Renal growth after neonatal urinary tract infection

This study presents the result of 12–21 years' follow-up in a group of children with neonatal urinary tract infection (onset within 1 month after birth) in whom early renal growth retardation was noted without concomitant classical renal scarring. In all cases the neonatal infection was diagnosed and treated within a few days of onset and the patients were closely supervised thereafter. Renal length, parenchymal thickness and area were measured at urography. At first follow-up (22 children, mean age 4.1 years) a significant reduction of renal parenchymal thickness was noted. Long-term follow-up (18 patients, mean age 17 years) demonstrated a normalization of renal size in the entire group, although less complete in the subgroup with reflux. There were two major findings in the present study. Firstly, renal growth retardation was seen after neonatal infection, both with and without reflux. Secondly, normalization of renal size in previously small kidneys was demonstrated, suggesting that growth retardation can be a reversible phenomenon. The tendency for such normalization was slightly more marked in children without reflux. Reduction of parenchymal thickness without calyceal deformity, therefore, does not necessarily mean irreversible damage, and differentiation between permanent scarring and temporary growth retardation can thus only be made at later follow-up, possibly not until after puberty. The demonstration of renal growth retardation in spite of early diagnosis and treatment emphasizes the great vulnerability of the kidney in the newborn.     

25 years experience of the surgical treatment of phaeochromocytoma.

OBJECTIVE: To assess the outcome of the surgical treatment of patients who had adrenalectomy for phaeochromocytoma. DESIGN: Retrospective clinical study. SETTINGS: University hospital, Germany. SUBJECTS: 87 consecutive patients with phaeochromocytoma who were operated on. INTERVENTIONS: 29 flank and 58 transabdominal adrenalectomies between 1974 and 2000. RESULTS: The mean tumour diameter was 5 cm (range 2-13), and the mean weight 91 g (range 7-550). The postoperative hospital stay was 11 days. The flank incision entailed the shortest operating time (95 minutes). Two of the phaeochromocytomas were malignant. There were two wound infections but no deaths. With a correct selection of patients, a flank incision is safe. Endoscopic retroperitoneal adrenalectomies should be preferred.     

Ischemia independent lesion evolution during focal stroke in rats

Lesion evolution during focal cerebral ischemia may depend on flow restrictions or on accumulation of toxic mediators within the infarct and expansion of these factors to the periinfarct region. So far, the precise contribution of flow dependent versus spreading-mediated impairment of viable periinfarct tissue has not been determined. Therefore, we measured lesion expansion, flow restrictions and glutamate distribution on serial brain sections at different time points after experimental focal ischemia.Permanent focal ischemia was induced by occlusion of the right middle cerebral artery in male rats and the flow reduction was subsequently measured at 1, 12 and 24 h using iodo[¹⁴C]antipyrine autoradiography. Additionally, the necrotic volume was determined on serial brain sections and the glutamate content was measured in tissue samples from adjacent microdissections.Twelve hours after focal ischemia no noteworthy viable areas with blood flow restrictions of 20-40 ml 100 g^− 1 min^− 1 existed but at 24 h the necrotic tissue exceeded the hemodynamically compromised region by 40 ± 21 mm³ (24%). Furthermore, at 12 and 24 h the glutamate content was elevated in areas surrounding the infarct.Relevant flow restrictions are detectable only during early stages of infarct maturation, whereas the propagation of secondary factors may be the predominant mechanism for delayed infarct evolution.     

First-pass effects of verapamil on the intestinal absorption and liver disposition of fexofenadine in the porcine model.

The aim of this study in pigs was to investigate the local pharmacokinetics of fexofenadine in the intestine and liver by using the pig as a model for drug transport in the entero-hepatobiliary system. A parallel group design included seven pigs (10-12 weeks, 22.2-29.5 kg) in three groups (G1, G2, G3), and a jejunal single-pass perfusion combined with sampling from the bile duct and the portal, hepatic, and superior caval veins was performed. Fexofenadine was perfused through the jejunal segment alone (G1: 120 mg/l, total dose 24 mg) or with two different verapamil doses (G2: 175 mg/l, total dose 35 mg; and G3: 1000 mg/l, total dose 200 mg). The animals were fully anesthetized and monitored throughout the experiment. Fexofenadine had a low liver extraction (E(H); mean +/- S.E.M.), and the given doses of verapamil did not affect the E(H) (0.13 +/- 0.04, 0.16 +/- 0.03, and 0.12 +/- 0.02 for G1, G2, and G3, respectively) or biliary clearance. The E(H) for verapamil and antipyrine agreed well with human in vivo data. Verapamil did not increase the intestinal absorption of fexofenadine, even though the jejunal permeability of fexofenadine, verapamil, and antipyrine showed a tendency to increase in G2. This combined perfusion and hepatobiliary sampling method showed that verapamil did not affect the transport of fexofenadine in the intestine or liver. In this model the E(H) values for both verapamil and antipyrine were similar to the corresponding values in vivo in humans.     

The alpha2-adrenergic agonist guanfacine reduces excitability of human motor cortex through disfacilitation and increase of inhibition.

OBJECTIVE: To test the acute effects of the alpha2-adrenoceptor agonist guanfacine (GFC) on motor excitability in intact humans. METHODS: Eight healthy right-handed adults received a single oral dose of 2 mg of GFC. Motor cortex excitability was tested by focal transcranial magnetic stimulation of the hand area of the left motor cortex. Motor evoked potentials (MEP) were recorded from the right abductor pollicis brevis muscle. In addition, spinal and neuromuscular excitability were tested. All measures were obtained immediately before GFC intake (baseline), and 2, 6, and 24 h later. RESULTS: GFC decreased the slope of the MEP intensity curve, increased paired-pulse short-interval intracortical inhibition, and decreased paired-pulse intracortical facilitation and I-wave facilitation. These effects were maximal at 2-6 h and returned to baseline at 24 h. Motor threshold, cortical silent period, and the measures of spinal (peripheral silent period, F waves) and neuromuscular excitability (maximum M wave) remained unaffected. CONCLUSIONS: This is the first study on the effects of an anti-noradrenergic drug on human motor cortex excitability. GFC reduced cortical excitability by disfacilitation and increased inhibition. These findings support the idea that anti-noradrenergic drugs are detrimental for cortical plasticity and learning which are down-regulated by disfacilitation or increased inhibition.     

Complications following combined transrectal aspiration and core biopsy of the prostate

Ultrasound guided biopsy of the prostate with fine needle (22G) as well as trucut needle (18G) was performed in 145 patients with a suspicion of prostate cancer. After three weeks all patients were interviewed about complications associated with the biopsy. Hematuria and/or hemospermia occurred in 2/3 of the patients. None of the hemorrhages was severe and all ceased spontaneously. E. coli infection of the urinary tract occurred in 9 cases (6.2%). Five of the infections caused high fever and necessitated hospital care with parenteral antibiotics for 1 to 8 days. The patients with infection had no signs of immunological defects by which they might have been identified before the biopsy. As a consequence of these observations we now use prophylactic antibiotics when core biopsy of the prostate is performed transrectally.     

The effect of major railway accidents on the psychological health of train drivers—I. Acute psychological responses to accident

The acute psychological reactions of 101 train drivers to on-the-track accidents were studied by means of clinical interviews and questionnaires (Impact of Event Scale, GHQ-20 and a questionnaire addressing stress symptoms, pre-accident expectancies and worries). More than half of the train drivers reported moderate to high intrusive distress (mean 11.3) within hours to days after the accident but only 1/3 reported symptoms of acute psychophysiological arousal. Intrusive symptoms related to visual impressions were most frequently reported. Avoidance was less prevalent (mean 8.8).

Clinical interviews, relationship between pre-accident worries and severity of the acute responses and positive correlation between GHQ-scores relating to the fortnight preceding the accident and IES-intrusion scores, suggest that premorbid variables may influence the stress response. Involvement in more than two previous accidents invoked a feeling of vulnerability and produced stronger acute responses. Post-accident experiences involving various personal contacts did not correlate with the stress responses in this study and only a few drivers experienced such events in a negative way. Denial of the possibility of being involved in accidents was not associated with increased risk of strong acute responses, indicating that denial does not predict poor outcome in healthy persons exposed to situations where possibility of avoiding the event is outside the control of the person.     

Receptor binding of N-(methyl-11C) clozapine in the brain of rhesus monkey studied by positron emission tomography (PET)

By means of positron emission tomography the uptake and kinetics of N-(methyl-¹¹C)clozapine in different brain regions have been studied in Rhesus monkeys. ¹¹C-clozapine rapidly entered the brain and maximum radioactive uptake was seen 5–12 min after administration. Highest uptake was measured in the striatum. Other regions with an uptake higher than in the cerebellum were thalamus and mesencephalon. The radioactivity from different brain regions decreased with an elimination half-life of about 5 h and parallelled the plasma kinetics of unlabelled clozapine. The striatum/cerebellum ratio of ¹¹C-clozapine-derived radioactivity remained constant during the period studied and did not change after pretreatment with atropine. In contrast, the striatum/cerebellum ratio was somewhat lower after pretreatment with N-methylspiperone (NMSP), indicating competition for the same binding sites in the striatum. After pretreatment with increasing doses of clozapine, a dose-dependent protection of binding sites in the striatum for ¹¹C-NMSP was seen. It is concluded that clozapine is more loosely bound to dopamine receptors in the striatum than N-methylspiperone and that the kinetics of clozapine in the brain parallel that in the plasma. The binding properties of clozapine within the brain may explain some of the clinical properties of the drug.     

The economics of general thromboembolic prophylaxis

The clinical and economic effects of each of 3 alternatives—no prophylaxis, general prophylaxis, and selective treatment—have been assessed in conjunction with 3 types of surgery—general surgery, the subset surgery for cholelithiasis, and elective hip surgery. The costs of thromboembolic and hemorrhagic complications have been calculated from the figures for 28 patients hospitalized at the Department of Surgery, Malmö General Hospital, Malmö, Sweden. The anticipated number of thromboembolic complications—and thus even the number of fatal pulmonary embolisms—can be minimized in all 3 types of surgery by means of general prophylaxis. General prophylaxis with low-dose heparin is, however, accompanied by the greatest incidence of hemorrhagic complications. Health care costs are minimized with general prophylaxis in elective hip and general surgery, while no prophylaxis is the best alternative in surgery for cholelithiasis. From the patient's point of view, general prophylaxis minimizes the duration of thromboembolic disease in general surgery as well as in elective hip surgery. In surgery for cholelithiasis, however, no differences in health loss for the individual are shown between the 2 main alternatives, no prophylaxis and general prophylaxis. Selective treatment means treatment after diagnosis of thrombosis with some screening method. The alternative selective treatment was the least satisfactory of those 3 studied.

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Resumen Los efectos clínicos y económicos de cada una de 3 alternatives en la profilaxis tromboembólica (no profilaxis, profilaxis general con heparina de baja dosis, y tratamiento selectivo) fueron valorados en 3 tipos de cirugía: cirugía general (abdominal), el subgrupo de cirugía general para colelitiasis, y cirugía electiva de cadera. Los costos de las complicaciones tromboembólicas y hemorrágicas fueron calculados a partir de las cifras observadas en 28 pacientes hospitalizados en el Departmento de Cirugía. El número de predicción de complicaciones tromboembólicas, y el número de embolismos pulmonares fatales pueden ser minimizados en los 3 tipos de cirugía mediante la profilaxis general. Sin embargo, la profilaxis general con heparina de baja dosis se acompaña de la más alta incidencia de complicaciones hemorrágicas.Los costos de la atención pueden ser minimizados mediante la profilaxis general en cirugía electiva de cadera y en cirugía general abdominal, en tanto que la no profilaxis es la mejor alternativa para la cirugía de colelitiasis.Desde el punto de vista del paciente, la profilaxis general minimiza la duración de la enfermedad tromboembólica en la cirugía general abdominal así como en la cirugía electiva de cadera. En la cirugía para colelitiasis, sin embargo, no se demuestran diferencias entre las dos alternatives principales, no profilaxis y profilaxis general.El tratamiento selectivo significa tratamiento una vez establecido el diagnóstico de trombosis mediante algún método de tamizaje. La alternativa de tratamiento selectivo fue la menos satisfactoria de las 3 alternatives estudiadas.

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Résumé Les effets cliniques et financiers de 3 comportements variables: absence de prophylaxie, prophylaxie, traitement sélectif ont été évalué en fonction de trois types de chirurgie: chirurgie générale, chirurgie spéciale de la lithiase biliaire, chirurgie élective de la hanche. Les coûts des complications thrombo-emboliques et hémorragiques ont été calculés à partir des données numériques concernant 28 malades hospitalisés dans le service de chirurgie. Le nombre envisagé des complications thromboemboliques et par conséquent le nombre d'embolie pulmonaire fatale a été réduit dans les 3 types de chirurgie choisis grâce au traitement prophylactique. Cependant il convient de noter que le traitement prophylactique à l'aide de faible dose d'héparine s'accompagne de complications hémorragiques plus nombreuses.Les coûts des soins de la chirurgie élective de la hanche et de la chirurgie générale sont réduits grâce au traitement prophylactique alors que l'absence de traitement prophylactique représente la meilleure modalité à observer dans le traitement de la chirurgie biliaire.En ce qui concerne le point de vue du malade le traitement prophylactique réduit la durée de la maladie thromboembolique compliquant la chirurgie générale ou la chirurgie de la hanche. En revanche dans la chirurgie de la lithiase biliaire aucun inconvénient pour la santé du malade ne s'observe que le traitement prophylactique soit ou ne soit pas appliqué.Le traitement sélectif qui répond au traitement institué après que le diagnostic ait été posé par des méthodes de dépistage est la moins satisfaisante des trois attitudes envisagées.

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Supported by grant no. 00759 from the Swedish Medical Research Council.