[Evaluation of cavernous artery by color Doppler ultrasonography--significance of ultrasonic beam angle]

Penile Doppler ultrasonography is widely accepted as an essential examination in the diagnosis of impotence. However, measurement blood flow velocity using Doppler ultrasonography may be subject to some errors. We performed color Doppler ultrasonography in 63 patients with normal penile vascular function as diagnosed using positive responses to intracavernous pharmacological stimulation. We compared the Doppler measurement results of the 126 cavernous arteries and the ultrasonic beam angles. We used a Hitachi EUB 515, a sonographic probe of 7.5 MHz, a sampling width of 0.8 mm, a sampling depth of 1 mm, and a wall motion filter was not used. Ultrasonic beam angles were 5 to 77 degrees. The mean peak systolic velocity and end diastolic velocity values were 40. 0 cm/s and 3.9 cm/sec, respectively. The peak systolic velocity and end diastolic velocity values remained stable regardless of the ultrasonic beam angles (Kruskal-Wallis test, p = 0.56, p = 0.70). However, the variance of values became greater when the ultrasonic beam angles was larger than 55 degrees in the case of peak systolic velocity (F test, p < 0.05) and 50 degrees in the case of end diastolic velocity (F test, p < 0.05), indicating a reduction in reliability. Resistance index variance was significantly higher when ultrasonic beam angle exceeds 50 degrees (F test, p < 0.05). We believe that we should accept only those cavernous artery peak systolic velocity measurements as reliable when the ultrasound beam angle is less than 55 degrees.(ABSTRACT TRUNCATED AT 250 WORDS)

Biliary excretion of copper, metallothionein, and glutathione into Long-Evans Cinnamon rats: a convincing animal model for Wilson disease

Long-Evans Cinnamon (LEC) rats, characterized by a gross accumulation of hepatic Cu and the spontaneous onset of hepatitis, have been established to be an animal model for Wilson disease. They were used to estimate the relationships among copper (Cu), metallothionein (MT), and reduced glutathione (GSH) in biliary excretion in this study. Even though a huge amount of MT existed in the LEC rat liver (5016 micrograms/g liver) compared to that (63 micrograms/g liver) of controls (Fischer rats), the biliary excretion of MT (65 ng/ml bile) did not reflect the accumulated MT level in LEC rats. It seems likely that MT does not excrete intrinsically into the bile. Biliary excretion of Cu (0.17 microgram/ml) in LEC rats was significantly lower than that (0.57 microgram/ml) in Fischer rats. The difference in biliary excretion of GSH between the two groups was significant but slight. The reduced excretion of GSH into bile in LEC rats may be due to increased hepatic gamma-glutamyltransferase but not to hepatic GSH levels. There were no differences in biliary potassium and inorganic phosphorous between the two groups. On the other hand, excretion of lysosomal enzymes such as beta-N-acetylglucosaminidase into bile was much lower in LEC rats (15.6 units/liter) than in controls (42.5 units/liter). The defective biliary excretion of Cu may be due to impaired lysosomal exocytosis, rather than canalicular membrane impairment. The LEC rat is very useful for research into the dynamics of metal excretion via the hepatobiliary system.

Nursing in Japan: caregivers of elderly family members with dementia

1. The difficulties that caregivers of elderly family members suffering from dementia confronted are divided into five categories: incomprehensible situations, strange behavior, deterioration of dementia, trouble or inconvenience caused by demented behavior, and remarks vis-a-vis support network. 2. The considerable differences among caregivers of elderly persons suffering from dementia, in terms of problems faced and methods of coping, existed in beginning and awakening stages. 3. Nurses must assess which stages of the developmental process families are going through to implement effective nursing interventions that vary between the two stages.

Evidence that Escherichia coli ubiA product is a functional homolog of yeast COQ2, and the regulation of ubiA gene expression

The Escherichia coli ubiA gene coding for 4-hydroxy benzoate octaprenyl transferase is thought to be a key enzyme of ubiquinone biosynthesis. Strains with ubiA disrupted were constructed by chromosomal gene replacement with the chloramphenicol resistance gene. The respiration-defective phenotype of the ubiA mutant was complemented by expression of the COQ2 gene encoding the 4-hydroxy benzoate hexaprenyl transferase of Saccharomyces cerevisiae and such strains produced ubiquinone-8. This strongly supports the idea that COQ2 catalyzes the same enzymatic reaction with UbiA and the substrate specificity of COQ2 is broad. Study of the expression of ubiA using an ubiA-lacZ fusion system showed that the ubiA expression was catabolite-repressed by glucose. This repression by glucose was obvious in the arcA mutant. ArcA is the positively acting transcriptional regulator of the oxygen regulated genes. The molecular mass of the protein product of ubiA was 32kD, found using the over-expression of the ubiA gene.

Defects of immune cells in the senescence-accelerated mouse: a model for learning and memory deficits in the aged

We investigated immune characteristics of SAMP8 mice that have early learning and memory deficiencies and a short life span accompanied by normal growth and compared them to those of SAMR1 mice that have a normal aging process. The indexes of immune responsiveness used were natural killer (NK) cell activity, in vitro anti-SRBC (sheep red blood cells) antibody responses, cell proliferation, and interleukin 2 (IL-2)-producing activity in response to concanavalin A of spleen cells. As early as 2 months after birth, SAMP8 mice showed markedly low activity for all the indexes that was not due to a delay of their development. Endogenous NK cell activity in SAMP8 mice remained low or at the background level for a few months, but the trace level of this activity increased after treatment with an immune potentiator of polyinosinic-polycytidylic acid. Because the number of cells bearing an NK cell marker in SAMP8 mice was comparable to that for SAMR1 mice, the low NK cell activity found for SAMP8 mice may not be caused by a low number of precursor cells but by defects in the lytic mechanism or low competence. Flow cytometry analyses showed that the size of the lymphocyte fraction in the spleen is the same for both strains and that T cell fractions, especially of CD4+ T cells in SAMP8 mice are smaller than in SAMR1 mice. In contrast, a B cell fraction was somewhat larger in SAMP8 mice. Together with the fact that the spleen cells of both strains equally stimulated allogeneic T cells in the mixed lymphocyte reaction, the low helper T cell activity in antibody responses, even under the condition of cell-number equivalence, indicates a qualitative defect of CD4+ T cells in SAMP8 mice. This defect probably is closely related to the low endogenous activity of NK cells.

[The relaxation of human corpus cavernosum caused by nitric oxide]

Non-adrenergic non-cholinergic nerves (NANC) are thought to be important in the relaxation of corpus cavernosum for erectile function. On the other hand, it has been shown that nitric oxide (NO) is synthesized from L-arginine and released by the endothelium of blood vessels and accounts for the activity of endothelium-derived relaxing factor (EDRF). We studied whether electrical field stimulation (EFS) of isolated strips of human corpus cavernosum released NO and whether it could act as a NANC neurotransmitter. Human penile tissue specimens were mounted in an organ bath and the isometric tension recorded. EFS was applied to precontracted strips between two parallel platinum electrodes. Relaxation induced by EFS was not influenced by guanethidine or atropine, but was markedly inhibited by NG-nitro-L-arginine which is an analog of L-arginine that inhibits the conversion of L-arginine to NO, and hemoglobin which is an agent that inhibits the biological actions of NO. Methylene blue which is an inhibitor of cytosolic guanylate cyclase also reduced the relaxation of EFS, but not completely. The inhibitory effect of NG-nitro-L-arginine was reversed by addition of excess L-arginine. Exogenous NO relaxed human corpus cavernosum. The relaxation was only a transient response and concentration-dependent. The profile of responses is similar to that evoked by EFS. Our data clearly demonstrate the release of NO during EFS and the function of NO as a NANC neurotransmitter. Human penile erection may be mediated by NO generated in response to NANC neurotransmission.

[A case of penile revascularization by Hauri's method for arteriogenic impotence]

In a 35 year old arteriogenic impotent patient without a history of hypertension, arteriosclerotic disease, or diabetes mellitus, the corpus cavernosum of the penis was revascularized using Hauri's method. Before surgery, erection after the intra-cavernous injection of 20 micrograms of prostaglandin E1 was very weak. In a color ultrasonography the peak systolic velocity of the cavernous arteries was recorded as being only 18 cm/sec. Furthermore, no artery except the right dorsal artery was evident even with a digital subtraction angiography. Accordingly he was diagnosed as having arteriogenic impotence, and we carried out the corpus cavernosum revascularization using Hauri's method under microscopic magnification. The dorsal artery and the deep dorsal vein were anastomosed side-to-side, and the hypogastric artery and dorsal artery were anastomosed end-to-side. After the revascularization surgery, the peak systolic velocity of cavernous arteries returned to normal (53 cm/sec), and the penis showed complete erection after an intracavernous injection of 20 micrograms of prostaglandin E1. Before surgery this patient had no experienced sexual intercourse, but he could achieve full sexual intercourse 2 weeks after the surgery. His erectile ability has been maintained for 4 months since the surgery. This is the 1st case of arteriogenic impotence treated using Hauri's method in Japan.

[Transition of diagnosis and treatment for impotence]

Statistic study was made on 685 outpatients with erectile dysfunction during 13 years periods from 1979 to 1991 in the Department of Urology, Takamatsu Red Cross Hospital. The age distribution showed the highest frequency in the thirties decade (27.9%). 1. Diagnosis Nocturnal penile tumescence monitoring was the only method to distinguish organic impotence from functional impotence during the first 5 years. From 1984 we have been able to diagnose corporal veno-occlusive insufficiency (CVI) by papaverine test and dynamic infusion cavernosometry and cavernosography. Measurement of penile brachial index and pelvic angiography were performed to diagnose arterial insufficiency (AI). In neurological examination we have measured bulbo-cavernosus reflex latency and nerve conduction velocity of the dorsal penile nerve and performed microvibration measurement and sweat spots test. All diagnostic methods were established in 1987 and we have been able to classify about 80% patients. We classified 305 patients during the last 5 years from 1987 as follows: psychogenic; 31.1%, CVI; 20.0%, AI; 7.9%, neurogenic; 7.9%, others; 14.1%, drop-out and unknown; 19.0%. 2. Treatment In the beginning only counseling and drug therapy were performed. However we lately performed various suitable methods for individuals based on their diagnoses. We performed counseling, drug therapy and intracavernous injection of vasoactive drug therapy for recovery of spontaneous erection (vascular training) for psychogenic IMP. The efficacy rate of counseling was low (30.4%) but that of drug therapy was 41.6%, and that of vascular training, 64.2%. For CVI without other factors we performed venous surgeries. Only about 25% of them perform sexual intercourse with or without self injection of vasoactive drug (self injection).(ABSTRACT TRUNCATED AT 250 WORDS)

[Postoperative results of ligation of crura penis for impotence with corporal veno-occlusive insufficiency]

We performed ligation of the crura penis for 34 impotents with corporal veno-occlusive insufficiency without arterial insufficiency and neural dysfunction from October 1987 to April 1991. Ages ranged from 24 to 72 (52.6 +/- 12.7) years old and follow up period was from 1 to 41 (17.7 +/- 12.6) months. For six patients ligation of the crura only was performed, for 22 ligation of the crura and deep dorsal vein (DDV) as well was performed at the same time, and for 6 crural ligation was performed after ligation of DDV. These operations required less than one hour and there were no severe complications. The postoperative results at 1 month were as follows: Excellent (sufficient spontaneous erection was recovered); 18, Improved (complete erection with intracavernous papaverine injection was achieved); 13, and Failure; 3. Erectile function was maintained only in 50% of the 18 pts. graded excellent. Ninety percent of the 31 patients graded either excellent or improved could maintain erectile function after 40 months with papaverine injection. Venous surgeries could not be a primary treatment for correcting the outflow abnormalities (of the veins). So it is conceivable that failure or recurrence could occur during a long follow up period. We concluded that crural ligation was acceptable as the first line treatment for erectile dysfunction due to corporal veno-occlusive insufficiency because of its relative non-invasiveness compared to other venous surgeries.

[Double-blind trial of oral prostaglandin E1 on impotence]

The effect of oral prostaglandin E1 (limaprost) on erectile function was studied in a double-blind placebo controlled trial. Fifty one patients who agreed to participate were examined for their subjective symptoms and nocturnal erection was recorded using an erectometer at the beginning of the study, after an initial 6 week period, and again after a second 6 week period. Patients were randomly assigned to a group which received placebo followed by limaprost or to a group which received limaprost followed by placebo. Ten cases dropped out. In the remaining forty one patients, NPT during the limaprost phase was significantly different from that during the placebo phase. Patients with the history of diabetes mellitus, hypertension, or pelvic surgery showed relatively poor responses to oral prostaglandin E1. Oral prostaglandin E1 achieved 42.9% effectiveness in the psychogenic impotence, and this effectiveness is significantly higher than that of placebo. Oral prostaglandin E1 was suggested as an additional or alternative therapy in the management of psychogenic impotence. Psychogenic impotent who didn't respond to sex therapy and patients with slight organic causes would seem to benefit from oral prostaglandin treatment.

On-line [11C]methylation using [11C]methyl iodide for the automated preparation of 11C-radiopharmaceuticals

A novel method for the efficient preparation of 11C-radiopharmaceuticals by on-line [11C]methylation using [11C]methyl iodide has been developed and applied to a rapid, convenient automated system. [11C]Methyl iodide is first trapped in a short column, containing an adsorber and coated substrate, which is connected to an HPLC injector. DMF is then introduced. Alternatively the substrate is added with the DMF. A whole reaction mixture can be easily injected onto an HPLC column for purification by switching the injector valve immediately after the reaction. Thus, radiochemical yields in the preparation of 11C-labeled doxepin, benztropine, cyproheptadine and N-methylspiperone have been improved remarkably and the synthetic procedure simplified.

[Assessment of autonomic nervous function in impotence using sweat response induced by intradermal injection of acetylcholine]

It is important to evaluate the autonomic nervous function which controls penile erection. One method utilizes intradermal injection of acetylcholine to produce localized sweat response. The sweat response depends on the peripheral autonomic nervous supply. Therefore, the response can be used to detect peripheral autonomic nervous dysfunction. We tried to evaluate the peripheral autonomic dysfunction in 29 impotence using a sweat spots test. We classified the 29 impotence into 6 groups with standard tests such as the papaverine test, nocturnal penile tumescence monitoring, recordings of bulbocavernous reflex, etc. The results were as follows: psychogenic IMP; 8, neurogenic IMP; 8, arterial insufficiency; 5, corporeal veno-occlusive insufficiency; 6 neurogenic with arterial insufficiency; 1, and neurogenic with corporeal veno-occlusive insufficiency; 1. The score of sweat spots test was 25.3 +/- 10.9, being in normal, nineteen severe in 3 and slightly abnormal in 7. Many cases of severe and slightly abnormal patients were DM patients classified into neurogenic IMP. We found 2 cases that were not detected by bulbocavernous reflex but found to be abnormal by sweat spots test. Therefore we conclude that this test effective to detect the autonomic nervous dysfunction in impotence.

Study of factors related to hypotension in hemodialysis patients

The factors related to hypotension in hemodialysis patients were evaluated. The subjects consisted of 120 hemodialysis patients (61 males and 59 females), whose ages ranged between 28 and 82 years, and who had undergone hemodialysis treatment for a period ranging between 3 and 201 months. They were divided into three groups: Group A, 53 normotensive patients; Group B, 52 patients with hypotension during hemodialysis; and Group C, 15 patients with constant hypotension. The evaluated factors were age, sex, etiology of renal failure, hemodialysis term, ultrafiltered volume, responsiveness to vasopressor drugs, Cr, Na, Ht, TP, cardiothoracic ratio, presence or absence of heart disease, and microvibration pattern. Statistical analysis was performed using multivariate analysis (Quantification II and IV methods). The results of the Quantification IV method indicated that Groups A and B were similar but Group C was quite different from the other two groups. The results of the Quantification II method indicated that the most important factor which characterized the difference between Group A and Group C was the responsiveness to vasopressor drugs, and the most important factor in the difference between Group B and Group C was the microvibration pattern. Group B was characterized by abnormal microvibration patterns and Group C was characterized by a low responsiveness of the peripheral vessels to vasopressor drugs. We conclude that the hypotension during hemodialysis was caused predominantly by dysfunction of the autonomic nervous system, while the constant hypotension was caused predominantly by a deterioration of constriction of the peripheral vessels.

[Multivariate analysis of prognostic factors in patients with prostatic cancer]

A multivariate statistical analysis of 9 potential prognostic factors was made, using data gathered on 107 patients admitted between 1975 and 1987. After each variable was assessed separately for its prognostic importance by means of univariate analysis, a multivariate analysis using Cox's proportional hazards regression model and multivariate logistic model was done. These tests identified Gleason's score as the most important factor for all patients followed by M category and alkaline phosphatase (ALP), while Gleason's score alkaline phosphatase and age at diagnosis were most important for stage D patients. For short-term survival, the significant prognostic factors were Gleason's score and M category while for long term survival they were Gleason's score and age. T. category, stage, acid phosphatase, prostatic acid phosphatase, and treatment were found to be significantly related to survival time when examined individually; they were not found to be significant in the multivariate analysis.

Determination of aluminum in the human serum of a dialysis patient by ion-pair reversed-phase partition high-performance liquid chromatography

An ion-pair reversed-phase partition high-performance liquid chromatography-spectrophotometric method is described for the determination of aluminum in human serum, based on its complexation with 2,2'-dihydroxyazobenzene. The chelate is separated on C18-bonded silica packing by using an aqueous methanol mobile phase containing tetrabutylammonium bromide and is detected with 0.005 AU full-scale at 510 nm. The proposed system offers a simple, sensitive, and selective method. The detection limits defined as twice the standard deviation of the blank signal, are 0.2 micrograms L-1 in pure solution and 6 micrograms L-1 in serum. The sample solution is prepared from 0.4 mL of serum after protein precipitation with hydrochloric acid and methanol. There was good agreement between the values obtained by this method and graphite furnace atomic absorption spectrophotometry. The aluminum concentrations in 121 patients on hemodialysis were 6-201 micrograms L-1.

Scleroderma renal crisis in progressive systemic sclerosis: a case report

We report a case of progressive systemic sclerosis with scleroderma renal crisis 10 years after onset. The patient (female) had progressive renal dysfunction, hypertension which was difficult to control, and massive gastrointestinal bleeding. An angiotensin converting enzyme inhibitor (enalapril) could not control her hypertension. Only intravenous nicardipine had a slight effect on her hypertension. Hemodialysis and plasma exchange, did not reverse the renal crisis, and the patient died. Microscopic examination of her kidney showed thickening of the capillary walls and mild nephrosclerosis.

[Review of 43 autopsy cases of urogenital malignant tumors]

Autopsy findings were reviewed in 43 patients clinically diagnosed in the last 12 years as having urogenital malignant tumors. Clinical diagnoses were 14 bladder carcinoma, 11 prostatic carcinoma, 6 renal cell carcinoma, 5 renal pelvic carcinoma, and 7 other malignant tumors. Autopsy showed that 31 cases died due to carcinoma and 12 because of other causes. The most common ultimate causes of death were DIC and infection, especially pneumonia and sepsis. Autopsy showed 36 of the 43 cases (83.7%) with metastasis. Clinical diagnosis showed 34 cases of metastasis, but the number of metastasized organs and lymph-nodes was much lower than in subsequent autopsy findings. Autopsy proved 5 cases of clinical misdiagnosis (11.6%) and 4 of undiagnosed malignant tumors (9.3%). In 15 cases (32.6%) the ultimate cause of death as revealed by autopsy had not been clinically diagnosed. Five cases diagnosed as having died due to cancer in fact were found to have died due to other causes. Recent diagnostic techniques are greatly advanced, yet many findings are still revealed for the first time by autopsy. Autopsy continues to be a very important final arbiter of progress and the effect of malignant tumors, and serves to remind us of the ongoing need for constant vigilance and improvement of clinical diagnostic techniques.

[Clinical evaluation of total cystectomy for bladder carcinoma: a ten-year experience]

Fifty-three patients with primary bladder carcinoma underwent total cystectomy during the past 10 years. Ages ranged from 32 to 87 years old, with an average of 68.2 years. Radical total cystectomy, including systemic lymphadenectomy was performed in 22 cases, simple total cystectomy in 8 cases and salvage total cystectomy in 23 cases. An ileal conduit was made for urinary diversion in 23 cases and the other 26 cases underwent cutaneous ureterostomy. Postoperative mortality was 9.4% (5 of 53 cases) and postoperative complications were noted in 17 of the 53 cases (32.1%). The 5-year cumulative survival rate by the life table method for all the cases was 42.6%. The 5-year cumulative survival rate of radical total cystectomy cases was 67.8%, that of simple total cystectomy cases was 50.0% and that of salvage total cystectomy cases was 7.5%. A significant difference was seen between the first 2 groups and the last group. The 5-year cumulative survival rate of the patients with low stage cancer (pTis, pTa, pT1 and pT2) was 56.1% and that of the patients with high stage cancer (pT3, pT4) was 22.7%. A significant difference was observed between the two groups. The 5-year cumulative survival rate of the patients with grades G1, G2 and G3 cancer was 66.7, 45.4 and 26.7% respectively. A significant difference was seen among the three grades.

[Renal cell carcinoma in the solitary kidney]

We have treated surgically 5 patients with renal cell carcinoma in the solitary kidney. The cause of renal absence was nephrectomy for renal stones, in 2 patients and renal tuberculosis, renal cyst and renal hypoplasia in 1 patient each. Four of the 5 patients died. One of the 4 patients died 5 days after surgery due to gastrointestinal bleeding, 1 due to metastasis, 1 due to gastric cancer and one due to hemodialysis complications. Surgical management of renal cell carcinoma of solitary kidney is discussed.

[Clinical study on adenocarcinoma of the prostate]

In 92 patients with prostatic carcinoma who were treated at the Takamatsu Red Cross Hospital from January 1976 to December 1985, we analyzed the age, chief complaint, degree of advancement, grade of tumor, way of therapy and prognosis. The age of the patients was between 51 and 87 years (mean: 74.8 years). The most frequent chief complaint was dysuria. In terms of the degree of advancement, 14 cases were assessed as Stage A, 23 cases as Stage B, 16 as Stage C and 39 as Stage D. Analysis of the grade of tumor disclosed that 38 cases (41.3%) had well differentiated adenocarcinoma, 20 cases (21.7%) had moderately differentiated adenocarcinoma and 29 cases (31.5%) poorly differentiated adenocarcinoma. Forty-four of the subjects have already died. The 5-year survival rate was 41.2% when calculated pursuant to life table method. The 5-year survival rate was 85.7% for Stage A, 36.1% for Stage B, 53.4% for Stage C and 24.3% for Stage D. The 5-year survival rate was 54.7% for well differentiated adenocarcinoma, 61.7% for moderately differentiated adenocarcinoma and 12.7% for poorly differentiated adenocarcinoma. Comparison of the 3-year survival rate among the 4 ways of therapy revealed only a small intergroup difference; namely, the rate was 58.5% for hormone therapy, 51.6% for intraarterial neocarzinostatin therapy, 77.1% for total prostatectomy and 57.1% for radiation therapy. These results indicate that our way of chemotherapy, which chiefly employs intraarterial administration of neocarzinostatin as an induction therapy, is at least comparable or superior to hormone therapy in terms of efficacy.

[The treatment of an impotent male with venous leakage]

The intracavernous pressure to produce a passive erection was recorded in a 40-year-old man suffering from impotence. The patient had passive erection with a flow of 160 ml/min. The flow needed to maintain erection was 40 ml/min. The pressure in the flaccid state was 15 mmHg, and 151 mmHg in the state of erection. In the state of erection, the perfused liquid was demonstrated to escape through the deep dorsal vein of the penis. No other causes of impotence were revealed, and we diagnosed his erectile failure to be due to venous leakage. We performed ligation of this vein. After the operation, nocternal penile tumescence was improved. His potency recovered completely, and no complication was noted.

[Oral administration of 5-fluorouracil (5-FU) with intravesical chemotherapy as prophylaxis against recurrence of superficial bladder tumors]

The oral administration of 5-FU together with the intravesical instillation of carboquone and cytosine arabinoside was attempted in cases of superficial bladder tumor for the purpose of prophylaxis against postoperative recurrence. The recurrence rate in 25 patients treated by this intravesical chemotherapy and oral 5-FU administration was 9.1% after one year, 14.0% after two years and 27.8% at three to five years. The recurrence rate in 13 patients with intravesical chemotherapy alone was 8.7% after one year, 31.5% after two years and 58.9% at three to four years. The recurrence rate in six patients with oral 5-FU administration alone was 18.2% after one year, 41.6% after two years and 100% after three years. These results suggest that oral administration of 5-FU in combination with intravesical chemotherapy is useful as prophylaxis against recurrence of superficial bladder tumors.

[Use of arterial infusion of neocarzinostatin with or without combination chemotherapy as a treatment of carcinoma of the prostate]

Prostate cancer patients were treated with a basic therapy of intra-arterial injection of neocarzinostatin (NCS). This therapy was divided into three types of regimen: NCS intra-arterial injection alone, NCS intra-arterial injection + diethylstilbestrol (DES), and NCS intra-arterial injection + aclacinomycin A (ACR) + peplomycin (PEP). A comparative study was carried out on the clinical efficacies of these three regimens, and at the same time an investigation was made of the prognosis in the cases receiving NCS intra-arterial injection alone and NCS + DES. The clinical efficacy was found to be high in each of the three treatment groups in terms of subjective symptoms and laboratory findings, except for ALP. In the evaluation of efficacy on the basis of histological findings, the rates were 60.0% for NCS intra-arterial injection alone, 71.4% for NCS + DES, and 88.2% for NCS + ACR + PEP. Thus, all three of these treatment regimens gave good efficacy rates, but it is especially noteworthy that the combined chemotherapy regimen yielded the highest efficacy rate. On the other hand, the incidence of adverse reactions was much higher in the case of the combined chemotherapy regimen than in the other two regimens. In the patient group administered the NCS intra-arterial injection alone, the one-year survival rate was 75.0% and the 4-year survival rate was 25.0%, while in the NCS + DES treatment group the one-year survival rate was 87.5% and the 4-year survival rate was 37.5%. For individual patients, the correlation between the clinical efficacy and the prognosis was not strong. However, it was concluded that all three of the chemotherapy regimens are useful as forms of remission induction therapy.

Immunoreactive somatostatin and vasoactive intestinal polypeptide in adrenal pheochromocytoma. An immunochemical and ultrastructural study

An adrenal pheochromocytoma producing somatostatin (SRIF) and vasoactive intestinal polypeptide (VIP) in a 17-year-old boy is presented. High concentrations of immunoreactive (IR)-SRIF were found in plasma taken from the antecubital vein (31.0-33.0 pg/ml) and the inferior caval vein near the tumor (54.6 pg/ml), but after removal of the tumor the values became normal (11.0-15.2 pg/ml). In two portions of the resected tumor, considerable but different amounts of IR-SRIF (151.7 and 12.1 ng/g wet wt) and IR-VIP (13.0 and 5.5 ng/g wet wt) were demonstrated with size heterogeneities. Immunohistochemically, many IR-SRIF cells and a few IR-VIP cells were observed, but no cell reacting with both anti-SRIF and anti-VIP sera was found. Electronmicroscopically, many tumor cells had catecholamine-like granules (250-350 nm in diameter) while some others had VIP-like granules (110-140 nm in diameter). However, no granules resembling the SRIF granules seen in the pancreatic D cells were found. This seems to be the first report of an adrenal pheochromocytoma that produces SRIF and VIP simultaneously. It provides information on the histogenesis of hormone-producing neurogenic tumors.

Association of mast cells with vaginal trichomoniasis in endocervical smears

In endocervical smears obtained from 40 women with Trichomonas vaginalis infection, 25 women with infections other than T. vaginalis and 35 cytologically normal women, inflammatory cells consistent with mast cells (tissue basophils) were examined. Mast cells were present predominantly in the smears of patients infected with T. vaginalis but were infrequent in those of patients with other infections and in those of the normal, control group. The numbers of mast cells in endocervical smears and the white blood cell counts in vaginal discharges showed a positive correlation with the degree of T. vaginalis infection. Our data seem to indicate that the presence of mast cells in the uterine cervix may be an immunologic response, possibly of an allergic nature, to T. vaginalis.

In vitro-produced antibody-coated bacteria

A new in vitro method was developed which enabled isolation and identification of ACB-positive bacteria in polymicrobial renal bacteriuria. This approach was used in 16 patients with permanent nephrostomies and asymptomatic bacteriuria who had shown positive ACB test by the method of Thomas et al. A total of 48 urinary isolates were obtained from these patients in which 21 (43.8%) were revealed as being positive by the present method. In 13 of the 16 patients, there was only one positive species among several species of bacteria. The species with a colony count of more than 10(5)/ml was found to be most commonly ACB positive (71.5%). Of the 13 patients who had creatinine clearance tests available, 11 (84.6%) showed a considerable decrease in renal function after the intervals since nephrostomy. The immunologically different characteristics observed among multiple bacterial species in polymicrobial renal bacteriuria suggest a possible aggressive role for the ACB-positive species and therefore a need for eradicating them.

Cytologic evaluation of atypical cells in cervicovaginal smears from women with tubal pregnancies

Cytologic changes in the cervicovaginal smears of 28 women with tubal pregnancies are described. Eleven cervicovaginal smears showed atypical cells, including two cellular patterns: glandular type and naked-nuclei type. About 60% of the cases with atypical cells included the naked-nuclei type of cell, which showed wide variations in nuclear size. Polyploid Feulgen DNA distributions were noted for both types of cells, which probably originate with the Arias-Stella reaction of the endometrium. The cytologic observation of atypical Arias-Stella cells in cervicovaginal smears may be useful in the early diagnosis of ectopic pregnancy, especially if both cell types are present.

[Laboratory and clinical studies on latamoxef in the field of obstetrics and gynecology]

Latamoxef (LMOX) is a new antibiotic synthesized by Shionogi Research Laboratory. Chemically LMOX is especially unique with a sulfur atom replacing the oxygen atom in the 1 position of the conventional cephalosporin nucleus, and in addition, this antibiotic has a cephamycin-like structure. The antibacterial activity of LMOX shows high potency against Gram-negative bacteria, but tends to be weak against Gram-positive bacteria. The tissue levels of LMOX in humans after intravenous injection of 1 g were examined. The levels in uterine and adnexa uteri tissue at 1 hour after administration were 25.4 and 27.4 micrograms/g respectively. LMOX was administered to 147 cases in infections of obstetric and gynecological field. The clinical effect according to disease was 94.6% for intrauterine infections, 95.0% for adnexitis, 87.0% intrapelvic infections, and 100% for external genital organ infections, making a total of 92.5%. The rate of occurrence of side effects or abnormal laboratory findings was similar to or slightly less than that seen with other beta-lactam antibiotics.

The cells from intrauterine contraceptive devices: with special reference to the occurrence of mast cells

A study of cytologic smears from 26 women using intrauterine contraceptive devices (IUDs) confirmed our previous findings for mast cells and further defined the averages, proportions and types of cells in IUD smears. The average number of cells was found to be 65.5 x 10(4), with a range of 1.3 x 10(4) to 280 x 10(4). The cellular proportions found were 49.0% macrophages, 42.7% polymorphonuclear leukocytes, 4.0% endometrial glandular cells, 1.3% mast cells and 3.0% other cells. Total nucleated-cell counts showed one group with a large number of cells (greater than 5 x 10(5) cells) and another group with a smaller number of cells (less than or equal to 5 x 10(5) cells). These groups showed significant differences in cell types, with a predominance of polymorphonuclear leukocytes in the former and macrophages in the latter. The mast cell counts were similar in both groups. The data suggest that mast cells have a role in IUD functioning. It may be based on an immunologic mechanism.

[Clinical evaluation of pivmecillinam in the maintenance therapy of chronic urinary tract infection (author's transl)]

In order to evaluate the efficacy and safety of pivmecillinam (melysin tablet, PMPC), PMPC was administered to 78 chronic UTI cases in the field of obstetrics and gynecology (posthysterectomy infection, chronic cystitis, chronic pyelonephritis and etc.). In principle, daily 400 mg of PMPC was administered for 2 weeks. (1) Overall clinical efficacy judged by doctor was evaluated in 78 cases and the result was; excellent in 17, good in 37, fair in 10, poor in 13 and unknown in 1 case with the effectiveness rate of 69.2%. (2) Overall clinical efficacy judged by 'criteria for clinical evaluation in complicated UTI' recommended by UTI study member was evaluated in 54 cases and the result was; excellent in 15, good in 20 and poor in 19 cases with the overall efficacy rate of 64.8%, the result of which was similar to that of doctor's judgement. (3) Efficacy on pyuria was evaluated in 72 cases and it was cleared in 27, decreased in 25, unchanged in 20 and unknown in 6 cases. Efficacy on bacteriuria was evaluated in 72 cases and it was eliminated in 44, decreased in 9, replaced in 8, unchanged in 8 and unknown in 9 cases. (4) Side effect, considered by doctors to be caused by PMPC administration, was noticed in 3 out of 78 cases (3.8%), all of which was mild gastrointestinal disturbance and the administration of PMPC was continued. Abnormal change of laboratory finding considered by doctors to be caused by PMPC administration was noticed in 1 out of 78 cases, which was slight elevation of GOT and GPT values. It is therefore considered that PMPC appear to be useful drug for the maintenance therapy of chronic UTI in the field of obstetrics and gynecology.

Cytologic findings in postpartum and postabortal smears

A study was undertaken to evaluate the cytologic features of pregnancy-induced cell patterns (PIP) observed in postpartum and postabortal cervicovaginal smears. A total of 3,000 PIP were evaluated and studied by an indirect immunofluorescent technique using human chorionic gonadotropin (HCG). Three characteristic types of PIP were demonstrated. In type I PIP, the cells had a sheetlike arrangement with a fine chromatin pattern and were thought to be of decidual origin. Type II PIP were shed in clumps and had round nuclei, cytoplasmic vacuoles and coarse chromatin. They were thought to originate in the endometrium with the Arias-Stella reaction. Type III PIP were large and had large nuclei with marked atypism. They were thought to be cytotrophoblasts. Almost all of the type III PIP were positive with the anti-HCG stain. It is concluded that this classification and analysis is significant and could reduce the number of false-positive cytology reports on postpartum and postabortal smears.