Does every patient with ureteropelvic junction obstruction need voiding cystourethrography?

PURPOSE

Voiding cystourethrography is routinely recommended to detect vesicoureteral reflux in children with ureteropelvic junction obstruction. Vesicouretral reflux coexisting with primary ureteropelvic junction obstruction is usually of low grade and resolves spontaneously after pyeloplasty, whereas pseudo ureteropelvic junction obstruction and obstruction secondary to high grade reflux usually present with a dilated ureter that is easily detected on real-time ultrasonography. We assessed the role of voiding cystourethrography in children with ureteropelvic junction obstruction by retrospectively evaluating the incidence and natural history of coexisting vesicourethral reflux.

MATERIALS AND METHODS

We reviewed the records of 106 children younger than 15 years who underwent pyeloplasty for ureteropelvic junction obstruction at our hospital between January 1990 and December 1998. A patient who had initially undergone antireflux surgery later underwent pyeloplasty for newly developed secondary obstruction was not included in the analysis. The diagnosis of ureteropelvic junction obstruction was based on ultrasonography and diuretic renography. Preoperative voiding cystourethrography was performed in all patients to detect vesicourethral reflux. We categorized reflux as low grade if the ureters were not dilated and as high grade if the ureters were dilated and tortuous.

RESULTS

There were 89 boys and 17 girls who underwent 115 pyeloplasties, including 9 who underwent bilateral pyeloplasty. Mean patient age at surgery was 27.4 months (63 infants, 6 between 1 and 2 years old, and 37 older than 2 years). Of these 106 patients 85 had unilateral (left side 64, right side 21) and 21 had bilateral ureteropelvic junction obstruction. Vesicourethral reflux was documented in 19 ureters of 12 children. Of the 85 cases of unilateral ureteropelvic junction obstructions 10 had vesicourethral reflux, which was bilateral 6, ipsilateral in 2 and contralateral in 2. Of the 21 cases of bilateral obstructions 2 had reflux, which was bilateral in 1 and was unilateral in 1. Reflux was low grade reflux in 6 and high grade in 6 cases. All low grade reflux disappeared spontaneously at an average period of 4.2 months (range 2 to 10) after pyeloplasty. All 6 patients with high grade reflux subsequently underwent antireflux surgery because of breakthrough urinary tract infection in 2 and persistent in 4 at an average of 36 months (range 3 to 112) after pyeloplasty. All high grade reflux coexisting with ureteropelvic junction obstruction was easily detected on real-time ultrasonography.

CONCLUSIONS

Low grade reflux coexisting with ureteropelvic junction obstruction spontaneously disappeared after pyeloplasty, and all high grade reflux coexisting with obstruction was easily detected on ultrasonography using real-time mode. Therefore, we believe that indication for voiding cystourethrography in children with ureteropelvic junction obstruction should be limited to those with dilated ureters on ultrasonography.

A case of hemorrhagic gallbladder paraganglioma causing acute cholecystitis

Gallbladder paraganglioma is a very rare tumor and so far only a few cases have been reported. Most of these were asymptomatic and were found incidentally during operation. Recently, we experienced a gallbladder paraganglioma that gave rise to hemorrhage, which in turn caused acute cholecystitis. Our case involved a 45 year-old female patient complaining of an intermittent right upper abdominal pain. After a preoperative evaluation, cholecystectomy and lymphadenectomy were performed under the impression of gallbladder cancer with acute cholecystitis. Postoperative pathologic examination revealed a hemorrhagic gallbladder paraganglioma accompanied by acute cholecystitis. Immunohistochemical staining of the chief cells for neuron specific enolase, chromogranin and synaptophysin were positive. Sustentacular cells also stained positively for S100 protein.

Does every patient with ureteropelvic junction obstruction need voiding cystourethrography?

PURPOSE

Voiding cystourethrography is routinely recommended to detect vesicoureteral reflux in children with ureteropelvic junction obstruction. Vesicouretral reflux coexisting with primary ureteropelvic junction obstruction is usually of low grade and resolves spontaneously after pyeloplasty, whereas pseudo ureteropelvic junction obstruction and obstruction secondary to high grade reflux usually present with a dilated ureter that is easily detected on real-time ultrasonography. We assessed the role of voiding cystourethrography in children with ureteropelvic junction obstruction by retrospectively evaluating the incidence and natural history of coexisting vesicourethral reflux.

MATERIALS AND METHODS

We reviewed the records of 106 children younger than 15 years who underwent pyeloplasty for ureteropelvic junction obstruction at our hospital between January 1990 and December 1998. A patient who had initially undergone antireflux surgery later underwent pyeloplasty for newly developed secondary obstruction was not included in the analysis. The diagnosis of ureteropelvic junction obstruction was based on ultrasonography and diuretic renography. Preoperative voiding cystourethrography was performed in all patients to detect vesicourethral reflux. We categorized reflux as low grade if the ureters were not dilated and as high grade if the ureters were dilated and tortuous.

RESULTS

There were 89 boys and 17 girls who underwent 115 pyeloplasties, including 9 who underwent bilateral pyeloplasty. Mean patient age at surgery was 27.4 months (63 infants, 6 between 1 and 2 years old, and 37 older than 2 years). Of these 106 patients 85 had unilateral (left side 64, right side 21) and 21 had bilateral ureteropelvic junction obstruction. Vesicourethral reflux was documented in 19 ureters of 12 children. Of the 85 cases of unilateral ureteropelvic junction obstructions 10 had vesicourethral reflux, which was bilateral 6, ipsilateral in 2 and contralateral in 2. Of the 21 cases of bilateral obstructions 2 had reflux, which was bilateral in 1 and was unilateral in 1. Reflux was low grade reflux in 6 and high grade in 6 cases. All low grade reflux disappeared spontaneously at an average period of 4.2 months (range 2 to 10) after pyeloplasty. All 6 patients with high grade reflux subsequently underwent antireflux surgery because of breakthrough urinary tract infection in 2 and persistent in 4 at an average of 36 months (range 3 to 112) after pyeloplasty. All high grade reflux coexisting with ureteropelvic junction obstruction was easily detected on real-time ultrasonography.

CONCLUSIONS

Low grade reflux coexisting with ureteropelvic junction obstruction spontaneously disappeared after pyeloplasty, and all high grade reflux coexisting with obstruction was easily detected on ultrasonography using real-time mode. Therefore, we believe that indication for voiding cystourethrography in children with ureteropelvic junction obstruction should be limited to those with dilated ureters on ultrasonography.

Measurement of B(0)(d)-B_(0)(d) mixing rate from the time evolution of dilepton events at the upsilon(4S)

We report a determination of the B(0)(d)-&B_(0)(d) mixing parameter Deltam(d) based on the time evolution of dilepton yields in Upsilon(4S) decays. The measurement is based on a 5.9 fb(-1) data sample collected by the Belle detector at KEKB. The proper-time difference distributions for same-sign and opposite-sign dilepton events are simultaneously fitted to an expression containing Deltam(d) as a free parameter. Using both muons and electrons, we obtain Deltam(d) = 0.463+/-0.008 (stat)+/-0.016 (syst) ps(-1). This is the first determination of Deltam(d) from time evolution measurements at the Upsilon(4S). We also place limits on possible CPT violations.

Caffeine as a lipolytic food component increases endurance performance in rats and athletes

Caffeine is one of the famous ergogenic aids in the athletic field. Caffeine has been known to stimulate lipolysis that spares stored glycogen utilization during moderate intensity exercise. Therefore, we investigated the effects of caffeine ingestion on exercise performance in rats and athletes. Rats were administered the caffeine (6 mg/kg) 1 h prior to the exercise then were run on a treadmill at a speed of 20 m/min. They were decapitated at 0 min, 30 min, 60 min of exercise, and exhausted time point. Human subjects ingested the caffeine (5 mg/kg) 1 h prior to the exercise. They exercised on a cycle ergometer at 60% of their VO2max for 45 min, and then the exercise intensity was increased to 80% of their VO2max until exhaustion. Blood and breathing gas samples were collected and calculated every 10 min during exercise. Respiratory exchange ratio of the caffeine trial was significantly lower than that of the placebo trial in the athletes' study (p<0.05). Blood free fatty acid (FFA) levels in studies of both rats and athletes were increased by caffeine ingestion during exercise (p<0.05). Blood lactate levels were also increased during exercise in both rats and athletes (p<0.05). Increased FFA and glycerol concentrations reduced glycogen utilization during exercise compared with placebo group in rats. In addition, endurance time to exhaustion was significantly increased by the caffeine ingestion in both rats and athletes (p<0.05). These results suggest that the caffeine ingestion enhanced endurance performance resulting from spare stored glycogen with increasing lipolysis from adipose tissues and fat oxidation during exercise both in rats and in athletes.

Measurement of the CP violation parameter sin2 phi(1) in B(0)(d) meson decays

We present a measurement of the standard model CP violation parameter sin2 phi(1) (also known as sin2beta) based on a 10.5 fb(-1) data sample collected at the Upsilon(4S) resonance with the Belle detector at the KEKB asymmetric e(+)e(-) collider. One neutral B meson is reconstructed in the J/psiK(S), psi(2S)K(S), chi(c1)K(S), eta(c)K(S), J/psiK(L), or J/psipi(0) CP-eigenstate decay channel and the flavor of the accompanying B meson is identified from its charged particle decay products. From the asymmetry in the distribution of the time interval between the two B-meson decay points, we determine sin2 phi(1) = 0.58(+0.32)(-0.34)(stat)+0.09-0.10(syst).

Massive gastrointestinal bleeding from jejunal varices

We report a patient with massive gastrointestinal bleeding from jejunal varices, confirmed by emergency laparotomy. A 54-year-old woman was admitted to Chonnam National University Hospital with a 5-day history of melena with hematochezia. Fifteen years previously, she had undergone cholecystectomy for gallstone. Seven years previously, she had undergone an operation because of possible common bile duct stone. The details of this operation were not known. Upper gastrointestinal endoscopy revealed no varices in the esophagus, stomach, and proximal duodenum. Colonoscopy demonstrated black-colored blood clots throughout the colon. A technetium-99m-labeled red blood cell (RBC) scan showed active proximal small bowel bleeding. Abdominal aortic angiography revealed mesenteric varices in the upper abdomen, but no active bleeding source was recognized. Because of the patient's continued massive gastrointestinal bleeding despite medical therapy, emergency laparotomy was performed. We found evidence of micronodular cirrhosis of the liver and an apparent Roux-en-Y anastomosis. There were numerous collateral variceal vessels in the jejunal limb with the liver and abdominal wall. Segmental resection of the involved jejunum and end-to-end anastomosis were perdilated formed. Histologic examination revealed submucosal veins with mucosal erosion.

Involvement of acetyl phosphate in the in vivo activation of the response regulator ComA in Bacillus subtilis

Development of genetic competence in Bacillus subtilis is regulated by ComP--ComA, a two-component signal transduction system. The response regulator ComA is primarily activated by ComP, a histidine kinase that mediates response to nutrient conditions and cell density, and the activated ComA is required for transcription of the srf operon, which is essential for the development of genetic competence and surfactin production. In this study we suggested that the ComA could also be activated by a small molecule phospho-donor, acetyl phosphate. Examination of srfA-lacZ expression indicated that a significant amount of srfA expression still occurs in the comP mutant during growth in a sporulation medium containing excess glucose. Analysis of a comP and pta mutant suggests that srfA activation seen in the comP mutant is dependent on the expression of pta, which encodes phosphotransacetylase (Pta). As Pta is responsible for the catalysis for conversion of acetyl coenzyme A to acetyl phosphate, we conclude that the expression of srfA seen in the comP mutant is mainly due to the activation of ComA by acetyl phosphate.

Genetic variation at eight STR loci in the Korean population

The frequency distributions of eight STR loci were surveyed in 510 unrelated individuals from the Korean population

Y-chromosome STR haplotype profiling in the Korean population

Allele and haplotype frequencies of seven Y-chromosome STR loci were determined from a sample of 330 unrelated males in the Korean population.

Closed-loop identification and control application for dissolved oxygen concentration in a full-scale coke wastewater treatment plant

The objective of this paper is to apply a closed-loop identification to actual dissolved oxygen control system in the coke wastewater treatment plant. It approximates the dissolved oxygen dynamics to a high order model using the integral transform method and reduces it to the first-order plus time delay (FOPTD) or second-order plus time delay (SOPTD) for the PID controller tuning. To experiment the process identification on the real plant, a simple set-point change of the speed of surface aerator under the closed-loop control without any mode change was used as an activation signal of the identification. The full-scale experimental results show a good identification performance and a good tracking ability for set-point change. As a result of improved control performance, the fluctuation of dissolved oxygen concentration variation has been decreased and the electric power saving has been accomplished.

A structurally biased combinatorial approach for discovering new anti-picornaviral compounds

BACKGROUND

Picornaviruses comprise a family of small, non-enveloped RNA viruses. A common feature amongst many picornaviruses is a hydrophobic pocket in the core of VP1, one of the viral capsid proteins. The pocket is normally occupied by a mixture of unidentified, fatty acid-like moieties, which can be competed out by a family of capsid-binding, antiviral compounds. Many members of the Picornaviridae family are pathogenic to both humans and livestock, yet no adequate therapeutics exist despite over a decade's worth of research in the field. To address this challenge, we developed a strategy for rapid identification of capsid-binding anti-picornaviral ligands. The approach we took involved synthesizing structurally biased combinatorial libraries that had been targeted to the VP1 pocket of poliovirus and rhinovirus. The libraries are screened for candidate ligands with a high throughput mass spectrometry assay.

RESULTS

Using the mass spectrometry assay, we were able to identify eight compounds from a targeted library of 75 compounds. The antiviral activity of these candidates was assessed by (i) measuring the effect on the kinetics of viral uncoating and (ii) the protective effect of each drug in traditional cell-based assays. All eight of the candidates exhibited antiviral activity, but three of them were particularly effective against poliovirus and rhinovirus.

CONCLUSIONS

The results illustrate the utility of combining structure-based design with combinatorial chemistry. The success of our approach suggests that assessment of small, targeted libraries, which query specific chemical properties, may be the best strategy for surveying all of chemical space for ideal anti-picornaviral compounds.

Aggressive epithelial odontogenic ghost cell tumor in the mandible: CT and MR imaging findings

We report a case of aggressive epithelial odontogenic ghost cell tumor arising from the mandible in a 32-year-old man. On CT and MR studies, the tumor was seen as a large, heterogeneous soft-tissue mass that caused marked destruction of the mandible and invaded the mouth floor and tongue base. The tumor displayed a variety of densities and signal intensities on CT and MR images, which correlated well with the degree of cellularity of epithelial islands, abundance of ghost cells and eosinophilic materials, calcification, and cystic areas on histologic sections. Owing to the unpredictable biological behavior of this type of tumor, careful, long-term follow-up is highly recommended.

Clinical results of the transjugular intrahepatic portosystemic shunt (TIPS) for the treatment of variceal bleeding

BACKGROUND

Transjugular intrahepatic portosystemic shunt (TIPS) has been popularized for the treatment of refractory variceal bleeding. The aim of this study was to assess the safety and long-term effect of TIPS in the treatment of variceal bleeding that is not controlled with pharmacological and endoscopic treatment.

METHODS

Thirty-six patients who underwent transjugular intrahepatic portosystemic shunt (TIPS) due to refractory variceal bleeding were included in the study. The effectiveness of portal decompression and bleeding control was evaluated. Upper gastrointestinal endoscopy was performed to analyse the degree of varices and portal hypertensive gastropathy (PHG) before TIPS procedure and one to three weeks after TIPS. Angiography was performed in surviving patients, if bleeding recurred, or if ultrasonography or endoscopy suggested stent dysfunction.

RESULTS

TIPS were successfully placed in 36 of 38 patients (94.6%). TIPS achieved hemostasis of variceal bleeding in 34 patients (94.4%). Portal venous pressure decreased from an initial average of 28.7 +/- 7.9 to 23.2 +/- 9.4 mmHg after TIPS (p < 0.05). The portosystemic pressure gradient was significantly decreased from 15.5 +/- 6.3 to 7.8 +/- 4.1 mmHg (p < 0.01). The degree of esophagogastric varices and PHG was significantly improved after TIPS. The total length of follow-up was from one day to 54 months (mean: 355 days). The actuarial probability of survival was 83% at one year and 74% at two years. Overall, 16 episodes of stent dysfunction were diagnosed during follow-up. Stent revision by means of angioplasty was successfully performed in 14 of these episodes.

CONCLUSION

TIPS is an effective and reliable nonoperative means of lowering portal pressure. This procedure has proved useful in the management of acute variceal bleeding refractory to endoscopic treatment. Surveillance by ultrasonography, endoscopy, and angiographic intervention is useful for the maintenance of shunt patency.

Expression of tissue inhibitors of metalloproteinases (TIMPs) in hepatocellular carcinoma

BACKGROUND

Matrix metalloproteinases (MMPs) have been implicated in the remodelling of extracellular matrix (ECM), including basement membrane. ECM remodelling is associated with pathological processes, including hepatic fibrosis, tumor invasion and metastasis. Tissue inhibitors of metalloproteinase (TIMP)-1 and TIMP-2 were known to inhibit MMP-9 and MMP-2, respectively. In the present study, we examined the expression of TIMP-1 and TIMP-2 in surgical specimen pairs of hepatocellular carcinoma and nontumoral liver and the correlation between their expression and clinicopathological characteristics.

METHODS

The localization of both transcripts and protein of TIMP-1 and TIMP-2 was studied by using in situ hybridization and immunohistochemistry.

RESULTS

TIMP-1 and TIMP-2 mRNA transcripts were found in tumor cells, hepatocyte, sinusoidal cells, endothelial cells and stromal cells. Signal intensity of TIMP-1 was stronger than that of TIMP-2. The results of immunohistochemical stainings were concordant with those obtained by in situ hybridization. Expression of TIMP-1 and TIMP-2 was observed in tumorous tissue, in nontumorous tissue and in the portions of the tumors adjacent to the capsules. However, a clear difference in TIMP-1 and TIMP-2 mRNA expression was not observed among the three tissue types. The intensity of TIMP-2 expression was generally weaker than that of TIMP-1, and the intensity of TIMP-1 and TIMP-2 mRNA expression did not correlate with variable clinicopathological characteristics.

CONCLUSION

TIMPs was expressed in tumor cells and many cell types of the nontumoral liver. Further investigations for TIMPs' unknown functional role are needed.

Prognostic significance of E-cadherin/catenin complex expression in gastric cancer

Abnormal expression of E-cadherin/catenin complex in cancer has been associated with poor differentiation and acquisition of invasiveness, suggesting a possible role of this protein as an invasion suppressor. In this study, we conducted an immunohistochemical investigation of all components of the E-cadherin/catenin complex in 65 gastric cancer patients. Abnormal expression of E-cadherin and, alpha- and gamma-catenin occurred more frequently in diffuse than in intestinal type of gastric cancer, and correlated with poor differentiation. Abnormal expression of E-cadherin and beta-catenin correlated with poor survival. Abnormal expression of all four components of the complex was associated with poorly differentiated and diffuse-type carcinoma, and poor survival. In the multivariate analysis, abnormal expression of the E-cadherin/catenin complex was not an independent prognostic factor. These results suggest that the E-cadherin/catenin complex may be a useful marker of differentiation and prognosis in gastric cancer. Further studies are warranted to clarify the impact of the E-cadherin/catenin complex on prognostic factor of gastric cancer.

A case of epidermoid cyst of the intrapancreatic accessory spleen

A 54-year-old woman presented with a huge palpable mass on left upper quadrant of the abdomen. After preoperative work-up, a cystic disease of pancreatic tail or accessory spleen was initially suspected. We performed exploratory laparotomy and resected both the spleen and a 15 x 11 cm-sized huge cystic mass containing a part of solid component which extended continuously to the pancreatic tail. The solid component, comprising the upper portion of the resected cyst, was reddish brown and granular like as normal splenic tissue. The inner surface of the cyst was smooth and was filled with yellowish white material. Histologic examination showed an epidermoid cyst originating in the accessory spleen of the pancreatic tail lacking hair or skin appendages.

Physical and functional interaction between the eukaryotic orthologs of prokaryotic translation initiation factors IF1 and IF2

To initiate protein synthesis, a ribosome with bound initiator methionyl-tRNA must be assembled at the start codon of an mRNA. This process requires the coordinated activities of three translation initiation factors (IF) in prokaryotes and at least 12 translation initiation factors in eukaryotes (eIF). The factors eIF1A and eIF5B from eukaryotes show extensive amino acid sequence similarity to the factors IF1 and IF2 from prokaryotes. By a combination of two-hybrid, coimmunoprecipitation, and in vitro binding assays eIF1A and eIF5B were found to interact directly, and the eIF1A binding site was mapped to the C-terminal region of eIF5B. This portion of eIF5B was found to be critical for growth in vivo and for translation in vitro. Overexpression of eIF1A exacerbated the slow-growth phenotype of yeast strains expressing C-terminally truncated eIF5B. These findings indicate that the physical interaction between the evolutionarily conserved factors eIF1A and eIF5B plays an important role in translation initiation, perhaps to direct or stabilize the binding of methionyl-tRNA to the ribosomal P site.

Analysis of tnrA alleles which result in a glucose-resistant sporulation phenotype in Bacillus subtilis

Bacillus subtilis cells cannot sporulate in the presence of catabolites such as glucose. During the analysis of Tn10-generated mutants, we found that deletion of the C-terminal region of the tnrA gene, which encodes a global regulator that positively regulates a number of genes in response to nitrogen limitation, results in a catabolite-resistant sporulation phenotype. Analyses of nrg-lacZ and nasB-lacZ, which are activated by TnrA under nitrogen limitation, showed that C-terminally truncated TnrA activates nitrogen-regulated genes constitutively. The relief of catabolite repression of sporulation may result from the uncontrolled expression of the TnrA-regulated genes.

Cloning of a new Bacillus thuringiensis cry1I-type crystal protein gene

A new cry1I-type gene, cry1Id1, was cloned from a B. thuringiensis isolate, and its nucleotide sequence was determined. The deduced amino acid sequence of Cry1Id1 is 89.7%, 87.2%, and 83.4% identical to the Cry1Ia, Cry1Ib, and Cry1Ic proteins, respectively. The upstream sequence of the cry1Id1 structural gene was not functional as promoter in B. subtilis. The Cry1Id1 protein, purified from recombinant E. coli cells, had a toxicity comparable to that of Cry1Ia against Plutella xylostella, but it was significantly less active than Cry1Ia against Bombyx mori. Cry1Id1 was not active against the coleopteran insect, Agelastica coerulea.

Inflammatory pseudotumor of the urinary bladder in a child

The inflammatory pseudotumor of the urinary bladder is rare, especially in children. It is a benign proliferative lesion of the submucosal stroma easily mistaken for a sarcoma clinically, so it should be differentiated from a malignant neoplasm. We report the case of bladder inflammatory pseudotumor in a 7-year-old girl.

New aspects of hepatic fibrosis

Hepatic stellate cells are the major source of extracellular matrix proteins in hepatic fibrosis, including Type I collagen. In response to liver injury, the hepatic stellate cells change from a quiescent to an activated phenotype. This activation process includes a phenotypic change to a myofibroblast-like cell, increased proliferation rate, loss of retinoid stores, increased production of extracellular matrix proteins, chemokines, and cytokines, and contractility. Ongoing studies are characterizing the genes that are differentially expressed in the quiescent and activated hepatic stellate cells. We have also investigated the regulation of Type I collagen expression, the cleavage of collagen propeptides, and the formation of collagen cross-links. Understanding these pathways may provide new insights into the molecular pathogenesis of hepatic fibrosis.

Tomographic measurement of joint photon statistics of the twin-beam quantum state

We report the first measurement of the joint photon-number probability distribution for a two-mode quantum state created by a nondegenerate optical parametric amplifier. The measured distributions exhibit up to 1.9 dB of quantum correlation between the signal and idler photon numbers, whereas the marginal distributions are thermal as expected for parametric fluorescence.