Inhibition of the 1,25-dihydroxyvitamin D3-induced increase in vitamin D receptor (VDR) levels and binding of VDR-retinoid X receptor (RXR) to a direct repeat (DR)-3 type response element by an RXR-specific ligand in human keratinocyte cultures.

The biological active form of vitamin D, 1,25-dihydroxyvitamin D3 (1,25(OH)2D3), mediates most of its actions through the intracellular vitamin D receptor (VDR). VDR binds to vitamin D responsive elements (VDREs) in the promoter region of responsive genes and regulates transcription. Usually the VDREs consist of a direct repeat of two hexanucleotides spaced by three nucleotides (DR-3), to which VDR preferentially binds as a heterodimer with the retinoid X receptor (RXR). In the present study, we examined the effect of 1,25(OH)2D3 and a specific ligand for RXR, CD2809, on VDR and RXR levels in cultured human keratinocytes and on the binding of RXR-VDR to a DR-3 type response element. Incubation with 1,25(OH)2D3 increased VDR levels as determined by Western blotting, increased VDR-RXR binding to a DR-3 type response element as determined by the electromobility shift assay (EMSA), and induced the 25-OH-D3 24-hydroxylase (24-hydroxylase) gene, containing a DR-3 type response element. CD2809 caused a slight decrease in RXRalpha levels, but had no effect on VDR levels. Addition of both CD2809 and 1,25(OH)2D3 decreased VDR levels as well as the VDR-RXR binding levels to the DR-3 type response element, compared to 1,25(OH)2D3 alone. In conclusion, an RXR-specific ligand interferes with the 1,25(OH)2D3-induced stimulation of VDR levels and VDR-RXR binding to DNA in keratinocyte cultures. It is therefore possible that RXR-specific ligands may counteract certain biological actions of vitamin D3.

The effect of intravesically administered Cetiprin on bladder spasms after transurethral resection of the prostate. A double-blind randomized study.

A double-blind study of the short-term effects of intravesically administered emepronium bromide (Cetiprin) versus placebo on bladder spasms after transurethral prostatectomy was done in 40 male patients. In the Cetiprin group there was a significant decline in the need for analgesia, and significantly fewer catheter problems. The use of intravesically instilled Cetiprin is recommended only in cases of severe postoperative bladder spasms.

Risk of accidental exposure to blood borne infection during plastic surgical operations.

To find out the incidence of accidental exposure to blood borne infections by the operation team in the department of plastic surgery a three month survey was carried out. All episodes of exposure of unprotected skin or mucous membranes to blood were recorded. There were 94 accidents in 746 operations, and 17 (18%) of the injuries penetrated the skin. These were mostly self injuries, typically the surgeon injuring his non-dominant index finger. Only one injured person wanted the patient to have an HIV test after the injury, and none of the injured people wanted an HIV test. Only two reported the injury as an occupational accident.

[Attitudes of staff at surgical departments in Denmark to surgery of suspected appendicitis. A questionnaire study]. / Kirurgiske afdelingers holdning til appendectomia per occasionem ved operation for mistaenkt appendicitis acuta. En spørgeskemaundersøgelse.

All Danish surgical departments were asked whether they would recommend removal of the appendix if this seemed normal at operation for suspected appendicitis. 14.0% recommended removal of a normal appendix only if there were no other pathological findings. 84.6% would remove the appendix under certain circumstances bearing risk factors in mind.

[Referrals to clinical mammography in a county without screening program]. / Henvisningsmønsteret til klinisk mammografi i et amt uden screening.

Systematic mammography-screening may reduce the number of unindicated diagnostic mammographies. Six thousand, eight hundred and four women from Rosklde County underwent mammography at the Roskilde County Hospital over a four-year-period. Five hundred and nineteen women were excluded from the study, leaving 6285 women to form the study population. Twenty-four percent of the women had no clinical indication for mammography, 15% of the women had an increased risk of breast cancer, and for 61% of the women there was a clinical indication for mammography. Breast cancer was found in 0.46% of the women undergoing mammography without a clinical indication, in 1.2% of the women belonging to risk-groups, and in 8.9% of the women with a clinical indication for mammography. Biennial screening for breast cancer of 15,394 women (7697 women a year) in the age group 50-69 years could reduce the number of diagnostic mammographies by 338 women a year. Cooperation with GPs in a reduction of unindicated clinical mammographies of women younger than 50 years could reduce the number by a further 171 women. Potential savings in the X-ray-departments is not a weighty argument in favour of introduction of mammography screening.

[Vasectomy in specialized surgical practice]. / Vasektomi i kirurgisk speciallaegepraksis.

In the county of Roskilde an exception was made from the Danish legislation concerning sterilization that vasectomy should be performed in hospitals only on account of the long waiting list for this intervention. Two surgical specialists were selected to perform the operation in their practices. 88% (176/199) elected to accept the offer. All of these sterilizations were carried out within a period of six months. A questionnaire investigation did not reveal any difference in satisfaction between conduct of the intervention by the practising specialist in surgery or in hospital. Justification of the requirement that this form of sterilization can only be undertaken in hospital is discussed.

PIP: The current Danish law on sterilization specifies that the procedure may be carried out only in a hospital. Because of the long waiting time at Roskilde county hospital, the Ministry of Health granted special permission for the procedure to be carried out for a limited time in the practice of a surgical specialist. Of the 308 men on the waiting list at the hospital, 167 elected sterilization at the office. 3 months after the procedure a questionnaire was sent to the men as well as to the 18 patients who had elected to be sterilized at the hospital. The questionnaire covered satisfaction with the procedure, pain during the procedure, pains on the first day following and pain or discomfort at present. There was no significant statistical difference between the replies of the 2 groups. In the hospital setting sterilization is usually performed by young residents in the ambulatory surgical ward. The results of this investigation indicate that there is no valid medical reason for the requirement that sterilization be performed in a hospital. Long waiting lists for sterilization at hospitals ensure that patients have sufficient time to consider the operation but it would be equally effective to include a mandatory waiting period in a revision of the law. The authors recommend that the present Danish sterilization law should be administered by the Ministry of Health rather than by the Ministry of Justice and that it should revised to provide sufficient waiting time.

[Patient information prior to sterilization]. / Patientinformation forud for sterilisation.

The law in Denmark prescribes that the patient and the general practitioner to whom the patient directs his or her request for sterilization are obliged to confirm by their signatures that the patient has received information about sterilization, its risk and consequences. We asked 97 men and 96 women, if they had received this information prior to their sterilization. They were also asked about their knowledge about sterilization. 54% of the women and 35% of the men indicated that they had not received information. Only few of these wished further information by the hospital doctor. Knowledge about sterilization was good. It is concluded that the information to the patient prior to sterilization is far from optimal. The patients' signature confirming verbal information is not a sufficient safeguard. We recommend, among other things, that the patient should receive written information and that both the general practitioner and the hospital responsible for the operation should ensure that optimal information is received by the patient.

[Desmoid tumor of the abdominal wall]. / Desmoid tumor i abdominalvaeggen.

Four cases of muscle-aponeurotic fibroadenomatosis (desmoid) of the abdominal wall are reported. The etiological factors, the recurrence rate, the treatment and the pre- and postoperative examinations are discussed.

A new treatment of ruptured Achilles tendons. A prospective randomized study.

Sixty patients with acute rupture of the Achilles tendon were included in a prospective study and assigned randomly for operative treatment using a 4-string suture with either a new mobile cast (30) or a rigid below-knee cast (30). All patients were evaluated clinically for 1 year after surgery. During surgery, a radiographic monitor was placed in the Achilles tendon above and beneath the site of rupture. Radiographic evaluation of tendon behavior during healing was also performed on all patients for 1 year. Major complications were 1 rerupture in the mobile cast group and 2 reruptures and 1 infection in the rigid cast group. There were fewer minor complications in the mobile cast group. More patients in the mobile cast group resumed sports activities at the same level as before the rupture than in the rigid cast group. They also had better recovery of normal ankle movement plus faster and better recovery of plantar flexion strength. Fewer patients in the mobile cast group had calf atrophy, and fewer had problems 1 year after the accident. Furthermore, patients treated with the mobile cast had a statistically significant shorter sick leave. Radiographic evaluation of the tendon monitor showed significantly less elongation of the tendon 1 year after rupture for patients in the mobile cast group. Operative treatment with a 4-string suture and use of a postoperative mobile cast proved safe and convenient and preferable to treatment with the traditional rigid below-knee cast.

The incidence of ureteral obstruction secondary to aorto-femoral bypass surgery. A prospective study.

Hydronephrosis is reported to be an infrequent complication of aorto-femoral bypass operations. To define the true incidence of this complication, renography (131I-Hippuran) and renal scintigraphy (99 Technetium) were performed both pre- and postoperatively on 56 asymptomatic patients following successful aortic reconstruction. No patient developed signs of ureteral obstruction. It is concluded that hydronephrosis is a rare complication to aorto-femoral bypass surgery and postoperative control is only indicated in patients with symptoms from the urinary tract.

Percutaneous transluminal angioplasty of infrarenal arteries in intermittent claudication.

Percutaneous transluminal angioplasty was performed on 55 iliac and 31 femoropopliteal arteries in 71 patients with intermittent claudication (23 women, 48 men). The two-year patency rate was 80% after iliac and 41% after femoropopliteal angioplasty. In 17 femoropopliteal cases with lesions greater than or equal to 5 cm the 2-year patency rate was only 32%, but the corresponding figure for shorter lesions was 53%. Complicating haematoma appeared in 10% of the cases and the arterial state deteriorated in one patient. There was no distal embolization. Percutaneous transluminal angioplasty in intermittent claudication is indicated for all cases of occlusion or stenosis of the iliac artery and for occlusion or stenosis shorter than 5 cm of the superficial femoral or the popliteal artery.

Percutaneous transluminal angioplasty of iliac and femoral arteries in severe lower-limb ischaemia.

Percutaneous transluminal angioplasty was performed 92 times in 86 patients with severe lower-limb ischaemia (40% occlusion), giving rise to rest pain and/or gangrene. The patients were thereafter observed for periods up to 5 years. Criteria for success were appearance of normal groin pulse (iliac angioplasty) or persistent greater than or equal to 0.15 rise in arm/ankle blood pressure index (femoropopliteal angioplasty). The respective technical success rates were 82% and 64%. The complication rate was 10.9%, including 5.4% distal embolization. Patency rates were higher in iliac than in femoropopliteal lesions, in stenotic than occluded vessels, and also when the lesion was shorter than 5 cm and if there was good run-off. Limb salvage exceeded patency by 10% in the iliac procedures and by 15% in the femoropopliteal. Percutaneous transluminal angioplasty is recommended for selected cases of severe lower-limb ischaemia, and should always be considered for limb salvage. Reocclusion does not necessarily imply clinical failure. Technical failures should be included in calculated patency rates in order to document the method's limitations.