Quantitative bone scanning of the hip. Comparison between the perfusion and static phases

Quantitative bone scanning of the hip was carried out in 50 patients, 45 with unilateral disorders, and 5 with no symptoms and normal radiographs. The uptake ratio of the involved femoral head was calculated in the perfusion and static phases. In the patients with no symptoms the difference in the uptake ratio between the right and left hips averaged less than 0.02 in both phases. In 5 patients with a unilateral endoprosthesis the average was 0.52 in the perfusion and 0.34 in the static phase. In 10 patients with intertrochanteric fractures, 9 with undisplaced femoral neck fractures and 7 with osteoarthritis, each uptake ratio averaged more than 1.1 in both phases. In 9 patients with displaced femoral neck fractures, the mean ratio was 0.76 in the perfusion and 0.92 in the static phase. In 5 patients with avascular necrosis the ratio was 0.82 in the perfusion and 1.57 in the static phase. Quantification of uptake in both phases provides objective data reflecting bone blood flow and metabolism in various disorders of the hip.

[Estimation of the weddellite to whewellite ratio by infrared spectroscopy]

Powder samples of 56 calcium oxalate stones the contents of weddellite, whewellite and apatite of which had been determined by thermogravimetry (TG) were studied by infrared spectroscopy (IR). When the ratio of the weddellite content to the total of weddellite and whewellite (weddellite ratio) calculated using Oka's method on the infrared spectra was compared with that determined previously by TG, the correlation coefficient between these ratios was 0.734. For the 24 calcium oxalate stones the apatite content of which was less than 10%, the correlation coefficient between these ratios was 0.976, although the weddellite ratio calculated using Oka's method was significantly higher than that determined by TG (P less than 0.01). In an attempt to estimate the weddellite to whewellite ratio by IR regardless of the content of apatite, the ratio of the depth of the absorption band at 780 cm-1 (H780) to the depth of the absorption band at 1,320 cm-1 (H1320) was compared with the ratio of the whewellite content to the total of whewellite and weddellite contents determined by TG. The correlation coefficient between these ratios was 0.953. We conclude that the ratio of H780 to H1320 determined from the infrared spectra obtained from a 0.3 to 1 mg powder sample of calcium oxalate stone is useful in the estimation of the weddellite to whewellite ratio.

[Percutaneous dissolution of uric acid and cystine stones causing acute ureteral obstruction]

Four cases with ureteral obstruction due to uric acid or cystine stones were treated successfully by percutaneous irrigation with sodium bicarbonate or tromethamine-E. These cases underwent percutaneous nephrostomy for the reason of prolonged complete obstruction (case 1), sustained pyelonephritis (case 2) or decreased renal function (case 3 and 4). Two catheters were placed through the nephrostomy tract before irrigation, 6 Fr. ureteral catheter just above the ureteral stone and 10 Fr. pigtail or 12 Fr. Malecot catheter in the renal pelvis. The ureteral stones were markedly reduced in size and passed spontaneously after 6-11 days' duration of irrigation in three cases. In case 2, the remaining stone was removed transurethrally after 14 days' duration of irrigation, and was found to be composed of organic matrix. Percutaneous dissolution is considered to be a safe and reliable method and may be an alternative way of treating uric acid or cystine stone causing acute ureteral obstruction.

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

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

[Fournier's gangrene: a case report]

A 40-year-old male was admitted complaining of high grade fever, pain, redness and swelling of the right scrotum, right perineum and right flank region. He had no apparent history of previous infection or diabetes mellitus. At the time of admission, the scrotum was partly necrotic with repulsive feculent pus discharge and there was crepitus on palpation of involved areas. Culture of purulent discharge yielded the growth of anaerobic organisms. Surgical drainage was performed immediately and debridement of necrotic tissue in the involved areas was often repeated. At the same time, the patient received antibiotic therapy that included agents effective against anaerobic bacteria. However, the scrotal skin developed gangrene and the right testis hung suspended with cord exposed. This testis was intact. The scrotal skin defect was cured using a skin graft, after the infection had been brought under control.

Regulatory effect of prostaglandin E2 on fibronectin release from human alveolar macrophages

Fibronectin (Fn), which is released from several kinds of cells including alveolar macrophages (AM), is important in inflammatory reactions in the certain lung diseases such as idiopathic pulmonary fibrosis (IPF). Therefore, information on the mechanisms regulating Fn release from AM may be useful for elucidating the pathogenesis of these diseases and developing therapeutic modalities. We supposed that prostaglandin E2 (PGE2), which is known to modulate cellular functions, might be involved in regulation of Fn release, and, accordingly, we measured the release of Fn and PGE2 from AM from normal volunteers (NV), control patients (CP), and patients with IPF. AM from patients with IPF were found to release more Fn than AM from NV (IPF: 250 +/- 58.8/10(6) cells.24 h, NV: 53.0 +/- 7.3 ng/10(6) cells.24 h) and to release less PGE2 than the latter (IPF: 0.48 +/- 0.12 ng/10(6) cells.24 h, NV:1.35 +/- 0.24 ng/10(6) cells.24 h). A negative correlation was found between the contents of Fn and PGE2 in the culture media of AM from NV, CP, and patients with IPF. Lipopolysaccharide, phorbol myristate acetate, and zymosan suppressed Fn release from AM but stimulated their PGE2 release, and these effects were reversed by indomethacin. Exogenous PGE2 (greater than 1 x 10(-8) M) suppressed Fn release. The albumin-antialbumin complex stimulated Fn release but did not affect PGE2 release. These results indicate that Fn release from AM changed in response to various stimuli, and that PGE2 is important in suppressing Fn release from AM, suggesting a negative feedback mechanism of PGE2 in releasing Fn.

Role of alveolar macrophages in the neutrophil-dependent defense system against Pseudomonas aeruginosa infection in the lower respiratory tract. Amplifying effect of muramyl dipeptide analog

Alveolar macrophages are thought to be important in immune or inflammatory reactions. We investigated the role of alveolar macrophages in defense against Pseudomonas aeruginosa infection in the lower respiratory tract. Intratracheal inoculation of formalin-inactivated P. aeruginosa (1 x 10(8)-1 x 10(10) organisms) into normal rats resulted in increase in the number of neutrophils in the bronchoalveolar lavage (BAL) fluid obtained 24 h later. The phagocytic activity of neutrophils for P. aeruginosa was higher than that of alveolar macrophages. These findings indicate that neutrophils are essential for phagocytosis of P. aeruginosa in the lower respiratory tract. On incubation with P. aeruginosa, alveolar macrophages released neutrophil chemotactic factor (NCF) dose-dependently. MDP-Lys(L18), a muramyl dipeptide analog, stimulated alveolar macrophages to phagocytize P. aeruginosa and stimulate the release of NCF from alveolar macrophages in vitro and enhanced the neutrophil response to inoculated P. aeruginosa in vivo. These results indicate that alveolar macrophages are important in initiating the neutrophil-dependent defense system against P. aeruginosa by releasing NCF and that MDP-Lys(L18) can amplify the defense system.

[Production of fibronectin and PGE2 by cultured human alveolar macrophages]

Production of fibronectin (Fn) and prostaglandin E2 (PGE2) by human alveolar macrophages (AM) which were obtained by bronchoalveolar lavage was studied in vitro. AM obtained from patients with idiopathic interstitial pneumonia (IIP) produced much more Fn than those from normal volunteers but produced less amounts of PGE2. We also tested the effect of lipopolysaccharide (LPS), phorbol 12-myristate 13-acetate (PMA), zymosan and albumin-anti albumin complex (alb-anti alb) on production of Fn and PGE2 from AM. LPS, PMA and zymosan suppressed Fn production but stimulated PGE2 production by AM from patients with IIP but indomethacin reversed the suppressive effect of LPS, PMA and zymosan on Fn production. On the contrary, alb-anti alb stimulated Fn production by AM. Furthermore, exogenous PGE2 suppressed Fn production by AM from patients with IIP in a dose-dependent manner. These data suggest that Fn production by AM may be changed by different stimuli or different states of disease, and there is close relationship between the production of Fn and PGE2 by AM.

[Study of oval crystals in urine]

Urinary crystals were collected by repeated centrifugation from two outpatients with calcium oxalate crystalluria where oval forms predominated and were studied by scanning electron microscopy and X-ray diffraction. Fibrous structure, biconcave surface and prismatic appearance of oval crystals were shown. The side view of oval forms may be prismatic X-ray diffraction patterns of urinary crystals indicated that oval crystals consist of calcium oxalate monohydrate.

[The role of urine pH in the occurrence of phosphaturia]

The density of calcium phosphate and the pH were determined in 15 postprandial urine specimens with heavy precipitation of amorphous calcium phosphate, that is phosphaturia, collected from 5 patients with calcium urolithiasis (stone-formers) and 3 patients with no known urological disease (controls). Phosphaturia, not related to urinary tract infection or administration of alkalinizing agents, was found repeatedly at our outpatient clinic in these patients. The correlative relationship was not confirmed between the density of calcium phosphate and the pH. The concentration of calcium and phosphorus was also determined in 10 urine specimens with phosphaturia. The concentration of phosphorus was correlated significantly with the pH (r = -0.775, p less than 0.01), although the concentration of calcium was not correlated with the pH. The pH of 11 urine specimens with phosphaturia from the controls was 7.51 +/- 0.31 (mean +/- S.D.) and the pH of 18 urine specimens with phosphaturia from the stone-formers was 6.81 +/- 0.34. The pH was significantly lower in the urine specimens from the stone-formers than in those from the controls (p less than 0.01). We have noted that the occurrence of phosphaturia depends not only on the urinary pH but on the concentration of phosphorus. It is interesting that phosphaturia often occurs in urine specimens with a pH below 7 in stone-formers.

[A clinical study of primary hyperparathyroidism]

Eight cases of primary hyperparathyroidism (P-HPT) confirmed pathohistologically, between April, 1974 and January, 1986 at our department, were reviewed. The patients consisted of three males and five females, ranging in age from 38 to 62 years old with an average of 50.3 years. All the cases belonged to the urolithiasis type and seven patients were recurrent or/and multiple stone-formers. Positive rates of the laboratory values studied in relation with P-HPT were 100% in serum Ca, C terminal parathyroid hormone, and % TRP, 87.5% in urine Ca, 75% in serum Cl/P ratio, alkaliphosphatase, 50% in serum Cl, 37.5% in serum P and 0% in urine P. Seven cases had clinically apparent hypercalcemia, while one was a so-called borderline P-HPT with intermittent hypercalcemia. The correct diagnosis of the localization was obtained preoperatively in two cases by angiography and one by C.T and Tl-Tc subtraction scintigraphy. Histological findings of the tumors extirpated by the cervical operation were parathyroid adenomas in six cases and hyperplasia in two. During the course of the postoperative follow up, hypercalcemia and urolithiasis did not recur in any case including two of hyperplasia.

[Study of the transformation of weddellite to whewellite in calcium oxalate stones by x-ray diffraction]

A clay film was made of the stone powder and water drops on a slide glass and dried at 100 to 110 degrees C or at room temperature in the horizontal position for 20 calcium oxalate stones which had been received between April, 1978 and August 1980. Each clay film was scanned with an X-ray diffractometer using CuK alpha radiation, stored at room temperature in a wooden sample case and analysed again by X-ray five to seven years after the first X-ray analysis. Then the recent diffractograms of 20 powder samples were compared with the previous ones regarding the peak heights at 14.2 degrees, 14.8 degrees and 25.8 degrees (2 theta), which were considered representative of weddellite, whewellite and apatite contents and designated as Iwe, Iwh and Iap, respectively. Since there was a good correlation between Iwe/Iwe + Iwh + Iap and weddellite/weddellite + whewellite + apatite that was determined by thermogravimetry (Fig. 1), the transformation rate of weddellite to whewellite can be expressed as the change of Iwe/Iwe + Iwh + Iap. One sample Iwe/Iwe + Iwh + Iap of which decreased by 48% in seven years (Fig. 3) and another sample Iwe/Iwe + Iwh + Iap of which increased by 10% in five years (Table) were excluded from this study because the clay films of these samples might have been overheated or incompletely dried before the first X-ray analysis.(ABSTRACT TRUNCATED AT 250 WORDS)

[A case of renal cell carcinoma during pregnancy]

Renal cell carcinoma during pregnancy is extremely rare. This 30-year-old patient was first seen on Dec. 18, 1983 at the 7th week of her 2nd pregnancy. She had asymptomatic hematuria. Cystoscopy revealed normal findings and sonogram showed well defined echogenic mass in the upper pole of the right kidney. She was admitted to our hospital on account of gross hematuria and severe lumbago on Jan. 19, 1984. The pregnancy was stopped by artificial abortion. Renal angiography revealed a rich-vascularized tumor in the upper pole of the right kidney. Preoperatively, arterial embolization was done and nephrectomy was performed. Histological examination showed a well-differentiated adenocarcinoma. There was no involvement of the renal vein and no lymph-node metastases were found in the operation specimen. The post-operative course was uneventful. This rare case of renal cell carcinoma during pregnancy is herein reported along with some discussion.

[Clinical study of total cystectomy in patients with bladder transitional cell cancer]

The late results on 53 patients with bladder transitional cell cancer, who were treated by total cystectomy at the Department of Urology, Jichi Medical School between 1974 through 1983, were reviewed. The ages ranged from 28 to 78 years old, with an average of 61.8 years. There were 48 men and 5 women, with a male to female ratio of 9.6:1. The relative 5-year survival rate was 58.2% as a whole, that of patients with low grade cancer (grade 1 and 2) was 116%, and that of patients with high grade cancer (grade 3) was 33.8%. A significant difference was observed (p less than 0.01). The relative 3-year survival rate of low stage cancer (pT1 and pT2) was 88.4%, that of high stage cancer (pT3 and pT4) was 16.6%, a significant difference being observed (p less than 0.01). The post operative mortality rate was 5.7%.