[Operations during a 5-year period (1982-1986) at our department]

The statistics of urological operations performed at our department between Jan., 1, 1982 and Dec., 31, 1986 were reviewed. During the 5 year period, 2331 patients were admitted to our hospital and 2192 urological operations were performed on 1834 patients. These statistics were compared with earlier statistics for two periods (1972-1976 and 1977-1981) and the recent trend of urological operations was investigated. With regard to operated organ, operations on the kidney were the most frequent followed by those on the urinary bladder. Operations on the ureter decreased during the recent 5 year period and they were the fourth most frequent following those on the scrotum, scrotal contents and penis. Operations on the adrenal gland, retroperitoneal space and parathyroid gland have gradually increased. As in the former report, transurethral resection of bladder tumor (TUR-Bt) was the most frequent and nephrectomy, TUR of prostate (TUR-P) and renal allotransplantation have followed. TUR-Bt and TUR-P have increased more and more and due to the introduction of percutaneous nephrolithotripsy and transureteral lithotripsy, open surgery for urolithiasis has greatly decreased. Endourological operations will still be on the increase.

Novel effector monocytes against human RBC antigens invading rejected renal allografts

A novel effector SPFC-MO may be involved in human renal allograft rejection, and the involvement of SPFC in rejected grafts may be reflected by the preoperative antidonor SPFC reactivity detected by the MLC-SPFC assay.

The level and stability of residual catalase in cultured acatalasemic skin fibroblasts

In an attempt to determine the level and heat stability of residual catalase in somatic cells of acatalasemic Japanese, skin fibroblasts from an acatalasemic subject were cultured, and the catalase activity of the cultured fibroblasts was compared with that of cultured normal fibroblasts. Catalase activity was determined using an oxygen electrode. The residual catalase activity in cultured acatalasemic fibroblasts was 10% of the normal. The heat stability at 55 degrees C of residual catalase in the acatalasemic fibroblasts was similar to that of normal fibroblasts.

[Pheochromocytoma: review of 22 patients and 23 operations]

Twenty-two cases of pheochromocytoma encountered at our department between 1965 and 1986 are reviewed. Eighteen of the patients were adults (26 to 62 years old) and 4 were children (9 to 13 years old). Thirteen were males and 9 were females. In a total of 23 operative procedures, 31 tumors were resected excluding lymph node metastasis. The preoperative accuracy of the diagnostic methods for locating the tumor was as follows. KUB and intravenous pyelography with tomography in 12 of 31 tumors (39%), aortography and/or selective arteriography in 21 of 27 (78%), selective venous sampling for catecholamine level in 4 of 4 (100%), computed tomography in 10 of 10 (100%), ultrasonography in 4 of 6 (67%), and iodine-131 metaiodobenzylguanidine scintigraphy in 4 of 6 (67%) tumors. The tumors resected were cases, as followings, a single unilateral adrenal tumor in 14 (right 6, left 8), bilateral adrenal tumors, bilateral adrenal plus extraadrenal tumors and unilateral adrenal plus extraadrenal in each, one case and extraadrenal tumor in six cases (single 5, multiple 1). Either lumbar or thoracolumbar surgery methods were adapted in 9 of 14 cases with single adrenal and one of 5 with single extraadrenal tumors, and in the remaining 13 cases transperitoneal methods were selected. One patient died on the 6th day after operation from gastrointestinal bleeding. Thus the surgical mortality rate in our series was 4.4%. Of the 3 patients with malignant pheochromocytoma, two (9 and 13 years old) are alive each 192 and 67 months after operation. The former is in a tumor-free condition, however in the latter multiple bone metastasis was detected 37 months after operation. The third patient (29 years old) died 62 months after operation from metastatic hemorrhagic tumors in the liver.

Extra-adrenal pheochromocytoma manifesting renovascular hypertension

A case with extra-adrenal pheochromocytoma, which was found by chance in the course of renovascular hypertension, is reported. The tumor was on the stenotic portion of the right renal artery. The results of examinations for pheochromocytoma were not conclusive, that is, inconsistent elevation of plasma catecholamines and urinary catecholamine excretion, equivocal results of pharmacological tests for pheochromocytoma, and negative results in [131I]metaiodobenzylguanidine scintigraphy. The stenosis of the right renal artery disappeared, the blood pressure was normalized by surgical resection of the tumor, and the extra-adrenal pheochromocytoma was finally diagnosed by pathohistological findings. Renovascular hypertension appeared to be the primary cause of this hypertension, judging from the significant decrease in blood pressure induced by an angiotensin II analog and a renal vein renin ratio of 7.3. Even in the case of obvious renovascular hypertension, the possibility of this unusual coexistence with pheochromocytoma should be considered.

IL 2 restores memory B cell activation by antigen-specific T cell clone variants

It has recently been demonstrated that there are at least two separate pathways by which a single keyhole limpet hemocyanin (KLH) reactive T cell clone can induce B cell differentiation. With the use of the high-dose antigen-driven system (10 micrograms/ml trinitrophenyl (TNP)-KLH), a KLH-specific T cell clone was able to induce a primary anti-TNP response in unprimed B cells. In the presence of aliquots of the same T cell clone, a low-dose of antigen (5 X 10(-2) micrograms/ml TNP-KLH) induced an immunoglobulin (Ig)G response in primed B cells. It has also been demonstrated that there are variant subclones of such KLH-specific helper T cell clones that are unable to provide antigen-specific help in the presence of low-dose antigen but maintain the high-dose antigen-driven helper response. This study was undertaken to investigate whether interleukin 2 (IL 2) had some activity in the low-dose, antigen-driven response induced by the T cell clone. With the use of a variant T cell clone (which lost low-dose, antigen-driven helper activity), it was demonstrated that IL 2 was capable of reconstituting the low-dose, antigen-driven helper activity. To investigate whether accessory cells were required in this system, we removed the adherent cell population from the primed spleen cells added to culture. Interestingly, removal of the G10-adherent cells eliminated the low-dose, antigen-driven response induced by IL 2. Additionally by add-back experiments, we were able to demonstrate that the necessary adherent cell population did not require major histocompatibility complex (MHC) restriction for reconstitution of the IL 2-dependent, low-dose, antigen-driven response. Furthermore, 1% concanavalin A (Con A) supernatant (Sn), but not interleukin 1 (IL 1), could replace this adherent cell function. These data suggest that in this system, IL 2 bypasses the MHC-restricted interaction between T cells and antigen-charged adherent cells; B cells can present antigen to cloned helper T cells efficiently for primary responses but need an added factor(s) to induce IgG production; and adherent cells are essential for IgG production in primed B cells, possibly through the release of soluble factor(s) included in Con A Sn.

Two independent pathways of helper activity provided by a single T cell clone

Data presented in this paper demonstrate the existence of two separate pathways by which a single T cell clone can induce B cell differentiation. With the use of high doses of antigen, a T cell clone can induce a primary antibody response in unprimed B cells. With the use of low doses of antigen, the same T cell clone can induce an immunoglobulin (Ig)G response in primed B cells. The primary response is accompanied by T cell proliferation and lymphokine production (interleukin 2, B cell growth factor, B cell differentiation factor for immunoglobulin M, and B cell differentiation factor for immunoglobulin G). The secondary response does not require proliferation and occurs independently of detectable lymphokine production. Variants of the wild type T cell helper clone have been isolated. One variant can provide help to unprimed B cells when high doses of antigen are used. This variant cannot provide help to primed B cells when low doses of antigen are used, nor can it provide help to CBA/N "xid" B cells at any antigen concentration tested. Additional variants have been isolated that proliferate on antigen-pulsed-presenting cells, but fail to secrete detectable lymphokines and do not induce B cell differentiation. These results suggest that a single T cell helper clone has multiple functional activities that can be independently expressed.

IL 2 restores memory B cell activation by antigen-specific T cell clone variants

It has recently been demonstrated that there are at least two separate pathways by which a single keyhole limpet hemocyanin (KLH) reactive T cell clone can induce B cell differentiation. With the use of the high-dose antigen-driven system (10 micrograms/ml trinitrophenyl (TNP)-KLH), a KLH-specific T cell clone was able to induce a primary anti-TNP response in unprimed B cells. In the presence of aliquots of the same T cell clone, a low-dose of antigen (5 X 10(-2) micrograms/ml TNP-KLH) induced an immunoglobulin (Ig)G response in primed B cells. It has also been demonstrated that there are variant subclones of such KLH-specific helper T cell clones that are unable to provide antigen-specific help in the presence of low-dose antigen but maintain the high-dose antigen-driven helper response. This study was undertaken to investigate whether interleukin 2 (IL 2) had some activity in the low-dose, antigen-driven response induced by the T cell clone. With the use of a variant T cell clone (which lost low-dose, antigen-driven helper activity), it was demonstrated that IL 2 was capable of reconstituting the low-dose, antigen-driven helper activity. To investigate whether accessory cells were required in this system, we removed the adherent cell population from the primed spleen cells added to culture. Interestingly, removal of the G10-adherent cells eliminated the low-dose, antigen-driven response induced by IL 2. Additionally by add-back experiments, we were able to demonstrate that the necessary adherent cell population did not require major histocompatibility complex (MHC) restriction for reconstitution of the IL 2-dependent, low-dose, antigen-driven response. Furthermore, 1% concanavalin A (Con A) supernatant (Sn), but not interleukin 1 (IL 1), could replace this adherent cell function. These data suggest that in this system, IL 2 bypasses the MHC-restricted interaction between T cells and antigen-charged adherent cells; B cells can present antigen to cloned helper T cells efficiently for primary responses but need an added factor(s) to induce IgG production; and adherent cells are essential for IgG production in primed B cells, possibly through the release of soluble factor(s) included in Con A Sn.

Two independent pathways of helper activity provided by a single T cell clone

Data presented in this paper demonstrate the existence of two separate pathways by which a single T cell clone can induce B cell differentiation. With the use of high doses of antigen, a T cell clone can induce a primary antibody response in unprimed B cells. With the use of low doses of antigen, the same T cell clone can induce an immunoglobulin (Ig)G response in primed B cells. The primary response is accompanied by T cell proliferation and lymphokine production (interleukin 2, B cell growth factor, B cell differentiation factor for immunoglobulin M, and B cell differentiation factor for immunoglobulin G). The secondary response does not require proliferation and occurs independently of detectable lymphokine production. Variants of the wild type T cell helper clone have been isolated. One variant can provide help to unprimed B cells when high doses of antigen are used. This variant cannot provide help to primed B cells when low doses of antigen are used, nor can it provide help to CBA/N "xid" B cells at any antigen concentration tested. Additional variants have been isolated that proliferate on antigen-pulsed-presenting cells, but fail to secrete detectable lymphokines and do not induce B cell differentiation. These results suggest that a single T cell helper clone has multiple functional activities that can be independently expressed.

Elimination characteristics of bredinin from patients serum in hemodialysis

The hemodialysability of bredinin, a new immunosuppressive drug, was investigated in five patients on longterm hemodialysis. Blood samples were collected periodically during and inter-dialysis and measured by high-performance liquid chromatography (HPLC) for bredinin. The half-life (t 1/2) of the elimination phase was 4.8 h in our patients during hemodialysis, a 97% reduction of the 155 h t 1/2 reported in uremic patients. The fraction of drug in the body which is removed by dialysis (f) calculated averaged 0.43. A mean of 43% of the drug in the body was removed during 4-hour hemodialysis. Because of the reduction in elimination t 1/2 and the significant drug removal during dialysis we conclude that bredinin is dialyzable.

The immunosuppressive mode of action of mizoribine

Mizoribine (MIZ) suppressed the mitogen response and mixed lymphocyte reaction (MLR) significantly at doses of 100 micrograms/ml and 10 micrograms/ml in a dose-response analysis. The 50% inhibition dose (ID50) was between 10 micrograms/ml and 1.0 microgram/ml, both in the mitogen response and MLR. In a kinetic study of the MLR, the degree of suppression with MIZ at a given dosage was essentially the same as the degree of suppression observed in the dose-response analysis when MIZ was added to MLR cultures from day 0 to day 4. In addition, MLR was more susceptible to the suppressive activity of MIZ at 100 micrograms/ml when MIZ was added near the peak of lymphocyte proliferation. This experiment also showed that MLR suppression induced by MIZ at 10 micrograms/ml was reversible and MLR activity had completely recovered 6-8 hr after its removal. MIZ had no inhibitory action on MLR-derived cytotoxic cells or the effector phase of cell mediated lymphocytotoxicity. These results clearly demonstrate that MIZ suppresses lymphoproliferation, but has no effect on the recognition phase or effector phase of cytotoxic lymphocytes.

Pharmacokinetics of bredinin in renal transplant patients

A pharmacokinetic study of bredinin, a new immunosuppressive agent, was carried out in 28 renal transplant patients. Serum bredinin concentration-time curves were analyzed using a one-compartment open model with a first order absorption process. The peak serum bredinin level appeared 2.4 h after oral administration of bredinin 50-200 mg. The calculated mean peak serum level was 0.852 micrograms/ml/mg/kg, when the dose was adjusted to the body weight of the patient. In the dosage range used of 0.85-4.46 mg/kg, a linear relationship was observed between the dose and the peak serum bredinin level. The elimination rate of bredinin from serum was dependent on kidney function, and the elimination rate constant was well correlated with the endogenous creatinine clearance. No circadian rhythm was apparent in the elimination rate constant. The absorption rate of bredinin from the gastrointestinal (GI) tract was affected by GI diseases. The need for dosage adjustment based on the renal function of the transplant patient is suggested.

Predictability of renal allograft prognosis during rejection crisis by ultrasonic Doppler flow technique

Using the ultrasonic Doppler technique, renal blood flow was measured in 67 patients who underwent living related renal transplantation from January, 1976 to December, 1979. In 58 of 67 cases, 81 acute and 9 chronic rejection episodes occurred. In the initial stage of acute rejection, there are no particular changes in the pattern of systolic blood flow and by contrast marked changes of diastolic flow. The disappearance of the diastolic phase is indicative of an advanced stage of rejection, the reappearance indicative of recovery from rejection, and persistent loss accompanied by changes of systolic flow indicative of an unfavorable prognosis of rejection. In chronic rejection, there are rapid changes of neither systolic nor diastolic flow though the acceleration time in the systolic phase lengthens gradually. The ultrasonic Doppler flow technique for blood flowmetry of a transplanted kidney is a useful means of knowing the prognosis of rejection and provides an index for corticosteroid bolus therapy.

Activities of catalase in leucocytes and glucose-6-phosphate dehydrogenase in erythrocytes of hypocatalasemia and acatalasemia

Catalase activity in leucocytes was found to be half the normal value in hypocatalasemia and extremely low in acatalasemia. Glucose-6-phosphate dehydrogenase activity in erythrocytes was not significantly different between normal, hypocatalasemia and acatalasemia in three families of acatalasemia, but in one family lower activities than normal were found in hypocatalasemia and actalasemia erythrocytes. Other enzyme activities in blood, such as alkaline phosphatase, lactate dehydrogenase, glutamic oxaloacetic and glutamic pyruvic transaminases were not significantly different between normal subjects, hypocatalasemia and acatalasemia.

Recovery of catalase activity after inhibition with aminotriazole in acatalasemia mice

The kinetics of catalase synthesis and degradation were determined in acatalasemia and normal mouse livers during recovery of catalase activity after inhibition with aminotriazole. Catalase turned over with a half life of 10.0 hr in acatalasemia mice and of 19.2 hr in normal mice. The rate of catalase synthesis (Ks) was 0.168 (PU/mg protein/hr) in acatalasemia mice and 0.271 in normal mice. The rate of catalase degradation (KD) was 0.069 and 0.036 per hour in acatalasemia and normal mice, respectively.