Development of musculoskeletal models for the design and the pre-clinical validation of hip resurfacing prosthesis

Background. The surgical treatment of dysfunctional hips is a severe condition for the patient and a costly therapy for the public health. Hip resurfacing techniques seem to hold the promise of various advantages over traditional THR, with particular attention to young and active patients. Although the lesson provided in the past by many branches of engineering is that success in designing competitive products can be achieved only by predicting the possible scenario of failure, to date the understanding of the implant quality is poorly pre-clinically addressed. Thus revision is the only delayed and reliable end point for assessment. The aim of the present work was to model the musculoskeletal system so as to develop a protocol for predicting failure of hip resurfacing prosthesis. Methods. Preliminary studies validated the technique for the generation of subject specific finite element (FE) models of long bones from Computed Thomography data. The proposed protocol consisted in the numerical analysis of the prosthesis biomechanics by deterministic and statistic studies so as to assess the risk of biomechanical failure on the different operative conditions the implant might face in a population of interest during various activities of daily living. Physiological conditions were defined including the variability of the anatomy, bone densitometry, surgery uncertainties and published boundary conditions at the hip. The protocol was tested by analysing a successful design on the market and a new prototype of a resurfacing prosthesis. Results. The intrinsic accuracy of models on bone stress predictions (RMSE < 10%) was aligned to the current state of the art in this field. The accuracy of prediction on the bone-prosthesis contact mechanics was also excellent (< 0.001 mm). The sensitivity of models prediction to uncertainties on modelling parameter was found below 8.4%. The analysis of the successful design resulted in a very good agreement with published retrospective studies. The geometry optimisation of the new prototype lead to a final design with a low risk of failure. The statistical analysis confirmed the minimal risk of the optimised design over the entire population of interest. The performances of the optimised design showed a significant improvement with respect to the first prototype (+35%). Limitations. On the authors opinion the major limitation of this study is on boundary conditions. The muscular forces and the hip joint reaction were derived from the few data available in the literature, which can be considered significant but hardly representative of the entire variability of boundary conditions the implant might face over the patients population. This moved the focus of the research on modelling the musculoskeletal system; the ongoing activity is to develop subject-specific musculoskeletal models of the lower limb from medical images. Conclusions. The developed protocol was able to accurately predict known clinical outcomes when applied to a well-established device and, to support the design optimisation phase providing important information on critical characteristics of the patients when applied to a new prosthesis. The presented approach does have a relevant generality that would allow the extension of the protocol to a large set of orthopaedic scenarios with minor changes. Hence, a failure mode analysis criterion can be considered a suitable tool in developing new orthopaedic devices.

Modulation der Immunogenität von humanen Nierenzellkarzinomzellen durch stabilen TAP1-Gentransfer

Bei Nierenzellkarzinomen (NZK), wie auch bei vielen anderen Tumoren konnte eine reduzierte Expression der Klasse I Haupthistokompatibilitäts-Komplexe (MHC Klasse I) nachgewiesen werden, die assoziiert sein kann mit der gestörten Expression oder Funktion von Komponenten der Antigenprozessierung. Eine verminderte Erkennung solcher Tumore durch zytotoxische T-Lymphozyten und ein Zusammenhang mit einem Fortschreiten der Erkrankung führte zu der Annahme, daß es sich bei diesen Störungen um "immune escape"-Mechanismen handelt. Um die Bedeutung des heterodimeren Peptidtransporters TAP ("transporter associated with antigen processing") für die Immunogenität von Nierenzellkarzinomen zu untersuchen, wurde im Rahmen dieser Arbeit erstmals der stabile Gentransfer des humanen TAP1A-Gens in Nierenzellkarzinom-Zellen erfolgreich durchgeführt.
Dies konnte durch die Optimierung der Transfektionsmethode und des verwendeten Plasmid-Vektors erreicht werden. Die Transfektionen wurden mit Hilfe der Rechteck-Impuls-Elektroporation unter spezifischen, in der Arbeit etablierten Bedingungen durchgeführt. Der CMV-regulierte TAP-Expressions-Vektor wurde dahingehend verbessert, daß durch die Einführung einer IRES ("internal ribosomal entry site") Sequenz eine bicistronische m-RNS transkribiert wird, die sowohl das TAP1-Transgen als auch den Neomycin-Selektionsmarker enthält.
Es konnte nach klonaler Selektion eine stabile, aber unter den sieben getesteten Klonen heterogene Transkription der transgenen TAP1-mRNS nachgewiesen werden. In der Protein-Expression zeigten 5/7 der TAP1A-positive Klone eine mindestens zweifache Induktion der TAP1-Expression. In 2/7 dieser TAP1A-positive Klone war die TAP1-Überexpression mit einer Erhöhung der MHC Klasse I-Expression und selektiver Induktion des HLA-A2-Moleküls in der Durchflußzytometrie verbunden. Eine Quantifizierung des Peptidtransportes ergab je nach verwendetem Modellpeptid eine geringe oder gar keine Erhöhung der Transportrate in den TAP1-Transfektanden gegenüber Kontrollzellen. Ebenfalls konnte in Zytotoxizitäts-Analysen mit einer autologen T-Zellinie eine Erhöhung der spezifischen Lyse nicht gezeigt werden. Jedoch wurden im Zellkultur-Überstand dieser Zytotoxizitäts-Analysen bei einigen TAP1A-positive Transfektanden gegenüber mock transfizierten-Kontrollzellen deutlich erhöhte Werte des Tumornekrose-Faktor-alpha (TNF-alpha) gemessen, was als Maß einer T-Zell-Aktivierung gilt. Diese Ergebnisse sind konsistent mit einer ebenfalls deutlich gesteigerten T-Zell-Proliferation in Anwesenheit von TAP1A-positive Transfektanden.
Die alleinige stabile Überexpression von TAP1 in Nierenzellkarzinomzellen kann somit zu einer Modulation der MHC Klasse I-Expression und der T-Zell-Reaktivität führen. Das weist darauf hin, daß eine starke, konstitutive TAP1-Expression eine grundlegende Voraussetzung für eine effiziente Antigenprozessierung und Immunantwort darstellt und die Immuntoleranz gegenüber NZK durch stabilen TAP1-Gentransfer beinflußbar ist. Eine denkbare klinische Anwendung dieser Technik ist die Herstellung einer Tumorantigen-präsentierenden Zellvakzine, die eine T-Zell-Anergie gegenüber NZK durchbrechen könnte.
Schlüsselwörter: TAP, MHC, Antigenprozessierung, Tumorimmunologie, Gentransfer

Funktionsanalyse von Gamma2-Adaptin: ein zellulärer Adaptor der Hepatitis-B-Virus-Morphogenese

Im Replikationszyklus umhüllter Viren entstehen neue Viruspartikel durch die Knospung an Membranen der Wirtszelle. An diesem Prozess sind verschiedene zelluläre Faktoren und Mechanismen beteiligt, speziell die ESCRT-Proteinkomplexe, welche die Vesikelbildung an den MVBs steuern. Auch bei HBV ist davon auszugehen, dass Komponenten der Wirtszelle an der Umhüllung und Freisetzung der Virionen beteiligt sind, allerdings sind diese noch weitgehend unbekannt. Ziel dieser Arbeit war es daher, die zellulären Faktoren genauer zu charakterisieren und ihre Funktion bei der Virusumhüllung aufzuklären. Den Ausgangspunkt für die hier durchgeführten Untersuchungen bildeten vorangegangene Arbeiten, in denen die spezifische Interaktion des L-Hüllproteins von HBV mit g2-Adaptin nachgewiesen werden konnte. Diese ist für die Morphogenese von HBV essentiell, allerdings ist die zelluläre ebenso wie die virusspezifische Funktion von g2-Adaptin bislang unbekannt. Im Rahmen dieser Arbeit sollte daher untersucht werden, wo und wie g2-Adaptin in der Zelle funktionell ist, um daraus Rückschlüsse auf die Vorgänge bei der Morphogenese von HBV ziehen zu können. Die Grundlage für die Charakterisierung von g2-Adaptin bildete seine Ähnlichkeit zu zellulären Clathrin-Adaptorproteinen. So konnte hier gezeigt werden, dass auch g2-Adaptin ein Clathrin-Bindungsmotiv besitzt, welches eine Interaktion mit Clathrin ermöglicht. Außerdem konnte ein Ubiquitin-Interaktions-Motiv (UIM) identifiziert werden, das die Bindung an ubiquitinierte Proteine vermittelt. Diese Beobachtung deutet darauf hin, dass g2-Adaptin zu einer Gruppe monomerer Adaptorproteine zählen könnte, welche als Ubiquitin-Rezeptoren in der Zelle funktionell sind. Die folgenden Analysen zeigten eine weitere Gemeinsamkeit, da auch g2-Adaptin selbst durch Ubiquitin modifiziert wird, wobei die Ubiquitinierung von einem intakten UIM abhängt. Dieser als Coupled Monoubiquitination bezeichnete Prozess wird hierbei durch die Ubiquitin-Ligase Nedd4 vermittelt, die direkt mit g2-Adaptin interagiert. Dabei konnte nachgewiesen werden, dass die C2-Domäne von Nedd4 ebenfalls mit Ubiquitin modifiziert ist, wodurch der Kontakt zum UIM von g2-Adaptin erfolgt. Die meisten der bislang bekannten Ubiquitin-bindenden Adaptorproteine, spielen bei der Vesikelentstehung an verschiedenen zellulären Membranen eine Rolle, wo sie an der Sortierung der vorwiegend ubiquitinierten Membranproteine beteiligt sind und zelluläre Komponenten rekrutieren, welche die Vesikelabschnürung vermitteln. Die Adaptorproteine sind dabei meist mit der jeweiligen Membran assoziiert, was auch für g2-Adaptin nachgewiesen werden konnte. Diese Membranbindung wird durch den N-terminalen Proteinbereich von g2-Adaptin vermittelt und erfolgt unabhängig von den Ubiquitin-bindenden Eigenschaften und von Nedd4. Allerdings scheint die Ubiquitin-Modifikation von g2-Adaptin ausschließlich in membrangebundener Form zu erfolgen. An welchen Membranen g2-Adaptin lokalisiert ist, wurde in Immunfluoreszenzstudien untersucht, wobei eine enge Assoziation von g2-Adaptin mit späten Endosomen bzw. MVBs zu beobachten war. Bei weiteren Analysen konnte auch ein funktioneller Einfluss auf die Vesikelentstehung an den MVBs nachgewiesen werden, da durch die Depletion von g2-Adaptin stark vergrößerte, defekte MVBs induziert wurden. Dies deutet darauf hin, dass g2-Adaptin als Ubiquitin-Rezeptor an diesen Prozessen beteiligt sein könnte. Ebenso wie andere Adaptorproteine könnte es hier an die Cargo-Proteine binden, diese durch den Kontakt zu Clathrin lokal konzentrieren und die Vesikelabschnürung durch die Rekrutierung der MVB-Maschinerie vermitteln. Möglicherweise stellt g2-Adaptin hierbei den bislang nicht identifizierten Adaptor dar, der die Verbindung zwischen Nedd4 und der MVB-Kaskade herstellt. Eine ähnliche Funktion für g2-Adaptin ist auch bei der Morphogenese von HBV denkbar. Aufgrund der durchgeführten Lokalisationsstudien ist anzunehmen, dass die Umhüllung der HBV-Partikel direkt an den MVBs erfolgt. Vermutlich bindet g2-Adaptin hier an das L-Hüllprotein, wobei es durch die Rekrutierung von Clathrin zu einer lokalen Anreicherung der Hüllproteine kommt. g2-Adaptin interagiert zudem in UIM-abhängiger Weise mit dem Nukleokapsid, wobei der Kontakt direkt erfolgen könnte oder durch die Ubiquitin-Ligase Nedd4 vermittelt wird, welche über eine Late-Domäne ebenfalls mit dem Nukleokapsid verbunden ist. Anscheinend gelangt das Nukleokapsid durch den Einfluss von g2-Adaptin und Nedd4 zum Ort der Virusmorphogenese, wo die eigentliche Umhüllung und die Abschnürung der Viruspartikel erfolgen. Vermutlich sind auch hier Komponenten der MVB-Maschinerie beteiligt, die womöglich durch g2-Adaptin rekrutiert werden.

Verständlichkeit von Bedienungsanleitungen : dysfunktionale Rezeption von Instruktionen

Das vorliegende Werk behandelt die Ursachen für die Nicht-, Schwer- und Missverständlichkeit von Bedienungsanleitungen und Instruktionen sowohl theoretisch durch eine Auswertung der einschlägigen Fachliteratur als auch praktisch durch eine empirische Untersuchung dreier Informationsprodukte. Zur Veranschaulichung der Tragweite von dysfunktionalen Instruktionen stellt die vorliegende Arbeit zunächst die rechtlichen Rahmenbedingungen für Bedienungsanleitungen dar. Im Anschluss daran erläutert sie die thematisch relevanten Kommunikationstheorien, die grundlegenden Kommunikationsmodelle sowie die zentralen Theorien der Kognitionswissenschaft zur Textverarbeitung und zum Textverstehen als Grundlage für die durchgeführten Lese- und Benutzertests. Die praktische Untersuchung veranschaulicht die vielfältigen und omnipräsenten Ursachen für eine dysfunktionale Rezeption von Instruktionen und legt aufgrund der potenziell gefährlichen Folgen die Durchführung von Benutzertests zur retrospektiven Vermeidung von Kommunikationsstörungen und zur prospektiven Stärkung des Problembewusstseins bei der Erstellung von Bedienungsanleitungen nahe.

Applications of GIS and remote sensing techniques for studying the housing patterns in Cairo Governorate

The main objective of this study is to reveal the housing patterns in Cairo as one of the most rapidly urbanizing city in the developing world. The study outlines the evolution of the housing problem and its influencing factors in Egypt generally and in Cairo specifically. The study takes into account the political transition from the national state economy to the open door policy, the neo-liberal period and finally to the housing situation after the January 2011 Revolution. The resulting housing patterns in Cairo Governorate were identified as (1) squatter settlements, (2) semi-informal settlements, (3) deteriorated inner pockets, and (4) formal settlements. rnThe study concluded that the housing patterns in Cairo are reflecting a multifaceted problem resulting in: (1) the imbalance between the high demand for affordable housing units for low-income families and the oversupply of upper-income housing, (2) the vast expansion of informal areas both on agricultural and desert lands, (3) the deterioration of the old parts of Cairo without upgrading or appropriate replacement of the housing structure, and (4) the high vacancy rate of newly constructed apartmentsrnThe evolution and development of the current housing problem were attributed to a number of factors. These factors are demographic factors represented in the rapid growth of the population associated with urbanization under the dictates of poverty, and the progressive increase of the prices of both buildable land and building materials. The study underlined that the current pattern of population density in Cairo Governorate is a direct result of the current housing problems. Around the depopulation core of the city, a ring of relatively stable areas in terms of population density has developed. Population densification, at the expense of the depopulation core, is characterizing the peripheries of the city. The population density in relation to the built-up area was examined using Landsat-7 ETM+ image (176/039). The image was acquired on 24 August 2006 and considered as an ideal source for land cover classification in Cairo since it is compatible with the population census 2006.rnConsidering that the socio-economic setting is a driving force of change of housing demand and that it is an outcome of the accumulated housing problems, the socio-economic deprivations of the inhabitants of Cairo Governorate are analyzed. Small administrative units in Cairo are categorized into four classes based on the Socio-Economic Opportunity Index (SEOI). This index is developed by using multiple domains focusing on the economic, educational and health situation of the residential population. The results show four levels of deprivation which are consistent with the existing housing patterns. Informal areas on state owned land are included in the first category, namely, the “severely deprived” level. Ex-formal areas or deteriorated inner pockets are characterized as “deprived” urban quarters. Semi-informal areas on agricultural land concentrate in the third category of “medium deprived” settlements. Formal or planned areas are included mostly in the fourth category of the “less deprived” parts of Cairo Governorate. rnFor a better understanding of the differences and similarities among the various housing patterns, four areas based on the smallest administrative units of shiakhat were selected for a detailed study. These areas are: (1) El-Ma’desa is representing a severely deprived squatter settlement, (2) Ain el-Sira is an example for an ex-formal deprived area, (3) El-Marg el-Qibliya was selected as a typical semi-informal and medium deprived settlement, and (4) El-Nozha is representing a formal and less deprived area.rnThe analysis at shiakhat level reveals how the socio-economic characteristics and the unregulated urban growth are greatly reflected in the morphological characteristics of the housing patterns in terms of street network and types of residential buildings as well as types of housing tenure. It is also reflected in the functional characteristics in terms of land use mix and its degree of compatibility. It is concluded that the provision and accessibility to public services represents a performance measure of the dysfunctional structure dominating squatter and semi-informal settlements on one hand and ample public services and accessibility in formal areas on the other hand.rn

The lectin-like domain of tumor necrosis factor improves lung function after rat lung transplantation--potential role for a reduction in reactive oxygen species generation

To test the hypothesis that the lectin-like domain of tumor necrosis factor, mimicked by the TIP peptide, can improve lung function after unilateral orthotopic lung isotransplantation. Because of a lack of a specific treatment for ischemia reperfusion-mediated lung injury, accompanied by a disrupted barrier integrity and a dysfunctional alveolar liquid clearance, alternative therapies restoring these parameters after lung transplantation are required.

Cardiac imaging after myocardial infarction

After myocardial infarction, optimal clinical management depends critically on cardiac imaging. Remodelling and heart failure, presence of inducible ischaemia, presence of dysfunctional viable myocardium, future risk of adverse events including risk of ventricular arrhythmias, need for anticoagulation, and other questions should be addressed by cardiac imaging. Strengths and weaknesses, recent developments, choice, and timing of the different non-invasive techniques are reviewed for this frequent clinical scenario.

Regulation of the cardiac sodium channel Nav1.5 by utrophin in dystrophin-deficient mice

Duchenne muscular dystrophy (DMD) is a severe striated muscle disease due to the absence of dystrophin. Dystrophin deficiency results in dysfunctional sodium channels and conduction abnormalities in hearts of mdx mice. Disease progression in the mdx mouse only modestly reflects that of DMD patients, possibly due to utrophin up-regulation. Here, we investigated mice deficient in both dystrophin and utrophin [double knockout (DKO)] to assess the role of utrophin in the regulation of the cardiac sodium channel (Na(v)1.5) in mdx mice.

EEG microstate analysis in drug-naive patients with panic disorder

Patients with panic disorder (PD) have a bias to respond to normal stimuli in a fearful way. This may be due to the preactivation of fear-associated networks prior to stimulus perception. Based on EEG, we investigated the difference between patients with PD and normal controls in resting state activity using features of transiently stable brain states (microstates). EEGs from 18 drug-naive patients and 18 healthy controls were analyzed. Microstate analysis showed that one class of microstates (with a right-anterior to left-posterior orientation of the mapped field) displayed longer durations and covered more of the total time in the patients than controls. Another microstate class (with a symmetric, anterior-posterior orientation) was observed less frequently in the patients compared to controls. The observation that selected microstate classes differ between patients with PD and controls suggests that specific brain functions are altered already during resting condition. The altered resting state may be the starting point of the observed dysfunctional processing of phobic stimuli.

Tight junctions in brain barriers during central nervous system inflammation

Homeostasis within the central nervous system (CNS) is a prerequisite to elicit proper neuronal function. The CNS is tightly sealed from the changeable milieu of the blood stream by the blood-brain barrier (BBB) and the blood-cerebrospinal fluid (CSF) barrier (BCSFB). Whereas the BBB is established by specialized endothelial cells of CNS microvessels, the BCSFB is formed by the epithelial cells of the choroid plexus. Both constitute physical barriers by a complex network of tight junctions (TJs) between adjacent cells. During many CNS inflammatory disorders, such as multiple sclerosis, human immunodeficiency virus infection, or Alzheimer's disease, production of pro-inflammatory cytokines, matrix metalloproteases, and reactive oxygen species are responsible for alterations of CNS barriers. Barrier dysfunction can contribute to neurological disorders in a passive way by vascular leakage of blood-borne molecules into the CNS and in an active way by guiding the migration of inflammatory cells into the CNS. Both ways may directly be linked to alterations in molecular composition, function, and dynamics of the TJ proteins. This review summarizes current knowledge on the cellular and molecular aspects of the functional and dysfunctional TJ complexes at the BBB and the BCSFB, with a particular emphasis on CNS inflammation and the role of reactive oxygen species.

Cardiac channelopathies: genetic and molecular mechanisms

Channelopathies are diseases caused by dysfunctional ion channels, due to either genetic or acquired pathological factors. Inherited cardiac arrhythmic syndromes are among the most studied human disorders involving ion channels. Since seminal observations made in 1995, thousands of mutations have been found in many of the different genes that code for cardiac ion channel subunits and proteins that regulate the cardiac ion channels. The main phenotypes observed in patients carrying these mutations are congenital long QT syndrome (LQTS), Brugada syndrome (BrS), catecholaminergic polymorphic ventricular tachycardia (CPVT), short QT syndrome (SQTS) and variable types of conduction defects (CD). The goal of this review is to present an update of the main genetic and molecular mechanisms, as well as the associated phenotypes of cardiac channelopathies as of 2012.

Xenomelia: a social neuroscience view of altered bodily self-consciousness

Xenomelia, the "foreign limb syndrome," is characterized by the non-acceptance of one or more of one's own extremities and the resulting desire for elective limb amputation or paralysis. Formerly labeled "body integrity identity disorder" (BIID), the condition was originally considered a psychological or psychiatric disorder, but a brain-centered Zeitgeist and a rapidly growing interest in the neural underpinnings of bodily self-consciousness has shifted the focus toward dysfunctional central nervous system circuits. The present article outlays both mind-based and brain-based views highlighting their shortcomings. We propose that full insight into what should be conceived a "xenomelia spectrum disorder" will require interpretation of individual symptomatology in a social context. A proper social neuroscience of xenomelia respects the functional neuroanatomy of corporeal awareness, but also acknowledges the brain's plasticity in response to an individual's history, which is lived against a cultural background. This integrated view of xenomelia will promote the subfield of consciousness research concerned with the unity of body and self.

Identification of a highly conserved valine-glycine-phenylalanine amino acid triplet required for HIV-1 Nef function

Background The Nef protein of HIV facilitates virus replication and disease progression in infected patients. This role as pathogenesis factor depends on several genetically separable Nef functions that are mediated by interactions of highly conserved protein-protein interaction motifs with different host cell proteins. By studying the functionality of a series of nef alleles from clinical isolates, we identified a dysfunctional HIV group O Nef in which a highly conserved valine-glycine-phenylalanine (VGF) region, which links a preceding acidic cluster with the following proline-rich motif into an amphipathic surface was deleted. In this study, we aimed to study the functional importance of this VGF region. Results The dysfunctional HIV group O8 nef allele was restored to the consensus sequence, and mutants of canonical (NL4.3, NA-7, SF2) and non-canonical (B2 and C1422) HIV-1 group M nef alleles were generated in which the amino acids of the VGF region were changed into alanines (VGF→AAA) and tested for their capacity to interfere with surface receptor trafficking, signal transduction and enhancement of viral replication and infectivity. We found the VGF motif, and each individual amino acid of this motif, to be critical for downregulation of MHC-I and CXCR4. Moreover, Nef’s association with the cellular p21-activated kinase 2 (PAK2), the resulting deregulation of cofilin and inhibition of host cell actin remodeling, and targeting of Lck kinase to the trans-golgi-network (TGN) were affected as well. Of particular interest, VGF integrity was essential for Nef-mediated enhancement of HIV virion infectivity and HIV replication in peripheral blood lymphocytes. For targeting of Lck kinase to the TGN and viral infectivity, especially the phenylalanine of the triplet was essential. At the molecular level, the VGF motif was required for the physical interaction of the adjacent proline-rich motif with Hck. Conclusion Based on these findings, we propose that this highly conserved three amino acid VGF motif together with the acidic cluster and the proline-rich motif form a previously unrecognized amphipathic surface on Nef. This surface appears to be essential for the majority of Nef functions and thus represents a prime target for the pharmacological inhibition of Nef.

The effect of terazosin on functional bladder outlet obstruction in women: a pilot study

PURPOSE: We assessed the effect of terazosin (Hytrin(R)) on functional bladder outlet obstruction in women. MATERIALS AND METHODS: Functional bladder outlet obstruction was defined as a maximum flow rate of less than 12 ml per second combined with a detrusor pressure at maximum flow rate of more than 20 cm H2O in pressure flow studies in the absence of neurological disorders or mechanical causes. In a prospective pilot study 15 women with functional bladder outlet obstruction were treated with terazosin. Terazosin was initiated at 1 mg daily and gradually increased to the maintenance dose of 5 mg daily during 2 weeks. Symptoms and urodynamic parameters were assessed before and 3 to 4 weeks after the initiation of alpha-blocker therapy. RESULTS: While on terazosin, voiding symptoms subjectively improved greater than 50% in 10 of the 15 women (p = 0.002). Median maximum urethral closure pressure at rest decreased significantly from 98 to 70 cm H2O (p = 0.001), median maximum detrusor pressure decreased from 45 to 35 cm H2O (p = 0.008), median detrusor pressure at maximum flow decreased from 34 to 27 ml per second and median post-void residual urine decreased from 120 to 40 ml (p = 0.006 and 0.002, respectively). There was a significant increase in the median maximum flow rate from 9 to 20 ml per second and in median voided volume from 300 to 340 ml (p = 0.0005 and 0.021, respectively). Storage symptoms, functional urethral length and maximum cystometric capacity did not change significantly with alpha-blocker therapy (p > 0.05). Overall terazosin resulted in a significant improvement in symptoms and urodynamic parameters in 10 of the 15 women (67%). CONCLUSIONS: Terazosin had a significant symptomatic and urodynamic effect in two-thirds of our patients. These results suggest that terazosin may be an effective treatment option in women with voiding dysfunction due to functional bladder outlet obstruction.

[Old and new interventional therapies in the treatment of symptomatic benign prostate hyperplasia (BPH)]

Benign Prostatic Hyperplasia is a common entity among the aging male population. Its prevalence is increasing with age and is around 80% in the over 80-years old. The androgen-estrogen ratio changes in favor of the estrogens, which leads to a growth of prostatic tissue, presenting histologically as hyperplasia. BPH can cause irritative or obstructive symptoms or both. Nowadays we speak of bladder storage or bladder voiding symptoms, summarised as LUTS (Lower Urinary Tract Symptoms). LUTS has a structural and a functional component, the structural being caused by the size of the adenoma itself the functional depending on the muscle tone of the bladder neck and the prostatic urethra. To investigate LUTS, we use validated symptom scores, sonography for residual urine and eventually a urodynamic evaluation. There are 3 grades of BPH. The indication for an interventional therapy is relative in BPH II, and absolute in BPH III. Prior to treatment, other diseases mimicking the same symptoms, have to be ruled out and adequatly treated. Electro-resection of the prostate (TUR-P) remains the standard therapy and the benchmark any new technology has to compete with. TUR-P has good short- and longterm results, but can be associated with a considerable perioperative morbidity, and the learning curve for the operator is long. The most promising of the newer techniques is the Holmium-Laser-Enucleation of the prostate (Laser-TUR-P), showing at least identical short- and median-term results, but a lower perioperative morbidity than TUR-P For several minimally-invasive techniques, indications are limited. TUMT TUNA, WIT and laser-coagulation all produce a coagulation necrosis of the prostatic tissue by thermic damage with secondary tissue shrinking. Urodynamic results however, are not comparable to TUR-P or Laser-TUR-P, and significantly more secondary interventions within 2 to 5 years are required. Minimal-invasive techniques present a favorable alternative for younger patients without complications of BPH, and for older patients with relevant comorbidities, and can usually be performed under local anaesthesia. The morbidity is low and further therapies remain possible later, if necessary.