Catalytic and regulatory properties of the heavy subunit of rat kidney gamma-glutamylcysteine synthetase

gamma-Glutamylcysteine synthetase (rat kidney), which catalyzes the first step of GSH synthesis, can be dissociated into subunits (M(r) 73,000 and 27,700) by native gel electrophoresis after treatment with dithiothreitol (DTT); the heavy subunit, which exhibits catalytic activity and feedback inhibition by GSH (Seelig, G. F., Simondsen, R. P., and Meister, A. (1984) J. Biol. Chem. 259, 9345-9347), was cloned and sequenced (Yan, N., and Meister, A. (1990) J. Biol. Chem. 265, 1588-1593). Here, the cDNA for the heavy sub unit was expressed in Escherichia coli, and the recombinant enzyme was separated from E. coli gamma-glutamylcysteine synthetase and purified. The recombinant enzyme and the isolated heavy subunit have much lower affinity for glutamate and higher sensitivity to GSH inhibition than the holoenzyme, suggesting that the heavy subunit alone would not be very active in vivo. A GSH analog, gamma-Glu-alpha-aminobutyryl-Gly (ophthalmic acid), inhibits only slightly, but inhibits much more after treatment of the holoenzyme with DTT. In contrast, ophthalmic acid inhibits the recombinant and isolated heavy subunit enzymes substantially without DTT treatment. We conclude that (a) the light subunit has a regulatory function affecting the affinity of the enzyme for glutamate and GSH and (b) feedback inhibition by GSH involves reduction of the enzyme and also competition between GSH and glutamate for the glutamate site.

Separation and characterization of the A chain and B chain in beta 1-bungarotoxin from Bungarus multicinctus (Taiwan banded krait) venom

The interchain disulfide bond between A chain and B chain of beta 1-bungarotoxin (beta 1-Bgt) was selectively cleaved by dithiothreitol, and the A and B chains were separated by HPLC. The separated A and B chains did not show detectable enzymatic activity and lethal toxicity, but exhibited an immunoreactivity with anti-beta 1-Bgt antibody. Analytical isoelectrofocusing revealed that the A chain is a neutral subunit with pI = 7.4, and the B chain is a basic one with pI = 9.6. The A chain exhibited a Ca(2+)-binding ability as revealed by fluorescence measurement. Moreover, fluorescence studies showed that the intact interchain disulfide bond is essential for maintaining the hydrophobic character of substrate binding site in beta 1-Bgt and stabilizing the architectural environment of Trp-19 in the A chain. However, combination of the A chain and B chain failed to restore the biological activities and physiochemical properties which the intact beta 1-Bgt possessed. These, together with our previous result that the Trp-19 of the A chain is involved in substrate binding, suggest that the integrity of the interchain disulfide bond favors the maintenance of the active conformation of beta 1-Bgt.

Probing the functional sites in Naja naja atra (Taiwan cobra) cardiotoxin III with monoclonal antibody

One monoclonal antibody (mAb) against Naja naja atra cardiotoxin III was prepared by using the hybridoma technique. The cytotoxic activity of cardiotoxin III which inhibited human lymphocyte proliferation was effectively neutralized by the mAb at a molar ratio of antibody to toxin of 1:2. On the contrary, the mAb did not exert a significant inhibition on the hemolytic activity of cardiotoxin III. These results suggest that the functional site responsible for the cytotoxicity might be different from that for the hemolytic activity of cardiotoxin III.

Status of tryptophan residue in cobrotoxin and alpha-bungarotoxin

Acrylamide quenching studies indicated that the exposure degree of the Trp residue in cobrotoxin was higher than that in alpha-bungarotoxin. The Trp residue of cobrotoxin was in a positively charged environment as revealed by iodide quenching, while the Trp residue of alpha-bungarotoxin was not accessible for iodide. Analysis of hydrophilicity profile and local concentration of positively charged residues of toxin molecule also indicated that Trp in cobrotoxin was in a highly hydrophilic and positively charged environment. Measurement of Trp fluorescence with increasing temperature showed that the stability of environment of Trp in alpha-bungarotoxin was higher than in cobrotoxin. Result of competitive binding for nicotinic acetylcholine receptor (AchR) between cobrotoxin and alpha-bungarotoxin revealed that the molecular interaction of the two toxins with AchR was not the same. These, together with the fact that the cationic groups of the two toxins are involved in the binding with AchR, suggest that the observed different environment surrounded Trp residue and different AchR binding mechanism might fulfill a different requirement of the invariant Trp in the lethality of cobrotoxin and alpha-bungarotoxin.

Silica stone--development due to long time oral trisilicate intake

We report a case of a 30-year-old female who had a long-term history of trisilicate-containing antacid intake for gastric discomfort. She had experienced repeated attacks of renal colic. Neither intravenous pyelography nor ureteroscopy could define the presence of calculi. The metabolic evaluations were normal. However, X-ray diffraction revealed a silicate stone. We suggest that the attack of renal colic in those patients with long-term history of trisilicate intake should arouse the possibility of silica urolithiasis.

Experience using extracorporeal shock-wave lithotripsy to treat urinary calculi in problem kidneys

Seventeen patients with urolithiasis in problem kidneys which comprised horseshoe kidneys, medullary sponge kidneys (MSKs), polycystic kidneys and duplex kidneys presented to our hospital and were evaluated for treatment with extracorporeal shock-wave lithotripsy (ESWL). A total of 21 renal units were treated with ESWL. Auxiliary procedures included preoperative retrograde ureteral catheterization (1 horseshoe kidney) placement of a retrograde double-J catheter stent (1 MSK), percutaneous nephrolithotomy (PCNL; 2 MSKs) and postoperative PCNL (1 MSK). The outcome showed that 5 renal units (23.8%) were stone free, 15 renal units (71.4%) had a decreased stone load with residual stone and improved symptoms, and 1 renal unit (4.8%) had residual stone with persistent symptoms. We conclude that ESWL can be used as a primary management tool for calculi in problem kidneys.

Local chemolysis of obstructive uric acid stone with 0.1 M THAM and 0.02% chlorhexidine

We used a modified chemolytic solution by combining 0.1 M THAM (tris[hydroxymethyl] aminomethane) with 0.02% chlorhexidine to treat 10 obstructive uric acid stone patients. A total of 23 local chemolysis sessions were performed. Five patients received 13 sessions (average: 2.6) as an adjuvant chemolysis after extracorporeal shock wave lithotripsy 5 patients received 10 sessions (average: 2) as a primary treatment. The average time of local chemolysis was 2.3 days, ranging from 1 to 4 days. In the 23 local chemolysis sessions, only one patient developed two episodes of fever (8.7%), which were managed successfully by conservative treatment. The mean values of effective renal plasma flow of treated kidney was increased from 108.2 to 155.6 ml/min (p < 0.05). The stone-free rate assessed by IVP and ultrasonography at 3 months follow-up was 80%. Our results indicate that the combined use of 0.1 M THAM and 0.02% chlorhexidine is an effective and safe method to treat obstructive uric acid stones.

Intradiverticular tumors of the bladder: surgical implications--an eleven-year review

An 11-year review of all vesical diverticula and bladder tumors was undertaken. Fourteen patients were found to have primary neoplasms arising in the diverticula. The most common type was transitional cell. Hematuria was the most common presentation. Diagnosis is relatively difficult and treatment is not well defined. Lack or thinness of muscular layer of the diverticulum also potentiates early peridiverticular invasion and results in poor prognosis. Early diagnosis and adequate treatment are indicated.

Acute pancreatitis following transurethral resection of prostate

Three cases of acute pancreatitis following transurethral resection of the prostate are reported. The incidence is rare. A review of perioperative data failed to disclose any unique factor except in 1 patient who had an underlying biliary tract disease. Hyperamylasemia or hyperlipaemia in association with abdominal pain and vomiting was noted in all patients to establish the diagnosis. Computed tomography also confirmed the existence of acute pancreatitis. One patient died of respiratory and renal failure. However, early diagnosis and prompt treatment are essential to reduce high mortality. In conclusion, acute pancreatitis should be considered as one of the differential diagnoses in the presence of abdominal pain with vomiting, azotemia or oliguria after transurethral resection of the prostate.

Correlation of contractile function and passive properties of rabbit urinary bladder subjected to outlet obstruction--an in vitro whole bladder study

The present study investigated the correlation between contractile function and passive properties of rabbit urinary bladder subjected to outlet obstruction. Mild bladder outlet obstruction was induced by placing silicone rings (7 mm. diameter) around the bladder necks of male New Zealand rabbits. The animals were sacrificed after 2 weeks of obstruction. Contractile function was evaluated by measuring the response of the in vitro whole bladder to 500 microM bethanechol administration. Passive properties was assessed by performing in vitro cystometry and stress-relaxation techniques utilizing six different infusion rates. When the intravesical pressure reached 30 cm. H2O the infusion was stopped, allowing the bladder to relax and intravesical pressure to drop to a steady state level. The results can be summarized as follows: 1) Although the intravesical pressure response to bethanechol was about the same in control (13.3 cm. H2O) and obstructed (12.4 cm. H2O) bladder, the obstructed bladder emptied significantly less than control (20.4 vs 89.3%); 2) the results of the passive properties study showed that bladder stiffness was significantly higher at all infusion rates in the obstructed bladder, 3) the obstructed bladder showed significantly less relaxation after rapid stretching of the whole bladder by high speed fluid infusion; 4) histological examination of obstructed bladders revealed marked fibrous thickening of the serosal layer, interstitial fibrosis of the muscle layers, and hypertrophic and/or degenerative changes of the muscle fibers. In summary, 2 weeks after mild outlet obstruction of the urinary bladder the emptying ability, but not pressure generation, was reduced along with increased bladder stiffness and diminished capacity for stress-relaxation. Interstitial fibrosis and changing the properties of the smooth muscle cells might be involved in the functional impairment and deranged viscoelasticity of the urinary bladder after outlet obstruction.

Uninephrectomy enhances urolithiasis in ethylene glycol treated rats

Uninephrectomy (uNX) usually induces compensatory hyperfunction of the remaining kidney in an attempt to preserve the homeostasis of body fluid composition. The present study used uninephrectomized Sprague-Dawley rats on a lithogenic diet (0.5% ethylene glycol, EG) to evaluate the influence on urinary stone formation and calcium oxalate crystal deposition of compensatory excretion of lithogenic substances in the remnant kidney. The results showed that there were no urinary stones or calcium oxalate crystal deposits in the intact or uNX rats fed a normal diet. In the EG feeding groups, the incidence of massive (grade 3) crystal deposits was significantly higher in the uNX rats (87.5%) than that in the intact rats (37.5%; P less than 0.05). The incidence of urinary stone formation was also higher in the uNX rats as compared to that of the intact rats, although the difference did not achieve statistical significance. The serum magnesium, phosphorus and creatinine increased significantly, whereas creatinine clearance (CCr), 24-hour urinary excretions of citrate, sodium, potassium and chloride decreased significantly in the uNX rats fed EG. These data indicate that uninephrectomy increases the vulnerability of the contralateral remnant kidney to urolithiasis and crystal deposition when the lithogenic risk factors are present. Furthermore, once the remnant kidney forms urolithiasis or massive calcium oxalate crystal deposits, the renal function is severely compromised.

Laparoscopic ligation of internal spermatic vein

Laparoscopic procedures have long been a standard form of treatment for gynaecological disorders but have only recently shown promise in the evaluation and treatment of urogenital diseases, such as pelvic lymphadenectomy. We performed laparoscopic ligation of the bilateral internal spermatic veins in 15 male pigs. The average operative time was 20 min and operative morbidity was minimal, comprising mild subcutaneous emphysema around the trocars. Engorgement of the spermatic vein proximal to the endoclip site was noted. There was no operative mortality. Laparoscopic ligation of the internal spermatic veins seems to be a feasible method for the treatment of varicoceles, especially bilateral lesions.

The filter properties of the arterial beds of organs in rats

The frequency properties of arterial beds in organs were studied by temporarily ligating the renal, the gastric, the splenic or the superior mesenteric arteries of rats. Blood-pressure waves of the tail arteries were recorded before and during the ligations, and were analysed by Fourier's transformation. Their frequency spectra have been found to change profiles following specific patterns with the ligations of different arteries. The results were significant with regard to the frequency selectivities of the organic arterial beds. Such frequency properties can be clearly explained when the circulation system is viewed as an electrical circuit network in which the organic arterial beds work as filters.

Elicitation of penile erection following activation of the hippocampal formation in the rat

We explore the possible involvement of the hippocampal formation in penile erection, using male, adult Sprague-Dawley rats that were anesthetized with pentobarbital sodium. The intracavernous pressure (ICP) was used as the experimental index for penile erection. Electrical activation of the hippocampal formation resulted in two patterns, viz, multiple and single episodes of elevation in ICP, along with visible penile erection and ejaculation. The former pattern exhibited an increase in ICP that was more sustained, with higher peak amplitude and longer latency. Furthermore, they originated respectively from the granule cells of the dentate gyrus and pyramidal cells of the CA1 and CA3 fields of the Ammon's horn. Chemical stimulation of the hippocampus with glutamate also elicited significant increase in ICP. These results thus provided direct evidence to establish that the hippocampal formation may be involved in central neural regulation of the erectile process.

[Laparoscopic orchiectomy for intraabdominal cryptorchism and varicocelectomy]

Laparoscopic procedures have recently been used in the evaluation and treatment of some urogenital diseases. A case of right intraabdominal cryptorchism associated with left varicocele was successfully treated by laparoscopic orchiectomy and ligation of the contralateral internal spermatic vein concomitantly. This new technology can be easily performed and has the advantages of less tissue trauma, easy application for bilateral lesions, and less patient morbidity. We consider laparoscopy is a promising method for the diagnosis and treatment of intraabdominal testis.

Human erythrocyte protein 4.2: isoform expression, differential splicing, and chromosomal assignment

Human protein 4.2 (P4.2) is a major membrane skeletal protein in erythrocytes. Individuals with P4.2 deficiency exhibit spherocytosis and experience various degrees of hemolytic anemia, suggesting a role for this protein in maintaining stability and integrity of the membrane. Molecular cloning of P4.2 cDNAs showed that P4.2 is a transglutaminaselike molecule in erythrocytes but lacks the essential cysteine for cross-linking activity. Two cDNA isoforms have been identified from a human reticulocyte cDNA library, with the long isoform containing a 90-base pair (bp) in-frame insertion encoding an extra 30 amino acids near the N-terminus. Characterization of the P4.2 gene suggests differential splicing as the mechanism for generating these two cDNA isoforms. The donor site for the short isoform (P4.2S) agrees better with the consensus than the donor site for the long isoform (P4.2L) does. Expression of P4.2L was detected by a long-isoform-specific antibody raised against a peptide within the 30-amino acid insert. Western blot analyses showed P4.2L to be a minor membrane skeletal protein in human erythrocytes with an apparent molecular weight (mol wt) of approximately 3 Kd larger than the major protein 4.2, P4.2S. By in situ hybridization of a full-length 2.4-kilobase (kb) cDNA to human metaphase chromosomes, the gene for P4.2 was mapped to bands q15-q21 of chromosome 15, and it is not linked to the gene for coagulation factor XIIIa (plasma transglutaminase, TGase).

Radionuclide renal function study in various surgical treatments of upper urinary stones

We conducted a radionuclide renal function study using 131I-hippuran in 188 patients with upper urinary stones before and every 3 months to the maximum of 12 months after various surgical treatments. Of 28 patients with renal staghorn stone, 24 underwent anatrophic nephrolithotomy and 4 percutaneous nephrolithotomy (PCNL). Of 36 patients with renal pelvic stone, 15 received open pyelolithotomy, 16 received PCNL and 5 received extracorporeal shock wave lithotripsy (ESWL). Of 71 patients with renal calyceal stone, 48 underwent PCNL and 23 ESWL. Of 53 patients with ureteral stone, 41 received ureterolithotomy, 8 PCNL and 4 ureteroscopic extraction. The renal function study determined individual and total renal function in terms of effective renal plasma flow (ERPF) at unilateral and bilateral kidneys. The mean total ERPF decreased 3-6 months after anatrophic nephrolithotomy (377.4 +/- 121.8 vs. 308.8 +/- 105.4 ml/min) or PCNL (447.4 +/- 152.3 vs. 386.8 +/- 140.8 ml/min) for staghorn stone. The mean ERPF of the kidney on the operative side decreased significantly to an extent of 29.4% up to 6 months after anatrophic nephrolithotomy. The mean ERPF on operative side increased significantly to an extent of 18.3% up to 6 months after ureterolithotomy. In conclusion, among the upper urinary stones, the unilateral (operative side) and total bilateral renal function decreased 1, 3, and 6 months, respectively, after anatrophic nephrolithotomy. On the contrary, the renal function increased significantly on the operative side up to 6 months after open ureterolithotomy. There was no significant change of mean ERPF at the kidney on operative or non-operative side in other kinds of upper urinary stones and surgical treatment.

Pericentric inversions of chromosome 9 in Taiwanese fetuses

Using trypsin-Giemsa banding, a total of 1,350 unrelated Chinese fetuses were studied for pericentric inversion of chromosome 9 [inv(9) (p11; q13)]. Sixteen cases (1.2%) were found to have this variant. The prevalence was higher than that in a previous report on Asians. All the fetuses with inv(9) were born with a normal phenotype.

[Intracellular effect of the ventral prostate in zinc deficient rats]

Concentration of androgens, binding-sites of androgen-receptors as well as the activity of 5 alpha-reductase of the ventral prostates have been studied in the zinc-deficient rats. Eight-week-old Sprague-Dawley rats were housed individually in cages and divided into two groups, I. Experimental group, redivided into 2 sub-groups: (a) maintained on a zinc-deficient diet for 3 and 6 weeks, (b) zinc-deficient diet for 3 weeks then re-fed normal diet, II. Control group fed with normal diet. The ventral prostates were dissected free and homogenized after the rats sacrificed. Androgens and androgen-receptor were quantified by RIA and "exchange assay" respectively. The result obtained from the zinc-deficient rats were significantly different (P less than 0.05) from those of the control group 1. The zinc-deficient 3 and 6 weeks rats showed the plasma testosterone concentration decreased by 18% and 15%. 2. The cytosolic (fmo1/mg protein) dihydrotestosterone and its binding receptor were decreased by 10-15% and 28-30%, respectively. 3. The nuclear (fmo1/mg DNA) dihydrotestosterone and its receptor protein were ony 2-3% and 3-3.6% of the control group respectively. 4. Studies on the androgen metabolism showed that the metabolite, dihydrotestosterone (fmo1/mg protein) of rats with zinc-deficient 6 weeks was only 48% of the control group. 5. The prostate weight (mg) of zinc-deficient rats was 45-50% of the control group.(ABSTRACT TRUNCATED AT 250 WORDS)

Determinant role of testosterone in the pathogenesis of urolithiasis in rats

By using an ethylene glycol-induced urolithiasis model, we assessed the role of testosterone in the pathogenesis of urolithiasis. The intact and castrated male and female rats were fed with 0.5% ethylene glycol in drinking water for four weeks. The renal excretions of oxalate, citrate and other electrolytes were measured, and the stone and crystal deposit were examined microscopically. The results showed that drinking a loading of 0.5% ethylene glycol for four weeks produced hyperoxaluria in all rats, but the intact male rats excreted more urinary oxalate than any other groups of rats. The ethylene glycol-fed rats exhibited hypocitraturia except the castrated male rats. However, urolithiasis occurred in intact male but not female rats. Castration in male rats fed with ethylene glycol dramatically decreased the incidence of renal stone from 71.4% (5/7) to 14.3% (1/7). On the other hand, there was still no renal stone formed in the oophorectomized female rats which received ethylene glycol treatment. These data indicate that serum testosterone level plays a determinant role in urolithiasis formation.

Intracavernous pressure as an experimental index in a rat model for the evaluation of penile erection

This report communicates our attempt to design a small animal model for the evaluation of penile erection, based on the pharmacological responses of cavernous tissues in the rat that resemble those of human subjects. Male adult Sprague-Dawley rats anesthetized with pentobarbital sodium were used in conjunction with papaverine and prostaglandin E1, two vasoactive drugs most commonly used in clinical management of impotence. Intracavernous administration of papaverine (0.05, 0.1, 0.02, 0.4 or 0.8 mg.) induced a progressive increase in intracavernous pressure that peaked at 0.4 mg. This effect was associated with visible penile erection that became conspicuous when accompanied by additional bursts of transient intracavernous pressure fluctuations. The duration of papaverine-induced increase in intracavernous pressure was significantly shortened by clonidine (15 micrograms, intracavernous). Injection of prostaglandin E1 (1, 2 or 4 micrograms) into the corpus cavernosum also elicited an elevation in intracavernous pressure, but the responses exhibited acute tachyphylaxis. By manifesting a response to papaverine and prostaglandin E1 that is similar to that in human, we conclude that the intracavernous pressure in the rat may represent a suitable index for the evaluation of penile erection in small laboratory animals.

Comparison of effective renal plasma flow (ERPF) and endogenous creatinine clearance (Ccr) in evaluation of the differential kidney function: an in vivo study

Eleven patients with obstructive uropathy were inserted with a pigtail catheter either for urinary diversion, endopyelotomy or percutaneous nephrolithotomy. Differential kidney functions were obtained by single-sample technique with I-131 orthoiodohippurate (OIH) and separate endogenous creatinine clearance (Ccr). Good linear correlation was noted between effective renal plasma flow (ERPF) and Ccr (r = 0.84, p less than 0.005), but there was still some discrepancy between these two examinations, chiefly found in two severely obstructed kidneys. Determination of ERPF by I-131-OIH single-sample technique is a simple, rapid, inexpensive and relative accurate test to measure the differential kidney function. But if the ERPF is at extremely low level, further investigations such as sonography of kidney and separate endogenous creatinine clearance should be done to avoid unnecessary nephrectomy.

Prenatal cytogenetic diagnosis in amniocentesis

From 1982 to 1990, cytogenetic studies were successfully conducted in 2,975 (96.19%) of the 3,096 pregnant women who underwent amniocentesis. The average maternal age was 33.7 years and the average gestational age was 18.1 weeks. Common indications of amniocentesis included advanced maternal age (AMA) (54.76%), previous fetus with chromosomal aberrations (6.82%) or gross anomalies (5.01%), intrauterine gross anomaly (4.97%) and maternal exposure to drugs or radiation (5.28%). Among the 89 cases (2.99%) with detected chromosomal aberrations, 53 were numeric (31 trisomies, 21 sex chromosome aberrations and one tripoidy) and 36 were structural (six de novo and 30 hereditary structural rearrangement). The incidence of chromosomal aberrations was 2.03% in cases with AMA. While only four of the 143 cases with previous fetal trisomy 21 had recurrence, the recurrent rate was 90.91% in 11 cases with previous fetal chromosomal translocation. Thirty (20.27%) of the 148 cases with abnormal sonograms showed chromosomal aberrations. Certain congenital anomalies are closely associated with cytogenetic changes: duodenal atresia and trisomy 21; cystic hygroma and 45,X; and polyhydramnios and trisomy 18. Only two of the 157 cases with indications of drug or radiation exposure had abnormal cytogenetic studies. Two of the 53 cases with detected numerical aberrations (47,XXY and 47,XXX) and 27 cases with hereditary structural rearrangement elected to continue their pregnancies. All of these babies were delivered without gross anomalies. This study suggests that for prenatal diagnosis. However, complementary measures, such as routine antenatal ultrasound and maternal serum alphafetoprotein, should be added to increase the efficacy of genetic amniocentesis.

Molecular cloning of the cDNA for the catalytic subunit of human DNA polymerase delta

The cDNA of human DNA polymerase delta was cloned. The cDNA had a length of 3.5 kb and encoded a protein of 1107 amino acid residues with a calculated molecular mass of 124 kDa. Northern blot analysis showed that the cDNA hybridized to a mRNA of 3.4 kb. Monoclonal and polyclonal antibodies to the C-terminal 20 residues specifically immunoblotted the human pol delta catalytic polypeptide. A multiple sequence alignment was constructed. This showed that human pol delta is closely related to yeast pol delta and the herpes virus DNA polymerases. The levels of pol delta message were found to be induced concomitantly with DNA pol delta activity and DNA synthesis in serum restimulated proliferating IMR90 cultured cells. The human pol delta gene was localized to chromosome 19 by Southern blotting of EcoRI digested DNA from a panel of rodent/human cell hybrids.

Immunochemical properties of Naja naja atra (Taiwan cobra) phospholipase A2 using polyclonal and monoclonal antibodies

The immuno-chemical properties of Naja naja atra phospholipase A2 (NNA-PLA2) were studied by using the chemically modified PLA2 derivatives and the PLA2 homologues toward anti-NNA-PLA2 polyclonal and monoclonal antibodies. Anti-NNA-PLA2 polyclonal antibodies inhibited the enzymatic activity of NNA-PLA2 and Hemachatus haemachatus DE-I by 87% and 68%, respectively. However, the enzymatic activities of Naja nigricollis CMS-9 and notexin were not significantly affected by the polyclonal antibodies. Competitive enzyme immunoassay revealed that the affinity of NNA-PLA2 for polyclonal antibodies was 330-fold higher than that of Hemachatus haemachatus DE-I. Naja nigricollis CMS-9 and notexin failed to inhibit the binding of NNA-PLA2 to polyclonal antibodies. This implies that the epitope(s) of NNA-PLA2 might comprise some substituted residues in the sequence of PLA2 homologues. Three monoclonal antibodies against NNA-PLA2 were prepared by a hybridoma technique. Two of these monoclonal antibodies inhibited the enzymatic activity of NNA-PLA2, but the other did not. Removal of the N-terminal octapeptide affected the epitope interacting with these monoclonal antibodies. Selective modification of tyrosine residues at positions 3 and 63 or lysine residues at positions 6 and 65 induced a substantial reduction in affinity of NNA-PLA2 for polyclonal and monoclonal antibodies. The three monoclonal antibodies failed to recognize PLA2 homologues. The comparison of the sequence of NNA-PLA2 to those of PLA2 homologues showed that most of the amino acid substitutions of PLA2 homologues occur in the spatially nearby region of the N-terminal region and residues at positions 63 and 65.(ABSTRACT TRUNCATED AT 250 WORDS)

Cisplatin-based chemotherapy for the treatment of advanced transitional-cell carcinoma of the urinary tract--a preliminary report

The CMV (cisplatin, methotrexate, and vinblastine) and M-VAC (methotrexate, vinblastine, doxorubicin, and cisplatin) regimens were used to treat 19 patients with advanced transitional-cell carcinoma (TCC) of the urothelial tract. In the CMV group, the partial response rate was 45.5% and the mean response duration was 6.3 months. No complete response was obtained in our series. The median duration of survival was 15.8 and 8.3 months in responders and nonresponders, respectively. The toxic symptoms included one case of sepsis and three cases of renal toxicity. However, nausea and vomiting were experienced by most patients and required the administration of antiemetics. In the M-VAC group, the median duration of survival for responders was longer than that of nonresponders (greater than 10.2 vs 7.2 months), although the number of patients was too small for this difference to reach statistical significance. The toxic symptoms included one case of sepsis, two cases of renal toxicity, and nausea and vomiting in most patients. Bone metastasis in three patients did not respond to chemotherapy (CMV), a finding that is compatible with the results reported by other investigators. In summary, chemotherapy with the CMV or M-VAC regimen was effective in improving the response rate of patients. However, the duration of response was short, toxicity was severe in some cases, and the efficacy against bone lesions was poor. These problems must be solved to improve the outcome of patients with TCC following chemotherapy with the CMV or M-VAC regimens.

Laparoscopic nephrectomy in a porcine model

Laparoscopic nephrectomy was performed in 15 male pigs, the procedure was successful in 14. Extraction of the intact kidney through a 5-cm lower abdomen incision was done in 7 animals; complete destruction and evacuation of the kidney was accomplished by a round-knife suction device through a 1-cm port in another 7 pigs. Grossly, the specimen consisted of sausage-like tubular renal tissue and a small amount of tissue debris. Pathology revealed that the glomerular and tubular structures were well preserved, no interstitial hematoma could be found. Four ports were usually used, one 1-cm umbilical camera port, one 0.5-cm port for ureter traction, and two 1-cm working ports along the midclavicular line. All the pigs recovered uneventfully. The average operation time was 3 h 20 min. The application of endo-GIA (United States Surgical Corporation) for renal hilum reduced the operative time to 2 h 20 min. Complications included renal vein tear during endoclip application and cutting in the first case, mild subcutaneous emphysema in 2 cases. This first pig received exploratory laparotomy for the repair and ligation of the renal vein. No more major complications occurred with increasing experience. From this porcine experiment, we conclude that the combination of laparoscopy, a tissue destroyer and an endobag for the entrapment of kidney seem to be a promising technique for clinical nephrectomy.

Papillary cystadenocarcinoma of the epididymis: a case report and review of the literature

Primary epididymal carcinoma is rare. We report a case of papillary cystadenocarcinoma of the epididymis presenting with a painful scrotal mass. The clinical course and histopathological features are reviewed.

Construction of detubularized ileal neobladder after radical cystoprostatectomy

In an attempt to improve the patient's quality of life, we performed construction of neobladder using detubularized ileum along with radical cystoprostatectomy in 3 male patients with invasive bladder cancer. The mean followup was 28.3 months (16-45 months). All 3 patients achieved continent urination through the natural urine pathway-urethra with a satisfactory urinary stream during the day, but only 2 of them could also obtain continence in the night. Urodynamic study of the ileal neobladder showed a low pressure (mean 15.3 cm water) and no involuntary pressure spikes in the neobladder. The maximal urethral closure pressure (mean 62.0 cm water) and functional profile length (mean 3.0 cm) were adequate. In addition, the maximal uroflow rate was good (mean 16.7 ml/sec). There was no reflux in any of our patients. The radionuclide renal function study revealed that the renal function was preserved after operation in all 3 patients. Neocystourethroscopy showed no tumor and no stricture at the ileourethral anastomotic site in our 3 patients. There was no complication related to the operation. No disturbances of nutrition or electrolytes were found in any patient. All 3 patients had a satisfactory quality of life after operation though one patient died of widespread metastasis 16 months after operation. In conclusion, construction of detubularized ileal neobladder may be one of the ideal surgical procedures for bladder substitution after radical cystoprostatectomy.

Acupuncture in the treatment of renal colic

A prospective randomized study was performed to compare the effect of acupuncture and intramuscular Avafortan injection in the treatment of renal colic. Our results showed that acupuncture is as effective in relieving renal colic as Avafortan but it had a more rapid analgesic onset (3.14 +/- 2.88 minutes versus 15.44 +/- 7.55 minutes, p less than 0.05). Of the patients in the Avafortan group 7 (43.8%) had side effects, including skin rash in 3, tachycardia in 2, drowsiness in 1 and facial flush in 1. No side effects were noted in the acupuncture group. During 2 hours of observation acupuncture and Avafortan seemed to be ineffective in promoting stone passage. However, patients receiving Avafortan treatment were more likely to have paralytic ileus. In summary, acupuncture can be a good alternative for the treatment of renal colic.

A second observation of the fetal methemoglobin variant Hb F-M-Fort Ripley or alpha 2G gamma 2(92)(F8)His----Tyr

We have identified a second baby with the fetal methemoglobin F-M-Fort Ripley. It was observed in a Caucasian infant from Canada; at least eleven additional members of that family were known to have had a neonatal cyanosis similar to that seen in the propositus and in a previously described baby (2). Sequencing of amplified DNA that included (part of) the G gamma gene greatly facilitated the characterization. The G gamma X chain was readily isolated by reversed phase high performance liquid chromatography; its quantity was approximately 12.5% of total gamma. Interestingly, the baby also carried the A gamma T mutation on one chromosome, either in cis or in trans to the G gamma X mutation. Hb F-M-Fort Ripley could be isolated in reasonably pure form by DEAE-cellulose chromatography. The isolated Hb FX was unstable, had spectral changes characteristic for the M-hemoglobins, while its methemoglobin derivative reacted rapidly with cyanide. Oxygen affinity data could not be obtained. It is suggested that the formation of a rather large amount (approximately 25%) of mixed hybrids (alpha 2G gamma X.gamma) with low oxygen affinity is the main cause for the occurrence of the neonatal cyanosis.

Dissociation of lethal toxicity and enzymic activity of notexin from Notechis scutatus scutatus (Australian-tiger-snake) venom by modification of tyrosine residues

Notexin from Notechis scutatus scutatus snake venom was subjected to tyrosine modification with p-nitrobenzenesulphonyl fluoride (NBSF), and four modified derivatives were separated by h.p.l.c. The results of amino acid analysis and sequence determination revealed that only Tyr-7, Tyr-70 and Tyr-77 were modified in notexin. Modification of Tyr-7 resulted in decreases in lethal toxicity and enzymic activity by 70.2% and 22.7% respectively. Conversely, modification of Tyr-77 caused a 1.8-fold increase in enzymic activity, in contrast with the loss of 52.5% of lethality. A drastic decrease in lethal toxicity was observed when both Tyr-7 and Tyr-70 were modified, whereas the enzymic activity decreased by only 35.8%. Likewise, the derivative in which Tyr-7 and Tyr-77 were modified retained 44.4% of enzymic activity, but showed a marked decrease in lethal toxicity. It is obvious that modification of tyrosine residues causes a decrease in lethal toxicity of notexin, which does not directly correlate with the change in enzymic activity. On the other hand, the antigenicity of NBS derivatives remained unchanged. The modified derivatives retained their affinity for Ca2+, indicating that the modified tyrosine residues did not participate in Ca2+ binding. These results indicate that modification of tyrosine residues can differentially influence the enzymic activity and lethal toxicity of notexin, and suggest that notexin might possess two functional sites, one being responsible for the catalytic activity and the other associated with its lethal effect.

Autonomic hyperreflexia in spinal cord injury patient during percutaneous nephrolithotomy for renal stone: a case report

Autonomic hyperreflexia or autonomic dysreflexia is a syndrome seen in approximately 85% of all quadriplegic patients and constitutes the only medical emergency related to spinal cord injury. We report on a paraplegic patient with a C5 to C7 spinal cord injury who suffered autonomic hyperreflexia during percutaneous nephrolithotomy for a right renal stone. The reflex-induced hypertension subsided with termination of the operation, and administration of an alpha and beta-adrenergic blocking agent (labelatol hydrochloride). The stone was removed successfully by pyelolithotomy with the patient under general anesthesia 4 days later.

A polymerase chain reaction mediated by a single primer: cloning of genomic sequences adjacent to a serotonin receptor protein coding region

Under appropriate conditions, specific double-stranded DNA product was generated after amplification of genomic DNA sequences in a polymerase chain-like reaction that contained only a single primer. This type of amplification reaction was performed with a variety of primers and substrate DNAs. In addition to nonspecific heterogeneous products, 5 of 11 primers reproducibly directed synthesis of double-stranded DNA that corresponded to the region of the template that contained the authentic primer annealing site. Three of these amplified products were cloned and their ends were sequenced. All three contained a copy of the primer at both 5' ends, and the position of one of the primers represented the authentic primer binding site. In each case, the location of the second copy of the primer indicated that it had initially hybridized to a partially homologous sequence in the template DNA. This single primer reaction makes it possible to amplify and clone a DNA region of unknown sequence that is adjacent to a known DNA sequence. One of the single primer reaction products described here included sequence to the 5' side of the coding region of a serotonin receptor gene that contained a functional promoter.

Transcriptional repression by YY1, a human GLI-Krüppel-related protein, and relief of repression by adenovirus E1A protein

A sequence within the transcription control region of the adeno-associated virus P5 promoter has been shown to mediate transcriptional activation by the adenovirus E1A protein. We report here that this same element mediates transcriptional repression in the absence of E1A. Two cellular proteins have been found to bind to overlapping regions within this sequence element. One of these proteins, YY1, is responsible for the repression. E1A relieves repression exerted by YY1 and further activates transcription through its binding site. A YY1-specific cDNA has been isolated. Its sequence reveals YY1 to be a zinc finger protein that belongs to the GLI-Krüppel gene family. The product of the cDNA binds to YY1 sites. When fused to the GAL4 DNA-binding domain, it is capable of repressing transcription directed by a promoter that contains GAL4-binding sites, and E1A proteins can relieve the repression and activate transcription through the fusion protein.

[Idiopathic retroperitoneal fibrosis causing obstructive uropathy: a case report]

Idiopathic retroperitoneal fibrosis leading to obstructive uropathy is a rare disease in our country, so a typical case deserves presentation. The patient is a 56-year-old female to have a clinical manifestation of obstructive uropathy. Retrograde pyelogram permitted 5 Fr. ureteral catheter to pass the stenotic segment. At the mean-time, there was hydronephrosis, medial deviation and gradual thinning and pointing of the middle segment of the ureter (classic triad). Computed tomography revealed that retroperitoneal soft tissue plaque enveloped aorta, inferior vena cava, and bilateral ureters. The patient received ureterolysis with ureter intraperitonealization and lateralization. The plaque was pathologically proved fibrosis. Renal function became normal postoperatively.

Neobladder construction using completely detubularized sigmoid colon after radical cystoprostatectomy

To improve the quality of life of the patient we used completely detubularized sigmoid colon for bladder reconstruction along with radical cystoprostatectomy in 6 men with invasive bladder cancer. Followup was 8 to 20 months. Postoperatively, all of the patients were continent during the day but only 4 (66.7%) were continent at night, although they had to awaken twice to remain dry. Neocystourethroscopy in 4 of the 6 patients revealed no tumor and no stricture at the urethrocolonic anastomosis. However, a stone in the neobladder was found in 1 patients. Urodynamic study of the neobladder showed a low pressure (mean 16.7 cm. water) at the filling phase of water cystometry and an adequate maximal urethral closure pressure (mean 52.0 cm. water) and functional profile length (mean 3.8 cm.). The uroflow rate in all patients was good (1 patient even had a maximal uroflow rate of 31 ml. per second). There was no reflux in any patient. One patient had intestinal obstruction 5 months postoperatively and died 5 months later of widespread metastasis. The remaining 5 patients are alive with a satisfactory quality of life. In conclusion, use of completely detubularized sigmoid colon may be an ideal operation for neobladder construction after radical cystoprostatectomy.

Prospective radionuclide renal function evaluation and its correlation with radiological findings in patients with Kock pouch urinary diversion

In an attempt to understand better the status of renal function after Kock pouch urinary diversion we conducted a prospective evaluation of renal function in 25 patients using the radionuclide 131iodine-hippurate. Studies were done before, and at 1 month and every 6 months for 30 months postoperatively. The radionuclide results were then compared to excretory urography and contrast study of the reservoir. Our renal function study included the determination of individual and total effective renal plasma flow (ml. per minute), the time to maximal radioactivity over the kidney (peak time in minutes) and a renogram. The mean total (both kidneys) effective renal plasma flow rates before (25 patients) and at month 1 (19), month 6 (14), month 12 (12), month 18 (6), month 24 (6) and month 30 (7) after operation were 385.5 +/- 112.2, 310.5 +/- 109.9, 362.7 +/- 69.2, 442.0 +/- 97.5, 468.2 +/- 82.5, 405.7 +/- 70.6 and 414.0 +/- 65.1, respectively. A comparison of individual and total effective renal plasma flow before and after operation revealed that only the change of the flow at each or both sides of the kidney before and at 1 month after the operation reached statistically significant differences, respectively (p less than 0.05, paired t test). Postoperatively 5 of 6 patients with hydronephrosis had abnormal peak time and a third segment on the renogram was performed on the corresponding side of the kidney. No reflux was noted on contrast study of the reservoir of any patient followed for up to 30 months. In conclusion, the radionuclide renal function evaluation showed a significant decrease of renal function 1 month after Kock pouch diversion, then it resumed and remained stable (neither improved nor deteriorated) for 30 months. Also the abnormal peak time and third segment on the renogram usually implicated a dilated upper urinary tract.

Comparison between histopathology and DNA histogram of testis

From January to July 1989, the DNA histogram of testicular open biopsies was done for 11 patients of primary infertility and 7 patients of a control group. There were 2 failures in these 36 specimens. The flow cytometric analysis revealed characteristic patterns in the relative numbers of haploid (1C), diploid (2C), and tetraploid (4C) cells. In the presence of normal spermatogenesis, the haploid compartment contained the majority of cells, followed by the diploid, and then the tetraploid (1C greater than 2C greater than 4C). The other diagnostic criteria of flow cytometry were as follows: hypospermatogenesis (2C greater than 1C greater than 4C), the maturation arrest (2C greater than 4C greater than 1C), and Sertoli-cell-only syndrome (2C, near 100%). According to the aforementioned diagnostic criteria, the results of DNA histograms were compared with the histopathology diagnosed by junior or senior pathologists. These patterns of DNA histograms correlated with the diagnoses by senior pathologists in 28 of 34 specimens (82.6%), while there were only 20 of 36 pathologic diagnoses (55.6%) which matched between junior and senior pathologists. It is shown that abundant experience is needed for testis pathologists to diagnose accurately. The DNA histograms correlate well with pathological findings, with the advantages of quantification and fewer specimens needed. In conclusion, testicular tubular cell DNA histograms appear to be a reliable modality in the evaluation of spermatogenesis. They provide the quantitative information of sperm maturation and help in making appropriate decisions in the management of male infertility.

A convenient method to differentiate the monoclonal antibodies with differing immunochemical properties

Three monoclonal antibodies (mAbs) against Naja naja atra phospholipase A2 (PLA2) were prepared by hybridoma technique. Of which two mAbs, 1E531 and 5F92 inhibited the enzymatic activity of PLA2, but 5F6F10 did not. 1E531 and 5F92 nearly exhibited the same binding patterns which was different from that observed with 5F6F10 toward the chemically modified derivatives and homologous variants of PLA2 as revealed by enzyme immunoassay. This suggests that, based on the results of comparative analysis on their relative reactivity with modified derivatives and PLA2 homologues, the mAbs with different immunochemical properties could be differentiated.

The incidence and prognostic significance of humoral hypercalcemia in renal cell carcinoma

This retrospective study was conducted to evaluate the incidence and prognostic significance of humoral hypercalcemia in 218 renal cell carcinoma patients during the last 20 years. Of 218 patients 20 (9.2%) were hypercalcemic, with serum calcium levels ranging from 10.7 to 16.0 mg./dl. The respective incidence of humoral hypercalcemia was 3% in patients with stage I, 5.9% with stage II, 14.1% with stage III and 18.9% with stage IV disease without bone metastasis. The survival curves between the hypercalcemic and eucalcemic groups among stages I to III cancer patients showed no statistical significance (p greater than 0.05). The survival curve deteriorated significantly in stage IV cancer patients with humoral hypercalcemia (p less than 0.005), with a median survival of 45.0 +/- 39.7 days versus 286.4 +/- 27.6 days in eucalcemic patients. No specific correlation was found between pathological cell type and humoral hypercalcemia.

Repressed expression of the HER-2/c-erbB-2 proto-oncogene by the adenovirus E1a gene products

The E3 region of adenovirus induces down-regulation of epidermal growth factor receptor (EGFR) through endocytosis. Here we report that an EGFR-related protein, the HER-2/c-erbB-2 gene product, p185, is also down-regulated by adenovirus, but via a different mechanism. We found that the adenovirus E1a gene is responsible for the repression of HER-2/c-erbB-2 at the RNA level.

Stone incrustation: a relevant complication of the intraprostatic spiral

Six high operative risk patients with urinary retention caused by benign prostatic hyperplasia were managed with an intraprostatic spiral at our hospital. Three of them had severe coronary artery disease, 1 had uremia, 1 had cerebral stroke and 1 had poorly controlled diabetes mellitus. The urinary retention was successfully relieved by the intraprostatic spiral in all patients. No operative mortality or severe complication was encountered. One patient experienced a repeat attack of urinary retention due to proximal migration of the spiral. Four patients complained of urgency, which was relieved by anticholinergic agents. Stone incrustation was found on 2 out of 3 spirals removed (66%), and the stone turned out to be calcium phosphate and struvite by scanning electron microscopy and infrared spectrophotometry. In 1 patient, stone formation was so abundant that it almost obstructed the lumen of the redundant tip of the spiral. From our preliminary results, the intraprostatic spiral seems to be a good alternative to an indwelling catheter for patients awaiting prostatectomy. Nevertheless, the potential complication of stone incrustation should be anticipated and it is suggested to remove the device as soon as possible or to replace it at regular intervals.

Venom constituents of Notechis scutatus scutatus (Australian tiger snake) from differing geographic regions

Column chromatography and polyacrylamide gel electrophoresis of Notechis scutatus scutatus venom showed that the venoms from different geographical locations had variations in their constituents. The venom collected from South Australia region contained both notexin and notechis II-5. The relative quantity of notechis II-5 was about three times that of notexin. On the other hand, the venom from Victoria region contained large amounts of notexin, but lacked notechis II-5. Instead, an unknown nontoxic protein, designated as notechis II-5b, exhibiting weak phospholipase A2 activity appeared in the position of notechis II-5 elution. This protein had an N-terminal sequence of N-L-I-Q-L-S-N-M-I-K-C-A-I-P-G-S-Q-P-L-F, sharing 45% homology with notexin and notechis II-5 and 60% homology with notechis II-1. The antibodies raised against Trp-modified notexin inhibited the enzymatic activities of notexin and notechis II-5 by 88 and 68%, respectively. However, the affinity of notexin for the antibodies was nine-fold greater than that of notechis II-5. This result is contrary to the previous finding (Mollier et al., FEBS Lett. 250, 479-482, 1989) in which notexin and notechis II-5 had similar binding affinities for antibodies raised against native notexin. This observation suggests that the antibodies prepared in this study could differentiate between isoforms of notexin.

Serum iron as a tumor marker in renal cell carcinoma

To evaluate the feasibility of using serum iron as a tumor marker for renal cell carcinoma, a retrospective review of serum iron, hemoglobin, hematocrit, mean corpuscular volume and pathology in patients with renal cell carcinoma was carried out. From January 1985 to December 1989, preoperative serum iron was obtained in 82 patients; 27 had stage I, 5 stage II, 23 stage III and 27 had stage IV disease. The serum iron levels (micrograms/dl) were 81.6 +/- 33.2 in stage I, 57.8 +/- 18.9 in stage II, 59.6 +/- 34.6 in stage III and 45.6 +/- 32.7 in stage IV disease, which were significantly lower as compared with the data (114.6 +/- 38.9) of a control group. Postoperative serum iron levels were available in 31 patients following nephrectomy and all showed an increase as compared with preoperative data except 2: 1 with recurrence and the other with progression of disease. It was concluded that the serum iron level may be used as a useful tumor marker in staging and follow-up of renal cell carcinoma.

Experience with percutaneous nephrostomy, extracorporeal shock wave lithotripsy and chemolysis in the treatment of obstructive uric acid stones

Intravenous pyelography (IVP), retrograde ureteral catheterization and percutaneous nephrostomy (PCN) have been used to locate radiolucent stones during ESWL in an X-ray localization system lithotripter. We also used an alternative method combining PCN, ESWL and chemolysis to treat 8 obstructive uric acid stones. The average number of shock wave pulses was 1,725 (range 1,000-2,000), the generator voltage of the HM-3 Dornier lithotripter was 20-22 kV, and the local chemolysis lasted 4 days (range 2-7). All radiolucent uric acid stones were successfully disintegrated. Of the 8 patients treated, 5 were completely free of stones and the other 3 had insignificant residual stones after 3 months. Three patients who developed fever during local chemolysis with 0.1 M sodium bicarbonate solution were managed conservatively without severe sequelae. Only 1 patient retained a PCN tube after discharge. Because PCN can provide a path for local chemolysis and better localization, it is especially helpful in treating obstructive uric acid stones.

Incidental adenocarcinoma of the prostate: a retrospective analysis

Between January 1980 and June 1990, 5875 patients underwent either TURP (5,529) or open prostatectomy (346) for the management of benign prostatic hyperplasia. Incidental carcinoma was identified in 53 patients (0.9%) - 49 in the TURP group and 4 in the open prostatectomy group. The overall incidence of stage A prostate carcinoma during the same period was 13.1% (53/406). Of those 50 regularly followed patients, only 6 (12.0%) underwent subsequent radical prostatectomy with pelvic lymphadenectomy, and residual tumors were identified in 4 patients (66.7%). The progression rate was 33.3% (3/9) in high-grade tumors (Gleason's score greater than 6) and 7.7% (2/26) in low-grade tumors (Gleason's score less than 5). In those 50 patients, 41 (82.0%) presented no evidence of disease and 9 (18.0%) stayed alive with progression. The mean length of follow-up was 34 months (range: 2-108 months). Our study demonstrates that the outcome of incidental carcinoma of the prostate is good. However, the residual tumor rate still remains high at 66.7%. Radical prostatectomy is recommended in young patients or in patients with high grade tumor.

Factors influencing radiation exposure during the extracorporeal shock wave lithotripsy

A prospective evaluation of 89 consecutive sessions of extracorporeal shock wave lithotripsy (ESWL) was undertaken to try and find the best way of minimising the amount of exposure to radiation. Forty-two patients were randomly allocated to undergo ESWL treatment by experienced surgeons (group A), and 47 to undergo the treatment by inexperienced surgeons (group B). The mean calculated entrance radiation exposure was 3.01 rads (group A: 2.64 (0.97) rads, range 1.00-4.48, group B: 3.38 (0.86) rads, range 1.11-5.75). Among factors that influenced radiation exposure, the tissue: air ratio should be borne in mind and the level of skill in controlling movement of gantry was the most important in reducing the exposure to radiation.

Penile brachial index in impotent patients with coronary artery disease

From March to July 1989, a total of 40 patients, who had received coronary catheterization, answered questionnaires concerning sexual potency. In those 30 patients with a diseased coronary artery, only 2 (6.6%) had no erectile dysfunction subjectively. On the contrary, 4 of 10 (40%) patients with angiographically proven normal coronary artery complained of erectile dysfunction. Penile Doppler ultrasonography was performed in 30 patients. The mean penile brachial index (PBI) of 8 patients with a normal coronary artery was 0.82 +/- 0.1, as compared with the diseased group, 0.73 +/- 0.1 (p = 0.05). When these patients were further divided into two groups by a PBI of greater or less than 0.65, there was also no significant difference in the degree of obstruction of the three main coronary arteries between these two groups. There was no correlation between PBI and obstruction of the left anterior descending artery (r = 0.316, p = 0.689). Most of the patients (93.4%) with an abnormal coronary artery had erectile dysfunction. Nevertheless a poor correlation was noted between the PBI and the severity of coronary artery obstruction. Our study suggests that it is hard to use PBI alone as a predictor of future major thromboembolic heart attack.

Retroperitoneal abscesses

Abscesses developing within the retroperitoneal spaces are complicated serious surgical infections marked by an insidious, occult process lead to considerable mortality and morbidity. In a retrospective review of 39 retroperitoneal abscesses in our hospital. Attention is directed to clinical presentation, diagnosis and treatment. On average, 19.2 days was required to establish the diagnosis and overall mortality is 7.7%. Two patients suffered from complications of discharged sinus and recurrent abscess respectively. Computed tomography (CT) is thought to be the best diagnostic modality of retroperitoneal abscesses. Only 2 patients (5.3%) shows bilateral lesions. Detailed anatomic reviews detailing the pathogenesis of bilateral retroperitoneal abscess are also discussed.