[Study on free enzymes and proteins in the urine. Report IV: The effects of Iohexol on elderly patients with renal function disorder]

We assessed the nephrotoxicity of a non-ionic contrast medium, Iohexol, in 18 elderly patients. They were divided into two groups. Group 1 consisted of 12 patients with glomerular flow rate (GFR) above 60 ml/min/1.73 m2 (range 69-136; average 96) and group 2 consisted of 6 patients with GFR below 60 ml/min/1.73 m2 (range 38-59; average 49). Urine samples, collected before, immediately after, and on the third and sixth days after drip infused pyeloureterography (DIP) were analyzed for gamma-glutamyl transpeptidase (gamma-GTP), N-acetyl-beta-D-glucosaminidase (NAG), beta 2-microglobulin (beta 2-MG) and albumin. In group 1, immediately after DIP, the urinary excretion of albumin, gamma-GTP and NAG were significantly increased (p < 0.01, p < 0.01, p < 0.01). In group 2, immediately after DIP, the urinary excretion of gamma-GTP and beta 2-MG were significantly increased (p < 0.01, p < 0.1). The gamma-GTP and NAG values in both groups suggest that the damage of proximal tubules cells will not continue for more than 4 days. However, as for the reabsorption of beta 2-MG on proximal tubules, in group 2 the value did not return to the pre DIP level until 6 days after DIP. We believe it is important to postpone injection of non-ionic contrast medium within 6 days of its last usage.

Long-acting nicardipine for elderly hypertensive patients: effect on diurnal variation of blood pressure

The effect of long-acting nicardipine tablets on diurnal variation of blood pressure was compared with that of standard nicardipine tablets and long-acting nifedipine tablets by 24-hour ambulatory blood pressure monitoring in 35 patients with hypertension. Long-acting nicardipine decreased systolic blood pressure in each age group, and there was no difference in its anti-hypertensive effect when compared with the other two drugs. All three drugs had no effect on the amplitude of daily blood pressure variation, and all three drugs decreased the baseline blood pressure in each age group when compared with untreated patients. In addition, no change was observed in the decrement of baseline blood pressure after switching from the other two drugs to long-acting nicardipine. Long-acting nicardipine had less effect on diurnal blood pressure variation than standard nicardipine tablets, which are administered three times daily. In each age group, long-acting nicardipine also more effectively inhibited the increase in cardiac work resulting from the morning rise phenomenon when compared with standard nicardipine tablets. These findings suggest that long-acting nicardipine may be a more useful preparation for the treatment of essential hypertension, particularly in elderly patients.

Improvement of upper limb function with respect to urination techniques in quadriplegia

A follow up study of urological management was carried out on 38 cervical spinal cord injury patients who were admitted to the Nagano Rehabilitation Centre Hospital and whose surgical reconstructions of their paralytic hands were performed since 1977. Self catheterisation was possible after reconstructive hand surgery in patients whose lowest functioning cord segment was C5-6. All of them had been unable to perform self catheterisation before surgery. Handling of instruments related to the act of urination was possible in two patients where the lowest functioning cord segment was C6-7 and where ileal conduit formation and reconstructive hand surgery had been performed.

[A case of muellerian duct cyst treated with minocycline hydrochloride sclerotherapy under ultrasound control]

We present a case of a muellerian duct cyst in a 55 year-old man. A cystic lesion was incidentally found between the prostate and the bladder on transabdominal ultrasound examination. Computerized tomography revealed a low density area homogeneous and round with a clear margin. Both urethrocystgram and vesiculogram demonstrated no cystic lesion. On diagnosis of muellerian duct cyst percutaneous needle aspiration was performed under ultrasound control. The aspirated fluid was yellow, clear and negative for cytology. Microscopically no spermatozoa were found in it. Minocycline (100 mg) was injected into the cyst. No recurrence has occurred since the operation. The literature of the cyst was briefly reviewed.

[The role of urodynamic study in female patients with urinary incontinence]

To determine the type of urinary incontinence in 96 female incontinent patients, we performed a comparative study between the clinical evaluation and the results of urodynamic studies. Their complaints, physical examination, laboratory examinations including routine urological X-ray and ultrasonic studies, revealed that 15 to 30% of the patients had another type of incontinence than those with stress incontinence, urge incontinence and those in whom diagnosis was made from urodynamic studies. Urodynamic studies disclosed that another urinary incontinence type was observed in 7 to 18% of the patients, who were not improved in spite of treatment which was required because of their complaints and physical examination. Our findings showed that urinary incontinence could not be classified according to the frequency of urination or vesical volume. Urodynamic studies may be essential in female patients with urinary incontinence scheduled to have an operation or for whom initial treatment was unsuccessful.

[The use of a metallic stent in 32 patients with benign prostatic hypertrophy. Preliminary results and 3 months of follow-up]

A prospective noncontrolled study of the safety and potential efficacy of the metallic stent was performed on 32 patients with benign prostatic hypertrophy. Mean age was 76.6 years (range, 56-98 years), and mean prostatic volume was 24.2 cm3. The patients were selected on the basis of a quantitative symptom score (QSS), uroflowmetry measurements, and residual urine volume (RU). Nineteen patients had urinary retention and remaining 13 patients had moderate symptoms and signs of prostatism. Placing the stent was successfully done in 31 patients (97%). It took 15 minutes to place the stent using transabdominal and/or endorectal sonography. After 3 months, 27 patients (87%) showed improved QSS. In patients with dysuria, maximum flow rate (MFR) and RU before treatment were 6.9 +/- 1.7 ml/sec and 112.3 +/- 61.8 ml, respectively. After treatment, they improved to 12.3 +/- 2.7 ml/sec and 12.7 +/- 6.7 ml, respectively. On the other hand, all patients who had urinary retention were able to urinate just after treatment, and MFR and RU were 12.9 +/- 3.6 ml/sec and 24.4 +/- 43.3 ml, respectively. Evaluation on the basis of improvement in MFR and reduction in RU showed that the stent was effective in 71% of total patients (22 out of 31 patients), 94% of the patients with urinary retention (17 out of 18 patients). The overall clinical efficacy of this stent was 68% (21 patients). There were no major complications such as urge incontinence and urinary tract infection during follow-up. Although proximal migration of the stent was observed in 6 patients, the stent could be taken out and replaced in 4 patients. From the above results, we conclude that the metallic stent is useful for the treatment of prostatism and urinary retention.

[Inhibitory effects of IFN on N-butyl-N-(hydroxybutyl) nitrosamine induced rats bladder tumors]

Bladder tumors were induced in rats by the oral administration of 0.025% N-butyl-N-(hydroxybutyl) nitrosamine (BBN). In order to study the suppressive effects of rat interferon-alpha (IFN-alpha) on induction of carcinogenesis in vivo, rats were treated with IFN-alpha i.m. twice a week. The treatment began at 5th week of BBN administration. The bladder mucosa was observed macroscopically and microscopically, and NK activity was examined. The results were as follows. 1) There was no significant difference in the bladder to body weight ratio between the BBN + IFN-alpha and BBN groups in during stage A (10th-14th week when changes in the mucous membrane such as hypertrophy in the bladder wall or vascular formation are observed). This ratio in the BBN + IFN-alpha group was less than that in the BBN group in during stages B and C (15th-19th week and 20th-30th week respectively when tumors are visually recognizable). 2) The rate of carcinogenesis in the BBN + IFN-alpha group was less than that in the BBN group in stages A and C. 3) The pathological grade and stage of the bladder cancer in the BBN + IFN-alpha group were lower than those in the BBN group in stages B and C. 4) There was no significant difference in NK activity between the two groups in stage A, but NK activity of the BBN + IFN-alpha group was higher than that of the BBN group in stage B. 5) These findings substantiated the hypothesis that IFN-alpha can suppress tumor-growth in BBN induced bladder carcinoma.

Temporal minor slow and sharp activity in psychiatric patients

TMSSA was found in 51 (4.7%) of 1091 psychiatric patients, with a higher incidence found in the older group (40 years of age or over). Although TMSSA was found in various disorders, a close association with cerebrovascular dementia was suggested. It was uncommon in patients with primary degenerative dementia. No increase of TMSSA was noted in cerebrovascular disorders without dementia. TMSSA was found fairly often in patients with affective disorders, neurosis, and other functional disorders, suggesting underlying mild cerebral dysfunction in some. TMSA, a variant of TMSSA, was very similar to TMSSA except for its greater frequency in cerebrovascular disorders without dementia.

[Mitral valve prolapse syndrome as an etiologic factor of anxiety disorder]

To assess whether a certain somatic disease is involved in the etiology of anxiety disorder, we examined the relationship between anxiety disorder and mitral valve prolapse syndrome (MVP). Patients with anxiety disorder were diagnosed according to the criteria of the American Psychiatric Association (Quick Reference to the Diagnostic Criteria from DSM-III). Two-dimensional echocardiography was carried out on 36 normal controls (15 males and 21 females) and 39 patients with anxiety disorder (19 males and 20 females); including 21 patients with panic disorder, 12 with generalized anxiety disorder, and 6 with atypical anxiety disorder. The echocardiograms were evaluated by a cardiologist unaware of clinical background about these patients. The presence of MVP was diagnosed according to the criteria by Yoshikawa, et al. or Nagata, et al. Findings of MVP were seen in 18 (46.1%) of the patients and 5 (13.9%) of the controls indicating a significantly higher incidence (chi 2 = 7.711, p less than 0.01) in the patients. In the patient subgroups, 14 patients with panic disorder (66.6%) and 4 with generalized anxiety disorder (33.3%) had MVP, showing a significantly higher incidence in the former (chi 2 = 14.335, p less than 0.01) than in the normal controls, but no statistical significance in the latter. No MVP was found in the patients with atypical anxiety disorder. These results suggest that some somatic diseases such as MVP may play a role in the etiology of anxiety disorder, especially panic disorder.

A newly designed deodorant pad for urinary incontinence

The authors designed a new pad for urinary incontinence. It is composed of a cloth of acrylonitrile copper sulfide and another cloth of iron-phthalocyanine. In vitro experiments showed that acrylonitrile copper sulfide cloth inhibited the growth of most bacteria causing urinary tract infection, and that iron-phthalocyanine cloth effectively eliminated bad-smelling gases. The use of this pad relieved diaper-dermatitis and diminished offensive smells from feces and urine. This pad was well received by nurses and helpers taking care of incontinent elderly people.

[Reappearance and recovery of alpha rhythm after eye opening]

To obtain more informations from routine EEG recording, we studied changes in alpha rhythm after eye opening that had been almost disregarded hitherto. The study was carried out on 26 normal controls and 137 patients with four categories of diseases including 52 patients with psychiatric diseases, 8 with trifling neurological symptoms, 68 with defined organic brain diseases, and 9 with headache without defined organic cause. Following routine EEG recording, each subject was asked to keep their eyes opened for three minutes. The major changes in alpha rhythm after eye opening were composed of two patterns; "reappearance" and "recovery". The reappearance was defined as appearance of 5 or more alpha waves in series; and the recovery, as the amount and amplitude of the alpha rhythm became equal to those of the back ground alpha-rhythm which was seen while their eyes were kept closed. The reappearance was noticed in 84.6% of normal controls and in 89.1% of all patients. In patients with organic brain diseases, the reappearance was seen in 88.2%, while it was in 68.6% of the patients without organic brain disease. The recovery was noticed in 34.3% of all patients (p less than 0.01), while it was only in 15.4% of normal controls. The incidence of the recovery in the patients with organic brain diseases was 41.2%, the value of which was significantly higher than that of the rest of patients (28.8%, 15 out of 52 patients, p less than 0.05). These patients with the recovery tended to show slower frequency and higher amplitude in the back ground alpha-rhythm than the patients without recovery.

[Design and application of laser-disk for clinical pulmonary data base system using the personal computer]

A database system is described for managing the information on pulmonary function test (PFT) measured by three different PFT devices. The data is transmitted into a personal computer, FM-11AD2+ (FUJITSU CO., LTD.) with a 20 MB hard disk and a 800 MB laser disk. Multitasking OS, OS-9/6809, is used to operate the software. PFT data of about 15,000 cases may be stored, which can be easily retrieved for research and discussions on a case study. Despite the present limitation of the processing speed and the capacity of the hard disk, this system is useful because it allows to provide reports readily.

Estimation of personal exposure to ambient nicotine in daily environment

To evaluate the actual exposure level of nonsmokers to environmental tobacco smoke (ETS) in their daily life, the exposure level of ambient nicotine was measured with a nicotine personal monitor carried by a nonsmoker. Average exposure levels of nicotine, even in such smoky places as cars, coffee shops and pubs, were less than 45 micrograms/m3. As a result of all-day monitoring, the highest amount of nicotine inhaled in a day was estimated, in this study, to be up to 310 micrograms, equivalent to actively smoking 0.31 ordinary cigarettes.

[Usefulness of nerve block therapy in patients with herpetic pain]

A retrospective study was performed on 230 patients with Herpes zoster. Among these patients, 156 patients (67.8%) were over 50 years old. Ninety-four percent of the patients who received the nerve block therapy within a month from the onset became ultimately free from pain while only seventy-nine percent of the patients upon whom this therapy was started after 2 months or more were relieved of pain. It was suggested that the earlier the therapy and the younger the patients, the more easily herpetic pain could be controlled. In conclusion, it became apparent that early treatment of Herpes zoster with nerve block therapy, is extremely important for prevention of post-herpetic neuralgia.

[Clinical effect of terodiline hydrochloride on nervous pollakisuria or irritative bladder]

The clinical effect of terodiline hydrochloride (TD-758) was studied in 95 patients with nervous pollakisuria or irritative bladder. TD-758 was given per os randomly at a dose of 24 mg or 12 mg once a day for 4 weeks. The symptoms such as urinary frequency, urinary incontinence and sense of residual urine were improved in 74% of the patients taking 24 mg, and in 51% of the patients taking 12 mg. The difference was statistically significant. Side effects such as dry mouth, constipation and heart burn were observed in 15% of the patients in each group and were not serious. The results of this study indicate that TD-758 is useful for these patients and its optimal dosage is 24 mg once a day.

Urinary tract dysfunctions in tethered spinal cord syndrome: improvement after surgical untethering

We reviewed 55 patients with urinary tract dysfunction owing to the tethered spinal cord syndrome, a form of spina bifida occulta with or without mild myelodysplasia, to evaluate the effects of neurosurgical treatment. Of the patients 24 underwent laminectomy with release of a tethered spinal cord and 31 were followed without the operation. Median followup was approximately 5 years. Urological findings at the most recent examination were compared between the 2 groups. In the operated group 5 patients, including 2 with myelodysplasia, apparently were cured of urinary tract dysfunction and 6, including 2 with myelodysplasia, had somewhat satisfactory results, whereas in the unoperated group only 4 patients had satisfactory results and the remainder were unaffected. Urinary tract dysfunction in some patients with spina bifida occulta may be relieved by surgical release of a tethered spinal cord.

Coexistence of aldosteronoma and pheochromocytoma in an adrenal gland

An extremely rare case is reported in which aldosteronoma and pheochromocytoma coexisted in an adrenal gland. Although the patients presented with clinical features of primary aldosteronism, preoperative examination showed an elevation of both plasma aldosterone and urinary catecholamines. Histology of the removed adrenal gland revealed that, concurrently with a round mass of adrenocortical adenoma, the adrenal medulla was totally occupied by the typical structure of pheochromocytoma.

Bladder function following spinal cord injury: a urodynamic analysis of the outcome

Repeated urodynamic testing was undertaken on a group of 58 consecutive patients admitted with acute spinal cord injury. Thirty-seven (64%) were able to void satisfactorily spontaneously, whereas 10 required bladder outlet surgery and 11 achieved emptying by either abdominal straining, intermittent self-catheterisation or an indwelling suprapubic catheter. The pattern of the initial cystometry soon after injury provided some idea of what possibilities could be expected of subsequent bladder function. Very high detrusor pressures exceeding 80 to 100 cm of water developed in a third of patients with supranuclear lesions. Six patients developed vesicoureteric reflux between 4 and 24 months after injury.

Mobilization of arachidonic acid between diacyl and ether phospholipids in rabbit alveolar macrophages

The metabolism of 20:4 (arachidonic acid) in alkenylacyl, alkylacyl and diacyl lipid classes in choline glycerophospholipids (CGP) and ethanolamine glycerophospholipids (EGP) in rabbit alveolar macrophages was examined. [3H]20:4 was very rapidly incorporated into diacyl glycerophosphocholine (GPC). After the removal of free 20:4, the radioactivity was gradually lost from diacyl GPC. Concomitantly, the radioactivities in alkylacyl GPC and alkenylacyl glycerophosphoethanolamine (GPE) were increased, indicating that 20:4 was mobilized from diacyl GPC to alkylacyl GPC and alkenylacyl GPE. The mobilization was considered to be a 20:4-specific event. The gradual accumulation of 20:4 in ether phospholipids leads to a high abundance of 20:4 in these lipids. These results suggest metabolic relationships between 20:4 and ether phospholipids, including platelet-activating factor (PAF).