Transurethral electrovaporization of the prostate: preliminary clinical results with pressure-flow analysis

BACKGROUND

We evaluated the safety and efficacy of transurethral electrovaporization of the prostate (TVP) as a new alternative treatment for patients with benign prostatic hyperplasia.

METHODS

A total of 22 patients with symptomatic benign prostatic hyperplasia, including 4 with urinary retention, underwent TVP. If enough of a cavity was not created after 60 minutes of vaporization, transurethral resection of the prostate (TURP) was performed successively. International Prostate Symptom Score (I-PSS) with quality-of-life index, maximum flow rate, and postvoid residual volume were measured at baseline and at 2 weeks, 1, 3, and 6 months. A pressure-flow study was performed at baseline and at 3 or 6 months after surgery.

RESULTS

TURP was required in 10 of 22 patients. At 6 months, mean I-PSS decreased from 20.0 to 5.2, quality-of-life index decreased from 4.6 to 1.1, mean maximum flow rate increased from 6.9 to 16.7 mL/s, and postvoid residual volume decreased from 152 to 32 mL. Detrusor pressure at maximum flow decreased from 108 to 39 cm H2O, with a significant relief of bladder outlet obstruction in 93% of the patients. Mean decrease in hematocrit was 4.4%, and in serum sodium, 4.8 mEq/L. None of the patients required transfusions or had TUR syndrome. A urethral stricture and a severe stress incontinence developed in 1 patient.

CONCLUSION

TVP seems to be a safe and effective alternative to a standard TURP associated with fewer intraoperative complications. Although preliminary clinical results have been promising, further study is necessary to establish long-term efficacy and safety of this procedure.

DNA polymorphism at the Pgi locus of a wild yam, Dioscorea tokoro

To study the origin and maintenance mechanisms of the PGI allozyme polymorphism of a wild plant, Dioscorea tokoro, DNA sequences of the entire coding region (1701 bp) and two intronic regions (total 2049 bp) of the Pgi gene as well as a part of the Adh gene (590 bp) were analyzed. Two replacement substitutions were revealed to be responsible for the differentiation of three allozymes alleles (Pgi-a, Pgi-b and Pgi-c) that occur in natural population in intermediate frequencies. Interspecific comparison of DNA sequences identified Pgi-b as the oldest allele, from which two other alleles were derived probably within the last 150,000 years. The level of DNA polymorphism at D. tokoro Pgi locus was low. No elevated level of DNA polymorphism was detected in the close vicinity of the two replacement sites differentiating the three allozymes. Departures from the neutral mutation hypothesis were detected by Fu and Li's and MK tests. The observed patterns of DNA polymorphism are explainable by both (1) the neutral mutation hypothesis with an assumption of small effective size of D. tokoro population, and (2) the positive selection hypothesis that the allele frequencies of Pgi-a and Pgi-c have increased in a short time by their selective advantages.

Variation in coxII intron in the wild ancestral species of wheat

To study the maternal lineage and evolution of polyploid species of wheat, variation in mitochondrial DNA was investigated in Triticum and Aegilops by PCR-aided RFLP analysis. A 1.3 kb region containing the intron of coxII was studied using 20 accessions from five species of Sitopsis section of Aegilops, one species of Einkorn wheat, four species of tetraploid wheat, and one species of common wheat. Only three restriction site changes and a single deletion/insertion were found among 884 restriction fragments surveyed. This fact suggests the highly conserved nature of this region within Triticum and Aegilops. Four haplo-types were recognized in coxII intron. A parsimonious relationship indicated that three haplo-types were independently derived from one prototype which was found in wild Einkorn and Aegilops species except for Ae. speltoides. All but one accession of Ae. speltoides possessed a derivative haplo-type, common in Timopheevi wheat. The result supported the hypothesis that Ae. speltoides donated the G genome to Timopheevi wheat; however did not agree with that Ae. speltoides was the B genome donor to the Emmer and common wheat.

Association of in vitro growth potential of urinary exfoliated cells with tumor localization and intraluminal recurrence rates of urothelial cancers

PURPOSE

One problem in the treatment of urothelial cancers, in particular of upper urinary tract cancers, is multifocal synchronous and/or metachronous tumor development in the heterotopic urothelium. We investigated the abilities of exfoliated cells in the urine of patients with urothelial cancers to colonize and proliferate in vitro.

MATERIALS AND METHODS

Short-term cultures of 129 urine samples obtained from patients with urothelial cancers and 53 samples from healthy volunteers were compared as to the growth potential of urinary-exfoliated cells and clinico-pathological features, in particular tumor localization and evidence of intraluminal tumor recurrence.

RESULTS

Primary cell outgrowth occurred in 112 (86.8%) of the 129 cell cultures from the patients and in 29 (54.7%) of the 53 from the healthy volunteers (p < 0.0001). "Sufficient cell growth" (more than 10(5) cells per flask) was obtained for 77 (59.7%) of the 129 cultures from patients and 7 (13.2%) of the 53 from the healthy volunteers (p < 0.0001). In terms of tumor localization, the rate of sufficient cell growth was significantly higher for patients with upper urinary tract tumor (21/25, 84.0%) than for those with bladder tumor (56/104, 53.8%) (p = 0.0062). Proportional hazard regression analysis showed that only the growth potential of the urinary-exfoliated cells was significantly predictive of intravesical tumor recurrence in patients with superficial bladder tumors (p = 0.011).

CONCLUSIONS

The potentials for the colonization and proliferation of urinary-exfoliated cells are associated with intraluminal multifocal tumor recurrence of urothelial cancers.

Transperitoneal laparoscopic adrenalectomy: experience in 100 patients

Between July 1992 and October 1996, 100 transperitoneal laparoscopic adrenalectomies were performed on 99 patients at our hospital and affiliated hospitals. The clinical diagnoses were primary aldosteronism (41 patients), Cushing's syndrome (15), pre-Cushing's syndrome (6), pheochromocytoma (7; 8 adrenal glands), adrenal cancer (2), nonfunctioning adenoma (22), myelolipoma (3), and complicated adrenal cyst (3). Ninety-seven glands were removed laparoscopically. The mean operative time was 240 +/- 76 (SD) minutes and the mean blood loss 68 +/- 80 mL for the series. The mean blood was 77 +/- 113 mL when the three operations that were converted to open surgery are included. The mean times for the return to a normal diet and unassisted ambulation were 1.3 +/- 0.6 and 1.4 +/- 0.8 days, respectively. The mean duration of the use of analgesics was 1.5 +/- 1.3 days, including the day of surgery. In contrast, in the latest 10 open adrenalectomies done at Kyoto University Hospital, the mean operative time was 186 +/- 53 minutes and the mean blood loss 220 +/- 170 mL. The mean times for return to a normal diet and for unassisted ambulation and the mean duration of the use of analgesics were 1.9 +/- 0.3, 2.9 +/- 1.1, and 2.9 +/- 1.7 days, respectively. Thirty-six operations, excluding one converted to open surgery, performed at Kyoto University Hospital were selected to look at the learning curve for transperitoneal laparoscopic adrenalectomy and evaluated for operative time and blood loss. The mean operative time and mean blood loss in the first 10 procedures performed at Kyoto University Hospital were 256 +/- 63 minutes and 89 +/- 57 mL; however, these values were reduced to 177 +/- 39 minutes and 48 +/- 32 mL in the next 10 procedures at the same hospital. Laparoscopic adrenalectomy via the transperitoneal anterior approach can be equivalent to open adrenalectomy in efficiency with a shorter convalescence.

Detection of telomerase activity in exfoliated cells in urine from patients with bladder cancer

BACKGROUND

Telomeres are specific structures located at the ends of chromosomes that help maintain chromosome stability. In most tissues, telomeres become shorter as cells divide, a phenomenon thought to be associated with limitations on normal cell proliferation. Almost all types of cancer cells, including bladder cancer cells, express the enzyme telomerase, which can maintain or extend telomere length.

PURPOSE

We examined telomerase activity in tumor specimens from a cohort of patients with bladder cancer and determined whether telomerase could be detected in exfoliated cancer cells present in urine from these patients.

METHODS

Spontaneously voided urine specimens and bladder-washing fluids (obtained by propelling normal saline into the bladder through a catheter and then withdrawing the liquid contents) were taken from 45 patients before they underwent surgery. Telomerase activity was examined by means of the TRAP (telomeric repeat amplification protocol) assay on extracts of tumor samples from 42 patients and extracts of exfoliated cells in urine and bladder-washing fluid from 42 and 43 patients, respectively. Standard cytologic examination (Pap staining) of urine specimens was also used to detect exfoliated cancer cells.

RESULTS

Telomerase activity was found in 41 (98%; 95% confidence interval [CI] = 87%-100%) of the 42 tumor samples examined. In contrast, it was not detected in normal bladder tissue from two autopsied individuals who were free of bladder cancer and five of six individuals who had bladder cancer. Telomerase was detected in exfoliated cells in 23 (55%; 95% CI = 39%-70%) of the 42 spontaneously voided urine specimens and in 36 (84%; 95% CI = 69%-93%) of the 43 bladder-washing fluids examined. Considering voided urine specimens and bladder-washing fluids together, telomerase was detected in exfoliated cells from 40 (89%; 95% CI = 76%-96%) of the 45 patients. Telomerase activity was not detected in bladder-washing fluids from 12 cancer-free individuals. Cancer cells were detected by means of standard cytologic examination in the urine of 19 (42%; 95% CI = 28%-58%) of the 45 patients. Urine cytologic examination detected cancer cells in one (8%; 95% CI = 0%-38%) of 12 patients with grade 1 tumors and in 13 (46%; 95% CI = 28%-66%) of 28 patients with grade 2 tumors. In contrast, telomerase activity was detected in exfoliated cells (in voided urine or bladder-washing fluids) from nine (75%; 95% CI = 43%-95%) of 12 patients with grade 1 tumors and from 27 (96%; 95% CI = 82%-100%) of 28 patients with grade 2 tumors.

CONCLUSION AND IMPLICATION

Telomerase activity can be detected in exfoliated cells in urine from patients with bladder cancer, and measurement of this activity appears to be more sensitive in detecting the presence of cancer than standard urine cytologic examination. These findings suggest that measuring telomerase activity in exfoliated cells would be useful in the diagnosis and follow-up of patients with bladder cancer, a possibility that warrants further study.

Laparoscopic adrenalectomy for bilateral pheochromocytoma: a case report

We report a case of bilateral (2.4-cm left and 6.5-cm right) adrenal pheochromocytoma in a 27-year-old man that was treated by laparoscopic adrenalectomy. The patient had no evidence of multiple endocrine neoplasia, type II. The left adrenalectomy was performed first, with the patient in a semilateral position, and then the patient was turned before the procedure was begun on the right side. His postoperative convalescence was uneventful, and he continues corticosteroid replacement therapy. Transperitoneal laparoscopic adrenalectomy can be a safe procedure for bilateral pheochromocytoma, if the patients are carefully selected and the procedures are performed by experienced laparoscopists.

Clinical experience of orthotopic urinary reservoirs in male patients with bladder cancer

Between 1988 and 1996, 23 male patients with bladder cancer underwent bladder substitution after cystectomy, using either the hemi-Kock, Hautmann, and Reddy procedures. The mean postoperative follow-up period was 36 months, with a range of 3 to 85 months. There were no perioperative deaths, and early postoperative complications occurred in 7 patients (30%); transient urine leak from the pouch in 4, wound infection in 3 and pyelonephritis in 2 patients. Twenty-two of the 23 patients (96%) were continent during the day, while 7 (30%) had nocturnal incontinence. All 3 patients with the Reddy procedure had nocturnal incontinence. Complete continence was preserved in 70% of the patients. Dysuria was seen in 4 patients, including retention in 1 patient. Late complications included urethral stricture in 3, wound hernia in 2, metabolic acidosis in 1, stone in the pouch in 1, and gallbladder stone in 1 patient. However, reoperation was necessary in 1 patient for internal urethrotomy and 1 patient for removal of a stone in the neobladder. Mild degree of hydronephrosis and unilateral reflux were seen in 3 patients each, and followed up conservatively. No urethral recurrence has occurred and only 1 patient died of cancer. The need for reoperation was very low and the high reservoir capacity resulted in continence from the beginning in most patients. We considered the neobladder useful as an alternative form of urinary diversion in selected cases.

A case of primary urethral lymphoma presenting as a huge mass surrounding the female urethra

A patient with a primary malignant lymphoma surrounding the female urethra is reported. Despite the good response of the primary tumor to radiotherapy, the patient died shortly after diagnosis due to disseminated disease. We reviewed 16 cases of this rare entity reported previously.

HLA-DRB1*0101 and *0405 as protective alleles in Japanese patients with renal cell carcinoma

A variety of malignancies have been linked to major histocompatibility complex genes, including the DRB1 alleles. The association of certain DRB1 antigens with renal cell carcinoma (RCC) has been both claimed and disclaimed. To determine whether HLA-DRB1 genotypes are associated with RCC, we used the modified PCR-RFLP method for the high-resolution HLA-DRB1 genotyping of 96 Japanese RCC patients. There were no significantly frequent HLA-DRB1 alleles, whereas the DRB1*0101 and *0405 alleles had significantly lower frequencies [P = 0.004, relative risk (RR) = 0.2 and P = 0.002, RR = 0.4) in the RCC patients than in the healthy Japanese controls (n = 1216). Moreover, patients with the HLA-DRB1 *0101 or *0405 allele tended to be in earlier stages and to have less aggressive tumors than patients with neither of these alleles. The corresponding serotyping subclassification, however, showed a significantly lower frequency only for DRB1-DR1 (P = 0.01, RR = 0.3). High-resolution genotyping is essential because the polymorphism of the peptide-binding domain of major histocompatibility complex class II molecules is more precisely determined by genotypes than serotypes. In addition, inherent technical difficulties and potential typing errors render serotyping inefficient. Our data suggest that HLA-DRB1*0101 and *0405 are protective alleles for both RCC development and tumor progression.

A case of exophytic hepatic hemangioma mimicking adrenal tumor

A rare case of exophytic hepatic hemangioma preoperatively diagnosed as a non-functioning adrenal tumor is reported. A 62-year-old man was admitted for treatment of primary hyper-parathyroidism and an incidental adrenal tumor. A 4.0 x 2.5 cm heterogeneous tumor located between the liver and the right kidney was detected by abdominal ultrasonography, computed tomography and magnetic resonance imaging. Color doppler images revealed no apparent blood flow. Since the tumor seemed to have originated from the liver under laparoscopy, an open partial hepatectomy was performed. Histopathological examination revealed cavernous hemangioma of the liver. When diagnosing non-functioning right adrenal tumor, it may be necessary to carefully rule out an exophytic liver tumor.

Urinary reconstruction using appendix as a urinary and catheterizable conduit in 12 patients

BACKGROUND

The appendix vermiformis can provide an excellent urinary conduit or a catheterizable outlet in continent urinary reservoirs in selected cases. We report our clinical experience using the appendix in urinary reconstruction in adult patients.

METHODS

A total of 12 patients underwent urinary reconstruction using the appendix. The indications were pelvic malignancies except for 1 patient with neurogenic bladder and difficulty in self-catheterization via urethra. The appendix was used as a catheterizable conduit in 8 patients, and as a urinary conduit in 4 patients. The in situ submucosally embedded method was used in 6 patients and the Mitrofanoff method was used in 2 patients. Follow-up ranged from 3 to 41 months (mean, 22).

RESULTS

Early complications occurred in 3 patients (wound infection, false passage and intestinal anasotomotic leak). Late complications occurred in 3 (slight hydronephrosis, ileus, stomal stenosis). Emergent colostomy and pouchstomy with resection of the appendix was performed in the patient with anastomotic leak. The isoperistaltic Kock nipple valve was reconstructed for continence in this case. Prolonged ileus in 1 patient was treated by open surgery. Other complications were managed conservatively. End results were excellent in 8 patients, good in 3, and poor in 1.

CONCLUSIONS

The appendix can be used advantageously as an outlet of continent urinary reservoirs or for a urinary conduit when the ureter is too short to reach the skin. Complete continence and easy catheterization can be obtained, and the appendix construction can be used as a urinary conduit instead of the ileal conduit in poor risk patients.

Low toxicity of inhaled interferon-gamma in four patients with lung metastasis from renal cell carcinoma

Inhalation of interferon-gamma (IFN-gamma) was used in four patients with pulmonary metastasis from renal cell carcinoma. Three million JRU IFN-gamma were inhaled every day (3 patients) or 5 times per week (1 patient). One patient achieved no change after IFN-gamma inhalation and three patients had no response. No drug-related side effects were observed. These findings point to the clinical feasibility of inhalation of IFN-gamma. However, further studies are needed to establish the anti-tumor efficacy of IFN-gamma inhalation therapy.

Vitamin B12 deficiency in patients with urinary intestinal diversion

BACKGROUND

Because vitamin B12 is absorbed exclusively by the terminal ileum, we investigated vitamin B12 deficiency as a potential metabolic complication after urinary intestinal diversion.

METHODS

We measured serum levels in patients with Kock pouches (n = 35); Indiana pouches (n = 27); and ileal conduits (n = 25). Serial determinations of serum B12 levels were obtained in 19 patients with kock pouches and 14 patients with Indiana pouches. The dual-isotope Schilling test was performed in 9 patients with Kock pouches and 6 patients with Indiana pouches.

RESULTS

No patient had an abnormally low serum B12 level (< 200 pg/mL). Mean (+/-SD) serum B12 levels in patients with the Kock pouch (506 +/- 202 pg/mL) and the Indiana pouch (536 +/- 249 pg/mL) were lower than that in patients with the ileal conduit (727 +/- 391 pg/mL). The mean serum B12 level was not significantly different between patients with and without preoperative irradiation. Serial determinations showed that serum B12 levels in some patients with continent urinary reservoirs were persistently near the lower normal limit, or became progressively lower. Three of the 9 patients (33%) with Kock pouches and 4 of the 6 patients (67%) with Indiana pouches were B12 malabsorbers, although no patients had megaloblastic anemia or neurologic symptoms.

CONCLUSIONS

Some patients with continent urinary reservoirs are at risk for vitamin B12 deficiency due to malabsorption. Routine evaluation of serum B12 levels is recommended for all patients with continent urinary reservoirs, and a Schilling test for those with subnormal serum B12 levels.

Mainz pouch with appendix-umbilical stoma using catheterizable conduit elongated with continuous cecal segment: a case report

The Mainz pouch with appendix-umbilical stoma is a very stable method for continent, self-catheterizable urinary reservoir in the presence of a healthy appendix. If the appendix is too short or an unexpected stenosis is seen at its distal portion, the elongation of the conduit using a part of the cecum and the implantation of the conduit to the pouch by the Mitrofanoff method can be a good alternative procedure. We herein report our experience in a 53-year-old male with high grade, invasive bladder tumor, who underwent cystourethrectomy and appendix Mainz pouch operation using the above technique.

[A case of primary localized amyloidosis of the urinary bladder]

A case of primary localized amyloidosis of the urinary bladder is reported. The patient was a 46-year-old female who suffered from macrohematuria and consulted our department. A yellowish non-papillary tumor at the retrotrigone of the bladder was observed on cystoscopy. Histological diagnosis was amyloidosis of the bladder. Since there was no evidence of disease in other organs, this patient was diagnosed with primary localized amyloidosis of the bladder and transurethral resection was performed. The clinical course was uneventful and she has been well without recurrence for 6 months postoperatively. This case was cured by transurethral resection, but close follow-up of the patients is necessary because of the recurrence.

Effect of surgical stress on immune function in patients with urologic cancer

BACKGROUND

To determine the immunosuppressive effect of surgery for urologic cancers, multiple variables of immune function were measured serially before and after operation in patients with urologic cancer.

METHODS

Peripheral blood was obtained before operation and at postoperative day 7 and 14 from 20 patients with bladder cancer, renal pelvic, or ureteral cancer, or renal cell carcinoma.

RESULTS

In patients with bladder cancer who were undergoing radical cystectomy with use of intestine for urinary diversion, the serum level of immunosuppressive acidic protein (IAP) increased, and serum levels of immunoglobulin (Ig)A, IgG, and IgM decreased after operation. In contrast, the number of CD25+ lymphocytes significantly increased. Transurethral resection of bladder cancer also resulted in an increase in serum IAP level, however, the number of CD4+ and human leukocyte-associated HLA-DR+ lymphocytes increased. In patients with renal pelvic or ureteral cancer undergoing nephroureterectomy with cuff, the level of serum IAP increased and serum IgG level decreased after operation. By contrast, the number of CD3+ lymphocytes increased. In patients with renal cell carcinoma, radical nephrectomy led to a significant increase in the number of CD8+ lymphocytes.

CONCLUSIONS

These findings suggest that surgical stress in patients with urologic cancer may result in both suppression and stimulation of host immunity.

Management of late complications of continent urinary diversion using the Kock pouch and the Indiana pouch procedures

BACKGROUND

Continent urinary diversion (CUD) is performed on patients after total cystourethrectomy due to invasive bladder cancer or other diseases requiring urinary diversion. Since 1984, we have performed CUD using either the Kock pouch procedure or a modified Indiana pouch method. During the long-term follow-up, increasing numbers of late complications occurred, especially after the Kock pouch procedure. We summarized the frequency of postoperative complications, their management, and outcome of CUD using these 2 methods.

METHODS

Between 1984 and 1995, CUD using the Kock pouch method was performed on 102 patients, and on 61 patients using the Indiana pouch method, with a mean follow-up period of 83 and 50 months, respectively. The patients were between 24 and 82 years old, with a mean age of 59 years. In most patients, the Kock pouch was constructed according to the original method, except for the use of a Dacron fabric collar, and the Indiana pouch was made using the ileal patch method.

RESULTS

Of 95 patients followed up for more than 3 months after CUD using the Kock pouch method, efferent and afferent nipple valve malfunction occurred in 21 (22%) and 26 (27%) patients, respectively. Efferent complications occurred during the first year after surgery, whereas afferent complications occurred several years after surgery. Open repair surgery (excluding ileus) was necessary for 36 (38%) patients. Of 59 patients followed for more than 3 months after CUD using the Indiana pouch method, 7 patients with stomal stenosis, 2 patients with stomal prolapse, and 1 patient with stricture at the ureterocolonic anastomosis were treated surgically. An hourglass-like deformity of the pouch was seen in 2 patients, on whom the original Indiana pouch method was performed. As a whole, 13 patients (22%) were retreated with open surgery. Urinary calculi occurred in 42 (44%) patients after CUD using the Kock pouch method and in 11 patients (19%) using the Indiana pouch method. The outcome was excellent, good, fair, and poor in 31, 37, 24, and 8% of the patients after CUD using the Kock pouch method, and in 36, 17, 42, and 5% of the patients after CUD using the Indiana pouch method.

CONCLUSIONS

We performed CUD using either the Kock pouch or the Indiana pouch method with a success rate of approximately 90%. The rates of revision, reoperation and stone formation were higher with the Kock pouch procedure than with the Indiana pouch procedure, while varying degrees of incomplete incontinence and difficulty in catheterization were seen more often in the latter.

[Two cases of small cell carcinoma of the urinary bladder]

Small cell carcinoma of the urinary bladder is a rare entity, and is considered to be of neurosecretary origin. Its prognosis is generally poor even with aggressive therapy. In Japan, 19 cases of small cell carcinoma of the urinary bladder have been reported including our cases. We herein report two cases of small cell carcinoma of the urinary bladder. One patient was an 80-year-old male. Cystoscopy revealed a large tumor centered on the posterior wall of the urinary bladder. The biopsy specimen of the tumor revealed small cell carcinoma. Intraarterial infusion chemotherapy was performed. He died of multiple liver metastasis 8 months after chemotherapy. The other patient was a 80-year-old male. Cystoscopy revealed a bladder tumor on the left lateral wall. The biopsy specimen of the tumor revealed small cell carcinoma. Irradiation and partial cystectomy were performed. He has been well without any evidence of recurrence 6 months after surgery. Our cases and a review of the literature indicate that a multidisciplinary treatment may improve prognosis of small cell carcinoma of the urinary bladder.

Molecular and biological studies on male-sterile cytoplasm in the Cruciferae. III. Distribution of Ogura-type cytoplasm among Japanese wild radishes and Asian radish cultivars

The distribution of Ogura male-sterile cytoplasm among Japanese wild radish populations and Asian cultivated radishes was studied by means of polymerase chain reaction (PCR)-aided assays using mitochondrial atp6 and orf138 loci as molecular markers. Three separate PCR experiments were performed to amplify the target sequences in normal-type atp6, Ogura-type atp6, and Ogura-specific orf138, and the cytoplasm of each plant was classified as either normal or Ogura. Among 217 wild radish plants, 93 had both Ogura-type atp6 and orf138 (or its modified form), whereas 124 had normal-type atp6. Of the 93 plants with Ogura-type cytoplasm, only a single plant showed male sterility. A complete linkage between Ogura-type atp6 and orf138 loci was found in Japanese wild radishes, confirming our findings that Ogura-type cytoplasm is distributed widely among Japanese wild radish populations. A modified form of orf138 (orf138-S) was identified in a few wild radish populations in a limited area of Japan, and the nucleotide sequence of the orf138-S revealed a 39-bp deletion shared in common with 'Kosena' male-sterile cytoplasm. Among the 44 Asian cultivars analyzed, 40 were determined to have normal cytoplasm since all 4 plants tested in each cultivar showed the same PCR amplification profiles as that of 'Uchiki-Gensuke', a reference cultivar with normal cytoplasm. The plants with Ogura-type cytoplasm (or its modified form) were found in 1, 1, and 2 cultivars from Tibet, Japan, and Taiwan, respectively. Except for 1 cultivar from Taiwan, those with Ogura-type cytoplasm included a few plants having male sterility. The multiple and independent introduction of Ogura-type cytoplasm from the wild radish in Asia into these cultivars is suggested.

Intracorporeal lithotripsy with the Swiss Lithoclast

BACKGROUND

In addition to currently available modalities of intracorporeal lithotripsy (ultrasonic, electrohydraulic, and laser), a new ballistic lithotriptor known as the Swiss Lithoclast has recently gained attention. This study reports our experience with the Swiss Lithoclast in the endoscopic management of urinary calculi.

METHODS

A total of 51 patients with urinary calculi were treated with the Swiss Lithoclast; one patient with a renal calculus, 28 with ureteral calculi, and 22 with lower urinary tract (bladder, urethra and Kock pouch) calculi.

RESULTS

The Lithoclast successfully fragmented 94% of the calculi, independent of stone composition. Complete failure of fragmentation was not encountered. In six of the 10 upper ureteral calculi, stone fragments were pushed up into the calyces. Adjunctive extracorporeal shock wave lithotripsy for residual fragments was performed in six cases. The stone-free rate at one and three months was 84% and 88%, respectively. There were no intraoperative or long-term complications directly related to the use of this device.

CONCLUSION

The Swiss Lithoclast is a safe and effective means of intracorporeal lithotripsy. Although suitable for mid and lower ureteral stones, the device has a risk of stone push-up in patients with upper ureteral stones.

Simultaneous left renal pelvic and bilateral ureteral tumors producing carbohydrate antigen 19-9

We report a case of a transitional cell carcinoma of the left renal pelvis and both ureters which secreted carbohydrate antigen 19-9. Aggressive surgery was performed including a left nephroureterectomy including the bladder cuff and a right total ureterectomy with an ileal graft replacement. The patient has had good kidney function and no evidence of disease for one year postoperatively.

Prognostic significance of circulating cytotoxic lymphocytes against autologous tumors in patients with bladder cancer

PURPOSE

Cell-mediated immunity is an important and central mechanism of host resistance to cancer. Many studies have used cultured tumor cell lines as targets for cell-mediated cytotoxicity. However, it is difficult to interpret the data generated from the cytotoxic activity against cultured tumor cell lines, since they may not represent the activity against fresh autologous tumor cells. We examined the prognostic significance of circulating antitumorigenic cytotoxic lymphocytes at operation.

MATERIALS AND METHODS

Peripheral blood lymphocytes derived from 89 patients with a bladder tumor were tested at operation for cytotoxic activity against a natural killer sensitive myeloid leukemia line K562, a human bladder tumor cell line T24 and freshly isolated autologous tumor cells in a 12-hour 51chromium release assay. The levels of the cytotoxic activity were evaluated for potential prognostic significance.

RESULTS

The mean cytotoxic activities of peripheral blood lymphocytes against K562 cells, T24 cells and autologous tumor cells were 37.2%, 19.8% and 9.7%, respectively, using an effector-to-target cell ratio of 40:1. Based on the analysis, patients with bladder tumors were divided into 2 groups of high (greater than the mean value) and low (less than the mean value) cytotoxic activity. The magnitude of the anti-K562 or anti-T24 cytotoxic activity did not correlate with the 5-year survival rate or the postoperative disease-free period. In contrast, bladder tumor patients with high anti-autologous cytotoxic activity had higher disease-specific survival rates and a longer postoperative tumor-free interval compared to those with low activity during the 5-year follow-up. In addition, similar analysis of the data at an effector-to-target cell ratio of 20:1 revealed that patients with high anti-autologous tumor cytotoxic activity also had a higher survival rate and a longer postoperative tumor-free period than those with low activity. No statistical differences were observed in patient age and sex, as well as the size, number, histological grade and stage of bladder tumors between patients with high and low anti-autologous tumor cytotoxic activity. The anti-autologous tumor cytotoxic activity was not paralleled with either anti-K562 or anti-T24 cytotoxic activity.

CONCLUSIONS

These results suggest that anti-autologous tumor cytotoxic activity of peripheral blood lymphocytes might be a significant and independent prognostic indicator in patients with bladder tumors, and that the autologous tumor cell killing system might have an important role in the immune surveillance against bladder tumors.

[A case of localized amyloidosis of the ureter]

A case of localized amyloidosis of the ureter is reported. The patient was a 49-year-old female whose chief complaint was macrohematuria. Roentogenographic examination showed left hydronephrosis due to stenosis of left middle ureter. Left nephrouretectomy with cuff was performed with a diagnosis of the left ureteral tumor, and pathological examination revealed localized amyloidosis of the left ureter. Localized amyloidosis of the ureter is a rare lesion, and this is the twenty-first case reported in the Japanese literature. Review of the literature revealed that it is difficult to differentiate this lesion from other ureteral tumors by roentgenographic examination, and it is important to perform preoperative or intraoperative biopsy of ureteral tumors if benign diseases cannot be ruled out.