The gonadotropin-releasing hormone antagonist abarelix depot versus luteinizing hormone releasing hormone agonists leuprolide or goserelin: initial results of endocrinological and biochemical efficacies in patients with prostate cancer

PURPOSE

We contrasted the endocrinological and biochemical efficacies of abarelix depot, a pure gonadotropin-releasing hormone antagonist, with a prospective concurrent control cohort receiving luteinizing hormone releasing hormone (LH-RH) agonists with or without antiandrogen for treatment of patients with prostate cancer receiving initial hormonal therapy.

MATERIALS AND METHODS

In this phase 2 open label study 242 patients with prostate cancer requiring initial hormonal treatment received abarelix depot (209) or LH-RH agonists (33) with or without antiandrogen. A total of 100 mg. abarelix depot was delivered intramuscularly every 28 days with an additional injection on day 15. LH-RH agonists with or without antiandrogen were administered according to the depot formulation used. Endocrine efficacy was measured by the absence of testosterone surge and rapidity of castration onset. The rate of prostate specific antigen decrease was assessed.

RESULTS

No patient treated with abarelix depot had testosterone surge during week 1 compared with 82% of those treated with LH-RH agonists. The concomitant administration of antiandrogen had no effect. During the first week of drug administration, in 75% of patients treated with abarelix depot and in 0% of those treated with LH-RH agonist medical castration was achieved. Prostate specific antigen decrease was faster, with no flare or surge in patients treated with abarelix depot. Abarelix depot was well tolerated.

CONCLUSIONS

Abarelix depot represents a new class of hormonal therapy, gonadotropin releasing hormone antagonists, that has rapid medical castration and avoids the testosterone surge characteristic of LH-RH agonists.

Role of substance P in several models of bladder inflammation

Substance P (SP) is a peptide found in the sensory nervous system which has multiple biologic effects including stimulation of muscle contraction, pain nociception, immune cell functions, plasma extravasation and a constellation of inflammatory effects. Here we investigate the role of SP in several animals models of bladder inflammation. Using the female Lewis rat, inflammation was induced using either xylene, lipopolysaccharide (LPS) or polyinosinic-polycytidylic acid (polyIC). Inflammation occurred rapidly (4 h) and was maintained in each model for at least 7 days. Each of these protocols decreased the bladder content of immunoreactive SP by approximately 50%, suggesting enhanced release. There was no change in the urinary frequency of these animals over 3 weeks, suggesting that urinary frequency changes are not mediated by acute inflammation. We also found that the SP receptor (NK1) antagonist, (-)CP96345, was unable to block the inflammation produced by polyIC, suggesting that SP is not an obligatory mediator of immune cell stimulation in this model.

Ginger: an ethnomedical, chemical and pharmacological review

Powerful medicinal properties have been recorded for Zingiber officinale, commonly known as ginger. All of these medicinal activities have been compiled with 99 references to the present status of the plant in the literature. Volatile components and the presence of trace metals are included. In addition, details of individual medicinal activities are given and the molecular structures of identified organic metabolites and their synthesis are described.

Catalytic action of Ni atoms in the formation of carbon nanotubes: a molecular dynamics study

Catalytic action of Ni atoms in the growth of single-wall carbon nanotubes is investigated using tight-binding molecular dynamics and ab initio methods. Our results demonstrate this to be a two step process in which the Ni atom first creates and stabilizes defects in nanotubes. The subsequent incorporation of incoming carbon atoms anneals the Ni-stabilized defects freeing the Ni atom to repeat the catalytic process.

When and how to evaluate a patient with nephrolithiasis

Nephrolithiasis is a common disorder that afflicts up to 12% of the population and continues to be a significant cause of patient injury. Evaluation of these patients should include the assessment of their comorbidities and underlying medical conditions. Patients who form stones can undergo a streamlined evaluation. A cause can be found in more than 90% of these patients. With medical treatment, stone-recurrence rates can be decreased by 85% for calcium oxalate stone formation, which affects a large proportion of patients. Introduction of nonspecific medical therapy in uncomplicated calcium stone disease may improve the quality of life for these patients and allow utilization a simple diagnostic protocol. This is in contrast to the previous recommendations of disease-specific therapy. Because patients without complications represent the majority of those who form stones, a simplified approach greatly reduces the cost of evaluation and treatment. Underlying medical conditions, however, require disease-specific therapy. The protocol represented here should aid physicians and patients in the approach to management of stone disease. The fasting calcium-load test is not required, and the entire evaluation can be performed in an ambulatory setting in two visits. Two 24-hour urine samples should be obtained on a random and restricted diet. Patients who form calcium stones can be subdivided into those who form hypercalciuric and normocalciuric stones. Patients who form normocalciuric stones are treated with conservative measures (increased fluid intake) and potassium and magnesium citrate. Patients who form hypercalciuric stones are treated with a combination of thiazides and potassium and magnesium citrate.

Chemistry of the rhenium-azopyridine family: an oxo parent and derivatives thereof including a novel oxo-imido dimer

The concerned azo ligands are 2-(phenylazo)pyridine (HL) and 2-((p-chlorophenyl)azo)pyridine (ClL). The reaction of KReO4 with HL in hot concentrated HCl is attended with metal reduction and ligand chlorination affording the oxo complex ReVOCl3(ClL), 2, which furnishes ReIII(OPPh3)Cl3(ClL), 3, upon treatment with PPh3. Aromatic amines, ArNH2, convert 2 to the imido complex ReV(NAr)Cl3(ClL), 5, and the unusual oxo-imido dimer (ClL)-Cl2(O)ReVOReV(NAr)Cl2(ClL), 7. The complex ReIII(OPPh3)Cl3(HL), 4, has been generated from ReVOCl3(PPh3)2 and HL. Reaction of 4 with HL has yielded ReV(NPh)Cl3(HL), 6, via azo splitting. The complexes have been characterized with the help spectral, magnetic, and X-ray structural data (2, 3, 5c (Ar = pClC6H4) and 7.CH2Cl2 (Ar = pMeC6H4)). In 2, 3, and 5c the ReCl3 fragment is meridionally disposed, and in 7 the ReCl2 fragments have a trans configuration. The Re-O(oxo) bond, 1.663(6) A, in 2 and Re-N(imido) bond, 1.719(5) A, in 5c are triple bonds. The corresponding bonds are slightly longer in 7 wherein the (O)Re(1)-O(2)-Re(2)(NAr) bridge is angular (151.0(5) degrees) and unsymmetrical, the Re(1)-O(2) bond, 1.849(7) A, having a large double-bond character (Re(2)-O(2), 1.954(7) A). In effect, cis-ReVO2 acts as a monodentate oxygen ligand toward ReVNAr in 7. In all cases the pyridine nitrogen binds trans to the oxo, OPPh3, or NAr donor. Bond length data are consistent with the presence of substantial d(Re)-pi*(azo) back-bonding. In acetonitrile solution the complexes display electrochemical one-electron metal (ReVI/ReV or ReIV/ReIII) and azo redox. The imido ligand in 5 stabilizes the ReVI state (E1/2 approximately 1.4 V) better than the oxo ligand in 2 (approximately 1.9 V). Parallely it is more difficult to reduce the azo group in 5 (approximately -0.4 V) than in 2 (approximately 0.0 V). In 7 the metal (approximately 1.0 V) and azo (approximately -0.4 V) couples correspond to the imido and oxo halves, respectively. The significantly higher (by 0.2-0.6 V) metal reduction potentials of the azopyridine compared to pyridine-2-aldimine complexes is ascribed to the superior pi-acidity and electron-withdrawing character of the azo function relative to the aldimine function. This also makes the transfer of the ReVO oxygen function much more facile under azopyridine chelation as in 2. For the same reason, ReOCl3(PPh3)2 reacts with HL affording only 4 while it reacts with pyridine-2-aldimines furnishing oxo species. Crystal data for the complexes are as follows: 2, empirical formula C11H8Cl4N3ORe, crystal system triclinic, space group P1, a = 7.118(4) A, b = 8.537(4) A, c = 13.231(9) A, alpha = 79.16(5) degrees, beta = 78.03(5) degrees, gamma = 70.96(4) degrees, V = 737.2(7) A3, Z = 2; 3, empirical formula C29H23Cl4N3OPRe, crystal system monoclinic, space group P2(1)/n, a = 11.264(2) A, b = 15.221(3) A, c = 17.628(4) A, beta = 94.21(3) degrees, V = 3014(1) A3, Z = 4; 5c, empirical formula C17H12Cl5N4Re, crystal system triclinic, space group P1, a = 9.683(3) A, b = 10.898(3) A, c = 11.522(3) A, alpha = 63.67(2) degrees, beta = 71.24(2) degrees, gamma = 86.79(2) degrees, V = 1026(1) A3, Z = 2; 7.CH2Cl2, empirical formula C30H25Cl8N7O2Re2, crystal system triclinic, space group P1, a = 12.522(6) A, b = 12.857(8) A, c = 13.182(7) A, alpha = 67.75(4) degrees, beta = 88.30(4) degrees, gamma = 82.09(4) degrees, V = 1945(2) A3, Z = 2.

Equilibrium Shapes of Solid Particles on Elastically Mismatched Substrates

Small particles or islands bonded to a substrate can be profoundly influenced by both interfacial and elastic driving forces that tend to have opposing influences on the apparent wetting behavior. The superposition of these two driving forces can therefore lead to a rich set of particle properties, most notably their equilibrium shapes. Here we present a variational analysis leading directly to an Euler-Lagrange equation that can be solved to yield the equilibrium shapes of partially wetting particles as a function of their size, interface energy densities, and elastic interaction with a rigid substrate. The solutions are used to gain insight into the variables that most significantly influence the equilibrium morphology, and to derive the approximate driving force for surface area reduction by coarsening among a dispersion of unequally sized particles. The relatively simple analytical model can also form a foundation upon which more realistic numerical simulations may be built and compared. Copyright 1999 Academic Press.

Oxalate: from crystal formation to crystal retention

Idiopathic calcium oxalate stone formation is a multifactorial disease. It is therefore unlikely that a single underlying condition will be responsible for entire spectrum of the disease; however, it appears that one important factor in the pathogenesis is an abnormality in oxalate metabolism. Whatever the cause, two critical parameters for stone formation are crystal formation and crystal retention in the renal tubules. Although crystal formination and role of oxalate in crystal formation have been evaluated extensively, it is only recently that crystal retention has been addressed. Previous studies from our laboratories demonstrated that oxalate exposure to renal epithelial cells in culture resulted in initiation of a program of events including DNA synthesis and cell death. The present studies evaluated effects of oxalate on cell proliferation and damage to distal tubular (Madin-Darby canine kidney cells) and proximal (LLC-PK1 cells) cells. Effects of oxalate exposure on calcium oxalate monohydrate (COM) crystal adherence to these cells were also evaluated. Results presented herein demonstrate that proximal tubular cells are more sensitive to oxalate than distal tubular cells. Furthermore, oxalate exposure to proximal tubular cells resulted in reinitiation of DNA synthesis, whereas no such effect was observed in distal tubular cells. Higher levels of oxalate (> 1 mM) resulted in cell loss of both proximal and distal tubular cells, as observed by crystal violet staining. Despite these differences, oxalate exposure to both proximal and distal tubular cells resulted in increased COM crystal adherence. Thus, oxalate exposure may promote crystal adherence to renal epithelial cells either secondarily to cell death and proliferation or by a yet unidentified mechanism. These studies provide the first direct evidence for the role of oxalate in promoting COM crystal retention by the urothelium.

Prognostic significance of the 1997 TNM classification of renal cell carcinoma

PURPOSE

The TNM classification of renal cell carcinoma was recently revised in 1997. The most significant change from the previous edition (1987) is an increase in the size cutoff between T1 and T2 tumors from 2.5 to 7.0 cm. We compared the 1997 and 1987 TNM staging classifications in predicting patient outcome.

MATERIALS AND METHODS

A total of 381 patients who underwent nephrectomy for renal cell carcinoma at our hospital between 1968 and 1994 were identified. Mean patient age was 61 years (range 15 to 89) and mean followup was 64.5 months. All pathological slides were re-reviewed in uniform manner and staged using the 1987 and 1997 TNM classifications. The impact of numerous pathological factors and each staging classification on disease specific survival and freedom from progression were statistically analyzed, and Kaplan-Meier survival curves were generated and compared.

RESULTS

The 1997 TNM classification resulted in a redistribution of 170 cases previously classified as stage II (T2N0M0) to stage I (T1N0M0) under the new system. Both classifications were strong predictors of survival on univariate and multivariate analyses, and essentially equivalent in the ability to predict patient outcome. However, comparison of survival curves on Kaplan-Meier life tables revealed better separation of survival for stage I (T1N0M0) and stage II (T2N0M0) cases under the 1997 TNM classification, with survival for TNM stage I essentially remaining unchanged.

CONCLUSIONS

The 1997 TNM classification of renal cell carcinoma appears to be equivalent to the previous classification in predicting outcome but permits better stratification of cases according to survival and, therefore, may have improved clinical usefulness.

Community physicians who provide terminal care

BACKGROUND

Most dying patients are treated by physicians in community practice, yet studies of terminal care rarely include these physicians.

OBJECTIVE

To examine the frequency of life-sustaining treatment use and describe what factors influence physicians' treatment decisions in community-based practices.

METHODS

Family members and treating physicians for decedents 65 years and older who died of cancer, congestive heart failure, chronic lung disease, cirrhosis, or stroke completed interviews about end-of-life care in community settings.

RESULTS

Eighty percent of eligible family and 68.8% of eligible physicians participated (N = 165). Most physicians were trained in primary care and 85.4% were primary care physicians for the decedents. Physicians typically knew the decedent a year or more (68.9%), and 93.3% treated them for at least 1 month before death. In their last month of life, 2.4% of decedents received cardiopulmonary resuscitation, 5.5% received ventilatory support, and 34.1% received hospice care. Family recalled a discussion of treatment options in 78.2% of deaths. Most discussions (72.1%) took place a month or more before death. Place of death, cancer, and having a living will were independent predictors of less aggressive treatment before death. Physicians believed that advanced planning and good relationships were the major determinants of good decision making.

CONCLUSIONS

Community physicians use few life-sustaining treatments for dying patients. Treatment decisions are made in the context of long-term primary care relationships, and living wills influence treatment decisions. The choice to remain in community settings with a familiar physician may influence the dying experience.

Cost comparison of orchiectomy and leuprolide in metastatic prostate cancer

PURPOSE

We objectively compare the costs associated with the medical and surgical treatment of metastatic prostate cancer.

MATERIALS AND METHODS

We analyzed and compared itemized billing statements for 28 men with metastatic adenocarcinoma of the prostate. Half of the men were treated medically with the luteinizing hormone-releasing hormone analogue leuprolide, while the other half underwent bilateral therapeutic orchiectomy. In addition, differences in hospital cost to treat these men were calculated.

RESULTS

During a mean followup of 24 months leuprolide treated patients were charged $500.00 per month of treatment compared to average monthly expenditure of $226.00 for orchiectomy patients during a 23-month interval. By 9 months charges incurred by both groups were equal and by 20 months medically treated patients accumulated urological charges twice that of the surgically treated patients. The true hospital cost to treat these patients followed the same trend, that is the medically treated group cost twice as much to treat by 15 months. For the average stage D2 case leuprolide therapy charges were $9,420, or 63%, more than orchiectomy. Similarly, leuprolide cost the hospital $8,924 more than surgery.

CONCLUSIONS

Medical management of metastatic prostate cancer is expensive. With broadening applications and androgen deprivation being initiated earlier in the course of disease, the amount spent on medical therapy will continue to escalate. For patients with a life expectancy of more than 9 months orchiectomy is the most cost-effective treatment option.

Effect of vitamin C on androgen independent prostate cancer cells (PC3 and Mat-Ly-Lu) in vitro: involvement of reactive oxygen species-effect on cell number, viability and DNA synthesis

Studies have described the protective role of vitamin C (ascorbic acid) in certain types of cancer. In this study, we report the effects of vitamin C treatment of two androgen independent prostate cancer cell lines from human (PC3) and rat (Mat-Ly-Lu or MLL) sources. In vitro treatment of PC3 and MLL with sodium ascorbate acid (0-10 mM) resulted in a decrease in cell viability and thymidine incorporation into DNA. These effects of vit. C were dose and time dependent. Ascorbate induced these changes through the production of hydrogen peroxide since addition of catalase (100-300 units/ml), an enzyme that degrades hydrogen peroxide, inhibited the effects of ascorbate on these cell lines. In contrast, superoxide dismutase, an enzyme that dismutates superoxide and generates hydrogen peroxide did not prevent ascorbate-induced changes emphasizing the involvement of reactive oxygen species (ROS) in cellular damage. That singlet oxygen scavengers such as sodium azide and hydroquinone, hydroxyl radical scavengers such as D-mannitol and DL-alpha-tocopherol did not counteract the effects of ascorbate on thymidine incorporation suggests that these free radicals are not involved in cellular damage. In conclusion, these results suggest that vitamin C inhibits tumor growth by virtue of producing reactive oxygen species. These results suggest that ascorbate is a potent anticancer agent for prostate cancer cells.

Antiproliferative effects of c-myc antisense oligonucleotide in prostate cancer cells: a novel therapy in prostate cancer

OBJECTIVES

To explore the possibility of using antisense oligonucleotide therapy for prostate cancer, we investigated the effect of c-myc-antisense-oligonucleotide (c-myc-As-ODN) in human prostate cancer cell lines such as LNCaP, PC3, and DU145.

METHODS

LNCaP, PC3, and DU145 cells were incubated in the presence of c-myc-As-ODN. Dose (0 to 10 microM) and time dependent (1 to 6 days) effects on proliferation and viability were examined by [3H]thymidine incorporation and MTT assay, respectively. Flow cytometry analysis was carried out to analyze cell cycle status by determining the DNA content in LNCaP cells. Control cultures received either c-myc-sense-ODN or scrambled (nonsense) nucleotides.

RESULTS

Time- and dose-dependent decreases in DNA synthesis and cell viability were noted for all three prostate cancer cell lines after c-myc-As-ODN treatment. Further studies using LNCaP cells indicated that these changes were accompanied by an increase in the percentage of cells with less than 2N DNA content after c-myc-As-ODN treatment. The results suggest that c-myc-As-ODN induces cell death. Comparison of a c-myc-As-ODN-treated group with a group subjected to isoleucine deprivation revealed that thymidine incorporation was almost the same in c-myc-As-ODN-treated LNCaP cells and in LNCaP cells at early S phase.

CONCLUSIONS

These results suggest that c-myc-As-ODN inhibits prostate cancer cell growth and proliferation mainly by decreasing cell viability.

Effect of vitamin C on prostate cancer cells in vitro: effect on cell number, viability, and DNA synthesis

BACKGROUND

Many studies describe the protective role of vitamin C (ascorbic acid) against cancer development and in treatment of established cancer. The present study investigated whether ascorbic acid demonstrates a therapeutic benefit for prostate cancer.

METHODS

Androgen-independent (DU145) and androgen-dependent (LNCaP) human prostate cancer cell lines were both treated in vitro with vitamin C (0-10 mM). Cell counts, cell viability, and thymidine incorporation into DNA were determined.

RESULTS

Treatment of DU145 and LNCaP cells with vitamin C resulted in a dose- and time-dependent decrease in cell viability and thymidine incorporation into DNA. Vitamin C induced these changes through the production of hydrogen peroxide; addition of catalase (100-300 units/ml), an enzyme that degrades hydrogen peroxide, inhibited the effects of ascorbic acid. Superoxide dismutase, an enzyme that dismutates superoxide and generates hydrogen peroxide, did not prevent decreases in cell number and DNA synthesis, suggesting further the involvement of hydrogen peroxide in vitamin C-induced changes. These results clearly indicate that reactive oxygen species (ROS) are involved in vitamin C-induced cell damage. However, that singlet oxygen scavengers such as sodium azide and hydroquinone and hydroxyl radical scavengers such as D-mannitol and DL-alpha-tocopherol did not counteract the effects of ascorbic acid on thymidine incorporation suggests that vitamin C-induced changes do not occur through the generation of these ROS.

CONCLUSIONS

Vitamin C inhibits cell division and growth through production of hydrogen peroxide, which damages the cells probably through an as yet unidentified free radical(s) generation/mechanism. Our results also suggest that ascorbic acid is a potent anticancer agent for prostate cancer cells.

Neurotensin receptor expression in prostate cancer cell line and growth effect of NT at physiological concentrations

BACKGROUND

Neurotensin (NT), a neuroendocrine peptide, exerts trophic effects in vivo and stimulates growth of some tumor cells in vitro. Androgen-sensitive prostate cells derived from lymph node carcinoma of the prostate (LNCaP) secrete NT and exhibit growth responses to NT. This study examines NT secretion, NT receptor and NT-growth responses in androgen-independent prostatic carcinoma (PC3) cells derived from prostate adenocarcinoma metastatic to bone.

METHODS

Binding of 125I-NT to PC3 membranes was studied by filtration. NT was measured by RIA. Reverse transcriptase polymerase chain reaction (RT-PCR) was used for NT and NT receptor mRNA. Growth was measured as 3H-thymidine incorporation into DNA.

RESULTS

Scatchard analyses gave two binding components (Kd1 = 40 pM and Kd2 = 300 pM) in equal amounts (15-30 x 10(3) sites/cell). The bioactive region of NT was essential and the specific, non-peptide NT antagonist, SR48692, inhibited (IC50 = 3 nM). GTP analogs, sodium ion and SH-directed alkylating agents also inhibited. Glutaraldehyde crosslinking labeled two substances (M(r) of 23 and 46 kDa). RT-PCR indicated robust expression of authentic NT receptor but little for NT precursor. NT was stable in PC3 cultures but it was not found in cells or conditioned media. Incubated with PC3 cells, NT exhibited a mitogenic effect with bell-shaped dose-response and maximum at 100 pM NT.

CONCLUSIONS

PC3 cells expressed genuine NT receptors and generated growth responses to physiologic levels of NT which were blocked by SR48692. If NT contributes to the survival of prostate tumor cells upon androgen deprivation therapy, NT antagonists might be useful agents in further treatment.

Mechanism of stone formation

This article reviews the physical principles involved in urolithiasis. For urinary stones to form, crystals must form first and they then should be retained in the urinary tract. These phenomena require the interaction between the forces of saturation, crystal inhibition, crystal nucleation, growth aggregation, and retention, which all occur in a complex solution. In the latter part of the article the authors review the relevance of these physical principles in the lithogenesis of the most common urinary stones.

Diameter-Selective Raman Scattering from Vibrational Modes in Carbon Nanotubes

Single wall carbon nanotubes (SWNTs) that are found as close-packed arrays in crystalline ropes have been studied by using Raman scattering techniques with laser excitation wavelengths in the range from 514.5 to 1320 nanometers. Numerous Raman peaks were observed and identified with vibrational modes of armchair symmetry (n, n) SWNTs. The Raman spectra are in good agreement with lattice dynamics calculations based on C-C force constants used to fit the two-dimensional, experimental phonon dispersion of a single graphene sheet. Calculated intensities from a nonresonant, bond polarizability model optimized for sp2 carbon are also in qualitative agreement with the Raman data, although a resonant Raman scattering process is also taking place. This resonance results from the one-dimensional quantum confinement of the electrons in the nanotube.

Experimental autoimmune cystitis in the Lewis rat: a potential animal model for interstitial cystitis

To develop an autoimmune animal model for interstitial cystitis (IC), we injected rats with Freund's adjuvant (CFA) containing bladder homogenate (experimentals) or CFA alone (shams). We observed a doubling of urinary frequency in the experimental animals over the shams (P = 0.004) and histopathologic changes (venular congestion) consistent with IC. Statistically significant bladder capacity changes were not found. Mast cell (MC) number was not statistically different between experimentals and controls but the number of MCs from section to adjacent section within the same animal's bladder did vary markedly, indicating the MC counts are not a reliable measure of disease in the rat bladder. Splenocytes cultured from the experimental animals and transferred to naive syngeneic recipients were capable of transferring the urinary frequency changes and vascular congestion while splenocytes from animals which did not develop the condition were without effect. In summary, we have developed and autoimmune model for IC consistent with the clinical features of IC. The features of this model can be transferred to naive syngeneic recipients via adoptive splenocyte transfer. The model will permit us to ask and answer important questions about the pathogenesis and treatment of the human disease.

17 beta-estradiol induced prostatitis in the rat is an autoimmune disease

PURPOSE

Studies suggest that alteration in steroid hormone levels may be one of the factors causing nonbacterial prostatitis (NBP) in rats. We hypothesized that hormonally induced prostatitis in the rat may be an autoimmune disease. Studies were carried out to prove this hypothesis.

MATERIALS AND METHODS

We injected 17 beta-estradiol (E2; 250 micrograms/kg. subcutaneously) or vehicle into 1-year-old male rats for 30 days, and isolated and cultured the splenocytes in the presence of con-A (Experiment 1). Approximately 10(7) splenocytes were adoptively transferred into young naive syngeneic rats. To find out whether or not the inflammation is mediated by T-lymphocytes, a pure population of T-lymphocytes from E2-treated 3-month-old rats was injected into young naive syngeneic rats (Experiment 2). To rule out the possibility that the inflammation was due to con-A itself, we cross-linked some T-cells with anti-CD3 antibody before adoptive transfer (Experiment 2).

RESULTS

The recipients of splenocytes from E2-treated animals presented evidence of inflammation in terms of lymphocytic infiltration and presence of degranulated mast cells. Furthermore, we observed in these animals an increase in histamine-releasing peptide (HRP) levels, an indication of plasma extravasation. The T-cells stimulated by anti-CD3 antibody produced a similar degree of inflammation, thereby ruling out the possibility that the inflammation was due to con-A. The results also indicated that the immune response to antigen(s) is not dependent on the age of the animal but is dependent on a population of CD3+ T-cells.

CONCLUSION

Our results demonstrate that hormonal imbalance and autoimmunity in male rats produce the symptoms of nonbacterial prostatitis.

Activation of c-myc gene mediates the mitogenic effects of oxalate in LLC-PK1 cells, a line of renal epithelial cells

Recent studies on LLC-PK1 cells demonstrated that oxalate, a simple dicarboxylic acid, acts as a mitogen for these renal epithelial cells. Exposure to oxalate initiates DNA synthesis, induces the expression of one of the early growth response genes c-myc and stimulates proliferation of quiescent cultures of LLC-PK1 cells. The present studies examined the possibility that expression of the c-myc protooncogene is obligatory for this mitogenic response. Specifically we determined whether pretreatment with c-myc antisense oligonucleotides would block the proliferative effects of oxalate in LLC-PK1 cells. Quiescent cultures of LLC-PK1 cells were exposed to oxalate in the presence and absence of c-myc antisense and the effects of oxalate on c-myc protein expression (Myc), DNA synthesis and cell growth were assessed. Exposure of cells to oxalate alone increased the expression of Myc within two hours. Pretreatment with c-myc antisense abolished this response. Further, pretreatment of cells with c-myc antisense but not nonsense oligonucleotides blocked the oxalate-induced initiation of DNA synthesis. Increases in cell number in response to oxalate (measured after 72 hr exposure) were also blocked by exposure to c-myc antisense. These findings suggest that c-myc gene expression is critical for the mitogenic effects of oxalate in LLC-PK1 cells.

Cryptococcal meningitis in patients with the acquired immunodeficiency syndrome

The optimum therapy for cryptococcal meningitis in patients with the acquired immunodeficiency syndrome (AIDS) remains unresolved. Traditional therapy consists of amphotericin B with or without flucytosine. Obstacles exist in administering these agents to patients with AIDS. Mortality rates during initial therapy are relatively high. Given the lack of proved benefit, we do not recommend adding flucytosine to amphotericin B routinely. The search for more efficacious and less toxic agents continues. The oral triazoles, especially fluconazole, have increased the options for treatment of this disease. New strategies and novel approaches in managing cryptococcal meningitis in patients with AIDS continue to be developed.

Prognostic value of argyrophylic nucleolar organiser regions (AgNORs) in breast lesions

A total of 200 breast tissues which included 5 normals, 55 benign and 140 malignant lesions were stained for Argyrophilic Nucleolar Organiser Regions (AGNORs). A comparison of the AGNOR values with histologic variables, viz., tumor type, size nuclear grade, desmoplasia, elastosis, lymph node metastasis and Oestrogen and Progesterone Receptor (ER/PR) status was carried out in malignant lesions. AGNOR values could sharply distinguish benign from malignant lesions. Among the malignant lesions, an attempt to determine the value of AGNOR count in prognostication was made. AGNOR counts correlated with tumor size, mitoses and desmoplasia. ER/PgR negative tumors showed a tendency for high NOR counts, but lymph node metastasis, which is considered one of the most reliable prognostic indicators, did not concur with AGNOR counts in our study. These results indicate that AGNOR counts can not be used as a sole independent marker in breast cancer prognostication.

Oxalate toxicity in LLC-PK1 cells, a line of renal epithelial cells

PURPOSE

The present studies assessed the possibility that high concentrations of oxalate may be toxic to renal epithelial cells.

MATERIALS AND METHODS

Subconfluent cultures of LLC-PK1 cells were exposed to oxalate, and the effects on cell morphology, membrane permeability to vital dyes, DNA integrity and cell density were assessed.

RESULTS

Oxalate exposure produced time- and concentration-dependent changes in the light microscopic appearance of LLC-PK1 cells with higher concentrations ( > 140 microM.) inducing marked cytosolic vacuolization and nuclear pyknosis. Exposure to oxalate also increased membrane permeability to vital dyes, promoted DNA fragmentation and, at high concentrations (350 microM. free oxalate), induced a net loss of LLC-PK1 cells.

CONCLUSIONS

Since high concentrations of oxalate can be toxic to renal epithelial cells, hyperoxaluria may contribute to several forms of renal disease including both calcium stone disease and end-stage renal disease.

Oxalate toxicity in LLC-PK1 cells: role of free radicals

Oxalate, the most common constituent of kidney stones, is an end product of metabolism that is excreted by the kidney. During excretion, oxalate is transported by a variety of transport systems and accumulates in renal tubular cells. This process has been considered benign; however, recent studies on LLC-PK1 cells suggested that high concentrations of oxalate are toxic, inducing morphological alterations, increases in membrane permeability to vital dyes and loss of cells from the monolayer cultures. The present studies examined the basis for oxalate toxicity, focusing on the possibility that oxalate exposure might increase the production/availability of free radicals in LLC-PK1 cells. Free radical production was monitored in two ways, by monitoring the reduction of nitroblue tetrazolium to a blue reaction product and by following the conversion of dihydrorhodamine 123 (DHR) to its fluorescent derivative, rhodamine 123. Such studies demonstrated that oxalate induces a concentration-dependent increase in dye conversion by a process that is sensitive to free radical scavengers. Specifically, addition of catalase or superoxide dismutase blocked the oxalate-induced changes in dye fluorescence/absorbance. Addition of these free radical scavengers also prevented the oxalate-induced loss of membrane integrity in LLC-PK1 cells. Thus it seems likely that free radicals are responsible for oxalate toxicity. The levels of oxalate that induced toxicity in LLC-PK1 cells (350 microM) was only slightly higher than would be expected to occur in the renal cortex. These considerations suggest that hyperoxaluria may contribute to the progression of renal injury in several forms of renal disease.

Successful management of intracardiac extension of tumor thrombus in a patient with advanced nonseminomatous germ cell testicular cancer

A young patient with testicular germ cell tumor presenting with inferior vena cava thrombus extending into the right heart with free-floating thrombus in the right ventricle and a simultaneous epidural spinal cord compression is presented. Due to the perceived high risk of embolization and the urgent need to begin systemic chemotherapy, he was managed with tumor thrombectomy utilizing cardiopulmonary bypass and hypothermic circulatory arrest followed shortly thereafter by systemic chemotherapy. There were no perioperative complications, and he is alive and without recurrence 24 months following four cycles of systemic chemotherapy.

Should we treat localized prostate cancer? An opinion

Localized prostate cancer is a progressive disease if left untreated. However, cancer-specific mortality is low in patients with moderately and well-differentiated prostate cancer treated with observation and delayed hormonal therapy, being 13% at 10 years and 20% to 30% at 15 years. By and large, radiation therapy does not appear to improve survival in these patients. With modern surgical techniques, mortality from prostate cancer is lowered by 23% to 65% in patients with moderately or well-differentiated tumors. However, the impact on relative cancer-specific survival is modest, since the mortality rate in untreated patients is low. The survival of conservatively managed patients with poorly differentiated prostate cancer is dismal: here radiation therapy or surgery significantly improves outcome. The QOL of patients with localized prostate cancer is significantly affected by the occurrence of distant metastasis. Metastatic rates are high in patients who are followed with observation and delayed endocrine treatment (19% to 85%). We were unable to deduce the effects of radiation therapy on grade-specific metastatic rates at 10 and 15 years. The only surgical series that addresses the issue shows a 50% to 80% reduction in metastatic rates. This results in an improvement in metastasis-free survival of 19% to 300%. The reduction in metastatic rates with surgery holds true for patients with poorly, moderately, or well-differentiated tumors. However, a significant proportion of the surgical patients were treated with adjuvant endocrine therapy, and it is impossible to identify the benefit from surgery and the benefit from adjuvant therapy. Radical prostatectomy improves survival in men who are 65 years or younger with moderately or well-differentiated adenocarcinoma of the prostate, and in men 75 years or younger who have poorly differentiated adenocarcinoma of the prostate. Its efficacy in reducing cancer-specific mortality in patients who have a survival expectancy of less than 15 years (older than 65 years) and moderately or well-differentiated adenocarcinoma of the prostate is less clear. Radical prostatectomy, with or without adjuvant hormonal therapy, decreases metastatic rates in men with a life expectancy of 10 years or more (age 75 years or younger) irrespective of tumor grade and, thus, should improve the QOL expectancy in these men. Nevertheless, between 20% and 60% of patients undergoing radical prostatectomy have biochemical recurrence, as defined by a detectable PSA, at 10 years of follow-up. This is worrisome and may portend clinical failure with longer follow-up.(ABSTRACT TRUNCATED AT 400 WORDS)

The University of Massachusetts technique of radical retropubic prostatectomy

A modified technique of radical retropubic prostatectomy is described which takes advantage of combining the antegrade dissection of prostate described by Skinner and the early control of prostatic vasculature as publicized by Walsh. Integration of both techniques of radical retropublic prostatectomy has resulted in improved exposure and minimal blood loss. The average blood loss with this technique was 500 ml in contrast to the average blood loss of 1100 ml while performing over 300 radical retropubic prostatectomies by the standard technique. The average operating times have been 150 minutes. Because of improved exposure and reduced blood loss, it is easy to teach this technique of radical prostatectomy to the surgeon in training (resident or the registrar) without any compromise to the primary goal of surgery which is to remove all tumour. No intra-operative complications were encountered during the performance of this modified technique of radical retropubic prostatectomy.

Oxalate-induced damage to renal tubular cells

Our own studies and those of others have shown that the incidence of calcium oxalate stones and plaques is markedly increased by nephrotoxins. The possible role of oxalate as a nephrotoxin has not been fully appreciated. However, recent studies in experimental animals and in cultured cells support this possibility. The results of these studies led us to hypothesize that hyperoxaluria promotes stone formation in several ways: by providing a substrate for the formation of the most common form of renal stones, calcium oxalate stones, and by inducing damage to renal epithelial cells. Damaged cells in turn would produce an environment favorable for crystal retention and provide membranous debris that promotes crystal nucleation, aggregation and adherence. The present report summarizes evidence for oxalate nephrotoxicity and discusses the potential importance of oxalate toxicity in the pathogenesis of stone disease.

Oxalate-induced initiation of DNA synthesis in LLC-PK1 cells, a line of renal epithelial cells

These studies examined the effects of oxalate, a constituent of renal stones, on the growth of LLC-PK1 cells. Exposure to oxalate resulted in an initiation of DNA synthesis in serum-starved, growth-arrested cells as measured by 3H-thymidine incorporation. The effects of oxalate were comparable to those observed in response to 10% serum. Moreover, exposure to oxalate plus 10% serum stimulated DNA synthesis to a greater extent than oxalate or serum alone. These studies indicate that oxalate promotes the progression of cells from the G0/G1 to the S phase of the cell cycle. However, the increase in DNA synthesis was not always followed by an increase in cell number since high concentrations of oxalate led to a reduction in cell number.

Simultaneous quadruple immunosuppression with cyclosporine induction therapy in high risk renal transplant recipients

High risk renal transplant recipients experience excess graft loss despite overall improvements in the results of cadaveric renal transplantation. We evaluated a novel immunosuppression regimen consisting of simultaneous administration of OKT3, cyclosporine, azathioprine and prednisone. Of the 12 high risk patients studied 5 received 2 transplants, 1 received 3 transplants and 8 had peak panel reactive antibodies of greater than 60%. The protocol consisted of cyclosporine (7 mg./kg. orally or 3 mg./kg. intravenously per day) starting from the day of transplant regardless of graft function; 5 mg. OKT3 per day for 10 to 14 days starting intraoperatively; 5 mg./kg. azathioprine per day for 2 days, then 1.5 mg./kg. per day and adjusted according to white blood cell counts, and prednisone taper at 2 to 0.4 mg./kg. per day on day 10. The dose of cyclosporine was increased to 14 mg./kg. per day orally when serum creatinine was less than 3 mg./dl. The cyclosporine whole blood levels (measured by high performance liquid chromatography) were maintained between 250 and 400 ng./ml. in the first 3 months. Followup evaluations ranged from 3 to 28 months (median 8.5). Seven patients (58.3%) had acute tubular necrosis and required dialysis support for 2 to 5 weeks. Six patients (including 5 with acute tubular necrosis) experienced 1 episode of acute rejection in the first 3 months (2 of these were due to accelerated vascular rejection). Two rejections responded to pulse steroid treatment, while 4 (including 2 with vascular rejection) were treated with antilymphoblast globulin rescue therapy for 10 to 14 days. Symptomatic cytomegalovirus pneumonia occurred in 3 patients (25%). There were no deaths or graft losses. No case of malignancy was observed to date. The serum creatinine is less than 2 mg./dl. in 9 patients, and 2.5 to 2.9 mg./dl. in the remaining 3. We conclude that simultaneous quadruple immunosuppressive regimen that includes induction cyclosporine and OKT3 is a highly effective therapy for high risk patients, yielding excellent short-term and intermediate success rates. Long-term results of this regimen, including neoplastic potentiation, cannot be addressed because of the limited followup of these patients.

Effects of sialoadenectomy and epidermal growth factor on testicular function of sexually mature male mice

The effect of sialoadenectomy (Sx) and epidermal growth factor (EGF) administration on testicular function was investigated in 8-week old C3H mice. Animals were divided initially into three groups: sham operated controls, Sx, and Sx + EGF treated (100 micrograms./kg./day subcutaneously for 28 days). Sialoadenectomy completely depleted the circulating levels of EGF and reduced body weight and reproductive organ weights. However, kidney weight was not affected. Quantitative analysis of spermatogenesis showed a decrease in preleptotene and pachytene spermatocytes and round spermatids, which resulted in a decrease in sperm counts. Sperm motility and fertility were also significantly decreased. Endocrinologic studies showed a 2- and 6-fold elevation in intratesticular and serum levels of testosterone and a decrease in luteinizing hormone (LH) levels. Follicle stimulating hormone levels were not altered. Administration of EGF to the Sx animals maintained reproductive organ weights, spermatogenesis and levels of LH and testosterone closer to control values; however, sperm motility was not maintained at control value. That sialoadenectomy resulted in a decline in androgen-dependent parameters, in spite of an elevation in testosterone levels, and EGF maintained them closer to the control value suggested that EGF may modulate androgen action. A comparison was therefore carried out between the effects of Sx and administration of flutamide (F), an androgen receptor blocker. Animals were subjected to Sx, F treatment (100 mg./kg./day subcutaneously for 28 days), Sx + F, or Sx + F + EGF. The effects of Sx and F treatment on organ weights, sperm counts and sperm motility were more or less similar. As expected, flutamide treatment increased LH and FSH levels, and testosterone levels were normal. The Sx + F animals showed no further decrease in organ weights, sperm count and motility. Treatment with Sx + F increased intratesticular and serum levels of testosterone by 2- and 10-fold. Circulating levels of LH and FSH were the same as in the flutamide-treated group. Administration of EGF to Sx + F maintained all these parameters, except sperm motility, closer to the control value. These results suggest that EGF either bypasses flutamide effects and acts directly or that EGF modulates androgen action at one or more steps in the signal transduction pathway in the male reproductive organs.