Retroperitoneal disorders associated with IgG4-related autoimmune pancreatitis

IgG4-related autoimmune pancreatitis is frequently accompanied by relevant lesions in the genitourinary tract and retroperitoneal organs, which cause various clinical problems, ranging from non-specific back pain or bladder outlet obstruction to renal failure. The diagnosis of IgG4-related retroperitoneal fibrosis requires a multidisciplinary approach, including serological tests, histological examination, imaging analysis, and susceptibility to steroid therapy. Radiological examinations are helpful to diagnose this condition, but surgical resection is occasionally unavoidable to exclude malignancy, particularly for patients with isolated retroperitoneal involvement. Steroid therapy is the treatment of choice for this condition, the same as for other manifestations of IgG4-related disease. For patients with severe ureteral obstruction, additional ureteral stenting needs to be considered prior to steroid therapy to preserve the renal function. Some papers have suggested that IgG4-related disease can affect male reproductive organs including the prostate and testis. IgG4-related prostatitis usually causes lower urinary tract symptoms, such as dysuria and pollakisuria. Patients sometimes state that corticosteroids given for IgG4-related disease at other sites relieve their lower urinary tract symptoms, which leads us to suspect prostatic involvement in this condition. Because of the limited number of publications available, further studies are warranted to better characterize IgG4-related disease in male reproductive organs.

[Specific features of a change in some blood biochemical indicators in virus urogenital infections]

Analysis of blood biochemistry in cytomegalovirus, papillomavirus infections and herpes simplex virus showed a significant decrease in blood albumins, a significant rise in total protein, the percentage of alpha2-globulins, and an increase in the activity of ALAT, aldolase 1.6. This reflects the activity of inflammation, reveals hepatic toxic activity, and indicates renal dysfunction and externally asymptomatic active processes in the liver.

[State of antioxidant defense and L-arginin-nitrogen oxide system in blood of patients with urogenital chlamydiosis]

The system L-arginine-nitrogen oxide plays a significant role in maintenance of the anti-infectious protection of an organism. A condition of the given system and activity of a enzymatic part of antiradical protection in the blood of patients with chlamydiosis has been studied. Obtained data specify an intensification of processes of an oxidizing way of recycling of arginine in an organism of patients. Substantial increase of NO-synthase activity and insignificant activity of arginase in the blood is revealed. The level of nitrite-anion in blood cells of patients authentically increases: 1.7 times in erythrocytes, and 1.4 times in lymphocytes. It is shown, that in patients with chlamydiosis glutathione system is intensified, that is evidenced by an increase glutathione-peroxidase activity and authentic increase of glutathione level. It is assummed that the established features of nitrogen oxide exchange play a significant role in formation of a pathological condition at urogenital chlamydia infections.

[Detection of antigens with the aid of the aggregate-hemagglutination reaction of different serotypes of Ureaplasma urealyticum in the blood serum of patients with inflammatory diseases of the urogenital tract and disorders of reproductive function]

A total of 110 samples of the blood serum, obtained from persons with inflammatory diseases of the urogenital tract and with disorders of the reproductive function were examined by the aggregate-hemagglutination reaction for antigens of the 3d and 8th serotypes, U.u., belonging, respectively, to biovars Parvo and T-960. Antigens U.u. of the 3d, 8th or of both serotypes were detected in 75 (68.18%) of the studies samples. There were no antigens U.u. of the 3d or 8th serotypes in 35 (31.82%) samples. Antigens of biovars Parvo and T-960 were detected at an approximately identical frequency rate. Besides, the mentioned antigens were found in almost one half of blood sera positive to the U.u. samples (48%). No significant differences between the concentrations of antigens Parvo and T-960 were detected in the blood serum samples in case both of them were found in one sample or only one ureaplasma serovar was found in a sample.

Treatment of urogenital atrophy with low-dose estradiol: preliminary results

OBJECTIVE

To determine the lowest dosage of vaginally administered estradiol (E2) that reverses signs and symptoms of urogenital atrophy but does not substantially increase plasma E2 levels.

DESIGN

Single-blind, single-arm study to determine the effects of de-escalating doses of vaginal estrogen on symptoms of urogenital atrophy, vaginal pH, and vaginal and urethral cytology. A questionnaire was used to assess subjective vaginal and urethral symptoms. Objective measurements included vaginal and urethral cytology, pH, endometrial biopsy, and 24-h circulating plasma luteinizing hormone, follicle-stimulating hormone (FSH), E2, and estrone levels obtained in a Clinical Research Unit. Circulating E2 levels were assayed with an ultrasensitive yeast bioassay with a detection limit of 0.02 pg/mL. Measurements were obtained over a 24-h period after administration of vehicle alone, on day 1 after the initial vaginal E2 dosage, after 3 weeks of daily E2 administration, and after an additional 9 weeks of twice weekly administration.

RESULTS

From the first seven subjects studied at a 10-microg dose of E2, 100% responded according to predefined criteria. Vaginal cytology showed statistical improvement at 3 and 12 weeks. Urethral cytology was statistically improved after 12 weeks. Vaginal pH decreased from postmenopausal to premenopausal levels at both 3 and 12 weeks. Eighty-two percent of symptoms were cured or improved. Endometrium remained atrophic. Circulating E2 levels remained within the postmenopausal range of 3-10 pg/mL.

CONCLUSION

A 10-microg dose of vaginal E2 effectively treated urogenital atrophy in seven women and did not cause endometrial hyperplasia or increase E2 levels.

Hepatitis C virus among genitourinary clinic attenders in Scotland: unlinked anonymous testing

Our objective is to gauge the prevalence of hepatitis C virus (HCV) antibodies among a population at risk of contracting sexually transmitted infections (STIs) and, thus, the efficiency with which the virus is transmitted sexually. The investigators undertook an unlinked anonymous HCV antibody testing study of residual syphilis serology specimens taken from attenders of genitourinary clinics in Glasgow, Edinburgh and Aberdeen during 1996/97. The results were linked to non-identifying risk information. Anti-HCV prevalences among non-injecting heterosexual men and women, and non-injecting homosexual/bisexual males ranged between 0 and 1.2%; the only exception to this was a 7.7% (4/52) prevalence among homosexual/bisexual males in Aberdeen. The overall anti-HCV prevalence for homosexual/bisexual males was 0.6% (4/668), for heterosexual males 0.8% (32/4135), for heterosexual females 0.3% (10/3035) and for injecting drug users 49% (72/148). Only 3 (all female) of the 46 non-injectors who were antibody positive were non-UK nationals or had lived abroad. HCV antibody positive injectors were less likely to have an acute STI and more likely to know their HCV status than non-injectors; no differences in these parameters were found between positive and negative non-injectors on anonymous HCV antibody testing. Our findings are in keeping with the prevailing view that HCV can be acquired through sexual intercourse but, for most people, the probability of this occurring is extremely low. Interventions to prevent the spread of HCV should be targeted mainly at injecting drug user (IDU) populations.

Studies on tumourous and other urogenital patients with respect to antigens of oncogenic adenovirus

The possible connection of viruses with tumours was investigated by serologic examinations. Concerning the presence of antibodies against adenoviruses, especially those against the early non-virion antigens of oncogenic adenovirus type 12, approximately 4000 tests were made with sera of 446 urogenital patients with and without tumours and 70 ones with internal diseases. It was found by complement fixation tests that antibodies against nonvirion antigens of adenoviruses were present in 53% of urogenital patients suffering from malignant tumours and prostatic hypertrophy, in 18% of non-tumourous urological patients and in 4% of patients with internal diseases, respectively. The results suggest that adenoviruses may play a role in tumourous diseases of the urogenital organs.

[Effect of metronidazole on luminol dependent chemiluminescence of neutrophils in whole blood of patients with chlamydial infection]

In vivo effect of metronidazole on the active oxygen production by neutrophils in the peripheral blood of patients with urogenital chlamydial infection (9 females and 7 males) was studied with the use of luminol dependent chemiluminescence. Metronidazole was administered orally in a dose of 250 mg twice a day for 10 days. Blood for the specimens was collected prior to the treatment and on the next day of the treatment course completion. No effect on the spontaneous and zymozan or phorbol-12-myristate-13-acetate stimulated chemiluminescence was observed, although a significant increase in the chemiluminescence indices was stated in 3 females and 1 male. It was suggested that the changes in the individual values of the neutrophil chemiluminescence after the treatment were associated with the influence of metronidazole and/or its metabolites on the blood cells and with different activity of the host enzymes participating in the drug biotransformation.

Serum alpha 2-HS glycoprotein concentration in patients with hematological malignancies. A follow-up study

We observed significantly reduced serum alpha 2-HS glycoprotein concentrations in patients with acute lymphocytic, acute nonlymphocytic, chronic granulocytic and chronic myelomonocytic leukemias, Hodgkin's and non-Hodgkin's lymphomas, myelofibrosis, and multiple myeloma, but not in patients with chronic lymphocytic leukemia and polycythemia vera, as compared with healthy controls. We followed the serum level of the protein for 18 months. Patients with infectious complications, those receiving cytostatic treatment, and those in the preterminal period had further reduced serum alpha 2-HS glycoprotein levels. The reduction of serum alpha 2-HS glycoprotein concentration was primarily due to decreased production caused by infiltration of the liver, a hepatotoxic effect of cytostatic treatment, and, to a lesser degree, to increased consumption. We found statistically significant negative correlations between serum alpha 2-HS glycoprotein concentration and erythrocyte sedimentation rate, serum aspartate aminotransferase and alkaline phosphatase activities, and IgG and IgM concentrations. The determination of the alpha 2-HS glycoprotein concentration is useful for the assessment and follow-up of the clinical status and therapy of patients with hematological malignancies and also has prognostic significance.

Identification of human papillomavirus DNA sequences in peripheral blood mononuclear cells

Polymerase chain reaction (PCR) was used to amplify and identify the presence of the DNA of human papillomavirus (HPV) types 6, 11, 16, and 18 in peripheral blood mononuclear cells (PBMCs) of women with and without urogenital HPV infections. HPV DNA of various types was found in PBMCs of 13 of 25 (52.0%) patients with urogenital HPV infections and in none of the 19 control subjects who are free of urogenital HPV infections. The presence of HPV DNA in PBMCs may impair the immunologic functions of the lymphocytes and play a role in the epidemiology of HPV infections and the pathogenesis of HPV-induced diseases.

[Clinical evaluation of serum S100ao protein in patients with urogenital diseases and healthy volunteers]

We investigated the clinical significance of the serum S100ao protein in patients with urogenital diseases. The serum levels of S100ao protein were measured in 179 patients with urogenital diseases and 180 healthy volunteers. The mean value of S100ao protein in serum from healthy volunteers was 203 +/- 107 pg/ml (Mean +/- SD). Therefore, the cut-off level was set to 524 pg/ml (Mean +/- 3SD). The levels of S100ao protein in serum were significantly higher in men than in women (P less than 0.05). The levels of S100ao protein in serum were significantly high in the patients in their fifties and sixties compared with the other patients (P less than 0.01). When serum levels exceeding the cut-off level were considered to be positive, the percentages of positivity in each disease were as follows: renal cell carcinoma; 38.7%, bladder tumor; 9.1%, prostatic carcinoma; 12.5%, testicular tumor; 0%, benign prostatic hypertrophy; 7.4%, urolithiasis; 7.1% and chronic renal failure; 100%. The levels of S100ao protein in serum were significantly correlated with those of BUN, serum creatinine and endogenous creatinine clearance, respectively. S100ao protein in serum was increased immediately after operation and returned to the normal range within one to two weeks after operation. As described above, the level of S100ao protein in serum was affected by renal function, operative procedures and age. However, the positive rate of S100ao protein was so high in patients with renal cell carcinoma that serum S100ao protein might be a valuable tumor marker in those patients.