Narrowing the position of the Werner syndrome locus by homozygosity analysis-extension of homozygosity analysis

Werner syndrome (WS) is an autosomal recessive disorder characterized by the premature occurrence of many age-related features. Previously, the WS gene (WRN) was mapped between D8S131 and D8S87, in an 8.3-cM interval. In this study, regions of homozygosity in 36 WS patients from inbred families were searched for by genotyping for 35 dinucleotide repeat polymorphic markers to narrow down the WRN critical region. The region most consistently homozygous in these patients was between the D8S1219/D8S1220 cluster and D8S278, within a 4.4-cM interval. For 16 markers mapped in this interval, 24 WS patients (22 Japanese patients and 2 Caucasian patients) in whom consanguinity failed to be proved were also genotyped, under the assumption that some of these patients might still be from consanguineous marriages. The data were analyzed by Fisher's exact test with a 2 x 2 contingency table for the 22 Japanese patients, excluding the 2 Caucasian patients. The frequencies of homozygosity in the 22 patients at 10 of 16 markers tested were significantly higher than those detected in the general population. Analysis of homozygosity patterns indicated that the region most consistently homozygous was between D8S1445 and D8S278. Thus the WRN locus is most likely between the two markers D8S1445 and D8S278, in a 1.6-cM interval.

[Rapidly deteriorating adult hydronephrosis due to an aberrant vessel: a case report]

Hydronephrosis due to ureteropelvic junction (UPJ) obstruction generally progresses gradually. We experienced a case of hydronephrosis due to UPJ obstruction deteriorating rapidly in an adult woman. In spite of percutaneous nephrostomy, 99mTc-DTPA renogram showed a non-functional pattern. A nephrectomy was done. Peri-operatively, the aberrant lower pole vessel was found to be obstructing the UPJ. The hydronephrosis deteriorated rapidly because the extrarenal pelvis dilated in the shape of box, became suspended from the aberrant vessel. Therefore, we believe that the box pelvis is one of the most important factors deteriorating hydronephrosis.

Temperature dependence of structure parameters in natural magnetite: single crystal X-ray studies from 126 to 773 K

Structural parameters and their thermal changes in natural magnetite, Fe3O4, have been studied using the single-crystal X-ray diffraction method in the temperature range 126–773 K. The cell dimensions, oxygen coordinate and atomic mean square displacements (m.s.d.'s) reversibly change as a function of temperature. The coordinate of oxygen remains almost constant at x = 0.2549 (1) below ~600 K, but increases with increasing temperature above this temperature. This characteristic behavior of the oxygen coordinate with temperature indicates that the cation disordering over the tetrahedral (A) and octahedral (B) cation sites occurs above 600 K. All atomic m.s.d.'s increase monotonously with temperature rise. The m.s.d.'s of the B atom show a unique temperature dependence. At lower temperatures the B atom prefers to vibrate along [111], but this preference is reduced with a temperature rise up to 630 K, above which the m.s.d. normal to [111] becomes dominant.

[Combined hormone-chemotherapy for stage D2 prostatic cancer: starting time of chemotherapy in relation to hormone therapy]

We retrospectively analyzed 29 patients with stage D2 prostatic cancer who had been treated with chemotherapy at the urological clinic of Tokyo Medical and Dental University Hospital between 1983 and 1992 to evaluate the efficacy of chemotherapy for advanced prostatic cancer. The patients were divided into three groups according to the starting time of chemotherapy in relation to hormone therapy; 9 patients who received chemotherapy more than four weeks after the initial hormone therapy (group H), 9 patients who received chemotherapy only or in combination with the hormone therapy more than four weeks previously (group C), and 11 patients in whom both therapies were started within four weeks (group HC). Follow-up period ranged from four to 108 months averaging 35. Combination chemotherapy including cisplatin was administered one to 17 times with the median of five. The five-year survival rates estimated by Kaplan-Meier method were 18% in group H, 28% in group C, and 78% in group HC, respectively (HC vs. C: p < 0.05, HC vs. H: p = 0.059). These findings indicate that a combination chemotherapy including cisplatin may improve the prognosis of patients with advanced prostatic cancer when it is started with the initial hormone therapy simultaneously.

[Relationship between pretreatment serum levels of prostate specific antigen and bone metastasis in prostate cancer]

We retrospectively reviewed pretreatment levels of serum prostate specific antigen (PSA) in 138 newly diagnosed, untreated patients with prostate adenocarcinoma to evaluate the usefulness of serum PSA levels to predict results of radionuclide bone scans. All of the 24 patients with serum PSA levels above 200 ng/ml showed positive bone scans whereas those with serum PSA levels below 10 ng/ml included only three cases (3/51, 5.1%) positive for bone metastasis. All of the three had poorly differentiated adenocarcinoma of the prostate. In conclusion, bone scans may not be necessary in the cases with serum PSA levels less than 10 ng/ml except for those with poorly differentiated adenocarcinoma.

[En bloc cystourethrectomy with preservation of potency]

BACKGROUND

The objective of this study is to evaluate efficacy of en bloc cystourethrectomy with preservation of potency in patients with bladder carcinoma.

METHODS

A total of nine patients underwent this procedure in 1991 and 1994. Following 2 cases of 1991 who were confirmed to recover potency and had no recurrence in the pelvis during 2-year follow up as a preliminary study, 7 cases underwent the same procedure in 1994. Erectile function was measured by the snap gauge band.

RESULTS

Six of the 9 patients recovered erection adequate for sexual activity and 4 of them have practiced sexual intercourse. The remaining 3 patients experienced mild erection but inadequate. One of them failed to accomplish adequate erection because of perineal pain at erection. Three to eighteen months after surgery, the first erection was experienced. Surgical margins were pathologically negative in each of the 9 specimens. By the present, all of the 9 patients survive with no evidence of disease.

CONCLUSION

The potency-sparing en bloc cystourethrectomy appears to preserve potency on the level comparable to the two-stage potency-sparing cystourethrectomy combined with delayed urethrectomy.

[The experimental evaluation of the difference in closing dynamics of internal urethral ostium on the urinary continence and on the ejaculation induced by an administration of phenylephrine]

BACKGROUND

The internal urethral ostium is usually closed both on the ejaculation and on the urine collection, although the difference of the closing characteristics have not been known.

METHODS

The difference in closing style of bladder neck (internal urethral ostium) between on the phenylephrine administration corresponding state to the ejaculation and on the filling of urinary bladder corresponding state to the urinary continence was evaluated by Stereo-UPP method using mongrel dogs.

RESULTS

On phenylephrine administration, the length between verumontanum and bladder neck was lengthened, and a remarkable pressure increase was observed in the area. On the urinary continence filling physiological saline in the bladder, the length of the urethra on the UPP curve of the anterior wall of urethra was lengthened (10%) and the base of bladder was gradually become flat. The pressure in the bladder neck was not relatively increased.

CONCLUSIONS

The internal urethral ostium was closed both on the phenylephrine administration and on the urine collection, although the closing characteristics of each was very different. It was demonstrated that on the phenylephrine administration the area between the verumontanum and the bladder neck was lengthened, together with the rise of pressure in the area, whereas on the urine collection bladder neck was closed in low pressure by flattening the base of bladder.

Antegrade and retrograde fluid transport through the vas deferens

Intraluminal pressure of the seminal tract at seminal emission from the ejaculatory duct and the mode of transport of cauda epididymal contents were investigated to explore the mechanism of sperm transport. Direct electrical stimulation of any site of the cauda epididymis and vas deferens, which generated nerve-transmitted muscle contraction, caused elevation of the intraluminal pressure only at the cauda epididymis, whereas stimulation of the testis, caput, and corpus epididymis caused no response. The dye instilled in the cauda was emitted into the urethra during the stimulation. Shortly after discontinuation of the stimulation, retrograde movement of residual dye in the vas resulted in its ultimate reentry into the cauda epididymis. Significant decrease of the muscle tonus just after contraction was observed at the cauda. Distension of the wall of the vas generated elevation of the intraluminal pressure only at the site distended. The above results indicate the presence of rapid antegrade and retrograde movement of the sperm and the crucial role of the cauda epididymis on the sperm transport.

Natural killer (NK) and lymphokine-activated killer (LAK) activities in a patient who recovered from cancer, and the characteristics of LAK cells generated from CD4-CD8- and CD8+ peripheral blood lymphocytes

The natural killer (NK) and lymphokine-activated killer (LAK) activities of a patient who recovered from bladder transitional cell carcinoma were determined. The patient was diagnosed in 1980 and repeated several therapies until 1986. Since 1987, he has been in a tumor-free state. Recently, very high NK and LAK activities were found. The NK activity was recognized not only against the NK-sensitive cell line K562, but also against NK-unsensitive Raji and Daudi cell lines and against autotumor cell line H41. The percentage of CD16+ in peripheral blood lymphocytes (PBL) was 52.9%, the CD8+CD16+ was 26.3%, and the CD4-CD8-CD16+ was 26.6% (17.5, 5.4 and 12.1% in healthy blood donor (control), respectively). Because the patient had large numbers of CD4-CD8- cells in the PBL, CD4-CD8- LAK were generated from them. The CD4-CD8- LAK cells exhibited extremely high killer activity, whereas the CD8+ LAK cells generated from the CD8+ cells showed a low level of killer activity. These results suggest that the tumor-free condition of this patient may be related to these high killer activities. In this patient, several cytokines were also determined, although the results were not completely interpreted.

Effects of clenbuterol on rabbit vesicourethral muscle contractility

Clenbuterol (10(-10)-10(-7) M), a selective beta 2-adrenoceptor agonist, reduced spontaneous contractile force of isolated rabbit bladder dome, bladder base and proximal urethra. Clenbuterol inhibited both acetylcholine (Ach)-and electrical field stimulation (EFS)-induced contractions of rabbit bladder dome, but was more potent in inhibiting EFS-than Ach-induced contractions. Acetylcholine-but not EFS-induced contractions in the bladder dome were completely inhibited by pretreatment with 10(-6) M atropine. The atropine resistant component of the EFS-induced contractions was completely inhibited by tetrodotoxin, 10(-6) M. Clenbuterol and a non-selective beta-adrenoceptor agonist, isoproterenol, potentiated the EFS-induced contractions of isolated striated muscle preparations from the external urethral sphincter and from the extensor digitorum longus in the rabbit. Clenbuterol was more potent than isoproterenol in increasing EFS-induced contractile force in the external urethral sphincter, whereas isoproterenol was more potent than clenbuterol in increasing EFS-induced contractile force in the extensor digitorum longus. These data suggest that clenbuterol may have a role in the treatment of urinary incontinence by inhibiting the detrusor contraction and fascilitating the external urethral sphincter selectively.

Differential effects of an acyl-coenzyme A:cholesterol acyltransferase inhibitor on HDL-induced cholesterol efflux from rat macrophage foam cells

When rat macrophages were converted to foam cells with acetylated low density lipoprotein (acetyl-LDL) and then reacted with high density lipoprotein (HDL) and an inhibitor of acyl-coenzyme A:cholesterol acyltransferase (58-035) (sequential incubation system), 58-035 did not enhance HDL-induced cholesterol efflux. In contrast, when macrophages were exposed to acetyl-LDL in the presence of both HDL and 58-035 (simultaneous incubation system), HDL-induced cholesterol efflux was enhanced 1.6-fold by 58-035. Cholesterol efflux with HDL alone was 2-fold greater in simultaneous incubation than in sequential incubation. These results suggest the presence of an efficient cholesterol efflux pathway in simultaneous incubation which is not available in sequential incubation. This pathway, which we refer to as the neutral cholesterol ester hydrolase-independent pathway, is characterized by the efflux of lysosome-derived cholesterol without re-esterification.

[Natural killer (NK) and lymphokine-activated killer (LAK) activities of a patient recovered from bladder cancer, and the characteristics of LAK cells generated from lymphocyte subsets]

NK and LAK activities of a patient who recovered from bladder transitional cell carcinoma were determined. He was diagnosed in 1980 and operations, radiations and chemotherapies were repeated until 1986. Since 1987, a relapse has not been recognized, and he is now in a tumor free state. Recently, his very high NK and LAK activities were found. The percentage of CD 16+ in his peripheral blood lymphocytes (PBL) was 52.9%, the CD 4- CD 8- CD 16+ was 26.6% (17.5% and 12.1% in control, respectively). It seems likely that his tumor free condition may be related to these high killer activities. As a high number of CD 4- CD 8- cells were included in his PBL, it was possible to generate a CD 4- CD 8(-)-LAK and compare it with the CD 8(+)-LAK. The CD 4- CD 8(-)-LAK exhibited higher killer activity which was maintained for a long period of the culture, and a strong adherence property against the cultured tumor cells. Whereas, the CD 8(+)-LAK did not show such a high level of killer activity which decreased after two weeks into the culture. However, the CD 8(+)-LAK in this patient demonstrated higher killer activity against the auto-tumor cell line compared to what occurred with the control. A type of specific killing against auto-tumor cells may be contained in his CD 8(+)-LAK, although the MHC-restrictive killing was not confirmed. It remains unclear why the killer activities increased in this patient.

[A clinico-pathological study of renal cell carcinoma with a diameter of less than 5 cm]

To examine the indication of nephron sparing operations, we searched 31 nephrectomized kidneys with renal cell carcinoma for small associated lesions in the normal-appearing portion of these kidneys. The diameter of the predominant tumors was between 15 and 50 mm. The kidneys were serially sectioned at 5-mm intervals, and all sections were examined microscopically. Two of the 31 kidneys had a small renal cell carcinoma, and four had a small adenoma in the normal-appearing portion. We recommend that the nephron-sparing operation should be is performed limitedly and that radical nephrectomy is yet a standard operation in the presence of a normal contralateral kidney.

The functional limitations of tetraplegic hands for intermittent clean self-catheterisation

Since the introduction of intermittent self-catheterisation by Lapides et al, low pressure voiding methods have been adopted actively in our centre. A retrospective review of 47 patients with cervical spinal cord injury (CSCI) who performed independent (self) clean intermittent catheterisation (CIC) on discharge is presented. Their functional abilities were evaluated by both the Frankel and the Zancolli scales. Fourteen out of the 47 patients could manage independent CIC, 17 assisted CIC, nine tapped or voided voluntarily, two were discharged with a diaper, one with a suprapubic catheter, and four with an indwelling catheter. According to Frankel's classification, four patients were in A category, four in B, one in C and five in D among the group of complete CIC. C6A/C5B (right/left hand) by Zancolli's classification was the highest level of ability for all these 14 patients; and one patient (a 30-year-old male, Frankel B classification) could manage independent CIC with the aid of our special device. However, the practical limit of functional hands for independent CIC appeared to be about C6B1.

Relationship of the structure of ureteral muscularis to in vitro spontaneous contractions

We investigated the anatomical structure of the smooth muscle layers of the mid portion of the canine ureter. In transverse sections the inner muscle bundles appear to be oriented longitudinally and the outer muscle bundles appear to be oriented in a circular configuration. In sections cut parallel with the longitudinal axis of the ureter, the inner and outer bundles appear to be oblique and are oriented in a mesh-line manner. In oblique sections, cut parallel with the helically oriented ureteral muscle, bundles appear to be oriented in a lengthwise configuration. These anatomical studies show that canine ureteral smooth muscle is composed of spiral fibers in a mesh structure and that helical muscle strips which include a significant percentage of continuous bundles have a greater capacity to generate spontaneous contractions in vitro than do transverse and longitudinal muscle strips.

Carrier detection of Werner's syndrome using a microsatellite that exhibits linkage disequilibrium with the Werner's syndrome locus

Werner's syndrome (WS) is a rare autosomal recessive disorder, one of the progeroid syndromes, characterized by features of premature aging. The genetic defect in WS is unknown but recently the genetic linkage of WS to several markers on the short arm of chromosome 8 has been reported. Genetic analysis of 25 families with WS demonstrated that D8S339 was the closest marker linked to the gene locus for Werner's syndrome (WRN), with a peak lod score of 18.29 at recombination frequency 0.001, and showed a linkage disequilibrium with the WRN locus. We studied two unrelated families with WS using ANK1, D8S339, and D8S360. The mutative haplotype identified through the generations in pedigrees provides a means of carrier detection and presymptomatic diagnosis.

A new method to generate canine seminal emission and its application to men: direct electrical stimulation of the vas deferens

Seminal emission from the ejaculatory duct (SEED) by direct electrical stimulation of the vas deferens was investigated in the dog, and the technique was applied to men. The stimulus parameters used were 2 msec, 10 Hz, and 8 V for dogs or 15-20 V for humans. In vitro studies using tetrodotoxin demonstrated that the major portion of the muscle contraction under the above stimulation was neurogenic. The stimulation of the pars epididymica, the middle vas, or the ampulla of the vas caused SEED in all dogs having intact hypogastric nerves (HNs) and receiving transection of bilateral HNs 1, 6, and 12 months before electrical stimulation. The dye instilled into the canine cauda epididymis was transported to the ampulla and emitted into the posterior urethra by electrical stimulation of the vas regardless of the site stimulated. The electrical stimulation of eight vasa deferentia (pars epididymica) of five prostatic carcinoma patients generated emission from the severed proximal end of all vasa examined at orchidectomy. All of the stimulations of 13 middle vasa of seven patients with emission loss caused SEED. The above results indicate that direct electrical stimulation of the canine and human vas deferens causes SEED regardless of the site stimulated or the absence of HNs, which are the major pathway of the efferent signal for SEED.

Effects of prostaglandins E1, E2 and F2 alpha on contractility and cAMP and cGMP contents in lower urinary tract smooth muscle

Prostaglandin (PG) E1, E2 and F2 alpha contracted smooth muscle strips from male adult rabbit urinary bladder. Contractile responses to each PG were significantly greater in urinary bladder body than in urinary bladder base. The magnitude of contractile response to each PG was F2 alpha > E2 > E1 in both of the bladder body and the bladder base. These contractions were almost completely eliminated by a calcium entry blocker, verapamil but not by atropine, phentolamine, propranolol or tetrodotoxin. PG E1 and E2 significantly relaxed the male rabbit urethral smooth muscle strips, whereas PG F2 alpha contracted the urethral smooth muscle strips. Cyclic adenosine monophosphate (cAMP) but not cyclic guanosine monophosphate (cGMP) increased significantly after administration of PG E1 or E2 in the urethral muscle strip. These results suggest that the regional differences in the magnitude of contractile responses to PG E1, E2 and F2 alpha between the bladder dome and the base and also suggest the contractile differences of PG E1 and E2 for the urinary bladder and the urethra; contractions for bladder and relaxations for urethra. These results also demonstrate that contractions induced by PG E1, E2 and F2 alpha in urinary bladder smooth muscles and by PG F2 alpha in urethral smooth muscles are mainly mediated by calcium influx and that relaxations induced by PG E1 and E2 in urethral smooth muscles are mediated by cAMP but not by cGMP.

Function and distribution of autonomic receptors in canine ureteral smooth muscle

There have been only a few reports of the measurement of autonomic receptors in ureteral smooth muscle. Furthermore, it is so difficult to maintain stable spontaneous contractions in the ureter, that either electrical field stimulation or KCl at high concentrations are utilized to induce ureteral contractions in many in vitro ureteral pharmacologic examinations. We used the spiral ureteral strips which generate spontaneous contractions in the ureter in present experiments. Norepinephrine, phenylephrine, clonidine, carbachol, and prostaglandin F2 alpha enhanced the spontaneous contractile force and/or increased the contractile frequency of spontaneous rhythmic contractions in spirally-incised muscle strips from isolated canine ureters. In contrast, isoproterenol, terbutaline, a beta 2-adrenergic agonist, and prostaglandin E2 reduced the spontaneous contractile force and/or decreased the contractile frequency of spontaneous rhythmic contractions. Dobutamine, a beta 1-adrenergic agonist, did not affect significantly the spontaneous rhythmic contractions. The effects of the prostaglandins were not influenced by autonomic antagonists or tetrodotoxin. The existence of alpha 1-, alpha 2-, and beta-adrenoceptors and muscarinic cholinergic receptors were demonstrated in the canine ureter using radioligand techniques. The density of alpha 1-receptors binding sites was significantly greater than that of the other receptors examined. Our data show that the sympathetic nervous system is more involved than the para-sympathetic nervous system in canine ureteral contractile activities, and that alpha- and beta-receptors contained in canine ureteral smooth muscle are comprised mainly of the alpha 1- and beta 2-subtypes. It is also suggested that prostaglandins directly affect canine ureteral contraction.