Lumbar disc herniation in patients up to 25 years of age

Retrospective analysis of 165 patients (105 males, 60 females) with a mean age of 21.2 years (range 14 to 25 years) of 6933 surgically treated patients from January 1987 to May 1999 focused on age and sex distribution, body mass, familial predisposition, trauma, histology, and clinical course. The incidence of herniated lumbar discs was 2.3% in patients aged up to 25 years. A valid family history was obtained in 121 patients and a positive history was found in 82 of these patients (67.8%). The patients had a higher body mass index compared to a group of individuals with a similar age structure. Radiography demonstrated bony changes in 124 patients (75.2%), primarily attributable to postural deformities such as scoliosis. The condition of the bony structures seems to be more important than the condition of the disc tissue in the occurrence of this disease in young patients.     

Spermine deficiency resulting from targeted disruption of the spermine synthase gene in embryonic stem cells leads to enhanced sensitivity to antiproliferative drugs

Polyamines are known to be essential for normal cell growth and differentiation. However, despite numerous studies, specific cellular functions of polyamines in general and individual polyamines in particular have remained only tentative, because of a lack of appropriate cell lines in which genes of polyamine-synthesizing enzymes have been disrupted by gene targeting. With the use of homologous recombination technique, we disrupted the gene encoding spermine synthase in mouse embryonic stem cells. The spermine synthase gene is located on X chromosome in mouse and, because the cells used in this study were of XY karyotype, a single targeting event was sufficient to result in null genotype. The targeted cells did not have any measurable spermine synthase activity and were totally devoid of the polyamine spermine. Spermine deficiency led to a substantial increase in spermidine content, but the total polyamine content was nearly unchanged. Despite the lack of spermine, these cells displayed a growth rate that was nearly similar to that of the parental cells and showed no overt morphological changes. However, the spermine-deficient cells were significantly more sensitive to the growth inhibition exerted by 2-difluoromethylornithine, an inhibitor of ornithine decarboxylase. Similarly, methylglyoxal bis(guanylhydrazone), an inhibitor of S-adenosylmethionine decarboxylase, and diethylnorspermine, a polyamine analog, although exerting cytostatic growth inhibition on wild-type cells, were clearly cytotoxic to the spermine-deficient cells. The spermine-deficient cells were also much more sensitive to etoposide-induced DNA damage than their wild-type counterparts.     

Motivation for and satisfaction with orthodontic-surgical treatment: a retrospective study of 28 patients

Motivation for starting treatment and satisfaction with treatment results were evaluated on the basis of replies to a 14-item questionnaire and clinical examination of 28 orthognathic patients from 6 months to 2 years after treatment. The most common reasons for seeking professional help were problems in biting and chewing (68 per cent). Another major reason was dissatisfaction with facial appearance (36 per cent). Many patients also complained of temporomandibular joint symptoms (32 per cent) and headache (32 per cent). Women (8/19) were more often dissatisfied with their facial appearance than men (2/9), but the difference was not statistically significant. In agreement with earlier studies, the results of orthognathic treatment fulfilled the expectations of almost every patient. Nearly 100 per cent of the patients (27/28) were satisfied with treatment results, although 40 per cent experienced some degree of numbness in the lips and/or jaw 1 year post-operatively. The most satisfied patients were those who stated temporomandibular disorders as the main reason for seeking treatment and whose PAR-index had improved greatly. The majority of the patients experienced the orthodontic treatment as painful and as the most unpleasant part of the whole treatment, but all the patients were satisfied with the pre-treatment information they were given on orthodontics. Orthodontic-surgical therapy should be of a high professional standard technically, but the psychological aspects are equally important in the treatment protocol. The professionals should make efforts to understand the patient's motivations for and expectations of treatment. Patients should be well prepared for surgery and supported for a long time after to help them to adjust to post-surgical changes.     

A midwife-public-health nurse's work in northern Finland, 1950-87

This paper describes the work of Jouki Nykänen, a midwife-public-health nurse in northern Finland during the years 1950–87. The material for the study was collected by a biographical interview. On the basis of content analysis, the work of the interviewee consisted of the following phases: (i) midwife-public-health nurse in the district of Sevettijärvi (1950–58); (ii) municipal midwife in Pyhäntä (1958–60); and (iii) midwife-public-health nurse in the rural district of Karunki (1962–87). In Sevettijärvi, Jouki’s work emphasised independent planning and implementation. In Pyhäntä, her health-care clinics were well organised. In Karunki, another midwife-public-health nurse working with Jouki made conditions flexible, with personal districts for the two nurses. During home visits, Jouki took care of the whole family, from the grandfather to the baby. The Finnish Public Health Act (1972) changed the character of Jouki’s work. The number of home visits decreased and clinics, fragmented into several fields of health care, took the place of home visits, requiring efficiency and results. The results of the study showed the core of a midwife-public-health nurse’s work in Finland in a changing historical and social context, as well as showing the changes in a midwife-public-nurse’s work since the post-war years.     

Combination of subcutaneous levonorgestrel implants and transdermal dihydrotestosterone gel for male hormonal contraception

The primary aim of the present study was to determine the therapeutic dose of subcutaneous levonorgestrel (LNG) to induce azoospermia or severe oligozoospermia (<3 x 10(6)/mL) in normal men requiring contraception. Transdermal 5 alpha-dihydrotestosterone (DHT) was combined to the treatments to maintain peripheral androgen level. Forty-three 21-45-year-old healthy men were enrolled in this phase II randomised and comparative clinical performance study. The subjects were allocated to five groups to receive: (1) transdermal DHT (Andractim(R), Besins Iscovesco, Paris, France) and one subdermal LNG implant (Jadelle, Leiras, Turku, Finland); (2) transdermal DHT and two subdermal LNG implants; (3) transdermal DHT and four subdermal LNG implants; (4) transdermal DHT and oral LNG (Microluton, Schering, Germany); or (5) transdermal DHT only. A total of 27 men completed the suppression phase. None of them reached azoospermia. One subject with oral LNG and transdermal DHT reached <3 million/mL at 5 months of suppression, but not repeatedly. Together 2/27 (7%) subjects, one with oral LNG and DHT and the other with four subdermal LNG implants and DHT reached <5 million/mL temporarily. Altogether 9/27 (33%) subjects reached <20 million/mL. Serum testosterone concentrations (S-T) decreased significantly during the first 3 months of treatment with one, two and four LNG implants and DHT and during the next 3 months S-T remained significantly lower with two or four implants. Serum oestradiol concentrations (S-E(2)) decreased significantly during the first 3 months only with four implants, but at 6 months S-E(2) was lower also in the group with two implants. Serum luteinizing hormone (LH) decreased significantly only with two LNG implants and DHT gel at 5 and 6 months. Serum FSH did not decrease in any of the groups. None of the subjects filled the criteria to continue to the efficacy phase. A total of 16 men discontinued for various reasons. Of the 27 men completing the suppression phase, all have recovered to sperm levels >20 million/mL. There were no changes in blood count, lipid profile, liver function tests, prostate-specific antigen (PSA), sex hormone binding globulin (SHBG), prolactin or cortisol. The mixed antiglobulin reaction (MAR)-IgG, MAR-IgA or tray agglutination test (TAT) did not change during any of the treatments. The present study shows that the LNG implants themselves are well-tolerated by men and safe, and might be suitable for replacing part of the testosterone used as injections to reduce the androgen dose during male hormonal contraception. The DHT gel was considered as quite or very uncomfortable by 66% of the men because of feeling cold during the time it was on the skin, but noncompliance in using the gel was not reported by the men.     

The assessment of colonic water retention prior to double-contrast enema

The detection of colonic water retention prior to double-contrast enema (DCE) was studied in 41 outpatients. Ultrasound examination of the cecum (USC) correctly showed 4 of the 5 patients with water retention as well as all 14 cases with dry colon. Changes in patient's weight or in the number of cleansing enemas were not associated with water retention. The USC seems to offer a rapid and accurate method for the detection of colonic water retention prior to DCE. Aspects of the handling of colonic water retention are also discussed.     

Protein kinase C and Gi-protein mediated modulation of cAMP production in different stages of the rat seminiferous epithelium

The modulatory role of protein kinase C (PK-C)- and G_i-protein-mediated signal transduction systems was studied in the cyclic variation of follicle-stimulating hormone (FSH)-stimulated cAMP production of rat seminiferous tubules. FSH (Metrodin, Serono, 30 mg/1) stimulated cAMP production 10-fold (p < 0.01) in a 3 h incubation of 5 mm segments of seminiferous tubules of stages II–VI of the epithelial cycle, but only 2-fold (p < 0.01) in stages VII–VIII. The PK-C activator 12-O-tetradecanoylphorbol 13-acetate (TPA, 100 nmol/1) suppressed the FSH effect on cAMP output by 50–70% (p < 0.01) in stages II–VI, but had no effect in stages VII–VIII. If the tubular segments were preincubated for 3 h in the presence of pertussis toxin (PT, 100 μg/1), the FSH-stimulated cAMP production of stages VII-VIII increased by 100–200% (p < 0.01), and now they also became responsive to the TPA suppression. Conversely, no effect of PT was observed in stages II–VI. Cholera toxin (CT, 100 μg/1) and forskolin (Fk, 100 μmol/1) nearly similarly stimulated the cAMP production in both stages studied (about 10-fold, p < 0.01), and TPA and PT potentiated the effects in a non-additive fashion. In conclusion, both G_i-protein and PK-C-mediated mechanisms modulate cAMP production of rat seminiferous tubules. A clear cyclic variation can only be demonstrated in FSH-stimulated cAMP production, but not if the G_s-protein or adenylate cyclase are directly stimulated. Upon FSH stimulation, the low cAMP production in stages VII–VIII is mainly due to the G_i-protein-mediated inhibition. In contrast, the absence (or non-function) of this inhibition mechanism explains the brisk cAMP response to FSH in stages II–VI. PK-C activation suppresses FSH-stimulated cAMP production only if it is not inhibited by the G_i-protein-mediated mechanism (stages II–VI), probably by inhibiting the FSH-receptor-G_s-protein association. It also increases CT and Fk-stimulated cAMP production, in this case inactivating the G_i-protein.     

Protein kinase C and Gi-protein mediated modulation of cAMP production in different stages of the rat seminiferous epithelium

The modulatory role of protein kinase C (PK-C)- and G_i-protein-mediated signal transduction systems was studied in the cyclic variation of follicle-stimulating hormone (FSH)-stimulated cAMP production of rat seminiferous tubules. FSH (Metrodin, Serono, 30 mg/1) stimulated cAMP production 10-fold (p < 0.01) in a 3 h incubation of 5 mm segments of seminiferous tubules of stages II–VI of the epithelial cycle, but only 2-fold (p < 0.01) in stages VII–VIII. The PK-C activator 12-O-tetradecanoylphorbol 13-acetate (TPA, 100 nmol/1) suppressed the FSH effect on cAMP output by 50–70% (p < 0.01) in stages II–VI, but had no effect in stages VII–VIII. If the tubular segments were preincubated for 3 h in the presence of pertussis toxin (PT, 100 μg/1), the FSH-stimulated cAMP production of stages VII-VIII increased by 100–200% (p < 0.01), and now they also became responsive to the TPA suppression. Conversely, no effect of PT was observed in stages II–VI. Cholera toxin (CT, 100 μg/1) and forskolin (Fk, 100 μmol/1) nearly similarly stimulated the cAMP production in both stages studied (about 10-fold, p < 0.01), and TPA and PT potentiated the effects in a non-additive fashion. In conclusion, both G_i-protein and PK-C-mediated mechanisms modulate cAMP production of rat seminiferous tubules. A clear cyclic variation can only be demonstrated in FSH-stimulated cAMP production, but not if the G_s-protein or adenylate cyclase are directly stimulated. Upon FSH stimulation, the low cAMP production in stages VII–VIII is mainly due to the G_i-protein-mediated inhibition. In contrast, the absence (or non-function) of this inhibition mechanism explains the brisk cAMP response to FSH in stages II–VI. PK-C activation suppresses FSH-stimulated cAMP production only if it is not inhibited by the G_i-protein-mediated mechanism (stages II–VI), probably by inhibiting the FSH-receptor-G_s-protein association. It also increases CT and Fk-stimulated cAMP production, in this case inactivating the G_i-protein.