[Pedicled prepuce flap plasty: results in patients with hypospadias or urethral sticture]. / Die gestielte Vorhautlappenplastik: Ergebnisse bei Patienten mit Hypospadie oder Harnröhrenstriktur.

BACKGROUND: Operative interventions of the urethra remain challenging procedures. The vascular onlay flap of the inner prepuce is a possible technique for short and long segment urethral defects. PATIENTS AND METHODS: A total of 195 patients were surgically treated with a vascular prepuce flap between 1994 and 2010 at the Urology Department of Essen Medical University. Patient data were analyzed retrospectively and a questionnaire was sent to all patients. RESULTS: Of the patients 115 answered the questionnaires and were included in the study. Of these 61 patients were treated in childhood due to hypospadias and 54 patients suffered from acquired urethral stricture. Major complications were postoperative fistulas in 8.2 % and 7.4 % and hematomas in 6.6 % and 11.1 % of cases, respectively. Operative revision had to be performed in 13.1 % and 14.8 % of cases and severe obstructive micturition problems (IPSS score ≥ 20) were observed in only 3.3 % and 11.1% of patients, respectively. Subjective overall satisfaction with the result of the operation was high (67.2 % and 88.9 %, respectively). CONCLUSION: The vascular prepuce flap is a reliable method for correction of short and long segment urethral defects and is associated with high patient satisfaction.

Changes in bicycle ergometer test performance and survival in men and women from 50 to 60 and from 70 to 80 years of age: two longitudinal studies in the Glostrup (Denmark) population.

BACKGROUND: During the aging process longitudinal changes for sustained work in humans are poorly understood. Only a few longitudinal follow-up studies have been published thus far, and most of them have been based on highly selected groups, such as physical education teachers or senior athletes. OBJECTIVE AND METHODS: On the basis of random samples of a general population, the purpose of this study was to analyze changes in bicycle test performance in two longitudinal designs: a 10-year follow-up period from 50 to 60 years of age, using a submaximal test protocol, and another 10-year follow-up period from 70 to 80 years of age, using indirect voluntary maximal tests. In addition, the preventive value of the bicycle test results for survival at different age levels was analyzed. The subjects in the first part of the study were members of a random sample of originally 514 men and 461 women living in the Glostrup area, close to Copenhagen, Denmark, in 1964. Of these, 367 men (71.4%) and 206 women (44.7%) were tested at the age of 50 years, and 309 men and 245 women were tested 10 years later. The subjects in the second part of the study came from the same original sample. At 70 years of age 171 men and 154 women and at 80 years of age 70 men and 68 women took part in the maximal test. RESULTS: The submaximal test results between the ages of 50 and 60 years showed a mean annual decline in body mass adjusted maximal power in sustained work (W/kg) of 0.54% in men and of 0.90% in women. Between the ages of 70 and 80 years, when the indirect maximal tests were applied, the annual decline in men was on average 1.79% and in women 3.03%. When the associations of submaximal test results at ages 50-60 years and the voluntary maximal test results at the higher ages were analyzed, a moderate positive correlation was observed with the results obtained at the age of 70 years. The survival analyses showed that the submaximal bicycle test results (W/kg body mass) at the age of 60 years had a predictive value for survival in women during the subsequent 10-year period. The same was true for the maximal test results obtained at the age of 70 years in men; a significantly larger proportion of men in the lowest quintile died during the subsequent 10 years than of those belonging to the higher quintiles. CONCLUSIONS: The changes in body mass related maximal power in sustained work observed in this population on the basis of longitudinal studies among the age groups 50-60 and 70-80 years indicated a steeper decline at the higher ages. The decline was relatively more pronounced in women than in men. However, differences in the test protocols employed at different times limit the possibilities for overall comparisons across the data. The results of the submaximal bicycle ergometer tests in middle-aged female subjects (60 years old) had a predictive value for survival over the 10 years immediately following the test; likewise, the voluntary maximal test results at higher ages predicted survival in men.

[Intervention for apoplexy patients discharged from hospital. Physical training: a literature review]. / Opfølgende indsats til apopleksipatienter efter udskrivelse fra hospital. Fysisk traening: et litteraturstudium.

Stroke is among the leading causes of disability in Denmark. Rehabilitation services are in the process of being reorganised into dedicated stroke units. There is a general tendency toward reduction of length of in-patient treatment. The literature on outpatient rehabilitation services following primary rehabilitation on an inpatient basis was reviewed. The results of 16 randomised studies indicate that: 1) Continued rehabilitation after discharge can improve functional capacity of disabled stroke survivors; 2) Home-based rehabilitation is as effective as hospital-based outpatient rehabilitation; 3) Early supported discharge (ESD) services can reduce length of hospital stay but the relative advantages and drawbacks remain unclear. Ongoing rehabilitation by teams specialised in stroke rehabilitation seems to be crucial. More research, including evaluation of home-based rehabilitation services, is called for and existing outpatient rehabilitation services should be evaluated scientifically.

[Intervention for apoplexy patients discharged from hospital. Psychosocial support: a literature review]. / Opfølgende indsats til apopleksipatienter efter udskrivelse fra hospital. Psykosocial støtte: en litteraturoversigt.

Psychosocial support has been suggested as a way of easing stroke survivors' and their carers' adjustment to a life with disability. The literature on psychosocial support services following primary rehabilitation in hospital was reviewed. Eleven controlled studies evaluating the effect of psychosocial support interventions after discharge from hospital were identified. The studies differed widely with respect to design, intervention and evaluation methods. The results suggest that psychosocial support after discharge can improve psychological well being and quality of life for stroke survivors and their families and improve the social activity of patients. The effect was achieved by using different types of intervention such as providing information, counselling and support from stroke clubs. Psychosocial support for carers was effective as well. Future research should elucidate this area, including evaluation of psychosocial support as a tertiary prevention strategy.

[Can readmission after apoplexy be prevented? Post-hospital follow-up intervention for apoplexy patients]. / Kan genindlaeggelse af apopleksiramte forebygges? Resultater af et randomiseret interventionsstudium. Posthospital opfølgende indsats til apopleksipatienter.

INTRODUCTION: The aim of this study was to evaluate two models of an organised postdischarge follow-up service for stroke survivors in comparison with standard aftercare. METHODS: One hundred and fifty-five stroke patients discharged to their homes with lasting impairment were randomised as follows: 54 to follow-up home visits by a physician (INT1-HVP), 53 to instruction by a physiotherapist in their home (INT2-PI), and 48 to standard aftercare (control). Six months after discharge, data on readmission were collected. RESULTS: The readmission rate over the six-month period was 26% in the INT1-HVP group, 34% in the INT2-PI group, and 44% for the controls (p = 0.028). Multivariate analysis of the readmission risk showed a significant, favourable effect of intervention in interaction with the length of hospital stay (p = 0.0332), which indicates that the effect of intervention was strongest for patients with a long inpatient rehabilitation. DISCUSSION: Follow-up intervention after discharge seems to be a way of preventing readmission, especially for patients with a long inpatient rehabilitation.

[The mini-mental state examination in screening of cognitive dysfunction and dementia]. / Mini-mental state examination ved undersøgelser af kognitiv dysfunktion og demens.

The mini-mental state examination (MMSE) is one of the most widely used screening instruments for the detection of cognitive impairments, used primarily in connection with screening for dementia. The intent of this review is to describe the original purpose of the MMSE and how it is currently used in clinical practice and in research. Advantages and limitations of the MMSE in providing a valid diagnosis of cognitive impairments (dementia) are discussed including sensitivity and specificity, the issues of the relationship of the MMSE scores to sociodemographic variables and examinations of factor structures of the MMSE. It is concluded that the MMSE provides a valid diagnosis of cognitive impairments among people with moderate and severe dementia in general populations. However, MMSE is not recommended as a screening instrument for the detection of early stages of dementia. Studies are needed to extend the present knowledge about how or whether the MMSE can be used in the clinical diagnostic evaluation of dementia and how demented patients treated with medications should be monitored.

[Physical fitness of Danish men and women aged 50 to 80 years]. / Danske maend og kvinders fysiske arbejdsevne fra 50- til 80-års-alderen.

Maximal power in sustained work in originally randomly selected men and women, born in 1914, was studied five times between the ages of 50 and 80 years in a longitudinal design. Of the originally 514 men and 461 women in 1964 living in the Western suburbs of Copenhagen, 23 men and 18 women performed a bicycle test at age 50, 60, 70, 75 and 80. The mean annual decline in body mass adjusted maximal power in sustained work (W/kg) was 1.43% in the 18 men and 1.64% in the 23 women. Based on "cross-sectional" comparisons of all subjects tested at any age, the mean annual decline in men was 1.56%; in women the corresponding figure was 1.80%. When the results of the "longitudinal" and "cross-sectional" analyses were compared with each other, a rather similar picture of the age-related decline in maximal power was obtained, especially in women. In the longitudinal data only moderate (women) or zero (men) correlations were observed between the submaximal test results at the ages of 50 and 60 years and the maximal test results at higher ages. The physical work load at the age of 50 years had no significant correlation with maximal power at that age or thereafter. There were only minor changes in mean body height, body mass and BMI during the follow-up.

A new biological glue for cartilage-cartilage interfaces: tissue transglutaminase.

In this study, we used an in vitro model to test the capacity of tissue transglutaminase to increase the adhesive strength at a cartilage-cartilage interface. Full-thickness cartilage-bone cylinders were prepared from fresh adult bovine shoulder joints, and the superficial half of the hyaline cartilage was then removed to provide a plane surface. Tissue transglutaminase was applied to the freshly cut surface of one cylinder, and a calcium-chloride solution (to act as an activating agent) was applied to that of the other. The cartilage surfaces were immediately apposed, one on top of the other, and an eighty-gram weight was applied to the upper cylinder for ten minutes at 37 degrees Celsius under defined humidity conditions. A measured force was then applied transversely to the upper cylinder until it was displaced from the lower one (which was clamped in a holding device), and the force recorded at this point was taken as a measure of the adhesive strength achieved at the cartilage-cartilage interface. The adhesive strength increased linearly with an increasing concentration of tissue transglutaminase (0.25 to 2.75 milligrams per milliliter) and was enhanced by increasing the duration of incubation, but it was not influenced by the level of humidity. The adhesive strength was improved by as much as 40 per cent when the cartilage surfaces had been pretreated with chondroitinase AC or hyaluronidase to remove glycosaminoglycan chains of proteoglycans, which are largely responsible for the intrinsic anti-adhesive properties of cartilage.

[Symptoms of irritable colon among the elderly]. / Colon irritabile-symptomer blandt aeldre.

A sex stratified random sample of 70-year-old Danes living in Glostrup County was interviewed about abdominal symptoms in order to assess 1) the prevalence of colon-related symptoms and irritable bowel syndrome among the elderly and 2) to which extent different definitions of irritable bowel syndrome identify different subjects as having irritable bowel syndrome. Abdominal pain occurred with a prevalence of 17% among men and 28% among women (p < 0.01), distension with a prevalence of 29% and 40%, borborygms with a prevalence of 16% and 27%, and varying consistency of stool with a prevalence of 25% and 28%, for men and women respectively. The median number of bowel movements a week was seven for both sexes. Prevalence of irritable bowel syndrome was 3-18% among men and 6-32% among women according to various definitions. The subpopulations identified by various definitions of irritable bowel syndrome had less than 50% of the subjects in common.

Interactions of insulin-like growth factor I with dexamethasone on trabecular bone density and mineral metabolism in rats.

Glucocorticoid treatment causes osteoporosis and growth retardation in humans. Insulin-like growth factor I (IGF-I) stimulates differentiation and replication of cultured osteoblast-like cells and induces longitudinal bone growth in IGF-I-deficient rats. We investigated the influence of subcutaneously infused IGF-I on bone and mineral metabolism of male rats treated with a high dose of dexamethasone. Dexamethasone was added to the drinking water in a concentration of 1 mg/l. After 30 days of dexamethasone treatment, recombinant human IGF-I (300 micrograms/day) or solvent was infused sc by osmotic minipumps for 21 days while dexamethasone was continued. Age-matched untreated male rats served as healthy controls. Dexamethasone-treated rats lost weight. Their IGF-I levels were decreased to 36% of healthy controls. Infusion of IGF-I resulted in an increase in IGF-I serum levels (582% compared to healthy controls) and allowed some weight gain. Osteocalcin and calcitriol levels were markedly decreased in dexamethasone-treated rats and were not influenced significantly by IGF-I infusion. In contrast, IGF-I treatment restored the free calcitriol concentration (molar ratio of calcitriol to vitamin D-binding protein) towards normal. Furthermore, infusion of IGF-I partially corrected the dexamethasone-induced hyperinsulinemia. Histomorphometric analysis revealed no difference in vertebral trabecular bone density (i.e. growth-independent bone remodeling) between the three groups. In contrast, mean trabecular bone density in tibial metaphyses was increased markedly by dexamethasone, presumably due to osteoclast inhibition. Insulin-like growth factor I infusion did not significantly influence these structural metaphyseal bone parameters.(ABSTRACT TRUNCATED AT 250 WORDS)

[Social situation of the 70-year old population in the past and present. A cohort comparison of 70-year old men and women born in 1987 and 1914 in Glostrup]. / 70-åriges sociale situation før og nu. En kohortesammenligning af 70-årige maend og kvinder tilhørende 1897- og 1914-populationerne i Glostrup.

A cohort comparison between two different populations of 70 year-olds in Glostrup studied in 1967 (230 men and 210 women) and in 1984 (412 men and 392 women) was conducted for the purpose of identifying differences in social background factors known to have influence on health and the quality of life of old people. The findings show, that from 1967 to 1984, the standard of housing had improved. Significantly more 70 year-olds had better housing conditions with bath, toilet, kitchen and central heating in 1984 (65-92%). Women in the 1914 cohort had significantly longer education and a larger proportion were employed outside the home than in the 1897 cohort. Another significant cohort difference found was a tendency toward earlier retirement in the order of 2-3 years. This was seen for both sexes and all occupational groups. Since the two populations of 70 year-olds in Glostrup differ with regard to both social conditions and on health variables, this cohort comparison offers a useful starting point for research on how living conditions in combination with other factors affect health and aging.

[Health status of the 70-year-old population in the past and present. A cohort comparison of 70-year old men and women born in 1987 and 1914 in Glostrup]. / 70-åriges helbred før og nu. En kohortesammenligning of 70-årige maend og kvinder tilhørende 1897- og 1914-populationerne i Glostrup.

A cohort comparison between two different populations of 70 year-olds in Glostrup who had health examinations in 1967 (230 men and 210 women) and in 1984 (412 men and 392 women) was conducted with the purpose of describing changes in health variables among old people during a period of falling mortality for both men and women. From the 1967 investigation to the 1984 investigation there was a significant improvement of the cardiovascular risk profile (i.e. body mass index, blood pressure, serum cholesterol, glucose tolerance) which is consistent with other such investigations. In contrast to these findings, symptoms of chronic conditions (angina pectoris, intermittent claudication and bronchitis) as well as the need for health care were the same in the two populations of 70 year-olds. In addition, the 1914 cohort reported a more pessimistic outlook with regard to their general health and greater consumption of medicine. The results of this investigation are consistent with expectations regarding changes in risk factors and mortality in older generations. The consequences of the falling mortality for morbidity and functional ability in a life perspective are, however, still uncertain, and cannot be evaluated alone from results such as these.

Thromboembolism in patients with atrial fibrillation.

On retrospective review of records of 150 patients with atrial fibrillation (AF), 31% experienced a stroke or peripheral embolism. The AF was not associated with cardiac valvular disease in 80% of the 150 patients. Most of the cerebral infarcts were large, disabling, and unheralded by transient ischemic attack. The thromboembolism typically occurred in patients whose AF was undetected prior to the infarction. Half of the patients with an ischemic event suffered multiple events, with one fourth of the recurrences arising within two weeks.

Wavelength of minimum dispersion in step-index monomode fibers: accuracy of evaluation.

The wavelengths of minimum dispersion in step-index monomode fibers are evaluated quite rigorously. These results are compared with those obtained when certain approximations used by several authors are introduced into the course of the calculation. Furthermore, a comparison is made between the wavelengths of minimum dispersion obtained when dispersive data measured by different authors are used for the evaluation.

Dispersion minimum of monomode fibers.

The wavelength of minimum dispersion of monomode fibers is shown to depend on the refractive properties of the core glass as well as of the cladding glass and on the fiber parameter V. Minimum-dispersion wavelengths in the 1.27-microm < lambda < 1.6-microm range are readily obtained with fibers made of fused silica and fused silica doped with GeO(2) and B(2)O(3), thus providing a wide choice of operating wavelengths for high-capacity communication systems.

Gaussian pulse transmission through monomode fibers, accounting for source linewidth.

When Gaussian pulses are transmitted through a monomode dielectric optical waveguide, the pulses are broadened. The total width of a received pulse consists of three components: The width of the emitted pulse and the broadening caused by dispersion in the waveguide together with both the bandwidth of the pulse and the linewidth of the source. The broadened pulses have an oscillating distortion function superimposed on them which deteriorates their resolution. The transmission capacity of an optical monomode transmission system can be calculated from the results of this paper by insertion of the appropriate parameters.