Early disease progression after intravesical bacillus Calmette-Guérin (BCG) therapy for superficial bladder cancer

BACKGROUND

Disease progression after Bacillus Calmette-Guérin (BCG) instillation therapy for bladder cancer is not rare. The purpose of this study was to evaluate the outcome of patients treated with BCG for superficial bladder cancer, focusing on the patients who developed invasive disease during follow-up. The possible mechanism and risk factors for early progression after BCG therapy are discussed.

METHODS

A total of 25 patients with superficial bladder cancer (pTa, pT1 and/or pTis) were treated with intravesical BCG instillation (80 mg in 80 ml saline) once a week for eight weeks. Four of the 25 patients received maintenance therapy with BCG (once a month for 3 to 10 months). Patients were followed every three months and underwent cystoscopy, biopsy, and urinary cytology at these intervals. Disease progression was defined as invasion to muscle or prostate, or development of metastatic disease. Clinicopathological features of the patients, especially those with progression, were analyzed.

RESULTS

Progression was observed in six of the 25 patients, (including four of 19 patients with carcinoma in situ and two of five patients treated prophylactically with BCG). The average time to progression was 8.7 months. Four patients died of cancer despite intensive treatment. Two patients are alive: one without evidence of disease after cystectomy and the other with metastatic disease.

CONCLUSIONS

Proper patient selection, careful follow-up, and immediate aggressive therapy in case of progression were considered to be important factors to obtain satisfactory results with BCG therapy for bladder cancer.

A case of isolated ACTH deficiency with hyporeninemic hypoaldosteronism

A case of isolated ACTH deficiency with hyporeninemic hypoaldosteronism, presenting severe hyponatremia, is described. A 57-year-old man complaining of nausea, vomiting and fatigability was admitted to our hospital because of hyponatremia (114 mEq/I). The low levels of serum cortisol and urinary 17-OHCS suggested glucocorticoid deficiency, and that the glucocorticoid deficiency was due to isolated ACTH deficiency was confirmed by a continuous ACTH loading test and pituitary gland stimulation tests. Although the low level of serum sodium was normalized after the administration of cortisone acetate (50 mg/day) combined with an increase in oral salt intake, urinary sodium loss persisted by the results of hypertonic saline infusion test. Treatment led to improvement of impairment of water diuresis due to hypersecretion of ADH. Hyporeninemic hypoaldosteronism persisted after treatment. We have shown that severe hyponatremia that occurs with combined deficiency of glucocorticoids and mineralocorticoids can be corrected with high salt intake and glucocorticoid replacement without correcting mineralocorticoid deficiency.

[Case of adult T-cell leukemia without antibodies for HTLV-I but with for pX gene region]

A 76-year-old woman had lymphocytosis with lymphocytes having convoluted or lobulated nuclei. These abnormal lymphocytes (leukemic cells) were positive for CD4, and some expressed IL-2R (CD25) and CD3 molecules, respectively. These morphologic and phenotypic features were compatible with adult T-cell leukemia, but serum antibodies to human T-cell lymphotropic virus type I (HTLV-I) were not detected by the particle aggregation method and an enzyme-linked immunosorbent assay. The polymerase chain reaction showed that the LTR, gag, pol, and env regions of HTLV-I proviral DNA had not been incorporated into the leukemic cells. Only the pX region was detected in these leukemic cells.

Chronic Prototheca meningitis

A case of chronic meningitis caused by the achloric alga Prototheca wickerhamii is described, which has persisted for more than 6 years despite treatment with various antifungal agents. For the last year no treatment has been given, but the patient has no complaints.

Effects of endothelin A and B receptors on aqueous humor dynamics in the rabbit eye

This study attempted to clarify the role of endothelin A and B (ETA and ETB) receptors in modulating aqueous humor dynamics in the rabbit eye. Intraocular pressure (IOP), aqueous flow, total outflow facility, and uveoscleral outflow were measured before, and 24 hours after, intravitreal injection (20 microliters) of a selective ETB agonist, sarafotoxin S6c (SRTX S6c, 10(-5) M), into one eye and its vehicle into the contralateral eye. The measurements were also performed before and after injection of a selective ETA antagonist, 97-139 (10(-2) M) + ET-1 (10(-5) M) into one eye, and vehicle + ET-1 (10(-5) M) into the contralateral eye. In the SRTX S6c-treated eye, total outflow facility increased significantly by 106% compared with that in the vehicle-treated eye 24 hours after injection; aqueous flow and uveoscleral outflow failed to change significantly. The ETA antagonist 97-139 inhibited the decrease in aqueous flow partially, but significantly, but failed to inhibit the increase in total outflow facility caused by ET-1. Therefore, both ETA and ETB play a significant role in modulating aqueous humor dynamics in the rabbit eye. ETA can modulate aqueous humor production, at least in part. ETB can modulate total outflow facility, and the possibility for ETB in modulating aqueous humor formation cannot be ruled out.

Thrombopoietin induces tyrosine phosphorylation and activation of mitogen-activated protein kinases in a human thrombopoietin-dependent cell line

Thrombopoietin (TPO) is a cytokine which can support the proliferation and differentiation of megakaryocyte progenitor cells, and the maturation of megakaryocytes. We show here that mitogen-activated protein (MAP) kinases, Erk1 and Erk2, are involved in TPO signal transduction in the human TPO-dependent megakaryocytic cell line, UT-7/TPO. TPO induced tyrosine phosphorylation of Erk1 and Erk2 proteins in a dose and time-dependent manner. Moreover, the activation of MAP kinases was actually induced by TPO. These results suggest that MAP kinase activation is involved in the signalling pathway of TPO, as it is for other cytokines, one of which is erythropoietin.

[Synthesis of estimated metabolites of 9-amino-2,3,5,6,7,8-hexahydro-1H-cyclopenta[b]quinoline monohydrochloride monohydrate (NIK-247). I. Synthesis of mono-hydroxylated metabolites]

The two mono-hydroxylated metabolites of 9-amino-2,3,5,6,7,8-hexahydro-1H-cyclopenta[b]quinoline monohydrochloride monohydrate (NIK-247), which is a new drug for the treatment of dementia, were synthesized to determine their chemical structures. Reduction of two tricyclic ketones, 9-amino-1,2,3,5,6,7-hexahydro-8H-cyclopenta[b]quinolin-8-one and 9-amino-2,3,5,6,7,8-hexahydro-1H-cyclopenta[b]-quinolin-1-one, with NaBH4 afforded the corresponding racemic alcohols. The optically active mono-hydroxylated metabolites, (+)-9-amino-2,3,5,6,7,8-hexahydro-1H-cyclopenta[b]quinolin-8-ol and (+)-9-amino-2,3,5,6,7,8-hexahydro-1H-cyclopenta[b]quinolin-1-ol, were obtained by optical resolution of each racemic alcohol using (+)-di-p-toluoyl-D-tartaric acid.

Successful 24-hour rabbit heart preservation by hypothermic continuous coronary microperfusion with oxygenated University of Wisconsin Solution

BACKGROUND

This study assessed whether a combination of hypothermic continuous coronary microperfusion and oxygenated University of Wisconsin Solution (UWS) improves postischemic functional recovery and minimizes myocardial tissue edema.

METHODS

Isolated rabbit hearts were divided into four groups (n = 6 each): group I (immediate reperfusion), group II (simple cold storage in UWS), group III (hypothermic continuous coronary microperfusion with UWS), and group IV (hypothermic continuous coronary microperfusion with oxygenated UWS). Hearts in groups II, III, and IV were preserved for 24 hours. Preischemic and postischemic cardiac function was measured using a Langendorff apparatus.

RESULTS

Hearts in group I showed complete functional recovery, whereas cardiac output in group II was inadequate. In groups III and IV, the percentage recovery rate (post/pre) of cardiac output was 57.0% +/- 3.1% and 82.2% +/- 9.1%, respectively (p < 0.05). In groups III and IV, perfusion pressures at the end of 24-hour preservation increased from the initial 5 mm Hg to 12.3 +/- 2.7 and 8.3 +/- 1.4 mm Hg (p < 0.05), respectively. In groups I, III, and IV, the percentage tissue water content was 82.8 +/- 1.0, 86.7 +/- 1.7, and 83.8 +/- 1.6, respectively (p < 0.05 for group III versus groups I and IV). There was a significant correlation between the percentage tissue water content and coronary perfusion pressure at the end of the 24-hour preservation (r = 0.60, p = 0.040) and a significant inverse correlation between percentage tissue water content and percentage recovery rate of cardiac output (r = -0.69, p = 0.014). In ultrastructural examination, myocardial tissue edema was limited and mitochondria were well preserved in group IV.

CONCLUSION

We conclude that the combination of a hypothermic continuous coronary microperfusion technique and oxygenation of UWS was the procedure of choice for reducing tissue edema and improving both the coronary microcirculation and functional recovery during 24-hour heart preservation.

Effect of prone position on apnea severity in obstructive sleep apnea

We describe a patient with obstructive sleep apnea (OSA) whose apnea-hypopnea index (AHI) improved remarkably in the prone position accompanied by an improved sleep quality, despite a higher AHI in the supine position and even in the lateral position. Magnetic resonance imaging revealed the most dilated upper airway in the prone position, which suggests the role of anatomical narrowing of the upper airway as an important component in the pathophysiology of positional apnea patients. Further studies are needed to determine the therapeutic efficacy of a prone sleeping position in patients with OSA.

Contribution of endothelin-1 to warm ischemia/reperfusion injury of the rat lung

The purpose of the present study was to clarify the role of endothelin-1 (ET-1) in the pathogenesis of ischemia/reperfusion lung injury and to determine whether pretreatment with an ET receptor antagonist prevents such injury. The left lung of Sprague-Dawley rats was subjected to 60 min of no-flow warm ischemia followed by 90 min of reperfusion. The plasma ET-1 concentration increased significantly after reperfusion compared with before and after ischemia (p < 0.05). Arterial oxygen tension was reduced, and the lung tissue wet/dry weight ratio increased in post-reperfusion lungs compared with both pre-ischemia and post-ischemia lungs. Histologic study showed pulmonary edema, hemorrhage, hyaline membrane formation, and a significant increase in lung tissue neutrophils after reperfusion. In addition, the expression of ET-1 mRNA was determined by Northern blot analysis. Although ischemia did not significantly alter ET-1 expression, reperfusion increased expression in the left lung markedly and in the right lung moderately. Pre-infusion of FR139317, an ETA receptor antagonist, prevented post-reperfusion damage to the lung. These results suggest that ET-1 contributes to the ischemia/reperfusion injury of the rat lung, mediated by an ETA receptor, and that an ETA receptor antagonist may inhibit ischemia/reperfusion lung injury.

Fibrinolytic activity in liver tissues of stroke-prone spontaneously hypertensive rats

1. Plasminogen activator activity was detected in the extract solution of the liver tissues of both stroke-prone spontaneously hypertensive rats (SHRSP) and Wistar-Kyoto (WKY) rats by the synthetic substrate assay. 2. The total PA activity in the liver extract of WKY (26.8 +/- 8.3 i.u.) was about 1.5-fold higher than that of SHRSP (18.5 +/- 4.1 i.u., n = 8, P < 0.005). 3. The enzymography of the liver extract revealed three lytic bands with a molecular weight of 67 kDa, 44 kDa and 38 kDa. 4. The inhibitor activity of the liver extract was detected by the reverse fibrin autography method with one lytic resistance band at 70 kDa. 5. Thus, fibrinolytic components exist in the liver tissue of both strains of rats, but their contribution to the stroke requires further study.

Effects of hyper- and hypoglycemia on blood growth hormone level in free-feeding rats with anterolateral deafferentation of the medial basal hypothalamus

In rats with anterolateral deafferentation of the medial basal hypothalamus, the growth hormone (GH) level in the blood showed irregular and small fluctuations instead of the usual high bursts and low trough level, and the baseline GH level was higher than that in sham-operated rats. Continuous infusion of a glucose solution to operated rats increased the baseline level, GH pulse and pulse amplitude. I.v. bolus injection of the glucose solution resulted in a significant but transient increase in GH level. Insulin-induced hypoglycemia decreased the blood GH level in operated rats more effectively than in sham-operated ones and that was prevented by simultaneous infusion of glucose. Since SS influence on GH secretion had been largely eliminated in rats with anterolateral deafferentation of the medial basal hypothalamus, it is highly unlikely that the effects of hyperglycemia or hypoglycemia on GH secretion were the consequence of altered SS secretion.

Phenotypic analysis of neoplastic cells from calf, thymic, and intermediate forms of bovine leukosis

Immunohistochemistry and flow cytometric analysis were used with monoclonal antibodies to examine the phenotype of neoplastic cells from cattle with sporadic bovine leukosis (three cases of calf form, two cases of thymic form, and three cases of intermediate form). Three cases of calf form and two cases of intermediate form were positive for B cell lineage in immunohistologic examination and in flow cytometric analysis for B-B2+, sIgM+, and major histocompatibility class II+. Two cases of thymic form and one case of intermediate form were CD2+, CD5+, CD6+, and CD8+ in immunohistologic examination and in flow cytometric analysis. The results show that neoplastic cells develop from B and T cell lineages in sporadic bovine leukosis.

[Clinical analysis of 62 patients with blunt renal trauma]

Sixty two patients with blunt renal trauma were treated and followed in our clinic between 1976 and 1993. Immediate operation was performed in one with major laceration, 3 with ruptures and one with pedicle injury, that is, nephrectomy in 4 and partial nephrectomy in one. Expectant management with the purpose of preserving the injured kidney was performed in 33 contusions, 20 minor lacerations and 5 major lacerations, resulting in no complications. We confirm that expectant management of blunt renal trauma may be reliable if the condition of the patient is stable even in the case of rupture, and the treatment of associated injury is preferential.

Use of the bidirectional Glenn procedure in the presence of forward flow from the ventricles to the pulmonary arteries

BACKGROUND

Relative regression of the pulmonary arterial size has been reported after a conventional bidirectional Glenn procedure. Maintaining a supplemental pulmonary flow could be of surgical value unless the option also militates against the efficacy of the partial right heart bypass.

METHODS AND RESULTS

Twenty-seven patients considered unsuitable for a Fontan-type procedure underwent a bidirectional Glenn procedure in the presence of forward flow from the ventricles to the pulmonary arteries, the flow being maintained through the pulmonary trunk in 22 or a systemic-to-pulmonary shunt in 5. There was one surgical death due to atrioventricular valvular regurgitation. Subsequently, 9 patients have successfully undergone a total cavopulmonary connection 2.6 +/- 1.9 years after the initial procedure. Preoperative and postoperative catheterizations revealed changes in arterial oxygen saturation (75 +/- 11% compared with 83 +/- 7%, P < .001) and end-diastolic volumes of the systemic ventricles (from 238 +/- 92% to 188 +/- 97% of the expected normal volume, P < .01), whereas no difference was detected in the mean cross-sectional area of the right and left pulmonary arteries compared with the expected normal value for the right pulmonary artery (from 76 +/- 21% to 81 +/- 20%) or in the ventricular ejection fraction (from 53 +/- 8% to 50 +/- 14%). The relative regression or growth of the pulmonary arterial size was statistically related to the size of the channel for forward flow.

CONCLUSIONS

Maintenance of forward flow from the ventricle provides a feasible means, when performing a bidirectional Glenn procedure, of protecting against regression of pulmonary arterial size as well as off-loading the ventricles and improving arterial oxygen saturation.

[Characterization of prostate cancer, benign prostatic hyperplasia and normal prostates using endorectal 1H magnetic resonance spectroscopy]

BACKGROUND

We evaluate the usefulness of 1H endorectal resonance spectroscopy to characterize prostate pathology.

METHODS

With an endorectal surface coil we have studied 20 individuals with normal (1), benign hyperplastic (9) and malignant (10) prostates.

RESULTS

The major findings of our studies were that the patients with cancer have a significantly lower citrate-to-choline ratio (cit/cho) and creatin-to-choline ratio (cre/cho) than the patients with BPH (p < 0.05). There is well correlation between cit/cho and gland-to-stroma ratio of the BPH tissue as well as histological grade of the cancer tissue. 1H spectroscopy offers the advantages of differential diagnosis between benign and malignant prostates. We, however, failed to demonstrate cancer in 2 cases; the lesion was too small in one case, and out of the region of interest in the other. It is necessary that the foci in the prostate is at least 1.5 X 1.5 X 1.5 cm3 of the volume in order to obtain genuine spectrogram of carcinoma.

CONCLUSION

Endorectal 1H magnetic resonance spectroscopy can characterize metabolic differences between the normal and malignant prostate.

[Current concept and problems of urinary diversion. 2. Selection of operation: reservoir]

The Kock continent urinary reservoir was constructed in 12 patients from 1988 to 1990 followed by the Indiana continent urinary reservoir in 14 patients thereafter. There were no perioperative death in either group. The period of postoperative follow-up was 11 approximately 70 months, with a mean of 58.9 months. Several modifications of the operative technique were made to the original Kock pouch, but stone formation was observed in 5 patients (42%), resulting from foreign materials permanently in contact with urine. In the Indiana pouch group with a mean postoperative follow-up period of 26.8 months (range 11 approximately 43 months), wound infection occurred in the initial 4 patients and difficulty of catheterization in the other 4 patients. The serum electrolyte values were found to be within the normal limits during the follow-up period in both groups, but, mild acidosis occurred in 2 patients. Patients with urinary diversion demonstrated mild azotemia (P = 0.02) despite similar serum creatinine levels and an increase in urine pH (P = 0.006) postoperatively. Asymptomatic bacteriuria was demonstrated in 22 of the 26 (83%) patients with the reservoir, but only 5 patients had significant pyuria. Our clinical experience suggests that the Indiana pouch is a more reliable method than the Kock pouch to construct a continent urinary reservoir.

Touch-inducible genes for calmodulin and a calmodulin-related protein are located in tandem on a chromosome of Arabidopsis thaliana

Genes for calmodulin and calmodulin-related proteins in Arabidopsis are up-regulated by a variety of physical stimuli, which include rain, wind and touch [Braam and Davis (1990) Cell 60: 357]. We have isolated five genes for calmodulin (AtCAL1, 2, 3, 5, 6) and one gene for a calmodulin-related protein (AtCAL4) from an Arabidopsis genomic library. Touch stimulus of Arabidopsis plants induces the accumulation of mRNA transcribed from AtCAL4 and AtCAL5, but not from the other isolated genes. The two touch-inducible genes are arrayed in tandem with a short intergenic region of 700 bp but they show different organ-specific patterns of expression.

Effects of subchronic treatments with SM-9018, a novel 5-HT2 and D2 antagonist, on dopamine and 5-HT receptors in rats

1. Receptor binding and behavioral studies were performed to compare the effects of subchronic treatments with SM-9018, a novel 5-HT2 and D2 antagonist, and with haloperidol (HAL) on dopamine and 5-HT receptors in rats. 2. SM-9018 treatment (10 mg/kg/day p.o.) for 2 weeks did not significantly change the density (Bmax) of striatal D2 receptors or the incidence of stereotyped behavior induced by apomorphine (APO). By contrast, HAL treatment (3 mg/kg/day p.o., for 2 weeks) significantly increased the D2 receptor density by about 55% and markedly enhanced the behavioral response to APO. 3. The density of 5-HT2 receptors in the cerebral cortex was significantly reduced (about 20%) by SM-9018 treatment without being affected by HAL. However, the hyperthermic response of rats to p-chloroamphetamine (p-CAMP, a putative 5-HT releaser) was unaltered by either treatment. 4. Neither SM-9018 nor HAL treatment changed the density of 5-HT1A receptors in the hippocampus. 5. These findings suggest that SM-9018 is weaker than HAL in inducing up-regulation and supersensitivity of the striatal D2 receptors after the subchronic treatment.

Characteristics of MHC antigen expression and tumor-infiltrating mononuclear cells in renal cell adenomas and carcinomas

We compared the expression of major histocompatibility complex (MHC; HLA class I and II) antigens and the presence of tumor-infiltrating mononuclear cells presenting S100 protein (S100), CD68 antigen, or CD45RO antigen in formalin-fixed, paraffin-embedded tissue sections of 10 renal cell carcinomas and 9 renal cell adenomas using immunohistochemistry. The expression of beta 2-microglobulin (B2MG) as an HLA class I antigen in all 10 cases (100%) and that of HLA-DR/alpha as an HLA class II antigen in 7 of 10 cases (70%) of carcinoma was stronger than that in the adjacent proximal convoluted tubule, but was respectively not different to weaker in 8 of 9 cases and not different to markedly weaker in all cases of adenoma. Furthermore, there was comparatively dense infiltration by S100(+) antigen-presenting cells in the carcinomas, but almost none in the adenomas and generally dense infiltration by CD45RO(+) T cells and CD68(+) macrophages in the carcinomas, but little to none in the adenomas. We concluded that the generally enhanced expression of MHC antigens in carcinomas must be an immunophenotypic deviation from not only the adjacent proximal convoluted tubule but also adenomas, and that the predominant infiltration of antigen-presenting cells, T cells and macrophages in the carcinomas, but not in the adenomas, reflects the anti-cancer immune reaction.