regions that are connected with the MPN and are involved in male sexual behavior, including the posteromedial bed nucleus of the stria terminalis (BNSTpm), posterodorsal preoptic nucleus (PD), posterodorsal medial amygdala (MEApd), and parvocellular subparafascicular thalamic nucleus (SPFp). The present study investigated whether the copulation-induced, activated neurons in these brain regions are involved in the bidirectional connections with the MPN. Therefore, mating-induced Fos expression was combined with application of anterograde (biotinylated dextran amine) or retrograde (cholera toxin B subunit) tracers in the MPN. The results demonstrated that neurons in the BNSTpm, PD, MEApd, and SPFp that project to the MPN were activated following copulation. However, in males that displayed sexual behavior but did not achieve ejaculation, few double-labeled neurons were evident, although both retrogradely labeled neurons and Fos-immunoreactive cells were present. In addition, retrograde neurons that expressed Fos were located in discrete subdivisions within the brain regions studied, where Fos is induced after ejaculation. Likewise, anterogradely labeled fibers originating from the MPN were not distributed homogeneously but were particularly dense in these discrete subdivisions. These results demonstrate that copulation-induced Fos-positive neurons in specific subdivisions of the BNSTpm, PD, MEApd, and SPFp have bidirectional connections with the MPN. Taken together with previous findings, this supports the existence of a discrete subcircuit within a larger neural network underlying male sexual behavior.

Infrared properties of chemical-vapor deposition polycrystalline diamond windows.

Low-resolution transmittance and reflectance spectra of high-quality chemical-vapor deposition (CVD) diamond windows were measured in the infrared in the 2.5-500-mum wavelength range (20-4000 cm(-1)). High-resolution measurements on a window with nearly parallel surfaces show well defined interference fringes at low frequencies. By standard procedures the optical constants n and k of CVD diamond were determined, for the first time to the author's knowledge, in the far-infrared region. It is shown that a window with a large wedge angle, close to 1 degrees , does not produce appreciable interference fringes. Modeling of these results confirms that interference fringes can be avoided by use of properly wedged CVD diamond windows. This result is of considerable relevance to the use of CVD diamond windows in spectroscopic applications for which fringe suppression is a major requirement.

Demonstration of ejaculation-induced neural activity in the male rat brain using 5-HT1A agonist 8-OH-DPAT.

Previous studies from our laboratory indicated that existence of ejaculation-related neural activation within the circuitry underlying mating behavior in the male rat. Clusters of Fos-immunoreactive neurons were present only following ejaculations and not after intromissions. However, it was not clear if this pattern of neural was specific to ejaculation or a result of summation of sexual activity preceding ejaculation. In the present study, the facilitative effect of the 5-HT1A receptor agonist 8-OH-DPAT on ejaculatory behavior was used to analyze the pattern of Fos immunoreactivity ejaculation preceded by minimal sexual activity. Male rats treated with 8-OH-DPAT (0.4 mg/kg) achieved ejaculation after a shortened latency and low numbers of mounts and intromissions. Ejaculation-induced Fos immunoreactivity was present in clusters of neurons in the lateral part of the posterodorsal medial amygdala, in two subregions of the posteromedial bed nucleus of the stria terminalis, in the posterodorsal preoptic nucleus, and in the parvicellular part of the subparafascicular thalamic nucleus. Males that ejaculated with the first intromission and were treated with a higher dose of 8-OH-DPAT (0.8 mg/kg) exhibited similar clusters of Fos-positive neurons in all areas except the posterodorsal preoptic nucleus. The results demonstrate the existence of a specific ejaculation-related subcircuit within a larger neural circuitry involved in male sexual behavior.

Distribution of Fos immunoreactivity following mating versus anogenital investigation in the male rat brain.

In the present study a detailed quantitative analysis was made using Fos as a marker for neural activation to define which subregions in the neural circuitry underlying male sexual behavior are involved in display of anogenital investigation versus copulation. Neural activity was differentially distributed following anogenital investigation versus mating and was restricted to specific subdivisions that form a heavily interconnected network. Chemosensory investigation increased neural activity in the posteromedial subdivision of the bed nucleus of the stria terminalis and the posterodorsal subdivision of the medial amygdala, brain regions that receive chemosensory signals processed through the olfactory bulbs, presumably reflecting the acquisition of chemosensory signals or the display of anogenital investigation. However, other sensory signals or sexual experience may also have contributed to the induction of neural activation in these brain areas. Moreover, consummatory behavior increased neural activity in the subparafascicular nucleus, a brain region that receives genital sensory inputs. In turn, this brain region projects to the medial preoptic nucleus and posterior nucleus of the amygdala, where neural activity was also abundant only following copulation. In addition, clusters of neurons were activated in the posteromedial subdivision of the bed nucleus of the stria terminalis and posterodorsal subdivision of the medial amygdala following consummatory behavior. The present study provides an anatomically detailed picture about the distribution of neural activation following sexual behavior in the rat, specifically in relation to differences following anogenital investigation versus mating.

The clinical and pathologic manifestations of iatrogenically produced mesothelium-rich fragments of operative debris.

OBJECTIVE: This report describes the clinical manifestations that may be associated with the amalgams of mesothelium and other debris which can be created iatrogenically when body cavities are opened or otherwise physically disturbed. METHODS: One autopsy and four surgical pathology cases are reviewed. Three of the studied patients had had recent cardiac surgery, one a laparotomy, and the fifth a thoracotomy. RESULTS: The series of five patients in this report demonstrates a wide range of manifestations when these tissue and debris amalgams are created. If the fragments gain an ingress to the vasculature, they may embolize and cause infarcts; if the origin of the amalgams is unappreciated, they may be confused with neoplasms; in other circumstances, the amalgams may represent incidental accompaniments of surgical specimens. CONCLUSION: Pathologists and clinicians should be aware of this recently described entity; only in the last couple of years has its pathogenesis been recognized. This report reviews an, until now, undescribed broad spectrum of clinical manifestations of these amalgams of iatrogenically created mesothelial and other operative debris.

Fos immunoreactivity in the rat brain following consummatory elements of sexual behavior: a sex comparison.

In the present study a comparison was made between the distribution of Fos immunoreactivity in the brain of female and male rats following successive elements of sexual behavior. The distribution of Fos immunoreactivity following either mounting, eight intromissions or one or two ejaculations was compared with that in control animals. In both females, Fos immunoreactivity was induced in the medial preoptic nucleus, posteromedial part of the bed nucleus of the stria terminalis, posterodorsal part of the medial amygdala, and the parvicellular part of the subparafascicular thalamic nucleus. In addition, Fos immunoreactivity in females was induced in the ventrolateral part and the most caudoventral part of the ventromedial nucleus of the hypothalamus and in the premammillary nucleus. Differences between females and males were detected in the phases of sexual activity that resulted in Fos immunoreactivity in these brain areas, allowing more insight in the nature of the sensory and hormonal stimuli leading to the induction of Fos immunoreactivity. The posteromedial bed nucleus of the stria terminalis appears to be involved in chemosensory investigation, while specific distinct subregions are only activated following ejaculation. In addition, the parvicellular subparafascicular nucleus and the lateral part of the posterodorsal medial amygdala appear to be involved in the integration of viscero-sensory input. The neural circuitries underlying sexual behavior in males and females appear to be similar in terms of integration of sensory information. In males the medial preoptic nucleus may be regarded as the brain area where the integration of sensory and hormonal stimulation leads to the onset of male sexual behavior, while in females the ventrolateral part of the ventromedial hypothalamic nucleus appears to have this function. In addition, Fos immunoreactivity was distributed in distinct clusters in subregions with various brain areas in males and females. This was observed especially in the posteromedial bed nucleus of the stria terminalis and posterodorsal medial amygdala, but also in the parvicellular subparafascicular nucleus, ventromedial hypothalamic nucleus and ventral premammillary nucleus. It appears that relatively small subunits within these nuclei seem to be concerned with the integration of sensory and hormonal information and may play a critical role in sexual behavior.

[Antibiotic treatment of complicated urinary tract infections]. / Die antibiotische Behandlung von komplizierten Harnwegsinfektionen.

The diagnosis of an urinary tract infection (UTI) is proved by the identification of a significant leucocyturia and bacteriuria of the mid-stream urine analysis in men and catheter urine in women. A diagnostical localisation is possible by the case history as well as clinical, sonographical and laboratory tests (leucocytes, CRP) to classify into a cystitis and infection of the parenchyma, respectively an uncomplicated or complicated UTI. Untreated complicated urinary tract infections have a bad prognosis. The therapy consists of bed rest, normalization of the urinary flow, a specific antibiotic therapy corresponding to the antibiotic sensitivity pattern and the administration of a prostaglandin-synthesis-inhibitor. Every physician should choose one of the many antibiotics and must get acquainted with the pharmacokinetics and side-effects. In severe acute infections, a calculated antibiotic therapy in certain combinations is necessary until the bacteriological findings are known. Corresponding to the spectrum of bacteria in complicated UTI, one should select a fluoro-chinolone, a broad-spectrum penicilline in combination with a beta-lactamase-inhibitor, a cephalosporine of the second and third generation with a relative stability against beta-lactamase as well as an aminoglycoside. Reserve-antibiotics for special indications are for example, cefsulodine. Less effective than the drugs mentioned above is cotrimoxazole, which was favourized before. In complicated UTI, the older gyrase-inhibitors like nalidixic acid, pipemidic acid, cinoxacin and nitrofurantoin are not longer indicated. There is only one indication for the application of doxycyclin: the treatment of bacterial prostatitis. A lower dosage of antibiotics and a drug therapy of 7-10 days are sufficient.(ABSTRACT TRUNCATED AT 250 WORDS)

[In vivo effects of high density lipoprotein rich serum fractions (HDLF) in the human. 2. Effect of repeated HDLF infusions on atherogenic risk factors and arteriosclerotic vascular changes in patients with and without hyperlipoproteinemia]. / In-vivo-Wirkungen High-Density-lipoprotein-reicher Serumfraktionen (HDLF) beim Menschen. 2. Mitteilung: Einfluss wiederholter HDLF-Infusionen auf atherogene Risikofaktoren sowie auf arteriosklerotische Gefässveränderungen bei Patienten mit und ohne Hyperlipoproteinämie.

10 patients with hyperlipoproteinaemia and 4 normolipaemic smokers with angiographically proved arteriosclerosis of different degrees of severity were infused in 2-week intervals 100 ml HDL-rich Cohn-IV-1 fractions each. After the infusion for 5 days essential phospholipids were injected and a permanent medication with cholestyramin and a choleretic drug were prescribed. In the patients with HLP increases of concentration, decreases of concentration, constancy of the plasma lipids and apoproteins independent of the phaenotype of the HLP as well as an improvement of the state of the antioxidant state were observed. In 6 of 10 patients in reproducible vascular areas regressions of athero- und arteriosclerotic findings could be made evident. Progressions were not observed also in extremely changed arteries in contrast to the normolipaemic smokers and the patients of the control group.

[Serum magnesium and heart arrhythmias in patients with pelvic-leg arteriosclerosis]. / Serummagnesium und Herzrhythmusstörungen bei Patienten mit Becken-Bein-Arteriosklerose.

In 122 male patients with arteriosclerosis of pelvis and legs up to 5 resting electrocardiograms were registered in the course of 4 years. 5.2% of these electrocardiograms showed disturbances of rhythm. In these cases no significant differences in the serum magnesium level could be ascertained between patients with and without disturbances of rhythm.

Selenium in cardiology and angiology.

The effect selenium in the form of sodium selenite on central hemodynamic conditions and coronary artery flow was studied in pig hearts infarcted by a ligature of the ramus interventricularis anterior. Infusions of sodium selenite solutions at levels of 1-3 mg/kg body wt improved the survival of infarcted pigs. Both short-term and long-term protective effects of selenite could be demonstrated. It is of potential therapeutic importance that sodium selenite administration suppresses the electrical vulnerability of the cell membrane, notably the occurrence of ventricular late potentials in the ischemic border zone. Coronary blood circulation, as evidenced by an increase of heart rate and coronary artery dilatation and peripheral vasodilation was also improved. The pulsatile coronary blood flow thus is altered, increasing total perfusion of the infarcted heart. Initial observations with human subjects suggest that selenium deficiency is a factor in the pathogenesis of ischemic and arteriosclerotic heart disease. In 54 hospitalized patients with clinical diagnosis of acute myocardial infarction, serum selenium levels were 670 +/- 266 nmol/L, as compared to 981 +/- 209 nmol/L in 93 healthy controls. In 32 patients with general arteriosclerosis, the serum Se level was 375 +/- 85 nmol/L, in 64 patients with arteriosclerotic occlusional disease in the leg region, 366 +/- 85 nmol/L, respectively. Serum selenium levels of healthy subjects were found to be age- and sex dependent. In men, the selenium concentrations reached maximum levels of 1083 nmol/L in the 41-50 y age group. In women in the same age group, the serum Se level was 1385 nmol/L. Evidence is presented to suggest that selenium is preventing oxidative damage of heart cell membranes by lipid peroxidation.

[Normalized living--an accident? A study of the Task Force on Normalized Living on nursing homes and group care departments of nursing homes]. / Genormaliseerd wonen--een incident? Een onderzoek naar de omvang van de doelgroep voor Genormaliseerd Wonen in verpleeghuizen en groepsverzorgingsafdelingen van verzorgingstehuizen.

This article describes a research project in 17 long-stay geriatric wards (13 psychogeriatric nursing homes and 4 special wards in old people's homes), designed to establish the proportion of residents which could be capable of living in experimental, normalized nursing homes. We used an existing group of residents, living in normalized care provisions, that belong to a nursing home in the Netherlands as a reference group. In two ways we tried to answer the research question. First we applied the criteria for selection of the normalized care provisions to our random sample. In the nursing homes, 8.6% of the residents conformed to all requirements. In the old people's homes, this percentage was 10.7%. These requirements are very strict, regarded the fact that in the experimental homes six months after admission only 65% of the inhabitants met all criteria. Second, we tried to establish the overlap between the long-stay geriatric wards and the normalized, experimental care provisions. For this purpose we used the behaviour observation scale 'Observation Psychogeriatrics' (OPG). With regard to their level of impairment, 11.6% of the nursing home residents were comparable to the experimental residents. In the special wards of the old people's homes this percentage was 14.6%. The result of both methods are the same. This study proves, that the experimental homes are a serious alternative, and that the traditional psychogeriatric long-stay wards all contain a number of residents for whom alternative ways of care are possible.

[The project 'Normalized Living' of the 'De Landrijt' nursing home in Eindhoven. Various results of an experiment in psychogeriatric care]. / Het project 'Genormaliseerd Wonen' van verpleeghuis 'De Landrijt' te Eindhoven. Enkele uitkomsten van een experiment in de psychogeriatrische zorg.

Four experimental nursing home settings have been established by nursing home 'De Landrijt' in Eindhoven, each providing care for 4 or 5 long-stay psychogeriatric patients, in order to create flexible living conditions. Nurses are in overall charge; medical care is not provided on a daily basis, but only when necessary. Daily care is also suited to individual needs and possibilities of the patients. In order to evaluate these innovative nursing home conditions, 41 patients were compared with the same type of patients in conventional long-stay wards. To ensure that during the period of the evaluation the homes received the same types of patients, patients considered to need long-term nursing care were allocated randomly to the experimental and conventional homes. The development in functioning of the two groups was measured with a behaviour observation scale for elderly, the OPG--Observation Psychogeriatrics. The most important improvements for the experimental group are observed with respect to Orientation, Mood and Behavioural Problems, Instrumental Activities of Daily Living and Care provided to other patients. More physical aspects of impairment (for instance Activities of Daily Living, Incontinence and Contact) showed hardly any differences between the two groups. Other findings about the project (financial consequences, transfer to general health care) are briefly discussed.

[Results of a long-term study of arteriosclerotic circulatory disorders with polyene fatty acid therapy]. / Ergebnisse einer Langzeitstudie arteriosklerotischer Durchblutungsstörungen unter Polyenfettsäurentherapie.

The antiatherogenic oil diet as one factor of therapy causes the hope of favourable effects in the complex primary prophylaxis. By means of this alone, however, a regression of a clinically significant arteriosclerosis cannot be achieved within 3 years, through biochemically unequivocal "antiatherogenic" effects are to be proved. Linseed-oil, fish and fish oil seem to be particularly suited to cause these effects desired.