Glomerular filtration rate up to 10 years after urinary diversion of different types. A comparative study of ileal and colonic conduit, refluxing and antirefluxing ureteral anastomosis and continent caecal reservoir

To evaluate the influence of conduit type (ileal or colonic) and method of ureterointestinal anastomosis (refluxing or antirefluxing) on renal function in patients with urinary diversion, a prospective randomized trial was conducted in 1977-1984. During these years urinary diversion via a continent caecal reservoir emerged as an alternative to conduit diversion at our hospital, and these patients with continent reservoir were also included in the study. Total and separate glomerular filtration rate (GFR) were measured, the latter with scintillation camera renography, preoperatively and at follow-up in 70 patients. Measurements 2-10 years postoperatively showed slight to moderate decrease of GFR in all groups, with no significant difference between values according to conduit type or caecal reservoir or between refluxing and antirefluxing ureterointestinal anastomosis. Almost all of the anastomotic strictures involved the ureter that had been brought beneath the sigmoid mesentery, indicating that ischemia secondary to extensive ureteral mobilization is a likely cause of stricture in these cases.     

A Phase II trial of high-dose intravenous interferon alpha-2 in advanced colorectal cancer

Twenty-one patients with metastatic colorectal cancer were treated with high-dose intravenous interferon alpha-2 (30-50 X 10(6) units/m2) administered daily for 5 consecutive days. Courses of therapy were repeated every 2 to 3 weeks. No tumor responses were seen among 15 evaluable patients. In two subjects, disease remained stable for 3 and 7 months, respectively. Toxicity was substantial and a de-escalation of dose was frequently required. Fevers, gastrointestinal symptoms, fatigue, leukopenia, and elevated serum transaminases were common. High-dose interferon was found to be ineffective in the treatment of metastatic colorectal cancer. A daily dose of 50 X 10(6) units/m2 was greater than the maximum tolerated dose in this group of patients.     

Long term side effects after myelography with watersoluble contrast media: Conturex,Conray Meglumin 282 and Dimer-X

Summary This is a report of primary myelographic investigations from Glostrup Hospital added to those from other regional hospitals, namely 650 added to 103 (753) Conturex myelographies and 1550 myelographies with Conray Meglumine 282, Dimer-X and Dimer-X + Depo-Medro added to 32 Conray, (1582). Reinvestigations are also included in these figures namely: 240 for Conturex, 76 for Conray, 45 for Dimer-X and 9 for Dimer-X + Depo-Medrol. — Arachnoidal changes (excluding local changes) were demonstrated in 25% of Conturex myelographies, 47.4% of Conray Meglumine 282, 55.5% of Dimer-X and 100% of Dimer-X + Depo-Medrol myelographies. There is no demonstrable correlation between arachnoidal changes and protein or cell content in the cerebrospinal fluid. A correlation of arachnoidal changes with the injected volume of contrast medium Dimer-X is demonstrated. The incidence of arachnoidal changes is higher after an intervening operation than without.

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Lang anhaltende Nebeneffekte nach Myelographie mit wasserlöslichem Kontrastmittel (Conturex, Conray, Dimer X)

Zusammenfassung Bericht über die Nebenwirkungen bei über 2000 Myelographien mit Conturex, Conray und Dimer X. 25% der Fälle von Conturex-Myelographien zeigten arachnoideale Veränderungen, bei Conray war dies in 47.4% der Fall, bei Dimer X in, 55.5%. Es besteht ein Zusammenhang zwischen den arachnoidealen Veränderungen und der Menge des injizierten Kontrastmittels. Diese arachonidealen Veränderungen treten öfter auf, wenn eine Operation durchgeführt worden ist.

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Complication tardive après myélographie lombaire à l'aide de produits de contraste hydrosolubles (Conturex-Conray Meglumin 282 et Dimer X)

Résumé Les auteurs rapportent les examens pratiqués au Glostrup Hospital et ceux des autres hôpitaux regionaux à savior 650 et 103 (753) myélographies au Conturex et 1550 myélographies au Conray Meglumin 282, Dimer X et Dimer X + Depo-Medrol ajoutées au 32 Conray (1582). Les examens de contrôle ont été inclus dans ce travail: 240 au Conturex, 76 au Conray, 45 au Dimer X et 9 au Dimer X + Depo-Medrol. — Les troubles arachnoïdiens (en dehors des remaniements locaux) sont démontrés dans 25% des cas de myélographie au Conturex, 47.4% avec le Conray Meglumin 282, 55.5% avec le Dimer X et 100% après Dimer X + Depo-Medrol. Il n'y a pas de correlation entre les troubles arachnoïdiens et le contenu cellulaire ou albumineux du liquide céphalo-rachidien. Il y a par contre une correlation entre ces troubles et le volume de Dimer X injecté. L'incidence des troubles arachnoïdiens est plus élevée chez les opérés que chez les non opérés.

     

Work resumption or not after rehabilitation? A descriptive study from six social insurance offices

The objective of this study was to describe measures and outcomes of vocational rehabilitation at six local national insurance offices in the same county in Sweden. Data were collected from mainframe registers and other records at each office. There were great differences in sickness allowance, incapacity rate, selected rehabilitation measures and resuming work. The percentage of sick-listed people who received any rehabilitation measure differed from 1.2 to 8.7%. The gender distribution for the study population was 36% men and 64% women and the predominant diagnosis was musculoskeletal pain conditions, which was followed by psychiatric disorders. Outcomes varied from office B, which reported 58% fully fit after completed planned rehabilitation, to office C, which reported only 24% fully fit. The clear differences in outcome between the offices indicate that various rehabilitation measures differ in effectiveness. The rehabilitation measure 'investigation of working ability' was not linked to any great proportion of people resuming work, but showed a greater correspondence to full disability pension. There were also large differences in social and demographic factors in the different municipalities. The effect of these on the rehabilitation process requires further investigation.     

Synthesis of novel 5-substituted 3-amino-3,4-dihydro-2H-1-benzopyran derivatives and their interactions with the 5-HT1A receptor

A series of new enantiomerically pure 3-amino-3,4-dihydro-2H-1-benzopyrans (3-aminochromans) has been synthesized from (R)- and (S)-5-methoxy-3-amino-3,4-dihydro-2H-1-benzopyran. The absolute configuration of the respective (R)- and (S)-enantiomers was deduced from X-ray crystallography of (R)-3-(N-isopropylamino)-5-methoxy-3,4-dihydro-2H-1-benzopyran, (R)-9a. Various 5-substituents were introduced via palladium-catalyzed carbonylation of N-substituted 3-amino-5-trifluoromethanesulfonyloxy-3,4-dihydro-2H-1-benzopyran. The effect of N- and 5-substitution on affinity for the 5-HT1A receptor was evaluated in competition experiments using rat hippocampal membranes and [3H]8-OH-DPAT as radioligand. Selected compounds were also tested for their affinity to the D1 (rat striatum), D2 (rat striatum), D2A (human cloned), and 5-HT2A (rat cortex) receptors. The intrinsic activity of the compounds was evaluated by measuring their effect on VIP-stimulated cAMP production in GH4ZD10 cells stably transfected with the 5-HT1A receptor. High-affinity compounds with high selectivity for the 5-HT1A receptor were found among structures substituted with carboxylate esters, amides, and ketones in the 5-position. Primary and secondary amines bound with lower affinity than tertiary amines. Larger substituents were well-tolerated by the receptor, but the smaller N-ethyl-N-isopropyl bound with lower affinity. Generally, the (R)-enantiomers displayed higher affinity for the 5-HT1A receptor than the corresponding (S)-enantiomers. In the present series of compounds, both full and partial agonists were found.     

Dexamethasone suppression test in depressive stroke patients

Depressive psychiatric patients often shown non-suppression to the dexamethasone suppression test (DST). Stroke patients shows a high frequency of depression. In the present study the DST was studied in 76 stroke patients and 26 controls. No difference was found in frequency of non-suppression to the DST between depressive and non-depressive stroke patients. It was found that postdexamethasone plasma cortisol level at 08 a.m. was significantly higher in patient with the lesion in the right hemisphere compared to patients with the lesion in the left hemisphere.     

Relationship between 99Tcm-MDP uptake and bone mineral density in patients with prostatic carcinoma

Seventeen men with prostatic carcinoma were investigated with quantitative bone scintigraphy and quantitative computed X-ray tomography before orchiectomy and up to 6 months after this operation. The uptake of 99Tcm-labelled methylene disphosphonate (99Tcm-MDP) and bone mineral density (BMD) were determined for each vertebra from Th10 to L4. Ten patients had normal scintigrams. No change in MDP uptake or BMD was seen after 6 months in these patients. Of the seven patients with abnormal scintigrams, one patient had a clinical sign of progression with an increase in both MDP uptake and BMD. The remaining six patients showed stable or improved clinical status. For their abnormal vertebrae a decrease in MDP uptake was seen, while BMD varied in different ways after 6 months. For the normal vertebrae in these patients with metastatic involvement, no change in MDP uptake was seen. However, the BMD values showed a decrease, indicating a generalized increase in bone resorption at sites distant from the metastases.     

Additional information from Quantitative 24-Hour 99MTc-Mdp Bone Scintigraphy in Patients with Prostatic Carcinoma

Quantitative bone scintigraphy was performed at 4 and 24 h after injection of ^99mTc-MDP. the lower thoracic and all the lumbar vertebrae were recorded in 37 patients with prostatic carcinoma before orchiectomy as well as two weeks, two and six months postoperatively. Fourteen patients had normal bone scintigrams. By means of the measured variation in the count rate between normal vertebrae, the criterion for a vertebra to be considered as abnormal was determined using the 4h-uptake values. for patients with normal scintigrams the count rate at 24 h was below the 4h level and the mean 24h/4h ratio was determined to be 0.85 ± 0.09 (1 SD). Normal vertebrae in patients with skeletal metastases had only slightly lower count rate values at 24 h than at 4 h. Abnormal vertebrae showed a higher count rate at 24 h, especially two weeks postoperatively, while a tendency towards lower values than at 4 h was seen after 6 months. If the 24 h/4 h ratio is used as an extra criterion to the count rate at 4 h, the vertebrae will be more accurately defined as normal or abnormal.