Physician's information about alcohol problems at hospitalisation of alcohol misusers.

Information was gathered on recognition and treatment of alcohol problems in the primary and secondary health sectors, the latter represented by a department of hepatology. The general practitioner finds in most cases (18/26, 69%) that it is relevant to advise about a patient's alcohol misuse on admission forms when the patient previously has been discharged from another department with this diagnosis. However, if the patient has not previously been hospitalised due to alcohol misuse, information on the diagnosis is only rarely (30/114, 26%) available. This difference is highly significant (P = 0.0001). The case-recording hospital physician at admission recognises 73% of alcohol misusers who are admitted with a non-alcohol-related diagnosis. When the patient had been evaluated by both the admitting physician and the case-recording hospital physician, information on the alcohol problem occurred significantly less often in female compared to male patients (75% vs. 94%; P < 0.002). Only 42 of 208 (20%) of alcohol misusers were under treatment with thiamine/B-vitamins and/or disulfiram before admission. There was a significant difference (P < 0.003) as to whether the patient was treated when the general practitioner wrote alcohol misuse on the admission form and when he did not (37% vs. 10%). At admission, treatment was begun in 54%, and by the discharge 78% were under treatment. Further quality assurance in the diagnosis and treatment of patients with alcohol problems is needed.     

The intraprostatic spiral: a new device for insertion with the patient under local anesthesia and with ultrasonic guidance with 3 months of followup

Acute or chronic urinary retention (median retention volume 1,000 ml.) was relieved successfully in 41 of 45 consecutive patients by insertion of an intraprostatic spiral with the patient under local anesthesia and with ultrasonic guidance. Insertion guided by ultrasound was successful in 35 patients (77 per cent). In 6 patients the spiral was inserted via the traditional endoscopic technique. During 3 months of followup the spiral remained in situ in 27 patients and in 6 it was repositioned. These 33 patients had free voiding with a median maximum flow rate of 13.6 ml. per second. Residual urine volume 1 month after insertion of the spiral was low (median 27 ml.). In 8 patients the spiral was removed during the observation period due to urinary incontinence or retention. The intraprostatic spiral is a favorable alternative to an indwelling catheter in patients awaiting an operation and in those with a high operative risk.     

Direct mounting of cultured epidermal grafts. A way to enhance the transplantation area

Cultured epidermal grafts were prepared in a new way, not allowing the epidermal sheets to shrink before mounting. Using this procedure, the graft area was increased by about 100%. Furthermore, this procedure is also quicker than the conventional technique. The directly mounted grafts take just as well as conventionally prepared grafts and their macroscopical and histological appearances are similar.     

Meniere's syndrome: An atypical presentation of giant cell arteritis (temporal arteritis)

The authors discuss three patients with biopsyproven giant cell arteritis (GCA) who experienced significant auditory and vestibular symptoms. Two of the patients who presented with audiovestibular symptomatology died as a direct result of GCA affecting the vertebral arteries. Postmortem findings are reported. This report illustrates the importance of maintaining a high index of suspicion of GCA in elderly patients who present with the acute onset of audiovestibular symptoms. These symptoms can be a herald of brain stem infarction if giant cell arteritis is the underlying cause. High-dose prednisone and rheumatologic/neurologic consultation is required.     

Contraction Induced Either by Iso-osmolar or Hyper-osmolar Potassium-rich Solutions Influences Relaxant Responses to Pinacidil and Verapamil in Rat Isolated Aorta

Abstract— Relaxant responses of pinacidil and verapamil were studied in rat isolated aorta contracted by either iso-osmolar or hyper-osmolar potassium-rich solutions. Relaxant response profiles of pinacidil and verapamil in rat isolated aorta contracted by 124 mm K⁺ hyper-osmolar Krebs solutions showed marked reductions in inhibiting E_max values and substantial increases in corresponding IC50 values in comparison with results obtained at iso-osmolar conditions. Changes in the slopes of the fitted log concentration-relaxation curves were also observed, whereas pinacidil relaxation curves obtained after initial contraction induced by 30 mm K⁺ Krebs solutions were only slightly influenced by osmolarity, a definite decrease in E_max occurred for verapamil at hyper-osmolar conditions. Initial tension development was much slower and maximal tension lower when induced by 124 mm K⁺ in hyper-osmolar compared with iso-osmolar Krebs solutions. After incubation in Ca²⁺-deprived EGTA-containing Krebs solutions the maximal tension produced by 124 mm K⁺ iso-osmolar Krebs solution in rat aorta was nearly 95% reduced, whereas it was only reduced by 50% at hyper-osmolar conditions. Hyper-osmolarity as established by direct addition of potassium chloride to Krebs solutions in order to induce contraction in vascular smooth muscle could influence the in-vitro action profile, potency and intrinsic activity of the two vascular relaxant drugs.     

Targeting of cholecystokinin-B/gastrin receptors in vivo: preclinical and initial clinical evaluation of the diagnostic and therapeutic potential of radiolabelled gastrin

The outstanding sensitivity of pentagastrin in detecting the presence of primary, recurrent or metastatic medullary thyroid cancer (MTC) suggests widespread expression of the corresponding receptor type in human MTC. Indeed, recent autoradiographic studies have demonstrated the presence of cholecystokinin (CCK)-B (= gastrin) receptors not only in more than 90% of MTCs but also in a high percentage of small cell lung cancers, stromal ovarian cancers, astrocytomas and several other tumour types. The aim of this study was to evaluate whether radiolabelled gastrin may be suitable for targeting CCK-B receptor-expressing tumours in vivo. For this purpose, the biodistribution of the radioiodinated human heptadecapeptide gastrin-I was studied in nude mice bearing subcutaneous xenografts of the human MTC cell line, TT. Initial therapy experiments were undertaken. Finally, the biodistribution of iodine-131- labelled gastrin-I was studied in a patient with metastatic MTC. At a peptide amount of approximately 1 μg, maximum tumour uptake (8.9±2.9%ID/g) was observed in animals at 1 h post injection, with tumour-to-blood ratios as high as 6.3±1.9. Physiological CCK-B receptors in the stomach, gallbladder and pancreas of the mice were targeted as well. The major route of excretion was renal, but strong evidence for a biliary excretion pathway also exists. Pilot therapy studies with ¹³¹I-labelled gastrin showed significant anti-tumour efficacy as compared with untreated controls. In accordance with the preclinical data, good receptor targeting was observed in the tumour sites, stomach, gallbladder and pancreas of a patient with metastatic MTC. These data suggest that gastrin and its analogues may represent a useful new class of receptor binding peptides for diagnosis and therapy of a variety of tumour types, including MTC and small cell lung cancer. Future preclinical and clinical studies will address in more detail the molecular features that render CCK-B receptor binding agents potentially useful candidates for in vivo scintigraphy and radionuclide therapy. Received 19 December 1997 and in revised form 6 January 1998     

Renal parenchymal appearance on 123iodine-hippurate renoscintigrams and excretory urograms

In 61 patients with vesicoureteral reflux renal scar formation was diagnosed by excretory urography and 123iodine-hippurate scintigrams. Scar formation on the nephrograms was detected in the upper, middle and lower zones of the kidneys on tomography exposures. Scintigraphic detection of scars was performed on the computerized uptake of the parenchymal phase. Maximal time elapse between the 2 investigations was 1 year. Excretory urography revealed 37 kidneys with a total of 74 regional scars. On scintigraphy 57 kidneys were judged to have 102 scars. There were 281 regions judged to be identical on the scintigram and the nephrogram. A true positive ratio (sensitivity) of 0.46 and a true negative ratio (specificity) of 0.90 were noted for the excretory urogram, compared to a sensitivity of 0.64 and a specificity of 0.81 for renography. The study confirms an over-representation of scars judged from scintigrams, which calls for further investigation of scar formation detection.