A simple photometric method for determination of blood loss during transurethral surgery.

A new method for determining blood loss during transurethral operations is presented. Its basic principle is photometry of blood concentrations in haemolysed irrigating fluid. At test study was run on 50 patients who underwent transurethral prostatic resection because of hyperplasia. The photometer was of a type commonly used for routine determination of a haemoglobin concentration in blood. The apparatus for the test is therefore readily available. The test is simple to perform and gives highly reliable results within a few minutes. In seven cases double sampling was done. Since the results within each pair of samples were practically identical, double sampling was considered superfluous for the rest of the case series. Visual estimation of blood loss during transurethral operations seems to be customary in most urologic units in Sweden. We found this method to be unreliable, with underestimates of about 100% in several cases.     

Prospective comparison of gastric secretory function after gastrectomy with either Billroth II or Roux-en-Y anastomosis

In order to delineate the role of enterogastric reflux in changes of postoperative gastric secretory functions, 22 patients with peptic ulcers, who were randomly assigned to partial gastrectomy without vagotomy with either Billroth II or Roux-en-Y anastomosis, were prospectively studied before and 6 months after surgery. Preoperatively, there were no significant differences in gastric secretory functions between the two groups of 11 patients. Postoperatively, median fasting bile acids in the stomach increased in the Billroth II patients from 0.35 to 16.10 mumol/hr (p less than 0.01), but significantly decreased in the Roux-en-Y patients from 0.30 to 0.10 mumol/hr (p less than 0.05), which indicated adequate prevention of enterogastric reflux after the Roux-en-Y procedure. Gastrectomy resulted in significant reductions of median values of basal acid output (4.6 vs 0.6 mmol/hr, p less than 0.01, and 4.2 vs 0.4 mmol/hr, p = 0.02), peak acid output (31.6 vs 4.2 mmol/hr, p less than 0.01, and 38.7 vs 4.5 mmol/hr, p less than 0.01), serum pepsinogen A (121 vs 86 micrograms/L, p less than 0.01, and 92 vs 45 micrograms/L, p less than 0.01), meal-stimulated serum gastrin secretion (1472 vs 199 pM.60 min, p less than 0.0001, and 1017 vs 199 pM.60 min, p less than 0.0001) in the patients with Billroth II and Roux-en-Y anastomosis, respectively. There were, however, no significant differences in gastric secretory parameters between the two groups when studied 6 months after surgery. Therefore it is concluded that after gastrectomy, enterogastric reflux does not affect the secretory function of the gastric remnant within the first 6 months after surgery.     

Long-term (8 days) effects of exposure to low concentrations of fluoride on enamel formation in hamster tooth-germs in organ culture in vitro

Second maxillary molars of 3-4-day-old hamsters were cultured for 7-8 days in the continuous presence of fluoride (F-) or chloride in concentrations between 2.63 microM and 1.31 mM. For biochemical study, explants were labelled during the last 24 h of culture with a triple label of [3H]-proline, 45Ca and 32PO4. The 3H-labelled presumptive amelogenins were separated from the 3H-labelled dentine collagens by a three-step extraction procedure. Histologically, chronic exposure to F- had no obvious effects below 26.3 microM; at 26.3 microM of F-, a non-mineralizing enamel matrix was observed besides that of a normal mineralizing enamel. From 52 microM of F- onwards, only a non-mineralizing enamel matrix was found in decreasing amounts extracellularly as F- concentrations increased. Except for the presence of globular dentine, dentinogenesis was not obviously affected by F-. Biochemically, total synthesis of presumptive amelogenins was hardly disturbed, but their solubility was changed by chronic F- treatment; more amelogenins became formic-acid soluble at the expense of water-soluble amelogenins. Chronic exposure to F- decreased the water-soluble amelogenin fraction according to a logarithmic function of the medium F- concentration. By extrapolation, it was calculated that concentrations higher than 1-2 microM of F- affect amelogenesis in vitro. Synthesis of dentine collagen was not affected by chronic exposure to F- in vitro. Chronic exposure to F- decreased uptake of 45Ca and to a less extent trichloroacetic acid-soluble 32PO4. Chronic F- exposure may inhibit energy production in the enamel organ resulting in an impairment of enamel matrix secretion as well as that of a trans-epithelial transport mechanism for calcium.     

The neural and neuro-endocrine component of the human thymus. II. Hormone immunoreactivity.

We evaluated the presence of anterior pituitary hormones; follicle-stimulating hormone (FSH) and its beta-subunit (beta-FSH), luteinizing hormone (LH) and its beta-subunit (beta-LH), beta-subunit of thyroid-stimulating hormone (beta-TSH), adrenocorticotropic hormone (ACTH), growth hormone (GH), and prolactin (PRL); the placental hormone human chorionic gonadotropin (hCG); and somatostatin, in paraffin and frozen sections of the human thymus. Epithelial cells in the medulla were immunoreactive for most of these hormones, in varying density and intensity of labeling. The cells labeled varied from epithelial cells surrounding Hassall's corpuscles toward solitary cells or small epithelial aggregates in the medulla. FSH immunoreactivity did occur predominantly in epithelial cells of the cortex, in apparent contrast to the predominant medullary location of cells immunolabeled for beta-FSH. The epithelial nature of FSH-immunoreactive cells was confirmed by two-color immunohistochemistry with anti-keratin antibody. In addition to FSH, some epithelial cells in subcapsule and cortex were labeled by antibodies to beta-FSH, beta-LH, beta-TSH, ACTH, GH, and PRL. Some macrophage-like cells surrounded by a rosette of lymphocytes were immunoreactive for FSH and GH. Some interdigitating reticulum-like cells were labeled by anti-beta-LH. Immunolabeling of lymphocytes was found for hCG, especially lymphocytes in the medulla. Two-color immunohistochemistry with anti-CD3 revealed a strong CD3 expression on hCG-immunoreactive cells, whereas CD3-negative cells were hCG-negative. T cells immunolabeled for hCG were also found in peripheral lymphoid organs.     

Die Dignität der Kalium- und Natriumbestimmungen von Leichenorganen bei verschiedenen Erkrankungen des Stoffwechsels

Zusammenfassung In 39 Fällen mit verschiedenen Erkrankungen des Stoffwechsels wurden von linker und rechter Kammerwand, Skeletmuskel, Leber und Niere der Kalium- und Natriumgehalt flammenphotometrisch bestimmt und die Elektrolytwerte in Korrelation zu den morphologischen Organbefunden gebracht. Die Kalium- und Natriumwerte der Organe wurden mit denen einer Kontrollgruppe verglichen. Eine Übereinstimmung zwischen pathomorphologischem Organbefund und einer Störung des Kalium-, Natrium- und Wassergehaltes des Organs fand sich in der linken Herzkammerwand in 32 Fällen, in der rechten Herzkammerwand in 30 Fällen, in der Leber in 25 Fällen und in der Niere nur in zehn von 39 Fällen. Demnach sind die Kalium-Natrium-Werte des Herzmuskels am besten, die der Niere am wenigsten verwertbar. Ein veränderter Kalium- und Natriumgehalt eines Leichenorgans ist stets mit pathohistologischen Veränderungen verbunden. Umgekehrt kann aus einem normalen Kalium- und Natriumgehalt eines Organs nicht auf seine morphologische Integrität und ausreichende Funktion geschlossen werden. Mit dieser kritischen Einschränkung sind die flammenphotometrischen Kalium- und Natrium-Bestimmungen von Leichenorganen eine brauchbare ergänzende diagnostische Methode.

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The value of determining the potassium and sodium of autopsy organs in various metabolic diseases

Summary The potassium and sodium content of the wall of the right and left cardiac ventricles, of the skeletal muscles, of the liver, and of the kidneys were determined by flame photometry in 39 autopsy cases of various metabolic diseases. The values of the electrolytes were correlated with the morphological changes found in the organs. The values for potassium and sodium of the organs were compared with those of a control group. An agreement between pathomorphologic changes in the organs and a disturbance of the content of potassium, sodium and water of the organ was found in the wall of the left cardiac ventricle in 32 cases, in the right cardiac ventricular wall in 30 cases, in the liver in 25 cases, and in the kidneys only in 10 of 39 cases. Accordingly, the potassium-sodium values of the myocardium are the most reliable, those of the kidney the least. A changed potassium or sodium content of an autopsy organ is always associated with pathohistologic changes. Contrarily, from a normal potassium and sodium content of an organ it is impossible to draw conclusions about its morphologic integrity and adequate function. Taking these critical limitations into account, the flamephotometric determinations of autopsy organs are a useful supplemental diagnostic method.

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Herrn Professor Dr. H.Reinwein zum 70. Geburtstage gewidmet.     

A survey on the occurrence of Vibrio parahaemolyticus on fish and shellfish marketed in The Netherlands

A survey was carried out on the occurrence of Vibrio parahaemolyticus on fish and shellfish, as sold in The Netherlands.     

Acute spontaneous streptococcal myositis. Case report

Streptococcal myositis of the acute spontaneous type is extremely rare. To the best of our knowledge, this report describes the first case in which a patient has survived, and reviews the differential diagnosis. The treatment is primarily surgical.