Distinct role of antigen-specific T helper type 1 (Th1) and Th2 cells in tumor eradication in vivo

The role of T helper type 1 (Th1) and Th2 cells in tumor immunity was investigated using Th cells induced from ovalbumin (OVA)-specific T cell receptor transgenic mice. Although Th1 cells exhibited stronger cytotoxicity than Th2 cells, both cell types completely eradicated tumors when transferred into mice bearing A20 tumor cells transfected with the OVA gene (A20-OVA). Th1 cells eradicated the tumor mass by inducing cellular immunity, whereas Th2 cells destroyed the tumor by inducing tumor necrosis. Both Th1 and Th2 cells required CD8(+) T cells to eliminate tumors, and neither of these cells were able to completely eliminate A20-OVA tumors from T and B cell-deficient RAG2(-/-) mice. Mice cured from tumors by Th1 and Th2 cell therapy rejected A20-OVA upon rechallenge, but CD8(+) cytotoxic T lymphocytes were induced only from spleen cells prepared from cured mice by Th1 cell therapy. Moreover, we demonstrated that Th1 and Th2 cells used distinct adhesion mechanisms during tumor eradication: the leukocyte function-associated antigen (LFA)-1-dependent cell-cell adhesion step was essential for Th1 cell therapy, but not for Th2 cell therapy. These findings demonstrated for the first time the distinct role of antigen-specific Th1 and Th2 cells during eradication of established tumors in vivo.

The natural killer T (NKT) cell ligand alpha-galactosylceramide demonstrates its immunopotentiating effect by inducing interleukin (IL)-12 production by dendritic cells and IL-12 receptor expression on NKT cells

The natural killer T (NKT) cell ligand alpha-galactosylceramide (alpha-GalCer) exhibits profound antitumor activities in vivo that resemble interleukin (IL)-12-mediated antitumor activities. Because of these similarities between the activities of alpha-GalCer and IL-12, we investigated the involvement of IL-12 in the activation of NKT cells by alpha-GalCer. We first established, using purified subsets of various lymphocyte populations, that alpha-GalCer selectively activates NKT cells for production of interferon (IFN)-gamma. Production of IFN-gamma by NKT cells in response to alpha-GalCer required IL-12 produced by dendritic cells (DCs) and direct contact between NKT cells and DCs through CD40/CD40 ligand interactions. Moreover, alpha-GalCer strongly induced the expression of IL-12 receptor on NKT cells from wild-type but not CD1(-/-) or Valpha14(-/-) mice. This effect of alpha-GalCer required the production of IFN-gamma by NKT cells and production of IL-12 by DCs. Finally, we showed that treatment of mice with suboptimal doses of alpha-GalCer together with suboptimal doses of IL-12 resulted in strongly enhanced natural killing activity and IFN-gamma production. Collectively, these findings indicate an important role for DC-produced IL-12 in the activation of NKT cells by alpha-GalCer and suggest that NKT cells may be able to condition DCs for subsequent immune responses. Our results also suggest a novel approach for immunotherapy of cancer.

The essential role of phorbol ester-sensitive protein kinase C isoforms in activation-induced cell death of Th1 cells

Th1 and Th2 cells, which were induced from naive T cells of TCR-transgenic mice, showed differential sensitivity to activation-induced cell death (AICD) triggered by stimulation with anti-CD3 monoclonal antibody. The Th1 cells showed more rapid AICD than Th2 cells. This accelerated AICD of Th1 cells was strongly blocked by protein kinase C (PKC) inhibitors (H-7 or GF 109203X). Moreover, long-term treatment of Th1 cells with phorbol 12-myristate 13-acetate (PMA) caused the abrogation of anti-CD3-induced AICD in parallel with the disappearance of PMA-sensitive PKC isoforms such as PKC alpha, gamma, epsilon and theta. Therefore, it was clearly demonstrated that PMA-sensitive PKC isoforms are essential for AICD of Th1 cells. The different susceptibility to AICD between Th1 and Th2 cells was not due to their differential expression levels of PMA-sensitive PKC isoforms but appeared to be due to their differential requirement for PMA-sensitive isoforms in the up-regulation of Fas ligand which is involved in suicide killing of activated Th1 cells.

Reconstitution of immune systems in RAG2-/- mice by transfer with interleukin-12-induced splenic hematopoietic progenitor cells

The administration of a high dose of IL-12 into the mice resulted in the induction of splenomegaly. From the flow cytometry analysis of cellularity in an enlarged spleen, it was demonstrated that Thyl.2-CD45RB-c-Kit + Sca-1 + Lin- hematopoietic progenitor cells markedly increased in IL-12-administered mouse spleen compared with untreated mouse spleen. The IL-12-induced hematopoietic progenitor cells showed a greatly enhanced colony-forming activity in CFU-granulocyte/macrophage (CFU-GM), blast-forming units-erythroid (BFU-E) and CFU-spleen (CFU-S) assay. Moreover, it was initially demonstrated that the transfer of IL-12-induced splenic hematopoietic progenitor cells into immunodeficient RAG2-/- mice caused a complete reconstitution of their immune functions including T- and B-cell-mediated immunity. Thus, the evidence that IL-12 has a capability of inducing hematopoietic progenitor cells possessing stem cell-like activity in vivo, indicated another important immunomodulating activity of IL-12 in immunotherapy.

The restraint stress drives a shift in Th1/Th2 balance toward Th2-dominant immunity in mice

When mice were physically restrained in 50-ml tubes for 24 h, a marked decrease of NK activity was demonstrated in parallel with the elevation of serum corticosterone levels. The release of mice from restraint stress resulted in the recovery of NK activity, with a decrease of serum corticosterone levels within 48 h. Using this stress model, we also investigated the influence of restraint stress on mouse Th1/Th2 balance. Consistent with the decrease of NK activity, IFN-gamma production of mouse spleen cells greatly reduced after suffering from restraint stress. In contrast, the IL-4 producing ability of spleen cells was not so much affected by restraint stress. These results initially indicated that stress may induce the skewing of the Th1/Th2 balance toward Th2-dominant immunity, which stimulates the occurrence of infectious diseases and allergic disorders.

Accumulation of IL-12-activated antitumor effector cells into lymph nodes of tumor-bearing mice

Simultaneous administration of high dose of IL-12 into tumor-inoculated mice resulted in a marked reduction of tumor growth in parallel with the augmented generation of cytotoxic T-cells, natural killer (NK) cells and IFN-gamma-producing Th cells. We found that these IL-12-activated antitumor effector cells preferentially accumulated in peripheral lymph nodes concomitantly with lymphadenopathy. However, IL-12 rather induced disappearance of antitumor effector cells including CD4+ T, CD8+ T and NK cells from spleen in spite of inducing splenomegaly. Lymph node cells obtained from IL-12-treated B16F0-bearing mice showed a marked IFN-gamma production in response to not only IL-2, IL-12, anti CD3 mAb but also B16F0 melanoma cells. Moreover, they could lyse B16F0 melanoma cells in a long-term cytotoxicity assay. It was also confirmed that IL-12-activated IFN-gamma producing Th1 cells were accumulated in tumor local site. Thus, IL-12 appeared to have a capability of stimulating selective migration of antitumor cells into lymph nodes and tumor local sites.

Manipulation of Th1/Th2 balance in vivo by adoptive transfer of antigen-specific Th1 or Th2 cells

We have investigated the possibility that the Th1/Th2 balance in vivo may be modulated by adoptive transfer of Th1 or Th2 cells induced in vitro. Thl cells were induced from I-Ad-binding OVA323-339-specific T-cell receptor-transgenic (TCR-Tg) mouse spleen cells by culturing with OVA323-339 peptide and antigen presenting cells (APC) in the presence of IL-2, IL-12 and anti-IL-4 mAb. Th2 cells were induced from TCR-Tg mouse spleen cells by culturing with IL-2, IL-4 and anti-IL-12 mAb in addition to OVA323-339 plus APC. Immunomodulating activities of both Th1 and Th2 cells were determined by their effect on delayed type hypersensitivity (DTH) responses or cytokine production. No significant DTH responses (footpad swelling) were observed in untreated BALB/c mice following a single injection of OVA323-339-pulsed syngeneic spleen cells. However, adoptive transfer of Th1 cells into BALB/c mice induced strong dose dependent DTH responses in response to I-Ad-bound OVA323-339 but not unrelated peptide. In contrast, only slight DTH responses were detected in BALB/c mice transferred with Th2 cells. In parallel with the DTH responses, increased levels of serum IFN-gamma were demonstrated in mice adoptively transferred with Th1, while no significant increase was observed in Th2-transferred mice. In vitro analysis also demonstrated that both spleen cells and popliteal lymph node cells prepared from Th1-transferred mice showed Th1-type cytokine production, while cells obtained from Th2-transferred mice revealed Th2-dominant cytokine production. Such immune deviation induced by antigen-specific Th1 cells was demonstrated up to three months after cell transfer. Therefore, it may be possible to manipulate the Th1/Th2 balance in vivo by adoptive transfer of antigen-specific Th1 or Th2 cells.

The role of phorbol ester-sensitive protein kinase C isoforms in lymphokine-activated killer cell-mediated cytotoxicity: dissociation between perforin-dependent and Fas-dependent cytotoxicity

Treatment of lymphokine-activated killer (LAK) cells with phorbol ester (PMA) caused the downmodulation of LAK activity concomitantly with the inhibition of serine esterase (SE) release, which has been shown as a marker for perforin-dependent cell-mediated cytotoxicity. The reduction of perforin-dependent LAK activity by PMA-treatment appeared to be due to the disappearance of PMA-sensitive protein kinase C (PKC) isoforms such as PKC alpha, gamma, epsilon, theta. In contrast, Fas-mediated LAK activity was refractory against PMA-induced downregulation. Treatment of LAK cells with PMA caused a disappearance of cytotoxicity against Fas L5178Y tumor cells, while cytotoxicity against Fas+ transfectants was not affected by PMA treatment. Moreover, Fas-mediated LAK activity of perforin-knockout mice was not inhibited by PMA treatment. These results clearly demonstrated that Fas-mediated cytotoxicity could be dissociated from perforin-mediated cytotoxicity by their different requirement of PMA-sensitive PKC isoforms.

Involvement of IL-4-producing Vbeta8.2+ CD4+ CD62L- CD45RB- T cells in non-MHC gene-controlled predisposition toward skewing into T helper type-2 immunity in BALB/c mice

It was found that freshly isolated BALB/c CD4+ T cells produced high levels of IL-4 and IL-10 in response to immobilized anti-CD3 mAb, while C57BL/6 CD4+ T cells produced low amounts of IL-4 and IL-10. The high IL-4-producing ability of BALB/c mice was demonstrated to be genetically dominant and it was controlled by non-MHC gene (or genes). The cells responsible for IL-4 production in BALB/c mice were defined as TCRVbeta8.2+ CD4+ CD62L- CD45RB- memory-type T cells, which were distinct from NK1.1+ CD4+ NKT cells. Although these memory-type T cells were also detected in C57BL/6 mouse spleen at the same frequency, they showed a functionally different property from BALB/c CD4+ CD62L- CD45RB- T cells in terms of IL-4 production. The fact that germfree BALB/c mouse spleen cells also produced high levels of IL-4 suggested that the IL-4 producer in BALB/c mice might be developed under the influence of unknown factors other than environmental Ags. The CD4+ CD62L- CD45RB- T cells obtained from BALB/c mice accelerated the development of IL-4-producing memory-type CD4+ T cells from CD4+ CD62L+ CD45RB+ naive T cells prepared from OVA-specific TCR-transgenic mice. Therefore, IL-4-producing CD4+ CD62L- CD45RB- T cells might play an important role in the preferential induction of Th2-dominant immunity in BALB/c mouse strain.

Involvement of IL-4-producing Vbeta8.2+ CD4+ CD62L- CD45RB- T cells in non-MHC gene-controlled predisposition toward skewing into T helper type-2 immunity in BALB/c mice

It was found that freshly isolated BALB/c CD4+ T cells produced high levels of IL-4 and IL-10 in response to immobilized anti-CD3 mAb, while C57BL/6 CD4+ T cells produced low amounts of IL-4 and IL-10. The high IL-4-producing ability of BALB/c mice was demonstrated to be genetically dominant and it was controlled by non-MHC gene (or genes). The cells responsible for IL-4 production in BALB/c mice were defined as TCRVbeta8.2+ CD4+ CD62L- CD45RB- memory-type T cells, which were distinct from NK1.1+ CD4+ NKT cells. Although these memory-type T cells were also detected in C57BL/6 mouse spleen at the same frequency, they showed a functionally different property from BALB/c CD4+ CD62L- CD45RB- T cells in terms of IL-4 production. The fact that germfree BALB/c mouse spleen cells also produced high levels of IL-4 suggested that the IL-4 producer in BALB/c mice might be developed under the influence of unknown factors other than environmental Ags. The CD4+ CD62L- CD45RB- T cells obtained from BALB/c mice accelerated the development of IL-4-producing memory-type CD4+ T cells from CD4+ CD62L+ CD45RB+ naive T cells prepared from OVA-specific TCR-transgenic mice. Therefore, IL-4-producing CD4+ CD62L- CD45RB- T cells might play an important role in the preferential induction of Th2-dominant immunity in BALB/c mouse strain.

Functional characterization of NK1.1 + Ly-6C+ cells

It was found that NK1.1+ cells were subdivided by their different expression pattern of Ly-6C antigen. To characterize their functional significance in immunoregulation, we separated NK1.1 + Ly6C+ cells and NK1.1 + Ly-6C- cells from C57BL/6 mouse nylon-passed spleen cells by FACStar. Both NK1.1 + Ly-6C+ and NK1.1 + Ly-6C- cells responded to the stimulation with IL-2 plus IL-12 and showed strong cytotoxicity against YAC-1 cells. However, these cells revealed different ability in terms of IFN-gamma production. Only NK1.1 + Ly-6C+ cells, but not NK1.1 + Ly-6C- cells, cultured with IL-12 alone or IL-2 plus IL-12, produced high levels of IFN-gamma. Flow cytometric analysis demonstrated that NK1.1 + Ly-6C+ cells consisted of NK1.1 + CD3-Ly-6C+ NK cells and NK1.1 + CD3 + Ly-6C+ NKT cells. Therefore, we further separated these two populations from NK1.1 + Ly-6C+ cells to define their functions. Although, both NK1.1 + CD3-Ly-6C+ NK cells and NK1.1 + CD3+ NKT cells showed the same level of cytotoxicity. It was clearly demonstrated that NK1.1 + CD3+Ly-6C+ NKT cells were major immunoregulatory cells to produce IFN-gamma in respond to IL-12 alone or IL-2 plus IL-12.

Antitumor activity of zinostatin stimalamer (YM881) in human hepatoma cell lines and VX2 liver tumor-bearing rabbits

Antitumor activities of zinostatin stimalamer (YM881) were examined in human hepatoma cell lines (SK-Hep1 and HuH2) and VX2 liver tumor-bearing rabbits. YM881 inhibited the growth of human hepatoma cells in a dose-dependent manner. The IC50 values of YM881 causing a 50% inhibition of growth of SK-Hep1 and HuH2 cells were 6.7 and 27 nM, respectively. In VX2 tumor-bearing rabbits, administration of YM881 suspended in Lipiodol, an iodinated fatty acid ethylester of poppyseed oil, (YM881/Lipiodol suspension, 0.2 mg/0.2 ml/body) into the hepatic artery showed significant (p < 0.01, vs. sham-operated and Lipiodol-treated groups) inhibitory effects on tumor growth and histopathological changes at 1 and 2 weeks after administration. In contrast, Lipiodol (0.2 ml/body) tended to inhibit the growth of VX2 tumor (p < 0.1, vs. sham-operated group) at 1 week after administration, but showed only moderate effects at 2 weeks after administration. Minimal necrosis was observed at 1 and 2 weeks after administration of Lipiodol, and histopathological findings were similar to those in the sham-operated group. From the present study, it is suggested that YM881/Lipiodol suspension showed antitumor activity in VX2 tumor-bearing rabbits presumably due to the inhibition of the growth of hepatoma cells by YM881 itself. Lipiodol, on the other hand, is considered to augment the antitumor activity of YM881 by maintaining high YM881 concentrations in tumor tissue.

[Anti-tumor activity of zinostatin stimalamer (YM 881) examined by human hepatoma cells in vitro and VX2 liver tumor in vivo]

Anti-tumor activities of zinostatin stimalamer (YM 881) were examined using human hepatoma cell lines (SK-Hep1 and HuH 2) and VX2 liver tumor-bearing rabbits. YM881 inhibited the growth of human hepatoma cells in a dose-dependent manner. The IC50 values of YM881 against SK-Hep 1 and HuH 2 cells were 6.7 and 27 mM, respectively. In VX2 tumor-bearing rabbits, administration of YM 881 suspended in iodinated fatty acid ethylesters of poppyseed oil (YM 881/Lipiodol suspension, 0.2 mg/0.2 ml/body) into the hepatic artery showed significant (p < 0.01, vs sham-operated and Lipiodol-treated groups) inhibitory effects on the growth and pathological changes 1 and 2 weeks after administration. On the other hand, Lipiodol (0.2 ml/body) showed a tendency to inhibit the growth of VX2 tumor (p < 0.1, vs sham-operated group) 1 week after administration, but it showed only moderate effects on the VX2 tumor growth 2 weeks after administration. Minimal necrosis was observed 1 and 2 weeks after administration of Lipiodol, and these pathological findings were similar to those in the sham-operated group. From the present study, it is suggested that YM 881/Lipiodol suspension showed the anti-tumor activity against VX2 tumor-bearing rabbits, presumably due to the inhibition of the growth of hepatoma cell by YM 881 per se. On the other hand, Lipiodol is considered to augment the anti-tumor activity by maintaining high YM881 concentrations in tumor tissue.

Tetrazomine, a new antibiotic produced by an actinomycete strain. Taxonomy, fermentation, isolation and characterization

A new antibacterial antibiotic tetrazomine was found from the fermentation broth of an actinomycete strain which was isolated from beach sand collected at Chichijima, Ogasawara Islands, Tokyo, Japan. The strain Y-09194L, was identified as Saccharothrix mutabilis subsp. chichijimaensis subsp. nov. The antibiotic exhibited broad antimicrobial activity against Gram-positive and Gram-negative bacteria in vitro. It also exhibited strong cytotoxic activity against P388 leukemia cells and showed antitumor activity against P388 leukemia. The apparent molecular formula of tetrazomine was determined as C24H34N4O5. It has a rare structure which consists of six rings including piperidine, piperadine, oxazole, and pyrrolidine.

[A study on the formation of apatite crystallized with gel method]

About apatite produced with a silicahydro gel method using calcium nitrate (group I) or calcium chloride (group II) and a gelatin gel method by use of calcium nitrate (group III) or calcium chloride (group IV), the formative volume as well as the formative condition of a periodic-layered precipitate (Liesegang ring), the pH measurement, calculation of Ca/P ratio, an estimation of the chlorine ion, morphological observation with a scanning electron microscope, qualitative analyses by X-ray diffraction (identification, crystallite size, lattice imperfections, lattice constants) and the composition analysis by infrared absorption spectroscopy were carried out to elucidate the formation of apatite using the gel method. The result showed that there were no distinct differences between group I-II and group III-IV, and it is suggested that it is possible to form satisfact fluorapatite with a gel method using calcium chloride as well as calcium nitrate.

[Results of the treatment of prostatic cancer]

Two hundred and twenty patients with prostatic cancer were treated in our clinic during the past ten years between April, 1977 and March, 1987. The age distribution was from 45 to 91 years old and more than half of patients were in seventies. Stages A, B, C and D were 3.5%, 19.7%, 21.2% and 55.6%, respectively. Hormonal therapy was given in 175 cases (79.5%) as an initial treatment. The first therapy showed effectiveness in 181 (83.8%) of 216 cases; in 153 (87.4%) of 175 cases treated by hormonal therapy. Reactivation after the initial treatment was observed in 59 (32.6%) of 181 cases; in 48 (31.4%) of 153 cases treated by hormonal therapy. The interval between the start of treatment and reactivation for the stage D was significantly shorter than that for the other stages. Elevation of serum alkaline-phosphatase levels, accelerated erythrocyte sedimentation rate and hydronephrosis were significant risk factors for reactivation. Of the 220 cases, 51 (23.2%) died of advanced cancer. The overall 5-year survival rate was 41.2%. High grade and high stage were significantly related to the poor prognosis. In our studies, as hormonal therapy, maintenance on 100 mg of diethylstilbestrol diphosphate daily was found effective for the treatment of prostatic cancer.

[Treatment of 255 patients with bladder tumors]

During about 10 years from November, 1977 to March, 1987, two hundreds and fifty-five patients with bladder tumors were treated at the Department of Urology, Hamamatsu University School of Medicine and the affiliated hospitals. There were 198 males and 57 females with the highest age incidence in the seventies. Histologically, 242, 11 and 2 tumors were of transitional cell, squamous cell and adenocarcinoma, respectively. Of the 242 transitional cell carcinomas, 7 were Tis; 43 Ta, 111 T1, 33 T2, 19 T3, 5 T4, 14 M+ (with metastatic lesion), and 10 TX. As to grading, 6 was G0; 66 G1, 100 G2, 64 G3, and 6 GX. Staging was correlated with grading. The 5-year survival rates (Kaplan-Meier's method) were 64% in patients with transitional cell carcinoma; 58% in those with squamous cell carcinoma. In patients with transitional cell carcinoma, the 5-year survival rates were 100% for G0, 73% for G1, 73% for G2 and 40% for G3. As to staging, the 5-year survival rates were 67%, 81%, 81%, 35%, 41%, 40% and 12% in patients with stage of Tis, Ta, T1, T2, T3, T4 and M+, respectively. As to the initial treatment, the 5-year survival rates after TUR (137 cases), partial cystectomy (4 cases) and total cystectomy (56 cases) were 81%, 36% and 61%, respectively. The rate of intravesical recurrence after TUR was evaluated with the cumulative non-recurrence rate calculated by Kaplan-Meier's method.(ABSTRACT TRUNCATED AT 250 WORDS)

[Treatment of 46 cases of renal pelvic and ureteral tumors]

During about 10 years from November, 1977 to March, 1987, 46 patients with renal pelvic and ureteral tumors were treated at the Department of Urology, Hamamatsu University School of Medicine and the affiliated hospitals. There were 34 males and 12 females with the highest age incidence in the seventies. Histologically, 44 transitional cell carcinomas and 2 squamous cell carcinomas were found. Of the 44 transitional cell carcinomas, 1 was Tis; 13 T1, 2 T2, 8 T3, 15 M+ (with metastatic lesion), and 5 TX. As to grading, 1 was G1; 24 G2, 15 G3, and 4 GX. Staging was correlated with grading. The 5-year survival rates (Kaplan-Meier's method) were 37% in patients with transitional cell carcinoma. Among patients with transitional cell carcinoma, the 5-year survival rate was 43% for G2 and 42% for G3. As to staging, the 5-year survival rates were 71% and 46% in patients with stage of T1 and T3, respectively. No patient with M+ survived longer than 4 years. The 5-year survival rates were 38% and 34% in renal pelvic tumors (24 cases) and ureteral tumors (20 cases), respectively. As to the treatments, the 5-year survival rates after curable treatment (24 cases) and non-curable treatment (20 cases) were 63% and 7%, respectively.

[Surgical treatment of metastatic lung cancer from colorectal cancers]

Based on conclusions obtained after the observation of 61 colorectal cancer patients with a lung metastasis, the resection of lung metastasis as a therapy was evaluated. Among these 61 patients, only 5 patients had been identified as having a lung metastasis at the time of resection of the primary lesion, whereas the other 56 patients developed the lung metastasis after the curative resection of the colorectal cancer. Only one patient with a synchronous lung metastasis and twelve patients (eleven with a solitary metastatic lesion and one with multiple metastatic lesions) with metachronous lung metastasis underwent removal of the lung metastasis. The three-year survival rate was 65.2% in the metachronous group.

Dual vascularized fibula transfer on a single vascular pedicle: a useful technique in long bone reconstruction

The use of dual vascularized fibula transfer on a single vascular pedicle for reconstruction of long bone defect is described. This technique involves dividing one length of donor vascularized fibula into two segments, without cutting the vessels. The vessels are then folded, thereby supplying blood circulation to both bones. Since 1985 the authors have treated six cases of bone reconstruction using this method. Two of these six cases are reported, with follow-up periods of over one year.

Intraoperative blood pressure control by ATP in pheochromocytoma

Three cases of pheochromocytoma which were successfully treated with the use of adenosine triphosphate (ATP) during the operation are reported. The mechanism of the hypotensive effect of ATP has been proved due to the antagonizing action of the agent to the vasoconstriction by noradrenaline and/or sympathetic nerve stimulation. In these 3 cases, ATP has been safely and effectively applied to control blood pressure in pheochromocytoma. ATP could be used as the first-choice drug to keep the circulatory state stable during surgery for pheochromocytoma.

[Clinical effect of allylestrenol on benign prostatic hypertrophy]

Allylestrenol at the daily dose of 50 mg was administered to 45 patients with benign prostatic hypertrophy. The treatment was performed for more than 12 weeks in 40 patients, and improvements, marked and moderate, were observed in 22 patients (55%) in the overall judgement. As side effects of this drug, decrease of potency was observed in 3 cases, decrease of libido in 1 case, pigmentation on breasts in 2 cases, palpitation in 2 cases, short breath in 1 case, and gastrointestinal symptoms in 1 case. However, these side effects were not serious. Our trial suggests that the treatment of benign prostatic hypertrophy with allylestrenol can be useful in urological clinics.

[Recurrence following operative treatment of renal staghorn calculi and prophylaxis]

Residual stone and stone recurrence following operation for renal staghorn calculus were investigated in 58 kidneys of 55 patients. Residual stones were found in 12 kidneys (20.7%), but cases who underwent intraoperative radiogram using Kodak X-O mat KS film or extracorporeal renal surgery showed no residual stones. True recurrence was observed in 9 kidneys (19.6%). The rates of true recurrence after partial nephrectomy, nephrolithotomy, extended pyelolithotomy and autotransplantation with extracorporeal renal surgery were 29.2%, 8.3%, 33.3% and 0% respectively. Morphological study of renal tissue removed intraoperatively from patients with staghorn calculus suggested that calcium deposits in pelvic mucosa or collecting tube might play an important role in stone recurrence. However, despite the calcium deposits in removed specimens, no recurrences have been observed in patients who underwent extracorporeal surgery for complicated staghorn calculus. Therefore, this procedure might be useful to prevent stone recurrence.

[Renal autotransplantation for ureteral lesions--the indication and the results of operation]

Renal autotransplantation has been a treatment of choice for renovascular hypertension, renal artery aneurysm, complicated staghorn calculi, ureteral disorders and others. The paper reports 5 cases of extensively damaged ureter and discusses the indication and the results of operation. There were three cases of postoperative extensive ureteral stricture. One patient had postoperative ureteral injury with retroperitoneal abscess. The last one showed renal foreign body calculi with recurrent pyelonephritis after ureterocutaneostomy. The postoperative course of four patients had been uneventful revealing well functioning autotransplanted kidneys without hydronephrosis and infection during the follow-up period of 22 to 42 months. However, the patient with the ureteral injury and retroperitoneal abscess died of bleeding from renal vein anastomosis on the 15th postoperative day, since the renal pedicle showed marked inflammatory change including renal vein wall. Subsequently, autotransplantation is contraindicated in the cases with marked inflammation in the renal pedicle. In cases of various other ureteral lesions including long distance ureteral stricture, this procedure is recommended when neither the end to side ureteral anastomosis, Boari's bladder flap operation nor bladder hitch operation is feasible.

[Primary hyperparathyroidism in cases of urinary stone]

During the 5-year period from October, 1978 to September, 1983, primary hyperparathyroidism has been found at our clinic in 16 out of 395 cases of urinary stones (4.1%) and in 12.6% of the recurrent or multiple stone-forming patients. Plasma-ionized calcium level and rapid rapid calcium load test were most valuable in the diagnosis of primary hyperparathyroidism. It has been proved that neck surgery for primary hyperparathyroidism prevents recurrence of urinary tract stones.

[Cefotaxime concentrations in the blood and kidney]

Serum and renal levels of cefotaxime (CTX) were studied. Biological half-life time values in serum of rat following 100 mg/kg intraperitoneal injection were 27.58 minutes by bioassay and 25.02 minutes by high performance liquid chromatography, and that in kidney was 27.79 minutes by bioassay. CTX attained high levels in kidney of both human and rat. The concentration was higher in the cortex than that in the medulla. The activity could not be detected in the fraction of brush border, mitochondria and lysosome. This finding was thought to be a favorable characteristic in conjunction with the gradual decrease in the kidney tissue parallel to serum level.

[Effect of Moristerol (anti-cholesterolemic agent) on benign prostatic hypertrophy]

Moristerol was orally administered in 20 cases of benign prostatic hypertrophy. One capsule of Moristerol contained 200 mg of soysterol . In all the cases, 9 capsules of Moristerol were given per day in three divided doses for 6 weeks. Clinical improvement was observed in 11 of the 20 cases (55%). It consisted mainly of subjective complaints such as improvement of dysuria, narrow and weak urinary stream and feeling of incomplete voiding. As objective findings, a statistically significant decrease of residual urine volume was noted after treatment, although shrinkage of the enlarged prostate was not clear upon palpation or roentgenography. In addition to the improvement of symptoms, serum lipid peroxide which might be considered to be a provocative cause of benign prostatic hypertrophy, was also significantly decreased by Moristerol administration. No marked side effects were seen in this study.

[Experience with cefmetazole in the urological fields]

Recently, a new antibiotic of cephamycins, cefmetazole (CMZ) has been developed. In our clinic, CMZ was used to examine its clinical effect and adverse reactions, and the results were herein reported. The CMZ was administered to 8 patients for the prevention of postoperative infections, 7 with genitourinary infections and 1 with maxillitis complicated with uremia. For these patients, a daily dose of 1 to 6 g of CMZ was intravenously given for a period of 4 to 12 days. Among the 8 patients who received CMZ for the prevention of postoperative infections, there were 1 case with urinary tract infection, 1 with wound infection and 2 with fever of over 38 degrees C, but they had no serious infections. In the clinical observations on 3 cases with pyelonephritis, the CMZ showed marked effectiveness in 2 cases and effectiveness in 1 case. It must be noted that CMZ was proved to be markedly effective for pyelonephritis caused by Serratia marcescens. In the cases with acute epididymitis and prostatitis, a good effect of CMZ was obtained. Similarly in the case with maxillitis complicated with uremia, the maxillitis was improved by the effect of CMZ and hemodialysis. No cases with hepatic or renal dysfunction were observed after using CMZ. It is concluded that satisfactory effect of CMZ was obtained clinically.

[Cefotetan, a new cephamycin antibiotic: in vitro and in vivo antibacterial activities (author's transl)]

Cefotetan (CTT) is a new parenteral semisynthetic cephamycin-type antibiotic with a broad antibacterial spectrum against both Gram-positive and Gram-negative bacteria. Against wide varieties of Gram-negative bacteria, particularly including indole positive Proteus, S. marcescens, Enterobacter sp. and C. freundii CTT was more highly active than cefmetazole, cefoxitin and cefazolin. The 50% inhibition doses (ID50) of CTT against E. coli, K. pneumoniae, P. mirabilis, indole positive Proteus and S. marcescens were by far superior to those of the 3 other antibiotics. The antibacterial activities of CTT were bactericidal and were little affected by addition of horse serum and by variation in pH of the medium, in inoculum size and in type of culture media. Model infections in mice against Gram-positive and Gram-negative bacteria were studied. The therapeutic effects after subcutaneous injection of CTT against various Gram-negative bacterial infections were superior to those of cefmetazole, cefoxitin and cefazolin.

Turbulence measurement by the pulse luminescence method using a nitrogen pulse laser

In order to visualize and measure with ease the velocity distribution and diffusion of turbulent flow, the pulse luminescence method was investigated. Turbulence intensity was obtained from the turbulent diffusion patterns by Taylor's diffusion theory. Apparatus was developed for easier measurement. A nitrogen pulse laser was used for instantaneous, high-power excitation. With the use of a night vision scope a bright image was recorded by a TV camera and video tape recorder. The optimum concentration of LC-G1A luminescent particles was about 0-05% wt for the measurement. High fidelity of the particles as an indicator of the fluid velocity was confirmed. It was demonstrated that the turbulence intensity could be visualized and measured quantitatively by the pulse luminescence method.