Regional diagnosis of lymphoedema and selection of sites for lymphaticovenular anastomosis using elastography

AIM

To evaluate the use of ultrasound elastography as a basis for determining the most appropriate sites for lymphaticovenular anastomosis (LVA) for treatment of lymphoedema.

MATERIALS AND METHODS

Preoperative elastography and LVA were performed in 11 patients (11 legs) with leg lymphoedema, including two cases of primary oedema and nine of secondary oedema.

RESULTS

The mean number of LVAs applied per leg was 4.4 (range 3-7). The mean reduction in the leg circumference was 91.7%, and 10 of the 11 cases (90.0%) were improved. Hardness was reduced from a mean of 1.6 before surgery to 0.9 after surgery, and improvement was also noted in 10 cases (90.9%). The severity of oedema was determined in five regions in each leg, and was classified as elastography stage (ES) 0 in 11 regions, ES1 in 23, ES2 in 15, and ES3 in six.

CONCLUSIONS

These results demonstrate the value of ultrasound elastography for the diagnosis of early-stage lymphoedema and determination of LVA sites. This is the first report of diagnosis of lymphoedema using elastography and the findings suggest that this procedure followed by LVA could be used as a new therapeutic method for early-stage lymphoedema.

Parallel multipoint recording of aligned and cultured neurons on corresponding Micro Channel Array toward on-chip cell analysis

This paper describes an advanced Micro Channel Array (MCA) so as to record neuronal network at multiple points simultaneously. Developed MCA is designed for neuronal network analysis which has been studied by co-authors using MEA (Micro Electrode Arrays) system. The MCA employs the principle of the extracellular recording. Presented MCA has the following advantages. First of all, the electrodes integrated around individual micro channels are electrically isolated for parallel multipoint recording. Sucking and clamping of cells through micro channels is expected to improve the cellular selectivity and S/N ratio. In this study, hippocampal neurons were cultured on the developed MCA. As a result, the spontaneous and evoked spike potential could be recorded by sucking and clamping the cells at multiple points. Herein, we describe the successful experimental results together with the design and fabrication of the advanced MCA toward on-chip analysis of neuronal network.

Pattern modification of a neuronal network for individual-cell-based electrophysiological measurement using photothermal etching of an agarose architecture with a multielectrode array

A new type of individual-cell-based on-chip multielectrode array (MEA) cell-cultivation system with an agarose microchamber (AMC) array for topographical control of the network patterns of a living neuronal network has been developed. The advantages of this system are that it allows control of the cell positions and numbers for cultivation using AMCs, as well as easy and flexible control of the pattern of connections between the AMCs through photothermal etching where a portion of the agarose layer is melted with a 1480 nm infrared laser beam. With adequate laser power, narrow micrometer-order grooves (microchannels) can easily be fabricated that can be used to combine neighbouring AMCs to enable topographical control of the neural network pattern. Using this system, an individual-cell-based neural network pattern was formed of rat hippocampal cells within the AMC array without cells escaping from the electrode positions in the microchamber during an eight-day cultivation, and could record cell firing in response to 1.5 V, 500 kHz stimulation through an electrode. This demonstrated the potential of the on-chip AMCMEA cell cultivation system for long-term single-cell-based electrophysiological measurement of a neural network system.

Modified block uniform resampling (BURS) algorithm using truncated singular value decomposition: fast accurate gridding with noise and artifact reduction

The block uniform resampling (BURS) algorithm is a newly proposed regridding technique for nonuniformly-sampled k-space MRI. Even though it is a relatively computationally intensive algorithm, since it uses singular value decomposition (SVD), its procedure is simple because it requires neither a pre- nor a postcompensation step. Furthermore, the reconstructed image is generally of high quality since it provides accurate gridded values when the local k-space data SNR is high. However, the BURS algorithm is sensitive to noise. Specifically, inaccurate interpolated data values are often generated in the BURS algorithm if the original k-space data are corrupted by noise, which is virtually guaranteed to occur to some extent in MRI. As a result, the reconstructed image quality is degraded despite excellent performance under ideal conditions. In this article, a method is presented which avoids inaccurate interpolated k-space data values from noisy sampled data with the BURS algorithm. The newly proposed technique simply truncates a series of singular values after the SVD is performed. This reduces the computational demand when compared with the BURS algorithm, avoids amplification of noise resulting from small singular values, and leads to image SNR improvements over the original BURS algorithm.

Analysis of single-cell differences by use of an on-chip microculture system and optical trapping

A method is described for continuous observation of isolated single cells that enables genetically identical cells to be compared; it uses an on-chip microculture system and optical tweezers. Photolithography is used to construct microchambers with 5-microm-high walls made of thick photoresist (SU-8) on the surface of a glass slide. These microchambers are connected by a channel through which cells are transported, by means of optical tweezers, from a cultivation microchamber to an analysis microchamber, or from the analysis microchamber to a waste microchamber. The microchambers are covered with a semi-permeable membrane to separate them from nutrient medium circulating through a "cover chamber" above. Differential analysis of isolated direct descendants of single cells showed that this system could be used to compare genetically identical cells under contamination-free conditions. It should thus help in the clarification of heterogeneous phenomena, for example unequal cell division and cell differentiation.

On-chip culture system for observation of isolated individual cells

To investigate the properties of isolated single cells with their environment, we developed the differential analysis method for single cells using an on-chip microculture system. The advantages of the system are, (i). continuous cultivation of a series of isolated single cells or a group of cells under contamination free conditions, (ii). continuous observation and comparison of those cells with 0.2 microm spatial resolution by a phase-contrast/fluorescent microscopy system with digital image processing. The core of the system is an n x n (n = 20-50) array of chambers, where each is 20-70 microm in diameter and 5-30 microm deep holes etched into a biotin-coated 0.17 mm thick glass slide. The biotin-coated glass slide is covered with the streptavidin coated cellulose semipermeable membrane, which is fixed on the surface of the glass slide by streptavidin-biotin attachment, separating those holes from the nutrient medium circulating through a 'cover chamber' above. A single cell or group of cells can thus be isolated from environment perfused with the same medium, and the medium in each chamber can be changed within the diffusion time (<1/30 s). In addition, the microchamber volumes of specific cells or cell groups can be controlled by the sizes of the chambers. By using this system we found that the length of isolated Escherichia coli increased at 0.06 microm min(-1) between cell divisions regardless of the chamber volume, and that the cell concentration reached 10(12) cells ml(-1) under contamination free conditions. The system is thus particularly useful for one cell level analysis because the direct descendants of single cells can be cultured and compared in the isolated microchambers, and the physical properties of the cells in each microchamber can be continuously observed and compared.

Autoantibodies to IL-1 alpha in sera from rapidly progressive idiopathic pulmonary fibrosis

To clarify the clinical significance of autoantibodies to interleukin-1 alpha (IL-1 alpha autoantibodies) in rapidly progressive idiopathic pulmonary fibrosis (IPF), we measured the level of IL-1 alpha autoantibodies in serum of 11 patients on the first hospital day, when patients were admitted due to severe symptoms, and on the 21st hospital day. IL-1 alpha autoantibodies in serum were measured using radioimmunoassay, and the limitation of this assay for IL-1 alpha autoantibodies was 5 ng/ml. These antibodies were detected in 5 of 11 patients on the first hospital day. On the 21st hospital day, these antibodies were detected in all patients, and its level was increased compared with that on the first hospital day. IL-1 alpha autoantibodies that appeared in patients corresponded to that of IgG. The half life of exogenous autoantibodies was investigated following administration of autoantibody rich plasma obtained from healthy blood donors to 6 control patients (CP) and 6 progressive IPF patients. These autoantibody levels in their serum were less than 5 ng/ml before administration. Serum was obtained at the indicated time after administration of IL-1 alpha autoantibodies and the level of these autoantibodies in serum was measured, then the half life was calculated. Half life of exogenous IL-1 alpha autoantibodies in progressive IPF patients was significantly shorter than that in CP (71.3 +/- 31.8 hr vs 352.0 +/- 98.3 hr, p < 0.01). These findings suggested that IL-1 alpha autoantibodies were generated in response to the inflammatory process of rapidly progressive IPF and may act as a regulatory factor for IL-1 alpha.

The development of a pollen information system for the improvement of QOL

The Kochi Prefecture Japanese Cedar and Cypress Pollen Information System (P-Net Kochi) was established in 1991 on the initiative of the Pharmaceuticals and Sanitation Division to improve the quality of life of people in Kochi Prefecture, particularly patients with pollinosis. Kochi Prefecture has the highest forests percentage (84%) in Japan. In addition, 40% of the population of the prefecture is concentrated in Kochi City. The average pollen count at 10 observation points an one year was about 20,000/cm2 during the observation period, but it exceeded 110,000/cm2 in 1995, when it was also high nationwide. Kochi Prefecture organized a system to promote people's understanding of pollinosis in connection with environmental problems, and to enlighten people on appropriate preventive measures. The system has been improved in the rapid and efficient transmission of information over the years with technological advances. The introduction of an automatic monitoring system not dependent on human labor and the support of the users proved to be indispensable for the maintenance of the system.

Applying the uniform resampling (URS) algorithm to a lissajous trajectory: fast image reconstruction with optimal gridding

Various kinds of nonrectilinear Cartesian k-space trajectories have been studied, such as spiral, circular, and rosette trajectories. Although the nonrectilinear Cartesian sampling techniques generally have the advantage of fast data acquisition, the gridding process prior to 2D-FFT image reconstruction usually requires a number of additional calculations, thus necessitating an increase in the computation time. Further, the reconstructed image often exhibits artifacts resulting from both the k-space sampling pattern and the gridding procedure. To date, it has been demonstrated in only a few studies that the special geometric sampling patterns of certain specific trajectories facilitate fast image reconstruction. In other words, the inherent link among the trajectory, the sampling scheme, and the associated complexity of the regridding/reconstruction process has been investigated to only a limited extent. In this study, it is demonstrated that a Lissajous trajectory has the special geometric characteristics necessary for rapid reconstruction of nonrectilinear Cartesian k-space trajectories with constant sampling time intervals. Because of the applicability of a uniform resampling (URS) algorithm, a high-quality reconstructed image is obtained in a short reconstruction time when compared to other gridding algorithms.

Predictive indicators of successful varicocele repair in men with infertility

OBJECTIVE

We sought predictive indicators of functionally successful repair in 168 infertile Japanese males who underwent high ligation of a varicocele via a retroperitoneal approach.

METHODS

Possible indicators evaluated included age at marriage, duration of infertility, testicular volume, varicocele grade, seminal analysis findings, and serum concentrations of follicle-stimulating hormone (FSH), luteinizing hormone (LH), prolactin (PRL), and testosterone. All patients had palpable or visible unilateral left varicoceles. Success in conception was evaluated in all subjects 1 year after varicocele repair.

RESULTS

No associations were observed between outcome and mean age at marriage, infertility duration, varicocele grade, seminal volume, or serum PRL and testosterone concentrations, but testicular volume, sperm count, percentage of motile sperm, and serum FSH and LH concentrations were significantly associated with outcome. Multiple regression analysis of dependence of outcome revealed testicular volume and serum FSH concentrations to be independent predictors.

CONCLUSIONS

Varicocele repair is likely to accomplish fertility in patients with a combined testicular volume of at least 30 mL or serum FSH concentrations lower than 11.7 mIU/mL.

Effects of intravenous administration of high dose-diethylstilbestrol diphosphate on serum hormonal levels in patients with hormone-refractory prostate cancer

The objective of this study was to elucidate the mechanism underlying the further suppression of serum testosterone (T) by diethylstilbestrol diphosphate (DES-DP) in patients with prostate cancer refractory to hormonal treatment. These patients received an LHRH agonist with or without a non-steroidal androgen-receptor blocker or a gestagen before DES-DP. We measured serum levels of total and free T, dihydrotestosterone (DHT), estradiol (E2), dehydroepiandrosterone sulfate (DHEA-S), dehydroepiandrosterone (DHEA), androstenedione, cortisol, aldosterone before and during intravenous administration of high doses of DES-DP (500 or 1000 mg/day). DES-DP administration suppressed the serum levels of FSH (p=0.04) and total T (p=0.02), and eliminated free T (p=0.04) and E2 (p=0.04) from serum, while reducing serum DHEA-S to approximately two-thirds of the pretreatment level (p=0.03). In contrast, serum levels of SHBG (p=0.02) and cortisol (p=0.02) were markedly increased after DES-DP administration. The latter had no significant effect on serum levels of LH, DHT, ACTH, 17alpha-hydroxypregnenolone, 17alpha-hydroxyprogesterone, DHEA, androstenedione, or aldosterone. The results suggest that the potent suppression of circulating total T by DES-DP is caused, in part, by the inhibitory effect of DES-DP on serum DHEA-S level. In most patients, high-dose DES-DP treatment completely suppressed the serum level of free T, while possibly elevating serum SHBG and decreasing serum total T. The mechanisms that maintain the serum level of serum DHT during DES-DP treatment require further elucidation.

Switching of output coupling in a grating coupler by diffraction transition to the distributed Bragg reflector regime

In a proposed switching grating coupler (SGC), the grating period Lambda is chosen so that the SGC converts from a first-order grating coupler to a third-order distributed Bragg reflector by means of a small change in the guided mode index. The principle for switching the radiated wave power and the effective aperture of the SGC were experimentally confirmed by use of the thermo-optic effect of a polymer waveguide. The extinction of the peak intensity of the wave radiated by the SGC and collected by an external lens was measured to be 5 dB with a temperature change of 10 degrees.

Alterations of asparagine-linked sugar chains of N-acetyl beta-D-hexosaminidase during human renal oncogenesis: a preliminary study using serial lectin affinity chromatography

Enzymatic properties and asparagine (Asn)-linked sugar-chain structures of N-acetyl beta-D-hexosaminidase A (Hex A) were compared in human tissues between normal renal cortex and renal cell carcinoma (RCC). No significant differences between the two Hex A preparations were observed with respect to enzymatic properties such as molecular mass, Michaelis-Menten value or optimal pH. With RCC preparations, relatively more Hex A passed through the concanavalin A (Con A) column, bound weakly to Con A, or bound strongly to Con A and also to the wheat germ agglutinin (WGA) column, than with preparations from normal renal cortex. In contrast, relatively less Hex A bound strongly to the Con A column, but passed through the WGA column with RCC preparations than with those from normal renal cortex. Asn-linked sugar-chain structures might apparently be altered during human renal oncogenesis.

Serum concentration of type I collagen metabolites as a quantitative marker of bone metastases in patients with prostate carcinoma

BACKGROUND

Bone scans, widely used for the detection of bone metastases from prostate carcinoma, can neither quantitate metastatic lesions nor detect osteolytic lesions.

METHODS

Serum concentrations of the carboxyterminal propeptide of Type I procollagen (PICP), the carboxyterminal pyridinoline cross-linked telopeptide of Type I collagen (ICTP), and prostate specific antigen (PSA) were measured by radioimmunoassays in 48 patients with benign prostatic hyperplasia (BPH), 25 patients with prostate carcinoma (PCA) without bone metastases, and 36 patients with PCA and bone metastases.

RESULTS

Serum concentrations of PICP were significantly higher in patients with PCA with bone metastases than in patients with BPH or PCA without bone metastases. No significant differences were observed between patients with BPH and those with PCA without bone metastases. Serum ICTP concentrations were significantly higher in patients with PCA than in patients with BPH regardless of the presence or absence of bone metastases. Serum concentrations of PICP, ICTP, and PSA correlated significantly with Soloway's grading system for bone scans. The serum concentrations of PICP and ICTP in patients without bone metastases showed a significant downward trend in response to antiandrogen therapy.

CONCLUSIONS

These observations suggest that the serum concentrations of PICP and ICTP are quantitative markers of bone metastases from PCA when followed serially in individual patients.

Serial lectin affinity chromatography with concavalin A and wheat germ agglutinin demonstrates altered asparagine-linked sugar-chain structures of prostatic acid phosphatase in human prostate carcinoma

Differences between human prostate carcinoma (PCA, five cases) and benign prostatic hyperplasia (BPH, five cases) in asparagine-linked (Asn) sugar-chain structure of prostatic acid phosphatase (PAP) were investigated using lectin affinity chromatography with concanavalin A (Con A) and wheat germ agglutinin (WGA). PAP activities were significantly decreased in PCA-derived PAP, while no significant differences between the two PAP preparations were observed in the enzymatic properties (Michaelis-Menten value, optimal pH, thermal stability, and inhibition study). In these PAP preparations, all activities were found only in the fractions which bound strongly to the Con A column and were undetectable in the Con A unbound fractions and in the fractions which bound weakly to the Con A column. The relative amounts of PAP which bound strongly to the Con A column but passed through the WGA column, were significantly greater in BPH-derived PAP than in PCA-derived PAP. In contrast, the relative amounts of PAP which bound strongly to the Con A column and bound to the WGA column, were significantly greater in PCA-derived PAP than in BPH-derived PAP. The findings suggest that Asn-linked sugar-chain structures are altered during oncogenesis in human prostate and also suggest that studies of qualitative differences of sugar-chain structures of PAP might lead to a useful diagnostic tool for PCA.

Studies of the expression of epidermal growth factor receptor in human renal cell carcinoma: a comparison of immunohistochemical method versus ligand binding assay

We evaluated the expression of epidermal growth factor receptor (EGFR) in 21 patients with renal cell carcinoma (RCC) by immunohistochemical staining of frozen tumor sections using a monoclonal antibody for EGFR and by a ligand binding method using radiolabeled epidermal growth factor. EGFR was detected in 16 of the 21 cases by ligand binding, while 11 of the 21 cases were detected by immunohistochemical staining. A significant correlation was observed between the two methods in detecting EGFR (p < 0.0001). EGFR was detected by the ligand binding method in all patients who died of RCC. Four cases that were graded as EGFR-negative on immunohistochemistry died of RCC. Observations suggest the ligand binding method was more sensitive than the immunohistochemical method in detecting EGFR and forecasting patient survival.

Articles on AIDS in major Japanese newspapers

People in general obtain knowledge about AIDS through the mass media. It is interesting to know how newspapers have dealt with AIDS in recent years, since newspapers are the most important mass media. The number of articles on AIDS from 1981 to 1994 was investigated in three major Japanese newspapers (Asahi, Yomiuri, and Mainichi) which are distributed nationwide. The first article appeared in 1982, and the number of articles gradually increased to a peak (total 785 articles) in 1987 when the first Japanese female patient was reported. Then, the number of articles decreased to 116 in 1989. The number of articles on AIDS in newspapers was not correlated with the reported number of patients.

Natural history of polypoid lesions in the gall bladder

BACKGROUND

Although polypoid lesions of the gall bladder are frequently observed in asymptomatic subjects, the natural history of these lesions has never been studied using ultrasonography.

AIM

The natural history of polypoid lesions of the gall bladder was investigated using ultrasonography.

SUBJECTS

Among 4343 patients who presented to the outpatient clinic of Tsuchiura Kyodo General Hospital in 1988, 111 subjects were diagnosed as having polypoid lesions of the gall bladder by ultrasonography. Among these patients, two had gall bladder carcinoma. The remaining 109 subjects (58 female; age: median 54, range 25-89) were enrolled in this study.

METHODS

The subjects were followed up by ultrasonography once or twice a year until 1994.

RESULTS

Four patients received cholecystectomy and two patients died of other causes during the observation period. In one patient, gall bladder carcinoma was found, but its location was different from that of the pre-existing polyp. The size of the lesions did not change in 88.3% of the other 130 patients during this period, even among those in whom the initial size of the lesion exceeded 10 mm. There was no apparent correlation between the change in the diameter of the polypoid lesions and patients' sex or age.

CONCLUSION

Most polypoid lesions of the gall bladder detected by ultrasonography are benign.

Quantitative bone scanning of the hip. Comparison between the perfusion and static phases

Quantitative bone scanning of the hip was carried out in 50 patients, 45 with unilateral disorders, and 5 with no symptoms and normal radiographs. The uptake ratio of the involved femoral head was calculated in the perfusion and static phases. In the patients with no symptoms the difference in the uptake ratio between the right and left hips averaged less than 0.02 in both phases. In 5 patients with a unilateral endoprosthesis the average was 0.52 in the perfusion and 0.34 in the static phase. In 10 patients with intertrochanteric fractures, 9 with undisplaced femoral neck fractures and 7 with osteoarthritis, each uptake ratio averaged more than 1.1 in both phases. In 9 patients with displaced femoral neck fractures, the mean ratio was 0.76 in the perfusion and 0.92 in the static phase. In 5 patients with avascular necrosis the ratio was 0.82 in the perfusion and 1.57 in the static phase. Quantification of uptake in both phases provides objective data reflecting bone blood flow and metabolism in various disorders of the hip.

[Estimation of the weddellite to whewellite ratio by infrared spectroscopy]

Powder samples of 56 calcium oxalate stones the contents of weddellite, whewellite and apatite of which had been determined by thermogravimetry (TG) were studied by infrared spectroscopy (IR). When the ratio of the weddellite content to the total of weddellite and whewellite (weddellite ratio) calculated using Oka's method on the infrared spectra was compared with that determined previously by TG, the correlation coefficient between these ratios was 0.734. For the 24 calcium oxalate stones the apatite content of which was less than 10%, the correlation coefficient between these ratios was 0.976, although the weddellite ratio calculated using Oka's method was significantly higher than that determined by TG (P less than 0.01). In an attempt to estimate the weddellite to whewellite ratio by IR regardless of the content of apatite, the ratio of the depth of the absorption band at 780 cm-1 (H780) to the depth of the absorption band at 1,320 cm-1 (H1320) was compared with the ratio of the whewellite content to the total of whewellite and weddellite contents determined by TG. The correlation coefficient between these ratios was 0.953. We conclude that the ratio of H780 to H1320 determined from the infrared spectra obtained from a 0.3 to 1 mg powder sample of calcium oxalate stone is useful in the estimation of the weddellite to whewellite ratio.

[Percutaneous dissolution of uric acid and cystine stones causing acute ureteral obstruction]

Four cases with ureteral obstruction due to uric acid or cystine stones were treated successfully by percutaneous irrigation with sodium bicarbonate or tromethamine-E. These cases underwent percutaneous nephrostomy for the reason of prolonged complete obstruction (case 1), sustained pyelonephritis (case 2) or decreased renal function (case 3 and 4). Two catheters were placed through the nephrostomy tract before irrigation, 6 Fr. ureteral catheter just above the ureteral stone and 10 Fr. pigtail or 12 Fr. Malecot catheter in the renal pelvis. The ureteral stones were markedly reduced in size and passed spontaneously after 6-11 days' duration of irrigation in three cases. In case 2, the remaining stone was removed transurethrally after 14 days' duration of irrigation, and was found to be composed of organic matrix. Percutaneous dissolution is considered to be a safe and reliable method and may be an alternative way of treating uric acid or cystine stone causing acute ureteral obstruction.

[Clinical evaluation of serum S100ao protein in patients with urogenital diseases and healthy volunteers]

We investigated the clinical significance of the serum S100ao protein in patients with urogenital diseases. The serum levels of S100ao protein were measured in 179 patients with urogenital diseases and 180 healthy volunteers. The mean value of S100ao protein in serum from healthy volunteers was 203 +/- 107 pg/ml (Mean +/- SD). Therefore, the cut-off level was set to 524 pg/ml (Mean +/- 3SD). The levels of S100ao protein in serum were significantly higher in men than in women (P less than 0.05). The levels of S100ao protein in serum were significantly high in the patients in their fifties and sixties compared with the other patients (P less than 0.01). When serum levels exceeding the cut-off level were considered to be positive, the percentages of positivity in each disease were as follows: renal cell carcinoma; 38.7%, bladder tumor; 9.1%, prostatic carcinoma; 12.5%, testicular tumor; 0%, benign prostatic hypertrophy; 7.4%, urolithiasis; 7.1% and chronic renal failure; 100%. The levels of S100ao protein in serum were significantly correlated with those of BUN, serum creatinine and endogenous creatinine clearance, respectively. S100ao protein in serum was increased immediately after operation and returned to the normal range within one to two weeks after operation. As described above, the level of S100ao protein in serum was affected by renal function, operative procedures and age. However, the positive rate of S100ao protein was so high in patients with renal cell carcinoma that serum S100ao protein might be a valuable tumor marker in those patients.

[Fournier's gangrene: a case report]

A 40-year-old male was admitted complaining of high grade fever, pain, redness and swelling of the right scrotum, right perineum and right flank region. He had no apparent history of previous infection or diabetes mellitus. At the time of admission, the scrotum was partly necrotic with repulsive feculent pus discharge and there was crepitus on palpation of involved areas. Culture of purulent discharge yielded the growth of anaerobic organisms. Surgical drainage was performed immediately and debridement of necrotic tissue in the involved areas was often repeated. At the same time, the patient received antibiotic therapy that included agents effective against anaerobic bacteria. However, the scrotal skin developed gangrene and the right testis hung suspended with cord exposed. This testis was intact. The scrotal skin defect was cured using a skin graft, after the infection had been brought under control.

Regulatory effect of prostaglandin E2 on fibronectin release from human alveolar macrophages

Fibronectin (Fn), which is released from several kinds of cells including alveolar macrophages (AM), is important in inflammatory reactions in the certain lung diseases such as idiopathic pulmonary fibrosis (IPF). Therefore, information on the mechanisms regulating Fn release from AM may be useful for elucidating the pathogenesis of these diseases and developing therapeutic modalities. We supposed that prostaglandin E2 (PGE2), which is known to modulate cellular functions, might be involved in regulation of Fn release, and, accordingly, we measured the release of Fn and PGE2 from AM from normal volunteers (NV), control patients (CP), and patients with IPF. AM from patients with IPF were found to release more Fn than AM from NV (IPF: 250 +/- 58.8/10(6) cells.24 h, NV: 53.0 +/- 7.3 ng/10(6) cells.24 h) and to release less PGE2 than the latter (IPF: 0.48 +/- 0.12 ng/10(6) cells.24 h, NV:1.35 +/- 0.24 ng/10(6) cells.24 h). A negative correlation was found between the contents of Fn and PGE2 in the culture media of AM from NV, CP, and patients with IPF. Lipopolysaccharide, phorbol myristate acetate, and zymosan suppressed Fn release from AM but stimulated their PGE2 release, and these effects were reversed by indomethacin. Exogenous PGE2 (greater than 1 x 10(-8) M) suppressed Fn release. The albumin-antialbumin complex stimulated Fn release but did not affect PGE2 release. These results indicate that Fn release from AM changed in response to various stimuli, and that PGE2 is important in suppressing Fn release from AM, suggesting a negative feedback mechanism of PGE2 in releasing Fn.

Role of alveolar macrophages in the neutrophil-dependent defense system against Pseudomonas aeruginosa infection in the lower respiratory tract. Amplifying effect of muramyl dipeptide analog

Alveolar macrophages are thought to be important in immune or inflammatory reactions. We investigated the role of alveolar macrophages in defense against Pseudomonas aeruginosa infection in the lower respiratory tract. Intratracheal inoculation of formalin-inactivated P. aeruginosa (1 x 10(8)-1 x 10(10) organisms) into normal rats resulted in increase in the number of neutrophils in the bronchoalveolar lavage (BAL) fluid obtained 24 h later. The phagocytic activity of neutrophils for P. aeruginosa was higher than that of alveolar macrophages. These findings indicate that neutrophils are essential for phagocytosis of P. aeruginosa in the lower respiratory tract. On incubation with P. aeruginosa, alveolar macrophages released neutrophil chemotactic factor (NCF) dose-dependently. MDP-Lys(L18), a muramyl dipeptide analog, stimulated alveolar macrophages to phagocytize P. aeruginosa and stimulate the release of NCF from alveolar macrophages in vitro and enhanced the neutrophil response to inoculated P. aeruginosa in vivo. These results indicate that alveolar macrophages are important in initiating the neutrophil-dependent defense system against P. aeruginosa by releasing NCF and that MDP-Lys(L18) can amplify the defense system.

[Production of fibronectin and PGE2 by cultured human alveolar macrophages]

Production of fibronectin (Fn) and prostaglandin E2 (PGE2) by human alveolar macrophages (AM) which were obtained by bronchoalveolar lavage was studied in vitro. AM obtained from patients with idiopathic interstitial pneumonia (IIP) produced much more Fn than those from normal volunteers but produced less amounts of PGE2. We also tested the effect of lipopolysaccharide (LPS), phorbol 12-myristate 13-acetate (PMA), zymosan and albumin-anti albumin complex (alb-anti alb) on production of Fn and PGE2 from AM. LPS, PMA and zymosan suppressed Fn production but stimulated PGE2 production by AM from patients with IIP but indomethacin reversed the suppressive effect of LPS, PMA and zymosan on Fn production. On the contrary, alb-anti alb stimulated Fn production by AM. Furthermore, exogenous PGE2 suppressed Fn production by AM from patients with IIP in a dose-dependent manner. These data suggest that Fn production by AM may be changed by different stimuli or different states of disease, and there is close relationship between the production of Fn and PGE2 by AM.

[Study of oval crystals in urine]

Urinary crystals were collected by repeated centrifugation from two outpatients with calcium oxalate crystalluria where oval forms predominated and were studied by scanning electron microscopy and X-ray diffraction. Fibrous structure, biconcave surface and prismatic appearance of oval crystals were shown. The side view of oval forms may be prismatic X-ray diffraction patterns of urinary crystals indicated that oval crystals consist of calcium oxalate monohydrate.

[The role of urine pH in the occurrence of phosphaturia]

The density of calcium phosphate and the pH were determined in 15 postprandial urine specimens with heavy precipitation of amorphous calcium phosphate, that is phosphaturia, collected from 5 patients with calcium urolithiasis (stone-formers) and 3 patients with no known urological disease (controls). Phosphaturia, not related to urinary tract infection or administration of alkalinizing agents, was found repeatedly at our outpatient clinic in these patients. The correlative relationship was not confirmed between the density of calcium phosphate and the pH. The concentration of calcium and phosphorus was also determined in 10 urine specimens with phosphaturia. The concentration of phosphorus was correlated significantly with the pH (r = -0.775, p less than 0.01), although the concentration of calcium was not correlated with the pH. The pH of 11 urine specimens with phosphaturia from the controls was 7.51 +/- 0.31 (mean +/- S.D.) and the pH of 18 urine specimens with phosphaturia from the stone-formers was 6.81 +/- 0.34. The pH was significantly lower in the urine specimens from the stone-formers than in those from the controls (p less than 0.01). We have noted that the occurrence of phosphaturia depends not only on the urinary pH but on the concentration of phosphorus. It is interesting that phosphaturia often occurs in urine specimens with a pH below 7 in stone-formers.

[A clinical study of primary hyperparathyroidism]

Eight cases of primary hyperparathyroidism (P-HPT) confirmed pathohistologically, between April, 1974 and January, 1986 at our department, were reviewed. The patients consisted of three males and five females, ranging in age from 38 to 62 years old with an average of 50.3 years. All the cases belonged to the urolithiasis type and seven patients were recurrent or/and multiple stone-formers. Positive rates of the laboratory values studied in relation with P-HPT were 100% in serum Ca, C terminal parathyroid hormone, and % TRP, 87.5% in urine Ca, 75% in serum Cl/P ratio, alkaliphosphatase, 50% in serum Cl, 37.5% in serum P and 0% in urine P. Seven cases had clinically apparent hypercalcemia, while one was a so-called borderline P-HPT with intermittent hypercalcemia. The correct diagnosis of the localization was obtained preoperatively in two cases by angiography and one by C.T and Tl-Tc subtraction scintigraphy. Histological findings of the tumors extirpated by the cervical operation were parathyroid adenomas in six cases and hyperplasia in two. During the course of the postoperative follow up, hypercalcemia and urolithiasis did not recur in any case including two of hyperplasia.

[Study of the transformation of weddellite to whewellite in calcium oxalate stones by x-ray diffraction]

A clay film was made of the stone powder and water drops on a slide glass and dried at 100 to 110 degrees C or at room temperature in the horizontal position for 20 calcium oxalate stones which had been received between April, 1978 and August 1980. Each clay film was scanned with an X-ray diffractometer using CuK alpha radiation, stored at room temperature in a wooden sample case and analysed again by X-ray five to seven years after the first X-ray analysis. Then the recent diffractograms of 20 powder samples were compared with the previous ones regarding the peak heights at 14.2 degrees, 14.8 degrees and 25.8 degrees (2 theta), which were considered representative of weddellite, whewellite and apatite contents and designated as Iwe, Iwh and Iap, respectively. Since there was a good correlation between Iwe/Iwe + Iwh + Iap and weddellite/weddellite + whewellite + apatite that was determined by thermogravimetry (Fig. 1), the transformation rate of weddellite to whewellite can be expressed as the change of Iwe/Iwe + Iwh + Iap. One sample Iwe/Iwe + Iwh + Iap of which decreased by 48% in seven years (Fig. 3) and another sample Iwe/Iwe + Iwh + Iap of which increased by 10% in five years (Table) were excluded from this study because the clay films of these samples might have been overheated or incompletely dried before the first X-ray analysis.(ABSTRACT TRUNCATED AT 250 WORDS)

[A case of renal cell carcinoma during pregnancy]

Renal cell carcinoma during pregnancy is extremely rare. This 30-year-old patient was first seen on Dec. 18, 1983 at the 7th week of her 2nd pregnancy. She had asymptomatic hematuria. Cystoscopy revealed normal findings and sonogram showed well defined echogenic mass in the upper pole of the right kidney. She was admitted to our hospital on account of gross hematuria and severe lumbago on Jan. 19, 1984. The pregnancy was stopped by artificial abortion. Renal angiography revealed a rich-vascularized tumor in the upper pole of the right kidney. Preoperatively, arterial embolization was done and nephrectomy was performed. Histological examination showed a well-differentiated adenocarcinoma. There was no involvement of the renal vein and no lymph-node metastases were found in the operation specimen. The post-operative course was uneventful. This rare case of renal cell carcinoma during pregnancy is herein reported along with some discussion.

[Clinical study of total cystectomy in patients with bladder transitional cell cancer]

The late results on 53 patients with bladder transitional cell cancer, who were treated by total cystectomy at the Department of Urology, Jichi Medical School between 1974 through 1983, were reviewed. The ages ranged from 28 to 78 years old, with an average of 61.8 years. There were 48 men and 5 women, with a male to female ratio of 9.6:1. The relative 5-year survival rate was 58.2% as a whole, that of patients with low grade cancer (grade 1 and 2) was 116%, and that of patients with high grade cancer (grade 3) was 33.8%. A significant difference was observed (p less than 0.01). The relative 3-year survival rate of low stage cancer (pT1 and pT2) was 88.4%, that of high stage cancer (pT3 and pT4) was 16.6%, a significant difference being observed (p less than 0.01). The post operative mortality rate was 5.7%.