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Biomedical subjects

H Jakobsen

Publications and source records attributed to H Jakobsen.

18 recordsLinked to original sources

Induction of intracellular and plasma 2',5'-oligoadenylate synthetase by pentostatin.

Similar to interferon alpha, pentostatin is highly effective in hairy cell leukemia and moderately active in other chronic lymphoid malignancies. In ten patients with hairy cell leukemia (HCL) and seven patients with other B-cell chronic leukemias (BCL), we have studied the intracellular 2',5'-oligoadenylate synthetase (2,5OAS) activity of the mononuclear cells before, 4 h, 24 h, and 48 h after pentostatin administration. In patients with HCL the median level of intracellular 2,5OAS increased 4.6-fold at 4 h and 11.5-fold at 24 h compared to the pretreatment value. Among the other seven patients, the median intracellular 2,5OAS remained unchanged in three patients and rose slightly by 2 to 14 times in four patients. Eleven patients (eight with HCL and two with BCL) responded to pentostatin. The median increase in 2,5OAS among the responders was 13.0-fold (range 4.8-30.0) whereas that among non-responders was 2.2-fold (range 0.2-6.3). The difference was highly significant (p less than 0.0001). In five of the total seventeen patients, the plasma levels of 2,5OAS activity were also determined and changes in plasma levels paralleled those measured intracellularly. To determine if the elevation of 2,5OAS is mediated by induction of interferon alpha, the expressions of mRNA for interferon alpha and beta were investigated by means of reverse transcription and polymerase chain reaction using the corresponding sense primers. In none of the five patients thus studied could we find an induction of mRNA for interferon alpha or beta in the leukemic cells during treatment with pentostatin. Thus, response to pentostatin correlates with induction of 2,5OAS directly and the 2',5'-oligoadenylate system seems to be involved in cytotoxicity.

2',5'-Oligoadenylate Synthetase

[The intraurethral plug. A new alternative in the treatment of women with stress incontinence].

The intraurethral plug has been developed for treatment of women with stress-incontinence. The plug is made of thermoplastic-elastomeric material and consists of a meatus plate, a soft stalk and one or two beads along the stalk. The individual plug is constructed on the basis of the result of the urethral pressure profile. The plug is removed manually prior to micturition and after micturition a new plug is introduced by the patient. A plug with two beads was employed in period 1 (seven days) and a plug with one bead for period 2 (seven days). Twenty-two patients completed period 1. Eight of these patients did not complete period 2, mainly on account of unchanged incontinence during period 1 or repeated loss of the plug with one bead. In periods 1 and 2, 73% and 79% of the patients, respectively, were both subjectively and objectively continent or considerably improved. This preliminary investigation demonstrates that the intraurethral plug may be an alternative form of treatment of women with stress incontinence.

Adult

Lack of effect of cholinergic blocking and alpha-adrenergic stimulation on nocturnal incontinence after ileocaecal bladder replacement. A controlled randomised study.

A controlled randomised trial was carried out in 9 patients to examine the possibility of achieving nocturnal continence after ileocaecal bladder replacement by reducing the amplitude of the peristaltic contractions and by increasing the maximum urethral pressure pharmacologically. The trial consisted of 4 treatment periods, each of 2 weeks' duration: a single-blind placebo period was followed by 3 double-blind periods with phenylpropanolamine hydrochloride 50 mg bd (Kontexin), oxybutynin chloride 5 mg tid (Ditropan), and combined treatment. Each patient completed a frequency/volume chart before the trial and for the last 7 days of each treatment period. Filling and storage urethrocystometry was performed before treatment and at the end of each treatment period. Treatment with phenylpropanolamine and oxybutynin failed to reduce the nocturnal urine leak of about 600 ml. Treatment did not influence the maximum urethral closure pressure, which remained unchanged at about 16 cm of water with the bladder substitute at rest and filled to its maximum cystometric capacity. At storage urethrocystometry, the treatment resulted in a decrease in the amplitude of the peristaltic contractions of about 10 cm of water to approximately 45 cm of water. Accordingly, the effect of alpha-adrenergic stimulation and anticholinergic suppression was found to be insufficient to achieve nocturnal continence in patients with ileocaecal bladder replacement.

Aged

Polyamines and other accessory sex gland secretions in human seminal plasma 8 years after vasectomy.

In 56 males, vasectomized 8 years previously, and in 56 age-matched non-vasectomized controls, a number of secretory products of prostatic, seminal vesicular and epididymal/testicular origin were used to monitor post-operative changes in accessory sex gland function. Significant reductions were observed in seminal plasma volume (3.0 vs 4.9 ml, P less than 0.01), and the total ejaculate contents of zinc (5.1 vs 9.7 mumol, P less than 0.01), magnesium (10.6 vs 26.5 mumol, P less than 0.01), PAP (371 vs 1260 IU, P less than 0.005) and citric acid (76.7 vs 127.9 mumol, P less than 0.05), indicating a major impact on secretions of prostatic origin. Unaltered PGE-1 (54.3 vs 53.2 micrograms, P less than 0.95) and fructose (3.9 vs 4.5 mumol, P greater than 0.1) indicated no effects on the secretory function of the seminal vesicles. A marked reduction was demonstrated in the ejaculatory contents of the polyamines, spermidine (366 vs 650 nmol, P less than 0.005) and spermine (5435 vs 11 804 nmol, P less than 0.05) but not their acknowledged precursor, putrescine, which is also of prostatic origin.

Acid Phosphatase

The long-term influence of vasectomy on prostatic volume and morphology in man.

During the past two decades several papers have described the changes in prostatic secretory capacity following vasectomy. Based upon results indicating a reduction of secretory function, it was suggested that even prostatic size and the incidence of benign prostatic hyperplasia (BPH) might be altered after the operation. In this study, which included 56 males who had been vasectomized 8 years previously and 56 age-matched control persons, transrectal ultrasonic scanning of the prostate was used for exact measurements of the prostatic volume and for the investigation of intraprostatic echo pattern. The total prostatic volume, the volume of the periurethral gland, and the volume of the peripheral zone were not influenced by the vasectomy; nor was the growth rate of these zones affected. In the vasectomy group, the frequency of adenomatous prostates was 19.6%, whereas 30.3% of prostates in the control group had ultrasonic signs of BPH. However, this is not a statistically significant difference. Subdividing the material according to age did not reveal altered BPH frequency in any age group when vasectomized and controls were compared.

Humans

Sensitivity of 131I-hippuran diuresis renography and pressure flow study (Whitaker test) in upper urinary tract obstruction.

Diuresis renography and pressure flow studies were performed in 14 patients with unilateral hydronephrosis. Based upon the results of intravenous pyelography, typical symptomatology, and the outcome of surgical treatment, all patients were found to have upper urinary tract obstruction. It was therefore possible to calculate the sensitivity of the two tests. Obstruction was found at the pressure flow studies in 7 of 14 patients (50%), while an obstructive pattern was found at diuresis renography in 12 of 13 patients (92%). Due to a very low glomerular filtration rate, diuresis renography was equivocal in 1 case. Based upon these results, diuresis renography seems to be superior to pressure flow studies in cases with upper urinary tract obstruction.

Adult

Transrectal prostatic ultrasonography. Equipment, normal findings, benign hyperplasia and cancer.

The principles of transrectal ultrasound scanning of the prostate and current imaging facilities are reviewed. The ultrasonic anatomy of the normal prostate is described and illustrated. Exact volumetric determination of the gland is discussed, and the ultrasonic presentation of benign hyperplasia is surveyed. Ultrasonography is useful in the diagnosis of prostatic cancer and in T-staging the tumours. Ultrasonically guided needle biopsy of the prostate is an important component in cancer diagnosis. An aim for ongoing technical developments should be detection of prostatic cancer before it becomes palpable.

Humans

Ultrasonic evaluation of age-related human prostatic growth and development of benign prostatic hyperplasia.

In 175 normal men aged 27-70 (median 40) years, the prostate was ultrasonically scanned by the transrectal route. Ultrasonic signs of adenoma were found in 26%. The earliest age at which signs of benign prostatic hyperplasia appeared was 27 years, and the incidence increased with age. Adenomatous prostates were significantly larger than nonadenomatous, with median volume 28.0 (14.5-62.1) ml versus 23.0 (11.3-39.1) ml (p less than 0.0005). The adenomatous prostates also had a larger median volume of the periurethral gland (4.1 ml vs. 3.0 ml; p less than 0.0005) and a larger peripheral zone (23.3 ml vs. 20.2 ml; p less than 0.005). The total prostatic volume increased statistically significantly with age and the growth rate was calculated to be 0.81 %/year +/- 0.25 (S.E.) corresponding to 0.2 ml/year. The growth rate of the periurethral zone was 1.5 %/year +/- 0.5 (S.E.). Volumetric correlation between periurethral gland and total prostatic volume depended on whether or not adenoma had developed. Prostatic volumes measured in vivo by ultrasound are slightly greater than values obtained at autopsy.

Adult

Pathogenesis of nocturnal urinary incontinence after ileocaecal bladder replacement. Continuous measurement of urethral closure pressure during sleep.

Urethral closure pressure was recorded in four patients during sleep in order to determine the pathogenesis of nocturnal incontinence after radical cystectomy and ileocaecal bladder replacement. The sleep stages were determined by electroencephalography. The resting pressure in the intestinal bladder was low and increased only slightly during filling. The maximum urethral pressure decreased during sleep but the urethral closure pressure remained positive when the intestinal bladder was not contracting. The peristaltic contractions in the intestinal bladder continued during sleep, causing incontinence. The nocturnal incontinence is probably a result of the reduced level of consciousness that makes it impossible to increase the tone of the external urethral sphincter during contractions of the intestinal bladder.

Electroencephalography

Detection of neutrophilocytes and NO2-producing bacteria in urine by dipstick BM-test-9.

A prospective study compared the detection of leucocytes and bacteria in urine with the dipstick test (presence of esterases in granulocytes and nitrite) to chamber counting of urine, microscopic examination of the urinary sediment, and urine culture. Examined were 174 urine specimens. The dipstick esterase test and the sediment count were almost equally sensitive in detecting leucocyturia. Using chamber count and a cut-off point of 10 or more leucocytes per cubic millimeter as denoting significant leucocyturia, the esterase test gave a predictive value for negative test (PV neg) of 75% and a predictive value for positive test (PV pos) of 96%. PV neg of the dipstick nitrite test was 78% and PV pos 100% in detecting bacteriuria (10(5) bacteria per milliliter). Combining the esterase test with the nitrite test did not increase PV neg. Our result was that the dipstick test seems to be a simple screening procedure for leucocyturia and bacteriuria. The test is suggested to replace the time-consuming microscopic examinations of urine for leucocytes. When the nitrite test is positive, routine urine culture may be omitted.

Adolescent

Benign cystic lesions of the tunica albuginea.

We report 4 cases of benign testicular cysts arising from the tunica albuginea. A review of the literature yielded only 15 similar cases. The cysts appear in the anterior and lateral aspects of the testis, show ample connection to the albuginea and are lined by a cuboidal epithelium. Clinically, these cysts may be manifested as a tumour or painful swelling or are discovered incidentally. The possibility of a conservative surgical approach is discussed.

Adult

Transpubic cystectomy and ileocecal bladder replacement after preoperative radiotherapy for bladder cancer.

Radical cystectomy was modified by leaving the apical prostatic capsule to facilitate anastomosis of the isolated ileocecal segment to the urethra and to preserve erectile potency. The transpubic approach was used to increase the exposure, and to facilitate dissection and anastomosis. A total of 15 patients with stages T1 to T4 bladder tumors underwent the operation: 13 after preoperative radiotherapy with 4,000 rad and 2 had salvage cystectomy after 6,000 rad. One patient died postoperatively. The remaining 14 patients underwent urodynamic evaluation 3 to 6 months postoperatively. The maximum urine flow rates were almost normal and none of the patients had significant residual urine. Daytime urinary continence was satisfactory in 13 patients and 1 was moderately incontinent. All of the patients were incontinent at night, probably owing to peristaltic contractions in the intestinal bladder and relaxation of the pelvic floor muscles. Preoperatively, 8 patients experienced erections and 7 had intercourse. Postoperatively, erectile potency was preserved in 4 patients and 3 had sexual function. No orthopedic disability occurred postoperatively. The median followup was 20 months, with a range of 3 to 30 months. There have been no local recurrences. A year postoperatively 6 of 9 patients had sterile urine. This technique makes it possible to avoid a urinary stoma, to obtain satisfactory voiding and urinary continence in almost all cases, and to preserve sexual function in some patients after cystectomy.

Aged

Management of neurogenic urinary incontinence with AMS artificial urinary sphincter.

The AMS artificial urinary sphincter was implanted in 33 patients with neurogenic urinary incontinence during a 10-year period. All sphincter types were employed, from the earliest AS 721 model to the latest AS 800. The mechanically unstable AS 721 and 761 types have all been removed and, when possible, replaced by later models. In 27 of the 33 patients the device is still in situ, and in 6 (18%) it was removed, mainly because of urethral erosion. Increasingly favourable sphincter survival rats have been obtained. The overall survival rate for model AS 742 was 55% (7 years) for first implant, while the 4-year survival rate for AS 791/792 was 90%. Successful control of voiding function, defined as complete continence or slight but not socially inconvenient incontinence, was obtained in 25 patients (76% of the series).

Adolescent

Premedication before day surgery. A double-blind comparison of diazepam and placebo.

Premedication with diazepam 0.25 mg kg-1 by mouth was compared with placebo in a double-blind trial in patients undergoing day-case surgery under general anaesthesia. Diazepam decreased significantly preoperative discomfort and apprehension. The patients were discharged on time regardless of the type of premedication, and complaints at the time of discharge and on the following day could be related only to the length of anaesthesia and not to the type of premedication. Premedication given early in the morning remained effective for up to 6 h.

Adolescent

Influence of vasectomy on the volume of the non-hyperplastic prostate in men.

The influence of vasectomy on the volume of the non-hyperplastic prostate was investigated in 24 men referred consecutively for vasectomy. A comparison of trans-rectal prostatic volume determined ultrasonically before vasectomy and three months post-operatively revealed a highly significant decrease (P less than 0.01) in the volume of the peri-urethral portion of the gland. The volume of the outer zone of the prostate did not change significantly (P greater than 0.1). This may indicate that the prostate is not a functionally homogenous organ. It is postulated that there may be a local influence on the prostate via a hormone transported in the deferent duct and/or the deferential vein.

Adult