Successful trachelectomy and re-vaginoplasty for cervico-vaginal stenosis following unsuccessful uterovaginal anastomosis and vaginoplasty in congenital cervical and vaginal aplasia: description of technique and a case report

We describe a successful surgical technique of abdominal trachelectomy and re-vaginoplasty for cervico-vaginal stenosis following unsuccessful uterovaginal anastomosis and vaginoplasty in a patient with congenital cervical and vaginal aplasia. After the surgical procedure, cervico-vaginal stenosis was resolved and periodic menstruation without dysmenorrhoea resumed. While long-term follow-up is essential to ensure successful pregnancy and delivery, we conclude that this novel surgical procedure is a promising alternative for improvement of the quality of life and normal sexual function, and for preservation of fertility in patients with cervical and vaginal aplasia.

Erratum: Structural and Valence Changes of Europium Hydride Induced by Application of High-Pressure H_{2} [Phys. Rev. Lett. 107, 025501 (2011)]

This corrects the article DOI: 10.1103/PhysRevLett.107.025501.

Magnetic Compton scattering studies of magneto-dielectric Ba(Co0.85Mn0.15)O3-δ

We revealed that the Ba(Co_0.85Mn_0.15)O_3-δ ceramic samples exhibited ferromagnetic-dielectric behavior below the magnetic transition temperature of about 35 K. The origin of their magnetic ordering was expected to super-exchange coupling of Co⁴⁺(d⁵)-O^2--Mn⁴⁺(d³) with bonding angle of 180° and/or Mn⁴⁺(d³)-O^2--Mn⁴⁺(d³) with bonding angle of 90°. The magnetic spin momentum estimated by the magnetic Compton profiles (MCP) of the samples had similar temperature dependence as that determined by the temperature dependence of magnetic moment by superconducting quantum interference device, which meant that the observed magnetic moments could be ascribed to the spin moment. The shapes of the MCPs of the samples were completely same regardless of the temperature measured. This result indicates that there are no changes of the momentum space distribution of spin density between ferromagnetic and paramagnetic states. So, this magnetic transition is simply caused by a thermal fluctuation of the spin.

Structural and valence changes of europium hydride induced by application of high-pressure H₂

Europium hydride EuH(x), when exposed to high-pressure H₂, has been found to exhibit the following structural and valence changes: Pnma(x = 2, divalent) → P6₃/mmc(x = 2, 7.2-8.7 GPa) → I4/m(x > 2, 8.7-9.7 GPa) → I4/mmm(x > 2, 9.7 GPa-,trivalent). With a trivalent character and a distorted cubic fcc structure, the I4/mmm structure is the β phase commonly observed for other rare-earth metal hydrides. Our study clearly demonstrates that EuH(x) is no longer an irregular member of the rare-earth metal hydrides.

Analysis of prognostic factors with cervical squamous cell carcinoma after neoadjuvant chemotherapy

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Background: The purpose of the study was to evaluate retrospectively the clinical effects of neoadjuvant chemotherapy (NAC) given to women with cervical squamous cell carcinoma using the response rates, prognostic parameters, and diagnostic imaging data (CT scan or MRI). Methods: Patients included in the study were 32 women with a mean age of 48.8 ± 10.6 who had stage Ib-IIIb cervical squamous cell carcinoma and was treated initially with platinum-based NAC prior to surgical intervention at our institution between 1994 and 2003. The response rates in these patients were assessed, and a statistical analysis was performed to evaluate the effects of NACT on survival rates and disease recurrence using the following 9 parameters: 1. clinical stage of cancer, 2. lymph node metastasis, 3. blood vessel invasion, 4. parametrial involvement, 5. depth of stromal invasion, 6. tumor diameter, 7. pre- and post-treatment serum levels of the squamous cell carcinoma antigen, 8. age, and 9. rates of response to NAC. CT scan or MRI obtained prior to and after NAC were compared and evaluated for any evidence of lymph node metastasis. Results: Five and 18 patients achieved complete response (CR) and partial response (PR), respectively, with a response rate of 71.8% for these CR and PR patients. A multivariate analysis revealed that lymph node metastasis was the only independent prognostic parameter for survival rates and disease recurrence. In 13 patients in whom lymph node metastasis was found by the was found by the CT scan or MRI prior to NAC, 8 (61.5%) still showed the evidence of metastasis after treatment. Among these, 7 (87.5%) actually had metastatic lymph nodes. In addition, the occurrence of lymph node metastasis was unrelated to rates of response to NAC. Conclusions: The rates of response to NAC dose not predict prognosis in patients with cervical squamous cell carcinoma. The occurrence of lymph node metastasis is unrelated to rates of response to NAC. If metastatic lymph nodes are suspected after NAC, appropriate treatment approaches should be well considered in such patients.

No significant financial relationships to disclose.

Staphylococcal scalded skin syndrome I. Purification of exfoliatin and maternal transmission of neutralizing ability against exfoliatin

Exfoliatin, an exotoxin produced by phage group 2 staphylococci, was separated and was analyzed. The toxin was separated in a single peak by Sephadex G-100 gel filtration and subsequent DEAE Sephadex chromatography. By acrylamide gel disc electrophoresis this single peak was found to contain 2 components both of which posessed exfoliative activity and the same antigenic properties. Their molecular weight, however, differed; the major component had a molecular weight of 30,000 and the minor component had 27,000. The toxin was stable when heated at 60 degrees C for 40 minutes, and labile at 100 degrees C for 20 minutes. The toxin was immunogenic to mice and produced antibody which could be transmitted to neonatal mice to neutralize exfoliative activity of the toxin. Innoculation of the bacteria caused the production of antibodies against both exfoliatin and alpha-hemolysin in mice. The antibodies were also transmitted to neonatal mice to neutralize the exfoliative activity of exfoliatin.

Staphylococcal scalded skin syndrome. II. Serum level of anti exfoliatin and anti alpha-toxin in patients with staphylococcal scalded skin syndrome or bullous impetigo

In order to study the differences between staphylococcal scalded skin syndrome (SSSS) and bullous impetigo, the anti exfoliatin level was assessed in the sera from both groups of patients, and no significant difference in the level was found. However a significant difference was noted in the anti alpha-toxin levels in sera from both group of patients; that of SSSS patients was much lower than that of impetigo patients and of children in a control group. Five out of 6 patients with SSSS showed an unchaged level of anti alpha-toxin at the second examination, while an increased anti exfoliatin level was noted in 4 out of 6 SSSS patients.

Pindolol potentiates the effect of fluoxetine on hippocampal seizures in rats

Recent studies have shown that behavioral and neurochemical changes induced by selective serotonin (5-HT) reuptake inhibitors such as fluoxetine are potentiated by coadministration of a 5-HT1A receptor antagonist. The present study assessed the effects of concomitant administration of fluoxetine and a 5-HT1A receptor antagonist, pindolol, on focal hippocampal (HIP) seizures elicited by electrical stimulation in rats. A 10 mg/kg dose of fluoxetine, which was ineffective by itself, produced a significant increase in the afterdischarge threshold of HIP seizures when combined with pindolol at 10 mg/kg. The inhibitory effect of this combination was eliminated by pretreatment with parachlorophenylalanine, a depletor of brain 5-HT. These findings suggest that treatments designed to increase 5-HT neurotransmission inhibit the generation of HIP seizures. A combination of fluoxetine with a 5-HT1A receptor antagonist could thus be therapeutically useful for the treatment of depressive symptoms in patients with epilepsy.

[Renal cell carcinoma detected by metastasis to the frontal sinus: a case report]

A 58-year-old man was admitted with a swelling in the frontal region. Computerized tomography scan, magnetic resonance imaging and angiography revealed a tumor in the right frontal sinus. The surgically extirpated specimen showed clear cell carcinoma which was suspected to be a metastasis from renal cell carcinoma. Subsequent urologic examination disclosed the right renal tumor. Since there were no other systemic metastases, right nephrectomy was performed. Pathologically, the renal tumor was clear cell subtype renal cell carcinoma and had the same histology as the frontal sinus tumor.

A case of adenosine-sensitive ventricular tachycardia in a very elderly male

The best-known type of adenosine-sensitive ventricular tachycardia is idiopathic and of right ventricular outflow origin; however, there is little information about other types of adenosine-sensitive ventricular tachycardia. Idiopathic adenosine-sensitive ventricular tachycardia is common in the young. An 87-year-old man with ventricular tachycardia was admitted to our hospital. His ventricular tachycardia was sensitive to adenosine triphosphate, edrophonium, verapamil, and Valsalva's maneuver. He had experienced no anginal episodes. His ventricular tachycardia was thought to be idiopathic. We report this very rare case of adenosine-sensitive ventricular tachycardia, which was not derived from the right ventricular outflow tract, in a very elderly male.

Neurofibromatosis complicated with XXX syndrome and renovascular hypertension

A 25-year-old woman with neurofibromatosis was admitted to our hospital for evaluation of hypertension. When she was 6 years old, she was diagnosed as having neurofibromatosis and XXX syndrome because of multiple café-au-lait spots, neurofibromas of the skin and mental retardation. Chromosome analysis revealed that her karyotype was 46, XX/47, XXX. Renal arteriography disclosed aneurysmal change and stenosis of the right renal artery. After right-side nephrectomy and aneurysmectomy, the kidney was autotransplanted in the left iliac fossa. Surgical procedure resulted in marked amelioration of the hypertension without medical treatment. Thus, aortorenal bypass and renal autotransplantation have emerged as the preferred revascularization operations. This is the first report of a chromosomal linkage between neurofibromatosis which is thought to be an autosomal dominant disease and the XXX syndrome.

[Random biopsy and recurrence risk in patients with bladder cancer]

BACKGROUND

We studied the relationship between the recurrence rate of primary superficial bladder cancer and random biopsy.

METHODS

We performed transurethral resection of primary superficial bladder cancer in 144 patients, and in 55 of those cases a random biopsy was also performed. The non-recurrence rate was examined in many recurrence facters.

RESULTS

The non-recurrence rate in the group with random biopsy was not significantly different from that observed in the group (100 patients) without random biopsy (chi 2 test, Generalized Wilcoxon test and multivariate analysis). Because the intravesical instillation therapy is an important inhibition factor in the recurrence rate of the primary superficial bladder cancer, we further analysed the recurrence rate in two non treated groups with or without random biopsy (13 and 35 patients respectively). No significant difference in the rate of recurrence between the two groups was observed. However, we noted recurrence of bladder cancer at biopsy positions in 8/13 patients.

CONCLUSION

It appears that random biopsy may have an effect on the recurrence or the implantation of tumor cells. Further studies are needed to clarify whether random biopsy is a risk factor in the recurrence rate of primary superficial bladder cancer.

[A study of testicular tumor on magnetic resonance imaging]

Magnetic resonance imaging (MRI) was performed on 13 testes of 12 patients with testicular abnormalities. In all cases, scrotal palpation and initial clinical course had suggested malignant testicular tumors. The normal testes showed homogeneous intermediate signal intensity on T1-weighted images and high signal intensity on T2-weighted images such as the appearance of the corpus cavernosum penis. Ten patients proved to have testicular tumors. In eight of them, the tumors showed homogeneous intermediate signal intensity on T1-weighted images, while in the other two, these images showed heterogeneous signal intensity. In four patients, tumors were of homogeneous low signal intensity on T2-weighted images, while in the other six, these images showed heterogeneous signal intensity. The rate of correspondence about local staging of testicular tumor between MRI and pathological diagnosis was 70 percent. In three patients whose testes were undoubtedly malignant according to clinical findings and examination data, MRI enabled us to diagnose one case of testicular atrophy. However, MRI suggested benign disease in the other two patients; nevertheless, surgery was performed as indicated by the other findings.

Administration and dosage of iohexol, a nonionic contrast medium, for dynamic renal computed tomography

We investigated the optimal method of administering iohexol, which contains 300 mg iodine/ml (Omnipaque 300), a nonionic contrast medium, to maintain adequate renal contrast while reducing artifacts during dynamic CT scanning. In this study, 76 patients with renal disease received 10-50 ml of iohexol as follows: group I (14 patients), 20 ml injected as an intravenous bolus for 5 sec, followed by 30 ml intravenous drip infusion for 5 min; group II (18 patients), bolus of 20 ml injected for 5 sec; group III (13 patients), 20 ml diluted with sterile water (total volume 40 ml), and injected as a bolus for 8 sec; group IV (15 patients), 20 ml injection for 5 sec followed by intravenous drip infusion of 200 ml of Hartmann-Ringer's solution given at maximum speed; and group V (14 patients), 10 ml diluted with sterile water (total volume 20 ml) injected as a bolus for 5 sec. We found that corticomedullary differentiation was most distinct on the images obtained from group IV. We concluded that a lower concentration of iohexol (150 mg iodine/ml) given by intravenous fluid loading can provide superior CT images.

Renal cortical scarring in acute pyelonephritis

A series of 14 patients with acute pyelonephritis was evaluated for the formation of renal scarring by serial computed tomography (CT) and intravenous urography. Although the urography results were normal, CT showed renal parenchymal atrophy (cortical scarring) in 6 patients. Cortical scarring was observed to occur after 61 to 187 days, and it was slower to develop in the patients with recurrent fever lasting for 2 weeks or more in total than in those with fever for less than 2 weeks. Scarring was significantly more frequent in patients with severe renal involvement than in those with mild involvement, and scars developed at the sites of the most extensive lesions seen on the initial CT scans. Cortical scars were detected in 6 of the 7 patients in whom the lesions occupied 30% or more of the renal parenchyma. We conclude that the extent of the initial renal parenchymal involvement was the most important determinant of eventual scar formation.

Phosphatidylinositol and inositolphosphatide metabolism in hypertrophied rat heart

The accumulation of both Inositol-(1,4,5)-trisphosphate (IP3) and Inositol-(1,3,4,5)-tetrakisphosphate (IP4) after hormonal stimulation has a physiological role, possibly in altering Ca2+ levels in cardiac tissue. However, the accumulation of inositol polyphosphate under pathophysiological conditions has not been studied. In our experiments the metabolism of phatidylinositol and IP3 in cardiac myocytes as investigated. It was shown that basal levels of cytosolic phosphatidylinositol specific phospholipase C (PI-PLC), phosphatidylinositol-(4,5)-bisphosphate specific phospholipase C (PIP2-PLC) activities markedly increased in stroke-prone spontaneously hypertensive rats (SHRSP) with age compared with age matched Wistar Kyoto rats (WKY). IP3 kinase and IP3 phosphatase activities also increased in SHRSP hearts with age. Their activities increased in WKY, but to a lesser extent than in SHRSPs. These data suggest that a PI turnover pathway such as the phosphatidylinositol 4,5-bisphosphate-IP3-Ca2+ pathway or the diacylglyceride-protein kinase C pathway may have an important role in the development of hypertrophy in SHRSP heart.

[Upper urinary tract obstruction diagnosis and treatment of congenital hydronephrosis in children]

Twenty nine children under 2 years old with congenital hydronephrosis have been treated in the last 14 years in our department. We report 4 cases which we found difficult to diagnose and treat. The diagnosis and the treatment of congenital hydronephrosis in children are discussed, especially concerning those patients under the age of 2 years. Pyeloplasty has been performed in 28 renal units out of 35 renal units. The results of the procedure were good in 82.1%, fair in 10.7%, no change in 3.6% and a lost case in 3.6%. The Aderson-Hynes dismembered technic was employed except for one renal unit in which the extrarenal pelvis was resected. Hydronephrosis in two renal units and one with nephrostomy for one year and one month improved spontaneously. Endopyelotomy was performed in 2 renal units and will be performed in one renal unit. Nephrectomy was carried out in one renal unit with renal dysplasia. A kidney with dysplasia excreted urine of several ml/day. Post-enhanced-X-ray computed tomography and T1-weighted image of magnetic resonance presented loss of function in the kidney. Degree of stenosis, position of stenosis and function of pelvis and ureter were different in each child. Children are constantly growing up and the condition of stenosis was changed in some cases. In conclusion, we should estimate the stenosis in children using several examinations.

A new technique of ureteric catheterization

Insertion of an indwelling stent catheter or ureteric catheterization using a new guide wire (the Radiofocus guide wire) was carried out in a total of 24 subjects. The subjects comprised 16 patients in whom insertion of a conventional guide wire and ureteric catheter was not possible due to previous use of an indwelling stent catheter for extracorporeal shock-wave lithotripsy (ESWL), 2 cases in whom a conventional guide wire could not be inserted due to post-ESWL formation of a stone street, 4 patients with ureteric stenosis and 2 patients with normal ureters in whom catheterization was impossible by the usual methods. Insertion of a Radifocus guide wire into the renal pelvis was successfully accomplished in all 24 cases and an indwelling catheter could be passed in 21 cases. These results suggest that the Radifocus guide wire should make a useful contribution to ESWL therapy. It can also be applied to retrograde pyelography, ureteric obstruction, and the dilation of ureteric stenosis.

Computerized tomography in acute pyelonephritis: the clinical correlations

Computerized tomography was performed on 19 patients diagnosed as having uncomplicated acute pyelonephritis. The relationship was investigated among the laboratory findings, presence of flank pain, clinical course and severity of the lesions detected by computerized tomography. In patients febrile for less than 2 weeks healing as assessed by computerized tomography took an average of 76 days. However, in patients with repeated febrile episodes occurring for longer than 2 weeks healing was delayed until an average 232 days after onset. Computerized tomography findings generally correlated well with the erythrocyte sedimentation rate, C-reactive protein level, and presence of pyuria and flank pain. However, in patients with a prolonged course computerized tomography proved to be a more reliable indicator of progress than either the results of laboratory tests or the symptoms. In conclusion, computerized tomography was useful in the diagnosis, assessment of severity and evaluation of healing of acute pyelonephritis.

[A study on accumulation of cholesterol in rat prostate]

An experimental model of prostatic hypertrophy was created by freezing the urethra at the opening of the ventral prostate in rats and administering a cholesterol-rich diet to induce cholesterol accumulation. Four-week-old Fisher rats were divided into a control group, a cholesterol-rich diet group (by adding 1% cholesterol to the diet), a frozen group, and a frozen and cholesterol-rich diet group, and were reared for 5 months. The animals were killed, and the ventral prostate was removed, weighed, and the lipid was extracted. Cholesterol content was measured by an enzymatic method. A cholesterol-rich diet without freezing had no effects on the ventral prostate, and after freezing alone, the weight of the prostate was smaller than that of the control group. However, in the group cholesterol-rich diet after urethral freezing, the cholesterol content per mg of tissue increased. This indicates that cholesterol accumulation can be induced in the prostate by administering a cholesterol-rich diet after creating the proper secretory disturbance.

Lack of evidence for existence of vitamin D and 25-hydroxyvitamin D sulfates in human breast and cow's milk

The presence of water-soluble vitamin D and 25-OH-D sulfates in human breast and cow's milk was studied. We first confirmed that synthetic vitamin D2 and D3 sulfates could not be hydrolyzed by alkali but by acid. Breast or cow's milk was separated into milk whey containing water-soluble components and milk curd containing crude proteins and lipophilic components. The separated milk whey and curd were hydrolyzed by acid or alkali and each lipid extract was subjected to HPLC analysis. Neither peak due to vitamin D and 25-OH-D was observed in the chromatograms of acid- and alkali-hydrolyzed milk whey, whereas the peaks due to vitamin D3 and 25-OH-D3 were found in the chromatograms of both acid- and alkali-hydrolyzed milk curd and there was no significant difference between the respective peak heights. The eluates corresponding to the respective peaks observed on the latter's chromatograms were collected and subjected to UV, HPLC, GC-MS and GLC to identify the existence of vitamin D3 and 25-OH-D3, respectively. We concluded from these results that neither breast nor cow's milk contained water-soluble vitamin D and 25-OH-D sulfates, whereas they contained fat-soluble vitamin D3 and 25-OH-D3. The concentrations of vitamin D3 and 25-OH-D3 in breast milk were about 125 and 350 ng/liter, while those in cow's milk were about 420 and 270 ng/liter, respectively. The experiments on the transfer of 3H-D3 and 3H-25-OH-D3 perorally dosed to lactating rats into suckling pups through their milk also supported the above conclusion.

[Fungal urinary infection: report no. 1]

Clinical studies were performed on 115 fungal strains isolated from the urine of 36 patients. The predisposing factors were fungal urinary tract infections, antibiotics and indwelling catheter. Forty five strains of the 115 strains were Candida albicans, the most prevalent, followed by 25 strains of C. tropicalis and 22 strains of Trichosporon beigelii. Species of Torulopsis were rare, only 5 strains were isolated. Sixty strains (56%) co-existed with bacteria in urine. The co-existing bacteria most frequently isolated were Pseudomonas and Streptococcus. The minimum inhibitory concentration (MIC) of 5-FU was measured using the Bact-Morphology Agar medium. C. albicans, C. guillermondii, and Torulopsis glabrata showed an excellent MIC (under 0.78 microgram/ml), C. tropicalis, C. parapsilosis, T. beigelii, and T. cutaneum showed a poor MIC (over 100 micrograms/ml).

The treatment of bladder cancer by neothramycin

Neothramycin (NTM), an anthramycin-group anticancer antibiotic, was used in the treatment of superficial carcinoma of the bladder. NTM was instilled into the bladder in the following dosages. Ten mg NTM in 20 ml of sterile distilled water was given first, and increased to 40 mg in 20 ml. This procedure was performed every second week to twice a day. Recently, in 2 patients, the treatment has been combined with 20 mg NTM intravenous administration. In 4 of the 11 patients (36%) the tumors disappeared completely, while in 6 patients (55%) there was partial disappearance of more than 50% and in one patient (9%) there was no effect. Three of the patients had irritable bladder symptom (temporarily). NTM was concluded to be effective for superficial carcinoma of the bladder.

[Silicone pig-tail catheter for the upper urinary tract]

Experience with pig-tail designed silicone rubber catheter for upper urinary tract is reported. There are several sizes of catheter: the small size (5, 6 F) is adequate for cystoscopic ureteral stenting, and the large size (8-14F) is suitable for the purpose of urinary diversion e.g. nephrostomy, cutaneostomy. In cases of long-term indwelling catheter like nephrostomy and cutaneostomy, there were some advantages; remarkably decreased frequency of catheter exchange, and prevention and/or treatment of dermatitis around the urostoma with Varicare system II. As a splint catheter after urinary tract surgery e.g. pyeloplasty, ureteroplasty, pyelolithotomy, the catheter was excellent.

[Pharmacokinetic study of cefmenoxime concerning its transfer into tissues]

Cefmenoxime (1 g) was intravenously administered by one shot to investigate its pharmacokinetic profile with respect to transfer into the kidney, vesical wall and prostatic adenoma. The concentration of cefmenoxime in the kidney reached a peak of 403 micrograms/g at 0.17 hour after administration. The biological half-life was 0.74 hour. In the vesical wall, the level of cefmenoxime reached a peak of 28 micrograms/g at 0.67 hour after administration. The half-life was 2.30 hours. The peak level of cefmenoxime in the prostatic adenoma was 22 micrograms/g at 0.39 hour after administration. The half-life was 2.90 hours. The concentrations of cefmenoxime in these urogenital tissues were higher than its MIC80 and MBC80 against various Gram-negative organisms.

[Statistics on outpatients and inpatients at the urological department of Kosei Hospital 1975-1982]

Statistical observations of 19,678 outpatients and 2,601 inpatients at our department from 1975 to 1982 revealed the following results. The new cases in the outpatient clinic were in decreasing order nonspecific infections (50.8%), urogenital tumors (11.9%), urolithiasis (9.3%) and urogenital anomalies (8.0%). The inpatients according to the organ were in decreasing order kidney (29.6%), prostate (25.5%), bladder (13.4%) and ureter (11.9%). Operations were performed 2,414 times. Frequent operations were in decreasing order phimosectomy (360 times, 14.9%), TUR-Bt (284 times, 11.8%), transurethral cryosurgery of the prostate (215 times, 8.9%), vasectomy (190 times, 7.9%) and orchiopexy (152 times, 6.3%). More young persons comprised the outpatients of our hospital than at other facilities.

[Combination (RaHPP) of radiotherapy, hyperthermia and chemotherapy (peplomycin and picibanil) for bladder cancer]

Four patients with urinary bladder carcinoma were treated by combination therapy which consisted of hyperthermia vesical irrigation of two anticancer drugs (peplomycin and picibanil), intravesical instillation of those drugs and radiation. Following the therapeutic method we planned, 40 mg of peplomycin and 10 KE of picibanil in 1,500 ml of sterile distilled water was irrigated at 42 to 43 degrees C into the bladder for 3 hours; 40 mg of peplomycin and 10 KE of picibanil in 40 ml of sterile distilled water was instilled into the bladder; and, the focus was irradiated with 60Co to a focal dose of 200 rad 30 minutes later. This pattern of treatment was repeated once a week, 3 to 5 times in total. On the days this pattern was not taken, 5 KE of picibanil in 20 ml of sterile distilled water was instilled into the bladder cavity. Complete response was observed in one patient and partial response in 3 patients. The side effect was temporary irritable bladder symptom.

[Clinical evaluation of dynamic renoscintigraphy using 99mTc-DTPA in practical urology. I. Diagnosis of ureteral calculi, cystic kidney and hydronephrosis]

Clinical usefulness of the renoscintigraphy using 99mTc-DTPA in practical urology was investigated for two years. 99mTc-DTPA injection and injectable preparation kit (supplied by Nihon Medi-Physics Co.) were used. The dynamic blood flow of the renal parenchyma could be detected from serial images and curves on the perfusion phase. Information of clear nephrogram and function of the upper urinary tract could be obtained from serial images and renogram. Separate and total renal function could be evaluated. This method of examination is evaluated as very safe, because no side effects were produced and radiation dose is low. This examination may be a useful tool and the first choice in practical urology.

[Experience using the laser rod in urological surgery]

The clinical use of a new surgical tool the "Laser Rod" is presented. This rod is made of ceramics and utilizes a neodymium-doped yttrium aluminum garnet (Nd-YAG) laser. With the Laser Rod, the surgeon can cut tissue by mechanical contact and still feel the resistance from the target tissue. In this study, this device has been used in various urological surgical procedures, such as nephrolithotomy, retropubic prostatectomy, ileocecal conduit diversion, urethroplasty and circumcision of the penis. Our results showed that laser surgery using this device, enables bloodless incision with minimal damage to adjacent tissue. In conclusion, the Laser Rod will probably be very useful in urological surgery, and its indications should be expanded through further study.

[Clinical evaluation of Claforan (CTX) in aged patients with chronic complicated urinary tract infections]

Claforan (CTX) was administered for 5 days at a daily dose of 4 g in two divided doses by intravenous injection to 18 in-patients, all of whom were over 70 years old and had chronic complicated urinary tract infections. The overall clinical efficacy of CTX was excellent in 4 cases, moderate in 8 cases and poor in 6 cases, the overall effectiveness rate being 66.7%. Twenty seven out of 34 organisms isolated from chronic complicated urinary tract infections before administration of CTX were eradicated after treatment. Both clinical findings and laboratory findings revealed no side effects. It is suggested that CTX is useful and a safe drug for elderly patients.

[On the clinical effects of cefotiam on acute cystitis and changes in form of E. coli in the urine]

Cefotiam (CTM) was administered to female patients suffering from acute cystitis to examine its clinical efficacy and changes in form of the bacteria in urine. CTM was administered to 15 female patients with acute cystitis once a day for three consecutive days (1 g/time in 13 cases, and 0.5 g/time in 2 cases). The overall clinical efficacy was 100%. Bacteriological examination, revealed 13 cases of single infection by E. coli, and one case of E. coli and S. epidermidis (MIC: 0.78 micrograms/ml). MIC of E. coli ranged from 0.05 to 0.78 micrograms/ml. All of the strains were eradicated, the eradication efficacy being 100%. The forms of bacteria in the urine after the administration of CTM were examined in 8 cases (all due to E. coli). Bacteria in urine disappeared or formed a spherical form 5 minutes after the administration of CTM. Disappearance of E. coli was observed in 7 cases at 15 or 30 minutes after drug administration, and with the disappearance, improvements were also observed in the urinary findings. Of these cases, the urinary concentration of CTM was measured in 4 cases. It ranged from 296 to 6,893 micrograms/ml at 5 minutes after the administration. In one case of deficient excretion in urine, filamentation was observed, and with the rise in CTM concentration in urine, granular changes were observed in the shape of bacteria. CTM's excellent clinical efficacy was substantiated by the changes in the form of bacteria in urine.

[A case of retroperitoneal malakoplakia]

A case of retroperitoneal malakoplakia is reported. A 50-year-old female was admitted with the chief complaint of right flank pain. Intravenous pyelography, computed tomography, selective iliac arteriography and abdominal echography revealed right pararenal abscess and the right renal tumor suspected. About one liter of yellowish fluid was drained from the retroperitoneal space, but no right renal tumor was found. Pathological diagnosis was retroperitoneal malakoplakia postoperatively. This is assumed to be the second case of retroperitoneal malakoplakia in Japan.

Purification and properties of urinary alkaline ribonucleases from patients with nephrotic syndrome

Four urinary alkaline ribonucleases (RNase, EC 3.1.4.22) were purified from patients with nephrotic syndrome using phosphocellulose, DEAE-cellulose and Sephadex G-75 chromatographiy. These enzymes were designated as RNases 1--4, respectively, in order of elution on phosphocellulose chromatography. The respective purification of each fraction was 41-, 23-, 34- and 27-fold with a total recovery of 25%. The pH optima of these RNases were around 8.5 with Tris/HCl buffer and the reaction was activated by mono- and divalent cations, such as Na+, K+, Mg2+ and Ca2+, but inhibited by Fe2+, Cu2+ and Zn2+. EDTA had little effect on the velocity of reaction. The molecular weights of RNases 1--4 were estimated by gel filtration as 45 000, 32 000, 20 000, and 13 000, respectively. Each enzyme hydrolyzed pyrimidine nucleotides preferentially with higher affinity for poly(C) than poly (U) as determined with synthetic polymers and was free from other nucleolytic enzymes. The patients with renal disorders excreted one to four RNases in urine and the number of enzymes increased as the concentration of urinary protein increased. On the other hand, normal subjects excreted a single fraction essentially identical to RNase 1.

Purification and properties of alkaline ribonuclease from human serum

1. Five alkaline ribonucleases (EC 3.1.4.22) were purified about 140- to 1900-fold from human serum by phosphocellulose and DEAE-cellulose chromatographies and Sephadex G-75 filtration, with a total recovery of 22%. These were designated as RNAases 1-5. 2. Optimum activities were observed at pH 8.5-8.7 for RNAases 1-4, and at pH 7.5 for RNAase 5. The molecular weights of these enzymes were estimated by gel filtration as 45 000, 32 000, 20 000, 13 000 and 8500, respectively. 3. These RNAases were found to be heat-labile proteins but are markedly stabilized with bovine plasma albumin. The reaction was activated by Na+, K+, Mg2+ and Ca2+, and inhibited by Co2+, Fe2+, Cu2+ and Zn2+. EDTA had little effect on the velocity of the reaction. Spermine caused 2- to 7-fold activation. 4. Among the substrates examined, these RNAases preferentially hydrolyzed pyrimidine bodies and except for RNAase 5 had a higher affinity for poly(C) than poly(U) as substrate. Each enzyme was free from other nucleolytic enzymes and hydrolyzed only RNA.