H. J. J. Van Lier

Local staging of prostate cancer using magnetic resonance imaging: a meta-analysis

Abstract. Our objective was to determine the influence of patient-, study design-, and imaging protocol characteristics on staging performance of MR imaging in prostate cancer. In an electronic literature search and review of bibliographies (January 1984 to May 2000) the articles selected included data on sensitivity and specificity for local staging. Subgroup analyses examined the influence of age, prostate specific antigen, tumor grade, hormonal pre-treatment, stage distribution, publication year, department of origin, verification bias, time between biopsy and MR imaging; consensus reading, study design, consecutive patients, sample size, histology preparation, imaging planes, fast spin echo, fat suppression, endorectal coil, field strength, resolution, glucagon, contrast agents, MR spectroscopy, and dynamic contrast-enhanced MRI. Seventy-one articles and five abstracts were included, yielding 146 studies. Missing values were highly prevalent for patient characteristics and study design. Publication year, sample size, histologic gold standard, number of imaging planes, turbo spin echo, endorectal coil, and contrast agents influenced staging performance (p=0.05). Due to poor reporting it was not possible to fully explain the heterogeneity of performance presented in the literature. Our results suggest that turbo spin echo, endorectal coil, and multiple imaging planes improve staging performance. Studies with small sample sizes may result in higher staging performance.

An index of inflammatory activity in patients with Crohn's disease.

An objective and quantitative standard of inflammatory activity for patients with Crohns disease was developed. This Activity Index (AI) was derived from data of 63 patients with Crohns disease who had been submitted to a total of 85 clinical examinations. On the basis of 18 predictor variables three physicians gave an overall evaluation of the severity of inflammatory activity in each patient. Stepwise multiple regression analysis was used to investigate which combination of variables contributed most to the overall evaluation. The combination of the following nine variables gave a very good correlation (r = 0.95) with the overall evaluation: serum albumin, ESR, body weight related to length, abdominal mass, sex, temperature, stool consistency, bowel resection, and extraintestinal symptoms related to Crohns disease. This combination of variables expressed in a score that was used as an activity index proved to be very useful in the assessment of disease activity and of the effect of therapy. Index values below 100 are associated with inactive disease, values between 100 and 150 can be regarded as indicating slight inflammatory activity, values between 150 and 210 as indicating moderate, and values above 210 as indicating severe-to-very-severe inflammatory activity.

Effect of sulphasalazine in patients with active Crohn's disease: a controlled double-blind study.

The response of active Crohns disease to sulphasalazine (4-6 g per day) has been studied in a placebo-controlled trial. The study was carried out at two hospitals. From August 1977 to August 1979 all patients with established Crohns disease were examined for their eligibility for the trial. A nine-item index of inflammatory activity was used as the primary measure of response. The variables in this index were serum albumin, ESR, body weight released to height, abdominal mass, temperature, stool consistency, bowel resection, and extraintestinal symptoms related to Crohns disease. A favourable response to therapy was defined as a decrease of the activity index with 25% or more at the end of the trial period, compared with the initial value. Twenty-six patients (13 in each treatment group) have been followed up for six months. The response of active Crohns disease to sulphasalazine was significantly better than to placebo.

Double‐blind comparison of 5‐aminosalicylic acid and acetyl‐5‐aminosalicylic acid suppositories in patients with idiopathic proctitis

Suppositories containing 300 mg 5‐aminosalicylic acid (1.96 mmol) or 425 mg acety1‐5‐aminosalicylic acid (1.96 mmol) were used in 40 patients with idiopathic proctitis to determine the efficacy of acetyl‐5‐aminosalicylic acid in treating this bowel inflammation. Each patient was treated with 5‐aminosalicylic acid or acetyl‐5‐aminosalicylic acid suppositories twice daily for 4 weeks in a double‐blind trial. Four patients were included twice in the trial. The second time they were treated with the alternative regimen. Six patients in the acetyl‐5‐aminoscylic acid group did not complete the trial, four of them because of diarrhoea. Complete clinical remission with normal rectal mucosa on sigmoidoscopy was achieved in 10 out of 18 patients on 5‐aminosalicylic acid and in only two out of 15 in the acetyl‐5‐aminosalicylic acid group (P= 0.03). A favourable histological improvement was demonstrated with 5‐aminosalicylic acid suppositories, but the difference with acetyl‐5‐aminosalicylic acid was not significant (P= 0.059). Three of the four patients who received both drugs recovered with 5‐aminosalicylic acid; in none of them was acetyl‐5‐aminosalicylic acid effective. The results from this study and from previous investigations show that acetyl‐5‐aminosalicylic acid is not superior to placebo.

Captopril and atenolol are equally effective in retarding progression of diabetic nephropathy

SummaryThe progression of diabetic nephropathy can be positively influenced by maintaining a low blood pressure level. This has been shown in studies with conventional antihypertensive treatment as well as with ACE inhibitors. Whether the latter group of drugs is more effective remains to be proven and was the aim of our study. In a prospective randomized study we compared the effects of ACE inhibition and β-blockade on retarding progression of renal function in IDDM patients with an early stage of overt diabetic nephropathy. Twenty-nine patients were studied for 2 years, 15 were randomized for treatment with captopril and 14 for atenolol. Every 6 weeks blood pressure and urinary albumin and total protein excretion were measured. GFR was measured every 6 months as 51Cr-EDTA clearance. Baseline values for blood pressure, renal function and albuminuria were identical in the two groups. The effect of both drugs on blood pressure was not significantly different. In the captopril-treated patients MAP before and after 2 years was 110±3 (SEM) and 100±2 mm Hg, respectively and in the atenolol-treated patients 105±2 vs 101±2 mm Hg. Both drugs reduced albuminuria and total proteinuria to the same extent. With captopril albuminuria decreased from 1549 (989–2399) to 851 (537–1380) mg/24 h and proteinuria from 2.5 (1.6–3.8) to 1.2 (0.8–1.8) g/24 h. With atenolol albuminuria decreased from 933 (603–1445) to 676 (437–1047) mg/ 24 h and proteinuria from 1.5 (1.0–2.4) to 0.9 (0.6–1.5) g/24 h. The rate of decline of GFR was similar with both treatments, on captopril −4.9±2.1 and on atenolol −3.7±1.6 ml · min−1· year−1. No major side effects with either drug were observed. We conclude that, in this 2-year study, captopril and atenolol are equally effective in retarding progression of diabetic nephropathy.

CYCLOSPORIN TREATMENT WITH CONVERSION AFTER THREE MONTHS VERSUS CONVENTIONAL IMMUNOSUPPRESSION IN RENAL ALLOGRAFT RECIPIENTS

In a prospective randomised trial, 72 recipients of cadaver renal allografts received cyclosporin for 3 months followed by azathioprine and prednisone (cyclosporin group), and 71 received azathioprine and prednisone from the day of transplantation (conventional group). Graft survival was better in the cyclosporin group at 3 months and 1 year (93% and 80%) than in the conventional group (83% and 70%). This was not a significant difference. The incidence of acute rejection episodes in the first 3 months was significantly lower in the cyclosporin group (35% versus 77%, p less than 0.00001), as was the number of grafts lost because of immunological failure (1 versus 10, p less than 0.02). After conversion, renal function improved. Only 5 patients had acute rejection after conversion. These episodes were easily reversible in all cases and did not lead to graft loss. The numbers of grafts lost after conversion were similar in the two groups. Conversion of cyclosporin to azathioprine 3 months after renal transplantation is a safe procedure that obviates the long-term toxic effects of cyclosporin.

DDAVP Test for Assessment of Renal Concentrating Capacity in Infants and Children

The renal concentration capacity was tested by intranasal administration of DDAVP in 97 infants and children. The test was simple and reproducible. The renal concentrating capacity increased during approximately the first year of life. At the ages between 1 and 16 years the mean maximal osmolality of 991 mosm/kg was reached. The urine osmolality obtained in the DDAVP test was significantly lower than during the water deprivation test.

Strain differences in hippocampal EEG are related to strain differences in behaviour in rats.

To date, EEG studies towards strain differences have focussed on pharmacologically altered or pathological EEG activity, but only few studies have investigated strain differences and normal EEG activity. A strong relation between behaviour and EEG activity has been demonstrated, especially for hippocampal EEG activity. This relation is known to be similar across species and strains, but no direct comparisons between rat strains within one study have been made. This study compared two rat strains (Sprague-Dawley and Long-Evans) with regard to open-field behaviour and concurrent hippocampal EEG recordings. A detailed behavioural analysis was made and spectral power was calculated for corresponding EEG activity in eight frequency bands. The two strains differed in exploratory activity and in spectral power in the 9-10-Hz frequency band (high frequency rhythmical slow activity [RSA] 6-10 Hz). Long-Evans rats showed higher exploratory activity and higher 9-10 Hz spectral power for voluntary movement and sniffing behaviours. Our results demonstrated these behaviour-specific strain differences in RSA power, although the relation between EEG and behaviour within each strain was similar. The strain differences in EEG were interpreted in relation to strain differences in exploratory behaviour, attributing the differences to a main motor component but also to a smaller sensory component integrated in exploratory behaviour. This is in accordance with theories on the sensory-motor function of the hippocampus and hippocampal theta activity.

The relationship between hippocampal EEG theta activity and locomotor behaviour in freely moving rats: effects of vigabatrin.

The relationship between hippocampal electroencephalogram (EEG) theta activity and locomotor speed in both spontaneous and forced walking conditions was studied in rats after vigabatrin injection (500 mg/kg i.p.). Vigabatrin increased the percentage of time that rats spent being immobile. During spontaneous walking in the open field, the speed of locomotion was increased by vigabatrin, while theta peak frequency was decreased. Vigabatrin also reduced the theta peak frequency during forced (speed controlled) walking. There was only a weak positive correlation (r=0.22) between theta peak frequency and locomotor speed for the saline condition. Furthermore, vigabatrin abolishes the weak relationship between speed of locomotion and theta peak frequency. Vigabatrin and saline did not differ in the slope of the regression line, but showed different offset points at the theta peak frequency axis. Thus, other factors than speed of locomotion seem to be involved in determination of the theta peak frequency.

EFFECT OF DISTAL OCCLUSIONS ON THE ASSESSMENT OF AORTO-ILIAC PATHOLOGY BY ANALYSIS OF DOPPLER SPECTRA

In patients with multilevel arterial obstructive disease, assessment of the severity and location of the pathology is a difficult diagnostic problem. As reported recently, the intra-arterial pressure in the common femoral artery may become normal, although aorto-iliac obstructive disease is present if the superficial femoral artery is occluded. Aorto-iliac obstructive disease can also be assessed by analysis of Doppler spectra obtained from the common femoral artery. In this study, we evaluate if this assessment of aorto-iliac obstructive disease is also harmfully affected by an occlusion in the superficial femoral artery. The results of this study demonstrate that some Doppler parameters (such as acceleration time, slope of the acceleration phase, and the resistance index), which are essential for the assessment of aorto-iliac obstructive disease, are not significantly affected by an occlusion in the superficial femoral artery. Moreover, the study shows that the status of the superficial femoral artery may also be assessed by analysis of Doppler spectra obtained from the common femoral artery.