Long-term clinical outcome of transurethral microwave thermotherapy (TUMT) 1991-1999 at Karolinska Hospital, Sweden.

OBJECTIVE: Minimal invasive methods, such as transurethral microwave thermotherapy (TUMT), are economical and have modest side effects compared with transurethral electro-resection of the prostate (TUR-P). The treatment results from different TUMT-systems vary. Follow-up studies on each system type are therefore necessary. The objectives of this study are to summon the long-term clinical results of our TUMT-system and search for a pre-treatment parameter that can measure responding patients. MATERIAL AND METHODS: Three hundred and seventy-one patients with benign prostate hyperplasia (BPH) were treated with TUMT at Karolinska Hospital, Sweden with the ECP-system (Comair AB, Stockholm), for 30 or 60 min. They were followed up 12 to 72 months after TUMT. RESULTS: At follow up approximately 76% subjectively judged that they had benefited from the treatment and 22% judged that they were fully cured. The over-all IPSS and Quality of Life score decreased approximately 40% and 30% respectively. Forty-one per cent of the patients with CAD (cathéter à demeure) before the treatment became permanently or temporarily catheter-free after the treatment. Q(max) increased 21% and 11% after 1 and 6 months respectively. Q(max) ranging from over 10 ml/s seem to be a selection parameter that increases the number of responding patients. CONCLUSION: These long-term clinical data show that TUMT treatment with ECP (electro-coagulation, prostate), gives a good success-rate, with reduction of symptoms. Furthermore there is a good chance of becoming catheter-free after TUMT.

Evaluation of penicillin and hyperbaric oxygen in the treatment of streptococcal myositis.

The purpose of this study was to evaluate effects of hyperbaric oxygen (HBO) and penicillin (PCN) therapy in a murine model of streptococcal myositis. The thighs of Swiss Webster mice were inoculated with Streptococcus pyogenes. Four groups were evaluated: (1) control (N = 10), (2) HBO treatment (N = 10), (3) PCN treatment (N = 8), and (4) PCN and HBO treatment (N = 6). Mortality (day of death) and the number of colony-forming units (cfu) were measured. PCN significantly lowered cfu from control (p < 0.05). Cfu in group 4 was significantly lower than PCN alone (p = 0.006). Survival was significantly longer in the PCN group compared with the control (p < 0.01). Survival in the combined treatment group was significantly longer than PCN alone (p < 0.01). These results suggest that (1) HBO treatment alone does not decrease mortality or bacterial proliferation in vivo significantly, (2) PCN therapy alone improves outcome significantly, and (3) the combined treatment of PCN and HBO exerts at least additive effects in both decreasing bacterial counts in vivo and increasing survival in this model.

Dietary factors and lung cancer among men in west Sweden.

BACKGROUND: Previous studies have reported an association between tea drinking and lung cancer. In view of these data, the relationship between tea drinking as well as other dietary factors and lung cancer was investigated in a case-control study in the west of Sweden. METHODS: Patients with suspected lung cancer were collected from pulmonary units at central hospitals in the area investigated, and population controls were matched for age. The material reported here comprises 308 male cases with a confirmed diagnosis of lung cancer and 504 controls. The participants were interviewed by specially trained nurses, using a questionnaire to assess smoking, dietary habits, occupational exposures and conditions in the residential area (local air pollution). This paper reports the results from dietary factors studied with a food frequency technique. RESULTS: The results demonstrated a strong protective effect of vegetables (odds ratio [OR] = 0.69, 95% confidence interval [CI]: 0.46-1.05, and OR = 0.37, 95% CI: 0.23-0.61 for intermediate and high consumption classes respectively). A low OR was consistent for all histological types of lung cancer. High consumption of fruits did not show any similar protective effect. Drinking milk was associated with a dose-response related risk increase after adjustment for smoking and vegetable consumption (P for trend = 0.07). Odds ratio was 1.73, 95% CI: 1.00-3.01 for high consumption of milk. CONCLUSIONS: High intake of vegetables had a strong protective effect among males. Diet is thus a potential confounding factor in studies on lung cancer and environmental factors and should thus be taken into consideration in the planning of such studies.

Preliminary descriptions of transient-evoked and distortion-product otoacoustic emissions from graduates of an intensive care nursery.

Transient-evoked (TEOAE) and distortion-product otoacoustic emissions (DPOAE) were measured in 51 graduates of an intensive care nursery and compared to data obtained from 80 normal-hearing children and adults. All infants had click-evoked auditory brainstem responses (ABR) at 30 dB nHL or less while the older subjects had pure-tone thresholds of 20 dB HL or less for octave frequencies from 250 to 8000 Hz. OAE data were collected using commercially available devices. All data were analyzed in terms of emission amplitude, emission-to-noise ratio, and response reproducibility as a function of frequency. DPOAEs were measured at three points per octave between f2 frequencies of approximately 500 and 8000 Hz. TEOAEs were elicited by clicks and were analyzed in both octave and 1/3-octave bands centered at frequencies from 500 to 4000 Hz, as well as in the broadband condition. In addition, stimulus amplitudes for the clicks used to elicit TEOAEs were analyzed within octave and 1/3-octave bands to determine whether any age-related differences in responses can be accounted for on the basis of stimulus differences. Both emission amplitude and noise amplitude were greater in neonates than adults, although there was variability across frequency. Emission-to-noise ratio and response reproducibility were more similar between groups. For TEOAEs, high-frequency emission-to-noise ratios were larger in neonates compared to older subjects, while the reverse was true in the lower frequencies. Less obvious frequency effects were observed for DPOAEs. These findings are discussed in relation to the potential use of OAEs as screening measures for neonatal hearing loss.

A comparison of transient-evoked and distortion product otoacoustic emissions in normal-hearing and hearing-impaired subjects.

The ability of transient-evoked otoacoustic emissions (TEOAEs) and distortion product otoacoustic emissions (DPOAEs) to distinguish normal hearing from hearing impairment was evaluated in 180 subjects. TEOAEs were analyzed into octave or one-third octave bands for frequencies ranging from 500 to 4000 Hz. Decision theory was used to generate receiver operating characteristic (ROC) curves for each of three measurements (OAE amplitude, OAE/noise, reproducibility) for each OAE measure (octave TEOAEs, 1/3 octave TEOAEs, DPOAEs), for octave frequencies from 500 to 4000 Hz, and for seven audiometric criteria ranging from 10 to 40 dB HL. At 500 Hz, TEOAEs and DPOAEs were unable to separate normal from impaired ears. At 1000 Hz, both TEOAE measures were more accurate in identifying hearing status than DPOAEs. At 2000 Hz, all OAE measures performed equally well. At 4000 Hz, DPOAEs were better able to distinguish normal from impaired ears. Almost without exception, measurements of OAE/noise and reproducibility performed comparably and were superior to measurements of OAE amplitude, although the differences were small. TEOAEs analyzed into octave bands showed better performance than TEOAEs analyzed into 1/3 octaves. Under standard test conditions, OAE test performance appears to be limited by background noise, especially for the low frequencies.

A comparison of auditory brain stem response thresholds and latencies elicited by air- and bone-conducted stimuli.

Auditory brain stem responses (ABRs) were measured for stimuli presented both by air conduction and by bone conduction. Stimuli included clicks and tone bursts at octave frequencies from 250 to 4000 Hz. ABR thresholds were comparable for air- and bone-conducted stimuli. Wave V latencies were longer for bone-conducted stimuli compared to similar responses for air conduction. This effect was evident for both clicks and tone bursts. The fact that these latency differences were largely independent of stimulus spectrum suggests that they are not due to differences between the frequency responses of air and bone conduction transducers. This finding is expected when one considers the interaction between output, threshold, and frequency for both transducer types. These data also suggest that there are inherent differences in transmission by air and bone conduction that affect response latency but are unrelated to the amplitude spectrum in the signal.

Otoacoustic emissions from normal-hearing and hearing-impaired subjects: distortion product responses.

Distortion product otoacoustic emissions (DPOAE) were measured in normal-hearing and hearing-impaired human subjects. Analyses based on decision theory were used to evaluate DPOAE test performance. Specifically, relative operating characteristic (ROC) curves were constructed and the areas under these curves were used to estimate the extent to which normal and impaired ears could be correctly identified by these measures. DPOAE amplitude and DPOAE/noise measurements were able to distinguish between normal and impaired subjects at 4000, 8000, and, to a lesser extent, at 2000 Hz. The ability of these measures to distinguish between groups decreased, however, as frequency and audiometric criterion used to separate normal and hearing-impaired ears decreased. At 500 Hz, performance was no better than chance, regardless of the audiometric criterion for normal hearing. Cumulative distributions of misses (hearing-impaired ears incorrectly identified as normal hearing) and false alarms (normal-hearing ears identified as hearing impaired) were constructed and used to evaluate test performance for a range of hit rates (i.e., the percentage of correctly identified hearing-impaired ears). Depending on the desired hit rate, criterion values of -5 to -12 dB SPL for DPOAE amplitudes and 8 to 15 dB for DPOAE/noise accurately distinguished normal-hearing ears from those with thresholds greater than 20 dB HL for the two frequencies at which performance was best (4000 and 8000 Hz). It would appear that DPOAE measurements can be used to accurately identify the presence of high-frequency hearing loss, but are not accurate predictors of hearing status at lower frequencies, at least for the conditions of the present measurements.

The influence of dental amalgam placement on mercury, selenium, and glutathione peroxidase in man.

Amalgam restorations were inserted in eight healthy persons, previously unprovided with dental restorations, who had several severe carious lesions. The mean number of surfaces restored were 16.1 (range, 11 to 22). The total mean calculated amount of mercury inserted was 2.9 g (range, 1.5 to 4.3 g). Blood and urinary levels were measured on seven occasions during a 4-month period before and a 3-month period after amalgam placement. One and 3 months after placement, the P-mercury mean values were almost equal to the preplacement values (3.3 nmol/l). After placement U-mercury increased continuously; 3 months after placement a statistically significantly higher (p less than 0.05) mean U-mercury value (0.58 nmol/mmol creatinine) was found compared with the mean preplacement value (0.34 nmol/mmol creatinine). No statistically significant correlation was found between the P- and U-mercury concentrations and the total number of amalgam surfaces. Selenium levels in plasma and urine and erythrocyte glutathione peroxidase showed no systematic change of pattern. The results show that the insertion of amalgam fillings contributed to the U-mercury concentration, but apparently even more extensive amalgam therapy and/or longer exposure periods are needed to affect the P-mercury concentration. No negative effects on the P- and U-selenium or the erythrocyte glutathione peroxidase levels could be found during the 3 months immediately after an extensive amalgam placement. The supplementary blood and urine analyses were not influenced by the insertion of amalgam fillings.

Mercury, selenium, and glutathione peroxidase before and after amalgam removal in man.

In 10 healthy persons all amalgam fillings were replaced with gold inlays. Blood and urinary levels were measured on 10 occasions during a 4-month period before and a 12-month period after amalgam removal. These variables were also measured three times in 10 healthy controls. A strong statistically significant relation was found between plasma mercury values and both the total number of amalgam surfaces (r = 0.71, p = 0.0006) and the total surface area of the fillings (r = 0.73, p = 0.0004). In the immediate postremoval phase plasma mercury rose three- to four-fold, whereas the urinary and erythrocyte mercury rose about 50%. These peak values declined to the preremoval level at about 1 month. Twelve months after the removal the plasma and urinary mercury levels were significantly reduced to 50% and 25%, respectively, of the initial values for the experimental group. Apart from the significantly lower plasma selenium values 5 and 10 days after removal no significant differences were found with regard to plasma selenium or erythrocyte glutathione peroxidase either within or between the experimental and the control groups. A large number of supplementary biochemical analyses did not show any influence on organ functions or any differences between the groups before or after the amalgam removal. Amalgam fillings considerably contributed to the plasma and urinary mercury levels.

Mercury, selenium, and glutathione peroxidase in dental personnel.

Eighteen persons, dentists and nurses, with urinary mercury levels higher than the group median value of all dental personnel in the country of Västerbotten were compared with a group consisting of 15 persons with low urinary mercury levels working in the same clinics. A statistically significant difference between the high urinary mercury group and the low urinary mercury group could be seen in the plasma mercury level. In each group a statistically significant relation could be seen between the plasma mercury level and the total number of amalgam surfaces. The two groups did not differ with regard to the levels of plasma selenium and erythrocyte glutathione peroxidase, and no correlation between these two variables and the plasma mercury levels could be found. To evaluate organ functions, a large number of supplementary analyses were performed. These analyses did not indicate any influence on organ functions. Although the persons in the present study were occupationally exposed to mercury, none of the biologic variables analyzed seemed to be affected. Even among dental personnel who handle amalgam professionally the number of amalgam surfaces is a major contributory factor to the P-mercury level.

Plasma-selenium, glutathione peroxidase in erythrocytes and mercury in plasma in patients allegedly subject to oral galvanism.

Twelve patients with subjective symptoms, ascribed by the patients themselves to mercury released from dental restorations, were investigated. In addition to a general dental examination the following parameters were registered: the total number of amalgam surfaces in the mouth; potential and polarization of existing and accessible dental metallic restorations for calculation of intraoral currents. As regards the highest calculated intraoral current for each individual there was a statistically significant difference between the patient group and a control group consisting of 12 persons. An analysis of the amount of selenium, glutathione-peroxidase and mercury in the blood showed no differences between the patient and the control group. However, a statistically significant positive correlation could be seen between the total number of amalgam surfaces and the plasma-mercury level for patients and controls pooled together. The numerous other blood parameters analyzed did not reveal any differences between the groups.