Role of ATP and related purine compounds on urethral relaxation in male rabbits

BACKGROUND

Non-adrenergic, non-cholinergic (NANC) relaxation evoked by electrical field stimulation (EFS) has been observed in the urethra, with nitric oxide (NO) considered the agent most probably mediating this effect. However, Burnstock's purinergic hypothesis suggests that ATP and related purine compounds are neurotransmitters in NANC relaxation, although the physiological and pharmacological effects of ATP and related purine compounds in the urethra have been little studied.

METHODS

The effects of ATP and related purine compounds, NG-nitro-L-arginine (NOARG; an inhibitor of nitric oxide synthesis from L-arginine), calcitonin gene-related peptide (CGRP), substance P and vasoactive intestinal polypeptide (VIP) on relaxation and smooth muscle tension induced by electrical field stimulation (EFS) were studied in isolated male rabbit circular urethral smooth muscle (functional study). In addition, the outflow of ATP elicited by EFS was measured using the luciferase technique (superfusion study). All experiments were performed in the presence of guanethidine (3 x 10(-3) mol/L) and atropine (10(-6) mol/L).

RESULTS

In preparations contracted with U46619, a prostaglandin peroxidase inhibitor, ATP had almost no effect on EFS-induced relaxation; however, suramin, a non-selective P2Y-purinoceptor antagonist, and NOARG each markedly attenuated this relaxation in a concentration-dependent manner. ATP and related purine compounds (adenosine, AMP and ADP) each reduced U46619-induced tonic contraction in a concentration-dependent manner. The potencies of the relaxant effects of ATP and these purine compounds were almost the same. In preparations contracted with U46619, CGRP and substance P had no effect on tonic contraction, but VIP reduced tonic contraction in a concentration-dependent manner. In the superfusion study, the outflow of ATP into the superfusate was markedly increased by EFS. When NOARG or prazosin was added to the superfusate, the increase in outflow of ATP was unchanged, but when suramin was added to the superfusate, no increase in outflow of ATP was observed.

CONCLUSIONS

These findings suggest that P2Y-purinoceptors exist in the male rabbit urethra, and that ATP and related purine compounds may play a role in non-adrenergic, non-cholinergic neurotransmission. Consequently, the pathways mediating urethral relaxation by ATP, NO and VIP may be different.

Potentiation of the activity of nitric oxide by the protein kinase C activator phorbol ester in human myeloid leukemic HL-60 cells: association with enhanced fragmentation of mature genomic DNA

Nitric oxide (NO) has been known to induce programmed cell death or apoptosis in murine macrophages, mouse splenocytes, and thymocytes. We demonstrate here that phorbol ester, a protein kinase C (PKC) activator, synergistically augments the antileukemic actions of the NO in HL-60 human promyelocytic leukemia cells. Exposure of cells to sodium nitro-prusside (SNP; 0.5 to 2 mM), a NO-generating agent, induced time- and concentration-related increases in morphological changes, including condensation of nuclear chromatin, nuclear fragmentation, and the apoptotic peak of propidium iodide-stained nuclei by flow cytometry. Phorbol ester alone had a small effect on inducing DNA damage, whereas SNP in combination with phorbol ester at all concentrations tested markedly increased the extent of fragmentation. Maximal potentiation of fragmentation (e.g., four- to fivefold greater than that obtained with 0.5 mM SNP alone) was observed with simultaneous treatment of phorbol ester. Similar results were obtained with another commonly used NO donor agents such as SNAP (0.5 mM) and GSNO (0.5 mM). DNA fragmentation of HL-60 cells was also augmented by 100 U/ml human recombinant interferon-gamma but not by 1.5% (v/v) DMSO or 1 microM retinoic acid. The stage-2 tumor promotor mezerein also mimicked the effect of phorbol ester to induce NO-induced apoptosis. In contrast, PKC inhibitors such as staurosporine and 1-(5-isoquinolinesulfonyl)-2-methyl-piperazine partially blocked high concentration of SNP (2-3 mM)-induced apoptosis, suggesting that activation of PKC closely relates to the potentiation of the activity of NO on HL-60 cell apoptosis. Under the same conditions, SNP in combination with phorbol ester caused apoptosis in another transformed cell line, U-937 cells, but was ineffective at inducing apoptosis in normal peripheral blood mononuclear cells. Taken together, these findings suggest that exposure of HL-60 cells to phorbol ester renders them more susceptible to NO-induced DNA damage and that this phenomenon contributes to the cytotoxic effects of the NO-PKC combination in myeloid leukemia cells.

Ginsenoside-Rh1 and Rh2 inhibit the induction of nitric oxide synthesis in murine peritoneal macrophages

The effects of ginsenoside-Rh1 and Rh2 in the induction of nitric oxide (NO) synthesis by IFN-gamma plus LPS were investigated using murine peritoneal macrophages. The NO production from rIFN gamma plus LPS-treated macrophages was markedly reduced by ginsenoside-Rh1 or Rh2 in a dose dependent manner, but had no inhibitory effects by ginsenoside-Rb1, Rc or Re. In addition, treatment of the cells with ginsenoside-Rh2 6 hr before the stimulation with IFN-gamma plus LPS showed more inhibitory effect than the treatment with ginsenoside-Rh2 6 hr after or simultaneously with the stimulation with IFN-gamma plus LPS in the NO production. Ginsenoside-Rh2 also effectively inhibited IFN-gamma induced NO production when the cells were treated with IFN-gamma 6 hr after the treatment with ginsenoside-Rh2. Our findings suggest that this phenomenon might be caused by inhibition of priming signal such as IFN-gamma for the synergistic induction of NO synthesis.

[Successful treatment of metastatic renal cell carcinoma with cimetidine--report of two cases]

There has been no effective therapy for metastatic renal cell carcinoma (RCC). Cimetidine has been demonstrated to block histamine mediated activation of suppressor T cells in man and in animal models, resulting in an anti-tumor immune response. We treated two patients with cimetidine for matastatic RCC. Case 1: A 61-year-old man presented with a diagnosis of metastatic lung and brain tumor of RCC. Interferon therapy was not effective, but after radiation therapy, his brain metastasis revealed partial response. He received cimetidine 800 mg orally after radiation, his lung metastasis revealed almost complete response. But he died of ischemic heart disease. Case 2: A 58-year-old woman presented with a metastatic lung tumor of RCC. We started interferon therapy. But because of general fatigue and anemia, she required discontinution of interferon therapy. So she received cimetidine 800 mg orally and her lung metastasis revealed complete response. She remained well and had no evidence of disease. Patients with metastatic renal cell carcinoma can occasionally respond to cimetidine and further investigation must be studied.

[Urodynamic evaluation of alpha-1 blocker tamsulosin on benign prostatic hyperplasia using pressure-flow study]

BACKGROUND

In order to evaluate the precise effect of alpha-1 blocker on benign prostatic hyperplasia, symptomatic and urodynamic parameters were compared between before and after 4 week administration of tamsulosin hydrochloride (0.2 mg/day) on 18 patients with untreated benign prostatic hyperplasia.

METHODS

Symptoms were scored with international prostate symptom score (I-PSS) and urodynamic parameters were measured with pressure-flow study.

RESULTS

The total score of I-PSS decreased significantly although the peak urinary flow rates, average flow rates or post-void residuals did not show a significant improvement after the treatment. On the other hand, the statistical analysis of pressure-flow studies revealed a significant decrease of vesical pressure at opening, at peak flow and at end of voiding after the treatment. In one patient, in whom the voided volume and urinary flow rate kept the same level throughout the treatment course, the total energy expelled from the bladder was calculated with the formula given as W = integral (pQ)dt. Both the detrusor work and vesical work (sum of detrusor contraction and abdominal straining) showed a marked decrease after the treatment.

CONCLUSIONS

It is suggested that alpha-1 blocker relieves overload of the detrusor and improves symptoms by reducing the energy demands for bladder emptying, even in case the flow rate does not improve. The urodynamic procedure including pressure flow study is a useful means for not only diagnosing bladder outflow obstruction but also assessing overload or impaired contractility of the detrusor.

Metabolism of subtoxic levels of selenium in animals and humans

Since high levels of selenium are used as cancer chemopreventive agents in animals and humans, a better understanding of the metabolism of subtoxic levels is desirable. Absorption from rat small intestine using in situ double perfusion, ligated intestinal segments, and brush border membrane vesicles (BBMV) was used to study selenium absorption. A level of 1.2 mM intraluminal selenite was required to inhibit 50 percent of the transepithelial transport of 3-0-methylglucose, indicating a high tolerance of the intestinal tract to selenium. The relative efficiency patterns for uptake of different selenocompounds during in vitro perfusion and in vivo ligated segments were identical with selenomethionine (SeMet) > selenate > selenite. In contrast, selenite was taken up most rapidly by BBMV, followed by SeMet and selenate in decreasing order. Ligated segments, double perfusion experiments, and uptake by BBMV indicated that selenium as selenodiglutathione or selenodicysteine was taken up faster than when present as selenite. Selenate and SeMet appeared in the vascular effluent largely unchanged, but selenite was metabolized extensively during absorption. Most of the selenium in plasma from subjects living in a high selenium area of China was associated with albumin, which is likely a result of high dietary intake of SeMet. Cracked fingernails and extensive hair loss were the symptoms of selenium toxicity in these individuals. Low adverse effect level of dietary (mean LOAEL) selenium was calculated to be about 1540 +/- 653 micrograms per day (or 28 micrograms/kg body weight) and the maximum safe dietary (mean NOAEL) selenium was calculated to be 819 +/- 126 micrograms per day (or 15 micrograms/kg body weight).

Role of intracellular calcium as a priming signal for the induction of nitric oxide synthesis in murine peritoneal macrophages

Because the role of intracellular Ca2+ in the two-signal process for the induction of nitric oxide (NO) synthesis is controversial, this study was undertaken to examine the role of Ca2+ in the transcriptional regulation of inducible NO synthase (iNOS) in murine peritoneal macrophages. Treatment of the cells with thapsigargin (TG) or 2,5-di-(t-butyl)-1,4-benzodihydroquinone (tBuBHQ), which are the specific and potent Ca(2+)-ATPase inhibitors of endoplasmic reticulum (ER), showed modest effects on tumoricidal function, whereas TG or tBuBHQ in combination with interferon-gamma (IFN-gamma) or lipopolysaccharide (LPS) showed marked effects on tumoricidal function of the cells. The tumoricidal effects of the activated macrophages were correlated with the amount of NO synthesis, and totally abrogated by the use of NOS inhibitor, NG-monomethyl-L-arginine (NGMMA). The increases in NO synthesis was reflected as increased amounts of iNOS mRNA by Northern blotting. To confirm that iNOS induction was due to the changes in the intracellular Ca2+ level, the acetoxymethyl ester of 1,2-bis(2-aminophenoxy)ethane-N,N,N',N'-tetraacetic acid (BAPTA-AM), an intracellular Ca2+ chelator, was used. Blocking the increase of cytosolic free Ca2+ significantly decreased the induction of NO synthesis. To demonstrate that intracellular Ca2+ acts as a 'priming' signal rather than a 'triggering' signal on the induction of NO synthesis by murine peritoneal macrophages, we designed several experiments. When the cells were treated with TG 6 hr after the treatment with IFN-gamma, there was no increase in NO synthesis. In addition, when the cells were treated with TG or LPS 6 hr after treatment with tBuBHQ, a synergistic increase on NO synthesis was shown only in the case of LPS. When phorbol 12-myristate 13-acetate (PMA), a protein kinase C (PKC) activator, was added to the cells 6 hr after the treatment with TG, there was a marked co-operative induction of NO synthesis, even though PMA alone has no effect. Based on the results obtained in this study, we suggest that cytosolic Ca2+ might be enough for the expression of iNOS gene as a priming signal and PKC might be involved in the induction of NO synthesis as a triggering signal by post-transcriptional modification of iNOS mRNA or iNOS itself in the activated murine peritoneal macrophages.

Synergistic cooperation between thapsigargin and phorbol ester for induction of nitric oxide synthesis in murine peritoneal macrophages

The biochemical transductional events involved in NO synthesis are not fully understood. These studies, therefore, were undertaken to elucidate the role of intracellular calcium and protein kinase C (PKC) in the induction of nitric oxide (NO) synthesis in murine peritoneal macrophages. Thapsigargin (TG), Ca(2+)-ATPase inhibitor of endoplasmic reticulum, had modest activity on NO synthesis by itself, whereas phorbol ester, PKC activator, alone had no effect. When TG was used in combination with phorbol ester, there was a marked cooperative induction of NO synthesis in a dose-dependent manner. The optimal effect of phorbol ester was shown in the first 6 h after TG treatment. In addition, the ability of TG with phorbol ester on NO synthesis could be mimicked by another chemically unrelated inhibitor of Ca(2+)-ATPase, 2,5-di-(t-butyl)-1, 4-benzohydroquinone, and Ca2+ ionophore, A23187. This increase of NO synthesis was reflected as increased amount of NO synthase (NOS) mRNA, as determined by Northern blotting. Intracellular Ca2+ transient by TG was not affected in the presence or absence of extracellular Ca2+, indicating that TG must be effective on cytosolic Ca2+ pool. In addition, chelation of intracellular Ca2+ by acetoxymethyl ester of 1,2-bis-(2-aminophenoxy)-ethane-N,N,N',N'-tetraacetic acid (BAPTA/AM), an intracellular Ca2+ chelating agent, blocked TG- or TG + PMA-induced NO production. PKC inhibitors such as staurosporine or polymyxin B reduced only the synergistic cooperative effect of TG with phorbol ester without affecting TG-induced NO production. In addition, when the cells were pretreated with phorbol ester before TG treatment, there was no synergy between TG and phorbol ester, indicating that PKC is not directly involved in the expression of NOS but involved in "triggering" signal. Secretion of NO corresponded with tumor cell killing, but TG plus phorbol ester-activated macrophages failed to kill tumor cell targets in the presence of Ng-monomethyl-L-arginine. Collectively, these data illustrate that mobilization of intracellular Ca2+ provides a "priming" signal for induction of NOS gene expression by itself and it also requires PKC as a "triggering" signal for macrophage tumoricidal activity.

Liposomal prostaglandin E1 in acute respiratory distress syndrome: a placebo-controlled, randomized, double-blind, multicenter clinical trial

OBJECTIVE

To evaluate the safety and efficacy of liposomal prostaglandin E1 (TLC C-53) in the treatment of patients with the acute respiratory distress syndrome (ARDS).

DESIGN

Randomized, prospective, multicenter, double-blind, placebo-controlled, phase II clinical trial.

SETTING

Eight community and university-affiliated hospitals in the United States.

PATIENTS

Twenty-five patients with ARDS.

INTERVENTIONS

Patients were prospectively randomized in an unbalanced ratio within each site to receive either TLC C-53 (n = 17) or placebo (n = 8). Study drug was infused intravenously over 60 mins every 6 hrs for a 7-day period, starting at a dose of 0.15 micrograms/kg/hr. The dose was increased every 12 hrs until the maximal dose (3.6 micrograms/kg/hr) was attained, intolerance to further increases developed, or invasive monitoring was discontinued. Patients received standard, aggressive, medical/surgical care throughout the trial.

MEASUREMENTS AND MAIN RESULTS

Outcome measurements were Pao2/FI0(2), dynamic pulmonary compliance, ventilator dependence on day 8, and 28-day all-cause mortality rate. At baseline, the distribution of variables describing Lung Injury Scores, Acute Physiology and Chronic Health Evaluation II scores, Pao2/FI0(2), pulmonary compliance, and time from onset of ARDS to first dose of study drug was similar between patients in the TLC C-53 and placebo treatment groups. On day 8, all eight patients given placebo required mechanical ventilation, while eight of 17 patients given TLC C-53 were healthy enough to be removed from the ventilator (p = .03). Improvement in PaO2/FIO2 during the initial 8-day study period was greater in patients receiving TLC C-53. This trend achieved statistical significance on day 3, when the increase in PaO2/FIO2 from baseline was 82.5 +/- 14.6 in the TLC C-53 group compared with 28.3 +/- 22.1 in the placebo group (p = .05). By day 8, lung compliance also increased from baseline significantly more in TLC C-53 patients than in placebo patients (5.7 +/- 1.7 vs -1.5 +/- 1.8 mL/cm H2O; p = .01). The 28-day mortality rate was 6% (1/17 patients) in the TLC C-53 group and 25% (2/8 patients) in the placebo group (p = .23). Drug-related adverse events were reported in 82% of the patients receiving TLC C-53 compared with 38% of the placebo group, with half of the adverse events in the TLC C-53 group being localized infusion site irritation. TLC C-53 was hemodynamically well tolerated, with transient hypotension occurring in three patients.

CONCLUSIONS

In patients with ARDS, TLC C-53 was associated with improved oxygenation, increased lung compliance, and decreased ventilator dependency.

[The adrenoceptor and calcitionin-gene related peptide receptor in the striated urethral sphincter in male rabbit]

BACKGROUND

The objective of this study is to analyze the adrenoceptor and calcitonin-gene related peptide receptor in the isolated striated urethral sphincter from a male rabbit.

METHODS

The striated urethral sphincter preparations were suspended in 2ml tissue chamber filled with Krebs Ringer solution, and the changes of isometric twitch contraction induced by electrical field stimulation (EFS-contraction) were recorded in the presence of 3-isobutyl-1-methyl-xanthine (IBMX, 10(-5) M).

RESULTS

The EFS-contraction was almost completely attenuated by tetrodotoxin (TTX, 10(7) M), vecronium (10(-4) M) and suxamethonium (10(-4) M). Norepinephrine (NE, 10(-8) M-10(-4) M) did not affect the EFS-contraction, but increased the tonic contraction in a dose-dependent manner. The tonic contractions induced by NE was significantly blocked by phentolamine (10(-6) M). Clonidine (10(-7) M), yohimbin (10(-7) M) and propranolol (10(-9) M-10(-6) M) did not affect the EFS-contraction. Isoproterenol (10(-9) M-10(-6) M) did not reduce the carbachol (10(-5) M) induced tonic contraction. Calcitonin-gene related paptide (CGRP, 10(-7) M-3 x 10(-6) M) did not affect the EFS-contraction and did not increase the tonic contraction.

CONCLUSION

These results suggested that alpha 1-adrenoceptors of the striated urethral sphincter play a role to modulate the resting tension level, but alpha 2-adrenoceptors, beta-adrenoceptors and CGRP receptors play no role in this regard.

Endoscopic correction of vesicoureteral reflux in patients with neurogenic bladder dysfunction

Transurethral injection of Teflon paste (TUI) was carried out in 24 ureters of 16 patients with vesicoureteral reflux (VUR) secondary to neurogenic bladder dysfunction at an age ranging from 4 to 77 years, and the results were compared with those of conventional open surgery. During the mean follow-up period of 20.1 months, reflux disappeared in 19 ureters (79%), so that the success rate of endoscopic operation was considered to be satisfactory as compared with that of conventional open surgery, in which reflux disappeared in 16 (80%) of 20 ureters in 16 patients with neurogenic bladder dysfunction at our department. No exacerbation of hydronephrosis was observed postoperatively, and no complication was noted. This procedure, which is minimally invasive and technically simple, may be regarded as the first choice for VUR secondary to neurogenic bladder dysfunction.

Intracellular Ca2+ pool depletion is linked to the induction of nitric oxide synthesis in murine peritoneal macrophages

The ability of putative Ca(2+)-ATPase inhibitor of endoplasmic reticulum (ER), thapsigargin (TG), to induce nitric oxide (NO) synthesis in murine peritoneal macrophages was examined. TG alone had small effect on NO synthesis, whereas TG in combination with LPS markedly increased NO synthesis in a dose dependent manner. This increase in NO synthesis was reflected as increased amount of inducible NO synthase (iNOS) mRNA by Northern blotting. In addition, the ability of TG on NO synthesis could be mimicked by another chemically unrelated inhibitor of Ca(2+)-ATPase, 2,5-DI-(t-butyl)-1, 4-benzohydroquinone (tBuBHQ). Adding EGTA, a calcium chelator, to the incubation medium significantly reduced the ability of macrophages to induce NO synthesis in response to the optimal stimulation of TG or TG plus LPS. These results therefore demonstrate that intracellular Ca2+ pool depletion is linked to the induction of NO synthesis in murine peritoneal macrophages and further suggest that it is also related with interferon-gamma (IFN-gamma)-induced signaling.

[How does thermotherapy effectively work on benign prostatic hyperplasia--an experimental study]

Isometric contractile force of rabbit prostatic tissue in response to electric field stimulation (EFS), KCl, and phenylephrine were measured at incubation temperature of 37 degrees C, before and after thermal exposure to 42 degrees C, 45 degrees C, 48 degrees C and 50 degrees C for 30 minutes. The contractile force in response to EFS decreased after thermal exposure above 45 degrees C, and the contractile force in response to KCL or phenylephrine decreased after thermal exposure above 48 degrees C. All the contractile response abolished after thermal exposure to 50 degrees C. The results indicate that the nerve is more hear-sensitive than the smooth muscle in the prostate. Histological examination revealed shrinkage of cell body and dark staining of nuclear chromatin of the smooth muscle cells after thermal exposure above 48 degrees C. The same histological change of the smooth muscle as well as degenerative change of the nerve cells was observed on the prostate 3-7 months after clinical thermotherapy. From these results, it is suggested that clinical effect of thermotherapy is brought about from both neural and muscular damage of the prostate. Since the least temperature to cause an irreversible tissue damage ranges from 48 degrees C through 50 degrees C, we believe it is ideal to heat the prostate around 50 degrees C to obtain a good clinical effect of thermotherapy on benign prostatic hyperplasia as a minimum invasive treatment.

Toxicity, metabolism and absorption of selenite by isolated rat hepatocytes

The uptake of various levels of selenite by isolated rat hepatocytes was investigated. The LD50 value of selenite was about 500 microM. The activity of lactic dehydrogenase in the medium was correlated with cell viability as determined by trypan blue exclusion. After incubation of selenite with hepatocytes, protein-bound Se was the predominant form (80-90% of the cellular Se) present. Subcellular fractionation indicated that most of the radioactivity was present in the cytosol when hepatocytes were incubated with 75Se-selenite. The uptake of 75Se by isolated rat hepatocytes was linear with selenite concentration up to the highest amount tested, 200 microM. Sulfite inhibited the uptake of selenite by hepatocytes.

Urinary incontinence in senile dementia of the Alzheimer type (SDAT)

Twenty patients (1 male and 19 females) with senile dementia of the Alzheimer type were studied using cystometry in combination with sphincter electromyography, brain computed tomography (CT) and evaluating the activities of daily life (ADL), with special reference to urinary incontinence. Seven of the patients were continent and the remainder were incontinent. Cystometry revealed uninhibited detrusor contraction in 8 out of the 13 incontinent patients, while no uninhibited contraction was found in 7 continent patients. There was a significant correlation between uninhibited detrusor contraction and urinary incontinence (p < 0.05). Brain CT showed that the degree of brain atrophy was more severe in those with uninhibited contraction than those without (p < 0.05). There was no clear relationship between sphincter coordination and the occurrence of incontinence. The ADL score tended to be lower in incontinent patients, although no significant difference was apparent (0.05 < p < 0.1). Uninhibited detrusor contraction and poor ADL functioning caused by brain atrophy are thought to be major causes of urinary incontinence in patients with senile dementia of Alzheimer type.

Burst activities of cremasteric motor units

Electromyographic activities of the ipsilateral cremaster muscle evoked by electrical stimulation of either the thigh or the penis were analyzed for latencies and burst durations. Response latencies were 30 ms on thigh stimulation and 30-35 ms on penile stimulation. With the increase in stimulus intensity the latencies decreased to 30 ms in both cases. The changes were stepwise, indicating the switching between different reflex arcs. The burst duration on thigh stimulation was about 50 ms, and that for penile stimulation was 45 ms. Impulses producing the burst consisted of larger and smaller spikes, and this indicates the grouping of motor units for wing tonic and phasic units. The results suggest the existence of parallel neuronal circuitries for the spinal cremasteric reflex, and it is expected to provide a clue for evaluating the clinical significance of the cremasteric reflex.

[Morphometric study of low compliant bladder]

Low compliant bladder is an important cause of detrusor dysfunction, although its cause is unknown. Two groups of patients who developed low compliant bladder have been studied by the morphometric technique. One group consisted of patients with neurogenic low compliant bladder, and the other group consisted of patients with non-neurogenic low compliant bladder. Control materials were obtained from postmortal samples offered from the department of anatomy. Bladder wall samples were obtained during bladder augmentation surgery. Morphometric computer analysis was used to measure the proportions of connective tissue and muscle layer in the bladder wall samples. In the non-neurogenic group, there was a significant increase in connective tissue and a marked decrease in muscle layer proportion than the control group. On the other hand, there was a mild increase in connective tissue, but no decrease in muscle layer proportion was observed in patients with neurogenic low compliant bladder. Comparison of the results obtained from the two groups suggested that low bladder compliance in neurogenic patients is mainly caused by functional alteration of the bladder wall, whereas that in non-neurogenic patients is caused by an organic change of the bladder wall.

Determination of two-dimensional planar displacement by moiré fringes of concentric-circle gratings

We investigate the moiré fringe pattern of two concentric-circle gratings with the aim of measuring the relative two-dimensional planar displacement induced between the gratings. In the first stage we give a comprehensive mathematical approach for the analysis of fringe patterns. Then we suggest a fast computational measurement algorithm that uses a Fourier transformation technique. Finally, our experimental results prove that a measuring accuracy of 0.01 µm can be achieved with this method.

[A new method of measurement of the urinary bladder blood flow in patients with low compliant bladder]

Laser-doppler blood flowmetry, a new instrument for measurement of tissue blood flow, was used to evaluate the changes occurring in the bladder blood flow and the intravesical pressure during bladder distension in 4 patients with normal detrusor function, 4 patients with neurogenic bladder dysfunction and one patient with non-neurogenic contracted bladder. In patients with normal detrusor function and normal compliance, the bladder blood flow relatively decreased, but the intravesical pressure was not affected by the bladder distension. On the other hand, the bladder distension in patients with low compliant bladder caused a significant decrease of the bladder blood flow and marked increase of the intravesical pressure. These observations suggest that the reduction of the bladder compliance is related to the decrease of the bladder blood flow. Furthermore, the bladder over distension and the high intravesical pressure in patients with low compliant bladder are thought to induce deterioration of bladder compliance and upper urinary tract.

[Clinical study of TZP-4238 on patients with benign prostatic hypertrophy--with special reference to urodynamics]

Twenty four cases of benign hypertrophy with bladder outlet obstruction were treated with 17 alpha-acetoxy-6-chloro-2-oxa-4,6-pregnadiene-3,20-dione (TZP-4238), and the effects on urodynamic parameters, clinical efficacy, safety, and usefulness were evaluated. Improvement rate of subjective rate of subjective symptoms was 52.9%. Obstructive symptoms improved more prominently than irritation symptoms. A significant improvement in flow rate of nomograms for maximum flow rate (MFR) and average flow rate (AFR) accompanied with the decrease in the prostatic weight were observed. However, no changes were observed on the urethral sphincter electromyography and the urethral pressure profile. A significant decrease of maximum cystometric capacity was observed, although the effective cystometric capacity was not changed. The overall improvement rate for urodynamic parameters was 43.7%. A significant decrease in weight and diameter of the prostate was observed. The prostatic weight decreased in 57.1%, and the average reduction rate was 15.4%. The overall improvement rate concerning clinical efficacy evaluating both subjective symptoms and objective parameters was 58.8%. Adverse reactions were observed in 5 cases. They were judged as not clinically problematic. Taking into account clinical safety and clinical efficacy, the clinical usefulness was 50.0%. TZP-4238 was considered to be an appropriate agent for treating patients with benign prostatic hypertrophy with bladder outlet obstruction.

Botulinum a toxin treatment of hemifacial spasm and blepharospasm

We studied the effects of botulinum A toxin in 101 patients with hemifacial spasm and 11 patients with blepharospasm in an open trial and double blind manner. All patients in the open trial and 6 patients in the double blind trial improved after the first injection of botulinum toxin. There was no improvement with placebo. The peak effect ranged from one to 6 days after injection and mean peak effect was 3.6 days in blepharospasm, and 4 days in hemifacial spasm. Of 144 treatments, 98.6% had excellent results, (below grade I). The duration of beneficial effect ranged 11 to 40 weeks (mean 16.5 weeks) in hemifacial spasm and 9 to 30 weeks (mean 14.2 weeks) in blepharospasm. Complications were encountered in 63.4% in hemifacial spasm and 72.7% in blepharospasm. The common side effects were dry eyes, mouth droop, ptosis and lid edema in order of frequency. These side effects were mild and resolved spontaneously in 1 to 3 weeks. Botulinum A toxin therapy is effective and convenient, and the treatment of choice for patients with hemifacial spasm and blepharospasm.

[Quantitative electromyographic analysis of the external urethral sphincter using automatic decomposition electromyography on normal subjects]

Motor unit action potentials (MUPs) of the external urethral sphincter muscle during cystometry were analysed on six normal males. Electrodes were of concentric needle type having the exposed tip surface of 0.07 mm2, and the potential changes were analysed by automatic decomposition electromyography (ADEMG), for isolation and characterization of unit discharges. Number of analysed units was as follows: Two at rest, 4 at first desire to void, and 6 at maximum desire to void. Number of the recorded units and the firing rate were increased along with the degree of bladder filling. Average MUP figures as follows: Amplitude of 206 microV, 8.3 msec. duration, and 5.4 Hz firing rate at rest; 246 microV, 9.7 msec and 7.3 Hz at first desire to void; 277 microV. 9.7 msec and 7.2 Hz at maximum desire to void, respectively. It is concluded that external urethral sphincter maintains its urinary continence by excitation of the neuromuscular units, and by the increase in the firing rate of individual MUP during bladder filling.

Affinity purification and binding analysis of the hemolymph juvenile hormone binding protein from Manduca sexta

A high-affinity juvenile hormone binding protein was purified from the hemolymph of the tobacco hornworm, Manduca sexta, employing ammonium sulfate precipitation and affinity and size-separation chromatography. The naturally occurring enantiomer of juvenile hormone III (10R) was converted to juvenile hormone III acid and then covalently attached to aminohexyl-Sepharose 4B. Hemolymph from early fifth stadium (60 h postecdysis) larvae was used as the source of hJHBP. The yield of hJHBP was approximately 25% of the starting material, with 3.5 mg of highly purified, biologically active hJHBP recovered from 100 mL of hemolymph. Binding parameters were examined using equilibrium dialysis and highly purified, enantiomerically correct juvenile hormone I and II and racemic JH III. The equilibrium dissociation constants for juvenile hormone I and II were approximately 6 x 10(-10) M at 4 degrees C, while racemic juvenile hormone III displayed an equilibrium dissociation constant of 1.9 x 10(-9) M. At 25 degrees C the equilibrium dissociation constant for juvenile hormone I was 1.6 x 10(-9) M. Half-times of dissociation were also determined for the three homologs. The half-time of dissociation was 30 s for juvenile hormone I, 20 s for juvenile hormone II, and 13 s for juvenile hormone III at either 4 or 25 degrees C. Using the new equilibrium dissociation constants, we calculate that better than 99% of the circulating juvenile hormone titer may be bound to this hemolymph protein.

[Clinical study of the timed voiding schedule for urinary incontinence in demented elders]

Fourty-one demented elderly patients who had been diapered because of urinary incontinence in Hanwa-Senboku Hospital were treated with the one-week timed voiding schedule. Finally 14 patients (34%) became dry, and free from diapers for more than 1 week after the treatment. With regard to their cystometrogram findings, 10 (67%) of 15 patients having normoactive detrusor function, 3 (14%) of 21 patients having overactive detrusor function and 1 (20%) of 5 patients having underactive detrusor function became free from diapers after the treatment. Therefore a patient with normoactive detrusor function is thought to be a good candidate for the timed voiding schedule. Regardless of their detrusor function, those who showed good responsiveness to the treatment had better activities in daily life (better than D in the Katz index) and small amount of residual urine (less than 80 ml), indicating that not only the detrusor function but also both activities in daily life and the amount of residual urine are the important factors to reestablish voiding behavior in demented elderly patients. The timed voiding schedule is thought to be a useful method to treat incontinence in demented elderly patients, and should be tried first of all, although intermittent catheterization and/or other alternatives would be necessary for those with a large amount of residual urine with poor activities in daily life.

[Anticholinergic therapy of urinary incontinence and urinary frequency associated with the elderly--with special reference to dementia]

Pharmacotherapy with anticholinergic agents was studied in a total of 80 patients aged 65 years or older with chief complaints of urinary frequency (4 patients) and/or ugency incontinence (76 patients). The subjects were 45 men and 35 women at the age ranging between 65 and 92 (mean 73.7). The patients received anticholinergic agents (terodiline hydrochloride 24 mg/day, oxybutynin hydrochloride 6 mg/day, propantheline bromide 60 mg/day separately or in combination) for more than two weeks. Subjective symptoms and objective findings were assessed before and after the administration. In addition, according to the result of Hasegawa's dementia rating scale the patients were divided into dementia group and non-dementia group for further evaluation of the study drugs. As a result, cystometrogram revealed significant increase of maximum bladder capacity in either dementia group or non-dementia group. There was no significant difference in rate of objective improvement between both groups. On the other hand, rate of subjective improvement was significantly higher in non-dementia group (40%) than in dementia group (15%). As mentioned above, improvement of cystometrogram findings was not associated with improvement of subjective symptoms in the demented patients. This suggests that the major cause of incontinence in demented patients is not the bladder dysfunction but the specific conditions of demented patients such as agnosia and apraxia.