Multiple forms of rat calpastatin cDNA in the coding region of functionally unknown amino-terminal domain

Partial mouse and rat calpastatin cDNAs containing functionally unknown amino-terminal regions were cloned by the polymerase chain reaction (PCR) method. Two types of clones were obtained for the rat calpastatin; one had a sequence similar to mouse and human calpastatins, while the other had a deletion of 38 amino acid residues in this region. Both types of the rat sequence differed from the previously reported rat calpastatin which had additional deletions. The occurrence of multiple forms of calpastatin suggests alternative splicing in the functionally unknown domain.

Primary malignant tumor of the small intestine

The records of 101 patients with primary small intestinal malignant tumor at NTUH, collected from 1960 to 1989, were reviewed. These patients represented 1.2% of the patients with gastrointestinal cancer at NTUH over the same period. Fourty-two (41.6%) of the cancer patients had lymphomas, 30(29.7%) had adenocarcinomas, 26 (25.7%) had leiomyosarcomas, and 3(3.0%) had carcinoid tumors. The average age at cancer presentation was 47.5 years (range from 3 to 96). The lymphoma patients had an average age of 35.1 years, while adenocarcinoma patients averaged 60.4 years of age. Leiomyosarcoma and carcinoid tumors averaged 51.2 years and 59 years, respectively. There were 65 male patients and 36 female patients, and there was a male predominance in all groups except for the leiomyosarcoma group which had an equal sex ratio. Generally speaking, the incidence rate for the areas involved were similar in the duodenum, jejunum and ileum. However, adenocarcinomas were more common in the duodenum (53%) and 45% of lymphomas were found in the ileum, as were the carcinoid tumors (66%). The most common presenting symptom was abdominal pain (62%), with bleeding second (32%). Obstruction and palpable mass together were present in 29% of the cases. Body weight loss was found in 25% of patients, and 14% of the patients presented with acute abdomen due to intestinal perforation. Laparotomy was the most common diagnostic procedure (60%). Preoperative diagnoses were possible in cases of duodenal and upper intestinal malignancies, but were rarely possible in patients with lower intestinal malignancies. Sixty-eight patients (68%) underwent tumor resection for palliation or cure. The operation mortality was 4%.(ABSTRACT TRUNCATED AT 250 WORDS)

Congenital broncho-oesophageal fistula in the adult

Five patients with congenital broncho-oesophageal fistula confirmed by fistulectomy are presented. Clinical symptoms were chronic or recurrent pulmonary infection, and three patients experienced coughing after swallowing. Pre-operative oesophagograms demonstrated broncho-oesophageal fistulas in all five patients. The fistulous communications were from the lower oesophagus to segmental bronchi of the lower lobe and to the left main bronchus. The fistulas showed smooth marginated serpentine margins with areas of internal trabeculation, and in two patients the fistulas communicated with anomalous bronchi. One patient had anomalous bronchi and subsequently underwent lobectomy which showed microscopic findings of intralobar sequestration. The oesophagus showed localized tenting with its apex to the fistula and mild ipsilateral displacement in four patients.

CT of infected bladder diverticulum

A case in which pus within a bladder diverticulum simulated a deep pelvic abscess is presented. This pitfall in CT diagnosis should be considered in patients with bladder outlet obstruction with symptoms of infection.

Immunohistochemical and biochemical demonstration of calcium-dependent cysteine proteinase (calpain) in calcifying cartilage of rats

Calpain is a Ca2(+)-dependent cysteine proteinase that has neutral pH optima. There are two classes of calpains that differ in their optimal calcium ion concentration for enzymatic activity. Calpain I requires a low concentration of Ca2+ for activation, and calpain II requires a much higher Ca2+ concentration. This report describes the immunohistochemical and biochemical demonstration of calpain II in calcifying cartilage in rats and also the degradation of the cartilage proteoglycan subunit by calpain II. Immunoperoxidase (peroxidase-antiperoxidase) staining of the frozen sections of the knee joint from 3-day-old and 6-day-old Wistar rats, using polyclonal antibodies against the respective heavy subunits of calpains I and II, showed positive staining only with the anti-calpain II antibody in the hypertrophic chondrocytes and surrounding cartilaginous matrix of the growth cartilage. Diethylaminoethyl-cellulose chromatography of the cartilaginous extract from 3-day-old rats showed a peak of caseinolytic activity attributable to calpain as well as an inhibitory peak of calpastatin, a specific inhibitor protein of calpains. Immunoblotting using the anti-calpain II antibody of the calpain peak demonstrated identity with the heavy subunit of calpain II (80 kDa). Proteoglycan-degrading activity of calpain was assessed using porcine kidney calpain II and the porcine articular cartilage proteoglycan subunit. After incubation in the presence of Ca2+, degradation of proteoglycan was demonstrated by the change of the elution position on Sepharose-2B chromatography. It is possible that calpain functions as one of the proteoglycan-degrading proteolytic enzymes of growth cartilage. Intracellular localization of calpain in hypertrophic chondrocytes also suggests a role in the hypertrophic process of the chondrocyte in growth cartilage.

Advances in percutaneous nephrostomy

Management of urologic patients is being gradually but dramatically altered with new advances in technical innovation and refinements of interventional uroradiology. The broadening of indications for percutaneous nephrostomy became possible only after it was learned that it is a safe and effective means of establishing access to the renal collecting system. Percutaneous stone extraction (Nephrolithotomy) and Endopyelotomy are now well established procedures. These techniques have clear advantages over the surgical treatment for the same conditions and will increase the quality of patient care and reduce health care cost.

CT manifestations of peritoneal leiomyosarcomatosis

Peritoneal leiomyosarcomatosis causes multiple discrete tumor nodules in the peritoneum, mesentery, and omentum with or without evidence of a primary site. The CT and pathologic findings in seven patients with this disease were reviewed. All seven patients had CT evidence of multiple, discrete peritoneal masses, and five patients showed a central low-attenuation area. CT grade of malignancy in peritoneal tumors was categorized as low (four patients) and high (three patients) on the basis of the degree of central necrosis of the tumors. The CT results correlated with the histopathologic grade of malignancy, although all tumors were grade 2 or higher histopathologically. Ascites and lymphadenopathy were not present in any of the patients. Liver metastases were identified in five patients with central necrosis of the metastases evident in four. The presence of liver metastases and the degree of central necrosis in the liver metastases did not correlate with the size or histologic grade of the primary tumor. Although uncommon, peritoneal leiomyosarcomatosis should be considered when CT shows multiple, discrete peritoneal masses with central necrosis and liver metastases in the absence of ascites and lymphadenopathy.

Complications of universal ureteral stent

The universal stent is primarily a ureteral stent that also permits optional nephrostomy drainage. The complications associated with universal stent placement were analyzed with respect to the underlying pathology. The major complications included stent-induced ureteral stricture in 2 patients, and stent migration requiring emergency repositioning in 2 patients. Stent malfunction due to stent migration or occlusion, and bladder irritation were frequent also.

Responses of vasopressin release in patients with cardiopulmonary bypass anesthetized with enflurane and morphine

Changes in plasma level of arginine vasopressin (AVP), arterial pressure, and urine flow were studied before, during and after cardiopulmonary bypass (CPB) in 11 patients with congenital heart disease. Anesthesia was induced with thiopental sodium (3-5 mg/kg) and was maintained with enflurane (1.0-1.5%), 50% N2O in O2 and morphine (0.5 mg/kg). Concentration of plasma AVP increased slightly from 3.8 +/- 1.5 pg/ml after induction and increased 3-fold after sternotomy. Plasma AVP level increased to 132 +/- 26 pg/ml and 218 +/- 54 pg/ml after 5 and 60 min on CPB, respectively. When the circulation returned to normal, plasma AVP level decreased gradually but was still significantly higher at 24 hr (13.4 +/- 2.5 pg/ml). Marked osmolar diuresis was induced with mannitol in the priming solution used during the CPB: increases in urine flow, Na excretion and osmolar clearance. Possible mechanisms of marked increase in AVP release and differences of AVP responses during CPB reported by other investigators are discussed.

Percutaneous nephrostomy in the management of renal candidiasis

A case of Candida infection of the kidney was successfully managed by percutaneous means. This case demonstrates that percutaneous nephrostomy is a simple, effective technique not only for drainage, extraction of fungus balls, and irrigation with amphotericin B, but also for examining the renal collecting system and obtaining urine samples for diagnostic culture verification. Because of the toxicity of antifungal drugs, the incorporation of this percutaneous technique into standard management will benefit the patient with a life-threatening renal fungal infection.

Photosynthetic apparatus of pea thylakoid membranes : response to growth light intensity

We investigated the effect of growth light intensity on the photosynthetic apparatus of pea (Pisum sativum) thylakoid membranes. Plants were grown either in a growth chamber at light intensities that ranged from 8 to 1050 microeinsteins per square meter per second, or outside under natural sunlight. In thylakoid membranes we determined: the amounts of active and inactive photosystem II, photosystem I, cytochrome b/f, and high potential cytochrome b(559), the rate of uncoupled electron transport, and the ratio of chlorophyll a to b. In leaves we determined: the amounts of the photosynthetic components per leaf area, the fresh weight per leaf area, the rate of electron transport, and the light compensation point. To minimize factors other than growth light intensity that may alter the photosynthetic apparatus, we focused on peas grown above the light compensation point (20-40 microeinsteins per square meter per second), and harvested only the unshaded leaves at the top of the plant. The maximum difference in the concentrations of the photosynthetic components was about 30% in thylakoids isolated from plants grown over a 10-fold range in light intensity, 100 to 1050 microeinsteins per square meter per second. Plants grown under natural sunlight were virtually indistinguishable from plants grown in growth chambers at the higher light intensities. On a leaf area basis, over the same growth light regime, the maximum difference in the concentration of the photosynthetic components was also about 30%. For peas grown at 1050 microeinsteins per square meter per second we found the concentrations of active photosystem II, photosystem I, and cytochrome b/f were about 2.1 millimoles per mol chlorophyll. There were an additional 20 to 33% of photosystem II complexes that were inactive. Over 90% of the heme-containing cytochrome f detected in the thylakoid membranes was active in linear electron transport. Based on these data, we do not find convincing evidence that the stoichiometries of the electron transport components in the thylakoid membrane, the size of the light-harvesting system serving the reaction centers, or the concentration of the photosynthetic components per leaf area, are regulated in response to different growth light intensities. The concept that emerges from this work is of a relatively fixed photosynthetic apparatus in thylakoid membranes of peas grown above the light compensation point.

A case of acute superior mesenteric embolism successfully treated by embolectomy

Superior mesenteric artery embolism is undoubtedly fatal unless operative intervention is promptly performed. The first case successfully managed by embolectomy in Taiwan is reported in this communication. The key to successful management lies in the early suspicion in patients with atrial fibrillation or recent myocardial infarction, presenting with sudden abdominal pain and an unremarkable physical examination. Abdominal angiography is strongly recommended; however, immediate laparatomy should not be postponed if angiography is not available. Early embolectomy is the only useful means of treatment to restore mesenteric circulation, preserve the bowel and rescue the patient. A 56-year-old woman was admitted with a 5-year history of rheumatic heart disease and atrial fibrillation. She had a sudden attack of severe abdominal pain 8 hours after cardiac catheterization. Abdominal examination was not remarkable and plain abdominal X-ray was negative, while bloody stools and leukocytosis developed 7 hours later. Superior mesenteric embolism was highly suspected and emergency laparotomy was performed. Successful embolectomy was carried out through the distal approach and the patient recovered completely without requiring small bowel resection. All branches of the superior mesenteric artery were demonstrated patent upon postoperative angiography.

Treatment of ureteropelvic strictures with percutaneous pyelotomy: experience in 62 patients

Percutaneous pyelotomy (endopyelotomy) is an endoscopic technique for the management of ureteropelvic junction obstruction. In a series of 62 consecutive patients, the success rate (measured by symptom-free status and improved uroradiographic findings) was 85%, including both primary and secondary obstructions. All failures were apparent within 3 months of the procedure and required open surgery. There were two major complications during the procedure. Our experience indicates that percutaneous pyelotomy is an effective alternative to traditional open pyeloplasty and has a similar success rate, lower morbidity, and a shorter recovery time.

Staghorn calculi: endourologic management in 120 patients

Symptomatic staghorn renal calculi were removed from 106 of 124 kidneys (85%) with percutaneous ultrasonic lithotripsy. All remaining fragments were less than 5 mm in greatest diameter, small enough to pass spontaneously. Use of two or more access routes was necessary in 91 kidneys (73%), and 29 patients (24%) required multistage nephrolithotripsy for complete stone removal. The total operative time averaged 162 minutes per patient. The average hospitalization period was 12.5 days, and the average convalescence time after discharge was 15 days. The most common adverse effect was bleeding necessitating transfusion (57%). Infection occurred in 27% of patients and may be intrinsic to removal of these infected stones. There was one death in the study group: a patient with multiple medical problems died of myocardial infarction. Successful stone extraction requires a clear understanding of renal anatomic features, properly placed access routes, and radiologic-urologic expertise. It is concluded that staghorn calculi can be safely and effectively treated with the use of percutaneous techniques.

Applications of the peel-away introducer sheath

The peel-away introducer sheath set, originally designed for the antegrade insertion of the silicone rubber Universal stent, also is useful for antegrade or retrograde basketing of ureteral stones, negotiation of a dilated renal pelvis and tortuous ureter with minimal trauma, retrograde flushing of ureteral stones for percutaneous extraction, removal of dislodged stents from the renal pelvis and ureteral examination with a flexible endoscope or rigid ureteropyeloscope.

Percutaneous nephrostomy for endopyelotomy

Percutaneous full-thickness incision and stenting of the ureteropelvic junction (endopyelotomy) relieved obstruction in 33 (87%) of 38 patients treated over a 2-year period. Proper placement of the percutaneous nephrostomy tract through a posterior middle calyx and of a guidewire across the ureteropelvic junction is necessary in order to gain access to the narrowed area with a rigid cutting instrument. Except in patients with long lesions, high insertion of the ureter, or an enormously redundant renal pelvis, endopyelotomy gives excellent results with less morbidity and a shorter recovery time than open pyeloplasty.

Complications of percutaneous nephrolithotomy

Of 582 patients who underwent percutaneous nephrolithotomy, 4% had complications. The most common complications were fever (23%) and bleeding necessitating transfusion (12%). Extravasation was seen in 7% of patients and transient ureteral obstruction in 6%. Other complications included pneumothorax or hydrothorax, pneumonia/atelectasis, paralytic ileus, nephrostomy-tube dislodgment or urine drainage from the flank lasting more than 1 week, significant infection, urinoma formation, renal pelvic laceration, ureteral avulsion, ureteropelvic or ureteral stricture, bowel injury, or escape of stone fragments into the retroperitoneum. Seven patients (1%) required immediate surgery: four to repair renal pelvic lacerations, one to repair a ureteral avulsion, and two to control bleeding after nephrostomy-tube removal when embolization failed. Four patients required delayed surgery for ureteral or ureteropelvic junction strictures, which may have been caused by a tissue reaction to the stones rather than by the procedure itself. There were two deaths--one from respiratory failure in a patient with severe interstitial pulmonary fibrosis and chronic renal failure and the other from myocardial infarction in an obese diabetic patient with hypertension.

Percutaneous nephrolithotomy: analysis of 500 consecutive cases

The first 500 patients who underwent percutaneous stone removal at our hospital and who have been evaluated for at least 8 months were reviewed. Comparison of the first 100 patients with the entire series showed a sharp improvement in the success rate as the radiologic and urologic team gained experience. The success rate for simple pelvicaliceal stones was 98% in the entire series (vs. 89% in the first 100 cases) and 87% for staghorn calculi. The most common complication was bleeding, with 12% of the patients requiring transfusion. Other complications include infection (0.6%), retained stone fragments (4%), and ureteropelvic junction stricture (1%). There was 1 death, an obese diabetic woman who suffered a myocardial infarction. Successful stone extraction requires a properly placed nephrostomy tract, and radiologic and urologic expertise. The advent of extracorporeal shock-wave lithotripsy will not abolish the need for nephrostolithotomy.

Morphologic and functional changes in the kidney after percutaneous nephrosto-lithotomy

Morphology and function of the kidney were studied before and after percutaneous stone extraction in 33 patients with unilateral calculus disease to assess damage secondary to the extraction procedures. Anatomic changes were studied using excretory urography before the procedure and at 3 to 6 months postoperatively, and using nephrostograms and noncontrast nephrotomograms several days after the procedure. Renal function was evaluated with radionuclide renography both before surgery and at either 4 to 6 weeks or about 1 year postoperatively. Six patients had early changes detected clinically and with nephrostograms, but only three of these had abnormalities on delayed excretory urography. Significant changes in renal function were found only in those patients who had clinically detectable complications (p less than 0.05), in one case before symptoms were manifest.

Management of male infertility: roles of contact thermography, spermatic venography, and embolization

The leading cause of male infertility is the presence of varicocele. Recently, selective spermatic vein embolization during spermatic venography has afforded a simple, nonoperative treatment. In this study, liquid crystal contact thermography was employed before spermatic venography and after embolization or surgery. Pretreatment thermographic results were in agreement with venography in 15 of 17 cases as 13 were considered positive and two negative by both methods. Thermography further served to document objectively the immediate physiologic effectiveness of either therapy in controlling spermatic vein reflux into the pampiniform plexus. It therefore provides a noninvasive means of evaluating treatment success or recurrence at an early stage. Preliminary thermographic evidence indicates that embolization is a highly effective treatment of reflux. Thermography can also function as a useful, noninvasive screening technique to aid in selecting patients for spermatic venography and embolization therapy.

Prophylactic use of ureteral stent in iatrogenic injuries to ureter

Injury to the ureter during pelvic and abdominal surgical procedures is not uncommon. We herein present the results of the prophylactic use of ureteral stents in iatrogenically traumatized dog ureters.