[Experience of ileal neobladder for bladder cancer by Hautmann procedure]

Operative results of ileal neobladder by the Hautmann procedure were studied in the patients with bladder cancer. From 1990 to 1993, 23 patients underwent total cystoprostatectomy for transitional cell carcinomas of the bladder. In 12 of these patients, an ileal neobladder was constructed for total bladder replacement under the following criteria; patients 1) with cancer confined in the bladder (T3b, M0, N0 or less), 20 without carcinoma in situ extending to more than half of urothelium of the bladder, 3) without cancerous lesion in the bladder neck or the prostatic urethra, 4) with performance status of 0 and the age of 75 or less. Pathologically, the disease was grade 2 in 3 patients, grade 3 in 9, stage pT1b in 3, stage pT2 in 4, stage pT3a in 1 and stage pT3b in 4. Two of 3 patients with the disease of stage pT1b had multiple papillary tumors. The remaining one patient had microinvasive cancer that carcinoma in situ infiltrated into submucosal area. Radical cystoprostatectomy and total bladder replacement by Hautmann procedure was performed in all patients. The maximum neobladder capacity was 349.5 +/- 58.1 ml (mean +/- SD). The intravesical pressure at maximum capacity was 30.6 +/- 6.2 cmH2O. At half maximum capacity, the intravesical pressure was 17.1 +/- 6.8 cmH2O. the maximum urethral closure pressure and the functional urethral length were 89.2 +/- 38.1 cmH2O and 25.5 +/- 7.0 mm, respectively. One patient had stress urinary incontinence. Slight nocturnal incontinence was found in 2 patients and nocturia was 1.86 +/- 0.55 times.(ABSTRACT TRUNCATED AT 250 WORDS)

Distinct relationship between HLA-DR genes and intractability of ulcerative colitis

OBJECTIVE

To explain the correlation between HLA class II genes and the intractability of ulcerative colitis (UC), DR genotyping and clinical analysis were performed for patients with UC.

METHODS

HLA-DRB types and HLA-DR2 subtypes of 45 patients with UC in our hospital were determined using molecular genotyping in combination with sequence-specific oligonucleotide hybridization by polymerase chain reactions. The extent of involvement, clinical course, and treatment were studied to evaluate the intractability of UC.

RESULTS

The gene frequency of DRB1*1502 in 18 patients with total colitis (0.444) was significantly higher than the group with left-sided colitis and proctitis (0.148; p < 0.05). In addition, DRw11 and DR2 increased significantly in the group including 18 cases with total colitis. In the 11 patients with total colectomy there were no cases with DRB1*1501, whereas 34 patients without operation included 12 genes of DRB1*1501 (p < 0.05). In addition, DRw11 increased significantly in the group with total colectomy compared to the group without operation (p < 0.05). When comparing between patients with and without intractability (defined based on the Japanese definition), DRB1*1502 and DRw11 were found more frequently in intractable UC patients (p < 0.01), whereas DRB1*1501 increased significantly in cases without intractability (p < 0.05).

CONCLUSIONS

DRB1*1502 or DRw11 have a probability of being closely related to the intractability of UC. In addition, patients with UC possessing DRB1*1501 have a lower probability of their cases leading to intractable UC. Thus, we believe there are unknown genes present that encode the intractability of UC.

[A case of pediatric Chlamydia pneumoniae infection and properties of the isolate]

Chlamydia pneumoniae was isolated from the throat of a 2-year-old girl with upper respiratory illness. The isolate, Shizuoka-37, was stained with C. pneumoniae specific monoclonal antibody (RR402), as well as the genus specific antibody (Cultureset), but not with C. trachomatis specific monoclonal antibody (Micro-Trak). C. pneumoniae genome was amplified by polymerase chain reaction in the isolate. Elementary bodies (EB) of the isolate was round shaped by electron micrograph.

Plasma levels of soluble fibrin in patients with malignancy-associated disseminated intravascular coagulation

Disseminated intravascular coagulation (DIC) is one of the most critical complications of malignant diseases. It is conventionally diagnosed by a decrease in platelets and an increase in fibrin/fibrinogen degradation products (FDP). Recently, an immunological assay was developed that can directly quantify the amount of soluble fibrin (SF) formed in the blood. This study examined this assay system in the diagnosis of DIC and found that it is a good indicator of both fibrin formation and of DIC. Plasma levels of SF correlated well with the DIC score, which is determined according to the 'DIC Scoring Guideline' proposed by the DIC Study Group under the Japanese Ministry of Public Welfare in 1988. It also correlated well with the serum levels of FDP. Normal values of plasma SF ranged between 0 and 9.50 micrograms/ml. Interestingly, values of SF in females tended to increase with age, for reasons that are not yet determined.

Cisplatin generates superoxide anion by interaction with DNA in a cell-free system

Cisplatin [cis-Diamminedichloroplatinum (II), DDP] generated superoxide anion (O2-), as measured by chemiluminescence from a Cypridina luciferin analog (CLA), by interaction with calf thymus DNA (ct-DNA) in phosphate-buffered saline (PBS) at pH 7.6. The intensity of chemiluminescence of CLA (CCLA) increased with increased concentration of DDP, ct-DNA or CLA in the limited range of concentrations of these agents tested. DDP-induced CCLA was completely inhibited by the addition of an O2- scavenger, superoxide dismutase (SOD), or an antioxidant, ascorbic acid. Heat-inactivated SOD did not affect CCLA. The hydroxyl radical (OH.) scavengers, mannitol, ethanol, and formic acid, also caused a partial suppression of CCLA, suggesting that DDP produced OH. as well as O2- in the cell-free system used.

[A successful case of two-staged operation for Stanford type B acute dissecting aneurysm complicated with total occlusion of the distal abdominal aorta]

A successful case of two-staged operation for Stanford type B acute dissecting aneurysm complicated with total occlusion of the distal abdominal aorta was reported. A 62-year-old male patient with a long history of systemic hypertension developed acute severe chest, back and bilateral legs pain. An enhanced CT demonstrated Stanford type B dissecting aneurysm with occlusion of the left renal artery and bilateral common iliac arteries. On the day of admission, an emergent right axillo-femoral bypass operation using 8 mm ringed EPTFE graft was undertaken to rescue the ischemic legs. The patient's postoperative course was complicated with acute renal failure and paralytic ileus, which were treated with medical treatment. Four months later, the second operation was done for the localized residual dissecting aneurysm in the proximal descending thoracic aorta. The aneurysm was excised, and the entry was closed with Dacron patch using the previously placed axillo-femoral bypass as a technique for preventing distal ischemia. He was recovered uneventfully and was discharged in a good condition.

STRUCTURAL BASIS FOR WAVELENGTH DISCRIMINATION IN THE BANKED RETINA OF THE FIREFLY SQUID WATASENIA SCINTILLANS

There is a greatly thickened region of retina in the ventral part of the eye of the firefly squid Watasenia scintillans, with an outer segment (OS) layer around 600 &micro;m thick. The distal two-thirds of this OS layer is yellow and contains a visual pigment, based on 4-hydroxyretinal (A4), with an absorbance maximum at 470 nm. The proximal third is pink and contains a visual pigment, based on dehydroretinal (A2), with an absorbance maximum at 500 nm. Light and electron microscopic investigations demonstrate the presence of four types of photoreceptor cell. In the pink layer, three of the four types (alpha, &szlig; and gamma) produce no microvilli and are columnar in structure. These cells form square microvillous rhabdoms only in the distal yellow layer. The fourth cell type (delta) produces microvilli in the pink layer only. These observations led us to propose that the A2-based visual pigment is contained in the pink-layer cells and that the A4-based visual pigment is contained in the three types of yellow-layer cells. The absorbance of fresh retina was determined by microspectrophotometry. The yellow OS layer, with an absorbance of 0.7 per 100 &micro;m thickness at 470 nm, is expected to act as a short-wavelength cut-off filter to the underlying pink OS cells, shifting their photosensitivity peak by an estimated 50 nm to 550 nm. Possible wavelength discrimination by this squid is discussed.

[Significance of transrectal ultrasonography in surgery for stress urinary incontinence and cystocele. Assessment of the bladder neck suspension by measuring posterior urethrovesical angle and angle of inclination of the upper urethra]

We treated 42 females (26 with genuine stress urinary incontinence, 13 with incontinence and cystocele, and 3 with cystocele) with bladder neck suspension using transrectal ultrasonography during operation. The optimum tightness of suspension was decided by adjusting the posterior urethrovesical angle to about 90 degrees in 26 patients with genuine stress urinary incontinence accompanied with flattened posterior urethrovesical angles and by adjusting the angle of inclination of the upper urethra to about 10 degrees in 16 patients with cystocele accompanied with rotationally descended urethra. Urinary continence was achieved in 35 of 39 patients presenting with urinary incontinence. Three patients with cystocele without urinary incontinence remained dry after the operation. The average of maximum urinary flow rate significantly increased after operation. The angles of inclination of the upper urethra measured on the ultrasonogram during operation corresponded well with those measured on the post-operative lateral urethrocystogram. In 26 patients without cystocele, the angles of inclination of the upper urethra and the posterior urethrovesical angles were correlated significantly on the pre-operative urethrocystograms. Roentgenographic changes in pre- and post-operative urethrocystograms showed concomitant restoration in the angles of inclination of the upper urethra and in the posterior urethrovesical angles as well as significant elevation of the bladder neck. Present results indicate that the angles of inclination of the upper urethra measured by transrectal ultrasonography during operation as well as the posterior urethrovesical angles are useful and reliable to decide the optimum tightness of bladder neck suspension for the patients with stress urinary incontinence accompanied with rotationally descended urethra.(ABSTRACT TRUNCATED AT 250 WORDS)

[A case of prostatic cystadenoma]

We report a case of prostatic cystadenoma in a 45-year-old man with the complaint of urinary retention. The large mass was palpated on rectal examination. The tumor was localized in the position of the left lobe of the prostate and was seen as multi-ocular on computerized tomographic (CT) scan. The serum levels of prostatic acid phosphatase (PAP) and prostate specific antigen (PSA) were slightly elevated. The tumor was enucleated retropubically, it weighed 210 g and had an multilocular structure macroscopically. The cyst seen on microscopic examination was lined with cuboidal or columnar epithelial cells and the lining cells were focally multilayered and formed papillary projections. The stroma surrounding the glands was composed of fibrous tissue containing smooth muscle fibers. The epithelial cells were immunoreactive for PAP and PSA.

Granulocyte colony-stimulating factor produced by bladder carcinoma of a patient with leukemoid reaction did not affect proliferation of the tumor cells

Bladder carcinoma associated with leukemoid reaction, though it rarely occurs, is considered highly malignant and has proved to produce granulocyte colony-stimulating factor (G-CSF). Interest exists in whether G-CSF itself or G-CSF producing ability reflects the malignant potential of such a tumor, possibly through an autocrine mechanism. In a patient with invasive bladder carcinoma, we found that the tumor cells produced G-CSF responsible for a remarkable leucocytosis. However, we could not detect the rearrangement and amplification of the G-CSF gene nor the expression of G-CSF receptor in the tumor cells. Our immunohistological and molecular biological study failed to demonstrate a crucial role for G-CSF in mediating a growth advantage for the tumor.

[Inverted Y ureteral duplication with a ureteral stone in atretic segment: a case report]

A 46-year-old male was admitted with the chief complaint of right side abdominal pain. A retrograde urogram disclosed right hydronephrosis and an anomalous branch in the shape of an inverted Y accompanied by a calculus on the right ureter. Extirpation of the calculus and vesicoureteroneostomy were performed just above the bifurcation. The anomalous branch was blind-ending.

Comparative study of goitrogenic actions of 3-substituted 1, 2, 4-triazoles in rats

Antithyroid actions of 3-amino-1, 2, 4-triazole (ATZ), 3-mercapto-1, 2, 4-triazole (MTZ) and 3-nitro-1, 2, 4-triazole (NTZ), which are substituents on the 3-position of 1, 2, 4-triazole (TZ), and those of the parental compound, were compared in rats. After administration of either ATZ, MTZ, or NTZ, the thyroids of rats were enlarged with decreasing of colloid content and a proliferation of the follicular epithelia. The serum concentration of 3, 5, 3'-triiodothyronine and thyroxine decreased, while that of thyroid-stimulating hormone increased. ATZ, MTZ, and NTZ inhibited thyroid peroxidase activity both in vivo and in vitro. These antithyroid actions were the most remarkable in case of MTZ and were the least in case of NTZ. TZ had no effect on the thyroid function in vivo and in vitro. The results of Lineweaver-Burk analysis on the effect to lactoperoxidase activity indicated that ATZ, MTZ, and NTZ showed competitive inhibition. These results suggest that both MTZ and NTZ have goitrogenic effects on the thyroid through antiperoxidase action, such as ATZ. Thus, the 3rd carbon position of TZ is thought to be important for induction of goiter in rats. A comparison of the relationship between substituent on the 3-position of TZ and antithyroid activity shows that a mercapto moiety has more potent antithyroid action than an amino and a nitro moiety. It is concluded that the differences in antithyroid activity of TZ derivatives depend on the potency of the substituents.

[Analysis of continence mechanisms by stress urethral pressure profiles]

The urethral pressure profiles (UPP) at rest and under stress, using double lumens microtip transducer catheter, in 17 females without urinary incontinence (normal group) were compared with those in 39 females with stress urinary incontinence (SUI group). And UPP were compared pre- and postoperatively in 21 females of SUI group who had surgical cure of SUI by bladder neck suspension (operative group). Pressure transmission ratios (PTR) were calculated in each quartile dividing functional urethral length (FUL) into four equal lengths. Maximum urethral closure pressure (MUCP) and Functional urethral length (FUL) in normal group were significantly higher than those in SUI group. In normal group, although bladder neck opening under stress (bladder neck incompetence) existed in 41% of them, the PTR in the distal three-quarters of the FUL were significantly larger than those in SUI group and urinary continence was remained in all of them. On the contrary, in SUI group, there was an almost linear decrease in the value of the PTR along the FUL. Therefore, it was suggested that SUI patients might lose distal urethral compensatory mechanisms. The results, obtained from the resting UPP, show that there is no significant change in MUCP or FUL following bladder neck suspension. In contrast, the stress UPP shows that successful operation generated a magnification of the PTR in the proximal three-quarters of the FUL. Only 1 case of post operative group showed bladder neck incompetence. Therefore suspending the bladder neck in a high position might produce the ability to occlude proximal three-quarters of the FUL.

[The correlation of the severity of stress urinary incontinence with static and stress urethral pressure profiles]

The urethral pressure profile (UPP) at rest and under stress was recorded by means of double lumen microtip transducer catheter in 58 females with stress urinary incontinence (SUI). The patients were divided into three groups including mild to moderate SUI patients (n = 29, group 1), severe SUI patients (n = 16, group 2) and very severe SUI patients (n = 13, group 3) according to a one-hour pad test. The functional urethral length (FUL) was divided into four equal lengths and the pressure transmission ratio (PTR) was calculated for each quartile for each female. We examined the correlation of the severity of SUI with urethral pressure parameters: maximum urethral closure pressure (MUCP) at rest and functional urethral length (FUL) at rest and PTR. SUI patients showed a negative association between the severity of SUI and MUCP, but no significant differences in the FUL were seen between the different groups. PTR was shown to be similar in order for all groups of SUI patients showing a linear decrease in the value of the PTR along the FUL. However, we found a negative association between the severity of SUI and PTR (P < 0.05) at the middle part of the FUL (Q3). These findings indicate that there are more defective distal sphincter mechanisms in severe SUI patients than in mild to moderate SUI patients. There was an overlap between the different groups in both MUCP and PTR at the middle urethra (Q3), suggesting that other parameters are related with the severity of SUI.

[Surgical treatment of infective endocarditis--an analysis of the risk factors for operative mortality and long-term follow-up]

From September, 1978, through January, 1993, 67 patients (mean age: 44 years) underwent surgical treatment for infective endocarditis (IE) at Kagoshima University. Of 67 patients, 36 showed active endocarditis and 31 healed endocarditis at the time of operation. The over-all hospital mortality was 22.4% (15/67). Risk factors associated with operative mortality by univariate analysis included increased blood urea concentration (BUN), increased cardiothoratic ratio, higher New York Heart Association functional class, infection status (active/healed), aortic valve infection, prolonged aortic cross-clamp time, annular abscess, and calendar year. The patients were operated earlier in the latter part of this series (1988-1993. Multiple logistic regression analysis demonstrated three factors to be statistically significant: BUN, operative year, and aortic valve infection. Complete survival information was obtained in all 52 discharged patients with a mean follow-up time of 4.8 years. There were 5 late deaths including 3 patients with valve related complication. The actuarial survival rate at 10 years after operation excluding hospital mortality was 89%, 92% for active infection 88% for healed infection. The actuarial freedom from valve related complication was 86% at 10 years. The degree of activity of the infection is not a risk factor for operative mortality by multiple logistic regression analysis. We conclude that surgical intervention should be undertaken without delay in the patients with IE before development of hemodynamic deterioration causing renal dysfunction and hypercatabolism.

Visual pigments in the pineal complex of the Japanese quail, Japanese grass lizard and bullfrog: immunocytochemistry and HPLC analysis

We investigated localization of visual pigments in the pineal complex of Japanese quail, Japanese grass lizards and bullfrogs immunocytochemically by use of the antiserum against bovine rhodopsin (Rh-As) and monoclonal antibodies against chicken iodopsin (Io-mAb). We also analyzed retinoids, chromophores of visual pigments, by a high performance liquid chromatography (HPLC). The outer segments and cell membranes of some photoreceptor cells in the pineal organ of the Japanese quail exhibited immunoreactivity to Rh-As, but there are also many immunonegative cells. The number of immunoreactive cells among individuals varied. Immunoreactivity to Io-mAb was weak or did not exist. The HPLC analysis revealed peaks of 11-cis and all-trans isomers of retinal in the oxime extracts of the pineal organ of Japanese quail and chickens. In the pineal of Japanese grass lizards, the outer segments of some cells were immunopositive to Io-mAb, but there were no cells immunoreactive to Rh-As. The parietal eye exhibited a well-developed lens and photoreceptor cells, but the outer segments of photoreceptor cells were immunonegative to both Rh-As and Io-mAb. In bullfrogs, three types of cells were identified in both the pineal and frontal organ; (1) immunopositive to Rh-As, (2) immunopositive to Io-mAb and (3) immunonegative to either of the antibodies. In the pineal organ of bullfrogs, 11-cis and all-trans retinal and 11-cis 3-dehydroretinal were detected, and 11-cis and all-trans retinal were also detected in the frontal organ. We detected 11-cis and all-trans retinal in the ventral part of diencephalon including the hypothalamus. Thus, the chromophore is the same between the retinal and pineal visual pigments, but the expression of opsins is different between the retina and pineal complex, which probably reflects the different function of each organ.

Fibroblast attachment to Arg-Gly-Asp peptide-immobilized poly(gamma-methyl L-glutamate)

The attachment of MRC-5 human fibroblasts was investigated on poly(gamma-methyl L-glutamate) (PMLG), and upon cell adhesion peptides Arg-Gly-Asp-Ser (RGDS)- and Gly-Arg-Gly-Asp-Ser (GRGDS)-immobilized PMLG (RGDS-PMLG and GRGDS-PMLG). The peptides were immobilized by their N-terminal amine to activated PMLG surfaces. Prior to peptide immobilization, the aminolysis of PMLG surfaces was performed with hydrazine hydrate (HA), ethylenediamine (EDA), and hexamethylenediamine (HMDA) and was followed by the activation with hexamethylene diisocyanate. Surface characterization of these films was carried out by means of a Fourier transform IR (FT-IR) spectrometer equipped with an attenuated total reflectance (ATR) attachment. The amount of immobilized RGDS could be controlled by the reaction time of the aminolysis. The effects of HA, EDA, and HMDA as a spacer on the cell attachment were also investigated, and it was suggested that a longer spacer promoted the cell attachment via specific receptor-ligand interaction.