Endopyelotomy failure is associated with reduced transforming growth factor-beta

PURPOSE

Approximately 15% of patients with ureteropelvic junction obstruction have endopyelotomy failure and require an additional surgical procedure to remove the obstruction. Transforming growth factor-beta (TGF-beta), a cytokine which stimulates mesenchymal cell proliferation and extracellular matrix deposition, increases in the renal pelvis in response to obstruction. However, TGF-beta also is implicated in smooth muscle regeneration and wound healing. To understand the pathophysiology of ureteropelvic junction obstruction and determine why endopyelotomy fails in some obstructed ureteropelvic junctions, TGF-beta expression in obstructed and normal ureteropelvic junction segments was compared.

MATERIALS AND METHODS

Immunohistochemical staining using a rabbit polyclonal anti-TGF-beta was performed on deparafinfized 4 microm. sections of paraffin blocked ureteropelvic junction segments. Human obstructed ureteropelvic junction segments were removed during primary pyeloplasties (11) and secondary pyeloplasties after endopyelotomy failure (11). Normal ureteropelvic junction segments were removed during nephrectomy for purposes unrelated to obstruction (11). Grading on a scale of 0 to 4 was performed by a physician blinded to the source of the specimen.

RESULTS

Mean TGF-beta expression plus or minus standard error of the mean was significantly increased (p <0.02) in obstructed ureteropelvic junctions from primary pyeloplasties (2.6+/-0.7) compared to normal ureteropelvic junctions (1.6+/-0.7), as expected. However, TGF-beta expression in the endopyelotomy failure group (1.8+/-0.6) was not significantly different from that in normal ureteropelvic junctions and was significantly lower (p <0.05) than that in obstructed ureteropelvic junctions from primary pyeloplasties.

CONCLUSIONS

Obstructed ureteropelvic junctions in cases of endopyelotomy failure have decreased expression of TGF-beta compared with other obstructed ureteropelvic junctions. These data suggest that an elevation of TGF-beta in obstructed ureteropelvic junctions may be necessary for successful tissue repair after endopyelotomy.

Necrosis of the urethra and tissue sloughing: a delayed complication after transurethral microwave thermotherapy

Transurethral microwave thermotherapy is a minimally invasive treatment for benign prostatic hyperplasia designed to destroy hyperplastic tissue without damaging the urethra. We present an unexpected complication of prostatic urethral necrosis and tissue sloughing after thermotherapy and discuss its possible cause.

Blind-ending ureteral duplication: cause of asymptomatic abdominal mass

Blind-ending ureteral duplication is a rare anomaly. The authors report on a 5-year-old girl who presented with an asymptomatic abdominal mass in which computerized axial tomography was used to make the diagnosis. The embryology of this anomaly is reviewed.

Increased susceptibility to tetanus toxin-induced seizures in immature rats

Studies were undertaken to compare tetanus toxin-induced electrographic and behavioral seizure activity in immature and adult rats. Multifocal epileptiform activity was induced by unilateral hippocampal injection of tetanus toxin in 10-day-old immature and in 90-120-day-old adult rats. Bilateral cortical surface electrodes and, in some animals, hippocampal depth electrodes were placed and serial video EEG was recorded for 2 h during the week following tetanus toxin injection. Tetanus toxin-induced interictal spike frequency was significantly higher and seizure duration was significantly longer in immature compared to adult rats. Immature rats tended to have more frequent seizures compared with adults, but the difference was not statistically significant. Ictal behaviors were different for the two groups with immature rats commonly demonstrating wild running seizures which were not seen in adult rats. These findings suggest that there are age-dependent differences in electrographic and behavioral seizure expression in the tetanus toxin seizure model and that the epileptic syndrome in immature rats is more severe.

Severity of medical and neurologic complications as a determinant of neurodevelopmental outcome at 6 and 12 months in very low birth weight infants

Very low birth weight (n = 154) and term infants (n = 119) had neurologic and developmental assessment at 6 and 12 months of age. Preterm infants with severe neonatal complications were considered to be at high risk, and those with milder complications were considered to be at low risk, for neurodevelopmental abnormality. Compared to term infants, high- and low-risk infants had abnormalities at 6 months in total neurologic score, cranial nerves, motor tone, motor coordination, and reflexes (P < .001). At 12 months, all groups had improved. However, high-risk infants had persistent abnormalities in the same subcategories (P < .001), whereas low-risk infants differed from term infants only in motor tone (P < .001). Bayley developmental scores were different for all groups at 6 months (P < .001), but at 12 months only high-risk infants differed from term infants (P < .01). These results demonstrate improvement in neurologic and developmental scores over time in very low birth weight infants. The degree of neurodevelopmental abnormality and improvement over time is related to severity of neonatal complications in preterm infants.

A model of bladder tumor xenografts in the nude rat

PURPOSE

An in vivo tumor model for the study of human urothelial carcinoma is desirable. Orthotopic xenografts are useful in order to better approximate human tumor cell behavior in situ. A prior model has been described in the nude mouse. However, its small bladder size limits both histologic characterization and the application of intravesical therapeutics. In the absence of preirradiation, orthotopic xenografts of human transitional cell carcinoma in the nude rat has not been previously reported.

MATERIALS AND METHODS

Nude rats 2 to 4 weeks of age were inoculated with 1-5 x 10(6) cells of RT4 (well differentiated papillary human bladder tumor cell line). Inoculation was performed via open cystotomy. Techniques of mucosal injury including acid treatment and cautery were explored in an effort to optimize tumor implantation and growth. Animals were sacrificed at varying intervals and histologic assessment was performed.

RESULTS

The overall rate of tumor implantation and growth was 93.4% (57 of 61). Tumors reliably grew within the muscularis and mucosal growth was seen as well. Intramuscular tumor growth was less differentiated and had a higher fraction of mitotic cells than mucosal tumor. Tumor growth was consistently seen as early as 2 weeks after inoculation which facilitates experimental trials. Distant metastasis was not observed. Mucosal injury did not increase the rate of tumor implantation.

CONCLUSION

This model is highly reproducible and will prove useful in the further study of bladder cancer progression as well as in the development of therapeutic modalities for both superficial and muscle invasive bladder carcinoma.

Model of human transitional cell carcinoma: tumor xenografts in upper urinary tract of nude rat

An in vivo model for the study of human transitional cell carcinoma (TCC) in the urinary tract is desirable. Orthotopic xenografts are useful in order to approximate better the behavior of human tumor cells in situ. Prior models have been described in the urinary bladder of the nude mouse and rat. We have developed the first model of implantation of human TCC in the upper urinary tract of an experimental animal. The kidneys of homozygous nude rats 4 weeks of age were inoculated with 1-5 x 10(6) cells of the RT4 well-differentiated papillary human TCC line through bilateral flank incisions, with transparenchymal injection of tumor cells into either the collecting system (renal pelvis) or the parenchyma. The overall implantation rate was 92% (54/59 kidneys). However, implantation into the collecting system occurred in only 45% (18/45) of the group. Ligation of the ureter prior to inoculation to produce urine stasis improved the mucosal implantation rate. Despite suspect urine cytology findings in the renal pelvis injection group, no distal seeding of the urinary tract was seen. Intraparenchymal tumor growth was less differentiated and had a higher fraction of mitotic cells than mucosal tumors. Vascular and lymphatic invasion were commonly seen; however, distant metastasis was not observed. This model will prove useful in determining the role of seeding in recurrent disease and in developing less invasive modalities for the treatment of upper tract TCC.

An unusual case of coccidioidomycosis

Dissemination of coccidioidomycosis is rare. The skin, musculoskeletal system, and central nervous system have been described as the most common sites of extrapulmonary disease. We present a case of an asymptomatic patient in whom the diagnosis of coccidioidomycosis was made on a lymph node biopsy. The biopsy was performed because of an abnormal mammogram and physical findings suggestive of malignancy.

Ras oncogene point mutations in bladder cancer resistant to cisplatin

Bladder tumors respond to cisplatin-based chemotherapy in 68% of cases, but only 30% will have a durable response. Recent studies have suggested that ras point mutations may produce cisplatin drug resistance in cell lines. To determine the role of ras point mutations in human tumors resistant to cisplatin, we evaluated ten tumors exposed to cisplatin and eight untreated bladder tumors for ras point mutations. Using polymerase chain reaction DNA amplification and allele-specific oligo-hybridization, we found that only one of the ten treated tumors and none of the untreated tumors harbored a ras point mutation. We conclude that ras point mutations occur infrequently in untreated bladder tumors and do not appear to correlate with cisplatin drug resistance in vivo.

Antibodies and their role in interleukin-1 research

The preceding paragraphs describe several uses of specific antibodies to IL-1. Standard radioimmunoassays and ELISA procedures were developed with demonstrated utility in studies attempting to quantitate the cytokine in cell culture fluids. In part, antibody-based assays circumvent the problems associated with bioassays. Bioassays are difficult to perform, often lack specificity due to the presence of competing cytokines and are insensitive when used with complex biological fluids due to non-specific protein binding and the presence of IL-1 antagonists. Thus, bioassays have not been broadly applicable with specimens in a clinical setting. In contrast, monoclonal antibodies and polyclonal antisera have provided a means of identifying functionally important regions of the IL-1 molecule, monitoring the post-translational processing of IL-1 which may include biologically inactive moieties, and developing new assays as illustrated by cell blot procedures.

Detection of posttransplant minimal disease chronic myelogenous leukemia by bcr rearrangement analysis

Until recently, cytogenetic detection of the Philadelphia chromosome (Ph) was the only reliable test to diagnose chronic myelogenous leukemia (CML) and detect minimal disease or early relapse following treatment. However, the recently developed ability to detect the Ph chromosome as a rearrangement in the bcr gene of chromosome 22 permits identification of the leukemic clone comprising as little as 5% of the cell population. We present results of simultaneous cytogenetic and DNA rearrangement studies in 28 CML patients considered for or treated with bone marrow transplantation. Our results show that the molecular method is significantly more sensitive than the cytogenetic method in the detection of minimal disease Ph-positive clones.

Evaluation of a new triphasic oral contraceptive in private practice

We evaluated the clinical and metabolic effects of a new triphasic regimen developed in the continuing attempt to reduce the dose of estrogen and progestogen in oral contraceptives. A combination of ethinyl estradiol (EE) and levonorgestrel (LNg) was used (six tablets with 30 micrograms EE + 50 micrograms LNg, five tablets with 40 micrograms EE + 75 micrograms LNg, and 10 tablets with 30 micrograms EE + 125 micrograms LNg), also known as Triphasil (Wyeth). In a private practice, 409 subjects participated in 7,286 treatment cycles. Three pregnancies occurred, all due to subject failure. Menstrual regulation was excellent and the incidence of side effects extremely low. Withdrawals from the study for possibly drug-related medical reasons totaled 9.0% through 56 cycles of treatment. Metabolic changes also were evaluated in 14 of these women over a 6-month period. The only statistically significant increase in carbohydrate values occurred at 6 months. The mean glucose level at 30 minutes of the oral glucose tolerance test was above the baseline mean value, but serum insulin levels showed no statistically significant deviation. Lipid values presented are total lipids, total cholesterol, triglycerides, alpha-, beta-, and pre-beta-lipoproteins, and high density and low density lipoprotein cholesterol. There was no statistically significant difference between the mean values at baseline and those during treatment for any lipid variable. These results indicate that this triphasic oral contraceptive has a high degree of efficacy, a low incidence of side effects, excellent cycle control, and high subject compliance, and would seem to indicate a minimal influence on the metabolism of lipids and carbohydrates in the small number of subjects studied.

A proposed alveolar model for adult human lungs: the regular dodecahedron

In an endeavor to delineate an alveolar configuration that would reasonably mirror the natural state, polygonal shapes of normal alveoli were tabulated in histological sections from inflation-fixed specimens of 16 men aged 16-48 years. The resulting alveolar population varied from three- to ten-sided polygons with a preponderance of tetragons, pentagons, and hexagons. These observations were compared with the possible combinations of polygonal sections through various polyhedral models proposed by other workers and the five classical regular polyhedrons. The potential types of sections through the regular dodecahedron, i.e., a twelve-sided shape with faces consisting of pentagons, seemed to fit best with present findings, and this is suggested as an idealized configuration that might be useful in various geometric determinations, e.g., estimates of alveolar surface area and volume.

Fatal pancarditis in a patient with coexistent Lyme disease and babesiosis. Demonstration of spirochetes in the myocardium

A 66-year-old man developed fever, chills, myalgias, three erythematous skin lesions, and transient left eyelid lag. Because of persistent fever, he was hospitalized 4 weeks after the onset of disease; a peripheral blood smear showed Babesia microti in 3% of his erythrocytes. Eighteen hours later, he died unexpectedly. Autopsy showed pancarditis with a diffuse lymphoplasmacytic infiltrate, and spirochetes were found in the myocardium. Antibody titers to both the Lyme disease spirochete Borrelia burgdorferi and Babesia microti were elevated. The finding of spirochetes in the myocardium and the elevated antibody titers to Borrelia burgdorferi suggest that the patient died from cardiac involvement of Lyme disease.

Site predilection of airway inflammation by emphysema type

To elucidate interrelations of airway inflammation and emphysema, bronchi from subjects with severe panlobular and centrilobular disease and normal lungs were compared. This disclosed an intense infiltration with chronic inflammatory cells, mucous gland hypertrophy, and thickening of bronchi, primarily in association with emphysema having a panlobular configuration. These changes complement a generalized thickening and inflammation of nonrespiratory bronchioles previously observed in these cases. We conclude that the panlobular pattern may be a close function of inflammatory thickening of the conductive airways to respective lungs and lung parts, but centrilobular emphysema is not reliant on these changes. The precursory defect for the centrilobular lesion instead has been shown to be a more peripherally oriented respiratory bronchiolitis around the centers of lobules.

Self-limited babesiosis in a splenectomized child

This report describes a self-limited babesia infection in a splenectomized child with hereditary spherocytosis. This is the first report of infectious babesiosis in a child and the second case of babesiosis reported on Cape Cod. The infection manifested itself 6 weeks after a 4-hour exposure to Nantucket. Hemolysis lasted only 4 days and resolved without specific treatment. Parasitemia was documented after resolution of symptoms.

Small airways in severe panlobular emphysema: mural thickening and premature closure

Histological measurements in cases of severe paniobular and centrilobular emphysema and in normal lungs disclosed a generalized thickening of the walls of small airways in the panlobular group. With mathematical models, this was depicted as a potential basis for airway closure at higher than normal lung volumes and trapping of air. Lungs with mixtures of panlobular and centrilobular emphysema predominate in the general population, and the obstructive component of airways in this setting is likely a net result of multiple lesions. These may be common in varying degrees to both varieties of disease but especially characteristic of one form. Bronchiolar thickening is one such general process. Present findings suggest that this is prone to be linked to emphysema with a panlobular pattern.

Affixment arrangements of peribronchiolar alveoli in normal and emphysematous lungs

Our investigation of the radially affixed alveoli of nonrespiratory bronchioles showed that the interalveolar interval was basically constant for normal bronchioles of all sizes, with a mean value of 0.146 mm. The mean interalveolar interval increased significantly to 0.173 and 0.209 mm, respectively, in the two most severe grades of emphysema. The pattern of alveolar affixment to the walls of bronchioles was also altered in emphysema, with irregular interruptions, variations in size and shape of abutting luminal spaces, and loss of alveolar attachment surface. These changes reflected the disruptive phase of emphysema and corroborated previous studies. A dominant extrinsic force normally responsible for bronchiolar patency is thus compromised. Any bronchiole so affected would logically be prone to collapse or contracture of its wall, luminal deformities, diminution of luminal caliber, and retarded airflow.

Labetalol steady-state pharmacokinetics in hypertensive patients

1 During chronic treatment of hypertensive patients observed mean steady-state plasma labetalol levels in ten patients were consistently and significantly higher than predicted from initial acute pharmacokinetic analysis. 2 Mean steady-state levels varied from 36 to 183 ng/ml on a chronic dose of 200 mg twice daily. 3 Patients with lower steady-state levels on a fixed dose of labetalol usually required higher maintenance doses to control blood pressure.

An analysis of the blood pressure response to labetalol in hypertensive patients

1. Blood pressure measurements were made in hypertensive subjects after single intravenous and oral doses of labetalol and subsequently during chronic administration.

2. Oral therapy can be as effective as intravenous therapy in achieving acute blood pressure reduction.

3. Blood pressure control with chronic labetalol monotherapy was satisfactory in 11 of the 12 subjects.

4. High dose therapy with labetalol and 49 diuretic produced greater postural blood pressure falls.

Smoking, mortality, and six in a community hospital necropsy population

Analysis of 344 necropsies at a community hospital disclosed a male to female ratio of 1.9:10 and a smoking incidence over twice that of the general population. Overall longevity for men was less than for women. Intragroup comparisons showed an inverse relationship between smoking and longevity. Smokers in general and subsets of male and female smokers thus died earlier than respective nonsmokers. Trends for nonsmoking men and women were not different. However, smoking women surprisingly died earlier than smoking men at comparable pack-year exposure levels. Conversely, nonsmokers were most likely to achieve old age with freedom from diseases usually associated with smoking. We conclude that smoking predisposes to hospitalization, with premature death. Men suffer the most, probably because of traditionally heavier usage. For reasons unclear, however, women who do smoke may exhibit excessive vulnerability in some situations.

Legal abortions and trends in fetal and infant mortality rates in the United States

Using states as the units for analysis, we found no evidence that during the early 1970s in the United States the legalization of abortions influenced trends in infant mortality rates. If fetal deaths were reduced by legal abortions during that period then the influence was modest and brief. These conclusions differ substantially from all earlier studies of the relationship between legal abortions and pregnancy outcomes in the United States which examined trends in areas with many legal abortions while ignoring areas with relatively few legal abortions.