Role of collagen enzymatic and glycation induced cross-links as a determinant of bone quality in spontaneously diabetic WBN/Kob rats

INTRODUCTION

Diabetes is associated with an increased risk of fracture, although type 2 diabetes is often characterized by normal bone mineral density (BMD). Enzymatic and glycation-induced non-enzymatic cross-links play important roles in the expression of bone strength. The serum vitamin B6 concentration is lower in patients with diabetes than in healthy controls. The aim our study was to see if spontaneously diabetic WBN/Kob rats in the pre- and post-onset of diabetes would serve as a suitable model for studying the pathogenesis of the susceptibility to fracture in diabetes without the reduction of bone mineral density. Seventy male WBN/Kob rats were obtained at the ages of 1 to 18 months.

METHODS

Seventy normal male Wistar rats were used as the non-diabetic, age-matched control. The contents of enzymatic cross-links (dihydroxylysinonorleucine, hydroxylysinonorleucine, lysinonorleucine, pyridinoline and deoxypyridinoline) and non-enzymatic cross-links (pentosidine) were determined in femoral bone. We also analyzed the serum concentration of vitamin B6 (pyridoxal and pyridoxamine), femoral BMD and a three-point bending test of the femur.

RESULTS

A low level of serum vitamin B6 was associated with a decrease in enzymatic crosslinking in bone during the subclinical diabetes stage. After the onset of diabetes, there was a steady decrease in enzymatic cross-links and a steep increase in pentosidine. Furthermore, impaired bone mechanical properties in the WBN/Kob rats despite the lack of reduction in BMD coincided with impaired enzymatic cross-link formation and increases in glycation-induced pentosidine.

CONCLUSIONS

These results indicate that the alteration of enzymatic and non-enzymatic crosslinking in bone could be important for explaining the variation of fracture susceptibility in diabetes.

Degree of mineralization-related collagen crosslinking in the femoral neck cancellous bone in cases of hip fracture and controls

Based on the present definition of osteoporosis, both bone density and quality are important factors in the determination of bone strength. Collagen crosslinking is a determinant of bone quality. Cross-links can form enzymatically by the action of lysyl oxidase or non-enzymatically, resulting in advanced glycation end products. Collagen crosslinking is affected by tissue maturation as well as the degree of mineralization. Homocysteine and vitamin B6 (pyridoxal) are also regulatory factors of collagen crosslinking. We elucidate the relationship between the degree of mineralization and collagen cross-links in cancellous bone from hip fracture cases. We also determined plasma levels of homocysteine and pyridoxal. Twenty-five female intracapsular hip fracture cases (78 +/- 6 years) and 25 age-matched postmortem controls (77 +/- 6 years) were included in this study. Collagen crosslinking was analyzed after each bone specimen was fractionated into low (1.7-2.0 g/ml) and high (>2.0 g/ml) density fractions. The content of enzymatic (immature reducible and mature nonreducible cross-links) and nonenzymatic cross-link (pentosidine) were determined. In the controls, there was no difference in total enzymatic cross-links between low and high density bone, while pentosidine content was significantly higher in high density bone. In the fracture cases, not only reduced enzymatic cross-links in high density bone and increased pentosidine in both low and high density bone, but also higher plasma homocysteine and lower pyridoxal levels were evident compared with the controls. These results indicate that detrimental crosslinking in both low and high mineralized bone result in impaired bone quality in osteoporotic patients.

MRI study of bioabsorbable poly-L-lactic acid devices used for fixation of fracture and osteotomies

BACKGROUND

The overall clinical results of bioabsorbable fixation devices made of poly-L-lactic acid (PLLA) used for fixation of fractures, bone grafting, and osteotomies have been favorable. However, clinical studies demonstrated no sign of normal bony architecture restored after surgery, although implant channels had been filled with fibrous tissue. The purpose of the present retrospective study was to examine the extent of structural changes in PLLA devices (PLLA-Ds) for fixation of rotational acetabular osteotomies and displaced malleolar ankle fractures using magnetic resonance imaging (MRI).

METHODS

Altogether, 14 patients with osteoarthritis of hip joints and 15 with displaced malleolar ankle fractures were operated on using PLLA-D (NEOFIX). Of these patients, 22 were finally enrolled in the study, and the period from operation to the time of the study ranged from 17 to 78 months. The postoperative radiographic findings were evaluated for union, and changes around the implant holes were classified as sclerosis, resorption, or no change. MRI was carried out to estimate changes in the PLLA-Ds.

RESULTS

Bone union was obtained in all cases; clinical complications such as infection, joint effusion, soft tissue irritation due to PLLA-D deviation, and motion pain in the joints were not observed. The MRI study suggested that water content in PLLA-D increased mainly due to biodegradation and that implants were not replaced by bony tissue.

CONCLUSIONS

The PLLA-Ds were degraded but were not replaced by bony tissue during the observation period. Considering these findings and the assumption that in bony tissues mechanical strength of PLLA-D decreases with time, attention should be paid to mechanical insufficiency, which may occur when the cross-sectional area of a PLLA-D extends beyond the cross-sectional area of the osteosynthesis site.

The "ligamentization" process in human anterior cruciate ligament reconstruction with autogenous patellar and hamstring tendons: a biochemical study

BACKGROUND

There is little information documenting whether the phenomenon of "ligamentization," as proposed by Amiel, occurs in the human anterior cruciate ligament after clinically effective reconstruction. To clarify this point, we analyzed biochemical differences between the native anterior cruciate ligament; the patellar, semitendinosus, and gracilis tendons; and anterior cruciate ligaments reconstructed with autografts.

STUDY DESIGN

Cohort study; Level of evidence, 2.

METHODS

Fifty patients who underwent arthroscopically assisted anterior cruciate ligament reconstruction using either semitendinosus and gracilis tendon or bone-patellar tendon-bone autografts were selected for the study. Samples of grafted tissue were collected during arthroscopy and quantitatively analyzed for collagen content and the amount of reducible and nonreducible crosslinks at 4 to 6 postoperative months in patients with semitendinosus and gracilis tendon grafts and at 11 to 13 months in all patients with semitendinosus and gracilis tendon or bone-patellar tendon-bone grafts.

RESULTS

The total collagen content and nonreducible/reducible crosslink ratios increased significantly during the postoperative period (P < .05). The dihydroxylysinonorleucine/hydroxylysinonorleucine ratio was 3.11 +/- 0.56 in the native anterior cruciate ligament, 1.21 +/- 0.47 in the patellar tendon, and 3.59 +/- 1.58 in the anterior cruciate ligaments reconstructed with bone-patellar tendon-bone autografts 1 year after surgery. The dihydroxylysinonorleucine/hydroxylysinonorleucine ratio in both semitendinosus and gracilis tendons was less than 1.0. However, in anterior cruciate ligaments reconstructed with semitendinosus and gracilis tendon autografts, it was 2.34 +/- 0.98 at 4 to 6 months and 3.43 +/- 1.61 at 11 to 13 months after the operation.

CONCLUSIONS

After anterior cruciate ligament reconstruction with autografts, biochemical characteristics of the graft resembled those of the native anterior cruciate ligament. These findings suggest that, regarding the amount of collagen crosslinks and their architecture, the phenomenon of ligamentization occurs in the successfully reconstructed human anterior cruciate ligament within 1 year after operation.

Akt activation in renal cell carcinoma: contribution of a decreased PTEN expression and the induction of apoptosis by an Akt inhibitor

BACKGROUND

Akt has been implicated in the oncogenesis of human malignant tumors, because Akt regulates many key effector molecules involved in cell survival. PTEN (phosphatase and tensin homolog deleted on chromosome 10) negatively regulates Akt activation.

MATERIALS AND METHODS

The expression of phosphorylated Akt (p-Akt), total Akt and PTEN was analyzed by Western blotting in 45 renal cell carcinoma (RCC) patients. The Bad and phosphorylated Bad (p-Bad) statuses were analyzed in 20 RCC patients. A phosphatidylinositol ether analog was used as an Akt inhibitor to treat four RCC cell lines, namely Caki-1, KU19-20, SW839 and Caki-2.

RESULTS

The PTEN expression in RCC was observed to decrease and p-Akt expression to increase significantly in comparison with that in the corresponding normal kidney tissue. The PTEN expression inversely correlated with the p-Akt expression. These alterations were specific for clear cell type RCC, but not for papillary or chromophobe type RCC. Alterations in Bad phosphorylation were also specifically observed in clear cell type. The Akt inhibitor induced apoptosis in KU19-20 and Caki-2 cells with a high Akt activity.

CONCLUSIONS

A decreased expression of PTEN may be an underlying mechanism for Akt activation. An Akt inhibitor may be a therapeutic option for a subset of RCC with an elevated Akt activity.

Inhibition of Wnt signaling downregulates Akt activity and induces chemosensitivity in PTEN-mutated prostate cancer cells

BACKGROUND

The cross-talk between Wnt signaling and the Akt pathway in prostate cancer (Pca) is still unclear. In the present study, we found that WIF-1 downregulates the Akt pathway and also enhances chemosensitivity in PTEN-null Pca cells.

METHODS

Wnt inhibitory factor-1 (WIF-1), an inhibitor of Wnt proteins, was transfected into PC-3 and DU145 Pca cells.

RESULTS

Akt was phosphorylated in PTEN-null PC-3 cells but underphosphorylated in PTEN-expressed DU145 cells. The levels of phosphorylated Akt in WIF-1 overexpressing PC-3 cells were lower than those in native or control vector-transfected PC-3 cells. However, WIF-1 showed no additional inhibition of already reduced Akt activity in DU145 cells. Overexpression of WIF-1 resulted in sensitizing PC-3 cells for paclitaxel to induce apoptosis. DU145 cells were more sensitive to paclitaxel but were not affected by WIF-1 transfection. The PI3K inhibitor LY294002 seemed to restore the chemosensitivity of native PC-3 cells like WIF-1 did.

CONCLUSIONS

Our results show that Wnt signaling is involved in Akt activation in Pca cells. Our data also indicate the possibility that Wnt and its signaling pathway can be therapeutic targets for PTEN-mutated advanced Pca.

Expression analysis of three isoforms of hyaluronan synthase and hyaluronidase in the synovium of knees in osteoarthritis and rheumatoid arthritis by quantitative real-time reverse transcriptase polymerase chain reaction

Hyaluronan is a major molecule in joint fluid and plays a crucial role in joint motion and the maintenance of joint homeostasis. The concentration and average molecular weight of hyaluronan in the joint fluids are reduced in osteoarthritis and rheumatoid arthritis. To elucidate the underlying mechanism, we analyzed the message expression of three isoforms of hyaluronan synthase and hyaluronidase from knee synovium, using real-time reverse transcriptase polymerase chain reaction. Synovia were obtained from 17 patients with osteoarthritis, 14 patients with rheumatoid arthritis, and 20 healthy control donors. The message expression of hyaluronan synthase-1 and -2 in the synovium of both types of arthritis was significantly less than in the control synovium, whereas that of hyaluronidase-2 in the synovium of both arthritides was significantly greater than in the control synovium. The decreased expression of the messages for hyaluronan synthase-1 and -2 and/or the increased expression of the message for hyaluronidase-2 may be reflected in the reduced concentration and decreased average molecular weight of hyaluronan in the joint fluids of patients with osteoarthritis and rheumatoid arthritis.

Significant decrease of the International Index of Erectile Function in male renal failure patients treated with hemodialysis

In order to evaluate the erectile function in male renal failure patients treated with hemodialysis (HD), we investigated the International Index of Erectile Function (IIEF) in patients and healthy controls. The subjects were 174 male patients treated with HD, of whom 43 had diabetes mellitus (DM) and the remaining 131 patients did not have DM. The controls were 1133 healthy males. We evaluated the prevalence of erectile dysfunction (ED) using the erectile function (EF) score, which is one of the five domains of the IIEF, in each age group (upto 39 y old, 40-49 y old, 50-59 y old, 60-69 y old). The severity of ED was classified into five categories using EF in each age group. The univariate logistic regression analysis and multiple variate analysis of IIEF in HD patients were performed. The prevalence of ED in HD patients was significantly higher than that in the controls in each age group. The severity of ED in HD patients was also significantly higher than that in the controls in each age group. In the logistic regression analysis and multiple variate analysis of IIEF in HD patients, DM and age were significant risk factors on sexual dysfunction. ED was more prevalent in male renal failure patients treated with HD than in the controls. In the patient group, ED was more prevalent in older DM patients.

Aging and erectile dysfunction: the role of aging and concomitant chronic illness

Erectile dysfunction (ED) can have a strong negative effect on the well-being and quality of life of the sufferer. Many factors may contribute to the development of this disorder; age in particular and also concomitant chronic illnesses including neurological, hormonal, arterial and cavernosal factors. An understanding of the prevalence and characteristics of risk factors for ED is required, in order to establish effective therapeutic strategies. However, the prevalence of ED depends on the definitions used and the use of an internationally established scale for the assessment of male sexual function is necessary to facilitate the comparison of data between different countries. Further epidemiologic research and analysis of individual risk factors is required. Such studies will clarify the interactive effects of organic factors and their probable etiology with the general physical, sociocultural and psychologic status of patients. These efforts will make it possible to design more effective future strategies for the treatment and prevention of ED.

The prevalence of renal cell carcinoma: a nation-wide survey in Japan in 1997

BACKGROUND

The present study was conducted to investigate the incidence of renal cell carcinoma by sex, age group and different regions in Japan.

METHODS

The survey was conducted from the beginning of January 1997 to the end of December 1997. A total of 1306 Institutions in all 47 prefectures throughout Japan were requested to register cases.

RESULTS

There were 6358 persons with renal cell carcinoma, consisting of 4372 men and 1986 women. The age-specific incidence rates showed a peak in the age group of 65-70 years in both men and women. The crude incidence rates per 100 000 population for men and women were 7.1 and 3.1, respectively, and age-standardized incidence rates per 100 000 population for men and women were 4.9 and 1.8, respectively. The incidence rates in the Hokkaido region were significantly higher than in other regions (P < 0.05), among which there was no significant difference in incidence rates.

CONCLUSIONS

The present study showed that the incidence rates of renal cell carcinoma in Japan were approximately the same as among Japanese in Los Angeles. The rates were, however, lower than North American and European countries, but higher than China, Central or South American countries and African countries. The reasons for the high incidence of renal cancer in the Hokkaido region are not entirely clear. Further epidemiologic research is required.

[Evaluation of rapidly growing Mycobacteria isolates in a general hospital: reports from the hospital microbiology laboratory]

Forty isolates of rapidly growing Mycobacteria, Mycobacterium fortuitum group including M. fortuitum and M. peregrinum and M. chelonae group including M. chelonae subsp. chelonae and M. chelonae subsp. abscessus at Showa University Fujigaoka Hospital collected between February 1981 and December 1997 were investigated in this study. These isolates were from the patients who were not infected with HIV. The average age of fourteen patients, from whom M. fortuitum group was isolated, was 58 years, ranging from 17 to 80 years old. One patient (71-year-old) with chronic myelogenous leukemia and another (64-year-old) with chronic diabetes mellitus were diagnosed with skin abscesses of M. fortuitum group, which were located on the right site of the neck and in the scar after injecting insulin (injection abscess), respectively. The average age of twenty-six patients, from whom M. chelonae group was isolated, was 57 years, ranging from 32 to 84 years old. One patient (75-year-old) with articular rheumatism was diagnosed with a lung infection of mixed M. chelonae group and Pseudomonas aeruginosa, and another (74-year-old) with diabetes mellitus and kidney failure was strongly suspected of a lung infection. The isolates of the two mycobacteria from the remaining patients were due to colonization, while these patients had the following underlying diseases contributing to infections: pulmonary emphysema; diabetes mellitus; leukemia; collagen diseases; lung cancer; chronic kidney diseases; systemic lupus erythematosus; carcinomatous pleurisy; bronchiectasis; post-tuberculosis. Most isolates of the two mycobacteria were separated from the specimens of patients' respiratory tracts, but since M. chelonae group was a contaminant in the tap-water for diluting concentrated chlorhexidine, the organism happened to be isolated with the mucous membranes of the 6 patients' colons that were picked up while using the washed fiber-scope. These findings suggest that M. fortuitum and M. chelonae groups, in spite of the fact that they rarely cause infection, have a significant risk of infecting aged patients in general hospitals with various underlying diseases attributable to infections. As only a few colonies were isolated from patients' specimens in the majority of cases, it took time to carry out these clinical examinations, and to improve this "laboratory's delay", it is needed to make faster report to clinicians.

Long-term results of anterior cruciate ligament reconstruction using semitendinosus and gracilis tendons with Kennedy ligament augmentation device compared with patellar tendon autografts

ACL reconstructions were postoperatively evaluated in 102 patients who underwent surgery using an arthroscopically assisted double-incision technique. Augmentation of the distally based semitendinosus and gracilis tendons was done either with the Kennedy ligament augmentation device (LAD) (Group 1 patients, mean follow-up of 108 months) or bone-patellar-tendon-bone graft (Group 2 patients, mean follow-up of 109 months). At follow-up, serial KT-1000 measurements showed < or = 5 mm side-to-side differences in 70% of Group 1 and 90% of Group 2 patients. No differences were found among patients regarding postreconstruction complications such as loss in motion range, patellofemoral crepitus, osteoarthritis, and muscle disfunction.

Age-related prevalence of erectile dysfunction in Japan: assessment by the International Index of Erectile Function

BACKGROUND

The effects of age and concomitant chronic illness on male sexual function were investigated to obtain insight into the prevention of erectile dysfunction (ED).

METHODS

A questionnaire from the International Index of Erectile Function (IIEF) was given to 2311 non-institutionalized men aged 23-79 years along with a survey of health status. The study sample consisted of 1517 men who provided complete responses to the questionnaire. For statistical analysis, ANOVA was conducted to evaluate the effect of aging on the sexual functions and a logistic regression model was used to identify significant independent risk factors for ED.

RESULTS

There was a significant correlation between age and the scores for erectile function, orgasmic function, sexual desire and intercourse satisfaction. The prevalence of moderate and severe cases of ED were 1.8% and 0% for ages 23-29; 2.6% and 0% for ages 30-39; 7.6% and 1.0% for ages 40-49; 14.0% and 6.0% for ages 50-59; 25.9% and 15.9% for ages 60-69; and 27.9% and 36.4% for ages 70-79 years, respectively. Hypertension, diabetes mellitus, heart disease, chronic hepatitis, disc herniation and cerebral infarction under treatment with anticoagulants were significant independent risk factors for ED.

CONCLUSIONS

The results obtained indicated a significant association between aging and chronic diseases and erectile function. Further epidemiologic research and analysis of individual risk factors are required to allow more effective future strategies for the treatment and prevention of ED.

[Epidemiological evaluation of Serratia marcescens isolates in one Japanese hospital during the two years from April 1997 to March 1999]

One hundred fourteen isolates of Serratia marcescens from different patients in Showa University Fujigaoka Hospital during the 2 years from April 1997 to March 1999 were investigated in this study. The isolation frequency(37%, 43 of the isolates) of O-serotype 14(O14) was highest among the 16 different serotypes, and that(24%, 27 of the isolates) of O2 was secondarily highest, while these types were frequently isolated from patients in the surgical ward. O14 with major bacteriocin types 4 and 9(B4 and B9, respectively) showed resistance to piperacillin, the third and fourth generation cephems, new quinolones and aminoglycosides except gentamicin tested. However, O2 with major B1 and B5 showed much greater sensitivity to the antimicrobial agents tested than O14. Furthermore, O2 and O14 were frequently isolated from patients' sputa(41%, 11 of the 27 isolates) and urine(72%, 31 of the 43 isolates), respectively. These findings suggested that S. marcescens O14 with B4 and B9, more resistant to various agents, and O2 with B1 and B5, more sensitive to various agents, show a tendency to inhabit the urinary and respiratory tracts in the hospital patient's body, respectively, having a high risk of hospital infection.

Isolation of Pseudomonas aeruginosa producing OXA-4 beta-lactamase in a Japanese hospital in 1996

One-hundred and fifty isolates of Pseudomonas aeruginosa were collected from different patients' specimens at Showa University Fujigaoka Hospital between April and August 1996. The 23 isolates resistant to piperacillin (minimum inhibitory concentration, >or=100 microg/ml) were widely distributed in the hospital wards. Using polymerase chain reaction-single-strand conformation polymorphism (PCR-SSCP) and isoelectric focusing (IEF) methods, we detected OXA-4 beta-lactamase hydrolyzing penams in 4 of the resistant isolates (17%) with O-serotype E. However, no other external beta-lactamase was detected by the IEF method. The hybridization results showed that the OXA-4 genes were located in chromosome, but not in plasmid. Furthermore, the isolation rate was significantly lower than that found between 1992 and 1993 (61%; P < 0.01; chi2-test), suggesting a decreased rate of hospital infection caused by P. aeruginosa producing the OXA-4 enzyme.

Surgical management of congenital permanent dislocation of the patella in nail patella syndrome by Stanisavljevic procedure

We report a patient with nail patella syndrome associated with congenital permanent dislocation of the patella successfully operated on using a modified Stanisavljevic method. The patient, a 26-year-old woman, complained of inability to completely extend her right knee joint. She had occasionally experienced the "giving way" phenomenon since childhood, but she had not received any treatment since birth. Physical examination showed that all fingernails were deformed, with longitudinal striations, while the lunules were of an abnormal triangular shape or were missing. Both patellae were palpably hypoplastic, with the right patella dislocated laterally, and the knee had an extension lag of 90 degrees. Thigh and leg muscle were slightly underdeveloped, but quadriceps muscle contraction was good. Several radiographs were taken and they showed bilateral iliac horns and hypoplasia of the bilateral humero-radial joints and of both patellae, and complete dislocation of the right patella. We employed the Stanisavljevic procedure for the reduction of the patella, with Z-lengthening of the rectus femoris and medial translocation of the tibial tuberosity. Four years after the operation, a 30-degree extension lag still exists in the right knee, but the treatment resulted in stable alignment of the quadriceps mechanism, and notably improved gait appearance.

[Effect of aging and diseases on male sexual function assessed by the International Index of Erectile Function]

PURPOSE

Many epidemiological factors contribute to erectile dysfunction (ED). The objective of the present research was to investigate the risk factors of ED and the influence of aging on male sexual function, to obtain some insight into prevention of ED.

METHODS

The study sample consisted of employees, aged from 22 to 59 years old of ten companies in Japan, who responded to the International Index of Erectile Function (IIEF) questionnaire and a survey of health status and related variables. The IIEF sexual activity questionnaire includes 15 items related to male sexual activity organized into five domains (that is erectile function, orgasmic function, sexual desire, intercourse satisfaction, overall satisfaction) to which 967 of the 1,020 subjects (94.8%) provided complete responses. These 967 men constitute the present study sample. For statistical analysis, ANOVA with Scheffe's (post hoc) test was conducted, and statistical significance was set at p < 0.05.

RESULTS

Presence of hypertension, heart disease, diabetes and hyperlipidemia was associated with a significantly decreased score for erectile function in subjects in their fifties (p < 0.05), however, it was not significant in the other age groups. In subjects, who were free from risk factors for sexual function, there was significant correlation between age and the scores for erectile function, orgasmic function, sexual desire and intercourse satisfaction.

CONCLUSIONS

Aging and chronic disorders that have been considered to be putative risk factors for ED, therefore affect male sexual function in the elderly. The IIEF was suggested to be suited for use in studies assessing epidemiology of ED.

Antitumor effects of an interferon-loaded silicone formulation in human renal cell carcinoma in nude mice

Conventional therapy for renal cell carcinoma using interferon (IFN) has shown limited antitumor action. The IFN-loaded silicone formulation (IFN-SF) is a sustained-release formulation of human lymphoblastoid IFN, with a medical grade silicone elastomer used as the carrier material. We evaluated the antitumor effect of IFN-SF on human renal cell carcinoma cell line (KU-2) transplanted to nude mice. The treatment was started when the tumor nodules had grown 6 to 8 mm in diameter. IFN-SF, on an aqueous solution of IFN, was given by subcutaneous or peritumoral injection. Antitumor effects were evaluated according to tumor weights calculated as (long diameter) x (short diameter)2/2 in 7 groups consisting of 6 mice each. Serum IFN levels remained detectable up to 30 days after subcutaneous injection of IFN-SF. IFN-SF administered by the subcutaneous and peritumor route significantly inhibited growth of the tumor when compared with tumor growth in the untreated mice and mice treated with aqueous IFN solution. IFN-SF had equivalent inhibitory effects on tumor growth by peritumor and subcutaneous injection. Results indicated that the use of IFN-SF could reduce the frequency of injections and provide better treatment of patients with renal cell carcinoma because of its long-acting effect when it is used systemically.

Detection of OXA-4 beta-lactamase in Pseudomonas aeruginosa isolates by genetic methods

In Pseudomonas aeruginosa, resistance to cefclidin is usually associated with resistance to another third-generation cephalosporin, ceftazidime. In this study we analysed 22 isolates of P. aeruginosa, collected at Showa University Fujigaoka Hospital between 1992 and 1993, which were resistant to cefclidin but susceptible to ceftazidime. All polymerase chain reaction (PCR) products amplified by a primer pair covering the full-length gene of OXA-4 (also OXA-1) precursor beta-lactamase were 0.84 kb in length. The isoelectric points of the beta-lactamases produced by these isolates were typical of the OXA-4 type of beta-lactamase (pl 7.5) rather than the OXA-1 type (pl 7.4). All PCR products at 216 bp were amplified by the primer pair covering the A928-->T point mutation, which corresponds to the Asp48-->Val amino acid substitution of OXA-1 beta-lactamase to form OXA-4 beta-lactamase. These single-strand conformation polymorphism (SSCP) patterns are typical of the OXA-4 gene, rather than the OXA-1 gene, demonstrating that these enzymes can be classified by SSCP analyses based on the PCR method. Although OXA-4 beta-lactamase is generally plasmid-mediated, the chromosomal DNA of these isolates, but not their plasmids, hybridized with the OXA-4 gene amplified by the PCR method. Based on these results, we suspected that the plasmids encoding OXA-4 beta-lactamase had been spontaneously cured, or that the gene had been deleted from the plasmid. The distribution of P. aeruginosa producing OXA-4 beta-lactamase amongst hospital wards and clinical specimens demonstrated that the OXA-4 enzyme in this collection period was representative of hospital P. aeruginosa.

Erectile function and nocturnal penile tumescence in patients with prostate cancer undergoing luteinizing hormone-releasing hormone agonist therapy

BACKGROUND

Luteinizing hormone-releasing hormone (LHRH) agonists have been widely used as effective agents in endocrine therapy for prostate cancer. Continuous administration of the drug results in profound suppression of testicular androgen production. However, the side effects on erectile function have not been fully investigated.

METHODS

We studied the influences of testosterone suppression on male sexual function and nocturnal penile tumescence in nine sexually active patients with prostate cancer who were treated with an LHRH agonist.

RESULTS

Following reduction of serum testosterone concentrations to a castration level by the administration of the LHRH agonist, sexual desire, sexual interest and sexual intercourse were totally annulled, with significant changes in frequency, magnitude, duration and rigidity of nocturnal erections observed in all patients.

CONCLUSIONS

These results demonstrate that the LHRH agonist strongly suppresses erectile function and sexual activity. Taking into account the quality of sexual function for relatively young and sexually active patients and their partners, it is necessary to establish effective modalities that minimize the adverse effects on sexual function for the treatment of patients with prostate cancer.

Interferon-alpha and 5-fluorouracil therapy in patients with metastatic renal cell cancer: an open multicenter trial. The Japanese Study Group Against Renal Cancer

OBJECTIVES

Recent clinical trials have implied the cytotoxic and antiproliferative effects of combining 5-fluorouracil and interferon-alpha in the treatment of metastatic renal cell cancer. We therefore conducted an open multicenter trial to test the efficacy of such a combination on this cancer.

METHODS

Human lymphoblastoid interferon (3 MIU per patient) was administered subcutaneously three times weekly for 12 weeks, while 5-fluorouracil was administered (600 mg/m2/day) as a continuous infusion for the first 5 days, followed by an intravenous bolus infusion of 600 mg/m2 once a week from the 3rd week until the 12th week.

RESULTS

Of the 63 patients entered into the trial, 55 were eligible and evaluable for systemic toxicities, and 53 were evaluable for their response. All patients had undergone a prior nephrectomy, and their European Cooperative Oncology Group (ECOG) performance status ranged from 0 to 3 (median 0). Three complete and eight partial responses were induced, with an overall response rate of 20.0%. The median time to progression and the median survival time were 11 and 33 months, respectively. World Health Organization grade 3 toxicities were observed in 8 patients; however, no grade 4 toxicities or toxicity-related deaths were noted.

CONCLUSIONS

Combination therapy of interferon-alpha plus 5-fluorouracil at the above-described dosage and schedule produced no better responses than interferon monotherapies. Prolongation of survival could be attributable to the fair performance status of the patients. This regimen has limited value for the treatment of patients with advanced renal cell cancer.

[Evaluation of Mycobacterium kansasii isolates from a clinical laboratory in a city hospital]

Fifteen isolates of Mycobacterium kansasii in Showa University Fujigaoka Hospital between 1982 and 1995 were investigated. Comparing by gender, 13 were isolated from male patients and only two were isolated from female patients. The average of cases was 48 years old and 14 out of 15 cases (93%) were isolated from respiratory tract specimens. The rate of the smear- and culture-positives was 64%, which was significantly higher than that (26%) of M. avium complex (p < 0.01 by chi 2 test). All 4 isolates were susceptible to rifampicin (10 micrograms/ml) by drug susceptibility testing using Ogawa egg medium, and only 1 was resistant to ethambutol (2.5 micrograms/ml). Seven out of 10 patients whose medical record was available were diagnosed as pulmonary infection with M. kansasii. Two out of 4 patients with primary infection type had underlying diseases such as diabetes mellitus and leukemia, while the remaining two patients did not have any underlying disease. Two out of 3 patients with secondary infection type had a medical history of tuberculosis and the remaining 1 patient had infected pulmonary cyst. Such as Pseudomonas aeruginosa, Enterobacter aerogenes and Flavobacterium spp., and Branhamella catarrhalis, associated with M. kansasii, bacteria more than 10(7) cfu/ml were isolated from the sputa of 3 patients with leukemia, infected pulmonary cyst and post-tuberculosis, respectively. M. kansasii, Stenotrophomonas maltophilia (10(7) cfu/ml) and Candida albicans were detected from the sputum of 1 patient with nephrosis, for which steroid (predonin) and antibiotics (piperacillin and latamoxef) were administrated, however, this patient was not diagnosed as a case of M. kansasii infection. These findings suggest the fact that M. kansasii inhabits among compromised hosts of a city hospital.

[Clinical background and treatment of brain metastasis from renal cell carcinoma]

OBJECTIVE

The objective of this study is to evaluate the clinicopathological characteristics and the effect of therapy of brain metastasis from renal cell carcinoma.

METHOD

Of 306 cases with renal cell carcinoma treated at Keio University Hospital from June, 1976 to May, 1996, 20 (6.5%) developed brain metastasis. Metastasis-free rate and survival rate were evaluated by Kaplan-Meier's method and tested statistically with Long-rank test.

RESULT

As for the time of the brain metastasis, it was already at the time of initial diagnosis in 6 cases, and in the other 14, it was after the diagnosis of original disease. The average interval between the diagnosis of original disease and metastasis was 53.9 months. Only 2 cases have no metastasis without brain, and 17 of 20 cases (85.0%) were complicated by pulmonary metastasis and 10 (50.0%) by bone metastasis. It was considered that the brain metastasis was accompanied with other metastases. As for the treatment, cytokine therapy was performed on 18 cases without efficacy. It was supposed that in cases with pulmonary metastasis, IL-2 therapy may have the possibility of increasing the frequency of brain metastasis. 9 of 20 cases were subjected to surgical treatment with significantly better prognosis than the cases without the operation. Two cases were long-term survivors more than 5 years after the diagnosis of brain metastasis and both underwent surgical treatment to brain metastasis.

CONCLUSION

Cytokine therapy was not effective to brain metastasis from renal cell carcinoma. On the other hand, however, it was suggested that surgical treatment could improve prognosis if the metastatic lesions could be resected.

[Epidemiological evaluation of Serratia marcescens clinical isolates in a general hospital during the past three years: appearance of O-antigens O2 and O14]

One hundred sixteen isolates of Serratia marcescens collected in Showa University Fujigaoka Hospital between April in 1994 and March in 1997 were investigated by O-serotyping, biotyping and antimicrobial susceptibility testing. The results were as follows. 1. Of the total isolates, 37.1 and 24.1% were O2 and O14, respectively, and these values were higher than that of any other serotype. 2. In the hospital, the O2 strains were often isolates in the wards of neurology, plastic surgery, general surgery and ophthalmology, while the O14 strains were often isolated in the wards of urology and orthopedic surgery. 3. The isolation percentages of the biotypes 5307721 and 70405356 with PII 20E and Microscan systems were 81.1 and 50%, respectively. Both biotypes showed typical S. marcescens. There was no relation between O2 or O14 and biotypes. 4. All of the O2 isolates were susceptible to third generation cephems, cefotaxime, ceftazidime and cefpirome, and at least 88% were susceptible to aminoglycosides, whereas the O14 isolates were much more resistant to these antibiotics than the O2 isolates. 5. The isolation percentages of O2 and O14 from urine were 57.1 and 16.3%, whereas those from sputum and pharynx swab were 7.1 and 53.5%, respectively. 6. The isolation percentage of O14 susceptible to gentamicin was very high (96.5%), compared with that of between April in 1991 and March in 1994 (23.3%). Furthermore, increased isolation percentages of the O14 isolates susceptible to gentamicin, tobramycin and amikacin in this period were linked with the decrease in the annual purchased amount of each aminoglycoside and with the decreased isolation percentage from urine. These findings revealed the environments in which the O2 and O14 isolates in this period were predominant over other O-serotypes, while S. marcescens mediated by patients inhabits in the hospital.

Single-column high-performance liquid chromatographic-fluorescence detection of immature, mature, and senescent cross-links of collagen

A high-performance liquid chromatographic-fluorescence detection method of reducible (immature) and nonreducible (mature and senescent) cross-links of collagen was established without the use of a radioisotope and preliminary fractionation step. This method used a gradient elution procedure of sodium citrate buffer containing 7% ethanol. The reducible cross-links (dihydroxylysinonorleucine, hydroxylysinonorleucine, and lysinonorleucine) and nonreducible cross-link (histidinohydroxylysinonorleucine) were detected by O-phthalaldehyde derivatization with the postcolumn method, whereas other nonreducible cross-links (pyridinoline, deoxypyridinoline, and pentosidine) were detected by natural fluorescence. The linear ranges of contents of the O-phthalaldehyde derivative cross-links and the natural fluorescent nonreducible cross-links were 20-600, 5-500 (pyridinoline, deoxypyridinoline), and 0.2-20 pmol (pentosidine), respectively. Tissue containing 1-2 mg dry wt of collagen was adequate for duplicate analyses of the reducible and nonreducible cross-links. An equivalent of 0.25 mg of hydrolyzed collagen could be analyzed by this HPLC system. Using this system, age-related changes in the cross-links of collagen from human connective tissues were also investigated.

Antitumor effects and pharmacological interaction of xiao-chai-hu-tang (sho-saiko-to) and interleukin 2 in murine renal cell carcinoma

Conventional therapy for renal cell carcinoma using interleukin 2 (IL-2) has shown limited antitumor action. The purpose of our study was to investigate synergistic antitumor effects of IL-2 and Xiao-Chai-Hu-Tang (XCHT), and to elucidate the mechanisms of interaction between the two drugs against the murine renal cell carcinoma cell line, Renca, in vivo. The treatment was started 5 days after subcutaneous transplantation of Renca tumor. XCHT was given at a dose of 2.5 g/kg daily for 30 days orally. IL-2 was given at a dose of 10(4) U/mouse by subcutaneous injection every other day 8 times. Combination of XCHT and IL-2 inhibited growth of the tumor and prolonged survival significantly as compared with the untreated mice. Increased cellular infiltration was observed in tumor tissue and the lungs of mice treated with XCHT alone and by combination of XCHT and IL-2, but there were no histological changes in the liver and kidney. Elevation of serum IL-6 was observed in tumor-bearing mice, but IL-6 was significantly suppressed by administration of XCHT. The results obtained suggest that combination of XCHT and IL-2 induces enhanced immunological reaction in specific organs and tissues, and IL-6 may have a role in the synergistic effect of these two agents. It was concluded that combination of XCHT and IL-2 is useful in the treatment of patients with renal cell carcinoma.

[Epidemiological evaluation of mycobacteria isolates in one city hospital: reports from the hospital microbiology laboratory]

The frequency of mycobacteria isolated from patient's specimens at Showa University Fujigaoka Hospital was investigated. By fitting a polynominal curve (degree = 3) of the annual frequency of culture-positive Mycobacterium tuberculosis (1977 through 1995), it was noted that the frequency had not changed since 1977. The patients in the 40s or older and 60s or older comprised 74 and 38%, respectively. Of 104 patients diagnosed as tuberculosis (between 1993 and 1995), 43 (41%) were compromised hosts with the following underlying diseases: kidney disease; diabetes mellitus; malignant tumor; respiratory disease; Behçet's disease; ophthalmosarcoidosis; multiple arthritis; Hashimoto's disease. This suggested that these compromised hosts are at high risk of onset and relapse of tuberculosis, and occasionally the doctor's or patient's delay was seen during the diagnostic process. By fitting a polynominal curve (degree = 3) of the annual frequency of culture-positive atypical mycobacteria (1977 through 1995), it was noted that the frequency had increased since 1981. The patients in the 40s or older and 60s or older comprised 88 and 60%, respectively. Between 1982 and 1994, we encountered 46 cases of atypical mycobacteriosis of the lung: 37 M. avium complex (MAX) diseases; 7 M. kansasii diseases; one M. chelonae disease; one unidentified disease involving Runyon Group II mycobacterium. Eight involved patients with bronchiectasia (5 cases), diabetes mellitus (2 cases), or leukaemia (one case). Haemophilus influenzae, Pseudomonas aeruginosa, and Moraxella catarrhalis at more than 10(7) CFU per ml of sputum were isolated from 6 patients diagnosed with MAC or M. kansasii lung diseases, suggesting the possibility of mixed infections. M. tuberculosis and atypical mycobacterium (15 cases), and two different atypical mycobacteria (16 cases) were isolated from the same or different specimens of the same patients at the same or different times. However, the pathogenicity of these mycobacteria remained unknown, because atypical mycobacteria are non-pathogenic in many cases. The above findings suggested that the environment fit for the mycobacteria growth in human body has gradually been formed associating with aging, lung-lesion, and decline of immune capacity.

Biochemical modulation of 5-fluorouracil with murine interferon-alpha/beta against murine renal cell carcinoma

BACKGROUND

Conventional therapy for renal cell carcinoma using interferon (IFN) has shown limited antitumor action. The purpose of our study was to investigate synergistic antitumor effects of IFN and 5-fluorouracil (5-FU), and to elucidate the mechanisms of interaction between the 2 agents in mice.

METHODS

Antitumor effects and biochemical modulation of murine IFN-alpha/beta and 5-FU were determined against the murine renal cell carcinoma cell line, Renca, in vivo. The activity of thymidylate synthetase and thymidine kinase was measured using cytosolic extracts of the tumors.

RESULTS

Combination treatment with IFN-alpha/beta and 5-FU produced a significant enhancement of growth inhibition against Renca tumor. Treatment with 5-FU resulted in a 2.7-fold increase in the total amount of thymidylate synthetase and an 11.6-fold increase in the thymidylate synthetase inhibition rate, while the administration of IFN-alpha/beta did not significantly reduce the 5-FU-induced increase in thymidylate synthetase. The administration of IFN-alpha/beta decreased thymidine kinase activity to 65.5% maximally, compared with that in the control mice or the mice treated with 5-FU.

CONCLUSIONS

The reduction of thymidine kinase caused by treating the mice with IFN-alpha/beta changes the utilization of exogenous thymidine for DNA synthesis, and may represent the mechanism of the additive antitumor effect of the 2 agents, through the suppression of the salvage pathway for deoxythymidine monophosphate induction.

Application of the interferon minipellet to human renal cell carcinoma in nude mice

BACKGROUND

The interferon (IFN) minipellet is a sustained-release formulation of human lymphoblastoid IFN, with atelocollagen used as the carrier material. We evaluated the antitumor effect of the IFN minipellet on an established human renal cell carcinoma cell line (KU-2) transplanted in nude mice.

METHODS

The treatment was started when tumor nodules had grown to 6 to 8 mm in diameter. The IFN minipellet, or an aqueous solution of IFN, was given by subcutaneous injection, or peritumor injection, on days 1 and 10. Antitumor effects were evaluated according to tumor weights calculated as (long diameter) x (short diameter)2/2 in 7 groups consisting of 6 mice each.

RESULTS

IFN levels remained detectable in both tumor tissue and serum up to 10 days after peritumor injection of the IFN minipellet. Administered by the peritumor route, the IFN minipellet inhibited growth of the tumor significantly as compared with tumor growth in the untreated mice. The IFN minipellet showed greater inhibition of tumor growth by peritumor injection compared to subcutaneous injection. The aqueous solution of IFN was not effective either by subcutaneous or by peritumoral injection.

CONCLUSION

Results indicate that the IFN minipellet is useful in the treatment of renal cell carcinoma.

Evaluation of high-level carbapenem resistance in atypical Serratia marcescens by a comparison with its revertants

A clinical isolate of Serratia marcescens (FHSM4055) was highly resistant to carbapenem (MIC of imipenem, 100 mg/L) and was atypical in that it was negative in the aesculin-hydrolysis test. This parent strain was compared with the revertants S1 and S5, which had lost resistance to imipenem alone and to imipenem and piperacillin respectively. The MICs of imipenem for the revertants were 16- to 32-fold lower than that for the parent strain. Only the crude extract of the parent strain had imipenem-hydrolyzing activity (0.27 unit/mg: panipenem-, meropenem- and biapenem-hydrolyzing activities were 53.4, 22.6 and 26.7% of the imipenem-hydrolyzing activity, respectively). From the isoelectric focusing profiles of beta-lactamases detected with nitrocefin, the parent strain produced beta-lactamases with pls of 9.2, 8.7 and 5.5, whereas the revertants did not produce the pI 8.7 beta-lactamase, which is a metalloenzyme. In the induction test, the pI 8.7 beta-lactamase was constitutive. These results indicated that the constitutive pI 8.7 beta-lactamase contributes to the carbapenem resistance of the parent strain. On the other hand, the MICs of imipenem for the revertants were 8- to 16-fold higher than that for the typical S. marcescens reference strain IFO3736, which was susceptible to various beta-lactam antibiotics other than first generation cephalosporins (according to the disk sensitivity test). This result revealed that the revertants were low-level resistant to carbapenem. The protein corresponding to the 42 kDa porin of strain IFO3736 (the major transport-channel) was absent on the outer membrane protein profiles of the parent strain and the revertants, and [3H]glucose uptake concomitantly decreased. Hence a combination of constitutive pI 8.7 metallo-beta-lactamase and decreased outer membrane permeability are major factors involved in the high-level carbapenem resistance of S. marcescens.

Pharmacokinetics and antitumor effects of an interleukin-2 immunocomplexing agent in murine renal cell carcinoma

BACKGROUND

Conventional therapy for renal cell carcinoma (RCC) using systemic administration of interleukin-2 (IL-2) has shown limited anti-tumor action. The purpose of this study was to investigate the anti-tumor effects of a newly developed immune complex of IL-2 (IC) against RCC.

METHODS

IC was prepared by mixing IL-2 and an anti-IL-2 monoclonal antibody at a molar ratio of 2:1. The pharmacokinetics and anti-tumor effects of IC were then studied in a murine RCC line, Renca.

RESULTS

Serum IL-2 levels were sustained longer in mice given IC than in mice given IL-2 alone after either subcutaneous or intratumoral injections. After an intratumoral injection of IC, the IL-2 concentration in the tumor nodules remained higher compared with mice given IL-2 alone. The anti-tumor effect was most pronounced in mice treated with intratumoral injections of IC.

CONCLUSIONS

Results obtained here indicate that an immune complex of IL-2 provides a useful tool for the treatment of RCC by altering the pharmacokinetics of IL-2 in vivo.

[O-serotypes, biotypes and antimicrobial susceptibilities of Serratia marcescens isolates from clinical specimens: 4th report]

The clinical isolates of Serratia marcescens in The Showa University Fujigaoka Hospital in the period V during the 3 years from 1991 April to 1994 March were epidemiologically investigated by determining O-antigens, biotypes and antimicrobial susceptibilities. The isolates were collected, while the consumption of beta-lactam antibiotics, new quinolones, and aminoglycosides in the hospital had not changed significantly since 1991. The urease positive O3 strains were predominantly isolated in the period II to IV during the 9 years and 3 months from 1982 January to 1991 April and were more resistant to third generation cephalosporins and the other drugs such as new quinolones and aminoglycosides than the other O-serotype strains. However, the urease negative O14 strains, unlike such O3 strains, were predominantly isolated in the period V and were more resistant to the above mentioned drugs than the other O-serotype strains, indicating that they had higher resistance rates for carbenicillin, latamoxef, ceftizoxime, cefoperazone, cefpirome, tobramycin, dibekacin, gentamicin and fosfomycin than the O3 strains in the period IV during the two years and three months from 1989 January to 1991 March. The hospital wards in which the O14 strains were mainly isolated were the departments of urology, general surgery, orthopedic surgery, haematology, and internal secretion and kidney medicines, corresponding to those in which the isolation number of the O3 strains decreased in the period V. These findings suggest that S. marcescens resident in the hospital inherits multiple drug resistance by changing the biotype and O-serotype.

The Effect of Magmatic Activity on Hydrothermal Venting Along the Superfast-Spreading East Pacific Rise

A survey of hydrothermal activity along the superfast-spreading (approximately 150 millimeters per year) East Pacific Rise shows that hydrothermal plumes overlay approximately 60 percent of the ridge crest between 13 degrees 50' and 18 degrees 40'S, a plume abundance nearly twice that known from any other rige portion of comparable length. Plumes were most abundant where the axial cross section is inflated and an axial magma chamber is present. Plumes with high ratios of volatile ((3)He, CH(4), and H(2)S) to nonvolatile (Mn and Fe) species marked where hydrothermal circulation has been perturbed by recent magmatic activity. The high proportion of volatile-rich plumes observed implies that such episodes are more frequent here than on slower spreading ridges.

Postgastrectomy aspiration pneumonia

One hundred eighty-six patients who had undergone total gastrectomy were analyzed in regard to pulmonary aspiration. Sixteen patients (8.6%) with recurrent respiratory tract inflammation (r-RTI) and 45 patients (24.2%) with sporadic RTI (s-RTI) were observed. The r-RTI group frequently showed symptoms related to esophageal reflux among the many factors affecting the onset of disease. They were also characterized by marked inflammatory responses with various and atypical clinical courses. The swallowing provocation test showed swallowing disturbances (prolonged latency) in patients with r-RTI. We concluded that the aspiration of esophageal reflux contents was the most important risk factor of recurrent pulmonary complications in patients with total gastrectomy.

Purification and characterization of metallo-beta-lactamase from Serratia marcescens

Carbapenem-hydrolyzing beta-lactamase from Serratia marcescens FHSM4055 was purified 926-fold by means of carboxylmethyl Sephadex C-50, Sephacryl S-200, and Mono S column chromatography. The molecular weight was 30,000 by SDS-PAGE and the isoelectric point was 8.7. The enzyme activity was inhibited by EDTA, and restored by adding zinc (II) or manganese (II). It was inhibited by p-chloromercuribenzoate and iodine as well as the heavy metals, Hg (II), Fe (II), Fe (III), and Cu (II). These results indicate that the enzyme is a metallo-beta-lactamase and that the SH-group of only one cysteine residue probably binds to the metal ion, thus contributing to the stability of the enzyme active center. The specific constant (kcat/Km) showed that the enzyme hydrolyzed various beta-lactam antibiotics such as carbapenems, cephalosporins, moxalactam, cephamycins, and penicillins other than monobactams. Ampicillin and piperacillin with respective amino- and imino-groups, ceftazidime with a carboxypropyloxyimino-group, and cefclidin with a carbamoylquinuclidine-group were poor substrates among the beta-lactam antibiotics other than the monobactams tested. The plots of the turnover number (kcat) against pH for the hydrolysis of cephaloridine gave an asymmetrical curve with the 'tail' on the acid side (pK1, 5.9; pK2, 9.0; pK3, 10.8), whereas those of kcat/Km gave a bell-shaped curve (pK1, 5.8; pK2, 9.8). Both results suggest that two ionic forms of an intermediate yield the same product at different rates and that the enzyme is stable under alkaline conditions.(ABSTRACT TRUNCATED AT 250 WORDS)

[Effect of chlorhexidine gluconate on Serratia marcescens clinical isolates: relevance to serotype O3]

Effect of chlorhexidine gluconate (CHG) on 98 clinical isolates of Serratia marcescens, previously O-serotyped, in The Showa University Fujigaoka Hospital (1989. 1-1991. 3) was investigated. The serotype O3 group (28 strains) was more frequently isolated than any other groups and more resistant to 28 different antimicrobial agents tested. 18 (50%) of 36 strains (MIC of CHG > or = 100 micrograms/ml) were serotype O3 and MIC-distribution of CHG for total O3 strains was more resistant than that for the other serotype strains. Bactericidal effect of CHG on 18 O3 strains (MIC of CHG > or = 100 micrograms/ml) was significantly lower than on the other 10 strains (MIC of CHG < or = 50 micrograms/ml). Although 19 (68%) of total O3 strains were resistant to cefotaxime and the other drugs, MIC-distribution of CHG for these strains was not associated with the antimicrobial resistance tested. The above results, at least, suggest that the serotype O3 group is suited for residing in hospitalized patients more than any other serotype groups.

[O-serotypes, biotypes, and antimicrobial susceptibility of Serratia marcescens isolates from clinical specimens: 3rd report]

O-serotypes, biotypes, and drug resistance of Serratia marcescens strains isolated from various clinical specimens in Showa University Fujigaoka Hospital were investigated: period I (1979. 1-1982.3), 122 strains; period II (1983. 1-1985. 3), 198; period III (1985. 4-198. 3), 129; period IV (1989. 1-1991. 3), 99. The frequency of serotype O 3 was higher than those of the other serotypes after the period II and ranged 17 to 37%. The isolation frequency (27%) of serotype O 4 was higher than those of other serotypes in the period I. However, this frequency decreased in the period II to III and, in the period IV (10%), was higher than in the period III. The isolation frequency of serotype O 17 suddenly increased in the period II (27%) alone, and 42% of the biotypes, obtained with API 20E, showed 5305701. The isolation frequency of non-typable strains ranged 9 to 14% through all periods. The group including 5317721 and 5307721 clustered by the furthest neighbor method, more frequently appeared through all periods. The former code of urease positive more frequently appeared in the period II to IV. The isolation frequency of the latter code of urease negative reduced to a minimum (18%) in period II, though it increased in the period II to IV. The isolation frequency (22%) of the pigmented strains in the period IV increased much higher than in the period I to III (ranged 2 to 4%). The frequency of the pigmented strains of serotype O 3, not belonged to the Grimont's biotype, was 27% of all pigmented strains isolated in the period IV.(ABSTRACT TRUNCATED AT 250 WORDS)

[Implantation of self-contained non-inflatable penile prosthesis in patients with organic impotence]

Between April, 1988 and August, 1990, the OmniPhase penile prosthesis, a non-inflatable self-contained penile prosthesis, was implanted in 34 patients, aged from 37 years to 79 years, averaging 54.2 years. The etiologies of the impotence were radical surgery for bladder cancer or rectal cancer in 17 patients, diabetes mellitus in 7 patients, vascular abnormality in 3 patients, spinal injury in 2 patients, penile disorders in 2 patients and others in 3 patients. Penile prosthesis was implanted by subcoronal incision under spinal or general anesthesia. Clinical results were evaluated 12 weeks after surgery. Thirty-two patients (94.1%) could have intercourse postoperatively. Eighteen patients (52.9%) were completely satisfied and 14 patients (41.2%) were satisfied, whereas one patient (2.9%) had no improvement and another patient (2.9%) deteriorated. There was no serious complication. However, prosthesis was explanted because of skin erosion in one patient. Pain, which lasted for more than 10 days, was seen in 3 patients (8.8%), penile edema in 11 patients (32.4%), and acute epididymitis in one patient. The obtained results showed that implantation of OmniPhase penile prosthesis is a safe and useful procedure for treatment of organic impotence.

Enhancement of lymphokine-activated killer activity induction in vitro by interleukin-1 administered in patients with urological malignancies

We have evaluated the synergistic effects of interleukin-1 (IL-1) and interleukin-2 (IL-2) on the induction of lymphokine-activated killer (LAK) activity. Subcutaneous injection of recombinant IL-1 beta at an initial dose of 1 x 10(4) U was given to nine patients (five with renal cell carcinoma, two with bladder carcinoma, one with renal pelvic tumor, one with testicular tumor) on days 1 and 2 weekly for 4 weeks. The dose was increased weekly up to 4 x 10(4) U, if it was well tolerated. Peripheral blood mononuclear cells (PBMC) were isolated from patients on day 3 in the 2nd and 4th weeks, and LAK activity of PBMC against Daudi cells was measured using a 4-h 51Cr-release assay at an effector:target cell ratio of 20:1, after incubation with 50 U/ml of recombinant IL-2 for 72 h. Proliferation of PBMC was measured by tritiated thymidine incorporation after incubation with IL-2 for 72 h. IL-2 receptor (IL-2R)-positive cells in PBMC were enumerated using monoclonal antibody and flow cytometry. Mean values of LAK activity induced by IL-2 were significantly augmented after administration of IL-1 beta (p less than 0.01). IL-1 beta, however, did not enhance proliferation of PBMC caused by IL-2, nor did it increase the number of IL-2R-positive cells in peripheral blood lymphocytes of the patients. Results suggest that combination of IL-1 and IL-2 has synergistic antitumor activity in treatment of malignant diseases.

Enzymatic synthesis and isolation of thymidine diphosphate-6-deoxy-D-xylo-4-hexulose and thymidine diphosphate-L-rhamnose. Production using cloned gene products and separation by HPLC

A two-step enzymatic synthesis of dTDP-L-rhamnose is developed using enzymes from sonicated extracts of cultures of Escherichia coli K12 strains harboring plasmids containing different parts of the rfb gene cluster of Salmonella enterica LT2. The intermediate dTDP-6-deoxy-D-xylo-4-hexulose was isolated after a 1-h reaction, using only dTDP-D-glucose and dTDP-D-glucose 4,6-dehydratase, followed by protein precipitation and desalting by gel chromatography (yield 89%). In a two-step reaction using dTDP-D-glucose and dTDP-D-glucose 4,6-dehydratase in the first step, and with NADPH, dTDP-6-deoxy-D-xylo-4-hexulose 3,5-epimerase and NADPH:dTDP-6-deoxy-L-lyxo-4-hexulose-4-reductase in the second hour of incubation, the dTDP-D-glucose was fully converted to dTDP-L-rhamnose. The hexoses of both products were identified by mass spectroscopy. The molar yield of dTDP-L-rhamnose, after protein precipitation, anion-exchange chromatography and desalting by gel chromatography, was 62%, corresponding to more than 150 mg, starting from 250 mg of dTDP-D-glucose. When stored lyophilysed under nitrogen, these products were found to be stable for several months. Both dTDP-6-deoxy-D-xylo-4-hexulose and dTDP-L-rhamnose have light absorption maxima at 267 nm, with molar absorption coefficients close to that of dTMP. However, the absorption coefficient of dTDP-6-deoxy-D-xylo-4-hexulose at the absorption maximum of 320 nm (specific for sugars containing keto groups) was found to be approximately 20% higher than values presented earlier. Furthermore, an HPLC technique is presented for determining the net activity of dTDP-6-deoxy-D-xylo-4-hexulose 3,5-epimerase and NADPH:dTDP-6-deoxy-L-lyxo-4-hexulose-4-reductase, based on separation of dTDP-6-deoxy-D-xylo-4-hexulose and dTDP-L-rhamnose. The HPLC technique is also suitable for determination of all the nucleotide components involved in the synthesis.

[Effects of recombinant interleukin 1 beta on peripheral blood cells and induction of lymphokine-activated killer activity in patients with urological malignancies]

Subcutaneous injection of human recombinant interleukin 1 (IL-1) beta was given to 9 patients with urological malignancies (5 renal cell carcinoma, 2 bladder carcinoma, 1 renal pelvic tumor, and 1 testicular tumor), at an initial dose of 1 x 10(4) units on days 1 and 2, and there after weekly for 4 weeks. The dose was increased by 1 x 10(4) units weekly up to final dose of 4 x 10(4) units. Peripheral blood mononuclear cells (PBMC) were isolated from patients on day 3 in week 2 and week 4, and lymphokine-activated killer (LAK) activity against Daudi cells was measured using 4 hr 51Cr-release assay, after incubation with human recombinant interleukin 2 (IL-2) of 50 units/ml for 72 hours. Proliferation of lymphocytes was measured by tritiated thymidine incorporation after incubation with IL-2 for 72 hours. IL-1 beta increased the number of peripheral blood granulocytes and lymphocytes, but did not increase the numbers of monocytes and platelets. IL-1 beta significantly augmented IL-2-induced LAK activity in vitro, but this augmentation was neither accompanied by the increase of IL-2 receptor-positive cell ratio in peripheral blood lymphocytes nor enhancement of IL-2-induced proliferation of lymphocytes. Administration of IL-1 beta increased LAK activity of the patients, despite the fact that IL-1 beta did not increase LAK activity in vitro. The result suggests that IL-1 beta-stimulated LAK activity may be mediated by the induction of some cytokines in the patients.(ABSTRACT TRUNCATED AT 250 WORDS)

[A clinical evaluation of AMS Hydroflex in the treatment of impotence]

The AMS Hydroflex penile prosthesis was implanted in 34 organic impotence patients between June 20, 1986 and Aug. 6, 1990. Patients ages ranged between 26 and 71 with an average of 50.5. The causes of impotences were; 17 cases of post-radical pelvic surgery, 7 cases of injury, 6 cases of diabetes and 4 of others. First evaluation was made after 12 weeks of implantation in terms of patient satisfaction with sexual intercourse and post operative complication. Sixteen patients (47.1%) were highly satisfied with intercourse, 13 (38.2%) satisfied with intercourse, 2 (5.9%) slightly dissatisfied even with successful intercourse, 1 (2.9%) with no improvement and 2 (5.9%) could not follow. Utility of the prosthesis, e.g. effectiveness and safety was; high utility in 20 (58.8%), good utility in 11 (32.4%), slight utility in 1 (2.9%), no favorable in 1 (2.9%) and no judgement in 1 (2.9%). The overall effectiveness and safety of the Hydroflex was demonstrated based on the above findings. Long term evaluation was made from the initial implantation of the device up to the termination of the trial with average of 19.2 months and was mentioned altogether.

[Immunotherapy and urological malignancy]

Immunotherapy gained popularity as a treatment modality for malignant diseases in the 1960s. A number of trials, using tumor vaccines, immunopotentiators, interferons, cytokines and others, demonstrated antitumor effects in several urological malignancies, and, to date, immunotherapy plays a major role in treatment of advanced renal cell carcinoma and superficial bladder carcinoma. Interferon or interleukin-2, which became available for large scale clinical trial with the development of bioengineering, however, were shown to be not effective as initially expected, by single agent. Rational design of new strategies with multiple agents in combination based on basic and clinical research, should provide progress in treatment of urological malignancies.

Antitumor effects of interleukin 2 against renal cell carcinoma: basic study and clinical application

In order to determine an optimum mode for systemic administration of recombinant interleukin 2 (rIL2), the effects of rIL2 on lymphocyte-mediated cytotoxicity against renal carcinoma cells were studied in vitro. Augmentation of the cytotoxicity by rIL2 was dose- and time-dependent. The optimum dose of rIL2 was 100-500 units (Jurkat units)/ml, and cytotoxicity increased significantly even at a low concentration such as 4 units/ml. We thus chose daily administration of multiple repeated dose for inpatients. To prevent withdrawal from the therapy as a result of untolerable adverse effects, the daily dose was set at 1 X 10(6) units, and rIL2 was given to 12 patients with metastatic renal cell carcinoma. Two-hour intravenous drip infusions containing 5 X 10(5) units of rIL2 was given daily 2 times to inpatients and after at least 28 days of this mode of administration, subcutaneous injection at a dose of 1 X 10(6) units was given 6 days a week to outpatients. Three patients showed complete response, 7 patients no change, and 2 patients progressive disease. Serious adverse effects due to capillary leak syndrome were not observed. We conclude that low-dose rIL2 is safe and has potential antitumor effects.

[O-serotypes, biochemical properties and antimicrobial susceptibilities of Serratia marcescens isolated from clinical specimens (2nd report)]

O-serotypes, biochemical properties and drug resistances of Serratia marcescens (129 strains) isolated from clinical specimens in Showa University Fujigaoka Hospital from April 1985 to March 1987, were compared with those of the previous results (Jpn J Clin Pathol 35:555-560, 1987). The isolation frequencies of serotype O 3 and O 23 strains were 35.7% and 8.5%, respectively. These strains with serotype O 3 or O 23 were wide-spread in the hospital. The urea-positive strains which occupied 61.2% of all isolates tended to increase more than those of the previous report. The isolation frequency of gelatin-positive and melibiose-negative strains was 85.5%. The resistance rate of all isolates to latamoxef and aminoglycosides significantly increased, comparing with the previous report (p less than 0.01, chi 2-test). The susceptibility of serotype O 3 strains to gentamicin and minocycline significantly increased (p less than 0.005). All of serotype O 23 strains were urea-negative. The resistance rate to kanamycin, tobramycin, gentamicin and nalidixic acid was higher than that of the other serotype strains. Furthermore, the resistance rate to ofloxacin showed the lowest (8.6%) among pyridonecarboxylic acids.

Discriminant analysis of cellular fatty acids of Candida species, Torulopsis glabrata, and Cryptococcus neoformans determined by gas-liquid chromatography

We used discriminant analysis of cellular fatty acid compositions determined by gas-liquid chromatography to differentiate yeastlike fungi (a total of 190 strains; including 37 Candida albicans strains, 21 Candida krusei strains, 13 Candida guilliermondii strains, 37 Candida tropicalis strains, 10 Candida pseudotropicalis strains, 24 Candida parapsilosis strains, 32 Torulopsis glabrata strains, and 16 Cryptococcus neoformans strains). Previous results with a standard strain of C. albicans indicated that reproducible fatty acid chromatograms can be obtained with cells grown in a medium of 2% Sabouraud glucose agar at 35 degrees C for between 48 and 72 h. These conditions were also maintained in cultures of the other organisms that we studied. The cellular fatty acid compositions of the organisms were determined quantitatively by gas-liquid chromatography and analyzed by discriminant analysis. The total correct identification expressed as relative peak percent was 95.8% (89.2% for C. albicans to 100% for C. krusei, C. guilliermondii, C. pseudotropicalis, T. glabrata, and C. neoformans). The total correct identification expressed as the common peak (palmitic acid) ratio was 94.7% (87.5% for C. parapsilosis to 100% for C. pseudotropicalis, T. glabrata, and C. neoformans). Both results suggest that cellular fatty acid compositions can be differentiated by this method.

Immunologic effects of recombinant interferon-gamma in patients with renal cell carcinoma

Immunologic and antitumor effects of human recombinant interferon-gamma were studied in patients with renal cell carcinoma. A daily dose of 6 to 12 x 10(6) units/m2 of interferon-gamma was given by intravenous drip infusion or intramuscular injection to nine patients over a period varying from two to 16 weeks. Antibody-dependent cell-mediated cytotoxicity and OKIa1-positive monocytes count increased significantly after the therapy was started. Interferon-gamma transiently increased OKT3- and OKT4- positive lymphocyte count. Tumor regression was not observed when clinical response was evaluated in seven patients. Two others, who had no measurable metastases, were not evaluated, because interferon-gamma were given to them as post-operative adjuvant therapy. Our results indicate that interferon-gamma stimulated monocytes and enhanced cell-mediated cytotoxicity; they also suggest the necessity of combining monoclonal antibodies and other biological response modifiers that effect tumor-associated antigens.