Treatment of patients with retrograde ejaculation in the era of modern assisted reproduction technology

PURPOSE

We determined a rational strategy for treatment of patients with retrograde ejaculation in the era of modern assisted reproduction technology.

MATERIALS AND METHODS

In 7 consecutive patients medical treatment or retrieval of spermatozoa from the bladder was performed at a male infertility clinic.

RESULTS

Antegrade ejaculation was restored in 3 patients, and spermatozoa were retrieved from the bladder and used for assisted reproduction in 3. Spermatozoa with good oolemma penetrating ability were collected by seminal vesicle massage.

CONCLUSIONS

Modern assisted reproduction technology is a powerful treatment option for retrograde ejaculation when combined with a technique to retrieve spermatozoa of good quality from the bladder.

[Estimation of integral value of input function for the quantification of cerebral blood flow with 123I-IMP using one-point arterial blood sampling]

Cerebral blood flow (CBF) has been measured using a microsphere model with octanol-extracted radioactivity counts (integral value of input function). We developed a new method estimating the integral value of input function. First, we fitted the whole brain time-activity curves early after intravenous injection of N-isopropyl-p-[123I]iodoamphetamine (123I-IMP) by the least-squares method. Second, we differentiated this equation. Third, we calibrated it using octanol-extracted radioactivity counts of the arterial blood sampled at 5 min. Finally, we integrated it. A significant correlation was found between the integral values obtained using a new method and those obtained using the continuous arterial blood sampling data (y = 1.048x-1206, r = 0.984). The errors between the CBF values obtained using a new method and those obtained using the 5-min continuous arterial blood sampling was 6.88 +/- 4.78%. Measurement of integral values of the input function using a new method with one-point arterial blood sampling is less invasive and convenient, and is not influenced by cardiopulmonary disease or smoking. Therefore, it would be useful for the routine measurement of CBF.

[Clinical evaluation of benign asbestos pleurisy]

Seventeen cases of benign asbestos pleurisy were evaluated clinically. All cases were male and almost all cases were more than 60 years-old. Most cases presented with chief complaints of chest pain and dyspnea, but 2 cases had no complaints. Pleural effusion appeared predominantly in the right side. Six cases had 2 or 3 episodes of pleural effusion, and 1 case had 5. Ten cases had an occupational history of asbestos exposure in shipyards and 5 other cases had a history in building construction. Almost all cases had more than 30 years of exposure to asbestos and benign asbestos pleurisy appeared after more than 30 years from the first exposure to asbestos. Among the patients, 6 cases had diffuse pleural thickening and 2 cases had malignancies. Pleural fluid was bloody in 14 of 17 cases (82%) and all pleural fluid showed an exudate. Lymphocytes represented 70% and eosinophils 15% of the cellular population of the pleural fluid. Hyaluronic acid in pleural fluid in cases of benign asbestos pleurisy averaged 29.5 micrograms/ml, which was significantly (p < 0.05) lower than in malignant pleural mesothelioma. Leukocytosis in peripheral blood and a high CRP value were uncommon in benign asbestos pleurisy.

[Simplified method to quantitate regional cerebral blood flow by 123I-IMP microsphere model: validity of input counts by using the whole brain time-activity curve and one point arterial blood sampling]

We developed a new microsphere method using 123I-IMP in which arterial blood is collected at one time point early after 123I-IMP injection instead of conventional continuous arterial blood sampling, and the input count is estimated using a whole brain time-activity curve until that time point. The differential curve dCb(t)/dt of the brain time-activity curve Cb(t) early after 123I-IMP injection (when the microsphere model is established) approximates the arterial time-activity curve Ca(t) as an input function. The input count as the integral value of Ca(t) at 0-5 min was estimated using the 50 min whole brain activity Cb(5 min) and the differential value dCb(5 min/dt and the 5-min octanol-extracted count of arterial samples obtained at one time point Ca(5 min). The input counts calculated by this method were very closely correlated with measurement values obtained by continuous arterial sampling. This method is more convenient and less invasive than the continuous arterial sampling method.

[A randomized study on intravesical pirarubicin (THP) chemoprophylaxis of recurrence after transurethral resection of superficial bladder cancer]

A prospective randomized study was conducted to evaluate the efficacy of prophylactic intravesical instillation of tetrahydropyranyladriamycin (THP) following complete transurethral resection (TUR) of superficial bladder cancer. A total of 80 patients were randomized into "THP" or "control" group. In the THP group, 20 mg of THP dissolved in 40 ml saline (or 5% dextrose) was administered intravesically once a week for 10 weeks, starting from about 7 days after TUR. In the control group, 40 ml saline was given with the same schedule. The patients were followed up by cystoscopy and urinary cytology every 3 months. The number of evaluable patients was 36 for the THP group and 37 for the control group. The non-recurrence rates in the THP group and control group were 79.4% versus 63.2% at 1 year and 69.8% versus 47.4% at 3 to 5 years, respectively. These figures were not statistically significant. However, THP instillation significantly reduced tumor recurrence rates for multiple tumors, and also tended to decrease recurrence rates for primary and pT1 tumors. Adverse effects were observed in 53.6% of the patients in the THP group, but they were tolerable. Our results suggest that intravesical THP instillation would not be effective for all patients with superficial bladder cancer. Further study is warranted in a selected group of patients.

Preventive effects of superoxide dismutase derivatives modified with monosaccharides on reperfusion injury in rat liver transplantation

BACKGROUND

Superoxide dismutase (SOD) derivatives modified with monosaccharides such as mannosylated SOD (Man-SOD) and galactosylated SOD (Gal-SOD) are taken up by parenchymal and nonparenchymal cells of the liver, respectively, via receptor-mediated endocytosis. We examined the preventive effects of Man- or Gal-SOD on cold ischemia-reperfusion injury in orthotopic liver transplantation (OLT) in rats.

METHODS

Male Lewis rats underwent OLT. Native SOD and modified SOD with mannose (Man-SOD) or galactose (Gal-SOD) were intravenously given just prior to reperfusion of the grafted liver.

RESULTS

After OLT, no significant changes in serum levels of aspartate aminotransferase or lactate dehydrogenase were evident among rats, with or without various types of SOD. However, tissue levels of Na+,K+-ATPase, an indicator of tissue viability, were significantly higher in rats treated with Man- and Gal-SODs compared with that in untreated OLT rats. When comparisons were made between Gal-SOD and Man-SOD, higher levels of Na+,K+-ATPase were evident in rats treated with Gal-SOD. Elevations of tissue levels of lipid peroxides were significantly inhibited by modified SODs. The survival rates of rats following OLT after prolonged cold preservation correlated with results of graft viability.

CONCLUSIONS

SOD derivatives, particularly Gal-SOD, have protective effects on cold ischemia-reperfusion injury during OLT in rats.

Complex polymorphisms in an approximately 330 kDa protein are linked to chloroquine-resistant P. falciparum in Southeast Asia and Africa

Chloroquine resistance in a P. falciparum cross maps as a Mendelian trait to a 36 kb segment of chromosome 7. This segment harbors cg2, a gene encoding a unique approximately 330 kDa protein with complex polymorphisms. A specific set of polymorphisms in 20 chloroquine-resistant parasites from Asia and Africa, in contrast with numerous differences in 21 sensitive parasites, suggests selection of a cg2 allele originating in Indochina over 40 years ago. One chloroquine-sensitive clone exhibited this allele, suggesting another resistance component. South American parasites have cg2 polymorphisms consistent with a separate origin of resistance. CG2 protein is found at the parasite periphery, a site of chloroquine transport, and in association with hemozoin of the digestive vacuole, where chloroquine inhibits heme polymerization.

Prion protein aggregation reverted by low temperature in transfected cells carrying a prion protein gene mutation

Prion diseases are characterized by the conversion of the normal cellular prion protein (PrPC), a glycoprotein that is anchored to the cell membrane by a glycosylphosphatidylinositol moiety, into an isoform that is protease-resistant (PrPres) and pathogenic. In inherited prion diseases, mutations in the prion protein (PrPM) engender the conversion of PrPM into PrPres. We developed a cell model of Gerstmann-Sträussler-Scheinker disease, a neurodegenerative condition characterized by PrPM-containing amyloid deposits and neuronal loss, by expressing the Gerstmann-Sträussler-Scheinker haplotype Q217R-129V in human neuroblastoma cells. By comparison to PrPC, this genotype results in the following alterations of PrPM: 1) expression of an aberrant form lacking the glycosylphosphatidylinositol anchor, 2) increased aggregation and protease resistance, and 3) impaired transport to the cell surface. Most of these alterations are temperature-sensitive, indicating that they are due to misfolding of PrPM.

Soluble haemoglobin is a marker of recent Plasmodium falciparum infections

Monoclonal antibodies (Mab) were raised against haemoglobin (Hb) associated with Plasmodium falciparum protein and used to develop an ELISA, measuring circulating levels of released Hb. This assay was evaluated in different malaria patients in parallel with ELISA assays for C-reactive protein (CRP) and haptoglobin. Levels of Hb were negatively associated with levels of haptoglobin. Increased levels of serum Hb and CRP and decreased levels of haptoglobin were seen in Danish malaria patients. Consecutive studies showed that increased Hb levels were detectable 3-7 days after initiation of treatment probably because of drug induced destruction of infected erythrocytes. Increased levels of CRP were measured 0-3 days after initiation of treatment. The Hb assay was used in an epidemiological study of malaria in an area of Sudan with unstable malaria transmission. The proportion of Sudanese adults with detectable soluble Hb was higher in the rainy season with malaria transmission compared to the dry season. Hb levels in the rainy season were negatively associated with levels of haptoglobin. Most adults had increased levels of soluble Hb and decreased levels of haptoglobin 7 and 30 days after their treatment of P. falciparum malaria compared to the levels during acute disease. Thus, both soluble Hb and haptoglobin appear to be markers of recent P. falciparum infections. Very high levels of CRP protein were measured in some of the malaria patients at the day of treatment while lower levels were recorded 7 and 30 days after treatment. Soluble Hb levels were associated with malariometric parameters in a similar fashion to haptoglobin. The new Mab-based assay for measuring soluble Hb in the peripheral blood of malaria patients may be useful for future epidemiological studies of malaria.

[A case of locally advanced squamous cell carcinoma in bladder diverticulum successfully treated by bladder-preserving therapy]

A 62-year-old man visited our hospital with asymptomatic gross hematuria. On cystoscopy, two diverticula were identified at the dome of the urinary bladder and one of them was packed with a tumor. Biopsy showed squamous cell carcinoma (SCC), G1, but malignancy was not detected in the rest of the vesical mucosa. We selected bladder-preserving therapy. Pathological diagnosis after partial cystectomy was SCC, G1 > G2, pT3b. Postoperatively, 3 courses of adjuvant chemotherapy with methotrexate, bleomycin and cisplatin were performed. The patient has remained free of recurrence for 4.5 years.

[Mechanism mediating hypertension induced by chronic inhibition of nitric oxide synthesis]

Although the inhibition of nitric oxide (NO) synthesis is known to induce systemic hypertension, the underlying mechanisms mediating this type of hypertension are incompletely understood. In the present study we investigated the influence of sodium intake on the pressor effect of long-term administration of the NO synthesis inhibitor, NG-nitro-L-arginine methyl ester (L-NAME, 16 mg/dl in drinking fluid for 8 weeks), in conscious Sprague-Dawley rats. Urinary excretion rates of catecholamine during NO synthesis inhibition were also examined. Long-term administration of L-NAME produced a sustained elevation in tail-cuff pressure without altering urine flow, or sodium excretion rate. L-NAME-induced hypertension was accompanied by a decreased urinary excretion of the stable NO metabolites, NO2- and NO3-, and was aggravated when rats drank 0.9% saline in place of tap water. Thus, inhibition of NO synthesis resulted in a rightward shift of the pressure natriuresis relationship and a significant decrease in the slope of this relationship. Urinary excretion of epinephrine and norepinephrine, but not that of dopamine, in L-NAME-treated rats significantly increased within the first week of the study when compared with those observed in control rats. A natriuretic index of the sympathetic nervous system, the ratio of dopamine to norepinephrine excretion, was significantly less in L-NAME-treated rats than in control rats. After 8-week treatment with L-NAME, renal morphologic evaluation revealed significant narrowing and obliteration of the arterioles. L-arginine (2 g/dl in drinking fluid) completely reversed the elevation of blood pressure as well as the decrease in urinary NO2- and NO3- excretion and the increased urinary excretion of catecholamines associated with L-NAME treatment after 3 weeks of concomitant administration. These results suggest that the inhibition of chronic NO synthesis produces sodium-sensitive hypertension and that changes in sympathetic nerve activity may, at least in part, contribute to the sodium sensitivity in this type of hypertension.

Molecular characterization and ultrastructural localization of Plasmodium falciparum Hsp 60

Heat shock proteins (Hsp) are a group of highly conserved proteins which are widely represented phylogenetically. Genes for members of the Hsp 70, 90 and 60 families have been cloned from the human malaria parasite Plasmodium falciparum. In this study, we have cloned and expressed the P. falciparum Hsp 60 (PfHsp60) in E. coli. The sequence analysis identified a previously unknown intron of 257 bp beginning after the nucleotide 142 in the coding sequence. Antisera raised against the recombinant PfHsp60 was employed in immunoprecipitation studies with biosynthetically labeled parasite extracts to investigate regulation of expression of PfHsp60 at various temperatures. In contrast to the three to four fold accumulation of PfHsp60 transcripts in heat shocked parasites (37-40 degrees C), the expression of PfHsp60 was not induced in the blood stages of P. falciparum. On the other hand, the effect of heat induction on PfHsp70 was seen both at the level of specific mRNA and protein. In these studies we also observed co-immunoprecipitation of a number of other cellular proteins suggesting possible interaction with PfHsp60. Immunofluorescence analysis indicated the presence of PfHsp60 in the cytoplasm of all the various stages of the parasite. In addition, immunoelectron microscopic analysis distinctly localized PfHsp60 in the mitochondrion of P. falciparum. This study suggests that different mechanisms are involved in the regulation of expression of various members of the heat shock proteins in the parasite.

Changes in the expression of type-X collagen in the fibrocartilage of rat Achilles tendon attachment during development

This study histologically and immunohistochemically demonstrated developmental changes in cell morphology and expression of type-X collagen in the attachment of the Achilles tendon to the calcaneus in the rat. Although the site of attachment in the mature rat showed a well organized, direct insertion that was composed of tendon, fibrocartilage, calcified fibrocartilage, and bone, this four-zone structure was not observed in the immature 1-week-old rat. Formation of fibrocartilage was observed at 2 weeks, together with the hypertrophy of chondrocytes and the appearance of the secondary center of ossification. Type-X collagen was not detected either in chondrocytes in the attachment area at 1 week or in hypertrophic chondrocytes at the attachment at 2 weeks. In the 3-week-old rat, the secondary center of ossification extended to the area of attachment and type-X collagen was detected both in cartilage spicules within the secondary center of ossification and in cells found at the attachment adjacent to the secondary center of ossification. A four-zone structure had been established by 6 weeks and remained through 20 weeks. After 6 weeks, type-X collagen was identified both in the attachment of the tendon and beneath the calcaneal fibrocartilage. Type-X collagen is produced by cells in transitional zones between calcified and noncalcified tissue, such as the interface between articular cartilage and subchondral bone. In these areas, the expression of this protein persists through maturity and is not transient.

Effects of YM-14673, a thyrotropin-releasing hormone analogue, injected into the shell and the core of the nucleus accumbens on production of repetitive jaw movements in rats: comparison with the effects of a dopamine D1 and D2 receptor agonist combination

The present study examined whether the shell and the core of the nucleus accumbens play a differential role in the display of YM-14673-induced jaw movements in rats. For that purpose the effects of YM-14673 were compared to those of a SKF 82958 and quinpirole combination, a dopamine D1 and a D2 receptor agonist respectively, that is known to functionally differentiate these two subregions of the nucleus. Consistent with the previous report, bilateral injections of a mixture of SKF 82958 (5 micrograms) and quinpirole (10 micrograms) into the shell of the nucleus accumbens produced repetitive jaw movements, whereas similar injections of the mixture into the core did not induce such an effect. In contrast, there was no regional difference in the effects of YM-14673 on the production of repetitive jaw movements. Thus, both bilateral injections of YM-14673 (0.1 or 1.0 microgram) into the shell or the core produced similar repetitive jaw movements in a dose-related manner. Moreover, the pattern of oral movements induced by YM-14673 differed from that induced by the mixture of SKF 82958 and quinpirole; frequent tongue protrusions were evident in rats treated with the mixture but were not seen in YM-14673-treated rats. It therefore appears that, unlike the effects of the mixture of dopamine D1 and D2 receptor agonists, the effects of YM-14673 in the shell on the production of rat jaw movements do not differ from the effects of the compound in the core.

Primary lymphoma of the heart, diagnosed antemortem

Primary cardiac lymphomas diagnosed antemortem are extremely rare. We present a case of primary cardiac lymphoma initially diagnosed antemortem by cytologic examination of pericardial effusion fluid. Echocardiography suggested the presence of a tumor localized at the right ventricular free wall. The cytologic examination of pericardial effusion was effective in establishing the correct antemortem diagnosis.

[Renal cell carcinoma associated with renal artery aneurysm]

We report the 5th case of renal cell carcinoma associated with renal artery aneurysm in the Japanese literature. A 57-year-old woman was admitted to our hospital for further examination of a right renal mass. Computerized tomography and magnetic resonance imaging revealed a 6 x 5 cm tumor at the upper pole of the right kidney and an aneurysm of the right renal artery. An angiography showed duplicated renal arteries and a saccular aneurysm 2.1 x 2.5 cm occurring at the first bifurcation of one renal artery. A transperitoneal radical nephrectomy was performed.

[Renal cell carcinoma in a horseshoe kidney: a case report]

A 69-year-old man presented for further examination for left renal mass. Computed tomography and magnetic resonance imaging revealed a heterogenous mass on the left side of a horseshoe kidney accompanied with renal vein thrombus. Aortography showed a hypervascular mass in the left kidney and aberrant arteries to the isthmus originating from the aorta. A left nephrectomy with the division of the isthmus was performed through an abdominal transperitoneal approach. Histological evaluation revealed grade 2, stage T3b, renal cell carcinoma. The patient was free of tumor, but died of intracerebral hemorrhage 5 months after the operation.

[Compton-scatter correction using the triple energy window (TEW) method in conventional single photon emission computed tomography without TEW acquisition hardware]

We devised a method which allowed the triple energy window (TEW) method to be applied for Compton-scatter correction in conventional single photon emission computed tomography (SPECT) systems without any hardware for TEW acquisition. In this method, the data within two subwindows located at both sides of the main window were acquired together. The effectiveness of this method was investigated by phantom experiments. The integral and differential uniformities measured using a flood phantom filled with 123I were minimized when the energy width of subwindows was 5 keV (5.8% and 4.2%, respectively). When this method was applied to a brain phantom filled with 123I in which the relative activities in white and gray matter were assigned as 1: 4.3, the ratio of SPECT values between them was more accurate (1:4.26) than that obtained without this method (1:208). This method appears to be useful for Compton-scatter correction in SPECT, because it can be applied to conventional SPECT systems without any hardware for TEW acquisition and is available for routine clinical use for its simplicity.

[Long-term follow-up study of bone mineral density in a patient with adult idiopathic Fanconi syndrome]

A 64-year-old woman complaining of severe lumbar pain was admitted to our hospital because of the finding of pre-existing mitral valve regurgitation on examination. Laboratory data revealed the proximal type of renal tubular acidosis, renal glucosuria, phosphaturia, generalized aminoaciduria and low-molecular-weight proteinuria. She did not have any cause of these tubular dysfunctions, and was diagnosed as adult idiopathic Fanconi syndrome. Dual energy X-ray absorptiometry (DEXA) revealed a reduction of bone mineral density in the lumbar spine to about 65% of the age-and gender-matched control value. Alkali agents (sodium citrate and potassium citrate), calcium lactate and 1 alpha-hydroxyvitamin D3 were administered. Bone mineral density estimated with DEXA improved with a reduction of serum alkali phosphate and disappearance of lumbar pain, and was restored to 82% of the age-and gender-matched control value after about 30 months of treatment. DEXA is useful for the long-term follow-up study of bone mineral density in a patient with Fanconi syndrome.