Biomedical subjects
Publications and source records attributed to T Krarup.
During a period of ten years, 111 patients with cancer of the bladder were treated by total cystectomy. In 69 patients a preoperative radiation dose of 40 Gy was administered, 23 received 60 Gy and 19 received no radiation. The crude-survival was 50%. The postoperative mortality was low, 3.6%.
In a prospective, randomized study 60 patients with prostatism caused by small prostate glands (estimated weight < 20 g) had either transurethral prostatectomy (TURP, n = 31) or transurethral incision of the prostate (TUI, n = 29). Operating time and blood loss were significantly less in the group that underwent TUI. There were no differences between the groups in number of days with an indwelling catheter or days in hospital after operation. Eight patients in the TUI group required further operation, as did four in the TURP group, one of whom was discharged with a permanent indwelling catheter. In addition one patient developed a urethral stricture. Nine of the failures of treatment occurred within the first month. Fifty-one patients were followed up at 3 months and 47 were also seen at 12 months. Both operations significantly improved symptom scores and maximum flow rates compared with preoperatively, but the improvement in maximum flow rate was significantly better in the TURP group than in the TUI group. At 12 months TURP had also improved micturition time and voided volume, which TUI had not. Neither operation caused any significant change in sexual activity or erective potency postoperatively. Retrograde ejaculation was, however, seen in more than half of the patients in the TURP group, and only one in the TUI group. We recommend TUI for the treatment of prostatism caused by small prostate glands in patients who want to preserve normal ejaculation or are at poor surgical risk.
The pancreatic polypeptide (PP) response to insulin-induced hypoglycaemia was studied in 18 juvenile diabetics and was calculated as the difference between the prestimulatory PP concentration and the maximal concentration measured. The response was severely impaired in patients with autonomic neuropathy (mean +/- SE of mean 22 +/- 12 pmol/l) as compared with patients without neuropathy (252 +/- 51 pmol/l). Patients whose diabetes was of only a few years' duration showed a normal PP response to hypoglycaemia, and the response diminished significantly with increasing duration of diabetes. The decreased PP response to hypoglycaemia was significantly correlated with an increased threshold of the sense of vibration, (rs = 0.86). These results suggest that impaired, secretion of PP may serve as an early sign of autonomic neuropathy in diabetes.
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The role of preserved beta-cell function in preventing ketoacidosis in type I insulin-dependent diabetes was assessed in eight patients with and seven patients without residual beta-cell function as determined from C-peptide concentrations. After 12 hours of insulin fatty-acid, and glycerol concentrations were all significantly higher in patients without beta-cell function than in those with residual secretion. Mean blood glucose concentrations reached 17.2 +/- SE of mean 1.3 mmol/l (310 +/- 23 mg/100 ml) in the first group compared with 8.8 +/- 1.4 mmol/l (159 +/- 25 mg/100 ml) in the second (P less than 0.01), while 3-hydroxybutyrate concentrations rose to 5.5 +/- mmol/l (57 +/- 5 mg/100 ml) and 1.4 +/- 0.3 mmol/l (15 +/- 3 mg/100 ml) in the two groups respectively (P less than 0.01). Individual mean C-peptide concentrations showed a significant inverse correlation with the final blood glucose values (r = -0.91; P less than 0.02). These findings strongly suggest that even minimal residual insulin secretion is important for metabolic wellbeing in diabetes and may prevent the development of severe ketoacidosis when insulin delivery is inadequate.
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The development of hypertension after kidney transplantation was examined in a consecutive series of 83 transplantations (79 patients) with a graft survival of more than 30 days. After transplantation, 50% of the normotensive recipients developed mild or severe hypertension, while 74% of the hypertensive recipients remained hypertensive. Stenosis of the graft artery with a narrowing of the diameter of more than 50% was found in 13 patients and in 3 patients a minor or peripheral stenosis was found. Significantly more stenoses were seen in the presence of two donor arteries, whereas no other etiological factors could be shown. In arterial stenosis, severe hypertension was established within a few months after transplantation, but in spite of satisfactory controlled blood pressure and good graft function, hypertensive crises could arise. It is therefore concluded that arteriography and renin analysis should be considered in all cases of severe hypertension, and surgical correction should be considered when arterial stenosis is present.
In order to investigate the clinical course and outcome of septicemia in urological patients, data were collected retrospectively from all patients admitted to a specialized urological department, in whom positive blood cultures were drawn. During a 5-year period 91 patients were registered with urosepsis corresponding to an incidence of 1.2%. In non-iatrogenic urosepsis due to ureteral obstruction women dominated over men, however, in iatrogenic disease--after investigative manoeuvres as well as after surgery--men by large dominated the material. Gram-negative bacteria were responsible for almost 75% of the septicemias and for 99% of the cases where septic shock was present. Where a urinary infection was demonstrated prior to septicemia (45%- identical bacteria were subsequently found in the blood, whether the focus had been successfully treated or not. Septic shock developed in 20 of the patients of whom 3 died. This overall mortality of 3% occurred only in patients with comcomitant serious disease. In general the course of septicemia was benign and the complication rate low. It is concluded that in urological patients septicemia is a less serious problem than in gastroenterological patients. The possible explanation for this is discussed in relation to the more discrete diagnostic and therapeutical procedures in the urological clinic.
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In torsion of the testis a large proportion of testes saved by surgery develop secondary atrophy. External manual reduction may be used as a first treatment, but surgical fixation is mandatory before the patient leaves the hospital. Prophylactic fixation of the contralateral testis should always be performed as 30% of the patients will otherwise develop symptoms. The preventive operation causes no discomfort to the patient and no harm to the testis. The fertility of the torsion patients is reduced. Patients treated for unilateral testicular torsion seem to have bilateral testicular abnormality resulting in decreased spermatogenesis.
The DNA content of individual nuclei in bladder washings was estimated by means of flow cytometry. A method of preparation using a detergent to produce single nuclei was used. By means of a differential count the DNA distribution was corrected for the content of leucocytes. The DNA histograms were divided into a 2c fraction containing nuclei with less than 3c DNA, a 4c fraction with 3c--6c DNA and an 8c fraction with more than 6c DNA. Three groups of patients were investigated: 17 patients with invasive bladder tumours, 38 patients with non-invasive bladder tumours, and 22 patients with normal bladders. The washings from patients with invasive tumours contained significantly larger 4c and 8c fractions than washings from normal bladders. There was a correlation between cell anaplasia and the DNA distribution: grade III bladder tumours had larger 4c and 8c fractions than grade II tumours.
Two cases are presented of reflux into a residual ureter causing recurrent urinary tract infection. A voiding cysto-urethrogram should be included in the investigative routines when nephrectomy for unilateral chronic pyelonephritis is planned. If severe reflux is seen, the entire ureter should be removed along with the kidney.
Thirteen patients with stage III or IV carcinoma of the prostate were treated with 2,6-cis-Diphenylhexamethylcyclotetrasiloxane (Cisobitan, a new organosilicon compound. The drug proved to be a strong antiandrogen and exerted all the known effects of estrogens, including feminization and cardiovascular complications. It is therefore doubtful whether Cisobitan will be a reasonable alternative to estrogens in the treatment of patients with advanced prostatic cancer.
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