Inhibitory effect of capsaicin on detrusor contractility: further study in the presence of ganglionic blocker and neurokinin receptor antagonist in the rat urinary bladder

In order to understand the mechanisms by which capsaicin at high concentrations affects the micturition reflex and detrusor contractility, in vivo and in vitro whole bladder studies were conducted using ganglionic blockers and a neurokinin receptor antagonist. Thirty-eight adult rats were divided into control (normal saline cystometry) and experimental (1,000 microM capsaicin cystometry) groups. Both groups were subdivided to receive pretreatment with intravesical hexamethonium, perivesical hexamethonium, or intravesical spantide ([D-Arg1, D-Trp7,9, Leu11]-substance P). After in vivo cystometry, the bladders were removed and in vitro whole bladder contractility studies using electrical field stimulation as well as bethanechol and KCl stimulations were performed. In the bladders pretreated with perivesical hexamethonium, the amplitudes of contractions and in vitro detrusor contractility under electrical stimulation were decreased. Other bladder preparations showed no significant differences from the controls. However, when 1,000 microM capsaicin was infused into the bladders, both control and experimental bladders showed an initial excitation and a final inhibition with an elevated basal intravesical pressure and retention. Capsaicin at 100 microM did not have this effect. The results of this study conclude that blockage of perivesical ganglia or neurokinin receptors in the submucosa did not influence the depressant effects of 1,000 microM capsaicin on the micturition reflex and detrusor contractility in rats. Nonspecific toxic effects on detrusor muscle or nerves is likely when intravesical high-concentration capsaicin is administered.

Protective effect of tetrandrine on normal human mononuclear cells against ionizing irradiation

Tetrandrine, an alkaloid isolated from the plant Stephania tetrandra, at low concentration (2 micrograms/ml) was shown to protect normal human mononuclear cells in vitro against damage due to a single high-dose of ionizing irradiation (10 Gy). The cell survival rate increased from 58.3 +/- 2.2% in the irradiated group to 78.0 +/- 2.6% in the tetrandrine-pretreated group, and similarly, the percentage of necrotic cells declined from 20.7 +/- 2.5% to 10.7 +/- 1.9%, respectively. This protective effect of tetrandrine for cell surviving fraction increased in a dose-dependent manner. Tetrandrine was also found to inhibit inflammatory responses induced by irradiation including the release of superoxide (NBT [nitroblue tetrazolium] reduction decreased from 21.3 +/- 2.3% to 10.2 +/- 2.5%) and phagocytic activity (decreased from 80.7 +/- 3.8% to 50.7 +/- 2.3%, the same range level as that of the control group). However, the alkaloid demonstrated no effect on the production of nitric oxide. In terms of cell morphology, only two types were observed-normal or necrotic cells, and there were no characteristics of programmed cell death. These results indicate that tetrandrine possesses radioprotective activity against 10 Gy of ionizing irradiation and could suppress irradiation-induced inflammatory processes.

Reversibility of the inhibitory effect of intravesical capsaicin on the micturition reflex in rats

The reversibility of the inhibitory effect of capsaicin on the micturition reflex was investigated in adult rats. The experimental group (n = 38) were given 0.5 mL of 1 mmol/L intravesical capsaicin. After 30 minutes the bladder was evacuated, then the rats were allowed to recover for various times from 0 to 24 hours before cystometrography. Control rats (n = 6) were injected with saline. Immediately after capsaicin treatment, the bladders showed detrusor hyperactivity and high intravesical pressure during cystometrography. All capsaicin-treated bladders showed final urinary retention and hematuria developed in 32 of 38. At 6 hours after intravesical instillation of capsaicin, detrusor hyperactivity was reduced and the micturition reflex gradually reappeared. By 12 hours, micturition reflexes were noted in seven of eight bladders with a volume threshold equal to that of the control group. At 24 hours, the volume threshold for the micturition reflex was significantly greater in the capsaicin-treated group than in the control group. The amplitude of detrusor contractions at 6, 12, and 24 hours showed no significant difference from that in the controls. In vitro whole bladder contractility in response to electrical field stimulation, bethanechol, and KCl also showed no significant difference between the control and the experimental groups. The bladder weight increased as the recovery period increased, indicating the presence of neurogenic inflammation. From this study we conclude that capsaicin-induced micturition reflex inhibition in rats is reversible at 12 hours and the volume threshold for eliciting the micturition reflex continues to increase up to 24 hours after capsaicin treatment. These results may provide insight into the clinical application of capsaicin in the treatment of various voiding disorders in humans.

Capsaicin inhibits detrusor contractility but not the micturition reflex in capsaicin-desensitized rats

Intravesical capsaicin at high concentration (1 mmol/L) inhibits the micturition reflex and detrusor contractility. To investigate the mechanism, we compared rats that had been desensitized by capsaicin at birth with control rats. In vivo cystometrography was performed with normal saline (n = 5) or 1 mmol/L capsaicin (n = 5), then an isolated whole bladder contractility study with electrical field stimulation, bethanechol, and KCl was carried out. In the bladders with normal saline cystometrography and after isolated bladder study, 0.5 mL of 1 mmol/L capsaicin was instilled into the bladders and another set of stimulations by electrodes, bethanechol, and KCl was given. The bladders of capsaicin-desensitized rats showed the presence of detrusor reflexes but diminished amplitudes of detrusor contractions. There was no urinary retention or increased intravesical pressure in these desensitized bladders after capsaicin cystometrography. The detrusor contractility in the isolated whole bladder study showed no significant difference between the control and experimental bladders. After 1 mmol/L capsaicin cystometrography the bladders had little contractility compared with bladders after saline cystometrography. The bladders of the desensitized rats increased in weight compared to the controls. Intravesical administration of 1 mmol/L capsaicin induced an initial excitatory effect on the micturition reflex and final urinary retention in control rats. After capsaicin treatment at birth, these effects no longer existed but the depressant effect of capsaicin on detrusor contractility persisted. We conclude that a high concentration of intravesical capsaicin acutely inhibits the micturition reflex and detrusor contractility. Neonatal desensitization by capsaicin can depress the detrusor contractility in rats but the micturition reflex is not affected.

Aspirin improves uterine blood flow in the peri-implantation period

A prospective clinical study at the Infertility Clinic of National Cheng Kung University Hospital investigated the effect of aspirin on infertile women with impaired uterine perfusion. A total of 127 women with unexplained infertility or repeated failure with various assisted-conception techniques were enrolled. Uterine perfusion was assessed by Doppler ultrasound and classified as normal or impaired (pulsatility index < 3.0 or > or = 3.0, respectively). One-third (43/127) of the women were found to have impaired uterine perfusion during their menstrual cycles. Those with impaired uterine blood flow were given aspirin (100 mg/day) starting on day 3 of the next ovulatory cycle. Only 36 women completed both the screening and the aspirin-treated cycles. The pulsatility index was measured in the natural and aspirin-treated cycles in the same group of women and compared using repeated measures analyses of variance. A significant improvement in the uterine blood perfusion (p < 0.05) was detected on the day leutinizing hormone peaked and in the midluteal phase (peri-implantation period) of aspirin-treated cycles. Thus, the use of low-dose aspirin may improve uterine perfusion in women with unexplained infertility and impaired uterine blood flow.

CARP, a cardiac ankyrin repeat protein, is downstream in the Nkx2-5 homeobox gene pathway

To identify the molecular pathways that guide cardiac ventricular chamber specification, maturation and morphogenesis, we have sought to characterize factors that regulate the expression of the ventricular myosin light chain-2 gene, one of the earliest markers of ventricular regionalization during mammalian cardiogenesis. Previously, our laboratory identified a 28 bp HF-la/MEF-2 element in the MLC-2v promoter region, which confers cardiac ventricular chamber-specific gene expression during murine cardiogenesis, and showed that the ubiquitous transcription factor YB-1 binds to the HF-la site in conjunction with a co-factor. In a search for interacting co-factors, a nuclear ankyrin-like repeat protein CARP (cardiac ankyrin repeat protein) was isolated from a rat neonatal heart cDNA library by yeast two-hybrid screening, using YB-1 as the bait. Co-immunoprecipitation and GST-CARP pulldown studies reveal that CARP forms a physical complex with YB-1 in cardiac myocytes and immunostaining shows that endogenous CARP is localized in the cardiac myocyte nucleus. Co-transfection assays indicate that CARP can negatively regulate an HF-1-TK minimal promoter in an HF-1 sequence-dependent manner in cardiac myocytes, and CARP displays a transcriptional inhibitory activity when fused to a GAL4 DNA-binding domain in both cardiac and noncardiac cell context. Northern analysis revealed that carp mRNA is highly enriched in the adult heart, with only trace levels in skeletal muscle. During murine embryogenesis, endogenous carp expression was first clearly detected as early as E8.5 specifically in heart and is regulated temporally and spatially in the myocardium. Nkx2-5, the murine homologue of Drosophila gene tinman was previously shown to be required for heart tube looping morphogenesis and ventricular chamber-specific myosin light chain-2 expression during mammalian heart development. In Nkx2-5(−/−)embryos, carp expression was found to be significantly and selectively reduced as assessed by both whole-mount in situ hybridizations and RNase protection assays, suggesting that carp is downstream of the homeobox gene Nkx2-5 in the cardiac regulatory network. Co-transfection assays using a dominant negative mutant Nkx2-5 construct with CARP promoter-luciferase reporter constructs in cardiac myocytes confirms that Nkx2-5 either directly or indirectly regulates carp at the transcriptional level. Finally, a carp promoter-lacZ transgene, which displays cardiac-specific expression in wild-type and Nkx2-5(+/−) background, was also significantly reduced in Nkx2-5(−/−) embryos, indicating that Nkx2-5 either directly or indirectly regulates carp promoter activity during in vivo cardiogenesis as well as in cultured cardiac myocytes. Thus, CARP is a YB-1 associated factor and represents the first identified cardiac-restricted downstream regulatory gene in the homeobox gene Nkx2-5 pathway and may serve as a negative regulator of HF-1-dependent pathways for ventricular muscle gene expression.

Comparative study of the effects of capsaicin on the contractility of normal and spinal cord injured human bladders

In order to investigate the effects of capsaicin on human detrusor contractility in both normal and spinal cord injury (SCI) bladders, a detrusor contractility study was performed in 10 normal and 8 SCI patients using isolated muscle strips. Eight bladder muscle strips were harvested from each patient undergoing surgery. Four strips were treated with capsaicin of 1-1000 microM, and electrical field stimulation and bethanechol were applied to the strips before and after capsaicin administration. The other four strips were pretreated with 40 nmole [D-Arg1, D-Trp7,9,Leu11]-Substance P (spantide) and then were underwent the same procedure. The results showed that capsaicin induced a dose-dependent increase in muscle tension on the human detrusor in both normal and SCI bladders. After treatment with varying concentrations of capsaicin for 10 minutes, low doses of capsaicin partially depressed detrusor contractility under both electrical and bethanechol stimulation while high doses of up to 1000 microM almost totally blocked detrusor contractility. The initial contractile effect of capsaicin was higher in normal bladders but the final depressant effect did not show any difference between normal and SCI bladders. With addition of spantide, the initial contractile effect and the final depressant effect of capsaicin remained the same, indicating that the contractile effects of capsaicin were not mainly through NK receptors but directly on muscle cells. Consecutive application of capsaicin to the same strip could not reproduce the contractile response. After washing free of capsaicin, the detrusor contractility under electrical stimulation and bethanechol was not reversible. A direct neurotoxic or cytotoxic effect could be found after high concentration capsaicin administration. In treating patients suffering from detrusor hyperreflexia using intravesical capsaicin instillation, this effect should be considered to prevent irreversible damage to the urinary bladder.

The uroflowmetry in normal men and after prostatectomy

OBJECTIVE

This study was designed to determine and compare the uroflow parameters of normal men and patients after prostatectomy in order to investigate the flow rate expression in men without bladder outlet obstruction.

MATERIALS AND METHODS

Five hundred and fourteen men aged from 17 to 84 years who subjectively felt that their urination was normal and were objectively demonstrated to be without prostatic hyperplasia were enrolled in the normal group. For comparison, 356 patients after prostatectomy were also included as age-matched treated groups. Both groups were further divided into age-based subgroups. Uroflowmetry and transrectal sonography were performed in all the subjects. The uroflow parameters and prostatic volumes of different patient groups were compared. Regression analysis was used to estimate the correlation between maximal flow rate (Qmax) and age, as well as between Qmax and volume.

RESULTS

The results show that voided volume decreased with age in asymptomatic men without prostatic hyperplasia. The decreased voided volume with age resulted in declining Qmax in normal men. In patients after prostatectomy, however, infravesical obstruction affected detrusor contractility more with age and resulted in a declining flow rate expressed in similar voided volumes. In normal men, the mean Qmax was 20.7 +/- 7.3 ml/s in a mean voided volume of 290.7 +/- 123.2 ml. As age increased, smaller bladder capacity resulted in lower flow rate expressions, but the corrected Qmax showed no significant differences.

CONCLUSION

Normal elderly men without prostatic hyperplasia can have good urinary flow and good bladder energetics. Asymptomatic men with low flows might have incipient infravesical obstructions. Patients after prostatectomy had impaired detrusor contractility that resulted in a low flow rate expression with age.

Clinical outcome and quality of life after enterocystoplasty for contracted bladders

From 1989 to 1995, a total of 21 patients underwent enterocystoplasty in order to increase their bladder capacity and decrease intravesical pressure. Of these, 18 had neuropathic bladders caused by spinal cord injuries and 3 had contracted bladders caused by irradiation cystitis following treatment of cervical cancer. Enterocystoplasty was performed using a 40-cm segment of terminal ileum. The postoperative follow-up periods ranged from 6 to 80 months (mean 36 months). Twelve patients, who had had preoperative hydronephrosis, showed complete resolution after enterocystoplasty. Sixteen patients, suffering from intractable urinary incontinence preoperatively, regained continence after surgery while 2 continued to have mild urgent or stress incontinence. Their mean bladder capacities were 165 +/- 97 ml preoperatively and 760 +/- 289 ml postoperatively. The end-filling pressures were 50 +/- 23 cm H2O preoperatively and 13 +/- 4.7 cm H2O postoperatively. Sixteen patients could urinate smoothly, but 12 of them occasionally needed intermittent catheterization in order to evacuate residual urine. Nineteen patients were satisfied with their surgical result, whereas 1 wished to become completely dry, and 1 could not be catheterized because of poor family support. All but 1 of the patients declared that the quality of life improved after surgery. In conclusion, enterocystoplasty is satisfactory treatment for contracted bladders that result in upper tract deterioration or intractable urinary incontinence. Acceptable continence was achieved in 90% of the patients and the overall satisfaction rate was 95%. Careful patient selection is necessary for achieving a good surgical outcome.

Recovery of bladder function after relief of mild outlet obstructions of different durations in rabbits

In order to understand the influence of obstruction duration on the recovery of obstructed bladders, a functional study of 36 obstructed rabbit bladders after relief of outlet obstruction was done. Bladder outlets were obstructed by placing a 5-mm inner diameter polyethylene cuff around the urethra. Obstructions were kept in place for varying periods: 1 day, 3 days, 1 week, 2 weeks, 4 weeks, 6 weeks and 8 weeks. The obstructions were then released and functional studies were performed after a recovery period of 2 weeks (experimental groups). Using results of another study of obstructed bladders as a basis, the bladder weight of the experimental groups decreased from an initial increase after obstruction, but stabilized at a 2.5-fold increase 8 weeks after release compared with the control bladders. In vitro whole bladder responses to electrical and carbachol stimulations were also studied. Significant functional recovery was noted in the experimental bladders of less than 4 weeks' obstruction, whereas in those of 6 weeks' and 8 weeks' obstruction, no definite functional improvement was noted after relief of outlet obstruction. The expulsion ability was not significantly better in the experimental bladders than in the obstructed bladders. A slight decrease in expulsion ability was noted in the experimental bladders as the obstructive duration increased but the difference was not statistically significant. An obstructive duration of up to 8 weeks did not have a significant influence on the functional recovery of the rabbit bladders. Applying these results to the management of humans with benign prostatic hyperplasia, surgical intervention seems indicated only in those patients with symptomatic outlet obstruction. Stable, mild obstruction can probably be treated conservatively.

Transrectal sonography of the female urethra in incontinence and frequency-urgency syndrome

Transrectal sonography of the bladder and urethra was performed to investigate urethral conditions in 296 women (191 with stress urinary incontinence, 78 with frequency-urgency syndrome, and 27 who were asymptomatic). Patients with stress urinary incontinence showed larger pubovesical angle during both resting and straining states than those with either frequency-urgency syndrome or those who were asymptomatic. Pubovesical length did not vary among the three groups of women. Five types of stress urinary incontinence were classified according to the four findings of transrectal sonography: hypermobility of the bladder neck, bladder neck incompetence, urethral sphincteric incompetence, and the presence of a cystocele. Of the patients with frequency-urgency syndrome, 55.1% showed bladder neck incompetence, whereas only 29.6% of the asymptomatic women did. Of the patients with frequency-urgency syndrome, nine had urethral sphincteric incompetence and one had a cystocele. none of the asymptomatic women had any of these disorders. However, the presence of bladder neck incompetence did not correlate well with the presence of clinical symptoms. Transrectal sonography could not differentiate symptoms caused by the bladder from those caused by the urethra. Although a large overlapping of pubovesical angle size was noted among the groups of women, the angle was largest in those with stress urinary incontinence, second largest in those with frequency-urgency syndrome, and smallest in those who were asymptomatic. These findings held true during both resting and straining. Bladder neck incompetence was often associated with a weak extrinsic continence mechanism, as was demonstrated by pubovesical angle changes in both frequency-urgency syndrome patients and asymptomatic women. Urethral sphincteric incompetence was not present in asymptomatic women but could be found in 12.8% of those with frequency-urgency syndrome.

Effects of capsaicin on detrusor contractility of rats: an in vivo and isolated whole bladder study

Capsaicin has been proven to deplete neuropeptides in sensory afferent nerve terminals, causing initial excitatory and final inhibitory effects on the urinary bladder in rats and humans. In order to investigate the effect of capsaicin on detrusor contractility, an in vivo and in vitro whole bladder study was undertaken in 32 adult rats with an intact neuraxis. With intravesical application of capsaicin solution, an increased inhibitory effect of detrusor contractility was observed while the concentration of capsaicin increased. At the concentration of 1,000 microM, all rat bladders showed urinary retention in vivo. While the bladders were mounted in the baths for in vitro study, detrusor contractility was significantly affected in bladders pretreated with 1,000 microM capsaicin. Substance P-induced detrusor contraction was not affected by the presence of high concentrations of capsaicin. The presence of exogenous substance P did not improve detrusor contractility in capsaicin-pretreated bladders. The results of this study reveal that capsaicin-sensitive primary afferents have an important role in modulating reflex micturition and detrusor contractility. Depletion of neuropeptides by topical capsaicin administration at high concentrations can inhibit detrusor contractility and results in urinary retention in rats with intact neuraxis.

Interference with uterine blood flow by clomiphene citrate in women with unexplained infertility

OBJECTIVE

To investigate the effect of clomiphene citrate on the uterine blood flow in women with unexplained infertility.

METHODS

Twenty-one women who had normal uterine blood flow (pulsatility index [PI] less than 3 from the LH peak to the middle luteal phase of a natural ovulatory cycle) were enrolled in this study. Patients were given clomiphene citrate (100 mg/day) from days 5-9 of the next ovulatory cycle. The PI values measured in the natural and clomiphene citrate-treated cycles were compared using repeated measures analysis of variance. Their correlations with the estradiol (E2) and progesterone concentrations in the treatment cycle were calculated using the Pearson correlation coefficient.

RESULT

In the natural cycles of those with normal uterine blood flow, the highest impedance of uterine blood flow was detected at the late follicular phase, then blood flow increased during the luteal phase. In the clomiphene citrate-treated cycles, a statistically significant decrease in uterine blood flow also occurred during the early luteal phase (P < .05). No significant correlation of E2 or progesterone serum concentrations with PI values of the uterine artery could be found in either natural or clomiphene citrate-treated cycles.

CONCLUSION

The use of clomiphene citrate decreases the uterine blood flow during the early luteal phase, a periimplantation stage.

Effects of mild bladder outlet obstruction on rabbit bladder structure and function

Mild bladder outlet obstruction was created in 42 New Zealand white rabbits by placing a 5-mm inner diameter polyethylene tube around the urethra. Periods of obstruction lasted for 1 day (7 rabbits), 3 days (7 rabbits), 1 week (7 rabbits), 2 weeks (6 rabbits), 4 weeks (7 rabbits), 6 weeks (4 rabbits) and 8 weeks (4 rabbits). Whole bladder functional study was performed in control (5 rabbits) and the obstructed bladders. The obstructed bladders increased in weight two-to threefold. There was no significant difference in bladder weight after different periods of obstruction. Electric stimulation showed a diminished response after 3 days of obstruction. Pharmacologic stimulation with 500 microM carbachol revealed a decreased response after obstruction, but intravesical pressure returned to the control level at 6 and 8 weeks of obstruction. However, the bladder weight and the expelling function of the obstructed bladders remained the same as on day 1 of obstruction. Histologic study of control and obstructed bladders revealed that: 1) dense submucosal fibrous tissue developed after 3 days of obstruction, 2) detrusor muscle hypertrophy and hyperplasia were noted with intermuscular collagenous fiber deposition after 2 weeks of obstruction, 3) trabeculation of the bladder wall with hyperplasia of muscular bundles was noted after 2 weeks of obstruction, 4) acute edematous and inflammatory reaction were apparent after 3 days and 1 week of obstruction, but resolved later and 5) degenerative changes of muscular cells were noted at 8 weeks of obstruction. The results show that despite apparent morphologic changes after outlet obstruction, no significant difference was observed in bladder expelling between short-term and long-term infravesical mild outlet obstruction. The bladder contractile apparatus appears to have a compensatory ability after mild outlet obstruction.

Serum level of squamous cell carcinoma antigen and tumor size are useful to identify preoperatively patients at high risk of cervical cancer

BACKGROUND

The benefit of postoperative adjuvant therapy for patients with cervical cancer is uncertain, and moreover, may increase morbidity. In this study, patient age, clinical stage of the cancer, tumor size, and levels of serum squamous cell carcinoma cell antigen and carcinoembryonic antigen were studied in patients with Stage Ib and IIa squamous cell carcinoma of the uterine cervix to determine if these parameters can be used, before the surgical intervention, to distinguish patients who require postoperative adjuvant therapy from those who do not.

METHODS

Ninety-nine patients were studied. After surgery, patients were classified either as high risk or low risk according to the results of histopathologic findings. The age of the patient was noted, and FIGO stage, squamous cell carcinoma antigen, carcinoembryonic antigen, and clinical tumor size were determined. A univariate analysis and then a stepwise logistic regression procedure were performed to select significant clinical predictors from among the five variables mentioned above. Any selected predictors were further analyzed by the receiver operator characteristic curve.

RESULTS

Serum squamous cell carcinoma antigen and clinical tumor size measured by colposcopic examination were significant clinical predictors of the treatment strategy postoperatively. From the receiver operator characteristic curve, a sensitivity of 84.2%, a specificity of 91.8%, a positive predictive value of 84.5% were attained.

CONCLUSIONS

Serum squamous cell carcinoma antigen assays and clinical tumor size estimated by colposcopic examination are helpful in identifying patients who require postoperative adjunctive therapy.

A new gene involved in stationary-phase survival located at 59 minutes on the Escherichia coli chromosome

We determined the DNA sequence of a 2,232-bp region immediately upstream of the pcm gene at 59 min on the Escherichia coli chromosome that encodes an L-isoaspartyl protein methyltransferase with an important role in stationary-phase survival. Two open reading frames of 477 and 1,524 bp were found oriented in the same direction as that of the pcm gene. The latter open reading frame overlapped the 5' end of the pcm gene by 4 bp. Coupled in vitro transcription-translation analysis of DNA containing the 1,524-bp open reading frame directly demonstrated the production of a 37,000-Da polypeptide corresponding to a RNA species generated from a promoter within the open reading frame. The deduced amino acid sequence showed no similarity to known protein sequences. To test the function of this gene product, we constructed a mutant strain in which a kanamycin resistance element was inserted at a BstEII site in the middle of its coding region in an orientation that does not result in reduction of Pcm methyltransferase activity. These cells were found to survive poorly in stationary phase, at elevated temperatures, and in high-salt media compared with parent cells containing the intact gene, and we thus designate this gene surE (survival). surE appears to be the first gene of a bicistronic operon also containing the pcm gene. The phenotypes of mutations in either gene are very similar and indicate that both gene products are important for the viability of E. coli cells under stressful conditions.

Color Doppler ultrasonography and serum CA 125 in the differentiation of benign and malignant ovarian tumors

Color Doppler ultrasonography and serum CA 125 were used to evaluate 114 adnexal tumors prior to surgery. Six patients were excluded from this study because of ovarian cancer, borderline ovarian malignancy, and tubal gestation. A total of 108 patients were eligible: 83 patients with benign and 25 patients with malignant ovarian tumors. Resistance index (RI) was used to determine the peripheral resistance of intratumoral vessels. The cutoff point for the RI was defined as 0.5. The blood flow was considered to be normal when the RI was greater than 0.5 and abnormal when it was less than 0.5. The blood flow was detected in 100% of malignant tumors and 59% of benign tumors. The initial cutoff value for CA 125 was 35 U/mL. Sensitivity, specificity, positive predictive value, and negative predictive value were compared in terms of RI, serum CA 125, and a combination of the two. Our conclusion is that the combination of RI and CA 125 gives a sensitivity of 100% and negative predictive value of 100%. If the cutoff point of CA 125 was raised from 35 to 65 U/mL, then a specificity of 100% and positive predictive value of 100% were also attained with the use of RI and CA 125 without changes in sensitivity or negative predictive value. We conclude that the combination of color Doppler ultrasonography and serum CA 125 is an effective method to differentiate benign from malignant ovarian tumors.

Primary malignant lymphoma of the uterine cervix shows favorable response to neoadjuvant chemotherapy

Primary malignant lymphoma localized in the uterine cervix is a rare condition for which radiation therapy, surgery, or chemotherapy either alone or in combination have been the mainstay of treatment. The effectiveness of neoadjuvant chemotherapy for this condition, however, has not been evaluated. We experienced one case of primary malignant lymphoma of the uterine cervix, stage IIa according to FIGO, and IEA according to the Ann Arbor staging system for extranodal lymphomas, which was treated with neoadjuvant chemotherapy and surgery. The patient first underwent neoadjuvant chemotherapy consisting of cyclophosphamide, vinblastine, epirubicin, bleomycin, procarbazin, and oncovin (COP-BLAM) to reduce the size of the tumor. This was followed by an extended total hysterectomy, left salpingo-oophorectomy, and bilateral pelvic lymph node dissection. Neoadjuvant chemotherapy given before surgery resulted in a remarkable reduction in the tumor size which made the subsequent surgery technically easy. In addition, it is possible that intraoperative micrometastasis of the tumor cells could be better prevented. The patient received additional chemotherapy with COP-BLAM schedules postoperatively. No evidence of recurrent lymphoma has been observed in 2 years after the treatment. Neoadjuvant chemotherapy may be an effective treatment modality for primary malignant lymphoma of the uterine cervix.

Application of transrectal sonography in the diagnosis and treatment of female stress urinary incontinence

One hundred and two women with genuine stress urinary incontinence (SUI) were examined by transrectal sonography and urodynamics. The patients were classified into five types according to their intrinsic and extrinsic continence mechanism defects. Twenty-five patients had a hypermobile bladder neck and urethra (type 1); 31 patients had an incompetent bladder neck and a hypermobile urethra (type 2); 31 patients showed an incompetent urethral sphincter in addition to urethral hypermobility (type 3); 12 patients had a cystocele accompanying incompetent urethral sphincter and hypermobile urethra (type 4); the remaining 3 showed an incompetent urethral sphincter without hypermobility of the urethra (type 5). Whereas the distance from the lower margin of symphysis pubis to the bladder neck (pubovesical ligament; PVL) showed a significant increase in straining state of types 3 and 4, this was not the case in types 1, 2 and 5. There is a significant increase in the posteroinferior rotational of PVL angle on straining compared with resting in types 1, 2, 3, and 4, but not in type 5. The angle on straining also showed an increased tendency from type 1 to 4. The functional degree of SUI showed a significant increase from type 1 to 5. With this classification, the functional class of SUI is thus well correlated with the anatomical defects. The PVL length and the angle of external rotation of this axis are significantly implicated in the severity of SUI.

Ureteroscopic treatment of lower ureteral calculi in the era of extracorporeal shock wave lithotripsy: from a developing country point of view

In a series of 229 lower ureteral calculi manipulated with either extracorporeal shock wave lithotripsy (ESWL) or ureteroscopy the stone clearance rate 7 days after treatment was 40.6% and 90%, respectively. Only 17 of 32 patients (53.1%) treated with ESWL were rendered stone-free at 4-week followup. In addition to concern about stone clearance, other medical and social factors, and the availability of health insurance coverage must be considered. Since the differences of living standards between highly developed and developing countries are great, the selection of ESWL or ureteroscopy as primary treatment of lower ureteral calculi must be based on the socioeconomical status of a specific country. Because ESWL devices are not readily available in most developing countries and ureteroscopy is cost-effective, highly efficacious (greater than 92%) and involves minimal morbidity (less than 10%) for calculi removal in experienced hands, we recommend ureteroscopy as the treatment of choice for lower ureteral stones, with ESWL as the alternative, in developing countries.

Predictive factors for successful surgical outcome of benign prostatic hypertrophy

Four hundred patients with benign prostatic hypertrophy (BPH) undergoing prostatic surgery were enrolled in this study in order to search for factors predictive of a successful outcome. 139 patients had acute urinary retention and the others had irritative and obstructive voiding symptoms. Preoperative examinations included intravenous urography (IVU), transrectal sonography of the prostate (TRSP), cystometry, uroflowmetry, and urethral pressure profilometry (UPP). Retropubic prostatectomy was undertaken in 16 cases, transurethral resection of the prostate in 335, and transurethral incision of the prostate in 49. In the follow-up period of 3 months to 3 years, a strictly successful result was achieved in 324 patients (81%). 26 patients (6.5%) had a fair result, 30 (7.5%) were stationary, in 18 (4.5%) the symptoms became worse, and 2 (0.5%) died postoperatively. On analysis of the success rate, 9 favorable factors and 9 unfavorable factors were noted. A symptomatic large prostatic adenoma proven by IVU, TRSP, or UPP will imply a higher success rate. Urodynamically obstructive BPH proven by a high voiding pressure and constrictive flow pattern can also predict a satisfactory outcome. The unfavorable factors always come from a small adenoma, uncertain irritative symptoms and detrusor underactivity. Patients with more than 2 unfavorable factors should be investigated carefully before surgery. The presence of 2 favorable factors without an unfavorable factor will usually predict the best surgical outcome.

Urodynamic findings in interstitial cystitis

Fifty patients with irritative voiding symptoms and a painful bladder when full were engaged in this study to clarify the role of urodynamics in the diagnosis of interstitial cystitis (IC). Patients underwent urodynamic study, cystoscopic hydrodilatation of the bladder under general anesthesia and bladder biopsy. Twenty-eight women and two men who presented with signs of glomerulations or petechial hemorrhage of the bladder mucosa were classified as having IC, while 20 women without this characteristic were classified as having non-IC. A hypersensitive urge sensation, a small bladder capacity, a lower maximal flow rate and an abnormal flow pattern were observed in both groups of patients, but no significant difference was noted. More IC patients had a lower bladder compliance than non-IC patients (p < 0.025), and the maximal bladder capacity under anesthesia was smaller in IC patients (p < 0.05). However, there does not seem to be any definite correlation to the pathologic findings, except in patients with marked bladder inflammation, in whom a small capacity and severe clinical symptomatology were found.

Antithrombin III activity in normal and toxemic pregnancies

From August 1989 to October 1990, 83 pregnant Chinese women were the subjects for measuring the levels of plasma functional antithrombin III (AT III) activity. The correlations of AT III activity with perinatal outcome and the changes in maternal hepatorenal function were analyzed. The population was divided into four groups: Group I (n = 30), normal pregnancies; Group II (n = 23), mild pre-eclampsia; Group III (n = 26), severe pre-eclampsia; and Group IV (n = 4), eclampsia. The results demonstrated that: 1) AT III activity decreased with the severity of toxemia (p < 0.001), 2) AT III activity correlated with the degree of perinatal outcome and maternal morbidity, and 3) reduction of AT III activity correlated with impairment of maternal hepatorenal function. In conclusion, plasma AT III activity is a valuable parameter in the evaluation of toxemia.

The primary application of three-dimensional ultrasonography in obstetrics

To date, no report of three-dimensional ultrasonography in obstetrics has been available in the literature. In this study we describe the primary experience with three-dimensional ultrasonography for the prenatal evaluation of nine fetuses between 21 and 33 weeks of gestation. We found that it provides more information for clinical diagnosis than the traditional two-dimensional ultrasonography. The following advantages are notable: (1) the anatomic area of interest can be located first with the conventional real-time two-dimensional mode, then switched to reveal three-dimensional images, instantly; (2) three images are exhibited concurrently; (3) each of the three images can be arrayed separately and scrolled to search for the area of interest within the scanned volume; (4) the three-dimensional ultrasonography can be equipped with Doppler color flow mapping for the study of the fetal cardiovascular system. In conclusion, we believe that three-dimensional ultrasonography can greatly strengthen diagnostic potential, which deserves obstetricians' attention.

Combinatorial splicing of exon pairs by two-site binding of U1 small nuclear ribonucleoprotein particle

A two-site model for the binding of U1 small nuclear ribonucleoprotein particle (U1 snRNP) was tested in order to understand how exon partners are selected in complex pre-mRNAs containing alternative exons. In this model, it is proposed that two U1 snRNPs define a functional unit of splicing by base pairing to the 3' boundary of the downstream exon as well as the 5' boundary of the intron to be spliced. Three-exon substrates contained the alternatively spliced exon 4 (E4) region of the preprotachykinin gene. Combined 5' splice site mutations at neighboring exons demonstrate that weakened binding of U1 snRNP at the downstream site and improved U1 snRNP binding at the upstream site result in the failure to rescue splicing of the intron between the mutations. These results indicate the stringency of the requirement for binding a second U1 snRNP to the downstream 5' splice site for these substrates as opposed to an alternative model in which a certain threshold level of U1 snRNP can be provided at either site. Further support for the two-site model is provided by single-site mutations in the 5' splice site of the third exon, E5, that weaken base complementarity to U1 RNA. These mutations block E5 branchpoint formation and, surprisingly, generate novel branchpoints that are specified chiefly by their proximity to a cryptic 5' splice site located at the 3' terminus of the pre-mRNA. The experiments shown here demonstrate a true stimulation of 3' splice site activity by the downstream binding of U1 snRNP and suggest a possible mechanism by which combinatorial patterns of exon selection are achieved for alternatively spliced pre-mRNAs.

A new classification of female stress urinary incontinence--based on transrectal sonographic cystourethrography

A new classification of female stress urinary incontinence was made according to the results of transrectal ultrasonography of the urinary bladder and urethra (cystourethrography) studied in 67 women with genuine stress urinary incontinence (SUI). This classification is based on the following changes of the bladder and urethra on abdominal straining: hypermobility of the urethra, bladder neck incompetence, urethral sphincter incompetence and presence of a cystocele. Five types of SUI has been classified. We believe that this new classification can provide a better understanding of the anatomical changes as well as the pathophysiology of SUI. In addition, it can serve as a guideline of proper surgical management for SUI.

Control of alternative splicing by the differential binding of U1 small nuclear ribonucleoprotein particle

Cellular factors controlling alternative splicing of precursor messenger RNA are largely unknown, even though this process plays a central role in specifying the diversity of proteins in the eukaryotic cell. For the identification of such factors, a segment of the rat preprotachykinin gene was used in which differential expression of neuropeptides gamma and K is dependent on alternative splicing of the fourth exon (E4). Sequence variants of the three-exon segment, (E3-E4-E5) were created, resulting in a sensitive assay for factors mediating the splicing switch between E4-skipping and E4-inclusion. A dinucleotide mutation in the 5' splice site of E4 that increase base-pairing of this site to U1 small nuclear RNA resulted in uniform selection of E4, whereas a control mutation that destroyed base-pairing resulted in uniform E4-skipping. Affinity selection of spliceosomes formed on these functionally distinct substrates revealed that the extreme difference in splicing was mediated by differential binding of the U1 small nuclear ribonucleoprotein particle (snRNP) to the 5' splice site of E4. These data show that, apart from its established role in selecting 5' splice sites, U1 snRNP plays a fundamental role in 3' exon selection and provides insight into possible mechanisms of alternative splicing.

Transrectal sonographic cystourethrography: studies in stress urinary incontinence

Transrectal ultrasonic sagittal transducer is an excellent modality to image the bladder and urethra in dynamic change. In female patients, we found it is also helpful for the diagnosis of urinary stress incontinence. The posterior urethrovesical (PUV) angle is measured with the transrectal sonoprobe under strain and non-strain conditions. We compared the results of sonographic cystourethrogram with the radiographic chain cystourethrogram. The sonographic cystourethrography is superior to the radiography. The former may estimate the PUV angle accurately and differentiate between the patients with and without stress urinary incontinence. Furthermore, we also use the transrectal sagittal probe intraoperatively to adjust the suspension force as well as PUV angle in patients who underwent vesical neck suspension for stress urinary incontinence (SUI).

A Sequential splicing mechanism promotes selection of an optimal exon by repositioning a downstream 5' splice site in preprotachykinin pre-mRNA

To explore the structural basis of alternative splicing, we have analyzed the splicing of pre-mRNAs containing an optional exon, E4, from the preprotachykinin gene. This gene encodes substance P and related tachykinin peptides by alternative splicing of a common pre-mRNA. We have shown that alternative splicing of preprotachykinin pre-mRNA occurs by preferential skipping of optional E4. The competing mechanism that incorporates E4 into the final spliced RNA is constrained by an initial block to splicing of the immediate upstream intervening sequence (IVS), IVS3. This block is relieved by sequential splicing, in which the immediate downstream IVS4 is removed first. The structural change resulting from the first splicing event is directly responsible for activation of IVS3 splicing. This structural rearrangement replaces IVS4 sequences with E5 and its adjacent IVS5 sequences. To determine how this structural change promoted IVS3 splicing, we asked what structural change(s) would restore activity of IVS3 splicing-defective mutants. The most significant effect was observed by a 2-nucleotide substitution that converted the 5' splice site of E4 to an exact consensus match, GUAAGU. Exon 5 sequences alone were found not to promote splicing when present in one or multiple copies. However, when a 15-nucleotide segment of IVS5 containing GUAAGU was inserted into a splicing-defective mutant just downstream of the hybrid exon segment E4E5, splicing activity was recovered. Curiously, the 72-nucleotide L2 exon of adenovirus, without its associated 5' splice site, activates splicing when juxtaposed to E4. Models for the activation of splicing by an RNA structural change are discussed.

An investigation of fluoride protection against dietary induced osteoporosis in the rat

The purpose of this study was to determine whether the accumulation of substantial levels of fluoride in the skeleton during bone formation would significantly reduce, or prevent, the occurrence of osteoporosis experimentally induced at a later time with a low mineral-containing diet. Male weanling rats were pretreated for 15 weeks with either 0 or 50 ppm F in their drinking water, followed by treatment for four to twelve weeks with diets either optimal or deficient in both Ca and P. Intake of the Ca and P deficient diet resulted in a progressive loss of bone mass (per unit volume of femur), with little effect on the remaining bone. High skeletal F offered no protective effect. Ca and P depletion caused a significant decrease in bone breaking strength but produced only slight reduction in percentage ash in bone. Fluoride offered little protection against either. Neither skeletal F nor dietary Ca and P levels influenced the concentration of Ca, P or Ca/P ratios in bone ash. Skeletal Mg levels were slightly lower in the Ca and P depleted rats; however, F treatment essentially eliminated this. Ca and P depletion resulted in higher F levels in both incisors and bone. We conclude that osteoporosis was produced by feeding the Ca and P deficient diet. High skeletal F did not prevent nor reduce the severity of this dietary-induced osteoporosis.