Recent experience of penile fracture (1989-1993)

Penile fracture is an uncommon injury in the genitourinary organ which occurs following a blunt injury on the rigid penis. Penile fracture with urethral injury is even rarer. A total of 11 new patients with penile fracture were treated at our institution from 1989 to 1993. All of these injuries occurred during sexual intercourse and received immediate surgical repair to preserve the sexual function. Only one patient with complete transection of the urethra received end-to-end anastomosis of the urethra. Unfortunately, he suffered from urethral-cutaneous fistula ten days later. Suprapubic urinary diversion was performed in 3 patients with partial urethral tearing, and they enjoyed satisfactory outcomes during the limited follow-up. Immediate surgical repair of tunica albuginea is recommended for preserving penile function. If associated with partial urethral tear, suprapubic urinary diversion is sufficient to treat urethral lesions.

Comparison of multidrug resistance gene expression levels with malignant potentials and influence of chemotherapy in urothelial cancers

BACKGROUND

We sought to determine how often P-glycoprotein is involved in the drug-resistance of urothelial cancer, and whether MDR1 gene expression is correlated with tumor grade, invasiveness, or metastasis.

METHODS

Forty-two tumor specimens and two normal bladder mucosal samples obtained from 34 urothelial cancer patients were analyzed. Reverse-transcription and polymerase chain reaction were conducted. MDR1 mRNA levels were determined by measuring the relative ratio of the MDR1 to beta-2-microglobulin (b2 m) mRNA specific PCR products.

RESULTS

The MDR1/b2 m in two normal urothelial samples were 0.044 and 0.045. For untreated primary tumors, levels of MDR1 gene expression in 46% tumor samples were less than that of normal urothelium, while 27% showed expression levels with a MDR1/b2 m ratio more than 0.1. There was no statistical correlation between MDR1 mRNA level and tumor grade, stage, or metastatic status. There was higher MDR1 gene expression in two lymph node metastasis specimens and almost equal expressions in two more. There was no significant difference in the mean MDR1/b2 m ratio between postchemotherapy and untreated tumors. A remarkable elevation of the MDR1 mRNA level (15 times greater than prechemotherapy) was found in one tumor; mRNA levels of the multidrug resistance-associated protein (MRP) gene, glutathione S-transferase pi (GST-pi) gene or DNA topoisomerase II (topo II) gene did not increase.

CONCLUSIONS

It is still unclear whether the MDR1 gene expression in urothelial tumor cells is inducible by the current combination chemotherapy regimens. RT-PCR quantitation is useful for determining the expression level of MDR1 gene in urothelial cancer.

Allelic frequency of p53 gene codon 72 polymorphism in urologic cancers

Alterations in the p53 tumor suppressor gene appear to be important in the development of many human tumors. The wild-type p53 gene has a polymorphism at codon 72 that presents the arginine (CGC) or proline (CCC) genotype, which recently has been reported to be associated with genetically determined susceptibility to smoking-related lung cancers. To determine whether this p53 genotype influences individual risk of urologic cancer and/or its progression, we used polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) analysis to assay the allelic frequencies of this polymorphism in 85 renal cell carcinoma patients, 151 urothelial cancer patients, 33 testicular cancer patients, 28 prostatic cancer patients and 56 patients without neoplastic disease. The allelic distributions of the three genotypes (Arg/Arg, Arg/Pro, Pro/Pro) in patients with renal cell carcinoma (29.4%, 55.3%, 15.3%), urothelial cancers (45.7%, 39.7%, 14.6%), testicular cancer (45.4%, 48.5%, 6.1%) or prostate cancer (42.9%, 50.0%, 7.1%) did not differ significantly from those in the normal controls. However, Pro/Pro genotype in renal cell carcinoma and urothelial cancer (smoking-related cancers) was more frequent than that in prostate cancer and testicular cancer (smoking-unrelated cancers) with borderline significance (P = 0.0881). There was no particular correlation between frequency of the three genotypes and grade or stage of each type of tumor. The association of genetic predisposition to urologic cancers with p53 gene codon 72 polymorphism is not so clear as the previous study of Japanese lung cancer patients, but this polymorphism may play some role in urothelial cancers and renal cell carcinoma, in which smoking is an epidemiological risk factor.

Influence of endothelium on responses of isolated dog coronary artery to beta-adrenoceptor agonists

AIM

To study the role of the endothelium in mediating the response of the coronary arteries to adrenoceptor agonists.

METHODS

Endothelium intact and denuded dog epicardial coronary artery rings were used. The contractile responses were recorded on forcetransducer and a pen recorder.

RESULTS

In all ring segments, norepinephrine (NE) and isoproterenol (Iso) produced concentration-dependent relaxation in the presence and absence of phentolamine. Endothelium-removal decreased this relaxation and depressed the maximal response. Inhibition of nitric oxide synthesis by N omega-nitro-L-arginine-methyl ester induced the same influences as endothelium-removal.

CONCLUSION

beta-adrenoceptor agonists produce relaxation of dog coronary artery by both endothelium-dependent and independent mechanisms, endothelium-dependent relaxation induced by beta-adrenoceptor agonists is mediated by nitric oxide.

Ethanol decreases the number and activity of splenic natural killer cells in a mouse model for binge drinking

The effects of acute administration of ethanol (EtOH) on natural killer (NK) cells have not previously been examined in mice or humans. In the present study, a single dose of EtOH (5.0-7.0 g/kg) was administered by gavage to B6C3F1 mice. This produced maximum blood EtOH levels of approximately 0.25 to 0.50% (wt/vol). A single dose of EtOH decreased splenic NK cell activity (as measured by lysis of YAC-1 target cells in vitro). This decrease was maximal 12 hr after dosing and was no longer evident at 60 hr. Suppression of NK cell activity was consistently significant at EtOH doses of 6.0 or 6.5 g/kg, and significant suppression occurred in two of three experiments at doses of 5.0 or 5.5 g/kg. Flow cytometric analysis indicated a decrease in the percentage of NK cells in the spleen in EtOH-treated mice, and there was a small decrease in the total number of splenocytes. However, the decrease in the percentage of NK cells was significantly less than the decrease in NK cell activity, suggesting an effect on NK cell activity as well as NK cell number. Splenic T cells were not depleted, but B cells were significantly decreased at the highest EtOH dose. Enhancement of NK activity after in vivo administration of polyinosinic-polycytidilic acid was blocked by EtOH (6.0 g/kg). These results indicate acute exposure to EtOH decreases basal and induced splenic NK cell activity in mice and that loss of NK cells at least partially explains the decrease in basal NK cell activity.

Oncogene amplification in urothelial cancers with p53 gene mutation or MDM2 amplification

BACKGROUND

Previously, p53 (also known as TP53) gene mutations have been shown to be frequently detected in highly malignant urothelial cancers. Evidence has been accumulating that the disruption of the normal function of p53 may lead to genomic instability, including predisposition to gene amplification. Furthermore, the normal function of p53 may be abrogated by MDM2 (murine double minute-2) gene amplification in some human tumors.

PURPOSE

Our purpose was to investigate the relationship between protooncogene amplification and p53 alteration in urothelial cancers by examining the existence of amplification of MDM2 and 14 other protooncogenes in 50 urothelial tumors in which p53 gene status was known.

METHODS

We analyzed gene amplification by Southern-blot analysis in 50 urothelial cancer specimens. These tumors were previously examined for p53 mutations by polymerase chain reaction-single-strand conformation analysis, and 17 tumors contained p53 mutations.

RESULTS

Two high-grade advanced tumors (4%) without p53 mutation harbored MDM2 amplification with concurrent int-2 gene amplification. As for other genes, amplification was detected for int-2 (also known as WNT2) (seven [14%] of 50), erbB-2 (also known as ERBB2) (three [6%] of 50), N-ras (also known as NRAS) (one [2%] of 50), L-myc (also known as MYCL1) (one [2%] of 50), and raf-1 (also known as RAF1) (one [2%] of 50). The amplification of at least one gene examined was observed in 11 (22%) of 50 tumors. The presence of p53 mutations was not significantly associated with the occurrence of gene amplification, since the amplification was detected in six (35%) of 17 tumors with p53 mutations and in five (15%) of 33 tumors without p53 mutations. However, eight (73%) of 11 tumors with proto-oncogene amplification harbored p53 mutations or MDM2 amplification.

CONCLUSIONS AND IMPLICATIONS

A subset of advanced urothelial cancers without p53 mutations may harbor MDM2 amplification. This finding should be taken into account when adopting p53 alteration as a marker of aggressiveness in urothelial cancers. Although the abrogation of normal p53 function may be one of the key steps to protooncogene amplification, the data further indicate that the predisposition to gene amplification in urothelial cancers was not determined by the presence of p53 alteration alone.

Protection of bradykinin on neonatal rat myocytes subjected to anoxia/reoxygenation injury

This study was to investigate the effects of bradykinin (BK) on myocyte cultures. The effects of BK against lipid peroxidation and oxygen free radicals were estimated on an anoxia/reoxygenation injured model. A salicylate hydroxylation product dihydroxybenzoic acids (DHBA) was detected using HPLC with electrochemical detection, a sensitive device for assaying the hydroxyl free radical. BK (10 nmol.L-1) reduced thiobarbituric acid reactive substances (TBARS, from 1.94 +/- s 0.28 to 0.25 +/- 0.03 nmol/10(6) cells, n = 5, P < 0.01), lactate dehydrogenase (LDH) release (1.28 +/- 0.23 to 0.63 +/- 0.12 u.ml-1, n = 8, P < 0.01) and DHBA (60 +/- 5 to 44 +/- 12 nmol.L-1, n = 6, P < 0.01). These improvements were nullified by pretreatment with K86/4321 (1 mumol.L-1), a kind of BK receptor antagonist. Indometacin (Ind, 1 mumol.L-1) had a synergic action with BK to decrease the LDH release, but Ind (30 mumol.L-1) attenuated the protection of BK, while both LDH and TBARS were increased. The mechanism for protection of BK was ascribable to the activation of BK receptor, the inhibition of lipid peroxidation, and the decreased hydroxyl free radical formation.

The altered expression of cytokeratin polypeptides in carcinomas of human bladder

After extraction in high salt buffers and Triton X-100, cytokeratin polypeptides could be isolated from normal epithelium and transitional cell carcinoma of the human bladder in the southwestern coast of Taiwan. The polypeptides were solubilized via lysis buffer, separated by two-dimensional gel electrophoresis, and identified by immunoblot. Five cases of normal epithelium expressed cytokeratin No. 5 (58 kd), 7 (54 kd), 18 (45 kd) and one case further expressed cytokeratin No. 19 (40 kd) in addition to the above cytokeratins. Combined patterns of cytokeratin polypeptides were observed among various Grades of transitional cell carcinoma of bladder. Comparing the patterns between the normal epithelium and the transitional cell carcinoma of bladder, 88% (14/16) of carcinomas expressed cytokeratin No. 8 (52.5 kd) and 63% (10/16) expressed No. 17 (46 kd), which were not seen in the normal epithelium. Some other cytokeratin polypeptides particular to carcinomas were No. 4 (59 kd), No. 10 (56.5 kd), No. 13 (54 kd) and No. 14 (50 kd) and were only present in less than 50% (ranging from 31-56%) of the examined specimens. Thus cytokeratin No. 8 and 17 could be helpful markers for diagnosis of bladder carcinoma.

Urolithiasis related to laxative abuse

Urinary calcareous disease related to laxative abuse is rare. The gastrointestinal loss of fluid and electrolytes leads to chronic depletion of the urinary volume, relative supersaturation and many other pathophysiologic derangements. These calculi are generally radiolucent with uric acid and ammonium acid urate as major components. We report on a female patient with frequent, repetitive formation of urinary calculi and rapid double J stent encrustation, which were related to the chronic abuse of bisacodyl. Although these stones can be fragmented successfully by extracorporeal shockwave lithotripsy, it seems that the better treatment for this type of stone formation is to avoid the abuse of laxatives.

Experience in the morbidity associated with double-J catheter indwelling and its management

Placement of internal ureteral stents for internal urinary diversion and prevention of urological complications has been well established. However, indwelling stents have occasionally been associated with patient morbidity and intolerance. A total of 255 patients while the internal ureteral stent had been used were analyzed. The symptoms including urinary frequency (42.0%), hematuria (41.6%) and suprapubic pain (20.4%), loin pain (17.3%) and micturition pain (16.9%) accounted for the major complaints of the stent indwelling patients. The major complications, i.e. stent migration, heavy encrustation, pyelonephritis, fragmentation, intolerance and penetration of collecting structure, were occasionally observed. These complications increase secondary morbidity in patients. The double-J stents should be used carefully with regard to the prevention and treatment of untoward conditions as early as possible.

Flow cytometric DNA analysis of advanced prostatic adenocarcinoma

Thirty-two patients with extracapsular invasive prostatic adenocarcinoma were analysed to investigate the prognostic significance of DNA flow cytometry by using the nuclear material extracted from paraffin embedded prostatectomy specimens. The DNA ploid pattern was diploid in 61% of the tumors and aneuploid in 39%. A significant correlation between the DNA diploid pattern with pathologic low grade tumors and the DNA aneuploid pattern with high stage tumors was not proved. The clinical stage correlated well with patients survival but only DNA ploidy pattern and pathologic grade had trends of correlation. However, if only the stage D tumors were analysed, a significant prognostic predictive value of DNA flow cytometry was identified. Although the results maybe regarded as preliminary, (in view of the small number of patients), these suggest that DNA content from the initial surgical samples provide only a synergistic effect to the clinical stage and pathologic grade in the prognostic evaluation of the advanced prostate cancers especially for those who underwent hormonal therapy postoperatively.

The distribution of the DHFR genes in trimethoprim-resistant urinary tract isolates from Taiwan

Between July 1987 and June 1989, 1054 urinary isolates of enterobacteria from Kaohsiung, Taiwan were studied for their trimethoprim resistance. Trimethoprim resistance was defined as MIC greater than 4 micrograms/ml and high-level resistance by MIC greater than 1000 micrograms/ml. The incidence of trimethoprim resistance increased from 33.6% in 1987 to 42.1% in 1989. Among the resistant strains studied, 90% were resistant to high levels of trimethoprim. An increase in the proportion of resistant strains (33.9-46.3%) exhibiting high-level non-transferable trimethoprim resistance was noted. The distribution of the dihydrofolate reductase (DHFR) genes by colony hybridization in 374 trimethoprim-resistant isolates revealed the presence of type I and type V DHFR genes in most of these isolates (45.4% and 10.4% respectively). Type I was predominant in Escherichia coli whereas type V was frequently seen in Enterobacter spp. None showed homology with the type II and type III DHFR probe DNA. In addition, transposon Tn7 was present in 7.8% of 374 trimethoprim-resistant enterobacteria.

Prevalence of transposons encoding kanamycin, ampicillin and trimethoprim resistance in isolates from urinary tract infections detected using DNA probes

Drug resistant Gram-negative bacteria causing urinary tract infections were collected. Kanamycin, ampicillin or trimethoprim-resistant strains were analyzed separately for the presence of Tn5, Tn3, or Tn7 by colony hybridization. Of these isolates, kanamycin-resistant transposons were present in 38.2% of 60 kanamycin-resistant isolates. A 3.3 kb fragment containing SacI-BamHI transposase of Tn3 and 42.6% showed a positive reaction in 129 ampicillin-resistant clinical isolates. Among the 75 trimethoprim-resistant isolates studied, 52% were shown to contain Tn7 when probed with a 1 kb BamHI fragment of Tn7. Results from Southern hybridizations demonstrated that these antibiotic resistant genes had been born on plasmids in some clinical isolates.

[Effect of alpha-human atrial natriuretic factor on isolated myocardial contractile force and action potential duration in guinea pigs]

The effect of alpha-hANF on contractile force and action potential duration (APD) of isolated myocardium in guinea pig was investigated. At the level of 20 nmol/L and 40 nmol/L alpha-hANF, the contraction amplitude and rate of contraction phase decreased to a remarkable extent. And at 40 nmol/L, APDs were shortened significantly 20 min after alpha-hANF. The results suggest that there exists a direct inhibitory effect of alpha-hANF on myocardial contractile force and action potential duration.

Insulinoma: 31 years of tumor localization and excision

This report is based on 31 years of experience with 116 cases of hyperinsulinism. Six cases had hypertrophy of the islets of Langerhans, 3 had widespead metastasis from malignant insulinomas, and 107 were benign adenoma cases. An immunoreactive insulin to glucose ratio of 0.3 of the peripheral venous blood before operation is of great value in diagnosing hyperinsulinism. Intraoperatively, immunoreactive insulin assay of the portal blood (IRI) is very valuable in determining if an insulinoma remains. The dividing line is 100 microU.ml-1. In localizing the tumor, "differential" PTPC is important before operation. During the operation, fine needle aspiration cytology may assist in ascertaining if the palpable tumor is an insulinoma. Multiple fine needle aspiration cytology examinations can sometimes reveal an insulinoma in an indurated pancreas. Portal vein blood IRI and blood sugar assays may serve to confirm if removal of the insulinoma is complete. Removal of the insulinoma controls hypoglycemia satisfactorily, but the brain damage incurred by prolonged hypoglycemia cannot be significantly altered. Removal of the tumor should be by enucleation, and the raw surface of the pancreas should be drained not sutured.

Insulinoma. Experience in surgical treatment

Sixty cases of insulinoma were treated surgically. The possible causes for failure to find the tumor during exploratory surgery are discussed. Simple enucleation is preferred in most cases of single or a few insulinomas. A technique of enucleation with minimal chance of injury to adjacent pancreatic ducts and larger blood vessels can be used. When no tumor is found after thorough exploratory procedures, controlled staged resection of the pancreas under blood glucose monitoring is the procedure of choice. Postoperative complications are common but the late results are gratifying provided the operation is carried out early in the course of the disease.