Analysis of urinary calculi by infrared spectroscopy

In the past 4 years, we used infrared spectroscopy to analyze 728 urinary calculi. The most common component of pure urinary calculi was calcium oxalate (whewellite and weddellite) 8.65%, followed by calcium phosphate (carbonate apatite, brushite and amorphous calcium phosphate) 6.87%, uric acid 5.91% and struvite 2.75%. The majority of urinary calculi had mixed components: whewellite/apatite 28.98%, weddellite/apatite 24.31% and whewellite/weddellite/apatite 14.42%. Only 3 cystine stones were found (0.41%). Good correspondence (82.7%) was noted when the results of 110 urinary calculi analyzed by infrared spectroscopy were compared with the results of polarization microscopy. The advantages and disadvantages of infrared spectroscopy are also discussed.

Molecular cloning of human protein 4.2: a major component of the erythrocyte membrane

Protein 4.2 (P4.2) comprises approximately 5% of the protein mass of human erythrocyte (RBC) membranes. Anemia occurs in patients with RBCs deficient in P4.2, suggesting a role for this protein in maintaining RBC stability and integrity. We now report the molecular cloning and characterization of human RBC P4.2 cDNAs. By immunoscreening a human reticulocyte cDNA library and by using the polymerase chain reaction, two cDNA sequences of 2.4 and 2.5 kilobases (kb) were obtained. These cDNAs differ only by a 90-base-pair insert in the longer isoform located three codons downstream from the putative initiation site. The 2.4- and 2.5-kb cDNAs predict proteins of approximately 77 and approximately 80 kDa, respectively, and the authenticity was confirmed by sequence identity with 46 amino acids of three cyanogen bromide-cleaved peptides of P4.2. Northern blot analysis detected a major 2.4-kb RNA species in reticulocytes. Isolation of two P4.2 cDNAs implies existence of specific regulation of P4.2 expression in human RBCs. Human RBC P4.2 has significant homology with human factor XIII subunit a and guinea pig liver transglutaminase. Sequence alignment of P4.2 with these two transglutaminases, however, revealed that P4.2 lacks the critical cysteine residue required for the enzymatic crosslinking of substrates.

Ofloxacin treatment of nongonococcal urethritis. A multi-center study in Asia

Ofloxacin, a new quinolone antibacterial agent, is active in vitro against gonococcal and nongonococcal urogenital pathogens. Chlamydia trachomatis infection is the most common cause of nongonococcal urethritis. In a multicenter study in seven Asian countries, 105 mal patients with chlamydial urethritis and 46 male patients with nongonococcal and nonchlamydial urethritis were treated with oral ofloxacin at a dosage of 200 mg twice daily for 5 to 10 days. The evaluation performed at day 5 and/or day 10 after treatment revealed good results in 58.2% and 96.8% of the chlamydial urethritis group, and 73.1% and 79.4% of the nongonococcal, nonchlamydial urethritis group, respectively. No severe side effects were observed. Ten-day treatment with ofloxacin showed good clinical efficacy on nongonococcal urethritis.

Castration may not affect the penile erection ability in terms of peripheral neurocavernous mechanism in dogs

The penile erection ability (PEA) was assessed in 27 dogs with intact orchids (Group I), seven dogs with bilateral orchidectomy for one month (Group II) and four dogs with bilateral orchidectomy for three months (Group III). PEA was indicated by the increase of the intracorporeal pressure (ICP) upon electrical stimulation of the cavernous nerves. PEA was significantly decreased in both orchidectomized groups. However, when reduction in the blood pressure was considered, the difference in PEA between Group I and the orchidectomized group was no longer significant. Before the orchidectomy, plasma testosterone level of 22 adult male dogs varied widely from 105 to 6302 pg./ml. At one or three months after the orchidectomy in 11 dogs, it decreased to a level below 100 pg./ml. There was no significant change in the body weight in the post orchidectomy period. These findings indicate that the castration and/or the resulting low plasma testosterone level does not directly affect PEA through the peripheral neural and cavernosal mechanism.

Prophylactic bladder neck incision in the treatment of small benign prostatic hyperplasia

From May 1986 to January 1989, a total of 178 patients with small prostate (less than 20 grams) received transurethral resection for benign prostatic hyperplasia. Twenty-two patients (12.4%) developed bladder neck contracture with an average interval of 247 days. The prophylactic bladder neck incision was performed concomitantly with transurethral resection of the prostate on 72 patients. Although smaller adenoma (average weight: 11.4 grams) was resected in this group, the bladder neck contracture occurred in 4 patients (5.6%), compared to 18 contractures in 106 patients (16.9%) who underwent transurethral resection of the prostate alone for larger adenoma (14 grams), P value less than 0.05. The operation time, peri-operative morbidity and hospital stay were similar in these two groups. It appeared that prophylactic bladder neck incision could protect against the formation of bladder neck contracture in patients with small obstructing prostatic adenoma.

Management of painful caliceal stones by extracorporeal shock wave lithotripsy

One hundred and seven patients with caliceal stones causing flank pain were treated by extracorporeal shock wave lithotripsy (ESWL), followed up and reviewed. The total stone-free rate 3 months after ESWL was 38.8%. The total pain-free rate was 50.5%. The pain-free rate was 85% in the stone-free group and 29% in the group with residual stones. No significant differences between the stone-free rate and the duration of pain or age was noted. Patients with abnormal intravenous pyelography (IVP) had a lower stone-free rate than patients with normal IVP (16 vs. 45%, p less than 0.05). The complications included: 6 cases of stone street formation with spontaneous passage; 1 case of stone street formation needing percutaneous nephrolithotomy for drainage; 1 perirenal hematoma; 9 cases of severe colic pain following ESWL; 3 cases of fever following ESWL, and 4 cases of hydronephrosis due to a stone in the ureterovesicle junction. These results show that ESWL is an effective, noninvasive treatment for painful caliceal stones.

[Experience in using modified HM-3 Dornier lithotripter to treat urinary tract stones]

Low pressure generator has been developed mainly to reduce pain and kidney injury while at the same time maintain an equally effective stone-free rate. Our experience in using Modified HM-3 Dornier lithotripter to treat urinary tract stones has given an average of stone-free rate (58.88%) quite similar to what the conventional one can give. Compared with the conventional intervention, the modified one might increase by 52.07% (2281 vs 1500 pulses) in the average frequency of shock wave and by 26.52% (38.40 vs 30.35 minutes) in average operation time. However, low pressure may contribute to less complications and overall smoother procedure under oral analgesic use.

Studies on the status of lysine residues in phospholipase A2 from Naja naja atra (Taiwan cobra) snake venom

Phospholipase A2 (PLA2) from Naja naja atra (Taiwan cobra) snake venom was subjected to lysine modification with trinitrobenzene sulphonic acid (TNBS), and two major trinitrophenylated (TNP) derivatives, TNP-1 and TNP-2, were separated by h.p.l.c. TNP-1 contained only one TNP group on Lys-6 and showed a marked decrease in enzymic activity, but still retained 45% of the lethal toxicity. Both Lys-6 and Lys-65 were modified in TNP-2, and modification of Lys-65 caused a further reduction of the lethal toxicity to 12.6%. However, the antigenicity of both TNP-1 and TNP-2 remained unchanged. The reactivity of Lys-6 and Lys-65 toward TNBS was greatly enhanced by Ca2+ and dihexanoyl-lecithin, suggesting that the two Lys residues are not directly involved in the binding of Ca2+ and substrate. The modified derivatives retained their affinity for Ca2+, indicating that Lys-6 and Lys-65 did not participate in the Ca2+ binding. The TNP derivatives could be regenerated with hydrazine hydrochloride. The biological activities of the regenerated PLA2 are almost the same as those of native PLA2. These results indicate that Lys-6 and Lys-65 are important for the biological activities of PLA2, and incorporation of a bulky TNP group on Lys-6 and Lys-65 might give rise to a distortion of the active conformation of PLA2.

Helper-free stocks of recombinant adeno-associated viruses: normal integration does not require viral gene expression

A method is described for the production of recombinant adeno-associated virus (AAV) stocks that contain no detectable wild-type helper AAV. The recombinant viruses contained only the terminal 191 nucleotides of the AAV chromosome bracketing a nonviral marker gene. trans-Acting AAV functions were provided by a helper DNA in which the terminal 191 nucleotides of the AAV chromosome were substituted with adenovirus terminal sequences. Although the helper DNA did not appear to replicate, it expressed AAV functions at a substantially higher level than did DNA molecules that contained neither AAV nor adenovirus termini. Since the recombinant viruses with AAV termini contained no sequence homology to the helper DNA, no wild-type AAV was generated by homologous recombination within infected cells. Since the terminal region of the AAV chromosome is required for replication and encapsidation, only recombinant DNAs were amplified and packaged into AAV virions. When human cells were infected at a high multiplicity with a recombinant virus carrying a drug resistance marker gene, approximately 70% of the infected cells gave rise to colonies stably expressing the marker. The recombinant virus gene was then used to generate drug-resistant human cell lines subsequent to infection. These cells contained stably integrated copies of the recombinant viral DNA which could be excised, replicated, and encapsidated by infection with wild-type AAV plus adenovirus. Thus, AAV gene expression is not required for normal integration of an infecting DNA containing AAV termini.

Adeno-associated virus P5 promoter contains an adenovirus E1A-inducible element and a binding site for the major late transcription factor

Activity of the adeno-associated virus P5 transcriptional control region was found to be induced by adenovirus E1A gene products. A pair of adjacent sequence elements was found to mediate both basal and E1A-induced P5 activity. The first element is a binding site for the major late transcription factor (MLTF), a factor first identified on the basis of its binding to a specific sequence within the adenovirus major late promoter. The second element is a tandemly repeated 10-base-pair sequence whose relationship to previously described binding sites is unclear. Each element individually conferred E1A responsiveness on a heterologous promoter, and deletion analysis demonstrated that each contributed to the level of P5 activity in the presence of E1A products both in transfection- and infection-based assays. Although deletion of the MLTF binding site led to reduced P5 transcriptional activity in the presence of E1A proteins, the deletion generated enhanced P5 basal activity in the absence of the transcriptional activator. The negative effect of the MLTF binding site in the absence of activator and its positive effect in the presence of activator combine to enhance the magnitude of the response by the P5 control region to E1A gene products.

Diagnosis of vasculogenic impotence: combination of penile xenon-133 washout and papaverine tests

The present study evaluates both penile xenon-133 washout (XWT) and papaverine tests (PT) in the diagnosis of vasculogenic impotence. XWT was accomplished by subcutaneous injection of xenon-133 (1-2 mCi in 0.1 mL saline solution) into the dorsal coronal prepuce. Abnormal XWT was suggested in patients whose clearance time (T1/2) was longer than 7.5 minutes and whose penile blood flow rate (Q) was less than 6 mL/100 g tissue/min. PT was done by intracavernous injection of papaverine (60 mg in 20 mL normal saline). Abnormal PT was indicated in patients whose onset of full erection was more than ten minutes after papaverine injection and whose duration of erection was less than one hour. Ten young and 11 older normal volunteers were examined with XWT only; all showed normal results. A total of 60 impotent patients were examined with both XWT and PT and were classified into four groups: in 2 patients (3.3%) both XWT and PT were normal (group I); in 8 (13.3%) XWT was abnormal and PT normal (group II); in 14 (23.3%) XWT was normal and PT abnormal (group III); and in 36 (60%) both XWT and PT were abnormal (group IV). On further examination with bilateral hypogastric arteriography in 10 XWT-abnormal patients and on surgical correction of abnormal curvature in 5 XWT-abnormal patients, all (100%) were proved to have penile arterial insufficiency. Erection cavernosography performed in 15 PT-abnormal patients confirmed penile venous insufficiency in 80 percent. We conclude both XWT and PT are simple and effective for evaluation of the penile arterial blood flow and venous competence, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Specific frequency properties of renal and superior mesenteric arterial beds in rats

In order to investigate the effects of arterial beds on pressure waveforms in arteries, the pressure waves observed in the rat tail artery were resolved into their Fourier moduli before and during ligation of the left renal artery and the superior mesenteric artery. Consistently different patterns of waveform changes in the tail artery were seen on occlusion of these vessels. Ligation of the renal artery reduced, and of the superior mesenteric artery increased, the pressure harmonics over most of the spectra. These results imply that to study the changes in the pressure contours as the observation point is moved downstream, one may have to account separately for the contributions of individual arterial beds. This is relevant in considering the degree to which it is appropriate for data to be amalgamated in models of the systemic arterial bed.

The effect of sexual activity on androgen metabolism, androgen-receptor translocation, and glandular weight of ventral prostates of rats

The present study was conducted to determine whether sexual activity exerts an effect on the action of androgen in the rat prostate. Eight-week-old Sprague-Dawley male rats were divided into two groups. Rats were grouped with female rats (sexualactive), or male (sexual-inactive) rats, and sacrificed 6 months later, The ventral prostates were dissected, homogenized and processed into cytosol and nuclei fractions. Testosterone and dihydrotestosterone were quantified by radioimmunoassay, and androgen receptor was determined by 'exchange assay' with radioactive methyltrienolone incubated for 18 h at 15 degrees C. The main result were: 1) The steroid levels of testosterone and dihydrotestosterone in plasma and in the cytosolic fraction of prostate showed no significant difference between the two group of rats. 2) The prostatic nuclear dihydrotestosterone concentration of the sexual-active group (4.3 +/- 0.83 pmol/mg DNA, N = 6) was significantly higher (P less than 0.01) than that of the sexual-inactive group (1.68 +/- 0.43, N = 6). 3) The androgen receptor was significantly higher (P less than 0.05) in nuclear extract (0.64 +/- 0.11 pmol/mg DNA, N = 6) and significantly lower (P less than 0.01) in cytosol (53.4 +/- 5.7 fmol/mg protein, N = 6) of the sexual-active group than those of the sexual inactive group (0.42 +/- 0.13, N = 6 and 74.6 +/- 11.8, N = 6, respectively).(ABSTRACT TRUNCATED AT 250 WORDS)

Extracorporeal shock wave lithotripsy in the management of upper third ureteral stones

From January 1986 to March 1988, 177 patients with 180 upper third ureteral stones (located at L3, L4, or L5 level) received extracorporeal shock wave lithotripsy (ESWL) in Veterans General Hospital-Taipei. The average size of stones was 10.4 mm. Seventy-seven percent of patients received one session of ESWL, twenty percent two sessions and three percent three sessions. One hundred and thirty-four cases (74.4%) had preoperative reposition of stones. The over-all success rate, being 78.3%, was significantly related to the size of stones, result of reposition, and severity of hydronephrosis and renal function impairement (Pearson's coefficient less than 0.05). For more rational use of ESWL, we suggest that if the failure in the reposition of the ureteral stone happens in company with other poor prognostic factors such as the stone size larger than 15 mm, severe hydronephrosis or renal function impairement other regimens should be tried instead.

Assessment of the role of tryptophan residues in phospholipase A2 by fluorescence quenching

Tryptophan (Trp) fluorescence of two phospholipases A2 (PLA2) from Naja naja atra and Naja nigricollis snake venoms was quenched by acrylamide and iodide. Trp residues in N. naja atra PLA2 were equally accessible to acrylamide and iodide. Iodide quenching studies indicate that there are two classes of Trp fluorophores in N. nigricollis CMS-9. The accessible class consists of Trp-18 and Trp-19. Removal of the N-terminal octapeptide caused a perturbation of the micro-environment of the Trp residues in the PLA2 enzymes. The presence of a substrate lowers the susceptibility of the Trp residues to iodide quenching in N. naja atra PLA2, suggesting that all three Trp residues are at the substrate binding site, but in N. nigricollis CMS-9 Trp-18 and Trp-19 are related to substrate binding.

Urodynamic and clinical outcome of Kock pouch continent urinary diversion

Urodynamic studies of the Kock pouch were conducted in 20 patients 3 to 36 months after radical cystectomy and urinary diversion for invasive bladder cancer. Functional pouch capacity, intrapouch pressure, maximal nipple pressure, maximal nipple closure pressure and functional nipple length with the pouch filled to capacity were measured. Intermittent involuntary pressure spikes resembling bowel peristaltic waves occurred in 5 patients (25 per cent). The mean functional pouch capacity was 280.0 +/- 119.2 ml. (standard deviation) and mean maximal intra-pouch pressure was 41.0 +/- 11.0 cm. water in patients with involuntary pressure spikes. In patients without involuntary pressure spikes these values were 332.7 +/- 114.5 ml. and 11.6 +/- 4.8 cm. water, respectively. For all patients the mean maximal nipple pressure was 72.1 +/- 24.6 cm. water, the mean maximal nipple closure pressure was 58.8 +/- 23.1 cm. water and the mean functional nipple length was 3.4 +/- 0.9 cm. A functional nipple length of less than or equal to 2.5 cm. and/or a low maximal nipple closure pressure (less than 40 cm. water) correlated with a small functional pouch capacity (less than 200 ml.) in 5 patients. Clinically, these 5 patients also required frequent catheterization to provide continence. A maximal nipple closure pressure greater than 60 cm. water and an adequate functional nipple length (greater than 3.0 cm.) correlated with a rather large functional pouch capacity (more than 350 ml.). The degree of continence provided by the Kock pouch appeared to be determined by functional nipple length, maximal nipple closure pressure, functional pouch capacity and maximal intrapouch pressure.

Electrohydraulic lithotripsy for stones in Kock pouch

During endoscopy of the Kock pouch, we found rather large stones in the pouches of 3 male patients 14-23 months after operation. The size of the stones varied from 1.5 to 3.5 cm. Because the stones in the pouch were too large to be extracted using forceps, for fear of damaging the efferent nipple valve, electrohydraulic lithotripsy (EHL) was applied and all stones could be broken down and removed easily. No complication occurred during or after EHL. Topical anesthesia was not necessary in all 3 patients. Usually the stones formed around staples. The major component of the stones was struvite. Urease-secreting bacteria as well as alkaline urine were found in all 3 patients. This result suggested that though EHL was used in an intestinal milieu (instead of urothelial bladder), it was an easy, safe and effective procedure for the removal of rather large stones (greater than 1.5 cm) from the Kock pouch. We suggest endoscopy of the Kock pouch at least once every 6 months or when stones have been demonstrated on plain X-ray of the abdomen. Stones in the pouch larger than 1.5 cm could be removed using EHL to avoid damaging the efferent nipple valve.

Role of the N-terminal region of the A chain in beta 1-bungarotoxin from the venom of Bungarus multicinctus (Taiwan-banded krait)

The N-terminal alpha-amino groups of beta 1-bungarotoxin (beta 1-Bgt) from Bungarus multicinctus venom were modified with trinitrobenzene sulfonic acid and the modified derivative was separated by high performance liquid chromatography. The trinitrophenylated (TNP) derivative contained two TNP groups at the alpha-amino groups of A chain and B chain and showed a marked decrease in enzymatic activity. Methionine residues at positions 6 and 8 of the A chain were oxidized with chloramine T or cleaved with cyanogen bromide to remove the N-terminal octapeptide. Oxidation of methionine residues and removal of the N-terminal octapeptide caused a precipitous decrease in enzymatic activity, whereas antigenicity remained unchanged. The presence of dihexanoyllecithin influenced the interaction between beta 1-Bgt and 8-anilinonaphthalene sulfonate (ANS) and revealed that beta 1-Bgt consists of two types of ANS-binding sites, one at the substrate binding site of the A chain and the other might be at the B chain. The modified derivatives still retained their affinity for Ca2+ and ANS, indicating that the N-terminal region is not involved in Ca2+ and substrate binding. A fluorescence study revealed that the alpha-amino group of the A chain was in the vicinity of substrate binding site and that the TNP alpha-amino groups were in proximity to Trp-19 of the A chain. In addition, the study showed that the N-terminal region is important for stabilizing the architectural environment of Trp-19. The results, together with the proposal that Trp-19 of the A chain is involved in substrate binding, suggest that the N-terminal region of the A chain plays a crucial role in maintaining a functional active site for beta 1-Bgt.

Transurethral prostatectomy with computer-monitored resectoscope

Based on the difference in electrical conductivity between hyperplastic prostatic tissue and tissue of the surgical capsule, we have developed a monitoring computer that distinguishes the former from the latter. The computer sounds an alarm when the cutting loop of the resectoscope touches the capsule, followed by an automatic cut-off of the power source 0.4 s later; thus inadvertent perforation of the surgical capsule can be avoided in most cases. The function of the computer has been tested in 73 patients with benign prostatic hyperplasia. The results show that, with Nesbit's technique of transurethral resection, tiny perforations of the surgical capsule, usually 1 to 2 mm in diameter, occurred in all 30 patients operated on without computer monitoring, but only 3 of 73 computer-monitored patients had such an occurrence. There was a slight increase in the weight of resected prostatic tissue among the computer-monitored patients, but the difference between the time spent on the procedure between the two groups of patients was not significant. Apart from its monitoring function, the computer may reduce eye strain and mental stress in the surgeon, especially when resecting a large hyperplastic prostate.

Local suppressive effect of clonidine on penile erection in the dog

Dogs, 8.5 to 10 kg. in weight, were anesthetized with sodium pentobarbital (35 mg./kg.), intraperitoneally. Penile erection as indicated by an increase in the intracorporal pressure (ICP-increase) was produced by electrical stimulation of the right cavernous nerves. Drugs were administered into the internal pudendal artery (IPA) and femoral vein. A low dose (0.2 to 0.4 microgram/kg.) of clonidine, an alpha 2 adrenoceptor agonist, which could not affect either ICP or systemic arterial pressure (SAP) through an intravenous route, did suppress the ICP-increase markedly via direct injection into the IPA which supplies the penile blood flow. By intra-IPA injection, yohimbine (2.5 micrograms/kg.), an alpha 2 adrenoceptor antagonist, remarkably restored the ICP to the erection state. By intravenous injection, clonidine at a dose of 1.6 to 3.2 micrograms/kg. also profoundly reduced the ICP-increase, but only negligibly lowered the SAP. The IPA blood flow (IPAF) decreased coincidentally when the ICP-increase was effectively reduced by either intravenous or intra-IPA injection of clonidine. These findings suggest clonidine could act locally in the penile structure to suppress penile erection, possibly resulting from a penile vasoconstriction involving alpha 2 adrenoceptor. Whether this vasoconstriction is caused by a direct alpha 2 stimulating effect on the vascular smooth muscle or by an alpha 2 presynaptic inhibition of the vasodilator nerve (cavernous nerve) endings has been discussed.