[Extracorporeal shock wave lithotripsy--difficulties in ESWL]

At Kanbara Hospital, 187 patients with urolithiasis have been treated by extracorporeal shock-wave lithotripsy (ESWL) since the first ESWL treatment in December, 1986. Some cases in which ESWL could not be performed easily were experienced. These difficulties were analyzed retrospectively and some problems in the ESWL treatment are discussed.

Clonidine induced variations of plasma norepinephrine and blood pressure in essential hypertension

To assess the contribution of sympathetic outflow to blood pressure in patients with essential hypertension, clonidine induced variations of plasma norepinephrine, mean arterial pressure and the pulse rate three hours after a 300 μg dose of oral clonidine, an antihypertensive agent that decreases central sympathetic outflow, were studied.

Baseline and clonidine suppressed plasma norepinephrine levels were not significantly different between the normal controls and patients with essential hypertension. The average plasma norepinephrine level, mean arterial pressure and pulse rate were significantly decreased from the baseline value in both normal control and essential hypertension (p<.005). The depressor response to sympathetic inhibition after clonidine were exaggerated in significant proportion in patients with essential hypertension compared to normal control group.

Our study suggests that the pressor sensitivity to norepinephrine plays more important role than sympathetic overactivity in some patients with essential hypertension.

[Clinical evaluation of a prostate-specific antigen as a serum marker of prostatic cancer]

Combined measurement of serum prostate-specific antigen (PA) and prostatic acid phosphatase (PAP) was performed in 235 patients with various urologic diseases including 55 patients with prostatic cancer. A PA level of over 24.7 ng/ml and a PAP level of over 3.1 ng/ml were considered to be positive. The positive rate of PA was 57% in the patients with untreated prostatic cancer and 3% in the patients without prostatic cancer. The positive rate of PAP was 52% in the patients with untreated prostatic cancer and 1% in the patients without prostatic cancer. PA and PAP were considered to be equally sensitive and specific serum markers of prostatic cancer. However, the positive rate increased to 65% without increasing the false positive rate when the PA and PAP were both measured simultaneously. The combined assay of PA and PAP is recommended for screening prostatic cancer. The cross-over titer of PA and gamma-Sm using standard samples in each kit revealed linearity, which suggested that PA and gamma-Sm possess the same antigenicity.

[Assessment of voiding disorders and conservative pharmacological treatment of benign prostatic hypertrophy]

The symptoms of benign prostatic hypertrophy consist of two major groups, obstructive symptoms and irritative symptoms. Uroflowmetry is a safe, easy and accurate method to assess the obstructive symptoms. Furthermore, electromyography of abdominal wall and the monitoring of rectal pressure is helpful to know involvement of abdominal straining. Cystometry provides us objective findings of bladder irritability in bladder outlet obstruction. Detrusor hyperreflexia was revealed in 55%, and uninhibited detrusor contraction was revealed in 22.5% of the patients with benign prostatic hypertrophy. The most sophisticated technique to estimate the volume of prostatic adenoma is transrectal ultrasonotomography. The value, cranio-caudal X left-right X antero-posterior axis length, has been proved to closey correlate to the resected volume of the prostatic adenoma. However there was no correlation between the estimated prostatic volume and the severity of dysuria. The comparison of the uroflow rates before and after loading phentolamine is a helpful method to determine the sympathetic influence to lower urinary tract obstructions. This test differentiates functional obstruction from organic obstruction. Conservative pharmacological therapy on the patients with benign prostatic hypertrophy were also studied. The value of efficacy of prazocine hydrochloride (0.5-6.0 mg/day), Eviprostat (6Tab/day), Prostetin (200-400 mg/day), Hachimi-Jiogan (5 g and 7.5 g/day) on subjective symptoms were 47.8 86.2, 58.5, 52.9 and 66.7% respectively. Ninety-one of the 141 patients with benign prostatic hypertrophy who visited the out-patient clinic in 1983 were given pharmacological treatment initially.

Soft-tissue profile--fallacies of hard-tissue standards in treatment planning

The study was designed to test the efficacy of using a cephalometric dentoskeletal standard as a clinical tool to produce predictable and desirable facial esthetics. Thirty adolescent patients were randomly selected who, at the completion of treatment, had lower incisors positioned approximately 1.5 mm anterior to the A-pogonion plane. A normal sample of excellent faces (Indiana sample) was used for comparison. Both profile measurements of hard and soft tissues were made. The most striking observation was the large variation in the facial profiles even in cases successfully treated to a cephalometric dentoskeletal standard. The variation (2 standard deviations) of lip protrusion from the subnasale pogonion plane was 5 mm or a total of 10 mm. Similar variations were found in other soft-tissue measurements. The results suggest that any given dentoskeletal standard has questionable validity in producing either desirable esthetics or reproducible profiles following treatment.

Accurate diagnosis of detrusor areflexia using combined uroflowmetry and abdominal wall electromyography

Twenty-three patients who previously demonstrated no detrusor contraction during cystometry were evaluated using a combined uroflowmetry and abdominal wall electromyography. Ten patients voided without abdominal straining (normal detrusor reflexia), 11 could not void without abdominal straining (detrusor areflexia, detrusor weakness, or bladder outlet obstruction), and 2 had equivocal findings with the method.

[Multiple endocrine neoplasia, type I and type II B: report of two cases]

Multiple endocrine neoplasia (MEN) is rare. We report two cases of type I and type IIb MEN. A 41-year-old female visited our clinic with a complaint of spontaneous discharge of urinary stones. Right lobe of the thyroid had been resected in previous operation for cancer. She was diagnosed to have hyperparathyroidism from hypercalcemia, hypophosphatemia and a small tumor in the neck. Left upper parathyroid and a lymphnode beside the left lower part of the thyroid were extirpated. Pathological examination revealed the former as adenoma and the later as metastasis of thyroid cancer. Since multiple pancreatic tumors and pituitary tumor were later detected, she was diagnosed to have type I MEN. Recently, her serum calcium level again elevated. A 27-year-old male visited our clinic with complaints of multiple tongue tumors, malfanoid habitus and characteristic facies, such as lip hypertrophy, everted eyelids and prognathism. This characteristic subjective picture made type IIb MEN doubtful. Medullary thyroid cancer was discovered, but pheochromocytomas could not be found.

[Double cancer in urology]

Since our clinic opened eight years ago, we have experienced a total of 397 patients with 400 tumors in the urinary system. Of them, 29 double tumors were observed in 26 patients. Statistical investigation was made on these double tumors. In this study, the definition of Billroth was employed and, in addition, a patient presenting with previous history of cancer and showing traces of any treatment was diagnosed as having double cancer. As a result, the incidence of double cancer was as high as 6.6%, although the disease has been considered to be rare. It is evident that double cancer is not rare. The disease was not specific to any organ concerning the urinary system and its incidence was higher in the female patients. Of 11 female patients with double cancer, 7 suffered from uterine cancer. The primary cancer had appeared in the uterine in 6 patients and all the 6 developed secondary cancer in the pelvic viscera (the urinary bladder and the lower part of the ureter). The mean age at which the patients developed the secondary cancer in the pelvic viscera was almost significantly lower in those in whom uterine cancer was the primary one than those in whom the primary cancer had not occurred in the uterine. This suggests that the operative procedures inside the pelvis or irradiation for the treatment of uterine cancer is related to the onset of the secondary cancer in the pelvic viscera.

Protective activities of aucubin against carbon tetrachloride-induced liver damage in mice

An iridoid glucoside, aucubin was isolated from Aucuba japonica leaves and its protective activities against CCl4-induced hepatotoxicity were evaluated by measuring the duration of hypnosis induced by hexobarbital after CCl4 challenge (0.2 ml/kg/day, po) and the levels of serum glutamic-oxalacetic (GOT) and serum glutamic-pyruvic transaminase (GPT). The duration of hypnosis for the saline control group, the CCl4 alone treated group and the aucubin plus CCl4 treated group was 24.8 +/- 8.5, 60.5 +/- 9.5 and 28.0 +/- 3.2 min, respectively. Treatment of mice with aucubin also effectively protected against CCl4-induced increased serum GOT and GPT activities. It was found that aucubin inhibited hepatic RNA and protein syntheses in vivo. Such inhibitory effects of aucubin might be responsible for protective activities against CCl4-induced liver damage.

Selective stimulation of the synthesis of an 80,000-dalton protein by calcium ionophores

Brief exposure of cultured chicken pectoralis muscle cells to ionomycin or A23187 selectively increases the rate of incorporation of [35S]methionine into an 80,000-dalton protein was also observed upon cell-free translation of poly(A)-enriched RNA isolated from ionomycin-treated, as compared with control, cultures. These observations suggest that ionomycin selectively increases the cellular concentration of mRNA, which codes for the 80,000-dalton protein. The effect is probably mediated through an increase in cytoplasmic [Ca2+] caused by the ionophore. A similar effect of ionomycin was observed in cultured fibroblasts, HeLa cells, mouse LSP cells, and monkey kidney CV1 cells.

Theory for the number of genes affecting quantitative characters : II. Biases from drift, dominance, inequality of gene effects, linkage disequilibrium and epistasis

Bias in the estimation of gene number from a population of finite size will be reduced when the number of generations and the selection differential in the primary selection program are increased. A procedure to minimize bias due to dominance is proposed. Bias due to linkage disequilibrium is decreased by long generations of selection and small change of linkage disequilibrium. Bias due to inequality of gene effects was studied assuming that gene effects follow a half normal distribution. The epistatic bias arising from multiplicative gene effects disappears when the logarithms of the original measurements are considered even though the gene number estimate is unsatisfactory without transformation.

Theory for the number of genes affecting quantitative characters : I. Estimation of and variance of the estimation of gene number for quantitative traits controlled by additive genes having equal effect

A general expression for gene number estimation which encompasses the conventional formula was derived. It provides a basis for gene number estimation from the data of recurrent selection experiments that are not of sufficient duration to measure total response to selection.Gene number estimates are considerably more reliable when heritability is high. The effect of heritability on sampling variance is particularly important when gene number is large.Generally the most effective ways of decreasing the variance of a gene number estimate will be 1) to increase the number of generations in a primary selection program, 2) to increase the number of generations in the two way selection program and 3) to increase population size.