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Objective To present and describe the validity and reliability of the International Continence Society-Benign Prostatic Hyperplasia study quality-of-life (ICS QoL) instrument, a new set of questions to assess the impact of lower urinary tract symptoms (LUTS) on quality of life (QoL) in middle-aged and elderly men. Patients and methods The study comprised 1271 consecutive men over the age of 45 years, attending urology departments in 12 countries, with LUTS and possible benign prostatic obstruction who were recruited to the ICS-'BPH' study (the clinic group); 423 ambulant men were recruited from a general practice in the UK to provide a community group. Each individual completed the ICS-'BPH' study questionnaire which includes six items addressing general and specific aspects of QoL (the ICS QoL). Content and construct validity were assessed by interviews with patients and by testing hypotheses within the study groups, e.g. the relationships with age, individual LUTS (as measured on the ICS male questionnaire) and generic health status, as measured by the Short Form (SF-36) and EuroQol instruments. Reliability was assessed by measures of internal consistency and a test-retest analysis. Results The ICS QoL items were easily understood by patients, were completed with low levels of missing data, and address some (but not all) concerns about the impact of LUTS on QoL. The ICS QoL items have good construct validity, showing expected differences between community and clinic samples, and expected relationships with each other and individual LUTS. Items had good test-retest reliability, but their internal consistency was poor, confirming that ICS QoL questions should not be combined into a score. General ICS QoL items were closely related with most domains of the SF-36 and the EuroQol. Conclusion ICS QoL items may be used individually or as a group in research studies or in clinical practice. [ABSTRACT FROM AUTHOR]

The regional blood supply to consecutive segments of the small intestine in the anaesthetized rat was investigated with a radioactive microsphere technique. A blood flow gradient with the lowest flow in the distal segments (0.85--0.89 ml/min.g) and the highest in the proximal segments (1.13--1.15 ml/min.g) was observed. Very few microspheres were found in the portal vein blood, indicating negligible arteriovenous shunting in the splanchnic area. The mean cardiac outputs in two consecutive measurements were 27.9 and 28.7 ml/min . 100 g, respectively. The cardiac output and regional blood flow values were in accordance with those obtained with other techniques.

The possibility that adrenaline may be synthesized locally in the eye was investigated in the rabbit and vervet monkey. L-tyrosine-3,5-3H, L-tyrosine (side-chain-2,3-3H) or L-3,4-dihydroxyphenylalanine (3H(G)) was injected into the anterior chamber or the vitreous. The animals were killed after 1/2 h up to 7 days in the tyrosine experiments and after 1 up to 24 h in the DOPA experiments. The synthesis of 3H-adrenaline, 3H-noradrenaline and 3H-dopamine was measured with a modified version of a double isotope technique for determination of catecholamines. No 3H-adrenaline was found. An attempt to stimulate the phenylethanolamine-N-methyltransferase activity with a glucocorticoid and to inhibit the metabolism of catecholamines with a monoaminoxidase inhibitor also failed to demonstrate 3H-adrenaline synthesis. 3H-noradrenaline was found in all experiments when 3H-DOPA had been given. The amounts were about 10 times higher after injection into the anterior chamber than after injection into the vitreous. 3H-dopamine was found in all except a few experiments after 3H-DOPA injection. The highest amounts were found after injection into the vitreous. In experiments with 3H-tyrosine we were unable to demonstrate any catecholamine synthesis. This prompts the question of whether tyrosine-hydroxylase may be absent in the eyes of certain animal species.

Two groups of rats were subjected to segmental ischaemia of the small intestine for 2 h. According to our previous findings such ischaemia causes impairment of the central circulation as well as of the splanchnic blood flow. Dopamine treatment was initiated 30 or 90 min after the establishment of ischaemia. In the 30-min group cardiac output increased and the blood flow was normalized in those parts of the small intestine where the arteries were not ligated (the non-occluded parts). This result corresponds well to our previous observations when dopamine treatment was started immediately after the establishment of ischaemia. In the 90-min group cardiac output was not affected. Again the intestinal blood flow was normalized in the non-occluded parts. In both groups the pancreatic circulation was impaired.

The influence of segmental small intestinal ischemia on the central circulation and on the regional blood flow to consecutive segments of the small intestine in the rat was investigated with the microscphere method. Ischemia was established by ligating 11 arterial mesenteric end arcades, corresponding to one quarter of the total length of the small intestine. The blood supply to different organs and central circulatory variables were determined before, and 10 min, 30 min, 2 h and 14 days after the establishment of the ischemia. After 10 min of ischemia, there was an increase of the blood flow to the segments distal to the ischemic region but after 30 min, this blood flow was the same as the control flow. The central circulatory variables weere not affected. After 2 h of ischemia, the blood supply to both the ischemic and the non-ischemic part of the small intestine had deteriorated considerably. Thus, the vascular resistance in the ischemic segments and the segments surrounding it was increased. Cardiac output was reduced by about 50%. In the experimental group investigated 14 days after establishment of the ischemia, the mortality rate was about 50%. In the survivors, the intestinal blood supply had returned to normal.

The early diagnosis of acute mesenteric occlusion presents a difficult problem in abdominal surgery. In a study on rats the relation between graded small bowel ischemia and the concentration of heme compounds in the plasma was investigated. The ischemia was produced by ligation of terminal vessels at the mesenteric margin of the intestine (mesenteric end arcades) or the superior mesenteric artery. Heme compounds were assayed by a benzidine method developed by Crossby et al. The concentration of heme compounds in the plasma was higher in animals with various grades of intestinal ischemia than in animals subjected to laparotomy alone. This increase was noted as early as 4 hours after induction of moderate and severe grade of ischemia. The results indicate that an increase in plasma concentration of heme compounds takes place at an early stage of moderate and severe small bowel ischemia following mesenteric vascular occlusion but not until after 48 hours in mild ischemia. The clinical value of this method has to be tested in a clinical study.

The effects of alpha-adrenergic and beta-adrenergic blockade on gastric evacuation and small bowel propulsion 15 hours after standardized laparotomy were evaluated. No retardation of gastric evacuation after the laparotomy appeared when alpha-receptor blocking treatment with phenoxybenzamine was instituted. Beta-receptor blocking treatment with propranolol did not prevent the retardation of gastric evacuation after the laparotomy. The time of analysis, 15 hours after the laparotomy, seemed to coincide with the period of resumption of normal small bowel propulsion.

Massive doses of methylprednisolone were given to rats subjected to segmental intestinal ischemis. The central and regional blood flows were studied with the microsphere technique. Ischemia was induced by ligating the arteries to 1/4 of the length of the small intestine. In rats subjected to 2 h of segmental intestinal ischemia methylprednisolone seemed to prevent the decrease in blood flow, previously noted in untreated rats, in the regions where the arteries were not occluded. When adequate volume replacement was given in combination with methylprednisolone, the blood flow in the ischemic region showed a slight improvement. The edema in the ischemic segments tended to be less marked in rats treated with methylprednisolone.

Segmental ischemia of the small intestine in the rat was established by ligating the mesenteric arterial end arcades of 1/4 of the length of the small intestine. Regional and central blood flow was measured with the microsphere technique before and 2 h after induction of the ischemia. In one series of rats an i.v. infusion of 16 ml plasma per kg body weight (b.w.) was given during the experimental period, which maintained the central circulation. However, the impairment of blood supply to the whole small intestine caused by the segmental ischemia was not normalized. Two other series of rats were treated with either phenoxybenzamine alone, 3 mg.kg-1 b.w., or the same dosage of phenoxybenzamine plus plasma infusion (16 ml.kg-1 b.w.). The central circulation was deteriorated and the blood flow to the small intestine reduced in the rats receiving phenoxybenzamine alone. Both the central circulation and the blood supply to the non-ischemic parts of the intestine were maintained in rats treated with both phenoxybenzamine and plasma. Combined treatment with phenoxybenzamine and volume replacement thus seems to be valuable for limiting the secondary hemodynamic changes caused by segmental intestinal ischemia.

Factors of decisive importance for the fate of the intestine following circulatory occlusion incluse the bacterial flora of the intestine, intravascular thrombosis peripheral to the level of occlusion, and the capacity of the collateral circulation. Standardized ischaemia of the small intestine was produced in the rat by ligation of a given number of mesentric end arcades. The passive absorption of radioiodide from a defined, central loop within the ischaemic intestinal segment-as an expression of the exchange circulation of the intestinal mucosa-was determined 14 days after induction of the ischaemia. Different forms of treatment were studied. In Sprague-Dawley rats the effect of heparin, oxitetracycline (OCD) and a combination of these two drugs was examined both concerning the survival of the animals and with regard to the available exchange circulation in the mucosa of the ischaemic intestinal segment. The survival frequency was increased in all treatment groups. The exchange circulation in the ischaemic segment was improved significantly by ODC-treatment and by treatment with heparin and ODC combined. Treatment with heparin alone gave no improvement of the mucosal circulation.

Gastric evacuation and small bowel propulsion were greatly retarded two hours after laparotomy in the rat. Adrenal demedullation, chemical sympathectomy with 6-hydroxydopamine or treatment with a cholinesterase inhibitor (Neostigmin), an alpha-receptor blocker (Dibenyline) or metoclopramide (Primperan) did not improve the gastric evacuation. Chemical sympathectomy or treatment with metoclopramide, however, significantly improved small bowel propulsion. A significant reflux of duodenal contents to the stomach was found in several animals treated with the cholinesterase inhibitor or subjected to adrenal demedullation.

In a prospective study, including fifty consecutive patients with acute ureteral-stone pain, the patients were randomly distributed into two groups for treatment. There were given either an intravenous injection of indomethacin (Confortid) 50 mg, or a subcutaneous injection of 2 mg hydromorphine chloride-atropine (Dilaudid-atropin 1 ml). Patients in the latter group also received a suppository of prochlorperazine (Stemetil) 25 mg. The analgesic effect of the two drugs did not differ significantly. Indomethacin was quicker acting, probably due to the intravenous route of administration. The side effects were alike but those caused by indomethacin had a tendency to be milder and of shorter duration.

The urinary excretions of adrenaline and noradrenaline were determined before and after a moderate thermal trauma in rats with intact adrenal glands, after adrenal demedullation and after adrenalectomy with grafting of adrenal cortical tissue. The basal excretions of adrenaline were 0.28 mug, 0.06 mug and 0.04 mug/24 h/rat, respectively. In rats with intact adrenal glands the adrenaline excretion was greatly increased already in the first 24 hours after the burn. In both the demedullated and adrenalectomized rats only a very slight increase of the adrenaline excretion was noted, but this may indicate a slight reaction of the extramedullary chromaffin tissue to the trauma. The basal excretion of noradrenaline was not affected either by demedullation or adrenalectomy, indicating that it consisted mainly in noradrenaline released from peripheral sympathetic nerve endings. From the second day after the burn there was an increase in the noradrenaline excretion, of equal magnitude in all experimental groups, indicating an increased liberation of peripheral adrenergic transmittor substances.

The effect of chemical sympathectomy on gastric evacuation and small bowel propulsion 15 hours after a standardized laparotomy was evaluated. The animals were pre-treated with 50 mg/kg i. v. of 6-hydroxydopamine 15 or 48 hours or 150 mg/kg 48 hours before the evaluation of gastrontestinal propulsion. The treatment did not prevent the postoperative retardation. On the contrary 6-hydroxydopamine in itself seemed to retard gastrointestinal propulsion. In simultaneously adrenal demedullated rats no further retardation was produced by the laparotomy.

Alteration of the gastrointestinal motility following abdominal surgery is a well substantiated clinical observation. Clinical reports concerning the effect of drugs theoretically suitable for normalizing inhibited gastric emptying during the postoperative period have been conflicting, however. The effect of chlorpromazine, neostigmine and metoclopramide upon retarded gastric emptying following laparotomy was studied in experiments on rats. Metoclopramide (Primperan) considerably improved the emptying ability of the stomach as early as 24 hours after laparotomy. After 72 hours this effect was further accentuated. No improvement of postoperatively retarded motility resulted from treatment with chlorpromazine or with neostigmine during the first 3 postoperative days.

Two groups of rats were subjected to a segmental intestinal ischaemia of a degree which, according to earlier investigations with this experimental model, causes secondary impairment of the splanchnic blood flow. Both groups were given plasma and an alpha-adrenergic blocking agent (phenoxybenzamine). They were also given dopamine but in different doses, 12 and 50 micrograms X min-1 X kg-1 b.w., respectively. It was found previously that a normal blood flow in the non-occluded parts of the small intestine could be maintained by phenoxybenzamine or the lower dose of dopamine alone in combination with plasma, but the higher dopamine dose caused vasoconstriction, probably because of an alpha-stimulating effect. The combined treatment with penoxybenzamine and dopamine in the present experiments normalized the intestinal blood flow in the non-occluded parts in both groups, i.e. also in the group treated with the higher dose of dopamine. Moreover, the pancreatic circulation was normalized in both groups. Hence alpha-adrenergic blockade combined with dopamine and plasma administration seems to have a positive effect on the splanchnic circulation during segmental intestinal ischaemia in the rat.

The influence of continuous intravenous infusion of dopamine on gastric evacuation, small bowel propulsion and mixing was studied in the rat. The study revealed no influence of dopamine infusion on gastrointestinal transport mechanisms.