Retrograde supernormal conduction in concealed accessory atrioventricular pathway following catheter ablation

A case is presented of a 63-year-old woman with a concealed accessory pathway that exhibited retrograde supernormal conduction after radiofrequency catheter ablation. Although ventricular pacing at a slow rate revealed no retrograde conduction over the accessory pathway following ablation, the tachycardia recurred 15 months later. During ventricular pacing there was retrograde 1:1 conduction over the accessory pathway at a fast rate while there was intermittent VA dissociation with rare retrograde conduction at the slower rate. Ventricular extrastimulus testing demonstrated a supernormal conduction zone of the coupling interval. Thus, accessory pathways may exhibit supernormal conduction after catheter ablation. Pacing should be performed at both slow and fast rates to confirm the presence of conduction block following ablation.

Purification and characterization of the protein kinase encoded by the UL13 gene of herpes simplex virus type 2

The proteins encoded by the UL13 genes of herpes simplex virus types 1 (HSV-1) and 2 (HSV-2) have been predicted to be protein kinases. To identify the UL13 gene product, we have raised a rabbit polyclonal antiserum against a His.Tag-HSV-1 UL13 fusion protein. The antibody specifically reacted with the 60-kDa UL13 fusion protein expressed in Escherichia coli and also recognized 56- to 57-kDa late proteins in nuclear fractions of HSV-1- and HSV-2-infected cells. On the other hand, novel casein kinase activity was induced at the late stage of infection when Vero cells were infected with HSV-1 and HSV-2. The induction of the activity was most prominent in the nuclear fractions of HSV-2-infected cells and therefore we purified the protein kinase (PK) from the nuclear extracts by successive column chromatography (phosphocellulose, DEAE-cellulose, and hydroxyapatite) using casein as an exogenous substrate. The final preparation of the enzyme contained a single major protein with an apparent molecular weight of 56 kDa which was specifically reacted with the UL13 antiserum. The PK activity was optimal in the absence of NaCl and at relatively high pH. Acidic proteins such as casein and phosvitin were efficiently phosphorylated by the PK. A basic protein, protamine, which is the best substrate for the HSV-2 US3 PK, was not detectably phosphorylated but histone was a relatively good substrate for the UL13 PK. Phosphoamino acid analysis revealed that the PK phosphorylated serine and threonine but not tyrosine. Moreover the enzyme was found to be highly resistant to heparin, a potent inhibitor of casein kinase II (CK II) and also resistant to CK I-7, a synthetic inhibitor of CK I, but very sensitive to a bioflavonoid quercetin. These results indicate that the HSV-2 UL13 PK had unique catalytic properties different from those of cellular CK I, CK II, and the viral PK encoded by the US3 gene. We have also determined the complete nucleotide sequence of the HSV-2 UL13 gene. The overall amino acid homology between the HSV-2 and HSV-1 UL13 PKs was 85.9% and the homology was highly conserved in the C-terminal region.

Accumulation and clearance of capsanthin in blood plasma after the ingestion of paprika juice in men

The pharmacokinetics of dietary capsanthin was measured in four male volunteers to assess the bioavailability of oxygenated carotenoids (xanthophylls). Capsanthin was used because this carotenoid was not detected in the men's plasma before ingestion of paprika juice. Supplementing capsanthin-rich paprika juice for 1 wk (equivalent to three doses of 5.4 micromol capsanthin/d; 16.2 micromol/d), the level of capsanthin reached a plateau (0.10-0.12 micromol/L) between d 2 and 7 and was not detectable by d 16. Capsanthin was distributed in the plasma lipoproteins (VLDL, 13 +/- 3%; LDL , 44 +/- 3%; HDL, 43 +/- 3%) at the end of the experiment. In a separate experiment involving the single ingestion of paprika juice (equivalent to 34.2 micromol capsanthin) in the same men, the plasma concentration of capsanthin ranged from 0.10 to 0.29 micromol/L at 8 h after ingestion. In contrast, the elevation of the plasma concentration of an acyclic hydrocarbon carotenoid, lycopene, by a single ingestion of tomato soup (equivalent to 186.3 micromol lycopene) in the same subjects was minimal (0.02-0.06 micromol/L). The areas under the curves (AUC) for capsanthin between 0 and 74 h and for lycopene between 0 and 72 h were 4.68 +/- 1.22 and 0.81 +/- 0.17(micromol.h)/L, respectively. The half-lives (t1/2) were calculated to be 20.1 +/- 1.3 and 222 +/- 15 h for capsanthin and lycopene, respectively. We conclude that the clearance of capsanthin is much faster than that of lycopene, although capsanthin is transported into plasma lipoproteins in larger amounts. This polar carotenoid may be metabolized in the human body more rapidly than lycopene. These data justify further research on the physiological functions of capsanthin and other xanthophylls.

Increased plasma tissue factor levels in acute myocardial infarction

BACKGROUND

Tissue factor (TF) is a low molecular weight glycoprotein that initiates the clotting cascade and is considered to be a major regulator of coagulation, hemostasis, and thrombosis.

METHODS AND RESULTS

We examined plasma TF levels in 31 consecutive patients with acute myocardial infarction (AMI) (within 6 hours after the onset of symptoms), 27 patients with stable exertional angina, and 27 control subjects. Ten patients with AMI had a history of unstable angina before infarction, and 21 had a sudden onset of infarction. The plasma TF level was higher in the AMI group than in the stable exertional angina and control groups (240 +/- 112 vs 184 +/- 46 pg/ml [p < 0.05] vs 177 +/- 37 pg/ml, p < 0.01, respectively). TF levels were decreased in the chronic phase (2 weeks after admission) compared with the acute phase of infarction (from 240 +/- 112 pg/ml to 222 +/- 97 pg/ml, p < 0.05). In addition, plasma TF levels were higher in patients with AMI with prodromal unstable angina than in patients with a sudden onset of infarction (300 +/- 169 pg/ml vs 212 +/- 57 pg/ml, p < 0.05). TF levels were similar in the acute and chronic phases in the patients with AMI with prodromal unstable angina (300 +/- 169 pg/ml vs 290 +/- 136 pg/ml, p = not significant) but were decreased in the chronic phase in the patients with AMI with sudden onset (from 212 +/- 57 pg/ml to 190 +/- 49 pg/ml, p < 0.05).

CONCLUSION

Increased plasma TF levels in patients with AMI may reflect enhanced intravascular procoagulant activity. The higher TF levels in patients with AMI with prodramol unstable angina may be associated with repeated episodes of myocardial ischemia and reperfusion.

A prospective trial of steroid cessation after renal transplantation in pediatric patients treated with cyclosporine and mizoribine

We conducted a multi-center prospective study to evaluate the safety and efficacy of steroid withdrawal after renal transplantation in children. In 52 children (51 living-related donor transplants and 1 cadaver donor transplant), immunosuppressive therapy was started with cyclosporine (CyA), mizoribine (MZ), methylprednisolone (MPL) and anti-lymphocyte globulin. Administration of MPL was reduced to alternate days more than 6 months after transplantation, and attempts were made to withdraw it. Acute rejection was noted in 19 patients (36.5%) by 1 month after transplantation. The whole-blood CyA trough level using monoclonal antibody was 175.0+/-17.0 ng/ml in patients who developed acute rejection and 282.0+/-25.3 ng/ml in those who did not show acute rejection (p<0.01). During the 37 attempts at alternate-day MPL administration, clinical acute rejection was observed in only 1 patient and chronic rejection in 3. During 10 attempts to withdraw MPL, acute rejection was noted in 3 patients, but graft function recovered to the pre-rejection level after treatment of the acute rejection. At the last observation, graft function was lost in 3 patients, 22 were receiving MPL on alternate days, and MPL had been withdrawn from 7 for a mean period of 16.7 months. The survival rate of the patients and the grafts was 100% and 94% after an average follow-up period of 4 years. Evaluation of growth showed catch-up growth in all patients during the withdrawal period.

[Preanesthetic meals in elective surgical patients]

This study investigated the effect of preanesthetic meals on the volume and pH of gastric contents in forty elective surgical patients ranging in ages from 20 to 60 years. Twenty patients who were given either isotonic beverage 250 ml or apple juice 250 ml on the morning of the operative day were subjected as control group and twenty patients of the breakfast group took two slices of bread with the above drink. About seven hours following drinking and feeding, the mean values of gastric volume were 20.9 +/- 18.3 ml in the control group and 19.2 +/- 16.3 ml in the breakfast group. The mean values of gastric pH were 4.3 +/- 2.3 in the drink group and 4.6 +/- 2.3 in the breakfast group. There were no significant differences in the gastric volume and pH between the two groups. However, very small amount of the bread was detected in the gastric fluid of three patients in the breakfast group. As preanesthetic drinking and feeding are advantageous for reducing the anxieties of preoperative patients and also for their nutrition during operation, it is encouraging that eating two slices of bread did not induce a significant effect of gastric volume or pH. The minute fragment of bread seems to have no clinically significant effect.

[Usefulness of 201Tl/123I-BMIPP myocardial SPECT to evaluate myocardial viability and area at risk in acute myocardial infarction--comparison with 201Tl/99mTc-PYP dual SPECT]

To evaluate the area at risk and the myocardial viability of acute myocardial infarction (AMI), we compared rest 123I-beta-methyl iodophenyl pentadecanoic acid (123I-BMIPP) and 201Tl myocardial SPECT with 201Tl/99mTc-PYP dual SPECT (D-SPECT) in 65 patients (mean age 64 +/- 11 years) with AMI. D-SPECT was performed in 3 to 5 days, 123I-BMIPP myocardial SPECT in 5 to 7 days, and left ventriculography on 1 month after onset of AMI. Furthermore, 201Tl/123I-BMIPP myocardial SPECT and left ventriculography were performed on 4 months after onset of AMI. The area which showed the reduced 123I-BMIPP uptake was larger than that showed the accumulation of 99mTc-PYP. The improvement of regional wall motion on 4 months after onset of AMI tended to be more closely correlated with the existence of discrepancy zone between 201Tl and 123I-BMIPP uptake than that of overlap zone between 201Tl and 99mTc-PYP uptake in acute period. We conclude that 201Tl/123I-BMIPP myocardial SPECT is more useful to evaluate the area at risk and myocardial viability of AMI than D-SPECT.

Captopril reduced plasminogen activator inhibitor activity in patients with acute myocardial infarction

Recent clinical trials have demonstrated that the administration of angiotensin-converting enzyme (ACE) inhibitors to patients with myocardial infarction reduces the incidence of recurrent myocardial infarction. It has also been reported that an elevated level of plasminogen activator inhibitor (PAI) appears to constitute a marker of the risk of recurrent coronary thrombosis. To determine whether the ACE inhibitor captopril reduces plasma PAI inhibitor activity, we measured changes in plasma PAI activity (IU/ml), tissue plasminogen activator (t-PA) antigen (ng/ml), and serum ACE activity (IU/L) in 14 survivors of myocardial infarction receiving captopril therapy (37.5 mg daily) and compared them with the values in 15 placebo-treated patients chosen at random. Blood sampling was performed at 07.00 h. In the captopril-treated group, serum ACE activity decreased significantly, from 14.0 +/- 0.8 to 11.5 +/- 1.2 IU/L 24 h after captopril therapy (p < 0.01), and those of PAI activity and t-PA antigen also decreased significantly-from 11.9 +/- 2.8 to 5.5 +/- 2.2 IU/ml (p < 0.02) and from 9.9 +/- 1.0 to 7.5 +/- 0.9 ng/ml (p < 0.05), respectively 48 h after captopril therapy. However, the levels of ACE activity, PAI activity, and t-PA antigen remained unchanged during the study period in the placebo group. Thus, our data indicate that the administration of captopril to patients with acute myocardial infarction may result in a reduced frequency of recurrent coronary thrombosis by increasing fibrinolytic capacity.

Subclinical Fabry's disease occurring in the context of IgA nephropathy

A 28-year-old male patient with both IgA nephropathy and an unusual case of Fabry's disease has been followed for 10 years. Diagnosis of both these diseases was made by histological examination of renal biopsy tissues and the enzyme activities of alpha-galactosidase A. Serial biopsies revealed the hithertofore unrecognized process of glomerular glycolipid accumulation peculiar to Fabry's disease at the initial stages of the disease. Physical examinations and routine laboratory analyses failed to show significant signs of Fabry's disease throughout the 10-year period. While alpha-galactosidase A activity is markedly decreased in the plasma of this patient as in classical Fabry hemizygotes, the activity in leukocytes and culture fibroblasts showed a considerable residual activity. Fabry's disease associated with IgA nephropathy apparently is extremely rare, and the present subclinical case is unique in that the early stages of substrate accumulation are demonstrable.

[Hemorheological effects of autologous blood storage before surgery for cardiac valvular diseases]

The hemorheological effects of autologous blood storage with or without the use of erythropoietin were examined before surgery for valvular disease. There was no rheological difference between patients with aortic (16 cases) or mitral (10 cases) valve disease. Before storage, the levels of hematocrit, whole blood viscosity, and especially coefficient of rheology, were lower (p < 0.05) in the blood stored with erythropoietin, but this difference disappeared after storage. The plasma viscosity of both groups did not change before and after storage. The viscosity of blood was equalized after the storage of blood, irrespective of the use of erythropoietin.

Experimental acute glomerulonephritis induced in the rabbit with a specific streptococcal antigen

FITC-labelled IgG obtained from patients convalescing from acute poststreptococcal glomerulonephritis (APSGN) stains glomeruli of patients with early APSGN. We previously reported a streptococcal antigen (preabsorbing antigen (PA-Ag)) that preabsorbed the stain out of sera from the convalescent patients and thus prevented glomerular staining. To confirm the nephritogenicity of PA-Ag, we administered up to 40 mg of this antigen to rabbits for 8 days and observed them for up to 9 weeks. Immunohistological analysis showed diffuse and global glomerular staining for C3 without notable staining for gamma-globulin. Light microscopic examinations revealed slight to moderate proliferative glomerulonephritis with exudative change. Control rabbits, which received similar doses of bovine serum albumin, did not show significant staining for C3. A transient and significant decrease in CH50 was observed from weeks 3 to 7 (9.7 +/- 0.3 U/ml at week 3; normal range 12.9 +/- 0.6 U/ml). This experimental model showed a resemblance to immunological and immunohistological features of APSGN in humans. Although the precise mechanisms are yet to be determined, complement activation by PA-Ag seems to hold a key position in this model and in the human disease.

Pulse-spray thrombolysis in acutely obstructed coronary artery in critical situations

Pulse-spray thrombolysis (PST) was performed to treat large coronary thrombus in 3 patients in critical situations. The originally developed pump system and a custom infusion catheter (SciMed/Boston Scientific, Maple Grove, MN) were used in combination. Case 1, a 48-yr-old male with extensive anterior myocardial infarction, failed to be recanalized by systemic thrombolysis. He underwent emergent coronary angiography, which revealed proximal occlusion of a large left anterior descending artery (LAD). TIMI 3 flow was achieved after 20 min with 200,000 units of urokinese by PST, followed by balloon angioplasty. In case 2, a 57-yr-old male, subacute stent thrombosis occurred 4 days after two and a half Palmatz-Schatz stents were implanted in mid-LAD. TIMI 3 flow was recovered at 20 min with 240,000 units of urokinese and an additional 72,000 units of rt-PA, followed by redilatation with a quarter-size larger balloon than that used in stent deployment. In case 3, a 70-yr-old male, during ultrasound study for unstable angina, a massive thrombotic complication occurred which occluded the left main trunk. PST was immediately performed under cardiac resuscitation, and the patient recovered from shock after 15 min. TIMI 3 flow was restored after 25 min. Two Palmatz-Schatz stents were implanted after thrombus completely disappeared. There were no complications, including distal embolization, intimal dissection, or bleeding. There was also no recurrence of the ischemic event. PST may be considered a potential treatment modality for coronary artery disease where large thrombus plays a major role.

[Effect of FUT-187, oral serine protease inhibitor, on inflammation in the gastric remnant]

Excessive enterogastric reflux following partial gastrectomy is believed to be responsible for the cause of inflammation in the gastric remnant. We examined the effect of FUT-187, a synthetic serine protease inhibitor, on symptoms and endoscopic findings in 33 patients who were diagnosed endoscopically as postgastrectomy gastritis. Patients took 50 mg FUT-187 orally after each meal and at bedtime for 8 weeks. Before treatment, 30 patients (91%) suffered from several symptoms including regurgitation and/or bitter taste in the mouth (49%), epigastric pain (42%) and nausea (36%). From endoscopic observation, erythema was detected in 32 patients, edema in 23 patients and erosion and/or ulcer in 9 patients. After treatment the global improvement rating for subjective symptoms was 76.7% (23/30) and the improvement of endoscopic findings was 63.6% (21/33). Diarrhea was observed in one patient but could be easily controlled by discontinuation of the drug. Our results suggest that FUT-187 can be a useful drug for the treatment of postgastrectomy gastritis with its efficacy and safety.

A method for direct DNA amplification of uncharacterized DNA viruses and for development of a viral polymerase chain reaction assay: application to the red sea bream iridovirus

A method is described for isolating a DNA segment of a virus for which no protein or DNA sequence information is available. This segment can then be used to develop a PCR-based assay for the virus. The method is based on the widespread presence and strong conservation of the ribonucleotide reductase gene among DNA viruses. The validity of the procedure is demonstrated by development of an assay for the fish iridovirus. We report the direct isolation from infected fish of a 738-bp segment of the iridovirus ribonucleotide reductase small subunit gene without prior virus purification. Using the sequence information obtained, a PCR-based diagnostic system was developed for detecting iridovirus infection.

Shortcut link between the fast and slow pathways and the mechanism of cure in atrioventricular nodal reentrant tachycardia by catheter ablation

The mechanism of cure in AV nodal reentrant tachycardia (AVNRT) by catheter ablation has not been fully clarified. We hypothesized that disruption of a shortcut link between the fast and slow pathways is responsible for the elimination of tachycardia.

RESULTS

AVNRT was eliminated in 20 patients by catheter ablation. In five patients (25%; group I) slow pathway conduction disappeared 1 week after ablation. In six patients (30%; group II), the effective refractory period of the slow pathway was prolonged by more than 50 ms (212 +/- 81 ms vs 340 +/- 81 ms; P < 0.05). In the remaining nine patients (45%; group III), there was no change in the refractory period (270 +/- 65 ms vs 273 +/- 74 ms), although tachycardia was not inducible. A shortcut link between the fast and slow pathways was examined by comparing the A-H intervals over the slow pathway during the tachycardia and during atrial pacing at the tachycardia cycle length. Prior to ablation, a shortcut link was assumed in 1 of group I patients, 2 of group II patients, and 8 of group III patients. Of the 9 patients in whom the slow pathway was not impaired after ablation (group III), 8 patients were found to have a shortcut link, while 8 of 11 patients with impairment of the slow pathway after ablation (groups I and II) had no shortcut link between the fast and slow pathways (P < 0.05).

CONCLUSION

In patients with a shortcut link between the fast and slow pathways, slow pathway conduction itself does not need to be impaired to eliminate the AVNRT, whereas in patients without this shortcut link, slow pathway conduction must be impaired.

Asymptomatic acute poststreptococcal glomerulonephritis following upper respiratory tract infections caused by Group A streptococci

During an observation period of 1-2 years in 2 different districts in Japan, 104 patients were found to have upper respiratory infections caused by group A streptococci. Fourty-nine of these patients were followed prospectively to determine if renal involvement would occur. Twelve patients developed transient serum complement (CH50) depression and urinary abnormality, and 2 of these developed mild hypertension. The latent period was from 1-8 weeks after the streptococcal infection. Renal biopsies of the 12 patients with "asymptomatic" of "subclinical" acute poststreptococcal glomerulonephritis (APSGN) were examined by light, immunofluorescent and electron microscopy. Glomerular lesions ranged from mild proliferative changes to the classical pathology seen in APSGN. The 12 patients were followed for 10 years. Two of them developed persistent or intermittent hematuria, and renal biopsies obtained 4 years after the initial infection revealed mesangial proliferative glomerulonephritis without IgA deposits. The remaining patients showed no abnormal findings after the acute episode. These findings suggested that glomerular involvement after group A streptococcal infection is frequent and mesangial proliferative glomerulonephritis, which was found to develop in some, may rank with IgA nephropathy as a major cause of unexplained microscopic hematuria.

Mother to fry, successful transfer of immunity against infectious haematopoietic necrosis virus infection in rainbow trout

We have tested whether immunity can be transferred from a mother fish to its fry. Rainbow trout mother fish were inoculated against infectious haematopoietic necrosis virus (IHNV) by intraperitoneal injection of a fragment of the IHNV glycoprotein spanning amino acids 31 to 310. This protein fragment was obtained by isolating the specific cDNA from Japanese IHNV strain HV7601 and expressing it in Escherichia coli. Fry from immunized and control fish were exposed to IHNV at various intervals after hatching, and their mortality monitored. Survival of the fry of immunized fish was significantly greater when exposure to virus occurred 7 days after hatching, and some immunity appeared to persist until at least 25 days after hatching.

Alpha-fetoprotein, carcinoembryonic antigen, and carbohydrate antigen 19-9-producing gallbladder cancer

We report a rare case of alpha-fetoprotein (AFP), carcinoembryonic antigen (CEA), and carbohydrate antigen (CA) 19-9-producing gallbladder cancer with high levels of CA125 and protein induced by vitamin K absence or antagonist II (PIVKA II). A 63-year-old man was diagnosed with gallbladder cancer with metastases to the liver, based on ultrasonography and computed tomography of the abdomen showing multiple tumorous lesions in the liver and a thickened gallbladder wall. Laboratory data showed high levels of tumor markers: 4647.4 ng/ml AFP, 9987.1 ng/ml CEA, 11,704.0 U/ml CA19-9, 847.6 U/ml CA125, and 0.2 AU/ ml PIVKA II. AFP in the present case showed an increase in Concanavalin A-nonbinding fraction and an increase in Lens culinaris lectin-binding fraction by affinity column chromatography. The patient died of hepatic failure. Autopsy revealed gallbladder cancer consisting of papillary adenocarcinoma and moderately differentiated tubular adenocarcinoma. By immunohistochemical staining, AFP was detected in the papillary adenocarcinoma portion of the primary focus and metastatic tumor cells in the liver, but was not detected in noncancerous liver tissue. CEA and CA19-9 were detected mainly in the tubular adenocarcinoma portion.

[Laparoscopic pelvic lymphadenectomy for localized prostate cancer]

We report the clinical results and efficacy of laparoscopic pelvic lymphadenectomy for localized prostate cancer. This procedure was followed by radical prostatectomy, when metastasis was not found in the frozen section, and by optional treatment, such as transurethral resection (TUR) or castration, other than radical prostatectomy when metastasized nodes were found. We performed transperitoneal laparoscopic lymphadenectomy on 30 patients and extraperitoneal approach on 20 between April, 1992 and September, 1995. The patients were between 52 and 78 years old. Nineteen, patients had stage B1, 17 stage B2 and 14 stage C cancer. Bilateral obturator nodes were dissected. We could not perform laparoscopic lymphadenectomy on two patients because of adhesion. The average operation time and blood loss were 166 minutes and 151 ml, respectively, in the transperitoneal group, while 142 minutes and 126 ml in the extraperitoneal group. The average number of removed nodes was 12 in the transperitoneal group and 10 in the extraperitoneal group. The extraperitoneal approach is a safer and useful procedure. Nodal metastasis were found in 12 patients by frozen section. Additional positive nodes were found in 7 patients by a further study. Two were not harvested laparoscopically and 5 were ascertained only by permanent section. Therefore, the two-staged operation might be preferable. Nodal metastasis was likely to be found in localized prostate cancer patients with clinical stage C, poorly differentiated cancer, or prostatic specific antigen density (PSAD) over 0.5 ng/ml/ml. Laparoscopic pelvic lymphadenectomy might be indicated for these cases.

Classification of pulsating flow patterns in curved pipes

The fully developed periodic laminar flow of incompressible Newtonian fluids through a pipe of circular cross section, which is coiled in a circle, was simulated numerically. The flow patterns are characterized by three parameters: the Womersley number Wo, the Dean number De, and the amplitude ratio beta. The effect of these parameters on the flow was studied in the range 2.19 < or = Wo < or = 50.00, 15.07 < or = De < or = 265.49 and 0.50 < or = beta < or = 2.00, with the curvature ratio delta fixed to be 0.05. The way the secondary flow evolved with increasing Womersley number and Dean number is explained. The secondary flow patterns are classified into three main groups: the viscosity-dominated type, the inertia-dominated type, and the convection-dominated type. It was found that when the amplitude ratio of the volumetric flow rate is equal to 1.0, four to six vortices of the secondary flow appear at high Dean numbers, and the Lyne-type flow patterns disappear at beta > or = 0.50.

[Hautmann's ileal neobladder: experience of 37 cases]

Between April 1993 and August 1995, a Hautmann's ileal neobladder was created in 37 men after total cystectomy for bladder cancer. Ureteroileostomy was performed using a submucosal tunnel instead of the Le-Duc Camey procedure. There was no operative mortality and only a few early complications. The mean postoperative follow-up time was 16 months, with a range of 3 to 31 months. Hydronephrosis occurred in 3 patients, being caused by stenosis at the uretero-ileo anastomosis in 2 and by proximal stenosis in 1. Neobladder-ureteral reflux did not occur in any of the patients. Postoperative ileus developed in 3 patients, and one required laparotomy. Stenosis of the urethro-ileal anastomosis developed in 3 patients, who were successfully treated by transurethral incision. Thirty five patients achieved daytime continence, while 2 patients had slight incontinence. Twenty nine patients achieved nighttime continence, and most of the patients awoke 1-4 times to prevent overflow incontinence. The mean maximum flow rate, average flow rate and post-voiding residual urine volume were respectively 15.3 ml/sec, 5.5 ml/sec and 81 ml at 6 months postoperatively, and 14.9 ml/sec, 5.4 ml/sec and 76 ml at 12 months. Four patients with more than 100 ml of residual urine required sterile intermittent catheterization 2-4 times a day. Urethral recurrence was detected in 2 patients. One was treated with transurethral resection and cisplatinum-based systemic chemotherapy, and the other required urethrectomy and urinary diversion using a new continent efferent limb.