Autogenous fat intracordal injection as treatment for unilateral vocal palsy

BACKGROUND

Intracordal injection, which is less time-consuming and avoids neck incision, remains an important method to correct glottic insufficiency induced by unilateral vocal palsy. Among the various new materials proposed for intracordal injection, autogenous fat draws our attention for its availability without cost and high bio-compatibility. This article reports our preliminary experiences of intracordal injection using autogenous fat to treat glottic insufficiency induced by unilateral vocal palsy.

METHODS

Autogenous fat is collected under local anesthesia by syringe aspiration from femoral or lower abdomen. Precautions to reduce resorption are taken while collecting and processing the fat. Under the guidance of flexible laryngovideostroboscopy, Bruning syringe with a bended needle is inserted transorally to make the intracordal injection. Serial pre-operation and postoperation evaluations by flexible laryngovideostroboscopy, the patient's selfassessment on the voice, the speech pathologist's perceptual ratings on the breathiness and roughness of the patient's voice, maximum phonation time, and mean airflow rate are made.

RESULTS

A total of 19 cases were recruited for the treatment, and 17 of them completed the procedure. The clinical applicability was 89.5%. The fat injection had no obvious effect on the posterior glottic gap correction. The postoperative glottic gap estimated by the videostroboscopy, was improved in 15 of the 16 cases two weeks after operation, and in five of the seven cases who has been followed up for three months. Twelve of the 16 cases felt improved voice in two postoperative weeks, and six of the seven cases still felt the improvement three months after operation. The rate and amount of resorption varied greatly among individuals. None of the injected cords showed untoward morphological or vibratory changes up to three months after injection.

CONCLUSIONS

Intracordal injection of autogenous fat to treat unilateral vocal palsy by the method we propose is relatively simple with high clinical applicability and no extra-cost. None of the injected cords showed unfavorable changes. Most of the patients were improved after injection, at least for a short period of time. The long-term effectiveness remains to be observed. Repetition of the injection is also simple, if the voice results deteriorate due to resorption of the injected fat.

Epidermoid cysts of the testis: diagnosis by ultrasonography and magnetic resonance imaging resulting in organ-preserving surgery

OBJECTIVE

To present experience in the diagnosis and management of patients with an epidermoid cyst of the testes and to confirm the role of conservative surgery.

PATIENTS AND METHODS

The records from the last 26.5 years of patients diagnosed as having a testicular tumour were reviewed retrospectively. Those patients with a confirmed epidermoid cyst were evaluated for age, clinical assessment, methods of diagnosis, treatment and follow-up.

RESULTS

Amongst a total of 131 testicular tumours, 11 patients (8.4%; mean age 25.7 years, range 21-35) were diagnosed pathologically as having an epidermoid cyst. Pre-operative suspicion of the benign nature of the lesions was supported by testicular ultrasonography in six patients and supplemented with magnetic resonance imaging (MRI) in one. An operation sparing the testicles was performed in eight patients after the diagnosis of epidermoid cyst was confirmed from frozen sections. Three patients were treated by radical orchidectomy. There were no relapses after a median follow-up of 47.3 months (range 2-82).

CONCLUSION

In this series, the relative incidence of epidermoid cyst was higher than that reported in the literature (1-2%). Ultrasonography and MRI of the testes may allow the diagnosis to be made preoperatively. The absence of relapse in these patients further supports the use of organ-sparing surgery in these young men.

Early discontinuation of gonadotropin-releasing hormone agonist in controlled ovarian hyperstimulation: a preliminary report

The purpose of this study was to evaluate the applicability of continuing daily injectable GnRHa, after pituitary desensitization, for the first 4 or 5 days of ovarian stimulation. We proposed a new calculation and estimated that it took as early as 6 to 7 days for pituitary and gonadotropin release to return after cessation of daily administered leuprolide acetate. A modified regimen based on this new calculation, i.e. Daily administered GnRHa continued for the first 4 or 5 days with ovarian stimulation after pituitary desensitization had been achieved was applied to patients undergoing assisted reproductive technology (ART). Thirty-five patients prospectively assigned to use this early discontinuation regimen were analyzed with respect to age, indications, duration of ovarian stimulation, dose of exogenous gonadotropin required, ovarian response and oocytes obtained, rate of fertilization, and rates of pregnancy. There was no spontaneous LH surge occurred. Premature luteinization occurred in one patient. We concluded that, after pituitary desensitization, there was no spontaneous LH surge when daily administered GnRHa continued for 4 or 5 days only with ovarian stimulation. Impacts on the ART outcome required further evaluation in a prospectively randomized study. Based on theoretical estimation, cessation of GnRHa at the beginning of ovarian stimulation might eliminate most, but not all, spontaneous LH surges.

Modal behavior of the mu 1 Na+ channel and effects of coexpression of the beta 1-subunit

The adult rat skeletal muscle Na+ channel alpha-subunit (mu 1) appears to gate modally with two kinetic schemes when the channel is expressed in Xenopus oocytes. In the fast mode mu 1 single channels open only once or twice per depolarizing pulse, but in the slow mode the channels demonstrate bursting behavior. Slow-mode gating was favored by hyperpolarized holding potentials and slow depolarizing rates, whereas fast-mode gating was favored by depolarized holding potentials and rapid depolarizations. Single-channel studies showed that coexpression of beta 1 reduces slow-mode gating, so that channels gate almost exclusively in the fast mode. Analysis of open-time histograms showed that mu 1 and mu 1 + beta 1 both have two open-time populations with the same mean open times (MOTs). The difference lies in the relative sizes of the long and short MOT components. When beta 1 was coexpressed with mu 1 in oocytes, the long MOT fraction was greatly reduced. It appears that although mu 1 and mu 1 + beta 1 share the same two open states, the beta 1-subunit favors the mode with the shorter open state. Examination of first latencies showed that it is likely that the rate of activation is increased upon coexpression with beta 1. Experiments also showed that the rate of activation for the fast mode of mu 1 is identical to that for mu 1 + beta 1 and is thus more rapid than the rate of activation for the slow mode. It can be concluded that beta 1 restores native-like kinetics in mu 1 by favoring the fast-gating mode.

Improved sperm recovery rate with Percoll gradient method in intrauterine insemination

The purpose of this study was to compare the different sperm manipulation methods on the recovery rate of motile sperm that was collected to use in the intrauterine insemination. Three hundred and thirty-five IUI (intrauterine insemination) cycle from a total of 963 treatment cycles was performed for non-peritoneal factor infertility couples. The sperm separation methods were swim-up, swim-down and Percoll gradient (since Mar. 1992). We compared the different sperm preparation methods in normal and abnormal semen analysis group. Our results show that in the abnormal semen samples (oligospermic approximately, asthenospermic approximately), the Percoll gradient method is superior to the swim-up and swim-down methods on the recovery of a higher number of total, motile and active motile spermatozoa (p < 0.05), even though the sperm quality before preparation was rather poorer than the samples prepared by the other two methods. The pregnancy rate in both groups are not statistically significant. We conclude that the Percoll gradient is an improved method for semen manipulation as it allows greater recovery of sperm with higher motility in intrauterine insemination.

Coexpression of beta 1 with cardiac sodium channel alpha subunits in oocytes decreases lidocaine block

Coexpression of the rat beta 1 subunit with rat brain and skeletal muscle sodium channel alpha subunits in Xenopus oocytes normalizes currents by accelerating sodium current decay kinetics, shifting steady state availability relationships, and accelerating recovery from inactivation. Unlike brain and skeletal muscle, the heart alpha subunit expressed without beta 1 has native-like decay kinetics in oocytes. Messenger RNA for beta 1 has been found in heart, but whether and how it affects cardiac sodium channel function are unclear. We studied coexpression of human heart alpha subunit with beta 1 in Xenopus oocytes using two microelectrode voltage-clamp and macropatch techniques. Coexpression with beta 1 caused a significant positive shift of 3-7 mV in the midpoint of the steady state inactivation relationship but did not affect single-channel conductance, activation, current decay, or recovery from inactivation. Sensitivity to lidocaine block, however, was decreased for both resting state block (Kd = 0.5-1.3 mM) and phasic block in response to pulse trains, but inactivated state block was not affected (Kd = approximately 10 microM). Coexpression with beta 1 increased the rate of recovery from lidocaine block, which accounted for the major part of the observed differences in tonic and phasic block. A beta 1 construct with the cytoplasmic tail removed also produced these effects, demonstrating that the beta 1 cytoplasmic tail was not involved in altering lidocaine block. We conclude that the beta 1 subunit is capable of affecting function of the cardiac sodium channel in oocytes by decreasing tonic and phasic lidocaine block with small effects on gating.

In vitro metabolism of a potent HIV-protease inhibitor (141W94) using rat, monkey and human liver S9

Compound 141W94 (Vertex VX478) (3S)-tetrahydro-3-furyl N-[((S,2R)-3-(4-amino-N-isobutylbenzenesulfonamido)-1-benzyl- 2-hydroxypropyl] carbamate, is a potent HIV-protease inhibitor and is currently undergoing clinical trials. The purpose of this study was the rapid identification of the phase I and II in vitro metabolite of 141W94 using mass spectrometry. Four different sources of liver S9 fractions were used for studying comparative in vitro metabolism of 141W94. They were obtained from Arochlor-induced rat, normal (untreated) rat, cynomolgus monkey and human livers. Selected incubations were supplemented with uridine diphosphate glucuronic acid and the reduced form of glutathione. The predominant species seen in the incubation mixture was the parent compound 141W94. Metabolites arising from ring opening to form the diol and carboxylic acid and oxidation of the tetrahydrofurran ring (formation of dihydrofuran) were identified. In addition, of the two monohydroxylated products identified, one resulted from hydroxylation on the aniline ring and the other from hydroxylation at the benzylic position. Two different glucuronides were also observed. Comparing the three species, very little metabolism was seen in the normal (non-induced) rat. The metabolic profile and extent of metabolism with induced rat, monkey and human S9 was similar. Induced rat S9 incubation showed the formation of two unique metabolites that were not seen in non-induced rat, monkey and human S9 fractions. They were the monohydroxylated glucuronide and a carbamate cleavage product. The metabolites were identified using mass spectrometry based on their molecular masses and fragmentation patterns.

The impact of the total motile sperm count on the success of intrauterine insemination with husband's spermatozoa

PURPOSE

The purpose of this study was to evaluate the relationship between the total motile sperm count and the success of IUI treatment cycles with postwashed husband spermatozoa in couples with infertility in a large patient population.

PATIENTS

When 939 couples underwent 1375 cycles of IUI with varying etiologies of infertility which included male factor, endometriosis, tubal factor, ovulatory dysfunction, uterine factor, cervical factor, and unexplained infertility, the results were 207 pregnancies.

RESULTS

The overall pregnancy rate per cycle was 15.1% (207/1375). The total motile sperm count were significantly increased in the pregnant group than the nonpregnant group (38.7 x 10(6) versus 28.6 x 10(6); P < 0.001). There was a trend toward an increased success rate with increased total motile sperm count. Significance was reached when the total motile sperm count exceeded 5 x 10(6). Life table analysis was performed and the curve representing a cumulative chance of pregnancy calculated from our data reached 72%.

CONCLUSIONS

Our findings suggest that a final postwashed total motile sperm count used for IUI may be considered predictive of the success for pregnancy and allow couples to be informed of the chances of success.

The relationship between ultrasonic volume and actual weight of pathologic uterus

Our purpose was to assess the correlation between the estimated volume based on ultrasonic measurement in vivo and the actual weight of the diseased uterus after hysterectomy, and then retrospectively tried to establish a simple equation to convert the volume into the weight in grams. A total of 105 women with nonmalignant diseased uteri which were prepared to undergo laparoscopy-assisted vaginal hysterectomy had had preoperative ultrasound scanning to estimate the uterine size by measuring three dimensions including the length (L), width (W) and anteroposterior (AP) diameter. The uterine volume was calculated by the use of a prolate ellipsoid formula (4/3 x pi x L/2 x W/2 x AP/2). Actual uterine weight was immediately taken after extirpation of the uterus. Linear regression analysis revealed uterine weight (g) = 50.0 + 0.71 x volume (cm3), with correlation coefficient = 0.93 and SE = 49.6 g. There was a close, positive correlation between the estimated uterine volume and actual uterine weight. With utilization of this equation, the uterine size in vivo can thus be expressed as a concrete, objective value in weight instead of "weeks' size' by comparison with pregnant uterus, which has been commonly used in traditional gynecologic practice.

Founding mutations and Alu-mediated recombination in hereditary colon cancer

By screening members of Finnish families displaying hereditary nonpolyposis colorectal cancer (HNPCC) for predisposing germline mutations in MSH2 and MLH1, we show that two mutations in MLH1 together account for 63% (19/30) of kindreds meeting international diagnostic criteria. Mutation 1, originally detected as a 165-base pair deletion in MLH1 cDNA comprising exon 16, was shown to consist of a 3.5-kilobase genomic deletion most likely resulting from Alu-mediated recombination. Mutation 2 destroys the splice acceptor site of exon 6. A simple diagnostic test based on polymerase chain reaction was designed for both mutations. Our results show that these two ancestral founding mutations account for a majority of Finnish HNPCC kindreds and represent the first report of Alu-mediated recombination causing a prevalent, dominantly inherited predisposition to cancer.

Parameters of semen analysis affecting the pregnancy rate of artificial insemination with husband's spermatozoa

The efficacy of intrauterine insemination with husband's semen (AIH) is well established for some types of infertility. Results that had been reported previously were Dwing difficult to assess owing to the low number of patients or treatment cycles as well as an inadequate definition of the indications in most cases. In this study, we report our experience with intrauterine insemination (IUI) using post-treated sperm suspension from husband's semen in the treatment of infertility. A total of 328 treatment cycles were completed from January to December in 1991. The indications for AIH/IUI were male infertility (130 cycles), unexplained infertility (87 cycles), sex selection (72 cycles) and anovulatory disorder (39 cycles). Sixty-eight pregnancies were achieved. The clinical usefulness of AIH/IUI with or without concomitant hMG regimens were established according to diagnostic subgroups. In our results, the cycle fecundity of pregnancy was higher in patients with ovulatory disturbance. The importance of sperm motility confirmed by our results that have compared by the serial sperm parameters. The motile sperm count may appear to be a highly consistent parameter that serves as a sensitive indicator of sperm function and correlation of successful pregnancy in our results. In conclusion, this study indicates that AIH with controlled ovarian hyperstimulation can result in higher viable pregnancy rate, and it is also a non-invasive and relatively easy procedure. We believe that this is a transient useful method for the treatment of non-organic infertility, prior to any attempt of aggressive assisted reproductive procedures.

The expression of ferritin on renal cancers and its relationship with cellular differentiation and tumour stage

OBJECTIVES

To investigate ferritin expression in renal carcinoma and the correlation of expression with tumour differentiation and stage.

PATIENTS AND METHODS

Ferritin was immunohistologically detected in 35 patients (23 men and 12 women; mean age 58.2 years, range 40-82) with renal carcinoma and the findings compared with cellular type, tumour stage and the ferritin expression of a similar control population of 16 patients.

RESULTS

The incidence of ferritin expression in renal carcinomas was 51%. Expression was significantly related to tumour stage and not cellular type.

CONCLUSION

The results of this study re-emphasize the high expression of ferritin in renal cell carcinoma and the correlation of expression with tumour behaviour.

Comparison between short-term and long-term post-operative evaluation of sleep apnoea after uvulopalatopharyngoplasty

For a long time uvulopalatopharyngoplasty (UPPP) has been used to treat the obstructive sleep apnoea syndrome (OSAS). The diverse surgical effects, the inadequate understanding of operation effect consistency, the possibility of disease progression, and the few reported papers for long-term evaluation after UPPP aroused our interest in designing this study. Fifteen OSAS patients who had undergone UPPP with pre-operative, initial post-operative and long-term post-operative polysomnographic studies were included in this study. Long-term post-operative polysomnography was undertaken more than five years after surgery. The polysomnographic evaluations included respiratory disturbance index (RDI), duration of saturation SaO2 < 85 per cent (DOS), and the lowest O2 saturation (LOS). Amongst them, 10 patients with initial post-operative RDI reduction > 50 per cent were considered responders. In these responders, the long-term follow-up results of all three parameters showed improvement compared to the pre-operative data. In a comparison between the initial and long-term post-operative sleep study results, LOS and DOS showed no significant difference. However, the long-term post-operative RDI result became significantly worse. More than 80 per cent of all cases had subjective symptomatic improvement in the long-term post-operative evaluation. The subjective improvement after operation is not adequately correlated to the polysomnographic result. We suggest that long-term follow-up for patients after UPPP is necessary.

Neurotoxin quinolinic acid is selectively elevated in spinal cords of rats with experimental allergic encephalomyelitis

Experimental allergic encephalomyelitis (EAE) is an autoimmune, animal model of multiple sclerosis (MS) in which demyelination and paralysis are evident. Quinolinic acid (QUIN) is a neurotoxin and endogenous N-methyl-D-aspartate receptor agonist formed from tryptophan. The role of neurotoxins in general and QUIN in particular in EAE or MS is unknown. Lewis rats inoculated with myelin basic protein developed signs of EAE by day 12, were killed, and their tissues assayed for QUIN by gas chromatography with mass spectrometry. QUIN levels were significantly elevated in the more caudal regions of the spinal cords of animals with EAE. Brain, serum, and liver levels of QUIN were not altered. In a similar manner, QUIN in mylin basic protein-injected, asymptomatic animals was not different from control animals. The time course for QUIN was similar to the neurological signs of the disorder; however, the initial elevation in QUIN occurred before the appearance of behavioral signs. Last, treatment with the glucocorticoid dexamethasone prevented both the signs of EAE and the elevation in spinal cord QUIN. It is not known whether QUIN contributes to the paralysis in EAE. However, if QUIN is pathogenic in EAE this finding could have therapeutic implications for MS.

Unexpected pregnancies exposed to leuprolide acetate administered after the mid-luteal phase for ovarian stimulation

Leuprolide acetate (Lupron) belongs to the group of gonadotrophin-releasing hormone agonists (GnRHa). It is used in conjunction with human menopausal gonadotrophin (HMG) and/or follicle stimulating hormone (FSH) for ovarian stimulation in the so-called ultra-short, short or long protocols. In our programme, the long protocol is mainly used, which starts routinely with s.c. administration of Lupron, 1 mg/day, from day 21 of the cycle preceding ovum retrieval. After pituitary desensitization is achieved, gonadotrophin administration is started. However, unexpected, spontaneous pregnancy may occur during the flare-up phase of Lupron administration. We present six pregnancies and four deliveries which have occurred under these circumstances. The mechanisms by which pregnancy may occur and escape from luteolytic, abortifacient and teratogenic effects of prolonged use of GnRHa are discussed, as well as pregnancy outcome.

Follicular fluid levels of insulin-like growth factor I, insulin-like growth factor binding protein I, and ovarian steroids collected during ovum pick-up

OBJECTIVE

To evaluate interrelationships between levels of insulin-like growth factor I (IGF-I), insulin-like growth factor binding protein (IGFBP-I), and ovarian steroids in late preovulatory follicular fluid (FF) after pituitary desensitization with GnRH agonist and controlled ovarian hyperstimulation.

DESIGN

Follicular fluid and matched serum were collected during the ovum pick-up. Insulin-like growth factor binding protein I, E2, P, and androstenedione (A) were measured by means of RIA, whereas T was measured by means of fluoroimmunoassay and IGF-I by means of immunoradiometric assay.

SETTING

University teaching hospital.

PARTICIPANTS

Fifty-nine patients underwent 62 ovum pick-ups for IVF.

MAIN OUTCOME MEASURES

Levels of IGF-I, IGFBP-I, E2, P4 (representative of follicular maturity), T, and A in FF and the volume of this fluid were determined. Levels of E2 to A (representative of aromatase activity) in FF were examined in relation to the volume of FF.

RESULTS

Levels of FF-IGF-I decreased with increasing volume of FF. This observation is unprecedented. In contrast, FF-P increased with increasing volume of FF. The reverse relationships with FF volume between FF-IGF-I and FF-P may not be causal because no correlation was found between concentrations of FF-IGF-I and FF-P. Our findings are consistent with and complementary to those in previous reports. The follicular fluid E2:A ratio, FF-E2, FF-A, FF-T, and FF-IGFBP-I were not found to be correlated with volume of FF.

CONCLUSION

Decreased levels of FF-IGF-I with unaltered levels of FF-IGFBP-I in larger follicles may favor a shift toward diminished action of IGF-I at the time of immediate preovulation. The physiological significance of this shift remains uncertain as it is not reflected in the levels of steroids in FF.

In vivo biotransformation of fenoctimine in rat, dog and man

1. The metabolism of fenoctimine (Fn) was studied in rat, dog and man following administration of 14C-Fn sulphate. 2. Seventeen Fn metabolites were isolated by hplc and tlc from rat bile, dog bile, dog urine, human urine, human faecal extracts, and human plasma and identified using nmr and MS. 3. The identified metabolites accounted for 75% of total radioactivity in rat bile, 80% in dog bile, and 40% in dog urine samples. In man, 90% of the urinary, 70% of the faecal, and > 50% of the plasma total radioactivity were identified. 4. Three major pathways for Fn metabolism were proposed. These pathways involved imino-bond cleavage, aromatic hydroxylation and oxidation of the aliphatic chain. 5. The imino-bond cleavage pathway was dominant in all species. However, the other two pathways differed in quantitative importance among the species studied. 6. The aromatic hydroxylation pathway appeared to be the most important means of biotransformation of Fn in dog since all but two of the metabolites were formed by this route. 7. The aliphatic oxidation pathway appeared to be important to the biotransformation of Fn in man and produced three major metabolites.

Endourologic management of impassable urethra stricture

Visual internal urethrotomy with the help of suprapubic urethroscopy and rectal digital palpation is an effective method of treating impassable urethral stricture. This technique was used to treat 25 male patients with completely obstructed membranous urethral stricture and three female patients with total obliteration of the urethra. The technique is relatively easy and safe and has produced satisfactory results. This procedure should be the management of choice when the impassable urethral segment is shorter than 2.5 cm. It is also very effective and safe in treating urethra stricture in females.

CRF facilitates NE release from the hippocampus: a microdialysis study

Using the in vivo microdialysis method, we have found that at moderate doses (1.44, 3.6 and 7.2 micrograms), corticotropin-releasing factor (CRF) facilitated norepinephrine (NE) release from the dentate gyrus of hippocampus in rats in a dose-response fashion. The same doses of CRF also enhanced locomotor activity in rats. On the other hand, CRF at the highest dose studied (14.4 micrograms) decreased NE release as well as locomotor activity in rats. These neuropeptide/neurotransmitter interactions may have significant physiological implications.

The use of low-energy collisionally activated dissociation negative-ion tandem mass spectrometry for the characterization of dog and human urinary metabolites of the drug BW 1370U87

Liquid chromatography (LC) combined with atmospheric pressure chemical ionization mass spectrometry was used to identify phase I and II metabolites of the drug BW 1370U87 in dog and human urine. Additional analysis of individual high-performance liquid chromatograph fractions collected from dog urine by combined gas chromatography/mass spectrometry identified one metabolite which was not detected by LC/MS methods. Using negative-ion LC/MS, the majority of BW 1370U87 metabolites in human urine were identified as glucuronic acid conjugates of phase I oxidative metabolites. The negative-ion fragmentation produced by low-energy collisionally activated decomposition (CAD), studied by tandem mass spectrometry experiments, confirmed that these compounds were drug-related and allowed metabolite structures to be assigned. Product-ion spectra of the metabolites were dominated by the loss of neutral molecules from even-electron deprotonated [M-H]- ions.

Flow cytometric DNA and cytomorphometric analysis in renal cell carcinoma: its correlation with histopathology and prognosis

Cell material from 49 cases of archival paraffin-embedded tumor specimens of newly diagnosed renal cell carcinoma (RCC) was studied retrospectively using rapid flow cytofluorometric (propidium iodide) DNA analysis. The degree of ploidy (DNA index), percentage of cells in the S-phase (SPF), and modal nuclear size were determined from histograms. The tumors were classified as diploid (DNA index = 0.9-1.1) or aneuploid. Proliferative activities of the tumors were assessed from the proportion of S-phase cells. The aneuploid occurrence was 77.6% in our series. Univariate and multivariate logistic regression analyses of DNA ploidy and associated parameters showed that DNA ploidy was correlated with SPF of cells (P = 0.0061) as no correlation was seen between DNA ploidy, sex, age, histological type, tumor size, stage, and nuclear size (P = 0.0697). Multiple aneuploid stem lines had no influences on ploidy and prognosis. Comparison of survival data using the multivariate stepwise hazard rate and Lee-Desu statistics showed that patient prognosis was closely related to tumor size (P = 0.006) and staging (P < 0.0001). DNA ploidy had marginal correlation to progression and disease-specific death (P = 0.064). Nevertheless, flow cytometric analysis in conjunction with conventional histopathology may have a potential role for the management of patients with RCC.

The management of ovarian cysts by sono-guided transvaginal cyst aspiration

Nineteen transvaginal, sono-guided ovarian cyst punctures were performed in 18 patients. These patients, who were high surgical risks, were diagnosed to possess benign ovarian tumors as revealed with sonography. Aspiration curettage of the inner surface of the cyst present during aspiration was also performed to facilitate cytologic diagnosis. The recurrence rate was 11.1%. Sono-guided transvaginal cyst aspiration has been demonstrated here to be the treatment of choice for dealing with an ovarian cyst in patients at high surgical risk.

The origin of HIV-1 isolate HTLV-IIIB

The striking similarity between the first two human immunodeficiency virus type 1 (HIV-1) isolates Lai/LAV (formerly LAV, isolated at the Pasteur Institute) and Lai/IIIB (formerly HTLV-IIIB, reported to be isolated from a pooled culture at the Laboratory of Tumor Cell Biology (LTCB) of the National Cancer Institute) provoked considerable controversy in light of the high level of variability found among subsequent HIV-1 isolates. In November 1990, the Office of Scientific Integrity at the National Institutes of Health commissioned our group to analyse archival samples established at the Pasteur Institute and LTCB between 1983 and 1985. Retrospective analyses have shown that contamination of a culture derived from patient BRU by one from patient LAI was responsible for the provenance of HIV-1 Lai/LAV; the contaminated culture (M2T-/B) was sent to LTCB in September 1983. Our goals were to determine which HIV-1 variants were present in the samples and the sequence diversity among HIV-1 isolates from the earliest stages of the AIDS epidemic. We examined archival specimens and report here the detection of six novel HIV-1 sequences in the cultures used to establish the pool: none is closely related to HIV-1 Lai/IIIB. A sample derived from patient LAI contained variants of both HIV-1 Lai/IIIB and HIV-1 Lai/LAV, and a sequence identical to a variant of HIV-1 Lai/IIIB was detected in the contaminated M2T-/B culture. We conclude that the pool, and probably another LTCB culture, MoV, were contaminated between October 1983 and early 1984 by variants of HIV-1 Lai from the M2T-/B culture. Therefore, the origin of the HIV-1 Lai/IIIB isolate also was patient LAI.

A successful pregnancy after subzonal insertion with epididymal sperm and coculture on Vero cell monolayer

A 26-year-old nulliparous woman conceived after transfer of three embryos cocultured on a Vero cell monolayer. The ET followed SUZI of epididymal sperm from her husband with congenital absence of vas deferens.

Maintenance of high extracellular pH does not influence cell pH or metabolism in submerged anoxic bullfrogs

We compared extracellular and intracellular acid-base states in paralyzed bullfrogs subjected to 4 h of anoxic submergence at 15 degrees C with or without maintenance of extracellular pH at preanoxic levels by bicarbonate infusion. We also assessed anaerobic metabolism under these conditions by measuring tissue lactate and glycogen concentrations in liver, heart, and skeletal muscle. Although bicarbonate infusion resulted in a significantly higher arterial blood pH (pHe) than saline infusion, intracellular pH (pHi) of heart and skeletal muscle, as determined by the DMO equilibration technique, were not significantly different after 4 h of anoxia. We were also unable to demonstrate any differences in anaerobic metabolic rate, since both tissue lactate accumulation and glycogen depletion were identical in bicarbonate- and saline-infused frogs in the tissues studied. We conclude that (1) alterations in the extracellular acid-base state by bicarbonate infusion are not necessarily reflected in the intracellular compartment, perhaps due to powerful intracellular buffering processes, and (2) maintenance of an alkaline extracellular pH during anoxia in bullfrogs does not influence the anaerobic metabolic rate. We could not, however, rule out a possible role for intracellular pH in regulating anaerobic metabolism during anoxia in frogs.

High-level expression, purification, and enzymatic characterization of full-length Thermus aquaticus DNA polymerase and a truncated form deficient in 5' to 3' exonuclease activity

The Thermus aquaticus DNA polymerase I (Taq Pol I) gene was cloned into a plasmid expression vector that utilizes the strong bacteriophage lambda PL promoter. A truncated form of Taq Pol I was also constructed. The two constructs made it possible to compare the full-length 832-amino-acid Taq Pol I and a deletion derivative encoding a 544-amino-acid translation product, the Stoffel fragment. Upon heat induction, the 832-amino-acid construct produced 1-2% of total protein as Taq Pol I. The induced 544-amino-acid construct produced 3% of total protein as Stoffel fragment. Enzyme purification included cell lysis, heat treatment followed by Polymin P precipitation of nucleic acids, phenyl sepharose column chromatography, and heparin-Sepharose column chromatography. For full-length 94-kD Taq Pol I, yield was 3.26 x 10(7) units of activity from 165 grams wet weight cell paste. For the 61-kD Taq Pol I Stoffel fragment, the yield was 1.03 x 10(6) units of activity from 15.6 grams wet weight cell paste. The two enzymes have maximal activity at 75 degrees C to 80 degrees C, 2-4 mM MgCl2 and 10-55 mM KCl. The nature of the substrate determines the precise conditions for maximal enzyme activity. For both proteins, MgCl2 is the preferred cofactor compared to MnCl2, CoCl2, and NiCl2. The full-length Taq Pol I has an activity half-life of 9 min at 97.5 degrees C. The Stoffel fragment has a half-life of 21 min at 97.5 degrees C. Taq Pol I contains a polymerization-dependent 5' to 3' exonuclease activity whereas the Stoffel fragment, deleted for the 5' to 3' exonuclease domain, does not possess that activity. A comparison is made among thermostable DNA polymerases that have been characterized; specific activities of 292,000 units/mg for Taq Pol I and 369,000 units/mg for the Stoffel fragment are the highest reported.

The effect of methylene blue-sensitized photodynamic treatment on bladder cancer cells: a further study on flow cytometric basis

The cytotoxic effect mediated by methylene blue-sensitized photoinactivation on bladder cancer cells has been well known for years, but the actual mechanism is still not clear. Specific fluorescence stains were used in a multiparameter approach. The changes in cellular size, granularity, protein content, RNA and DNA were analyzed by flow cytometry. The results showed that, in addition to cell size, all the other parameters, including cellular granularity, protein, RNA and DNA, diminished following photodynamic therapy. The cytotoxic efficacy is closely related to time of stain and illumination. The DNA and cell cycle were affected simultaneously with decreased DNA content and arrest in the G0/G1 phase. These multistage processes occurred synchronously after the phototherapy. Our results suggest that the methylene blue-sensitized photooxidation of bladder cancer cells is carried out by multimedia reactions through which the intracellular proteins (enzymes in mitochondria), RNA (ribosomes) and DNA (chromatin) decrease with loss of cytoplasmic granularity.

Treatment of infertility using controlled ovarian hyperstimulation with intrauterine insemination: the experience of 343 cases

Fecundity rates were measured for 343 patients in 467 cycles of ovulation induction with intrauterine insemination (IUI) from January 1990 to April 1992. Total pregnancy rate per cycle (PR) was 15.6% with a spontaneous abortion (SA) rate of 19.2%, an ectopic pregnancy (EP) rate of 4.1%, a multiple pregnancy (MP) rate of 19.2%, and an ongoing or live-birth (LB) rate of 12.0%. Using gonadotropins as a unique or as an additional stimulatory reagent improved the pregnancy rate of anovulatory patients by more than three-fold over use of clomiphene citrate (CC) alone (33.3% vs 10.7%). In other diagnostic entities, the PRs were higher, but the difference was not statistically significant between these two stimulation protocols (13.9% vs 8.4%; t = 1.70, p > 0.05). Pretreatment sperm motility and the post-treatment total motile sperm count were significantly correlated with the PRs. The same phenomena occurred when the number of follicles > or = 12 mm and the serum estradiol concentrations were taken into account. The highest PR was detected when the endometrial thickness fell between 8 and 13 mm. The spontaneous abortion rate was higher in CC only cycles and when the serum E2 was below 1000 pg/mL on the day human chorionic gonadotropin was administered. A multiple pregnancy could be predicted when a cycle of more than 10 follicles > or = 12 mm was detected (44.4%). The complications of controlled ovarian hyperstimulation with IUI were low and mild in our study, comprising six cases of moderate to severe ovarian hyperstimulation syndrome and three cases of acute pelvic inflammatory disease.(ABSTRACT TRUNCATED AT 250 WORDS)

Vicryl mesh for repair of severely injured kidneys: an experimental study

We evaluated the efficacy of wrapping the kidney with semi-elastic Vicryl mesh for control of hemorrhage and preservation of renal function following grade III kidney lacerations (shattered kidney) in dogs in which nephrectomy was indicated clinically. Wrapping of fragmented kidneys resulted in prompt, sustained hemostasis and reapposition of the renal parenchyma. At an average of 80 days after injury the renal lacerations were well healed. The Vicryl mesh had been fully reabsorbed and there was considerably less scar tissue at the site of parenchymal rupture and neither perirenal or intrarenal abscess nor hematoma was found, grossly or microscopically. Among 12 dogs with grade III kidney lacerations, the mean ratio of the effective renal plasma flow (ERPF) in the affected kidney to the ERPF in the uninjured contralateral kidney was 0.53 +/- 0.22. The mean ratio of creatinine clearance of the injured kidney to that of the uninjured contralateral kidney was 0.41 +/- 0.23. Changes in the serum renin levels were not statistically significant following injury. Our results seem to confirm that simple and rapid surgical treatment of severely shattered kidneys using semi-elastic Vicryl mesh is possible. The method may also be suitable for uncontrollable bleeding during nonextirpative kidney surgery.

[Vertical partial laryngectomy and its reconstruction methods]

In the past ten years, we performed vertical partial laryngectomy in 25 patients with glottic carcinomas. These included two T1 cases, seven T2 cases, six T3 cases, and ten post-irradiation recurrent cases. Three types of reconstructive surgery were performed in 24 patients which included 14 patients reconstructed by superior based sternohyoid muscle flap covered with A-E fold or free oral mucosa flap, 7 patients by epiglottic flap, and 3 patients by free fat graft. Most patients healed well post-operatively. Only two post-irradiated patients suffered from fistula due to poor healing, one of whom was found necrosis of sternohyoid muscle flap. In three of those reconstructed by sternohyoid flap, more granulation tissues were noted in the glottis. Transient aspiration was noted in all those reconstructed by epiglottic flaps and some of those by sternohyoid muscle flaps. Later, however, all patients get satisfied with phonation post-operatively. Seventeen patients were followed over year and one T3 patients suffered from recurrence six months after surgery. We concluded that superior based sternohyoid muscle flap covered with free oral mucosa for reconstruction of glottis after ventrical partial laryngectomy was a safe and effective method except for post-irradiated patient. Reconstruction with epiglottic flap might be better for such post-irradiated patients. More satisfactory reconstructive method still deserves further investigation.

Radioimmunoassay for the chemical stable prostacyclin analog, 15AU81: a preliminary pharmacokinetics study in the dog

15AU81 is a chemically stable tricyclic benzindene analog of prostacyclin, with possible application to the treatment of congestive heart failure. Effective pharmacological doses in a dog model are in the microgram to sub-microgram/kg range, necessitating an analytical method of high sensitivity for determination of the drug in plasma. This report describes the development and validation of a radioimmunoassay for 15AU81, and its application to a pharmacokinetic study in the beagle dog. An antiserum elicited by immunization with a 15AU81-bovine thyroglobulin conjugate was employed, along with 3H-15AU81, in the radioimmunoassay. Analogs of 15AU81, as well as a glucuronide metabolite produced by a dog liver subcellular fraction in vitro, were used to demonstrate the specificity of the radioimmunoassay. Specificity was confirmed by comparative analysis by radioimmunoassay and by a quantitative GC/MS procedure of plasma samples from dogs dosed with 15AU81. The limit of quantitation in dog plasma was 1.6 ng/ml; accuracy and precision were both acceptable. The assay was applied to a study of the pharmacokinetics of 15AU81 in the beagle dog after intravenous or intratracheal administration of a single 20-micrograms/kg dose. Following intravenous dosing, 15AU81 was eliminated rapidly from plasma (t1/2, 2.8 min), while after intratracheal administration, clearance appeared to be somewhat slower and bioavailability was appreciable (mean, 46%), suggesting that this route of administration may be worthy of further evaluation.

Lack of mutational alteration in the conserved regions of ZFY and SRY genes of 46,XY females with gonadal dysgenesis

To further our understanding of the mechanism of action of regulatory and structural genes involved in human sex determination, we have examined three sex-reversed 46,XY females and two of their normal fathers for any mutational alteration in ZFY and SRY genes, using polymerase chain reaction and single-strand conformation polymorphism and by subsequent DNA sequencing. We could not find any mutation in the ZFY and SRY genes of these patients and their fathers. The results seem to suggest that although ZFY and SRY may be required for initiation of testis differentiation and male sex determination, sex-reversed females may predominantly result from alterations in genes either downstream or secondary to ZFY or SRY.

No detrimental effects in delaying initiation of gonadotropin administration after pituitary desensitization with gonadotropin-releasing hormone agonist

OBJECTIVE

To determine if delaying initiation of exogenous gonadotropin administration after pituitary desensitization with gonadotropin-releasing hormone agonist (GnRH-a) is a realistic option to avoid scheduling clinical and laboratory work on weekends/holidays.

DESIGN, PATIENTS

A review of 57 in vitro fertilization (IVF) cycles in which, after pituitary desensitization with GnRH-a, initiation of gonadotropin administration were delayed in an attempt to avoid off-hour work. Thirty-eight IVF cohort cycles served as control.

SETTING

Tertiary medical center.

RESULTS

There were no statistically significant differences in ovarian response, dose of gonadotropin required, oocytes and embryos obtained, pregnancy rates, and abortion rates between groups. Eighty-three percent of the delayed cycles had clinical and laboratory work that fell within weekdays.

CONCLUSION

Delaying initiation of exogenous gonadotropin administration after pituitary desensitization had no detrimental effects on IVF outcomes. It may be used to avoid scheduling work on weekends/holidays.

Cloning and expression in Escherichia coli of the gene encoding an extracellular deoxyribonuclease (DNase) from Aeromonas hydrophila

The gene encoding an extracellular DNase from Aeromonas hydrophila CHC-1 has been cloned and sequenced. Following expression of the dns in Escherichia coli, it was revealed that some of the cloned enzyme was present in the cell-free extracellular supernatant fluid, and there was no cell lysis and concurrent release of cytoplasmic or periplasmic proteins. Therefore, results suggest that E. coli cells were capable of secreting the DNase extracellularly, albeit very inefficiently. The dns is transcribed from its own promoter in E. coli, and expressed as a 25-kDa product, as determined by sodium dodecyl sulfate-polyacrylamide-gel electrophoresis of the culture supernatant preparations followed by a DNA-hydrolysis assay. Nucleotide sequence analysis predicted a single open reading frame of 690 bp encoding a 230-amino acid (aa) polypeptide, with a potential 20-aa signal peptide located at the N terminus of the predicted protein. The deduced aa sequence of the entire protein is highly homologous with that of the DNase of Vibrio cholerae.

Postmenopausal tuboovarian abscess

Twenty postmenopausal women with tuboovarian abscess were surgically managed at CGMH during 1981 to 1991. Fever with lower abdominal pain were the most common symptoms and signs. Laboratory, sonographic & roentgenologic studies helped in detecting and in making a correct preoperative diagnosis of the origin of the inflammatory complex. Half of the patients had postmenopausal bleeding or discharge. Six tuboovarian abscesses were ruptured at the time of surgery and of these had prolonged hospitalization due to complications. Among the six complications, 2 suffered from intraoperative bowel injury, 2 had postoperative wound infection, 1 colonocutaneous fistula and 1 sigmoid stricture. Abdominal total hysterectomy was tried in all the cases but the surgical procedure was changed to subtotal hysterectomy in two and bilateral salpingo-oophorectomy in one. Septic condition and suspicion of ruptured abscess are indications for immediate operation. No major medical complication developed in the post-operative period. However, the early detection and treatment of unruptured tuboovarian abscess had less surgery related complications and had a shorter mean length of hospitalization.

[Mouse embryos co-cultured with various generations of human ampullary cells]

The pregnancy rates for the gamete intra-fallopian transfer (GIFT) and tubal embryo transfer (TET) methods have been shown to be high. The oviductal environment appears to be suitable for fertilization and subsequent cleavage. Many authors have reported that when co-cultured with human ampullary cells, the embryos can develop in vitro as well as in vivo. Thus, significantly more embryos reach the early blastocyst stage, and more successful implantation may be obtained. However, the characteristics of the ampullary cells may change after a series of sub-cultures. In this study, we compared the first and the seventh sub-culture ampullary cell co-cultured systems with a control group. There were significantly more embryos cleaved to blastocysts in these two co-cultured systems than in the control group, but no significant difference between these two co-cultured systems. Detoxification of the medium by co-cultured cells may play an important role in improving embryo quality.

Inhibitory effects of suramin on a human renal cell carcinoma line, causing nephrogenic hepatic dysfunction

A sarcomatoid renal cell carcinoma has been isolated from a patient with Stauffer's syndrome. The tumor, designated BA1119, has been established in tissue culture over 80 passages. Subcutaneous deposition of BA1119 in athymic mice induced splenomegaly and hepatic dysfunction which became fatal within four weeks without metastasis. Suramin is a synthetic polyanionic compound which is capable of altering the function of a number of biologic systems and inhibiting the activity of a variety of protein and growth factors. In this study we attempted to study the effect of suramin on growth of BA1119 in culture and in nude mice. Suramin, at 300 micrograms/ml., had a profound inhibitory effect on cell growth during a six-day culture period. Suramin given i.p. weekly to nude mice at clinically relevant doses (200 mg./kg.) caused significant shrinkage of subcapsular tumor deposits. Splenic hypertrophy secondary to BA1119-induced Stauffer's syndrome was inhibited by suramin. Synergistic effect with enhanced cytotoxicity on BA1119 cells was observed when suramin (100 micrograms/ml.) was used in combination with lymphokines, such as gamma interferon (500 units/ml.) and alpha tumor necrosis factor (300 ng./ml.). These results may suggest a therapeutic efficacy of suramin in renal cell carcinoma patients with Stauffer's syndrome.

Metabolic and cardiodynamic responses of isolated turtle hearts to ischemia and reperfusion

We used 31P and 1H nuclear magnetic resonance spectroscopy to measure intracellular pH, high energy phosphates, and lactate levels in hearts of turtles (Chrysemys picta bellii) subjected to 1.5 h of global ischemia followed by reperfusion. We simultaneously monitored maximum ventricular developed pressure (Pmax), maximal rate of pressure development (dP/dtmax), rate-pressure product (RPP), cardiac output, and heart rate and also measured lactate efflux from the hearts during reperfusion. Our goal was to test the hypothesis that turtle hearts would prove tolerant of prolonged global ischemia at 20 degrees C and would recover completely on reperfusion without any indication of ischemia-or reperfusion-related injury. The 1.5 h of ischemia resulted in decreases in phosphocreatine and ATP to 31.4 +/- 2.8 and 87.3 +/- 6.3% of control, respectively, while Pi rose to 236.6 +/- 26.3%. Intracellular pH decreased during this period from 7.38 +/- 0.02 to 6.87 +/- 0.04. Most of these changes occurred during the first 30 min. Tissue lactate rose during 1.5 h of ischemia from approximately 1.5 to 22.3 mumol/g wet tissue wt. However, the rate of lactate production was much higher during the first 21 min of ischemia (0.41 mumol.g-1.min-1) than during the remaining 70 min (0.10 mumol.g-1.min-1). With the onset of ischemia, Pmax, dP/dtmax, RPP, and heart rate all decreased dramatically with roughly the same time course as the changes in high-energy phosphates and intracellular pH. On reperfusion, turtle hearts rapidly restored high-energy phosphates, intracellular pH, lactate, and cardiodynamics to control levels, usually within 15-30 min, with no evidence of reperfusion injury.(ABSTRACT TRUNCATED AT 250 WORDS)

Ovum donation program at Chang Gung Memorial Hospital, Taipei

The ovum donation program at Chang Gung Memorial Hospital currently confronts the difficulty of limited oocyte resources. The oocytes might be donated from the surplus oocytes of IVF patients. However, after the successful introduction of embryo cryopreservation, patients preferred to have their surplus embryos cryop-reserved and thus, few surplus oocyts were available for donation from IVF program. In addition, official policies discourage use of oocytes donated by consanguineous relatives of either one of the recipient couple or for financial rewards. Among the first three oocytes recipients, with ovarian failure, one chemical pregnancy resulted. Oral premarin and transvaginal and intramuscular progesterone were administered as hormone replacement. The fourth recipient, who had had bilateral oophorectomy, received transdermal estradiol patch (Estraderm) and transvaginal progesterone (Utrogestan) as hormone replacement. The Estraderm/Utrogestan protocol became standard in later cases since the first ongoing pregnancy was achieved in patient 4. We feel this protocol satisfies the required ample levels of hormone replacement for ovum donation.

[The factors of diagnosis and treatment delay in the late stage of cancers in pharynx, larynx and oral cavity]

Cancers of pharynx, larynx and oral cavity (CPLOC) are the tumors can be easily found by patients themselves. Unfortunately, the diagnosis and treatment delay in CPLOC is very severe in our country. The study was based on the data collected through questionnaire from 100 patients with CPLOC in late stages. The causes of diagnosis and treatment delay in those patients were evaluated. The study reveals that traffic and financial difficulties are not the principal factors causing the delay. Instead, limited knowledge which the patients learned from television and newspapers, and sometimes bias cancer knowledge play major role in the delay. When the symptoms developed, 64% of the patients either did not pay attention to their symptoms, or took some improper medical treatments according to their own diagnosis. It took them 207 days on average from having the symptoms to consulting a doctor, about 108 days on average from consulting a doctor to getting a right suggestion. The latter delay was often caused by ambiguous and improper suggestion from doctors. However, if a patient receives a proper suggestion from a doctor, the major reason for diagnosis delay was that patients felt their symptoms were not severe or the examinations required too much time. Even if patients were confirmed to have cancer, treatment delay is still not avoidable as they often turned to Chinese herb doctors, took herb drugs, or feared of receiving an operation. Therefore, the best way of reducing treatment delay in CPLOC is to enhance medical knowledge and education, and to correct the image that traditional Chinese herbs are effective in curing CPLOC.

Cytomorphometric and flow cytometric analysis of bladder transitional cell carcinoma using acridine orange fluorochrome: correlation with histopathology and clinical behavior

Cell material from 79 cases of archival paraffin-embedded tumor specimens of newly diagnosed transitional cell carcinomas of the urinary bladder was studied retrospectively using rapid flow cytofluorometric DNA analysis. The male to female ratio was 62/17. The mean age at diagnosis was 65.3 +/- 10.8 years. Clinical characteristics, including survival, recurrence and progression were closely related to the histopathologic grading and tumor staging. The tumors were classified as diploid (DI = 0.9-1.1) or aneuploid. Total aneuploid occurrence was 46%. The aneuploid frequency for the various tumor grades was 25% for grade 1, 37% for grade 2 and 78% for grade 3. Stages Ta (O) and Tl (A) tumors differed from muscle-invasive tumors (T2-4) in that they had a lower frequency of aneuploid occurrence (34%, 41% vs 50%, 73%, and 75%). Multiple aneuploid stem cell lines had no influence on tumor grade or stage. The DNA ploidy was closely related to the five-year survival rate, the probability of tumor recurrence and progression. On the contrary, the modal nuclear size of the tumor cells had no correlation with histopathology or the clinical characteristics. Bladder tumors of an intermediate grade (grade 2) may be subdivided into two groups with different outcomes on the basis of flow cytometric characteristics. It is concluded that DNA flow cytometry can serve as an additional prognostic parameter for bladder cancer patients in addition to conventional histopathology.

Simultaneous bilateral tubal pregnancies after in vitro fertilization and embryo transfer: report of a case

Ectopic pregnancies continue to be a major complication of in vitro fertilization and embryo transfer (IVF-ET). A case of bilateral simultaneous tubal pregnancy after IVF-ET is described. The patient underwent ovum pick-up (OPU) through a laparotomy with concomitant pelvic surgery. Embryo transfer (ET) was performed two days after OPU; this resulted in bilateral tubal pregnancies, diagnosed and treated one month apart. There are several possible causal mechanisms for the increased rate of ectopic pregnancies following IVF-ET. It is important to recognize that care in the transfer technique, with respect to the catheter position and limiting the volume of transfer medium to 20 microL, and an awareness of previous occlusion of the tubal ostia, or of a salpingectomy before IVF-ET, can help to minimize this complication rate. Two important points are the possibility of a simultaneous bilateral tubal pregnancy after IVF-ET, and the necessity of carefully examining both adnexa at the time of surgery for an ectopic pregnancy. Early and accurate diagnosis of a simultaneous bilateral ectopic pregnancy can prevent the necessity of a second operation and reduce maternal morbidity and mortality.

Safety and immunoresponse study of intravesical instillation of Taipei-NIPM bacillus Calmette-Guérin

The intravesical instillation of bacillus Calmette-Guérin (BCG) has proved to be an effective modality for prophylaxis of recurrent superficial bladder cancer and treatment of carcinoma in situ. The domestic BCG, named Taipei-NIPM, which is produced by the National Institute of Preventive Medicine, has been used as an anti-TBC vaccine in Taiwan for decades. In this study, we have investigated the safety and immune response in animals after intravesical BCG treatment to test its feasibility in future clinical application. Weekly instillation of BCG (1 mg/ml, 5-8 x 10(7) CFU/mg) for 6 instillations could induce lymphocytic infiltration, submucosal fibrosis, and granulomatous reaction after 4 weeks with mild decrease of bladder weight and high incidence of hematopyuria (75%). No changes in appetite, body weight, and splenic weight were noticed in the chronically treated rats. A delayed hypersensitivity test through foot pad swelling measurement reached 80% positive rates at 2 weeks. Cystometric study revealed a mild decrease in bladder capacity (33.3%) at 2 weeks and of contractile pressure of the urinary bladder in rats receiving BCG instillations. In addition, increase in lymphocytic infiltration by natural killer (NK) cells against YAC-1 cells could be detected after BCG treatment and this was related to dosage of BCG. The urothelial damage by cauterization and the number of instillations could also enhance NK cell activity. Low toxicity and high safety of intravesical instillation of the domestic BCG are demonstrated by this pilot animal study. This information on local and systemic immune responses can provide a solid base for future efficacy of BCG immunotherapy in bladder cancer patients using this domestic strain BCG.

DNA ploidy, S-phase fraction and cytomorphometry in relation to survival of human penile cancer

The prognostic significance of DNA ploidy, DNA index, S-phase fraction (SPF) and median nuclear size was studied in 11 patients with squamous cell carcinoma of the penis. These patients have been followed for a minimum of 7 months after diagnosis. Nuclear DNA content was determined by flow cytometry from paraffin-embedded tissue. Patients with DNA diploid cancer (n = 7, 64%) had a better survival rate than patients with aneuploid cancer, and a small SPF was associated with a favorable outcome. A statistically significant relation between median nuclear size and survival could be demonstrated. Small modal nuclear size associated with poorer prognosis. There was a significant difference in survival between metastatic and nonmetastatic groups of tumors during the follow-up period. This study suggests that flow cytometric determination of nuclear DNA ploidy from paraffin-embedded samples in penile cancer does add an additional prognostic determinant in addition to the clinical staging of tumors.