Meal stimulated levels of pancreatic polypeptide (PP) and vasoactive intestinal polypeptide (VIP) in gastroplasty for morbid obesity.

Plasma concentrations of pancreatic polypeptide (PP) and vasoactive intestinal polypeptide (VIP) were measured after a meal consisting of 11 ml meat extract and 40 ml of 20% soya oil in 11 patients before and 3 months after gastroplasty for morbid obesity. Gastroplasty results in a small proximal pouch with a narrow stoma allowing delayed emptying into the distal pouch, and consequently postprandial distension of the proximal pouch. Postprandial plasma PP increased significantly (P less than 0.01) independent of gastroplasty. PP is therefore not involved in the early satiety after gastroplasty. Postprandial plasma VIP increased significantly from fasting levels both before and after gastroplasty (P less than 0.05). Only 10 min after a meal, the median value of VIP was significantly higher after than before gastroplasty (P less than 0.02) and may be caused by distension of the proximal pouch.

Plasma levels of neurotensin in gastroplasty for morbid obesity.

Fasting and postprandial plasma levels of the tridecapeptide neurotensin were determined in ten women before and three months after gastroplasty for morbid obesity. Measurements were by radioimmunoassay in unextracted plasma with two antisera recognizing intact neurotensin (NT1-13) or intact neurotensin together with small C-terminal fragments, which may circulate as metabolites of neurotensin. Levels of both intact neurotensin and C-terminal immunoreactivity in obese women were in the same order of magnitude as those found previously in lean persons. Fasting levels measured with both antisera were significantly reduced following gastroplasty (P less than 0.01). Meal-stimulated levels and increments were unchanged. The cause of this prolonged reduction is at present unknown, but may be a reduced luminal stimulation of the small intestine or an altered vagal tonus following gastroplasty.

Expression and characterization of preproVIP derived peptides in the human male urogenital tract.

Expression of the gene sequence encoding vasoactive intestinal polypeptide (VIP) leads to the synthesis of a 170 amino acid precursor molecule which can be processed to five fragments: preproVIP 22-79, peptide histidine methionine (PHM), or peptide histidine valine (PHV), preproVIP 111-122, VIP and preproVIP 156-170. Using region specific radioimmunoassays and antisera against the functional domains of the VIP precursor in combination with immunocytochemistry and chromatography, the localization, distribution and identity of the preproVIP derived peptides within the human male urogenital tract were investigated. Postmortem as well as fresh tissue specimens were used. All the preproVIP derived peptides were expressed and could be demonstrated in nerve fibres throughout the urogenital tract in close relation to the epithelial lining and in vascular as well as non-vascular smooth muscle. The VIP-related peptide containing fibres were most abundant in the prostate parenchyma and the seminal vesicle. Using double immunostaining, co-localization of the various preproVIP derived peptides could be evidenced. The fact that all preproVIP derived peptides are present in the urogenital tract, should be taken into consideration when the regulatory aspects of neuropeptides in physiological and pathophysiological functions are discussed.

[Semirigid and flexible uretero-nephroscopy]. / Semirigid og fleksibel uretero-nefroskopi.

Thirty-seven ureteronephroscopies with the modern ureteroscope were attempted in 30 patients (median age of 60 years) because of radiographic filling defects, tumours, stenoses, stones, broken double "J" stent, unilateral haematuria and surveillance. Only one ureteronephroscopy (3%) could not be performed. The radiographic filling defects represented tumour (ten), stones (three) and a torn-off papilla (one). The ureteric stenoses could be classified as congenital (one), secondary to a vascular graft (1), tumour (1) or inflammation (two). In nine patients the stones were removed, and in four fragmented and the fragments passed during the next two to four weeks while treated with a stent. One ureteric tumour and two pelvis/calyx tumours were coagulated. One broken stent was removed, and one displaced nefrostomy catheter was caught in the calyx and pulled into the pelvis. There were three cases with transient fever, all in patients with infected nefrostomies. The modern ureteronephroscopy is a valuable method with only few complications.

[Esophageal varices: physiopathology and treatment. The role of the lower esophageal sphincter]. / Esophagusvaricer: patofysiologi og behandling. Betydningen af lav øsofageal sphincter.

Development of esophageal varices depends on local esophageal factors and portal gradient, vascular resistance in the azygos vein or presence of other portosystemic collaterals. Esophageal varices are found in the lamina propria of lower esophageal sphincter (LES), the pressure of which exceeds the normal portal pressure. Factors reducing LES pressure promote development of varices and enlarge these. Contraction of LES leads to reduction of the variceal and azygos flows, decrease in the pressure gradient across the varix wall and diminishes the varices. Pharmacological contraction of LES arrests the endoscopically proved bleeding from esophageal varices. Manipulation of LES pressure appears to be a genuine alternative to the current methods of treatment of the bleeding esophageal varices.

[Follow-up of patients after splenectomy at a local hospital]. / Opfølgning af splenektomerede patienter på et lokalsygehus.

We have studied the records of 79 patients splenectomised between 1965-1995 and questioned the 39 patients still alive regarding pneumococcal immunisation and measures against infections. Fifty percent of patients operated before 1978 had still not been immunised. Twenty-four percent of the patients operated after 1978 were neither immunised at the hospital nor recommended this, and 10% had still not been immunised in 1995. Eight percent of the patients did not know that they had lost their spleen. Eighty-three percent of the patients had not been informed about measures against infection. Only 17% had penicillin available at home. We recommend that besides pneumococcal immunisation, special splenectomy cards and antibiotic prescription, splenectomised patients should be given written guidelines about dealing with infections and recommendations that pneumococcal antibody levels be controlled five years after the primary immunisation. Extraordinarily, hospitals should also inform previously splenectomised patients.

[Blood loss during transurethral resection of the prostate]. / Blodtab ved transuretral resektion af prostata.

Measurement of the perioperative blood loss during transurethral resection of the prostate was performed using the modern HemoCue photometer in 100 men. The measurement lasts only 5-10 minutes. The median weight of the removed prostate was 28 grams and the operating time 60 minutes. The median blood loss was 393 ml (range 8-1843 ml) and was positively correlated to operating time, change in the peroperative blood pressure, volume of the irrigating fluid and the drop in the postoperative serum sodium. Perioperative measurements of the blood loss draw the surgeons' attention to the haemostasis, provide an objective measure of the most important factor for morbidity during TURP and allow a rational policy for blood transfusion. It is an advantage to place this measurement in the hands of professionals, i.e. laboratory technicians, who are trained to quality-secure the measurement and preserve the photometer.

[Vasectomy using the Li method]. / Vasectomia ad modum Li.

The no-scalpel vasectomy is described and evaluated. Nineteen out of 21 consecutive patients could be operated with this technique. The median operating time was 16 minutes, range 9-50 minutes. There were no complications and the scar was barely visible after ten days. The median score for pain was 0.4 cm (range 0.0-5.0 cm) and for discomfort 0.7 cm (range 0.0-5.0 cm) on a 10 cm long visual analogue scale. The method is minimally invasive and well-tolerated by the patients. When some routine is gained the operating time is short.

PIP: The no-scalpel vasectomy developed by Shunqiang Li was used in a prospective, nonrandomized study on 21 patients with the average age of 38 in the out-patient surgery department of the Sundby Hospital, Copenhagen, Denmark, during March 1-July 15, 1993. The necessary instruments were tongs with a ring at the top and pointed scissors for skin penetration and extraction of the ductus deferens (DD). For local analgesia 3-4 ml of intracutaneous 2% lidocaine injection was used. Two patients were excluded because they could be vasectomized on only one side. One of the two was operated on in a conventional method on one side by means of scrotal obstruction, while for the other vasectomy failed because of pronouncedly atrophic testicles. 19 out of 21 consecutive patients could be operated bilaterally with the no-scalpel technique. The median operating time was 16 minutes (range 9-50 minutes), and the last 10 were operated on in 13 minutes. There were no complications and the scar was barely visible after 10 days. The median score for pain was 0.4 cm (range 0.0-5.0 cm) and for discomfort 0.7 cm (range 0.0-5.0 cm) on a 10 cm long visual analogue scale. All patients resumed their normal activities the day after the operation. One patient had soreness in the first postoperative week. To acquire the necessary skills about 10-15 operations are needed, which can be a problem in Denmark where vasectomy is performed in a limited number of cases with large time intervals. The most difficult technical part is the securing of DD with the tongs at midline without the scrotum contracting. Once learned, the method is quick, minimally invasive, well-tolerated by the patients, and economical. Once routine, the operating time is short.

[Results of radiotherapy of ureteral obstruction in invasive bladder cancer]. / Resultater af strålebehandling for ureterobstruktion ved invasiv blaerecancer.

Retrospective evaluation of the records of 574 patients with muscle-invasive bladder cancer revealed 90 patients (16%) with ureteric obstruction; the obstruction was bilateral in 24%. The effect of radiotherapy was assessed in 55 patients with 68 obstructed kidneys. Six patients with eight obstructed kidneys required percutaneous nephrostomy or ureteric catheters in addition to radiotherapy. Drainage improved in only 20% of kidneys and the diverting catheter could be withdrawn permanently in only one (17%) of the diverted patients. The median survival was 11 months. Irradiation was followed by significant complications in 37 patients (67%). This raises doubts about the assumed beneficial effect of irradiation on ureteric obstruction due to muscle invasive bladder cancer. The short median survival of 11 months confirms that ureteric obstruction is a poor prognostic factor in muscle invasive bladder cancer.

[Urethral stricture]. / Urethrastriktur.

The incidence of urethral stricture has increased since the introduction of gonorrhoea to Europe in the 15th century. Nowadays, transurethral instrumentations and catheterisations are responsible for the majority of the urethral strictures. The mechanism is inflammatory or traumatic lesion of the urethral epithelium causing extravasation of urine and fibrosis. The symptoms often suggest to infravesical obstruction. The diagnosis is made from the patient's history in combination with flowmetry, ante- and/or retrograde urethrography, external ultrasound examination or urethral calibration and is verified at urethroscopy. Dilatation is relatively simple but seldom curative and carries a considerable morbidity. Urethrotomy is very common but also hampered with a high rate of recurrence. A technique where urethrotomy is followed by intermittent self-catheterisation or implantation of a selfexpanding wire netting seems promising but needs further investigation. Reconstructive operations in form of a free or pedicled skin island patch, skin tube graft, endourethral free split skin graft, multistaged urethroplasty, meatoplasty and excision of prostatomebraneous stricture are followed by cure in 50-95% of the cases.

[Treatment of superficial bladder tumors with intravesical BCG]. / Behandling af superficielle blaeretumorer med intravesikal BCG.

Thirty three patients with carcinoma in situ (CIS) or/and numerous recurrences of superficial bladder tumor were treated with intravesical BCG after transurethral resection. 63% of patients with CIS were free of recurrence after two years, two underwent cystectomy and one died because of progression. Patients with Ta and concomitant CIS responded well to BCG, while the patient with T1 tumor and CIS was free from recurrence for 15 months. Dysplasia of grade II disappeared after BCG. 62% of patients with Ta tumor were without recurrence after one year, but after two years 86% of the patients had recurrences. Patients with T1 tumor were free from recurrence for eight months, after which 25% had progression. The side effects of BCG were transient: urinary frequency in 48%, malaise in 39%, dysuria in 36%, haematuria, bladder pain and fever in 24%. 15% of the patients required isoniazid treatment. It is concluded that intravesical BCG is beneficial in CIS and superficial bladder tumors.

[Circumcision by the method of Lucas]. / Circumcisio ad modum Lucas.

Circumcision a.m. Lucas is described and the results are given in 85 boys with a median age of four years (range, 2-14 years). The postoperative period was uncomplicated in 79% of the cases. The most frequent complication was bleeding (8%), but reoperation was only needed in one case. Haematomas were registered in 4% of the boys. Glans was free or nearly free in 89% of the cases. Only 12% of the families were dissatisfied with the length of the remaining prepuce: the Muslim parents found the prepuce too long (8%), the Danish parents found that too much of the prepuce had been removed (4%). Circumcision a.m. Lucas gives uniform results, is without major complications, and can be performed on medical as well as ritual indications.

[EMLA cream (lidocaine/prilocaine) versus infiltration analgesia with carbocaine (mepivacaine) in vasectomy]. / Emla-creme (lidocain/prilocain) over for infiltrationsanalgesi med Carbocain (mepivacain) ved vasektomi. En randomiseret undersøgelse.

The analgesic efficacy of EMLA cream was compared with infiltration with 1% carbocaine in 13 bilateral vasectomies. Twelve patients preferred infiltration analgesia. EMLA analgesia was only effective in the skin, and had to be supplemented as the incision reached subcutaneous tissue.