Effect of soluble and insoluble fiber diets on serum prostate specific antigen in men.

PURPOSE: We assess whether high fiber diets influence serum prostate specific antigen (PSA) related to effects on serum sex hormone levels and fecal steroid excretion. MATERIALS AND METHODS: A randomized crossover controlled trial was performed on 14 healthy men with hyperlipidemia on 2 metabolic diets 4 months in duration with each containing foods high in soluble or insoluble fiber and approximately 25 to 30 gm. dietary fiber per 1,000 kilocalories. Serum PSA, free testosterone and estradiol, and fecal bile acid and neutral sterol excretion were evaluated. RESULTS: Mean serum PSA was lower with the soluble than the insoluble fiber diet (0.07+/-0.03 ng./ml., p = 0.035). No treatment difference was seen in free testosterone or estradiol, although the latter decreased significantly with the insoluble fiber diet (9+/-3 pmol./l., p = 0.004). After 16 weeks total fecal bile acid output was greater with the soluble (341+/-56 mg. daily) compared to the insoluble (203+/-35, p = 0.001) fiber diet but no differences were seen in fecal neutral sterol elimination. The treatment difference in fecal lithocholic acid output related to the difference in serum PSA (r = 0.57, p = 0.035). CONCLUSIONS: A small but statistically significantly lower serum PSA was seen in healthy men consuming soluble fiber, which was not related to changes in serum sex hormones but was related to the increased lithocholic acid output as a possible marker of increased fecal steroid elimination. The effect of soluble fiber on prostatic disease may warrant further investigation.

Managed care has taken root.

Managed care has taken root in Michigan. While its growth in rural areas of the state may occur at a slower pace, managed care--and capitated reimbursement--will ultimately replace fee-for-service health care in the Upper Peninsula for the same reasons it is doing so in Detroit. Both private and public payers want to increase the predictability of their outlays for health care. They want to contain cost growth, and receive demonstrable value for their investment.

1994: the health reform puzzle comes together.

Policy decisions to help the health care reform puzzle come together in the upcoming year require key information about hospitals and health care. The information contained in this year's annual data article illustrate the current status and the historical trends in hospitals and health care in Michigan. In addition, issues surrounding health care reform and measures of health status in Michigan are highlighted.

Aluminum toxicity and death following intravesical alum irrigation in a patient with renal impairment.

Intravesical alum irrigation is the safest and most effective method of treatment for intractable hematuria. Systemic absorption is reported to be minimal and there have been no reported deaths following its use. We describe an elderly man with compromised renal function (serum creatinine 420 mumol./l.) who was treated with 1% alum irrigation for 48 hours for hematuria due to inoperable bladder cancer. He received a total of 9.6 l. during 48 hours, which controlled the bleeding. After cessation of the alum he became lethargic, suffered respiratory depression and died the next day. Laboratory data showed mild metabolic acidosis and increasing daily aluminum levels that peaked at 7,014 nmol./l. (toxic greater than 2,000) beginning on the day after treatment was commenced. The efficacy and safety profile of alum irrigation is discussed.

A randomized comparative study of the prophylactic use of trimethoprim-sulfamethoxazole versus netilmycin-metronidazole in transrectal prostatic biopsy.

An open randomized study was done to compare the prophylactic value of single doses of netilmycin-metronidazole versus trimethoprim-sulfamethoxazole in the prevention of postoperative infections associated with transrectal prostatic biopsy. Of 117 patients enrolled in the study 101 were evaluated and of these patients 47 received netilmycin-metronidazole and 54 received trimethoprim-sulfamethoxazole. The bacteremia rate in the netilmycin-metronidazole group was 28% (13 of 47 patients) with a 95% confidence interval of 18 to 42% and in the trimethoprim-sulfamethoxazole group it was 37% (20 of 54) with a confidence interval of 26 to 50% (p = 0.43). None of the patients with bacteremia was symptomatic. Urinary tract infection rates were greater in the netilmycin-metronidazole group: 17% (8 of 47 patients) versus 2% (1 of 54) in the trimethoprim-sulfamethoxazole group, p = 0.01. Trimethoprim-sulfamethoxazole (cotrimoxazole) is a better choice as an antimicrobial prophylaxis for patients undergoing transrectal prostatic biopsy.

Are Michigan hospitals facing a shortage of trained personnel?

The 1990 MHA Health Personnel Shortage Survey requested information on 31 personnel positions to determine the extent of personnel shortages, the sources of replacement personnel, the positions for which it is most difficult to recruit applicants, and the positions for which it is most difficult to retain personnel. In addition, hospitals were asked about the impact of personnel shortages on hospital services, the strategies they had implemented to alleviate the problems caused by shortages, and their commitment to, and involvement in, training and educational programs to increase the availability of health care personnel in Michigan. A total of 77 Michigan hospitals and health care institutions responded to the survey. Analyses were performed on a sample of 69 community hospitals distributed similarly, with respect to hospital bed size category and geographic location, to the state total of 176 Michigan community hospitals. For more information, or for a copy of the complete 1990 MHA Health Personnel Shortage Survey report, contact the MHCI Health Policy Analysis Department.

Effect of diuresis and glucagon on upper urinary tract dynamics in the dog.

The effect of glucagon on upper urinary tract peristalsis during extreme diuresis was studied in an unsedated dog preparation. In all experiments glucagon inhibited the peristaltic contraction waves without affecting urine propulsion, suggesting that peristalsis, at least for short periods, is not necessary for effective urine transport during extreme diuresis.

Does perfusion equal diuresis in the upper urinary tract?

Pressures occurring in the upper urinary tract during perfusion and diuresis were compared in an unsedated dog preparation. Perfusion pressures were significantly higher, suggesting that a product of diuresis actively reduces upper tract tone.

Renal artery aneurysm: a complication of Gianturco coil embolization of renal adenocarcinoma.

A complication of Gianturco coil infarction of a massive renal carcinoma with caval obstruction is presented. The immediate response was excellent but at 4 months the patient became hypertensive and potassium-depleted. A large aneurysm of the renal artery had developed at the site of the coils, necessitating nephrectomy.