Percutaneous treatment of transitional cell carcinoma of the upper urinary tract

BACKGROUND

We evaluated the long-term effect of percutaneous resection in 2 Japanese patients with transitional cell carcinoma of the renal pelvis, and reviewed the medical literature on similar patients, to determine the appropriate indications for percutaneous treatment of transitional cell carcinoma in the upper urinary tract.

RESULTS

Indications for endoscopic resection in the 2 patients were renal insufficiency and unsuitability for major open surgery. The patients had no recurrence during follow-up. Seven previous reports described percutaneous resection of upper urinary tract transitional cell carcinoma in 82 patients. Although 72.6% of the patients were successfully treated by percutaneous resection, half of the patients with grade 3 carcinoma developed recurrence.

CONCLUSION

These results, together with those of the 7 published reports, suggest that percutaneous resection should be limited to selected patients with low-grade transitional cell carcinoma.

Enzymes involved in DNA synthesis in the testes are regulated by temperature in vitro

OBJECTIVE

Temperature is considered to be an important local regulating factor of testicular function. We investigated whether a high temperature would affect the activity of DNA polymerases alpha, beta, and gamma (EC2.7.7.7) and DNA topoisomerase I in the testes which are required for germ cell differentiation.

METHODS

An in vitro rat testis tissue culture system was used to evaluate the activity of DNA polymerases alpha, beta, and gamma and DNA topoisomerase I after incubation at 31 and 37 degrees C. The expression of proliferating cell nuclear antigen was evaluated immunohistochemically in the testis.

RESULTS

Incubation at 37 degrees C significantly reduced the activity of all four enzymes as compared with incubation at 31 degrees C. Reducing the temperature to 31 degrees C after prior incubation at 37 degrees C partially restored DNA polymerase alpha activity. Expression of proliferating cell nuclear antigen demonstrated a reduction in DNA synthesis in the seminiferous tubules after incubation at 37 degrees C CONCLUSION: These findings indicate that a high temperature of 37 degrees C reduces the activity of the enzymes involved in the testicular synthesis of DNA which may cause the impairment of spermatogenesis.

Treatment of root fracture by CO2 and Nd:YAG lasers: an in vitro study

The purpose of this in vitro study was to use scanning electron microscopy and polarized light microscopy to evaluate the feasibility of using either the CO2 laser or an Nd:YAG laser in combination with air/water surface cooling to effect fusion of fractured tooth roots. The experimental unit consisted of 81 single-rooted teeth, each with an induced root fracture. Fifty-six teeth that had been reapproximated in dental stone and 25 teeth that had been reapproximated with C-clamps were assigned to untreated control groups or groups for treatment using CO2 and Nd:YAG lasers. Laser treatment consisted of multiple passes along the line of fracture, which was inspected using a dissecting microscope after each pass until a visual indication of fusion or irreparable damage resulted. Scanning electron microscopy evaluation of the treated lines revealed heat-induced fissures and cracks, areas of cementum meltdown and resolidification, crater formation, and separation of cementum from underlying dentin. In no instance-regardless of reapproximation technique, laser type, energy, and other parameters-did the treatment effect fusion of the fractured root halves.

Two cases of small cell carcinoma of the prostate

We describe the clinical and pathological findings in two Japanese men with small cell carcinoma of the prostate; case 1 was 58 years old and case 2 was 24 years old. Case 1 was initially diagnosed as a poorly differentiated adenocarcinoma of the prostate, stage D2, with marked elevation of serum neuron-specific enolase (NSE), carcinoembryonic antigen (CEA), and CA 19-9 levels. The patient had undergone castration and systemic chemotherapy. After three courses of chemotherapy, tumour markers were normalized. However, 6 months later serum levels of tumour markers again rose, and biopsy of the prostate revealed a small cell carcinoma component in the adenocarcinoma of the prostate and benign prostate hypertrophy. The patient was again treated with systemic chemotherapy but died within 1 year after relapse. In case 2, the patient presented with initial symptoms of lumbago and dysuria, and an enlarged prostate was radiologically diagnosed. Shortly after admission he developed ileus, and an exploratory laparotomy revealed a large tumour arising from the prostate and invading the peritoneal cavity. This tumour was pathologically diagnosed as a small cell carcinoma. The patient died shortly thereafter without responding to chemotherapy. Immunohistological evaluation was done using a panel of antibodies against NSE, chromogranin A, CEA, CA 19-9, prostatic acid phosphatase (PAP), prostate-specific antigen (PSA), leukocyte common antigen (LCA), epithelial membrane antigen (EMA), adrenocorticotropic hormone (ACTH), calcitonin, serotonin, gastrin, vasoactive intestinal peptide (VIP), and glucagon. CEA was intensely positive in the tumour lesions from case 1, and NSE and ACTH were focally positive, and calcitonin, serotonin, CA 19-9, and PSA were weakly positive only in several cells in the tumour lesions from case 1. In the tumour lesion from case 2, NSE was intensely positive, and chromogranin A was weakly positive. These findings support the neuroendocrine nature of this neoplasm.

Assessment of germ-cell kinetics in the testes of patients with varicocele using image analysis of immunostained proliferating cell nuclear antigen

OBJECTIVE

To examine the germ-cell kinetics of varicocele testis using proliferating cell nuclear antigen (PCNA) immunostaining and image cytometry to evaluate the staining intensity, and to compare the proliferative index (PI) of varicocele and normal testes.

PATIENTS AND METHODS

Fifty-six testicular biopsy specimens were taken from 28 patients with varicocele during high ligation. The specimens were fixed and embedded in paraffin, and sections immunostained using an anti-PCNA antibody. The PI was measured using an image analyser and expressed as the percentage of the total nuclear area stained positively with PCNA monoclonal antibody, assessed from > 20 seminiferous tubules. Sections stained with haematoxylin and eosin were used to determine Johnsen's score using conventional microscopy. Normal control testicular biopsies were obtained from subjects undergoing vasectomy.

RESULTS

In patients with varicocele, both testes had a significantly lower PI than normal testes; the mean (SD) PI of the right and left testes was 11.3% (4.1) and 11.3% (4.8), respectively, and the PI of normal testes was 21.7% (3.1). There was no significant correlation between PI and sperm concentration or Johnsen's score.

CONCLUSION

PI is useful for assessing germ-cell kinetics; in patients with varicocele both testes showed a deterioration in DNA synthesis, suggesting that reduced DNA synthesis is one of the causes of spermatogenic dysfunction in the varicocele testes.

Comparison of hormonal therapy and chemohormonal therapy in patients with newly diagnosed clinical stage D prostatic cancer

BACKGROUND

In order to examine the usefulness of chemohormonal therapy, we conducted a multicentered randomized trial comparing hormonal therapy, using a luteinizing hormone-releasing hormone (LH-RH) agonist, with chemohormonal therapy, hormonal therapy plus cyclophosphamide (CPM), in patients with newly diagnosed clinical stage D prostatic cancer.

METHODS

Between January 1991 and March 1995, 41 evaluable patients with stage D prostatic cancer were randomized into 2 groups: group A (hormonal therapy alone), goserelin acetate depot 3.6 mg subcutaneously every 4 weeks: group B (chemohormonal therapy), goserelin acetate depot 3.6 mg subcutaneously and CPM 1000 mg/m2 intravenously every 4 weeks. The responses to the therapies were evaluated based on the criteria of The Japanese Urological Association.

RESULTS

There were no significant differences between the 2 groups with regard to objective and subjective response rates. No advantage in chemohormonal therapy was observed in the survival rate and progression-free survival rate. However, the survival rate and progression-free survival rate of responders were significantly higher than those of nonresponders in both groups. When the results were categorized by histologic grade patients with poorly-differentiated adenocarcinoma had significantly higher response rates, survival rates, and disease-progression-free survival rates in Group B compared to similar patients in Group A.

CONCLUSIONS

We conclude that chemohormonal therapy does not definitely improve the clinical response and prognosis of patients with stage D prostatic cancer; however, for patients with poorly-differentiated adenocarcinoma, chemohormonal therapy is a useful treatment.

[Radical prostatectomy for localized prostate cancer]

We studied 81 patients who underwent radical prostatectomy for prostate cancer. Ten, 57 and 14 patients were clinically diagnosed with stage T1, T2 and T3, respectively. Pelvic lymph node dissection was performed prior to prostatectomy in all cases. The neurovascular bundle was preserved in 21 patients. Compared with pathological stage, the accuracy rate of clinical staging in T1, T2 and T3 was 40, 46 and 64% respectively. Approximately half of the patients clinically diagnosed with stage T2 were pT3. The positive rate of lymph node in pT2 and pT3 was 3.3 and 37% respectively, showing a marked difference between these two pathological stages. The 3-year non-recurrence rates were 89% in patients with pT2 and 79% in pT3. In the well differentiated carcinoma group, no patients had recurrence for up to 3 years. All of the patients with infiltration (INF) gamma showed recurrence within 3 years. Fifty-five patients had no problem on urination post-operatively, while the other 23 patients had a mild or moderate incontinence and the remaining 3 patients had a small urine stream. Regarding erectile potency, 4 out of 18 evaluable patients were potent.

[Serovars and drug susceptibility of Salmonella isolated in humans from 1987-1993 in Aichi prefecture]

Drug susceptibility and serovars for a total of 1,110 strains of Salmonella isolated from humans during a period from 1987-1993 in Aichi prefecture were studied. The isolates consists of 1,022 strains from healthy individuals and patients with sporadic diarrhea, 36 imported strains from overseas travellers, and 52 strains from patients involved in 7 food poisoning incidents. The strains of the first group were serologically classified into 93 serovars. The predominant serovars isolated were S. Enteritidis, S. Litchfield, S. Hadar, S. Typhimurium and S. Infantis. In drug susceptibility tests using 8 drugs, the frequency of drug resistance and number of patterns of resistant isolates were 46% and 33 patterns, respectively. There were different resistant rates and characteristic resistance patterns in each serovar of the isolates. Some of the resistance patterns of isolates derived from food poisonings were rare during the year of occurrence. Thus, it seems that surveillance of Salmonella may provide valuable fundamental epidemiological data.

Tamsulosin and chlormadinone for the treatment of benign prostatic hyperplasia. The Kobe University YM617 Study Group

The recent introduction of selective alpha-adrenoceptor blockers adds a further therapeutic option for the treatment of benign prostatic hyperplasia (BPH). Tamsulosin, a selective alpha 1-blocker, has proved effective in relieving irritative and obstructive symptoms caused by BPH. To investigate whether the combination of tamsulosin with the anti-androgenic drug chlormadinone is of further therapeutic benefit, 80 patients randomly received tamsulosin 0.2 mg daily, chlormadinone 50 mg daily or a combination of tamsulosin 0.2 mg and chlormadinone 50 mg daily for 16 weeks. Greater improvement in subjective symptoms of BPH was obtained with either tamsulosin alone or in combination with chlormadinone than with chlormadinone alone. However, the greatest improvement in objective uroflowmetric data was obtained with chlormadinone in combination with tamsulosin. Thus, the combination of tamsulosin with chlormadinone appears to be more beneficial than either of these agents used as monotherapy. Further investigation is required to fully evaluate the therapeutic effects of this combination. After the trial period one-third of the chlormadinone and tamsulosin/chlormadinone-treated patients needed no further treatment due to the satisfactory relief of symptoms. At 12 months follow-up, however, one-fourth of the patients had undergone transurethral resection of the prostate (TUR-P) regardless of medication. This suggests a limitation of the medical treatment of BPH.

Rejection of mouse renal cell carcinoma elicited by local secretion of interleukin-2

We introduced the interleukin-2 (IL-2) gene into mouse renal cell carcinoma (RenCa) in order to examine the mechanism of tumor rejection. IL-2 gene-transfected RenCa (RenCa/IL-2Hi) exhibited marked retardation of tumor growth when implanted in a syngeneic host. Growth retardation of RenCa/IL-2Hi was also observed in athymic nude mice even after depletion of natural killer (NK) cells by treatment with anti-asialo GM1 antibody. Histological analysis of RenCa/IL-2Hi tumors disclosed non-specific inflammatory changes in syngeneic hosts. Co-injection of Bacillus Calmette Guerin with RenCa/IL-2Hi considerably enhanced the anti-tumor effects. Taken together, these findings strongly suggest that in situ IL-2 production leads to tumor rejection through non-specific inflammatory responses without participation of T cells and NK cells. On the other hand, the syngeneic mice that had rejected RenCa/IL-2Hi acquired immunity against parental RenCa, suggesting possible participation of memory T cells in the second rejection of the tumor.

Metenkephalin in seminal plasma of infertile men

BACKGROUND

Enkephalin is one of the opioids, which is expressed widely in reproductive organs. However, the function of enkephalin in male reproduction is not completely understood. The effect of metenkephalin on sperm motility remains especially controversial. In this study we examined the level of metenkephalin in seminal plasma from men with normal sperm production and patients with asthenospermia, oligospermia, and azoospermia to investigate the role of metenkephalin in seminal plasma on sperm function. We also investigated the effect of metenkephalin on sperm motility in vitro.

METHODS

Sixty nine infertile patients (31 oligospermic, 21 asthenospermic, and 17 azoospermic) were included in this study. The level of metenkephalin in seminal plasma of these men was measured and the effect of the peptide on the motility of human sperm was examined in vitro. Seventeen men with normal seminograms were a control group.

RESULTS

The level of metenkephalin in the seminal plasma of semen from asthenospermic men was significantly lower than that from the controls (P < 0.05). No significant correlations between the level of metenkephalin and the mean pathing or progressive velocity of sperm, or serum hormone levels were observed. In the in vitro study, which used semen from the controls, treatment of sperm with metenkephalin (50-200 pg/mL) maintained sperm motility for 4 hours. On the other hand, motility of sperm incubated without metenkephalin began to decrease at 3 hours. Metenkephalin levels of 50 pg/ mL in seminal plasma is considered to be necessary for maintaining sperm motility.

CONCLUSION

These results suggest that metenkephalin in seminal plasma is an important clue in the investigation of decreased sperm motility.

Hyperprolactinaemia among infertile patients and its effect on sperm functions

The effects of hyperprolactinaemia on sperm function were investigated in 264 men with oligozoo-, asthenozoo-, or teratozoospermia and who were attending a male infertility clinic. None of the patients exhibited galactorrhea or complained of impotence. There was no correlation between abnormal values in spermiogram and hyperprolactinaemia. After multiple measurements of serum prolactin concentration, 15 cases (5.7%) were diagnosed as hyperprolactinaemic (> or = 10 ng ml-1). Six of these patients were taking cimetidine and six were taking anti-anxiety drugs. Serum prolactin returned to the normal level after discontinuation of these drugs; thus these 12 cases were considered as drug-induced hyperprolactinaemia. The other three patients were diagnosed as having pituitary microadenomas and received bromocriptine treatment; the serum prolactin levels normalized within 1 month. No changes in sperm concentration, motility or morphology were found after normalization of serum prolactin levels. Sperm fertilizing ability was monitored by the hamster test for 10 months in the three patients with pituitary microadenoma, and no improvement was observed. Results suggest that hyperprolactinaemia, which does not cause symptoms, has little effect on the impairment of sperm functions. Measurement of serum prolactin in infertile men could be justified, however, for early detection of pituitary adenomas.

A case of microhepatoma associated with schistosomiasis japonica diagnosed by enhanced ultrasonography after hepatic intraarterial injection of carbon dioxide gas

The patient was a 58-year old man whose complaints were generalized malaise and right epigastralgia. He had liver cirrhosis and schistosomiasis japonica, previously diagnosed by laparoscopy. Computed tomography (CT) showed a high density funicular shadow in the liver. However no tumorous lesions in the liver were visualized. Ultrasonography (US) of the liver showed a reticulate or scaly pattern, but no images of tumorous lesions. Hepatic angiography showed a single, deeply colored image about 1cm in diameter, in the segmentum anterosuperior. Preoperative and intraoperative enhanced US with hepatic intraarterial injection of carbon dioxide gas was performed. It showed a hyperechoic tumor shadow about 1cm in the segmentum anterior. The segmentum anterosuperior including the tumor was partially resected. Pathologically, the tumor was found to be a hepatoma of Edmondson type II, caused by cirrhosis and schistosomiasis japonica. The patient's postoperative course was uneventful. Enhanced US with hepatic intraarterial injection of carbon dioxide gas was useful for the diagnosis and treatment of the microhepatoma associated with schistosomiasis japonica.

[DNA synthesis in the testes of infertile men with varicocele--image cytometeric analysis of proliferating cell nuclear antigen]

BACKGROUND

The analysis of cell kinetics of germ cells have been implicated as important clue to investigate the etiology of infertile patients. We examined the germ cell kinetics of varicocele testis using proliferating cell nuclear antigen (PCNA) immunostaing by image cytometry (CAS 2000), which is very accurate and useful method to evaluate the staining intensity.

PATIENTS AND METHODS

Testicular biopsy specimen obtained from 28 cases of male infertility with left varicocele and 5 normal controls were quantitatively examined concerning PCNA expression. Positive rate of PCNA (PR) was expressed as the percent of nuclear area positively stained with PCNA monoclonal antibody compared with total nuclear area analyzed in more than 20 seminiferous tubules. A hematoxylin and eosin-stained sections, which were fixed in Bouin's solution were used to examine Johnsen's mean score by photomicroscopy.

RESULTS

PR of right and left testes of varicocele patients were 11.3 +/- 4.8% and 11.3 +/- 4.1%, respectively. PR of normal testes was 21.7 +/- 3.1%. PR of each side were reduced similarly and the difference of PR between right and left testes of varicocele patients were not significant. Bilateral PR was 11.4 +/- 4.1%. Bilateral PR was significant lower than that of normal testes (p < 0.001). Concerning varicocele grade, sperm concentration of seminogram, Johnsen's mean score and the improvement of seminogram, no significant correlations between PR and those were observed.

CONCLUSION

PR evaluated by image cytometry is very useful biological parameter to assess the germ cell kinetics. In varicocele patients, not only left side but also right side of testes were deteriorated in the cell kinetics and the decrease in DNA synthesis is one of the causes that have deleterious effects on spermatogenesis.

Infection with GB virus C in leprous patients in Japan

The detection of hepatitis C virus (HCV) in blood donors and patients with acute and chronic hepatitis has brought to the fore another virus or viruses which can be transmitted parenterally and induce liver disease. The RNA of a candidate virus designated GB virus C (GBV-C) was determined by the polymerase chain reaction with primers deduced from a helicase-like region in 229 leprous patients in Japan. GBV-C RNA was detected in 12 (5.2%) patients, and HCV RNA in 41 (18%). Three patients were coinfected with GBV-C and HCV. The nine patients infected with GBV-C alone had aminotransferase levels lower than the three patients with the mixed infection or the 38 patients infected with HCV only (P < 0.001). Sequence comparison within 100 base pairs in the helicase-like region suggested that two, three and three patients, respectively, would have been infected with three distinct strains of GBV-C. These results indicate that patients with leprosy are at increased risk for infection not only with HCV, but also with GBV-C, and that the infection with GBV-C alone would not induce hepatic injuries as severe as HCV infection.

Introduction of basic fibroblast growth factor gene into mouse renal cell carcinoma cell line enhances its metastatic potential

To clarify the role of basic fibroblast growth factor (FGF-2) in the malignant progression of renal cell carcinoma, we transfected the FGF-2 gene, which lacks the typical signal sequence, into RenCa, a mouse renal cell carcinoma cell line that does not express FGF-2 mRNA. In an in vitro tumor cell invasion assay, the FGF-2-transfected cell lines (RenCa/F) exhibited 3- to 4-fold higher invasive potential than either the parental RenCa (RenCa/P) or the vector-only transfected cell line (RenCa/C). Zymography showed a marked increase in matrix metalloproteinase 2 (MMP-2) production in the culture supernatants of RenCa/F. Furthermore, when injected i.v. or into the renal subcapsule in syngeneic mice, RenCa/F formed more than 10 times as many metastatic nodules in the lung as did RenCa/P and RenCa/C. Metastases to the liver and mesenteric lymph nodes were observed only after the injection of RenCa/F into the renal subcapsule. In contrast, there was no significant difference in either cell proliferation in vitro or tumor growth in vivo among RenCa sublines. These results suggest that if it is overexpressed, endogenous native FGF-2 plays an important role in the invasion and metastasis of renal cell carcinoma, probably through the production of MMP-2.

Messenger ribonucleic acids for fibroblast growth factors and their receptor in bladder and renal cell carcinoma cell lines

FGF-like growth factors have been detected in the urine of patients with bladder or renal cell carcinoma. FGF-1-like and FGF-2-like proteins have been detected in the urine of patients with bladder carcinoma. However, the expression of FGFs and their receptor in bladder and renal cell carcinoma cells remains limited. We measured the mRNA levels of FGFs and their receptor in these carcinoma cell lines by means of RT-PCR. We detected FGF-8 mRNA expression in murine cell lines of bladder and renal cell carcinomas but not in those of the normal bladder and kidney. Furthermore, FGF-8 mRNA expression was detected in all human bladder and renal cell carcinoma cell lines tested. We also frequently detected FGF-1, FGF-2 and FGF-5 mRNA expression in human bladder and renal cell carcinoma cell lines. These results indicate that FGF-8 is also candidate for marker of these types of carcinoma as well as FGF-1 and FGF-2.

Expression and regulation of neuropeptide Y messenger ribonucleic acid in cultured immature rat Leydig and Sertoli cells

Neuropeptide Y (NPY) potentiates the release of gonadotropins from the pituitary in response to GnRH in the hypothalamus and modulates reproductive function. In the present study, we showed that 1) specific organs in the male rat reproductive tract express NPY messenger RNA (mRNA); 2) the multifactorial regulation of NPY mRNA in rat Leydig and Sertoli cells is temporally and hormonally regulated in vitro; 3) both Sertoli cell factor(s) and germ cell factor(s) potentiated to stimulate NPY gene levels in Leydig cells; and 4) intense NPY immunoreactivity was detected in cultured Leydig cells. Using the RT-PCR method, we found that Leydig cells, Sertoli cells, epididymis, and vas deferens expressed NPY mRNA, whereas germ cells, seminal vesicle, and prostate did not. Northern blot analyses showed that NPY mRNA was not expressed in freshly isolated immature Leydig cells, but that NPY mRNA levels were increased by the addition of LH, cytokines such as interleukin-1 alpha and -1 beta, forskolin, or phorbol 13-myristate 12-acetate. Npy mRNA levels in immature Sertoli cells were also increased by FSH. In addition, a germ cell factor(s) secreted from pachytene spermatocytes or round spermatids purified by centrifugal elutriation as well as a Sertoli cell factor(s) stimulated by FSH increased NPY gene levels in Leydig cells. Immunocytochemical analyses showed that the immunostaining was more marked in Leydig cells than in Sertoli cells in vitro. These findings indicate that testicular NPY gene expression is induced in Leydig cells or Sertoli cells by gonadotropins or cytokines within the testes, and that factors secreted from Sertoli cells or germ cells affect NPY gene expression in Leydig cells in vitro. Our findings suggest that NPY expressed in the reproductive system may modulate reproductive function as well as that in the nervous system.

The significance of E-cadherin in transitional-cell carcinoma of the human urinary bladder

E-cadherin is a Ca(2+)-dependent intracellular adhesion molecule in the epithelial tissue. The urothelium also expresses E-cadherin molecules. We determined E-cadherin expression in bladder carcinoma immunohistochemically and investigated its relationship with pathological and clinical data. The percentage of cases showing pattern B, less than 50% of which cancer cells expressed the same intensity of E-cadherin as did the normal epithelium, was higher in cases of high-grade or high-stage tumors as compared with those of low grade or low stage. Heterogeneous staining was observed in the same specimens, which suggested changes in the cell phenotype. Immunoblotting demonstrated no evidence of gross alteration of E-cadherin molecules. The decrease in E-cadherin expression was associated with the invasiveness of bladder carcinoma, as has been reported in other carcinomas.

Hepatitis C virus antibody, viral RNA and genotypes in leprous patients in Japan

BACKGROUND/METHODS

Markers of hepatitis C virus infection were tested for in 229 patients with leprosy (male 154, female 75) in Japan.

RESULTS

Antibody to hepatitis C virus by a second-generation enzyme immunoassay was detected in 68 patients (30%), and RNA of hepatitis C virus in 41 (18%), in prevalence rates much higher (p < 0.001) than those in matched controls (11/923 or 1.2% and 9/923 or 1.0%, respectively). Hepatitis C virus genotypes were II/1b in 37 (90%), III/2a in three (7%) and IV/2b in one (2%), in which II/1b was more frequently (p < 0.003) represented than in hepatitis C virus carriers without leprosy in Japan (520/767 or 68%). The 41 patients with hepatitis C virus viremia had serum transaminase levels significantly higher than those in the other 188 patients without viremia (p < 0.01).

CONCLUSIONS

These results indicate that leprous patients confined in institutions are at high risk of hepatitis C virus infection, and that patients infected with hepatitis C virus should be monitored for liver function and placed on interferon therapy whenever required.

GABAergic inhibitory response of locus coeruleus neurons to caloric vestibular stimulation in rats

We examined the effects of caloric vestibular stimulation on the neuronal activity of the locus coeruleus (LC) in urethane-anesthetized rats. The middle ear cavity was irrigated with hot (44 degrees C) or cold (30 degrees C) water through a polyethylene tube. Most neurons (hot water: 76%, 55/72; cold water: 90%, 19/21) exhibited suppression of neuronal discharge in response to caloric stimulation. The suppression of LC neuronal discharge following caloric stimulation occurred with a long latency (approximately 80 s), and lasted a long period of time (approximately 3 min). Neither caloric stimulation of the auricle, nor irrigation of the middle ear with water at 37 degrees C, nor caloric stimulation of the middle ear after labyrinthectomy inhibited LC neuronal discharge. The caloric stimulation-induced LC neuronal inhibition was significantly attenuated by the intravenous injection of picrotoxin and by the iontophoretic application of bicuculline methiodide. These findings indicate that the predominant effect of caloric vestibular stimulation on LC neuronal discharge is inhibitory, and that the caloric stimulation-induced LC neuronal inhibition is mediated by GABAA receptors located on the membrane of LC neurons. It is suggested that the suppressed activity of noradrenergic LC neurons is involved in the vestibulo-autonomic reflex.

Cervical cemental tears in older patients with adult periodontitis. Case reports

This communication reports 5 cases of cervical and 1 apical cemental tears. The diagnosis of the cervical tears was made by a characteristic feature which presented radiographically as a prickle-like body. The fragment of cementum could be detached by root planing or during periodontal surgery and uneventful healing was obtained following these procedures. The process of aging in addition to continuous occlusal strain may lead to this phenomenon. Cervical cemental tear may be one of the contributing factors in the progress of adult periodontitis.

Local expression of cytokine messenger RNA in rat model of Escherichia coli epididymitis

PURPOSE

In order to investigate whether cytokines play an important role in the regulation of host defense against bacterial epididymitis, we examined the local expression of cytokine mRNA in a rat model of Escherichia coli epididymitis.

MATERIALS AND METHODS

Escherichia coli was inoculated into the spermatic cord of the rats and provoked epididymitis. At 6, 12, 24, 48, and 72 hours postinfection (p.i.) epididymides were harvested. We examined interleukin-6 (IL-6) and other inflammatory cytokine mRNAs in epididymides by Northern blotting and reverse transcriptase polymerase chain reaction (RT-PCR). Histopathological findings and immunohistochemistry for IL-6 were also examined.

RESULTS

Infected epididymides expressed IL-6 mRNA maximally at 6 hours p.i. and then the signal decreased by Northern blotting. mRNA for IL-1 beta and TNF-alpha also increased within 6 hours by RT-PCR. Histopathological examination showed that no inflammatory cells were observed at 6 hours p.i. and that inflammatory changes were most prominent at 72 hours p.i. Epididymal epithelium expressed IL-6 locally in response to local bacterial infection by immunohistochemistry.

CONCLUSIONS

mRNA for IL-1 beta, IL-6, and TNF-alpha is expressed locally in response to bacterial infection before inflammatory cell infiltration. This rapid expression in the epithelial cells may be important in host defense to local genital infection.

[Postoperative care of neobladder using a detubularized intestinal segment]

Neobladder using a detubularized intestinal segment was constructed in 74 cystectomized patients between October 1986 and July 1994. There were 65 males (87.8%) and 9 females (12.2%) with an average age of 63 years (range 36 to 77 years). The mean follow-up period was 35 months (range 7 to 85). Problems of postoperative care assessed were continence, renal function, metabolic consequences, neoplasms and other complications. Moreover, the impact of these problems on the quality of life was evaluated by a self-administered questionnaire. Continence in the daytime was achieved in 70/74 (94.6%) patients. Nocturnal incontinence was noted in 15/74 (20.3%) patients. Serum BUN and creatinine levels were maintained within normal limits. Metabolic acidosis (base excess < -5.0 occurred in 7/74 (9.5%) patients, 4 patients of whom needed alkalizing agents. Colon adenomas in neobladder were found and resected in 3 patients. The other postoperative complications were stone formation in neobladder in 4 (5.4%), urethral stricture in 7 (9.5%) and ureteral stenosis in 3 (4.1%) patients respectively, which were satisfactorily corrected by endourological procedures. As to quality of life assessment, the majority was satisfied, whereas 11% of the patients reported emotional distress and limitations in the usual physical activities by nocturnal incontinence. Our finding suggest that nocturnal incontinence is the most important problem and we need longer follow-up to evaluate the problems of metabolic consequences and neoplasms of the urinary tract.