[A case of multilocular renal cyst with calcification]

A 55-year-old woman was incidentally found to have a calcified right renal mass on ultrasonography. A plain film of the abdomen revealed a 3.5 X 4.4 cm, curvilinear calcification in the midportion of the right kidney, and an excretory urogram showed no compression or distortion of the pelvocalyceal system. Computed tomography demonstrated a low density renal mass associated with both peripheral and central calcification. Renal arteriogram revealed a hypovascular mass. Right nephrectomy was performed and the multilocular renal cyst with calcification was confirmed histologically. In the Japanese literature, 53 cases of multilocular renal cyst have been reported, but calcification of the multilocular renal cyst seems to be the first as far as we know.

A case of 48,XXYY Klinefelter's syndrome with incurable skin ulcer

A 40-year-old male was referred to the Chiba University Hospital for hypogonadism. He showed many of the phenotypic features of Klinefelter's syndrome. Cytogenetic studies revealed a 48,XXYY karyotype. The significance of the association of this karyotype with incurable skin ulcer is discussed.

[Clinical observation of non-gonococcal urethritis]

Sixty-one male urethritis cases, 28 gonococcal urethritis and 33 nongonococcal urethritis (NGU), were out-patients at the Department of Urology, Asahi General Hospital, during the 4 months, Oct. 1, 1984-Jan. 31, 1985. Thirteen of the 33 NGU patients (39.4%) were infected with C. trachomatis (CT). The efficacy of Doxycycline and the route of infection was studied in the cases of CT-positive CT-negative-NGU. CT infection from prostitutes was not so frequent as in the other pathogen infection of NGU. The efficacy of Doxycycline (100 mg b.i.d. for 2 weeks) against CT infection was excellent in the disappearance of subjective complaints and that of white blood cells in the urethral discharge in the CT positive-NGU group (13/13), in comparison with CT negative-NGU group (7/18). The efficacy of Doxycycline against CT was also confirmed from the follow-up study by the isolation of CT and by detection of CT antigen from urethral swabs using FITC conjugated monoclonal antibody against CT antigen.

The ompA signal peptide directed secretion of Staphylococcal nuclease A by Escherichia coli

The hybrid pre-enzyme formed by fusion of the signal peptide of the OmpA protein, a major outer membrane protein of Escherichia coli, to Staphylococcal nuclease A, a protein secreted by Staphylococcus aureus, is translocated across the cytoplasmic membrane of E. coli with concomitant cleavage of the signal peptide. A DNA fragment containing the coding sequence for the ompA signal peptide was initially ligated to a DNA fragment containing the coding sequence for nuclease A, with a linker sequence of 33 nucleotides separating the coding sequences. When this fused gene was induced, an enzymatically active nuclease was secreted into the periplasmic space; sequential Edman degradation of this protein revealed that the ompA signal peptide was removed at its normal cleavage site resulting in a modified version of the nuclease having 11 extra amino acid residues attached to the amino terminus of nuclease A. The 33 nucleotides between the coding sequences for the ompA signal peptide and the structural gene for nuclease A were subsequently deleted by synthetic oligonucleotide-directed site-specific mutagenesis. The nuclease produced by this hybrid gene was secreted into the periplasmic space and by sequential Edman degradation was identical to nuclease A. Thus, the ompA signal peptide is able to direct the secretion of fused staphylococcal nuclease A, and signal peptide processing occurs at the normal cleavage site. When the hybrid gene is expressed under the control of the lpp promoter, nuclease A is produced to the extent of 10% of the total cellular protein.

Squamous metaplasia of the trigone in women with recurrent cystitis syndrome

Urocystic mucosal biopsies of the white patch on the trigone in 44 women complaining of dysuria and frequency with or without bacteriuria showed varying degrees of squamous metaplasia as well as submucosal fibrosis. The patients with more frequent episodes of such symptoms in the past had more severe squamous metaplasia with submucosal fibrosis. Introital bacteria were found in almost all patients with mild or moderate development of squamous metaplasia, but not in those with severe lesions. These facts suggest that introital bacteria may be one of the causative factors for the initiation and early development of these abnormal mucosal changes. However, the further progression to severe mucosal alteration seems to be independent of any bacteria and this severe mucosal alteration may result in recurrence of such symptoms.

Secretion cloning vectors in Escherichia coli

The DNA fragment coding for the signal peptide of the OmpA protein, a major outer membrane protein of Escherichia coli, has been inserted into the high-level expression vectors, pIN-III. A foreign DNA fragment can be cloned in any one of the three reading frames at the unique EcoRI, HindIII or BamHI sites immediately after the ompA signal peptide coding sequence. The cloned foreign gene is under the control of both the lpp promoter and the lac promoter-operator. The expression of the gene is regulated by the lac repressor produced by the same vectors. Using the pIN-III-ompA vector, the DNA fragment coding for only the mature portion of beta-lactamase was inserted into the EcoRI site. Upon induction of gene expression, beta-lactamase was secreted into the periplasmic space. The ompA signal peptide was correctly removed resulting in the production of beta-lactamase with four extra amino acid residues (Gly-Ile-Pro-Gly) at its amino terminus due to the linker sequence in the vector. After a 3-h induction, beta-lactamase was accumulated to 20% of total cellular protein without any detectable accumulation of pro-beta-lactamase. Using oligonucleotide-directed site-specific mutagenesis, we have also removed the linker sequence and upon induction of gene expression, beta-lactamase with the authentic NH2-terminal sequence was produced, in even larger amounts than the beta-lactamase with the linker sequence.

[2 cases of renal cell carcinoma on long-term hemodialysis]

Two cases of renal cell carcinoma on maintenance dialysis for chronic renal insufficiency are reported. The first case, a 40-year-old man, complained of hematuria after 9.3 years of dialysis. Nephrectomy was done and small renal cell carcinoma with acquired cystic disease of the kidney were observed. The second case, a 48-year-old man, was found to have renal cell carcinoma after 2.5 years of dialysis by means of routine examination without any symptoms. The kidney showed carcinoma with small cystic areas and four adenomas. Usefulness of routine examination with echogram is stressed for management of hemodialysis.

[Clinical significance of type III procollagen peptide in sera of patients with liver cancer]

We assayed type III procollagen peptide in the sera of 213 patients with various liver diseases and 23 normal controls by radioimmunoassay. The non-cancerous limit of the serum level of type III procollagen peptide was defined as the mean +/- 2 SD of the patients with chronic hepatitis, liver cirrhosis and alcoholic liver disease; it was 50 ng/ml. The percentage of type III procollagen peptide in sera exceeding this limit was 22.2% in patients with hepatocellular carcinoma and 17.4% in metastatic liver cancer. Only patients with liver cirrhosis accompanied by alcoholic hepatitis exceeded this limit. In patients with hepatocellular carcinoma with peptide concentrations above 50 ng/ml, the serum level of GOT, GPT, LDH, T. Bil., LAP, gamma-GTP and T. Chol. was significantly higher than in patients with hepatocellular carcinoma whose serum peptide level was below 20 ng/ml.

[A study of 65 cases of urinary tract injury]

Since 1968, we experienced 65 cases of urinary tract injury. These include a rare case of traumatic renal artery thrombosis which was later followed by renovascular hypertension, a rare case of complete ureteral disruption, and 2 cases of renal injury which were first treated conservatively but were nephrectomized later because of rebleeding. These cases are reported and discussion is made about the relationship between the clinical findings and the indication of nephrectomy. We used endoscopic management (Yasuda method) in the cases of complete disruption of posterior urethra accompanied by pelvic fracture and obtained good results.

Indomethacin suppresses prolactin release in men

Indomethacin administered intrarectally at a dose of 100 mg elicited a statistically significant decrease of serum prolactin level in men. Serum LH level was depressed slightly but the decrease was not statistically significant. There was no effect on serum FSH concentration.

[Circle tube nephrostomy--designing of a circle tube and connector]

We performed circle tube nephrostomy in 17 patients using a newly designed catheter. The catheter which we called 'Chiba Nephrostomy Circle tube' consisted of a silicon tube which has three holes in the middle portion, and a metal connector. The renal function recovered to normal in 12 of the 17 patients (recovery rate 71%), improved in 4 (24%), and remained unchanged in only one patient. Although temporal urinary leakage occurred in 5 patients (29%), there were no serious complications with this newly designed tube. Furthermore, pyelonephritis, renal bleeding and urolithiasis, which occasionally occur by single nephrostomy, did not occur with this method. Thus, we proved the clinical usefulness of the newly designed circle tube.