Influence of nitrovasodilators and endothelin-1 on rheology of human blood in vitro.

1. The shear stress of flowing blood profoundly influences the release of endothelium-dependent vasodilative and constrictive factors. Conversely, the influence of these mediators such as nitric oxide (NO) or endothelin-1 (ET-1) on blood rheology remains elusive. In the present study the influence of nitrovasodilators and ET-1 on red blood cell (RBC) shape and whole blood viscosity were investigated. 2. Incubation of whole blood with sodium-nitroprusside (SNP, 10-5 - 10-2 M), glyceryl trinitrate (GTN, 0.0001 - 0.1 mg mL-1), S-nitroso-N-acetylpenicillamine (SNAP, 10-6 - 10-3 M), and the active metabolite of molsidomine (SIN-1, 10-6 - 10-3 M), but not molsidomine (10-6 - 10-3 M), resulted in significantly increased amounts of methaemoglobin, indicating a relevant interaction with RBCs. Treatment with SNP at 10-2 M induced a marked echinocytosis (morphological index: 2.23+/-0.98 vs -0.17+/-0.10; P<0.001) and increased blood viscosity (haematocrit 45%) at a high shear rate of 94.5 s-1 (6.46+/-0.60 vs 5.07+/-0.35 mPa.s; P<0.01) and a low shear rate of 0.1 s-1 (88.6+/-36.8 vs 42.1+/-11.7 mPa.s; P<0.01). Echinocytosis was probably due to cyanide accumulation. SIN-1 at 10-3 M slightly decreased high shear viscosity (4.88+/-0.28 vs 4. 95+/-0.30 mPa.s; P<0.05). SNAP at 10-3 M slightly increased both high (5.14+/-0.23 vs 5.05+/-0.24 mPa.s; P<0.01) and low shear (53.9+/-7.2 vs 51.2+/-5.9 mPa.s; P<0.05) viscosity. Molsidomine and GTN failed to influence whole blood viscosity. ET-1 (10-9 - 10-6 M) had no effect on RBC shape and viscosity. 3. We conclude that the most important modulators of vascular tone, NO and ET-1, do not affect RBC shape and blood viscosity, which is important from both a physiological and a pharmacological point of view.

[A questionnaire with a new urge-score and stress-score for the evaluation of female urinary incontinence (author's transl)]. / Der Inkontinez-Fragebogen mit dem neuen Urge-Score und Stress-Score.

A questionnaire with a new stress-score and urge-score is being presented, which is designed to differentiate with high statistical significancy between stress-urinary-incontinence (urethral-insufficiency with negative urethral closure pressure on sphincterometry) and urge-urinary incontinence (motor-urge-incontinence with uninhibited detrusor contractions on cystometry). With these scores we expect to facilitate the diagnostic screening, to indicate the way of therapy and to avoid unnecessary surgery for urinary incontinence in cases of motor-urge-incontinence (detrusor instability, unstable bladder), as long as a urodynamic examination is not feasible on every incontinent women.

[Effect of prostaglandin F2 on the bladder muscles in women]. / Die Wirkung von Prostaglandin F2 alpha auf die Harnblasen-Muskulatur der Frau.

The effect of intravenous Pg F2 alpha on the detrusor muscle in young healthy females during filling cystometry and during a long period of pressure normalization was studied. It was possible to induce uninhibited detrusor contractions in two thirds of the cases, very much resembling those of patients with motor-urge-incontinence. The sensitivity of the uterus was found to be higher than that of the bladder. Both organs responded with a gradual tone increase followed by regular contractions of the uterus and more erratic contractions of the detrusor. Therapeutic studies with a Pg-synthesis inhibitor (Indometacin) were undertaken with moderate success.

[Bladder dysfunctions years after radical hysterectomy without subsequent radiation therapy for cervical cancer. A urodynamic investigation. (author's transl)]. / Spätstörungen der Blasenfunktion nach erweiterter Hysterektomie, ohne Nachbestrahlung, wegen eines Kollumkarzinoms. Eine urodynamische Nachuntersuchung

52% (21/40) of patients treated for cervical cancer by a radical hysterectomy without subsequent radiation therapy, complained months and years later still about a significant bladder dystunction and about urinary incontinence. A urodynamic investigation of the urologically sumptomatic cases revealed a severe hypertonus of the detrusor muscle in 58% (10/17). Uninhibited detrusor contractions are not typical of the bladder dysfunction after radical hysterectomy. The urinary incontinence was in most cases a mixed one, where a hypertonic detrusor and a sphincter incontinence are both present.

[The importance of an additional retropubic urethroply by the pereyra or the Marshall-Marchetti-Krantz method in the primary operative treatment of stress incontinence involving rotational descent of the urethra (author's transl)]. / Die Bedeutung einer Zusatzoperation (Pereyra oder Marshall-Marchetti-Krantz) bei der primären operativen Behandlung einer Urethralinsuffizienz

Between 1971 and 1974, 270 patients underwent a hysterectomy and anterior colporrhaphy for severe stress incontinence of Type Green II with loss of the posterior urethrovesical angle and rotational descent of the urethra. All these patients had an additional retropubic urethropoly either of the Pereyra of Marshall-Marchetti type or an additional sling operation. 176 patients were followed up. The total series showed a cure rate of 57%, an improvement rate of 28% and persistent or recurrent incontinence in 14.3% of the cases. The importance of pre-operative diagnosis by cystometry and sphincterometry is stressed. An irritable bladder is emphasized as a contraindication to an operation for stress incontinence. The conclusion is reached that the primary stress incontinence operation is the most decisive and the most likely to succeed. Operations for recurrent stress incontinence show a much lower cure rate. Since the anterior colporrhaphy according to Stoeckel or Kelly is not capable of curing severe forms of stress incontinence with rotational descent of the urethra, our results show that an additional retropubic urethropoly is desirable and justified in these cases.

[Treatment of motor dysfunction of the urinary bladder]. / Therapie der motorischen Reizblase.

Symptoms and objective characteristics of 86 female patients with bladder instability and uninhibited detrusor contractions suffering from urgency incontinence were analyzed. The subjective and objective response to a six week-parasympathicolytic treatment with Emepronium-Bromide (Cetiprin) was examined and the results are discussed.

[The importance of the sphincterometric parameters using microtip-transducers and of the urilos-nappy-test for the investigation of female urinary incontinence (author's transl)]. / Wertigkeit der Sphinkterometrie mit Mikrotip-Transducer und des Nappy-Testes (Urilos-Meter) bei der Abklärung der weiblichen Stress-Inkontinenz.

The value of the patient's history, the nappy-test (urilos meter) and urethro-cystometry with microtip-transducers was analized in 125 "stressincontinent" women. We consider the results of the nappy-test together with urine loss during coughing in the erect position as an objective evidence of incontinence. On this basis, two groups of patients were formed which allowed that statistical comparison of the different urethro-cystotonometric parameters. The urethral closure pressure under stress (urethral stress profile) is still the best criterium for the diagnosis of an urethral insufficiency. We studied especially the urethral closure pressure at rest and the pressure transmission from the bladder to the urethra. Although we could prove that both these parameters were statistically more often altered in cases of "proven" incontinence (urine loss when erect and positive nappy-test) than in cases without "proven" incontinence (no urine loss when erect and negative nappy-test), the lower limits of normal could not be determined because of the broad range of confidence. The diagnostic and therapeutic consequences are discussed.

Motor urge incontinence: diagnosis and treatment.

A detailed study and analysis of several hundred cases of motor urge incontinence in the female is presented and summarized. This includes the incidence, the history referring to a questionnaire with a new urge and stress score, the symptomatology, possible etiological factors, the cystometric manifestation and the responsiveness to several treatment modalities and medications. A comparison of flavoxate, emepronium, propantheline and a placebo for the treatment of urinary incontinence due to bladder instability is made, the results are discussed and recommendations are made.

[Extensive eosinophilic pulmonary infiltrates in a depressive patient treated with maprotiline]. / Ausgedehnte eosinophile Lungeninfiltrate unter antidepressiver Behandlung mit Maprotilin.

A 74 year old man developed progressive dyspnea under treatment with the tetracyclic antidepressant maprotiline for three months. A chest x-ray revealed extended pulmonary infiltrates. Marked eosinophilia of the periperal blood was found (up to 2300/microliter). Rapid clinical and radiological improvement was observed solely by withholding the drug. The eosinophil count retourned to normal within a few weeks. The possible pathogenesis is discussed and the literature reviewed.

Isolation of Chlamydia trachomatis from women with urethral syndrome.

Urethral swabs were examined for Chlamydia trachomatis in 22 women suffering from urethral syndrome and in an age-matched control group without genito-urinary symptoms. Full urodynamic investigation was done in patients with urinary symptoms. In this group the isolation rate of C. trachomatis was significantly higher than in the control group (59% versus 13%, P less than 0.01). Therefore C. trachomatis must be considered as one of the possible causes of the female urethral syndrome. Five out of eight patients with positive culture who were treated with minocycline had a negative follow-up culture and the clinical results of this treatment were variable.

[Intravaginal PgE2 administration for inducing labor in premature rupture of fetal membranes]. / Intravaginale Pg-E2-Gabe zur Geburtseinleitung bei vorzeitigem Blasensprung.

In a prospective study, 121 patients with spontaneous rupture of the membranes of greater than 6 hours duration and unfavourable Bishop-Score (less than 6) were stimulated with 3 mg vaginal prostaglandin-E2-tablets. All patients started labour. Only one patient had a hyperstimulation which was corrected with betamimetics. There were no systemic side effects. Almost 90% of the women delivered on the first day. The rate of the Caesarean sections was low. There was no case of intraamniotic infection; the foetal outcome was good. In conclusion, vaginal prostaglandin-E2-tablets are safe to use in spontaneous rupture of the membranes.

[1989 Basel Mammography Action]. / Mammographie-Aktion Basel 1989.

To evaluate the compliance for a breast cancer screening program in the region of Basel, a mammography and a clinical examination has been offered free of charge to women between 40 and 60 years of age, especially to women with familial breast cancer. From September to November 1989, 602 women participated. Results were obtained from an epidemiologic questionnaire and a two-view mammography. The median age was 55.1 years. 70.2% of the women never had a mammography before. 28.8% indicated a history of familial breast cancer. So far 444 women have been evaluated. No pathological results were obtained in 84.8% In 10.7% a second examination has been recommended in the near future. In 4.5% the mammography led to an aspiration biopsy or surgical lumpectomy where 5 (1.2%) neoplasms have been detected. Due to the limited duration of the campaign and the invitation especially addressed to women at risk, our results are not comparable with large-scale screening campaigns known from the literature. Nevertheless, we succeeded to sensitize the female population for this kind of breast care. The overwhelming success shows that the basis for a large-scale screening program may exist.