[Comparison of digital subtraction angiography, CT angiography, and ultrasonic Doppler examination in the evaluation of penile arterial lesions]

BACKGROUND

CT angiography reconstructed by a multidetector-row helical CT scanner is a newly developed form of imaging. We compared CT angiography and ultrasonic Doppler examination with digital subtraction angiography (DSA) in the diagnosis of arterial lesion.

METHOD

Eighteen patients with arteriogenic erectile dysfunction (ED) underwent color Doppler study, DSA, and CT angiography after providing informed consent. The CT angiography images were obtained by a multidetector-row helical CT scanner, Asteion TSX021A (TOSHIBA). We injected prostaglandin E1 into the penile cavernous body, and then rapidly infused nonionic contrast medium into the antecubital vein. DSA and CT angiography images of the bilateral internal pudendal arteries and cavernous arteries were examined for stenotic lesions or occlusion. We also compared the peak systolic blood flow velocity in the cavernous artery measured by color Doppler ultrasound with CT angiography and DSA.

RESULTS

The CT angiography and color Doppler studies were performed on an outpatient basis, but DSA required hospitalization. In the 36 internal pudendal arteries, DSA represented 22 normal arteries and 14 stenosis or occlusions. CT angiography showed 15 normal arteries and 21 occlusions. For the diagnosis of stenosis or occlusion in the internal pudendal artery, the CT angiography image had a good agreement, with a sensitivity of 1.00, specificity of 0.68, and accuracy of 0.81. For diagnosis in the cavernous artery, CT angiography image also showed a good agreement with DSA; however, the quality of the images of fine arteries was better in the DSA images. The inferior view and internal view of the pelvis in CT angiography were helpful for visualizing the internal pudendal artery, especially at the pubic bone. There was insufficient correlation between peak systolic blood flow velocity and DSA findings. There were no serious complications involved in either examination.

CONCLUSIONS

CT angiography has not yet reached the same level as DSA in the evaluation of fine arteries. However, CT angiography can produced images sufficient for the diagnosis of arteriogenic ED with some advantages. We believe that with improvement, CT angiography will become an adequate replacement for DSA in the diagnosis of penile arterisl lesion.

Spring balance evaluation of the ischiocavernosus muscle

We studied the voluntary contractile activity of the ischiocavernosus muscle (ICM) in 21 sexually potent and 97 erectile dysfunction (ED) subjects using a spring balance. A strap was placed around the coronal grove of the glans penis and tensioned with the spring balance. Subjects were asked and encouraged to contract the ICM against the spring balance. We evaluated the length of stroke, duration of contraction, and maximum contractile force. The length of stroke, duration of contraction, and maximum contractile force showed statistically significant differences between potent and ED subjects. Diagnosed psychogenic ED and arteriogenic ED showed higher contractile activity than cavernous ED and neurogenic ED. Our results corresponded to those of previous studies that have urged consideration of the role of the ICM during the process of erection in animal experiments and in human electrophysiological studies. The spring balance evaluation is a useful, inexpensive method for evaluating the ICM.

Feasibility of multi-slice computed tomography in the diagnosis of arteriogenic erectile dysfunction

OBJECTIVE

To compare computed tomography (CT) angiography (CTA) obtained by multi-slice CT (a new minimally invasive method) with the current standard of arterial imaging, digital subtraction angiography (DSA), in diagnosing arteriogenic erectile dysfunction (ED).

PATIENTS AND METHODS

Twenty-one patients with suspected arteriogenic ED underwent DSA and CTA after providing informed consent. Prostaglandin E1 was injected into the penile cavernosal body and then non-ionic contrast medium was rapidly infused into the antecubital vein. The DSA and CTA images were diagnosed as showing a normal or abnormal status by three reviewers independently. CTA was undertaken on an outpatient basis but DSA required hospitalization.

RESULTS

In the 42 internal pudendal arteries, DSA showed 28 normal and 14 impaired arteries; CTA showed 21 normal arteries and 21 occlusions. The CTA image correlated closely with the diagnosis of stenosis or occlusion in internal pudendal arteries, with a sensitivity of 93%, a specificity of 71% and an accuracy of 79%. In the cavernosal arteries, DSA depicted 14 normal and 28 impaired arteries; CTA showed seven normal arteries and 35 occlusions. The CTA image agreed closely with the diagnosis of stenosis or occlusion in cavernosal arteries, with a sensitivity of 96%, a specificity of 43% and an accuracy of 79%. Of the 42 inferior epigastric arteries, DSA could not depict 11 arteries but CTA showed all 42 inferior epigastric arteries.

CONCLUSIONS

CTA images correlated with DSA images; at present DSA is better than CTA in visualizing stenosis in fine arteries. However, CTA is less invasive and relatively inexpensive, and in future will probably provide even greater improvements in graphic quality. CTA would be an adequate replacement for DSA in evaluating internal pudendal arterial stenosis.

[Treatment of phimosis with betamethasone ointment in children]

OBJECTIVE

We evaluated the efficacy of betamethasone ointment in the treatment of childhood phimosis and determined the most effective concentration of betamethasone.

MATERIAL AND METHODS

Between August 1996 and May 2000, 69 patients (median age 3.0, range 0-12) presented to our department with severe phimosis (grade 4, Tsugaya's classification), and were enrolled in this study and treated with betamethasone ointment for 4 weeks. The ointment was applied on the narrowed preputial skin twice a day by parents. During the first week, parents were asked not to retract the foreskin. After this period, parents were encouraged to retract the foreskin gently and without intense tension. The concentration of betamethasone were 0.12%, 0.05% and 0.025%. If the patients become to be able to retract foreskin satisfactory, we consider the state as complete response. If he become to be able to retract to allow partial exposure of the glans, we consider the state as partial response. We compared the efficacy among each of the concentrations, and at 3 months after the end of the treatment, we also assessed the adverse effects and recurrence.

RESULTS

The overall success rate was 85.5%. Success rates with 0.12%, 0.05% and 0.025% ointment were 96.8%, 82.8% and 55.6%, respectively (p = 0.0001). The 0.12% ointment was most effective. Recurrence was observed in 3 patients (4.3%). No adverse effects were observed in any of the patients.

CONCLUSIONS

Treatment with betamethasone ointment is very effective, easy and safe. We recommend betamethasone ointment as the first treatment of choice for childhood phimosis.

Effect of radical retropubic prostatectomy on erectile function, evaluated before and after surgery using colour Doppler ultrasonography and nocturnal penile tumescence monitoring

OBJECTIVE

To assess the effect of radical retropubic prostatectomy on erectile function, by evaluating objectively patients' erectile function before and after surgery.

PATIENTS AND METHODS

The study comprised 126 patients with clinically localized prostate cancer who were scheduled to undergo radical retropubic prostatectomy. After giving informed consent for the study, 123 patients underwent intracavernosal injection tests, colour Doppler ultrasonography and nocturnal penile tumescence monitoring before and after surgery.

RESULTS

From the intracavernosal injection tests and nocturnal penile tumescence monitoring, 21 patients (17%) were evaluated as having normal erectile function before surgery. After radical retropubic prostatectomy, nine (43%) of these 21 potent men had preserved erectile function. In eight patients whose neurovascular bundles were preserved, five were potent after surgery. The cause of erectile function after surgery was a neurogenic disorder in seven and a related vascular disorder in five.

CONCLUSION

From objective tests of erectile function on patients scheduled to undergo radical prostatectomy, 17% had normal erectile function. However, even after nerve-sparing radical retropubic prostatectomy, the proportion retaining potency was unsatisfactory. Although a neurological disorder was the main cause of erectile dysfunction after surgery, vascular disorders were also important.

Screening of ischemic heart disease with cavernous artery blood flow in erectile dysfunctional patients

Erection is a hemodynamic event and accordingly, erectile dysfunction (ED) is closely related with ischemic heart disease. We should confirm that the cardiac condition of the ED patient is safe enough to perform sexual intercourse prior to beginning treatment for ED. Asymptomatic ischemic heart disease cannot be diagnosed only in an interview, but it's difficult to perform cardiac exercise tests on all patients complaining of ED. Therefore, screening methods to evaluate patients who should undergo exercise tests are needed. Sixty patients with erectile dysfunction participated in this study. Physical examinations, interviews, and color Doppler examinations were conducted. Chest X-rays and electrocardiograms of all patients in the resting position were obtained, as were electrocardiograms following exercise. Echocardiograms, treadmill test results, thallium exercise scintigrams, and coronary angiograms were obtained as required for diagnosis. Two patients were excluded because they had obvious arteriogenic ED due to perineal injury. Fifty-eight patients underwent Doppler evaluations of their cavernous arteries and heart exercise tests. Fourteen patients (24.1%) were diagnosed with ischemic heart disease. Although six of them had already been diagnosed with ischemic heart disease, eight were newly diagnosed by the exercise tests. Cardiovascular risk factors such as advanced age, hyperlipidemia, diabetes mellitus, hypertension, smoking, and obesity were not sufficient predictive factors. The mean peak systolic velocity of the patients without ischemic heart disease was 34.6 cm/s vs 22.0 cm/s in those with ischemic heart disease. Only 3.7% of patients whose peak systolic velocity in the cavernous artery was equal to or exceeded 35 cm/s had ischemic heart disease. On the other hand, 41.9% of patients with peak systolic velocity of less than 35 cm/s had ischemic heart disease. The sensitivity of peak systolic velocity against ischemic heart disease was 92.9%, and specificity was 59.1%. In ED patients, incidences of complications involving symptomatic or asymptomatic ischemic heart disease were found to be high. The peak systolic velocity in the cavernous artery is thought to be a useful predictive factor of ischemic heart disease in ED patients. When a patient reveals a peak systolic velocity of less than 35 cm/s, he should undergo heart exercise tests prior to treatment of ED.

[Ischemic heart disease in patients with erectile dysfunction]

BACKGROUND

Erection is an hemodynamic event and accordingly, erectile dysfunction is closely related with ischemic heart diseases. Sufficient study has yet to be made of this relation.

METHOD

Fifty-eight patients with erectile dysfunction participated in the present study. Intracavernous injection tests and color Doppler examination were conducted for assessment of erectile function. For patients with history of ischemic heart disease, we referred to their doctor for data from their examinations. For patients otherwise, chest X-rays and electrocardiograms in the resting position were obtained and also electrocardiograms following exercise. Echocardiograms, treadmill test results, thallium exercise scintigrams, and coronary angiograms were obtained as requires for diagnosis.

RESULTS

Eighteen patients (31.0%) were diagnosed as ischemic heart disease or at high risk. Although 6 of them had been already diagnosed with ischemic heart disease, 12 were newly diagnosed by the exercise tests. Among these 18 patients 16 had one or more significant risk factors for ischemic heart disease such as age, hyperlipidemia, and diabetes mellitus. 3.7% of patients whose peak systolic velocity in the cavernous artery was equal to or exceeded 35 cm/sec had ischemic heart disease or were at high risk. 54.8% of patients with peak systolic velocity of less than 35 cm/sec had ischemic heart disease or were at high risk.

CONCLUSIONS

In erectile dysfunctional patients, incidence of complications with symptomatic or asymptomatic ischemic heart disease was found to be high. Therefore, in patients with risk factors or low peak systolic velocity in the cavernous artery, exercise tests should be implemented prior to treatment of erectile dysfunction.

Tyk2 plays a restricted role in IFN alpha signaling, although it is required for IL-12-mediated T cell function

Janus kinases (Jaks) play an important role in signal transduction via cytokine receptors. Tyk2 is a Janus kinase, and we developed tyk2-deficient mice to study the requirement for tyk2 in vivo. Tyk2-deficient mice show no overt developmental abnormalities; however, they display a lack of responsiveness to a small amount of IFNalpha, although a high concentration of IFNalpha can fully transduce its signal even in the absence of tyk2. Furthermore, IL-12-induced T cell function is defective in these mice. In contrast, these mice respond normally to IL-6 and IL-10, both of which activate tyk2 in vitro. These observations demonstrate that tyk2 plays only a restricted role in mediating IFNalpha-dependent signaling while being required in mediating IL-12-dependent biological responses.

[Localized amyloidosis of the ureter and bladder treated effectively by occlusive dressing technique therapy using dimethyl sulfoxide: a case report]

We report here the first case of localized amyloidosis of the ureter and bladder to be treated effectively by occlusive dressing technique therapy using dimethyl sulfoxide. The patient was a 48-year-old woman whose chief complaint was macrohematuria and right back pain. Ultrasound sonography demonstrated right hydronephrosis and an intravesical mass in the region of the right ureteral orifice. Retrograde pyelography revealed severe stricture of the right lower ureter. Cystoscopy demonstrated a yellow submucosal tumor around the right ureteral orifice. We suspected urinary tract amyloidosis, and transurethral biopsy and resection of the intravesical mass were performed under right ureteral stenting. Histopathological diagnosis was amyloidosis. There was no evidence of systemic amyloidosis. To treat residual amyloidosis of the ureter and bladder, we performed occlusive dressing technique therapy using dimethyl sulfoxide every day. After 6 months of therapy, the right hydronephrosis disappeared, and there was no evidence of a recurrence of amyloidosis. We concluded that this therapy was very effective and safe for urinary tract amyloidosis.

The cyclization reaction of ortho-ethynylbenzaldehyde derivatives into isoquinoline derivatives

In order to elucidate the reaction mechanism of the cyclization between an ethynyl group and an imino group at the ortho-position on an aromatic ring to afford isoquinolines, reaction of 2-ethynylbenzaldehydes under various conditions was examined. It is concluded that reaction proceeds via an ionic process and the isoquinoline 4-hydrogen atom derives from the solvent. In addition, it was found that 2-ethynylbenzaldehyde O-methyloximes underwent cyclization in the presence of primary and secondary alcohols to give 3-substituted isoquinolines.

[A family with DRPLA and chronic renal failure]

We reported a family with dentato-rubro-pallido-luysian atrophy (DRPLA) and chronic renal failure. The proband was a 66-year-old woman who developed gait disturbance, limb ataxia, pyramidal tract signs, and dementia since age 54. T2-weighted brain MR images revealed symmetric high-signal lesions in the cerebral white matter, in addition to cerebellar, brainstem, and cerebral cortical atrophy. She suffered from renal failure and became dialysis-dependent at the age of 59, four years after the onset of chronic nephritic syndrome. At the age of 66, she was admitted to our hospital because of hyperthermia and disturbance of consciousness, and died of DIC. Her CAG repeats in the DRPLA gene were 58 and 12. An autopsy was performed. The brain weighed 910 g. Histological findings confirmed the diagnosis of DRPLA. Her mother died of chronic renal failure. All three siblings had cerebellar ataxia, and two siblings had chronic nephritic syndrome. Among them, only her younger brother was diagnosed as non-IgA glomerulonephritis based on kidney biopsy findings at the age of 48. Though the nature of the association between DRPLA and renal dysfunction remains obscure, the DRPLA gene abnormality may be correlated with chronic renal failure in this family.

[Microsurgical penile revascularization in patients with pure arteriogenic erectile dysfunction]

BACKGROUND

We report the results of microscopic penile revascularization in patients with arteriogenic erectile dysfunction.

METHODS

One patient with localized obstruction of the common penile artery underwent the Michal II penile revascularization, 13 patients underwent the Furlow-Fisher procedure, and 5 patients underwent the Hauri procedure. The mean age was 33.0 years and the mean follow-up period was 32 months (4-80 months). Eight patients were tobacco smokers, one patient was over 50 years old. Surgery was considered successful when the patients had a permeable anastomosis and were able to achieve satisfactory erection resulting in normal sexual intercourse.

RESULTS

All surgery was successful except for one patient who had undergone the Furlow-Fisher procedure. In Spite of antithrombotic therapy, graft occlusion occurred in two patients. Post operative glans hypervascularity occurred in two patients.

CONCLUSION

Penile revascularization surgery is a highly effective treatment for selected patients. There is a need for further study of graft occlusion and glans hypervascularity.

Isolation and structures of schleicherastatins 1-7 and schleicheols 1 and 2 from the teak forest medicinal tree Schleichera oleosa

Bioassay (P-388 lymphocytic leukemia cell line)-guided separation of an extract prepared from the bark and stem of the Sri Lankan tree Schleichera oleosa led to the isolation of seven cancer cell growth inhibitory hydroxylated sterols designated schleicherastatins 1-7 (1-7) and two related sterols, schleicheols 1 and 2 (8, 9). The structure of schleicherastatin 1 (1) was completely elucidated by X-ray crystal structure determination. Based upon that defined structure, the remaining new sterol structures were deduced by highfield (300 and 500 MHz) NMR and MS interpretations. In this new series of sterols, hydroxylation at C-22 appears to be important for promoting cancer cell growth inhibition.

Inhibitory activities of 2-pyridinecarboxylic acid analogs on phytogrowth and enzymes

Five 2-pyridinecarboxylic acid-related compounds (1, 2 and 5-7) showed germination inhibition against the seed of Brassica campestris L. subsp. rapa HOOK fil et ANDERS at a concentration of 5.0 x 10(-4) M. These compounds also demonstrated inhibitory activity on the growth of the root of this plant at a concentration of 3.0 x 10(-4) M; among these compounds, 2-pyridylacetic acid (5) showed the strongest inhibitory activity, and the effect was slightly stronger than that of sodium 2,4-dichlorophenoxyacetate (2,4-D) used as a positive control. The amounts of chlorophyll in the cotyledons of this plant treated with these active compounds was lower than that of the control group. Four compounds (1 and 5-7) with germination inhibition also showed inhibitory activities against alpha-amylase and carboxypeptidase A, and 5 was the strongest inhibitor toward both enzymes.

[Long-term results of venous surgery for cavernous erectile dysfunction]

BACKGROUND

It is well known that the effectiveness of venous surgery declines during the follow-up period. The onset of recurrence after surgery varies greatly among patients. There are only a few studies which have evaluated the effectiveness of venous surgery with objective tests.

METHODS

We treated 123 cases of cavernous erectile dysfunction with venous surgery, and evaluated the results objectively. We performed intracavernous injection tests using 20 micrograms of prostaglandin E1 every 3 months until the recurrence of cavernous erectile dysfunction.

RESULTS

Mean follow up period was 32 months (0.2-134.0 months). According to the Kaplan-Meier analysis, the effectiveness of surgery at 1 year, 3 years, 5 years, and 10 years was 85%, 61%, 30%, and 26%, respectively.

CONCLUSION

There was no statistically significant difference between the outcomes following deep dorsal vein surgery and crural ligation surgery. Operative complications were more frequent, however in deep dorsal vein surgery.

Studies on inhibitory activities of fukiic acid esters on germination, alpha-amylase and carboxypeptidase A

Fukinolic acid (1) and cimicifugic acid A (2), caffeic acid analogs, as well as rosmarinic acid (3) and caffeic acid (4) showed inhibition on seed germination and seedling growth. The potency of 1 and 2 was comparable with that of 3. Compounds 1 and 2 also showed strong inhibitory activities as well as 3 and 4 on alpha-amylase. The activity of 1 was higher than that of acarbose used as a positive control, and its 50% inhibitory concentration (IC50) was 2.41 x 10(-5) M. Compounds 1 and 2 also showed inhibitory activities strong as 3 and stronger than 4 on carboxypeptidase A. The activities of 1 and 2 were higher than that of 1, 10-phenanthroline used as a positive control.

Insecticidal and antifungal activities of aminorhodanine derivatives

Aminorhodanine (1) showed strong insecticidal activity against Culex pipiens pallens and Musca domestica, with respective LD50 values of 0.21 microgram/insect and 0.87 microgram/insect. Compound 1 had antifungal activity against Aspergillus niger ATCC-16404, Trichophyton mentagrophytes IFO-32412, Candida albicans ATCC-10231, Hansenula anomala OPS-308 and Penicillium expansum IFO-8800. In particular, 1 had potent antifungal activity against Aspergillus niger ATCC-16404, its minimal inhibitory concentration (MIC) being 6.25 micrograms/ml. Both activities of 1 were much higher than those of rhodanine (4), suggesting that the introduction of an amino group into N-3 of 4 plays an important role in the biological activity of rhodanine-related compounds. On the other hand, N-acetylaminorhodanine (2) and N-benzoylaminorhodanine (3) did not show either activity, suggesting that the free amino group at N-3 of 1 is closely related to the inhibitory activity of rhodanine derivatives.

Cytotoxic substances produced by a fungal strain from a sponge: physico-chemical properties and structures

Five novel metabolites, trichodenones A-C (1-3), harzialactone A (4) and B (5), have been isolated together with known R-mevalonolactone (6) from the culture broth of a strain of Trichoderma harzianum OUPS-N115 originally separated from the sponge Halichondria okadai. Their structures have been elucidated by spectral evidence. Among them, 1-3 exhibited significant cytotoxicity against cultured P388 cells.

[A case of multiple endocrine neoplasia type I with primary hyperparathyroidism, prolactin secreting pituitary microadenoma and gastrin secreting duodenal carcinoid]

A case of MEN type I in a 64-year-old man is reported. He had undergone partial duodenectomy because of gastric ulcer and multiple duodenal polyps (gastrin secreting carcinoid). Blood examination revealed hypercalcemia, hyperPTHemia, and hyperprolactinemia. Neck US and CT showed enlargement of 4 parathyroid glands. Brain MRI revealed the microadenoma in left pituitary gland. Total parathyroidectomy with auto-transplantation in the left forearm were performed. Histological examination showed the hyperplasia of the parathyroid. Three and a half year after parathyroidectomy, there was no evidence of recurrence of gastrin secreting tumor and hyperparathyroidism, and enlargement of pituitary microadenoma. This is the first MEN type I case in Japan which have detected 3 endocrine tumors clinically with gastrin secreting duodenal carcinoid.

[Clinical studies for venogenic impotence with color Doppler ultrasonography--evaluation of resistance index of the cavernous artery]

BACKGROUND

Pharmaco-dynamic infusion cavernosometry and cavernosography (pharmaco-DICC) is essential for diagnosis of venogenic impotence, however it is so invasive. On the other hand, color Doppler ultrasonography is non-invasive and has become one of the useful diagnostic methods for arteriogenic impotence. And there are some reports evaluating whether venogenic impotence can be diagnosed using color Doppler ultrasonography. In this study, we investigated whether the resistance index (RI) could be useful for screening for venogenic impotence.

METHODS

We performed color Doppler ultrasonography in 49 patients who had shown negative responses to an intracavernous injection of 20 mcg of prostaglandin E1 (PGE1). They previously underwent pharmaco-DICC and were diagnosed venogenic impotent when the maintenance flow rate was equal to or more than 20 ml/min. In 49 patients, 17 patients had DICC normality, while 32 patients had corporal leakages. After an intracavernous injection of 20 mcg of PGE1, we performed color Doppler ultrasonography, and measured peak systolic velocity (PSV) and end diastolic velocity (EDV) in the cavernous artery. RI was calculated as follows. RI = (PSV-EDV)/PSV We adopted the RI value near to 1 as the case's RI from two RI values of bilateral cavernous arteries, and compared RI values with the results of pharmaco-DICC.

RESULTS

RI range in patients with normal DICC results was 0.895 +/- 0.092 (0.70-1.00), while RI range in patients with corporal leakages was 0.742 +/- 0.095 (0.55-0.97). RI values in patients with corporal leakages were significantly lower than those in patients with normal DICC results although there was some overlap in each group. From receiver-operating-characteristic curve (ROC curve) of the correlation between sensitivity and specificity at various RI values compared with DICC results, the RI cut off values were set up at 0.75 and 0.90, and classified the patients into 3 group according to their RI cut off values. In 10 patients with 0.9 < RI, 9 patients (90%) had DICC normality. In 17 patients with 0.75 < RI < or = 0.9, 7 patients had DICC normality while 10 patients had corporal leakages. In 22 patients with RI < or = 0.75, 21 patients (95.5%) had corporal leakages.

CONCLUSION

We consider without carrying out pharmaco-DICC that patients with 0.9 < RI were not venogenic impotent, while patients with RI < or = 0.75 had corporal leakages. Pharmaco-DICC will remain essential only in patients with 0.75 < RI < or = 0.9.

[New nocturnal penile tumescence recorder]

BACKGROUND

Records of nocturnal penile tumescence are still important test and necessary to distinguish organic impotence from psycogenic impotence.

METHODS

We developed the nocturnal penile tumescence recorder with a disposab indiumgallium straingauge, and we examined its clinical usefulness for volunteers with normal erectile function.

RESULTS

The results were that the indium-gallium straingauge had almost the same resistance change with extension, and that it showed almost the same resistance value at respective circumferences with consecutively ten times measurements. Only two of thirty-nine volunteers experienced the snapping of the indium-gallium strain-gauge. None of the volunteers complained of discomfort during measurements. The nocturnal penile tumescence of five volunteers were recorded with a conventional mercuric straingauge and a newly developed indium-gallium straingauge simultaneously, and there were no significant differences between the results of the two materials. This recorder is very simple to manage, and the softwares for preservation of data and making graph are also simple. This new straingauge is clean and dose not require maintenance because of the disposable use.

CONCLUSION

We concluded that this recorder system was clinically useful for t examination of nocturnal penile tumescence.

[Evaluation of cavernous artery by color Doppler ultrasonography--significance of ultrasonic beam angle]

Penile Doppler ultrasonography is widely accepted as an essential examination in the diagnosis of impotence. However, measurement blood flow velocity using Doppler ultrasonography may be subject to some errors. We performed color Doppler ultrasonography in 63 patients with normal penile vascular function as diagnosed using positive responses to intracavernous pharmacological stimulation. We compared the Doppler measurement results of the 126 cavernous arteries and the ultrasonic beam angles. We used a Hitachi EUB 515, a sonographic probe of 7.5 MHz, a sampling width of 0.8 mm, a sampling depth of 1 mm, and a wall motion filter was not used. Ultrasonic beam angles were 5 to 77 degrees. The mean peak systolic velocity and end diastolic velocity values were 40. 0 cm/s and 3.9 cm/sec, respectively. The peak systolic velocity and end diastolic velocity values remained stable regardless of the ultrasonic beam angles (Kruskal-Wallis test, p = 0.56, p = 0.70). However, the variance of values became greater when the ultrasonic beam angles was larger than 55 degrees in the case of peak systolic velocity (F test, p < 0.05) and 50 degrees in the case of end diastolic velocity (F test, p < 0.05), indicating a reduction in reliability. Resistance index variance was significantly higher when ultrasonic beam angle exceeds 50 degrees (F test, p < 0.05). We believe that we should accept only those cavernous artery peak systolic velocity measurements as reliable when the ultrasound beam angle is less than 55 degrees.(ABSTRACT TRUNCATED AT 250 WORDS)

Cytotoxic metabolites from a fungal adherent of a marine alga

Leptosins G, G1, G2 and H, belonging to a series of dimeric epipolythiodioxopiperazines, were isolated from the mycelium of a strain of Leptosphaeria sp. stuck on the marine alga Sargassum tortile. Their stereostructures were elucidated by chemical and spectral evidence.