Biological activity of 26,26,26,27,27,27-hexafluoro-1,25-dihydroxyvitamin D3 in the chick

A newly synthesized fluorinated analogue of 1,25-dihydroxyvitamin D3 (1,25(OH)2D3), 26,26,26,27,27,27-hexafluoro-1,25-dihydroxyvitamin D3 (26,27-F6-1,25-(OH)2D3) has been compared with 1,25(OH)2D3 as to its biological activity in vitamin D-deficient chicks. One day-old, white Leghorn cockerels were fed a rachitogenic diet for 5 weeks. They were then given vehicle or 32.5, 130 or 325 pmol of 26,27-F6-1,25(OH)2D3 or 1,25(OH)2D3 in a solution of propylenglycol:ethanol (95:5 v/v) sc every day for 2 weeks. Twenty-four hours after the last dose, the animals were sacrificed and their femurs were removed. 26,27-F6-1,25(OH)2D3 was more active than 1,25(OH)2D3 in stimulating growth, healing of rachitic cartilage visualized by soft X-ray radiography, elevation of serum inorganic phosphorus, and mineralization of rachitic bone. These biological differences between two compounds were observed only for the dose of 130 pmol. However, this fluorinated compound has less binding ability than 1,25(OH)2D3 to fetal chick intestinal cytosol receptors. The mechanism of the higher potency of this analogue is still unknown, but its affinity to the 1,25(OH)2D3 receptor does not account for the higher activity. Since 26-hydroxylation can be postulated as the inactivation step in vitamin D metabolism, these results suggest that the reason for increased activity of this fluorinated analogue is most likely its slower metabolism.

[Adjuvant chemotherapy after cystectomy of bladder tumor]

Adjuvant chemotherapy mainly consisting of cisplatin, adriamycin and mitomycin C was administered to 17 patients after cystectomy for bladder tumor (chemotherapy group). Seventeen concurrently treated patients did not receive adjuvant chemotherapy (control group). From the comparison of survival curves of these two groups, the following results were obtained. 1) Survival curves of the patients in all stages did not differ significantly between chemotherapy and control groups. 2) Among patients in stage pT3, pT4 and/or N+, survival of the chemotherapy group seemed to have some advantage over that of the control group, but the survival curves did not differ significantly between these two groups. 3) Among patients in N+, survival of the chemotherapy group was far better than that of the usual cases. Review of the literature on adjuvant chemotherapy after cystectomy for bladder tumor revealed the necessity of randomized study to determine whether adjuvant chemotherapy is effective.

[Clinical analysis of 40 total cystectomies for bladder tumor]

Between June, 1983 and December, 1988, 40 patients with primary bladder tumor underwent total cystectomy. Of the 40 patients, 33 (82.5%) were treated by total cystectomy at first presentation. Only 7 patients (17.5%) had prior history of bladder tumors. The mean time from the onset of symptoms to consultation was 11.5 months. In 68.5% of the evaluable 35 patients, gross hematuria was the first symptom. In 74.4% of the 39 evaluable patients, preoperative urine cytology was positive. If class III (suspicious) was included, the positive urine cytology rate was 82.1%. The operative mortality rate was 15%. Early complications occurred in 52.5% of the 40 patients. Late complications occurred in 35.3% of the 34 patients. The 1-, 2- and 3-year actual survival rates of the 40 patients were 69.6%, 65.5% and 65.5% respectively. The 2-year survival rate according to pathologic stage was 14.3% for patients in pT4, 43.8% in pT3b, 75% in pT3a, 100% in pT2, 78.8% in pT1 and 100% in pT0 + pTis. Of the 28 patients who underwent pelvic lymphadenectomy, 8 (28.6%) had positive nodes, including 1 of 1 (100%) in pT4, 5 of 7 (71.4%) in pT3b, 1 of 6 (16.7%) in pT3a, 1 of 4 (25%) in pT2 and 0 of 10 (0%) in pT1 + pT0 + pTis. The prognosis of the 7 patients who had prior history of bladder tumor was poor. The selection of initial therapy and the clinical follow-up should be done carefully.

[A case of renal cell carcinoma which was left untouched for five years]

We report a case of bilateral synchronous renal cancers for which only right radical nephrectomy was performed at another hospital. Five years later we performed partial nephrectomy (enucleation) for the left renal cancer. By computed tomographic scans we studied the radiological change of this tumor which occurred during a five-year period. We found a slow doubling time of this tumor. Three years after enucleation, tumor recurrence was noticed and we performed left partial nephrectomy with a normal parenchymal margin. We reviewed the literature about enucleation of renal cancer.

[A study of 22 cases of renal injury]

Between June, 1984 and May, 1988, 22 cases of renal injury were treated. There were 13 males and 9 females. The most frequent causes were traffic accidents (13 cases) and the next were falls (7 cases). Associated injuries were seen in 9 cases, including bone fractures, head injuries, liver lacerations, hemothorax and splenic laceration. Out of the 22 patients, there were 13 cases of renal contusion, 6 cases of renal laceration, 1 case of renal rupture and 2 cases of pedicle injury. Evaluation was made by IVP, CT, arteriography and so on. Arteriography was the most useful method whether immediate surgery should be done or not. Three cases were treated surgically (2 nephrectomies for rupture and pedicle injury, 1 drainage for laceration). The other cases were treated conservatively and no complications have been seen.

[A case of metastatic tumor of spermatic cord from renal cell carcinoma]

A 51-year-old man was admitted with the complaint of left scrotal swelling (11 x 5 x 5 cm). He had undergone left nephrectomy and removal of tumor thrombus in inferior vena cava due to renal cell carcinoma. Nine months after the nephrectomy, left scrotal enlargement was noticed. Left high orchiectomy was performed on January 20, 1988. A clear cell carcinoma was present in spermatic cord and pampiniform plexus histologically but testis and epididymis were intact. Renal cell carcinoma seemed to disseminate retrograde through the spermatic vein to spermatic cord. The metastatic tumor of spermatic cord from renal cell carcinoma is very rare and this case is the fifth case in the Japanese literature.

[Pharmacokinetic evaluation of continuous infusion cisplatin]

Cisplatin was administered to 11 patients as a continuous infusion, 25 mg/m2/day for 1 to 4 days. Total and filterable platinum in plasma were monitored for 12 courses and a pharmacokinetic study was carried out in 7 patients by computerized nonlinear least-squares analysis. Following interruption of the infusion, the decrease of plasma filterable platinum was biphasic, with initial and terminal half-life of 21.6 +/- 11.4 min and 31.7 +/- 27.1 hr. Filterable platinum was still detectable in plasma 24 hours after the end of infusion. The total AUC exposure of filterable platinum for 24 hrs, 48 hrs and 96 hrs infusion were 3.67 micrograms.hr/ml, 13.68 micrograms.hr/ml and 14.75 micrograms.hr/ml, which were at least 3-fold higher than that observed for the short-term infusion of equal dose in literature. Gastrointestinal toxicity was evaluated and compared with short-term infusion of equal dose. In the continuous-infusion patients, the reduction of vomiting was observed but the duration of nausea was not shortened.

[Tunica vaginalis autografting in Peyronie's disease]

Surgical excision of the indurated penile plaque and tunica vaginalis autografting was done in 3 patients. Preoperatively, their chief complaints had not been impotence but penile angulation or pain. Postoperatively, all of them improved and erectile failure was not seen, although hypesthesia of glans developed in all patients. One patient complained of impotence. The patients had been followed from 2 months to 9 months. As prosthesis is not prevailing in Japan and tunica vaginalis is easy to procure and handle, tunica vaginalis autografting is recommended.

[Effect of estrogen treatment on antithrombin III activity in patients with carcinoma of the prostate]

Since reduced antithrombin III (AT III) activity are associated with increased risk of thromboembolism, we have determined it in 39 patients with prostatic carcinoma. Pre-treatment levels were determined in 24 patients, 6 additional patients with prostatic carcinoma on estrogen treatment and 9 patients on chlormadinone acetate (CMA) therapy. In 12 of 24 patients we studied AT III levels before and after estrogen therapy was initiated. A significant decrease in AT III activity of 23.5% was found after one month on estrogen treatment, the patients on low doses of estrogen. Recovery of the levels of AT III was found after 6 months treatment even in in 5 of 6 patients who had shown depression of AT III levels initially. CMA treatment did not cause its depression. AT III levels was not connected with the stage of the disease or age of the patient.

[A case of advanced paratesticular rhabdomyosarcoma]

A case of paratesticular rhabdomyosarcoma is presented. An 18-year-old male was admitted with the complaint of giant scrotal swelling and abdominal fullness on September 5, 1986. Left radical orchiectomy was performed with the pathologic diagnosis of alveolar rhabdomyosarcoma. The tumor was paratesticular in location and had invaded a spermatic cord. Radiological examination showed a gross metastatic mass in retroperitoneal lymph nodes, supraclavicular lymph nodes and Douglas pouch. The patient received induction chemotherapy containing vincristine, actinomycin-D, cyclophosphamide, bleomycin, CDDP and VP-16. After 3 courses, he had no mass in Douglas pouch and supraclavicular lesion. He received retroperitoneal lymph node dissection for residual retroperitoneal mass, and postoperative radiotherapy was given. However, recurrent disease was developed in the paraaortic region with malignant ascites. He was treated with salvage chemotherapy, had without any significant effect. He died of liver dysfunction due to progressive mass in hepatic hilum. A review of the current approach of paratesticular rhabdomyosarcoma with the usefulness of combination chemotherapy is given.

Effects of mucopolysaccharides on penicillin-induced lysis of Staphylococcus aureus

Effects of four mucopolysaccharides and dextran sulphate on penicillin-induced lysis of Staphylococcus aureus FDA 209P were studied. Heparin and dextran sulphate inhibited lysis, whereas hyaluronic acid enhanced it. Chondroitin sulphates A and C had no effect. Incubation of S. aureus suspended in 0.03 M phosphate buffer (pH 7.0) with dextran sulphate inhibited autolysis of the bacteria, whereas incubation with hyaluronic acid enhanced autolysis. Both extracellular and cell-associated autolysin activities of S. aureus were suppressed by dextran sulphate and high concentrations of heparin. The addition of hyaluronic acid enhanced autolysin activity. The release of lipoteichoic acid (LTA), a modulator of autolysin activity, from penicillin-treated bacteria was inhibited by heparin and dextran sulphate. However, hyaluronic acid had no effect on release of LTA. These results suggest that inhibition of penicillin-induced lysis of S. aureus by heparin results mainly from inhibition of LTA release while dextran sulphate inhibits both autolysin activity and LTA release. Hyaluronic acid appears to enhance penicillin-induced lysis through activation of the autolysins.

Treatment of Graves' ophthalmopathy with high-dose intravenous methylprednisolone pulse therapy

This preliminary study was undertaken to investigate the efficacy of high-dose iv methylprednisolone pulse therapy in 5 patients with Graves' ophthalmopathy. One gram of methylprednisolone sodium succinate was given iv daily for 3 successive days. The 3-day infusion was repeated 3 to 7 times at intervals of 1 week; total duration of pulse therapy was 3 to 7 weeks. The clinical improvement of eye involvements by pulse therapy was assessed immediately after the last pulse therapy. The clinical assessment of the effect of pulse therapy for Graves' ophthalmopathy showed a good response in 3 patients, a fair response in one, and no response in one. However, in one patient, who was judged to show no response, complete improvement of the enlarged extraocular muscle was observed on orbital computed tomography. Moreover, two patients, who have been followed without any other therapies, showed no relapse of eye involvements for 32 and 10 months, respectively. Although it is impossible to determine whether pulse therapy is more effective than other immunosuppressive therapies, the results of this preliminary study suggest that pulse therapy may be a good immunosuppressive therapy for Graves' ophthalmopathy too. Controlled studies are desired.

[Rhabdomyosarcoma of the kidney: report of a case]

A case of rhabdomyosarcoma of the right kidney is presented. A 78-year-old man was admitted with the complaint of abdominal pain and abdominal fullness on March 15, 1985. Radiological examination showed a giant tumor of the right kidney. Radical nephrectomy and right hemicolectomy were performed. Histological findings were embryonal rhabdomyosarcoma of the kidney. Residual tumor in the duodenal area recurred and he died of peri-duodenal abscess 2 months after admission. This case is the 17th case of rhabdomyosarcoma of the kidney in Japan. The literature is reviewed and discussed.

[Clinical experience of percutaneous nephrolithotomy]

Between July, 1984 and January, 1986, 20 cases of renal and ureteral stones were treated by percutaneous nephrolithotomy (PNL). Stone removal was successful in 17 cases (85%). In 14 cases, stones were removed completely and in 3 cases there were small residual fragments. There were 4 major and 9 minor complications. The major complications consisted of loss of tract in 2 cases, bleeding from the tract after removal of nephrostomy catheter in 1 case and pneumothorax in 1 case. The minor complications consisted of small perforation during PNL in 6 cases, gross hematuria impossible to continue PNL in 2 cases and ureteral injury due to ureteral occlusion catheter in 1 case. No patients required blood transfusion. In near future all urologists will be required to master the technique of PNL.

[Hormonal environment following treatment with a small dose of estrogen--small dose of estrogen alone and in combination with an anti-androgen]

The testosterone, luteinizing hormone (LH), follicle stimulating hormone (FSH) and prolactin levels were measured by radioimmunoassay up to one year in 21 patients with prostatic carcinoma treated with diethylstilbestrol diphosphate (DESP), 50 mg/day, and chlormadinone acetate (CMA), 100 mg/day. The purpose of this treatment was to reduce the cardiovascular side effects which were believed to occur dose-dependently and to achieve the direct drug action to the prostate gland. The same measurements were made on 9 patients treated with DESP, 50 mg/day, alone. Marked reduction of plasma testosterone and FSH levels with weaker LH suppressions was observed during the first 1-3 months in both groups. The same levels were maintained up to the end of follow-up in DESP and CMA treatment group. In the DESP treatment group, the plasma level of testosterone showed a gradual increase to 1.0 +/- 0.5 ng/ml at the sixth month. Prolactin level increased gradually in both groups. Cardiovascular side-effects were found in 29% of the patients treated with DESP and CMA and in 22% of those treated with DESP alone. In two patients in the former group gynecomastia with lactation was observed.

Inhibitory effect of interferon-gamma on the response of human thyrocytes to thyrotropin (TSH) stimulation: relationship between the response to TSH and the expression of DR antigen

Thyroid epithelial cells (thyrocytes) in autoimmune thyroid disease have been found to express DR antigens on their surfaces, and interferon-gamma (IFN gamma) induces DR antigen expression. This study was undertaken to determine the effect of IFN gamma on the response of human thyrocytes to TSH stimulation and the relationship between the response to TSH and the expression of DR antigen induced by IFN gamma, using monolayer cultures of Graves' thyrocytes. When confluent thyrocyte monolayers were incubated with TSH or Bu2cAMP (DBcAMP) for 7-9 days, T3 and thyroglobulin concentrations in the culture medium increased gradually in a dose-dependent manner. However, when TSH or DBcAMP was added after the cells had been cultured for 4 days with IFN gamma, T3 and thyroglobulin secretion in response to both 10 mU/mL TSH and 1 mM DBcAMP was significantly inhibited. The inhibition by IFN gamma was dose dependent and correlated with the number of DR antigen-positive thyrocytes present on the last day of culture. IFN alpha and -beta did not affect the response of thyrocytes to TSH or DBcAMP stimulation. These results suggest that DR antigen-positive thyrocytes fail to respond to TSH stimulation at a site located distal to cAMP formation.

[Two cases of renal angiomyolipoma]

Two cases of renal angiomyolipoma without tuberous sclerosis are reported. The first case was of a 35-year-old man with complaints of right upper abdominal and right flank pain. Preoperative diagnosis was right renal angiomyolipoma. Thoracoabdominal radical nephrectomy and lymphadenectomy were performed. The pathological diagnosis was renal angiomyolipoma with lymph node involvement. The second case was of a 46-year-old woman whose left renal mass had been accidentally found by ultrasound study. Preoperative diagnosis was left renal angiomyolipoma. This tumor was enucleated from the left kidney through flank incision.

Latent and clinically manifest prostatic carcinoma

In a histological study of 17 prostates excised in toto for stages B and C primary carcinoma, we found one focus of well differentiated carcinoma in each of six prostates, which, in addition to these foci, had large tumors of invasive prostatic carcinoma. In four of the six prostates, the foci were located near but separate from the main tumor, and in the remaining two they were invaded by the main tumor. These findings strongly suggest that prostatic carcinoma is multifocal in origin and that focal well differentiated carcinomas are different in biological behavior from invasive poorly differentiated carcinomas.

[Direct renal pelvic puncture in the bacteriologic study in patients with uretero-intestinal urinary diversion (a new technic for diagnosis of upper urinary tract infection)]

The renal pelvis of ten patients with ileal or colonic conduit was punctured with a 22G spinal needle under fluoroscopic guidance. Renal pelvic urine was obtained from nine patients. Two patients temporarily developed gross hematuria as a complication due to this procedure. The obtained renal pelvic urine was investigated bacteriologically. Direct renal pelvic puncture was concluded to be a useful and safe technique for locating urinary tract infection. Reflux of infected urine into the renal pelvis did not occur in any of the nine patients who had no obstruction of the ileal or colonic conduit.