Biomedical subjects

M Ruutu

Publications and source records attributed to M Ruutu.

At least 19 recordsLinked to original sources

PubMed1997

Is it possible to prevent bacterial adhesion onto ureteric stents?

The aim of this study was to determine whether the use of bactericidal coatings or immersion in antibiotic solution reduces or prevents bacterial adhesion onto ureteric stents. Precut segments of full silicone, silver-coated and hydrogel-coated ureteric stents were incubated with two uropathogenic bacterial strains with and without previous immersion in antibiotic solution. Tobramycin, ceftriaxone and ciprofloxacin solutions were used, as these antibiotics are commonly administered for the prophylaxis and treatment of urinary tract infection (UTI). Microbiological analysis showed that immersion of ureteric stents in ceftriaxone and ciprofloxacin yielded a significant reduction of bacterial adhesion, whereas immersion in tobramycin did not. The surface material of the stents had no direct influence on bacterial adhesion. In this experimental study, neither the silver nor the hydrogel coat reduced bacterial adhesion onto ureteric stents whereas immersion in a suitable antibiotic solution significantly reduced and even prevented this phenomenon, probably due to the adhesion of the antibiotic onto the stent surface. Prevention of bacterial adhesion onto ureteric stents is essential to reduce the risk of UTI in connection with these devices.

Anti-Bacterial Agents↗

PubMed1997

Evaluation and follow-up of patients with N1-3 M0 or NXM1 prostate cancer in phase III trials.

OBJECTIVES: The aim of this discussion is to review the design and conduct of phase III trials in metastatic prostate cancer, to seek ways of improving their study design, accuracy, relevance to clinical practice, acceptability to patients, and ease of participation by clinicians. We also aim to try to set uniform definitions for the evaluation of the different endpoints used in clinical trials on metastasized prostate cancer. METHODS: The work was started by correspondence between the participants in the group for the year before the consensus meeting. Two comprehensive questionnaires were circulated and the answers were distributed to all the members of the group. The statements were finalized during the consensus meeting. RESULTS: There were some differing opinions concerning the methods of evaluation of endpoints for follow-up, such as time to tumor progression and time to treatment failure. After the consensus conference, there were no major disagreements within the group. CONCLUSIONS: The aim of phase III trials is to influence clinical management. To obtain a credible result they require a sound statistical basis with appropriate power and encompassing patients from small urologic practices as well as large or academic institutions. However, deviation from routine practice may affect the accrual rate, and the trial procedure should therefore be as similar as possible to routine management. Trials inevitably involve extra work and cost. Both should be kept to a minimum to encourage participation and hasten a timely conclusion. It is mandatory to create uniform ways of designing and evaluating clinical trials in prostate cancer.

Clinical Trials, Phase III as Topic↗

PubMed1997

Immersion in antibiotic solution prevents bacterial adhesion onto biodegradable prostatic stents.

OBJECTIVE: To determine whether immersion in antibiotic solution reduces or prevents bacterial adhesion onto biodegradable prostatic stents. MATERIALS AND METHODS: Pre-cut segments of polyglycolic acid (PGA) and polylactic acid (PLA) prostatic stents were incubated with two common uropathogenic bacterial strains (Enterococcus faecalis and Escherichia coli) with and without previous immersion in antibiotic solution. Tobramycin, ceftriaxone and ciprofloxacin solutions were used, as these antibiotics are commonly administered for the prophylaxis and treatment of urinary tract infection (UTI). RESULTS: Immersion in ciprofloxacin solution prevented the adherence of both bacterial strains. Immersion in ceftriaxone solution prevented only the adherence of the E. coli strain. Immersion in tobramycin solution had no effect on either of the strains. The stent materials per se did not influence bacterial adhesion. After immersion in ciprofloxacin, the stent segments retained significant antibacterial activity even after one day's incubation in saline. CONCLUSION: Immersion in a suitable antibiotic solution may significantly reduce and even prevent bacterial adhesion onto biodegradable prostatic stents. Preventing bacterial adhesion may reduce the risk of UTI during the use of these devices.

Anti-Bacterial Agents↗

PubMed1996

Biocompatibility of latex and silicone T tubes in the porcine common bile duct: an experimental study.

Toxicity of materials used in indwelling drains or catheters has the potential to damage surrounding tissues. The biocompatibility of biliary T-tubes was investigated using in groups of piglets (total 30 animals). In group 1 (n=16) a choledochotomy was performed with insertion of a latex T-tube (n=6) or a silicone T-tube (n=8), or without a T-tube (n=2). In group 2 (n=14) the common bile duct (CBD) was 3/4-transected, and the lesion was sutured over a latex T-tube (n=4) or a silicone T-tube (n=5), or without a T-tube (n=5). The groups were reoperated upon after 2 and 6 weeks respectively, and the CBD was harvested for scanning electron microscopy and light microscopy. The T-tubes were examined for cell culture toxicity with a DNA synthesis inhibition test. According to the cell culture tests, latex T-tubes were toxic and silicone T-tubes nontoxic. T-tubes induced moderate to pronounced fibrosis and epithelial damage in the CBD wall, but did not induce excessive fibrosis or scarring at the site of CBD suture. In the 6-week study period, however, the grade of tissue reactions in the CBD did not correlate with the toxicity of the T-tube materials, but rather reflected a foreign body reaction and mechanical pressure. Although gross anatomical changes did not occur, neither material seemed to be completely harmless for porcine CBD wall.

Animals↗

PubMed1996

Simple methods of quantifying oxidation products and antioxidant potential of low density lipoproteins.

OBJECTIVES: The present study describes new methods for the measurement of oxidation products and antioxidant potential of low density lipoproteins (LDL). DESIGN AND METHODS: LDL is isolated by precipitation with buffered heparin. The assay for LDL oxidation products (LDL-BDC) is based on determination of baseline levels of conjugated dienes (BDC) in lipids extracted from LDL. The assay for antioxidant potential of LDL (LDL-TRAP) is based on the ability of LDL to trap peroxyl radicals. RESULTS: LDL-BDC was found to increase linearly over a range from 100 to 1750 microL, LDL-TRAP from 250 to 1750 microL of serum taken for precipitation. For LDL-BDC, the CV was 4.4% and 4.5% for within- and between-assay precision, respectively. For the LDL-TRAP, the CV was 8.1% and 8.7% for within- and between-assay precisions, respectively. Freezing of the serum (2 weeks at -70 degrees C) did not affect LDL-BDC or LDL-TRAP levels. A negative correlation was found to exist between the LDL-BDC and LDL-TRAP values. LDL-BDC and LDL-TRAP values were at the same level in both sexes. The LDL-BDC was found to increase with age. Short-term intervention with antioxidants increased LDL-TRAP substantially, but did not affect the LDL-BDC level. CONCLUSIONS: These methods are fast and simple to perform, and can, therefore, be applied to clinical purposes.

Adolescent↗

PubMed1996

Aortofemoral surgery and sexual function.

OBJECTIVES: To determine the incidence and pathophysiology of erectile dysfunction (ED) in patients with aortoiliac occlusive disease (AIOD) and the effects of aortofemoral surgery, including endarterectomy (E) and reconstruction (R), on erectile function (EF). DESIGN: Evaluation of EF before and 3 months after surgery. METHODS: 31 out of 40 male patients scheduled for aortofemoral surgery were given multiple choice questionnaires and penile dynamic Colour Doppler Ultrasonography. RESULTS: Of the 31 who agreed to enter the study five (16%) were found to be potent and 26 (84%) to suffer from ED. This was purely arteriogenic in 8% of the cases, purely venogenic in 23%, combined arteriogenic and venogenic in 53%, and neurogenic in 16%. Twenty patients returned for postoperative evaluation of EF, nine who had undergone E and 11 who had undergone R. Improvement of EF, in terms of increased penile arterial inflow, occurred in seven patients, six who had undergone E and one who had undergone R. EF remained unchanged in nine patients, three who had undergone E and six who had undergone R. Deterioration of EF occurred in four patients, all who had undergone R, and was attributable to decreased arterial inflow in two cases and to neurogenic surgical injury in the other two. CONCLUSIONS: The majority of patients with AIOD suffers from ED. Reduced penile arterial inflow and cavernovenous leakage are equally important in the pathophysiology of ED in patients with AIOD, suggesting that atherosclerosis may also compromise the penile veno-occlusive mechanism. Endarterectomy seems more likely than reconstruction to improve or maintain EF.

Aorta, Abdominal↗

PubMed1996

cDNA cloning and characterization of a novel nucleolar protein.

In an initial study of anti-nuclear antibodies in the chronic inflammatory bladder disease interstitial cystitis, we reported that 7% of interstitial cystitis patients studied had autoantibodies to the nucleolus. We now report that, using an autoimmune serum from a patient with interstitial cystitis, we have identified and partially characterized a novel protein with an M(r) of approximately 55 kDa (hereafter referred to as No55) localized to the granular component of the nucleolus. No55 was initially characterized by diffuse nucleolar immunofluorescence staining in interphase cells and by Western blotting as a 55-kDa doublet on whole-cell extracts. During mitosis, No55 was associated with chromosomes and appeared in prenucleolar bodies during telophase, but it did not colocalize with p80-coilin in coiled bodies. Immunoelectron microscopy revealed that No55 was localized uniformly throughout the granular component of the nucleolus compared with a more peripheral localization of nucleolar granular component protein B23. On segregation of the nucleolus with actinomycin D, No55 remained with the granular component of the segregated nucleolus, whereas protein B23 was found predominantly in the nucleoplasm. Finally, a cDNA expression library was screened with the human autoantibody against No55, and a 2.4-kb insert was isolated, subcloned to homogeneity, and then sequenced. Analysis of this sequence showed an open reading frame of approximately 1.3 kb coding for 437 amino acids with a predicted molecular weight of 50 kDa. A search of the gene sequence database indicated homology with SC65, a rat synaptonemal complex protein. Therefore, on the basis of molecular weight, nucleolar sublocalization, response to actinomycin D, and cDNA sequence determination, No55 is a novel protein of the interphase nucleolus.

Amino Acid Sequence↗

PubMed1996

Bacterial adherence and biofilm formation on latex and silicone T-tubes in relation to bacterial contamination of bile.

BACKGROUND: T-tube-related bacteriobilia causes infectious complications and obstruction. To prevent these, the choice of T-tube material may be of importance. METHODS: Transected common bile ducts (CBDs) of 17 piglets were sutured over latex or silicone T-tubes, or without a T-tube. RESULTS: After 6 weeks bacteriobilia was found in all of 12 CBDs with and in 1 of 5 CBDs without a T-tube (p < 0.05). By scanning electron microscopy (SEM) four of five latex and none of five silicone T-tubes had bacterial biofilms (p < 0.05). All tubes remained patent. Segments of T-tubes were incubated with five different bacterial strains. Sonication and SEM showed that 0.1-1.1% of 10(7) colony-forming units of inoculum adhered to T-tubes. Two to six times more bacteria adhered to latex than to silicone (p < 0.05). CONCLUSIONS: Silicone offers better long-term patency than latex. Less infectious complications occur if T-tubes are omitted.

Animals↗

PubMed1996

Bacterial adhesion and biofilm formation on various double-J stents in vivo and in vitro.

The aim of this study was to determine whether bacterial adhesion and biofilm formation occur on various ureteric stent materials in vivo and in vitro and whether there is any correlation between biofilm formation and urinary tract infection. Using an open surgical procedure, 23 double-J stents of 8 different types were inserted in the ureters of 13 piglets. After 6 weeks intubation, 2 (9%) of the 23 stented renal units yielded positive urine culture. Scanning Electron Microscopy (SEM) showed sporadic bacteria on 7 (30%) of the 23 indwelling ureteric stents and bacterial biofilms on only 2 (9%), those indwelling the renal units which yielded positive urine cultures. Precut segments of the 8 double-J stent brands were incubated with 5 different bacterial strains. Microbiological and SEM analysis of the stents revealed that only 0.1-0.01% of the bacterial inoculum adhered to the stents. There was no statistically significant difference in bacterial adherence to the various stent materials. Interestingly, the two Escherichia coli strains with P-fimbriae adhered significantly more than the two without P-fimbriae. Sporadic bacterial adhesion to ureteric stents seemed to have little clinical significance whereas biofilm formation seemed to result in urinary tract infection. None of the tested stents proved to be superior to the others in this respect, and adhesion appeared to depend on the virulence of the bacteria rather than the properties of the biomaterials.

Animals↗

PubMed1996

Cyclosporine in severe interstitial cystitis.

PURPOSE: Cyclosporine is a widely used immunosuppressive drug in organ transplantation and recently it has been used in several autoimmune disorders with good results. Because interstitial cystitis may have an autoimmune etiology, we wished to determine whether cyclosporine has any effect on symptoms in patients with severe interstitial cystitis. MATERIALS AND METHODS: A total of 11 patients, who fulfilled the criteria for interstitial cystitis according to an international accrual form, received cyclosporine for 3 to 6 months at an initial dose of 2.5 to 5 mg./kg. daily and a maintenance dose of 1.5 to 3 mg./kg. daily. Blood pressure, serum creatinine and cyclosporine concentrations were monitored regularly. The patients completed frequency-volume charts at 2-week intervals. RESULTS: The frequency-volume charts showed favorable effects. Micturition frequency decreased (p<0.01), and mean and maximum voided volumes increased significantly (p<0.001 and p<0.01, respectively). Bladder pain decreased or disappeared in 10 patients, allowing for storage of large urine volumes. Serum creatinine did not change with the dosages used. Mild hypertension occurred in 2 patients and resolved after the cyclosporine dose was lowered. After cessation of treatment symptoms recurred in the majority of patients. CONCLUSIONS: The findings revive the concept of interstitial cystitis as an autoimmune disease.

Adult↗

PubMed1996

A positive pharmacological erection test does not rule out arteriogenic erectile dysfunction.

PURPOSE: We tested the assumption that a positive pharmacological erection test implies normal penile vascular status. MATERIALS AND METHODS: From March 1991 to February 1995, 372 patients with erectile dysfunction were referred to our institutions. Penile hemodynamics were studied in 205 patients with color coded Doppler ultrasonography after intracavernous injection of 40 micrograms. prostaglandin E1. RESULTS: Of the 205 patients undergoing color coded Doppler utrasonography 92 had a rigid erection, that is a positive pharmacological erection test. Doppler wave analysis showed that 76 of the 92 patients (82%) had normal and 7 (8%) had borderline arterial function (peak systolic velocity greater than 35 and 25 to 35 cm. per second, respectively), while 9 (10%) had arterial insufficiency (peak systolic velocity less than 25 cm. per second). All 92 patients had a normal veno-occlusive mechanism (resistance index greater than 0.90). Of the 9 patients with pure arteriogenic erectile dysfunction 8 had risk factors for arterial insufficiency, such as aortoiliac occlusive disease (5), diabetes mellitus (3), longer than 20-year smoking history (8) and hypertension (7). CONCLUSIONS: Our study shows hemodynamically that a positive pharmacological erection test does not rule out arteriogenic erectile dysfunction.

Adult↗

PubMed1996

Etilefrine in the prevention of prolonged erection after diagnostic pharmacological stimulation.

The aim of this study was to verify the efficacy and safety of intracavernous injection of etilefrine hydrochloride in the prevention of pharmacologically induced prolonged erection. Two hundred rigid erections due to diagnostic pharmacological stimulation were treated with immediate intracavernous injection of 5 to 10 mg etilefrine hydrochloride. Penile response and general side effects after the injection were recorded. Patients were interviewed after 1-2 weeks about possible side effects. Detumescence occurred within 10 minutes in 194 (97%) cases. In the remaining six (3%), detumescence occurred after cavernous aspiration and additional injection of 5 mg etilefrine. Thirteen patients (6.5%) had transitory palpitations. None of the patients had hypertensive crisis, cardiac arrythmia or ischaemic events. Intracavernous injection of etilefrine is effective and safe in preventing prolonged erection after diagnostic pharmacological stimulation.

Adult↗

PubMed1995

Pregnancy results from a vibrator application, electroejaculation, and a vas aspiration programme in spinal-cord injured men.

In an infertility treatment programme for spinal-cord injured men, vibrator application was primarily used in cases of upper motor neurone lesion and electroejaculation in men with lower lesions, or when vibrator application failed to induce ejaculation. Spermatozoa were obtained by these methods from 29 out of 35 men who desired infertility treatment. No ejaculate was obtained from six men. Three of these men plus two others with very poor sperm quality with electroejaculation underwent micro-surgical sperm aspiration from the vas deferens for invitro fertilization (IVF), and spermatozoa were obtained from all of them. Thus it was possible to obtain spermatozoa from almost every spinal-cord injured man who had ongoing spermatogenesis using these three methods. Insemination was the primary infertility treatment used with all the couples where there was successful ejaculation. In all, 12 pregnancies resulted from home vaginal inseminations, eight from intrauterine inseminations, two from IVF with ejaculated spermatozoa, and two from IVF with spermatozoa aspirated from the vas. Three couples had children from donor inseminations (not counted in the results); 12 are still in the programme. From 24 pregnancies, 22 children have now been born to 18 couples out of the original 35 (51%), and there were four abortions. Hence, overall, infertility treatment of spinal-cord injured men has given good results.

Ejaculation↗

PubMed1995

Biocompatibility of various indwelling double-J stents.

The biocompatibility of 8 double-J stent brands was evaluated both in vivo, by scanning electron microscopy and histological analysis of pig ureters intubated for 6 weeks, and in vitro, by cell culture methods. In vivo findings showed that superficial epithelial destruction was milder in the ureters intubated with hydrogel-coated stents than in those intubated with other stents. Inflammatory reactive changes were milder in the ureters intubated with silicone stents than in those intubated with other stents, while encrustation was more severe on silicone and Grey stents than the others. In vitro, the 3 stent brands made of "modified polyurethane" were found to be cytotoxic while the others were not. Overall, silicone and hydrogel-coated stents seemed to be more biocompatible than the others, and hydrogel-coated stents to be more suitable than silicone stents for long-term ureteral stenting, being less prone to encrustation. Although they are of an experimental nature, these findings may be of relevance to clinical practice.

Animals↗

PubMed1995

Alternating mitomycin C and bacillus Calmette-Guerin instillation therapy for carcinoma in situ of the bladder. The Finnbladder Group.

PURPOSE: Our aim was to prove if alternating chemotherapeutic and immunotherapeutic instillations improved efficacy and reduced toxicity in patients with carcinoma in situ of the bladder. MATERIALS AND METHODS: Of 68 carcinoma in situ patients randomly treated with instillations 40 received mitomycin C and 28 received mitomycin C and Pasteur bacillus Calmette-Guerin (BCG) in alternating courses. Mean followup was 33 months. RESULTS: The complete response rates with mitomycin C and mitomycin C/BCG were 45% and 71% at 3 months, 59% and 82% at 12 months, and 47% and 74% at 24 months, respectively (p = 0.041). The disease-free interval showed the superiority of alternating therapy (p = 0.043). Recurrence rates during the instillation period were 1.834 with mitomycin C and 0.922 with mitomycin C/BCG (p = 0.013). No remarkable side effects developed in the alternating group. CONCLUSIONS: Therapy of carcinoma in situ with alternating mitomycin C and BCG is more effective than mitomycin C alone. Compared to BCG monotherapy only few side effects occur.

Adjuvants, Immunologic↗

PubMed1994

The effects of various indwelling JJ stents on renal pelvic pressure and renal parenchymal thickness in the pig.

OBJECTIVE: To determine whether indwelling JJ stents significantly alter renal pelvic pressure and consequently have deleterious effects on renal function. MATERIALS AND METHODS: Thirteen piglets were used totalling 26 renal units. Using an open, sterile surgical procedure, 23 renal units were stented with 6 F JJ catheters of eight different types: three renal units were not stented and served as controls. Intra-pelvic pressure values during diuretic stress were measured before and after 6 weeks of intubation. The kidneys were then removed and sent for pathological evaluation of renal parenchymal thickness. RESULTS: A marked increase in intra-pelvic pressure values was found in two of the 19 stented renal units suitable for this measurement. A significant reduction (more than one third with respect to the control values) in renal parenchymal thickness was found in six of the 21 stented renal units suitable for this measurement, three of which had been intubated with a Cook polyurethane stent and three with an Angiomed Puroflex stent. CONCLUSION: In the present experimental study some JJ stents seemed to cause long-lasting changes in renal pelvic pressure and consequently to have deleterious effects on renal function. Although experimental findings are not always fully related to clinical practice, a knowledge of the potential effects of these prostheses is essential to minimize complications related to their use.

Animals↗

PubMed1994

Penile necrosis in a diabetic with renal disease and clean intermittent catheterization for recurrent urethral stricture. Case report.

In a patient with diabetic microangiopathy and renal disease, penile necrosis occurred in connection with clean intermittent catheterization. Microangiopathy of the urethral and penile arteries presumably lowered the local defences, so that the catheterization initiated penile necrotic changes by introducing bacteria and traumatizing the poorly vascularized urethral epithelium.

Diabetes Mellitus, Type 1↗

PubMed1994

Prognostic factors in the management of ureteric injuries.

The outcome of 137 ureteric injuries was analysed with respect to previous radiotherapy, site, type and length of the injury and time of treatment, to evaluate the prognostic significance of each of these factors. The length of the injury was the most important prognosticator of treatment outcome (P = < 0.0005). Previous radiotherapy and timing of treatment had prognostic significance (P = < 0.05) but the predictive value seemed to be linked to the frequent association with injury length. The site and the type of injury had no prognostic significance. The unfavourable prognostic significance of extensive injury length appeared to be related to the treatment procedures (urinary diversions) which in themselves carry a high failure rate. Knowledge of the impact of these factors on the outcome of ureteric injuries is valuable in choosing the best treatment option for each patient.

Female↗