[Clinical evaluation of gamma-seminoprotein as a serum marker of prostate carcinoma]

The serum levels of gamma-Seminoprotein (gamma-Sm) were determined by enzyme immunoassay in 77 patients with prostatic cancer (30 untreated and 47 treated), 44 patients with benign prostatic hypertrophy and 12 patients with prostatitis. Serum levels of gamma-Sm in each disease were as follows; untreated prostatic cancer 23.2 +/- 18.3 ng/ml (positive rate 93%), treated prostatic cancer 4.7 +/- 8.3 (positive rate 25.5%), benign prostatic hypertrophy 3.6 +/- 3.3 (positive rate 23.7%), prostatitis 2.0 +/- 2.0 (positive rate 7.7%). Serum gamma-Sm levels in prostatic cancer were higher in advanced stage but relatively low in poorly differentiated adenocarcinoma. We consider that the level of serum gamma-Sm is a useful tumor marker as well as prostatic acid phosphatase (PAP) in diagnosis and follow-up of the patients with prostatic cancer.

Stable prostacyclin analogue preventing microcirculatory derangement in experimental cerebral ischemia in cats

We evaluated the effect of a stable synthetic prostacyclin analogue, TRK-100, on the microcirculatory derangement occurring in feline pial vessels with endothelial damage after middle cerebral artery occlusion. Fifteen adult cats were divided into an untreated group (Group 1, n = 8) and a treated group (Group 2, n = 7). Thirty minutes after 10 minutes of ultraviolet irradiation, which selectively damaged endothelium in the pial vessels, the middle cerebral artery was occluded in both groups and maintained for 30 minutes. In Group 2, 50 ng/kg/min TRK-100 was continuously infused intravenously following ultraviolet irradiation. In both the pial arteries and veins, platelet aggregate adhesion to the endothelium with subsequent thrombus formation was significantly (p less than 0.01 and p less than 0.05, respectively) inhibited during middle cerebral artery occlusion in Group 2 compared with Group 1. Similarly, blood flow stasis in the pial veins was effectively prevented in Group 2 during occlusion. Furthermore, the pial artery diameter returned to the control level during the late period of occlusion, whereas in Group 1 the pial artery remained constricted. Our data suggest that TRK-100 can prevent microcirculatory derangement in the acute stage of ischemic stroke.

[Microorganisms isolated from urinary tract infection and their beta-lactamase production and evaluation of clinical efficacy of sulperazone]

Clinical survey of microorganisms isolated from urinary tract infection (UTI) was carried out at the four major hospitals in Mie Prefecture from May to July, 1987, and production of beta-lactamase of the microorganisms was determined by the acidimetric method, "beta-checker". Among the total of 460 strains isolated from urine samples, 135 of gram positive cocci and 325 of gram negative rods were contained. Sixty percent of the gram negative rods and 14% of gram positive cocci produced beta-lactamase. Pseudomonas aeruginosa, E. coli and Serratia marcescens were representative organisms which produced beta-lactamase. Acinetobacter, Klebsiella, Enterobacter and Citrobacter species produced beta-lactamase at a higher rate but those were not so frequently isolated. In the sensitivity test to Sulperazone, the representative organisms isolated from urine, as a whole, had a sensitivity of 74% and E. coli, Klebsiella, S. epidermidis and Pseudomonas aeruginosa were highly sensitive, while Enterobacter cloacae and Serratia marcescens showed low sensitivity. The clinical efficacy of Sulperazone was evaluated in 26 patients with complicated UTI. Overall effectiveness rate and eradication rate of beta-lactamase production organisms were 73.1 and 63%, respectively. Sulperazone is concluded to be a useful antibiotic for treating complicated UTI induced by beta-lactamase production organisms from the point of microbiology and safety.

A male subject with 3 Y chromosomes (48, XYYY): a case report

We describe a male subject with 3 Y chromosomes who presented with complaints of lack of sexual desire and failure to achieve rigid erection. The patient was tall and had markedly incurved little fingers on both hands as well as small testes. Karyotype was 48, XYYY. The patient's parents had normal karyotypes. Endocrinological profile suggested a primary functional disturbance of the gonads. Testicular biopsy demonstrated atrophic seminiferous tubules without spermatogenesis. To our knowledge this case represents the third instance of a man with an 48, XYYY karyotype without mosaicism.

[Clomiphene citrate therapy in idiopathic male infertility]

Clomiphene citrate therapy was performed on 30 patients with idiopathic male infertility, who were intractable to non-hormonal therapy. Clomiphene citrate was administered orally at a dose of 25 mg per day for 25 days with 5 days of rest following Paulson' protocol, and we favorable results were obtained: Both sperm count and sperm motility improved in 11 cases (36.7%). Odera's score count decreased in 14 cases (46.7%), which were judged as effective. The wives of 4 patients treated by this therapy became pregnant. After this therapy, the serum levels of luteinizing hormone, follicle stimulating hormone, testosterone and prolactin were 1.90, 1.81, 1.89 and 1.22 times higher, respectively. These findings indicate that clomiphene citrate therapy is an effective for idiopathic male infertility, but we need to consider that the sudden and marked elevation of serum testosterone level by this therapy might affect male accessory sex organs such as the prostatic gland which shows androgen dependency later in life.

A case of pseudohypoparathyroidism type 1 associated with gonadotropin resistance and hypercalcitoninaemia

A case of a thirty-eight year old man with pseudohypoparathyroidism (PHP) type 1 associated with gonadotropin resistance and hypercalcitoninaemia was reported. The basal levels of the luteinizing hormone and follicle-stimulating hormone were elevated, and the responses to the luteinizing hormone-releasing hormone were exaggerated. The basal level of testosterone was normal, but the response to human chorionic gonadotropin was blunted. The serum calcitonin level was high, and hyper-responsiveness was observed by pentagastrin administration. From these results, it was suggested that partial testicular resistance to gonadotropin and the possibility of resistance to calcitonin were present in our case.

[Effects of etidronate disodium (EHDP) on urogenital malignancies with bone metastasis: a multicentered collaborative evaluation]

Clinical effects of EHDP on relief of bone pain, changes in bone lesions on X-ray and 99mTc-MDP scintigram and performance status were investigated in 19 patients with bone metastasis from urogenital cancers (4 renal cell cancers, 1 renal pelvic cancer, 4 bladder cancers and 10 prostatic cancers). EHDP was effective in relieving bone pain in prostatic cancer patients with osteoblastic lesions. Bone lesions on X-ray and 99mTc-MDP scintigram were slightly improved in prostatic cancer patients with osteoblastic lesions. Administration of EHDP did not improve the performance status. Changes in laboratory data such as serum alkaline phosphatase, serum calcium and urinary total hydroxy-proline following EHDP administration indicated inhibition of osteolytic activity with no effect on bone formation in the early period of treatment (in 4 weeks) and development of both osteolytic activity and bone formation in the later period (from 8 to 12 weeks). No marked side effects were observed. EHDP seems to be effective in relieving bone pain in prostatic cancer patients with osteoblastic bone metastasis. Moreover, some diphosphonate groups including EHDP are expected to be useful to the patients with malignant hypercalcemia.

[The determination of oxalate in urine by enzymatic method using oxalate oxidase: comparison between enzymatic and gas-chromatographic methods]

Urinary oxalate is one of the most important constituents of urolithiasis, but the determination of oxalate in urine has not been performed as a routine laboratory examination. We tried to measure oxalate in urine by the enzymatic method with oxalate oxidase. The linearity of the standard curve and reproducibility of this method were confirmed. (Linearity: r = 0.996, S.D./mean: 0.5-3.6%, recovery rate: 99.5 +/- 3.3 (mean +/- S.D.)%) The correlation between this method and gas-chromatographic method was 0.926. The enzymatic method with oxalate oxidase can be utilized for determining the urinary oxalate as a routine laboratory examination.

[A case of testicular feminization]

A 21-year-old female visited the gynecological clinic because of primary amenorrhea. The patient was a phenotypic female with scanty pubic hair, short and blind-ending vagina and bilateral inguinal soft masses. The patients was referred to our clinic. The serum luteinizing hormone level was 27.1 mIU/ml, follicle stimulating hormone level was 8.8 mIU/ml, and testosterone level was 11 ng/ml. Chromosomal analysis of peripheral lymphocytes revealed the karyotype 46, XY. The pathological specimens of bilateral inguinal masses showed atrophic testis without spermatogenesis and with Sertoli's cell nodular hyperplasia. The diagnosis of testicular feminization was established.

Temporal and spatial factors in diethylstilbestrol-induced squamous metaplasia of the developing human prostate

The effects of exogenous estrogen on the developing human prostate were examined in human fetal prostatic rudiments grown for 1 month as subcapsular renal grafts in athymic male nude mice treated with diethylstilbestrol (DES). Prostatic rudiments grown in untreated (control) hosts exhibited normal ductal morphogenesis, growth, and secretory cytodifferentiation. Squamous metaplasia was observed rarely in controls (2 of 22). Conversely, squamous metaplasia was observed in the prostatic utricle and urethra of all 17 specimens grown in DES-treated hosts. Proximal and distal prostatic ducts exhibited DES-induced squamous metaplasia in 13 and 12 of the specimens, respectively. When present, metaplastic changes were mild in the distal ducts. The distribution and intensity of metaplasia were related to the age of the specimen during the period of DES exposure. In specimens grown in DES-treated hosts to a gestational age equivalent of 16.5 weeks or less, squamous metaplasia was only seen in the prostatic utricle and urethra; however, in specimens grown to a gestational age equivalency of 17 weeks or more, squamous metaplasia was observed in the prostatic ducts as well. The nonuniform distribution of estrogen-induced squamous metaplasia within the developing prostatic ductal system emphasizes a regional and age-dependent susceptibility to exogenous estrogens in proximal ductal areas (near the urethra) as compared with distal ductal regions of the developing human prostate.

[Clinical evaluation of pyeloplasty of ureteropelvic junction obstruction]

Twenty-five of 34 patients who underwent pyeloplasty operation for ureteropelvic junction obstruction were able to be followed up for three months or more after operation. Postoperative results were compared in twenty-six kidneys of these patients according to clinical conditions such as age, duration of indwelling nephrostomy tube and splint catheter, operative method (one-stage or two-stage operation), preoperative urinary tract infections, preoperative grade of hydronephrosis and the postoperative period evaluated. Postoperative results evaluated at three months after operation, revealed no case with excellent improvement. At 36 months after operation excellent improvement rate was 46.7% and there was a significant difference in excellent improvement rate between these times. At 3, 6, 12 and 36 months after operation, improvement rate was 35.7, 55.0, 52.9 and 86.7%, respectively. At 3 and 6 months or more, deterioration rate was 29 and 0%, respectively. It is concluded that evaluation of pyeloplasty should be done at least 6 months after operation and even if renal function is stable at this period, more improvement in renal function can be expected at one year or more after operation.

Huge pelvic fibromatosis encroaching on the urinary bladder. A case report

A patient with a huge pelvic fibromatosis, a form of intra-abdominal desmoid, encroaching on the urinary bladder is described. Because of its rarity, there is frequently a lack of diagnostic awareness of this tumor, particularly in the gynecological or urological patient. Although this tumor is a locally invasive benign tumor which dose not metastasize, management by radical tumor excision without the sacrifice of the major pelvic nerves and vessels is mandatory, since this tumor has generally a high postsurgical recurrence rate.

[Quadruple cancers (gastric adenocarcinoma, multiple myeloma, transitional cell carcinoma and leiomyosarcoma of the bladder]

Multiple primary cancers form 1 to 10% of all malignancies, but only a few cases of quadruple cancers are reported a year in Japan. We report a case of quadruple cancers--gastric adenocarcinoma, transitional cell carcinoma of bladder, multiple myeloma and leiomyosarcoma of bladder.

[Fever attack in percutaneous nephrolithotomy and transurethral ureterolithotripsy]

We studied the fever attacks and their factors in the cases of percutaneous nephrolithotomy (PNL) and transurethral ureterolithotripsy (TUL). In PNL, fevers were significantly higher and more frequent in the cases with infected urinary stones than those with sterile stones, but prophylactic administration of antibiotics did not lower the fever or its frequency of attack. There was no significant difference between the cases of single procedure and those of multiple procedures although multiple procedures were likely to increase the frequency of fever attacks. In TUL, single J-catheter indwelling decreased fever attacks, but infection and administration of antibiotics did not affect the fever significantly. However, careful control of urinary tract infections before and after operation and of intrarenal pressure during operation are thought to be most important for prevention of fever attacks and urosepsis.

[Adult Wilms tumor: a case of prolonged survival achieved by multimodal treatment]

Wilms tumor is one of the most common malignant neoplasms in children. In the last 2 decades the survival rate of children with this disease has dramatically increased. However, in adults, the guideline for its management is less clear. We herein report the prolonged survival of a patient with advanced adult Wilms tumor after treatment with chemotherapy, irradiation and operations. Adult Wilms tumor should be treated aggressively with a well-timed combination of surgery, chemotherapy and radiotherapy (i.e., multimodal treatment), even if the stage of the disease was advanced. Thereby, we suspect that the prognosis of adult Wilms tumor would be markedly improved.

Comparison between pial and intraparenchymal vascular responses to sympathetic stimulation under hypercapnic conditions. With special reference to the mechanism for escape phenomenon

We have shown that secondary vasodilation ('escape' phenomenon) during sympathetic nerve stimulation occurs in the intraparenchymal vessels but not remarkable in the pial vessels. To test a possible role of CO2 accumulation in the brain tissue in this phenomenon, the responses of pial and intraparenchymal vessels to sympathetic nerve stimulation were investigated during hypercapnia in 9 cats by using a video camera photoelectric system. The ipsilateral superior cervical ganglion was electrically stimulated for 5 min during hypercapnia (PaCO2 = 50 +/- 2 mm Hg). The intraparenchymal vessels as well as pial vessels remained constricted throughout the stimulation. Secondary dilation of the intraparenchymal vessels as seen at the later stage of sympathetic stimulation during normocapnia was not observed under the hypercapnic conditions. We assume that the arterial CO2 tension was so high that the constriction of inflow vessels could not result in accumulation of CO2 in the brain parenchyma. The accumulation of chemical metabolites as represented by CO2 is therefore considered to be the most probable mechanism underlying the escape phenomenon of the intraparenchymal vessels.

[Prostatic development, cytodifferentiation and growth: epithelial-mesenchymal interaction and heterogeneity of prostatic cellular activity]

Prostatic growth and hormonal effects on the prostate play a basic role in the pathogenesis of abnormal proliferative diseases (i.e. benign prostatic hyperplasia and prostatic carcinoma). During the embryonic period, the prostate is organized through the budding and branching of the epithelial cords into the urogenital sinus mesenchyme. The urogenital sinus mesenchyme has an inductive potential for the prostatic epithelial development and cytodifferentiation under the influence of androgen and an epithelial-mesenchymal interaction. In this interaction, mesenchymal cells are considered as a mediator of hormonal action on epithelial cells. Postnatal prostatic growth is obtained further ductal branching morphogenesis and regulated by the epithelial-mesenchymal interaction, androgen, and epithelial/mesenchymal ratio. Castration-induced degeneration, and androgen-induced regeneration of the glandular architecture of the mouse prostate were investigated by microdissection techniques that permitted precise quantitation of the numbers of the terminal ductal tips and ductal branch-points. During the first 15 days after birth, active branching morphogenesis occurred as a result of focally high levels of DNA synthesis confined almost exclusively to the distal tips of the branching ducts. Following castration about 35% of the ductal tips and branch-points were lost in distal regions (usually near the capsule). By contrast, in more proximal regions of the prostate the ducts survived in an atrophic condition. The lost distal ductal morphology completely regenerated following administration of testosterone propionate (TP) to the castrated males. Whole-mount autoradiography demonstrated that labelling intensity reached a maximum on the third day of TP treatment in distal ductal areas. Recognition of the mesenchymal-epithelial interaction and heterogeneities in the morphogenesis, androgen dependency, and DNA synthetic activity within the prostatic architecture is fundamental to understanding the mechanism of androgenic regulation of normal or abnormal prostatic growth and development.

[Chromosomal investigation in infertile cases of azoospermia]

Chromosomal examination in 85 patients with azoospermia revealed 62 patients (73%) with the karyotype 46, XY and 23 patients (27%) with other abnormal karyotypes. In this population, there were 17 patients with 47, XXY. Other anomalies were: 46, XYp+, 46, XXp+, 46, XYp-, 45, X, t (Ynf; 21), 45, XY, t (13q 15q), and 46, XY, r (18). Serum LH and FSH levels were high and testosterone level was low in the patients with 47, XXY compared with the other 6 patients (p less than 0.01). Also the mean value of testicular volume was low in the patients with 47, XXY (p less than 0.05).

[A case of Werner's syndrome associated with bladder cancer]

A 41-year-old woman was diagnosed as having Werner's syndrome associated with bladder cancer. The patient noticed sudden, total gross hematuria in September, 1985. Cystoscopy revealed a papillary tumor with a stalk that was accompanied by a daughter tumor and concealed the left ureteral orifice. The tumors were 25 X 20 X 10 mm and 15 X 10 X 5 mm. Double contrast cystograms, computed tomography and transurethral echo showed no invasion of muscle layer. Intravesical instillation of mitomycin (10 mg), cylocide (300 mg) and adriacin (30 mg) was carried out 3 times per week for 4 weeks. Tumor size was reduced, and then TUR was performed. High power section of the removed bladder tumor showed pathologically PNT, TCC, grade II, INF alpha, pTla, lyo and v(-). The patient had such clinical manifestations as short stature with low body weight, thin limbs and stocky trunk, senile face, early graying hair, highpitched voice, bilateral cataracts, osteoporosis, sclerodermia-like signs, flat feet, tendency toward diabetes mellitus and parental consanguinity. Hyaluronic acid was not detected in the urine. To the best of our knowledge, this seems to be the 30th report describing the association of malignancy with Werner's syndrome in Japan; besides, only one other case of bladder cancer in Werner's syndrome has been reported to date in the world.