Studies on production and function of pulmonary nitric oxide

Nitric oxide is involved in pulmonary vascular and bronchial regulation and appears to be of paramount importance in the adaptation of the pulmonary circulation at birth. Nitric oxide is present in exhaled gas. The main objective of the present study was to investigate the physiological regulation of pulmonary nitric oxide production, considering factors that are known to be important during pulmonary adaptation at birth, with special reference to the role of nitric oxide in the regulation of pulmonary vascular function. An animal model for continuous analysis of single-breath quantification of lower airway nitric oxide, by chemiluminescence, in vivo was established. The findings show that respiratory system nitric oxide formation is stimulated by stretch-sensitive and [beta]1-adrenoceptor sensitive calcium dependent processes, where the stretch-sensitive process can be blocked by gadolinium. The marked increase in pulmonary vascular resistance upon gadolinium, by far exceeding that attained by direct blockade of NO synthase, suggests that one or several other powerful vasodilators are activated by stretch during pulmonary breathing-induced excursions. The [beta]1-adrenoceptive mechanism is activated by adrenaline released from the adrenals. Carbon dioxide exerts a rapid inhibitory effect on pulmonary nitric oxide formation and especially when nitric oxide formation is stimulated by stretch. It is likely that the findings presented here represent important regulatory mechanisms on pulmonary nitric oxide production, and therefore are of importance for extrauterine pulmonary adaptation at birth and continuous ventilation/perfusion matching throughout extrauterine life

Robotkirurgi ger bra resultat vid radikal prostatektomi. Prostatacancer kan behandlas mer effektivt och skonsamt

Operationsresultat redovisas f\uf6r m\ue4n opererade med radikal prostatektomi – \uf6ppen kirurgi j\ue4mf\uf6rt med robot\uadassisterad laparaskopi – under 2002–2006 vid Karolins\uadka universitetssjukhuset, Solna.M\ue4n som f\uf6ljdes under minst 1 \ue5r besvarade enk\ue4tfr\ue5gor; 768 robotkirurgiska och 411 \uf6ppenkirurgiska operationer utv\ue4rderades.Under perioden minskade andelen m\ue4n med positiv resektionsrand fr\ue5n 37 procent till 22 procent och med erektil dysfunktion fr\ue5n 66 procent till 60 procent. Andelen optimala operationsresultat (\ubbtrifecta\uab) \uf6kade fr\ue5n 19 procent till 28 procent.Vi har inte hittat n\ue5gra indikationer p\ue5 att inf\uf6randet av robotkirurgi har f\uf6rs\ue4mrat situationen f\uf6r m\ue4n diagnostiserade med prostatacancer.Vi kan inte avg\uf6ra om de positiva operationsresultaten skulle ha blivit b\ue4ttre eller s\ue4mre om ett utvecklingsprogram f\uf6r \uf6ppen radikal pros\uadtatektomi i st\ue4llet initierats.En nationell studie, LAPPRO, avseende effekterna av de tv\ue5 operationsformerna p\ue5g\ue5r

Orgasm-Associated Urinary Incontinence and Sexual Life after Radical Prostatectomy.

Introduction.  Involuntary release of urine during sexual climax, orgasm-associated urinary incontinence, occurs frequently after radical prostatectomy. We know little about its prevalence and its effect on sexual satisfaction. Aim.  To determine the prevalence of orgasm-associated incontinence after radical prostatectomy and its effect on sexual satisfaction. Methods.  Consecutive series, follow-up at one point in calendar time of men having undergone radical prostatectomy (open surgery or robot-assisted laparoscopic surgery) at Karolinska University Hospital, Stockholm, Sweden, 2002-2006. Of the 1,411 eligible men, 1,288 (91%) men completed a study-specific questionnaire. Main Outcome Measure.  Prevalence rate of orgasm-associated incontinence. Results.  Of the 1,288 men providing information, 691 were sexually active. Altogether, 268 men reported orgasm-associated urinary incontinence, of whom 230 (86%) were otherwise continent. When comparing them with the 422 not reporting the symptom but being sexually active, we found a prevalence ratio (with 95% confidence interval) of 1.5 (1.2-1.8) for not being able to satisfy the partner, 2.1 (1.1-3.5) for avoiding sexual activity because of fear of failing, 1.5 (1.1-2.1) for low orgasmic satisfaction, and 1.4 (1.2-1.7) for having sexual intercourse infrequently. Prevalence ratios increase in prostate-cancer survivors with a higher frequency of orgasm-associated urinary incontinence. Conclusion.  We found orgasm-associated urinary incontinence to occur among a fifth of prostate cancer survivors having undergone radical prostatectomy, most of whom are continent when not engaged in sexual activity. The symptom was associated with several aspects of sexual life. Nilsson AE, Carlsson S, Johansson E, Jonsson MN, Adding C, Nyberg T, Steineck G, and Wiklund NP. Orgasm-associated urinary incontinence and sexual life after radical prostatectomy. J Sex Med **;**:**-**

Correction to: Outcome of kidney function after ischaemic and zero-ischaemic laparoscopic and open nephron-sparing surgery for renal cell cancer

Following publicatio

Outcome of kidney function after ischaemic and zero-ischaemic laparoscopic and open nephron-sparing surgery for renal cell cancer

Abstract Background Nephron-sparing surgery (NSS) remains gold standard for the treatment of localised renal cell cancer (RCC), even in case of a normal contralateral kidney. Compared to radical nephrectomy, kidney failure and cardiovascular events are less frequent with NSS. However, the effects of different surgical approaches and of zero ischaemia on the postoperative reduction in renal function remain controversial. We aimed to investigate the relative short- and long-term changes in estimated glomerular filtration rate (eGFR) after ischaemic or zero-ischaemic open (ONSS) and laparoscopic NSS (LNSS) for RCC, and to analyse prognostic factors for postoperative acute kidney injury (AKI) and chronic kidney disease (CKD) stage ≥3. Methods Data of 444 patients (211 LNSS, 233 ONSS), including 57 zero-ischaemic cases, were retrospectively analysed. Multiple regression models were used to predict relative changes in renal function. Natural cubic splines were used to demonstrate the association between ischaemia time (IT) and relative changes in renal function. Results IT was identified as significant risk factor for short-term relative changes in eGFR (ß = − 0.27) and development of AKI (OR, 1.02), but no effect was found on long-term relative changes in eGFR. Natural cubic splines revealed that IT had a greater effect on patients with baseline eGFR categories ≥G3 concerning short-term decrease in renal function and development of AKI. Unlike LNSS, ONSS was significantly associated with short-term decrease in renal function (ß = − 13.48) and development of AKI (OR, 3.87). Tumour diameter was associated with long-term decrease in renal function (ß = − 1.76), whereas baseline eGFR was a prognostic factor for both short- (ß = − 0.20) and long-term (ß = − 0.29) relative changes in eGFR and the development of CKD stage ≥3 (OR, 0.89). Conclusions IT is a significant risk factor for AKI. The short-term effect of IT is not always linear, and the impact also depends on baseline eGFR. Unlike LNSS, ONSS is associated with the development of AKI. Our findings are helpful for surgical planning, and suggest either the application of a clampless NSS technique or at least the shortest possible IT to reduce the risk of short-time impairment of the renal function, which might prevent AKI, particularly regarding patients with baseline eGFR category ≥G3

Beta-adrenoceptor agonist stimulation of pulmonary nitric oxide production in the rabbit

1. Nitric oxide (NO) is continuously produced in the lung and is present in exhaled air. We examined the effect of β-adrenoceptor stimulation on the production of pulmonary NO in rabbits. 2. Exhaled NO was measured by chemiluminescence in anaesthetized and mechanically ventilated rabbits and in buffer-perfused rabbit lungs. 3. Intravenous infusions of adrenaline (0.1–10 μg kg(−1)  min(−1)) elicited dose-dependent increases in exhaled NO. The increases in exhaled NO comprised an initial peak followed by a lower plateau level. The increase in exhaled NO was inhibited by propranolol (1 mg kg(−1)) but not by phentolamine (1 mg kg(−1)). 4. Prenalterol, a β(1)-adrenoceptor agonist, and terbutaline, a β(2)-adrenoceptor agonist, also caused dose-dependent increases in exhaled NO. However, prenalterol was >100 times more potent than terbutaline. 5. Infusions of forskolin (0.01–0.03 μmol kg(−1)  min(−1)), an adenylate cyclase stimulator, elicited dose-dependent decreases in blood pressure and concomitant increases in heart rate but caused no alterations in exhaled NO. 6. Nimodipine, a L-type calcium channel blocker, antagonized the increases in exhaled NO in response to prenalterol infusions. 7. The increases in exhaled NO in response to adrenaline and prenalterol were also present in blood-free, buffer perfused lungs during constant-flow conditions. 8. These results demonstrate that pulmonary nitric oxide production can be enhanced by β-adrenoceptor stimulation. Furthermore, the results indicate that the β-adrenergic stimulation of pulmonary NO production is not critically dependent on cyclic AMP formation but may require intact calcium-channels