Forced oscillation technique. Reference values for total respiratory resistance obtained with the Siemens Siregnost FD5.

Total respiratory resistance (Rrs) was measured by the application of a sine wave of airflow to the mouth at an oscillation frequency of 10 Hz. The instrument used was the Siemens Siregnost FD5. The Rrs data were correlated with height, age, sex, and weight in 73 patients and 29 healthy subjects. The patients took part in a rehabilitation program for restoration of their locomotion function. Both groups had normal lung function (VC, FEV1) and no signs of pulmonary disease. The only important determining factor for the value of the Rrs was height. The mean Rrs of 102 subjects was 0.29 +/- 0.08 kPa.1-1.s. Other studies gave values between 0.23 +/- 0.05 and 0.32 +/- 0.10 kPa.1-1.s.     

Prospective study on the value of endosonographic follow-up after surgery for esophageal carcinoma

Background: Half of the patients who undergo surgery for cancer of the esophagus or gastric cardia present with recurrent disease within 2 years after the operation. We investigated the value of endosonography for the early detection of recurrent disease. Methods: Forty-three patients entered a follow-up protocol in which endosonography was performed every 6 months within the first 2 years after resection. Results: During 16 of a total of 66 examinations, suspicious abnormalities were found. In three patients free fluid was seen, but recurrence could not be confirmed during follow-up. In eight patients suspicious lymph nodes were seen; six died within 6 months, one was alive with a proven recurrence at 6 months, and one was alive without recurrence at 22 months. In five patients focal wall-thickening or a mass was seen; three died within 6 months, and two were alive with a proven recurrence at 2 and 5 months. After exclusion of free fluid, the positive predictive value of abnormalities on endoscopic ultrasonography (EUS) was 92%. Conclusions: Endosonography, performed at 6-month intervals after resection of cancer of the esophagus or gastric cardia, is accurate in the early detection of locoregional recurrent disease. Two thirds of the patients were still without symptoms when the recurrence was found. (Gastrointest Endosc 1997;46:487-91.)     

Sialic acid concentrations in the urine of men with and without renal stones

Summary It has been suggested that urinary sialidase may play a role in the formation of renal stones. The present study was therefore undertaken to compare spectrophotometrically the different types of sialic acid concentrations and sialidase activities in fresh first morning urine specimens of men (21–65 years) with (13) and without (9) calcium oxalate renal stones. Although the free urinary sialic acid concentrations of the two groups of men were statistically about the same (P=0.0614), the total (P=0.003) and bound (P=0.0012) urinary sialic acid concentrations differed significantly. Both the total and bound sialic acid concentrations were lower in the urine specimens of the stone patients than in their healthy counterparts. This decrease in urinary sialic acid concentrations was firstly thought to be the result of elevated breakdown enzymes of sialic acid, which would favour the production of pyruvate. However, spectrophotometric determinations of the endogenous pyruvate concentrations of the two types of urine specimens did not differ significantly (P=0.0708). Secondly, the decrease in total urinary total sialic acid concentration of stone patients, could be attributed to less sialic acid synthesis or less renal excretion. Therefore, the same experiments were repeated using serum of 13 patients and 9 healthy men. Conversely, the total (P=0.4425) and bound (P=0.2850) serum sialic acid concentrations were found to be similar in the two types of subjects. However, the free serum sialic acid concentration of stone patients was significantly lower than in the healthy subjects (P=0.0062). This phenomenon is also reflected in the average ratio for serum free: bound sialic acid in healthy and stone patients, 1:7.9 and 1:18.7 respectively (P=0.0009). The lower free serum sialic acid concentration may lead to lower renal excretions of sialic acid. This may explain the decrease in total urinary sialic acid concentration in stone patients. The lower bound urinary sialic acid concentrations in patients was also reflected in the urinary free: bound sialic acid ratio for healthy (1:2.3) and stone patients (1:1.3). The difference between these two groups of men was highly significant (P=0.0001). This phenomenon might be explained by the urinary sialidase activities, which was spectrophotometrically determined at 334 nm at 37°C of 11 patients with stones and 17 healthy men. The ages of both groups of men were the same (P=0.326). An increase in urinary sialidase activity was observed with the stone patients (P=0.00001) when compared to specimens of healthy men. This might explain the decrease in urinary bound sialic acid concentration of the stone group. It seems from these results that the urinary concentration of sialic acid and the activity of urinary sialidase, may play a role in the pathogenesis of the multifactorial disease, urolithiasis.     

Decrease of inorganic blood sulfate following treatment with selected antirheumatic drugs: potential consequence for articular cartilage

The elimination kinetics of inorganic blood sulfate in mice was followed for four hours after a single, oral administration of an antirheumatic drug. Sodium salicylate, aspirin, diflunisal and benorylate, all in a dose of 1.25 mmol/kg, reduced the sulfate level to the less than half that of control. This phenomenon was also demonstrated by phenylbutazone, oxyphenbutazone (both 1 mmol/kg), chloroquine diphosphate (0.6 mmol/kg) and tiaprofenic acid (0.02-0.35 mmol/kg). Niflumic acid (1.08 mmol/kg), piroxicam (0.03 mmol/kg), indomethacin (6.10(-3) mmol/kg), diclofenac (5.10(-3) mmol/kg), ketoprofen (0.2 mmol/kg), naproxen (0.08 mmol/kg) and ibuprofen (0.24 mmol/kg) possessed no sulfate lowering properties. The potential relevance of the use of sulfate lowering drugs for articular cartilage integrity is discussed in the light of what is already known about this subject.     

Operative treatment of Smith-Goyrand fractures

Optimal treatment of Smith's fracture remains controversial. Conservative management of type III fractures is acceptable, but results are moderate for types I and II.

This study includes 53 patients operated on during the past 10 years; six of type I, 17 of type II and 30 of type III.

The functional end result was good in 32 cases (60.3 per cent) and excellent in nine cases (16.9 per cent).

Functional results of types I, II and III were comparable when the excellent and good groups were added together.

There was no correlation between anatomical result and functional outcome (κ = 0.07), although a good anatomical result usually accompanied a good to excellent functional end result. Operative treatment of Smith's fractures have good functional end results in our hands, regardless of the fracture type.     

MHPG and heart rate as correlates of nonresponse to drug therapy in panic disorder patients

Little is known about biological predictors of treatment response in panic disorder (PD). In the present study heart rate, blood pressure, plasma cortisol and plasma MHPG were investigated at baseline in a sample of 44 PD patients as possible predictors for nonresponse to treatment. We used a strict definition of nonresponse to find patients who did not respond at all after 12 weeks of treatment with brofaromine or fluvoxamine. Patients were considered nonresponders when they fulfilled two criteria: they did not show a 50% reduction of agoraphobic avoidance and they still experienced panic attacks at endpoint. The variables that differed significantly between the groups were used to predict nonresponse to drug therapy. Using this strict definition of nonresponse, 15 patients (32.6%) were considered nonresponders. These patients were characterised by a higher plasma MHPG concentration and a higher heart rate at baseline. These variables were subsequently used to predict nonresponse.