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Biomedical subjects

J T Andersen

Publications and source records attributed to J T Andersen.

At least 55 records · Page 3Linked to original sources
PubMed1995

Alpha 1-blockers vs 5 alpha-reductase inhibitors in benign prostatic hyperplasia. A comparative review.

During recent years, pharmacological treatment of symptomatic benign prostatic hyperplasia (BPH) has become the primary treatment choice for an increasing number of patients. The 2 principal drug classes employed are alpha 1-blockers and 5 alpha-reductase inhibitors. Current information from placebo-controlled double-blind clinical trials is reviewed. The effect of alpha 1-blockers on symptoms and objective parameters for bladder outlet obstruction is well documented. However, alpha 1-blockers carry a small but significant incidence of adverse effects. Parameters for identification of patients who will respond well to alpha 1-blockers have yet to be identified, and data concerning the long term effects of these drugs are not yet available. 5 alpha-Reductase inhibitors have a slow onset of effect, but treatment leads to improvement in symptoms, reduction of the size of the prostate gland and improvement in objective parameters for bladder outflow obstruction. Approximately 30 to 50% of patients will respond to treatment with 5 alpha-reductase inhibitors. The definitive role of pharmacological treatment in symptomatic BPH remains to be established, although it seems that patients unfit or unwilling to undergo surgical resection of the prostate will benefit from such therapy.

5-alpha Reductase Inhibitors↗
PubMed1994

Prevention of urethral stricture recurrence using clean intermittent self-catheterization.

OBJECTIVE: To investigate the effect of clean intermittent catheterization (CIC) on prevention of urethral stricture recurrence after internal urethrotomy. PATIENTS AND METHODS: Of 55 men who were randomly selected, 43 completed the investigation. Of these, 21 patients performed CIC weekly for 1 year following Sachse's operation for urethral stricture and 22 patients formed the control group after the same operation. All had an objective examination for urethral stricture every 2 months after surgery. RESULTS: Significantly fewer (P < 0.01) patients developed recurrence of urethral stricture within the first postoperative year in the CIC group (n = 4) compared with the control group (n = 15). No CIC complications were seen, and patients who completed the CIC programme considered the method fully acceptable. CONCLUSION: Weekly CIC is a simple method of reducing the frequency of urethral stricture recurrence after internal urethrotomy.

Adolescent↗
PubMed1994

Primary in situ extracorporeal shock wave lithotripsy for ureteral calculi.

The use of a second generation lithotriptor (Siemens Lithostar) for ESWL treatment of 199 consecutively referred patients with ureteral calculi is evaluated. Follow up data were available in all patients. In 79 patients the calculus was located in the upper third of the ureter, in 43 patients in the middle third and in 77 patients in the lower third of the ureter. In situ ESWL was performed in 187 patients (94%) under local infiltration analgesia, if invasive procedures in conjunction with ESWL were not planned. The overall stone free rates for all patients after 1, 3 and 6 months were 62.3%, 82.4% and 89.9% respectively. The size of the calculus influenced the outcome of treatment, the number of treatments and number of shock waves given. The stone free rates 3 and 6 months after ESWL in patients with upper ureteral calculi were 86.1% and 91.1%; the number of treatments per patient was 1.2. The corresponding rates for patients with mid or lower ureteral calculi were 76.7%, 86.0% (1.0 treatment) and 81.8%, 90.9% (1.2 treatment) respectively. ESWL alone failed to clear calculi in 4 patients with upper ureteral stones, 6 patients with mid-ureteral calculi and 14 patients with lower ureteral calculi. The number of additional procedures post-ESWL was significantly higher among patients with calculi in the lower third of the ureter. It is concluded, that ESWL in situ with a second generation lithotriptor using X-ray localization is an effective and noninvasive method to treat ureteral calculi. In situ ESWL is recommended as first line treatment for ureteral calculi in the upper and mid-thirds.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1993

Maximum urinary flow rate by uroflowmetry: automatic or visual interpretation.

We measured the maximum urinary flow rate monthly for 1 year by uroflowmetry in 1,645 patients in a double-blind, placebo-controlled study of finasteride therapy for benign prostatic hyperplasia. Patients were randomized to receive placebo (555) or finasteride (1,090). A total of 23,857 flow measurements was obtained. Because of the presence of artifacts on many uroflow curves, we read the maximum urinary flow rate values manually and compared them to the values provided electronically by the uroflowmeter. On average, the manually read values were 1.5 ml. per second lower than the machine read values. Artifacts causing a difference of 2 ml. per second or more between the 2 methods were found in 20% and of more than 3 ml. per second in 9% of the tracings. The difference between treatment groups in mean maximum urinary flow rate change at the end of the study was the same with both reading methods. However, confidence intervals were 15 to 25% larger for the machine read compared to the manually read values. This larger variability in machine read maximum urinary flow rate has a marked negative impact on the power of statistical tests to assess any given difference in maximum urinary flow rate between treatment groups. Furthermore, it increases sample size requirements by 50% to achieve any given statistical power. We conclude that maximum urinary flow rate artifacts contribute significantly to the variability of maximum urinary flow rate measurement by uroflowmetry. Manual reading of the maximum urinary flow rate eliminates an important fraction of such variability.

5-alpha Reductase Inhibitors↗
PubMed1993

Treatment of cystine stones: combined approach using open pyelolithotomy, percutaneous pyelolithotripsy, extracorporeal shock wave lithotripsy and chemolysis.

Treatment of cystine stones in the urinary tract can be difficult because of a high frequency of recurrence, resistance to Extracorporeal Shock Wave Lithotripsy (ESWL), difficulty in localization and access to peripheral stones during Percutaneous Nephrolithotripsy (PCNL), and the insufficient effect of oral chemolysis. We present two cases of urinary cystine calculi treated with a combination of pyelolithotomy, PCNL, ESWL and percutaneous irrigation chemolysis, using N-acetylcysteine and Tromethamine-E.

Acetylcysteine↗
PubMed1993

Age as a prognostic variable in patients undergoing transurethral prostatectomy.

In a retrospective study the outcome of transurethral prostatectomy (TURP) for benign prostatic hyperplasia (BPH) in patients more than 80 years old was compared to a control group of patients with a mean age ten years younger. The elderly had significantly more tissue resected and presented with a higher rate of preoperative urinary tract infection. More urological complications were seen among the elderly but these were generally short lived and had no influence on the morbidity, mortality and symptomatic outcome. The perioperative mortality was 3.2% among elderly and 0% in the younger age group. A cardiorespiratory risk score could not predict patients at risk. In conclusion the age per se had no major influence on the outcome of TURP.

Aged↗
PubMed1993

The "Wallstent": a new stent for the treatment of urethral strictures.

Ten patients have been reviewed in whom urethral stents were implanted for treatment of urethral stricture. Their urethral strictures had been treated with a median of 4.2 endoscopic urethrotomies under direct vision without success. The patients were first treated with optical urethrotomy, and dilatation to 30 F--after which the stents were inserted under direct endoscopic control. A total of 12 stents were inserted. All patients had a 30 mm stent inserted first, and two patients had an additional 20 mm stent inserted because of recurrent stricture at the distal or proximal end of the first stent. One patient had a urethrotomy 12 months after insertion of the stent because of a short recurrent stricture at its distal end. The median length of follow up was 24 months. The median preoperative maximum flow rate was 6.5 ml/s, and the median postoperative maximum flow rate was 20.3 ml/s. Half the patients had postmicturition dribbling postoperatively. The stents were covered with epithelium after 6-18 months, most between 12 and 18 months.

Adult↗
PubMed1993

A new patient weighted symptom score system (DAN-PSS-1). Clinical assessment of indications and outcomes of transurethral prostatectomy for uncomplicated benign prostatic hyperplasia.

A patient weighted symptom score system, the Danish Prostatic Symptom Score (DAN-PSS-1), including a disease specific self administered quality of life questionnaire, is presented. The model was evaluated pre- and postoperatively in 29 patients apparently suffering from uncomplicated benign prostatic hyperplasia. The score system is based on the severity of 12 symptoms related to bladder storage and voiding function, and three questions related to sexual function (symptom score). For each of these parameters the patient must also evaluate its influence on his daily life (bother score). In the 29 patients with uncomplicated benign prostatic hyperplasia (BPH) bother scores exceeded symptom scores for the irritative symptoms but not for the obstructive symptoms, and surprisingly the symptom score was less improved than the bother score 6 months after transurethral resection of the prostate (TUR-P). Furthermore the postvoiding dribble was worsened after the operation. We find that this model, DAN-PSS-1, assists in creating a solid base for the indication for and the evaluation of treatment of uncomplicated BPH.

Aged↗
PubMed1992

Overexpression and rapid purification of the orfE/rph gene product, RNase PH of Escherichia coli.

The pyrE gene, encoding the pyrimidine biosynthetic enzyme orotate phosphoribosyltransferase, is the promoter distal gene of the dicistronic orfE-pyrE operon. The promoter proximal orfE gene, whose transcription and translation is important for regulation of the pyrE attenuator, encodes a 238-amino acid residue protein which was recently identified as the phosphorolytic ribonuclease, RNase PH, that removes nucleotides from the 3' ends of tRNA precursors. In this paper we report the construction of a plasmid, which overexpresses the orfE and pyrE gene products substantially, as well as the purification of the OrfE protein by ammonium sulfate precipitation and chromatography on phosphocellulose. The highly purified protein catalyzes the phosphorolytic cleavage of poly(A) at a rate of 1.6 mumol/min/mg and the formation of CDP from tRNA-CCA-Cn and orthophosphate at a rate equal to 0.14 mumol/min/mg, as characteristic for RNase PH. OrfE/RNase PH contains helix-turn-helix motifs resembling those in DNA-binding proteins, and it binds nonspecifically to DNA. On SDS gels, OrfE/RNase PH migrates as two distinct protein bands. This heterogeneity might be caused by post-translational modification other than proteolysis, or may be an electrophoretic artifact. The native protein is composed of two or more subunits.

Amino Acid Sequence↗
PubMed1992

Attenuation in the rph-pyrE operon of Escherichia coli and processing of the dicistronic mRNA.

We have substituted on a plasmid the native promoter of the Escherichia coli rph-pyrE operon with an inducible transcription-initiation signal. The plasmid was used to study the mRNA chains derived from the operon at different intracellular concentrations of UTP and as a function of time following induction of transcription. The results showed that dicistronic rph-pyrE mRNA was formed when the UTP pool was low, and that a monocistronic rph mRNa was the major transcription product in high-UTP pools, thus supporting an UTP-controlled attenuation mechanism for regulation of pyrE gene expression. However, the dicistronic rph-pyrE transcript was rapidly processed into two monocistronic mRNA units, and a cleavage site was mapped near the attenuator in the intercistronic region, close to the site where transcription was terminated in high-UTP pools. Furthermore, the major 3' end of the pyrE mRNA was mapped near a palindromic structure of similarity to the family of repetitive extragenic palindromic sequences, 35 nucleotide residues after stop codon of the pryE gene.

Base Sequence↗
PubMed1992

[Surgery of penile deviation by Ebbehøj's method].

A questionnaire investigation to evaluate the results of surgery for penile angulation by plicature of tunica albuginea by Ebbehøj's method is presented. In 31 patients with congenital penile angulation, 24 (77%) were satisfied with the functional result and 20 (65%) with the cosmetic result of the operation. In 14 patients with Peyronie's disease, eight (57%) were satisfied with the functional result and six (43%) with the cosmetic result of the operation. This is in accordance with previously published surveys of the results of surgery using this method. However, a high prevalence of late sequelae was observed, especially penile shortening and pain. In conclusion, the method yields acceptable functional and cosmetic results and is easy to perform. However, optimal surgical technique is imperative to reduce the prevalence of late sequelae which also necessitate detailed preoperative information and restrictive indications for surgery.

Adult↗
PubMed1992

Anesthesia and complications of extracorporeal shock wave lithotripsy of urinary calculi.

The techniques of anesthesia for extracorporeal shock wave lithotripsy of urinary calculi and the associated complications in 600 treatments with the second generation lithotriptor Siemens Lithostar were studied. General anesthesia was used in 17 treatments (2.8%) and epidural anesthesia was applied in 73 (12%), primarily in children and patients in need of simultaneous surgical auxiliary procedures. A total of 510 treatments (85%) was performed with a combination of local infiltration anesthesia and supplementary intravenous opiates. In 65% of the cases only 2 injections of opiates were sufficient for pain relief. There were no complications in 394 treatments (77%) and minor complications, such as arrhythmia (9.2%) and nausea/vomiting (7.6%), were easily treated. Respiratory depression was observed in 10 cases (2%) and this potentially dangerous complication was associated with simultaneous administration of opiates and midazolam. Only 9 treatments (1.8%) had to be terminated due to complications. It is concluded that most treatments of urinary calculi with this second generation extracorporeal shock wave lithotriptor can be performed with local infiltration anesthesia combined with supplementary short-acting opiates intravenously for pain relief and sedation. When administering supplementary midazolam for sedation the risk of respiratory depression should be considered.

Adolescent↗
PubMed1992

Local anesthesia for extracorporeal shock wave lithotripsy: a study comparing eutetic mixture of local anesthetics cream and lidocaine infiltration.

A study of the anesthetic efficacy of a eutetic mixture of local anesthetics (EMLA cream) versus lidocaine infiltration in extracorporeal shock wave lithotripsy (ESWL) was done. A total of 46 patients had 30 gm. of EMLA cream applied to the skin over the kidney and 45 had subcutaneous infiltration anesthesia with 20 ml. 1% lidocaine with epinephrine. All patients received an intravenous dose of morphine just before ESWL. The patients were comparable with regard to age, sex, weight, morphine dosage, number of shock waves given and duration of treatment. Median pain score and the amount of supplementary analgesics were not significantly different between the 2 groups. There were no significant differences between the groups with regard to post-ESWL skin changes. Therefore, EMLA cream can be recommended for ESWL provided it is applied correctly.

Adolescent↗
PubMed1991

Transurethral resection of very large prostates. A retrospective study.

Twenty-one patients with benign prostatic hypertrophy (BPH), and a weight of transurethrally resected tissue exceeding 80 g (Group 1), were compared to a control group of 30 patients with a weight of resected tissue less than 80 g (Group 2) with regard to the peri- and postoperative course and the symptomatic and urodynamic results of surgery. All patients were followed 12 months postoperatively. In both groups more than 90% of the patients were satisfied with the results of the operation. However, the obstructive symptoms were better relieved than the irritative symptoms. The group who had large resections performed had a longer operating time and a greater perioperative blood loss than the group of minor resections. No differences were found with regard to other peri- or postoperative complications or subjective results. Transurethral resection is safe and efficient in treating BPH, also with very large prostates.

Aged↗
PubMed1991

Role of transcription pausing in the control of the pyrE attenuator in Escherichia coli.

Expression of the Escherichia coli pyrE gene is regulated by transcription attenuation in the intercistronic orfE-pyrE region and modulated by the distance between the transcribing RNA polymerase and the leading ribosome as a function of the supply of UTP and GTP. In this communication we show that pyrE expression is hyper-repressed in vivo following addition of uracil in strains carrying the nusAcs10 mutation. This phenotype, previously seen in rpsL1204 strains whose ribosomes are pseudodependent on streptomycin and work at suboptimal elongation rate, indicates that RNA polymerase escapes from the ribosomes in the pyrE attenuator region in the nusA mutant. In vitro transcription studies revealed that the build-up of the full-length attenuated orfE transcript occurred more slowly in the presence of the NusA protein than in its absence. Moreover, the NusA protein enhanced several transcription pauses through the orfE gene. These effects were more pronounced when low concentrations of either UTP or GTP were used than at low concentrations of either CTP or ATP. The results indicate that the NusA protein is required for proper regulation of pyrE gene expression and is involved, together with the NTP pools, in maintaining the coupling between transcription and translation in the pyrE attenuator region by inhibiting RNA chain elongation.

Bacterial Proteins↗
PubMed1991

Benign prostatic hyperplasia: symptoms and objective interpretation.

Considerable new knowledge about benign prostatic hyperplasia has been gained over the past two decades, particularly with regard to its natural history, hydrodynamic changes in the lower urinary tract, and the symptomatic and urodynamic results of treatment. A survey of the literature has been undertaken with special attention to the results of interventional studies and suggestions for future research.

Aged↗