[Influence of extracorporeal shock wave lithotripsy (ESWL) on renal function assessed by 99mTc-DMSA scintigraphy: comparative analysis between ESWL and percutaneous nephroureterolithotripsy (PNL)]

99mTc-DMSA renal scintigraphy was utilized to investigate the influence of ESWL on renal function in comparison with that of PNL. In the beginning, the reproducibility of renal uptake rate by the scintigraphy was examined in eleven healthy volunteers under both non-diuretic and diuretic states. The renal uptake rate was shown to be sufficiently reproducible in the same person in the two different trials. However, the differences and the standard deviations were shown to be a few percentages, which were not statistically significant. Changes in the repeated renal uptake rate seem to indicate not only changes of renal function with the treatment but also some technical errors. Herein, to investigate changes in renal function of the therapeutic side, the uptake ratio rate (rate of uptake rate in the therapeutic side/uptake rate in the contral lateral side) was utilized instead of uptake rate. Renal scintigraphy was carried out in 48 patients with unilateral renal stones before and after ESWL or PNL monotherapy or the combined ESWL and PNL therapies. Within one week of treatment, the uptake ratio rate significantly decreased in patients with PNL or the combined ESWL and PNL, although DMSA uptake rate in the therapeutic side did not significantly changes. Neither renal uptake rate nor uptake ratio rate significantly changed after ESWL treatment. There was no significant difference in changes of uptake ratio rate between Siemens Lithostars Plus and the improved Dornier HM-3 lithotriptors. This study indicated that ESWL monotherapy did not affect the uptake ratio rate, although PNL monotherapy and the combined ESWL and PNL therapies may affect the uptake ratio rate to some extent.

Matlystatins, new inhibitors of type IV collagenases from Actinomadura atramentaria. IV. Synthesis and structure-activity relationships of matlystatin B and its stereoisomers

The first total synthesis of matlystatin B (1a), a low molecular weight inhibitor of type IV collagenases, was accomplished, and its absolute configuration was unambiguously determined. Furthermore, ten stereoisomers of 1a were synthesized, and the inhibition of the 92 kDa type IV collagenase and of other metalloproteinases by each stereoisomer was investigated.

[A case of retrovesical hemangiopericytoma]

A case of retrovesical hemangiopericytoma is reported. The patient was a 44-year-old woman with right lumbago. Cystoscopy showed extra-vesical compression in the area from the trigone to right wall of bladder. The histological examination of the specimen obtained with ultrasound-guided transvaginal biopsy revealed hemangiopericytoma. Because of the invasion to the bladder mucosae, total cystectomy and ileal conduit were performed. The patient received postoperative irradiation of 3,060 rad for pelvis. Eight months after operation, computerized tomography showed no evidence of local recurrence of the tumor.

[Effects of nephrectomy and interferon administration on immunological parameters in patients with renal cell carcinoma]

To study the changes in the subsets of peripheral blood lymphocytes before and after nephrectomy and interferon (IFN) therapy, 57 patients with renal cell carcinoma were divided into three groups; one group consisted of 16 patients with metastasis who had been administered IFN-alpha, one group consisted of 16 patients without metastasis who had been administered IFN-alpha, and the other consisted of 25 patients without metastasis who had not been administered IFN-alpha. Immunological parameters such as percentages of NK (Leu-11+ [Leu-7-) cells, percentages of activated CD4 (Leu-3a+ HLA-DR+) positive cells and percentages of activated CD8 (Leu-2a+ HLA-DR+) positive cells were examined by two color flow cytometry and the percentages of CD4 (Leu-3a+) positive cells, percentages of CD8 (Leu-2a+) positive cells values and the ratio of percentages of CD4 positive cells/percentages of CD8 positive cells were evaluated. The percentages of NK cells showed a tendency to decrease after nephrectomy and the administration of IFN-alpha. The percentage of CD4 positive cells showed a significant increase after the administration of IFN-alpha. The percentage of activated CD4 positive cells and the ratio of percentage of CD4 positive cells/percentage of CD8 positive cells showed a tendency to increase slightly. The percentage of CD8 positive cells and percentage of activated CD8 positive cells showed no particular changes. There was a specific correlation between the administration of IFN-alpha and the changes of percentage of CD4-positive cells and this suggests that the administration of IFN-alpha led to the increase of helper T cells.

[Study on clinical effects of tosufloxacin (TFLX) and the long-term low dose therapy for the prophylaxis of recurrent urinary tract infection]

Forty five patients with complicated urinary tract infections were treated with tosufloxacin (TFLX) in the initial antibacterial treatment. Excellent and moderate responses were obtained in 39 patients (86.7%). No side effects were seen. Clinical efficacy and safety of long-term preventive administration of TFLX (150mg, a day) were also examined in 39 patients who showed an excellent or a moderate response in the initial treatment. The period of the administration ranged from 28 to 112 days (average; 55 days). The rate of preventing recurrence of urinary tract infection was 92.3% on the last day of treatment. These findings suggested that TFLX was useful not only in treating the patients with complicated urinary tract infections but also in preventing recurrence of urinary tract infection.

[Local recurrence of ureteral tumor histologically similar to malignant lymphoma: a case report]

A 65-year old man, who had had resection of a right ureter tumor two years earlier, was hospitalized with complaints of lower abdominal discomfort and hematuria. Pathological diagnosis of the ureteral tumor was grade 3 transitional cell carcinoma. Computed tomography and magnetic resonance imaging demonstrated a large tumor in the retrovesical space and recurrence of transitional cell carcinoma was suggested. Total pelvic exenteration was performed and pathological diagnosis of the tumor was undifferentiated carcinoma simulating malignant lymphoma. Immunohistochemical examinations revealed no antigens specific for the lymphoid cells or epithelial cells on the specimen. This tumor consisting of undifferentiated carcinoma was considered to be recurrence of transitional cell carcinoma with the diffuse pattern simulating malignant lymphoma proposed by Zukerberg et al.

[Initial chemotherapy followed by orchiectomy and retroperitoneal lymphadenectomy--a case of seminoma with a testicular tumor and enlarged regional lymph nodes]

A 43-year-old male visited our hospital with complaints of right scrotal swelling and lower abdominal mass. Computed tomographic (CT) scan showed the right testicular tumor and regional enlarged lymph nodes. However, there were no metastasis in lung, brain, liver, and bone. First, we performed chemotherapy of modified PVB regimen (cisplatinum, vinblastine, peplomycin) prior to the right orchiectomy, because a tumor lump was palpable from the right testis to the lower abdominal mass. After three courses of modified PVB chemotherapy, beta-HCG, HCG and LDH values became within normal limits and all tumors were necrotic on the CT scan. Then, we performed the right orchiectomy and retroperitoneal lymphadenectomy simultaneously. After operation, two courses of VIP chemotherapy (etoposide, ifosfamide, cisplatinum) were performed since viable cells in one of the obturator lymph nodes were pathologically noticed. The patient has been free of recurrence of the tumor for 15 months after the treatment. In the particular case, in which the primary testicular tumor was not extirpated en bloc, the initial chemotherapy followed by orchiectomy was found to be feasible.

Age-related changes of the prostate gland in the senescence-accelerated mouse

Aging is of utmost importance in the pathogenesis of the prostate gland (i.e., benign prostate hyperplasia or prostatic carcinoma). The object of this study was to examine the morphological and histological changes of the aging prostate of the so-called senescence-accelerated mouse (SAM). Ventral and dorsolateral lobes of prostate glands of SAM were microdissected into two-dimensional ductal arrays. Gross morphology, ductal branching patterns, and histology were examined in these microdissected specimens. Wet weight and numbers of ductal tips in ventral and dorsolateral prostate glands in senescence accelerated-prone (SA-P) mice were significantly smaller than those of senescence accelerated-resistant (SA-R) mice, although the changes of patterns of gross ductal morphology were virtually identical in these groups. High incidence of stromal hyperplasia with fibrosis and inflammation was observed in the dorsal lobe of the aged SA-P mouse. Atypical glandular epithelial cells and cribriform glandular deformity were observed in the dorsal and lateral lobe of aged SA-P mice. Marked heterogeneity in age-related pathological changes was observed between prostatic lobes. These data suggest that the aging process occurs heterogeneously within the prostate gland, and that SA-P mice may be an important model for the study of age-related changes in the prostate gland.

[Endorectal magnetic resonance imaging of the prostate and bladder]

Endorectal magnetic resonance imaging (MRI) using an endorectal surface coil has been evaluated basically and clinically. This new modality obtained increased resolution magnetic resonance images of the pathologic conditions of the prostate and bladder. Compared with images obtained with a body coil, the surface coil images clearly demonstrate prostatic intraglandular zonal anatomy. The clear images of prostatic capsule and neurovascular bundle seen on the surface coil may contribute to the local staging of prostate cancer. The staging diagnosis of bladder tumor located in the bladder neck will be the best candidate for endorectal MRI. Enhancement with gadolinium may improve the ability to differentiate superficial from deep bladder-wall tumors. We concluded that endorectal MRI is safely performed and is extremely useful for the local staging of prostate cancer and bladder neck tumor. Further studies will be required to evaluate the clinical significance of this new modality.

The development and practical use of information systems in the pharmaceutical industry

To provide information on the efficacy, safety, and quality of medicine promptly and accurately, we have developed two databases: a literature database with numerical data, and a Drug Information database. By an easy-to-use, company-wide information network system, over 1,000 medical representatives in more than 80 offices throughout Japan can retrieve information. Information derived from the system is displayed on the terminal and the original documents are automatically output through a facsimile.

N-benzyl-D-glucamine dithiocarbamate and N-p-isopropylbenzyl-D-glucamine dithiocarbamate improve the protective effect of diethyldithiocarbamate against cadmium-induced testicular toxicity in rats

The protective effects of combined treatment with diethyldithiocarbamate (DED) plus N-benzyl-D-glucamine dithiocarbamate (BGD) or DED plus N-p-isopropylbenzyl-D-glucamine dithiocarbamate (PBGD) against the testicular toxicity caused by acute exposure to cadmium (Cd) in rats were studied. Rats were injected subcutaneously with 109CdCl2 (3 mg Cd and 74 kBq of 109Cd/kg) and 30 min later, they were injected intraperitoneally with the chelating agents (1 mmol/kg each). Cd injection increased lipid peroxidation and concentrations of hemoglobin, Ca and Fe in the testes, decreased the testicular weight and nonprotein SH (NP-SH), and caused sterility. The coadministration of DED with BGD or PBGD significantly prevented the increase in the lipid peroxidation, hemoglobin, Ca and Fe in the testes, the decrease in the testicular weight and NP-SH, and the sterility caused by Cd injection. DED plus BGD or DED plus PBGD significantly decreased the Cd concentration in the testes without the redistribution of Cd to the brain and kidney, which is observed following treatment with DED alone. The coadministration of DED plus BGD or DED plus PBGD significantly increased the blood Cd concentration and the Cd distribution in the red blood cells compared to Cd alone. These results indicate that the coadministration of BGD or PBGD with DED prevents the accumulation of Cd in the testes on the basis of greater blood distribution of Cd, which results from the uptake of Cd by the red blood cells, without the redistribution of Cd to the brain, resulting in an improvement of the protective effect of DED against the Cd-induced testicular toxicity.

Mean nuclear volume of bladder cancer: stereological estimation and its clinical value

Mean nuclear volumes (MNVs) of bladder cancer cells from the specimens of 100 patients were estimated by stereological procedure. The value of MNVs of bladder cancer were ranged widely, from 114.6 to 1,041.9 microns3. However, strong correlation was observed between MNV and histopathological grade and stage. Furthermore, the MNV predicts the biological behavior including the malignant potential and prognosis of the patient. Patients with MNV below 315 microns3 had significantly better prognosis than those with MNV above this value (p < 0.01). The 5- and 10-year survival rates for patients with MNV below 315 micron3 were both 97%, while those for patients with MNV above 315 microns3 were 65 and 58%, respectively. MNVs of the recurrent tumors were significantly increased, compared with those of the initial tumors (p < 0.01). MNV of extirpated tumor specimens following chemotherapy consisting of cisplatin and Adriamycin through balloon-occluded arterial infusion (BOAI) was significantly decreased, compared with that before BOAI (p < 0.01). We conclude that the MNV is an excellent predictor for the prognosis of the patient and the tumor recurrence. Furthermore, the stereological estimation of nuclear volume is a simple, quick, inexpensive, and reliable method to assess quantitative analysis of the histological and biological character of bladder cancer.

Multimodality therapy for advanced clear cell sarcoma of the kidney in a young adult

We report a clear cell sarcoma of the kidney (CCSK) in a young adult with multiple liver and bone metastases who was treated with surgery, chemotherapy and radiation. Combination chemotherapy consisting of vinblastine, actinomycin D, cyclophosphamide, pepleomycin, cisplatin (modified VAB-6 regimen) and arterial infusion of mitomycin C and doxorubicin into the hepatic artery resulted in the complete disappearance of the liver metastasis. Although systemic and localized combination chemotherapies were very effective against the liver metastasis, the clinical course was that of high-grade malignancy, resulting in death with brain metastasis 32 months after tumor resection. Differing from typical Wilms tumor in children, the treatment of CCSK has been a subject of controversy, particularly in the advanced and adult type. Nevertheless, we consider that the multimodal treatment has an important role in the stabilization of metastatic lesions even at an advanced stage in the adult type of CCSK.

[Multilocular cystic renal cell carcinoma: a report of two cases]

Two cases of multilocular cystic renal cell carcinomas in a 48-year-old man and in a 41-year-old woman are reported. Radical nephrectomy was performed in both cases. Both histologic diagnoses were multilocular cystic renal cell carcinoma, clear cell subtype, grade 1. We had some difficulty in diagnosing the latter case with multilocular cystic mass which had smooth, glistening lining and contained clear-yellow fluid. Microscopical examination of the permanent sections revealed that the cysts were lined by a cuboidal or flattened epithelium, but no tumor cells. However, laminar growth of renal cell carcinoma of the clear cell type was present in several areas in the septa, and a few residual tumor cells were found in the hyalinized septa. When renal cell carcinoma is present in only a part of the multilocular cystic renal mass, it should be diagnosed as multilocular cystic renal cell carcinoma. The literature was surveyed.

In vitro culture of coconut endosperm: callus induction and its fatty acids

Successful induction of callus from coconut endosperm was achieved by using the tissue situated near the micropylar end of a young fruit. For initiation of callus, a high concentration of auxin (20 to 100 ppm) was added to the basal medium containing activated charcoal. Subcultured callus showed a 40-fold increase during culture of three months. Based on the analysis of fatty acid composition, the maturation of endosperm was characterized by an increase in short chain fatty acids (C8, C10, C12, C14)and a decrease in long chain fatty acids (C16, C18: 1, C18: 2). In developing endosperms, proportion of short chain fatty acids was higher in lipids of the antipodal than those of other regions. In the final stage of maturation, around 82% of total fatty acids was short chain fatty acids, while the proportion of long chain fatty acids decreased up to 16%. The fatty acid composition of callus subcultured for six months was comparable to that of the immature endosperm. Lipids were accumulated in callus as globular bodies.

[A case of a child with extra-adrenal pheochromocytoma associated with renovascular hypertension]

A 7-year-old female was discovered to be severely hypertensive. Urinary noradrenaline excretion and plasma noradrenaline level were elevated. Plasma renin activity was markedly elevated. She was found to have a mass in the hilus of the left kidney and left renal artery stenosis. Magnetic resonance imaging (MRI) of the mass revealed an extremely bright lesion on T2 weighted image. DMSA renal scintigraphy revealed a low uptake rate (4.7%) in the left kidney. A diagnosis of extra-adrenal pheochromocytoma associated with left sided renal artery stenosis was made. The mass and left kidney were removed. Electronmicroscopic examination of the mass revealed characteristic neurosecretory granules. There was only slight fibrosis in the wall of the removed left renal artery.

Effects of dithiocarbamates on testicular toxicity in rats caused by acute exposure to cadmium

N-Benzyl-D-glucamine dithiocarbamate (BGD), N-p-isopropylbenzyl-D-glucamine dithiocarbamate (PBGD), and diethyl-dithiocarbamate (DED) were compared for their protective effects against the testicular toxicity in rats induced by acute exposure to cadmium. Rats were injected subcutaneously with 109CdCl2 (3 mg Cd and 74 kBq of 109Cd/kg) and 30 min later, they were injected intraperitoneally with the chelating agents (0.4 or 3 mmol/kg). Cadmium injection increased lipid peroxidation and concentrations of hemoglobin and Ca in the testes, decreased the testicular weight, and caused sterility. The treatment with BGD (0.4 mmol/kg) did not satisfactorily protect against the testicular toxicity of cadmium. The administration of PBGD or DED at a dose of 3 mmol/kg significantly prevented the increase in the lipid peroxidation and hemoglobin concentration in the testes, the decrease in the testicular weight, and the sterility caused by cadmium. PBGD and DED significantly decreased the cadmium concentration in the testes, but DED increased the cadmium concentration in the kidney and brain. Only DED significantly prevented the increase in the testicular Ca concentration after cadmium. These results indicate that PBGD and DED protect against the sterility caused by cadmium in rats and that the effect of DED to increase the brain level of cadmium is more dangerous than the lack of effect of PBGD to prevent the increase in the testicular Ca level. The protective effects of PBGD and DED against the cadmium-induced testicular toxicity presumably result from a decrease in the cadmium concentration in the testes.

Hemorrhagic myocardial infarction after reperfusion detected by X-ray CT--experimental and clinical study

The purpose of this study was to determine whether computed tomography (CT) can detect hemorrhagic infarction occurring after intracoronary thrombolytic therapy (ICT) for acute myocardial infarction (AMI). In an experimental study, 12 dogs underwent 2-4 h of left anterior descending artery (LAD) occlusion, followed by reperfusion, and infusion of contrast material into the LAD. After CT examination, the heart was cut into transverse sections. A good correlation was obtained between the CT-enhanced area and the hemorrhagic area in the sliced heart section (r = 0.895, p less than 0.001). In a clinical study, we applied CT immediately after ICT in 25 patients with AMI. In 13 of 25 patients, the CT showed post-ICT myocardial enhancement areas. To evaluate the relationship of the enhancement areas shown by CT to the viability of the myocardium, we compared enhancement areas by CT with the corresponding perfusion defect areas of Thallium-201 imaging (SPECT) one month later. There was no significant correlation between the enhancement areas and perfusion defect areas (r = 0.38, p greater than 0.1). The SPECT defect areas were consistently smaller than the CT enhancement areas. These results indicate that CT can detect hemorrhage into the myocardium after ICT, and that after ICT half the AMI patients showed hemorrhagic infarction. However, hemorrhage did not cause complete deterioration of the myocardium.

Clinical experience of the Kock continent ileal urinary reservoir in 20 cases focusing on complications

From August 1986 through July 1990, 20 patients underwent construction of the Kock continent ileal reservoir and were observed for more than three months. The early complications within the first 3 months were wound infection in four patients (20%), leakage at uretero-intestinal anastomosis in three patients (15%), prolapse of efferent limb and ileus in two patients (10%) and reflux, ureteral stenosis, intestinal fistula and postoperative pancreatitis in one patient (5%). The three late complications included stone formation in two patients and stenosis at an afferent limb in one patient. The stenosis occurred at the position of Dacron collar. The patients were divided into two groups and we compared the recent 10 patients with the initial 10 patients on complications and end results. In the initial group, 8 patients (80%) had 14 complications. In the recent group, 4 patients had 4 complications. The early complications have been reduced with the increase of Kock pouch operation. The result of the recent group was better than that of the initial group. Frequency of postoperative hydronephrosis in patients with Kock pouch was investigated. In nine patients (45%) the minimal hydronephrosis occurred within the first two months and in 5 patients (25%) three months after the operation. It had a normalizing tendency. The maximum pouch pressure at the pouch volume of 400 to 500 ml was not significantly high (37.9 +/- 12.2 cmH2O, mean +/- S.D.).

The syntheses of plastocyanin and cytochrome c-553 are regulated by copper at the pre-translational level in a green alga, Pediastrum boryanum

The green alga Pediastrum boryanum synthesizes alternatively two photosynthetic electron carrier proteins, plastocyanin and cytochrome c-553, depending on the copper concentration of the medium. We studied the levels at which the syntheses of the two proteins are regulated. Plastocyanin and cytochrome c-553 were purified from P. boryanum NIES-301 cells, having apparent molecular weights of 14,600 and about 12,000, respectively. Western blotting with antisera raised against these proteins showed accumulation of (apo)plastocyanin and (apo)cytochrome c-553 in the cells grown with (2 microM) and without added CuSO4, respectively, but no accumulation of the precursor proteins in both cultures. The translatable mRNAs for the two proteins were examined by in vitro translation with total RNA and wheat germ extract followed by immunoprecipitation and SDS-PAGE. The 21-kDa polypeptide (preapoplastocyanin) was detected with anti-plastocyanin serum in copper-sufficient cells; the 23-kDa polypeptide (preapocytochrome c-553) with anti-cytochrome c-553 serum in copper-deficient cells. The translatable mRNA for preapoplastocyanin appeared in 1 h and (apo)plastocyanin in 2-3 h after the addition of 2 microM CuSO4 to the copper-deficient culture. The translatable mRNA for preapocytochrome c-553 disappeared within 4-5 h, while (apo)cytochrome c-553 disappeared more slowly. It is concluded that the syntheses of plastocyanin and cytochrome c-553 are regulated by copper at the pre-translational (i.e., transcriptional or post-transcriptional) level in P. boryanum NIES-301.

[A clinical study on renal cell carcinoma]

A retrospective study was carried out on 95 patients affected with renal cell carcinoma (RCC) between January 1973 and December 1988. Male to female ratio was 3 to 1 and the average age was 61 years. Hematuria was the most common initial symptom (44 patients, 46.3%), followed by incidental findings (18 patients, 18.9%). Five- and 10-year survival rates for all patients with RCC were 51.9 and 37.1%, respectively. Five-year survival rates for stage I, II, III, and IV were 82.7 54.7, 20.0, and 4.7%, respectively. Statistical analyses identified variables that significantly influenced survival, including lymph node metastasis (p less than 0.01) and distant metastasis (p less than 0.01). Cell type and renal vein involvement did not influence survival significantly. The three different forms of therapy (mitomycin therapy vincristine therapy and immunological therapy) did not influence survival significantly, but the beneficial effect of VBL therapy was obtained.

Morphological and functional heterogeneity in the rat prostatic gland

Ductal morphogenesis and adult ductal branching patterns were examined in the rat prostate by a microdissection method. The rat prostate consists of paired (right and left) subdivisions which correspond in large part to the classically defined lobes: ventral prostate, lateral prostate, dorsal prostate, and coagulating gland. Of particular interest was the finding that the lateral prostate consists of two different ductal zones: (1) lateral type 1 prostate with 5-7 long main ducts (resembling miniature palm trees) that extend cranially towards both the seminal vesicle and dorsal prostate to arborize near the bladder neck, and (2) lateral type 2 prostate with 5-6 short main ducts that arborize caudal to the bladder neck and give rise to compact bushy glands. Both lateral prostatic groups had a ductal-acinar organization. The adult structure of the other rat prostatic lobes was also examined, and closely resembled their mouse counterparts. The ventral prostate, which had 2-3 pairs of slender main ducts per side, and the coagulating gland, which had 1 main duct per side, was completely ductal in structure. In contrast, the dorsal prostate, which had 5-6 pairs of main ducts per side, had a ductal-acinar structure. Ductal branching morphogenesis occurred at different rates in different lobes and was essentially complete in the prostate at the 30 days. Immunocytochemical studies with an antibody to DP-1, a major secretory protein of the rat dorsal prostate, revealed that secretory function was initiated at approximately 30 days after birth in the coagulating gland, the dorsal prostate, and lateral type 1 prostate. A consistent feature of the lateral type 2 prostate was the absence of DP-1. On Western blots, DP-1 was detected in the secretion of the coagulating gland, lateral type 1 and dorsal prostate, but not in the ventral and lateral type 2 prostate. Polyacrylamide gel electrophoresis confirmed this result and demonstrated that the lateral type 2 prostate expressed several low-molecular weight secretory proteins not found in the other lobes of the prostate. On the whole, the rat prostate exhibited considerable heterogeneity both between and within lobes in developmental processes, ductal patterning, histology, and functional expression.

[A clinical investigation on renal pelvic and ureteral tumors]

The 60 cases of primary renal pelvic and ureteral tumors treated at Mie University hospitals between January 1977 and December 1987 were reviewed and factors predicting the prognosis were investigated. The patients consisted of 47 men and 13 women (3.6: 1.0). Their ages ranged from 38 to 82 years with a mean of 65.2 years. According to Akaza's category classification of the ureteropelvic tumor, 42 cases were classified to category A, 15 cases category B and 1 case was classified to category C. Histologically, 59 transitional cell carcinomas and 1 squamous cell carcinoma were found. As to grading, 5 was G1, 31 G2, 21 G3 and 2 GX. As to staging, 20 were pT1, 10 pT2, 21 pT3, 3 pT4 and 6 pTX. Staging was correlated well with grading. Total nephroureterectomy with bladder cuff was performed on 39 patients and the other surgical treatments were done on 15 patients. Recurrence of the bladder tumor was found in 22.4%. The 5-year survival rate (Kaplan-Meier's method) was 47.8% for all of the patients. Among the patients with transitional cell carcinoma, the 5-year survival rate was 100% for G1, 57.6% for G2 and 28.6% for G3. As to staging the 5-year survival rate was 90.0% for below pT1, 20.0% for pT2 and 41.1% for pT3. The results from the present study suggest the prognosis is decided by grade and stage in pelvic and ureteral tumors, and it is wanted to develop a system of postoperative adjuvant therapy.

Sclerotherapy of bleeding esophageal varices using a thrombogenic cocktail

The short- and long-term efficacy of a thrombogenic sclerosant (1% tetradecyl sulfate, thrombin, and cefazolin) was studied in 101 patients. The majority of patients had alcoholic cirrhosis with Child's C classification (84/101). Bleeding was controlled in 94 per cent of patients with the first sclerotherapy. In-hospital and early (within 6 weeks) mortality were 14 per cent and 19 per cent, respectively. There was a strong correlation with hospital mortality and the severity of hepatic disease. Long-term follow-up in 70 patients (mean of 16 months) showed that survival correlated with compliance to follow-up sclerotherapy and abstention from further alcohol intake. Mortality in patients compliant with follow-up was 5 per cent (1/19), as compared with 24 per cent (12/51) in patients who were not compliant with follow-up sclerotherapy. The mortality in alcoholic cirrhotic patients who abstained from further alcoholic intake was 6 per cent (1/17), as compared with 23 per cent (10/44) in those who continued to abuse alcohol. No systemic thrombotic or allergic events related to the use of bovine thrombin were noted during a total of 349 sclerotherapy sessions.

[Efficacy of combination of Ea-0643 (bunazosin hydrochloride) and bethanechol chloride in patients with neurogenic bladder]

Bethanechol chloride, a cholinergic agent and bunazosin hydrochloride, an alpha adrenergic blocking agent were administered orally to 28 patients with neurogenic bladder due to peripheral nerve disorders. To compare the effect of the two drugs, one of the drugs was initially administered orally for 2 weeks, and then both of them were administered for the next 2 weeks. Since there were some significant differences in the patient background between the two groups, it was difficult to compare the two drugs. However combined use of these drugs resulted in both objective and subjective good responses in those patients.

Biosynthesis of bisbenzylisoquinoline alkaloids in cultured roots of Stephania cepharantha

Cultured roots of Stephania cepharantha, which are rich sources of bisbenzylisoquinoline alkaloids, were fed 14C-labelled tyrosine, tyramine or dopamine. While tyrosine was well incorporated into the bisbenzylisoquinolines, tyramine and dopamine were poorly incorporated. Incorporated tyrosine was shown to be decarboxylated and stored as tyramine in the roots, then gradually converted to the bisbenzylisoquinolines. Tracer experiments using [3-13C]tyrosine demonstrated that tyrosine was specifically incorporated into the corresponding sites of aromoline, which verified that aromoline was composed of four molecules of tyrosine. The ratio of 13C-enrichments of C-4 and C-alpha in (R) and (S) halves of aromoline was the same within experimental limits. This indicated that the two coclaurine units must have one and the same biogenetic origin.

Upper GI bleeding in an urban hospital. Etiology, recurrence, and prognosis

Acute upper gastrointestinal bleeding (UGIB) continues to be a common cause of hospital admission and morbidity and mortality. This study reviews 469 patients admitted to a surgical service of an urban hospital. There were 562 total admissions because 53 patients were readmitted 93 times (recurrence rate, 20%). The most common causes of bleeding, all endoscopically diagnosed, included acute gastric mucosal lesion (AGML) (135 patients, 24%), esophageal varices (EV) (121 patients, 22%), gastric ulcer (108 patients, 19%), duodenal ulcer (78 patients, 14%), Mallory-Weiss tear (61 patients, 11%), and esophagitis (15 patients, 3%). Nonoperative therapy was sufficient in 504 cases (89.5%). Endoscopic treatment was used in 144 cases. Operations were performed in 58 cases (10.5%), including 29% of ulcers. Emergency operations to control hemorrhage were required in only 2.5% of all cases. The rate of major surgical complications was 11% and the mortality rate was 5.2%. There were 58 deaths (12.6%), with 36 deaths directly attributable to UGIB. Factors correlating with death include shock at admission (systolic blood pressure less than 80), transfusion requirement of more than five units, and presence of EV (all p less than 0.001). Most cases of UGIB can be treated without operation, including endoscopic treatment, when diagnostic endoscopy establishes the source. Subsequent operation in selected patients can be done with low morbidity and mortality rates.

[Correlation between histologic grading and prognosis of prostatic cancer--comparing the grading system of the Japanese general rules of prostatic cancer with Gleason's grading]

To evaluate the correlation between the histological grade and the prognosis, we reviewed 100 cases of prostatic cancer according to the Japanese General Rules of Prostatic Cancer (JGRPC) and Gleason grading system. The study led to the following results: (1) There was a close relation between the JGRPC grade and Gleason score (GS). (2) The JGRPC grade and Gleason score were equally concerned with the clinical stage. (3) There were significant differences in survival rate between well and moderately, well and poorly differentiated groups by the JGRPC grading system, and between GS 2-4 and GS 5-7, GS 2-4 and GS 8-10 groups by Gleason score. (4) In proportion to the JGRPC grade, the cancer death rate increased linearly in each stage. (5) When the patients were grouped according to their JGRPC grades of main lesion and accompanied lesion, the cancer death rate increased in the cases with lower differentiated elements. We conclude that the JGRPC grading system is easily comprehensible, and equal with the Gleason grading system to predict the prognosis of prostatic cancer.

A specific 70 kDa protein induced in the epileptogenic cortex of rats elicits bursting activity and inactivation of potassium current in snail neurons

The capability of a specific 70 kDa (P70) protein produced in cobalt-induced epileptogenic cortex of rat cerebrum in promoting epileptic bursting activity was examined in snail neurons, using the voltage clamp method in combination with the pressure injection technique. Injection of P70 into the neurons elicited bursting activity with paroxysmal depolarization shift together with a reduction in the delayed outward current which was suppressed by tetraethylammonium. These changes of membrane properties induced by P70 were dose-dependently inhibited by prior treatment with the anticonvulsant phenytoin. These findings indicate that P70 causes an inactivation of potassium conductance which may generate epileptic bursting activity.

[A case of renal cell carcinoma and bladder carcinoma associated with von Hippel-Lindau disease]

A case of renal cell carcinoma and bladder carcinoma associated with von Hippel-Lindau disease is reported. A 31-year-old female was referred to the Department of Urology for further examination of right renal mass which was incidentally found on abdominal computed tomography (CT). The patient was operated on spinal hemangioma in May 19 and July 8, 1975, on cerebellar hemangioblastoma in July, 1976 and June 10, 1981 and on cerebellar cyst in June 20, 1988. Angiography revealed three hypervascular renal tumors in the right kidney. Cystoscopy revealed a papillary bladder tumor (TCC Grade 1). Transurethral resection of bladder carcinoma was performed on July 28, 1988. Right radical nephrectomy and lymphadenectomy were performed on August 2, 1988. Histopathologically, the tumor was renal cell carcinoma of clear cell type (Grade 1). Postoperative course was uneventful and the residual kidney is being followed up in the outpatient clinic.

[A case report of extragonadal germ cell tumor with retroperitoneal origin]

A case of extragonadal germ cell tumor is reported. A 41-year-old man, an elementary school teacher, was referred to our department with left abdominal pain and gynecomastia on September, 1985. Laboratory examinations revealed markedly high levels of LDH, AFP and HCG-beta. IVP and abdominal CT disclosed dislocation of the left kidney and the large left retroperitoneal mass. The mass was supplied by the left lumbal arteries on the aortogram. Chest X-ray film showed multiple coin lesions in the bilateral lung fields. By percutaneous needle biopsy, the histological finding of the tumor showed choriocarcinoma. No abnormal findings were found in either testicle by the physical and ultrasonic examinations. This case was diagnosed as extragonadal choriocarcinoma with lung metastasis. After 3 courses of chemotherapy (PVB regimen), resection of the retroperitoneal residual mass and lymphadenectomy were performed. Postoperatively, the chemotherapy, CISCA II - VB IV regimen, was repeated. The patient was discharged after 7 months hospitalization. Now, 35 months after operation, tumor markers, chest X-ray and abdominal CT showed no evidence of recurrence of the tumor.

Crystal structure of plastocyanin from a green alga, Enteromorpha prolifera

The crystal structure of the Cu-containing protein plastocyanin (Mr 10,500) from the green alga Enteromorpha prolifera has been solved by molecular replacement. The structure was refined by constrained-restrained and restrained reciprocal space least-squares techniques. The refined model includes 111 solvent sites. There is evidence for alternate conformers at eight residues. The residual is 0.12 for a data set comprising 74% of all observations accessible at 1.85 A resolution. The beta-sandwich structure of the algal plastocyanin is effectively the same as that of poplar leaf (Populus nigra var. italica) plastocyanin determined at 1.6 A resolution. The sequence homology between the two proteins is 56%. Differences between the contacts in the hydrophobic core create some significant (0.5 to 1.2 A) movements of the polypeptide backbone, resulting in small differences between the orientations and separations of corresponding beta-strands. These differences are most pronounced at the end of the molecule remote from the Cu site. The largest structural differences occur in the single non-beta strand, which includes the sole turn of helix in the molecule: two of the residues in a prominent kink of the poplar plastocyanin backbone are missing from the algal plastocyanin sequence, and there is a significant change in the position of the helical segment in relation to the beta-sandwich. Several other small but significant structural differences can be correlated with intermolecular contacts in the crystals. An intramolecular carboxyl-carboxylate hydrogen bond in the algal plastocyanin may be associated with an unusually high pKa. The dimensions of the Cu site in the two plastocyanins are, within the limits of precision, identical.

[Renal function study assessed by 99mTc-DMSA renal scintigraphy before and after PNL]

99mTc-DMSA renal scintigraphy was carried out in 54 patients with unilateral renal stones before and after PNL. Four to 8 weeks after PNL the DMSA renal uptake significantly decreased to 17.2 +/- 6.0% from 18.2 +/- 6.7% before PNL. DMSA renal uptake did not change in the contralateral side. Since in some patients changes in the DMSA renal uptake of 5-7% were observed after PNL not only in the PNL side but also in the contralateral side, the renal function was assessed by the formula: DMSA renal uptake in the PNL side/DMSA renal uptake in the contralateral side, and the change of this ratio was evaluated in 44 patients, in whom the renal DMSA uptake in the PNL side was less than two times that in the contralateral side. The DMSA renal uptake ratio decreased to 95.6 +/- 8.7% from the base line 4-8 weeks after PNL. This change was statistically significant. Some functional risks such as massive bleeding with PNL, the fever after PNL and the number of nephrostomy tract did not affect the decrease in the renal function. In 29 patients in whom renal function was reevaluated one year after PNL, the DMSA renal uptake ratio significantly decreased to 94.2 +/- 9.6% from the base line 4-8 weeks after PNL. But the ratio significantly improved to 99.6 +/- 11.6% about one year after PNL. In two patients with a cold area on the renal image, the renal function of the operated side still remained at about 80% levels from the base line even one year after PNL.(ABSTRACT TRUNCATED AT 250 WORDS)

[Testicular tumor following orchiopexy: a case report]

Herein we report a 26-year-old patient in whom seminoma developed in the testicle which had been fixed 9 years earlier. Thirty five of such cases in the Japanese literature are reviewed.

[Clinical evaluation of serum prostatic specific antigen in prostatic cancer: simultaneous assays of prostatic specific antigen, gamma-seminoprotein and prostatic acid phosphatase in 113 newly diagnosed patients with prostatic cancer]

Serum prostatic specific antigen (PA), gamma-seminoprotein (gamma-Sm) and prostatic acid phosphatase (PAP) levels were measured in 113 untreated patients with prostatic cancer and in 137 patients with benign prostatic hypertrophy (BPH). We used a PA-TESTWAKO enzyme immunoassay kit, gamma-Sm enzyme immunoassay kit and PAP radioimmunoassay kit. Of the 113 patients, 81.4%, 73.5% and 69%, respectively, were detectable using a single assay. PA was more sensitive than the other two markers in all stages, especially in localized disease (stages A, B and C). Using the BPH group as a negative control, specificities of PA, gamma-Sm and PAP were 85.4%, 81.0% and 94.2%, respectively. Efficiency was, respectively, 81.2%, 79.6% and 82.8%. In the follow up period, 15 patients presented disease progression. At the time of clinical detectable progression, the sensitivities of PA and gamma-Sm were both 100% (15/15), while 67% (10/15) for PAP. Concerning the sensitivity within 6 months prior to progression, gamma-Sm and PA tended to be more sensitive than PAP in early detection of disease progression. This study shows that PA is more reliable than gamma-Sm and PAP in detecting and staging of prostatic cancer. gamma-Sm and PA appear to be more reliable in earlier prediction of disease progression.

[Secondary amyloidosis of the bladder associated with Sjögren's syndrome: a case report]

A 57-year-old woman visited the Mie University Hospital with the complaint of lower abdominal pain on December 2, 1987. Cystoscopic examination revealed a non-papillary tumor with a broad base in the left posterior wall. A diagnosis was made by biopsy of the bladder epithelium. Amyloid fibrils were confirmed in the biopsy specimen with polarization and electron microscopies. Symptomatic secondary amyloidosis of the bladder is very rare. To date, only 15 cases have been reported in the American and European literatures. This seems to be the first case reported in Japan.

Some properties and amino acid sequence of plastocyanin from a green alga, Ulva arasakii

Plastocyanin was purified from a multicellular, marine green alga, Ulva arasakii, by conventional methods to homogeneity. The oxidized plastocyanin showed absorption maxima at 252, 276.8, 460, 595.3, and 775 nm, and shoulders at 259, 265, 269, and 282.5 nm; the ratio A276.8/A595.3 was 1.5. The midpoint redox potential was determined to be 0.356 V at pH 7.0 with a ferri- and ferrocyanide system. The molecular weight was estimated to be 10,200 and 11,000 by SDS-PAGE and by gel filtration, respectively. U. arasakii also has a small amount of cytochrome c6, like Enteromorpha prolifera. The amino acid sequence of U. arasakii plastocyanin was determined by Edman degradation and by carboxypeptidase digestion of the plastocyanin, six tryptic peptides, and five staphylococcal protease peptides. The plastocyanin contained 98 amino acid residues, giving a molecular weight of 10,236 including one copper atom. The complete sequence is as follows: AQIVKLGGDDGALAFVPSKISVAAGEAIEFVNNAGFPHNIVFDEDAVPAGVDADAISYDDYLNSKGETV VRKLSTPGVY G VYCEPHAGAGMKMTITVQ. The sequence of U. arasakii plastocyanin is closet to that of the E. prolifera protein (85% homology). A phylogenetic tree of five algal and two higher plant plastocyanins was constructed by comparing the amino acid differences. The branching order is considered to be as follows: a blue-green alga, unicellular green algae, multicellular green algae, and higher plants.

[A case report of adult Wilms' tumor]

A 49-year-old women who presented with right upper abdominal mass and back pain had a nephroblastoma, Wilms' tumor, in the right kidney. After radical nephrectomy the patient was treated with chemotherapy in the form of actinomycin D and vincristine. Despite the intensive chemotherapy, the patient died of respiratory failure by multiple metastasis at chest wall and lung. The pathology and treatment of adult Wilms' tumor were discussed.

[A case of bilateral testicular germ cell tumor]

A case of bilateral successive tumor of germ cell origin is reported. A 29-year-old man visited our clinic with a complaint of swelling of right scrotal contents 18 months after initial left orchiectomy for a seminoma. The right orchiectomy was performed and its histological finding was also seminoma. Between 1965-1987 we treated 55 patients with testicular germ cell tumors. Two of them suffered a second germ cell tumor. One of them who had different histology of teratocarcinoma on left side and seminoma on right side had been reported previously. Herein, we report the second case and review the literature.

Synthetic studies of 1-beta-methylcarbapenem antibiotics

The diastereoselective synthesis of the 1-beta-methylcarbapenems, (1R,5R,6S)-6-((R)-1-hydroxyethyl)-2-((S)-1-acetimidoylpyrrolidin-3 - ylthio)-1- methyl-1-carbapen-2-em-3-carboxylic acid and sodium (1R,5R,6S)-6-((R)-1-hydroxyethyl)-2-(5-chloro-2-oxobenzoxazolin-3- y l)-1- methyl-1-carbapen-2-em-3-carboxylate has been achieved. The key step was an aldol reaction between the achiral boron enolate which was generated from dibutylboron triflate and 3-propionyl-2-oxobenzoxazoline, and (3R,4R)-4-acetoxy-3-((R)-1-hydroxyethyl)azetizin-2-one.

[Comparison of non-HPLC 1 alpha, 25(OH)2D assay system with the HPLC method]

Recently, a method not requiring high performance liquid chromatography (HPLC) has been developed (Amersham Inc., U.K) for the measurement of levels of 1 alpha, 25(OH)2D, which demonstrates the most potent physiological effect among the metabolites of vitamin D. Until recently, purification of 1 alpha, 25(OH)2D fraction with HPLC has been considered indispensable prior to radioreceptor assay of this metabolite. Therefore, we used the Amersham assay system to determine whether it is possible to correctly measure the level of 1 alpha, 25(OH)2D without the HPLC process. The procedures we used were to extract the serum with an organic solvent, followed by fractionation of vitamin D metabolites through an LH-20 column. The products with or without the use of HPLC were submitted to radioreceptor assay using chick embryo intestinal receptors. As a result, it was found that (1) Separation and yield were improved by changing the column size, (1) Serum values 1 alpha, 25 (OH)2D in healthy subjects obtained by HPLC and non-HPLC methods were in good agreement with the theoretical values. Although the values thus obtained in patients with chronic renal insufficiency (with or without dialysis) were somewhat lower than the theoretical values, the result was consistent because there was no significant difference between the tow sets of measured values, and the correlation coefficient was r = 0.990. (3) Variations within the assay were CV = 16.5% for HPLC group and CV = 21.4% for non-HPLC group.(ABSTRACT TRUNCATED AT 250 WORDS)

[Establishment of the new cell lines derived from the human renal cell carcinoma and study of the sensitivity test of anti-cancer drugs to cell lines]

We took cultures of many human renal cell cancers and established two cell lines in vitro which were derived from the spindle cell carcinoma of a 67-year-old woman (MR-1) and from the dark cell carcinoma of a 74-year-old woman (MR-2). Using a nude mouse, we established the cell line in vivo (MRV) which was derived from the same patient as that for MR-1. MR-2 was maintained through 140 passages and MR-2 110 passages. MRV was maintained through 7 passages. With passaging, the characteristics, the doubling times and the chromosomal numbers of these cell lines changed, these changes were caused by the transformation, the mutation and the selection of the passaging cells. The study of the sensitivity test of the anti-cancer drugs to the established cell lines was done using the radioisotope uptake assay in vitro and the tumor volume changes in nude mice in vivo. We considered there were differences between the effective drugs used in vitro assay and in vivo assay. As to radioisotope uptake assay, it is difficult to judge the exact effect of the plant alkaloids, which inhibit the cell division and are dependent on the contact time, and we may overestimate the effect of the cytotoxic antibiotics. Further investigation on the methodology of the sensitivity test of the anti-cancer drugs would be necessary for the clinical application.