Mechanism of the nephrogenic repair response. Studies on proliferation and vimentin expression after 35S-1,2-dichlorovinyl-L-cysteine nephrotoxicity in vivo and in cultured proximal tubule epithelial cells

Studies were performed in vivo using 35S-(1,2-dichlorovinyl)-L-cysteine, a nephrotoxin that damages the S3 segment of the proximal tubule after metabolism to a reactive intermediate. Initiation of damage (35S covalent binding) was complete by 6 hour, and an early proliferative response was observed by 24 hour in the S2 or S3C segments. Necrosis in the S3M and increased blood urea nitrogen were maximal at 48 hours and were accompanied by an increase in proliferation of cells at the wound site. Regeneration was marked by the appearance of vimentin expressing cells that lacked brush border enzymes. The loss of differentiated character in the regenerative epithelium persisted after the proliferation (bromodeoxyuridine incorporation) had stopped; redifferentiation occurred between days 5 and 13. Much of the process was reproduced by culturing rat kidney proximal tubule epithelial cells in defined medium. As growth increased, the cells expressed vimentin and lost brush border marker enzymes. However, as the cells reached high density and stopped dividing there was an increase in brush border markers, as was seen in vivo. Vimentin expression did not decrease, however. The data support a mechanism for damage and nephrogenic repair composed of 1) interaction of the toxin with the target cells, 2) necrosis and exfoliation, 3) loss of differentiation and cell growth, 4) recovery of the damaged area and cessation of cell growth, and 5) differentiation of the quiescent cells. Nephrogenic repair may have similarities with the differentiation of the tubular epithelium during development.

[Compatibility of Chinese drugs radix Aconiti carmichaeli with rhizoma Pinelliae]

To find out whether the Chinese drug Radix Aconiti Carmichaeli is compatible with another Chinese drug Rhizoma Pinelliae in preparation, the two medicinal herbs were made into different forms of decoctions. Experiments with these decoctions were carried out to observe the action on isolated hearts of toads and the ECG and acute toxicity on mice. The results showed that in terms of toxicity there was no marked increase in the mixed decoction as compared with the other two decoctions prepared from Radix Aconiti Carmichaeli and Rhizoma Pinelliae separately.

Transurethral balloon dilatation of the prostatic urethra: effectiveness in highly selected patients with prostatism

Transurethral balloon dilatation of the prostate has been shown to be a safe and potentially effective alternative to surgery in the treatment of benign prostatic hyperplasia, with a 66% success rate in relatively unselected patients. This study hypothesized that more careful patient selection might result in a significantly better rate of improvement. Ninety-one subjects with symptoms and signs of prostatism attributable to benign prostatic hyperplasia were studied. Group 1 comprised 42 patients with an initial mean symptom score of 16.8, residual urine of 249 ml, maximal flow rate of 7.9 ml/sec, and nomogram of maximal flow rate of -1.5. Group 2 comprised 49 less symptomatic patients with an initial mean symptom score of 14.5, residual urine of 105 ml, maximal flow rate of 10.7 ml/sec, and nomogram of maximal flow rate of -0.8. The difference in mean age and prostate size between groups was not statistically significant, but differences in baseline symptom score, residual urine, maximal flow rate, and nomogram of maximal flow rate were significant (p less than .04). Transurethral balloon dilatation of the prostate was performed under local anesthesia or IV sedation and analgesia with single-or double-balloon catheters with maximal diameters of 25-30 mm inflated to 2.5-4.0 atmospheres pressure for 10 min. Patients were followed up with repeat symptom scoring, uroflometry, and measurement of residual urine. After a mean follow-up of 22 months (range, 6-48 months), an improvement in symptom score was seen in 80% of group 2 patients compared with 43% in group 1. Improvement in symptom scores was statistically significant in both groups (p less than .04). We conclude that transurethral balloon dilatation of the prostate is more effective in patients with more moderate symptoms and with less marked signs of obstruction than in patients with more marked prostatism.

Synchronous bilateral testicular germ cell tumors of different histologic type. Pathogenetic and practical implications of bilaterality in testicular germ cell tumors

Patients with a germ cell tumor (GCT) in one testicle are prone to develop cancer in the contralateral testicle. Metachronous development of a GCT in the remaining testicle occurs in 3% of patients. The synchronous development of bilateral GCT occurs in 0.5% of patients. Bilateral testicular neoplasms are almost always identical histologically. Only five cases of synchronous bilateral GCT of different histologic types have been reported in the literature. The authors report the sixth case of this uncommon phenomenon and discuss its clinical and pathogenetic implications.

[Application of polychotomous logistic regression in the study of risk factors predisposed to postpartum hemorrhage]

To determine the role of history of induced abortion and pregnancy induced hypertension in postpartum hemorrhage, a polychotomous logistic regression method was introduced to analyze the data gathered in an investigation of blood loss among 933 parturients in some counties of Sichuan and Ningxia provinces. The results show that postpartum hemorrhage caused by placenta factors is related to a history of induced abortion and pregnancy induced hypertension with relative risks 2.55 (95% confidence interval = 1.2-5.3) and 4.94 (95% confidence interval = 1.8-13.2), respectively. An increased risk was noted for postpartum hemorrhage associated with pregnancy induced hypertension (relative risk = 2.58, 95% confidence interval = 1.3-5.2), but not with induced abortion. Suggestions were made for prevention of postpartum hemorrhage.

High-performance self-pumped phase conjugator with a multichannel in KNSBN:Cu crystal

A Cu-doped (0.04 wt. %) (K(0.5)Na(0.5))(0.2)(Sr(0.61) Ba(0.39))(0.9)Nb(2)O(6) crystal produced as much as 68% self-pumped phaseconjugate reflectivity at the laser wavelength lambda = 514.5 nm. We also observed some phenomena that helped us to understand the mechanism for the self-pumped phase-conjugate mirror.

Ureteral pseudodiverticula: frequent association with uroepithelial malignancy

Ureteral pseudodiverticula are tiny outpouchings usually seen as incidental findings on retrograde urography during routine work-up for common urinary tract disorders. We report 37 patients with ureteral pseudodiverticula, of whom 17 (46%) had associated uroepithelial malignancy. Ureteral pseudodiverticula were diagnosed in all patients on excretory or retrograde urography as an incidental finding during evaluation for a variety of urologic symptoms and signs. All patients were assessed with urinalysis, urine culture, cystoscopy, and when indicated, ureteroscopy. Diagnosis of transitional cell carcinoma was made by surgery or endoscopic biopsy in 16 patients and squamous cell carcinoma in one. In nine patients with radiographs showing ureteral pseudodiverticula and a urinary tract filling defect (usually in the bladder), 78% of the cases were proved malignant. In six patients with ureteral pseudodiverticula and a stricture in the ureter or renal collecting system, 67% of the cases were proved malignant. Of the patients with tumor, 53% had a single ureteral pseudodiverticulum. In two cases, the pseudodiverticula antedated the diagnosis of malignancy by 2 and 4 years, respectively. Our experience suggests that the association between ureteral pseudodiverticula and uroepithelial malignancy may be more common than previously assumed, approaching 50%. Even a single ureteral pseudodiverticulum should be regarded as a serious marker for potential malignancy, antedating cancer by 2-10 years, and such patients should be closely followed up. The coexistence of ureteral pseudodiverticula and a stricture or filling defect in the urinary tract is highly suggestive that a tumor is present.

Long-term followup results after expectant management of stage A1 prostatic cancer

A total of 132 patients with stage A1 adenocarcinoma of the prostate was followed for 5 to 23 years (mean 8.2 years). Of these patients 52 underwent a second staging transurethral resection of the prostate between 1977 and 1986. Progressive disease developed in 3 of the 12 patients (25%) in whom residual foci of well differentiated cancer were detected by the second transurethral resection and who did not undergo further treatment. Of the 38 patients in whom the second transurethral resection did not detect residual cancer 3 (8%) also had progressive disease. From April 1989 to December 1989, 44 patients were re-evaluated by transrectal ultrasonography and ultrasonographically guided biopsies. Of these patients 3 had locally progressive disease. Progressive disease also developed in 4 more patients. Thus, 13 of the 132 patients (10%) had either locally or systemically progressive disease after long-term followup. The interval from diagnosis of stage A1 disease to detection of progression ranged from 6 months to 20 years (mean 7 years). Ten patients underwent definitive treatment for what was believed to be locally progressive disease, 2 underwent palliative therapy and 1 had no therapy due to poor physical condition. Of the 10 patients who underwent definitive therapy 6 are alive without evidence of disease, 2 died of unrelated causes without evidence of disease and 2 are alive with stage D1 disease. These data suggest that patients in whom a second staging transurethral resection of the prostate detects residual cancer have a high probability of progressive disease. Also, negative findings from a second staging transurethral resection may not exclude the possibility of disease progression. Expectant management of stage A1 disease is warranted but regular and long-term followup is mandatory.

[Serum mitochondrial aspartate aminotransferase (ASTm) in acute myocardial infarction]

The increase of serum ASTm activity might reflect the severity of damage at the subcellular level of the myocardium. 50 patients with acute myocardial infarction (AMI) were observed. The mean peak ASTm activity was 34.34 +/- 34.60 IU/L and 48 patients (96%) greater than or equal to 9 IU/L (two times median value of normal subject). The peak time (36 h) came later and the duration (120 h) was longer than that of CK-MB. ASTm/ASTt ratio in groups of AMI, non-AMI heart failure and acute ictero-hepatitis was 0.25 +/- 0.10, 0.02 +/- 0.05 and 0.05 +/- 0.02 respectively. The former was significantly greater than other two groups (P less than 0.01). The activity of ASTm in AMI cases with heart function at I, II and III + IV (Killip classification) was 21.8, 40.2 and 76.2 IU/L respectively (F = 8.407 P less than 0.01) and it was 84.9 and 24.7 IU/L in the death and surviving groups (P less than 0.01). The result showed that the estimation of serum ASTm level was helpful to the establishment of diagnosis in the patients with AMI who were sent delayed to the hospital. It held special significance in evaluating the severity of myocardial damage, heart function and in predicting the prognosis of AMI.

[Effect of alcohol-extract from scorpion on checking externally active cysticerus cellulosae]

Putting the alcohol-extract from scorpion in the ordinary aqueous solution of 15% pork bile and having it cultured at the temperature of 37 degrees C have proved for the first time that in contrast with the chemical albendazole, Scorpion has a conspicuous effect on the external killing of the cysticercus cellulosae, The action of killing cysticercus cellulosae has almost nothing to do with the difference of processed products or of the parts used in medicine.

[Conditional logistic regression analysis of coronary heart disease]

A case-control study on 215 pairs was carried out in Jinan. Conditional Logistic regression analysis showed that the following five factors were associated with coronary heart disease, i.e., hypertension, hypercholesterolemia and heavy smoking, serum copper and HDL-C/TC. The former three were risk factors, and the latter two were protective factors. There is remarkable dose-response relation between heavy smoking and coronary heart disease. The data analysis show that these five factors are contributory to coronary heart disease with synergism.

[Relationship between radiology and prognosis in sarcoma of jaw]

A new radiologic grading based on the comprehensive studies of radiographs of 76 cases of jaw bone sarcomas is suggested. Cortical expansion or sclerotic rim is regarded as grade 1, localized destruction with sharp edges as grade 2, moth-eaten destruction as grade 3, and diffuse destruction as grade 4. A close relationship exists between the rate of 5 year survival and the radiologic grading which is considered to be one of the four main X-ray criteria for evaluation of prognosis. The other 3 criteria are the extent of destruction, the tumor location, and the changes of the teeth and periodontal space.

Altered growth regulation of rat kidney proximal tubule epithelial cells transformed in vitro by SV40 viral DNA: fibroblast growth factors (heparin-binding growth factors) are potent inducers of anchorage-independent growth

The majority of renal cancers are thought to arise from the proximal tubule epithelium, but little is known about their etiology. In this investigation, we have established an in vitro model to study the transformation of these target cells using rat kidney proximal tubule epithelial cells (RPTE) transformed in defined medium with SV40-viral DNA. Selection by passaging cells onto plastic surfaces yielded a population of cells (SV-RPTE) that expressed keratin and vimentin along with SV40 large-T antigen. The cells were morphologically transformed and lost their differentiated character as determined by several RPTE markers. SV-RPTE cells grew in soft agar in serum-supplemented medium containing insulin, epidermal growth factor, and cholera toxin, but were unable to grow when serum and growth factors were not combined. Acidic and basic fibroblast growth factors (aFGF and bFGF) were unique since they were the only single factor that induced anchorage-independent growth in the presence of serum alone. Transforming growth factor-beta 1 (TGF-beta 1) was a potent inhibitor of anchorage-independent growth, but the inhibition was partially overcome by a combination of growth factors. The growth factor responses of SV-RPTE in monolayer cultures differed from those in soft agar; the cells were more sensitive to growth stimulation by insulin and insulin-like growth factor, neither of which stimulated anchorage-independent growth. SV-RPTE cells in monolayer cultures had also lost the sensitivity to growth inhibition by TGF-beta 1 characteristic of normal RPTE. The RPTE transformation model described here will be very useful for investigating the molecular basis and etiology of renal cancers. Furthermore, the data suggest that maintenance of the transformed phenotype by aFGF and bFGF and loss of negative growth regulation by TGF-beta 1 could play a role in renal carcinogenesis.

[Reversed anterolateral thigh island flap and myocutaneous flap transplantation]

The blood supply of free anterolateral thigh flap and myocutaneous flap comes from the descending branch of the lateral femoral circumflex artery. On the basis of anatomical data, the descending branch coincides with the lateral superior genicular artery. Therefore, the authors suggested reversed anterolateral thigh island flap and myocutaneous flap transplantation. The blood supply of the reversed island flap, is from the lateral superior genicular artery. The flap seemed to have a constant vascular anatomy with a long pedicle and a large diameter, so that dissection of the flap can be accomplished easily. Moreover, donor defects were usually closed primarily without the need of skin-grafting. Since 1985, 4 cases of soft tissue defect around the knee joint have been repaired with reversed anterolateral thigh island flap and myocutaneous flap. All flaps survived completely and obtained satisfactory results. In this paper, the anatomy, design and operative technique of the flap are discussed.

Patient acceptance of and satisfaction with an external negative pressure device for impotence

Patient acceptance of and satisfaction with an external negative pressure device as a treatment for impotence were retrospectively analyzed among 100 men. The over-all satisfaction rate was 68%. Reasons for dissatisfaction with and discontinuing the use of the device included premature loss of penile tumescence and rigidity, pain or discomfort either during application of suction or during intercourse and inconvenience. Negative pressure therapy is an effective treatment for impotence of various etiologies and should be among treatment options offered to the impotent patient.

[Angiographic study of osteosarcoma and fibrosarcoma of the jaw]

It has been well known that the sarcomas of jaw are very vascularized, but reports on the angiography of jaw sarcomas were very few. Based on the preoperative angiography of 3 cases of jaw bone sarcomas and arteriography of their specimens, it has been noticed that the supplying arteries of the mandible ramus sarcoma can be directly from the external carotid arteries; and the supplying arteries can be from inferior alveolar artery in sarcomas of the body of mandible. The tumors are more vascularized than the surrounding normal tissues, and the direction of the arteries can be from central to peripheral in the tumors, which are different from the long bone sarcomas. The vascularization and the retarded blood flow in the tumor are the significant anatomic bases for local perfusion chemotherapy of jaw sarcomas.

Experimental treatment of benign prostatic hyperplasia with transurethral balloon dilation of the prostate: preliminary study in 73 humans

A prospective noncontrolled study of the safety and potential efficacy of transurethral balloon catheter dilation of the prostate (TUDP) in the treatment of benign prostatic hyperplasia (BPH) was performed in 73 subjects with moderate to severe symptoms and signs of prostatism who were selected on the basis of a quantitative symptom score (SS), uroflowmetry measurements, and residual urine volume. Seven patients had urinary retention. Mean age was 69.6 years (range, 59-95 years). TUDP was successfully accomplished in 70 patients (96%). There were no significant complications. Mean follow-up was 16.2 months (range, 6-36 months). Forty-six patients (66%) showed improved SS at the most recent follow-up. In 24 patients (34%) SS was unimproved, necessitating prostatectomy in 17 subjects (24%). Reduction in mean residual urine volume was not statistically significant. Only 38% of patients with median lobe enlargement showed improvement in SS, compared with 74% for the others. The authors conclude that TUDP is safe and shows promising effectiveness and that the ultimate demonstration of effectiveness requires a controlled clinical trial.