Arterial stiffness is increased in young women with endometriosis

Endometriosis is a chronic gynaecological disorder that is accompanied by inflammation and oxidative stress. Atherosclerosis has a long subclinical progression in arteries of children and young adults decades before overt clinical manifestations of the disease. In this study, we determined arterial stiffness by measuring brachial-ankle pulse wave velocity (baPWV) in women with endometriosis to assess the presence of subclinical atherosclerosis. We also measured markers of inflammation and oxidative stress in women with endometriosis. baPWV in women with endometriosis aged over 30 years was significantly higher than that in women without endometriosis aged over 30 years (p < 0.05), but not in women aged less than 30. Serum high-sensitivity C-reactive protein level in women with endometriosis was significantly higher than that in controls (p < 0.05). Young women with endometriosis show significantly increased arterial stiffness, suggesting that women with endometriosis need to be cautious of the future onset of atherosclerosis.

Difference in the ratio of high-molecular weight (HMW) to total adiponectin and HMW adiponectin in late post-menopausal women

OBJECTIVE

High-molecular weight (HMW) isoform level and HMW ratio have been shown to be better predictors of insulin sensitivity and metabolic syndrome than total adiponectin level.We examined the changes in circulating levels of HMW adiponectin and ratios of HMW to total adiponectin in women during the menopausal transition.

METHODS

We conducted a cross-sectional study in 217 healthy women and divided them into 4 stages: 58 women in pre-menopausal, 69 women in perimenopausal, 62 women in early post-menopausal and 28 women in late post-menopausal phase. Serum levels of total adiponectin and HMW adiponectin were measured by an enzyme-linked immunosorbent assay.

RESULTS

In late post-menopausal women, HMW adiponectin level was significantly higher than that in peri-menopausal women and the HMW to total adiponectin ratio was significantly lower than that in early post-menopausal women. In peri-menopausal women, HMW adiponectin level was significantly lower than that in pre-menopausal women and HMW to total adiponectin ratio was significantly lower than the ratios in pre-menopausal and early post-menopausal women.

CONCLUSION

The ratio of HMW to total adiponectin is low in late post-menopausal women, though both levels of total and HMW adiponectin were high after menopause in our cross-sectional study.

Identification of the human sperm protein that interacts with sperm-immobilizing antibodies in the sera of infertile women

OBJECTIVE

To identify the target antigen of sperm-immobilizing antibodies present in the circulation of infertile women.

DESIGN

Laboratory research.

SETTING

Academic research laboratory.

PATIENT(S)

Twenty-nine infertile women with sperm-immobilizing antibodies, 22 infertile women with other disorders, and 20 fertile women.

INTERVENTION(S)

Titers of antibodies to the sperm protein, rSMP-B, were determined by ELISA using as substrate the synthetic peptide segment (rSMP-230) that corresponds with the hydrophilic domain of rSMP-B. Tests for sperm immobilization and zona pellucida penetration were performed using the human IVF system.

MAIN OUTCOME MEASURE(S)

Human sera with sperm-immobilizing activity were assayed for the presence of antibodies to rSMP-230. Polyclonal antibodies to rSMP-230 were assessed for the same biologic activities as sperm-immobilizing antibodies.

RESULT(S)

Antibodies to rSMP-230 were detected in 10 (34%) of 29 sera obtained from women with immunologic infertility. In contrast, only one serum sample (2%) from women without sperm-immobilizing activity had a low titer of antibodies to rSMP-230. Polyclonal antibodies to rSMP-230 completely immobilized human sperm in the presence of complement and blocked sperm penetration across the zona pellucida.

CONCLUSION(S)

The human sperm protein, rSMP-B, probably is the target antigen of sperm-immobilizing antibodies.

Expression of messenger RNAs for membrane-type 1, 2, and 3 matrix metalloproteinases in human renal cell carcinomas

PURPOSE

Three different membrane-type matrix metalloproteinases (MT1, 2, and 3-MMP) that can activate proMMP-2 (progelatinase A) are thought to play an important role in invasion and metastasis by various human carcinomas. To further clarify this role, we examined mRNA expression of MT-MMPs in human renal cell carcinomas.

MATERIALS AND METHODS

mRNA was extracted from 25 clinical specimens of renal cell carcinoma and 23 specimens of normal renal parenchyma remote from the tumor. Reverse transcription polymerase chain reaction (RT-PCR) using specific primers was performed, and PCR products were hybridized to 32P-labeled internal probes and analyzed by a bioimage analyzer.

RESULTS

MT1, 2, and 3-MMP mRNA expression in carcinomas was significantly higher than in normal parenchyma. In terms of the pathologic stage, MT1-MMP mRNA expression in pT2 and pT3 tumors was significantly higher than those in pT1 tumors. Although the sample size was small, it was evident that MT3-MMP mRNA expression in clear cell subtype renal cell carcinomas was higher than in the group of tumors including the granular cell subtype.

CONCLUSIONS

These three MT-MMPs may play an important role in the pathogenesis of human renal cell carcinoma, and MT1-MMP in particular is important in invasion by carcinoma cells. It is interesting that the expression of MT3-MMP was higher in carcinomas, especially clear cell carcinoma, than in normal parenchyma, so that MT3-MMP may provide a clue an understanding of the molecular mechanism of carcinogenesis in human kidney.

[Renal cell carcinoma recurrence in the mediastinum lymph node 19 years after nephrectomy: a case report]

A 62-year-old male, who had undergone right nephrectomy to treat renal cancer 19 years earlier, was recently referred to our hospital to receive a detailed examination and treatment of mediastinal lymph node swelling. Biopsy of the swollen lymph nodes allowed a diagnosis of renal cell carcinoma (alveolar type, clear cell subtype, GI) to be made. The pathological features of his tumor were consistent with those of the renal tumor resected 19 years previously. Because there was a high probability of further growth of the swollen mediastinal lymph nodes and consequent high probability of compression of the superior vena cava, we performed mediastinal lymph node excision. Immediately after surgery, prophylactic interferon therapy was started. To date, five cases (including the present case) in which renal tumors recurred more than 15 years after surgical treatment have been reported in Japan.

beta-Microseminoprotein/prostatic secretory protein is a member of immunoglobulin binding factor family

Human seminal plasma contains a factor that binds human IgG, designated as immunoglobulin binding factor (IgBF). Under reducing condition IgBF interacts with anti-Leu-11b, a murine monoclonal antibody raised against human FcgammaRIII/CD16. IgBF shows no binding activity under non-reducing condition. Three components having IgBF activity were separated by HPLC and their amino acid sequences determined. The main IgBF showed structural identity to beta-microseminoprotein (beta-MSP), prostatic secretory protein of 94 amino acids (PSP94) and beta-inhibin. The slight variation in the reported sequences of these proteins has been attributed to analytical error. In the present study the molecular masses of main IgBF and beta-MSP/PSP94 were found to be identical by mass spectrometry. In addition, a large component of IgBF and a shorter beta-MSP consisting of 93 amino acids were identified. The binding of beta-MSP for human IgG and anti-Leu-11b antibody is demonstrable only under reducing condition, determined by Western blot analysis. The present data clearly show that IgBF is a family composed of at least three isoforms. One of the members is beta-MSP/PSP94. This family should be designated as IgBF.

Expression and tissue localization of membrane-types 1, 2, and 3 matrix metalloproteinases in human urothelial carcinomas

PURPOSE

Three different membrane-type matrix metalloproteinases (MT1, 2, 3-MMP) which can activate proMMP-2 (progelatinase A) are thought to have an important role in various human carcinoma invasions and metastases. We examined the mRNA expression of MT-MMPs and the tissue immunolocalization of MT1-MMP in human urothelial carcinomas.

MATERIALS AND METHODS

mRNA was extracted from 27 clinical urothelial carcinomas and 10 normal urothelial mucosa tissues remote from the tumor. RT-PCR using specific primers was performed, and PCR products were hybridized to 32P-labeled internal probes and analyzed by a bioimage analyzer. Immunolocalization was studied using a monoclonal antibody against MT1-MMP (114-6G6).

RESULTS

MT1-MMP and MT2-MMP mRNA expressions in urothelial carcinomas were significantly higher than those in the normal mucosa. In contrast, MT3-MMP mRNA was little expressed in both tissues, and the amount of MT3-MMP mRNA appeared to be much lower than MT1-MMP and MT2-MMP in the tissue samples. In terms of the tumor multiplicity, MT1-MMP and MT2-MMP mRNA expressions in the group of multiple tumors were significantly higher than those in the solitary tumor group. The carcinoma cells were immunostained for MT1-MMP predominantly in invasive and superficial carcinoma cells. The immunoreactivity was more intense in the invasive type than in the superficial type.

CONCLUSIONS

It is suggested that MT1-MMP and MT2-MMP play an important role in the development of human urothelial carcinomas and reflect some aspects of the pathogenesis of multifocal occurrence. In spite of the possible contribution to the invasive and metastatic phenotype, MT1-MMP mRNA and its product are thought to be expressed already in the clinical superficial stage in some cases of this tumor type.

Effects of MK-801 on bladder overactivity in rats with cerebral infarction

PURPOSE

Our objective was to evaluate the underlying mechanisms of neurogenic voiding dysfunction following cerebral infarction.

MATERIALS AND METHODS

The left middle cerebral artery (MCA) was occluded using 4-0 monofilament nylon thread in male S-D rats. Cystometric examination was performed in unanesthetized and urethane-anesthetized rats through a catheter chronically implanted in the dome of the bladder.

RESULTS

Bladder capacity of unanesthetized or urethane anesthetized rats was significantly reduced just after occlusion of the left MCA; 2 weeks after the occlusion, the capacity was less than half that in sham-operated rats. Intravenous administration of N-methyl-d-aspartate (NMDA) receptor antagonist MK-801 to the unanesthetized sham-operated rats led to a marked dose-dependent decrease in bladder capacity. Its administration to unanesthetized rats with cerebral infarction resulted in a slight decrease in bladder capacity. In the urethane-anesthetized state, the bladder capacity of the rats with cerebral infarction was significantly increased by MK-801, 0.1 mg./kg., without inhibiting the contraction pressure or increasing the amount of residual urine. A high dose (1 mg./kg.) of MK-801 was required to increase the bladder capacity of sham-operated rats. This led to an inhibition of contraction pressure and an increase in residual urine.

CONCLUSION

Results in urethane anesthetized rats indicate that NMDA glutamatergic transmission is important in the overactivity of the bladder following a cerebral infarction. This model is useful in studying the neurogenic voiding dysfunction observed in patients with cerebrovascular disease.

Chemotherapy of metastatic testicular germ cell tumors: relationship of histologic response to size reduction and changes in tumor markers

BACKGROUND

Although testicular germ cell tumor is one of the most curable cancers, approximately 20% of advanced cases remain incurable. In this study we investigate factors that may predict a poor response to standard chemotherapeutic regimens and thus allow earlier initiation of more aggressive measures.

METHODS

We analyzed the records of 19 patients with metastatic testicular germ cell tumors (8 seminomas and 11 nonseminomas). Sixteen patients underwent surgical exploration for residual tumors following chemotherapy, and the histological findings on the resulting specimens were correlated with reductions in tumor size observed on computed tomography and with changes in tumor marker levels.

RESULTS

Complete necrosis was obtained in 10 of 12 lesions that shrank by at least 80%, while continued existence of teratoma or cancer was confirmed in 9 of 11 lesions with smaller size reductions. An initial human chorionic gonadotropin-beta subunit (HCG-beta) level more than 100 times the upper limit of normal appeared to predict poor histological response (teratoma/cancer) to chemotherapy. Slow fall (prolonged half-life) of tumor markers during chemotherapy also correlated with poor histological response.

CONCLUSION

Factors which predict poor histological response of tumors to chemotherapy include size reduction less than 80%, initial HCG-beta levels more than 100 times the upper limit of normal, and prolonged half-life of tumor markers (placental alkaline phosphatase, alpha-fetoprotein and HCG-beta).

Telomerase activity in human urothelial tumors

Telomerase is a ribonucleoprotein that synthesizes telomeric DNA onto chromosomal ends by using an RNA component as a template. Telomerase extends the telomeric repeats, which prevents telomere shortening during cell division, contributes to chromosomal stability, and, possibly, leads to immortalization of the cells. The telomerase activity in 22 urothelial tumors, including 13 bladder cancers, 8 ureter cancers, and 1 renal pelvic cancer, as well as in 12 adjacent normal tissues, was examined with the use of a nonradioisotope polymerase chain reaction (PCR)-based telomeric repeat amplification protocol assay. Different levels of telomerase activity were detected in the urothelial tumors. No significant activity was observed in normal adjacent tissues; however, two cases exhibited weak activity. Nine tumors retained positive telomerase signals after 100-fold dilution of extracts, which suggests that these tumors express high levels of telomerase activity. These findings indicate that telomerase activation may be a critical step in the pathogenesis of urothelial tumors. Unexpectedly, no significant correlation was observed between high levels of telomerase expression and the clinicopathologic features of the tumors, including clinical stage, pathologic grade, tumor multiplicity, and status of recurrence.

Urodynamic effects of intravesical instillation of lidocaine in patients with overactive detrusor

PURPOSE

We evaluated the effects of intravesical administration of lidocaine on the overactive detrusor in patients with spinal cord injury and cerebrovascular disease.

MATERIALS AND METHODS

Cystometry was performed before and 15 minutes after intravesical instillation of 20 ml. of 1 and/or 4% lidocaine in 48 patients with spinal cord injury and 67 with cerebrovascular disease.

RESULTS

A significant increase in bladder capacity was observed following administration of 1 and 4% lidocaine in patients tested longer than 1 year after spinal cord injury. However, no significant increase was noted even with 4% lidocaine in those tested within 1 year after injury. A significant increase in bladder capacity was observed in patients with cerebrovascular disease with 4 but not 1% lidocaine. When comparing the percent increase in bladder capacity obtained with 4% lidocaine in the 2 groups, patients with spinal cord injury showed a significantly greater increase than those with cerebrovascular disease (91.6 versus 31.9%, respectively). Detrusor contractions disappeared in 37.5 versus 5.4% of patients, respectively.

CONCLUSIONS

Intravesical administration of lidocaine appears to be useful in differentiating detrusor hyperactivity caused by lesions of the spinal cord versus those of the brain.

Trends in clinical outcome of transitional cell carcinoma of the ureter: have the results improved?

We divided 53 consecutive patients with transitional cell carcinoma of the ureter into two groups. Group A consisted of patients treated in the 1970s and group B of patients treated in the 1980s. Clinical features and outcomes were compared between the groups. Group B patients saw an increased use of new diagnostic modalities, including antegrade pyelography, computed tomography, and bone scintigraphy. Regional lymphadenectomy was added to the operative routine in group B and combined chemotherapy, using methotrexate, vinblastine, adriamycin and cisplatinum, the most effective regimen at present, was used in 9 patients in group B and no patients in group A. In spite of new diagnostic modalities and treatments, the survival rate for ureteral cancer failed to improve from the 1970s to the 1980s.

[Molecular staging of hematogenous microdissemination of prostate cancer cells]

We have used a reverse transcriptase-polymerase chain reaction assay for prostate specific antigen (PSA) expression to detect hematogenous microdissemination in patients with prostate cancer. Thirty-nine consecutive patients with prostate cancer were surveyed. Nineteen patients (48.7%) were positive for PSA-expressing cells in this assay. Positivity rates by stage were as follows: stage A1-0/1, A2-0/2, B-2/6, C-2/9, D0-3/3, D1-1/4, D2-11/14. In clinically organ-confined cancers with a positive assay result, two stage C patients subsequently developed bone metastasis, while two stage B patients who were positive had no evidence of disease progression. In patients with a negative assay result, 3 of the 3 stage A, 3 of the 4 stage B, and 6 of the 7 stage C patients did not develop hematogenous dissemination during the follow-up period. Molecular assay for hematogenous microdissemination of prostate cancer cells provides an opportunity for earlier detection of disseminated disease and may have prognostic value.

Fluorescence spectra from human semen and their relationship with sperm parameters

Fluorescence spectra of human semen, seminal plasma, and spermatozoa were investigated. A total of 51 semen samples were obtained from 45 men, including 40 suspected subfertile men and 5 normal volunteers. Fluorescence spectra excited at 488 nm for each component in 10 mM phosphate-buffered saline (PBS) were scanned in a range of 500 to 700 nm. Under these conditions, emission peaks from each component were observed at 622 nm. The intensity of emission peaks from spermatozoa at 622 nm correlated strongly with the concentration of spermatozoa (r = .837, p = .0001). Sperm motility also correlated significantly with fluorescence intensity emission peaks from spermatozoa (r = .369, p = .019) and semen plasma (r = .356, p = .024). To clarify the origin of emission peak of 622 nm with 488 nm excitation, some components in seminal plasma were dissolved in PBS and the fluorescence spectra were measured. The standard single solutions in PBS, such as citric acid, zinc, calcium, and riboflavin (vitamin B2), did not yield an emission peak of 622 nm with 488 nm excitation. However, blood plasmas and albumin revealed similar fluorescence peaks at 622 nm. Thus, the fluorescence spectra may originate from some protein complex.

Melanotic neuroectodermal tumor of infancy in the epididymis. Case report and literature review

We report a case of melanotic neuroectodermal tumor that originated in the right epididymis of a 4-month-old Japanese male and review reports of similar cases. Since we could not exclude malignant disease preoperatively, we performed a radical orchiectomy. Histopathological and immunohistochemical studies revealed features characteristic of a melanotic neuroectodermal tumor. Imaging studies showed no distant metastases.

Radiofrequency capacitive hyperthermia combined with irradiation or chemotherapy for patients with invasive bladder cancers

To assess the immediate therapeutic clinical efficacy and long-term outcome, hyperthermia in combination with irradiation or chemotherapeutic agent was used in 46 patients with invasive bladder cancer. Radiohyperthermia (RH) was employed in 19 cases and chemohyperthermia (CH) in 27 cases. Complete response (CR) was obtained in 5 and partial response (PR) in 15 of the 46 cases. One-year survival rates by the Kaplan-Meier method were 65.0% in the CR/PR group and 46.2% in the no change (NC)/progressive disease (PD) group. Five-year survival rates were 43.8% and 18.3%, showing no difference in survival rate between the CR/PR group and the NC/PD group The overall median survival period for the CR/PR group without metastasis was 61.6 months compared to 32.3 months for the NC/PD group without metastasis (P < 0.05).

Topical anaesthesia for bladder biopsies and cautery: intravesical lidocaine versus caudal anaesthesia

A total of 62 patients were randomized to receive bladder biopsy and cautery with either topical lidocaine anaesthesia or caudal anaesthesia. The patients were asked to describe the level of pain experienced during the procedure on a scale from 0 (no pain) to 5 (unbearable pain). In 29 patients receiving topical lidocaine anaesthesia, the mean value was 1.6 at cold-cup biopsies and 2.7 at cautery, which were considered to be tolerable for the patients. On the other hand, in 33 patients who had biopsies and cautery with caudal anaesthesia, the mean values were 0.8 and 1.0, respectively, which were significantly lower than those in patients receiving topical anaesthesia (p < 0.01). Serum lidocaine levels were measured in 5 patients at 15 minutes from the beginning of biopsies, and were negligible. These results revealed that caudal anaesthesia provided more effective pain relief, although most patients could tolerate biopsy and cautery with topical lidocaine anaesthesia. The technique of topical anaesthesia is very simple and no side effects were observed. We thus conclude that topical lidocaine anaesthesia is useful and safe for bladder biopsies and cautery in most cases.

Comparative clinical features of stage A1 and stage A2 prostate cancers. Is the concept of stage A changing from the current status?

We surveyed the comparative clinical features of patients with stage A1 and stage A2 prostate cancer. Preoperatively, prostate specific antigen (PSA) level was elevated in 50.0% of stage A2 patients as compared to 18.2% of stage A1 patients. Compared to low positivity of prostatic acid phosphatase in 12.5% of stage A2 and in 0% of stage A1, PSA was more sensitive to the presence of incidental carcinoma. During the observation period (mean 35.7 months) no stage A patient died of cancer. No evidence of the disease showed significantly higher rate, and death without cancer was significantly lower in stage A1.

Radiofrequency capacitive hyperthermia combined with irradiation or chemotherapy for patients with invasive bladder-cancer

The immediate therapeutic clinical efficacy and long-term outcome of hyperthermia in combination with irradiation or chemotherapeutic agent was evaluated in 46 patients with invasive bladder cancer. Radiohyperthermia was performed in 19 cases and chemohyperthermia in 27 cases. Complete response (CR) was obtained in 5 and partial response (PR) in 15 of the 46 cases. Five-year survival rates by the Kaplan-Meier method were 43.8% in the CR/PR group and 18.3% in the no change (NC)/progressive disease (PD) group, showing no difference of survival rate between the CR/PR group and the NC/PD group. The overall median survival period for the CR/PR group without metastasis was 61.6 months compared to 32.3 months for the NC/PD group without metastasis (P<0.05).

Adjuvant therapy with 5-fluoro-1-(2-tetrahydrofuryl)-2,4 (1H,3H)-pyrimidinedione (UFT) and Bestatin in patients with transitional cell carcinoma of the bladder--comparison between UFT therapy alone and UFT therapy in combination with Bestatin

To prevent postoperative recurrence a randomized prospective trial was performed on 45 patients with bladder cancers by dividing them into 2 groups given either UFT therapy alone or UFT therapy in combination with Bestatin. In principle, oral administration of these drugs was initiated 4 weeks postoperatively and continued for a period of 1 year. Bestatin was given at the dose of 30 mg/day after breakfast per os, and UFT at the dose of 400 mg/day twice a day per os. After a median follow-up period of 628 days the relapse-free rate was 43.5% for the group given UFT alone and 81.8% for the group given a combination of UFT plus Bestatin, showing a significantly more favorable result in the latter group. In patients with a solitary and papillary tumor the relapse-free rate was significantly better in the UFT plus Bestatin group compared with the group of UFT alone. Accordingly, it was suggested that postoperative administration of UFT in combination with Bestatin is more effective in preventing recurrence of bladder cancer, compared with the administration of UFT alone.

Refractory haemospermia: any predictive factors?

A total of 56 patients with haemospermia were reviewed. Twenty-four patients suffered from prolonged haemospermia for more than 1 month or recurrent haemospermia (refractory group). In 32 patients haemospermia disappeared within a month (non-refractory group). Patient age in the refractory group was significantly higher than that in the non-refractory group (p < 0.05). Clinical symptoms other than haemospermia, white blood cell counts in the semen, expressed prostatic secretion and urine after prostatic massage, and transrectal ultrasonography findings were studied in both groups, with no significant differences found in any of these parameters. We concluded that, among these clinical findings, only patient age is a predictive factor for refractory haemospermia.

Whole bladder wall photodynamic therapy for refractory carcinoma in situ of the bladder

Whole bladder wall photodynamic therapy (PDT) with haematoporphyrin derivative and an argon dye laser as a light source was performed on 34 patients with refractory carcinoma in situ (CIS) of the bladder. Twenty-five of the 34 patients (73.5%) had achieved a complete response (CR) at 3 months after the treatment. The median follow-up for these CR patients is 49.3 months. Although recurrence within 2 years of follow-up occurred in 14 (77.8%) of the 18 CR patients followed to that point, since most of the recurrent tumours were superficial and low-grade papillary tumours, transurethral resection of the bladder tumours appeared to be sufficient. Of the total of 34 patients, ten were alive with bladder intact with a mean follow-up period of 64.0 months. Skin photosensitivity and transient decrease in bladder capacity were noted as adverse reactions, caused by retention of haematoporphyrin derivative in the skin and normal portion of the bladder. These data suggest that PDT can be an effective form of therapy for CIS of the bladder.

Is CIS of the ureter responsible for skipped lymph node metastasis? A case report

A case of skipped lesion of lymph node metastasis of left ureteral tumour with concurrent carcinoma in situ in the affected ureter is presented. Postoperatively, lymph node metastasis was de novo detected in the left retrocrural and renal hilar regions on CT scan, although only the obturator lymph node was histologically metastatic among the regional lymph nodes completely dissected. The possible explanations of this rare metastatic mode are discussed.

Analysis of fluorescence spectra from Chinese herbal medicine for male infertility

To clarify the contribution of Chinese herbal medicine to the treatment of male infertility, fluorescence spectra from Chinese herbal drugs at 500-700 nm with 488 nm excitation were investigated. The fluorescence spectra patterns from Hachimi-jio-gan, Gosha-jinki-gan and Hochuekki-to were similar to those from semen, seminal plasma and spermatozoa. Our previous report revealed that the concentration of spermatozoa correlated with the intensity of the emission peaks from spermatozoa, while sperm motility correlated with the emission peaks from spermatozoa and semen plasma. Thus, it was suggested that the components of these fluorescence productions in Chinese herbal medicine may contribute to clinical effects for male infertility.

Fibroepithelial polyp of the verumontanum. A case report and literature review

A case of fibroepithelial polyp of the verumontanum in a 20-year-old male is presented. The endoscopic examination revealed polypoid lesion protruding from the verumontanum, and transurethral resection of the tumour was performed. The histopathological diagnosis was fibroepithelial polyp, containing no prostatic glandular structures. As the nomenclature of the lesions is widely varying, we tried to classify polypoid or papillary lesions of the prostatic urethra by a literature review.

Combined treatment of radiofrequency capacitive hyperthermia for urological malignancies

During the period from April 1984 to July 1993, we investigated the clinical efficacy of local hyperthermia used to treat 110 patients with urological malignancies. We investigated the long-term outcome of 40 (36.4%) responders who exhibited an immediate, partial or better response to the therapy. The one-year survival rate was 75% for retroperitoneal tumor, 65% for bladder cancer, 33% for each of renal cell carcinoma and prostatic cancer and 29% for renal pelvic and ureteral cancer. The 5-year survival rate was 48% for bladder cancer, 29% for renal pelvic and ureteral cancer, 25% for retroperitoneal tumor, and 0% for renal cell carcinoma and prostatic cancer. Subsidence of intolerable pain caused by cancer invasion was achieved in 29 of 42 patients (69.0%), indicating an improvement in patient's quality of life through pain relief.

Experimental-study of radiofrequency capacitive hyperthermia on transplanted tumor

The in vivo effects of radiofrequency capacitive hyperthermia combined with cis-diammine-dichloroplatinum (CDDP) were studied using nude mice bearing a subcutaneous graft of KK-47 cells derived from human bladder cancer. Tumor growth curve was obtained by measuring the transplanted tumor volume for 21 consecutive days after the treatment. After the treatment, the tumor was removed and examined light-microscopically. Tumor growth was inhibited for 21 days after chemotherapy, hyperthermia, or chemohyperthermia, as compared with the control group. Comparing the chemohyperthermia group with the other groups, it was found that tumor reduction rate was greater in the former group than those in other groups tested. With respect to the combined chemohyperthermic treatment, hyperthermia significantly enhanced the anti-tumor efficacy of CDDP.

Stomachic principles in ginger. III. An anti-ulcer principle, 6-gingesulfonic acid, and three monoacyldigalactosylglycerols, gingerglycolipids A, B, and C, from Zingiberis Rhizoma originating in Taiwan

An anti-ulcer constituent, 6-gingesulfonic acid, and three monoacyldigalactosylglycerols, gingerglycolipids A, B, and C, were isolated from Zingiberis Rhizoma, the dried rhizome of Zingiber officinale Roscoe which was cultivated in Taiwan, together with (+)-angelicoidenol-2-O-beta-D-glucopyranoside. Based on chemical reactions and physicochemical evidence, the structures of 6-gingesulfonic acid, gingerglycolipids A, B, and C have been determined. In addition, the absolute stereostructure of (+)-angelicoidenol-2-O-beta-D-glucopyranoside was clarified on the basis of its synthesis from d-borneol. 6-Ginesulfonic acid showed weaker pungency and more potent anti-ulcer activity than 6-gingerol and 6-shogaol.

[The mode of lymph node metastasis and post-operative recurrence in transitional cell carcinoma of the upper urinary tract]

We surveyed 34 patients of transitional cell carcinoma of the upper urinary tract treated with nephroureterectomy with excision of a cuff of bladder or combined with regional lymphadenectomy to investigate the mode of lymph node metastasis and post-operative recurrence. In 8 of 14 patients undergoing nephroureterectomy with excision of a cuff of bladder combined with regional lymphadenectomy, lymph node metastasis was histologically confirmed in the neighbouring lymph node, of which 2 patients showed the skipped lymph node metastasis simultaneously. Subsequent bladder cancer developed in 12 out of 34 patients (35.3%) and the primary tumor showed papillary growth in all patients except for one patient which showed non-papillary growth, but with pR1. During the observation period with the mean of 9.4 months, remote metastases in other organs were detected in 6 patients with invasive primary tumor more than pT2.

Nuclear deoxyribonucleic acid content in inverted papilloma of the urothelium

We analyzed formalin-fixed and paraffin-embedded materials from urothelial inverted papillomas using flow-cytometric DNA analysis to investigate the intrinsic nature in terms of the malignant potentials. DNA indices of the inverted papillomas ranged between 1.00 and 1.26 with a mean value of 1.12. The percentage of S phase of a tumor DNA histogram showed greater values in every case compared with a normal DNA histogram. This tumor form could be thus regarded as a diploid neoplastic disease with a relatively higher proliferative activity, although 1 case showed an aneuploid pattern (DNA index = 1.26), in which bladder carcinoma developed subsequently.

Studies of effects of anticancer agents in combination with/without hyperthermia on metastasized human bladder cancer cells in chick embryos using the polymerase chain reaction technique

Cultivated T24 cells derived from a human bladder cancer were inoculated into the chorioallantoic membrane vein of chick embryos. Hyperthermic treatment was performed following injection of anticancer agents 3 days after the inoculation of the T24 cells. DNA samples were obtained from the livers of the chick embryos, and the polymerase chain reaction technique was used to amplify a DNA fragment specific to the human beta-globin gene. The Southern hybridization method was used to evaluate the inhibitory effects of anticancer agents in combination with/without hyperthermia on T24 cells metastasized to the liver. The hyperthermia exerted an inhibitory effect on the growth of the T24 cells in the livers of the chick embryos, and this was dependent on the thermal dose. The antitumor effects of hyperthermia performed at 42.5 degrees C for 20 min and at 43.0 degrees C for 10 min were evidenced by 69.2% an 82.0% inhibition of the growth of the metastasized T24 cells, respectively, as compared with the growth of untreated T24 cell. Hyperthermia performed at 42.5 degrees C for 10 min alone produced 26.7% tumor growth inhibition, and these conditions for hyperthermia were subsequently used as a criterion for evaluating the effects of its combination with various anticancer agents. Adriamycin (20 micrograms/egg) alone, mitomycin C (10 micrograms/egg) alone, carboplatin (10 micrograms/egg) alone, and cisplatin (10 micrograms/egg) alone produced 13.5%, 58.9%, 27.3%, and 29.1% tumor growth inhibition, respectively. Adriamycin and mitomycin C applied in combination with hyperthermia showed additive inhibitory effects on the growth of the metastasized T24 cells in this chick embryo model.

Transrectal ultrasonography of the prostate and seminal vesicles with hemospermia

Transrectal ultrasonography was performed in 46 patients with hemospermia. Abnormal findings in the prostate and seminal vesicles, including prostatic stones, benign prostatic hyperplasia, prostatitis, and dilatation and calculi of the seminal vesicles, were observed in 34 patients (73.9%). However, no malignant lesions were found in the prostate or seminal vesicles. Transrectal ultrasonography was a useful and noninvasive procedure to investigate the causes of hemospermia. Furthermore, transrectal ultrasonography could demonstrate latent diseases and exclude malignancy of the prostate and seminal vesicle in patients with hemospermia.

A case of inverted papilloma of the ureter: is the DNA ploidy pattern associated with occurrence of transitional cell carcinoma of the bladder?

We describe herein a case of inverted papilloma of the ureter, in which transitional cell carcinoma of the bladder developed twenty-three months after nephroureterectomy. Flow cytometric analysis of formalin-fixed and paraffin-embedded archival material of the inverted papilloma revealed DNA aneuploidy pattern and relatively high percentage of S phase. Retrospectively, DNA measurement thus provided the predictive value regarding biological activity and the clinical behaviour of the present case.

Magnetic resonance imaging of bladder hemangioma

An 18-year-old woman with a bladder hemangioma is described. The tumor had a low signal intensity with multilocular pattern on T1-weighted magnetic resonance (MR) images and high signal intensity on T2-weighted MR images. MR images were useful in evaluating tumor character and its extent.

Percutaneous mitomycin C perfusion of bilateral ureteral carcinoma in situ

We treated a 61-year-old patient with a diagnosis of bilateral ureteral carcinoma in situ with percutaneous perfusions of mitomycin C. After 16 sessions of mitomycin C therapy instilled through bilateral nephrostomy tubes, the urine cytology results became negative for malignancy. Bilateral ureteroscopy and cold-cup punch biopsies of the ureter revealed no evidence of disease. The patient did not experience side effects. He has remained free of disease during a 12-month follow-up period. Percutaneous perfusion of mitomycin C appears to be one of the effective and safe treatments for the carcinoma in situ of the upper urinary tract.

[A case of retroperitoneal Castleman's disease associated with bladder tumor and a review of 59 cases in Japan]

We present a case of retroperitoneal Castleman's disease associated with bladder tumor. The patient was a 62-year-old man, who underwent partial cystectomy under a diagnosis of bladder tumor in 1989. Subsequently, recurrent bladder tumor was detected and he consulted the outpatient clinic at our University Hospital in November, 1990, at which time computerized tomography (CT) revealed a retroperitoneal tumor. From February, 1991 four courses of combined chemotherapy (methotrexate, vinblastine, pirarubicin, cisplatin) were administered for the tumor. The tumor reduction rate after the chemotherapy was 60% on CT, and retroperitoneal lymph node dissection and left nephroureterectomy were performed in July, 1991. Histological examination revealed Castleman's disease, hyaline-vascular type. Fifty-nine reported cases of retroperitoneal Castleman's disease in Japan are reviewed.

[Oncogene amplification and inactivation of tumor suppressor genes in urological malignant tumors--the application of restriction fragment length polymorphism analysis]

We applied restriction fragment length polymorphism (RFLP) analysis to 24 cases of renal cell carcinomas (RCC), 18 cases of prostate adenocarcinomas (PC), and 11 cases of transitional cell carcinomas (TCC) in the renal pelvis to study the oncogene amplification and inactivation of tumor suppressor genes. All of the cases showed no amplification nor gross rearrangements of the Harvey ras, c-myc, c-fos, c-myb, EGFR and PDGFR. In contrast, RFLP analyses demonstrated allelic losses interpreted as inactivational events of TSGs among the tumor forms studied. RCC had allelic losses on the short arm of chromosome 3 (3p) (68%), the long arm of chromosome 18 (18q) (33%), Y chromosome (29%), and 17p (27%) at high frequencies. PC showed frequent allelic losses on 16q (67%), 8p (50%), 18q (43%), 10p (40%), and 10q (38%). TCC had allelic losses on 17p (73%), 11p (64%), and 9p (40%). It was likely that the cases with the more malignant grade tumor had the more allelic losses.

[Overexpression of c-myc, c-fos and Harvey ras oncogenes in renal cancers--analysis at the messenger RNA levels]

The accumulating data have shown that a single or certain combinations of proto-oncogenes are genetically altered and acquire oncogenic activities in certain tumor types, through a point mutation and/or overexpression. In the present study, Northern blotting analysis was applied to clinical samples of renal cell carcinomas (RCC) to elucidate expression levels of the c-myc, c-fos and Harvey ras genes in this tumor form. In 11 cases of 23 tumors examined (48%) was shown more than 3-fold expression level of the c-myc gene compared with the matching normal RNA, the c-fos gene in 6 cases (26%), and the Harvey ras gene in one case (4%) showing the concomitant overexpression of two other genes. Overexpression of both the c-myc and c-fos genes was detected in 5 cases (22%). Although the distinct correlation between overexpressions of any genes and the clinical background was not induced, it is considered that these aberrations of proto-oncogenes are involved in oncogenesis of a certain subgroup of RCC.

Allelotyping of human prostatic adenocarcinoma

Allelotyping (using at least one probe detecting a restriction fragment length polymorphism on each chromosomal arm, with the exception of the short arms of the acrocentric chromosomes), showed loss of genetic information in 11 of 18 prostate adenocarcinoma specimens analyzed (61%). Frequent allelic deletions were detected on the long arm of chromosome 16 (6 of 10 informative cases, 60%), on the short arm of chromosome 8 (3 of 6 informative cases, 50%), and on the short and/or the long arms of chromosome 10 (6 of 11 informative cases (10p), 55% and 4 of 13 informative cases (10q), 30%, respectively). No losses of alleles were detected in any case unless at least one of the chromosomes 8, 10, or 16 also showed deletions. The long arm of chromosome 18 also showed a high frequency of allelic deletions (3 of 7 informative cases, 43%). Allelic deletions on the following chromosomes were detected at lower frequencies: chromosomes 2, 3, 7, 12, 13, 17, 22, and XY. Tumors with allelic deletions on more than one chromosome had a higher histological malignancy grade. Tumors from patients with advanced disease all showed allelic deletions.

Deletion mapping of chromosomes 8, 10, and 16 in human prostatic carcinoma

In an allelotyping study prostatic carcinoma, we found the highest frequency of allelic deletions on chromosomes 8, 10, 16, and 18. In all cases with allelic deletions, at least one of the chromosomes 8, 10, and 16 were involved. A detailed deletion mapping of these chromosomes in 18 cases was carried out with probes that detect restriction fragment length polymorphisms (RFLP) on chromosomes 8 (6 probes), 10 (11 probes), and 16 (9 probes). The highest frequency of allelic deletions were found on 8p (65%), where the minimally deleted region was between the PLAT locus and pter. The long arm of chromosome 16 had allelic deletions in 56% of informative cases, with three different break points, the most distal being located between D16S4 and D16S7. Chromosome 10 exhibited a complex deletion pattern with terminal deletions of the p or the q arm (2 cases each), a deletion pattern that could be interpreted as nonreciprocal translocations of the q arm (2 cases), or allelic losses on all informative loci, suggesting monosomy (2 cases). Our data suggest that tumor suppressor genes involved in the oncogenesis of prostatic carcinoma may be localized between 8 pter and the PLAT locus and that additional/alternative tumor suppressor genes may be localized on chromosome 10 and on the long arm of chromosome 16 distal to the D16S4 locus.

Molecular genetics and human prostatic carcinoma

Advances in molecular genetic techniques have reached the point where clinical material can be reasonably well-characterized in detail. One area that is receiving increasing attention is the genetic abnormalities of tumors. Using the technique of restriction fragment length polymorphism analysis, it is possible today to build up a picture of the genome and to identify which regions are deleted or are rearranged in the tumor cells of an individual patient. Twenty years ago, experimental and theoretical findings suggested that loss of gene function could be an essential component in oncogenesis. Such genes have been named tumor suppressor genes. The significance of the consistent loss of specific regions of genetic information from the genomes of tumor cells of a particular histological type is now appreciated, as such areas may contain as yet unrecognized tumor suppressor genes. The characterization of regions consistently lost thus forms the first step in localizing such genes. We have applied this technology to the study of prostate cancer and our preliminary findings show consistent losses of genetic information from chromosomes 8, 10, and 16.

A gene near the D3F15S2 site on 3p is expressed in normal human kidney but not or only at a severely reduced level in 11 of 15 primary renal cell carcinomas (RCC)

Renal Cell Carcinoma (RCC) has been associated with the loss of heterozygosity at several loci on the short arm of chromosome 3 (3p). We have previously found that one of these loci, D3F15S2 (pH3H2) was lost in 76% of the tumor cells derived from heterozygous donors (Kovacs, G., Erlandsson, R., Boldog, F., Ingvarrsson, S., Müller-Brechlin, R., Klein, G. & Sümegi, J. (1988), Proc. Natl. Acad. Sci., 85, 1571-5). More recently we have identified a putative CpG island in the vicinity of D3F15S2, suggesting that DNA sequences in or around this site may have coding potential (Boldog, F., Erlandsson, R., Klein, G. & Sümegi, J. (1989). Cancer Genet. Cytogenet., 42, 295-306). The screening of a human placenta cDNA library with DNA probes derived from D3F15S2 has led to the isolation of several cDNA clones. They identified a 2.9 Kb long message in human placenta and kidney. In total RNA from 11 of 15 primary RCCs the gene expression was reduced to less than 20% compared to eight normal kidneys. This low level of expression may be due to contaminating normal tissue. In the remaining 4 tumors the expression varied from 24-51% compared to normal kidney. To facilitate reference, the gene was provisionally designated as 'RIK'. It was expressed in the HEK 293, one osteosarcoma (HOS), two carcinoma (COLO320 and QDMT), and three Burkitt lymphoma lines (BL2, BL29 and BL31). It was not expressed in one Burkitt lymphoma (DG75) and two EBV transformed lymphoblastoid cell lines (LCL) (NAD-20 and Cherry).

[Adrenocortical carcinoma with Cushing syndrome: report of a case]

We report a 45-year-old female with left adrenocortical carcinoma resulting in Cushing syndrome. She visited the 3rd Department of Internal Medicine, Kanazawa University Hospital with complaints of moon face, amenorrhea and hypertension. A diagnosis of left adrenal tumor with Cushing syndrome was made and she was transferred to our clinic. Left thoracoabdominal adrenalectomy was performed. The histologic report was compatible with adrenocortical carcinoma with no invasion into adjunctive tissues. She is now on endocrinologic study and is being administered 1,1-dichloro-2-[o-chlorophenyl]-2[p-chlorophenyl] ethane. There is no evidence of local recurrence or remote metastasis.

[A case of bilateral renal angiomyolipoma diagnosed by fine needle biopsies]

We describe a 37-year-old female with bilateral renal angiomyolipoma. She visited the Emergency Department at our hospital because of right severe flank pain. Computed tomography (CT) disclosed a bilateral renal tumors with fat components and high density lesions compatible with a hematoma. Conservative treatment was started, resulting in the improvement in laboratory findings and symptoms. Needle biopsies were performed under the guidance of ultrasonography. The histology was renal angiomyolipoma. She has been receiving a follow-up study at our out-patient clinic with an uneventful course.

[A case of lupus cystitis]

A case of lupus cystitis in a 23-year-old male is reported. The patient began to complain of diarrhea and vomiting in October, 1985. When the diagnosis of systemic lupus erythematosus (SLE) was established at the Department of Internal Medicine in our hospital, he was referred to our clinic for examination of pollakisuria on November 22. DIP revealed a loss of bladder distensibility, and bilateral hydronephrosis and hydroureter. Transurethral cold cup biopsies revealed subcutaneous edema. A diagnosis of lupus cystitis was made and he was treated with steroids, which resulted in symptomatic and radiographic improvement.

[Complete ureteric duplication associated with ureterocele: two cases report]

Herein we report two cases of complete ureteric duplication associated with ureterocele. A 4-month-old girl with non-visualizing left kidney was hospitalized with complaints of cloudy urine and fever. An antegrade left pyelogram revealed a completely duplicated collecting system; a duplex tortuous ureter, and round radiolucent filling defect in the bladder. Under the diagnosis of completely duplicated ureter associated with the upper pole ureterocele, ureterocystoneostomy was performed. A circumferential incision was made around the base of the ureterocele and the Politano-Leadbetter technique was employed. Her postoperative course was uneventful. However, an excretory urogram showed a mild hydronephrotic upper pole. A 1-year and 4-month-old girl with the history of repeated urinary tract infections and fever attacks was admitted. The excretory urogram showed a left hydronephrotic lower pole with a "drooping flower" and no opacification of the upper pole. A radiolucent filling defect was seen in the bladder. A left antegrade pyelogram demonstrated the massively dilated upper pole with a hydroureter terminating in the ureterocele. Left heminephrectomy with partial ureterectomy was performed and left hydronephrosis and hydroureter with an atrophic kidney were seen. The postoperative course was uneventful.

[Photodynamic therapy of superficial bladder tumors]

Photodynamic therapy (PDT), using hematoporphyrin derivative (HPD) and the red light (wavelength 630 nm) of an argon-dye laser as the source of excitation energy was performed on 46 patients with superficial bladder tumors. Two methods of laser irradiation, (1) focal PDT using a 400 micron quartz fiber through a cystourethroscope in 22 patients with superficial bladder tumors and (2) whole bladder wall total PDT using a motor-driven laser light scattering device in 24 patients with multifocal carcinoma in situ and/or dysplasia of bladder mucosa associated with multicentric concurrent superficial tumors, were used. The patients in (2) had been referred for total cystectomy, and 19 of these 24 patients had a history of several transurethral resections, hyperthermia and/or instillation therapy. HPD 2-4 mg/kg was i.v. injected 48 to 72 hours before PDT. Judging from the results of 60 protrusions treated by focal PDT, the light power should be 200 mW/cm2 for 5-10 minutes or more and the total light energy should be 100 J/cm2 or more in tumors up to 2 cm in size. With focal PDT, 4 of the 22 patients had no recurrence with the mean tumor free time of 20.8 months. In 6 of the 24 patients treated with total PDT using 10, 20 or 30 J/cm2 of light energy, there was no recurrence with a mean tumor-free time of 7.5 months and there was no significant relationship between the recurrence rate and total light energy used.