Gatekeeper for coronary angiography: reply

We thank Geluk and Zijlstra for their kind words as well astheir considerations and proposals. The latter hits right intothe heart of the issue: should one stick to the ‘anatomic’paradigm urging us to detect and treat coronary stenoses andcalcifications rather than follow     

Fixation of displaced femoral neck fractures: A comparison between sliding screw plate and four cancellous bone screws

In a prospective, randomized trial, 104 consecutive patients with displaced femoral neck fractures were allocated either to fixation with a sliding screw plate or 4 ASIF cancellous bone screws. The patients were reexamined at fixed intervals to determine the time of union. The 2-year-cumulated rate of union was 64 per cent in the plate group and 84 per cent in the screw group.     

Inter- and intraobserver variability in the histopathological diagnosis of medullary carcinoma of the breast,and its prognostic implications

Summary One hundred thirty-one breast carcinomas with medullary features, registered in the Danish Breast Cancer Cooperative Group from 1977–1982, have been histopathologically reviewed by two senior pathologists and classified as typical medullary carcinoma (TMC), atypical medullary carcinoma (AMC), and non-medullary carcinoma (NMC). Diagnostic criteria were based on those put forward by Ridolfiet al. and Fisheret al. The procedure was repeated with an interval of about one year by both pathologists. The diagnostic interobserver agreement was 72% with a Kappa of 0.55. The intraobserver agreement was 77% and 63% with Kappa values of 0.64 and 0.44, respectively. To see whether the observed inter- and intraobserver variability had any prognostic implications, diagnostic subgroups for both pathologists were analyzed with Kaplan Meier plots for recurrence-free survival (RFS) and with log rank tests. In the first evaluation pathologist 1 segregated a group of TMC with a significantly better RFS than for the NMC group, and pathologist 2 segregated a group of TMC with a corresponding strong trend. These findings could not, however, be reproduced in the second evaluation. The study indicates that the criteria of TMC and AMC as proposed by Ridolfiet al. need to be sharpened and simplified in order to reduce inter-and intraobserver variability. Larger studies with a control group of infiltrating ductal carcinomas are mandatory to elucidate the clinical importance of the diagnoses of Typical and Atypical Medullary Carcinoma of the breast.     

Do patient characteristics,disease, or treatment explain social inequality in survival from colorectal cancer?

This paper investigates the association between individually measured socioeconomic status (SES) and all-cause survival in colorectal cancer patients, and explores whether factors related to the patient, the disease, or the surgical treatment mediate the observed social gradient.     

Transurethral resection versus transurethral incision of the prostate. A prospective randomized study

In this ongoing study, patients with an estimated prostate size of no more than 20 gm are randomized to undergo either transurethral resection of the prostate (TURP) or transurethral incision (TUIP) at the 6 o'clock position. To date, 93 patients have been included, and 3 months postoperatively, 80 to 90 per cent of the patients in each group reported improvement. There was also a significant decrease in symptom scores and a significant increase in maximum urinary flow rate, with great variation within each group but without difference between the groups. In both groups, there appears to be some deterioration over time. Operating time, estimated blood loss, time to catheter removal postoperatively, and duration of postoperative hospital stay were all significantly in favor of TUIP. Loss of ejaculation was reported by 37 per cent of patients after TURP and by 13 per cent after TUIP (not statistically significant). There was no difference between the groups in the need for further surgery. Therefore, TUIP is recommended as an alternative to TURP in patients with small prostates.     

Diagnostic and therapeutic problems in prostatitis. Therapeutic position of ofloxacin.

Lower tract localisation studies have been the gold standard in diagnosing various kinds of prostatitis. Four clinical categories are recognised: acute and chronic bacterial prostatitis, nonbacterial prostatitis, and prostatodynia. In acute bacterial prostatitis Gram-negative bacteria are the most common pathogens isolated. The roles of Gram-positive bacteria in chronic bacterial prostatitis and of Chlamydia trachomatis in nonbacterial prostatitis are contentious. Treatment of these various forms of prostatitis has been a challenge to the clinician. The lack of penetration of various drugs into the prostatic tissue, because of poor lipid solubility, ionisation, protein binding, and unfavourable pH gradients from the plasma to the prostatic fluid, may be the main reasons for poor results. The minimum inhibitory concentration (MIC) of antibacterial drugs used, and the concentration of drugs actually obtained in the prostate, combined with the influence of pH and inoculum size, and the effect of prostatic fluid and prostatic extracts on MIC are important factors in determining at least the theoretical efficacy of various drugs in the treatment of prostatitis. The new fluoroquinolone ofloxacin, the first quinolone to be approved for the treatment of chronic bacterial prostatis, has excellent penetration into human prostate and high in vitro activity in human urine and prostatic tissue. From a theoretical standpoint, ofloxacin should be ideal in the treatment of chronic bacterial prostatis. Comparative studies have shown its superiority to carbenicillin. Several noncomparative studies have also been reported. The initial results are promising, but further investigations are needed.     

Anion channels in a leaky epithelium

We have used the patch-clamp technique to characterize three anion channels in the ventricular membrane of the choroid plexus epithelium from Necturus. The most frequently occurring channel had a nonlinear IV-curve. The conductance in excised patches with 112 mM chloride at both sides was 28 pS at 0 mV, increasing towards positive membrane potentials. The selectivity ratios were P _NaP _Cl 0.1 and . SITS and furosemide (1 mM) on the inside reduces chloride flux to 0.15 and 0.37 times the control value. In attached patches, the most commonly observed channel had a conductance of 7.5 pS. The single-channel current for this channel reversed direction at 15 mV hyperpolarization, indicating accumulation of chloride to a factor of 1.8 above equilibrium. External stimulation of the tissue by theophylline, IBMX and dbcAMP, or by hypotonic shock did not increase the activity of this channel. In very few excised patches, we have observed a chloride channel with a conductance of 7 pS with 112 mM chloride at both sides. The 7 pS channel appears to be identical to a 2 pS channel found in attached patches. The 2 pS channel was not normally active in attached patches but was activated in 28% of the patches by external stimulation. Finally, in few excised patches we have found a 375 pS channel which inactivates within seconds when membrane potential is stepped from 0 mV to a value that differs more than 10–20 mV from zero. The channel did not conduct gluconate but and P _NaP _Cl 0.1. Internal SITS and furosemide (1 mM) reduced chloride flux to 0.3 and 0.5 times the control value. The channel was never seen in attached patches. The current carried through these channels can not account for the transepithelial steady state Cl^–-flux measured by microelectrodes. KCl exit from the cell is suggested to be carried by KCl-cotransport or by channels that are too small to be seen in patch-clamp experiments.     

Contraction-specific differences in maximal muscle power during stretch-shortening cycle movements in elderly males and females

Elderly people (age 75 years; n=48 males and 34 females) were studied in order to elucidate gender differences in elderly subjects on the determinants of muscle power (force and velocity) during a stretch-shortening cycle. All subjects performed three maximal counter-movement vertical jumps using both legs, on a force platform (Kistler 9281 B). The eccentric (Ep) and concentric (Cp) phases of the jumps were analyzed. The Ep was further divided into an acceleration phase (Ep_acc: from the start of the downward movement to the maximal negative velocity) and deceleration phase (Ep_dec: from the maximal negative velocity to the end of the downward movement). Jump height for the men was higher than for the women (P < 0.001). During both Ep_acc and Ep_dec no significant differences were observed between males and females in force and power generation. However, the men had a higher peak muscle power during the Cp, which may be explained exclusively by the velocity determinant (P < 0.001). No specific gender-related strategy appeared to influence the motor pattern of the movement. The comparable eccentric force generation of the leg extensors in both genders suggests a similar ability to cope with eccentric muscle actions during everyday activities. In contrast, the marked lower capacity for concentric contractions in women may result in an impaired performance, especially in activities where intense and rapid movements are essential, for example when reversing a forward fall. This may be one reason why elderly women are more prone to falls than are elderly men. Accepted: 19 September 2000