Localization of transglutaminase 1 mRNA in normal and psoriatic epidermis by non-radioactive in situ hybridization

We examined the expression of the transglutaminase 1 (TGase 1) gene in frozen sections of normal and psoriatic epidermis by means of non-radioactive in situ hybridization with digoxigenin-labelled cRNA probes. TGase 1 mRNA was expressed in the granular layer of normal epidermis, regardless of ortho- or hyperkeratosis. However, in psoriatic epidermis, TGase 1 mRNA was detected in the suprabasal spinous layer, but not in the subcorneal layer. These results indicate that TGase 1 gene expression is limited to the last stage of keratinization in normal epidermis and this regulation is disturbed in psoriasis.

Experience with one-stage repair of severe proximal hypospadias: operative technique and results

Our experience with one-stage repair of severe proximal hypospadias in children is reported. The operative technique, which makes one-stage repair of hypospadias and associated bifid scrotum feasible, is described in detail. A 45% chance of secondary repair notwithstanding, we recommend our one-stage repair for all children with severe hypospadias.

[Flow cytometric analysis of the DNA content in the urinary bladder cancers treated by radical cystectomy and pre-operative irradiation]

The DNA ploidy of bladder cancers treated by radical cystectomy following pre-operative irradiation was analyzed by flow cytometry using paraffin embedded samples. The DNA ploidy and its changes by irradiation were studied. We used flow cytometry in 30 patients with transitional cell carcinoma of the bladder who received pre-operative irradiation (40 Gy in 24 patients, 20 Gy in 5 patients and 60 Gy in one) with follow-up for at least 3 years. Total 140 paraffin embedded samples (4.6 samples per one patient) were available. The effects of therapy were related to the DNA patterns before irradiation and to the DNA ploidy changes after irradiation. 1. Eight DNA diploid tumors and twenty-two DNA aneuploid ones were detected before irradiation. Although diploid group didn't change its DNA ploidy after irradiation, of 22 aneuploid tumors 18 were changed to DNA diploid and 4 were not changed in their ploidy. 2. The tumor eradicating effect of irradiation was shown to be higher (p < 0.05) in the diploid group (5 of 8, 63%) than in the aneuploid group (5 of 22, 23%). 3. Overall survival rates were discussed in 3 groups (A, B and C), the group A was 10 of tumor free and 3 diploid tumors after irradiation, the group B was 13 of aneuploid tumors which changed to diploid ones and the group C was 4 of persistent aneuploid tumors. Each of 5 year survival rate was 100% (A), 58% (B) and 0% (C). Overall survival for C group was significantly shorter than for other groups (p < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

[Localization of androgen receptor in male sex organ, accessory sex organs and external genital skin]

Previously, we established an anti-androgen receptor (AR) monoclonal antibody. Using the antibody, we investigated immunohistological AR localization in human testes, epididymides, seminal vesicles and scrotal skins. The testes, epididymides and scrotal skins were obtained from a prostate cancer patient without pre-hormonal therapy undergoing bilateral orchiectomy. The seminal vesicles were obtained from a bladder cancer patient undergoing radical cystectomy. The tissues were immediately frozen in liquid nitrogen and kept at -80 degrees C until used. Cryostat-frozen sections were cut at 5 microns and stained by an indirect method. We obtained the following results. 1) In the testes, nuclei of Leydig cells were stained though Sertoli cells were not stained. AR localization in Leydig cells which produce testosterone suggests autocrine or intracrine mechanism in the testis. 2) In the epididymides, nuclei of epithelial cells of epididymal ducts were stained, while muscles and connective tissues were not stained. In the seminal vesicles, nuclei of glandular epithelial cells were stained. 3) In the scrotal skins, the cells of squamous cell layer have positive stainings. The cells in the upper portion of squamous cell layer were stained more intensely than the cells in the lower portion. The basal layer was not stained. The cells of the outer root sheath of hair follicles in the scrotal skins were also stained. 4) In androgen target organs, AR-positive cells and AR-negative cells were mixed in the epithelium of a glandular duct, which suggests heterogeneity of AR localization in the androgen target organs.

Structure of the gene for human transglutaminase 1

Transglutaminase 1 (TG1) is an enzyme that is expressed and activated during terminal differentiation of keratinocytes and synthesizes cornified envelope by a cross-linking reaction. The gene encoding human TG1 was isolated from human genomic DNA and characterized. It spans 14.3 kilobase pairs and is composed of 15 exons. All exon-intron junctional sequences conformed to the canonical GT-AG rule. The translation start was located in the second exon. The active site Cys residue of the enzyme was in exon 7. The coding sequence for human TG1 was comprised of 2454 nucleotides identical with the published human TG1-cDNA sequence (Yamanishi, K., Liew, F.-M., Konishi, K., Yasuno, H., Doi, H., Hirano, J., and Fukushima, S. (1991) Biochem. Biophys. Res. Commun. 175, 906-913). The sizes of exons from 3 to 14 were markedly conserved between the genes for the human TG1 and factor XIIIa, another member of the transglutaminase family. The one major and two minor transcription initiation sites of the TG1 gene were determined by primer extension. The 5'-flanking region of the human TG1 gene showed features of a housekeeping gene and contained potential regulatory motifs, including elements found in keratinocyte-related genes. The chromosome sublocalization of the TG1 gene was assigned to 14q11.2.

[Flow cytometric analysis of DNA content in adult testicular germ cell tumors]

Flow cytometric DNA analysis was carried out in 54 patients with testicular germ cell tumors (GCTs) experienced at our hospital, to evaluate the clinical relevance of DNA index (DI) and provide some insight into the pathogenesis of testicular GCTs. Histological types with their incidences were seminomas in 31 patients and nonseminomatous germ cell tumors (NSGCTs) in 23 adults. DNA ploidy and DI were analyzed by flow cytometry in 158 paraffin embedded samples; 2.9 samples per case on the average. This study revealed that 52 cases (96%) of evaluable 54 adult GCTs were DNA aneuploid, while DNA diploid tumors were observed in only each one case of NSGCT and seminoma. There was a significant difference (p less than 0.01) between the distribution of DIs in adult NSGCTs (median DI = 1.50) and that in pure seminomas (median DI = 1.85). Although we found no significant correlation between DI and clinical staging of Japanese Urological Association, on the basis of Indiana University staging system, the median DI in NSGCT patients of the advanced extent was lower than those of the other extents. DNA heterogeneity was observed only in 4 of 23 NSGCT patients (17%) and 3 of those 4 patients were assigned to advanced extent. These data suggest that the lower DI and the presence of DNA heterogeneity may have prognostic relevance for NSGCTs.

Measurement of blood flow in the parameatal foreskin flap for urethroplasty in hypospadias repair

During the one-stage repair of hypospadias the blood flow of the parameatal-based foreskin flap was measured in 30 patients by using laser Doppler velocimetry. The mean blood flow in the penile foreskin was estimated to be 15 ml/min/100 g and it increased to 150-200% after the induction of anesthesia, and then decreased to 72% at the tip of the created parameatal foreskin flap. Topical application of papaverine hydrochloride restored the flow to the preincision level in half of the cases. The parameatal foreskin flap, both in the form of a manta-wing and in extended circumferential form, appears to have an enough microcirculation suitable for one-stage repair (OUPF II and OUPF IV, respectively) of hypospadias.

[The effect of sustained-release theophylline granules in the inhibition of exercise-induced asthma]

We studied the protective effect of sustained-release theophylline granules on early or late response in exercise-induced asthma (EIA) in 16 patients ranging in age from 7 to 18 years. A standardized exercise test was examined 2 hours after administration of theophylline granules on one day and after no medication on another day. On both days, the lung functions and the serum theophylline and cortisol concentrations of the patients were examined before exercise and over a period of 8 hours after exercise. On days without medication, early response was seen in 16 patients and late response in 6. On days with medication, the theophylline granules inhibited early response in 13 of the 16 patients and late response in 5 of the 6 patients. This suggests that theophylline preparation is a useful drug for inhibiting the dual responses of EIA.

A case of neurofibromatosis associated with clitoral enlargement and hypertension

We report a case of clitoral and renovascular involvement of neurofibromatosis resulting in an enlarged phallus with juvenile hypertension. The patient was successfully treated by removal of the clitoral tumor and nephrectomy. This is the first of 15 reported cases with clitoral involvement, that showed concurrent renovascular hypertension.

Autoradiographic localization of alpha 1-adrenoceptors in human prostate: special reference to zonal difference

Using autoradiography, localization of alpha 1-adrenoceptor in human prostate was examined with particular reference to zonal difference. Prostatic tissues were obtained from total cystoprostatectomy specimens of six male bladder tumor patients. Peripheral zone (PZ), central zone (CZ) and preprostatic region which contained preprostatic sphincter and periurethral gland were dissected from the tissues. [125I]-HEAT was used as radioligand for autoradiography. Autoradiographic distribution of alpha 1-adrenoceptor was quantitated by grain counting using a light microscope equipped with a micrometer. Specific binding was demonstrated predominantly in fibromuscular stroma of PZ, fibromuscular stroma of CZ and preprostatic sphincter. No specific binding was demonstrated in glandular epithelium of PZ and periurethral gland. Glandular epithelium of CZ showed a few specific bindings. Among fibromuscular portion, specific bindings in both CZ and preprostatic sphincter were significantly higher than in PZ. Specific binding in glandular epithelium of CZ was significantly less than in fibromuscular stroma of PZ. These results show that the human prostate has a zonal difference in the distribution of alpha 1-adrenoceptors, probably reflecting some functional difference in these regions.

[Intrarenal reflux in children with vesicoureteral reflux]

Voiding cystourethrography (VCU) of 407 children with vesicoureteral reflux (VUR) at our hospital during 1969-1990 was reviewed and 7 cases (8 ureters) of intrarenal reflux (IRR) were found. All the children were male and had had an episode of febrile urinary infection under one year of age. One child had a left flank mass, which was later proven a urinoma. VUR was moderate (grade III) in 3 and massive (grade IV and V) in 5. VUR was estimated as primary in one child and as secondary in 6 (anterior urethral ring 2, posterior urethral valve 2, neurogenic bladder 2). IRR was localized to the upper area in 3, to the lower area in 2, and to the whole kidney in 3. Sixty percent of those with IRR in the polar areas was associated with moderate VUR, whereas all of those in the whole kidney was with massive one. Renal scarring was assessed by excretory urography (IVP) and/or 99mTc-DMSA renoscintigraphy. Seven kidneys were evaluable; polar scars in 5, dwarf with polar scar in 1 and dwarf with poor function (suspected hypodysplasia) in 1. In 4 kidneys new scar formation was observed. It was noted, however, that IRR did not necessarily accompany renal scars of the corresponding areas and IRR to the whole kidney did not always lead to multiple scars in the whole kidney. The nature and problems of IRR, renal scars and 99mTc-DMSA renoscintigraphy were discussed. It was suggested that urinary infection played a greater part in renal scar formation.

[Early experience with an ileocolic bladder substitution (Mainz pouch) in 11 cases]

In the last decade, many continent urinary diversions have been developed for the cystectomy patients. Mainz pouch, which seems to be a sophisticated one without using an alloplastic prosthesis, was adopted in our clinic. We preliminarily report our result in 11 patients who underwent a Mainz pouch procedure in the last 2 years: 1 for bladder augmentation, 5 for total bladder substitution after cystoprostatectomy and 5 (including 2 females) for continent urinary diversion. The mean age of them was 54 years old and the follow up periods ranged from 6 to 24 months. The antimesenteric longitudinal incision of the ileum and cecum and their sutures were performed similarly to the usual detubularized intestinal pouch. The ureteral reimplantation to the colonic segment was accomplished by the submucosal tunnel method. Although the ureteral hiatus was initially positioned at the anal edge of the colon, a new hiatal creation by stabbing the more oral portion of the colon according to the Goodwin's ureterocolic anastomosis was subsequently employed to avoid the trouble of closure of this portion. When the urethral anastomosis was achieved by 4-5 interrupted sutures between the most dependent portion of the cecum and the urethral stump after cystoprostatectomy, the mucosa was everted to the colonic serosa to prevent the stricture. The continent stoma was created by an intussusception of the proximal ileum, which was stabilized by the seromuscular stripping and 2-3 rows of external metal staples. Complication of the alimentary system occurred in 6 of 11 cases (55%), though they were successfully treated by an appropriate conservative management except one who suffered an ileostomy and nephrostomy because of severe panperitonitis.(ABSTRACT TRUNCATED AT 250 WORDS)

[Posterior urethral valves. Experience with 21 cases]

Twenty-one cases of posterior urethral valves experienced in the last 26 years were reported with special references to the morphological and functional sequelae of the upper and lower urinary tracts after the valve ablation. Furthermore, several problems, such as transient urinary diversion, vesicoureteral reflux (VUR), lower ureteral obstruction, transurethral valve ablation, bladder function and renal insufficiency, were also discussed. The age at the first examination ranged from 0 day to 13 years. Eight boys were first examined under one year of age. Although the most frequent complaint was urinary infection, some characteristic features were observed in each age group. In all of the children the valves were classified as type I (Young). Seven children had severe ones. Endoscopic examination was thought to be essential to find mild ones. VUR was found in 16 children (28 ureters). Grade IV was encountered most frequently (13 ureters) with prominent laterality to the left side. The severity of the renal scar paralleled to the grade of VUR. Most of the dwarf kidneys were thought to be hypodysplastic. Valve ablation was performed immediately after the diagnosis in 17 of the 21 children. Eight children were under one year of age when their valves were ablated. As a principle, VUR was followed conservatively after the valve ablation. VUR highly tended to disappear or improve when it was of low grade or valve ablation was performed under one year of age. However, when the ureteral orifices were disappearance of VUR was rare and recovery of renal function was not observed. In 5 children antireflux surgery was added. Although a dilated upper urinary tract without VUR was found in 2 children (2 ureters), it disappeared promptly after the valve ablation.(ABSTRACT TRUNCATED AT 250 WORDS)

Distinctive glycolipid patterns in Wilms' tumor and renal cell carcinoma

Glycolipid patterns were analysed chromatographically in Wilms' tumor and renal cell carcinoma tissues and compared with those of uninvolved tissue. Ganglioside GM3 was found to be increased in both cancer tissues, whereas sulfatides accumulated only in renal cell carcinoma, as reported earlier. Neolactotetraosylceramide was detected in both cancer tissues, but not in the uninvolved kidney tissues. In four cases of Wilms' tumors, only a low level of sulfotransferase towards galactosylceramide was found in one case, while no activity was detected in the three other cases. Present results show that the increased sulfatide(s) in the renal cell carcinoma and the deficiency of the sulfatides in Wilms' tumors appear to be biochemical characteristics of histologically different carcinomas.

Single photon emission computed tomography with Tc-99m-dimercaptosuccinic acid in patients with upper urinary tract infection and/or vesicoureteral reflux

By means of Tc-99m dimercaptosuccinic acid (DMSA) scintigraphy, an established method for assessing renal cortical damage, we evaluated the pick-up rate for renal defects (scars) by single photon computed tomography (SPECT) and planar images of 10 normal volunteers, and 58 patients (70 scintigrams) with upper urinary tract infections, most of whom had a history of vesicoureteral reflux (VUR). The positive study rate for renal defects depended on the severity of VUR. The overall positive rates for renal cortical defects obtained by DMSA SPECT imaging and DMSA planar imaging were 60% and 43%, respectively, and the difference between these was significant (p less than 0.005). The mean absolute individual renal uptake (/injected dose) at 2 hours post-injection was decreased in kidneys with defects detected by SPECT alone. The positive study rate for intravenous urography (IVU) depended on the grade of VUR and was 15% overall. DMSA SPECT imaging detects renal cortical defects at greater frequency than previously achieved.

[A case of Kennedy-Alter-Sung syndrome with type IIa hyperlipidemia--study on sex hormone receptor and lipid metabolism]

A 57-year-old man of Kennedy-Alter-Sung syndrome (K-A-S) with type IIa hyperlipidemia was reported with studies of several sex hormone receptors. He noticed tremulous movements of hands on gripping at age 40 and gynecomastia at age 46. He had been pointed out to waddle since 52 years old, and also noticed difficulty in going up stairs and standing up at age 54. He was admitted to our Neurology Service on June 5, 1989. On general physical examinations, gynecomastia, eyelids xanthomas and hypertrophy of Achilles tendons were found. Neurologic examination revealed clear consciousness and slight dysarthric speech with nasal voice. Cranial nerves showed mild bilateral facial weakness, poor uvula and soft palatal movements, atrophy and weakness of bilateral sternocleidomastoid muscles, and atrophy of tongue with fasciculation. The four extremities were hypotonic, and proximal muscular atrophy and weakness of four extremities were seen. Deep tendon reflexes were absent in four extremities and fasciculation on both thighs was noted on contraction. Sensory and cerebellar functions were intact. Waddling gait and Gowers' sign were present. In K-A-S syndrome, abnormal lipid metabolism such as a family of type IIa hyperlipidemia, or familial and sporadic cases of type IV hyperlipidemia has been documented. In the family of our cases, his elder sister was found to have type IIa hyperlipidemia, while his son had type IV hyperlipidemia. The coexistence of these two types of hyperlipidemia in the same family of K-A-S syndrome has not been reported so far to our knowledge.(ABSTRACT TRUNCATED AT 250 WORDS)

[Flow cytometric analysis of DNA content in testicular seminomas--correlation to mitotic count]

The DNA ploidy of testicular seminomas was studied by flow cytometry using paraffin embedded samples. The mitotic count and DNA index (DI) for 27 seminomas were analyzed in 80 samples with a mean of 3.0 samples per case. Six anaplastic seminomas which were with 3 or more mitoses per a high power field were distinguished from 21 typical seminomas. DNA ploidy pattern was aneuploid in all seminomas except one case of anaplastic seminoma, and clonal heterogeneity in DNA content was found in 3 of 20 (15%) cases of which 2 or more samples were analyzed. Although the DI had no significant difference between those two groups of seminomas classified by mitotic count, the DI in anaplastic seminomas was ranged from 1.5 to 2.0 (median DI = 1.70), otherwise the DI in typical seminomas ranged from 1.5 to 3.5 (median DI = 1.89), particularly 9 cases in 21 (43%) typical seminomas distributed in hypertetraploid region. The median DI of stage I seminomas was 1.88 and that of stages II + III seminomas was 1.75, though there was also no significant correlation between DI and clinical stages. In general, it is postulated that the higher DI is paralleled to the more malignant nature of neoplasms, nevertheless this study suggested that the higher DI in seminomas is not always related to high malignant potentiality determined by histological type and clinical stage.

[Unilateral massive vesicoureteral reflux associated with congenital mechanical obstruction of lower urinary tract]

We reviewed 9 children with unilateral massive (III and IV, Dwoskin-Perlmutter) vesicoureteral reflux associated with congenital mechanical obstruction of the lower urinary tract. Four children with bilateral reflux with bilateral difference of severity more than 2 grades were also included. Obstruction was attributed to posterior urethral valve in 5, anterior urethral stricture in 3 and mega-urethra in 1. The chief complaints were febrile episodes and urinary infection, followed by voiding difficulty, bed wetting and/or urinary incontinence and voiding through anus. All 4 children with troubles other than posterior urethral valve had either anorectal anomaly or H-type rectourethral fistula without imperforate anus. Of the 9 children 8 had massive reflux on the left side. The majority of these left ureters with massive reflux were associated with ipsilateral severe renal hypofunction on scintigraphy. After prompt resolution of obstruction, the majority of these massive reflux did not disappear. Decompression appeared to salvage none of such kidneys. The orifice positions of such ureters were far cranio-lateral and the resected kidneys showed dysplasia or severe hypoplasia. The prognosis was generally excellent except one child with massive reflux on the right side who progressed to an end-stage renal disease. The embryogenesis of this "VURD syndrome" was discussed in its relation to the "bud theory" of renal hypo-dysplasia. It was showed that this syndrome was observable in obstructions other than the posterior urethral valve. Massive reflux appeared to serve as "pop-off" mechanism to buffer high pressure and to lead to preservation of better renal function. Reflux in children with congenital mechanical obstruction may be the result of 2 different mechanisms.(ABSTRACT TRUNCATED AT 250 WORDS)

Use of testosterone ointment before hypospadias repair

Fifteen children, aged between 2 and 9 years old, with hypospadias (4 penile; 6 penoscrotal; 3 scrotal; 1 perineal) were administered testosterone ointment before one-stage urethroplasty. Temporary penile growth and skin enlargement were obtained in all. Side effects were negligible. The plasma testosterone level was measured before, during and after testosterone administration. During testosterone stimulation, the plasma testosterone level ranged from 30 to 190 ng/dl, and returned to the normal range a week after administration had been stopped. Primary success of hypospadias repair was obtained in 10 of 15 children (66.7%).

[Immunohistochemical study of glutathione S-transferase in normal and experimental cryptorchid testes rats]

Using the antibody for glutathione S-transferase (GST) purified from human kidney, normal testes and experimental cryptorchid testes from newborn to 20-week-old rats were immunohistochemically stained by the peroxidase antiperoxidase (PAP) method. The cryptorchidism was surgically created at 1 week of age. The localization of GST was particularly examined by light microscopy, and the amount of Leydig cells was measured by a stereological method. 1. Leydig cells in the normal and cryptorchid testes showed strong GST activity at all ages. The amount of these cells in normal testes increased from 4 to 8 weeks of age and then slightly decreased, whereas in cryptorchid testes it was significantly larger than in the normal testes at 20 weeks of age, indicating hyperplasia of Leydig cells. 2. In the normal and cryptorchid testes, degenerating primary spermatocytes with GST activity appeared in the seminiferous tubules at 2 to 4 weeks of age. In the cryptorchid testis, degenerating germ cells with GST activity were also found in the regressing seminiferous tubules after 4 weeks of age. It is possible that GST acts as a detoxification system in the degenerating germ cells. 3. The PAP staining of GST in the rat testes is considered to be useful method for evaluating metabolic function of the spermatogenic cells and the distribution and amount of Leydig cells. 4. Experimental cryptorchidism showed that germ cells become sensitive after 4 weeks of age.

Onlay urethroplasty with parameatal foreskin flap for distal hypospadias

A new technique of onlay flap urethroplasty is described. The cosmetic and functional results of this logical extension of our one-stage urethroplasty with parameatal foreskin-flap have been good. The onlay urethroplasty with parameatal foreskin flap was recommended for the repair of distal hypospadias without chordee.

[Clinical experience of adrenal incidentaloma with particular reference to adrenal cortical function]

The adrenal function mainly cortical one, was evaluated in 16 patients with incidentally discovered adrenal masses. Pathological examination was possible in 15 cases. The finding consisted of adrenocortical adenoma in 9, adrenocortical nodular hyperplasia in 1, adrenal medullary hyperplasia in 1, metastatic tumor in 2 and adrenal cyst in 2. Another case of adrenal cyst was diagnosed by percutaneous puncture. In all cases peripheral levels of plasma cortisol, plasma aldosterone concentration and plasma renin activity were normal. Plasma catecholamine levels were also normal except in a case of adrenal medullary hyperplasia. On the other hand, the cases of adrenocortical adenoma displayed elevation of urinary 17-hydroxycorticosteroids in 6/9 (67%), a loss of plasma cortisol circadian rhythm in 3/7 (43%) and insufficient suppression on dexamethasone (DXM) suppression test in 6/9 (67%). Their adrenal scintigraphy (with 131I-6 beta-iodomethyl-9-nor-cholest-5 (10)-en-3 beta-ol) revealed an increased ipsilateral up-take and insufficient suppression after DXM in all, while a diminished contralateral up-take in 4/9 (44%). These data suggested that a considerable number of adrenal incidentalomas may not be truly "non-functioning". Two patients with cortical adenoma experienced post operative adrenal insufficiency (25%). It was suggested that a pre-operative loss of plasma cortisol circadian rhythm was the most prognosticating of the post operative adrenal insufficiency, rather than insufficient DXM suppression or scintigraphic absence of contralateral up-take. Among the patients with malignancy, differentiation of incidental adrenal adenoma from metastasis by size alone may not be reliable.