In the present study, we analyzed the development of the axial skeleton in human trisomy 21 fetuses and defined the fields in the axial skeleton affected in this form of aneuploidy. We investigated 31 human fetuses with trisomy 21, gestational ages 12-24 weeks, on the basis of radiographs of midsagittal tissue blocks of the axial skeleton, comprising the cranial base and the spine. Malformation or agenesis of the nasal bone was present in 19 of 31 fetuses. Nineteen cases had vertebral malformations. Fourteen fetuses had malformations in the cervical region, four in the thoracic and eight in the lumbosacral region. In 1 of 31 fetuses, malformation was seen in the basilar part of the occipital bone. The basisphenoid component appeared scallop-shaped in 30 cases. The pattern of axial skeletal malformations in trisomy 21 fetuses recorded here has not been described previously. Comparison is made with our recent study of trisomy 18, where the pattern of axial skeletal malformations was quite different. It is recommended that axial skeletal radiography should be part of the autopsy of fetuses where chromosome abnormalities are known or suspected.

The prevalence of urinary incontinence during pregnancy was 3.3 times higher compared with a control group of nulliparous women. After 1 year, the difference was reduced, but still 2.5 times higher in the primiparous group. The symptoms and impact on quality of life seemed to be mild to moderate in both groups.

Objectives

SUI or MUI 1 year after the first vaginal delivery was strongly associated with UI during the pregnancy and inversely associated with oxytocin augmentation.

SUMMARY This study was performed to determine the relationship between myocardial infarct size estimated by serum CK-MB methods and the extent of irreversible injury in acute myocardial infarction. In 321 consecutive patients, infarct size was estimated by different mathematical models, and in 22 patients who died in hospital, the extent of myocardial necrosis was determined by autopsy. We also investigated the depletion of CK-MB in infarcted tissue, the recovery of CK-MB in the plasma volume, and the elimination of CK-MB from plasma.Myocardial CK-MB depletion was relatively greater in the larger infarcts, whereas the recovery of enzyme in plasma was independent of the infarct size. Correction of serum CK-MB for changes in plasma volume improved the estimate significantly (p < 0.05). The correlation between the measured infarct size (g) and the estimated infarct size (units per liter and gram-equivalents) was highly significant (r = 0.85-0.89, SEE = 23-27%, p < 0.001). Thus, a semiquantitative expression of the extent of myocardial necrosis can be determined in vivo. AMI. Of these, 72 were excluded: 48 because the symptoms of AMI had lasted more than 15 hours before admission or because the second blood sample did not show higher CK-MB activity than the first and 24 because not enough blood samples had been obtained because patients died or were transferred to another department. The remaining 321 patients form the study group. Forty-three of these patients died within 18 days and were divided into group A, which included 22 patients in whom a detailed heart autopsy was performed, and group B, which included 21 patients in whom no detailed heart autopsy was performed. All patients autopsied had survived for at least 48 hours from the appearance of CK-MB activity in serum and there were no signs of reinfarction before death. Furthermore, all plasma curves showed a pure elimination phase (first-order kinetics).The 22 patients in group A included 12 women and 10 men who died at a mean age of 69.7 years (range 49-88 years). The median time from onset of symptoms until death was 6.4 days (range 2-14 days). Cardiogenic shock was the main cause of death in 12 patients and recurrent ventricular fibrillation in six patients. Two died from asystole and two from noncardiac causes.Heart biopsies were taken postmortem every 6 hours for 30 hours in eight patients from group B. The total enzyme depletion in whole heart homogenates was measured in 10 other patients.In 10 patients who died without signs of heart disease, myocardial biopsies were made to estimate CK and CK-MB activity. Tissue extracts were made from about 0.3 g tissue (wet weight) in a mixture of 10 ml 0.25 mol/ 1 sucrose, 3 ml 0.01 mol/l TRIS buffer (pH 7.4), 3 ml 1 mmol/l EGTA (pH 7.4) and 3 ml 1 mmol/ I mercaptoethanol, and homogenized on ice in an Ultra Turax blender for 1 minute. The homogenate was centrifuged (3500 g) and the supernatant was used to determine isoenzyme activity. The samples were diluted with heat-inactivated serum or TRIS buffer to the line...

Helicobacter pyloni infection is associated with increased meal stimulated gastrin secretion, but the reason for this is unknown. Sequence specific radioimmunoassays were used to measure the concentration of ot-amidated gastrin, the total progastrin product, and somatostatin in biopsy specimens of human antral mucosa. The antral concentrations of ct-amidated gastrin and of total progastrin products were significantly higher in H pyloni infected patients than in those not infected by this organism. In contrast, the antral somatostatin concentration was significantly decreased in infected patients. Progastrin processing, determined by gel chromatography, seemed unaffected by H pyloni infection. The results suggest that the finding of increased gastrin secretion from the antral G cells in H pyloni infected patients may be a result of reduced inhibition of G-cell secretion by somatostatin.

Objective  To compare the Danish Prostatic Symptom Score (DAN‐PSS) with the International Prostatic Symptom Score (IPSS), Madsen‐Iversen and Boyarsky symptom indexes in a clinical setting, and to evaluate the potential significance of any differences in information obtained from these questionnaires. Patients and methods  The study comprised two substudies: in the first, 205 patients with lower urinary tract symptoms (LUTS) suggestive of bladder outlet obstruction (BOO), a Madsen‐Iversen score >6 and a maximum flow rate of <10 mL/s were randomized to receive either placebo or alfuzosin in a double‐blind study of 16 weeks. The symptoms were assessed using the Madsen‐Iversen, DAN‐PSS and the IPSS questionnaires. In the second, 138 patients with LUTS suggestive of BOO were selected for treatment with transurethral microwave thermotherapy (TUMT, 52°C for 60 min, microwave energy 200 kJ) and their symptoms assessed using the Boyarsky and the DAN‐PSS questionnaires. Patients were then followed for one year. Rank correlation coefficients and regression lines were calculated using Spearman’s non‐parametric test. The relative changes, i.e. responsiveness, calculated for the DAN‐PSS, IPSS and Boyarsky indexes were compared pairwise using the Wilcoxon‐Pratt test. Results  The DAN‐PSS, IPSS and Madsen‐Iversen indexes were correlated on a pairwise basis. The DAN‐PSS and IPSS indexes have significant construct validity in terms of correlation with the Madsen‐Iversen system (Spearman’s correlation coefficient, rs=0.51 and rs=0.45, respectively). The DAN‐PSS and the IPSS indexes were correlated (rs=0.61). The DAN‐PSS was more sensitive than the IPSS to changes after pharmacological treatment, with scores decreasing 70% and 29% (P<0.05), respectively, after treatment with an alpha‐blocker for 4 months, and 50% and 29% (P<0.05), respectively, after 4 months on placebo treatment. Finally, the responsiveness of the Boyarsky and DAN‐PSS indexes to TUMT showed that the DAN‐PSS system was significantly more responsive than the Boyarsky index, with scores decreasing 57% and 15% (P<0.05), respectively, after one year. Conclusions  The DAN‐PSS index is more sensitive than the IPSS, Madsen‐Iversen and Boyarsky symptom indexes, incorporates important outcome events, includes a patient‐weighting of each symptom, thereby reflecting better the patients’ global assessment of outcome.

There is an almost 40-fold difference in incidence rates of symptomatic coeliac disease between Denmark and Sweden. In an attempt to explain this difference, the present study focused on the interobserver agreement when pathologists were assessing small intestinal biopsy specimens from children suspected of suffering from coeliac disease. The study was performed on 90 biopsy specimens from 73 children. Most of the biopsies came from children who turned out not to suffer from coeliac disease after a clinical evaluation including small intestinal biopsy. Using the kappa methodology, the interobserver agreement between two Danish pathologists and one Swedish pathologist, all of whom were experienced, was "moderate" to "substantial" or 0.57-0.75. Kappa indices when the pathologists evaluated selected histological elements were in the interval from 0.24 to 0.67. A comparison of a previous routine diagnostic assessment of the 90 biopsies (14 pathologists) with the results of the experienced pathologists in the present study gave kappa indices of from 0.53 to 0.57. The study could prove no major differences in the histopathological assessment of small intestinal biopsy specimens made by Danish and Swedish pathologists. The difference in clinical presentation of coeliac disease in Denmark and Sweden does not relate to differences in the histopathological assessment of small intestinal biopsies.